Sessile polypoid gastric heterotopia of rectum: a report of 2 cases and review of the literature.

OBJECTIVE: The term heterotopia, a term derived from Greek, implies "other place." It refers to the finding of normal tissues at foreign sites. Heterotopic gastric tissue rarely involves the large bowel. We report 2 cases of this rare entity. DATA SOURCES: Case reports of 2 patients with sessile polypoid lesion in the rectum, with a review of the available literature, using both MEDLINE and relevant bibliographies of published articles. RESULTS: Biopsies of the rectal lesions in our 2 cases revealed the presence of gastric tissue. Only 27 other such cases have been reported in the English literature. CONCLUSIONS: Patients with rectal gastric heterotopia usually present with bleeding, but other presentations and complications are possible. Endoscopic or surgical excision is the treatment of choice, although the lesions also respond to histamine 2 receptor blockers.

Idiopathic eosinophilic esophagitis.

A retrospective review was performed of 13 patients with the diagnosis of idiopathic eosinophilic esophagitis (IEE) occurring alone or in conjunction with idiopathic eosinophilic gastroenteritis (IEG) to identify clinical, radiographic, endoscopic, manometric, and therapeutic similarities. All patients presented with esophageal symptoms, predominantly dysphagia. An allergic disorder was present in 10 (77%) patients, and peripheral eosinophilia was present in 12 (92%) patients. Clinical investigation disclosed esophageal strictures in 10 patients, motility disorders in three, ulcerations in two, a cervical web in one, and a mucosal ring in one as the cause of esophageal symptoms. A proximal esophageal stricture was the single most common esophageal abnormality demonstrated. IEE should be included in the differential diagnosis of dysphagia and should be suggested in a patient with an allergic disorder, peripheral eosinophilia, and concurrent abdominal symptoms, especially in conjunction with IEG. Prompt diagnosis is extremely important since treatment with steroids produces rapid clinical remission in most patients.

Gender differences in Manning criteria in the irritable bowel syndrome.

The objective of this study was to determine if gender differences exist when using the Manning criteria for diagnosis of irritable bowel syndrome. In an outpatient setting, 61 women and 36 men with entry complaints of abdominal pain, altered bowel habits, or both underwent full evaluation by board-certified/eligible gastroenterologists who also systematically rated the presence or absence of the six Manning criteria. Irritable bowel syndrome was defined as the absence of an organic disease explanation for the entry complaints. This determination was made by two other board-certified gastroenterologists after patients had been in the study for 9 months. These raters were independent of the study and rated the transcripts of patients' clinic visits, all other available clinical data from this and other clinics, all laboratory data obtained during the 9-month study period, and the results of a 9-month telephone follow-up to patients and their physicians. Sixty-five percent of the study population had no organic disease explanation for the entry symptoms, thereby representing irritable bowel syndrome for this study. A similar proportion and type of organic disease and irritable bowel syndrome were experienced by men and women. For the total sample of 97 subjects, the correlation of the Manning criteria with irritable bowel syndrome was 0.22 (P less than 0.01). In the 61 women, correlation between the Manning criteria and irritable bowel syndrome was significant (r = 0.47; P less than 0.01). In the 36 men, however, the correlation was in the opposite direction, although it was not significant (r = -0.16). It was concluded that significant gender differences exist when using the Manning criteria for the diagnosis of irritable bowel syndrome and that the Manning criteria were not of diagnostic value in men.

Acute sulfasalazine overdose.

Sulfasalazine (salicylazosulfapyridine, Azulfidine) has been widely used over the last half century for inflammatory bowel diseases, but overdose has not been reported. A 23 year-old male ingested 25 g of sulfasalazine in a suicide attempt. He underwent prompt treatment and survived with no ill-effects.

Psychosocial factors are associated with health care seeking rather than diagnosis in irritable bowel syndrome.

The objective of this prospective study was to test the hypothesis that 6 reportedly important psychosocial factors were useful criteria for diagnosing the irritable bowel syndrome. Ninety-seven new patients with entry complaints of abdominal pain, altered bowel habits, or both underwent full evaluation by board-certified or -eligible gastroenterologists in an outpatient setting. The independent measures were 6 questionnaires concerning anxiety, depression, stress, lack of social support, somatization, and abnormal illness behavior. The dependent measure, irritable bowel syndrome, was defined as the absence of an organic disease explanation for patients' entry complaints. Two other board-certified gastroenterologists, independent of the study, made this determination. Their rating was based on full review of transcripts of patients' clinic visits, laboratory data, and the results of a 9-mo telephone follow-up to patients and their physicians. Sixty-five percent of the sample had no organic disease explanation for the entry symptoms, thereby representing irritable bowel syndrome. The psychosocial predictors did not show a significant association with irritable bowel syndrome; the power of the study was 0.86. Post hoc analysis revealed that patients with organic disease, as well as patients with irritable bowel syndrome, had significantly more (p less than 0.01) psychosocial abnormality than normal subjects, which likely contributed to the inability of the psychosocial predictors to distinguish irritable bowel syndrome from organic disease. It was concluded that psychosocial criteria were of limited value in differentiating irritable bowel syndrome from organic disease but that they were determinants of health care seeking for the entire study group.

Effects of desipramine on irritable bowel syndrome compared with atropine and placebo.

Antidepressant treatment trials of irritable bowel syndrome (IBS) have suggested beneficial effects. Twenty-eight patients with the disorder (9 constipation-predominant, 19 diarrhea-predominant) completed a double-blind crossover study using desipramine, atropine, and placebo in random sequence. A four-week observation period preceded three six-week test periods. Bowel habits, abdominal distress, and affect were reported daily and in biweekly evaluations. Psychological assessments and rectosigmoid contractile studies were done in each period. Stool frequency, diarrhea, abdominal pain, depression, and slow contractions decreased significantly more in diarrhea-predominant patients during desipramine compared with placebo and atropine treatments. Diarrhea-prone patients' depression scores fell more in all periods than constipation-prone patients. Fifteen patients (13 diarrhea-predominant) improved globally during desipramine, five during placebo and six during atropine treatments. Desipramine may be helpful in treating IBS, perhaps through antidepressant and antimuscarinic effects.

On the loss of uricolytic activity during primate evolution--I. Silencing of urate oxidase in a hominoid ancestor.

Urate oxidase activity is not detectable in liver homogenates from the gibbon, orangutan, chimpanzee, gorilla and human. Liver homogenates from five genera of Old World and two genera of New World monkeys have easily detectable levels of urate oxidase activity. There is no evidence for extant detectable intermediate steps in the loss of urate oxidase activity in the hominoids. Urate oxidase activity from Old World and New World monkeys is stable, a simple observation which debunks a long-standing myth. Urate oxidase activity was silenced in an ancestor to the five living genera of hominoids after divergence from the Old World monkeys.

False positive liver scan due to a thin left hepatic lobe.

A young man with pectus excavatum and Gilbert's syndrome was found to have an abnormal hepatic photoscan, repeatedly interpreted as showing a mass lesion in the left lobe. Although his habitus suggested that it was a normal anatomic variant, numerous diagnostic procedures did not convincingly exclude disease of the liver. Peritoneoscopy confirmed that the left lobe was thin but otherwise normal. We review the causes of false positive liver scans.