[Dysfunction of the sphincter of Oddi in cholecystectomy patients]. / La dysfonction du sphincter d'Oddi chez les patients cholécystectomisés.

Sphincter of Oddi dysfunction (SOD) is an obstructive syndrome of the papilla not resulting from a stone. It may cause recurrent biliary type pain to cholecystectomized patients. SOD is caused by sphincter dyskinesia or benign stenosis. Diagnosis is usually based on symptoms, serum biochemistry, endoscopic retrograde cholangiopancreatography and Sphincter of Oddi manometry. The latter is the best means of evaluating Sphincter of Oddi dynamics. However, because of the many inconveniences of Sphincter of Oddi manometry and of its high morbidity rate, it is seldom used. Non invasive techniques, such as cholescintigraphy, have been developed to replace Sphincter of Oddi manometry in diagnosing SOD. Patients can be cured by sphincterotomy. Certain drugs could also be effective but few controlled studies have been carried out of date.

[Erosive duodenitis. Clinical study of 287 cases]. / La bulbite érosive. Etude clinique de 287 observations.

We relate here the results of a retrospective (1984-1987) investigation on 1043 protocols of gastroscopy, where the diagnosis of erosive duodenitis (ED) has been made 372 times in 287 patients. The presence of Campylobacter pylori was not investigated. ED endoscopic incidence was 5.6%. Patients were divided into three groups: 1. ED alone: 15.7%. 2. ED associated with duodenal ulcer (DU): 48.4%. 3. E.D. associated with various diseases: 35.9%. There was a higher male/female ratio in the three groups, and mean ages were similar (50 years). In the group ED alone, the first symptom was nonspecific epigastric pain in 61%; no risk factor appeared, and it did not recur. When associated with DU, ED preceded DU in 8.8% of the cases, followed DU in 18.9%, had the same course in 37.1%, appeared transiently in 2.5%, or during DU healing in 3.7%. The two diseases were unrelated in 28.3% of the cases. Only tobacco seemed to promote the association of DU with ED.

Prevention of duodenal ulcer recurrence by pirenzepine 50 mg twice daily.

Eighty-four patients with healed duodenal ulcers were treated for 1 year with pirenzepine, 50 mg twice daily, or placebo in this double-blind, randomized, multicenter trial. Clinical follow-up and endoscopy were performed before and after 3, 6, and 12 months of treatment. Endoscopy was also carried out whenever symptoms compatible with ulcer recurrence were present for more than 2 days. Both groups were well matched for age, sex, duration of peptic ulcer disease, and smoking habits. There were 21 drop-outs due to lack of compliance. Therefore, 32 patients treated with pirenzepine and 31 with placebo were included in the analysis. Expressed in cumulative percentage of recurrence, with pirenzepine, 28% of the patients had a relapse at 3 months, 41% at 6 months, and 53% at 12 months; with placebo, the recurrence rates were 58% at 3 months, 68% at 6 months, and 71% at 12 months. The mean success time at 1 year is also longer for pirenzepine (7.38 months) than for placebo (5.52 months). These differences are significantly in favor of pirenzepine (p less than 0.05). Both treatments were well tolerated. Dry mouth was more frequently observed with pirenzepine (14 versus 5 patients). We conclude that pirenzepine, 50 mg twice daily, significantly reduces the relapse rate of duodenal ulcers during a 1-year maintenance treatment.

Lack of clinical and physiological relationship between gastrin and calcitonin in man.

The clinical and physiological relevance of the relationship between gastrin and calcitonin has been investigated in normal subjects and in patients suffering from gastritis or duodenal ulcer. Basal plasma levels of calcitonin are increased in these patients but there is no significant relationship between calcitonin and gastrin levels. Acute pentagastrin injection in normal male subjects increased significantly (P less than 0.05) plasma calcitonin levels whereas lower doses of pentagastrin which are known to stimulate gastric secretion are without effect on calcitonin levels. Moreover, stimulation of gastrin secretion by a protein test meal and by intragastric administration of a calcium chloride solution is not followed by any significant increase of plasma calcitonin levels. These results suggest that the stimulation of calcitonin secretion by gastrin and its synthetic analogue pentagastrin is a pharmacological rather than a physiological phenomenon.

[Blood calcitonin in alcoholic cirrhosis]. / La calcitonine sérique dans la cirrhose éthylique.

In spite of an important metabolic role of the liver in the synthesis and degradation of hormonal peptides and seco-steroïds, the clinical occurrence of disturbed regulation of calcium and phosphorus metabolism is rare in hepatic disorders. 23 patients suffering from alcoholic cirrhosis were studied. All had normal plasma calcium and phosphorus concentration as well as immunoreactive parathyroid hormone levels. 25 hydroxyvitamin D3 levels were decreased. Immunoreactive calcitonin were increased in relation to the increase in plasma alkaline phosphatase activity. The causes and consequences of these endocrine disturbances are discussed.