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The herbicide, pendimethalin, is used worldwide, but its acute toxicity is not yet widely known. There have been some reported acute pendimethalin poisoning cases in humans and most of them intentionally ingested the concentrated formulation. We describe a 73-year-old man who developed corrosive gastroduodenal injury after accidental ingestion of the diluted (300 times with water) pendimethalin formulation. He had a history of reflux oesophagitis and had been taking omeprazol (10 mg/day) for a year. He consumed alcohol two hours after the accidental ingestion and then had nausea and epigastric pain. Endoscopy performed three days post-exposure revealed gastroduodenal injury. As he had consumed alcohol every day for years and had no history of gastroduodenal ulcer, the accidental ingestion may be associated with this injury. He was successfully treated by increasing his dosage of omeprazol (20 mg/day) for two weeks. This case indicates that ingestion of a small quantity of pendimethalin can provoke gastroduodenal injury.

A 22-year-old man presented with a two-year history of colicky upper abdominal and dyspnoea. His absolute eosinophil count (AEC) was 980/mm3. Chest x-ray revealed hilar prominence. An upper gastrointestinal endoscopy showed marked oedema and nodularity of duodenal mucosal folds. Duodenal biopsy disclosed heavy lymphoplasmacytic infiltrates in the lamina propria and sheets of eosinophils and rhabdtiform larvae of Strongyloides stercoralis in the crypts. The patient was not on steroids and his HIV ELISA was nonreactive. His IgG ELISA for Strongyloides stercoralis was positive. Nodular duodenal mucosa may thus be seen with Strongyloides stercoralis infection.

Gastroduodenal tuberculosis (TB) is a rare condition and is often associated with pulmonary TB. We report the case of a primary duodenal TB in an immunocompetent patient without evidence of pulmonary TB. Diagnosis of this disease is difficult and is often confused with chronic peptic ulcer disease. Literature data concerning this challenging diagnosis are analysed.

The aim of this study was to determine the influence of nifedypine--competitive antagonist of voltage-gated dependent L-type Ca2+ channels (VGCCs)--on inhibition of reticulo-ruminal motility, heart beats, respiratory rates and other nociceptive behavior symptoms caused by duodenal distention (DD). The animals, which were under general anesthesia, had duodenal and ruminal fistulas and intracerebroventriculary (i.c.v.) cannulas inserted into the lateral ventricle. Reticulo-ruminal contractions were recorded mechanographically using an electronic tensometer. The frequency of reticulo-ruminal contractions was determined by the number of mechanograms with 5 min intervals prior to and after DD (for 180 min). The duodenal distention was performed using a rubber balloon (10 cm length), which was inserted via the duodenal fistula and filled with 40 ml water. Five min DD caused immediate and almost complete inhibition of reticulo-ruminal contractions, nociceptive behavior symptoms, tachycardia and hyperventilation. Nifedypine per se did not change the reticulo-ruminal motility, general behavior or clinical symptoms; however, doses of 1 and 2 mg of nifedypine in toto infused i.c.v 10 minutes before DD prevented all signs of reticulo-ruminal disorders, as well as the general nociceptive behavior. Nifedypine inhibited particularly clinical symptoms such as tachycardia and hyperventilation. The observed antinociceptive action of VGCCs type-L blockers suggests that these channels play a crucial role in the modulation of acute visceral hyperalgesia. Nifedipine can be useful in controlling acute visceral pain associated, for example, with different kinds of colic.

Unlabelled: To study prevalence of polyresistance (PR) among the strains of Helicobacter pylori isolated from patients with chronic gastritis, gastroduodenal ulcer and gastric cancer in Georgia. Material and methods. Biopsies of gastric mucosa and resection material were studied in 206patients with gastroduodenal zone diseases for identification of H. pylori (HP) and PR strains of HP. Results. The number of antibiotics involved in development of polyresistant strains varies from 3 to 8. The greatest number of strains (28.57 +/- 1.06%) develop PR to 5 antibiotics, the least--to 8 antibiotics., Conclusion: PR prevalence among HP strains is 35.25 +/- 4.05%. PR is most frequently seen to metronidasol and oxacilline, least frequently--to amoxicilline and clarithromycin.

