Chronic Dyspeptic Symptoms Research Articles

A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim.

Esophageal candidiasis once thought to be restricted amongst immunocompromised patients is being increasingly reported among non-immunocompromised individuals. It is debilitating and if not treated well may cause chronic long-lasting infections. The objective of this study was to identify the various species of Candida causing esophageal candidiasis and analyse their antifungal susceptibility pattern. This was an observational, prospective study. Total of 108 patients who attended the Gastroenterology Department of Sir Thutob Namgyal Memorial Hospital, Govt of Sikkim, Gangtok, India between July 2012 - May 2018 were included in the study. They had complaints of upper gastrointestinal disturbances and chronic dyspeptic symptoms that required an endoscopy. Esophageal biopsy and brushings were taken and were transported to Microbiology Department. They were subjected to microscopic observation, fungal culture on Sabourauds dextrose agar. Preliminary species identification was done by chlamydospore formation and growth characteristics on CHROMagar Candida. Species confirmation and antifungal susceptibility testing was done on VITEK 2 system at Microbiology Department, Kasturba Medical College and Hospital, MAHE, Manipal, Karnataka, India. A total of 108 patients were screened among which 73 samples were positive for Candida species and species identification and antifungal susceptibility was performed. Forty fiveisolates were found to be C. albicans, 8 were C. glabrata, 4 were C. tropicalis, 3 were C. lusitaniae 2 were C. krusei, 2 were C. lipolyticaand 1 was C. parapsilosis. Eight isolates could not be identified and were recorded as Candida spp. C. albicans isolates were predominantly sensitive strain with susceptibility of 95% for both amphotericin B and fluconazole and 100% for caspofungin. C. glabrata showed high resistance to fluconazole with one isolate showing intermediate resistance to caspofungin. Upper gastrointestinal symptoms even in non-immunocompromised patients need to be screened by endoscopy to rule out esophageal candidiasis. With the emergence of drug resistant non albicans Candida species diagnostic testing laboratories should include Candida species identification and antifungal susceptibility testing facility to provide effective patient care.

Differential Expression of Tissular miRNA-155 in Pediatric Gastritis.

Background: MicroRNA molecules, among them the intensely studied miRNA-155 (miR-155), are regarded as potential biomarkers of chronic gastric inflammation and premalignant lesion progression. However, literature data are scarce in terms of pediatric studies and in the evaluation of the predictive role of miRNA in early gastric inflammation. This study aims to assess the differential expression of miR-155 in relation to pediatric gastritis. Methods: The present research was conducted on 192 patients with chronic dyspeptic symptoms who underwent upper digestive endoscopy. Bioptic samples were harvested for histopathological analysis and tissue miR-155 depiction. MiR-155 expression analysis was carried out through quantitative real-time polymerase chain reaction (qRT-PCR). The study population was divided into two groups: controls (93 patients) and study group (99 patients) with inflammatory modifications. Results: MiR-155 expression was augmented in patients with gastritis but did not differ significantly from controls (p = 0.16). An increase in miR-155 expression was noted in relation to chronic gastritis, H. pylori infection, or increase in gastritis severity, but these variations were not important (p = 0.30, p = 0.44, and p = 0.45, respectively). Conclusions: According to our study, pediatric gastritis increases, but does not greatly influence, miR-155 expression. Dynamic evaluation of miR-155 might enlighten its prognostic role in pediatric gastritis.

Clinical and endoscopic study of dyspepsia in overweight and obese patients.

