Upper gastrointestinal endoscopy.
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Barium↗
Biomedical subjects
G E Sladen
Publications and source records attributed to G E Sladen.
Upper gastrointestinal endoscopy: its effects on patient management.
Out of 95 patients referred for upper gastrointestinal endoscopy after a barium-meal examination, 44 underwent a change in management. Some changes were minor but in 12 patients a decision on surgery was required. Seven of these patients were among a group of 13 for whom the referring consultant would have recommended laparotomy had endoscopy not been available, while the other five were subjected to an unplanned laparotomy. These findings support the practice of performing endoscopy on patients whose symptoms are not fully explained by barium-meal examination, especially patients aged over 45. In such cases the procedure also seems to be cost-effective.
Adult↗
Effects of ileal and caecal resection on the colon of the rat.
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Animals↗
Diabetes and the gut.
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Bile Acids and Salts↗
Post-vagotomy diarrhoea.
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Bile Acids and Salts↗
14C-Glycocholate test in Crohn's disease--its value in assessment and treatment.
The (14)C-glycocholic acid test ((14)C-GCA) has been assessed in 27 patients who have had resection of the ileum and colon for Crohn's disease and in 19 patients with unoperated stable Crohn's disease. The incidence of increased breath output of (14)CO(2) and faecal output of (14)C was significantly greater in operated patients. Half the unoperated patients had normal results and, of the others, a modest increase in faecal (14)C was the usual finding. There was no correlation between the (14)C-GCA test, the Schilling test, and the extent and severity of the radiological signs in the unoperated patients. Metronidazole therapy was poorly tolerated and had little or no influence on symptoms but did decrease the excretion of (14)CO(2) in the breath when the (14)C-GCA test was repeated. Cholestyramine therapy was beneficial in the majority of resected patients with diarrhoea and an increased faecal (14)C excretion and, on repeat testing, there was a significant increase in the output of breath (14)CO(2). The beneficial effect was less marked in the unoperated patients and the breath (14)CO(2) output remained normal in those retested. Interruption of the enterohepatic circulation of bile acids did not seem to make an important contribution to the symptoms of patients with stable unoperated (and uncomplicated) Crohn's disease, even when the ileum was extensively involved.
Adult↗
Appraisal of the 14C-glycocholate acid test with special reference to the measurement of faecal 14C excretion.
The (14)C-glycocholate test, including the measurement of marker corrected faecal (14)C, has been assessed in the following groups of subjects: normal controls (18), patients with diarrhoea not attributable to altered bile acid metabolism (21), patients with diverticula of the small intestine (12), patients with previous resection of ileum and often proximal colon (34), and established ileostomists (10). Patients with diverticular disease had increased breath (14)CO(2) excretion, but normal faecal excretion of (14)C, and this test was more frequently abnormal than the Schilling test. Ileostomists excreted increased amounts of faecal (14)C, even when the ileum was intact and apparently normal. The pattern after resection was complex. Breath (14)C output was normal if the ileal resection was less than 25 cm in length, although some of these patients had increased faecal (14)C excretion if, in addition, at least 15 cm of proximal colon had been resected or by-passed. Longer ileal resections were associated with increased breath and/or faecal (14)C excretion, depending in part on the length of colon resected or by-passed and the 24 hour faecal volume. Fewer than half these patients had both increased breath and faecal excretion of isotope and faecal (14)C alone was occasionally normal with an ileal resection of 50 cm of more. The (14)C-glycocholate test was more frequently abnormal than the Schilling test in this group. The use of faecal marker correction had only a minor impact on the results. These data suggest that, in patients with ileal resection, faecal (14)C, like faecal weight, is determined by the extent of colonic resection as well as by the amount of ileum resected.
Adult↗
Malabsorption in relation to abdominal irradiation and quadruple chemotherapy for lymphosarcoma.
A case of severe diarrhoea and steatorrhoea following chemotherapy and abdominal irradiation for lymphosarcoma, is described. Investigations demonstrated bile acid malabsorption, and treatment with cholesytramine and a low fat diet was successful. A questionnaire was sent to thirty-two subjects who had undergone similar treatment for similar pathology and failed to demonstrate any sustained alteration of bowel function. Additionally, nine of these subjects underwent a 14C-glycocholic acid test and no evidence of interruption of the enterohepatic circulation of bile acids was found.
Abdomen↗
A case of myasthenia gravis treated with steroids: some suggestions for the mechanisms underlying their effect.
This report deals with a patient with long standing myasthenia gravis treated with a small dose of corticosteroids. The response to treatment was prompt and the post-therapeutic deterioration in function was minimal and cholinergic in nature. It is suggested that the dose of anticholinesterases be reduced concomitantly with the institution of steroid treatment.
Cholinesterase Inhibitors↗
Small intestinal transit in diabetics.
Small intestinal transit was assessed in diabetic patients and healthy controls by measuring the breath hydrogen appearance time after the ingestion of lactulose. Transit in diabetics with autonomic neuropathy was significantly slower than in diabetics without neuropathy and controls. Delayed transit is probably due to vagal denervation. These slower transit times would allow bacteria to proliferate, which might explain why some diabetics have diarrhoea. The test cannot be used in patients with bacteria in the small bowel because these may metabolise lactulose and release hydrogen prematurely.
Autonomic Nervous System↗
Gastric emptying of solid meals in diabetics.
The gastric emptying rate of an isotopically labelled solid meal was compared in 29 insulin-dependent well-controlled diabetics and 18 normal controls. The diabetics were assessed for evidence of autonomic neuropathy. No significant difference in gastric emptying rate was found between controls and diabetics with or without autonomic neuropathy. Only three diabetics had greatly delayed gastric emptying, but in one of these the test had given a normal result on an earlier occasion.
