Role of routine small intestinal biopsy in adult patient with irritable bowel syndrome-like symptoms.

AIM: The clinical evaluation of patients with chronic diarrhea and/or abdominal pain requires a complex work-up. The aim of the study was to evaluate whether routine duodenal biopsy sampling of macroscopically normal mucosa of patients with irritable bowel syndrome-like symptoms undergoing upper endoscopy assists in diagnosis and management. METHODS: Consecutive adults scheduled for upper endoscopy for evaluation of uninvestigated dyspepsia and abdominal pain and/or chronic diarrhea based upon the history, were enrolled. Gastric biopsies and 3 duodenal biopsies were taken for histological evaluation. RESULTS: A total of 786 sets of biopsies from 262 consecutive patients (200 females and 62 males, mean age 46 years; range: 15-82), were analyzed. Microscopic damage was observed in 212 of 262 patients (81%) with normal mucosa. Mild to moderate and severe duodenitis or villi atrophy was histologically confirmed in 65%, 26% and 8% of 212 patients respectively. The negative predictive value of a normal appearing duodenal mucosa was 19%. Additional tests confirmed celiac disease in 12 patients. Lactose malabsorption was present in 42%, bacterial overgrowth in 14%, and H. pylori infection in 28%. Colonoscopy performed in 92 patients revealed non specific colitis (25%), microscopic colitis (28%), Crohn's disease (1%), and diverticulosis (15%). CONCLUSION: Duodenal biopsies revealed abnormalities in the majority of adults with chronic diarrhea and/or abdominal pain despite macroscopically normal gross findings. These results suggest that duodenal biopsies could be helpful in patients with chronic diarrhea and/or abdominal pain for the following work up.

[Psychosomatic assessment in patients with gravidic hyperemesis]. / Indagine psicosomatica in pazienti affette da iperemesi gravidica.

Thirty female subjects examined in the first three months of pregnancy took part in the study. Ten of these suffered from severe gravidic hyperemesis, while twenty had a physiological pregnancy. All subjects with hyperemesis and six controls were subjected to measurement of cortisolaemia at the following times: 8, 12, 16, 20, 24 and 4.00 so as to obtain the circadian curve of the hormone, measurement of T3 and T4 and of TSH. The Cattell test in form C was carried out in all patients. The results obtained evidenced a global increase in the production of cortisol in the group of hyperemetic women, with maintenance of the circadian rhythm. The Cattell test identified characteristic personality traits in the subjects suffering from hyperemesis compared to the controls.