characteristics of intestinal pseudo-obstruction in patients with mitochondrial diseases

AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were di-agnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined. RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO. CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.

Shape of Barrett's epithelium is associated with prevalence of erosive esophagitis

AIM:To test the hypothesis that the shape and length of Barrett's epithelium are associated with prevalence of erosive esophagitis.METHODS:A total study population comprised 869 patients who underwent endoscopy during a health checkup at our hospital.The presence and extent of Barrett's epithelium were diagnosed based on the Prague C & M Criteria.We originally classified cases of Barrett's epithelium into two types based on its shape,namely,flamelike and lotus-like Barrett's epithelium,and into two groups based on its length,its C extent < 2 cm,and ≥ 2 cm.Correlation of shape and length of Barrett's epithelium with erosive esophagitis was examined.RESULTS:Barrett's epithelium was diagnosed in 374 cases(43%).Most of these were diagnosed as shortsegment Barrett's epithelium.The prevalence of erosive esophagitis was significantly higher in subjects with flame-like than lotus-like Barrett's epithelium,and in those with a C extent of ≥ 2 cm than < 2 cm.CONCLUSION:Flame-like rather than lotus-like Barrett's epithelium,and Barrett's epithelium with a longer segment were more strongly associated with erosive esophagitis.

Effect of sumatriptan on gastric emptying:A crossover study using the BreathID system

AIM:To determine the effect of oral sumatriptan on gastric emptying using a continuous 13 C breath test(BreathID system).METHODS:Ten healthy male volunteers participated in this randomized,2-way crossover study.The subjects fasted overnight and were randomly assigned to receive a test meal(200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg(sumatriptan condition),or the test meal alone(control condition).Gastric emptying was monitored for 4 h after administration of the test meal by the 13 C-acetic acid breath test performed continually using the BreathID system.Then,using Oridion Research Software(β version),the time taken for emptying of 50% of the labeled meal(T 1/2) similar to the scintigraphy lag time for 10% emptying of the labeled meal(T lag),the gastric emptying coefficient(GEC),and the regression-estimated constants(β and κ) were calculated.The statistical significance of any differences in the parameters were analyzed using Wilcoxon's signed-rank test.RESULTS:In the sumatriptan condition,significant differences compared with the control condition were found in T 1/2 [median 131.84 min(range,103.13-168.70) vs 120.27 min(89.61-138.25);P = 0.0016],T lag [median 80.085 min(59.23-125.89) vs 61.11 min(39.86-87.05);P = 0.0125],and β [median 2.3374(1.6407-3.8209) vs 2.0847(1.4755-2.9269);P = 0.0284].There were no significant differences in the GEC or κ between the 2 conditions.CONCLUSION:This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal.

Endoscopic diagnosis of Barrett's esophagus

The Prague C and M Criteria have been developed for the objective endoscopic diagnosis of Barrett's esophagus(BE).BE arises between the squamocolumnar junction and the gastroesophageal junction at the proximal margin of the gastric folds.In this study,we reported that 43.0% of the subjects examined were diagnosed with BE based on the Prague C and M Criteria.Previous criticism by John Dent proposed that our data should be considered invalid because the prevalence of BE reported in our study was extraordinarily high and discordant with previous studies.Dent predicted that the position of the gastroesophageal junction in our study was judged to be lower than the actual position due to the effacement of the proximal ends of the gastric folds because of the routine use of a high degree of air distension during typical Japanese endoscopic examinations.The endoscopic evaluation of the superior gastric folds is certainly influenced by the degree of air distension of the esophagus.However,in our study,the proximal limit of the gastric mucosal folds was prospectively imaged while the oesophagus was minimally insufflated.Then,under a high level of air distension,the distal ends of the palisade-shaped longitudinal vessels were imaged because they are more easily observed when distended.In the majority of patients,the distal ends of the palisade-shaped longitudinal vessels correspond to the proximal limit of the gastric mucosal folds.Our endoscopic evaluation was appropriately performed according to the Prague C and M Criteria.We suspect that the high prevalence of BE in our study may be due to the inclusion of ultrashort-segment BE,which defines BE with an affected mucosal length under 5 mm,in our positive results.

Phosphorus Recovery from Dehydrated Water Sludge by Incineration Using Alkali Metal Compounds

In order to recover the phosphorus from the waste water sludge,the dehydrated sludge was mixed with the reagent of NaOH,KOH or Na2CO3,and incinerated at 750℃ or 900℃.Phosphorus in the incinerated ash of the sludge was dissolved by the addition of water,and recovered by the evaporation of the phosphorus resolved water.The recovered phosphorus was confirmed to be an alkali metal phosphate,and the recovery rate reached about 75%regardless any combination of the reagents(NaOH,KOH or Na2CO3).

Early effects of oral administration of omeprazole and roxatidine on intragastric pH

Objective:The ideal medication for the treatment of acid-related diseases,e.g.,peptic ulcers,stress-related gastric bleeding,functional dyspepsia,and gastroesophageal reflux disease,should have a rapid onset of action to promote hemostasis and relieve the symptoms.The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral administration of a proton pump inhibitor,omeprazole 20 mg,and an H2-receptor antagonist,roxatidine 75 mg.Methods:Ten Helicobacter pylori-negative male subjects participated in this randomized,two-way crossover study.Intragastric pH was monitored continuously for 6 h after single oral administration of omeprazole 20 mg and roxatidine 75 mg.Each administration was separated by a 7-d washout period.Results:During the 6-h study period,the average pH after administration of roxatidine was higher than that after administration of omeprazole(median:4.45 vs.2.65;P=0.0367).Also during the 6-h study period,a longer duration of maintenance at pH above 2,5,and 6 was observed after administration of roxatidine 75 mg than after administration of omeprazole 20 mg(median:90.6% vs.55.2%,P=0.0284;43.7% vs.10.6%,P=0.0125;40.3% vs.3.3%,P=0.0125;respectively).Conclusions:In Helicobacter pylori-negative healthy male subjects,oral administration of roxatidine 75 mg increased the intragastric pH more rapidly than that of omeprazole 20 mg.