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Polymorphonuclear leukocytes in cord blood and in blood of women at delivery and six weeks after delivery were examined by means of a modified NBT-test. The results were compared with those of healthy controls. It is shown that the increased NBT-positivity of the polymorphonuclear leukocytes of the examined groups is due to increased ingestion capacity, while NBT reduction capacity of the polymorphonuclear leukocytes is not increased.

The effect of cigarette smoking on gastroesophageal reflux and the effect of the pH electrode on salivary secretion and swallowing frequency were studied in 30 healthy volunteers (15 habitual smokers, 15 non-smokers) and in 10 smoking patients with proven gastroesophageal reflux disease. Twenty-four-hour pH profiles were measured while the subjects were ambulatory using a combined glass electrode connected to a portable recorder. In 8 of the smoking volunteers, swallowing frequency and salivary secretion were measured, both when smoking and when not. Smokers had more reflux episodes than nonsmokers [median per hour 2.8 (range 0.4-7.1) for the upright body position and 0.5 (range 0.0-1.7) for the supine body position vs. 1.4 (range 0.0-2.1) upright and 0.0 (range 0.0-0.7) supine, p less than 0.01], but the total time of exposure of the esophageal mucosa to acid was affected neither by the status of being a smoker nor by actual smoking. Nasopharyngeal intubation with the pH electrode did not affect the swallowing frequency, but it increased salivary secretion two-to threefold for a period of 4 h. Six hours after introduction of the pH electrode and later, salivary flow was similar to baseline. It is concluded that smoking and nasopharyngeal intubation does not adversely affect the results of 24-h pH-metry.

A two-marker technique was used to determine gastric emptying rate and postprandial duodenogastric reflux rate without transpyloric intubation. The fractional gastric emptying rate in five dogs with normal pylorus was 3.0 +/- 0.3 (SE) X 10(-2)/min. In three dogs with circular pylorectomy, it was 5.8 +/- 0.8 X 10(-2)/min (P less than 0.01). The duodenogastric reflux rates were 0.72 +/- 0.23 (SE) ml/min and 3.21 +/- 0.97 ml/min. (P less than 0.05). The percentage of the test meal that by to-and-fro movements across the pylorus was emptied more than once was 2.3 +/- 1.0 (SE) in normal dogs and 15.5 +/- 2.4 after pylorectomy (P less than 0.005). Because the higher emptying rate was accompanied by more to-and-fro movements, the amount of the meal remaining in the stomach, and thus net gastric emptying, was similar in both groups. It is concluded that pylorectomy increases both reflux rate and emptying rate. This effect on emptying can only be detected by a method that includes the measurement of to-and-fro movements across the pylorus. The pylorus thus appears to prevent postprandial duodenogastric reflux and to slow gastric emptying.

In a controlled randomized clinical trial the effect of the secretory inhibitors Cimetidine and pirenzepine on the visibility of the areolar gastricae in barium studies of the upper gastrointestinal tract was examined. Both drugs improved the radiological imaging of the areolar tidine reduced the amount of radiologically visible fasting gastric contents. Thus, factors other than the volume alone of gastric secretions appear to play a major role in the quality of imaging of the gastric fine relief.

A two-marker technique avoiding transpyloric intubation was used to measure the volume of gastric secretion, the rate of gastric emptying and the degree of postprandial duodenogastric reflux in 8 dogs, 5 without and 3 with Heineke-Mikulicz pyloroplasties. The stomach emptied after a liquid fatty meal at an overall rate of 4.9 ml/min +/- 0.2 s.e.m. in animals with a normal pylorus and 5.7 +/- 0.2 ml/min in those with pyloroplasties (P less than 0.05). Though mean fractional emptying rates were similar, the fractional emptying rate was greater in animals with pyloroplasties than in those without in the first 10 and in the last 20 minutes. The rate of duodenogastric reflux was likewise greater in animals with pyloroplasties than in those without (1.8 +/- 0.2 ml/min and 0.7 +/- 0.2 ml/min respectively, P less than 0.05). The rates of gastric secretion did not differ materially (2.2 +/- 0.3 ml/min and 2.1 +/- 0.2 ml/min), but a greater proportion of the gastric contents was emptied more than once in animals with pyloroplasties than in those without (7.7 +/- 1.5 per cent and 2.3 +/- 1.0 per cent, P less than 0.05).

