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The authors review the recent literature about the classification of primary motor disorders of the oesophagus: achalasia, diffuse oesophageal spasm, nutcracker oesophagus, hypertensive lower oesophageal sphincter and non-specific intermediary disorders. In fact these motility disorders belong to a spectrum of diseases closely related, with chronological transformation of a specific disorder to another one or to intermediary disorders. Most of the recent pathophysiological research concerned primary achalasia, secondary achalasia syndromes being a kind of experimental model. These studies point to a morphological or functional deficiency of postganglionic nerves inhibiting the lower oesophageal sphincter (LOS) through noncholinergic nonadrenergic neurotransmitters. Recent advances in the treatment of achalasia and other motility disorders are not yet based on these findings. Although calcium channel blockers, like nifedipine, lower LOS basal pressure, they are not very useful on long term relief of symptoms of achalasia. Pneumatic dilatations or cardiomyotomy still remain the best methods of treatment of this disease.

The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastro-oesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.

Patients with gastroparesia or intestinal pseudo-obstruction frequently have a motility disorder of the antro-pyloric region that makes the passage of tubes through the pylorus impossible or a very long procedure. We describe a rapid endoscopic method, inspired by the one used for nasobiliary drainage, that simplifies this procedure. In our manometric studies, we observed that spontaneous positioning needed a mean of 57 min (SD 34) in nondyspeptic subjects and a mean of 147 min (SD 68) in non-organic highly dyspeptic patients. Our method allowed us to shorten to a mean of 22 min (SD 5) the time needed to position the manometric tube and to start the recording of gastro-intestinal contractions in highly dyspeptic patients.

We studied digestive manifestations occurring during follow-up of 19 cases of myotonic dystrophy. GI symptoms occurred in 10 patients (53%), mainly dysphagia (n = 7). In patients undergoing investigations (n = 7), their digestive troubles were probably or definitively related to the neurological disease in 6 cases. Upper GI endoscopy was normal in 5 dysphagic patients. The oesophageal manometry was abnormal in 3 of 4 patients. Complications developed in 3 cases (16%). One patient presented two episodes of spontaneous pneumoperitoneum. A second one developed a chronic colonic pseudo-obstruction with megacolon treated by subtotal colectomy. Manometric studies revealed oesophageal aperistalsis, low amplitude of gastro-jejunal contractions but persistence of migrating motor complexes and a normal recto-anal reflex. A third patient developed an acute pseudo-obstruction with ischemic colitis. In conclusion, myotonic dystrophy frequently disturbs digestive tract motility and may cause complications such as intestinal pseudo-obstruction.

We report the case of a patient with "lymphocytic gastritis" surprisingly associated with an intestinal lymphoma which was treated after intestinal resection by corticosteroids and a combination of antimitotic agents. Comparing gastric mucosa before and 3 months after therapy, we observed a striking reduction of inflammation. Such a case suggests the possibility of a beneficial effect of immunosuppressive therapy on "lymphocytic gastritis" and favors the hypothesis of an immunological disorder.

Serum CA 19-9 has been proposed as a tumour marker for pancreatic cancer (PC). However, false positive results are seen in sera of patients with benign jaundice. The CA 19-9 assay was performed by a solid state radioimmunoassay in 86 icteric patients (total bilirubin greater than 2 mg/dl). 24/86 had PC (12 men, 12 women, mean age 74 years) and 62/86 had benign jaundice (29 men, 33 women, mean age 56 years; cirrhosis: n = 20, angiocholitis: n = 21, hepatitis: n = 21). At a cut-off level of 60 U./ml, for detecting icteric PC, sensitivity was 83%, and specificity was 79%. At 120 U./ml, sensitivity was 79%, but specificity was increased to 92%. We conclude that 21% of patients with benign jaundice had a CA 19-9 level greater than 60 U./ml, and using a CA 19-9 level of 120 U./ml, the specificity of the test to detect icteric PC was increased, with little decrease in the sensitivity.

From 1976 to 1985, 1063 patients (614 men, 449 women, mean age: 63 years) underwent the excision of 1887 adenomatous or villous colonic or rectal polyps. Regular controls by barium enema or total colonoscopy have been proposed to these patients. A first control, performed in 715 patients (67%) after a mean of 27 months, revealed the presence of polyps in 162 of them (23%). A second control performed in 331 of the 535 controllable patients (61%), was positive (presence of polyps) in 82 of them (24%). During the follow-up period, 16 cancerous lesions were observed. Comparing the initial status of the patients with the results of the different controls, 3 risk factors for developing a new colonic or rectal polyp emerged: 1) male sex, 2) the presence of multiple lesions at the initial examination, 3) a recurrence at a previous control.

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.