Assessment of optimal dose of lactose for lactose hydrogen breath test in Indian adults.

To evaluate the possibility of using a 12.5 g or 25 g oral dose of lactose for hydrogen breath test for diagnosis of lactose intolerance instead of the usual 50 g dose. 35 patients with non-ulcer dyspepsia and an abnormal 50 g lactose breath hydrogen of more than 20 ppm over the base line were retested using 12.5 g and 25 g lactose. 32 (91.4%) and 15 (42.8%) of these 35 patients had an abnormal hydrogen breath test using 25 g (p = ns compared to 50 g dose) and 12.5 g (p < 0.001) lactose doses respectively. This study reveals that it may be possible to use a 25 g lactose dose instead of a 50 g dose for the lactose hydrogen breath test.

Fungal colonization of untreated peptic ulcer.

AIM: To evaluate the relationship between Candida and peptic ulcer. METHODS: One hundred consecutive patients with untreated peptic ulcer (81 with duodenal ulcer and 19 with gastric ulcer) were studied using histopathology, culture and fungal serology. Twenty subjects with non-ulcer dyspepsia were taken as controls. RESULTS: Forty seven patients (47%) with peptic ulcer were colonized by Candida as compared to 3 patients (15%) with non ulcer dyspepsia (p < 0.05). Confluent growth of Candida on culture of gastric aspirate or biopsy from ulcer edge was a more sensitive method for diagnosis of peptic ulcer-associated candidiasis than histological examination. There was no significant difference in the prevalence of Candida isolation in relation to age or sex of the patients, smoking habit and alcoholism. Large ulcers (> 2 cm) were, however, more often colonized by Candida (75%) than smaller ones (43%) (p < 0.05). Candida albicans was the commonest species isolated (60%). Invasive candidiasis was associated with Candida agglutinin titer of 1:128 in 81% of cases. CONCLUSION: Candida colonization rate in peptic ulcer is significantly higher than in non-ulcer dyspepsia.

Colonic diverticulosis in India: the changing scene.

BACKGROUND: The prevalence of colonic diverticulosis has a wide geographic and ethnic variation and has been considered to be quite low in India. This study was aimed at determining the prevalence of colonic diverticulosis in northern India based on barium enema examination in symptomatic patients. METHODS: All barium enema examinations performed between January 1985 and December 1991 were reviewed for the presence of colonic diverticulosis. Clinical data of such patients were retrieved. RESULTS: 51 (3.2%) of 1610 barium enema studies showed colonic diverticulosis. The frequency of diverticulosis in barium studies increased from 0.3% among subjects in the third decade to 32.4% in patients above 60 years. Most patients were city dwellers, vegetarians and belonged to the upper socio-economic stratum. Twenty patients (39.2%) presented with a complication; the spectrum of such patients was no different from that reported from the West. While the sigmoid colon was the commonest site of diverticuli, there was a relative preponderance of right sided diverticuli as compared to the Western experience. Seven patients with complications required surgical treatment, while the rest were managed conservatively. CONCLUSION: Colonic diverticulosis and its complications are not rare in India and should be considered in the differential diagnosis of abdominal disorders.

Distribution of digestive enzymes in gastrointestinal tract of young rhesus monkeys.

The distribution of different mucosal digestive enzymes along the gastrointestinal tract of young rhesus monkeys were studied by biochemical analysis of homogenized specimen from 13 different segments (i.e. stomach-fundus, body, antrum; small intestine-D1, D2, proximal, middle, distal; caecum; colon-ascending, transverse, descending and rectum), obtained from 6 monkeys of approximate age 8-12 months. The activity of all the enzymes was lowest in gastric mucosa rising through duodenum to peak in small intestine and declining towards the large bowel. There was no significant difference in levels of any of the enzymes between different parts of stomach or large bowel. This study suggests that like humans in rhesus monkeys maximum activity of digestive enzymes is present in small intestine and much less in gastric and large bowel mucosa.

