Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding.

Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater) is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors. It can pose a significant diagnostic and therapeutic dilemma due to its anatomical location and that bleeding into the duodenum is intermittent and cannot be easily diagnosed by endoscopy.

Rapid protection of the gastroduodenal mucosa against aspirin-induced damage by rabeprazole.

Background: The ability of a proton pump inhibitor to reduce or prevent NSAID-induced gastroduodenal damage during the first 24 h has not been tested.

Aim: To determine, whether oral rabeprazole, administered 5 h before the initiation of therapeutic dosing of aspirin protects the gastroduodenal mucosa.

Methods: Normal subjects were randomized into two groups - one received rabeprazole, 20 mg at 07:00 hours and the other placebo, before initiation of aspirin 650 mg at 12:00 hours, and then q4 h for 3 days.

Increased Barrett's esophagus for the decade between 1991 and 2000 at a single university medical center.

Barrett's esophagus is being diagnosed increasingly in the United States. The aim of this study was to determine whether the increased diagnosis of Barrett's esophagus is due to endoscopic reporting and/or a truly increasing rate. This retrospective study reviewed 18,183 endoscopy reports at Temple University Hospital from January 1991 through December 2000.

Predictors of recurrent specialized intestinal metaplasia after complete laser ablation.

Objectives: The aim of this study was to determine whether specialized intestinal metaplasia recurs after complete laser ablation and to evaluate the persistence of colon epithelial protein in esophageal mucosa after laser ablation as a predictor of recurrence.

Methods: A total of 31 patients with specialized intestinal metaplasia (Barrett's esophagus) underwent laser photoablation. Investigators without knowledge of treatment status evaluated serial hematoxylin and eosin-stained slides, Alcian blue-stained slides, and immunohistochemistry for the detection of colon epithelial protein (mAb Das-1).

Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis.

Background: Computed tomography (CT) can play a vital role in the diagnosis and staging of patients with acute pancreatitis. However, according to current guidelines, a CT examination should not be performed in all patients. We assessed the use of CT scanning in the evaluation of patients with acute pancreatitis at an urban teaching hospital.

Idiopathic Constipation and Fecal Incontinence.

Patients with constipation or fecal incontinence have great potential for remediation. Both disorders warrant a thorough diagnostic evaluation to search for remediable causes, especially to identify defecation disorders. Constipation should be treated by relieving any impactions and then starting a course of fiber supplementation of at least 20 g per day.

Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms.

Objective: In a single noninvasive, quantitative test, whole gut transit scintigraphy (WGTS) measures gastric emptying (GE), small bowel transit (SBT), and colonic transit (CT). The aim of this study was to investigate the clinical utility of WGTS in patients with functional gastrointestinal (GI) symptoms.

Methods: A total of 108 patients with either dyspeptic upper GI symptoms (n = 35) or constipation (n = 73) underwent WGTS.

Role of flexible endoscopy in the evaluation of possible esophageal trauma after penetrating injuries.

Objective: In urban medical centers, penetrating injuries of the chest, neck, and head are frequently encountered due to the use of firearms and sharp weapons. Successful management of esophageal injury requires a high index of suspicion and prompt diagnosis. The role of flexible endoscopy, a readily available modality, has not been studied extensively in the management of potential esophageal injuries due to trauma.

Enteroscopy improves the clinical outcome in patients with obscure gastrointestinal bleeding.

Push enteroscopy is often performed to identify and treat the source of blood loss in patients with obscure gastrointestinal blood loss. This study was designed to determine whether enteroscopy alters the clinical outcome in these patients. This was a retrospective study of 50 patients who underwent push enteroscopy for obscure GI blood loss.

Rapid progression of Barrett's esophagus to metastatic esophageal carcinoma in a patient with chronic lymphocytic leukemia.

Barrett's esophagus is a common premalignant condition that predisposes to the development of adenocarcinoma of the esophagus through a process of transformation from metaplasia to dysplasia and then carcinoma. Periodic endoscopic surveillance with multiple biopsies is adopted by most physicians to detect dysplasia or early carcinoma. We report a case of an 80-year-old white man with chronic lymphocytic leukemia (CLL) who had periodic endoscopic surveillance without any evidence of dysplasia or cancer, and who died of metastatic carcinoma of the esophagus only 18 months after his last upper endoscopic examination.

Effects of in vitro versus in vivo red cell labeling on image quality in gastrointestinal bleeding studies.

Objective: Both in vivo and in vitro red cell labeling methods are available for performing gastrointestinal bleeding studies. While in vitro labeling has been shown to result in higher binding efficiency, no comparison of clinical image quality has been reported between those techniques. This study compares in vivo and in vitro methods using both subjective and objective measurements of image quality.

Detection and treatment of angiodysplasia.

