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Lymphocytic gastritis is a recently described gastric inflammation, characterized by an increased intraepithelial lymphocytic infiltrate mainly composed of T-lymphocytes. Endoscopically it correlates mainly with diffuse varioliform gastritis. Ménétrier's disease is a hypertrophic gastropathy with enlarged gastric folds. The histological picture is that of foveolar hyperplasia and glandular cysts of the mucosa. A few small series of lymphocytic gastritis with microscopic and endoscopic features of Ménétrier's disease have been published previously. We describe a similar case associated with a gastric adenocarcinoma.

SummarySix patients with collagenous colitis are described and the literature is reviewed. Collagenous colitis is not a rare disease. Its most prominent feature is profuse watery diarrhoea. Although the endoscopic picture of the mucosa is usually normal, there is a microscopic thickening of the (subepithelial) basement membrane. For diagnostic purposes, multiple colon biopsies are warranted in patients with chronic or relapsing diarrhoea. There is no established therapy for this disease.

The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann–Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.

We performed a US-guided aspiration of the gallbladder in 27 patients with an acute cholecystitis and severe concurrent disease, not responding to IV antibiotics and supportive therapy. Twenty six of the 27 patients improved after the procedure. One patient died 7 days after the procedure due to multi organ failure; in the others immediate surgery could be avoided. Three patients experienced local pain after the procedure; no other puncture related complications were encountered. Long-term results (mean follow up 18 months; range 2-36 months) were excellent in 20/26 survivors with no biliary complications or need for elective cholecystectomy. Six of the 26 patients needed subsequent cholecystectomy for relapse or incomplete cure.

In five immunocompetent patients, 3 of whom were moderately ill, herpes simplex virus (HSV) oesophagitis was diagnosed. HSV oesophagitis is a frequent infection in immunocompromised hosts. Nevertheless the English medical literature (Medline) contains at least 33 cases of HSV oesophagitis in immunocompetent persons over the period 1983 to 1993. Odynophagia, dysphagia and chest pain are common symptoms. Endoscopy is necessary for diagnosis: brush cytology, biopsy for histology and viral culture are the tools for identification of herpes simplex as the cause of the oesophagitis. HSV oesophagitis in an immunocompetent patient is an acute but self-limiting disease. Nevertheless acyclovir per os or intravenously may be recommended if started early after onset of symptoms.

In three patients, two women of 37 and 58 and a man of 68 years, a papillomatous lesion was incidentally detected in the distal part of the oesophagus. Microscopically a squamous papilloma was seen with parakeratosis and in two patients poikilocytosis, indicating an infection with human papilloma virus (HPV). The lesions were removed endoscopically, in one patient with laser photocoagulation. Squamous papillomas of the oesophagus are benign tumours with a very low incidence. The pathogenesis still remains unclear. Some authors suggest local irritation as a possible mechanism. On the other hand there is growing evidence of an aetiological role of HPV. In several studies the presence of viral antigen or DNA has been demonstrated. These papillomas may undergo malignant transformation, which means that they are best removed preventively.

Lymphocytic gastritis is a histopathological entity corresponding with diffuse varioliform gastritis but also with other gastroscopic findings. Eighteen patients were followed over a mean period of 25 months. The symptoms, the endoscopic and histopathological abnormalities remained unchanged in the majority of the cases. Conventional peptic ulcer therapy failed to control symptoms or to normalize endoscopic alterations. Helicobacter pylori did not seem to play a role in the pathophysiology. Lymphocytic duodenitis was found in four patients. The relationship between lymphocytic gastritis, Ménétrier's disease and coeliac disease has further to be elucidated.

In 18 high-risk patients with acute cholecystitis and severe concurrent disease, we aspirated the gallbladder by using a percutaneous technique under ultrasound guidance. 17 of the 18 improved after aspiration, the only complication being local pain in 2. 13 of the 17 who improved remained free from biliary infections during a mean follow-up period of 14 months. 4 had an uncomplicated cholecystectomy 6-10 weeks later for recurrent cholecystitis. Percutaneous transhepatic gallbladder aspiration is a safe and effective procedure in critically ill patients with acute cholecystitis.

Six patients with collagenous colitis are described and the literature is reviewed. Collagenous colitis is not a rare disease. Its most prominent feature is profuse watery diarrhoea. Although the endoscopic picture of the mucosa is usually normal, there is a microscopic thickening of the (subepithelial) basement membrane. For diagnostic purposes, multiple colon biopsies are warranted in patients with chronic or relapsing diarrhoea. There is no established therapy for this disease.

In a prospective study of 123 patients with clinical signs of acute intestinal inflammation, the sensitivity of ultrasonography in diagnosing acute colonic diverticulitis was 84.6% and the specificity 80.3%. The predictive value of a positive and a negative sonogram was 76.0% and 87.7%, respectively. Of the 52 patients with subsequently proven acute colonic diverticulitis, 44 presented sonographically with a thickened (greater than 4 mm) hypoechoic bowel wall. In 15 patients, enlarged fluid-filled bowel loops were also present. Air-containing diverticula were demonstrated in 3 patients, abscesses in 8 patients, and colovesical fistulae in 2 patients. Eight large abscesses were successfully treated without emergency surgery by percutaneous sonographically guided evacuation. The described sonographic abnormalities strongly suggest acute colonic diverticulitis, particularly when localized in the left lower abdomen.