Adult↗
The 14C-glycocholate test in diabetic diarrhoea.
Twenty-four insulin-dependent diabetics, including seven with diabetic diarrhoea, were studied by means of the 14C-glycocholate (14C-GCA) test and various tests for autonomic dysfunction. The breath component of het test was abnormal in four of the seven patients with diarrhoea and one of the other diabetics. Three patients with diarrhoea and a positive breath test result responded to antibiotics, whereas two with diarrhoea and a negative test result did not. High faecal 14C, suggesting bile acid malabsorption, was found in only one patient with diarrhoea and he had previously failed to respond to cholestyramine. These results suggest that bacterial overgrowth in the small intestine does occur in some but not all patients with diabetic diarrhoea and that the 14C-GCA test can predict the response to antibiotics. All the patients with diabetic diarrhoea had good evidence of autonomic dysfunction.
Anti-Bacterial Agents↗
The role of the colon in urea metabolism in man.
1. The urea content of ileostomy effluent has been measured by the urease method as an indirect estimate of the urea concentration in the lumen of the normal ileum. 2. The plasma disappearance of intravenously administered[14C]urea was used to study intestinal urea breakdown. Normal subjects on high and low protein diets and patients with either excised (i.e. with ileostomies) or excluded colons were studied. 3. The 24 h intestinal urea breakdown was considerably greater than the quantity of urea estimated to be entering the colon from the ileum and across the colonic mucosa. 4. Intestinal urea breakdown increased with increase in dietary protein and decreased with, but was not abolished by, exclusion or excision of the colon. 5. Our results suggest that the colonic lumen is not the only site of intestinal ureolysis and that significant quantities of urea must be broken down either at a juxtamucosal site or in the ileum.
Body Weight↗
Protein absorption and ammonia production: the effects of dietary protein and removal of the colon.
1. The effect of increasing dietary protein content on the amount of faecal nitrogen was measured in six normal subjects and five subjects without functioning colons (three with ileostomy and two with ileo-rectal anastomosis). 2. There was a significant inontent in the subjects without functioning colons. 3. In normal subjects with intact colons, faceal N content was found to be lower than that in subjects without colons, and furthermore there was no significant variation with diet. 4. The source of the increase in faecal N with increased dietary protein content in subjects without functioning colons is discussed and the significance of these findings in relation to the efficiency of protein absorption is considered.
Ammonia↗
Oesophagoscopy, biopsy, and acid perfusion test in diagnosis of "reflux oesophagitis".
The results of fibreoptic endoscopy have been assessed retrospectively in 71 patients referred for consideration of the oesophagus as the possible or probable cause of their symptoms. Gross endoscopic abnormality was uncommon but friability of the mucosa was seen in about half of the patients with typical symptoms of "reflux-pain" and a quarter of those without. The combination of radiological reflux and endoscopic abnormality--that is, true reflux oesophagitis--was seen in only a third of the patients with typical symptoms though much less commonly in those with atypical symptoms. Histological abnormality was common but did not relate well to symptom pattern. The results of the acid perfusion test were significantly related to symptom pattern though overlap was observed between the two symptomatic groups. Six of these patients had had or were awaiting surgery to correct reflux and they all had uniformly positive findings. This study confirms the value of the acid perfusion test in clarifying the diagnosis of reflux pain, espcially if the symptoms are difficult to assess. Endoscopy and biopsy added little further information of diagnostic value and could probably be reserved for the small minority of patients who have special problems such as blood loss or dysphagia or where clarification of a radiological lesion is required.
Adult↗
Ammonia and urea transport by the excluded human colon.
1. Ammonia and urea transport across the colonic mucosa was studied by a perfusion technique in four subjects with colonic exclusion for chronic hepatic encephalopathy. 2. Reduction of luminal pH inhibited net and unidirectional transport of ammonia from lumen to plasma, but net absorption from high luminal concentrations persisted at low pH. 3. Neither addition of urea to the perfusate nor intravenous infusion of urea produced a consistent increase in the colonic excretion of ammonia when ammonia-free solutions were perfused. 4. In one subject intravenous infusion of (15N)-ammonium chloride produced rapid labelling of colonic effluent ammonia and within 60 min the specific enrichments of ammonia in effluent and in arterial plasma were approximately equal. 5. During perfusion of nitrogen-free solutions, only small amounts of urea appeared in the effluent, suggesing limited permeability of the colonic mucosa to urea. 6. These results are discussed in relation to the equilibration of ammonia across the colonic mucosa by both ionic and non-ionic diffusion. The lack of evidence of 'juxtamucosal' (as opposed to luminal) ureolysis is in contrast to other observations on the intact colon. The possible reasons for and implications of this discrepancy are discussed.
Ammonia↗
A double blind trial of carbenoxolone and geranyl farnesyl acetate in gastric ulcer.
57 patients with a chronic gastric ulcer were treated as outpatients in a double blind comparison of carbenozolone 100 mg three times daily with the same dose of geranyl farnesyl acetate (Gefarnate). Healing rates for carbenoxolone were better than for gefarnate, but not significantly so. Nearly half the carbenoxolone-treated patients developed hypokalaemia or oedema, whereas no similar side-effects were found with gefarnate. Gefarnate, while not as effective as carbenoxolone, does appear to promote gastric ulcer healing. Its virtual absence of side-effects makes it a safe and useful drug.
Carbenoxolone↗