Arthur P. Klotz

Intestinal disaccharidase deficiencies in gluten-sensitive enteropathy

SummaryThe disaccharidase activity of the intestinal mucosa in 6 patients with gluten-sensitive enteropathy has been described. Intestinal disaccharidase activity was evaluated by disaccharide oral loads and by disaccharidase assay of homogenates of intestinal mucosa. There seemed to be some correlation between abnormalities of structure noted histologically and diminished enzyme activity. A deficiency of several disaccharidases was demonstrated with the concomitant malabsorption of oral sugar loads.Deficiency of lactase activity appeared to be the most frequent, expressing itself clinically as a lactase deficiency, as well as a lactose intolerance with lactosuria. Histological recovery and prompt symptomatic relief was noted in these patients by removing the offending disaccharide from the diet, as well as excluding gluten. Improvement in intracellular enzyme activity occurred after specific treatment.

Alterations of Alcohol Dehydrogenase and Other Hepatic Enzymes Following Oral Alcohol Intoxication

T lIE PURPOSE of this paper is to report hepatic enzyme abnormalities in adult rats subjected to chronic oral alcohol intoxication under conditions of controlled food intake. Reports in the literature demonstrate that alcohol seems to exert a direct toxic effect on >

Treatment of toxic megacolon a comparative review of 29 patients

A review of 29 patients with toxic megacolon complicating ulcerative colitis was undertaken to (1) compare the results of medical and surgical treatment; (2) determine the optimal timing for surgical intervention; and (3) identify possible precipitating factors. Twenty-one patients were treated medically with nasogastric suction, steroids, parental fluids, blood transfusion, and antimicrobial agents. Of the 21 patients, 11 (53%) showed improvement by subjective and objective creria and 10 (47%) failed to respond. Sixteen patients were treated surgically. This group was subdivided into 8 patients who failed to respond to medical treatment and 8 treated surgically. Total proctocolectomy with ileostomy was performed in 8, and subtotal colectomy and ileoproctostomy in 8, with subsequent proctectomy and ileostomy in 6 patients. Six of 8 patients (75%) treated primarily surgically improved, and 2 (25%) died. Seven of 8 patients (87.5%) treated surgically after failure of medical trial showed definite postoperative improvement, and 1 (12.5%) failed. Those who were operated on within the first 48–72 hr after the diagnosis of toxic megacolon was made responded uniformly well. Anticholinergics, opiates, barium enema, and colonoscopy were identified as possible precipitating factors in 70% of cases. The results of this study in this patient population indicate that early surgical therapy in toxic megacolon is associated with better results than medical therapy (P<0.025). Although intensive, optimal medical therapy plays a significant role in the management of toxic megacolon, failure to induce rapid improvement within 48–72 hr constitutes an indication for definitive surgical treatment.

Intestinal Lactase Deficiency and Diarrhea in Adults

ConclusionsTwo cases of adult lactose intolerance are reported. The absence and severe deficiency of the enzyme B-galactosidase resulting in the syndrome was confirmed by both histochemical staining and paper chromatography.Methods to determine intestinal enzyme activity by peroral biopsy open a new avenue of investigation of absorption in the gastrointestinal tract and of patients with unexplained diarrhea.Such cases narrow the concept of food “allergies” often loosely employed for conditions unrelated to immune phenomena.

Comparison of the pancreozymin-secretin test and the Lundh test meal.

The pancreozymin-secretin test and the Lundh test meal were performed on different days for comparison. Statistically significant differences in six parameters indicate that the pancreozymin-secretin test is more sensitive in detecting mild, acute or chronic pancreatic disease (P<.01). Results of the Lundh test meal were clearly abnormal in patients with severe chronic pancreatic disease.

