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Chronic pancreatitis in the Western Cape.

A review of 1,006 patients studied over a 12-year period underlines the importance of alcohol in calcific, chronic and, to a lesser extent, acute pancreatitis. The racial incidence, natural history an

The radiology of tuberculosis of the gastro-intestinal tract.

Abstract The radiological appearances of tuberculosis of the gastro-intestinal tract are presented. One hundred and seventeen cases were seen at the Groote Schuur Hospital over the period 1962–71. In only 44 cases was there evidence of pulmonary tuberculosis. The series included three cases of oesophageal, two of gastric, three of pyloroduodenal, and ten of mesenteric lymph-node tuberculosis, 17 cases of malabsorption or protein losing enteropathy, three of small bowel strictures, 11 ileocaecal lesions, 10 colonic tubercle and 58 of tuberculous peritonitis. The appearance of tuberculosis of the gastro-intestinal tract radiologically depends on the presence of ulceration, fibrosis, enlarged lymph nodes, or caseous lesions with abscess formation. The differentation of tuberculosis from neoplasms or Crohns disease is discussed and the difficulty and limitations of radiology in this condition is stressed.

Fat-soluble vitamin concentration in chronic alcohol-induced pancreatitis : relationship with steatorrhea

In order to study the fat-soluble vitamin concentration of patients with chronic alcohol-induced pancreatitis (CAIP) we measured vitamins A and E, total lipids, and retinol-binding protein (RBP) in the plasma of 44 patients with CAIP and 83 controls (44 healthy controls; 39 Crohns disease patients). Mean plasma vitamin E and vitamin E/total lipid ratio were significantly lower in CAIP when compared with either control or Crohns disease groups. A low vitamin E/total lipid ratio was found in 75% of CAIP patients (91% with steatorrhea) and a ratio less than 1.0 was virtually 100% predictive of steatorrhea. The mean plasma vitamin A level for the CAIP group was significantly lower (overall 16%, 38% with steatorrhea) than in controls. Patients with CAIP show subnormal plasma levels vitamin E more often as compared to vitamin A. Further, the plasma vitamin E/total lipids ratio may be a sensitive and practical means in the detection and follow-up of steatorrhea in these patients.

Endoscopic manometry of the pancreatic duct and sphincter zone in patients with chronic pancreatitis

A possible mechanism for pain in alcohol-induced chronic pancreatitis is increased pancreatic duct pressure. A study has been done to compare sphincter of Oddi and pancreatic duct pressures in normal controls and patients with alcohol-induced chronic pancreatitis who had recently had pain or who were pain-free. Pressures were measured in the sphincter of Oddi in 10 controls and 33 patients, in the pancreatic duct in six controls and 15 patients, and in the common bile duct in four controls and five patients during station pull-through at the time of an endoscopic retrograde cholangiopancreatogram. There was no significant difference in the mean pressures in the pancreatic duct, sphincter of Oddi (basal and phasic), and frequency of papillary contraction when comparing patients with alcoholic pancreatitis and controls. There was also no difference between patients with or without pain and patients with or without strictures. This study has not confirmed the hypothesis that increased pancreatic duct pressures may be incriminated as a possible mechanism of pain in alcoholic-induced chronic pancreatitis.A possible mechanism for pain in alcohol-induced chronic pancreatitis is increased pancreatic duct pressure. A study has been done to compare sphincter of Oddi and pancreatic duct pressures in normal controls and patients with alcohol-induced chronic pancreatitis who had recently had pain or who were pain-free. Pressures were measured in the sphincter of Oddi in 10 controls and 33 patients, in the pancreatic duct in six controls and 15 patients, and in the common bile duct in four controls and five patients during station pull-through at the time of an endoscopic retrograde cholangiopancreatogram. There was no significant difference in the mean pressures in the pancreatic duct, sphincter of Oddi (basal and phasic), and frequency of papillary contraction when comparing patients with alcoholic pancreatitis and controls. There was also no difference between patients with or without pain and patients with or without strictures. This study has not confirmed the hypothesis that increased pancreatic duct pressures may be incriminated as a possible mechanism of pain in alcoholic-induced chronic pancreatitis.

CRST Syndrome and Nodular Transformation of the Liver: A case report

A 56-year-old woman with the CRST syndrome (calcinosis cutis, Raynauds phenomenon, sclerodactyly, and telangiectasia) associated with nodular transformation of the liver is presented. The sclerodermatous changes involved the entire gastrointestinal tract resulting in dysphagia, steatorrhea, and severe recurrent gastrointestinal bleeding. Some clinical aspects of the affected gastrointestinal tract and the relationship between the CRST syndrome and liver disease are discussed.

Gastric emptying after vagotomy and pyloroplasty: Relation to some postoperative sequelae

