Digestive endoscopy from rigid to fiber-optic instruments; the Polish contribution to the development of gastrointestinal endoscopy.

In 1987 on the occasion of the 50(th) anniversary of the British Society of Gastroenterology Sir Francis Avery-Jones (1) wrote (perhaps a little exaggerating) in his introductory remarks: "In 1937 the alimentary tract was invisible, impalpable and inaccessible-except the top and the bottom". Indeed, diagnostics in gastroenterology was very weak and uncertain at the beginning and even in the middle of the last century. Endoscopy and radiology, developing first apart and then together revolutionized the diagnostics and consequently the practice in gastroenterology. Endoscopy brought a new access to operative procedures alleviating the burden of open surgery as well. The method, apart from knowledge, needs personal skills and so new problems of postgraduate education and ethics appeared. Due to the enormous progress in science and in technology it has reached the present level of accuracy. Polish gastroenterology with its early achievements in gastric secretion (Leon Popielski, histamine), abdominal surgery (Ludwik Rydygier, first gastric resection), endoscopy (Jan Mikulicz-Radecki) and later research upon the neuro-hormonal brain-gut axis (Stanislaw J. Konturek) tried to keep pace with the world-wide progress in this field. The Polish contributions to the growing knowledge and improving practice may be traced from the very beginning of the 20(th) century.

[Science priority, medical paternalism or participation in medical practice]. / Priorytet nauki, lekarski paternalizm czy partycypacja w praktyce medycznej.

During a last decade alternative methods in medicine were observed. A resin of this situation is a crisis of believe in scientific medicine.

An evaluation of arbaprostil at multiple doses for the treatment of acute duodenal ulcer: a randomized double-blind placebo-controlled international trial.

Six hundred and thirty patients were enrolled in a randomized double-blind placebo-controlled trial evaluating two arbaprostil dosages (25 micrograms and 50 micrograms) qid for 4 wk for the treatment of acute duodenal ulcers. The healing rates in the placebo, 25-micrograms, and 50-micrograms treatment groups were 39%, 51%, and 60%, respectively. Smoking was found to adversely affect the healing rates in all the treatment groups. Pain severity was less with either arbaprostil treatment. The only side effect found was diarrhea: 10%, 14%, and 32% in the placebo, 25-micrograms, and 50-micrograms treatment groups, respectively. Severe diarrhea occurred in 1% of those patients who received the 50-micrograms dosage regimen, but in none of the other two groups. Arbaprostil at these two dosage levels, when given for 4 wk, appears to be a safe and efficacious agent for the treatment of acute duodenal ulcers.

Seasonal prevention of duodenal ulcer recurrences with pirenzepine.

Seasonal accumulation of duodenal ulcer recurrences suggests that maintenance therapy could be limited to the more risky periods. We carried out a 2-year, multi-centre, randomized, double blind study in 250 patients in whom the last ulcer proved to be healed at the endoscopy on entry. One-hundred-and-twenty-six patients in group A were given pirenzepine 2 X 25 mg while 124 in group B had 2 X 50 mg daily from the beginning of January to the end of March, and from the beginning of September to the end of November for two consecutive years. Test endoscopies were performed each year at the end of February, May and November. Both groups proved to be well comparable. Thirty-five patients dropped out from group A in the first and 10 in the second year; in group B 27 and 29, respectively. As the effect did not show any dose relation, the four yearly cycles were summarized. Recurrence rate checked in May was 22.1% while in both pirenzepine protected months it was 11.3% (p less than 0.0005) and 13.4% (p less than 0.001), respectively. We conclude that pirenzepine administered in the risky seasons prevents the peak ulcer incidence and reduces the recurrence rate to a level lower than in the non-risky season. Thus pirenzepine is effective in ulcer prevention even if administered in an interrupted manner.