Globally, the prevalence of obesity is increasing at an alarming rate. Obese patients often suffer from chronic dyspeptic symptoms. The aim of the study was to know the gross and histologic upper gastrointestinal mucosal changes and the prevalence of Helicobacter Pylori (H. Pylori) infection in overweight and obese dyspeptic patients. A cross-sectional, observational study was done on 100 patients with dyspepsia and a body mass index (BMI) of ≥25 kg/m2. The study was done between August 2019 and September 2021 at a tertiary care hospital in Maharashtra, India. Chi-square test, Mann-Whitney test, and Fischer exact tests were applied to study the association between categorical variables. A P value of < 0.05 was considered statistically significant with a confidence level of 95%. There were 59 males and 41 females. The mean age of the study subjects was 41.95 ± 12.32 years and the age range was 19-67 years. The maximum number of patients (36%) were in the age group of 50-59 years. Hypertension (45%) and type 2 diabetes mellitus (T2DM) (30%) were the common comorbidities present. Heartburn and regurgitation were the most common symptoms, present in 37% and 35% of the subjects, respectively. Inflammatory lesions oesophagitis (28%) and gastritis (43%) were the common findings in upper gastrointestinal endoscopy (UGIE). The stomach was the most common site with lesions. On histopathological examination, erosive gastritis (33%) and oesophagitis (28%) were confirmed. A total of 86% of obese subjects had at least one grossly abnormal finding. The prevalence of H. Pylori was 32%. Obese subjects had significantly more abnormal findings on UGIE compared to overweight subjects (P < 0.05). Obese patients suffering from type 2 diabetes mellitus had significantly abnormal findings on UGIE compared to non-diabetic obese patients (P < 0.05). Obese patients with higher body mass index (BMI) and the presence of H. Pylori infection were more likely to have abnormal UGIE findings. Inflammatory and erosive lesions of the stomach and oesophagus are more common in obese dyspeptic patients. UGIE should be the investigation of choice and should be performed in overweight and obese patients with dyspepsia to predict and prevent Gastrointestinal (GI) disorders and their related complications.

Prevalence of Helicobacter Pylori Infection in Patients with Chronic Dyspeptic Symptoms at Rawal General and Dental Hospital, Islamabad

Background: Helicobacter Pylori infection is the most common cause of chronic dyspeptic symptoms all over the world and covers more than 60% of the out-patient department’s (OPD) registry. That is why we aimed to conduct this study to determine the prevalence of helicobacter pylori infection in patients with chronic dyspeptic symptoms visiting at our out-patient department (OPD) of Rawal General and Dental Hospital.&#x0D; Methods: This was a descriptive cross-sectional hospital based study conducted in the Department of Gastroenterology, Rawal General and Dental Hospital, Islamabad between the periods of two years June 2018 – June 2020 with in patients who presented with a chief complain of dyspepsia through a consecutive sampling technique. Baseline and clinical variables were collected and correlated with the presence and absence of H. pylori infection among 355 finally recruited participants.&#x0D; Results: The overall prevalence of H. pylori infection was 59.71% (n = 212). Among them, married males were more common. Positive H. pylori patients were younger than negative H. pylori patients, 40.24±6.62 vs. 44.9±8.05 (p 0.04). Participants who had a history of NSAIDS intake for past 7 days were significantly associated with positive H. pylori infection, 54.24% (n = 115), p 0.02. While on the other hands, patients who were receiving proton pump inhibitor for the past 4 weeks were significantly associated with absence of H. pylori infection when they presented with chronic dyspeptic symptoms, 65.03% (n = 93), p 0.01.&#x0D; Conclusions: Our study has found that almost two third of the population suffering from chronic dyspeptic symptoms had positive H. pylori infection and these patients are younger than H. pylori negatives. Chronic NSAID users have direct relation in increased prevalence of H. pylori detection while use of PPI plays safety role in prevention and reducing of H. pylori infection.

Endoscopic sub-mucosal resection of gastric antrum stromal tumour

Abstract Rationale: Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour of the gastrointestinal tract with 10% to 30% being malignant. Resection of GIST lesions require wide local excision to achieve negative margins. Patient concerns: A 68-year-old woman presented with acute on chronic dyspeptic symptoms, including abdominal pain, postprandial nausea, bloating, and early satiety. She did not have any history of previous malignancy or gastro-intestinal haemorrhage. The patient had no other significant past medical history. Diagnoses: Endoscopy revealed a 2 cm nodular lesion in the gastric antrum which was confirmed to be GIST on endoscopic ultrasound and computed tomography. Intervention: The 2 cm GIST was successfully resected (RO) endoscopically. Outcomes: The patient was discharged from the hospital the next day, and follow-up suggested no disease recurrence. Lessons: To the best of our knowledge, this is the first reported case of endoscopic submucosal dissection for a 2 cm GIST. The current gold standard for the majority of GISTs is laparoscopic resection, with open resection sometimes needed for larger malignant tumours with multi-visceral involvement. Endoscopic or combined endoscopic/laparoscopic techniques are evolving and may become the preferred choice for smaller lesions and for lesions in areas that are more difficult to approach surgically, such as around the esophagogastric junction and the pre-pyloric antrum.

