Studies on inhibin-like peptide in gastric juice and serum of patients with duodenal ulcers.

Immunoreactive inhibin-like material (ILM) was measured by radioimmunoassay in serum and gastric juice samples of 23 fasting normal men and 23 men with duodenal ulcers (DU). Concentrations of ILM in gastric juice and serum of patients with DU were significantly higher than those in normal men (P less than 0.01). A strong positive correlation (r = 0.894) was observed between pH and ILM levels in gastric juice of normal men but not in patients with DU. Inhibin-like material in the gastric juice had a chromatographic profile similar to that of human seminal plasma.

Endoscopic brushing cytology and biopsy in the diagnosis of upper gastrointestinal tract lesions. A study of 350 cases.

Direct-vision endoscopic examination conducted on 4,000 patients for persistent upper gastrointestinal (GI) complaints over a period of five years revealed 350 visible lesions that were subjected to brushing cytology and biopsy. Cytologic examination of brushing smears from all 350 cases showed malignant cells in 67 (19.14%), cells suggesting benign polypoid neoplasms in 4 (1.14%), ulcerative and reparative features with attendant atypias in 186 (53.14%), inflammatory findings in 91 (26%) and false-negative findings in 2 cases (0.57%). Only 259 (74%) of the visible lesions were also subjected to endoscopic biopsy. Of the 67 patients with positive cytology, 52 were judged positive on the biopsy specimen; the 2 false-negative cytologic reports were confirmed as positive by biopsy. In four patients with gastric ulcers, malignant cells were seen along with gastric repair cells. This study indicates that brushing cytology is very useful in detecting benign ulcerative lesions with their atypias, a feature that could be useful in monitoring and controlling lesions in high-risk groups of patients, such as in India. In this study, endoscopic brushing cytology gave a better diagnostic yield than did endoscopic tissue biopsy. However, the two techniques are complementary for the diagnosis of upper GI malignancies.

Multiple esophageal webs.

Multiple esophageal webs are rare and are described in association with gastroesophageal reflux disease (GERD). We describe a case of multiple esophageal webs secondary to GERD.

Esophageal dilation in pediatric patients using balloon along the side of the endoscope.

Balloon dilation is an effective modality of treatment for esophageal strictures. As standard through-the-scope balloons do not pass through the biopsy channel of pediatric endoscopes, we have developed a technique by which these balloons can be used in pediatric patients by passing them alongside the endoscope. We report our experience of dilation in four patients using this technique.

Achalasia cardia dilatation using polyethylene balloon (Rigiflex) dilators.

OBJECTIVE: Results of 20 dilatation sessions in 15 patients with achalasia cardia were assessed to determine the safety and efficacy of polyethylene balloon achalasia dilators (Rigiflex). METHODS: All patients underwent an initial dilatation by inflating a 30 mm balloon to 9 psi for one minute. Need for subsequent dilatations was assessed on symptom assessment; 35 mm balloon was used for repeat procedure. RESULTS: Overall success rate was 93.3%. The 30 mm balloon achieved a satisfactory result in 73.3% and the 35 mm balloon in 75% of the remainder. Only one patient needed surgery. No short-term complications were observed. The only late complication encountered over an average follow-up period of 16.2 months was gastroesophageal reflux in two patients. CONCLUSIONS: Dilatation using Rigiflex dilators is a safe, effective and simple procedure for treating patients with achalasia.

Helicobacter pylori and intestinal metaplasia of gastric mucosa.

BACKGROUND: The role of Helicobacter pylori in stomach carcinogenesis is currently under study. H pylori-related chronic gastritis leading to dysplasia or intestinal metaplasia (IM) especially of the colonic type is postulated as one of the mechanisms. METHODS: We studied 120 patients with or without H pylori infection to determine the frequency of occurrence of IM in the stomach. RESULTS: IM was found in 16.6% of patients; most cases had the small intestinal type, which is not known to have a malignant potential. There was no relation between H pylori infection and development of IM. CONCLUSION: H pylori infection leading to IM does not appear to be a factor in the genesis of carcinoma stomach in our population.

Comparison of gastric mucosal blood flow in normal subjects and in patients with portal hypertension using endoscopic laser-Doppler velocimetry.

OBJECTIVE: To compare gastric mucosal blood flow (GMBF) in normal subjects with that in patients with portal hypertension with or without portal hypertensive gastropathy (PHG). METHODS: GMBF was measured by endoscopic laser-Doppler velocimetry in 20 gastroscopically normal subjects and 30 patients with portal hypertension with or without PHG. The effects of breath-holding (vasomotor reflex), submucosal epinephrine and sublingual isosorbide dinitrate were also studied. RESULTS: In normal subjects, GMBF on the greater curvature was (mean +/- SD) 9.5 +/- 1.3 V and on the lesser curvature, 9.1 +/- 1.9 V. Breath-holding caused a reduction in GMBF by 57.1 +/- 13.7%, submucosal epinephrine reduced it by 41.5 +/- 21.5% and sublingual isosorbide caused a rise of 25.8 +/- 15.2%. The GMBF on the greater and lesser curvature respectively in patients with mild PHG (7.7 +/- 1.2 V and 7.7 +/- 0.8 V) and those with severe PHG (6.5 +/- 3.5 V and 6.3 +/- 2.2 V), was significantly less than that in normal subjects (p < 0.05 and p < 0.001 respectively). Vasomotor reflex was blunted in patients with mild and severe PHG (23.3% +/- 20.3 and 23.1% +/- 17.7 respectively, p < 0.001). Responses to submucosal epinephrine and sublingual isosorbide were similar to those recorded in normal subjects. CONCLUSIONS: Patients with portal hypertension have significantly reduced GMBF and significantly attenuated vasomotor reflex in the gastric vascular bed as compared to normal subjects.

