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To study the feasibility and to gauge the potential clinical impact of quantifying small bowel motility using magnetic resonance imaging (MRI) in a larger population with a spectra of gastrointestinal conditions with impaired small bowel motility.

In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first-line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localising mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn’s disease are evaluated by MRI- enterography and CT-enterography.

To study the feasibility and to gauge the potential clinical impact of quantifying small bowel motility using magnetic resonance imaging (MRI) in a larger population with a spectra of gastrointestinal conditions with impaired small bowel motility.Data were gathered retrospectively from a cohort of 127 patients undergoing MR enterography (1.5 Tesla) in 2011. Cine motility sequences were processed with validated motility analysis software and a parametric motility map was generated. Regions of interests were drawn in the jejunum, ileum, and terminal ileum, and Jacobian standard deviation mean motility index' score (MIS) was calculated. Patients were divided into Crohn's disease (CD), ulcerative colitis, irritable bowel syndrome, and healthy subjects.In CD, terminal ileum motility was lower in comparison to healthy subjects (mean difference: -0.1052 arbitrary units, 95% confidence interval: -0.1981--0.0122, P = 0.018). Subgrouping of CD showed that the difference was recognized in patients with disease limited to the small bowel (mean difference: -0.1440 arbitrary units, 95% confidence interval: -0.2491--0.0389, P = 0.002). Visible dysmotility of terminal ileum on MRI reflected a reduced MIS compared with normal motility (0.22 ± 0.09 and 0.33 ± 0.15 arbitrary units, respectively, P = 0.043). Motility correlated negatively between ileum and age (P = 0.021), and between terminal ileum and C-reactive protein in ulcerative colitis (P = 0.031).Motility quantitation revealed a significant difference in motility of terminal ileum in patients with small bowel CD compared with healthy subjects, concording with visible dysmotility and inflammatory changes. J. Magn. Reson. Imaging 2016;44:277-287.

Background: Flat and depressed colorectal tumours are common in Japan but are very rare or non-existent in Western countries. Aims: To study the occurrence of flat colorectal tumours in a southern Swedish population. Methods: In this prospective study, 371 consecutive European patients were examined by high resolution video colonoscopy combined with chromoendoscopy. The nature of the lesions was determined by histopathological examination. Results: A total of 973 tumours were found; 907 (93.2%) were protruding and 66 (6.8%) were flat or depressed. Of the flat/depressed tumours, five (7.7%) were early adenocarcinomas infiltrating the submucosa. Eleven carcinomas (1.2%) were found among protruding tumours. High grade dysplasia was observed in 18% (n=11) of flat/depressed adenomas in contrast with 7.3% (n=65) of protruding adenomas, and occurred in smaller flat/depressed tumours compared with protruding ones (mean diameter 8 mm v 23 mm, respectively). Furthermore, high grade dysplasia was significantly more common in flat elevated tumours with central depression or in depressed adenomas (35.7%; 5/14) than in flat elevated adenomas (12.8%; 6/47). Conclusion: Flat and depressed tumours exist in a Western population. Future studies should address whether or not chromoendoscopy with video colonoscopy is necessary in the search for flat colorectal neoplasms.

BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evidence of peptic ulcer disease (PUD). We therefore assessed the PiZ deficiency variant of the major plasma protease inhibitor alpha1-antitrypsin (alpha1AT) as a risk factor for PUD in H. pylori-infected individuals. METHODS: The cohort comprised 100 patients with endoscopically or surgically proven PUD (30 patients with duodenal ulcer (DU) and 70 patients with gastric ulcer (GU)) and 162 age- and sex-matched controls with PUD-negative endoscopic findings and no history of PUD. Plasma samples were screened for alpha1AT deficiency (PiZ) with an enzyme-linked immunosorbent assay (ELISA) and phenotyped by isoelectric focusing. H. pylori infection was evaluated with an IgG ELISA technique. RESULTS: Among the 262 patients 17 (6.5%) were positive for the PiZ alpha1AT deficiency, a frequency of the same magnitude as in the Swedish general population (4.7%). Of the PiZ carriers 76% (13 of 17) had H. pylori antibodies compared with 61% (151 of 245) of the non-PiZ carriers (NS). The prevalence of DU tended to be higher in H. pylori-positive PiZ carriers than in non-PiZ carriers (15.4%, 4 of 26 versus 0 of 4). Furthermore, among patients with DU a high PiZ allele frequency (13.3%, 4 of 30) was found compared with the general population (4.7%) (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.09-8.94; P = 0.02). All DU patients carrying the PiZ allele were positive for H. pylori. In addition, four of five PiZ carriers with H. pylori infection and PUD had DU. CONCLUSIONS: The PiZ allele may be a contributing factor in the development of DU in H. pylori-positive individuals. (Less)

