Franco Ferrarini

Gastric secretion and emptying of liquids in reflux esophagitis

We have investigated the gastric secretory activity and the emptying half-time of a liquid meal in 17 selected patients with reflux esophagitis compared to 10 controls. The basal acid output and the basal and maximal secretory volume were higher in the patient group (P<0.05,P=0.05, andP<0.01, respectively), while the maximal acid output and the basal and maximal acid concentration were not different in the two groups. The gastric emptying half-time of a liquid meal was higher in the patient group (P<0.001). Our results show that gastric function may be altered in reflux esophagitis patients and suggest particularly that a delayed emptying of liquids may play a role in the pathogenesis of the disease in some patients.

Non-cardiac chest pain: a real clinical problem.

Non-cardiac chest pain is a frequent clinical problem. Between 10 and 50% of patients with anginal pain who are referred for arteriography are found to have normal coronary arteries. An oesophageal source of non-cardiac chest pain is reported in up to 60% of cases, most of which are attributable to gastro-oesophageal reflux disease. The exclusion of heart disease and the identification of an oesophageal origin of the pain may require an extensive work-up. The outcome in patients with non-cardiac chest pain is influenced by both the underlying diagnosis and the patients perception of his or her symptom.

Effect of Various Stimulants and Inhibitors of Gastric Acid Secretion on Mucosal Potential Difference in Man

Pentagastrin and histamine in doses effective in stimulating gastric acid secretion (5 microgram/kg/h intravenously and 25 microgram/kg intramuscularly, respectively) produce a significant decrease in the gastric mucosal potential difference (PD) in man. In contrast, atropine and cimetidine (2 mg/30 min intravenously and 4.5 mg/kg/h intravenously respectively) cause a significant increase in gastric PD. The subsequent or simultaneous administration of cimetidine reverses the effect of the stimulating agents on gastric PD and pH. Similarly, the subsequent administration of pentagastrin reverses the effect of atropine. The intragastric instillation of 100 c HCl 0.1 N increases significantly the gastric PD valuesp in this case the patterns of PD and pH changes are dissimilar. This study indicates that substances that modify gastric acid secretion also induce changes in gastric PD; this last effect does not seem to depend on variations of the intragastric pH. Therefore, in the clinical evaluation of the gastric PD in man, its multifactorial origin must alway be considered.

Nizatidine in the treatment of reflux oesophagitis: an Italian multicentre studyt

Objective To evaluate the various doses and administration schedules of nizatidine in the treatment of reflux oesophagitis. Design and methods Two hundred and forty patients with erosive-ulcerative oesophagitis were randomly allocated to a 6-week treatment regimen with nizatidine 150 mg three times daily (group A, n = 79), 150 + 150 + 300 mg (group B, n = 79) and 300 mg twice daily (group C, n = 82). Clinical evaluation was performed at entry and after 3 and 6 weeks, whereas endoscopy and laboratory tests were performed only at entry and at the end of the study. Results Reflux symptoms were significantly reduced in all three groups after 6 weeks. The patients on three times daily regimens (groups A and B) improved some of their symptoms faster than those in group C. Oesophagitis healed with similar frequency in the three groups (A = 81.1%, B = 79.2% and C = 67.6%). Adverse events were rare and mild. Conclusions High-dose nizatidine is safe and effective in relieving the symptoms and healing the lesions of oesophagitis.