Agostinho Bettarello

Lack of Specificity of the Acid Perfusion Test in Duodenal Ulcer Patients

The acid perfusion test was performed on 36 selected patients with duodenal ulcer; 22 of them also had a diagnosis of reflux esophagitis, while the remaining 14 had no esophageal disease. Radiologic, endoscopic, and histologic studies were made to evaluate the state of the esophageal and gastric mucosae. The correlations between the presence of esophagitis and gastritis (P<0.05), between gastritis plus esophagitis and heart-burn (P<0.01), and between esophagitis plus gastritis and a positive acid perfusion test (P<0.01) were statistically significant, while the correlations between the presence of esophagitis and heartburn (P>0.05), between gastritis, and heartburn (P>0.05), and between esophagitis and a positive acid perfusion test (P<0.05) were not significant. The validity of a positive acid perfusion test as a definite diagnosis and of heartburn as a symptom characteristic of reflux esophagitis is questioned. Rather, this experiment points out that both are more apt to occur when both the esophageal and the gastric mucosae undergo inflammatory reaction.

Acute pancreatic necrosis in chronic alcoholic pancreatitis

Necrotic lesions are rarely observed in chronic pancreatitis, but its presence in a few patients has been misinterpreted in the diagnosis of acute pancreatitis. In this series, 12 patients (11.2%) of 107 operated for chronic alcoholic pancreatitis, presented with acute pancreatic necrosis associated with pancreatic fibrosis characteristic of chronic pancreatitis. Ten patients were treated by pancreatic debridement and drainage and two by distal pancreatic resections. Postoperative complications included five pancreatic fistulas and two pancreatic abscesses. Despite the severity of the pancreatic lesions which led to several complications, all the patients survived. The occurrence of pancreatic necrosis in patients with chronic pancreatitis is demonstrated.

Juxta-Ampullar Duodenal Diverticula as Cause of Bilio-Pancreatic Disease

Sixteen cases of juxta-ampullar duodenal diverticula are presented. These diverticula had an obvious participation in bilio-pancreatic pathology, such as gallstones, ductal stones and pancreatitis. Four patients had been cholecystectomized and two gastrectomized in other Services. All patients were operated on combined operations, 10 undergoing cholecystectomy, 13 choledocholithotomy and 15 papillosphincteroplasty. In 10 patients the diverticulum was removed. During the postoperative follow-up, 5 patients who did not have the diverticulum removed, presented recurrence of bilio-pancreatic symptoms and had to undergo reoperation. It is concluded that juxta-ampullar diverticula constitute a pathology that may determine involvement of the terminal parts of the pancreatic ducts. The best surgical procedure is represented by removal of the diverticulum associated to papillosphincteroplasty. When it is not possible to remove the diverticulum for technical reasons, and the bile duct being dilated, there is a recurrence of symptoms in the biliary tract. In these cases, the methods of choice are biliary-digestive derivations (Roux-en-Y or choledocho-duodenal anastomosis in gastrectomized patients, second Billroth II).

Coffee Drinking in Patients with Duodenal Ulcer and a Control Population

The ingestion of plain coffee was compared in 150 duodenal ulcer patients (DU) and 100 control subjects without digestive complaints (C). The DU and C groups were registered in accordance with their daily consumption of coffee: none, 1-100 ml, 101-300 ml, 301-500 ml, and more than 500 ml. Fifty millilitres of coffee as prepared in Brazil contain around 50 mg of a caffeine, which is 2.8 times more than in an equal volume of coffee in the United States. Patients with DU stopped drinking coffee or reduced the volume significantly after symptoms started. There was a significant change in coffee intake at all volume levels except at 1-100 ml. The main reason for the reduction of coffee ingestion was the relationship observed by the patients between the consumption of coffee and dyspeptic complaints. Our results suggest a close correlation between the ulcer-like symptoms and the amount of coffee ingested by patients with duodenal ulcer.

