Gastric residue is not more copious in obese patients.

IMPLICATIONS: Previous studies have shown that obese patients have a larger volume of gastric content than lean patients do. However, methodological limitations call into question the validity of these findings. We have reexamined this issue and found identical gastric content volumes in fasting obese and lean subjects after an 8-h fast.

[Epidemiology of gastro-esophageal-reflux in general practice. . Predictive factors for health care utilization in the course of a year]. / Epidémiologie du reflux gastro-oesophagien en médecine générale. Facteurs prédictifs de la consommation de soins sur un an.

AIM: To assess the epidemiology and course of GORD, treatment demand, and factors predictive of GORD course in a 1-year study in patients with heartburn consulting general practitioners. METHODS: A total of 984 patients with pyrosis were included by general practitioners. After the initial visit, they had follow up at 3, 6 and 12 months by phone contact. RESULTS: Most patients (87%) had been suffering from heartburn for 4+/-1.5 years; upper GI endoscopy had been performed in 63% of patients. Patients evaluated the symptoms of the current episode as mild (6%), moderate (60%), or severe/incapacitating (34%). During the year of follow up, 12% of the patients were free of heartburn; the mean number of consultations with general practitioners and gastroenterologists was 5.1 and 0.5 respectively. At day 90, discomfort due to heartburn was absent in 4% of patients, slight in 51%, moderate in 32%, and severe in 6%. At day 360, predictive factors for discomfort were: discomfort related to heartburn on D90, the length of time the patients had been suffering from GORD, and the main reason for consultation on D1; patients for whom heartburn was not the main reason for consultation on D1 experienced a higher level of discomfort. The predictive factors for the extent of treatment demand over 12 months were: age, discomfort related to heartburn on D90, severity on D1, the frequency of episodes prior to the episode on D1 and the levels of stress and anxiety measured on D1. CONCLUSIONS: Epidemiologic characteristics of patients with heartburn consulting a general practitioner were different from these of the general population. Treatment demand depends both on severity of heartburn and level of stress and anxiety.

Twenty-four-hour intragastric acidity and plasma gastrin during 3-month treatment with omeprazole in healthy subjects.

BACKGROUND: Prolonged treatment with omeprazole 20 or 40 mg/day is sometimes required, especially for severe oesophagitis. However, information about long-term effects on intragastric acidity and plasma gastrin response with such drug regimens is scarce. METHODS: Sixteen healthy subjects (11 men, 5 women, mean age 29 years) randomly received either 20 or 40 mg of omeprazole once daily (at 08.00 h) for 3 months. Gastric pH was recorded every 6 s for 24 h from noon to noon under standardized conditions, and blood samples were collected hourly in order to determine the 24-h plasma gastrin response on day 0 (pre-entry), day 7, day 28 and day 90. RESULTS: From day 0 to day 7, 24-h median pH increased from 1.7 to 4.6 and mean percentage of time at pH < 4 decreased from 89% to 35% with omeprazole 20 mg. Respective values with omeprazole 40 mg were 1.9 to 4.3, and 89% to 34%. Inhibition of gastric acidity remained unchanged during the 3 months of treatment. Despite similar effects on the basis of 24-h analysis, the decrease in daytime acidity was slightly higher with omeprazole 40 mg than with omeprazole 20 mg. Twenty-four-hour integrated plasma gastrin significantly increased with both drug regimens between day 0 and day 7 (P < 0.01), and between day 7 and day 28 (P < 0.01) with omeprazole 40 mg; there was no significant increase between day 28 and day 90 with either of the drug regimens. CONCLUSION: Omeprazole 20 and 40 mg/day provides long-term stable acid suppression with a progressive increase in gastrin response, stabilizing after 2 months of treatment.

Multivariate analysis of pathophysiological factors in reflux oesophagitis.