Background: Proton-pump inhibitors are effective at preventing the acid component of gastro-oesophageal refluxate from entering the oesophagus. It is not clear whether proton-pump inhibitors prevent duodenogastro-oesophageal reflux., Aim: To measure oesophageal exposure to duodenogastro-oesophageal refluxate while on proton-pump inhibitors in patients with Barrett's oesophagus., Methods: Twenty-five patients (23 male) with Barrett's oesophagus underwent 24 h oesophageal pH and Bilitec 2000 monitoring while on omeprazole 40 mg/day (n = 19) or omeprazole 60 mg/day (n = 6). All patients were undergoing argon plasma ablation of their Barrett's epithelium as part of a clinical trial and the Bilitec measurements were only carried out after the ablation had been completed., Results: 20 of 25 (80%) patients had a normal oesophageal pH profile. Fifteen of the 25 (60%) had abnormal oesophageal exposure to bile as measured by Bilitec 2000. Of the 20 patients who had a normal 24 h oesophageal pH profile, 11 (55%) had pathological exposure to bile in their oesophagus., Conclusion: Complete acid suppression does not guarantee elimination of duodenogastro-oesophageal reflux.

Background: Montelukast, a competitive cysteinyl leucotriene-1 receptor antagonist, reduces airway eosinophilia in asthmatics. We evaluated the effect of this drug in children with eosinophilic duodenitis, defined histologically as duodenal mucosa with peak eosinophil count of more than 10 eosinophils/hpf., Methods: Forty children and adolescents (6-18 yr) with dyspepsia and duodenal eosinophilia were enrolled in a double blind, randomized, placebo-controlled, cross-over study of monteleukast therapy. Subjects were randomized to receive either 10 mg montelukast or an identical placebo once daily and were evaluated on day 14 for symptomatic and biochemical responses. Subjects were also randomized to one of two blood sampling schemes to evaluate montelukast pharmacokinetics., Results: Using a post treatment global pain assessment, a positive clinical response was observed in 62.1% of patients receiving montelukast compared with 32.4% on placebo (p < 0.02). Pain assessment score deteriorated in 45% of montelukast responders (5/11) after cross-over to placebo and improved in 62% (8/13) of placebo non-responders on cross-over to montelukast. In patients with peak duodenal eosinophil counts between 20-29/hpf (n=19), a positive pain assessment response was observed in 84% of patients receiving montelukast compared to 42% receiving placebo (p < 0.01). Response rate did not differ by age, gender or histologic findings at baseline. Pharmacokinetic analysis yielded parameter estimates for absorption rate constant (Ka), apparent volume of distribution (Vd/F) and elimination rate constant (Kel) of 0.42 h, 0.19 L/kg and 0.26 h, respectively. The relative extent of systemic drug exposure was comparable to that observed in previous pediatric investigations with similar weight-adjusted montelukast doses. Neither dose nor calculated drug exposure were associated with the level of post treatment pain assessment or the change in biochemical markers., Conclusions: These data suggest a beneficial role for montelukast in the treatment of pediatric patients with dyspepsia associated with duodenal eosinophilia.

Eighty-two cases of un formed high intestinal fistulas are analyzed. Degree of non-formation and volume of chymus loss are the main criteria determining treatment policy. Early surgery (one or two-sided switching of fistulas zone) is indicated in intestinal loss more then 600-700 ml per day or in complete fistula. Mezonnes surgery was un effective in the majority of cases. Special policy including trunk vagotomy, antrumectomy and plastic repair of the duodenal bulb permitted in the last years to avoid duodenal fistulas in the treatment of ulcer disease.

