In a prospective study in 1224 patients referred for upper alimentary endoscopy, reflux oesophagitis was found in 195 (16%) of the patients and hiatus hernia in 249 (20%). In patients with reflux oesophagitis a coexisting hiatus hernia was found in 68%. The weight-for-height index (W/H1.8), which expresses the degree of overweight, was significantly higher both in patients with hiatus hernia and in the patients with reflux oesophagitis, indicating an overweight of approximately 5% in both groups. The overweight was most pronounced in oesophagitis grades 1 and 2, whereas in patients with severe oesophagitis (grade 3) body weight was normal, possibly owing to weight loss caused by dysphagia and excessive regurgitation. The results support the view that adiposity is associated with both sliding hiatus hernia and reflux oesophagitis and that hiatus hernia plays a role in the development of reflux oesophagitis.

A prospective study of the incidence of hiatus hernia and/or reflux oesophagitis was carried out in 670 patients referred for routine upper alimentary endoscopy. Hiatus hernia was found in 16.6% and reflux oesophagitis in 15.1% of the patients. Forty-two per cent of the patients with hernia did not have oesophagitis, whereas 63% of the patients with reflux oesophagitis had hernia. In patients without reflux oesophagitis the incidence of hiatus hernia was 8%. Reflux oesophagitis was significantly (p less than 0.001) related to hiatus hernia. The severity of the oesophagitis was significantly (p less than 0.05) related to the presence and the size of hernia, and severe oesophagitis without hernia was significantly (p less than 0.01) related to chronic alcoholism. The results suggest that a sliding hiatus hernia may play a role in the development of reflux oesophagitis.

We measured serum levels of carbohydrate deficient transferrin (CDT) in 420 subjects: 100 healthy blood donors, 82 healthy employees, 70 abstaining patients with different chronic nonalcoholic liver disease, 16 abstaining patients with alcoholic fatty liver, 50 abstaining patients with alcoholic liver cirrhosis, 25 abusing patients with alcoholic fatty liver, 41 abusing patients with alcoholic liver cirrhosis, and 36 patients with alcohol dependence syndrome with a daily ethanol consumption of 173 +/- 120 g the last 4 weeks before blood was drawn. In controls the serum level of CDT was significantly higher in females compared with males (17.7 +/- 5.1 and 13.7 +/- 3.8 units/liter, respectively), and the upper normal limit was defined as 27 and 20 units/liter. Sixty-two of 102 (60.8%) abusing patients with alcoholic liver disease had increased levels of CDT compared with 1 of 66 abstaining (1.5%) patients with alcoholic liver disease, and 10 of 70 (14.3%) abstaining patients with nonalcoholic liver disease among them 3 with primary biliary cirrhosis and 2 with chronic autoimmune hepatitis. No correlation was found between serum CDT and gamma-glutamyltranspeptidase (GGT), AST, ALT, and mean red cell volume (MCV). The sensitivity and specificity for serum CDT was 61 and 92%, respectively, compared with 85 and 18% for GGT and 70 and 66% for MCV. No advantage was gained by using the CDT/transferrin ratio. Our study confirms that CDT is a specific marker for chronic alcohol abuse, except in few patients with other chronic liver diseases. Serum CDT seems to be a better indicator of abstention than GGT; AST and MCV in patients with alcoholic liver disease. However, in our hands CDT is not so sensitive for alcohol abuse in patients with liver disease as reported earlier in unselected alcoholics.

The symptomatic effect of a 2-week low-dose antacid tablet regimen was assessed in a prospective, double-blind, randomized, placebo-controlled, crossover trial in 47 patients with endoscopically verified reflux oesophagitis. During treatment with antacid there were lower global symptomatic scores (p less than 0.05), less acid regurgitation (p less than 0.05), and fewer days (p less than 0.01) and nights (p less than 0.05) with heartburn than during placebo therapy. Also, significantly more patients preferred antacid than placebo treatment (p less than 0.05). Thus, a low-dose antacid tablet regimen relieves symptoms significantly better than placebo in patients with reflux oesophagitis.

A PBS was found in only 50% of the patients. Colonoscopy had a slightly higher diagnostic yield, and as expected, resulted in a significantly higher cancer detection rate than OGD. In older patients, colonoscopy should be done irrespective of the findings at OGD. Gastrointestinal-specific symptoms and the use of ASA/NSAIDs were not predictive in finding or localizing PBS.