Do parotid duct abnormalities occur in patients with chronic alcoholic pancreatitis?

OBJECTIVE: Several studies have suggested that ethanol affects the pancreas and parotid gland. We performed a prospective study to determine whether ductal lesions of ethanol-induced chronic pancreatitis occur in the parotid. METHODS: Parotid sialograms were performed in 11 alcoholic patients who had endoscopic retrograde pancreatograms. Sialograms and pancreatograms were examined in all subjects for ductal abnormalities. RESULTS: Seven of nine patients (77.8%) with ductal lesions of the pancreas had coexistent ductal abnormalities of the parotid gland (Kendall's tau = 0.578, p = 0.035). CONCLUSIONS: Chronic ethanol intake induces ductal alterations in the parotid gland similar to those seen in the pancreas. These results suggest a common histopathological effect of alcohol in the ductal system of the parotid gland and pancreas and raise the possibility that the parotid sialogram could be useful as an adjunct in the diagnosis of ethanol-induced chronic pancreatitis.

Standardization of clinical criteria required for use of the 12.5 millimeter barium tablet in evaluating esophageal lumenal patency.

BACKGROUND: Although the barium tablet is commonly used in evaluating lumenal patency of the esophagus, the conditions under which the tablet should traverse a normal esophagus have not been established. This study was designed to standardize the minimal criteria required to ensure successful esophageal transit of a commercially available barium tablet in normal subjects. METHODS: Each of 20 volunteers swallowed a standard 12.5 mm barium tablet under fluoroscopy in the supine, 45 degrees incline, and upright positions. Tablets were swallowed dry and with fixed volumes of water (15, 30, 60, and 100 cc). Success of pill passage into the stomach was determined by fluoroscopy at 20, 40, 60, and 90 seconds. RESULTS: Successful pill passage correlated significantly with position (passing 17.0%, 66.5%, and 69.7% in the supine, incline, and upright position, respectively; p < .0001) and volume of water ingested (passing 9.1% when swallowing dry, and 38.7%, 55.8%, 70.0%, and 81.6% with 15, 30, 60, and 100 cc of water, respectively; p < or = .004). Duration of time beyond 20 seconds failed to affect rate of pill passage. Ingestion of 60 cc of water in the incline position was associated with a 95% pill passage, a rate significantly greater than any position at lower volumes. Increasing water volume above 60 cc or assuming the upright position did not increase this passage rate further. CONCLUSIONS: The minimum criteria required to optimize successful transit of a 12.5 mm barium tablet through a normal esophagus is to perform the test in the 45 degrees incline position with 60 cc of water for a period of 20 seconds. Failure of the pill to pass under these conditions may suggest a true structural abnormality of the esophagus.

Benign schwannoma of the small intestine: an unusual cause of gastrointestinal bleeding.

Neurogenic tumors of the small intestine are exceedingly rare accounting for less than 1% of all neoplasms involving the gastrointestinal (GI) tract. These lesions may remain clinically silent for years, but usually manifest by the 5th or 6th decade of life. Occult transient hemorrhage from the GI tract interspersed by relatively long asymptomatic periods is the most common presentation. This report describes a case of a patient with a solitary benign duodenal schwannoma and no prior symptoms presenting as an acute life-threatening upper GI hemorrhage. Small bowel tumors of neurogenic origin represent an unusual cause of GI hemorrhage. The diagnosis should be considered in such cases to insure appropriate and timely management.

Alterations in upper gastrointestinal motility in Helicobacter pylori-positive nonulcer dyspepsia.

OBJECTIVE: To study the association between gastrointestinal motility and Helicobacter pylori (HP) among patients with nonulcer dyspepsia (NUD). METHODS: We examined the gastric emptying and orocecal transit times (OCTT) in patients with NUD who were colonized with Helicobacter pylori (n = 27). NUD was defined as dyspeptic symptoms for at least 3 months in the absence of gastrointestinal pathology as seen on endoscopy and ultrasound. Subjects with diabetes mellitus, thyroid disorder, or abdominal surgery except appendectomy were excluded. The HP-negative patients with NUD (n = 38) served as controls. Solid phase gastric emptying was assessed by radionuclide scintigraphy. OCTT was determined by measuring exhaled breath hydrogen upon administration of lactulose. RESULTS: The two groups were similar with respect to age, sex, race, and history of smoking. Gastric emptying (t1/2) was 64.96 +/- 3.61 min in the HP-negative and 61.0 +/- 6.59 in the HP-positive group (p = NS). The OCTT was 130.9 +/- 17.26 minutes in the HP-negative and 84.28 +/- 11.07 in the HP-positive group (p = 0.03). There was no difference in the prevalence of nonhydrogen producers between the two groups. There was no correlation between gastric emptying and OCTT (p > 0.05). CONCLUSIONS: OCTT is faster among HP-positive patients with NUD than among HP-negative patients. However, gastric emptying is similar in the two groups.