Full-thickness biopsy findings in chronic intestinal pseudo-obstruction and enteric dysmotility.

BACKGROUND AND AIMS: Small bowel manometry is increasingly used in the clinical investigation of patients with symptoms of intestinal motor dysfunction. Enteric dysmotility (ED) has been suggested as a new diagnostic term for patients with abnormal intestinal motor activity but no radiological signs of chronic intestinal pseudo-obstruction (CIP). Histopathological features of adult patients with ED and CIP have been compared in a large case series to study differences and similarities between the two diagnostic groups. METHODS: Routine staining and an extensive panel of immunohistochemical stains on transversal and tangential cuts from full-thickness biopsies of the small bowel were used. RESULTS: 39 females and 11 males with CIP and 58 females and 7 males with ED were investigated. The underlying lesion was more often a visceral myopathy (22% vs 5%) or neuromyopathy (30% vs 12%) in patients with CIP than in those with ED, whereas the predominant lesion in ED was neuropathy with inflammation. CONCLUSION: CIP in adults is associated with very different underlying pathology, whereas ED is more homogeneously associated with neuropathy in the enteric nervous system. Neuropathy of enteric ganglia with inflammation seems to be the most common cause for measurable disturbances of intestinal motor function.

Gastroesophageal reflux in healthy subjects. Significance of endoscopic findings, histology, age, and sex.

BACKGROUND: Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. METHODS: We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. RESULTS: Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. CONCLUSION: Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.

Comparison of the effect of lansoprazole and omeprazole on intragastric acidity and gastroesophageal reflux in patients with gastroesophageal reflux disease.

BACKGROUND: Lansoprazole (LAN) and omeprazole (OME) heal esophagitis effectively and to similar extents, but LAN has a faster effect on the relief of symptoms of gastroesophageal reflux. However, no strict comparison of the two proton pump inhibitors' effect on acid reflux and gastric acidity has been published. The aim of this study was to compare the effects of LAN and OME on gastroesophageal reflux with simultaneous measurements of gastric acidity in patients with established gastroesophageal reflux disease (GERD) and esophagitis. METHODS: Fourteen patients with endoscopically verified erosive esophagitis and with a pretreatment esophageal 24-h pH measurement showing acid reflux to the esophagus participated in the study. This was a double-blind, randomized study with crossover design. Before (day 0) and on the last day (day 5) of each treatment period with encapsulated 30 mg LAN or 20 mg OME daily, 24-h intraesophageal and intragastric acidity were measured with antimony electrodes connected to an ambulatory pH recording system. RESULTS: Ten of 14 patients completed the study. There were no differences in intragastric or intraesophageal acidity or the number of reflux episodes on day 0 between the two treatments. Both LAN and OME treatments increased the median and nocturnal intragastric pH and decreased the 24-h area under the time curve for intragastric acidity significantly and to about the same extent (79% and 69% acid inhibition by LAN and OME, respectively) (NS). However, the percentage of time with pH below 4 in the esophagus was significantly less during LAN treatment (1.92% +/- 2.29; mean +/- standard deviation) than during OME treatment (4.76% +/- 2.88%) on day 5 (P = 0.002). There were also significantly fewer reflux episodes >5 min during treatment with LAN (1.00 +/- 1.33) than with OME (2.90 +/- 2.42) at the end of the treatment period (P = 0.031). CONCLUSIONS: In this study lansoprazole and omeprazole had a comparable effect on gastric acidity in patients with established GERD with esophagitis. However, 30 mg lansoprazole daily reduced the acidity in the oesophagus and the number of refluxes more effectively than 20 mg omeprazole daily. This might indicate that proton pump inhibitors affect the esophageal clearance and/or influence the lower esophageal sphincter differently.

24-hour ambulatory electrogastrography in healthy volunteers.

BACKGROUND: Development of electrogastrography, the recording of gastric electric rhythm from cutaneous electrodes, for clinical purposes has been hampered by methodologic problems and the lack of an ambulatory technique. We have evaluated a newly developed system for ambulatory electrogastrography. METHODS: 24-Hour recordings were obtained from 30 healthy volunteers. We used digital filtering, a Hamming window, and spectral analysis to determine the dominant frequency of successive 256-sec segments of data. RESULTS: Low-frequency noise disturbed the primary signal. After secondary filtering a stable normogastric (2-4 cpm) rhythm was present during a median of 49% (range, 34-79%) of the recording time. The mean frequency of gastric electric activity varied from 2.92 +/- 0.15 cpm (mean +/- SD) at mid-day to 2.72 +/- 0.13 cpm in the late night. CONCLUSIONS: Ambulatory recording of electrogastrography needs technical improvement. The electrogastrogram shows a circadian variation in frequency.

Digital ambulatory monitoring of small-bowel motility.

This paper describes a new technique for ambulatory long-term monitoring of small-bowel motility. Intraluminal pressure was measured with a silicon catheter with two strain-gauge transducers spaced 15 cm apart. Pressure data were stored in a portable memory unit. Initial studies showed that a recording frequency of 2 Hz was sufficient for obtaining reliable motility measurements. Twelve-hour recordings of motility in the upper jejunum were done in 12 healthy volunteers. After a 1964-kJ meal the median duration of fed-state motility was 4.6 h (3.4-5.3 h, interquartile range). The activity front of the migrating motor complex propagated with a velocity of 2.7-5.3 cm/min, and the median cycle length was 77 (40-103) min. The frequency of contractions in the activity front was 11.4 (10.9-11.6)/min at the proximal transducer. This new technique enables small-bowel motility to be monitored over longer periods of time and with much less inconvenience to the patient than previously used methods.