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Biomedical subjects

G Vantrappen

Publications and source records attributed to G Vantrappen.

At least 217 records · Page 12Linked to original sources
PubMed1982

Acute infective colitis caused by endemic pathogens in western Europe: endoscopic features.

In a 4-year period 45 patients were admitted to our gastroenterological u nit with acute infective colitis. The endemic pathogens responsible for the colitis were Yersinia enterocolitica (46%), Campylobacter fetus jejuni (20%), common Salmonellae (13%), less virulent strains of Shigella (9%), Entamoeba hystolytica (7%) and Cytomegalovirus (4%). These microorganisms caused very severe disease in 18% of the patients, who were mostly predisposed. While Salmonella- and amoebic colitis always mimicked ulcerative colitis by the presence of diffuse lesions, the other pathogens caused focal colitis, thus necessitating differential diagnosis vis a vis Crohn's colitis. Two patients (4%) died of complications, while 93% of the patients were cured by proper antimicrobial therapy. In the same period 12 patients were admitted with an acute attack of inflammatory bowel disease due to an intercurrent infection with the same pathogens. In most of these patients clinical remission of IBD was achieved by treating the intercurrent infection. These data indicate that in the presence of an acute attack of colitis an infective etiologic agent must always be sought, and that an attack of chronic idiopathic inflammatory bowel disease may be caused by an intercurrent infection.

Adolescent↗
PubMed1982

Kinetics of primary bile acids in patients with non-operated Crohn's disease.

The metabolism of cholic acid and chenodeoxycholic acid was studied in seventeen patients with non-operated Crohn's disease, eleven ileitis and six ileocolitis patients. The turnover of cholic acid was significantly increased in patients with ileitis (k = 2.01 +/- 1.13 days-1; P less than 0.001) and ileocolitis (k = 0.91 +/- 0.47 days-1; P less than 0.005) as compared to normals (k = 0.35 +/- 0.19 days-1). Although chenodeoxycholic acid was better preserved in the enterohepatic circulation than cholic acid its turnover was also significantly faster in ileitis (k = 0.81 +/- 0.56 days-1; P less than 0.005) and ileocolitis patients (k = 0.62 +/- 0.18 days-1; P less than 0.01) than in normals (k = 0.20 +/- 0.09 days-1). The fractional turnover of cholic acid was related to the length of ileal involvement (r = 0.761; P less than 0.001; n = 17). Patients with Crohn's ileitis tended to preserve normal fasting total bile acid pools by increased synthesis of primary bile acids and efficient absorption of deoxycholic acid and ursodeoxycholic acid by the normal colon. Patients with active ileocolitis had decreased total fasting pool sizes (2.62 +/- 1.83 mmol; P less than 0.001) as compared to normals (7.69 +/- 1.61 mmol). In these patients there was no increase in bile acid synthesis as compared to normals and secondary bile acids were absent from bile. It is concluded that the colon has an important role in maintaining the fasting pool size to a normal level in the presence of an interrupted enterohepatic circulation of bile acids due to ileal disease.

Adolescent↗
PubMed1982

Morphological identification of alpha-I-antitrypsin in the human small intestine.

Alpha-I-antitrypsin immunoreactivity was demonstrated by immunofluorescence in epithelial cells of the normal human small intestine. Its presence was also confirmed in biopsies of patients with Crohn's disease. Specific fluorescence was observed in only four out of 14 adult patients with coeliac disease. These results implicate the human small intestinal epithelium as a possible source of alpha-I-antitrypsin. The absence of positive cells may have implications in the aetiology of coeliac disease.

Adult↗
PubMed1982

A comparative study of colloidal bismuth subcitrate and cimetidine on the healing and recurrence of duodenal ulcer.

In a randomised open study of 28 outpatients with endoscopically proven duodenal ulcers, 14 patients were treated with colloidal bismuth subcitrate (CBS) and 14 patients with cimetidine tablets. Clinical and endoscopic assessments were made before starting therapy and then four and six weeks after the commencement of therapy. The trial was carried out in adult patients and included 21 men and 7 women. After four weeks treatment, 9 of the CBS-treated ulcers (64%) and 8 of the cimetidine treated ulcers (57%) were completely healed. After 6 weeks of therapy, complete ulcer healing was seen in 86% of ulcers in each group. In both groups the reduction of the pain scores after 4 and 6 weeks was highly significant. No adverse reactions were observed in respect of blood pressure or the various laboratory data. The blood bismuth levels after four and six weeks treatment with CBS remained within the safety limits. To determine the ulcer relapse rate, 20 of the 24 completely healed ulcer patients (10 of each group) were followed-up for a period of three months. Endoscopic control showed that recurrent ulcer was found in one CBS-treated patient and in three cimetidine-treated patients. The results showed that CBS tablets are as effective as cimetidine in the treatment of duodenal ulcer. Our results confirm the previously reported CBS efficacy in duodenal ulcer after using the liquid preparation.