PURPOSE: Changes in morbidity pattern of ulcerative colitis have created a need to update understanding of the course of the disease. METHOD: A follow-up study was done of relapse rates and progression of inflammation in 571 nonselected patients with ulcerative and indeterminate colitis. RESULTS: Relapse rate ten years after diagnosis was 70 percent in definite ulcerative colitis, 22 percent in probable ulcerative colitis, and 77 percent in indeterminate colitis. During the study period, there was no change in the relapse rate. In relapsing proctitis, 52 percent developed more extensive inflammation. Fifty-four percent of patients with only one attack of colitis had persistent signs of inflammatory bowel disease. CONCLUSIONS: Shift in morbidity pattern to a greater proportion of patients with proctitis at diagnosis and a shorter time from onset of symptoms to diagnosis had no influence on the relapse rate. Indeterminate colitis has a worse prognosis than definite ulcerative colitis. Considering the documented efficacy of sulfasalazine, the high relapse rate calls for studies of the effectiveness of such treatment in everyday practice.

Background and study aims Chronic atrophic fundic gastritis (CAFG) is associated with several diseases, such as gastric cancer, gastric ulcer, pernicious anemia, and bacterial overgrowth. In spite of recent technical improvements, the gastroscopic diagnosis of CAFG remains uncertain. Congo red chromogastroscopy is capable of visualizing acid-producing normal fundic mucosa, but has hitherto not been suitable for routine use. The aim of our study was to establish a reliable endoscopic technique with which to diagnose CAFG. Patients and methods This prospective study comprises 124 consecutive patients (71 women, 53 min) with a mean age of 65 years (range 36-92). Macroscopic evaluation of the gastric fundic mucosa in routine endoscopy using video techniques was compared with evaluation by means of a modified endoscopic Congo red test (MCRT). In routine gastroscopy, CAFG was recognized by the thin, friable mucosa, with a marked visible vascular pattern and fold atrophy. With MCRT, the diagnosis of CAFG was made within five minutes' observation when no red-to-blue color shift in the fundic mucosa could be induced by 0.2 mu g/kg intravenous pentagastrin. The results were then compared with the histological examination of biopsies from the fundic mucosa. Results CAFG was confirmed by histology in 40 of 124 cases. The diagnostic sensitivity of MCRT was 1.0 (40/40), with a positive predictive value of 0.90, whereas the values for macroscopic gastroscopic evaluation were 0.25 (10/40) and 0.50, respectively. Conclusions We conclude that MCRT is a sensitive, fast, and cost-effective method of identifying patients with CAFG, and well suited for use in routine gastroscopy.

Cancer morbidity and all cause mortality were studied prospectively in all patients with definite and probable ulcerative colitis and indeterminate colitis diagnosed from 1958 to 1982, in the city of Malmo, Sweden. The follow-up to Jan. 1, 1990 was complete for all but ten patients. Nine of the 471 patients with ulcerative colitis and three of the 100 patients with indeterminate colitis developed colo-rectal cancer. The incidence of colorectal cancer in ulcerative colitis was 1.4 per 1000 person-years. The observed number of cases was 2.1 times higher than expected; (95% C.I. 1.0–4.1), based on the age- and sex-specific cancer incidence in the city during the study period. Indeterminate colitis was associated with a higher colorectal cancer risk than ulcerative colitis; 2.4 per 1000 person-years; (SMR 8.6, 95% C.I. 1.8–25.1). Both conditions were associated with a slight increased mortality rate, for ulcerative colitis 12.6 per 1000 person-years; (SMR 1.3, 95% C.I. 1.0–1.5), and for indeterminate colitis 11.7 per 1000 person-years; (SMR 2.7, 95% C.I. 1.6–4.4). Complications of colitis were the main cause of death in both groups. The cancer risk was related to extent of disease, duration of disease and female gender. Ten out of the 12 cases with cancer had or developed total colitis. However, only seven of the 134 cases with total ulcerative colitis and two of 87 cases with total indeterminate colitis developed cancer. Considering these low frequencies and the low cancer incidence per 1000 person years, it is suggested that proctocolectomy to prevent cancer is not to be recommended simply at the basis of the extent of the disease.