Effect of a short course of indomethacin on gastric mucosal blood flow using endoscopic laser-Doppler velocimetry.

OBJECTIVE: To assess the effect of a short course of indomethacin on gastric mucosal blood flow (GMBF). METHODS: Patients with musculo-skeletal pain of recent origin and were prescribed a short course of therapy with indomethacin (25 mg tid for 7 days) were studied Baseline measurements of GMBF were carried out using endoscopic laser-Doppler velocimetry prior to starting indomethacin. At sites on the antrum, incisura, lesser and greater curvatures, and fundus. GMBF measurements were repeated after indomethacin therapy, as above and also on sites of erosions, it any. RESULTS: Baseline GMBF at sites on the antrum, incisura, greater and lesser curvatures, and fundus were (mean) 8.6, 7.9, 8.8, 8.5 and 8.7 volts, respectively. Post-therapy values did not differ from the corresponding baseline values (8.7, 8.5, 8.6, 8.6 and 8.3 volts, respectively). However, ten of the 16 patients developed gastric mucosal erosions and the mean GMBF on these sites of erosion was significantly reduced (6.6 +/- 1.3 volts, p < 0.05). CONCLUSIONS: A short course of indomethacin therapy produces a patchy decrease in blood flow in the gastric mucosa and erosions were seen in these areas.

Esophageal involvement in pemphigus vulgaris.

Twenty five patients with pemphigus vulgaris were prospectively studied for esophageal involvement by endoscopic examination. Eighteen (72%) had esophageal involvement; the majority of the lesions were bullae. Histological examination showed acantholysis of the cells and exuberant inflammation.

Large villous adenoma of the duodenum.

A 27-year-old man, who had symptoms of gastric outlet obstruction, was found on endoscopy to have a large duodenal polyp which on histology was diagnosed as villous adenoma. The tumor was resected surgically and the patient remained asymptomatic until two years later.

Prepyloric diaphragm detected following foreign body ingestion.

Prepyloric diaphragms are unusual and are usually detected in adulthood. We report a five-year-old boy who presented with history of ingestion of a coin and was found to have a prepyloric diaphragms on laparotomy.

Asymptomatic spinal tuberculosis presenting as esophageal stricture.

Esophageal tuberculosis is rare and is usually due to secondary extension from contiguous structures. We report a patient who presented with dysphagia and was found to have esophageal stricture. Endoscopic biopsy was not suggestive of malignancy or tuberculosis. CT scan of the thorax revealed involvement of the fourth thoracic vertebra with paratracheal lymphadenopathy. The patient responded to anti-tubercular therapy.

Spontaneous regression of large gastric carcinoid.

We report a female patient who presented with an epigastric lump proved on open biopsy to be a carcinoid tumor. She had raised serum glucagon level and increased excretion of 5-hydroxy indolacetic acid in the urine. She refused surgery and was followed up at 3 monthly intervals. At 6 months the tumor had decreased considerably in size. At one year it was no longer palpable and ultrasound examination clarified that there was no tumor. This was confirmed by the finding of normal levels of 5-HIAA in the urine.

Rectal lymphogranuloma venereum in association with rectal adenocarcinoma.

Rectal involvement in lymphogranuloma venereum (LGV) is more common in women. Inguinal bubo is often absent and the patient seeks medical attention only at a late stage when rectal stricture has developed. LGV rectal stricture resembles and is known to predispose to rectal cancer. Hence it is necessary to rule out rectal malignancy in patients with LGV stricture. We report a case of rectal LGV associated with rectal adenocarcinoma.

Burning sensation in the throat--should it be named caloripharyngeus?

A burning sensation in the throat is often complained of by patients, but this symptom has been neglected in the literature. To emphasize its importance, should we give the name 'caloripharyngeus' to the symptom of burning in the throat? A preliminary study of 30 patients with the sensation of burning in the throat is presented in this study. Of the patients studied 73.33 per cent had hyperacidity detected for the first time. Reflux was presented in only one patient; four patients showed oesophagitis in the lower one-third of the oesophagus; 90 per cent of the patients responded to antacids. We suggest that one of the causes of burning in the throat is a referred sensation due to hyperacidity.

Unusual features of Helicobacter (Campylobacter) pylori--associated gastritis in India. A study of 200 cases.

