Short-Term and Long-Term Pancreatic Exocrine and Endocrine Functions After Pancreatectomy

Exocrine and endocrine functions of the pancreaswere assessed in 44 Japanese patients who underwentpancreatic head resection. Functions were analyzedcomparing levels before surgery, at a short-termfollow-up (<2 months), and at a long-term follow-up(12-31 months). The N-benzoyl-L-tyrosyl-p-aminobenzoicacid (BT-PABA) excretion test, fasting blood sugar (FBS)level, and oral glucose tolerance test (OGTT) were used to determine pancreatic function. Thepatients were divided into three groups according to thesize of the main pancreatic duct: group 1, 15 patientswith a normal sized duct (3 mm); group 2, 20 with a moderately dilated duct (>3 mm,<10 mm); and group 3, 9 with a markedly dilated duct(10 mm). The mean BT-PABA value (6-hr urinary PABArecovery rate) in group 1 showed no change during the postoperative period. In contrast, theBT-PABA values in groups 2 and 3 had dropped by theshort-term follow-up and returned to the preoperativelevel by the long-term examination. FBS and 120-min OGTT levels were not different between the threegroups preoperatively. Although these values showed nochange in all the three groups at the short-termmeasurements, the FBS in group 3 and 120-min levels in all the three groups had increased at thelong-term. These findings suggest that exocrinepancreatic function shows a short-term deterioration inpatients with a dilated pancreatic duct but recovers to the preoperative level over the long term afterpancreatic head resection. Endocrine insufficiency,however, may occur at a long-term point after surgeryirrespective of the preoperative pancreatic ductal dilatation.     

Density of Gastric Helicobacter pylori Colonization Is Not Associated with Occurrence of Dyspeptic Symptoms

In most studies, the prevalence of Helicobacterpylori infection in patients with dyspeptic symptomsdoes not clearly differ from the prevalence inasymptomatic controls. However, the degree of H. pylori colonization might play a role for theoccurrence and severity of dyspeptic symptoms. BetweenAugust 1993 and July 1994, we screened 1500 apparentlyhealthy volunteers (1036 men, 464 women, 42 ± 12years) for H. pylori infection using the[¹³C] urea breath test. The noninvasive ureabreath test enables a semiquantitative assessment of theextent of H. pylori colonization in the stomach. Of the1500 volunteers, 526 (35.1%) complained of occasional orfrequent dyspeptic symptoms. No difference was observedin the H. pylori prevalence between asymptomaticsubjects (35.5%) and those with dyspeptic symptoms(35.9%; P > 0.95). A high density of H. pyloricolonization in the gastric mucosa was not associatedwith a higher frequency of dyspepsia (P > 0.80).According to these findings, an eradication therapy onthe basis of dyspeptic symptoms alone cannot berecommended as H. pylori is not a proven etiology ofdyspepsia.     

Rabeprazole in Treatment of Acid Peptic Diseases (Results of Three Placebo-Controlled Dose-Response Clinical Trials in Duodenal Ulcer, Gastric Ulcer, and Gastroesophageal Reflux Disease (GERD))

Rabeprazole, a new proton pump inhibitor, wasstudied in patients with acid-pepticrelated diseases(duodenal ulcer, gastric ulcer, GERD) in threeplacebo-controlled, double-blind, randomized clinicaltrials. Men and women over the age of 18 were enrolledif the presence of an active duodenal or gastric ulceror erosive or ulcerative esophagitis was confirmed onupper gastrointestinal endoscopy. Patients were randomly allocated to either placebo orrabeprazole 20 mg or 40 mg in the duodenal and gastriculcer protocols or to placebo or rabeprazole 10 mg, 20mg, or 40 mg in the GERD protocol. All doses ofrabeprazole in all three studies were statisticallysignificantly superior to placebo in healingacid-related lesions. There were no treatmentdifferences between the rabeprazole doses in healingactive peptic lesions. The incidence of positive [¹³C]ureabreath test for H. pylori was 53% in patients withduodenal or gastric ulcers. H. pylori status was noteffected by treatment with rabeprazole.