[When should patients with bleeding peptic ulcer resume oral intake? A randomized controlled study]. / Quand faut-il reprendre l'alimentation orale après hémorragie ulcéreuse gastro-duodénale? Etude contrôlée randomisée.

OBJECTIVES: Patients presenting with bleeding peptic ulcers are often kept fasted. The contribution of feeding in bleeding recurrence rate is unknown. The aim of this prospective controlled study was to evaluate the effect of early feeding in (a) the bleeding peptic ulcer recurrence rate and (b) the outcome of patients with severe bleeding peptic ulcer. PATIENTS-METHODS: From January through December 1995, all consecutive patients admitted for active bleeding from peptic ulcer were included. All patients underwent emergency endoscopic injection with adrenaline around and into the base of the ulcer and were randomized in two groups. Group A patients (n = 12) received milk on day 1, mixed warm feeding on day 2 and normal diet from day 3, Group B patients (n = 14) were nil by mouth until day 3, then received milk on day 4, mixed warm feeding on day 5, and normal diet from day 6. Twenty-six patients (17 men, 9 women, mean age 71 years) were included. RESULTS: On day 0, both groups (group A vs group B) were comparable (mean +/- SD): hemoglobin (8.8 +/- 2.7 vs 8.1 +/- 2.0 g/dL), transfusion requirements in the first 24 h after admission (2.2 +/- 2.0 vs 2.1 +/- 1.4 units), localization of ulcers (duodenal ulcer: 8 vs 9, gastric ulcer : 4 vs 5). There were no significant differences in group A and group B for bleeding ulcer recurrence rate (0 vs 1 patient) and transfusion requirements (2.6 +/- 2.1 vs 3.3 +/- 2.1 units). Hospital stay was significantly shorter in group A (6.8 +/- 2.1 days) than in group B (9.9 +/- 3.7 days), P = 0.01. CONCLUSION: These results did not provide any evidence of advantages of fasting in patients with active bleeding peptic ulcer treated by endoscopic sclerotherapy. Early feeding did not worsen outcome in patients with active bleeding peptic ulcer and reduced hospital stay.

Effects of octreotide on lower esophageal sphincter in patients with cirrhosis and portal hypertension.

We investigated the effects of octreotide infusion on the contractile activity of the esophageal body and lower esophageal sphincter in cirrhotic patients with esophageal varices. Esophageal manometry was performed in 36 alcoholic cirrhotic patients. They were randomly allocated to three groups and received the following treatments blindly for 90 min: an initial 100-microg intravenous bolus followed by a continuous 25 microg/hr octreotide infusion (group I, N= 13), a continuous 25 micro/hr octreotide infusion without an initial bolus (group II, N=13), and a continuous placebo infusion (group III, N=10). Before drug infusion, mean lower esophageal sphincter pressure and mean esophageal body contraction pressure and duration were similar in the three groups. Compared to the placebo group, lower esophageal sphincter pressure increased significantly in groups I and II, 30 min (30%, 22%, 3% respectively; P= 0.006), 60 min (44%, 35%, 0.6%; P=0.0002), and 90 min (67%, 41%, 2.5%; P=0.0001) after octreotide infusion, as did esophageal body contraction pressure and duration. We conclude that octreotide has a potent effect on LES tone in cirrhotic patients.

[Peripheral neuropathies and chronic hepatitis C: a frequent association?]. / Neuropathies périphériques et hépatite chronique virale C: une association fréquente?

OBJECTIVE: The aim of this prospective study was to evaluate the prevalence of the peripheral neuropathies associated with chronic hepatitis C and their clinical, electrophysiological and histological characteristics. PATIENTS AND METHODS: Thirty six patients admitted from December 1994 to January 1996 for chronic hepatitis C were prospectively investigated. Laboratory data included liver blood tests, serum cryoprecipitate immunoelectrophoresis, assays for anti-nuclear antibody, rheumatoid factor, circulating immune complexes, anti-SSA and anti-SSB antibodies. For each patient, a clinical neurological evaluation as well as an electrophysiological evaluation were performed by the same operator. In presence of peripheral neuropathy, a neuromuscular biopsy was performed. RESULTS: In seven patients (19%), a peripheral neuropathy was diagnosed related to hepatitis C virus in 3 patients. In these 3 patients presenting with leg paresthesia, an axonal sensitive neuropathy was evidenced by electromyography. A neuromuscular biopsy performed in two of these patients showed a severe diminution of the myelinated fibers associated with vasculitis lesions in one patient. A skin biopsy was performed in the third patient with leg purpura revealing a leukocytoclasic vasculitis. A positive cryoglobulinemia was found in two of these patients. CONCLUSION: In chronic hepatitis C, the prevalence of peripheral neuropathy is 8% and usually associated with cryoglobulinemia. It is an axonal neuropathy with diminution of the myelinated fibers and vasculitis lesions in the absence of cryoglobulinemia.

Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study.

The aim of this randomized controlled study was to assess the nutritional and clinical effects of early enteral nutrition (EN) in cirrhotic patients with bleeding from esophageal varices. From August 1994 through August 1995, all patients admitted for acute variceal bleeding underwent emergency sclerotherapy or banding ligation and continuous infusion of octreotide and were randomized in two groups. In group A, patients received from day 1 discontinuous polymeric EN (1665 kcal/day, through nasogastric tube) and in group B, patients were nil by mouth. On day 4, all patients received oral diet. Nutritional status, liver function, and rebleeding were evaluated on days 4, 7, and 35. Twenty-two patients (17 men, 5 women, mean age 56 years) were included. On day 0, patients in group A (N = 12) and group B (N = 10) were comparable. On day 4, nitrogen balance was 0.7 +/- 2.5 g/day in group A and -11.2 +/- 6.7 g/day in group B (P = 0.01, Mann-Whitney test). On days 4, 7, and 35, no significant differences between the two groups were observed for nutritional status and liver function. Four (33%) group A patients rebled compared with one (10%) group B patient (NS). Hospital stay (14.5 +/- 4.1 days vs 12.9 +/- 5.3 days) and mortality (3 vs 2 patients), were comparable between the two groups. In conclusion, our study failed to demonstrate any favorable effect of short-term EN on nutritional status and liver function in cirrhotic patients hospitalized for variceal bleeding.