From March to October 1989, 237 French gastroenterologists included 1 301 patients referred for irritable bowel syndrome in a 9-month epidemiological survey based on questionnaires and monthly auto-evaluation. In the patient population, the high preponderance of women (sex ratio: 2,33), the high prevalence of cholecystectomy (9 %), appendectomy (53 %) and an association with at least one symptom of non-ulcer dyspepsia (70 %) were observed. Fifty per cent of the patients completed the 9-month follow-up period; among them, 60 % declared an improvement in their symptoms, but only 30 % in their quality of life and independently of the clinical course. This study suggests that symptoms and quality of life in patients consulting for irritable bowel syndrome should be taken into account separately, both in daily practice and in therapeutic evaluation.

The inhibitory effect of omeprazole, a benzimidazole derivative, on gastric acid secretion was investigated in seven patients with Zollinger-Ellison syndrome resistant to treatment with large doses of histamine H2-receptor antagonists administered alone or in combination with pirenzepine. In two patients with an acute form of the syndrome, rapid control of acid overproduction was achieved with 180-mg intravenous and 120-mg oral daily doses, respectively. The other five patients, who were free of complication, initially received a standard regimen of omeprazole 60 mg orally once a day; dosage was subsequently adjusted until the basal acid output, measured 1 hr before the next dose of the drug, was less than 10 mmol/hr. The initial daily dose proved to be adequate in three patients and had to be increased to 80 mg and 60 mg bid, respectively in the remaining two patients. In all patients omeprazole therapy resulted in clinical recovery and rapid healing of mucosal lesions. The seven patients have now been followed up for 4–24 months (average 15 months). The adequacy of the daily dosage was periodically reassessed by measuring basal acid output in the hour preceding the morning dose. In one patient initially treated with 180 mg/day, dosage could be reduced to 60 mg/day. In three others, who were initially controlled with 60 mg/day, dosage had to be increased during follow-up. Despite adequate control of gastric acid secretion, one patient underwent total gastrectomy and tumor resection and another died of extensive liver metastases. The five patients still receiving omeprazole remain free of symptoms and mucosal lesions. No side effects or laboratory abnormalities ascribable to the drug were observed. It is concluded that omeprazole therapy is a good alternative in patients with Zollinger-Ellison resistant to currently available antisecretory drugs. Its safety and effectiveness in long-term therapy remain to be evaluated.

Omeprazole is a new, potent and long-acting antisecretory drug (1). It was used in seven severe cases of Zollinger-Ellison syndrome, resistant to high doses of histamine H2-antagonists given alone or in combination with pirenzepine.

Dystrophia Myotonica (DM) is a hereditary disease characterized mainly by progressive muscular atrophy and myotonia involving skeletal muscles with progressive muscle wasting and weakness. The electrophysiological feature of the disease is repetitive discharges of striated muscle cell membrane observed after voluntary or induced contractions. Cataract, testiculus atrophy, mental deficiency and fronto-parietal baldness are the more commun extramuscular symptoms of the disease (1, 2, 3). Cardiac muscle is commonly involved and conduction defects are observed. Gastrointestinal smooth muscle may also be involved : oesophagus (4, 5), stomach (6, 7), colon (8) and anal sphincter (9).

We described a case of voluminous exogastric leiomyoblastoma revealed by abdominal pain and clinical mass. Ultrasonography showed a mixed mass, with both solid and liquid components, without determining specifically the organ of origin. CT body examination showed an intense hypervascularization, associated with cystic components. Laparotomy with tumor excision was done without any metastases. Such US and CT aspects can lead to the exact diagnostic, if they prove the gastric origin of the mass. Otherwise, the discussion is between pancreatic or epiploic tumors.

Chez un homme de 86 ans. Le diagnostic evoque par la radiographie sans preparation de l'abdomen et l'echographie a ete confirme par l'autopsie. Les reins etaient normaux