BACKGROUND: Reflux oesophagitis is considered a multifactorial disease, but the respective roles of the main factors involved in its pathophysiology have not been clearly established. AIMS: To attempt to assign these roles by means of a multivariate logistic regression analysis of the main parameters associated with reflux oesophagitis. PATIENTS: Eighty seven patients with gastro-oesophageal reflux disease were studied: 41 without oesophagitis and 46 with reflux oesophagitis grade 1 to 3. METHODS: (1) Monovariate comparison of patients' characteristics and of parameters derived from in hospital 24 hour oesophageal pH monitoring, oesophageal manometry, double isotope gastric emptying studies, and basal and pentagastrin stimulated gastric acid and pepsin output determinations, between patients with and without oesophagitis. (2) Multivariate logistic regression analysis including the parameters significant in the monovariate analysis. RESULTS: Among the 16 significant parameters from monovariate analysis, three significant independent parameters were identified by multivariate logistic regression analysis: number of refluxes lasting more than five minutes, reflecting oesophageal acid clearance (p = 0.002); basal lower oesophageal sphincter pressure (p = 0.008); and peak acid output (p = 0.012). These three parameters were not correlated with each other. The multivariate model was highly discriminant (correct classification of 81.3% of the cases (95% confidence intervals 0.723, 0.903). Risk for oesophagitis increased as a function of the tercile threshold values of the three parameters. Odds ratios of the three parameters for oesophagitis risk were similar, regardless of whether they were calculated when the patients were compared as a function of oesophagitis grade or the presence or absence of oesophagitis. CONCLUSIONS: This multivariate approach adds evidence that impaired oesophageal acid clearance and hypotonic lower oesophageal sphincter are the two major independent pathophysiological factors of oesophagitis, but also showed that the acid secretion level is an independent pathophysiological factor.

[Effect of Ramadan fasting on intragastric pH recorded during 24 hours in healthy subjects]. / Effet du jeûne du ramadan sur le pH intragastrique enregistré sur 24 heures chez le sujet sain.

OBJECTIVES: Lifestyle changes during Ramadan as the meals are taken exclusively in the evening, and nightly sleep is often delayed and shortened. The wake/sleep cycle is also modified. The aim of this study was to evaluate the influence of Ramadan on gastric acidity in healthy volunteers. METHODS: Nine healthy volunteers had 24-hour measurement of the gastric pH; 4 periods were compared: one week prior to Ramadan, day 10 and day 24 during Ramadan, and one month after Ramadan. The pH profiles and the [H+] activity (area under the curve) were measured during 24 hours, the night phase (5PM-8AM) and diurnal phase (8AM-5PM). RESULTS: The diurnal variations of the pH profile were more significant; the median pH was 2.3 prior to Ramadan, 1 at day 10 and day 24 and 1.6 one month after Ramadan. The 24-hours [H+] activity increased by 45% at day 10 of Ramadan compared with its level prior to Ramadan. This increase was mostly diurnal (+122%) and also nightly (+25%). The activity [H+] was steady during Ramadan. One month after Ramadan, the 24-hours [H+] activity was 23% higher than the one noted before Ramadan. CONCLUSIONS: This study shows that the conditions of feeding imposed by Ramadan are associated with an increase of the gastric acidity mainly in diurnal phase. These results do not explain the origin of the healthy volunteer digestive symptoms encountered during Ramadan.

[Hepatic psittacosis: a case of liver abnormality diagnosed by ultrasonography]. / Psittacose hépatique: un cas avec anomalie échographique du foie.

Psittacosis marked by liver and spleen involvement and minimal pericarditis was observed in an 18-year-old patient hospitalized for fever of 1 month duration. At admission, there was no other clinical manifestation and the chest X-ray showed no sign of pulmonary involvement. Liver tests revealed cholestasis. Ultrasonography of the abdomen revealed multiple nodular formations in the liver and spleen, images confirmed on computed tomography. Liver biopsy showed granulomatous with hyperplasia of the Kupffer cells surrounded by healthy tissue. Complement fixation to psittacosis antigen was positive and increased significantly over a 15-day interval. Treatment with tetracycline led to rapid remission of the fever and normalization of the liver tests and hepatic images. Liver involvement in psittacosis is not uncommon, but this is apparently the first case reporting echographic anomalies. The absence of pulmonary involvement has been reported earlier in a few cases. The diagnosis is usually suggested on the basis of epidemiologic criteria and confirmed by complement fixation.