This study was designed to assess time trends in the incidence of ulcerative colitis and indeterminate colitis in an urban population.Medical records of in- and out-patients with inflammatory bowel disease were reviewed by a panel to establish the diagnosis. All histopathologic specimens and almost all radiographs were re-examined.During the time period 1958 to 1982 there were 354 new cases of definite ulcerative colitis, 117 of probable ulcerative colitis, and 100 of indeterminate colitis. This corresponds to an average annual incidence per 100,000 of 5.5, 1.8, and 1.6, respectively. The incidence was higher in men than in women. Peak incidence was between 20 and 29 years, but indeterminate colitis was most common in 10- to 19-year-old males. The incidence was stable from 1958 to 1972 but then increased in almost all age groups in both sexes. The increase in annual incidence of definite ulcerative colitis from 4.2 to 9.4/10(5) corresponds to an average annual increase of about 5% (p0.001). The increase in the incidence of definite ulcerative colitis was due to an increased proportion of patients with proctitis.This study has shown an increased incidence of ulcerative colitis and indeterminate colitis, and we have found no reason to believe that this is a spurious finding.

Background Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time. Methods Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded. Results Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE. Conclusion The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.

Balloon dilatation of benign esophageal strictures has been widely used since its introduction. We have performed 224 dilatation procedures in 52 patients. Dilatation was done as an outpatient procedure. Strictures were due to reflux esophagitis in 25 patients, anastomatic stenosis in 6, achalasia in 5, complications of sclerotherapy in 5, corrosive lesions in 3, and long-standing nasogastric intubation in 2. The cause was unknown in 6 cases. The intention was to dilate all strictures up to 20 mm. Three major complications occurred, and one of these patients died. The risk of perforation seems to be higher after repeated procedures than during the first one.

The understanding of gastrointestinal diseases has changed dramatically during the past four decades. Many of these changes may be attributed to successful technical and pharmacological developments, typified by fibre-optic techniques and the detection and eradication of Helicobacter pylori. Endoscopic investigation of the gastrointestinal tract and endoscopic treatments continue to play increasing roles. During the same period radiology has contributed to the understanding of motility disorders, tumour biology, and the spread of tumour.

Background. Many individuals are infected with the bacterium Helicobacter pylori. Some develop ulcers or mucosal atrophy. Aims. To correlate the histological characteristics of the H. pylori-induced gastritis to the immunoblot pattern of the H. pylori infection and to compare the presence of H. pylori bacteria in tissue specimens with ELISA serology and immunoblot analysis. Methods. One hundred and sixty-six consecutive patients were referred to gastroscopy. Forty patients were excluded for various reasons and 126 were included in the study. Results. Twenty-three patients had ulcerations and 25 erosions. Ninety-two (73%) had a chronic gastritis and in 90 (71%) it involved both the antrum and corpus. Ninety-one (72%), of whom 96% had a chronic gastritis, had visible bacteria in the tissue specimens, used as the 'gold standard' for the detection of infection. In patients with chronic gastritis 65 (70%) had positive H. pylori ELISA serology, 27 (30%) had negative H. pylori ELISA, while 76 (83%) had a positive immunoblot pattern. The ELISA positive patients had more advanced chronic gastritis but a lower frequency of metaplasia and atrophy. Acute inflammatory activity in the chronic gastritis had a high immunoreactivity to 120 kDa (CagA) protein and was significantly correlated to antibody reactivity to proteins in the 53-65 kDa range (heat shock proteins) and to a 43 kDa subunit. Metaplasia and atrophy in antrum was associated with a 62 kDa protein band. Conclusion. Almost all H. pylori-infected patients had a pangastritis, visible in both antrum and corpus. Acute inflammatory activity in the chronic gastritis and the presence of metaplasia and atrophy in antrum were associated with a specific immunoblot pattern, indicating infection with more virulent strains. Immunoblot analysis had a better sensitivity than ELISA H. pylori serology.