Adult↗
PubMed1982

Effect of 15(R)-15-methyl prostaglandin E2 (arbaprostil) on the healing of duodenal ulcer: a double-blind multicenter study.

A multicenter study was conducted on 173 patients with active, endoscopically proven duodenal ulcers (158 men, 15 women). They were randomly assigned, in a double-blind manner, to two groups: those receiving placebo capsules (91 patients) and those receiving capsules containing 100 microgram of 15(R)-15-methyl prostaglandin E2 (arbaprostil) (82 patients). Each drug was ingested four times a day (1 h before meals and at bedtime) for 28 days. Endoscopy was performed on days 0, 14, and 28 after the trial began. At each examination, the ulcer size was measured and whether the ulcer had healed was recorded. Arbaprostil increased the incidence of ulcer healing to approximately the same degree as reported in most extensive studies with cimetidine. At 14 days, three times as many patients were totally healed in the arbaprostil-treated as in the placebo-treated group (37% vs. 12%, p less than 0.001). At 28 days, 67% of patients receiving arbaprostil were healed compared with 39% in the group receiving placebo (p less than 0.001). Similarly, the ulcer size, measured endoscopically, was much smaller after arbaprostil administration than in the group receiving placebo after both 14 and 28 days (p less than 0.001). Side effects attributable to treatment consisted primarily of loose stools and diarrhea (34%). Smoking retarded healing in the placebo-treated group (p less than 0.05), but did not significantly retard healing in patients treated with arbaprostil. We conclude that arbaprostil markedly accelerates the healing rate of active duodenal ulcers. This effect may be due to inhibition of acid secretion as well as gastric cytoprotection.

Adolescent↗
PubMed1982

Controlled trial of YAG laser treatment of upper digestive hemorrhage.

A trial of neodymium-yttrium-aluminum-garnet laser treatment was conducted in 152 patients with upper gastrointestinal hemorrhage. Laser photocoagulation was applied in 0.5- to 1-s pulses of 55-80 W power. A first part of the trial studying patients with arterial bleeding was uncontrolled. Spurting arterial bleedings could be stopped in 87% of the 23 patients with acute arterial hemorrhage. The recurrence rate after endoscopic treatment of this type of bleeding was high (55%). The operation rate of 61% was, however, lower than the operative indications amounting to 95% in patients with arterial spurters admitted previously to our department. One hundred twenty-nine patients were included in a controlled randomized trial of laser photocoagulation. In 86 patients with active, nonspurting bleeding, the laser was significantly better (p less than 0.001) at stopping the bleeding than conservative treatment in randomized controls, and there was a numerical although not significant reduction of the rate of bleeding recurrence and the necessity for surgery (both p less than 0.1). In 43 patients with fresh stigmata of bleeding (i.e., fresh clot or visible vessel) laser treatment resulted in a numerical reduction in the rate of rebleeding and in the operative indications, but the difference did not reach statistical significance. The mortality rates were not influenced in any of the groups.

Adolescent↗
PubMed1981

Ileal dysfunction and bacterial overgrowth in patients with Crohn's disease.

The intestinal bile acid metabolism was studied in sixty-one patients with non-operated Crohn's disease (twenty-seven ileitis and thirty-four ileocolitis patients) by means of the 14C-glycocholate breath test with marker-corrected faecal analysis before and after a short course of antibiotics. The results of the combined breath and faecal analysis were compared with the data of other tests detecting bacterial overgrowth and ileal dysfunction. Fifteen of the sixty-one patients (25%) presented with a 14C excretion pattern consistent with bacterial overgrowth of the small bowel. Repetition of the combined breath and faecal analysis after antibiotic treatment revealed that concurrent ileal dysfunction was present in at least six of these fifteen patients. In twenty other patients elevated marker-corrected 14C faecal excretion indicated ileal dysfunction. Thus, the overall incidence of ileal dysfunction amounted to 26/61 (44%). The sensitivity of the bile acid breath test with marker-corrected stool analysis was comparable to that of aerobic and anaerobic jejunal cultures in twenty non-selected patients for the detection of bacterial overgrowth, and to that of chemical bile acid measurement in stools for the detection of ileal dysfunction. The bile acid breath test with faecal analysis was more sensitive than measurement of glycine-taurine ratio in bile (twenty patients) and the Schilling test.

