Selection of patients for successful maintenance treatment of esophagitis with low-dose omeprazole: Use of 24-hour gastric pH monitoring

Objective: Treating patients with erosive esophagitis and maintaining remission in a cost-effective fashion is a desirable goal in clinical practice. There are no established criteria to identify patients with healed esophagitis who will subsequently remain in remission with low-dose omeprazole therapy. We investigated whether 24-h esophageal-gastric pH monitoring could provide criteria to select patients for low-dose omeprazole maintenance therapy. METHODS: Seventy consecutive symptomatic outpatients with grade 2-3 reflux esophagitis were prospectively investigated. They were treated with 20 mg/day omeprazole for 2 months. Those with healed esophagitis were given alternate-evening 20-mg omeprazole maintenance therapy for 6 months. Clinical evaluation, endoscopy, and 24-h esophageal-gastric pH were done at the end of each treatment period. Results of pH studies of patients in remission were compared with those with endoscopically documented relapse of esophagitis. RESULTS: In 63/70 patient (intention-to-treat, 90%; 95% confidence interval [CI], 83-97%) esophagitis was healed at 2 months. During the 6-month maintenance period esophagitis remain healed in 28 (G1) (40%; 95% CI, 29-52%), but recurred in 32 patients (G2). During healing with omeprazole 20 mg/day the 24-h gastric pH was below 4 for < 10% of the time in 96% of the patients, who subsequently remained in long-term remission with low-dose maintenance therapy (G1), but not in any patient with recurrence of esophagitis (G2). The 10% threshold value has a specificity of 1.00 and sensitivity of 0.96. CONCLUSIONS: The 24-h intragastric pH monitoring during 20 mg/day omeprazole therapy provides criteria by which to preselect patients with reflux esophagitis who will remain in remission with low-dose omeprazole therapy. (C) 2000 Am. Coll. of Gastroenterology

Honey may have a laxative effect on normal subjects because of incomplete fructose absorption

Honey contains fructose in excess of glucose, which may lead to incomplete fructose absorption associated with abdominal symptoms and/or diarrhea. This hypothesis was investigated in 20 healthy volunteers (13 males, 7 females) with a mean (± SD) age of 35.9 ± 12.1 y. Each subject drank the following aqueous solutions in random order: 20 g lactulose, 100 g honey, 50 g honey, and 35 g each of a glucose and fructose mixture. The breath-hydrogen concentration was measured every 15 min for 6 h. Semiquantitative estimates of carbohydrate malabsorption were assessed with lactulose as a nonabsorbable standard. Breath hydrogen concentrations increased by 52 ± 6, 30 ± 4, 20 ± 3, and 4 ± 1 ppm (x̄ ± SEM) after each of the four test solutions, respectively. The estimated carbohydrate malabsorption was 10.3 ± 1.8, 5.9 ± 1.2, and 0.5 ± 0.2 g after 100 g honey, 50 g honey, and the glucose- fructose mixture, respectively (F([2.57]) = 16.05, P < 0.001). Within 10 h after the ingestion of 100 g honey, 50 g honey, and the glucose-fructose mixture, six, three and none of the volunteers, respectively, reported loose stools (χ2 = 7.1, df = 2, P < 0.03). The results of this study suggest that carbohydrate malabsorption after ordinary doses of honey is frequent in healthy adults and may be associated with abdominal complaints. Honey may have a laxative effect in certain otherwise healthy individuals, probably because of incomplete fructose absorption

