Biomedical subjects
Publications and source records attributed to R de Peyer.
Over a 15-year period we have treated 50 patients with achalasia by pneumatic dilatation (61 dilatations). Perforation occurred in 5 patients, 2 of whom required surgery while the other 3 were successfully managed by conservative means. These 3 patients are reported on with reference to the indications and modalities of the medical treatment.
Mortality in upper GI tract bleeding has not been affected by the introduction of diagnostic fibre optic endoscopy. Recently, however, several modes of treatment delivered through the endoscope have been shown to be effective in improving the outcome of bleeding ulcers. We have retrospectively evaluated the course of 58 patients who underwent endoscopic treatment of a bleeding ulcer. Hemostasis was initially obtained in 93% of patients. 19 (34%) had a relapse of hemorrhage and 15 of these underwent emergency operation. 5 patients (8.6%) died; one of these deaths was due to a complication of endoscopic treatment. Definitive hemostasis was obtained in 41 patients (71%). Endoscopic sclerotherapy of bleeding gastroduodenal ulcers is effective, simple, and cheap, and should be considered in all patients presenting a high risk of relapse.
Terminal constipation is a common ailment which may be readily suspected by appropriate questioning of the patient. Investigation is by function tests such as anorectal manometry and measurement of colonic transit time. The goal of this investigation was to explore the relative merits of these two methods in terminal constipation. Measurement of colonic transit time did not make it possible to distinguish terminal from other forms of constipation, whereas anorectal manometry allowed this distinction and, in cases of terminal constipation, provided information on the physiopathological mechanisms, thereby permitting appropriate anorectal reeducation by biofeedback. We conclude that, once an organic cause has been excluded by coloscopy, anorectal manometry is the investigation of choice in terminal constipation.
Constipation and fecal incontinence are frequent motives of gastroenterological consultation. An etiological diagnosis can often be suspected from the history and can be confirmed by functional testing. We here report our experience with the measurement of colonic transit time (TTC), anorectal manometry (MAR) and defecography (D). Whilst TTC was unhelpful, MAR revealed abdomino-pelvic asynchrony (anismus) in 60 constipated patients and 7 (47%) of 15 incontinent patients. Perineal descent was suspected in 25 constipated patients and confirmed by defecography, which also revealed associated static pelvic disorders. Our experience confirms the role of functional exploration in the investigation of constipation and fecal incontinence and permits a more precise therapeutic approach.
40 patients with achalasia underwent pneumatic dilatation. 25 were followed up for a mean duration of 3.96 years. Digestive symptoms disappeared in 32% of cases, were diminished in 40% and remained unchanged in 28%. In 8 patients oesophageal manometry after dilatation showed a significant reduction in lower oesophageal sphincter pressure. The patients showing improvement had a more marked drop in lower oesophageal sphincter pressure, lower residual pressure in the lower oesophageal sphincter measured by wet swallows, and negative pressure in the oesophagus. As complications 3 patients developed oesophageal perforation with one subsequent death, and 3 symptomatic gastro-oesophageal reflux. In view of these results, we regard pneumatic dilatation as the treatment of choice in achalasia.
Biliary complications have recently been reported in patients with AIDS. This may take the form of acalculous cholecystitis or more commonly cholangitis, which may or may not be associated with stenosis of the papilla. These conditions must be sought in patients presenting with right hypochondrial pain and elevated alkaline phosphatase. Infection with Cryptosporidium or cytomegalovirus is often associated.
Of 69 patients with non-cardiac chest pain, one third had abnormal esophageal motility as evidenced by basal esophageal manometry. 8 patients (12%) reported chest pain during a provocation test (edrophonium). While this pain seemed similar to the spontaneous chest pain described by 7 patients, it was not associated with manometric changes in 30% of these cases. The causal relationship between disorders of esophageal motility and non-cardiac chest pain has still to be confirmed, and caution must be exercised in interpreting edrophonium tests.
60 consecutive patients underwent sclerotherapy for hemorrhage from ruptured esophageal varices. Sclerosis was always started within the first 48 hours. 12 patients (20%) died during initial hospitalization, but only 5 from recurrent bleeding. Of 48 survivors, 22 (46%) did not rebleed during a mean 18-month follow-up, whereas 26 (54%) had recurrences, 27 of these bleeding episodes occurred early (within 4 months) and 17 late (mean 16.5 months). Eradication of the varices was achieved in 29 patients (60%) with a mean of 6.2 sessions and within a mean of 6 months. Of these 48 patients 2 have been lost to follow-up, 25 (52%) are alive after a mean follow-up of 29 months, and 21 (44%) died (though only 2 from variceal bleeding). The survival curve (Kaplan-Meier) of these 60 bleeders is 45% and 37% at 2 and 4 years respectively. Sclerotherapy caused no death and only minor adverse effects. These results confirm those in the literature. We advocate endoscopic sclerosis as first choice in the treatment of ruptured esophageal varices.
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The sensitivity, specificity and positive predictive value of fecal blood testing are too poor to allow its general use as a screening test for colorectal cancers. Even the predictable qualitative improvement of these tests will be of no avail with regard to non-tumoral sources of bleeding or the non-hemorrhagic tumoral sources of bleeding or the non-hemorrhagic tumours which are frequent in the early stages of colorectal cancer. It is therefore essential to define high-risk groups, to pay particular attention even to minor symptoms, and to perform the necessary endoscopic or radiological diagnostic tests.
Drug-induced ulcers of the oesophagus represent a rare but probably under-recorded complication. In a series of 5900 endoscopies performed in 32 months, oesophageal ulcers were seen in 4 cases following the intake of doxycycline, and in one case after ingestion of pinaverium bromide and a bulk laxative respectively. Oesophageal ulcers were seen mainly in young patients without underlying oesophageal disease, presenting with chest pain and odynophagia. The most common site of involvement was at the aortic notch in the middle third of the oesophagus. The course was quickly favorable within 5-10 days after the drug was discontinued, but transient complete abstention from oral intake was required in some cases. Ulceration is thought to be secondary to drug stasis and local cytotoxic effects. Oesophageal ulcers can be prevented simply by recommending intake of the drug with sufficient water in the upright position at least two hours before retiring.
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The association between drugs and diseases of the gastrointestinal tract is well known but has always been evaluated qualitatively and not quantitatively. To study the importance of this association, a prospective study was undertaken at the University of Geneva Hospital in 456 subjects. A statistically significant (p less than 0.05) correlation was found in the following associations: aspirin and multiple gastric ulcers, aspirin and severe erosive gastritis; non-steroidal antiinflammatory drugs and multiple duodenal ulcers, non-steroidal antiinflammatory drugs and mild erosive gastritis. On the other hand, no correlation was found between any of the observed gastrointestinal diseases and prednisone, alcohol or tobacco.
Intestinal lactase assays before and after a Billroth II procedure for chronic duodenal ulcer did not reveal a significant difference. Postoperative lactose intolerance is due to the loss of pyloric function, causing entrance of lactose into the jejunum at a rate exceeding the hydrolytic capacity of the mucosa if the lactase level is low.
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A case of severe enterocolitis which occurred on initiation of chrysotherapy for rheumatoid arthritis is reported. The patient, a male aged 50 years, suffered from dramatic diarrhea for several weeks. Biopsy specimens from the stomach, ileum and colon revealed signs of inflammation. Later, general toxicodermia, mouth ulcers, blood eosinophilia and asymptomatic proteinuria were observed. After several months all the side effects disappeared. The toxicodermia was the most persistent.