[Rationality and irrationality in the medicine and in the life]

The spiritual life of man has a rational and irrational component. Both have positive as well as negative effects and under normal circumstances they are well balanced. In medicine rationality is an essential feature of the medical science and the basis of medical practice but it is not sufficient for fulfilling all curative needs. In the practice, gaps in knowledge must be complemented by empiricism and empathy which originate in the personality of the physician.

Comments on Rome criteria of functional gastrointestinal disorders

The following comments and critical remarks on Rome criteria are submitted on the basis of 50 years' experience: Rome criteria do not distinguish between non-organic disturbances which are truly digestive and those which are neuropathic or psychopathic. Yet the distinction is important both theoretically and practically. Dyspepsia is defined as pain or discomfort in the epigastrium but distinction of both terms is important for identification of subgroups and for therapy. An alternative and useful basis for definitions of functional digestive disorders is the sensations accompanying eating and defecation. Rome criteria disregard the fact that the distinction of functional from organic is not in the symptoms themselves but rather in the circumstances in which they appear or disappear. In Rome criteria some conditions are incorrectly interpreted (globus, aerophagia) and some typical syndromes are not mentioned namely fermentative enteropathy (carbohydrate dyspepsia) and pain arising in the abdominal nervous plexus - solar (celiac plexus) syndrome.

What is the origin of ulcerative colitis? Still more questions than answers

Despite more than a century of existence as a clinical entity, the true origin of ulcerative colitis still remains elusive. Several factors probably contribute to the development of this condition. Recently discovered technologies have clarified the role of bacterial species, which may account for intestinal dysbiosis, as a factor triggering ulcerative colitis. Genetic susceptibility together with abnormal innate immunoreactivity probably comprise the essential prerequisites for the initiation and perpetuation of ulcerative colitis. Although the genetic background has been more clearly recognised in patients with Crohn's disease than in those with ulcerative colitis, some candidate loci associated with ulcerative colitis have also been intensively studied. Additionally, environmental factors may interfere with inherent predispositions to ulcerative colitis, and either suppress or reinforce them. Whatever the origin, the search for the aetiology of ulcerative colitis must have the same goal: the improvement of treatment and the quality of life in patients with ulcerative colitis.

[Diagnosis and therapy of functional gastric and intestinal disorders]

The author summarizes his own views and experience as regards the classification, diagnosis and treatment of gastric and intestinal dyspepsias. In the diagnosis he emphasizes in particular a detailed case-history, in treatment and individual approach based on careful analysis and careful interviews with every patient.

Endoscopic diagnosis of gastritis. Pros and cons

The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking. "Endoscopic gastritis" does not correlate sufficiently with "histologic gastritis" and the term "gastritis" is to be limited to cases confirmed histologically. Terminology of gastric mucosa changes should be based on macroscopic features and should use descriptive terms proposed by the OMED nomenclature.

Celiac (solar) plexus syndrome. A frequently overlooked source of abdominal pain

Of the nonorganic abdominal disorders the celiac/solar plexus syndrome represents a frequently seen entity characterized by the typical association of epigastric pain and "lambda-type" tenderness. It is a special type of abdominal neurosis in which the pain arises in the periaortic nervous plexuses. Its clinical importance is in the differential diagnosis, since it is often misinterpreted as a painful condition of abdominal or retroperitoneal origin.

[New developments in the treatment of non-specific intestinal inflammation]

This term comprises idiopathic proctocolitis (IPC) and regional enteritis (RE, Crohn's disease). Despite a number of similarities (similar age, symptoms, immunology, drugs), the two conditions differ substantially (site, pathology, surgery) and thus from a practical aspect it is essential to differentiate them. The term "ulcerative colitis" comprises also other inflammations, e.g. recently identified infections with causal agents which are difficult to diagnose. There are also several types of regional enteritis which differ as to their course and sequelae. As regards medical treatment, in both conditions in particular corticosteroids are used and 5-aminosalicylic acid. An important novelty are 5-aminosalicylic acid tablets with prolonged action; different types are used depending on the site of the disease. Surgical treatment differs not only as to its frequency but also by the type of operation. In regional enteritis operations confined to the affected site are used, while in idiopathic proctocolitis standard operations are available: proctocolectomy, colectomy with an ileorectal anastomosis, with continent ileostomy or with an ileoanal anastomosis and reservoir. The latter is preferred nowadays.

Digestive diseases are functional and organic

The classification of digestive problems into organic and functional is logical and helpful in medical practice. The diagnosis of a functional disorder must be positive--not only exclusive.

The role of terminology in medical education and training

The aims are to present a uniform terminology (terms), which can be suitably used throughout the world for enumeration of characteristics by which an item can be identified and distinguished. Nomenclature is a list of terms classified in a logical system. Description must be as objective as possible and the terms used must be specific for the method. Terminology, definitions, and diagnostic criteria in digestive endoscopy have been published in several languages.

Terminology and its application to computer-aided data processing in digestive endoscopy

Endoscopic word database systems are not standardized. An endoscopic word reference has been developed by the World Organization for Gastrointestinal Endoscopy. The suggestion is made to develop a standard software program for gastrointestinal endoscopy based on this system or one similar.

Histochemistry of the gastric and duodenal mucosa under cimetidine and carbenoxolone treatment

Histological and histochemical patterns of the gastric and duodenal mucosa was investigated in nine subjects with duodenal ulcer or ulcerlike syndrome after 4 to 5 weeks treatment with cimetidine or carbenoxolone. No spectacular changes were found after carbenoxolone except for a slight increase in goblet cells in the duodenal bulb. In the patients treated with cimetidine, findings suggesting an influence of this drug on the biochemical cytology of parietal cells and some interference in the differentiation of enterocytes were established.

Incidence of colorectal cancer in proctocolitis: a retrospective study of 959 cases over 40 years

The incidence of colorectal cancer was studied by the actuarial method in 959 patients with idiopathic proctocolitis seen from 1942 to 1981. Forty five per cent had rectal, 23% left-sided, and 32% total involvement of the colon. Six cancers were found: one in the rectal, one in the left-sided, and four in the total form of the disease. The risk of cancer per patient year in total colitis was zero per 2151 patient years in the first decade, 1/462 in the second decade, 1/315 in the third decade, and 1/75 in the fourth decade. The cumulative risk of developing cancer was zero at 10 years of duration of the disease, approximately 5% at 20 years, 15% at 30 years, and 20% at 35 years. This increase in risk of cancer is less than reported in some other series. Geographical differences in the incidence of cancer in proctocolitis could influence the risk and therefore also the long-term management of patients with proctocolitis in different geographical areas.

Hyperplasia of Brunner's glands. Radiology, endoscopy and biopsy findings in 11 cases of diffuse, nodular and adenomatous form

Eleven cases of hyperplasia of Brunner's glands are reported including 10 cases of diffuse and nodular type and one case of Brunnerian polyadenomatosis. Histological changes were identified in aspiration biopsy specimens and termed "biopsy indication of hyperplasia of Brunner's glands". Polypoid pattern seen roentgenologically and endoscopically in the case of the adenomatous type was constant whereas in the case of the diffuse and nodular type it was not constant; it is suggested that this is due to irregular contraction of muscularis mucosae disrupted by protruding Brunner's glands. Most patients had epigastric distress; less than half had duodenitis.