The effect of oral ranitidine 150 mg on the acid and pepsin response to sham feeding or pentagastrin was examined in healthy volunteers in a double-blind randomized trial. Gastric juice was collected up to 255 min after ingestion of the drug. In placebo treated subjects, basal acid secretion rate and the secretion rate following sham feeding and injection of 6 micrograms kg-1 of pentagastrin were 5.3 +/- 2.0 S.E.M., 12.3 +/- 3.2, and 24.4 +/- 5.4 mmol h-1, respectively. The corresponding values in ranitidine treated subjects were 0.1 +/- 0.1, 0.5 +/- 0.2, and 3.4 +/- 1.2, respectively. The reduction of acid secretion in all three instances is statistically significant (p less than 0.025, p less than 0.05, and p less than 0.05, respectively). Basal, sham feeding stimulated, and pentagastrin stimulated pepsin secretion rates in the placebo treated group were 38.4 +/- 7.0 S.E.M., 68.6 +/- 13.2, and 39.2 +/- 8.0 mg h-1, respectively. In the ranitidine treated group, the values were 5.0 +/- 3.4, 13.2 +/- 5.6, and 19.6 +/- 6.0, respectively. The reduction of pepsin secretion during basal state and following sham feeding is statistically significant (p less than 0.005 and p less than 0.01). Thus, oral ranitidine inhibits the acid and pepsin response to sham feeding in man. Its inhibitory effect on the acid response to pentagastrin lasts for at least 4 h.

Orally or intravenously administered beta 2-adrenergic drugs have been found to inhibit esophageal motor function. Since inhalation of these drugs results in less systemic side effects, the present double-blind study was designed to investigate the influence of inhalation of the beta 2-adrenergic agonist albuterol (salbutamol) on esophageal motor function and gastroesophageal reflux in ten healthy volunteers. Esophageal motor function was recorded using a pneumohydraulically perfused multilumen manometry tube. Twenty-four-hour pH profiles were measured while the volunteers were ambulatory using a combined glass electrode connected to a portable recorder. Inhalation decreased neither lower esophageal sphincter pressure nor esophageal peristaltic amplitudes. Gastroesophageal reflux was similar on both occasions during inhalation of albuterol (3.1% [range, 1.0% to 25.5%] median upright time, with esophageal pH less than 4; and 0.1% [range, 0.0% to 10.7%] supine time) and during placebo treatment (3.6% [range, 1.6% to 19.8%] upright and 0.0% [range, 0.0% to 2.5%] supine time). Our data support the study of inhalation of beta 2-adrenergic drugs in asthmatic patients with accompanying gastroesophageal reflux.

Twenty original papers that reported on the effect of wheat bran on large bowel function were analysed. Bran increased the stool weight and decreased the transit time in each study in healthy controls and in patients with the irritable bowel syndrome, with diverticula, and with chronic constipation. Statistical evaluation of the data showed, however, that constipated patients had lower stool output and slower transit whether or not they had taken bran, and they responded less well to bran treatment than controls. From these data it is concluded that bran can be expected to be only partially effective in restoring normal stool weight and transit time in patients who are constipated.

In 3935 patients who underwent upper fiberpanendoscopy in two Zurich hospitals the coincidence of different active peptide lesions has been investigated. There was an association of reflux esophagitis and duodenal ulcer in old age: in patients with reflux esophagitis aged over 60 years, duodenal ulcer was found twice as often as in elderly patients without esophagitis. No association of reflux esophagitis and gastric ulcer or of gastric ulcer and duodenal ulcer was observed.

Experimentally, the gastric and the duodenal mucosa can both be damaged by acute exposure to small intestinal juice. Though chronic exposure to bile causes mucosal erythema and hyperplasia, the gastric mucosal barrier is not damaged. Duodenogastric reflux is relevant in the pathogenesis of postoperative bilious vomiting and probably of "alkaline" reflux esophagitis. The exact mechanism of mucosal damage has not been established. Duodenogastric reflux is likely to be irrelevant in the pathogenesis of (microscopic) gastritis, of gastric ulcer, and of reflux esophagitis without previous gastric surgery.