Diagnosis of pancreatic exocrine insufficiency by fecal chymotrypsin activity

Fourteen control subjects and 9 patients with severe pancreatic exocrine insufficiency were carefully studied to establish normal values of fecal chymotrypsin activity. Mean values for fecal chymotrypsin were uniformly abnormal in patients with pancreatic exocrine insufficiency. This study supports the previous literature in validating this test as a simple but effective method of screening patients with steatorrhea for the diagnosis of pancreatic exocrine insufficiency.Fourteen control subjects and 9 patients with severe pancreatic exocrine insufficiency were carefully studied to establish normal values of fecal chymotrypsin activity. Mean values for fecal chymotrypsin were uniformly abnormal in patients with pancreatic exocrine insufficiency. This study supports the previous literature in validating this test as a simple but effective method of screening patients with steatorrhea for the diagnosis of pancreatic exocrine insufficiency.

The Effect of Whiskey and Low-Protein Diets on Hepatic Enzymes in Rats

ConclusionsChronic administration of whiskey to adult female rats reduced hepatic alcohol dehydrogenase activity. Isocitric dehydrogenase and glutamic pyruvic transaminase activities were also decreased.When a low-protein diet was given in addition to whiskey, the activity of the hepatic alcohol dehydrogenase and mean activity of isocitric dehydrogenase decreased even more.Animals subjected to a low-protein diet only did not experience changes in alcohol dehydrogenase activity, but activities of isocitric dehydrogenase and of the transaminases were reduced.Results obtained in these experiments indicate that whiskey given to rats affects the liver cells directly, altering the alcohol-dehydrogenase system, the isocitric dehydrogenase system, the glutamic pyruvic transaminase system, and glutamic oxalacetic transaminase system.Depression of AD occurred more rapidly with whiskey than with ethanol.

APhysiologic interpretation of gastric freezing in the human

ConclusionsTemporary clinical improvement in peptic ulcer does occur with so-called gastric “freezing.” Destruction of gastric mucosa is not a necessary requirement.Although, in this study, histologic evidence of nerve damage could not be identified in biopsies, the most likely physiologic explanation for improvement is temporary partial vagotomy and sympathectomy due to the effect of low temperatures on terminal nerve fibrils in the gastric mucosa.Gastric secretory alterations are temporary; return to normal occurs in 3 weeks in many patients, and in 3 months in the majority of cases.

Pancreatic function in malabsorbing alcoholic cirrhotics.

A six-month prospective study to identify malabsorbing alcoholic cirrhotics was performed in a 500-bed general medical and surgical Veterans Administration Hospital. Of 50 patients with alcoholic liver disease, only 9 met the criteria of, cirrhosis and malabsorption. Six of these subjects were studied using pancreozymin-secretin tests and Lundh tests meals. Only 1 of the 6 malabsorbing cirrhotics had distinctly abnormal test results from both methods of study.A six-month prospective study to identify malabsorbing alcoholic cirrhotics was performed in a 500-bed general medical and surgical Veterans Administration Hospital. Of 50 patients with alcoholic liver disease, only 9 met the criteria of, cirrhosis and malabsorption. Six of these subjects were studied using pancreozymin-secretin tests and Lundh tests meals. Only 1 of the 6 malabsorbing cirrhotics had distinctly abnormal test results from both methods of study.

Depression of gastric secretion by a new anticholinergic agent

Summary and conclusionsThe anticholinergic medicationN-ethyl-3-piperidyl-benzilate metho-bromide (Piptal) was studied in 88 patients with elevated and normal gastric secretory patterns. In 77 (88 per cent) of the patients there was a decrease in the output of free acid as compared to the basal hour. In 35 patients (40 per cent) anacidity for 30 minutes or longer was produced.In no cases were there complaints of any side effects in this study. Piptal is apparently unique in that it represents a potent antisecretory agent without side reactions.Patients show varied responses to the same dosage of the drug, and larger dosages do not necessarily increase the number of patients on whom the drug will have an inhibitory effect. Probable anticholinergic escape appeared in some patients after an unknown period of time. Prolonged use did not consistently or permanently depress basal gastric secretion.Presently available anticholinergic drugs serve as an adjunct in the treatment of peptic ulcer, not as a substitute for effective antacid management. Further pharmacologic development may be expected to produce highly potent antisecretory agents without undesirable side effects. Piptal is a desirable development in this general direction.