Pathology of the alimentary tract in Salmonella typhimurium food poisoning

Fecal leukocytosis, indium-111-labelled autologous polymorphonuclear leukocyte abdominal scanning, and quantitative fecal indium-111 excretion in acute gastroenteritis and enteropathogen carriage

Abdominal scintiscans were performed and three-day fecal indium-111 radioactivity measured, following injection of indium-111-labeled polymorphonuclear leukocytes, in patients with acute gastroenteritis, enteropathogen carriage, exacerbations of chronic inflammatory bowel disease, and patients without gastrointestinal symptoms. The colon was more commonly inflamed than the small intestine in acute gastroenteritis. Fecal indium-111 radioactivity excretion was elevated in gastroenteritis and in chronic inflammatory bowel disease. The magnitude of the intestinal inflammatory response, as measured by fecal indium-111 excretion, is equivalent in acute gastroenteritis caused by a defined enteropathogen and exacerbations of chronic inflammatory bowel disease. All patients with microscopically detected fecal leukocytosis gave positive intestinal scintiscans, whereas negative scans were obtained on patients without fecal leukocytosis. The results of this study suggest that indium-111-labeled polymorphonuclear leukocytes can be used to study pathophysiology of the enteric inflammatory response in acute infectious gastroenteritis.

Potential hazards of hypochlorhydria in the treatment of peptic ulcer

The introduction of ulcer-healing drugs that do not induce hypochlorhydria--the main aim of therapy thus far--has led to the consideration of the possible disadvantages of acid secretion inhibition. Potential dangers are that micro-organisms destroyed by the normal stomach survive and proliferate in the stomach and small intestine. The incidence of gastric cancer is higher in pernicious anemia and after partial gastrectomy. It has been suggested that the intragastric bacteria may convert dietary nitrate into nitrite that may then be nitrosated to carcinogenic N-nitroso compounds. The third potential hazard is the development of stagnant loop syndrome in patients treated with H2 antagonists. In a double-blind randomised trial of colloidal bismuth subcitrate (CBS) versus cimetidine in duodenal ulcer, gastric juice was aspirated for pH measurement. There was a significant increase in the total number of bacteria isolated during cimetidine treatment (P less than 0.01) and an increase in nitrate-reducing organisms (P less than 0.05), but no change in the CBS group. It is concluded that there may be advantages in using ulcer-healing drugs that do not reduce H+ concentration.