Protein-losing enteropathy in systemic lupus erythematosus.

Two patients with systemic lupus erythematosus (SLE) presented with anasarca, pleural effusions and severe hypoalbuminema. Both were demonstrated to have protein-losing enteropathy, a rare complication of SLE. Other causes of gastrointestinal protein loss were excluded. There were marked similarities in both cases including circulating ANF with speckled staining, anti-(U1)RNP antibodies and low serum complement levels. Complete remission was achieved in both with prednisolone. Anti-(U1)RNP may be a marker for a subset of SLE in which protein-losing enteropathy is a major manifestation.

Healing and relapse of severe peptic esophagitis after treatment with omeprazole.

We have studied the response of erosive or ulcerative esophagitis to treatment with omeprazole and its subsequent relapse on cessation of therapy in 196 patients. In the first phase of the study omeprazole (20 or 40 mg daily) was compared with placebo in 64 patients. After 4 wk there was endoscopic healing in 81% (25 of 31) of omeprazole-treated patients and in only 6% (2 of 32) of placebo-treated patients. Endoscopic healing of esophagitis was accompanied by symptom relief and histologic healing of ulceration. In the second (dose finding) phase a further 132 patients were randomized to omeprazole (20 or 40 mg daily) and endoscopic healing was assessed. In patients with the mildest grade of ulcerative esophagitis (grade 2), healing occurred at 4 wk in 87% receiving 20 mg and in 97% receiving 40 mg. In patients with grade 3 esophagitis, 67% (20 mg) and 88% (40 mg) were healed. Less than half the patients with grade 4 esophagitis (Barrett's ulcers or confluent ulceration) healed with either 20 mg (48%) or 40 mg (44%). Regression analysis in the 164 omeprazole-treated patients showed no evidence that healing was influenced by factors other than severity of esophagitis at entry and omeprazole dose. In phase 3 of the study the rate of endoscopic relapse was determined in 107 endoscopically healed patients after stopping omeprazole. Erosive or ulcerative esophagitis recurred in 88 of 107 (82%) by 6 mo. Neither initial dose, grade of esophagitis, nor smoking was shown to influence relapse rate. Omeprazole is a highly effective treatment for peptic esophagitis. The 40-mg/day dosage produces endoscopic healing slightly more quickly than the 20-mg/day dosage, and the initial endoscopic gradings are of prognostic value. Relapse occurs rapidly when treatment is stopped.

Solitary caecal ulcer as a cause of gastrointestinal bleeding.

A case of solitary caecal ulcer in an elderly woman who developed rectal bleeding is reported. The difficulties encountered in the detection of this rare lesion are described, and the importance of excluding other gastrointestinal disorders in a patient with peptic ulcer disease are highlighted.

Vacuolar myopathy associated with chloroquine, lupus erythematosus and thymoma. Report of a case with unusual mitochondrial changes and lipid accumulation in muscle.

Pathological and biochemical observations are presented in a 55-year-old woman with lupus erythematosus and thymoma who developed a vacuolar myopathy while being treated with chloroquine. Electromyography showed prominent spontaneous muscle activity including myotonic discharges. Vacuoles were present in all fibre types but, in contrast to previous cases of chloroquine myopathy, were most prominent in intermediate fibres. Electron microscopy showed cytoplasmic sequestration by membranes in proximity to the t-system, many autophagic vacuoles, tubular networks, and a variety of membranous bodies, some identical to those found in certain forms of cerebral lipidosis. Other features not previously described in chloroquine myopathy included prominent mitochondrial vacuolation and sequestration of glycogen within mitochondria. Thin-layer chromatography of muscle homogenates showed an increase in all major neutral and phospholipid fractions.