During the course of viral infections, acute delays in gastric emptying are common. Usually, dietary measures suffice, but treatment with dopamine antagonists with their additional antiemetic effect, may be beneficial. The major causes of chronic delayed emptying are diabetes mellitus with autonomic neuropathy, connective tissue diseases such as systemic sclerosis, and gastroparesis following gastric surgery. Diet alone is rarely effective, and prokinetic drugs should be prescribed. The new compound cisapride seems to be particularly effective. Abnormally rapid emptying occurs exclusively following surgical destruction of the gastric outlet and may lead to the dumping syndrome. In general this can be adequately controlled by dietary measures.

Long-term esophageal pH-metry has become the preferred test to quantify acid gastroesophageal reflux, but its accuracy in separating physiologic from pathological reflux is not well defined. To establish optimal thresholds of 24-h pH-metry, we studied 45 patients with clinically proven gastroesophageal reflux disease and 42 healthy volunteers. Twenty-four-hour esophageal pH was measured while the subject was ambulatory, using a combined glass electrode connected to a portable recorder. Percentage of time with esophageal pH less than 4, the number and mean duration of reflux episodes, the number of episodes lasting longer than 5 min, and the duration of the longest episode were calculated for periods of upright and supine body position, respectively. Discriminant analysis and receiver-operating-characteristic analysis were used to define optimal thresholds. A maximum of sensitivity (93.3%) and specificity (92.9%) was obtained using receiver-operating-characteristic analysis with the following criteria. Only percentage of time with esophageal pH less than 4 is considered. A subject is classified as "normal" if both values for the upright and supine body position are below the thresholds, otherwise the subject is classified as "pathological." The thresholds are 10.5% of time with esophageal pH less than 4 for the upright position and 6.0% for the supine position. Within the limits of this retrospective study, it is concluded that rather simple criteria yield a high diagnostic accuracy in the evaluation of long-term esophageal pH-metry. Nevertheless, a prospective and independent confirmation of these criteria is needed.

A modification of the NBT-reaction is described which allows a differentiation of the NBT uptake and NBT-reduction. By means of this method it has been shown that the capacity of NBT-reduction of neutrophil granulocytes taken from hematologically healthy persons is independent of the probands' age and, moreover, of the presence of acute infections and their etiology. It has been shown, that the increase in the NBT-reduction of neutrophilic granulocytes of newborns and persons with acute bacterial infections results from an increased NBT-ingestion. To grive an example of a strongly reduced capacity of NBT-reduction of the neutrophilic granulocytes 2 patients suffering from fatal granulomatous disease in childhood have been examined.

The effect of cigarette smoking on gastric emptying, gastric secretion, and bile salt reflux was measured in 19 healthy habitual cigarette smokers (greater than or equal to 20 cigarettes per day) and 18 nonsmokers. They were studied both in the fasting state and after being fed a mixed liquid meal. Ten of the smokers were studied twice, when smoking and when not, in randomized order. Smokers had lower basal gastric secretion rates than nonsmokers irrespective of actually smoking or not. In smokers, bile salt reflux and postprandial gastric bile salt concentration were higher than in nonsmokers even when not actually smoking (p less than 0.01). Smoking during the experiment slowed gastric emptying, and increased bile salt reflux rate and gastric bile salt concentration (p less than 0.01). It is concluded that cigarette smoking has both chronic and acute effects on gastric function, and that bile salt reflux may contribute to the increased incidence, and lower healing rate, of gastric ulcers in smokers.

The ingestion- and Nitro Blue Tetrazolium-(NBT)-reduction-capacity of neutrophil leukocytes in three newborn infants with lethal septicemia was studied using a modified NBT-test. In comparison to 25 controls in healthy newborns (umbilical vein-blood) the results indicate a failure in the functioning of leukocytes. Besides other disturbances the impaired ingestion- and NBT-reduction-capacity of the neutrophil granulocytes during an infection probably leads to septicemia.