Biomedical subjects

A Berstad

Publications and source records attributed to A Berstad.

At least 91 records · Page 5Linked to original sources

PubMed1995

Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer. Significance of somatization.

Patients with duodenal ulcer or functional dyspepsia do not differ on dyspeptic symptoms. The aim of the present study was to test the hypothesis that functional dyspepsia and duodenal ulcer are two different diagnostic entities by examining the discriminating power of several anamnestic, biological, and psychosocial variables. Ninety-four patients with duodenal ulcer and 86 patients with functional dyspepsia were included. Anamnestic data, global assessment, Helicobacter pylori status, blood group, Lewisa+ phenotype, and several measures of psychological distress and somatic complaints were registered. Compared to patients with functional dyspepsia, the duodenal ulcer patients were more often infected by Helicobacter pylori and had their stomach discomfort more often relieved by eating. Compared to patients with duodenal ulcer, patients with functional dyspepsia had higher scores of depression, trait anxiety, general psychopathology and different somatic complaints (called somatization). They were also less satisfied with the health care system, their disorder had a greater negative impact on their quality of life, and their global assessment of own health was poorer. Discriminant analysis including age, smoking, Helicobacter pylori status, global assessment, and somatic complaint classified 86.1% of the patients correctly (77.9% of the patients with functional dyspepsia and 93.6% of the patients with duodenal ulcer). It is concluded that duodenal ulcer and functional dyspepsia are two separate diagnostic entities. Patients with duodenal ulcer are older, smoke more often, and almost all are infected with Helicobacter pylori, while patients with functional dyspepsia are characterized by somatization and a negative assessment of their own health.

Adult↗

PubMed1995

In vivo comparison of 3D ultrasonography and magnetic resonance imaging in volume estimation of human kidneys.

The objective of this study was to evaluate the accuracy of a three-dimensional ultrasound system (3D-US) compared with Magnetic Resonance Imaging (MRI) in volume estimation of human kidneys in vivo. Twenty healthy volunteers were scanned fasting in supine position with MRI and with a 3D-US. An ultrasound sector scanner with a mechanical transducer coupled to a tilting motor provided images of multiple sections of kidneys. A 3.25-MHz transducer was tilted through 88 degrees yielding 81 frames, and volume estimation was performed on a Unix workstation after manual contour indication. Data acquisition with MRI was performed by using a 1-T magnet. Eighteen included kidneys [mean +/- standard deviation (SD)] measured 155.7 +/- 26.4 mL (range 110.0-205.0 mL) by 3D ultrasound and 171.8 +/- 24.6 mL (range 127.5-211.0 mL) by MRI, yielding a good correlation (r = 0.82, p < 0.001) between the two methods. The mean difference was -16.1 +/- 15.6 mL (SD) and the limits of agreement were -49.0 mL. We conclude that this 3D-US is accurate in volume estimation of human kidneys in vivo.

Adult↗

PubMed1995

Spiramycin in triple therapy of Helicobacter pylori-associated peptic ulcer disease. An open pilot study with 12-month follow-up.

BACKGROUND: Spiramycin (Rovamycin) is a well-established macrolide antibiotic with good anti-Helicobacter pylori activity in vitro. It is acid-stable and found in high concentration in various body fluids and cells after oral administration. Its anti-H. pylori activity in vivo has not yet been tested. METHODS: Twenty-five consecutive patients with endoscopically verified peptic ulcer and a positive biopsy urease test were given spiramycin tables 1.5 MIU instead of oxytetracycline 500 mg q.d.s. in our triple therapy regimen with bismuth subnitrate suspension 10 mL (150 mg bismuth subnitrate) q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Bismuth was taken between meals and spiramycin and metronidazole with meals. Re-endoscopy and 14C-urea breath test were performed 4 weeks after completion of therapy. Those who were H. pylori negative according to the breath test returned for 1-year follow-up. RESULTS: Per protocol analysis at 4 weeks showed that 21 out of 23 patients were H. pylori negative and had healed ulcers. These 21 patients were persistingly H. pylori negative and had no ulcers at 1-year follow-up. H. pylori eradication and ulcer healing rates were thus 91.3%; 95% confidence interval from 72.0% to 98.9%. Side-effects limiting daily activity were significantly less frequent than we have experienced previously using oxytetracycline in triple therapy. CONCLUSIONS: Spiramycin appears to be an alternative to tetracycline in the triple therapy of H. pylori infection. Further studies to position spiramycin as an anti-H. pylori drug are warranted.

