Esophageal motility disorders in patients with diabetes mellitus

The prevalence of gastrointestinal symptoms seems to be increased in diabetics compared with general population. The aim of this work is to study the esophageal motor abnormalities in diabetic patients to determine whether esophageal motility disorders are related to the symptoms and the clinical status of the patients. The study was conducted on 120 diabetic patients and 20 healthy control divided into-group I: 20 healthy controls, group II: 60 type I diabetic patients, group III: 60 type 2 diabetic patients. They were monitored by laboratory tests-Fundus examination-Abdominal sonography-upper esophagogastric endoscopy-esophageal manometry including lower esophageal sphincter study, esophageal body study, and upper esophageal sphincter study. The data was collected, statistically analyzed using computer program SPSS version nine. There was significant difference between type I and 2 diabetics compared to controls regarding decrease in lower esophageal resting pressure, decrease in peristalsis wave percent, and decrease in proximal, distal body peristaltic amplitude. None significant difference regarding lower esophageal sphincter relaxation percent, residual pressure, proximal body duration, distal body duration and upper esophageal sphincter resting pressure were detected. There was significant difference regarding decrease in peristaltic wave% non transmitted wave% and proximal body amplitude in type I diabetics compared to type 2. Diabetes per se is a significant risk factor for increased incidence of esophageal motility dysfunction in the form of decreased lower esophageal resting pressure, decreased body peristalsis, increased non-transmitted wave percent. Increased double-peak wave percent decreased proximal and distal body amplitude

Helicobacter pylori infection and hyperemesis gravidarum: possible causal relationship with evaluation of a new immunoassay in stool compared with standard diagnostic techniques

The aim of the present study was to investigate any possible association between infection with Helicobacter pylori [H. pylori] and hyperemesis gravidarum [HG]. Moreover; evaluation of different methods used in the diagnosis of H. pylori during pregnancy aiming to present a simple non-invasive and reliable method. 68 pregnant women with hyperemesis gravidarum and 72 control pregnant women were enrolled in the study. All participants were examined both for H. pylori serum immunoglobulin G antibodies [HpIgG Ab], showing chronic infection, and H. pylori stool antigens [HpSA], and showing active gastrointestinal colonization. Serologically positive H. pylori infection was detected in 59 [86.8%] subjects of the hyperemesis gravidarum group and in 32 [44.4%] of the controls [P<0.01]. HpSA was detected in 45.6% of patients with hyperemesis gravidarum, whereas only 5.6% of patients in the control group were positive for this specific antigen [P<0.001]. The new stool immunoassay test had a sensitivity of 96% [95% confidence interval 90.6% to 100%], specificity of 93% [85.1% to 99.5%], positive predictive value of 92%, and negative predictive value of 96%. In conclusion, this study supports the studies suggesting an association between H. pylori and HG. Infection with H. pylori should be kept in mind in cases of HG in pregnant women. The findings of the current study have, also, demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection of active H. pylori infections in pregnant women with hyperemesis gravidarum. This stool immunoassay represents a new, accurate, and non-invasive method for H pylori infection that overcomes the limitations of existing tests

Evaluation of the mesh-bridged posterior partial fundoplication-a new technique in treatment of gastroesophageal reflux disease

Disruption of the wrap and slipping are the most frequent causes of deficient reflux control after anti-reflux surgery. Isolauri et al. [1997], after an experimental study, suggested that if scarring could be induced between the fundal wrap and the esophagus, it could probably help to prevent slippage and disruption of the fundoplication wrap. This study was randomly conducted in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospital on 60 patients suffering from GERD during the period from May 2003 to June 2005. They were randomly classified into two groups; group I comprised 30 patients for whom posterior partial fundoplication [modified Toupet technique] was performed and group II comprised 30 patients for whom mesh-bridged posterior partial fundoplication was performed. At 24 months postoperatively, 4 out of the 30 patients belonged to group I developed recurrence of GERD while none of the 30 patients belonging to group II developed recurrence. The difference in the recurrence rate between the two groups was found to be statistically significant. [P<0.0412]. The mesh-bridged posterior partial fundoplication proved to be effective in achieving the advantages and avoiding the disadvantages of both total and partial fundoplication in short term and mid-term follow-up; good reflux control and low incidence of mechanical complications. Moreover, did not significantly prolong the operation time and did not add to the patients' morbidity