Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation

Article Abstract:

In a variety of conditions, a patient's failing liver must be replaced with a healthy liver from a donor individual (orthotopic liver transplantation). In order to prevent the body from rejecting the foreign organ, orthotopic liver transplant patients are given immunosuppressive therapy to blunt their immune response. In immunosuppressed patients, complications involving the biliary system (the system of ducts carrying digestive juices from the liver to the intestines) are associated with high mortality unless they are diagnosed and treated properly. Biliary complications (which occur in up to 13 percent of liver transplant patients) can be confused with rejection of the liver transplant, as the symptoms are often similar. Consequently, accurate imaging of the liver and biliary system is an important diagnostic requirement. To investigate to potential of endoscopic retrograde cholangiopancreatography (ERCP; imaging the liver, pancreas, and biliary system by infusing radiopaque dye into the biliary system via an intestinal route), 12 of 178 liver transplant patients underwent ERCP after transplantation. The most common precipitating factor in initiating ERCP was cholestasis (an interruption of bile flow from the liver to the intestines); in most cases the cholestasis resulted from deposits in the donor common bile duct. Three of the patients undergoing ERCP eventually died from complications resulting from the liver transplant; nine are alive and well. In no case did any complications ensue from administration of the ERCP procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Liver, Liver transplantation, Bile ducts, Endoscopic surgery, Biliary tract diseases, Endoscopic retrograde cholangiopancreatography

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Vitamin C in the human stomach: relation to gastric pH, gastroduodenal disease, and possible sources

Article Abstract:

The acid level of stomach juice and the concentration of vitamin C in stomach fluids were measured in 73 patients undergoing endoscopy, a visual inspection of a cavity inside the body using a special instrument, an endoscope. Vitamin C concentrations were significantly lower in those with hypochlorhydria, a deficiency of hydrochloric acid in gastric juices, and there was a significant correlation between gastric juice and plasma concentrations. Patients with normal findings had significantly higher levels of vitamin C in their stomachs than those with gastric (stomach) cancer or ulcers, or in patients following stomach surgery. In a test tube, vitamin C concentrations remained stable in acidic juice, but fell significantly over 24 hours in alkaline gastric juice. The results indicate that low fasting levels of vitamin C in hypohydrochloric gastric juice may be caused by chemical instability and that vitamin C may be secreted by the stomach.

Analysis, Vitamin C, Vitamin C metabolism, Vitamin metabolism, Gastrointestinal cancer, Digestive system cancer, Gastric juice, Duodenal ulcer

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Cellobiose/mannitol sugar test - a sensitive tubeless test for coeliac disease: results on 1010 unselected patients

Article Abstract:

The cellobiose/mannitol sugar test is a non-surgical method for measuring the permeability of the intestines. A drop in the absorption of small molecules and a rise in the absorption of large molecules occurs during coeliac disease. Two forms of sugar, cellobiose, a disaccharide, and mannitol, a sugar alcohol, when administered at the same time, allow the permeability of small bowel mucous membranes to be studied, and keep other factors such as gastric emptying and incomplete urine collection from influencing the results of the test. Taking into account patients who had jejunal biopsies, the test's sensitivity for coeliac disease is 96 percent, its specificity 70 percent, the predictive value of the positive is 36 percent and the predictive value of the negative 99 percent.

Research, Diagnosis, Complications and side effects, Celiac disease, Malabsorption syndromes, Mannitol, Jejunum

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