Spectrum of lower gastrointestinal hemorrhage: an endoscopic study of 166 patients.

BACKGROUND: The spectrum of lesions causing lower gastrointestinal hemorrhage shows marked geographic variation. The study was aimed to determine this spectrum in our region using endoscopic examination. METHODS: 166 patients presenting with lower gastrointestinal hemorrhage were investigated using colonoscopy as the first investigation. RESULTS: Lesions responsible for bleeding could be identified in 141 patients (84.9%). In 25 patients (15.1%), the etiology of bleed could not be determined either because of failure to identify a lesion (10 patients) or because of an incomplete examination (15 patients). Major causes of lower gastrointestinal bleeding included idiopathic ulcerative colitis (19.3%), acute colitis (12.0%), colonic polyps (10.2%), radiation colitis (9.0%), solitary rectal ulcer (7.8%), colonic carcinoma (7.2%), colonic tuberculosis (4.2%) and enteric fever (3.0%). CONCLUSION: Endoscopic examination is very useful in evaluating patients with lower gastrointestinal hemorrhage. The predominant causes of lower gastrointestinal bleeding in our experience are different from those reported from western countries.

Lactose intolerance in idiopathic ulcerative colitis in north Indians.

The incidence of lactose intolerance in 60 patients with idiopathic ulcerative colitis (IUC) from northern India and the effect of disease activity and extent of colonic involvement on the occurrence of lactose intolerance, was studied. Twenty controls matched for age and sex were also studied using 50 g lactose hydrogen breath test. The incidence of lactose intolerance in patients with IUC (41.7%) was no different from that in the control group (40%). There was however, a significant difference (P < 0.05) in the incidence of lactose intolerance in patients with active colitis (59.1%) as compared to those with quiescent disease (31.5%).

Identification of Helicobacter pylori by endoscopic crush cytology.

BACKGROUND: Gastric crush cytology is employed in a variety of situations including diagnosis of malignant disease and the detection of Helicobacter pylori infection. OBJECTIVE: To evaluate the usefulness of gastric crush cytology in the detection of H pylori infection. METHODS: Gastric biopsy specimens from 50 patients of gastric or duodenal peptic ulceration were studied by gastric crush cytology, histopathology, bacteriologic culture and rapid urease test and results of various methods compared. RESULTS: Thirty seven patients had H pylori demonstrable in crush smears and 28 in histopathological sections. In 15 patients, the organism was detected by cytology alone and in 6 samples by histopathology alone. There was concordance of 76% between these two morphological techniques. The organism could be cultured from 22 biopsy specimens and urease test was positive in 37 specimens. CONCLUSION: Gastric crush cytology is a useful method for detection of H pylori infection.

Immunoglobulin deficiency.

Twenty three patients with primary immunoglobulin(Ig) deficiency were seen during the last ten years. Nine had hypogamma globulinemia (hypo-Ig) and the rest, selective Ig deficiency. Most were in pediatric age group. There was preponderance of males with only one female. Clinical symptoms pertaining to gastrointestinal and sinupulmonary infections were most common. Complete absence of B cells was not observed in any patient with hypogammaglobulinemia. They could be typed as physiological in one patient, X-linked immunodeficiency in 2 patients and common variable immunodeficiency in the remaining six. Three patients with selective IgA deficiency were above 20 years of age. Two had only secretory IgA deficiency, confirmed by jejunal fluid examination and the rest had both secretory and serum IgA deficiency. Low IgM was seen in one patient. We see a spectrum of immunoglobulin deficiencies varying from subtle defects like absence of secretory IgA only, to severe depletion of all immunoglobulins. Therapy is still not ideal due to economic reasons.

Evaluation of radical treatment of carcinoma esophagus using a combination of external beam and intracavitary irradiation.

