T. P. J. Hennessy

Barrett's esophagus and the presence of Helicobacter pylori

Objective:Although the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease and antral gastritis has been well documented, the role of H. pylori in esophageal disease has not been clearly defined. To clarify this issue, we analyzed 141 patients with histologically confirmed esophageal disease.Methods:The study group consisted of 82 patients with Barretts esophagus, 19 with adenocarcinoma of the esophagus arising in columnar epithelium and 40 patients with reflux esophagitis without columnar metaplasia of the esophagus. In each of these cases the presence or absence of H. pylori was assessed histologically.Results:H. pylori was present in 19 of 82 patients (23%) with Barretts esophagus, but was absent in all patients with adenocarcinoma of the esophagus and in patients with reflux esophagitis without Barretts metaplasia. H. pylori was found only in areas of gastric type metaplasia in the patients with Barretts esophagus. All of the 19 Barretts esophagus group with H. pylori had chronic inflammation, and in 16 the inflammation was severe. H. pylori was significantly associated with severity of inflammation in patients with Barretts esophagus (p < 0.001). Members of the Barretts group with evidence of moderate to severe dysplasia were negative for H. pylori.Conclusion:These data confirm that the presence of gastric type mucosa within the esophagus is a prerequisite for H. pylori colonization, and that H. pylori may contribute to the severity of inflammation in Barretts epithelium.

Helicobacter Pylori infection increases following cholecystectomy

Cholecystectomy is frequently linked with duodenogastric reflux and gastritis but its effect onHelicobacter Pylori (H pylori) infection has not been examined. In a prospective study, twenty two patients with documented cholelithiasis underwent upper gastrointestinal endoscopy and biopsy and 24hr dual channel pH monitoring prior to cholecystectomy and again at 3–6 months post-operatively. The antral biopsies were histologically assessed forH pylori and gastritis and awarded an alkaline reflux score. The number of patients withH pylori infection increased from 7 (32%) preoperatively to 15 (68%) post-cholecystectomy (p<0.05). Cholecystectomy was also associated with an increase in the incidence of gastritis from 7 to 15 (p<0.05). The increase inH pylori infection rate occurred in association with an increase in the percentage time gastric pH >4 in the supine position, from 9.6 (2.2) to 22.2 (4.8) percent, (p<0.01). The median chemical gastritis score, however, did not change significantly following surgery [8(3–11) vs 7(3–11)]. Seven patients remained symptomatic following cholecystectomy all of whom wereH pylori positive and had gastritis.H pylori can survive in the alkaline environment which follows cholecystectomy and may contribute to the post-cholecystectomy syndrome.

Intradermal xylocaine : dobs it have a role in setting up a drip ?

SummaryTo assess the value of intradermal xylocame when setting up a routine intravenous infusion, 100 consecutive patients were randomly allocated to cannula insertion with and without 0.5 c.c. of intradermal Xylocaine. No differences in patient discomfort were demonstrated. Insertion of cannulae with Xylocaine were more often unsuccessful, but when successful, infiltration was more frequent (13 vs 4, p<0.62), they lasted for a shorter time (52 vs 77 hrs, p<0.62), and were associated with greater cost than those set up without Xylocaine. Routine use of intradermal Xylocaine when setting up an intravenous infusion can not be recommended.

A new technique for measuring lower oesophageal sphincter competence in patients

SummaryOesophageal sphincter measurements were carried out on 80 patients using the stationary pull through technique; Normals (n=21), Nutcracker (n=12), Refluxers (n=21), and Barrett’s (n=26). Sphincter pressure (LOSP), abdominal length of sphincter, and overall sphincter length were measured. The Sphincter Function Index (SFI) was calculated as the product of sphincter pressure and percentage sphincter length (AL) exposed to abdominal pressure. Patients also had routine endoscopy and 24 hour pHmetry. SFI values discriminated between all four groups. LOSP was significantly different for Barrett’s (p<0.01) and Nutcracker (p<0.01) compared to normals. AL was significant for Refluxers (p<0.001) and Barrett’s (p<0.001) compared to normals. SFI gives better discrimination than LOSP or AL alone and may be useful in evaluating the response to treatment.

Oesophageal motility and digestion of cream liqueurs in combination with common alcohol mixers.

When acidic mixers are added to cream liqueur curdling occurs. Oesophageal motility was studied in normal volunteers during ingestion of this mixture and the effect of combining with gastric juice was assessed in a simulated physiological environment. Twenty-four h ambulatory manometry and pH (n=22) and gastric studies (n=7) were carried out. There was no detrimental effect on oesophageal motility. The precipitation is rapidly broken down by the digestive process in the stomach.

Retrograde electrical pacing and its influence on the migrating motor complex of the canine jejunum

SummaryA STUDY was undertaken to evaluate the effect of retrograde electrical pacing on the mechanical component of the migrating myoelectrical complex. Jejunal transections and reanastomoses were performed on five dogs at 20 cms and 60 cms from the Ligament of Treitz. Electrical and motor activity were recorded using stainless steel electrodes and serosal strain gauges placed within the segment. Retrograde electrical pacing was achieved by electrical stimuli using electrodes just proximal to the distal transection. Each fasting dog was studied on four occasions with and without retrograde electrical pacing for two hours following the appearance of a migrating motor complex. In a separate study of fed dogs the times of reappearance of migrating motor complexes with or without pacing were compared. Results showed that retrograde pacing does not alter the migrating motor complex except in its frequency of contractions which were significantly increased (13.6 ± 0.3 versus 17.8 ± 0.4 per min, p<0.01 ). Retrograde electrical pacing did not significantly delay the reappearance of migrating motor complexes after feeding. These findings are consistent with the hypothesis that migrating motor complex propagation is controlled by extrinsic nerves and suggests that retrograde pacing will have little effect on transit during fasting.

Oesophageal manometry. A comparison of hydraulic and syringe catheter infusion systems using a simple hydrostatic bench model

A simple hydrostatic bench model is described which can be used to validate oesophageal intraluminal manometry measurements. Conventional syringe pump infusion was compared with the hydraulic capillary infusion system using this model. Accurate recording of pressure changes was achieved on the low compliance hydraulic system at infusion rates of 1 X 10(-8) m3 s-1 (0.6 ml min-1). To achieve comparable accuracy with syringe pump infusion, undesirably rapid infusion rates of 10.35 X 10(-8) m3 s-1 (6.2 ml min-1) were required. We believe that the hydrostatic bench model is a useful tool for checking the accuracy of infused catheter systems.

Sequential development of bilateral ovarian carcinoids

SummaryA case is reported of bilateral ovarian carcinoid tumours with no evidence of a primary site or metastases extrinsic to the ovaries. On each occasion the tumour gave rise to the carcinoid syndrome which regressed after surgery.

The present position of gastric hypothermia

ConclusionIt is clear from experimental evidence that under optimum conditions gastric hypothermia can result in prolonged depression of secretory activity in the stomach.The failure to achieve comparable results in man is due to technical problems related mainly to the variable distensibility of the stomach. Until these problems are overcome the clinical use of gastric hypothermia should be restricted to centres interested in the elucidation of the problem. The clinical use of gastric freezing in skilled hands while not offering as yet a permanent cure appears to be a safe method of producing temporary relief of symptoms which can be repeated.Gastric cooling would seem to be a valuable method of treatment for massive gastric haemorrhage.