Nissim Levy

Continuous electrocardiographic monitoring with Holter electrocardiocorder throughout all stages of gastroscopy.

Continuous electrocardiographic recording on magnetic tape with a Holter electrocardiocorder was performed during gastroscopy on 55 consecutive patients. ECG recording was begun before premedication and was terminated 1 hr after the withdrawal of the gastroscope. The ECG changes during the different stages of the procedure were separately analyzed: 38.18% of patients had E.C.G. changes—sinus tachycardia (20%), ST-T changes (23.6%), ventricular and atrial premature beats (20.0% and 7.27%, respectively), atrial premature beats with aberrant conduction (3.6%), and coronary sinus rhythm (1.8%). All changes disappeared spontaneously after the procedure. Although relatively safe, gastroscopy requires careful consideration of the risks, especially in severe cardiac patients.

The changing epidemiology of diverticular disease in Israel

In a retrospective evaluation of 1244 consecutive barium enemas performed at two hospitals over a five-year period (1979 to 1984), colonic diverticula were found in 177 (14.2 percent). The prevalence among the Ashkenazi Jews was 19.7 percent, among the Sephardi and Oriental Jews, 16 percent, and among the Arabs, 9.5 percent. Comparing these figures with the results of a similar study performed ten years ago, it becomes obvious that the prevalence of diverticular disease in the Ashkenazi group remained the same, while there was a three-fold increase among Sephardi and Oriental Jews, and a seven-fold increase among Arabs. It is postulated that, in less than one generation, diverticular disease will be equally frequent among all ethnic groups in Israel.

Ulcerative colitis in pregnancy in Israel.

Sixty pregnancies in 31 ulcerative colitis patients were studied retrospectively. Twelve patients (20 per cent) improved, 11 (18.3 per cent) deteriorated, while in 37 (61.6 per cent) there was no change during pregnancy. Seven pregnancies (13.7 per cent) ended by spontaneous and two by artificial abortions. There were 50 full-term deliveries and one premature birth. Seven of the patients were treated with sulfasalazine; five were given steroids; and two, azathioprine. All gave birth to normal children. Of unplanned pregnancies 38.4 per cent were associated with activity of the disease versus only 12 per cent of planned gestations. Pregnancy does not seem to aggravate the course of pre-existing ulcerative colitis, nor does the colitis interfere with the outcome of the pregnancy.

Bowel habits in Israel : a cohort study

We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)-about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex-male > female (p = 0.0001); (b) age-young > old (p = 0.0001); (c) physical activity-high > little (p = 0.001); (d) body habitus-lean > obese (p = 0.02); (e) marital status-married > single (0 = 0.009); and (f) ethnic group-Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the “ideal” bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was “harmful to health;” women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

Ambience in the endoscopy room has little effect on patients

With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patients complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.

Effect of ranitidine on the urea breath test: a controlled trial.

Because Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We tested this hypothesis in a prospective and controlled trial including 43 patients positive for H. pylori using the rapid urease test. Twenty-six patients received 150 mg ranitidine twice daily and 17 patients received no treatment. The 14C-urea breath test was performed in both groups at the beginning of the study and 2 weeks later. Radioactive 14C in exhaled carbon dioxide was significantly increased (p = 0.045) in the patients treated with ranitidine, compared with the patients in the control group. Administration of this drug to patients infected with H. pylori is associated with an increase in the bacterial load after 2 weeks of treatment. This phenomenon might be attributed to increased bacterial growth due to the H2 blocker.

Seasonal fluctuations in acute gastrointestinal bleeding

We investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988-92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patients were included in the study: duodenal ulcer, 202; hemorrhagic gastritis 108; gastric ulcer 101; duodenal ulcer and hemorrhagic gastritis 12; and duodenal ulcer and gastric ulcer, 10. The highest incidence of bleeding was observed during winter (31.7%) and spring (28.3%), progressively diminishing throughout summer (18.5%) and fall (21.5%) (p < 0.0001). Both females and males showed this significant seasonal variation (p < 0.025 and p < 0.005, respectively). As a group, patients over 57 years of age had the highest incidence of bleeding during winter and spring (p < 0.005). Interestingly, the ingestion of NSAID had no influence in the increased seasonal bleeding. Duodenal ulcer (p < 0.01) and hemorrhagic gastritis (p < 0.05) showed a significant seasonal variation while gastric ulcer did not. Although there are several reports in the literature concerning seasonal fluctuations in duodenal and gastric ulcers, no such studies have hitherto been published on hemorrhagic gastritis.