Background: The long term safety of potent gastric acid suppressive therapy has yet to be established., Method: General practice record review at a median interval of 26 months followed by retrieval of details of all deaths within four years using the UK National Health Service Central Registers in 17 936 patients prescribed omeprazole in 1993-1995. Death rates were compared with general population rates., Results: Records of 17 489 patients (97.5%) were examined. A total of 12 703 patients received further scripts for antisecretory drugs, 8097 for omeprazole only (65.6%): 3097 patients have died. All cause mortality was higher in the first year (observed/expected (O/E) 1.44 (95% confidence intervals (CI) 1.34-1.55); p<0.0001) but had fallen to population expectation by the fourth year. There were significant mortality increases in the first year, falling to or below population expectation by the fourth year, for deaths ascribed to neoplasms (1.82 (95% CI 1.58-2.08); p<0.0001), circulatory diseases (1.27 (95% CI 1.13-1.43); p<0.0001), and respiratory diseases (1.37 (95% CI 1.12-1.64); p<0.001). Increased mortality ascribed to digestive diseases (2.56 (95% CI 1.87-3.43); p<0.0001) persisted, although reduced. Increased mortality rates for cancers of the stomach (4.06 (95% CI 2.60-6.04); p<0.0001), colon and rectum (1.40 (95% CI 0.84-2.18); p=0.075), and trachea, bronchus, and lung (1.64 (95% CI 1.19-2.19); p<0.01) seen in the first year had disappeared by the fourth year but that for cancer of the oesophagus had not (O/E 7.35 (95% CI 5.20-10.09) (p<0.0001) in year 1; 2.88 (95% CI 1.62-4.79) (p<0.001) in year 4). Forty of 78 patients dying of oesophageal cancer had the disease present at registration. Twenty seven of those remaining cases had clinical evidence of Barrett's disease, stricture, ulcer, or oesophagitis at registration (O/E 3.30 (95% CI 2.17-4.80)). Six deaths occurred in patients with hiatal hernia or reflux only (O/E 1.02 (95% CI 0.37-2.22)) and five in patients without oesophageal disease (O/E 0.77 (95% CI 0.25-1.80)). No relationships were detected with numbers of omeprazole scripts received., Conclusions: Increases in mortality associated with treatment are due to pre- existing illness, including pre-existing severe oesophageal disease. There was no evidence of an increased risk of oesophageal adenocarcinoma in those without oesophageal mucosal damage recorded at registration.

A human Echinostoma hortense infection was diagnosed by gastroduodenoscopy. An 81-year-old Korean male, living in Yeongcheon-shi, Gyeongsangbuk-do and with epigastric discomfort of several days duration, was subjected to upper gastrointestinal endoscopy. He was in the habit of eating fresh water fish. Two live worms were found in the duodenal bulb area and were removed using an endoscopic forceps. Based on their morphological characteristics, the worms were identified as E. hortense. The patient was treated with praziquantel 10 mg/kg as a single dose. The source of the infection in this case remains unclear, but the fresh water fish consumed, including the loach, may have been the source. This is the second case of E. hortense infection diagnosed by endoscopy in Korea.

Cystic dystrophy in heterotopic pancreas of the duodenal wall is a rare but benign disease, associated in most of the cases with chronic pancreatitis. Treatment of this disease is controversial. We report here the use of a long-acting somatostatin synthetic stable analogue in the treatment of a cystic dystrophy in heterotopic pancreas of the duodenal wall: a 45-year-old man, hard drinker, was treated successfully during three months with lanreotide acetate; disappearance of cysts was confirmed by a computed tomography two months after the end of treatment.