Gastric distension, hunger and energy intake after balloon implantation in severe obesity.

OBJECTIVE: To investigate the interrelationships between satiety feelings, abdominal perception, energy intake and weight loss, related to the presence of an intragastric balloon. DESIGN: Randomized double blind study. SUBJECTS: 20 severely obese subjects, BMI > 40 kg/m2, randomly assigned either to receive an air filled balloon (n = 11) or to have a sham procedure (n = 9). All subjects had dietary counselling to help them follow a relatively low energy diet (60% of individual spontaneous intake). MEASUREMENTS: During biweekly visits, body weight was recorded, visual analogic scales for stomach distension, hunger and feeling of balloon presence were completed. Blood chemistry profiles were monitored once every 4 weeks. RESULTS: In the balloon group, the sensations related to the presence of the balloon and to abdominal distension dramatically increased after insertion, and plateaued during the next 4 weeks. Both feelings of presence and distension decreased thereafter, and after 10 weeks they were not significantly different from those of the sham balloon group. Hunger dramatically decreased to about 30% of initial rating in the first week, but slowly returned to the initial value by the 12th week. Hunger feelings were highly and negatively correlated with feelings of distension. During the same period, the sham balloon group continued to maintain the low energy intake, and did not register any feelings of distension or presence; hunger level did not differ from initial levels throughout the whole study. The energy intake and the rate of weight loss (8-9 kg) was similar in the two groups during the study, and were not correlated with the feelings of distension. CONCLUSION: This study showed that in severely obese subjects submitted to a restrictive diet, an intragastric balloon has a measurable but transient effect on the sensation of epigastric distension and is able to decrease feelings of hunger. Unfortunately, these effects were not associated with a lower energy intake or a higher rate of weight loss than the sham situation. Thus, the present study does not support the interest of such a balloon (500 ml, air filled) in the treatment of severe obesity.

[Diagnosis of colitis caused by cytomegalovirus infection in AIDS. Comparative value of total colonoscopy and rectosigmoidoscopy (apropos of 24 cases). AIDS GIT]. / Diagnostic de colite à cytomégalovirus au cours du SIDA. Valeur comparative de la coloscopie totale et de la rectosigmoïdoscopie (à propos de 24 cas). AIDS GIT.

OBJECTIVES: To evaluate the respective diagnostic value of flexible rectosigmoidoscopy and colonoscopy in the cytomegalovirus colitis. METHODS: Twenty-four patients with AIDS were studied retrospectively. The entry criteria were: flexible rectosigmoidoscopy or colonoscopy, with 2 rectal and 2 caecal biopsies, presenting cytomegalovirus inclusions bodies linked to an inflammation at least on one colonic biopsy. RESULTS: Twenty-four patients had 29 colonoscopies. In 16 cases colonoscopy was performed to the caecum. The endoscopic findings of the 16 full colonoscopies were: 7 right colitis, 5 diffuse colitis, 2 bisegmentary colitis, 1 proctitis and 1 non endoscopic lesion. The histologic findings of the 16 full colonoscopies were: 5 cytomegalovirus inclusions on rectal biopsies and 16 on caecal biopsies. For the 13 incomplete colonoscopies, 11 had inclusions on rectal biopsies. So the flexible rectosigmoidoscopy was not sufficient to find inclusions 13 times out of 29. CONCLUSION: Our study indicates that in the cytomegalovirus colitis, inclusions predominate in the caecum, isolated right colitis exists and extra-colonic cytomegalovirus disease is not always found. For these reasons full colonoscopy is necessary for diagnosis in patients with normal flexible rectosigmoidoscopy.

