D. W. Piper

Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis.

This study aims to determine whether the features of dyspepsia can discriminate a subgroup of patients who present with non-ulcer dyspepsia from other diagnostic categories. The following groups were studied: One hundred and thirteen patients with endoscopically confirmed non-ulcer dyspepsia in the absence of clinical, biochemical or radiological evidence of other gastrointestinal diseases or disorders, termed essential dyspepsia; Fifty five patients with symptomatic and endoscopically proven peptic ulceration (32 duodenal ulcers, 23 gastric ulcers); Fifty three patients admitted to hospital with biliary pain and cholelithiasis without other lesion at laparotomy. All patients completed a structured history questionnaire at personal interview. Stepwise logistic regression analysis was done on 19 predefined variables to determine if one or more of these could discriminate between the diagnostic categories. The results suggest that certain groups of symptoms may be of diagnostic value, but many are not. Upper abdominal pain aggravated by food or milk, pain severity, night pain, vomiting, weight loss, and age significantly discriminated essential dyspepsia from the other diagnostic categories. A scoring system was established based on these discriminating symptoms. Using the weighted score, at a sensitivity of 57%, the specificity for a diagnosis of essential dyspepsia was 94%, but only prospective studies will determine if this scoring system is of actual clinical value.

Prognosis of Chronic Unexplained Dyspepsia A Prospective Study of Potential Predictor Variables in Patients With Endoscopically Diagnosed Nonulcer Dyspepsia

The aim of this study was to determine if there were predictors of the symptomatic course of patients with chronic unexplained (essential) dyspepsia. After endoscopic assessment, 111 patients with essential dyspepsia were followed up by telephone interview every second month. Data were gathered, for a mean of 17 mo per patient, on the number of days of upper abdominal pain (the response variable) each month. In the 6-mo period before entry to the study the following predetermined predictor variables were collected: demographic factors (age, sex, social grade), number of pain days in the 6 mo before diagnosis, environmental factors (analgesics, nonsalicylate nonsteroidal antiinflammatory drugs, alcohol, smoking, coffee, tea), length of dyspepsia history, and past history of peptic ulcer. Prospectively for each month of follow-up, the following additional variables were recorded: environmental factors, treatment, and development of gastroesophageal reflux symptoms. It was found that patients with more pain before diagnosis were significantly more likely to have pain over the follow-up, and the taking of medications for dyspepsia and development of gastroesophageal reflux were associated with more days of pain over the follow-up (all p less than 0.001). Demographic and environmental factors, length of dyspepsia history, and a past history of ulcer were of no significant predictive value. There was a decrease in pain over the follow-up period (p = 0.002), but this effect was limited to the first two periods after endoscopic diagnosis.

Environmental factors and chronic unexplained dyspepsia. Association with acetaminophen but not other analgesics, alcohol, coffee, tea, or smoking.

A subgroup of patients with nonulcer dyspepsia (NUD) have no definite cause for their dyspepsia, termed essential dyspepsia.The aim of the present study was to determine if environmental factors are associated with essential dyspepsia. The patterns of ingestion of analgesic drugs (aspirin, acetaminophen, dextropropoxyphene), nonaspirin, nonsteroidal antiinflammatory drugs, alcohol, coffee, tea, and smoking in 113 essential dyspepsia patients were compared with 113 randomly selected community controls matched for age, sex, and social grade. Associations were studied in two six-month periods, before diagnosis in all patients and before the onset of NUD in those patients with a short history of dyspepsia. It was found that acetaminophen ingestion was associated with essential dyspepsia, and this association was present both before the onset of the dyspepsia (OR 3.1, 95% CI 1.3– 7.1) and before diagnosis (OR 1.8, 95% CI 1.2– 2.6). None of the other environmental factors were associated with essential dyspepsia.