Percutaneous biopsy of the pancreas under ultrasound control using a Chiba-needle, established a preoperative cytological diagnosis of pancreas carcinoma in 15 out of 17 cases. In four patients additional positive cytobiopsy of liver metastases was obtained. Using ultrasonography as a guidance, percutaneous aspiration biopsy of a pancreatic mass is a rapid, easily tolerated, inexpensive and apparently safe procedure.

32 patients with chronic postprandial dyspepsia were selected for a 4-week controlled double-blind trial of domperidone and a placebo. The patients received either domperidone or a placebo at a dose rate of two 10-mg tablets t.i.d. before meals. A questionnaire was completed at the start of the study, and after 2 and 4 weeks of treatment. Excellent or good improvement was obtained in 71% of the domperidone-treated patients compared to only 13% of the placebo-treated cases. Domperidone was also significantly superior to the placebo when both drugs were compared to previously used medications. Side effects were not reported. It is concluded that domperidone has a beneficial effect on chronic postprandial dyspepsia.

Les auteurs rapportent un cas d’epaississement sous-muqueux et diffus de l’antre gastrique, detecte par l’echographie abdominale. Une infiltration maligne de la paroi gastrique a ete suggeree par l’endoscopie et par la radiographie barytee. Le diagnostic histo-pathologique final fut celui de gastrite a eosinophiles (variante sous-muqueuse). Ce cas demontre la necessite de macro-biopsies gastriques, meme en presence d’une muqueuse apparemment normale, chez les patients presentant une paroi gastrique epaissie lors de l’examen echographique de l’hemi-abdomen superieur.

In a prospective study of 1000 consecutive patients, abdominal sonography added diagnostic information to that available by history and physical examination in 8.9%. The yield ranged from a high of 27.4% in patients with acute abdominal symptoms to a low of 2.7% in screening sonograms of patients without abdominal symptoms. Sonographically guided biopsy-proven diagnoses were obtained in 6.6% of the patients and were clinically not suspected in 4.4%. The percentage of false-positive and false-negative sonographic studies was 0.5% and 1.1%, respectively. Sonography shortened the duration of hospitalization in 15.3%.

A primary malignant melanoma of the gallbladder, metastatic to the common bile duct, is reported. Both tumor sites were first visualized by abdominal sonography. The presence of the common bile duct metastasis was confirmed by endoscopic retrograde cholangiopancreatography. Histologic evidence is presented that the primary tumor did arise in the gallbladder and that the metastasis to the common bile duct most likely occurred as a consequence of mucosal implants from tumor cells that were shed in the bile.

Enterokinase, alkaline phosphatase and sucrase were measured in human duodenal mucosa before and after intravenous injection of glucagon. A net increase in mucosal enterokinase, but not in alkaline ph

Intravenous miconazole monotherapy for 3 weeks cured a 67-year-old patient with a 2-year history of esophageal candidiasis. Polymorphonuclear leukocytes from this patient demonstrated impaired phagocytic capacity for Candida albicans.

The efficacy and safety of omeprazole, 40 mg once daily for four to eight weeks of treatment, were studied in 61 patients with ulcerative reflux esophagitis. A double-blind controlled study design was used, and the patients were randomly allocated to treatment with either omeprazole 40 mg once daily or ranitidine 150 mg twice daily. Endoscopy was performed prior to inclusion into the study, after four weeks and, if unhealed, again after eight weeks. Healing of esophagitis was defined as complete disappearance of all esophageal ulcerations. Symptoms were recorded before entry, after four weeks, and again after eight weeks in unhealed patients. Fifty-one patients were included in the per-protocol analysis at day 29, and 50 patients at day 57. The healing rate after four weeks of treatment was 22 of 26 patients (85%) treated with omeprazole and 10 of 25 patients (40%) treated with ranitidine (P

Three cases of dilated abdominal left paraaortic lymphatic duct are described. The diagnosis was established by means of sonography and confirmed with lymphography in all three patients. A sonographically guided puncture of the lymphatic duct was performed in one patient. Dilatation of these lymphatic ducts was possibly the consequence of previous upper abdominal surgery in two patients and a coronary bypass operation in one.

Intravenous miconazole monotherapy for 3 weeks cured a 67-year-old patient with a 2-year history of esophageal candidiasis. Polymorphonuclear leukocytes from this patient demonstrated impaired phagocytic capacity for Candida albicans.

Forty patients who were suffering from chronic dyspepsia, diagnosed clinically and radiologically as being related to delayed gastric emptying, were treated with either domperidone or placebo in a double-blind trial. The trial lasted four weeks and the dose of domperidone was 10 mg orally t.d.s. before meals. The results showed that the drug markedly improved symptoms and that side effects were few, being recorded in one patient only, on active treatment. It is concluded that domperidone is a useful agent for the treatment of dyspepsia with retarded gastric emptying.