Reproducibility of ambulatory esophageal pH monitoring in the aperistaltic esophagus.

The reproducibility of ambulatory 24-h esophageal pH monitoring was evaluated in 16 consecutive patients by comparing the difference in two consecutive 24-h periods. The study group included 8 patients with scleroderma esophagus and 8 treated achalasia patients. The amount of reflux was expressed as the percentage of time the pH was < 4.0. Both groups demonstrated excellent intrapatient reproducibility overall: 96% in scleroderma patients and 95% in those patients with achalasia. The least concordance was found in the lengths of the longest reflux events-70% when supine in scleroderma patients and 59% when upright in patients with achalasia. There was no significant difference (p > 0.05) between day 1 and day 2 for either group of patients for any of the elements studied. These results indicate that intrapatient variability of gastroesophageal reflux in patients with scleroderma esophagus and treated patients with achalasia is very low and following therapeutic intervention, a high level of confidence can be placed in subsequent pH monitoring as an indicator of treatment effect.

Value of gallium-67 citrate scanning in Crohn's disease: concise communication.

A frequent problem in Crohn's disease is the distinction between exacerbated inflammation of the bowel, which can be treated medically, and intra-abdominal abscess, a common complication that requires surgical management. We present evidence that the gallium scan is of value in making this distinction. From a series of 11 studies, negative gallium scans correctly excluded abscess in over half. All patients were symptomatic at the time of the scan. Most patients with active Crohn's disease do not have abnormal gallium uptake and in these patients the gallium scan is useful to exclude the possibility of abscess.