Omeprazole in the treatment of patients with severe reflux oesophagitis not responding to H2-receptor antagonists and ineligible for surgery.

In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage I (erosions must be present).

[Chronic pancreatitis and pancreatic cancer. An often difficult differential diagnosis].

A retrospective study of 101 patients whose final diagnosis was chronic pancreatitis (N = 40) or pancreatic cancer (N = 61) aimed to test the respective values of clinical symptoms, laboratory tests, ultrasonography, computerized tomography and endoscopic retrograde cholangiopancreatography for screening of pancreatic lesions and for differential diagnosis. The diagnosis of chronic pancreatitis was found uncertain or erroneous in 7 out of the 40 patients and the diagnosis of pancreatic cancer in 10 out of the 61 patients. The difficulties of differential diagnosis were related to three factors: clinical presentation of some cancers resembling that of chronic pancreatitis, presence of pancreatitic calcifications in some cancers and misinterpretation of pancreatic cavities as cysts or as tumour necroses.