[Rehabilitation for digestive and metabolic diseases. Quo vadis?].

The position of rehabilitation in gastroenterology, hepatology and metabolic diseases has changed little in the last 25 years. Initial improvements in quality are oriented more to the content of rehabilitative measures and less to organizational basic conditions. Nevertheless, there is an urgent need for action if rehabilitation medicine is to achieve an equivalent and recognized position in the interaction between primary care and other medical specialties.

[Chronic pancreatitis: weight loss and poor physical performance - experience from a specialized rehabilitation centre].

There are various potential explanations for weight-loss and poor physical performance in patients with chronic pancreatitis: In severe chronic pancreatitis the decline in enzyme secretion is an important cause for the malassimilation syndrome frequently seen in these patients. Occasionally, difficulties may arise in establishing this decline and in quantifying the secretory capacity of the gland. Many patients limit their food intake because of the pain caused by eating.

The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy.

Objective: To assess the influence of pancreatic enzyme supplementation on symptoms, energy intake, bowel habits, and fat malassimilation in patients after total gastrectomy.

Design: A prospective, double-blind, randomized, parallel, placebo-controlled, multi-centre trial.

Setting: Institutionalized patients in three gastroenterological rehabilitation clinics.

Determinants of medico-social functioning after total gastrectomy.

Aim: To describe medico-social functioning after total gastrectomy and the factors determining it.

Patients And Methods: In three medical rehabilitation centres, 173 consecutive patients (female/male = 62/111) after potentially curative total gastrectomy for gastric malignancy 206 days earlier (median, interquartile range = IQR 56-644) were evaluated for different pre- and post-operative parameters with potential influence on post-operative medico-social functioning as measured with the Edinburgh Rehabilitation Status Scale (ERSS). Parameters evaluated were: gender, age, time since operation, tumour stage, type of operation, clinical centre of admittance, haemoglobin, ferritin, albumin, presence of small bowel bacterial overgrowth, rapid oro-coecal transit, dyspepsia, early satiety, reflux, dysphagia, vomiting, a symptom based score, body mass index in health, at operation and on admission, weight loss since operation, calorie intake, bowel habits, and fat malassimilation.

Treatment of reflux oesophagitis of moderate and severe grade with ranitidine or pantoprazole--comparison of 24-hour intragastric and oesophageal pH.

Background: Proton pump inhibiting drugs strongly decrease gastric acid secretion and have proven more effective in the treatment of reflux oesophagitis than H2-receptor antagonists.

Methods: In a double-blind randomized trial, 24 patients with oesophagitis grade II (n = 15) and III (n = 9) were treated for 4 weeks with either ranitidine 150 mg b.d.

Total gastrectomy: the influence of preserved duodenal transit and of pouch reconstruction on abdominal symptoms, nutrient assimilation, and medico-social functioning.

Background/aims: The aim of this retrospective study was to establish whether patients with different reconstruction after total gastrectomy (duodenal bypass without pouch (subgroup Ia, n = 88); duodenal bypass with pouch (subgroup Ib, n = 27); continuous duodenal transit (subgroup II, n = 27)) differ concerning abdominal symptoms, nutrient assimilation, and medico-social functioning.

Methods: The 142 patients (49 females, 93 males; mean age 57.2 years, (95% confidence interval 55 to 59)) after potentially curative total gastrectomy for gastric malignancy 500 days earlier (mean: 95% confidence interval 334 to 666) were evaluated for abdominal symptoms, biochemical and haematological parameters, endoscopic findings, small intestinal bacterial overgrowth, oro-caecal transit time, objective signs of malassimilation, and the degree of medico-social functioning.

Small bowel bacterial overgrowth in patients after total gastrectomy.

The aim of this study was to elucidate the consequences of small bowel bacterial overgrowth (SBBO) after total gastrectomy. A total of 127 patients, evaluated for SBBO with a radiographically controlled H2-breath test (subgroup I, without SBBO, n = 80; subgroup II, with SBBO, n = 47) after potentially curative total gastrectomy for gastric malignancy, were uniformly evaluated. Mean time since operation was significantly shorter in subgroup II than in subgroup I [370 days, confidence interval (CI) 96-645 days, vs.

The risk factor profile of recto-sigmoid adenomas: a prospective screening study of 665 patients in a clinical rehabilitation centre.

During a prospective screening study for recto-sigmoid adenomatous polyps, the influence of the following risk factors was evaluated: age; gender; body mass index; heredity for colorectal malignancy; diabetes; hypertension; constipation; previous gastric surgery; previous gastric acid inhibition; alcohol and cigarette consumption; serum cholesterol; serum triglycerides; and serum gastrin. Screening fibre-sigmoidoscopy of 665 patients (aged between 50 and 60 years) at a clinical rehabilitation centre for gastrointestinal and metabolic diseases showed that 146 had one or several adenomas. The study population was overweight by a mean of about 15%.

[Effect of elevated head position in bed in therapy of gastroesophageal reflux].

