The lactulose hydrogen breath test has been evaluated as a diagnostic test for small-bowel bacterial overgrowth using the 14C-glycocholate breath test for comparison. Twenty-seven patients with suspected bacterial overgrowth and 37 control patients were studied. The lactulose test was positive in 8 out of 9 patients with Subsequently proven bacterial overgrowth, all of whom had positive 14C-glycocholate tests. However, 6 patients with ileal disease or resection had positive 14C-glycocholate tests but negative lactulose tests. subsequent bacteriological study of duodenal juice from these patients was negative. Negative results were obtained by both tests in the remaining 12 patients, none of whom were subsequently shown to have bacterial overgrowth. All 37 control subjects had negative lactulose tests. The lactulose breath test is a simple and promising diagnostic test for the detection of small-bowel bacterial overgrowth and, unlike the 14C-glycocholate test, has the advantage of being able to distinguish bacterial overgrowth from ileal disease.
Summary Previous studies have shown that sera from patients with pancreatic cancer often contain a mucus glycoprotein that expresses the oncofetal antigen galactose 1-3, N-acetyl galactosamine, which is the T blood group antigen and the binding site for the lectin peanut agglutinin (PNA). An enzyme-linked lectin assay has been developed to quantify PNA-binding glycoproteins in serum and has been evaluated as a serological test for pancreatic cancer. Sera were studied from 53 patients with pancreatic cancer and 154 controls, including benign obstructive jaundice, acute and chronic pancreatitis, chronic liver disease and inflammatory bowel disease. The enzyme-linked peanut lectin assay proved highly reproducible and has 77% sensitivity and 83% specificity for pancreatic cancer, results that are very similar to those achieved in the same sera by CA19-9 radioimmunoassay (75% sensitivity, 82% specificity with the upper limit of normal set at 37uml-1). CEA assay pro.ved less useful (60% sensitivity, 47% specificity). In this study better results were obtained if an upper limit of normal of 50uml-1 was used for CAl9-9 (75% sensitivity, 92% specificity). Combination of CA19-9 assay with the upper limit set at 50uml-i and the peanut lectin assay improved the sensitivity to 85% with only a slight fall in specificity (85%). These results compare well with published results for ultrasound and CT scanning.
Intraluminal duodenal diverticulum is a recognised but rare cause ofacute pancreatitis. This patient had three attacks of pancreatitis, each requiring a stay in hospital, within a four month period. The apex of the diverticulum was incised endoscopicaily, whereupon peas and food debris gushed from the incision site. The patient has had no further symptoms in the 12 months since the endoscopic procedure. (Gut 1994; 35: 557-559) Intraluminal duodenal diverticulum is thought to be part of the spectrum of congenital abnormalities, which includes duodenal atresia. It usually presents in adults, after enlargement of the diverticulum with food or ingested foreign bodies, resulting in obstruction of the duodenal lumen, or more rarely of the ampulla of Vater. Definitive treatment has historically been surgical, but we report on a patient with recurrent pancreatitis in whom a satisfactory outcome was achieved with an endoscopic sphincterotome. As far as we are aware, this technique has not previously been reported for treatment of an intraluminal diverticulum.graphy showed changes compatible with acute pancreatitis but no other abnormality and plasma calcium and lipid analyses were repeatedly normal. Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled, but before this could be performed, he had a further attack of pancreatitis, which again settled quickly.At ERCP a small (approx 7 mm diameter) diverticular opening was seen at the presumed site of the ampulla of Vater, with a 5 cm long polypoid swelling protruding into the duodenal lumen distal to the ampulla (Fig 1). The mucosa overlying this swelling looked normal, but was baccate (as if containing spherical objects). When prodded with a cannula the texture was soft and compressible. This was initially felt to be a prolapsing ampulla, possibly with a stone at the lower end of a dilated bile duct, although the possibility of an intraluminal diverticulum was considered. The ampullary opening could not be located, and so a small precut was carefully made at the apex of the swelling. On enlarging the opening with a conventional sphincterotome, several peas and other food debris gushed into Gastroenterology Unit
An unusual case of sponraneous rupture of the liver associated with polyarteritis nodosa is reported.
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