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The British Society of Gastroenterology Gut: first published as 10.1136/gut.20.10.A901 on 1 October 1979. Downloaded from Gut, 1979, 20, A901-A956 The British Society of Gastroenterology The 40th Annual Meeting of the British Society of Gastroenterology and the 8th Annual Meeting of the British Society of Digestive Endoscopy were held at the University of Surrey, Guildford, on 18-21 September 1978, under the Presidencies of Dr. C. C. Booth, President of the BSG, and Dr M. Atkinson, President of the!BSDE. Starting with a teaching day, a scientific programme covering all aspects of gastroenterology was presented to the two Societies. The Plenary Session concluded with the Sir Arthur Hurst lecture given by Professor B. S. Blumberg and entitled 'History of the Australia antigen'. The abstracts of the 178 papers presented to the two Societies are printed below. advantages over surgical insertion in the presence ofatrophic gastritis and intestinal ENDOSCOPY palliation of malignant oesophageal stric- metaplasia is to be expected in the elderly. W1-W12 tures. The suggested associations of gastritis with iron-deficiency anaemia and gastric ulcer and cancer should be questioned, as (Wi) most studies do not include age-matched Insertion of oesophago-gastric tubes in (W2) controls. malignant oesophageal stricture: endoscopy Prevalence and significance of chronic or surgery? gastritis in patients undergoing endoscopy (W3) AND P. A. H. LISHMAN, A. W. DELLIPIANI, AND G. E. HOLDSTOCK, C. L. SMITH, Quantification of human gastric G-cell http://gut.bmj.com/ H. B. DEVLIN (North Tees General Hos- ISAACSON (Southampton University Hos- density in endoscopic biopsy specimens: pital, Stockton on Tees, Cleveland) Many pitals) A total of 980 gastric biopsies variability and relationship to gastritis and patients with malignant oesophageal were taken from 245 consecutive patients circulating gastrin strictures are inoperable at the time of attending for upper gastrointestinal endo- presentation, and without intervention scopy. Ninety-nine were diagnosed endo- R. L. E. MCINTYRE, J. PIRIS, AND M. G. W. face death by starvation or aspiration. scopically to have gastritis, but of these KETTLEWELL (The John Radcliffe Hos- Any method of palliation in such patients only 85 were confirmed histologically; pital, Oxford) Reduced gastric acidity must be minimally invasive and allow the 181 (74%) had evidence of histological may cause G-cell hyperplasia and hyper- patient to live as normal a life as possible. gastritis, which was superficial in 102 gastrinaemia. It is possible to study this by on October 1, 2021 by guest. Protected copyright. We present 16 patients with inoperable (42 %) and atrophic in 79 (32 %); 49 (30 %) measuring changes of G-cell density in malignant strictures of the distal oeso- had intestinal metaplasia. The incidence of endoscopic biopsy specimens. It has been phagus into whom oesophago-gastric both atrophic gastritis and intestinal suggested, however, that the distribution tubes were inserted by a method using the metaplasia increased progressively with of gastrin within the gastric antrum is very flexible fibreoptic endoscope and fluoro- age and was found in 60% of patients variable1. We have therefore studied the scopy, and compare them with 28 patients over 60 years. Superficial gastritis was variability of G-cell density and its from the same hospital whose tubes were unrelated to age. Tobacco, alcohol, drugs, relationship to stimulated gastrin output inserted by surgical methods. including aspirin, and other previously and the presence of gastritis. Four patients (25%) in the endoscopic suggested predisposing factors were not Eight patients had multiple biopsy group died in the immediate post- associated with a higher incidence of specimens taken from standard sites in operative period as a result of the pro- gastritis. There was no correlation the stomach four hours after an Oxo- cedure, compared with 13 patients (45 %) between histological gastritis and sympto- stimulated gastrin test. Sections from in the surgical group. Of the remainder, matology, and 78 % of 37 patients mucosa of pyloric type were stained for G- the majority were mobilised and taking included in the study with no gastro- cells by an immunoperoxidase method2. diet on the day after the procedure, and intestinal symptoms were found to have G-cell densities and their variability were the morbidity associated with the surgical gastritis. Similarly, there was no relation- measured in each patient. method was not seen in the endoscopic ship between the presence of gastritis and A mean of 13 suitable biopsies was group. other lesions. obtained from the pre-pyloric area of each It is concluded that the endoscopic We conclude that, even in asymptomatic patient. The mean