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Thirty five subjects underwent upper gastrointestinal endoscopy and multiple biopsy (30 patients, five normal subjects). A total of 11 biopsies per subject from four sites (oesophagus (three), gastric body (two), antrum (three), duodenum (three] were examined for inflammation and the presence of Campylobacter pylori and using standard methods of culture and by light (LM) and electron microscopy (EM). The organism was cultured from oesophageal biopsies in eight of 30 (27%) patients but could not be identified at this site by LM or EM. There was evidence of oesophageal inflammation in 20 patients which was associated with the local finding of C pylori in five (25%) including two of seven (29%) with Barrett's mucosa. Antral C pylori was present in 22 of 23 (96%) patients with chronic active gastritis. The organism was found in the antrum and oesophagus in four of 22 patients (18%), in the antrum and duodenum in four of 22 patients (18%) and in all three sites in a further two of 22 patients (9%). Antral C pylori was found in five of six patients with peptic ulceration. C pylori was cultured from the duodenum in six patients with confirmation by LN and EM in three, but only on areas of gastric metaplasia. The organism was not found in the normal group. This study indicates that C pylori may be irregularly isolated from the oesophagus and duodenum in patients with antral C pylori and chronic active gastritis. The role of C pylori in the oesophagus is most likely that of a commensal or contaminant. [ABSTRACT FROM PUBLISHER]

Multiple endoscopic specimens were obtained from 58 patients with a columnar lined gesophagus to study the histological and histochemical features of this metaplastic epithelium. Five patients (8.6%) had presented with a primary oesophageal adenocarcinoma. Three different epithelial types, junctional, atrophic fundic and intestinal were identified. Twenty two (38%) patients had just one type of epithelium present, the other 36 (62%) having a combination of two or three different types. Intestinal type of epithelium, either alone or in combination with gastric type epithelium was present in 48 (83%) patients. In every case this intestinal type epithelium took the form of an incompletely differentiated variant of intestinal metaplasia, although complete intestinal metaplasia as a focal change was also present in 14 of these patients. Histochemically, sulphomucins were present in the biopsies of 43 (74%) of the patients studied. They were seen in both goblet and columnar mucous cells with almost equal frequency. Incomplete intestinal metaplasia with sulphomucin production was present in four of the five patients with an oesophageal adenocarcinoma. In the columnar lined oesophagus sulphomucin production is common and its presence does not help to identify those individuals at particular risk of developing an adenocarcinoma. [ABSTRACT FROM PUBLISHER]

Myoelectrical activity was recorded from the human antrum on 136 occasions using a monopolar mucosal electrode in preoperative and post-vagotomy patients, and bipolar serosal electrodes in post-cholecystectomy patients, and the incidence of antral arrhythmias observed. Arrhythmias of long duration were observed in five out of 62 patients after vagotomy and one out of 10 patients after cholecystectomy, but not in preoperative patients. They were characterised by slow waves with increased frequency, variable period, amplitude, and wave shape and were associated with periods of slow wave inhibition. None of the patients with an arrhythmia had any symptoms of disordered gastric motility. Antral arrhythmias could also be induced in some patients by the administration of insulin, secretin, cholecystokinin-pancreozymin, glucagon, and pentagastrin. The appearance of antral arrhythmias is probably due to a relative increase of sympathetic over parasympathetic activity. The maximal slow wave frequency observed was 8.3 cycles per minute and it is probable that in vivo human antral smooth muscle has a maximum frequency above which it cannot be driven. [ABSTRACT FROM PUBLISHER]

Both monopolar and bipolar recordings of human colonic myoelectrical activity have been made on 29 occasions from implanted serosal electrodes attached to either the ascending colon or transverse colon. Visual and computer analysis of the signals were made and the incidences of the two electrical rhythms present in the colon were compared for the two recording techniques, recording sites, and methods of analysis. The percentage incidence of both rhythms was similar for the mono and bipolar recording techniques in both parts of the colon. The incidence of the two rhythms in the transverse colon was approximately twice that recorded in the ascending colon, this being true for both recording techniques and methods of analysis, but neither was detected for more than 50% of the time. It is concluded that the methods of data analysis probably account for the differing incidences of electrical activity in the human colon that have been reported previously. [ABSTRACT FROM PUBLISHER]

The immediate and delayed effects of different types of vagotomy on the antral myoelectrical activity have been studied in 52 patients who had previously undergone either highly selective vagotomy (HSV) or truncal vagotomy and pyloroplasty (TV + P) for the treatment of chronic duodenal ulceration up to eight years previously. The frequency of the electrical activity was not statistically different between the two types of operation. After HSV the triphasic waveshape of the antral myoelectrical activity was retained; it was recorded more frequently in the delayed tests (98.0 plus or minus 1-7%) of the recording period than in immediate tests (74-7 plus or minus 6-5%) whereas mean amplitude in the immediate tests (1-59 plus or minus 0-13 mV) was not significantly changed in the delayed tests (1-49 plus or minus 0-08mV). After TV + P the waveform was more sinusoidal in shape, being recorded more often in the delayed tests (91-7 plus or minus 2-7%) than in the immediate tests (41-4 plus or minus 8-9%) although the mean amplitude between the immediate (0-090 plus or minus 0-06 mV) and delayed tests (0-94 plus or minus 0-07 mV) was not significantly different. The only significant change in the myoelectrical activity with the passage of time after vagotomy was an increase in the percentage activity. [ABSTRACT FROM PUBLISHER]

The effects of varying the extent of vagotomy on the myoelectrical and motor activity of the stomach have been successfully studied in 21 patients undergoing either truncal, selective, or highly selective vagotomy for the treatment of chronic duodenal ulceration. The mean percentage time that regular antral myoelectrical activity was recorded preoperatively was 95·8% ± 1·0 and this was decreased following highly selective vagotomy (74·0% ± 6·6), selective vagotomy (37·8% ± 12·4), and truncal vagotomy (30·2% ± 10·4). The mean amplitude of the pacesetter potential was less following truncal (0·86 mV ± 0·05), selective (1·32 mV ± 0·09), and highly selective vagotomy (1·67 ± 0·09) than in preoperative studies (2·21 mV ± 0·12). Following truncal and selective vagotomies the triphasic waveform of the pacesetter potential changed to a sinusoidal shape. No significant change in the mean preoperative frequency of the myoelectrical activity (3·03 cpm ± 0·08) occurred after vagotomy. Thus the changes in the electrical activity of the stomach are related to the extent of the vagal denervation. Intravenous administration of insulin did not alter these patterns except after highly selective vagotomy when the amplitude of the electrical waves, the incidence of action potentials, and percentage motor activity were increased. [ABSTRACT FROM PUBLISHER]

Barren's oesophagus (BO) is the major risk factor for adenocarcinoma of the oesophagus, which is increasing in incidence more rapidly than any other cancer in the Western world. BO confers a lifetime risk for developing adenocarcinoma of 10-15%. Both photodynamic therapy using 5-aminlaevulinic acid as a photosensitiser and argon plasma coagulation (APC) have been shown to be effective in the oblation of 80, but a comparative trial of these two modalities has not been reported. PDT and APC are both effective modalities for ablating Barrett's oesophagus. PDT requires more equipment and is more costly in the short term. APC appears to be more effective than PDT for ablation of Barrett's oesophagus.