A. H. G. Love

Three- to 4.5-Year Prospective Study of Prognostic Indicators in Gastro-oesophageal Reflux Disease

BACKGROUND Data on the long-term natural history of gastro-oesophageal reflux disease (GORD) are sparse. This prospective study was designed to determine the clinical outcome on the basis of therapeutic requirements 3 to 4.5 years after initial diagnosis of GORD and to identify specific prognostic indicators of a poor outcome. METHODS One hundred and one GORD patients were followed up by symptomatic questionnaire 3 to 4.5 years after diagnosis and offered repeat investigation with endoscopy and oesophageal pH monitoring if symptoms persisted. RESULTS Seventy-seven (76%) patients responded (mean follow-up period, 39 months; range, 32-54 months); of these, 28 had grade-II or -III oesophagitis at initial endoscopy, 17 had normal endoscopy but abnormal pH monitoring, and 32 had normal investigations but frequent heartburn. At follow-up 32 (42%) were taking acid suppression therapy, and a further 15 patients started acid suppression therapy after repeat investigation indicated a need to do so, giving a total of 47 (61%) patients receiving acid suppression. The following factors predicted a need for acid suppression at follow-up: oesophagitis on initial endoscopy (P = 0.009), abnormal pH monitoring (P = 0.0005), increased age (P < 0.0005), and increased body mass index (BMI) (P = 0.001). Gender, smoking status, alcohol intake, and lower oesophageal sphincter pressure had no prognostic value. Regression analysis confirmed that age (P = 0.0007), BMI (P = 0.04), and endoscopy result (P = 0.04) all independently affected outcome. CONCLUSIONS Most GORD patients still require acid suppression therapy 3 to 4.5 years after initial diagnosis. Age, BMI, and presence of oesophagitis at initial endoscopy all independently predict those who will require long-term acid suppression therapy.

Anthropometric Measurements in the Elderly

Anthropometric measurements (weight, skinfold thickness at triceps, subscapular and dorsum of the hand and circumference of upper arm and abdomen) of 126 aged subjects, studied in four groups, are reported. The relationship of any of these anthropometric parameters with energy intake was not significant in the majority of the groups. Abdominal circumference was the only measurement which showed a significant correlation with body weight in the males and females of the four groups. The use of abdominal circumference as an indicator of nutritional status needs further study.

Zinc Absorption in Alcoholics Using Zinc-65

Alcoholism is occasionally complicated by zinc deficiency. We have assessed the possibility that malabsorption of zinc may be a potential cause. Using a dual isotope absorption technique the absorption of 65Zn in 18 alcoholic patients was 37% (13 +/- SD) and 56% (10 +/- SD) in a normal control group (p less than 0.001). The mean serum zinc in 55 alcoholic patients was 11.6 mumol/l (3.0 +/- SD) and in 36 normal volunteers the mean serum zinc was 13.6 mumol/l (1.8 +/- SD; p less than 0.001). This study suggests that chronic alcohol abuse will decrease the absorption of zinc and this may contribute towards the zinc deficiency occasionally associated with alcoholism.

The effect of healing oesophagitis on oesophageal motor function as determined by oesophageal scintigraphy and ambulatory oesophageal motility/pH monitoring.

Oesophagitis has been shown by standard manometry to be associated with impaired oesophageal motility, but it remains unclear if this abnormality improves with healing of oesophagitis.

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double‐blind placebo‐controlled trial

There are few data on the role of prokinetic agents as maintenance therapy in moderately severe reflux oesophagitis despite the high relapse rate of this condition after healing.

An evaluation of a test using14C labelled triglyceride in the diagnosis of steatorrhoea

SummaryIntestinal fat absorption has been studied in fifty-six patients by a simplified Kaihara and Wagner technique using14C labelled triglycerides. The peak radioactivity in the expired air is attained in the majority of patients between five and seven hours after administration of the dose. The highest of these three one hourly readings of14CO2 below 30×10−4 per cent of the14C−T.G. dose per m.mol of exhaled CO2 is consistent with steatorrhoea provided there is no disturbance of lipid or general metabolism. The test is well tolerated and easy to carry out but is not reliable in the presence of obesity and uncontrolled thyrotoxicosis.

Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease

Fasting and post-prandial circulating levels of insulin, gastrin, gastric inhibitory polypeptide, pancreatic polypeptide and neurotensin were measured in patients with flatulent dyspepsia, with and without gallbladder disease and post-cholecystectomy. Levels were also measured in non-dyspeptic patients with gallbladder disease and normal controls. There were no consistent significant differences from controls for fasting and post-prandial responses in patients with a history of dyspepsia or those who experienced dyspepsia at the time of the test. In patients with gallbladder disease, with and without dyspepsia, there was a reduced neurotensin response compared to normal controls. It is concluded that circulating levels of these hormones are not related to symptoms of flatulent dyspepsia.

The effects of tolbutamide and glibenclamide on intestinal glucose absorption.

Abstract At low mucosal concentrations the hypoglycaemic sulphonylureas, tolbutamide and glibenclamide, reduced active glucose transfer by sacs of everted rat jejunum. At high drug concentrations glucose metabolism was reduced to levels observed under anaerobic conditions. It is possible that the sulphonylureas disrupt intracellular supplies of ATP, thereby affecting the intestinal transport mechanism. Long-term oral administration of glibenclamide to rats had no effect on weight gain, blood sugar levels or transfer, uptake and metabolism of glucose by gut sacs in vitro . Incubation of an open-ended gut loop, allowing replacement of both mucosal and serosal fluids, demonstrated that response to drug exposure was slow and that recovery from exposure even to high concentrations possible. It therefore seems likely than an oral dose in man under normal conditions would not maintain a sufficiently high intraluminal concentration long enough for a significant change in glucose absorption. Even if some imbalance did occur, removal of the inhibitory influence would allow a return to normal conditions.

Gastric Emptying of a Solid-Liquid Meal and Gastro-Intestinal Hormone Responses in Patients with Erosive Oesophagitis

Abnormal gastric motility has been recognised recently in some patients with excessive gastro-oesophageal reflux. The cause of this motility disturbance is unknown. A dual isotope study has been used to assess gastric emptying of solid and liquid components of a test meal in 16 patients with erosive oesophagitis and in 16 control subjects. The release of insulin, gastrin, pancreatic polypeptide, gastric inhibitory polypeptide and neurotensin in response to the test meal was monitored in all subjects. A significant delay in both solid and liquid emptying was observed in patients with erosive oesophagitis. However, they demonstrated no alteration in the pattern of hormone release in response to the test meal.

Lack of effect of bran enriched bread on plasma lipids, calcium, glucose and body weight

SummaryThe effects of a fibre-enriched diet upon 17 normal volunteers during a 5-week cross-over trial were studied. No change was found in body weight, blood glucose, plasma cholesterol, plasma triglycerides or serum calcium.