coefficient of variation insertion of oesophago-gastric tubes has patients, chronic gastritis is common. The of G-cell density for the group was 36% A901 Gut: first published as 10.1136/gut.20.10.A901 on 1 October 1979. Downloaded from A902 The British Society of Gastroenterology (range 23 °-52 %). The distribution of (W5) dye into the bile duct reproduced their G-cells in the stomach was related to the Practical classification of chronic pancrea- typical pain. extent of gastritis but there was poor titis In conclusion, ERCP is unlikely to correlation between G-cell densities and demonstrate biliary pathology in patients circulating gastrin levels or integrated M. I. LAVELLE AND C. W. VENABLES with postcholecystectomy pain who have a gastrin output. (Gastroenterology Group, Departments of normal IVC even if the alkaline phospha- An acceptable estimate of G-cell density Radiology and Surgery, Royal Victoria tase is raised. Intermittent spasm of the in the gastric antrum can be made from Infirmary, Newcastle upon Tyne) Classi- sphincter of Oddi may be responsible for four biopsy specimens but there appears to fications of chronic pancreatitis in current the raised alkaline phosphatase and be no simple relationship between density usage are based either on clinical and aspartate transaminase. In patients with and G-cell function. histological features or else on the severity atypical postcholecystectomy pain, repro- ofchanges found at endoscopic retrograde duction of their usual pain by ERCP may References cholangiopancreatography (ERCP). While be of diagnostic value. 'Corbishley, T. P., and Russell, R. C. G. (1978). Gut, 19, 437. these have their advantages, they provide 'Piris, J., and Whitehead, R. (1974). Journal of an unsatisfactory basis for therapeutic Clinical Pathology, 27, 798-799. management. A new classification is proposed based on the distribution of radiological features at ERCP in 72 cases (W7) of proven chronic pancreatitis. Four types Endoscopic assessment of the small bowel emerge-namely, A: proximal; B: mid; in Crohn's disease (W4) C: distal, or D: total gland involvement. Prevalence and significance of duodenitis in Type D is subdivided into two groups, one with a 'chain of lakes' with R. L. E. MCINTYRE, D. J. NOLAN, E. G. LEE, patients undergoing endoscopy duct, the other AND M. G. W. KEITLEWELL (The Radcliffe dilated or irregular duct. Each type may Infirmary, Oxford) Assessment of the G. E. HOLDSTOCK, C. L. SMIT$H, AND P. be 'simple' or 'complicated' by a pancrea- presence and extent of small bowel ISAACSON (Southampton University Hos- tic cyst or stricture of the common bile involvement is important in the manage- pitals) Endoscopic duodenal biopsies were duct. This classification provides infor- ment of patients with Crohn's disease. taken from 118 consecutive patients mation of practical value in management, The barium infusion examination' of the undergoing routine upper gastrointestinal particularly to the surgeon, and its small bowel has been a great diagnostic endoscopy. Duodenitis was diagnosed application to the available operative advance. Endoscopy and radiology are endoscopically in 27, but, of these, only 17 procedures is discussed. complementary techniques for investi- were confirmed histologically. Histological gating the upper and lower gastro- evidence of duodenitis was found in 34 intestinal tract. We have therefore http://gut.bmj.com/ patients (29 %) and was mild in 18, investigated the role of endoscopy in the moderate in 11 and severe in six. Duo- (W6) management of patients with small bowel denitis was found in five (46%) of 11 Retrograde cholangiography in the post- Crohn's disease. patients with duodenal ulcer and one cholecystectomy syndrome Thirty-one endoscopic examinations (7%) of 15 patients with gastric ulcer. were performed on 28 patients with There was no relationship between J. J. CONNON AND C. WHITESIDE (Depart- suspected or proven small bowel Crohn's symptoms-for example, dyspepsia, nau- ment of Medicine, Toronto General disease. In 27 examinations (87%) the sea, and heartburn-and the presence or Hospital, Toronto, Ontario) Forty-five ileum or jejunum was reached and biop- on October 1, 2021 by guest. Protected copyright. severity of the duodenitis. Five (28 %) of consecutive patients complaining of typi- sies were taken. The terminal ileum was 18 patients included in the study with no cal postchclecystectomy pain were studied. successfully examined in 15 of 19 colon- gastrointestinal symptoms also had histo- In 36 patients, the pain began two months oscopies when the colon was intact (79 %). logical evidence of duodenitis. Previously to 16 years after cholecystectomy and in The findings could be compared with suggested predisposing factors-for ex- seven patients the pain preceded
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