Chronic idiopathic intestinal pseudo obstruction (CIIP) is a severe condition presenting with abdominal pain and dysmotility. Inflammatory or degenerative changes of the autonomic nervous system or of the muscles of the bowel have been observed in CIIP.1,2 As patients with inflammatory bowel disease (IBD) may show clinical3,4 and histological5 signs of autonomic neuropathy and dysmotility,6,7 the aim of this study was to examine whether there is an association between CIIP and IBD. Six patients at our hospital presenting with signs and symptoms of intestinal dysmotility were diagnosed with CIIP based on clinical features, antroduodenojejunal manometry, and full thickness biopsies (table 1).8,9 Patient No 1 had an acute erosive colitis some years previously with bloody diarrhoea and an enhanced sedimentation rate, which was treated with steroids, …

Capsule endoscopy allows for the first time total and painless imaging of the entire small bowel. The main indication for capsule endoscopy is obscure gastrointestinal bleeding which not explained by upper gastrointestinal endoscopy, colonoscopy and small bowel radiology. Capsule endoscopy has also the capacity to detect tiny small bowel manifestations of other pathologic conditions such as Crohns's disease.The GivenM2A wireless capsule endoscopy system for investigation of the whole small bowel was developed in the late 1990s. The small size swallowable capsule contains a miniature video camera, four light sources, two batteries and a radiotransmitter. This paper describes the capsule endoscopy examination method and summerizes the initial achievements from two medical centres, the Petz Aladár County and Teaching Hospital and from the Malmö University Hospital.42 patients were included of whom 37 patients with obscure gastrointestinal bleeding. Pathological small bowel findings were detected in 62% of the all cases, and the source of bleeding was identified by the M2A capsule in 56.7% of the chronic bleeders. The diagnostic sensitivity of the capsule endoscopy in obscure gastrointestinal bleedings was superior both to that of push enteroscopy, 19%, and enterography, 6.7%. The capsule endoscopy was well tolerated and accepted by the patients.This new diagnostic method is promising mainly for detection of a small bowel source of obscure bleedings. The availability of the method in major gastroenterological centers is strongly recommended.

Since 1.5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, apthoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn's disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressure will follow. Capsule adaptation for screening for Barrett's esophagus and colon cancer might come true.

This study aims at describing the natural history and outcome of small duct primary sclerosing cholangitis (PSC).Thirty-two patients with small duct PSC were studied. The average time taken for diagnosis was 69 (1-168) months. The median follow-up time was 63 (1-194) months.All patients including one who underwent liver transplantation because of end-stage liver disease and hepatocellular carcinoma were alive at follow-up. None developed cholangiocarcinoma. In 27 patients repeated cholangiographic examinations were done after a median time of 72 (12-192) months from first ERCP. Four developed features of large duct PSC.Small duct PSC rarely progresses to large bile duct PSC and it seems to have a benign course in most patients and no development of cholangiocarcinoma was found.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis (EIP) provides an opportunity to study different pathophysiologic events early in the course of acute pancreatitis. AIMS: To investigate whether the leakage of pancreatic proenzymes (anionic trypsinogen), pancreatic protease activation (carboxypeptidase B activation peptide), cytokine response (interleukin [IL]-1 receptor antagonist, IL-6, and soluble tumor necrosis factor receptor-I) and neutrophil activation (neutrophil gelatinase-associated lipocalin and polymorphonuclear elastase) differ between patients with and without EIP. A second aim was to clarify the temporal relation between these different events. METHODOLOGY: Ninety-nine nonconsecutive patients undergoing ERCP were investigated in the study. RESULTS: Fourteen of 99 patients undergoing ERCP developed mild EIP. Six hours after the investigation the concentration of anionic trypsinogen was significantly higher in patients with EIP than in patients without EIP. The day after ERCP, higher concentrations of anionic trypsinogen, carboxypeptidase B activation peptide, IL-6, and polymorphonuclear elastase were recorded in the EIP group. No significant differences in IL-1 receptor antagonist, soluble tumor necrosis factor receptor-I or neutrophil gelatinase-associated lipocalin were found between the groups in this study. CONCLUSION: Mild EIP was accompanied by early leakage of proenzymes and later activation of trypsinogen/proteases. A significant cytokine response and neutrophil activation were recorded the day after ERCP, but further studies are needed to determine the temporal relation between these different pathophysiologic events.

