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The cellobiose/mannitol (Ce/Ma) test is a non-invasive technique for investigating intestinal permeability. In coeliac disease there is a decreased absorption of small molecules and paradoxically increased absorption of large molecules. The simultaneous administration of cellobiose and mannitol as two probe molecules allows the permeability of the small bowel mucosa to be studied, eliminating extraneous factors such as gastric emptying, and incomplete urine collection. One thousand and ten patients presenting to a gastroenterology clinic with symptoms, signs, or biochemical indices compatible with coeliac disease had a Ce/Ma test. Eight hundred and seventeen had a normal test and of these 197 had a jejunal biopsy showing 148 normal mucosa, two coeliac disease, 43 non-specific abnormalities, four giardiasis. One hundred and ninety three had an abnormal test; of these 132 had a jejunal biopsy showing 62 normal mucosa, 48 coeliac disease, and 22 other abnormalities. Considering those who had jejunal biopsies, the sensitivity of the test for coeliac disease is 96%, specificity 70%, the predictive value of the positive 36%, and predictive value of the negative 99%. Eleven per cent of the patients with a 'false positive' test had abnormalities in the jejunal biopsy or a diagnosis which could explain the abnormal permeability. [ABSTRACT FROM PUBLISHER]

Fasting gastric juice pH and concentrations of vitamin C in gastric aspirate and plasma were measured in 73 patients undergoing endoscopy. Vitamin C concentrations were significantly lower in those with hypochlorhydria (pH greater than 4; n = 23) compared with those with pH less than or equal to 4 (p less than 0.005) and there was a significant correlation between gastric juice and plasma concentrations (p = 0.002). Patients with normal endoscopic findings had significantly higher intragastric concentrations of vitamin C than those with gastric cancer (p less than 0.001), pernicious anaemia (p less than 0.005), gastric ulcer (p less than 0.01), duodenal ulcer (p less than 0.05), or after gastric surgery (p less than 0.01). There was a strong trend (0.05 less than p less than 0.1) towards lower intragastric concentrations of vitamin C in patients with chronic atrophic gastritis. In vitro, vitamin C concentrations remained stable in acidic but fell significantly over 24 hours in alkaline gastric aspirate. Gastric secretory studies in five volunteers showed that vitamin C concentrations increased significantly after intramuscular pentagastrin. These findings suggest that the low fasting levels of vitamin C in hypochlorhydric gastric juice may be caused by chemical instability and that vitamin C may be secreted by the human stomach. [ABSTRACT FROM PUBLISHER]

Colonic mucus production was measured in vitro by means of incorporation of tritiated glucosamine using biopsy material from patients with ulcerative colitis and compared with data from patients with Crohn's disease, colonic carcinoma, colonic polyps and patients with apparently normal colonic mucosae. Mucus production was significantly decreased (p less than 0.03) in all patients with ulcerative colitis, and in particular in patients with inactive disease when compared with normal subjects. In patients with active disease mucus production was not significantly different from normal subjects. The radiolabelled material was characterised by gel filtration and ion exchange liquid chromatography as mainly high molecular weight glycoproteins. These results indicate that the quantitative character of colonic mucus is abnormal in inactive ulcerative colitis. [ABSTRACT FROM PUBLISHER]

We report the results of a prospective study of screening for colorectal epithelial dysplasia by regular colonoscopy in patients with longstanding, extensive colitis (DET group: 112 patients, 366 colonoscopies) together with the findings in all other patients with colitis who have undergone colonoscopy in our unit (non-DET group: 77 patients, 196 colonoscopies). Thirty six DET patients had dysplasia on at least one examination: two patients with high grade dysplasia (HGD) were colonoscoped on suspicion of carcinoma, one asymptomatic patient had HGD at first colonoscopy and one patient had HGD on his sixth colonoscopy, all having carcinomas resected at surgery; the remainder had low grade dysplasia (LGD). Of the DET patients, 100 constituted an ongoing surveillance group (354 colonoscopies) in which LGD was common, being seen on at least one occasion in 33% of patients (16.4% of examinations), but HGD was noted only once with a Dukes A cancer found at surgery. Six non-DET patients had dysplasia diagnosed, this being LGD in all. Even in a carefully selected group of colitics the incidence of HGD is low, but its detection may enable the removal of a colorectal carcinoma at an early and curable stage. [ABSTRACT FROM PUBLISHER]