Adult↗

PubMed1995

Life events and stress in patients with functional dyspepsia compared with patients with duodenal ulcer and healthy controls.

BACKGROUND: Life events and stress may be important for functional dyspepsia and duodenal ulcer. METHODS: The perception of life events in the preceding 6 months was recorded in 100 patients with functional dyspepsia, 100 patients with duodenal ulcer, and 100 healthy controls. In addition, psychologic and social factors were assessed. RESULTS: Patients with functional dyspepsia experienced significantly more life events than patients with duodenal ulcer and healthy controls. The difference in life events between the groups was due to the difference in stressful life events. The patients with functional dyspepsia had higher levels of state-trait anxiety, general psychopathology, and depression than patients with duodenal ulcer and healthy controls. CONCLUSION: Patients with functional dyspepsia had higher scores on negative life events than patients with duodenal ulcer and healthy controls. This may be causally related to the higher levels of anxiety, depression, and general psychopathology in these patients.

Adult↗

PubMed1995

The predictive value of symptoms in gastro-oesophageal reflux disease.

BACKGROUND: Gastro-oesophageal reflux disease (GORD) must be distinguished from functional dyspepsia and peptic ulcer disease because, albeit similar symptomatology, they are different diseases with greatly differing pathogenesis and treatment. METHODS: A new endoscopic grading of reflux oesophagitis was applied in two large prospective studies. RESULTS: High consistency of endoscopic findings and low predictive value of symptoms. CONCLUSIONS: The low predictive value of symptoms stresses the importance of applying solid endoscopic criteria in the assessment of GORD.

Diagnosis, Differential↗

PubMed1995

What are the real problems for patients with functional dyspepsia?

BACKGROUND: Patients with functional dyspepsia (FD) have more complaints than just the dyspepsia. METHOD: One hundred FD patients were assessed with regard to psychologic, medical, and social factors, before randomization, in a study of cognitive therapy. They were asked to list their main problem areas or 'target complaints'. RESULTS: Dyspepsia was the third most frequent target complaint (26 patients), and anxiety was the most frequent one (65 patients). Patients identifying dyspepsia as a target complaint differed from the other FD patients in several aspects. They had significantly more dyspeptic symptoms (p < 0.05) and scored significantly higher on multiple somatic complaints (p = 0.001), depression (p = 0.025), general psychopathology (p = 0.043), the global assessment scale (p = 0.001), and the General Health Questionnaire (p = 0.040). However, they did not have more somatic predisposing factors like consumption of alcohol and coffee or infection with Helicobacter pylori than the patients with other target complaints. CONCLUSIONS: Anxiety and not dyspepsia was the most frequent target complaint, and patients who identified dyspepsia as a target complaint did not have more somatic predisposing factors.

Adult↗

PubMed1995

Lansoprazole capsules and amoxicillin oral suspension in the treatment of peptic ulcer disease.

