Celiac sprue after surgery of the upper gastrointestinal tract. Report of 10 patients with special attention to diagnosis, clinical behavior, and follow-up.

The clinical onset of celiac sprue (CS) may be precipitated by upper digestive tract surgery. We report a series of 10 patients who developed CS after diverse types of peptic ulcer surgery. Six were male and 4 female. Gastrectomy with Billroth II anastomosis was performed in 5 patients, truncal vagotomy and pyloroplasty in 2, parietal cell vagotomy and pyloroplasty in 1, and vagotomy with gastrojejunal anastomosis in 2. We found that eight patients had had previous symptoms that suggested CS. Symptoms occurred early in the postoperative period. Severe diarrhea and striking weight loss were the most prominent clinical findings. The response to gluten-free diet was independent of the type of surgical procedure performed and was similar to that observed in the general celiac population.

Short-term antibiotic treatment in Whipple's disease.

We report the results of short-term antibiotic treatment in 19 patients with Whipple's disease (WD). The diagnosis was based on clinical features and on a characteristic small bowel biopsy. Patients received treatment for a mean of 7.9 weeks (range 4-20). Fourteen were treated with de-methyl-chlortetracycline (600 mg/day), and 1 also received chloramphenicol (1 g/day); 1 was treated with ampicillin (2 g/day), and 4 were treated with amoxicillin (1.5 g/day). In all patients, the clinical response was rapid and excellent, body weight increased significantly, diarrhea subsided, and fecal fat values returned to normal. Intestinal biopsies obtained after treatment was completed showed significant improvement based on a decrease in the number of macrophages staining positive with periodic acid-Schiff (PAS), normalization of villous structure, and decreased dilatation of lymphatic channels; free bacilli were absent, as shown both by light and electron microscopy. Seventeen patients have been followed for a mean of 99.4 months (range 6-300). Two died 30 and 72 months after diagnosis of Whipple's disease, 1 of laryngeal carcinoma and the other of colonic carcinoma. Fifteen patients are in excellent health. Three patients treated with tetracycline have had clinical and/or histologic relapses. In our experience, short-course antibiotic treatment with tetracycline or ampicillin and derivatives can be effective in WD, with few relapses and excellent outcome. No neurologic symptoms, either initially or during follow-up were observed.

[Primary lymphoma of the small bowel and malabsorption]. / Linfoma primario de intestino delgado y malabsorción.

Between 1974 and 1984 we saw 69 patients with lymphoma that involved the gastrointestinal tract. In ten patients the lymphoma compromised the small bowel and were associated to malabsorption. Seven patients fulfilled the criteria to be considered as primary small bowel lymphoma. We presumed the intestinal origin in the other 3 patients, but it was impossible to confirm it. The peroral small bowel biopsy showed histological findings compatible with celiac disease in 7 patients. Other particular histological signs were patchy alterations, inconstant epithelial pseudo-stratification and ulcerations. In 2 cases we found findings that suggested the diagnosis of lymphoma. In 50% of patients we found unspecific malabsorption signs in the small bowel radiology. We found giant ulcers and stenosis too. The gluten-free diet or the steroid therapies resulted in temporary or inconstant improvement. The laparotomy was the most effective diagnostic approach. It was performed electively in 6 patients and in 1 because of a small bowel perforation. The primary small bowel lymphoma is an entity of difficult diagnosis. The most important trouble is to differentiate it with celiac disease.

Linfoma primario de intestino delgado y malabsorción. / [Primary lymphoma of the small bowel and malabsorption]

Between 1974 and 1984 we saw 69 patients with lymphoma that involved the gastrointestinal tract. In ten patients the lymphoma compromised the small bowel and were associated to malabsorption. Seven patients fulfilled the criteria to be considered as primary small bowel lymphoma. We presumed the intestinal origin in the other 3 patients, but it was impossible to confirm it. The peroral small bowel biopsy showed histological findings compatible with celiac disease in 7 patients. Other particular histological signs were patchy alterations, inconstant epithelial pseudo-stratification and ulcerations. In 2 cases we found findings that suggested the diagnosis of lymphoma. In 50

of patients we found unspecific malabsorption signs in the small bowel radiology. We found giant ulcers and stenosis too. The gluten-free diet or the steroid therapies resulted in temporary or inconstant improvement. The laparotomy was the most effective diagnostic approach. It was performed electively in 6 patients and in 1 because of a small bowel perforation. The primary small bowel lymphoma is an entity of difficult diagnosis. The most important trouble is to differentiate it with celiac disease.

[Clinico-manometric correlation in esophageal involvement of progressive systemic sclerosis]. / Correlación clínico-manométrica en el compromiso esofágico de la esclerosis sistémica progresiva.

The esophageal response studied in the systemic illness has been developed clearly in the body of the esophagus as well as in the lower esophageal sphincter, showing important alterations in the peristalsis and a significant fall of lower esophageal sphincter pressure, proving conditions such as those in which gastro-esophageal reflux is produced. The authors studied the esophageal motility in 10 patients with progressive systemic sclerosis by electromanometry by means of an open-tipped catheters system. They found that the pressure of the inferior esophageal sphincter was altered in the 100 per cent of the cases; in 50% of the patients there was a lack of peristaltic waves and in the remaining 50% the middle pressure was less than in normal subjects. It was observed dysquinethic waves in 40% of the cases. The intensity of the epidermic compromise is no related with alterations in the esophageal functioning.