Controversias en cirugía: Erradicación del Helicobacter pylori ¿Terapia a todos o según indicaciones usuales?

La infección por Helicobacter pylori (H. pylori), es la infección bacteriana crónica más frecuente de la raza humana, afecta al 50 % de la población mundial y, por lo menos, al 80 % de la población colombiana. Esta bacteria es reconocida desde hace más de 15 años como un carcinógeno tipo I. De acuerdo con las indicaciones del Consenso de “Maastricht V” esta infección debe ser buscada y tratada en los pacientes con úlcera péptica activa, Linfoma MALT (por sus siglas en inglés, mucosa associated lymphoid tissue), cáncer gástrico temprano, púrpura que presenten síntomas dispépticos crónicos y usuarios crónicos de AINES.&#x0D; Debido al papel que tiene en la fisiopatología del cáncer gástrico, nace la iniciativa de realizar una búsqueda activa del H. pylori y erradicarlo en todas las personas, incluyendo aquellas asintomáticas en países con alta incidencia de esta neoplasia.&#x0D; Existen diversas publicaciones alrededor del mundo que así lo sugieren, mostrando resultados con impacto positivo en el curso y progresión de la enfermedad, sobre todo en las etapas más tempranas de la infección.&#x0D; Sin embargo, otros autores resaltan la creciente problemática de la resistencia bacteriana, y demuestran que el peso estadístico y los diferentes análisis de los estudios disponibles en la actualidad tienen poca validez para dar una recomendación extendida al paciente asintomático. Se cuestiona que tal vez, estamos utilizando las estrategias inadecuadas para manejar una situación de salud pública, ya que estamos enfocados en impactar a cada individuo con terapias antibióticas complejas, en vez de a la población en general con políticas de salud pública.

Pediatric gastritis and its impact on hematologic parameters.

Non-invasive biomarkers, such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, may predict inflammation in various disorders, including gastritis, according to recent data. Nevertheless, various studies reported an association between Helicobacter pylori (H pylori) and immune thrombocytopenia in both adults and pediatric patients. The objective of our study was to evaluate the impact of pediatric gastritis, caused or not by H pylori infection on erythrocytes, their parameters, thrombocytes, mean platelet volume, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).We performed a prospective, case–control study on 151 patients aged between 1 and 17 years who presented with chronic dyspeptic symptoms. An upper digestive endoscopy with gastric biopsies and a complete blood count was performed in each case.Control group consisted of 67 patients with normal histological findings, while the two study groups were divided into group 1—H pylori-induced gastritis (31 patients) and group 2—non-H pylori-induced gastritis (53 patients). Children from the rural area were more likely to develop both types of gastritis (P < .01). No significant difference was found between either of the study groups and control group in terms of platelets, mean platelet volume, NLR and PLR (P > .05). However, significantly higher values of lymphocytes were associated with non-H pylori-induced gastritis (P < .01). Comparison of the two study groups did not reflect any significant differences in terms of hematological parameters. When assessing these constants in relation to gastritis severity, severe gastritis led to a compelling decrease in hemoglobin (Hb) and hematocrit (Htc) levels. The comparison of parameters between severe, moderate, and mild gastritis did not reveal any significant results.Childhood and adolescent gastritis does not produce a significant effect upon platelet counts, their mean volume, PLR or NLR, according to our study. An important increase in lymphocyte count might predict non-H pylori pediatric gastritis. Moreover, severe gastritis might result in an important decrease in Hb and Htc levels.

