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Several anti-inflammatory, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and other drugs, have been implicated as a cause of upper gastrointestinal bleeding. Although there is extensive anecdotal evidence to support this link, only a very few studies involving a very small number of subjects have been performed with adequate control conditions to draw firm conclusions. To further investigate the relationship between anti-inflammatory drugs (aspirin as well as others) and gastrointestinal (GI) bleeding, a study was carried out with 161 patients (102 men and 59 women) who were being treated for either hematemesis (vomiting blood) or melena (blood in stool), and an age-matched control group of patients who were being treated for non-gastrointestinal maladies. There was significantly more use of both non-aspirin NSAIDs and aspirin in the gastrointestinal treatment group. There were no differences between the groups in the extent to which they used other drugs, including acetaminophen, corticosteroids, tobacco, and alcohol. When patient characteristics were calculated for users and non-users of the various drugs, NSAID users were found to be older, more likely to be female, and to have a higher mortality rate than non-users. Among those patients who were found to be suffering from bleeding peptic ulcer disease, NSAID users were equally likely to have reported previous symptoms of ulcer compared with non-users, and did not have a higher frequency of multiple gastric or duodenal ulcers. The increased risk of developing gastrointestinal bleeding attributable to non-aspirin NSAID use was higher than that attributable to the use of aspirin. (Consumer Summary produced by Reliance Medical Information, Inc.)

A case of a 53-year-old man with an intragastric intussuscepted small bowel segment is presented. The patient had previously been operated on for recurrent bleeding gastric ulcers. A discussion is presented on the unusual aspects of the intussusception.

The authors describe a patient who was admitted with total necrosis of the oesophageal and gastric mucosa after ingestion of concentrated sodium hydroxide solution. An emergency total gastrectomy and blunt, thoracic oesophageal stripping was performed. Three months later, the continuity of the digestive tract was restored by a retrosternal colon interposition. The necessity of an aggressive diagnostic and therapeutic approach after the ingestion of caustics is recommended. An emergency endoscopic evaluation of the upper G.I. tract is mandatory. If a third degree oesogastric mucosal burn is diagnosed urgent laparatomy should be performed to assess transmural wall necrosis. If present an oesophageal gastrectomy should be performed as a life saving intervention.

Twenty-four patients (average age 72 years) took part in a study of the effectiveness and tolerance of indapamide as medication for essential hypertension in elderly subjects. 2.5 mg was administered daily for two months, after which the same amount was given once every other day in order to investigate whether the antihypertensive effect would persist at this dosage. After two months treatment with 1 tablet of indapamide 2.5 mg daily, statistically significant (P less than 0.01) drops in the mean systolic and diastolic blood pressures both erect and supine were observed. In 18 of the patients, the results obtained underwent no statistically significant modifications during the second 2-month treatment period at reduced dosage. In 5 others, dosage had to be maintained at 1 tablet daily. In all cases, the drug was well tolerated clinically. ECG recordings were unchanged. Laboratory results remained within the normal range despite a slight increase in serum uric acid and a slight decrease in potassium.

The association of duodenal diverticula and pancreatitis is rare. Various types of such diverticula are reviewed, especially intra- and extraluminal Vaterian diverticula in which common and pancreatic duct terminate. The pathogenesis of the pancreatitis in case of interposed Vaterian diverticula is thought to be mechanical by means of the creation of a closed Vaterian pouch in which higher pressures produce reflux of bile and pancreatic enzymes. Two patients with this particular type of duodenal diverticula are presented.