Correlacion clinico-manometrica en el compromiso esofagico de la esclerosis sistemica progresiva. / Clinico-manometric correlation in the esophageal involvement of progressive systemic sclerosis

La repercusion esofagica de la enfermedad sistemica estudiada se manifesto muy claramente, tanto en el cuerpo del organo como en el esfinter inferior, caracterizando importantes alteraciones en la peristalsis y una significativa reduccion en la presion del esfinter inferior, determinante de condiciones tales como aquellas en las que se produce reflujo gastro-esofagico

Correlación clínico-manométrica en el compromiso esofágico de la esclerosis sistémica progresiva. / [Clinico-manometric correlation in esophageal involvement of progressive systemic sclerosis]

The esophageal response studied in the systemic illness has been developed clearly in the body of the esophagus as well as in the lower esophageal sphincter, showing important alterations in the peristalsis and a significant fall of lower esophageal sphincter pressure, proving conditions such as those in which gastro-esophageal reflux is produced. The authors studied the esophageal motility in 10 patients with progressive systemic sclerosis by electromanometry by means of an open-tipped catheters system. They found that the pressure of the inferior esophageal sphincter was altered in the 100 per cent of the cases; in 50

of the patients there was a lack of peristaltic waves and in the remaining 50

the middle pressure was less than in normal subjects. It was observed dysquinethic waves in 40

of the cases. The intensity of the epidermic compromise is no related with alterations in the esophageal functioning.

Correlacion clinico-manometrica en el compromiso esofagico de la esclerosis sistemica progresiva. / Clinico-manometric correlation in the esophageal involvement of progressive systemic sclerosis

La repercusion esofagica de la enfermedad sistemica estudiada se manifesto muy claramente, tanto en el cuerpo del organo como en el esfinter inferior, caracterizando importantes alteraciones en la peristalsis y una significativa reduccion en la presion del esfinter inferior, determinante de condiciones tales como aquellas en las que se produce reflujo gastro-esofagico

[Value of the breath test with cholylglycine C14 in the diagnosis of bacterial contamination in patients with gastric surgery]. / Valor del test del aire espirado con colilglicina 14C en el diagnóstico de contaminación bacteriana en operados gástricos.

The TAE C14 has been evaluated as a diagnostic method of small bowel contamination in a group of patients operated for gastric disturbances. It has been compared with bacterial culture and bile salts chromatogrpahy of jejunum liquid and therapeutic response. 36 patients have been studied and divided in 3 groups: a) negative control: 8 subjects without pathology; b) positive control: 6 patients with intestinal resection and 1 with intestinal scleroderma, all of them with steatorrhea; c) gastric operated patients: 16 BII with and without vagotomy, 3 gastroenteroanastomosis and vagotomy, 1 superselective vagotomy and pyloroplasty and 1 B I, all the patients had steatorrhea, except one with BII. The period elapsed between the operation and the studies varied from 1 to 17 years (X: 4.9 +/- 4.1). The average value of steatorrhea was 23.9 +/- 10.2 g/24 hs. 100% of group b and 80% of group c had abnormal TAE C14. In 80% of the patients of the group c chromatogrpahy was performed and it agreed with TAE C14 in 80% of the studies. Bacteriology was positive in 100% of 18 studies, coinciding with TAE C14 in 70% patients. Therapeutic control of 100% of group c was positive in 90%.

Valor del test del aire espirado con colilglicina 14C en el diagnóstico de contaminación bacteriana en operados gástricos. / [Value of the breath test with cholylglycine C14 in the diagnosis of bacterial contamination in patients with gastric surgery]

The TAE C14 has been evaluated as a diagnostic method of small bowel contamination in a group of patients operated for gastric disturbances. It has been compared with bacterial culture and bile salts chromatogrpahy of jejunum liquid and therapeutic response. 36 patients have been studied and divided in 3 groups: a) negative control: 8 subjects without pathology; b) positive control: 6 patients with intestinal resection and 1 with intestinal scleroderma, all of them with steatorrhea; c) gastric operated patients: 16 BII with and without vagotomy, 3 gastroenteroanastomosis and vagotomy, 1 superselective vagotomy and pyloroplasty and 1 B I, all the patients had steatorrhea, except one with BII. The period elapsed between the operation and the studies varied from 1 to 17 years (X: 4.9 +/- 4.1). The average value of steatorrhea was 23.9 +/- 10.2 g/24 hs. 100

of group b and 80

of group c had abnormal TAE C14. In 80

of the patients of the group c chromatogrpahy was performed and it agreed with TAE C14 in 80

of the studies. Bacteriology was positive in 100

of 18 studies, coinciding with TAE C14 in 70

patients. Therapeutic control of 100

of group c was positive in 90

.

Valor del test del aire espirado con colilglicina 14C en el diagnóstico de contaminación bacteriana en operados gástricos / [Value of the breath test with cholylglycine C14 in the diagnosis of bacterial contamination in patients with gastric surgery]

The TAE C14 has been evaluated as a diagnostic method of small bowel contamination in a group of patients operated for gastric disturbances. It has been compared with bacterial culture and bile salts chromatogrpahy of jejunum liquid and therapeutic response. 36 patients have been studied and divided in 3 groups: a) negative control: 8 subjects without pathology; b) positive control: 6 patients with intestinal resection and 1 with intestinal scleroderma, all of them with steatorrhea; c) gastric operated patients: 16 BII with and without vagotomy, 3 gastroenteroanastomosis and vagotomy, 1 superselective vagotomy and pyloroplasty and 1 B I, all the patients had steatorrhea, except one with BII. The period elapsed between the operation and the studies varied from 1 to 17 years (X: 4.9 +/- 4.1). The average value of steatorrhea was 23.9 +/- 10.2 g/24 hs. 100

of group b and 80

of the patients of the group c chromatogrpahy was performed and it agreed with TAE C14 in 80

of the studies. Bacteriology was positive in 100

of 18 studies, coinciding with TAE C14 in 70

patients. Therapeutic control of 100

of group c was positive in 90