Gall stones induced by octreotide EDITOR, -The beneficial effects of treatment with octreotide are accompanied by an increased risk of gall stones.Grant W Bigg-Wither and colleagues found that in 22 patients (13 of whom had acromegaly) octreotide increased the fasting gall bladder volume; they propose that this may predispose to the formation of gall stones.'We believe, however, that this is unlikely to be the main factor in the pathogenesis of gall stones induced by octreotide.We have measured fasting gall bladder volumes in nine acromegalic patients before and after octreotide and found no significant increase during treatment.2Furthermore, although the fasting gall bladder volume in 31 untreated acromegalic patients was 30% larger than that in normal subjects, we found only a minor increase in the prevalence of gall stones.3Octreotide impairs contraction ofthe gall bladder in response to a fatty meal and increases the residual volume of the gall bladder.This might be expected to promote the formation of stones because of relative stasis of the gall bladder.The residual volume of the gall bladder in untreated acromegalic patients, however, is three times that ofnormal subjects and yet the increase in gall stone prevalence in these individuals is small.Our data suggest that although a reduction in gall bladder emptying may well play a role in the formation of stones, an increased fasting gall bladder volume is not a major factor in their pathogenesis.Native somatostatin increases the cholesterol saturation in bile,4 and we have found similar changes in acromegalic patients with gall stones associated with octreotide.5These observations suggest that changes in bile chemistry may be at least as important as motor dysfunction of the gall bladder in the pathogenesis ofgall stones induced by octreotide.
Abstract We report four cases of collagenous colitis. These show the variable course of the disease and emphasise the difficulties that this involves in assessing therapy.
Background Colonic manometry is performed using either colonoscopically assisted catheter placement, after bowel preparation, or nasocolonic intubation of the unprepared bowel. There has been little systematic evaluation of the effects of bowel cleansing upon colonic propagating pressure wave sequences. Methods Eight healthy volunteers underwent nasocolonic placement of a water-perfused silicone catheter which recorded pressures at 16 recording sites each spaced 7.5 cm apart in the unprepared colon for 24 h. These measures were compared with those obtained in another eight healthy volunteers in whom the catheter was placed to the caecum at colonoscopy in the prepared colon. Key Results The colonic motor responses to meals and morning waking, and the normal nocturnal suppression did not differ between the two groups, nor were the overall frequency, regional dependence nor extent of propagating sequences (PS) influenced by bowel preparation. Bowel preparation did result in a significant increase in the frequency of high amplitude PS (22 ± 7 vs 8 ± 4 HAPS/24 h; P = 0.003). Additionally, a number of the measures of spatiotemporal organization among consecutive PS (linkage among sequences and predefecatory stereotypical patterning) were significantly altered by bowel preparation. Conclusions & Inferences The overall frequency of PSs, the colonic responses to physiological stimuli such a meal and morning waking and nocturnal suppression, are not influenced by prior bowel preparation. However, investigators wishing to study HAPS frequency, or the more complex spatiotemporal relationships among consecutive PSs, should control for bowel preparation when making comparisons among study groups.
Background The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate 'manometric signatures' that may serve as biomarkers of the disorder. Methods In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5 cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24 h. Key Results Pan-colonic, 24 h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the mid-colon (P = 0.01), as a consequence of a significant (P < 0.0001) decrease in extent of propagation of PS originating in the proximal colon; an increase in frequency of retrograde PS in the proximal colon; a significant reduction in the spatiotemporal organization among PS (P < 0.001); absence of the normal nocturnal suppression of PS. Conclusions & Inferences Pan-colonic, 24 h, spatiotemporal pressure mapping readily identifies characteristic disorganization among consecutive PS, regions of diminished activity and absent or deficient fundamental motor patterns and responses to physiological stimuli. These features are all likely to be important in the pathophysiology of slow transit constipation.
Abstract Patients with acromegaly are at increased risk of colorectal neoplasia and, by analogy with high-risk nonacromegalic patients, may require regular colonoscopic screening. However, it is unknown whether the risk is equal in all patients or whether some should be regarded as carrying a particularly high risk. The aims of this study were: 1) to establish the natural history of colorectal neoplasia in acromegaly; 2) to establish which patients are at increased risk of developing neoplasia; and 3) to elucidate the influence of insulin-like growth factor I (IGF-I) in adenoma formation. A prospective colonoscopic evaluation of the development of new premalignant adenomas in the colon was performed in 66 patients with biochemically proven acromegaly who had previously undergone colonoscopic screening and removal of all visible polyps. Twenty-five patients (38%) had a total of 37 polyps detected at the second colonoscopy: nine (14%) had at least one adenoma, and 18 (27%) had one or more hyperplastic polyps (2 patients had both). The development of new adenomas, but not hyperplastic polyps, was associated both with elevated serum IGF-I (P < 0.005) and, to a lesser extent, with a previous adenoma at the original colonoscopy (P < 0.07). In summary, patients with acromegaly and in whom serum IGF-I remains elevated and/or who have had a previous adenoma should be regarded as having an especially high risk for the development of subsequent colorectal neoplasia. Serum IGF-I seems to be implicated in the development of colorectal neoplasia in acromegaly, although the exact mechanisms remain uncertain.
Since 1956 to the time of his death he was head of this department which in 1970 was incorporated in the newly consti tuted Institute for Clinical and Experimental Medicine.For 30 years Pavel Fabry and his collaborators studied intensively problems of biochemical mechanisms and pathophysio logical consequences of nutritional adapta tions.In the fifties and sixties this research was focussed in particular on investigations of the metabolic effects of infrequent food intake.This pioneering work, the results of which were published in hundreds of papers and summarized in several monographs, was highly valued at home and abroad.
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