In a randomized multicentric trial the effect of sleeping with the bed-head raised was studied in inpatients with reflux symptoms. All patients underwent an endoscopic and pH-metric examination. As a result from the diagnostic procedures three groups were formed: group 1 - refluxlike dyspepsia (endoscopic and pH-metric examination normal), group 2 - reflux disease without esophagitis (endoscopy normal, pH-metric examination abnormal), group 3 - refluxesophagitis (endoscopy abnormal).

Screening for gastrointestinal neoplasia: efficacy and cost of two different approaches in a clinical rehabilitation centre.

Mortality from colorectal cancer (CRC) can be reduced by screening of asymptomatic individuals and by removal of colorectal adenomas (CRA). It is still under debate which screening method should be used. In a clinical rehabilitation centre we compared two widely different approaches: faecal occult blood testing (FOBT) with subsequent endoscopy of test-positives in an unselected patient group, and primary sigmoidoscopy of asymptomatic persons between 50 and 60 years of age.

Nutrient malassimilation following total gastrectomy.

Background: The aim of the study was to elucidate the degree and the pathophysiology of abdominal symptoms, malnutrition and malassimilation after total gastrectomy.

Methods: In 174 consecutive patients, with potentially curative total gastrectomy for gastric malignancy, subjective symptoms and objective parameters of malassimilation were evaluated.

Results: Abdominal symptoms were present in 86% of the patients.

Observation of gastric glandular cysts in the corpus mucosa of the stomach under omeprazole treatment.

In patients undergoing long-term treatment with omeprazole, tiny gastric polyps, described histologically as glandular cysts, have occasionally been reported. We report on a further nine patients (5 women and 4 men) undergoing omeprazole treatment who developed endoscopically visible and histologically verified glandular cysts. Eight patients were on long-term treatment with omeprazole for reflux oesophagitis, and the glandular cysts were observed between 8 and 60 months after the start of treatment.

[Mexiletine in treatment of painful diabetic neuropathy].

The objective of this double-blind placebo controlled multicenter study was to prove the efficacy of mexiletine in painful diabetic neuropathy. Treatment was provided for in three dosages. For pain measurements a visual analogue scale (VAS) and McGill's verbal rating scale were chosen.

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases.

Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.

Determination of faecal chymotrypsin concentration and 72-hour faecal chymotrypsin output in the detection of pancreatic steatorrhoea.

In 96 consecutive patients who underwent a 72-h faecal fat determination because of suspected nutrient malassimilation (maldigestion and/or malabsorption) faecal chymotrypsin (F-Chym) was estimated with a commercial photometric test (Monotest Chymotrypsin), comparing F-Chym concentrations in the first 24-h stool with the total 72-h F-Chym output. In the first 24-h faeces, the F-Chym concentration, calculated as a mean of three random samples, did not significantly differ from a single value obtained after homogenization. In known pancreatic disease, a F-Chym concentration less than 3.

Development of gastric dysplasia in pernicious anaemia: a clinical and endoscopic follow up study of 80 patients.

The development of gastric dysplasia and neoplasia in patients with pernicious anaemia has been evaluated in a prospective clinical and endoscopic follow up study. After initial screening of 80 patients between 1978 and 1980, one patient underwent total gastrectomy for a gastric malignancy and 12 were kept under surveillance and underwent endoscopy at a mean interval of 14 months. In the remaining 67 patients further investigation was attempted six to seven years after the initial investigation.

The influence of telenzepine on gastrointestinal transit: comparison with placebo and domperidone.

In a placebo controlled trial, the effect of the M1-antagonist telenzepine (3 mg in the morning) and of the dopamine antagonist domperidone (10 mg t.d.s.

The effect of cisapride on defaecation in normal human subjects--lack of effect on faecal excretion of water, fat, and bile acids.

In order to elucidate whether or not the increased stool frequency that occurs during cisapride treatment is a result of malabsorption of water, fat, and bile acids, 12 healthy volunteers were dosed with either tablets of placebo q.d.s.

[Possibilities for use and limits of the H2 breath test in gastroenterologic diagnosis].

The H2 breath test is a non-invasive, safe, and - using modern analytical equipment - simple and non-expensive investigation, which reflects gastrointestinal bacterial fermentation of carbohydrate. It is widely used to study sugar malabsorption, and, with mainly scientific intent, also that of complex carbohydrates. The test plays an important role in the investigation of upper intestinal motility disturbances as it is suitable to monitor the orocaecal transit time.

[Lambliasis: a cause of malabsorption and diarrhea?].

Multiple biopsies from the lower duodenum were obtained during endoscopy of 171 patients with dyspepsia, diarrhoea and/or suspected malabsorption. Histological evidence of lambliasis was obtained in six (3.5%).

The benefit of pancreatic enzyme substitution after total gastrectomy.

The aim of the present study was to evaluate the effect of the pancreatic enzyme preparation Kreon on abdominal symptoms, bowel habits, faecal fat excretion and oro-caecal transit time in patients after total gastrectomy for carcinoma of the stomach with Roux-en-Y anastomosis. A hydrogen breath test was carried out in each patient to detect bacterial overgrowth. In a double-blind crossover trial, 15 patients were treated with either Kreon or placebo (3.