[Dissolution of gallstones by chenodeoxycholic acid]. / Auflösung von Gallensteinen durch Chenodeoxycholsäure.

A 2-year prospective study with chenodeoxycholic acid (CDCA) (750 mg per day) was performed in 34 asymptomatic patients with radiolucent gallstones. 17 patients dropped out before completion of the trial. In 5 cases (29%) the stones dissolved and in 5 additional cases they decreased in size, while in 2 cases (13%) they increased in size during treatment. Favorable criteria for dissolution were round stones without edges and fissures on radiological appearance and a stone diameter of less than 1 cm. In 3 cases drug-induced nausea or diarrhea were so pronounced that treatment could not be continued. CDCA treatment also caused a significant rise in SGPT for at least one year. Thus, CDCA is at best moderately effective in a highly selective group of patients with gallstones.

Gastro-oesophageal reflux disease: correlation of subjective symptoms with 7 objective oesophageal function tests.

Seven tests which have been recommended for the diagnosis of gastro-esophageal reflux were applied in 24 healthy controls and in 48 patients with symptoms of reflux disease. The correlation coefficient of test results with the subjective symptoms of the patient decreased in the following order: 1) acid clearance from the distal esophagus (r = 0.558, p less than 0.001), 2) suction biopsy 5 cm above lower esophageal sphincter (LES) with evaluation of granulocytic infiltrates (r = 0.450, p less 0.001), 3) radiological demonstration of hiatal hernia (r = 0.435, p less than 0.001), 4) reflux provocation test (r = 359, p less than 0.01), 5) modified Bernstein test (r = 0.322, p less than 0.01), 6) acid relux test (r = 0.252, p less than 0.05), 7) resting pressure of LES (r = 0.246, p less than 0.05). Results of the Maudsley Personality Inventory were not correlated with subjective symptoms (r = 0.188, p greater than 0.1). By stepwise multiple regression analysis it was shown that optimal diagnosis of reflux is achieved by combination the following 4 procedures: 1) acid clearance, 2) modified Bernstein test, 3) suction biopsy, and 4) radiology.

Esophageal function in progressive systemic sclerosis.

A prospective study was performed in 13 consecutive patients with systemic progressive sclerosis (PSS). For the diagnosis of impaired esophageal peristalsis cineradiography and manometry are equally useful. Esophageal suction biopsy allows the diagnosis of esophagitis but not of scleroderma. Mild to severe esophageal involvement was observed in 12 patients. In only one patient the esophagus was virtually normal. Dysfunction of the esophageal body may occur early in the course of the disease while incompetence of the lower esophageal sphincter is observed on an average after 7 to 8 years. Both impairment of peristalsis and pressure of the lower esophageal sphincter may lead to delayed esophageal clearance. Relaxation of LES is normal even in the absence of primary peristalsis. Extensive esophageal damage including severe gastroesophageal reflux may be present in the absence of esophageal symptoms.