Twenty five patients with squamous cell carcinoma arising from the middle third of the esophagus were treated radically, with external radiation, to a dose of 55-60 Gy. All patients had lesions less than 6 cm in length with no extra-esophageal spread on computed tomography scan. Eleven of these patients received additional intracavitary radiation to a dose of 12 Gy, 1 cm from the source axis in two sessions of 6 Gy each, a week apart. There was no significant difference in the relief of dysphagia and survival among these receiving and those not receiving intracavitary radiation. Addition of intracavitary radiation to radical external radiation was associated with significant complications like stricture and fistulae formation, which accounted for the poor results.

Cimetidine therapy and duodenal candidiasis: role in healing process.

Patients with Candida colonization and invasion were studied in 20 duodenal ulcer (DU) patients, 10 non-ulcer dyspepsia (NUD) cases and 10 controls with non-gastroenterological disorders. Of 20 DU patients, Candida albicans was cultured from duodenal aspirates of 6 (30%) DU patients and pseudohyphae, indicating invasive form, were present in two (10%) prior to treatment. NUD patients and controls had positive Candida culture in 3 (30%) and 1 (10%) cases respectively; pseudohyphae were found in none. Six DU patients (30%) failed to heal with 4 weeks of cimetidine therapy; all six showed invasion of duodenal ulcer mucosa with Candida on histology. The pseudohyphae form of Candida was always found to be associated with non-healing of DU. Candidal invasion is associated with failure to respond to, H2-receptor antagonist therapy.

Extraintestinal manifestations of idiopathic ulcerative colitis.

One hundred and fifty patients of idiopathic ulcerative colitis were studied for extraintestinal manifestations by clinical, radiological and biochemical means. One or more such manifestations occurred in 34.7% of patients. Sacroiliitis (14%) and peripheral arthritis (10.7%) were the commonest manifestations, followed by ocular (8%), mucocutaneous (2.7%), vascular (2%) and hepatobiliary (1.3%) manifestations. We conclude that the incidence and spectrum of extraintestinal manifestations in Indian patients with idiopathic ulcerative colitis are similar to those in western patients.

Effect of instant preparation of betel nut (pan masala) on the oral mucosa of albino rats.

Paste made out of an instant betel nut preparation was painted into the oral cavity of 21 albino rats on alternate days for a period of six months. Biopsies were taken from the oral mucosa at the beginning of the study and every two months there after and compared histopathologically with those obtained from a control group of 14 albino rats. Mild to moderate loss of nuclear polarity and increase in keratoses, parakeratoses, inflammatory cell infiltration and vascularity were noted when compared to the control group. The increase in mitotic figures was statistically insignificant and no definite changes in pigmentation or atypical cells were seen. These findings suggest the possibility of mild leukoplakia. Submucosal collagen increased steeply and steadily throughout the study period and at the end of six months, 88.23 per cent of biopsies showed thickened and condensed sub-mucosal collagen, indicating submucous fibrosis.

High dose rate intracavitary therapy in advanced carcinoma esophagus.

Nine patients with advanced squamous cell carcinoma of the middle third of the esophagus were treated by high dose rate intracavitary therapy. The dose delivered was 12 Gy in two sessions at 1 cm from the center of the source. All nine patients were alive after 9 months. Six months after treatment, 4 patients had strictures which were dilated. At the end of nine months, 6 patients had dysphagia, four of whom had strictures and two had recurrence which was treated by further intracavitary irradiation. Intracavitary radiation using high dose rate, remote controlled afterloader has a significant role in palliation in patients with advanced esophageal carcinoma and avoids intubation.

ERCP in the evaluation of choledochal cyst due to anomalous pancreatobiliary junction.

With the application of endoscopic retrograde cholangio pancreatography (ERCP), the association of anomalous pancreatobiliary junction and choledochal cyst is being increasingly recognized. We describe here the ERCP findings in three patients who had this anomaly in association with fusiform (Type I) choledochal cyst. Two of our patients also had evidence of pancreatitis. The importance of ERCP in the preoperative assessment of such patients is highlighted.