High-dose proton-pump inhibitors as a diagnostic test of gastro-oesophageal reflux disease in endoscopic-negative patients.

BACKGROUND: To evaluate a high dose of a proton-pump inhibitor as a diagnostic test in endoscopy-negative patients presenting with symptoms indicating gastro-oesophageal reflux disease. METHODS: 64 patients were studied in a prospective, randomized, double-blind study, using a cross-over design. After a run-in period with the diary registration of basic GORD symptoms and recording of the consumption of antacid tablets, the patients were given either 60 mg of lansoprazole once daily or placebo in randomized order. Symptoms were recorded, as well as antacid tablets taken in order to relieve pain. GORD was determined by 24-h oesophageal pH monitoring. The test was considered positive when consumption of antacid tablets was reduced > or = 75% compared to pretreatment. RESULTS: In the GORD group, 29 (85%) tested positive during active treatment compared to 3 (9%) when on placebo. Corresponding figures for the non-GORD patients were 50% and 27%, giving a test sensitivity and specificity of 85% and 73%, respectively. During active treatment, VAS scores for acid regurgitation, heartburn and over all were significantly lowered in GORD patients, compared to heartburn only in the non-GORD group. CONCLUSIONS: 60 mg lansoprazole once daily for 5 days is an easy to use method for diagnosing GORD in endoscopy-negative patients. Using 24-h oesophageal pH monitoring as the reference method, the sensitivity was relatively high, while the specificity was lower. Further studies are needed to determine how a PPI could be used as a diagnostic test in GORD.

Preliminary experience with plasma exchange in patients with ulcerative colitis.

We decided to test the effect of plasma exchange (PE) in selected patients with inflammatory bowel disease in which conventional medical treatment proved insufficient. Twenty-six patients with ulcerative colitis (UC) were treated with PE, six patients with fulminant colitis and 20 with long lasting severe colitis. After very promising results initially, 17 patients with long lasting severe colitis were selected in a careful prospective study. Twelve patients completed the treatment protocol. Two litres of plasma were exchanged every second or third day, 5-6 times in two weeks. The replacement fluid was fresh frozen plasma. The activity indices and histological evaluation were used as criteriae for treatment response. A reduction of 35% in the activity index is considered a significant improvement. In all but three patients (out of 12), the activity indices were reduced two weeks after end of treatment. Six patients had a reduction of more than 35%, three patients had a reduction between 22-28% and three had a reduction less than 10%. None became worse. In this carefully studied group, the immediate beneficial effects of PE was only demonstrable by the activity indices and not evident by blind evaluation of biopsies from the mucosa. In two of the six patients with fulminant colitis, PE was followed by an immediate dramatic clinical improvement. In the follow up period (2-14 years) 14 of the 26 patients reported marked and long lasting improvement of inflammatory bowel disease. We conclude that PE might be beneficial in subsets of patients with UC.

[Gastrointestinal endoscopy in children]. / Gastrointestinale endoskopier av barn.

BACKGROUND: Abdominal pain and other gastrointestinal symptoms in children may be, but are not always due to disease. Endoscopy in general anaesthesia may be necessary in children with long-term symptoms from the gastrointestinal tract. MATERIAL AND METHODS: We present a retrospective study of all children under the age of 15 who underwent endoscopy at the Central Hospital in Akershus (SIA) in the period 1993-98. 254 gastro-, 123 colono- and 43 sigmoideoscopies were performed. A conclusive diagnosis was made following endoscopy. There were few complications to the endoscopies. RESULTS AND INTERPRETATION: Our results indicate a higher incidence of inflammatory bowel disease than in similar studies, but with the same relative rates. Celiac disease occurs at a rate similar to the Swedish epidemic in the 1980s.

[Alcohol--no universal drug against heart disease]. / Alkohol--ingen universalmedisin mot hjertesykdom.

Alcohol is part of the normal culture for a majority of the population in western countries. Few investigators or clinicians disagree with the contention that there is a positive relationship between cardiovascular disease and mortality in the upper part of the alcohol consumption curve. No such general agreement exists when infrequent users and non-users are studied. Epidemiological evidence of the relationship between cardiovascular mortality and levels of alcohol consumption is scrutinized, with emphasis on how alcohol anamnestic data are collected, the characterization of non-users, and the authors' definition of moderate consumers. The results indicate that there is hardly any evidence to advocate moderate consumption of alcohol as a health-promoting activity. On the other hand there seems to be a positive relationship between moderation in many aspects of lifestyle and some health gain.