BACKGROUND: Lansoprazole is a potent antisecretory drug also possessing anti-Helicobacter pylori activity in vitro. It is a candidate drug for combination regimens with antibiotics for treating H. pylori infections. METHODS: In a semiblind study, 65 patients with duodenal and/or gastric ulcer and pathologic 14C urea breath test results were treated with either 60 mg lansoprazole every morning only for 14 days or combined with 500 mg amoxicillin oral suspension four times daily between meals, given for 11 days. Endoscopy and breath test were repeated after 6 weeks and 6 months. Patients with unhealed ulcers were withdrawn. RESULTS: Eradication of H. pylori infection was attained in 46% of patients receiving lansoprazole and amoxicillin but in no patient receiving lansoprazole alone. Ulcers healed significantly more often in those who were H. pylori-negative (18 of 19 (95%)) than in those who were H. pylori-positive (20 of 41 (49%)). Adverse events, particularly stomatitis/sore throat and diarrhea, occurred significantly more often when amoxicillin was combined with lansoprazole. CONCLUSIONS: Lansoprazole eradicated H. pylori infection only when combined with amoxicillin. Eradication rates in this study are hardly acceptable, and further studies are necessary to define optimal doses and duration of treatment. Using amoxicillin as an oral suspension may not be of any substantial benefit and may cause stomatitis and sore throat.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed1995

Gastric relaxation in response to a soup meal in healthy subjects. A study using a barostat in the proximal stomach.

BACKGROUND: Meal-induced relaxation of the proximal stomach can be investigated by means of a barostat. Using a standard liquid meat soup that elicits symptoms and a wide antrum in patients with functional dyspepsia, we aimed at finding the best meal size and fat load for studying gastric relaxation. METHODS: In the first trial 200 ml and 500 ml meat soup (1 g fat/200 ml) was given to six healthy individuals. In the second trial a constant volume of soup (200 ml) containing graded amounts of fat (1, 10, and 20 g/200 ml) was given to seven healthy individuals. Gastric relaxation was investigated for 1 h after consumption of the soup. A sagittal cross-sectional antral was assessed ultrasonographically every 10 min, and abdominal discomfort was scored. RESULTS: Overall, a positive response (volume increase of 30 ml or more within 5 min after consumption of the meal) was found in 26 of 30 (87%) investigations. Individual maximal responses ranged from 38 to 482 ml (mean, 180 ml +/- 128). Area under the time-volume curve (AUC) was similar after 200 and 500 ml soup (mean, 100 ml/30 min and 107 ml/30 min, respectively). AUC increased with increasing fat content, with a significant difference between the low-fat and high-fat meal (p < 0.05). The barostat bag induced fed-state antral contractions in most individuals (p < 0.001). There was a negative correlation between AUC and postprandial abdominal discomfort (p = 0.04). CONCLUSIONS: The barostat is a sensitive technique for detecting gastric relaxation, also in response to our standard meat soup meal. The postprandial relaxation response in healthy individuals in dependent on the fat content of the meal. The barostat bag may alter gastric motor activity. Abdominal discomfort after soup ingestion may be related to poor gastric relaxation.

Adult↗

PubMed1995

Monitoring postprandial size of the proximal stomach by ultrasonography.

The purpose of this study was to develop a sonographic method to monitor postprandial size of the proximal stomach. Twenty-three healthy persons were scanned in a sitting position with a 3.25 MHz transducer after ingestion of 500 ml meat soup. The area in a sagittal section and the maximal diameter in an oblique frontal section were chosen as standard measurements. The soup emptied from the proximal stomach in a linear manner (r = 0.99) and at a rate of 2.0 +/- 1.3%/min. Intraobserver error of the scans (mean +/- SD) was 5.6% +/- 2.3% and 9.5% +/- 4.5% for sagittal area and frontal diameter, respectively, and the corresponding interobserver error was 5.3% +/- 4.0% and 8.3% +/- 5.3%, respectively. This sonographic method demonstrated a moderate day-to-day variation, had low intra- and interobserver error, and allowed estimation of initial emptying fractions of the proximal stomach.

Adult↗

PubMed1995

Reproducibility of the 14C urea breath test repeated after 1 week.