High Prevalence of Slow Transit Constipation in Patients With Gastroparesis.

Background/AimsCurrent evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated.MethodsWe retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups.ResultsTwo hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings.ConclusionsPatients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.

Glass half empty? Lessons learned about gastroparesis.

Gastroparesis is defined as a combination of chronic dyspeptic symptoms and delayed emptying of a solid test meal. It remains a difficult-to-treat disorder with a significant impact on quality of life. Although gastroparesis is defined by delayed emptying, several important studies did not find a correlation between this biomarker and symptom severity or treatment success. Thus, some of the more recent trials explored strategies that ranged from antiemetics to antidepressants. Although dietary management showed benefit, most of the other interventions were barely superior to placebo or were not superior at all. Placebo responses were often quite high and this complicates the assessment of active agents. While it complicates the design and interpretation of clinical trials, high response rates for active and sham interventions indicate that we can achieve symptom relief in many patients and thus give them some reassurance. If indeed most therapies are only marginally better than placebo, the differences in adverse effects should be weighed more strongly, a point that is especially important in view of the controversy surrounding metoclopramide. Mechanistic studies introduced the network of macrophages as another potentially important player in the development of gastroparesis. Results are too preliminary and are largely based on preclinical data but show up- and downregulation of cellular elements controlling gastric function. Thus, future developments may teach us how they interfere with some of these mechanisms in clinical settings, potentially making gastroparesis a reversible process.

Prevention of Functional Dyspepsia with Carica Papaya Extract

Functional dyspepsia (FD) is a set of relapsing or chronic dyspeptic symptoms in the absence of structural organic lesions. Approximately 15-20% of the general population in many developed countries suffers from dyspeptic symptoms at any time in a year, whereas in Pakistan, 14-22 % of general population suffers from FD. Objective: This study was designed to evaluate the effectiveness of carica papaya extract (CP) in preventing functional dyspepsia in human volunteers.Methodology: A community based, placebo-controlled, double -blind, multi-centered, and randomized clinical trial through systematic random sampling was conducted in Lahore urban community. After initial diagnostic investigations in 200 patients diagnosed as cases of FD fulfilling Rome III criteria were recruitedafter taking written consent and randomly assigned to one of 2 treatment groups (CP extract group or placebo) in equal number. A 7 days medication free period was observed before the start of trial. Each patient received the treatment for 6 weeks. The primary outcome variable was the improvement in gastrointestinalsymptom score (GIS) consisting of evaluation of 10 dyspeptic symptoms rated on Likert scale. Dyspeptic symptoms were assessed at the start of trial then after 2, 4 and 6 weeks. Results: In this trial, 200 patients fully participated in this study (age 36.31±9.711 years, range 18-55, 60% female). Compared with placebo, Carica papaya extract (CP group) showed a clinically significant improvement. The GIS significantly decreased in CP group during the first 2 weeks, compared to the placebo (p &lt; 0.05). During the second and third 2-week period, symptoms further improved in CP group (p &lt; 0.05). After 6 weeks, 95.7% on CP treatment and 3.1% on placebo were completely relieved of FD symptoms (p &lt; 0.001). Conclusions: CP extract was significantly effective gastro-protective as compared with placebo.

Laparoscopic cost effective management of cholecystoduodenal fistula

Introduction: Contraindication to laparoscopic surgery is decreasing with time, expertise and innovation. One such uncommon condition is cholecystoduodenal fistula (CDF), now increasingly managed with laparoscopic technique. We are reporting eight such incidentally diagnosed cases during laparoscopic operation, which were successfully and cost-effectively managed with traditional laparoscopic instruments.Materials and Methods: During March 2008 to March 2017, 1500 patient underwent laparoscopic cholecystectomy for benign gall bladder condition or their complications, eight of these having chronic dyspeptic symptoms of gallstone, were found to have cholecystoduodenal fistula, intraoperatively. All cases were managed laparoscopically using common laparoscopic instruments without any special gadgets and extra costs. Medical records of eight cases were reviewed for age, sex, operative technique, intra and post-operative complications and length of stay in hospital.Results: Five patients were male and three were female with a mean age of 63 years. All of them had gall stones at abdominal ultrasound and cholecystoduodenal fistula were found intraoperatively. Fistula tract was dissected, cleaned and sealed with combination of intracorporeal simple transfixation ligation and interrupted stitches to invert the stump within the duodenal wall in transverse fashion. All eight had uneventful postoperative course with hospital stay of 4-7 (mean 5) days.Conclusion: In expert hands cholecystoduodenal fistula can successfully and safely be managed laparoscopically using common instruments and logistics with slight modification of open technique without extra cost.Bangladesh Crit Care J September 2017; 5(2): 110-112

