Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing.

Background: Pathophysiology of rumination syndrome (RS) is not well understood. Treatment with diaphragmatic breathing improves rumination syndrome. The aim of the study was to characterize vagal tone in patients with rumination syndrome during and after meals and during diaphragmatic breathing.

Non-invasive diagnosis of Helicobacter pylori infection in adult dyspeptic patients by stool antigen detection: does the rapid immunochromatography test provide a reliable alternative to conventional ELISA kits?

Stool antigen-testing allows non-invasive detection of Helicobacter pylori that is indicative of active infection. Three commercial kits are currently marketed in the UK for stool antigen-testing. The aim of this study was to conduct a comparative evaluation of the performances of each of these tests, compared with culture and histological examination of gastric biopsies, for pre-treatment diagnosis of infection in an adult dyspeptic population in south-east England.

PCR-based diagnosis of Helicobacter pylori infection and real-time determination of clarithromycin resistance directly from human gastric biopsy samples.

A novel PCR detection assay that amplifies the Helicobacter pylori-specific vacuolating cytotoxin gene (vacA) and thus enables rapid diagnosis of infection is described. Additionally, a real-time probe hybridization melting point analysis assay to detect all three mutations in the 23S rRNA gene associated with clarithromycin resistance was applied directly to antral gastric biopsy samples. Comparison with culture and an alternative PCR assay targeting the 16S rrn gene showed that the vacA assay was sensitive and specific when tested on biopsy samples from 121 patients.

Genetic diversity in the Helicobacter pylori cag pathogenicity island and effect on expression of anti-CagA serum antibody in UK patients with dyspepsia.

Aims: To investigate variation within the cag pathogenicity island (PAI) of Helicobacter pylori isolated from patients with dyspepsia in mid-Essex, and to evaluate the effect on expression of anti-CagA antibody.

Methods: Sixty two isolates of H pylori cultured from gastric biopsies were screened by specific PCR assays for the presence of cagA and other gene markers (cagD and cagE, and virD4) in the cag PAI. An enzyme linked immunosorbent assay (ELISA) kit (Viva Diagnostica helicobacter p120) was used to test for anti-CagA IgG antibody in matching sera.

Molecular epidemiology of Helicobacter pylori in England: prevalence of cag pathogenicity island markers and IS605 presence in relation to patient age and severity of gastric disease.

The cagA gene is a key marker for the Helicobacter pylori cag pathogenicity island (PAI), which may vary in composition in different strains with insertion sequence mediated interruptions and deletions of genes. While presence of cagA has been associated with increased risk for peptic ulcer disease and gastric cancer, the precise link with virulence is controversial. We investigated H.

Comparison of 99m technetium hexamethylpropylene-amine oxime labelled leucocyte with 111-indium tropolonate labelled granulocyte scanning and ultrasound in the diagnosis of intra-abdominal abscess.

Fifty patients with suspected intra-abdominal abscess were investigated prospectively with ultrasound and with 99mTc-hexamethylpropylene-amine oxime (HMPAO) isotope labelled mixed leucocytes, using 111-In tropolonate granulocyte scanning as the reference standard. Twenty five patients had inflammatory bowel disease (three were postoperative): 21 of these had Crohn's disease and four had ulcerative colitis. The remainder comprised nine with postoperative fever and 16 with fever and abdominal pain.

Paradoxical lack of ultrasound attenuation with gross fatty change in the liver.

The cardinal features of hepatic steatosis on ultrasound examination are now accepted as increased echogenicity of the liver parenchyma with increased attenuation of the ultrasound beam. Three cases are presented of patients with gross diffuse fatty infiltration of the liver, who showed a paradoxical lack of posterior attenuation on ultrasound examination. These examples serve to illustrate the role of scattering in attenuation of the ultrasound beam seen in fatty livers.

Ultrasonic patterns in inflammatory bowel disease.

Ultrasound examination was performed in 90 patients with varying bowel pathology. Ultrasound reliably demonstrated thickening of the bowel. In addition, the pattern of abnormality seen in Crohn's disease and ulcerative colitis was different, and corresponded to the pathological changes seen in these disease processes.

Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy.

Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold.

Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease.

To establish the accuracy of ultrasonography in assessing diffuse parenchymal liver disease we performed a prospective comparative study with histology in 50 patients with a wide range of liver disease. Liver biopsy was performed within 24 h of the ultrasound examination and ultrasonography was performed by a single operator who was unaware of clinical details of the patients. Histology was reviewed blind and the degree of steatosis graded mild, moderate or severe while increased portal fibrous tissue was graded mild, moderate or established cirrhosis.