Purpose: In the eradication of Helicobacter pylori infection, a 1-week therapy improves patient compliance, but drug resistance may limit its efficacy. The effectiveness of the 1-week nonbismuth quadruple therapy was studied prospectively in children with proven H pylori infection in a population with a high rate of metronidazole resistance., Methods: All pediatric patients who presented to our institutions with acute and chronic upper gastrointestinal conditions requiring endoscopy from June 1997 to February 2000 were investigated prospectively for H pylori infection. Gastric biopsy specimens were analyzed with rapid urease test and histopathology, H pylori-positive children were treated with omeprazole, clarithromycin, amoxicillin, and metronidazole for 7 days. The result of treatment was assessed 1 month after treatment with endoscopy and biopsy. The same treatment was repeated for 2 weeks if H pylori was still present. In patients who needed a third endoscopy, their biopsy specimens were cultured to determine antibiotic sensitivity. Results were correlated with patients' symptoms and endoscopic findings., Results: Thirty-three children with acute (severe epigastric pain, n = 14; gastrointestinal bleeding, n = 9) and chronic (recurrent abdominal pain, n = 7; anemia, n = 3) conditions were treated for H pylori. Thirty-one (94%) were confirmed to have H pylori eradicated by a 1-week therapy, whereas 1 patient had eradication after a further 2-we'ek therapy (3.3%). The only unresponsive patient had H pylori resistant to both clarithromycin and metronidazole. All ulcers and erosions healed after the eradication of H pylori. Three patients had persistent recurrent abdominal pain despite H pylori eradication., Conclusions: The 1-week therapy with omeprazole, clarithromycin, amoxicillin, and metronidazole is an effective treatment of H pylori in children in a population with a high incidence of metronidazole resistant strain of H pylori. Peptic ulcers and erosions healed with the eradication of the bacteria., (Copyright 2001 by W.B. Saunders Company.)

Background: To follow-up clinical and biochemical features in patients with Crohn's disease (CD) of the upper gastrointestinal (GI) tract and to evaluate the impact of different therapeutics on the outcome of these patients., Methods: 32 CD patients with endoscopically and histologically proven CD of the upper GI tract were included into this retrospective study. Gastroduodenal and intestinal permeability tests, inflammatory parameters, Crohn's Disease Activity Index (CDAI), and upper gastrointestinal complaint profile were sequentially assessed. These parameters were assessed at the beginning and followed up during therapies with antisecretory drugs, mesalamine, prednisolone, and azathioprine., Results: Symptoms responded to antisecretory drugs. Gastroduodenal permeability increased under mesalamine. Gastroduodenal and intestinal permeability as well as CDAI decreased under prednisolone. Under azathioprine, gastroduodenal and intestinal permeability, CDAI, and C-reactive protein decreased.

A 17-year-old boy was operated on for gastric outlet obstruction; laparotomy revealed a mass with nodules in the first part of the duodenum and multiple mesenteric lymph nodes. The histopathological examination of the duodenal mass and the lymph nodes showed caseating tuberculosis. Because of the rarity of duodenal tuberculosis, the case is reported herewith.

History and Admission Findings: A 79-year-old local resident, presenting with abdominal pain, sweating and weight loss and suspected of having cancer of the pancreas was referred for diagnosis and treatment. Physical examination was negative except for pain on pressure over the right upper abdomen and the epigastrium., Investigations: Erythrocyte sedimentation rate was increased; as were the transaminases and cholestasis parameters. Ultrasonography and computed tomography of the abdomen revealed an echo-poor mass with cystic areas in the region of the head of the pancreas, as well as extra- and intrahepatic dilatation of the biliary tract. Endoscopic retrograde cholangiopancreatography failed to demonstrate a ductal pancreatic carcinoma. Biopsies of a macroscopically peculiar-looking duodenal ulcer demonstrated a noncaseous epithelioid granuloma. A fine-needle biopsy was performed for further diagnosis., Diagnosis, Treatment and Course: Histological examination of the needle biopsy revealed a caseous granuloma and acid-fast bacteria. The tuberculin test (GTI) was strongly positive (14-15 mm), indicating tuberculosis of the pancreas and duodenum. Multiple tuberculostatics rapidly improved the patient's symptoms, and the further course was without complications., Conclusion: Tuberculosis should be included in the differential diagnosis of consumptive disease with an atypical presentation, especially because treatment could well be curative.

Clinical studies of peristil demonstrated that this drug is effective in hypomotor and dysmotor gastroduodenal disturbances leading to reduction of clinical symptoms of primary and secondary duodenodyskinesias. A systemic prokinetic action of peristil is beneficial in patients with duodenodiskinesia combination with gastroesophageal reflux as well as hypomotor constipation syndrome. Also, peristil reduces depressive symptoms and improves quality of life in patients with primary and secondary duodenodyskinesias.