English

Background: The term “dyspepsia” is derived from the Greek language and it literally means “bad digestion.”1 Dyspepsia is a common complaint among individuals seeking medical care as well as in general population. Rome III a recent consensus, has defined dyspepsia as the presence of symptoms considered by the physician to originate from the gastroduodenal region and only four symptoms (bothersome postprandial fullness, early satiation, epigastric pain, and epigastric burning) are now considered to be specific for a gastroduodenal origin, although many other symptoms are acknowledged to coexist with dyspepsia. Patients having chronic dyspeptic symptoms for the past 3 months with onset at least 6 months before diagnosis in absence of structural abnormality on upper GI endoscopy and metabolic or systemic causes explaining the symptoms are classified as Functional Dyspepsia (FD)2. Prevalence of dyspepsia is about 20-30% worldwide3. Functional dyspepsia (FD) or essential dyspepsia is characterized by upper abdominal pain without the presence of an ulcer4. People with functional dyspepsia have a significantly reduced quality of life when compared to the general population5.

Current issues in functional dyspepsia

Functional dyspepsia is one of the most common gastrointestinal disorders encountered in clinical practice. Functional dyspepsia is currently defined by Rome III criteria as the chronic dyspeptic symptoms (postprandial fullness, early satiety, epigastric pain or burning) in the absence of underling structural or metabolic disease that readily explain the symptoms. According to the Rome III consensus, functional dyspepsia can be subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Although the Rome III criteria have been published more than 8 years ago, not much effort has been put into validating these criteria and direct scientific evidence supporting the validity of the subdividing functional dyspepsia into PDS and EPS are lacking. This article is intended to review the validity of the Rome III criteria on the subdivisions of functional dyspepsia, i.e. PDS and EPS. The impact of sleep disorder, Helicobacter pylori-associated dyspepsia, and the emerging drug therapies in functional dyspepsia will also be discussed in this article.

Why dyspepsia can occur without organic disease: pathogenesis and management of functional dyspepsia

Functional dyspepsia (FD), one of the most common conditions in medicine, is a gastrointestinal disorder in which the patient suffers from chronic dyspeptic symptoms such as epigastralgia and a heavy feeling in the stomach despite the absence of organic disease. Elucidating the pathogenesis of FD means answering the question, "Why do symptoms occur?" The factors contributing to symptom manifestation in FD probably should be divided into 3 categories: (1) physiological abnormalities that directly induce symptoms, (2) factors that modify those physiological abnormalities, and (3) factors that govern abnormal responses to stress. The symptoms of FD are directly caused by two major physiological abnormalities-abnormal gastric motility and visceral hypersensitivity-occurring in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle. If the basis of this model of FD pathogenesis is excessive responsiveness of gastrointestinal function to stress and external stimuli, psychosomatic approaches to alter stress perception could be important treatment options. However, in the primary care setting, the treatment of FD has focused on local gastric factors, including abnormal gastric acid secretion, abnormal gastric motility, and H. pylori infection. Acid secretion inhibitors and prokinetics have been commonly used, and H. pylori eradication therapy has been carried out, but the effectiveness of drug therapy has been limited.

Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared with healthy controls. We performed a prospective study of consecutive new patients, ages 8-16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n = 50), or normal histology results (n = 53). Healthy children were followed up as controls (n = 143). Patients and controls were evaluated 5-15 years later. They provided self-reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression. When the study began, the groups with histologic evidence of esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality-of-life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up evaluation, use of acid-suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients who had normal histology findings when the study began. Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.

Chronic Gastrointestinal Symptoms of Thomas “Stonewall” Jackson following Mexican-American War Exposure: A Medical Hypothesis

In a recent study, a large proportion of veterans seen for chronic heartburn or dyspepsia after the Persian Gulf War had evidence for Helicobacter pylori. Thomas Jackson was born and raised in an area of West Virginia that has a high prevalence of H. pylori. He suffered chronic dyspeptic symptoms following his service in the Mexican-American War. Therapies that he tried included treatment with a variant of the Sippy diet. Following a bullet wound to the left arm at the battle of Chancellorsville on Saturday, May 2, 1863, Thomas Jackson underwent amputation of the left arm below the left shoulder. He died 1 week later with a diagnosis of pleuropneumonia. The records of the postsurgical course are incomplete. The available clinical information raises the hypothesis that his chronic dyspepsia and his cause of death could have been related to chronic peptic ulcer disease due to gastric H. pylori infection.

Duodenojejunal Motor Activity in Patients with Chronic Dyspeptic Symptoms

We used a low-compliance manometric system to study duodenal and jejunal motility in 33 patients with chronic dyspeptic symptoms and previous negative conventional findings. Nine healthy controls were studied in the same way. Manometric recordings disclosed activity front abnormalities (retrograde or simultaneous propagation) in 45% of patients and an absence of activity fronts in 6%. Moreover, intestinal motor response to a 600-kcal test meal was significantly impaired in the patient group (61.1 +/- 8.1 versus 113.2 +/- 4.2 min, p less than 0.05). We conclude that manometric techniques may be important for investigating patients with chronic dyspepsia and negative findings at previous conventional examinations.

An Advance in Understanding of Dyspepsia and Gastritis

The prevalence of Campylobacter pylori (CP) rises with age, as does gastritis. There is now convincing evidence that CP is causative in the majority of cases of active chronic gastritis and that its eradication substantially improves the severity of the gastritis, even back to normal in some cases. A small minority of people may have other factors causing their gastritis, bile reflux, or anti-inflammatory drugs, for example. CP causes temporary dyspeptic symptoms when an individual receives an acute infection for the first time, but what is much less certain is whether or not CP is responsible for chronic dyspeptic symptoms, and whether eradication of CP will improve dyspepsia. At present the therapeutic trials are too few and too small to be sure, but some individuals may benefit.

CONTROL BY RADIUM FOR GASTRIC ACIDITY

The importance of hyperacidity of the gastric juice as a factor in the causation of duodenal ulcer and of chronic dyspeptic symptoms is widely recognized. Most forms of treatment aim at controlling hyperacidity by means of repeated chemical neutralization or by surgical intervention. The occurrence of gastrojejunal ulceration following surgical treatment, however, suggested that other methods for the control of gastric acidity might be tried, and to this end a study was made of the effects of irradiation of the gastric mucosa by radium. METHOD As a preliminary 3 elderly patients with a long history of duodenal ulceration were selected for trial, and later, as the results were promising, a number of younger patients with hyperacidity and a shorter history also underwent treatment. In all cases gastric function was studied before and after the use of radium. Either two 25 mg. needles or four 10 mg. needles of radium were

Partial duodenal obstruction

1. Partial duodenal obstruction can be demonstrated in a large proportion of oases with chronic dyspeptic symptoms. 2. The cause of the obstruction varies, but the most common is compression by the supr. mesenteric artery. 3. In our experience it is nearly always associated with an abnormal condition of the colon. 4. The possession of a mesentery,i.e., Mobility alone is not sufficient; some other factor is necessary, such as descent over the pelvic brim, chronic constipation or loss of tone in the abdominal muscles. 5. Treatment consists in regular emptying of the colon with support for the latter by an efficient abdominal belt. Failing improvement on these lines, colopexy is indicated, or possibly duodeno-jejunostomy.