Effect of proton pump inhibitors on markers of risk for high-grade dysplasia and oesophageal cancer in Barrett's oesophagus.

BACKGROUND: It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high-risk group for Barrett's oesophagus. AIM: To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus influences markers for risk development of subsequent high-grade dysplasia/adenocarcinoma. METHODS: A review of all patients with Barrett's oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett's oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low-grade dysplasia. Subsequent development of high-grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low-grade dysplasia at entry was determined. RESULTS: Fourteen patients developed high-grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98-5.85) more likely to have a macroscopic marker or low-grade dysplasia than those patients already on a proton pump inhibitor. CONCLUSIONS: Use of proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett's oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.

In vivo studies with fibre components.

There are few studies in man examining the in vivo effects of dietary fibre on bile acid metabolism but divergent results have been recorded depending on the amount and type of fibre eaten. Studies in which the fibre components pectin, cellulose, and lignin were fed to normal volunteers for four weeks have been reported. The highly fermentable component pectin is associated with increased secondary bile acid formation in contrast to the partially fermentable component cellulose in which the opposite occurs. Lignin has no effect on bile acid metabolism. No component significantly alters biliary lipids. Since ordinary diets contain a mixture of different fibres the net effect will depend on the relative amounts of each. Significant changes in bile acid metabolism and biliary lipids in the longer term (greater than 4 weeks) however, are not precluded by the results of these short term studies.

Effects of the fibre components pectin, cellulose, and lignin on bile salt metabolism and biliary lipid composition in man.

Randomised crossover studies in three separate groups of 10 healthy volunteers were undertaken to determine the effects of biliary lipid composition and bile salt metabolism of daily dietary supplementation for four weeks with the purified fibre components pectin (12 g/day), cellulose (15 g/day) and lignin (12 g/day). The subjects' biles were initially unsaturated with cholesterol and no significant changes in the lithogenic indices or mean percentages of cholesterol, phospholipid, or total bile acids after any of the supplements were observed. After pectin, the mean (+/- SD) percentage of cholic acid decreased significantly from 42.8 (+/- 10.8) to 39.0 (+/- 11.2), the mean (+/- SD) percentage of deoxycholic acid increased significantly from 18.2 (+/- 13.7) to 25.4 (+/- 13.5) and C14-deoxycholate metabolites were raised significantly by 65%. After cellulose, the mean (+/- SD) percentage of chenodeoxycholic acid was increased significantly from 33.6 (+/- 6.3) to 35.4 (+/- 7.0), the mean (+/- SD) percentage of deoxycholic acid decreased significantly from 18.6 (+/- 9.6) to 14.2 (+/- 8.3) and C14-deoxycholate metabolites halved. Lignin did not exert any significant effects. Though these results show that individual fibre components are associated with quite different effects on bile acid metabolism, in the short term no significant effect on biliary cholesterol saturation was observed in bile initially unsaturated with cholesterol. The bile acid changes most likely result from the different effects on colonic metabolism induced by the individual fibre components.

Psychoneurotic symptomatology in the irritable bowel syndrome: a study of reporters and non-reporters.

An appreciable proportion of the general population have the irritable bowel syndrome but do not report it. Results of psychological assessments showed that outpatients with the syndrome and non-reporters of it were psychologically similar, but both groups showed more somatic distress than normal controls. Anxiety, depression, obsessive compulsion, and interpersonal sensitivity were similar in both groups with the syndrome and the normal controls. The preponderance of women referred to outpatient clinics may reflect sociological factors rather than the severity of the irritable bowel syndrome.

The effects of the fiber components pectin, cellulose and lignin on serum cholesterol levels.

Eight-week randomized cross-over studies in three separate groups of 10 healthy volunteers were undertaken to determine the effects of daily dietary supplementation with pectin (12 g/day), cellulose (15 g/day) and lignin (12 g/day) on serum lipid levels. Detailed dietary records were kept throughout the study and there was no significant change in dietary intakes except for the fiber supplement. Neither pectin, cellulose, nor lignin significantly altered serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, or the ratio of high-density lipoprotein to total cholesterol in healthy normolipidemic subjects over four weeks.

Irritable bowel patients and their long-term response to a high fiber diet.

Clinical details of 30 Caucasian women suffering from the irritable bowel syndrome were analyzed. Dietary fiber intakes, stool transit time, and stool weights were compared between groups of differing bowel habit and no statistically significant differences were found. A significant correlation between the clinical severity and the anxiety score on the Middlesex Hospital Questionnaire was present, but there was no correlation with other psychoneurotic traits or self-rating depression scores. Two to 3-year follow-up after management with a high fiber diet in 14 patients, showed that symptoms had improved greatly in seven, were unchanged in five, and were worse in two. Although dietary fiber had increased by a mean of 6.7 g/day, the clinical course could not be correlated with the amount of fiber consumed nor was it possible to predict the course of the individual patient from any clinical or psychological score. Despite persistence of symptoms at follow-up these were generally less severe and associated with significant decreases in anxiety, somatic and self-rating depression scores with the somatic score correlating with a decrease in clinical severity.

Dietary intakes and stool characteristics of patients with the irritable bowel syndrome.

Detailed dietary records were obtained from 30 women with the irritable bowel syndrome and 25 healthy, asymptomatic women. Stool transit times and wet stool weights were measured. Analysis of the dietary data revealed no significant difference between energy, protein, fat, carbohydrate, or total fiber intakes. Total dietary fiber intake was 17 g/day in the irritable bowel group and 18 g/day in the control group, but vegetable fiber intake was significantly lower in the patients (6.6 g/day) than the controls (8.2 g/day). Cereal and fruit fiber were comparable for both groups as were the stool transit times and wet stool weights. These results do not support the hypothesis that symptoms of the irritable bowel syndrome are directly related to total or cereal fiber depletion.

Acute oesophagitis due to emepronium bromide.

Six cases of endoscopically documented acute oesophagitis during therapy with emepronium bromide (Cetiprin) for urinary symptoms are described. The oesophagitis was associated with acute severe retrosternal pain and dysphagia which resolved spontaneously on stopping medication. The potential of this drug to induce severe oesophageal inflammation and ulceration should be emphasised.

Fibresigmoidoscopy: technique of choice?

A study was undertaken to determine the practicality of replacing rigid sigmoidoscopy with flexible fibresigmoidoscopy. A total of 388 examinations were performed and complete examination was possible in 79% of patients in less than 10 minutes. Abnormalities were found in 18% of patients; colorectal polyps and tumours were identified in 11% of patients. No complications occurred and the investigation was well tolerated. Fibresigmoidoscopy is a practical, safe procedure for routine use in the outpatient setting and has several advantages over rigid sigmoidoscopy.

Prolonged ileus following gastroscopy--a case report.

A patient who developed signs of acute bowel obstruction following upper intestinal endoscopy is described. Relations of endoscopy to the symptoms and therapeutic measures are discussed.