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It was recently demonstrated in experimental models that, after pancreatic outflow obstruction, serum amylase levels first increase and then progressively decline regardless of whether the obstruction was maintained or relieved. Furthermore, early decompression of the ductal biliary system may prevent the progression of the disease. This finding prompted us to look for a similar pattern in patients with obstructive acute pancreatitis due to biliary stones. Forty-two patients with biliary acute pancreatitis were prospectively studied. Twenty-one patients underwent urgent endoscopic sphincterotomy (ES), and 21 received conservative medical treatment (CMT). The two groups were comparable for sex, age, onset of pain, and seventy. Serum amylase and lipase were determined in all patients on admission and 24 h later. The percentage variation of serum amylase and lipase was calculated considering, for each patient, the concentrations of the two enzymes assayed on admission and 24 h later. On admission, all patients had elevated serum concentrations of amylase (mean ± SEM: ES, 2,560 ± 473 UL; CMT, 1,783 ± 481 U/L) and lipase (ES, 3,037 ± 574 U/L; CMT, 3,179 ± 724 U/L). The serum amylase variation (mean ± SEM) was −65.6 ± 5.5 in the ES and −47.2.1 ± 8.1 in the CMT patients. The serum lipase variation was −59.1 ± 7.7 and −33.1 ± 18 in the same groups, respectively. These differences were not statistically significant. Acute pancreatitis worsened in one patient in the ES group and in seven in the CMT group; this difference was statistically significant (p <0.02). The mean length of hospitalization was 8.9 days in the ES group and 19.7 days in the CMT group (p <0.001). Serum pancreatic enzymes determination is not useful to evaluate the results of the early decompression of biliary duct in human acute pancreatitis. Indeed, early endoscopic sphincterotomy may result in a substantial improvement in the outcome of biliary acute pancreatitis.

Businger JA, Miglio F, Gasbarrini T, Vismans FJ, Geraedts AAM, Stocker H. Rioprostil, a new prostaglandin E, analogue, in the once-daily treatment of acute duodenal ulcer: a comparison with ranitidine. Scand J Gastroenterol 1989, 24(suppl 164), 161-168The efficacy of Rioprostil® (a new prostaglandin E1 analogue) is compared with ranitidine in the once-a-day treatment in the evening for 4 or 6 weeks of active uncomplicated duodenal ulcer disease. A total of 255 patients are entered in this study; of these 243 have been statistically evaluated. One hundred and twenty (120) patients receive rioprostil 600 μg/daily, and 123 patients receive ranitidine 300 mg/ daily. After 4 weeks 63.3% of the patients on rioprostil are endoscopically healed, as compared with 69.1% on ranitidine. After 6 weeks the cumulative cure rates are 87.3% and 89.9%, respectively, the difference not being statistically significant. Pain relief is similar for both drugs. Diarrhoea with rioprostil occurs in about 2% of the treatment days and is generally self-limiting.

1. Anti-liver-specific protein (LSP) antibody and liver membrane autoantibody (LMA) have been evaluated in 88 patients with hepatitis B virus (HBV)-induced chronic liver disease by means of radioimmunoprecipitation and immunofluorescence. Among our patients, 38 presented circulating HBe antigen while 43 had HBe antibody and seven were negative for both. 2. Anti-LSP was mainly found in HBeAg positive chronic active hepatitis (CAH), anti-HBe in positive CAH and in anti-HBe positive chronic persistent hepatitis (CPH). 3. Similar prevalences of LMA (range 13-33%) were detected in the various groups studied. 4. Taking into account the histological diagnosis of disease activity (periportal inflammation and piecemeal necrosis) no significant differences were found between active and inactive patients. 5. Taking into account the HBeAg/anti-HBe status, no significant differences were found between the patients positive for ‘e’ antigen or ‘e’ antibody. 6. Humoral autoimmune reactions may also play a role in HBV-induced chronic (active) liver disease irrespective of HBeAg/anti-HBe status and hence of the viral replication activity of the patients.