Enterotachogram analysis to distinguish irritable bowel syndrome from Crohn's disease.

Crohn's disease is often initially misdiagnosed as irritable bowel syndrome. The goal of this research was to determine if computerized auscultation (fasting enterotachogram analysis) could have a role in distinguishing between these diagnoses. Patients with irritable bowel syndrome, Crohn's disease, and a control group were enrolled in the study. The fasting sound-to-sound interval, standard deviation of the interval, sounds per minute, and percentage time involved with bowel sounds was determined by computerized enterotachogram analysis. The mean sound-to-sound interval for the Crohn's group (1232 msecs) and the controls (1706 msecs) was significantly higher than the irritable bowel group (511 msecs, P < 0.0001). We conclude that Crohn's is not characterized by a shortened interval. The high negative predictive value of the fasting enterotachogram for irritable bowel syndrome suggests that an interval greater than 740 msecs should trigger a search for an alternative diagnosis to irritable bowel. Crohn's disease should be included in that differential.

A single blind randomized endoscopic study comparing the effects of diflunisal and naproxen in patients with osteoarthritis.

A single blind randomized endoscopic study comparing the effects of diflunisal and naproxen on the gastric and duodenal mucosa of 34 patients with osteoarthritis was performed over a 2-week period. At the dosages utilized in the study, diflunisal produced significantly less gastric injury than naproxen, as assessed by mean gastric injury scores (p = 0.0002). Sixty-five percent of the diflunisal treated group had no evidence of gastric mucosal injury compared with 13% in the naproxen group. Moreover, treatment with diflunisal resulted in a significantly lower incidence of severe gastric injury than naproxen (p less than 0.01).

Comparison of different methods for endoscopic hemostasis of bleeding canine esophageal varices.

Despite advances in the therapy of acute esophageal variceal hemorrhage, morbidity and mortality remain high. Continued severe variceal hemorrhage remains a major clinical problem in poor risk patients who cannot tolerate emergency surgery for hemostasis. Several endoscopic hemostatic methods might be effective for variceal hemostasis, but they have not been systematically evaluated. Using a reproducible canine model of esophageal varices, several hemostatic modalities were tested and compared to determine which were most effective in stopping variceal bleeding. Methods tested were endoscopic sclerotherapy, organ laser, neodymium-yttrium-aluminum-garnet laser, monopolar electro-coagulation, bipolar electrocoagulation, ferromagnetic tamponade, and endoscopic heater probe. Both neodymium-yttrium-aluminum-garnet laser and endoscopic sclerotherapy provided reliable hemostasis in acutely bleeding canine varices. Large heater probe controlled bleeding 50% of the time, and all the other methods stopped bleeding in less than half the trials. Rebleeding after balloon inflation proximal to the coagulated bleeding site did not occur with neodymium-yttrium-aluminum-garnet laser or endoscopic sclerotherapy-treated varices but did occur with the other methods. The principal differences between neodymium-yttrium-aluminum-garnet laser and endoscopic sclerotherapy were the ease of application of neodymium-yttrium-aluminum-garnet laser, the higher frequency of esophageal ulcers or erosions with neodymium-yttrium-aluminum-garnet laser, and the lack of variceal obliteration with neodymium-yttrium-aluminum-garnet laser.