OBJECTIVES: The aim of this study was to determine the numerical and categorical reproducibility of the 14C urea breath test in a routine clinical setting. BACKGROUND: The 14C urea breath test is used for diagnosis of Helicobacter pylori infection and is regarded by some centers as the gold standard. METHODS: In 140 referrals, duplicate tests were performed 1 wk apart. Eighteen patients were excluded because they had taken antibiotics or had changed medication that could influence the gastric urease activity between the tests. RESULTS: The limits of agreement between the repeated tests were 45-234%. Hence, the numerical result of a repeated test was 95% likely to differ from the first with a factor of approximately two or less. However, when patients were classified as "positive" or "negative" according to our previously determined cut-off limit, only three patients were discordantly classified by the two tests. The observed agreement between the tests was 98%, and the chance-corrected proportional agreement (kappa) was 95%, which is far better than that reported for the histological diagnosis of gastric H. pylori infection. CONCLUSION: The diagnostic reproducibility of the urea breath test was very good.

Adolescent↗

PubMed1994

[Gastrointestinal diseases--the place of endoscopy in examination, treatment and control].

Dyspepsia, defined as discomfort in the upper abdomen after a meal, is the most frequent indication for gastroscopy. Such dyspepsia was earlier considered to be an element of the ulcer disease, Moynihan's disease. Whether examination showed an ulcer or not was of minor importance as long as the treatment was the same. Similar opinions still contribute to a negative attitude towards the need to obtain a more specific diagnosis, especially in young patients where risk of cancer is low. We are of the opinion that dyspepsia is a non-specific symptom of several different diseases, and that curative therapy is often available today provided the diagnosis is correct. It is therefore necessary to make an active effort to diagnose the cause of the dyspepsia, also in younger persons. In practice, this means that there are many different indications for gastroscopy. We try, however, to practice a restrictive policy with respect to control gastroscopy.

Cost-Benefit Analysis↗

PubMed1994

[10 days of triple treatment of Helicobacter pylori infection and peptic ulcer. Status after treatment of 4 weeks and of one year].

We treated 143 Helicobacter pylori positive ulcer patients (duodenal ulcer 81, gastric ulcer 24, pyloric ulcer nine, previous duodenal ulcer 27, others two) with a ten days regimen of bismuth subnitrate, oxytetracycline and metronidazole. Four weeks after cessation of treatment the 14C-urea breath test showed that the infection was eradicated in 133 out of 140 patients (95%). The ulcer had healed in 129 (97%) of the H. pylori negative patients. Status at one year after treatment showed that 121 (98.4%) of 123 patients who had become H. pylori negative had remained negative. None of the H. pylori negative patients experienced ulcer relapse. The results show that the treatment is effective and that the rate of recurrence of H. pylori during the first year is very low.

Adult↗

PubMed1994

[Alternatives of drug therapy in Helicobacter pylori infections].

The last three years of research on treatment of Helicobacter pylori infection support the recommendations made by the Working Party, World Congress of Gastroenterology 1990. Meta-analysis shows a noteworthy difference between the recommended regimens favouring the combination of bismuth, metronidazole and tetracycline. No regimen without bismuth has been shown to have a sustained Helicobacter pylori eradication rate exceeding 90%, nor has any alternative regimen been shown convincingly to stem the adverse effects without loss of efficacy. No serious adverse effects have been reported after following the current recommendation of bismuth medication. The highest reported Helicobacter pylori eradication rate according to "intention to treat" approximates 90%, which was obtained using bismuth subnitrate, metronidazole, and oxytetracycline.

Bismuth↗

PubMed1994

[Prokinetics in reflux disease. Action mechanisms and clinical effects].

Gastro-oesophageal reflux disease is a primary motility disorder of the upper gastro-intestinal tract, with varying degrees of disturbed lower oesophageal sphincter function, disturbed peristalsis of the oesophageal body and delayed gastric emptying. Traditional treatment has focused on "detoxifying" the refluxate by suppressing gastric acid secretion. With the advent of cisapride (Prepulsid), prokinetic drugs offer a possibility of influencing the underlying motility disturbances without causing the serious side effects of earlier prokinetic drugs. It seems to be well documented that cisapride is useful in both the short-term and the long-term treatment of grade 1 reflux oesophagitis, and also in more severe cases as part of combination regimens involving acid suppressive drugs.

Cisapride↗

PubMed1994

Volume measurements of gastric antrum by 3-D ultrasonography and flow measurements through the pylorus by duplex technique.