Helicobacter (Campylobacter) pylori has been cultured from the antral biopsies of 85-90% of patients of gastritis, gastric ulcer and duodenal ulcer at different centres. Studies conducted all over the world have firmly implicated this organism in the aetiology of active superficial gastritis and recurrences of duodenal ulcer. Two hundred patients with upper abdominal pain, distension, vomiting and/or haemetemesis were subjected to OGD scopy. In 163 of these patients there was endoscopic evidence of gastritis; in 24 there was DU; in 3, GU and in 10 it was normal. Diagnosis of H pylori infection was made by the rapid biopsy urease test which is nearly 100% specific and 98% sensitive. 170 out of 200 patients were positive for H pylori. Among these were 138 patients of gastritis (84.6%); 22 cases of DU (91.6%); 2 cases of GU (66.6%) and 8 in whom endoscopy was normal. Histological examination of the antral biopsy specimens showed mild to severe infiltration of mucosa with lymphocytes and plasma cells. None of the 170 H pylori positive cases showed polymorphonuclear infiltration which has been stressed repeatedly by most Western authors to be characteristic of "active" superficial gastritis associated with H pylori infection. Even in those with a history of dyspepsia of barely 4 weeks duration or less there was no PMN infiltration in the mucosa. Thus the local response to infection by H pylori of the gastric mucosa is different in Indian patients.

Acute Campylobacter jejuni enteritis in 385 hospitalised patients.

Twenty healthy controls and 385 adult patients suffering from acute enteritis or gastroenteritis were enrolled for the study of Campylobacter Jejuni infection over a period of 2 years. Thirty five stool samples showed C jejuni on stool culture. The isolation rates were at peak in the monsoon season and from watery and bloody stool specimens. Pure C jejuni culture was obtained in 18 of 35 samples; the other 17 samples showed polymicrobial infection or infestation. Nine of 35 patients were treated with erythromycin 1 g in divided doses for 7 days. Repeat stool cultures did not grow C jejuni. There was no resistance to erythromycin therapy. C jejuni are fastidious organisms and require special medium and microaerophilic environment for culture.

Rapid diagnostic test of Campylobacter pylori infection in patients of gastritis, duodenal ulcer and gastric ulcer. A study of 100 cases.

Campylobacter pylori has been cultured from 85-90% of antral biopsies of patients of gastritis, duodenal ulcer and gastric ulcer at different centres in the world. It has been now firmly implicated in the aetiology of active gastritis as well as suspected to cause repeated recurrences of peptic ulcers. However, the organism is very fastidious and is difficult to grow by standard culture methods as a result of which low positivity is often obtained even in well equipped centres. The rapid biopsy urease test for the diagnosis of C pylori infection, in which the biopsy is directly cultured in a solid medium containing urea, is a very simple test. A change in colour indicates the growth of the organism. This test is 100% specific and 98% sensitive. We performed this test in 100 patients; 93 of gastritis, 6 of DU and 1 of GU during a three month period. 87 of 93 cases of gastritis (90%) and all 6 cases of DU (100%) were positive. The single case of gastric ulcer was negative. Treatment of C pylori positive cases showed that they responded poorly to 4 weeks therapy with tinidazole; 33% were cured after 2 weeks of 1.5 g amoxycillin daily, but all responded when the therapy was continued for 4 weeks.

Association of peptic ulcer with Helicobacter pylori and the recurrence rate. A three year follow-up study.

Helicobacter pylori is associated with 70-100% of peptic ulcers. Relapse of infection has been shown to cause recurrences of ulcers in a large number of studies. We diagnosed 137 cases of peptic ulcer (121 DU; 16 GU) during a 3 year period. Of these, 117 were positive for H pylori. Sixty six of the 117 cases staying in the vicinity of the Hospital were followed up for a minimum period of 3 months upto a maximum period of 3 years. In 91 examinations there was relapse of H pylori infection and ulcer recurrence was seen in 58 (63%), whereas ulcer recurred only in 6 out of 61 examinations where H pylori had not relapsed (10%). The difference was highly significant by Chi square test. (P less than 0.001).

Relapse of Helicobacter pylori infection after different treatment regimens. A 3-month follow-up study.

Helicobacter pylori infection of gastric antrum is associated with a majority of cases of peptic ulcer (70-100%). Studies have shown that when this organism is eradicated, the recurrence of ulcer falls to less than one-third of those in whom the infection persists or relapses. Monotherapy with bismuth salts, tinidazone or amoxycillin has been shown to result in early relapse and recurrence of ulcers. However, dual or triple therapy regimens are more effective. We conducted a randomised controlled study using tripotassium dicitrato bismuthate (TDB) (10 patients); amoxycillin (combined with ranitidine for ulcer healing) (9 patients) and dual therapy with both amoxycillin and TDB (10 patients). Our study showed that relapse rates at the end of 3 months was significantly less if dual therapy with TDB and amoxycillin is used as compared to TDB alone (p less than 0.05).