Eighty patients with duodenal ulcer were randomly allocated to treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine. Ulcers healed in 78% of patients treated with TDB and in 74% treated with cimetidine, supporting previous observations that the efficacy of these two agents is similar. Duodenal ulcer recurred in 43% of patients in the 12 months after treatment with TDB and in 78% of patients treated with cimetidine, with a significantly greater incidence of recurrence 6-12 months after cimetidine treatment. Tripotassium dicitrato bismuthate tablets may be preferable to cimetidine in the initial management of duodenal ulcer, because they offer a smaller likelihood of recurrence in the 12 months after successful treatment. [ABSTRACT FROM PUBLISHER]

A prospective double blind trial of vancomycin vs placebo was undertaken in 40 consecutive adult patients with exacerbation of idiopathic colitis (33 ulcerative colitis, seven Crohn's disease). Vancomycin or placebo (500 mg six hourly) was given for seven days in addition to routine medical therapy. Although there was no significant overall difference in outcome between the two groups, there was a trend towards a reduction in the need for operative intervention in patients with ulcerative colitis treated with vancomycin compared with controls. The efficacy of vancomycin was not attributable to its known action against C difficile, which was not isolated from any of the patients. The data suggest that microbiological factors may play a part in the pathogenesis of ulcerative colitis and that further studies using antimicrobials are desirable. [ABSTRACT FROM PUBLISHER]

One hundred and fifteen patients were reviewed between 18 months and five years after successful endoscopic biliary sphincterotomy for choledocholithiasis, postcholecystectomy in 93 (81%). Thirteen (14%) postcholecystectomy patients and 11 (50%, p less than 0.001) with intact gall bladders are dead (cause of death was ascertained in each case). Of the others, 43 were interviewed and 48 completed a postal questionnaire. Stone free common ducts had been documented in 69 (76%), presumed in 16 (17%), and not achieved in six (7%, excluded from analysis). None of the responding patients had developed serious new problems. Current symptoms of those with and without gall bladders and those with 'documented' and 'presumed' duct clearance are similar. In no case has an episode of cholangitis since sphincterotomy been confirmed and only one patient has had documented recurrent duct stones. Continued incompetence of the sphincter was shown radiologically by the presence of bile duct gas in 14 (41%) of 32 patients. These results suggest that medium term complications of endoscopic sphincterotomy are unusual. [ABSTRACT FROM PUBLISHER]

Terminology in classification of pancreatograms was discussed at a recent international workshop on chronic pancreatitis. A new terminology based on morphological radiographic appearances and a new classification to describe the severity and localisation of pancreatogram changes were agreed. Pancreatograms in chronic pancreatitis are graded as normal or equivocal, or as showing mild, moderate, or marked changes, either diffuse or local. It is hoped that these definitions will help communication between centres, serve as a basis for prospective and comparative studies, and facilitate computerisation. [ABSTRACT FROM PUBLISHER]

Forty patients with duodenal ulcer were randomly allocated to treatment with either tripotassium dicitrato bismuthate tablets or cimetidine for six weeks. Endoscopically confirmed healing of the ulcer occurred in 80% treated with tripotassium dicitrato bismuthate tablets and in 85% treated with cimetidine. Symptomatic improvement was also similar in the two groups. Treatment with cimetidine was associated with an increase in pH of gastric aspirate during treatment and increased numbers of bacteria were isolated from the gastric aspirate during treatment, while the pH and bacterial flora of gastric aspirate did not change during tripotassium dicitrato bismuthate treatment. Serum and urinary bismuth levels rose during treatment with tripotassium dicitrato bismuthate and urinary excretion remained raised two weeks after cessation of treatment. Tripotassium dicitrato bismuthate tablets appear to be as effective as cimetidine in the treatment of duodenal ulcer without the potentially undesirable effects of a reduction in gastric acid secretion. [ABSTRACT FROM PUBLISHER]

The past decade has seen the development of an array of complex flexible fibreoptic instruments for gastrointestinal (GI) endoscopy, and an increasing use of these for diagnostic and therapeutic purposes. It has been recognised more recently that the use of contaminated endoscopic equipment can lead to serious and occasionally fatal infections. Infection with a wide variety of micro-organisms has been reported following oesophago-gastroduodenoscopy (OGD) and endoscopic retrograde cholangio-pancreatography (ERCP). [ABSTRACT FROM PUBLISHER]