Angiodysplasias of the colon are difficult to detect but usually easy to treat. Colonoscopy is the most sensitive and specific method for detection, but angiography, endoscopic ultrasound, and nuclear medicine techniques are also useful. Emerging optical analysis techniques, such as remote endoscopic digital spectroscopy and enhancement with opioid antagonists, may improve detection rates.

Regional differences in gastric acidity and antacid distribution: is a single pH electrode sufficient?

Unlabelled: Accurate measurement of intragastric acidity has both clinical and investigational importance in studying gastric pathophysiology.

Objectives: The aims of this study were fourfold: (1) to investigate whether regional differences in intragastric acidity exist; (2) to determine intragastric acidity after a standard antacid was administered in both the fasting and fed states; (3) to monitor gastric emptying of and anatomic distribution of radiolabeled antacid during fasting and postprandial periods; and (4) to determine whether the regional effects of ingested antacid correlated with the anatomic distribution of the antacid.

Methods: Eight normal male volunteers were studied after fluoroscopically guided nasogastric placement of a tube assembly containing four pH electrodes, with one electrode in each quartile of the stomach.

Nonexpandable silicone esophageal stents for treatment of malignant tracheoesophageal fistulas: complications and radiographic appearances.

Background: The aim was to evaluate the radiologic appearances and complications that occurred after placement of nonexpandable silicone stents used as palliative therapy for patients with malignant tracheoesophageal fistulas (TEFs).

Methods: Records of 11 patients (6 males, 5 females) who underwent placement of esophageal stents for malignant TEF between 1988 and 1994 were reviewed. Nine patients had esophageal carcinoma and two patients bronchogenic carcinoma.

Enteroscopy in patients with gastrointestinal bleeding of obscure origin.

Approximately 5% of all patients with gastrointestinal hemorrhage will not have a bleeding site found after standard evaluation with upper endoscopy and colonoscopy. The source of bleeding in these patients is often the small intestine. In the past 2 decades, our ability to examine the small bowel endoscopically has been enhanced by the use of intraoperative enteroscopy and the development of push and sonde enteroscopes.

Optimal evaluation of patients with nonobstructive esophageal dysphagia. Manometry, scintigraphy, or videoesophagography?

The aims of this study were to compare diagnostic accuracy, cost, and patient tolerance of videoesophagography and esophageal transit scintigraphy to esophageal manometry in the evaluation of nonobstructive esophageal dysphagia. Eighty-nine consecutive patients underwent videoesophagography, scintigraphy, and manometry. The sensitivities for diagnosing specific esophageal motility disorders, using esophageal manometry as the standard, were 75% and 68% for videoesophagography and scintigraphy, respectively, with positive predictive accuracies of 96% and 95% for achalasia, 100% and 67% for diffuse esophageal spasm, 100% and 75% for scleroderma, 50% and 67% for isolated LES dysfunction, 57% and 48% for nonspecific esophageal motility disorders, and 70% and 68% for normal esophageal motility.

A single intragastric pH electrode does not accurately measure intragastric acidity.

Objectives: Recent studies have raised concerns about the validity of using a single intragastric pH electrode to measure gastric acidity accurately and reproducibly. The aim of this study was to compare simultaneous intragastric pH measurements obtained from an indwelling glass pH electrode to those determined by aspirations from the gastric pool and from ex vivo measurement.

Methods: Twenty two normal volunteers were studied after fluoroscopically guided placement of a combined nasogastric tube-pH probe assembly.

Heart transplantation is associated with an increased risk for pancreaticobiliary disease.

Objective: To determine the risk factors for and the incidence, morbidity, mortality, and outcome of pancreaticobiliary disease in patients who have had orthotopic heart transplantation.

Design: Retrospective case-control analysis.

Setting: University hospital-based heart transplantation center.

Opioid and opioid-like drug effects on whole-gut transit measured by scintigraphy.

Unlabelled: We studied the effects of several drugs on gastrointestinal transit (tramadol HCl, acetaminophen with codeine and placebo) in a randomized, double-blind, crossover study.

Methods: Combined gastric emptying, small bowel and colonic transit scintigraphy was performed in 12 normal subjects. Each subject received a standardized diet and study drug on Days 1-5.

Whole-gut transit scintigraphy in the evaluation of small-bowel and colon transit disorders.

Scintigraphic methods for performing gastric emptying and colon transit studies are now well standardized. Although not as well established, several methods have been proposed for measuring small-bowel transit. The measurement of orocecal transit time appears to be a practical scintigraphic measurement of small-bowel transit.

Endoscopic estimation of size: improved accuracy by directed teaching.

Previous studies have demonstrated the inaccuracy of endoscopic estimation of size. Although several devices have been developed to help improve estimation of size, none are convenient for clinical use. We have designed and evaluated a clinical teaching protocol to aid endoscopists in better estimating size.