Esophageal manometry and vectorcardiography study of asymptomatic patients with Chagas' disease

A forma indeterminada da Doenca de Chagas e caracterizada por sorologia positiva com ausencia de manifestacoes clinicas, na presenca de resultados normais aos exames radiologico do tubo digestivo e eletrocardiografico. No presente trabalho, os autores estudam simultaneamente o esofago e o coracao, nos mesmos individuos. Treze adultos com diagnostico de forma indeterminada da Doenca de Chagas e nove adultos controles foram submetidos ao exame vetorcardiografico e a manometria esofagica em condicoes basais e sob estimulo com cloridrato de betanecol (0,08 mg/kg p.c). No grupo controle nenhum dos individuos apresentou concomitância de alteracoes esofagicas e cardiacas, enquanto no grupo chagasico 92,3% dos pacientes apresentaram exames concomitantemente alterados. Concluem que os pacientes estudados apresentam evidencias de desnervacao parassimpatica manifestada por alteracoes simultâneas esofagicas e cardiacas.

Esophagitis and Duodenal Ulcer

36 male patients (average age, 36 years) with duodenal ulcer (DU) were studied with the purpose of investigating the incidence of reflux esophagitis. Ten of them had duodenal stenosis due to scarring.

Jejunal flora of patients with megaoesophagus secondary to Chagas disease.

The jejunal flora of 15 patients with megaoesophagus secondary to Chagas disease was studied and compared with that of 15 control individuals. In addition to the serological reactions for Chagas disease (immunofluorescence and complement fixation reaction), all subjects were submitted to endoscopy and X-ray of the oesophagus, gastric secretory study and investigation of the jejunal flora. The mean bacterial counts (log10) of Chagas disease patients (4.14 +/- 2.15 c.f.u./ml) was significantly higher than those of the control group (2.83 +/- 1.34 c.f.u./ml). Aerobic bacteria were isolated from 14 Chagasic patients (maximum count 10(10) c.f.u./ml) and 7 controls (maximum count 10(5) c.f.u./ml). Anaerobes were isolated from 7 patients (maximum count 10(7) c.f.u./ml) and 1 control (10 c.f.u./ml). Controls and Chagas disease patients differed significantly in the maximum acid output, but there was no statistically significant relation between bacterial counts and maximum output.

Small Bowel Bacterial Overgrowth in Strongyloidiasis

Small bowel bacterial growth was studied in patients with strongyloidiasis, and the results were compared to controls. We concluded that in strongyloidiasis there is small bowel bacterial overgrowth, and so it should be considered in the pathogenesis of some of the gastrointestinal manifestations and complications of strongyloidiasis.

Progressive systemic sclerosis: II. Esophageal involvement. Correlation between blind biopsy of the esophagus, acid drip test, and radiology.

SummaryTwenty-two patients with progressive systemic sclerosis (scleroderma), 18 female and 4 male, between 21 and 56 years old, were divided into 2 groups according to the presence or absence of heartburn. Correlations were made between heartburn, radiological evidence of esophagitis, and acid drip test (Bernstein and Baker test). In all patients blind biopsy of the esophagus was performed with a modified Wood biopsy tube.Esophagitis was diagnosed in 12 patients with heartburn and in 2 without it. Normal mucosa was observed in 1 patient with heartburn and in 5 without it. In 3 patients gastric instead of esophageal mucosa was obtained.“Blind” biopsy may be useful in the diagnosis of esophagitis in situations in which visualized biopsies cannot be done for technical reasons.

Histologic and functional alterations of human exocrine pancreas in Manson's schistosomiasis

The exocrine pancreas of 20 patients with the hepatosplenic form of Mansons schistosomiasis and portal hypertension was examined. Surgical biopsies taken from the tail of the pancreatic gland during splenectomy and splenorenal shunts were examined histologically. Studied by the secretin test, peak bicarbonate concentrations in 16 of the 20 patients were below the lower critical statistical level; in 14 patients, marked histopathologic changes were found in the exocrine pancreas.