Both saliva and jejunal aspirate were cultured from 22 patients with suspected small bowel bacterial overgrowth and from eight controls. Large numbers of organisms (greater than 10(6)/ml) were recovered from the jejunal aspirate of 16 subjects, in five of whom the same organisms were present in similar relative proportions in the saliva, suggesting contamination of the sample with saliva, while in 11 the jejunal organisms differed from those in saliva. In eight of these the jejunal flora was a typical 'faecal' flora usually associated with small bowel bacterial overgrowth but, in three, the jejunal floral was superficially similar to that of saliva. Distinct subpopulations of bacteria, typically Gram-positive non-sporing rods, were, however, evident in the jejunum of these patients, and were also recovered, in smaller numbers, from the jejunum of controls, suggesting that they form a distinct jejunal microflora. Culture of saliva in addition to jejunal aspirate may be useful in the recognition of contamination of the proximal small bowel with saliva, and in the diagnosis of small bowel bacterial overgrowth. [ABSTRACT FROM PUBLISHER]

Bacterial contamination of gastrointestinal fibre-endoscopes is a potential source of clinically significant infection. Aqueous 2% alkaline glutaraldehyde adequately disinfects fibre-endoscopes but may cause serious sensitivity reactions among endoscopy staff. A new 'closed-system' disinfecting apparatus is described that disinfects with glutaraldehyde for 30 minutes before an endoscopy session, for two minutes between patient procedures, and for 10 minutes before storage. Bacteriological cultures of the endoscope after disinfection were virtually sterile. Extremely low glutaraldehyde vapour levels were detected by gas chromatography in endoscopy room air during disinfection procedures. This relatively simple apparatus offers rapid, effective, and safe disinfection of fibre-endoscopes. [ABSTRACT FROM PUBLISHER]

Intestinal permeability has been studied in 21 patients with coeliac disease in relapse and after gluten withdrawal using an oral test of intestinal permeability based on the simultaneous oral administration of two probe molecules. The increased absorption of the larger molecule (cellobiose) and the decreased absorption of the smaller (mannitol) found in untreated coeliac disease both returned to normal within five months of starting treatment, the abnormality in cellobiose absorption correcting more rapidly than that of mannitol. After exposure to a single oral dose of gluten, the intestinal permeability of six patients with treated coeliac disease became transiently abnormal with an increased absorption of cellobiose, returning to normal within one week. The possible structural and functional implications of these findings are discussed. The cellobiose/mannitol ratio appears to be of value in assessing the response to gluten withdrawal in coeliac disease, and also in monitoring patients who are already established on a gluten free diet by detecting dietary lapses and 'non-responding coeliac disease'. It may also offer an alternative to jejunal biopsy in patients subjected to gluten challenge. [ABSTRACT FROM PUBLISHER]

Thirty patients with distal colitis (proctosigmoiditis) in relapse were randonly allocated to twice daily treatment with traditional aqueous hydrocotrisone enemas (Cortenemas) or a suspension of hydrocortisone in an inert foam base (Colifoam). Each treatment contained the same amount of hydrocortisone. Clinical, sigmoidoscopic, and histological response was assessed after two weeks. Both agents were effective, and broadly similar in terms of objective improvement, but subjective improvement was greater with the foam preparation, and several patients expressed a preference to this mode of treatment. [ABSTRACT FROM PUBLISHER]

Faecal samples were collected from 23 patients with active ulcerative colitis, 15 patients with established ulcerative colitis in remission, 20 patients with active colitis of cause other than ulcerative colitis, and 20 normal control subjects. Ten coliform colonies were randomly selected from the faecal sample cultures and serotyped before the testing of each different serotype from each sample for adhesive or invasive properties on HeLa cell monolayers. In the patients with both active ulcerative colitis and ulcerative colitis in remission and those with other types of colitis one serotype tended to dominate the faecal coliform flora. In normal controls more variety was encountered. Thirty-five per cent of the patients with active ulcerative colitis and 27% of the patients with ulcerative colitis in remission had at least one adhesive or invasive faecal coliform as compared with 5% of the patients with other types of colitis and 5% of the normal controls. These findings are significant (P < 0.05) and may have aetiological and therapeutic significance. [ABSTRACT FROM PUBLISHER]

In disease states of the small intestine--for example, gluten-sensitive enteropathy--there is an increased permeability to large molecules. This increased permeability extends to polar molecules of intermediate size such as disaccharides, whereas small polar molecules are malabsorbed. A recently-developed oral test, based on the simultaneous administration of two test substances, cellobiose (a disaccharide) and mannitol (a small polar molecule) has been used to investigate permeability in a variety of gastrointestinal diseases, the result of the test being expressed as the ratio (cellobiose/mannitol) of the five hour urinary recoveries of the two probe molecules. Results for patients with pancreatic insufficiency, intestinal bacterial overgrowth, primary hypolactasia, ileocolic or colonic Crohn's disease, and ulcerative colitis were comparable with those in normal controls, whereas in 23 out of 24 untreated coeliacs, and five out of eight patients with Crohn's disease involving the more proximal small bowel, the cellobiose/mannitol ratio was clearly abnormal. A study of its application as a screening procedure for coeliac disease showed that the test was both sensitive and accurate, with fewer false-positive and false-negative results than other recognised screening tests--namely, the xylose test, reticulin antibodies, and blood folate estimations. [ABSTRACT FROM PUBLISHER]