Adolescent↗
PubMed1981

Safety and efficacy of Neodymium-Yag laser photocoagulation: an experimental study in dogs.

Acute and chronic experiments were carried out in 26 beagle dogs to study the safety and efficacy of Neodymium-Yag laser photocoagulation in the treatment of bleeding gastric lesions. Continuous high power (50-60 W) Neodymium-Yag laser photocoagulation applied to the exposed stomach of the dog produced evaporation lesions that reached the muscle layer after six to 10 seconds and caused free perforation after 10 to 12 seconds. The tissue damage caused by these long lasting exposures was closely related to the working distance. Moreover, long pulses of high power photocoagulation were not always effective in stopping experimentally induced gastric bleedings. Short pulses (1/2-1 s) of very high power (60-70 W) caused less tissue evaporation, which reached the muscle layers only after 14 to 18 pulses and caused free perforation after 22 to 24 pulses. The tissue damage was not related to the working distance when short pulses were used. Repeated shots of high power Yag laser radiation always resulted in stopping the experimental bleedings without deep injury. It is concluded that high power Neodymium-Yag laser photocoagulation is safe and may be used with success in the treatment of bleeding gastric lesions if the radiation is performed in shots of short duration (1 s or less). Clinical studies in man are warranted and indicated.

Animals↗
PubMed1981

A new method for the measurement of bile acid turnover and pool size by a double label, single intubation technique.

A new method is described for measuring the cholic acid turnover and pool size by a single duodenal intubation technique. The method is based on determination in a single bile sample of the ratio of the specific activities of [14C]cholic acid and [3H]cholic acid administered intravenously with an interval of 24 hr. With this ratio the fractional turnover rate (k) of cholic acid can easily be calculated as well as the half-life and pool size. Studies in ten normal subjects indicate that the cholic acid half life and pool size, determined by this single intubation technique, correlate very well (r greater than or equal to 0.98) with the results obtained by Lindstedt's method. Unlike the other methods using a single intubation, this method allows a good estimate of the bile acid turnover as well as the bile acid pool size.

Adult↗
PubMed1980

Vascular changes in the esophageal mucosa. An early histologic sign of esophagitis.

The histologic features of esophagitis were studied in 18 patients with clinical evidence of reflux and in 20 normal subjects. Striking vascular changes were observed in addition to superficial acute inflammatory changes, basal zone hyperplasia, and close proximity of the stromal papillae to the epithelial surface. These lesions corresponded to endoscopically observed red points or strips of the esophageal mucosa. These vascular phenomena probably represent the first sign of esophagitis recognizable endoscopically as well as histologically.

Basement Membrane↗
PubMed1980

A microscopic and ultrastructural study hemostasis after laser photocoagulation.

Fiberoptic-coupled, Neodymium-Yag laser beams were directed at induced bleeding mucosal lesions in the stomachs of 13 dogs. Hemostasis was achieved in all cases. The lesions induced by photocoagulation were examined by light microscopy and transmission electron microscopy. Phototherapy induces an endothelial reaction followed by the formation of a platelet thrombus in the damaged vessels. Hemostasis starts shortly after coagulation therapy has been performed.

Acute Disease↗
PubMed1980

Crohn's disease of the stomach and duodenum: A clinical study with emphasis on the value of endoscopy and endoscopic biopsies.

The aim of this study was to correlate endoscopic, radiological and pathological observations in 30 patients with Crohn's disease, with involvement of the stomach and/or duodenum. The incidence of gastroduodenal involvement in our patients with Crohn's disease is about 3%. 22 of the 30 patients had intrinsic lesions of the stomach and/or duodenum; in 8 patients the lesions seemed to be produced by involvement from contiguous diseased bowel. Radiological studies and endoscopy of the gastroduodenal region are complementary. Endoscopy allows better visualisation of mucosal defects. Other features, for example a diminished expansion and the presence of contiguity lesions, are better demonstrated by barium meal. The mucosal lesions found at endoscopy are heterogenous, but irregularly-shaped ulcers and erosions in a disrupted mucosal pattern are typical for gastroduodenal Crohn's disease. Pathological examination of endoscopic "forceps"-biopsies permitted a conclusive diagnosis based on the presence of granulomas, in 15/22 (68%) of the cases with intrinsic gastroduodenal disease. This observation indicates that simple forceps biopsy is a very useful diagnostic tool. Involvement of the first part of the duodenum in Crohn's disease was complicated by a biliary fistula in two patients.

Adolescent↗