Crohn's disease may involve any area of the digestive tract, but its localization in the duodenum is rare. The clinical, radiological or endoscopic findings may simulate those of peptic ulcer and histologic examination is not diagnostic. In contrast with Crohn's disease of any other localization, the formation of fistulas is exceptional. The authors present one case of duodenal Crohn's disease the unspecific symptomatology of which deviated the original orientation towards the more common diseases. Steroid treatment was not sufficient to control the disease which led to complications with the formation of an enterocutaneous fistula. The association of azathioprine was very effective not only in achieving remission of the process, but also in resolving the complications.

The results of examining the mechanisms of development of neurogenic visceral abnormalities induced by the body's extreme exposures, search for modes of its pharmacological correction are presented. Experiments have provided evidence for that the neutropic agents recovering the functional activity of the sympathetic nervous system, normalizing energy and plastic exchange have a positive effect in the treatment of the cardiovascular and gastroduodenal diseases which are caused by a neurogenic agent. A basically new approach to treating peptic ulcer, coronary heart diseases, and myocardial infarction is proposed depending on the stage of a disease.

Ménétrier's disease is a rare cause of hypertrophic gastropathy, usually confined to gastric body and fundus, which is characterized by giant rugae, hypoalbuminemia, and foveolar hyperplasia. The etiology of this disease is still unknown. We report a case of a 74-yr-old man who had dyspepsia, hypoalbuminemia, weight loss, and diffuse polypoid, nodular lesions affecting the whole stomach and proximal duodenum on gastroscopy and barium meal study. The histology of gastric and duodenal mucosal lesions fulfilled the diagnosis of Ménétrier's disease, that was not described to involve duodenum in the literature. The disease resolved clinically, endoscopically, and pathologically after therapy with famotidine for 3 months. We speculated that extensive pyloric metaplasia and then foveolar hyperplasia of duodenum in this patient might be a variant of Ménétrier's disease with favorable clinical course.

Gastroduodenal tuberculosis (GDTB) is an uncommon condition which can mimic other gastrointestinal disorders. It usually occurs secondary to pulmonary tuberculosis. We describe two young Somalian patients who presented with abdominal pain and gastric outlet obstruction. GDTB was diagnosed in both patients and they were successfully treated with antituberculous drugs.

A case with leakage of duodenal stump treated by a somatostatin analogue (SMS 201-995,SMS) effectively was reported. A 39-year-old man had underwent gastric resection (Billroth I) and distal pancreaticojejunostomy for transsection of duodenal bulbus and pancreatic body. After 14 days later duodenal diverticulization was performed due to anastomotic stricture of the gastro-duodenostomy, which resulted in leakage of duodenal stump and voluminous fluids from drains were lasting about 5 weeks. Amylase (AMY) value was shown as high as 703,812 U/l in the exudate. SMS was injected by 100 micrograms, s, c, by three times a day for 24 days. The volume of exudate decreased immediately after the administration of SMS and to one-half in volume in 2 weeks. AMY also fell to 42, 378 U/l. The drain was removed two months after the third surgery. The patient was discharged on post operative day 200. SMS was known to inhibit secretion of bile and intestinal as well as pancreatic juice and its usefulness for leakage of the intestinal tract, especially of the duodenum, is suggested.

A patient from Thailand presented with symptoms suggestive of peptic ulceration. Radiology showed an ulcerated duodenal stricture, a pancreaticoduodenal mass and extensive retroperitoneal lymphadenopathy suggestive of metastatic carcinoma. Tuberculosis was diagnosed only at laparotomy. The incidence of tuberculosis is increasing, and alimentary tuberculosis should be considered in patients from populations at risk presenting with obscure abdominal complaints or unexplained radiologic findings.

We report a case of watery diarrhea due to duodenal toxoplasmosis in a patient with the acquired immunodeficiency syndrome. Treatment with pyrimethamine, clindamycin, and folinic acid decreased the diarrhea as well as the duodenal toxoplasma cyst load. Hepatic toxoplasmosis was also present, associated with an elevated serum alkaline phosphatase activity and a minimally elevated lactate dehydrogenase level.