Seventeen patients with proven systemic sclerosis had a peroral jejunal biopsy performed. Four biopsies were regarded as showing abnormalities, which were mostly confined to the deeper structures, although in two there was a minimal degree of villous atrophy without epithelial cell changes. Passive intestinal permeability, as assessed by the cellobiose/mannitol test, was normal in all patients. In contrast, seven patients had a low xylose test result, which in five of them could be accounted for by impaired renal function, small intestinal bacterial contamination, or altered gastrointestinal transit. These results indicate that passive intestinal permeability is unaltered in systemic sclerosis, and that malabsorption, when it occurs, is caused by other factors. [ABSTRACT FROM PUBLISHER]

In man, the main pancreatic duct is normally derived from ventral and dorsal embryological buds of the pancreas. In a minority of people, failure of fusion of the two buds results in separate drainage of the dorsal and ventral pancreas, so that the accessory duct provides the main drainage for the gland. Patients with this anomaly demonstrated at endoscopic retrograde pancreatography (ERP) have been investigated to assess whether non-fusion of the main pancreatic duct predisposes to the development of pancreatitis. A failure of fusion of the pancreatic ducts was seen in 21 out of 449 (4.7%) successful pancreatograms; four of these 21 patients had definite clinical evidence of pancreatitis and two patients had possible pancreatic disease, but in the remainder the anomaly was not considered to be clinically relevant. An abnormal pancreatogram suggesting pancreatitis was present in 116 out of the 428 patients (27.1%) with a normally fused duct system. The anomaly was found as frequently in the whole series as it was seen in patients with pancreatitis. These findings suggest that embryological failure of pancreatic duct fusion does not predispose to the development of pancreatitis. However, the presence of this anomaly may lead to misinterpretation of ultrasonographic and CT scan findings. [ABSTRACT FROM PUBLISHER]

Passive intestinal permeability has been investigated in rats infected by the nematode, Nippostrongylus brasiliensis, by the simultaneous administration of two probe molecules. Experiments using a closed intestinal loop show that there is a significantly increased absorption of lactulose and decreased absorption of mannitol in rats at the 10th to 11th day of infection. Experiments using serial oral administration techniques show that these changes start during the second week of the infection with a return towards normal values by the end of the third week. The results are similar to those found in human coeliac disease and add weight to previous studies which have stressed the similarity in the two disease processes. [ABSTRACT FROM PUBLISHER]

The Lundh test and endoscopic retrograde cholangiopancreatography (ERCP) were used to investigate 40 patients with known or suspected pancreatic disease. Pancreatograms were classified as being normal or showing minimal or gross changes. There was good correlation between the two tests in assessing the degree of pancreatic disease (P less than 0.01). Gross radiographic changes were associated with a mean tryptic activity (MTA) of less than 6 IU/ml, while minimal changes were associated with an MTA between 6 and 14 IU/ml. Although some patients with normal pancreatograms had MTAs within this range, no patients with an MTA above 14 IU/ml had an abnormal pancreatogram. The Lundh meal is of great value in detecting extensive pancreatic disease and an unequivocally normal result virtually excludes significant chronic pancreatic disease. Values in the equivocal range usefully draw attention to early pancreatitis which may be confirmed by ERCP. In this paper the interpretation of pancreatograms is discussed and the clinical features of the patients with minimal change disease are reviewed. [ABSTRACT FROM PUBLISHER]

Various sugars were administered intravenously to rabbits and the rate of exsorption from plasma to intestinal lumen was measured. The exsorption rates of lactulose, mannose, and xylose were directly related to their plasma concentration but varied according to their molecular weight. Wglucose and galactose did not appear in the intestinal lumen until very high plasma concentrations were reached. The mucosal barrier which prevented glucose and galactose exsorption was abolished when luminal phlorizin M times 10-minus 2 or another actively absorbed sugar was placed in the lumen. 2:4 Dinitrophenol M times 10-minus 3 and the absence of the sodium ion did not impair the ffficiency of the barrier. When the plasma glucose concentration was raised to very high levels, glucose began to appear in the lumen; further increases in the glucose concentration then produced a rapid exsorption of glucose. [ABSTRACT FROM PUBLISHER]