Evaluation and management of esophageal manifestations in systemic sclerosis

Systemic sclerosis (SSc) is a multisystemic autoimmune connective tissue disorder; in the gastrointestinal tract, the esophagus is the most commonly affected organ. Symptoms of esophageal disease are due to gastroesophageal reflux disease (GERD) and esophageal motor dysfunction. Since the development of high-resolution manometry (HRM), this method has been preferred for the study of SSc patients with esophageal involvement. Using HRM, classic scleroderma esophagus, defined as absent or ineffective peristalsis of the distal esophagus in combination with a hypotensive lower esophageal sphincter, was found in as many as 55% of SSc patients. Endoscopy is the appropriate test for evaluating dysphagia and identifying evidence and possible complications of GERD. In the therapeutic area, treatment ranges from general supportive measures to the administration of drugs such as proton pump inhibitors and/or prokinetics. However, as many SSc patients do not respond to existing therapies, there is an urgent need for new therapeutic modalities. Buspirone, a 5-hydroxytryptamine 1A receptor agonist, could be a putative therapeutic option, as it was found to exert a significant beneficial effect in SSc patients with esophageal involvement. This review summarizes our knowledge concerning the evaluation and management of esophageal manifestations in SSc patients, including emerging therapeutic modalities. © 2018 Hellenic Society of Gastroenterology

Colonic gas explosion during therapeutic colonoscopy with electrocautery

Therapeutic colonoscopy with electrocautery is widely used around the world. Adequate colonic cleansing is considered a crucial factor for the safety of this procedure. Colonic gas explosion, although rare, is one of the most frightening iatrogenic complications during colonoscopy with electrocautery. This complication is the result of an accumulation of colonic gases to explosive concentrations, but may be prevented by meticulous bowel preparation. The purpose of this review is to discuss the indications and the types of bowel preparations for therapeutic colonoscopy, and to contribute recommendations for the adequate bowel preparation for colonoscopy with electrocautery. © 2007 WJG. All rights reserved

Lactose maldigestion and milk intolerance in healthy Greek schoolchildren

The prevalence of lactose maldigestion in Greek adults is 75% but the age at which the lactase activity starts declining is not known. The prevalences of lactose maldigestion and intolerance were investigated in 150 randomly selected Greek children 5-12 y old by using breath-hydrogen analysis after ingestion of lactose (2 g/kg body wt, maximum 50 g) or 0.240 L of milk. Prevalence of lactose maldigestion increased with age (y = -7.30 + 6.49x, r = 0.88, P = 0.004), being 29.4% and 80.0% at ages 5 and 12 y, respectively. Before testing, the reported prevalences of milk-related symptoms by children with high and low lactose-digestion capacity were 21.1% and 39.7% (x2 = 5.96, P = 0.015), respectively. However, the corresponding prevalences of lactose intolerance after ingestion of milk were 7.3% and 8.6% (X2 = 0.1, P = 0.72) and only three children had a ΔH2 ≥ 20 ppm postprandially. Although intestinal lactase activity declines before age 5 y and many Greek children report milk-related symptoms, true malabsorption and intolerance of lactose after a glass of milk is rarely seen at this age

The nature of small intestinal mucositis: A video-capsule endoscopy study

Background and aims: Alimentary mucositis is a life-threatening side effect in patients receiving conditioning therapy for stem cell transplantation. While oral mucosa can be easily inspected, there are no endoscopic data on small intestinal mucositis. The aim of our study was to investigate small intestinal lesions using video-capsule endoscopy in patients undergoing peripheral blood stem cells transplantation. Materials and methods: We prospectively studied five consecutive patients who underwent peripheral blood stem cells transplantation: three patients (four studies) without concomitant recombinant human keratinocyte growth factor (palifermin) treatment and two patients with palifermin treatment. We performed video-capsule endoscopy studies 7 days after cells infusion, when transplant patients usually have severe abdominal symptoms. Results: In three patients who did not receive palifermin, video-capsule endoscopy revealed extensive confluent ulcerations with bleeding spots in the small intestine. Two patients had lesions in the jejunum and in the ileum. One of them underwent repeat video-capsule endoscopy 6 days later that showed significant healing of the lesions, but still there were diffuse edema of small intestinal mucosa, erosions and scarce ulcerations. In the third patient, the capsule remained in the stomach for 7.5 h but showed duodenal erosions with bleeding spots. Both patients on palifermin treatment had normal examinations. All studies were uneventful. Conclusion: Our data reveal for the first time that small intestinal mucositis in patients undergoing conditioning therapy for peripheral blood stem cells transplantation presents as small intestinal ulcerations and that palifermin treatment prevents these lesions. © 2008 Springer-Verlag