We present a method for estimating volumes of abdominal organs using 3-D ultrasonography. In vitro validation experiments demonstrated excellent agreement between estimated and true volumes. In vivo estimations after ingestion of 500 ml meat soup showed greater antral filling and poorer emptying of the gallbladder in patients with functional dyspepsia (FD) than in healthy controls. Abnormal antral filling was associated with dyspeptic symptoms. The relationship between motility and transpyloric movements of luminal contents after ingestion of 500 ml meat soup was studied in healthy subjects by duplex technique. Accurate timing of antegrade and retrograde flow were recorded using bidirectional velocity curves. Mid-cycle and end-cycle reflux were often observed; end-cycle reflux was more frequent in conjunction with coordinated than with uncoordinated antroduodenal contractions. The peristaltic closure of the pylorus was normally preceded by a short gush of duodenogastric reflux.

Dyspepsia↗

PubMed1994

Psychotherapy in functional dyspepsia.

Patients with functional dyspepsia were assigned at random to cognitive psychotherapy (10 sessions of 50 min duration, n = 50) or to a control group (no treatment, n = 50). Before treatment all patients were assessed on psychological, somatic and lifestyle factors. If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ('target complaints'). The patients were evaluated at the end of therapy (after 4 months) and at 1 yr follow-up. Outcome measures were dyspeptic symptoms, scores on 'target complaints' and psychological parameters. Both groups showed improvement in dyspeptic and psychological parameters after 1 yr. The improvement in the control group was attributed to a non- specific effect of increased interest and attention. The therapy group showed greater reduction than the control group on dyspeptic symptoms [days of epigastric pain (p = 0.050), nausea (p = 0.024), heartburn (p = 0.021), diarrhoea (p = 0.002) and constipation (p = 0.047)]; and on scores on 'target complaints' (p = 0.001).

Adult↗

PubMed1994

Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls.

One hundred patients with functional dyspepsia, 100 patients with duodenal ulcer and 100 healthy controls were assessed on anamnestic factors, somatic symptoms and psychological measures. Patients with functional dyspepsia had significantly higher levels of state-trait anxiety, general psychopathology, depression, a lower general level of functioning and more somatic complaints from different organ systems, especially the musculo-skeletal system, compared to patients with duodenal ulcer and healthy controls. Patients with functional dyspepsia had more frequent dyspepsia symptoms and a longer disease history than duodenal ulcer patients. Discriminant analyses using a model of fifteen psychological and anamnestic variables, classified correctly 71.5% of the subjects due to diagnoses. The test for multiple somatic complaints (Giessener Beschwerdebogen) was the most important discriminating factor (Eigenvalue 0.78). Seventy-five per cent of the patients were correctly classified, 71% by diagnosis with respect to diagnoses of duodenal ulcer and functional dyspepsia using frequency of dyspeptic symptoms as discriminating factor (Eigenvalue 0.40). Functional dyspepsia seems to be a disease entity of its own, distinct from duodenal ulcer and strongly associated with psychological factors.

Adaptation, Psychological↗

PubMed1994

In vitro evaluation of three-dimensional ultrasonography in volume estimation of abdominal organs.

The purpose of this study was to evaluate the accuracy and precision of a three-dimensional (3D) ultrasound system in volume estimation of abdominal organs in vitro. A mechanical sector scanner coupled to a stepping motor recorded images of porcine stomach and kidneys. The transducer was tilted through 88 degrees yielding 81 frames, and volume estimation was performed digitally after interactive manual contour indication and organ reconstruction in 3 dimensions. This 3D system showed good correlation (r = 0.998) between estimated and true volumes. Volume estimation of stomach and kidneys using 3.25 MHz probe demonstrated limits of agreement of 0.877 to 1.146 and 1.007 to 1.125, respectively, depicting estimated volumes as a proportion of true volumes in 95% of the examinations. Intra- and interobserver variation of the tracing procedure revealed low values. We conclude that this 3D ultrasound system performs high accuracy and precision in volume estimation.

Abdomen↗