"Open-access" endoscopy for general practitioners. Experience of a private gastrointestinal clinic.

Previous authors have questioned the value of an "open-access" upper gastrointestinal endoscopy service, its increased usage and its low useful diagnostic yield. We have analysed the results of 8270 consecutive endoscopies that were performed in one private outpatient gastrointestinal clinic from 1977 to 1984. Of these, 1409 endoscopies were performed as part of an open-access service for referring doctors. The remainder were performed after referral for a gastrointestinal consultation. No deaths or major complications occurred in either group. A steady increase in referrals to both groups was noted over the years, with an increasing proportion of normal results. A positive endoscopic finding was found significantly more frequently in the open-access group (61%) compared with those patients that were referred for a gastrointestinal consultation (52.6%). Individual endoscopists varied significantly in their tendency to report mucosal inflammatory lesions. We believe that outpatient open-access endoscopy that is performed by experienced clinicians with trained staff and appropriate facilities is a safe and acceptable alternative to barium meal examinations.

Munchausen's syndrome. A study of the casualty "Black books" of Melbourne.

Unofficial registers or casualty "Black books" have evolved to assist busy casualty department staff in the identification of patients who are suffering from Munchausen's syndrome, are drug abusers or have other "problem" disorders. Fourteen of Melbourne's 17 general public hospitals have such books which contain information on 835 patients. Amalgamation of information from all of these books reduced this to 713 individual patients, of whom 21 were regarded as cases of Munchausen's syndrome, 20 were probable cases, 652 were classified as drug abusers and 20 were classified as dangerous patients. All four groups shared a similar mean age, between 32 and 37 years. Munchausen's syndrome patients showed greater tendency to use aliases. Men predominated in all four groups, especially among dangerous patients. Conventional records rely upon obtaining an honest and accurate name and information from the patient and are quite inadequate for the identification and treatment of patients with Munchausen's syndrome and drug abusers. When these conditions are suspected, a detailed standard identification form, suitable for computerization, should be used at all hospitals.

Ranitidine and placebo in the treatment of reflux oesophagitis. A double-blind randomized trial.

A study was carried out to assess the effectiveness of ranitidine in the short-term treatment of reflux oesophagitis. In a double-blind randomized trial of 37 outpatients with symptomatic, endoscopically proven, moderate or severe reflux oesophagitis, 18 patients received ranitidine (150 mg twice a day) and 19 patients received identical-looking placebo tablets for a period of six weeks. Clinical, laboratory, and endoscopic assessments were made initially, and at the end of six weeks. Two patients withdrew during the trial. Endoscopic evidence of improvement was found in 15 of 17 ranitidine-treated and in five of 18 placebo-treated patients. This difference was significant (P less than 0.01). Antacid consumption was significantly lower in the ranitidine-treated group (P less than 0.01). Improvement in histological findings, and the relief of retrosternal pain, regurgitation, dysphagia, and epigastric pain did not achieve levels of statistical significance. No adverse clinical or laboratory changes occurred in patients in either group. It is concluded that, as judged by endoscopic evidence, ranitidine is an effective drug for the short-term treatment of reflux oesophagitis.

Scleromalacia perforans in ulcerative colitis.

Ulcerative colitis is associated with many ocular complications. The only systemic disease currently recognized to be complicated by scleromalacia perforans is rheumatoid arthritis. A 36-yr-old male is described whose long-standing ulcerative colitis was complicated by scleromalacia perforans at a time of disease activity. The scleromalacia was successfully treated with high-dose steroids and total proctocolectomy.

Fecal characteristics contrasted in the irritable bowel syndrome and diverticular disease.

A comparison has been made of the fecal characteristics in controls and patients with the irritable bowel syndrome and diverticular disease. No detectable difference was found in the fecal wet weight, dry weight, or total bile acid excretion in the four groups. A significant increase in the percentage of the water content of the stool was seen in the idiopathic diarrhea group with irritable bowel syndrome. Significantly less magnesium, potassium, and calcium was found in the stools of patients with diverticular disease and a similar trend was noted in patients with the spastic colon. These changes did not relate to the age of the patients. This suggests a common etiology for these disorders. The presence of increased water and primary bile acids in the feces of patients with idiopathic diarrhea suggests that this is a separate entity.