A bismuth-peptide complex (BCP Compound), an antacid (Maalox) and corresponding placebos were studied in a 6-week comparative double-blind trial of treatment in 106 randomized ambulant patients with endoscopically proven duodenal and gastric ulcers. Patients were examined after 1, 3 and 6 weeks' treatment and results assessed separately for duodenal and gastric ulcers on endoscopic evidence at weeks 3 and 6 respectively. Bicitropeptide was significantly better than antacid and placebo at 3 and 6 weeks for treatment of both duodenal and gastric ulcers. In the bicitropeptide group 100% of the patients in the duodenal ulcer group and 95,2% in the gastric ulcer group responded to treatment (improved or healed). No haematological or biochemical changes were noted and no adverse effects were recorded.
Serum immunoglobulin concentrations were measured in 40 patients with calcific pancreatitis. A significant elevation of the mean serum IgA and IgG concentration when compared with a control group was found. The IgA was raised in 50% and the IgG in 27·5% when the individual results were assessed. The IgA did not appear to be of the secretory type. The possible significance of the raised IgA and IgG is discussed with reference to local pancreatic IgA production, autoimmune factors in chronic pancreatitis, and the ductal protein plugs in this disease.
The value of emergency upper gastrointestinal fibre-endoscopy, followed where required by the use of a modified Sengstaken tube, was studied during 84 episodes of acute bleeding in 75 patients who had evidence of portal hypertension with varices. The portal hypertension was due to alcoholic cirrhosis in 80% and to cryptogenic cirrhosis in 9% of the patients. By definition, varices were present in all patients, but in only 66% of episodes were the varices the cause of the bleed. The correct diagnosis of the source of bleeding was made at endoscopy in 89%. A Boyce modification of the Sengstaken-Blakemore tube was passed in 73% of the episodes of variceal bleeding. It effectively stopped the bleeding primarily in 85% of patients but was successful as a final definitive measure only in 46%. Furthermore, only 40% of the patients in whom the tube was passed, survived. Mortality rate could be related to the severity of the bleed and to hepatocellular dysfunction. Survival increased from 23% in those patients with jaundice, ascites, and encephalopathy on admission to 92% in those without these manifestations. The in-hospital survival rate was 52% in patients bleeding from varices and 64% in those bleeding from other causes, with an overall survival rate of 56%, indicating the poor prognosis in cirrhotic patients with gastrointestinal bleeding, irrespective of the cause.
We have reviewed all endoscopies performed in our hospital between 1977 and 1986. During that period, 1337 endoscopies were performed to identify bleeding from peptic ulcers. Excluded were cases in which a predisposing factor was found, such as the use of ulcerogenic drugs. Also excluded were chronic or critically ill patients. The remaining 540 cases were reviewed. In 447 of those cases, the bleeding lesion was a duodenal ulcer, whereas, in 93 cases, a gastric ulcer was found (a ratio of 5:1). The seasonal variation in the incidence of bleeding from peptic ulcers was evaluated. We found a significant difference in bleeding in the cold and hot seasons, the incidence being significantly greater during the cold season (November until February). A similar pattern was found for bleeding from both duodenal and gastric ulcers.
The radiological and endoscopic appearance of “etat mammelonne” has been attributed to hypertrophic gastritis or prominence of the areae gastricae. An additional cause for this appearance is described in two patients with benign lymphoid hyperplasia of the gastric antrum. The significance of these lesions is discussed.
Case l: An 83-year-old minister of religion has been diagnosed (biopsy proven) as having an inoperable pancreatic cancer. He has a strong family history of gastrointestinal cancers and has tended to have episodes of depression, requiring psychiatric treatment in the past. His three daughters and two sons vehemently oppose telling their father either the diagnosis or the prognosis.
The radiological appearances of tuberculosis of the gastro-intestinal tract are presented. One hundred and seventeen cases were seen at the Groote Schuur Hospital over the period 1962–71. In only 44 cases was there evidence of pulmonary tuberculosis. The series included three cases of oesophageal, two of gastric, three of pyloroduodenal, and ten of mesenteric lymph-node tuberculosis, 17 cases of malabsorption or protein losing enteropathy, three of small bowel strictures, 11 ileocaecal lesions, 10 colonic tubercle and 58 of tuberculous peritonitis. The appearance of tuberculosis of the gastro-intestinal tract radiologically depends on the presence of ulceration, fibrosis, enlarged lymph nodes, or caseous lesions with abscess formation. The differentation of tuberculosis from neoplasms or Crohn's disease is discussed and the difficulty and limitations of radiology in this condition is stressed.
The presence of gastric epithelium or mucosa at any level of the gastrointestinal tract is a well-known phenomenon. In duodenal mucosa, congenital heterotopic gastric mucosa or acquired metaplastic gastric surface epithelium (MGE) may be found. In the present study 325 duodenal biopsies (260 upper gastrointestinal endoscopy and 65 abdominal surgery biopsies) from 297 patients were retrospectively reviewed. Normal duodenal mucosa was present in 119 specimens, duodenitis in 155 and duodenal ulcer in 51. Heterotopic gastric mucosa was present in only one patient with duodenal ulcer, and MGE in 31% of the biopsies with a normal mucosa, in 21.7% with duodenitis and in 82% with duodenal ulcer (P less than 0.01). MGE was present in 120 biopsies of 109 patients--68 men and 41 women, 91% Jews, and 9% Arabs. The hospitalized population of our region comprised 82% Jews and 18% Arabs. Duodenal ulcer was more frequently found in Arab (69%) than in Jewish patients (41%). We conclude that MGE is a common finding, even in the presence of normal duodenal mucosa (30%) and occurs in most (80%) duodenal ulcer cases. The fact that MGE is more frequent in the Jewish population suggests that a genetic factor may be involved.
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