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Aims: To establish the prevalence of functional gastrointestinal (GI) disorders in adult patients with symptoms of gastroesophageal reflux disease (GERD) and to assess the impact of GERD treatment on functional GI disorders in medical practice in France., Methods: 3318 patients with GERD symptoms (mean age 53 yr; 1726 women and 1592 men) were involved in the survey. A questionnaire on demographic data, GERD features, presence of functional GI disorders and their features, and impact of GERD treatment on functional GI disorders was performed by the physician. The size of the different groups was compared using either a chi2 test or a Mantel-Haenszel analysis, on a case by case basis., Results: Seventy-two percent of patients with GERD had associated functional GI disorders, with a mean of 4.1 +/- 1.9 functional digestive symptoms per patient. Gas, flatulence, transit disorders and abdominal distension were the most commonly reported symptoms. Among patients with functional GI symptoms, 27% had symptoms suggestive of irritable bowel syndrome (IBS), 16% were suggestive of dyspepsia while 57% had both upper and lower functional digestive symptoms. According to the patients, GERD treatment had a positive impact (significant to complete improvement) on their functional GI disorders in about one-third of patients particularly in those with dyspeptic-type symptoms., Conclusions: Functional GI disorders are particularly common in adult patients suffering from GERD, with a three times higher prevalence than in the general population.

Objectives: Bacterial imbalance may be involved in the pathogenesis of diversion colitis, via diminished production of short chain fatty acids. The aim of the study was to evaluate the effectiveness of short chain fatty acids on microbial flora of patients with diversion colitis and to compare this flora to the microbial flora of controls., Methods: We prospectively evaluated the effectiveness of short chain fatty acids irrigation on bacterial flora of the excluded colon in 13 patients (8 males, 5 females; mean age: 43.7 years). The causes of diversion were inflammatory bowel disease (n = 4) colonic cancer (n = 2) sigmoid diverticulitis with perforation (n = 3) ischio-rectal abscess (n = 2) and miscellaneous (n = 2). Patients were given, twice a day for 14 days in a double blind manner, a 60 mL enema containing either short chain fatty acids (acetate: 60 mmol/L; propionate: 30 mmol/L; and n-butyrate: 40 mmol/L) (group 1; n = 7) or isotonic NaCl (group 2; n = 6). Bacteriological studies were carried on before starting the trial (D1) and 14 days later (D14)., Results: Before and after treatment, there was no difference between group 1 and group 2 concerning bacterial counts and species. Bacterial flora of patients with diversion colitis was characterized by: a) an increase of the count of aerobic bacteria; b) an increase of aerobic and aeroanaerobic species; c) the presence of black pigmented Gram negative anaerobic rods such as Prevotella intermedia and Porphyromonas asaccharolytica which were not found in rectal flora of the control group (16 volunteers, mean age: 27 years)., Conclusions: These data suggest that: a) enema with short chain fatty acids does not induce significant changes in the composition of the microbial flora in patients with diversion colitis; b) bacterial dysbiosis may be involved in pathogenesis of diversion colitis without involving the action of short chain fatty acids.

We report the case of 4 male patients, smokers, with alcoholic cirrhosis, mean age 54.7 +/- 6 years, treated by sclerotherapy for bleeding esophageal varices. Variceal eradication was obtained following juxtacardial intravariceal injection of 1.5 p. 100 polidocanol in one case (100 ml), and 0.5 p. 100 polidocanol in 3 cases (90, 240 and 310 ml). Local complications were observed in all patients (ulcers: 3; stenosis: 1). Carcinoma of the lower third of the esophagus was detected 12, 20, 22 and 30 months after esophageal sclerosis. Carcinoma was circular (one case), semicircular (2 cases), and nodular superimposed on Barrett's esophagus (one case). Histologic features included squamous cell carcinoma in 3 cases and adenocarcinoma in one case. Sclerotherapy could lead to the development of carcinoma because of mucosal alterations. However, other high risk factors (age, alcohol-tobacco intoxication, Barrett's esophagus) and different histologic features suggest a causal association. Endoscopic follow-up of patients after esophageal sclerosis could confirm this hypothesis.

We report five families with 3 or more children having Crohn's disease. In one family, 6 out of 11 siblings were affected. HLA haplotype study in affected children showed that the probability of random segregation was only 38 percent, making improbable a linkage between the histocompatibility locus and the development of Crohn's disease. However similar clinical patterns in siblings could suggest a genetic factor not linked to the HLA system.

The stomach may be used for esophageal reconstruction after resection of esophageal cancers. The aim of this study was to assess the motility of retrosternal esophagoplasty (RO) following the Akiyama procedure in 6 men (mean age: 56.7 years), at least two months after surgery by means of two techniques: a) manometry of the transplant with a multilumen perfused catheter in 50 and 40 cm from the incisor teeth including spontaneous (5 min) and poststimulation recordings, b) an isotopic method for assessing the gastric emptying of a meal labelled with 111In for the liquid phase and with 99mTc for the solid phase, compared to 12 volunteers as controls. Baseline pressure was 11.2 +/- 2.4 H2O cm without spontaneous activity. After dry and wet deglutition (5 ml of water), 6 patients showed synchronous rise in pressure, having mean amplitude of 12.7 +/- 2.3 cm H2O and lasting 4.3 +/- 1.2 s. Liquids T1/2 was 16.2 +/- 7.8 min in controls (p less than 0.01) and solids T1/2 was 17.7 +/- 6.4 min vs 61.7 +/- 16.5 min (p less than 0.001). The lack of propagated activity associated with rapid emptying of the meal through the plasty with no discrimination between solids and liquids suggests that RO does not participate actively in digestion.

A previously healthy 50-year old man presented with acute small bowel obstruction. No etiology was found at laparotomy. Postoperatively, the patient remained symptomatic with nausea, vomiting and severe constipation. Gastroscopy revealed retained food in the stomach. Gastric emptying of solids and liquids was dramatically decreased at scintigraphy. The colon was dilated on X-ray study. Chest X-ray revealed a pneumopathy and a small-cell lung cancer was discovered at bronchoscopy. The patient died 5 months after onset. Histologic study of the gut showed widespread degeneration of the myenteric plexus with plasma cell infiltration, Schwann cell proliferation and a reduced number of neurons of which many were abnormal. Intestinal pseudo-obstruction can reveal a small-cell lung cancer; the mechanism of neuronal impairment leading to pseudo-obstruction remains unknown, but could be related to the pathophysiology of paraneoplastic syndromes.

Two patients with acute colectasia, and acute urinary retention following pregnancy (case n. 1) and Klebsiellae septicemia (case n. 2) requiring endoscopic exsufflation in both cases, were seen. At onset, both patients had esophageal and anorectal manometric abnormalities with right colonic transit delay, and in case n. 2 urodynamic perturbation. Several months later, abnormalities disappeared in case 1, but remained unchanged in case 2. Jejunal manometry performed in case 2 showed decreased interdigestive complex frequency. These data suggest that: 1) acute colectasia may be major expression of digestive and urinary motility disorders, 2) acute colectasia can be the first symptom of a chronic disease, suggesting the usefulness of manometric studies in these patients, once the acute episode is over.