Gallbladder wall thickening (congestive cholecystopathy) in chronic liver disease: a sign of portal hypertension.

A thickened gallbladder wall is often seen with ultrasound in alcoholic cirrhosis. Hypoalbuminaemia is thought to be the cause since there is a strong association between bowel wall thickening and low serum albumin. To determine the role of portal hypertension in producing gallbladder wall thickening we studied 40 consecutive stable patients-37 with cirrhosis and three with portal hypertension due to primary biliary cirrhosis.

Correlation of 111indium WBC scintigraphy with ultrasound in the detection and assessment of inflammatory bowel disease.

111Indium (111In) WBC scintigraphy is an accurate method of assessing the extent of inflammatory bowel disease. A prospective study was performed to determine the correlation of ultrasound scanning with 111In WBC scintigraphy in the assessment of inflammatory bowel disease. Eighty-three indium and ultrasound scans were performed in 57 patients.

Thermodynamic effects of bile acids in the stomach.

The surface thermodynamic effects of bile acids in the stomach were assessed in 48 subjects who had undergone gastric surgery for peptic ulcer disease and in 52 controls with medically healed ulcers. We derived values for surface tension of gastric mucosa from contact angle using a goniometer and measured the surface tension of gastric juice by the drop-weight method. Subjects with gastric surgery had higher median fasting bile acid concentrations than controls (1.

Surface hydrophobicity of gastric mucosa in peptic ulcer disease. Relationship to gastritis and Campylobacter pylori infection.

The hydrophobicity of biopsy specimens of gastric mucosa in 228 dyspeptic subjects undergoing diagnostic endoscopy was assessed by measuring the plateau-advancing contact angle of saline drops using a goniometer. Subjects with duodenal ulcers (n = 49) and gastric ulcers (n = 17) had significantly lower mean contact angles than controls (n = 124) without ulcer (57 degrees in duodenal ulcer, 59 degrees in gastric ulcer vs. 66 degrees in controls; p less than 0.

Ultrasound in the diagnosis of granulomatous liver disease.

Ultrasound is a widely used method of assessing the liver for space occupying lesions and, more recently, parenchymal liver disease. We have reviewed the ultrasound scans and reports of 11 patients with biopsy proven granulomatous liver disease. Multiple echogenic lesions 3-5 mm in diameter, each surrounded by an hypoechoic halo, were seen in the liver of all the patients and in the spleens of three patients.

Quantification of radiolabelled granulocyte migration in vivo.

Quantification of the tissue localisation of granulocytes is difficult, particularly in man. With the aim of facilitating such quantification, a technique is described which combines the micropore filter skin window technique with the infusion of autologous 111In-labelled granulocytes. The radioactivity in the removable micropore filters, placed on small forearm skin window abrasions, was compared with peripheral blood radioactivity following injection of 111In-labelled 'pure' granulocytes in normal subjects.

Thickened stomach--an ultrasound sign of portal hypertension.

Congestive gastrophy occurs with portal hypertension and is associated with vascular changes including dilatation and tortuosity of the submucous veins. Transabdominal ultrasound measurements of the stomach were made to determine whether these changes resulted in increased thickness of the stomach in patients with established cirrhosis and portal hypertension. Mean thickness of the antrum and body was 22.

Quadruple antimycobacterial chemotherapy in Crohn's disease: results at 9 months of a pilot study in 20 patients.

Twenty patients with active Crohn's disease, the majority refractory to conventional therapy, were treated with rifampicin, ethambutol, isoniazid, and pyrazinamide or clofazamine for 9 months. After this period, 10 were in remission (Crohn's disease activity index less than 150). Of the 10 not in remission, three had been at 6 months, but had relapsed on treatment.

Measurement of the surface hydrophobicity of human gastrointestinal mucosa.

A technique has been developed for assessing the surface hydrophobicity of human gastrointestinal mucosa by measuring the plateau contact angle of saline drops applied to endoscopic biopsy specimens. The plateau contact angle was not affected by the mode of drying. The intraobserver and interobserver coefficient of variation was less than 5%.

Use of endoscopic biopsy for diagnosing congestive gastropathy.

The specificity of endoscopic biopsy specimens in diagnosing congestive gastropathy in 20 patients with portal hypertension, 20 patients with liver disease without portal hypertension, and 20 patients with a normal stomach at endoscopy without liver disease was examined. Histological assessment, which was performed without knowledge of the clinical details, showed changes previously reported to be indicative of congestive gastropathy in 9 (47%) of patients with portal hypertension. Similar changes were also seen in 17 (85%) of patients with liver disease without portal hypertension and in 16 (84%) of patients with normal endoscopies without liver disease.