[Duodenosigmoidal fistula in a patient with Crohn's disease]. / Duodenosigmoidale Fistel bei Morbus Crohn.

The development of enteral fistulas - internal and external - is common in Crohn's disease with a frequency of about 45 % in large series of patients. Most internal fistulas arise in the small bowel, but internal large bowel fistulas occur in about one fourth of all patients with fistulas in Crohn's disease. Colonic gastroduodenal fistulas do occur, but are very rare. Of the 35 cases of colonic-duodenal fistulas that we found in the literature, most have been described to involve either a previous ileocolostomy site or the ascending or transverse colon. There are only three cases displaying sigmoidoduodenal fistulas. To these we add a fourth case with this report. A 42-year-old woman presented with upper abdominal pain, loss of appetite and regurgitations with a foul smell as well as abdominal gas complaints. A duodenosigmoidal fistula was diagnosed by local application of contrast and the fistula tract was excised in typical fashion by resection of the colonic fistula and primary closure of the duodenum. The patient experienced a good recovery with relief of symptoms.

Measurement of transit disorders in different gastrointestinal segments of patients with diabetes mellitus in relation to duration and severity of the disease by use of the metal-detector test.

The existence of gastrointestinal transit disorders in other intestinal segments beside the stomach in Type-1 diabetes mellitus (DM) and occurrence in Type-2 DM and in uremia has yet been confirmed only in few studies. Eleven healthy volunteers, 34 patients with Type-1, 32 patients with Type-2 DM in different stages of their disease and 34 non-diabetic patients with endstage-renal disease were investigated by use of the metal detector test. Patients were divided in three subgroups, depending on the duration of their disease: < 1 year: "Short", 1 - 10 years: "Middle", > 10 years: "Long". For comparison with the metal detector test scintigraphic studies of esophageal and gastric transit were performed in 17 patients and small intestinal transit was studied by use of the H2-lactulose breath test in 20 patients with long-standing DM Type-1. In Type-1 DM there is an increase of gastric (135 +/- 18, p < 0.01; 218 +/- 26, p < 0.0001 vs. 73 +/- 7 min.) and large intestinal transit times (79 +/- 18, P < 0.02; 76 +/- 11, p < 0.04 vs. 40 +/- 5 h) in patients with middle or long standing DM. In Type-2 DM similar transit disturbances occur (gastric emptying, long group: 120 +/- 15 min., p < 0.02; colonic transit, long group: 80 +/- 13 h, p < 0.01). In uremia transit disturbances were only found in patients with chronic ambulatory peritoneal dialysis (colonic transit: 71 +/- 9 h, p < 0.05). In 65% gastric scintigraphy and in 55% of cases the H2-lactulose breath test showed a prolongation of gastric emptying or a prolonged mouth-to-cecum transit. Transit disorders can occur in every stage of DM with preferential involvement of the stomach and the colon. These findings are of clinical relevance, since transit disturbances can result in instable metabolic condition.

Enteric protein loss as a marker of intestinal inflammatory activity in Crohn's disease: comparability of enteric clearance and stool concentration of alpha-1-antitrypsin?

Intestinal alpha 1-antitrypsin (alpha 1-AT) clearance has been shown a reliable index of intestinal inflammatory activity in Crohn's disease (CD). For reasons of practicability, it has been repeatedly suggested to replace alpha 1-AT clearance by alpha 1-AT concentration in random stool samples. In 60 controls and in 70 patients with CD, in 21 patients before and after treatment, fecal alpha 1-AT concentration and the ratio of stool and serum alpha 1-AT concentration were compared with alpha 1-AT clearance. In 11 patients alpha 1-AT clearance, fecal concentration and stool/serum alpha 1-AT concentration ratio were compared with 51Cr-albumin clearance. alpha 1-AT clearance (104 +/- 14 vs. 17.5 +/- 2 ml/d, p < 0.0001) as well as fecal alpha 1-AT concentration (155 +/- 21 vs. 30 +/- 3 mg/100 ml, p < 0.0001) and stool/serum alpha 1-AT concentration ratio (45 +/- 6 vs. 12 +/- 1) were significantly higher in CD patients than in controls. alpha 1-AT clearance (60 +/- 9 vs. 37 +/- 4 ml/d, p < 0.01), fecal alpha 1-AT concentration (113 +/- 21 vs. 59 +/- 8 mg/100 ml, p < 0.01) and the stool/serum alpha 1-AT concentration ratio (27 +/- 4 vs. 18 +/- 2) decreased after treatment, but fecal alpha 1-AT concentration and the stool/serum alpha 1-AT concentration ratio failed to parallel the course of alpha 1-AT clearance in 33% and in 24% of patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)