Antacid therapy of peptic ulcer Part II An evaluation of antacids in vitro

All the parameters needed to calculate the adequate dose of antacid will probably never be known in most cases of peptic ulcer before treatment; some of the techniques, such as the measurement of emptying rate and starting index, are moderately time-consuming procedures (Hunt and Spurrell, 1951). The basal secretion, however, is known in many, if not most patients, and with knowledge of its value and the observations of other workers on emptying rates and starting indices, an approximation ofthe antacid dosage can be obtained (Fig. 1). If no information at all is available an approximate dose can be determined based on statistical data as in Table II. The calculated doses listed in both the Figure and Table II are those required to neutralize basal secretion and do not take into consideration the secretory response to frequent meals that further increase gastric secretion and consequently the required dose of antacid. It is obvious from Table V that doses of antacid must be given at least hourly if any effect is to be produced by commonly used doses. It is emphasized that while the adequacy of the mathematical model here employed to describe the secretion into and emptying from the stomach is well established in the literature, there is wide variation in the values of the different parameters in various reports (Table 1), and thus the calculated doses of antacid are approximate only. The independence of the half-time of gastric emptying and the starting index, assumed in some calculations above, may not be strictly true and would also affect the calculated antacid dosage. Inadequate mixing of antacid is a further unpredicatable factor influencing the required dose of antacid. Any rhythmic gastric actions would introduce further uncertainties, since for given average basal secretion and emptying rates the dose required would vary according as the time of administration was related to the commencement of the cyclic periods. Notwithstanding these uncertainties, the general agreement in antacid requirement between the study of Price and Sanderson (1956) in vivo and this mathematical study using data from the literature confirms the general validity of the conclusions. It is emphasized that the dosage determined in the above calculations is minimum dosage. The stimulation of gastric secretion by meals would necessitate increased antacid dosage, and it is possible that gastric secretion and emptying may not be independent variables, and those patients with high secretion rates may have rapid emptying rates, thereby increasing dosage of antacid. We believe that the minimum antacid doses are as follows: If no information is available on the patients gastric function, then a dose of 50 mEq. once hourly is adequate for duodenal ulcer in a man, 26 mEq. for duodenal ulcer in a woman or gastric ulcer in a man. If the patients basal secretion rate is known, a dose of neutralizing capacity eight times the secretion rate should suffice in most cases, if given hourly.

Effect of a sulfated polysaccharide on peptic digestion. A study in vitro of carrageenin (Ebimar).

Summary 1.The two sulfated polysaccharides, Ebimar and heparin, inhibit peptic digestion. 2.Ebimar appears to act predominantly on substrate in digestion studies. It is less active at high substrate levels but is uninfluenced by the pepsin concentration. 3.Ebimar alters the electrophoresic mobility of albumin at pH 2 and 4, but has little effect on pepsin at these pH levels. 4.Previous work on the mode of action of the sulfated polysaccharides on proteins is discussed in relation to the above findings with Ebimar.

A comparison of a series of newer anticholinergic agents with atropine as regards their effect on saliva flow and gastric secretion in man.

The effect of anticholinergic agents—atropine, propantheline, oxyphencyclimine, and propionyl atropine methyl nitrate—on silva flow and on hypoglycaemic stimulated gastric secretion has been studied. The acid secretion of the nervous phase of gastric secretion was inhibited by anticholinergic drugs. They influenced gastric secretion to a greater extent than saliva flow. Both propantheline and oxyphencyclimine have a selective action on the stomach superior to atropine. Propionyl atropine methyl nitrate appears to have only weak anticholinergic activity in the dose recommended and is not superior to atropine.

The adsorption of pepsin

Summary1. The most powerful adsorbents of pepsin are aluminum hydroxide gel and charcoal.2. The adsorbent action of pepsin is uninfluenced by the substrate concentration and is less active at lowpH levels. When used to inactivate pepsin, the adsorbent effect of aluminum hydroxide gel is more important than thepH effect.3. The capacity of aluminum hydroxide gel to adsorb other substances such as anticholinergic agents and antibiotics should be remembered when it is used in the treatment of peptic ulcer.4. The antipeptic capacity of aluminum hydroxide gel and the secretory responses found in ulcer patients have been discussed in relationship to the dosage used in ulcer therapy.

The carcinogenic effect of cigarette smoke: The effect of cigarette smoke on human gastric mucosal cells in organ culture

The carcinogenic effect of cigarette smoke on certain organs is well established epidemiologically, but the evidence in relation to gastric carcinoma is inconclusive. The present study reports the effect of cigarette smoke condensate (CSC) on gastric mucosa grown in organ culture and its effect is compared with that of the known gastric carcinogen, N‐methyl‐N1‐nitro‐N‐nitrosoguanidine (NG). Viability of the cells was assessed by the uptake of labelled glucose and glycine. It was found that, as gauged by lactate and β‐glucuronidase production into the ambient fluid, CSC produced a response typical of malignancy that did not differ from that with NG.

The electrophoresis of human gastric juice Part I In normal controls

The electrophoretic pattern of normal human gastric juice is described. The effect of autodigestion of gastric juice and of the peptic digestion of albumin is described. The fallacies involved in the study of gastric juice proteins where peptic digestion of the protein constituent has not been prevented are emphasized. In this study the gastric juice was neutralized within the stomach to prevent changes due to autodigestion.

A radiographic study of the portal and hepatic venous systems in cirrhosis of the liver

SummaryThe hepatic and portal venous systems were studied by postmortem contrast radiography in 12 cirrhosis patients. The hepatic venous system was abnormal in 11 cases, the most common abnormalities being distortion of the smaller veins and deficient filling of the hepatic venous system. In some cases the caliber of the veins appeared irregular. In no case was there a definite abnormality of the portal vein.There did not appear to be any correlation between the extent of the vascular changes and the etiology of the cirrhosis, the presence of splenomegaly, varices, ascites, a low serum albumin, or the pathological findings.