Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome.

UNLABELLED: Recent evidence suggests that psychological factors may affect esophageal as well as intestinal motility. To study this further, we compared the psychological profiles of 20 irritable bowel patients and 20 patients with recurrent noncardiac chest pain associated with high-amplitude peristaltic contractions in the distal esophagus, the "nutcracker esophagus." Three control groups with 20 patients each also were evaluated. The Millon Behavioral Health Inventory was administered to all subjects. This is a 150-item self-report instrument developed to assess psychological impact of medical illnesses in nonpsychiatric populations. The nutcracker and irritable bowel patients differed significantly (P less than 0.05) from controls on scales of gastrointestinal susceptibility and somatic anxiety, suggesting that these patients react to psychological stress with an increase in symptom frequency and severity. They also tend to be hypochondriacal and seek early medical care. Irritable bowel patients, however, have a more generalized disorder, as they also scored significantly higher (P less than 0.05) than the other groups on three general measures of depression and anxiety. CONCLUSION: as previously observed in the irritable bowel syndrome, emotional factors may modulate pain perception in the nutcracker esophagus. Simple psychometric instruments like the Millon Behavioral Health Inventory may be useful in identifying these patients who may benefit from psychotropic drugs or behavior modification.

Tracheoesophageal fistula: a serious complication of infectious esophagitis.

Infections of the esophagus are common in individuals with altered immune status. A review of the literature reveals that, in such patients, fungal organisms, particularly Candida and Aspergillus, can invade deeply into esophageal muscle. We report the development of a tracheoesophageal fistula following polymicrobial infectious esophagitis. This case, of a young woman with leukemia, emphasizes the need for early recognition and aggressive treatment of esophageal infections.

The extent of successful colonoscopy: a second assessment using modern equipment.

Records of 200 consecutive and unselected colonoscopies were reviewed to determine both the success in viewing the entire colon and the average extent of colon visualized, using the most modern equipment. Colonoscopy was completed to the cecum or ileum in 82.5% of studies, and an average of 93.8% of the colon was viewed. These data show considerable improvement compared to those previously reported by us. However, the significant number of incomplete colonoscopies still suggests that colonoscopy and barium enema examination must remain complementary for maximum detection of colonic lesions.