Emptying of liquids from the stomach was studied in 19 patients who had had a vagotomy and pyloroplasty and the results compared with 12 patients with duodenal ulcers and 9 patients with normal upper gastrointestinal tracts. The patterns of gastric emptying after vagotomy and pyloroplasty was found to consist of a very rapid initial emptying phase followed by emptying at a rate rather faster than in the other two groups. There was no difference in the gastric emptying of patients with duodenal ulcer and those with a normal gastrointestinal tract. Patients who complained of postprandial fullness and dumping after vagotomy and pyloroplasty had extremely rapid initial gastric emptying, more than half the test solution leaving the stomach almost immediately. Three patients who had postoperative gastric ulcers, 2 patients with vomiting since operation and 1 with postvagotomy persistent diarrhea showed a starting index and half-life similar to those of asymptomatic postoperative patients and only minor differences in the emptying time. Serial tests at varying intervals during the weeks after operation showed the gastric emptying of liquids was faster than normal from the earliest postoperative test. Over the succeeding weeks, emptying became still faster and probably reached a static state in 2 or 3 months.Emptying of liquids from the stomach was studied in 19 patients who had had a vagotomy and pyloroplasty and the results compared with 12 patients with duodenal ulcers and 9 patients with normal upper gastrointestinal tracts. The patterns of gastric emptying after vagotomy and pyloroplasty was found to consist of a very rapid initial emptying phase followed by emptying at a rate rather faster than in the other two groups. There was no difference in the gastric emptying of patients with duodenal ulcer and those with a normal gastrointestinal tract. Patients who complained of postprandial fullness and dumping after vagotomy and pyloroplasty had extremely rapid initial gastric emptying, more than half the test solution leaving the stomach almost immediately. Three patients who had postoperative gastric ulcers, 2 patients with vomiting since operation and 1 with postvagotomy persistent diarrhea showed a starting index and half-life similar to those of asymptomatic postoperative patients and only minor differences in the emptying time.Serial tests at varying intervals during the weeks after operation showed the gastric emptying of liquids was faster than normal from the earliest postoperative test. Over the succeeding weeks, emptying became still faster and probably reached a static state in 2 or 3 months.

Pathogenesis of Pain in Chronic Pancreatitis: Ongoing Enigma

The pathogenesis of pain in chronic pancreatitis remains an enigma. The cause of pain is almost certainly multifactorial and may vary at different stages of the disease process. These factors may include the release of excessive oxygen-derived free radicals, tissue hypoxia and acidosis, inflammatory infiltration with influx of pain transmittent substances into damaged nerve ends, and the development of pancreatic ductal and tissue fluid hypertension due to morphological changes of the pancreas. Investigations into the causes of pain have been limited by changes in the dynamics with the progression of the disease process, limitations in studying functional and morphological changes of the pancreas in the clinical setting, and the psychosomatic profile of patients. Many of these patients are addicted to alcohol, and suffer from personality disorders. The difficulty in quantifying pain, which is at best subjective, further compounds the issue, especially when assessing the efficacy of treatment.

Immunoproliferative small-intestinal disease: clinical features and outcome in 30 cases.

Experience with 30 patients with immunoproliferative small intestinal disease followed prospectively between 1971 and 1986 is described. All presented with malabsorption or growth retardation and had similar clinical, biochemical, and radiological features, irrespective of the presence of lymphoma or immunological abnormality. Alpha-chain disease protein was detected in 4 of the 11 patients who had a non-lymphomatous, predominantly plasmacytic infiltration of the small bowel; and in 5 of the 19 cases with diffuse intestinal lymphoma. The importance of exploratory laparotomy to include full-thickness intestinal biopsy in patients who have a benign infiltrate on peroral biopsy is demonstrated by the finding of lymphoma in operative specimens in 9 of 15 patients with mature, lymphoplasmacytic cells, and 5 of 8 patients with atypical, lymphoplasmacytic cells. The majority of patients with fully established benign disease, even those elaborating alpha-chain disease protein, appeared to have a good prognosis. No patient with immunoproliferative small intestinal disease developed immunologically demonstrated alpha-chain disease or frank lymphoma, when this was not found initially at explorative laparotomy.

Structure and function in noncalcific pancreatitis

A group of 47 carefully assessed patients with noncalcific pancreatitis was studied with ERCP and the secretin pancreozymin pancreatic function test (PFT). A simple scoring system was constructed for each of the PFT indices to create a PFT score for each patient and four grades of ERCP abnormality were documented, from minimal to gross. A simple pancreatic pain score was constructed to allow for the inclusion of patients with classical pancreatic pain in the absence of acute attacks associated with an elevated serum amylase. In general there was a correlation between the degree of structural change and functional impairment, with patients with the worst pancreatic function having the grossest ERCP changes. ERCP was abnormal in 45 of the 47 patients (96%) and the PFT in 34 of the 47 (72%). However, there were some marked discrepancies between the two methods, in particular two patients with normal function in the presence of gross structural changes. ERCP proved to be the more sensitive diagnostic technique than the PFT in this group of patients.A group of 47 carefully assessed patients with noncalcific pancreatitis was studied with ERCP and the secretin pancreozymin pancreatic function test (PFT). A simple scoring system was constructed for each of the PFT indices to create a PFT score for each patient and four grades of ERCP abnormality were documented, from minimal to gross. A simple pancreatic pain score was constructed to allow for the inclusion of patients with classical pancreatic pain in the absence of acute attacks associated with an elevated serum amylase. In general there was a correlation between the degree of structural change and functional impairment, with patients with the worst pancreatic function having the grossest ERCP changes. ERCP was abnormal in 45 of the 47 patients (96%) and the PFT in 34 of the 47 (72%). However, there were some marked discrepancies between the two methods, in particular two patients with normal function in the presence of gross structural changes. ERCP proved to be the more sensitive diagnostic technique than the PFT in this group of patients.

Serum immunoglobulins in calcific pancreatitis

Serum immunoglobulin concentrations were measured in 40 patients with calcific pancreatitis. A significant elevation of the mean serum IgA and IgG concentration when compared with a control group was found. The IgA was raised in 50% and the IgG in 27·5% when the individual results were assessed. The IgA did not appear to be of the secretory type. The possible significance of the raised IgA and IgG is discussed with reference to local pancreatic IgA production, autoimmune factors in chronic pancreatitis, and the ductal protein plugs in this disease.