[Helicobacter pylori, a rediscovered bacterium. Implication in gastroduodenal diseases]. / Helicobacter pylori, une bactérie redécouverte. Son implication dans les maladies gastro-duodénales.

Helicobacter pylori is a microaerophilic bacterium initially found in the gastric antrum of patients with peptic ulcer disease. As a result, H. pylori is now believed to have a pathophysiologic role in gastritis as well as in peptic ulcer disease. Several recent studies showed that it may be associated with duodenal ulcer relapse and that eradication therapy using antibiotics may significantly decrease the ulcer recurrence rate in duodenal ulcer patients. Moreover, epidemiological studies suggest that it may increase the relative risk of carcinoma in the stomach and preliminary studies seem to indicate that some low-grade lymphoma in the stomach may regress after H. pylori eradication. Although the mechanisms by which H. pylori induces mucosal injury and/or neoplasm is not clearly understood, several modifications in gastric functions have been reported. The most specific way of detecting H. pylori in tissue is a combination of culture and histologic staining of mucosal biopsy specimens obtained by endoscopy. Rapid urease test, cytology and PCR procedures performed on biopsies may give rapid, sensitive and specific results. Breath test using 13C- or 14C-radiolabelled urea and serology tests are of particular importance when H. pylori diagnosis is needed via no invasive procedures. Helicobacter pylori is supposed to interact with G and D cells. Gastrin and somatostatin are synthetized and released from antral G and gastric D cells respectively. The gastric D cells are in close contact with either G and parietal cells. Gastrin stimulates gastric acid secretion and epithelial gastric cell proliferation (parietal and EC-L cells) while somatostatin inhibits these effects. Chronic gastritis is associated with fundic duodenal ulcer disease. In this situation, basal gastrin and meal- or bombesin-stimulated gastrin in the serum (especially gastrin G17) have been found to be higher in H. pylori positive than in negative patients. Moreover, gastrin decreases up to normal levels after eradication of H. pylori. The long term effect of a such hypergastrinemia is not so far established. The mechanism underlaying hormonal modification is poorly understood. Since no G/D cell ratio modification could be found after H. pylori eradication while the amount of somatostatin increases, one would suggest functional alteration of either G or D cells in the H. pylori-related chronic gastritis. The role of inflammatory mediators on the gastrin release and the processing of progastrin induced by the bacterium need further investigations.

[Helicobacter pylori and gastroduodenal disease]. / Helicobacter pylori et pathologie gastroduodénale.

Gastroduodenal infection by Helicobacter pylori is a known cause of many gastric and duodenal disorders. Infection by H. pylori is very frequent ant its prevalence increases with age by about 1% per year. Human-to-human transmission appears probable. H. pylori lives under the mucous layer of gastric-type epithelium. It is the main causal agent of chronic diffuse superficial gastritis (type B). After several decades lesions of superficial gastritis can evolve to atrophic gastritis. Spontaneous short- or long-term disappearance of H. pylori from the antral mucosa is rare. H. pylori infection appears to be necessary for the recurrence of duodenal as well as gastric ulcer. Eradication decreases the frequency of relapses, but its long-term effect remains to be evaluated. The presence of H. pylori, however, is not itself sufficient for ulcer development. Why only some patients infected with H. pylori develop ulcer has not been elucidated. The role of H. pylori infection in the gastrotoxicity of non-steroid anti-inflammatory agents is still debated. It has not yet been determined whether eradication leads to reduction of the high digestive morbidity linked to intake of such agents, but it is known that eradication of H. pylori does not obviate the risk of ulcer and of complication. There is a significant association between H. pylori infection, atrophic gastritis and intestinal type gastric cancer. H. pylori infection appears to be one of the factors in gastric cancerogenesis. Cellular proliferation of gastric lymphomas to low-grade B cells would in most cases be secondary to chronic H. pylori infection.(ABSTRACT TRUNCATED AT 250 WORDS)