Clopidogrel is a new antiplatelet agent that offers increased protection over aspirin in preventing vascular ischaemic events in patients with symptomatic atherosclerosis. In a large, randomized, international study of clopidogrel and aspirin (n = 19,185 patients) clopidogrel was associated with a lower incidence of gastrointestinal adverse events, including gastrointestinal haemorrhage and hospitalizations because of gastrointestinal haemorrhage. The aim of the study was to determine whether macroscopic differences in the gastric mucosa between aspirin- and clopidogrel-treated subjects could be detected by gastroscopy after short-term treatment.Thirty-six healthy volunteers were randomized in a double-blind, double-dummy, parallel design, to 75 mg/day of clopidogrel or 325 mg/day of aspirin for 8 days. Gastroscopy was performed at base line before administration of study drug and directly after treatment completion. Gastroduodenal effects were measured in accordance with a modified Lanza scale.At base line no difference between the groups was detected (median Lanza score, 0.0 in both groups). At the end of treatment the aspirin group showed a median score of 7.5, and the clopidogrel group showed an unchanged median score of 0.0 (P0.001). In the aspirin group 13 individuals reported 19 adverse events versus 8 individuals and 13 adverse events for clopidogrel, with approximately half of the adverse events being gastrointestinal in each group. No serious adverse events were reported.In contrast to aspirin, short-term treatment with clopidogrel does not induce macroscopic changes in the gastroduodenal mucosa. The study results show that in patients without gastroduodenal disease clopidogrel, but not aspirin, does not induce any gastroscopically evident erosions during short-term treatment.

Background: In patients with a narrow-necked juxtapapillary diverticulum the endoscopic cannulation of the papilla of Vater and the subsequent biliary therapy is sometimes impossible. Patients and Methods: Three patients referred for endoscopic retrograde cholangiography and stone extraction were included. Earlier attempts to cannulate failed because visual control was impeded by narrow-necked juxtapapillary diverticula with the papilla located in the fundus. Endoscopic balloon dilation of the narrow diverticular neck, using a 15-mm stone retrieval balloon, was carried out. Results: In all three cases the papillary orifice was readily brought into view after balloon dilation of the diverticular opening. Subsequent endoscopic treatment to the bile duct was successful without any complications. Conclusion: Balloon dilation of a narrow-necked juxtapapillary diverticulum is a safe and easy procedure, which facilitates both cannulation of the papilla and subsequent biliary endoscopic treatment.

Double-contrast barium enema has a reduced sensitivity in patients with severe sigmoid diverticulosis. Therefore a carboxy methyl cellulose enema was employed after the conventional double-contrast examination in 15 patients with sigmoid diverticulosis. A significant increase in lumen diameter and a superior removal of barium residue from the diverticulas facilitated the interpretation of the sigmoid loops. Conclusion: The addition of methyl cellulose enema to double-contrast barium imaging improves diagnostic imaging in diverticulosis by expanding the lumen and emptying the diverticulas.

Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended.

The purgative effect of bisacodyl, anthraquinone glycosides (Cascara), and sodium picosulfate, alone or in combination with a saline purge and a tap water enema, was studied in 1200 patients. The cleansing effect was scored with regard to retained fecal residue evident on double-contrast studies of the colon. The combination of a contact laxative and a saline purge produced good cleansing effect in 52%-80% of the patients. With an additional tap water enema given 1 hour before the colon examination, however, 96% of the colons were clean. The taste and the effects of the cleansing systems were tolerated favorably by more than 90% of the patients. However, 17% reported restriction in work capacity on the day of bowel cleansing.