AIM--To investigate the natural history of lymphocytic gastritis (LG) and its relation to Helicobacter pylori infection and to coeliac disease using serology, duodenal biopsy and a small intestinal permeability test. METHOD--Twenty two patients diagnosed as having LG between 1984 and 1994 were investigated by upper gastrointestinal endoscopy at which gastric and duodenal biopsy specimens were taken for histological assessment and immunohistology. Serum was collected for measurement of anti-H pylori, anti-gliadin and anti-endomysial antibodies. A lactulose/mannitol absorption test was performed within one week of endoscopy. Control groups were studied by histology, serology and permeability tests. RESULTS--Three patients had been recently diagnosed as having LG while 15 still had the condition after a mean of 13.9 (range two to 38) months. LG involved the antrum alone in three patients, antrum and body in seven, body alone in six, and gastric remnant in two. Gastroduodenal intraepithelial lymphocytes (IELs) were T cells and predominantly of T suppressor (CD8) type. Duodenal IELs were increased compared to age/sex matched controls with chronic gastritis. Four patients had duodenal villous atrophy. Four patients no longer had LG after a mean of 29.3 (10-70) months but had increased gastroduodenal IELs. H pylori was present in four (22%) of 18 patients with LG but H pylori serology was positive in 11 (61%) of 18. There was no difference in seropositivity when compared with age/sex matched controls with dyspepsia. Eleven of 20 patients with LG tested had abnormal lactulose/mannitol absorption (v none of 22 controls with chronic gastritis). Four patients with LG, all with villous atrophy, were seropositive for IgA endomysial antibody. CONCLUSIONS--The persistence of LG with time, the association with increased duodenal IELs and abnormal small intestinal permeability suggests LG may be a manifestation of a diffuse lymphocytic gastroenteropathy related to sensitivity to gluten or some other agent. [ABSTRACT FROM PUBLISHER]

Presents a summary of the surveillance conducted by the Working Party in identifying the factors which place an individual at a significantly greater risk of developing gastrointestinal cancer as of August 2, 1994. Reason the effectiveness and the potential risks of the surveillance protocol must be considered; Gene mutations that play a role in gastrointestinal carcinogenesis; Discussion on the pathology of premalignant lesions.

Abnormal intestinal absorption has been suggested as an aetiological factor in schizophrenia. A procedure for investigating intestinal permeability was carried out in a group of chronic psychiatric in-patients. A proportion of the subjects studied showed abnormal intestinal permeability which could not be attributed to established bowel disease. Patients who were receiving neuroleptic but not anticholinergic drugs were those most often showing abnormal intestinal permeability. This work is at an early stage of development but preliminary findings suggest that further investigations should be carried out to establish the circumstances in which changes in intestinal permeability may be associated with mental illness. [ABSTRACT FROM AUTHOR]

Oesophago-gastro-duodenoscopy was successfully performed in 196 of 208 patients admitted with haematemesis or melaena, or both. A precise visual diagnosis was made in 80% of all patients and in 96% of those where the final diagnosis lay within the oesophagus, stomach, and first two parts of the duodenum. Bleeding oesophagitis was more common and bleeding duodenal ulcer less common than in other series using mainly radiology. Altogether, 26% of all patients with endoscopically-proved duodenal ulcers were bleeding from another site, and 15·4% of all patients had more than one lesion. This fact, and inability to detect surface lesions limits the value of acute barium radiology, which was performed in only 81 patients. Accurate diagnosis should lead to better understanding of individual lesions and more rational management of individual patients. Where a good service is available oesophago-gastro-duodenoscopy should be performed on all bleeding patients within 24 hours of admission. [ABSTRACT FROM PUBLISHER]

The permeability of the rabbit small intestine has been studied by measuring the plasma clearances of water-soluble molecules over the molecular weight range 60-33,000. An inverse relationship has been demonstrated between permeability and molecular weight. The significance of these findings in relation to current concepts of the `pore hypotheses' is discussed, and the possible physiological and pathological implications are considered. [ABSTRACT FROM PUBLISHER]

Digestive endoscopy covers a wide variety of procedures; the need for sedation is governed by the invasiveness and length of the procedure, the wishes of the patient, the desire of the operator for a compliant patient, and safety. Many patients are prepared to undergo upper digestive endoscopy using throat spray without sedation, while fewer accept unsedated colonoscopy. There are clinical advantages as well as disadvantages in employing sedation and sometimes general anaesthesia is the preferred option. This paper provides an introduction to the choices available and the approaches that are employed in endoscopic sedation practice. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]