Vincent A. DeLuca

Hydrogen peroxide colitis: a report of three patients.

We have seen three patients with acute ulcerative colitis after hydrogen peroxide enemas. The colitis is probably the result of the explosive entrance of gas into the loose connective tissues of the mucosa and submucosa of the rectum and sigmoid. Fortunately, it is transitory in nature, but it should be distinguished from ulcerative, ischemic, or pseudomembranous colitis.

Sulfasalazine-induced pulmonary disease

SummarySulfasalazine has been widely used in the treatment of inflammatory bowel disease. Although a high incidence of side effects has been reported, pulmonary complications are rare. The clinical, radiographic, and histological abnormalities that occurred in a patient three months after initiation of sulfasalazine are described. A review of the literature suggests that the possibility of drug-induced pulmonary disease should be considered in any patient with inflammatory bowel disease receiving treatment with sulfasalazine who develops symptoms or radiographic evidence of pulmonary disease. Transbronchial biopsy may be useful in confirming the type of pulmonary injury.

The effectiveness of panendoscopy on diagnostic and therapeutic decisions about chronic abdominal pain.

To evaluate the impact of panendoscopy on diagnosis and management, we asked several gastroenterologists to state their diagnoses, management plans, and confidence in these plans before performing endoscopy in patients with chronic abdominal or thoracic pain; and to repeat the same decisions after endoscopy. To evaluate acceptance of the procedure, patients were later interviewed about their discomfort during its performance.To check the way that changes in diagnosis may have affected patient management, we formed six diagnostic groups that roughly correspond to differing treatments. The postendoscopic diagnostic groupings revealed two unsuspected cancers and disagreed with the original classification in 38 (45%) of 84 patients. Dramatic or substantial changes in management occurred in 37 (44%) patients, but often did not correspond to changes in diagnosis. Conversely, management was often unchanged despite alterations in diagnosis. Patients expressed about equal preferences for barium meal as for panendoscopy, and 75% would have agreed to a repeat endoscopy without hesitation.Although the ultimate benefits of postendoscopy management changes were not ascertained, we believe that these results support the use of panendoscopy in patients with persistent and unexplained symptoms.

No acid, no polys--no "active" gastritis, no dyspepsia. A proposal.

The current dilemma in characterizing non-ulcer dyspepsia (NUD) is due to the very nature of the term which has forced the dependence for diagnosis primarily on symptomatology and the absence of an ulcer crater as ascertained by radiographs or endoscopy. I propose a new classification which I believe is consistent and well founded, based on the presence of histologic gastritis and acid secretion of the stomach. Four categories are presented: (a) normal histology, (b) “active” gastritis, (c) “inactive” gastritis, and (d) atrophic gastritis with achlorhydria. Acid secretion is present in categories a-c. The classification is dependent on the presence of the “poly” to denote active gastritis, round cells to classify inactive gastritis, and the loss of parietal and chief cells with achlorhydria to define gastric atrophy. I propose that polys and acid, which characterize active gastritis, are necessary for producing dyspepsia and/or gastroduodenal mucosal injury, and provide a rationale for treatment. The accepted causes of active gastritis include acid-peptic disease, Campylobacter pylori, and aspirin/nonsteroidal anti-inflammatory drug (NSAID) medication.

Endoscopic Photography, Biopsy, and Cytology of the Esophagus and Stomach with the Olympus Fiberesophagoscope

Clinical experience with the recently introduced Olympus EF Fiberesophagoscope is described in 125 examinations. It allows ease of passage, minimal patient distress, and examination of the entire esophagus and often the upper one-half of the stomach. The instrument allows 90-degree bending angle of its head, fully automatic exposure control of light source with direct, through an external camera observation, pushbutton control of aspiration, insufflation of fluid feeding, and a separate biopsy channel. Comprehensive study can involve observation, biopsy, cytology, and photography of esophageal and gastric lesions. We believe that the Olympus EF Fiberesophagoscope is a valuable addition to esophageal endoscopy.

Duodenal epithelial thymidine uptake in patients with duodenal ulcer or endoscopic duodenitis.

To evaluate the relationship between duodenal ulcer disease and duodenitis, duodenal epithelial cell renewal was measured in mucosal biopsies by the incorporation of [3H]thymidine. When 14 patients with duodenal ulcer were compared to 13 control subjects or 7 with endoscopic duodenitis alone, the crypt size was the same in all groups. Similar to other inflammatory processes of the gastrointestinal tract, patients with endoscopic duodenitis showed increased proliferative indices including a greater number of cells incorporating [3H]thymidine. In contrast, the proliferative indices from the duodenal mucosa of patients with duodenal ulcers did not differ from a control group. In a group of 6 patients with both endoscopic duodenitis and duodenal ulcer, the [3H]thymidine incorporation was intermediate between control subjects or patients with duodenal ulcer alone and those with endoscopic duodenitis alone. When subjects were divided according to the histologic appearance of the duodenal mucosa, those having chronic duodenitis demonstrated enhanced [3H]thymidine incorporation in comparison to a control group or patients with chronic active duodenitis (polymorphonuclear leukocytes present). Although there are many possible explanations of these findings, one may speculate that duodenal ulceration does not stimulate duodenal epithelial proliferation.

The Yale-Affiliated Gastroenterology Program: 1965-1995. A community-university model of collaboration.

The Yale-Affiliated Gastroenterology Program (YAGP) originated in 1965 from the informal arrangements of two gastroenterologists, one university based and the other in a community hospital. Conceived at a time when there was little central authority, either on a national or on a hospital/medical school level, its links were forged by the personal relationships of its directors. The process of growth remained informal and flexible enough for the directors to meet the special requirements of their own community and hospital. YAGP provided an important model for improving medical care and education in community hospitals since it addressed personnel needs, contributed to the education of physicians, and fostered clinical research in digestive diseases. YAGP evolved its own standards and its own accreditation mechanism, but faltered when the Accreditation Committee on Graduate Medical Education provided national rather than local criteria. Increased controls by hospitals and medical schools led to more formal ties and programs, and YAGP ceased to matter. Still, there may be lessons from what was in its time an innovation, on a local and state level rather than on a national level.

Ulcerative colitis and scleroderma : a coincidental relationship ?

Speculation continues that ulcerative colitis is an autoimmune disorder that is frequently associated with other diseases with a similar underlying pathogenic mechanism. In 1965 we reported a patient with ulcerative colitis and scleroderma in support of this hypothesis. Now we supply a follow-up of over 30 years to describe how each disease acted independently, evidence, we believe, that the association was primarily fortuitous.

Treatment of benign chronic gastric ulcer with ranitidine. A randomized, double-blind, and placebo-controlled six week trial.

A randomized, multicenter, double-blind, placebo-controlled study was conducted to determine whether ranitidine 150 mg b.i.d. for 6 weeks would expedite endoscopic healing or relief of symptoms in patients with benign gastric ulcer. Of 203 patients enrolled, 101 received ranitidine and 102 received placebo. Endoscopic evaluations were conducted at baseline and at 2 and 6 weeks. At 6 weeks 68% of the patients treated with ranitidine had healed compared with 53% in the placebo group (p = 0.02). In those patients who had not healed by 6 weeks, ranitidine provided greater relief from pain than placebo. More patients in the placebo group dropped out of the study because of worsening symptoms (13 versus 4, p = 0.04). No differences in laboratory abnormalities or incidence of adverse events were detected between the two study groups. These results indicate that ranitidine 150 mg b.i.d. is superior to placebo in the treatment of benign gastric ulcer.