Sixty-five non-icteric patients presumed to have the postcholecystectomy syndrome (PCS) were followed up for 4-13 years after their first endoscopic retrograde cholangiopancreatography (ERCP) examination, which gave normal findings. All patients, however, experienced severe pain on injection of only 1-2 ml of contrast medium over 5-10 sec into the common bile duct (CBD). Thirty-four of the 65 patients were found to have true PCS on long-term follow-up studies, whereas 31 of them had other diseases. A second ERCP also showed normal results, and the injection-related pain was preceded by an abnormal pressure rise in the CBD at manometry. The CBD acted like a pain trigger zone, and the pain reaction might be diagnostic in everyday clinical practice. In conclusion, ultrasonography is an adequate diagnostic method in non-obstructive PCS. Medical treatment is often successful. ERCP and interventional treatment should be reserved for patients with obstructive symptoms and for patients in whom all medical treatment has failed.

Double contrast barium enemas in 21 patients with primarily overlooked colon carcinomas were reviewed. The carcinomas were flat and measured less than 30 mm in 18 cases. These tumours constitute almost 1.4 per cent of the carcinomas diagnosed during a 12-year period. The retrospective analysis revealed the following signs of carcinoma: missing haustral folds, disharmony of interhaustral fold patterns; radiolucent filling defects; local contractions; residue-like masses and decrease of volume. In all cases, at least two secondary signs of carcinoma, range 1.7 to 3, were seen.

In a consecutive group of 1,067 noncholecystectomized patients referred for computed tomography including the upper abdomen, gallstones were seen in 13%. In 4% of the patients with gallstones, gas-containing calculi were found. On reviewing the conventional plain films such stones were revealed in less than one-half of the patients.

Granulated wheat-fibres were tested as an additive to normal food before colon radiography in 52 out of 177 consecutive out-patients. The cleansing day food was prohibited. The results show no adverse effect of fibres on cleansing. Thus patients with organic and functional disturbances of the large bowel already treated with fibres do not have to stop this medication during days preceeding colon radiography. This means simple patient management and indicates that a routine use of fibres before colon cleansing in the old persons ought to be beneficial.

Cineradiographic examinations of 72 patients with dysphagia and normal or abnormal studies demonstrating a range of pharyngeal dysfunctions during swallowing were retrospectively reviewed independently by six radiologists. The interobserver variability was then assessed. There was high concordance for the assessment of contrast medium reaching into the trachea, absent pharyngeal constriction, and the presence of Zenker diverticula. The concordance was less for normal pharyngeal function as well as decreased pharyngeal constriction and cricopharyngeal muscle impression less than 50%. The number of disagreements varied according to the observer's experience. Cineradiographic examinations of pharyngeal function during swallow had an acceptable degree of interobserver variability and can be a useful tool for the evaluation of pharyngeal function in patients with dysphagia.

A total of 2,118 consecutive patients, examined with double-contrast examination of the large bowel (DCE), were evaluated radiographically, clinically, and endoscopically for up to 48 months. A total of 402 polyps were diagnosed during the follow-up period. Of these, 307 were revealed at the first DCE and 95 at subsequent endoscopy or autopsy. The accuracy of the DCE for demonstrating or excluding patients with polypoid lesions of the colon was 97%, whereas the predictive value of a positive DCE report was 96% and a negative one, 97%. However, the ability to demonstrate every known polyp at DCE was only 63%, although the probability of a polypoid lesion demonstrated at DCE being a true polyp was 92%.

Emptying and peristaltic activity of the esophagus and proximal jejunum were studied using scintigraphy and fluoroscopy documented on videotape in 11 patients after total gastrectomy and Roux-Y loop reconstruction. Impaired esophageal motor function, as judged by both methods, was seen in five patients who were all 50 years of age or older. This was in contrast to the findings in a group of healthy control subjects, all over 50 years of age, in whom esophageal function appeared normal on scintigraphy in five of seven. Disturbed jejunal function, as judged by radiography, was found in eight patients, whereas the emptying rate according to scintigraphy was judged normal in all but two patients. Five of the patients complained of various adverse alimentary tract symptoms, but the scintigraphic and radiographic findings did not correlate with these symptoms.

Constipation is today treated by adding non-absorbable fibres to a normal diet. The aim of this investigation was to study the influence of fibres on colon cleansing results in patients referred for double contrast examination of the colon. A series of 240 consecutive patients were separated into two groups, one treated with one day of starvation and the routine cleansing regimen, the other group with wheat fibres thrice daily for four days before the day of the regular cleansing program. No difference in cleanness between the two groups was seen.