Questions

1.It is stated that nitric oxide (NO) inhibits the relaxation of the lower

oesophageal sphincter (LOS) and that sildenafil is given for treating

achalasia. As far as I know, sildenafil acts to increase the guanine

monophosphate (GMP), just as NO uses the same mechanism to relax the

LOS. Could you explain this paradox?

2.In Kumar and Clark Clinical Medicine you mention that auscultation

is not important in cases of gastrointestinal disorders, but Harrison's

Principles of Internal Medicine gives this as being of equal importance

because succussion splash and bowel sounds can help in presumptive

diagnosis. Succussion splash indicates gastric obstruction (e.g.

gastroparesis) and likewise bowel sounds can help determine the status

of developing ileus. Would you agree that this is therefore a diagnostic

tool?

3.Is it hazardous to give aspirin in the antiplatelet doses (75-325 mg/day)

to a patient with a past history of haematemesis proved to be from a

peptic ulcer?

4.How can upper gastrointestinal (GI) bleeding be distinguished from

lower GI bleeding by using faecal analysis?

5.In upper gastrointestinal bleeding, without knowing the cause or

source of bleeding, why do we give proton pump inhibitors (PPIs,

e.g. omeprazole)? What is the role of these, if the source of bleeding is

not peptic or duodenal ulcer?

6.Why is the incidence of coeliac disease increasing in many countries?

7.Are small amounts of gluten harmful to a patient with coeliac disease?

8.I refer to the treatment of complications related to diverticular disease.

Under 'bleeding' you mention that 'Persistent bleeding can often be

arrested by undertaking an "instant" barium enema, which acts to plug

the offending diverticulum'. When I mentioned this to my consultant he

said he had never heard of this. Could you clarify how this would work

and where I could obtain more information?

9.In children with abdominal pain and fever, does a white cell count help

establish a diagnosis of appendicitis?

10.I have always been taught that ulcerative colitis only affects the large bowel with some associated proctitis. I read in your chapter on gastrointestinal disease that it can cause mouth ulcers and am now confused.