Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

An examination of esophageal function using manometric techniques and long-term pH measurement was carried out on 14 patients suffering from cirrhosis of the liver who had esophageal varices. The resting pressure in the lower esophageal sphincter was found to be slightly reduced in 50 per cent of those examined, while 100 per cent showed a slightly reduced contraction amplitude in the distal tubular esophagus which became progressively lower in the distal direction, and a pathological gastro-esophageal reflux was observed in 57 per cent. We were able to carry out a control examination on 10 of these patients after sclerosing procedure. Sclerotherapy was found to have lowered resting pressures in the lower esophageal sphincter in 80 per cent of those patients, while all of them showed a grossly impaired tubular peristalsis in the form of simultaneous, mostly repetitive contractions with a considerably lowered contraction amplitude, however it had no negative influence on gastro-esophageal reflux patterns.

After ingestion of a solid test meal the postprandial motor activity in 17 dyspeptic patients and 12 healthy controls were examined. In all individuals the gastric emptying was measured by scintigraphy. - The antral pressure activity after food intake was delayed in dyspepsia and showed a distinct reduction with time (antral hypomotility). In contrast the postprandial duodenal motility was increased significantly (duodenal hyperdyskinesia). All 6 dyspeptic patients with prolonged gastric emptying had gastroduodenal manometric abnormalities. - Our results suggest that in chronic dyspepsia the interdigestive and postprandial motility is often disturbed. The delayed gastric emptying occurs because of impaired antral peristalsis and/or increase of duodenal resistance.

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were 9 polyps with an early cancer and 8 polyps with severe dysplasias (borderline lesions) as well as 1 polyp, in which an advanced carcinoma has been developed. This is the outstanding greatest number of hyperplasiogenic polyps with a malignant transformation. In addition in 9 patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignant developments of 3.7%. It seems that stomachs with multiple polyps are endangered in particular. The recurrence rate of follow-up examinations covering a period of up to 8 years was 36.1%.

A single dose 0.2 U/kg b.w. of insulin was administrated after an hour of infusion of pentagastrin 2 micrograms/kg b.w. for 6 healthy volunteers aged about 27 (22-30); the investigation was carried out for 1.5 h. The control group consisted of 6 health volunteers aged about 27 (21-36) which were administrated infusion of pentagastrin. While applicating stimuli the gastric juice was aspirated for analysis. In 15-minutes fraction of gastric juice the volume, concentration and output of hydrochloric acid, pepsin, protein and carbohydrates components of gastric mucus: hexoses, hexosamine, fucose and sialic acid were measured. It was stated that insulin decreases gastric secretion stimulated by pentagastrin in two first 15-minutes fractions after administration of insulin dependently on decrease of gastric juice volume. Insulin-hypoglycemia is a stimulus decreasing gastric mucus secretion, stimulated by pentagastrin. On this ground the conclusion can be arrived, that pentagastrin evokes the mechanism decreasing gastric mucus secretion, probably adrenergic. Insulin does not change hydrochloric acid secretion, but it appears to be en extremely strong stimulus for pepsin secretion which proves hypothesis, that secretion of this enzyme is regulated mainly by vagus.

We observed 87 patients with duodenal ulcer disease about one year. 46 patients (first group) after proximal gastric vagotomy were observed. A second group (41 patients) were treated with antacids only. We compared our patients for their complaints, consumption of antacids, relapse rate and clinical, social and genetic aspects. The clearly better results of the surgically treated patients allow the conclusion for a better quality of life in patients after proximal gastric vagotomy.

The increased oxalic acid absorption is a well documented finding in gastroenterological diseases. The malabsorption of bile acids and fat is important in the pathogenesis of the hyperoxaluria. The enteric absorption of 14C-labelled oxalic acid was measured in 49 patients with different diseases. The dihydroxy-trihydroxy-ratio of bile acids is significantly decreased in patients with hyperoxaluria over 20% of the ingested dosage. We didn't find any correlation between the excretion of oxalic acid and the intraduodenal pancreatic lipase activity.

In gastric cancer the tumor markers CEA, TPA and CA 19-9 display relatively low sensitivity, which in relation to a specificity of 90% lies between 20% and 25%. Compared with the simple ESR method, these sensitivities are not remarkably greater. But a combination of parameters based on discriminant analysis achieves distinctly greater sensitivities.

The interdigestive gastroduodenal motility was studied in 28 patients suffering from chronic dyspepsia and in 15 healthy controls. The pressure activity was recorded using a four-lumen manometric probe positioned in the gastric antrum, the proximal and distal duodenum as well. - The mean cycle duration of the interdigestive myoelectric complex lasted 108 +/- 36 min. in dyspepsia and 81 +/- 30 min. in controls (p less than 0.05). In the antrum this prolongation resulted from a longer duration of phase 1. 7 dyspeptic patients had no activity fronts in the stomach. Both examined groups showed little differences in duodenal motility patterns, except for a significant increase of tonic pressure component during phase 3 activity in dyspepsia. Between gastric emptying time and interdigestive motility no correlation were established.

This contribution covers the X-ray documentation of primary coloscopy findings in 29 patients. High coloscopy as a primary method of diagnosis used to have the disadvantage that when dealing with a circumscribed lesion requiring surgery, a barium enema had to be administered on order to localize it and determine its extent. The endoscopic-radiological coloscopy method described here combines primary coloscopy with a spatial visualization of the colon on an X-ray picture. It should bei applied wherever coloscopy is used as the primary method of examining the colon.

We investigated in-vitro the relation of the lipase and trypsin activity, containing in native duodenale juice, to pH-values, similar to them registered in the duodenum of patients with severe exocrine insufficiency. Therefore week alcaline duodenal juice was acidified by native gastric juice or hydrochloric acid to pH-value 7, 6, 5 und 4. The remaining activity was estimated after 5, 10, 15 and 20 minutes. We determined a fast inactivation of lipase at pH 5.0 or below (incubation of 5 minutes only decreased the activity to 35% of origin), and of trypsin at pH 4.0 or below (incubation of 5 minutes at this pH-value decreased the activity to 26% of origin). According to the denaturating effect on the enzymes, there was no difference between gastric juice and hypochloric acid. It is concluded, that the activity of decreased secreted pancreatic enzymes in severe exocrine pancreatic insufficiency and also of the oral substituted enzymes is additionally reduced by acidic duodenal circumstances, so that a gastric acid neutralizing or inhibiting therapy proves as necessary.