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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 253 records · Page 14Linked to original sources
PubMed1987

Comparison of potential cytoprotective action of sucralfate and cimetidine. Studies with experimental feline esophagitis.

The potential mucosal protective effects of a liquid sucralfate preparation and the histamine (H2)-antagonist cimetidine on acid-induced esophagitis were studied. Esophagitis was induced in adult cats using a constant infusion of 0.1 N hydrochloric acid at 1 ml/minute for 20 minutes. Mucosal lesions were evaluated by blinded investigators using both fiber-optic endoscopy and light microscopy. Histology was scored for basal cell hyperplasia, intraepithelial leukocytosis, and subepithelial leukocytosis. Liquid sucralfate given prior to acid infusion consistently prevented acid-induced lesions, demonstrated by quantitative histologic scoring. Although cimetidine did not show the same degree of protection as sucralfate, the results did show a trend towards a cytoprotective effect.

Animals↗
PubMed1987

Multicenter trial of sucralfate suspension for the treatment of reflux esophagitis.

The efficacy of sucralfate suspension in the treatment of reflux esophagitis was assessed in a multicenter, randomized, double-blind, placebo-controlled trial. Sixty-eight patients with symptomatic and endoscopic esophagitis received either sucralfate suspension (n = 31) or liquid placebo (n = 37) for eight weeks. The two groups were comparable at entry with the exception that despite randomization, a disproportionately high number of patients with esophageal ulcers were assigned to receive sucralfate. After four and eight weeks of treatment, both groups had reduced heartburn frequency and severity, but there was no difference in improvement between sucralfate and placebo (p greater than 0.05). Endoscopic results after eight weeks of sucralfate treatment revealed complete healing in 36 percent (placebo, 35 percent) and improvement in an additional 45 percent (placebo, 24 percent). Although neither of these differences was significant, the percent of patients in whom healing or improvement occurred with sucralfate (81 percent) was greater than with placebo (59 percent) (p = 0.07). These data fail to establish that eight weeks of treatment with sucralfate suspension improves symptoms or heals lesions in reflux esophagitis at a rate significantly greater than placebo. However, the unequal distribution of patients with ulcers and the trend toward endoscopic improvement indicate that a potential beneficial effect of sucralfate suspension for the treatment of reflux esophagitis cannot be excluded.

Clinical Trials as Topic↗
PubMed1987

Sucralfate treatment of nonsteroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage.

In a randomized, double-blind trial, sucralfate therapy, 1 g four times daily, was compared with placebo in 143 symptomatic patients to assess the treatment of gastrointestinal symptoms and gastric mucosal damage associated with nonsteroidal anti-inflammatory drugs (NSAIDs). All patients followed a fixed regimen of NSAIDs, were assigned to one of two groups based on the presence or absence of gastric erosions at baseline endoscopy, and were then assigned randomly to receive sucralfate or placebo for four weeks. Patients were then followed for up to six months while receiving open-label sucralfate 1 g twice daily to up to 1 g four times daily. After four weeks of double-blind therapy, patients taking either nonsalicylate NSAIDs or long half-life NSAIDs and who were treated with sucralfate experienced a significant reduction in both peptic symptom frequency and intensity (p less than 0.03) as compared with patients receiving placebo. Sucralfate-treated patients with baseline endoscopic lesions showed a significant reduction in lesion scores (p less than 0.005) at four weeks as compared with baseline, whereas no improvement was observed in gastric mucosal lesions of patients given placebo. Long-term sucralfate therapy resulted in continued improvement in gastrointestinal symptoms and gastric lesion scores in patients receiving all types of NSAIDs. The results indicate that sucralfate used in conjunction with NSAIDs may allow patients to continue therapy by relieving gastrointestinal symptoms and mucosal damage associated with NSAID therapy.

Aged↗
PubMed1987

Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions.

UNLABELLED: Although esophageal manometry is widely used in clinical practice, the normal range of esophageal contraction parameters is poorly defined. Therefore, 95 healthy volunteers (mean age: 43 years; range 22-79 years) were studied with a low-compliance infusion system and 4.5-mm-diameter catheter. All subjects were given 10 wet swallows (5 cc H2O) and 38 subjects also were given 10 dry swallows. RESULTS: Amplitude, but not duration, was greater (P less than 0.05) after wet compared to dry swallows. Both distal mean contractile amplitude and duration of wet swallows significantly increased with age and peaked in the fifties. Double-peaked waves frequently occurred after both wet (11.3%) and dry (18.1%) swallows, but triple-peaked waves were rare (less than 1%). Nonperistaltic contractions were more common (P less than 0.001) after dry compared to wet swallows (18.1% vs 4.1%). This difference resulted from frequent simultaneous contractions after dry swallows (12.6% vs 0.4%). CONCLUSIONS: Distal esophageal contractile amplitude and duration after wet swallows increases with age. Triple-peaked waves and wet-swallow-induced simultaneous contractions should suggest an esophageal motility disorder. Double-peaked waves are a common variant of normal. Dry swallows have little use in the current evaluation of esophageal peristalsis.

Adult↗
PubMed1987

Effects of antireflux therapies on salivary function in normal humans.

Saliva has received recent attention because of its potential role in esophageal clearance and neutralization of refluxed gastric contents. Gastric antisecretory drugs or promotility drugs used to treat reflux have not been studied for their ability to affect salivary function. We conducted a double-blind randomized study of four antisecretory drugs, two promotility drugs, and placebo (PL) on 12 healthy volunteers on seven different days. Following a 6-hr fast, accumulated saliva was expectorated at least once per minute. The initial 10-min sample was discarded and a baseline 20-min sample collected. One of the following was given per os: PL, pirenzepine (PIR), 50 mg; propantheline (PRO), 30 mg; cimetidine (CIM), 300 mg; ranitidine (RAN), 150 mg; bethanechol (BET), 25 mg; or metoclopramide (MET), 10 mg. Saliva was collected for 60 min. Saliva was then stimulated (STIM) by sucking a peppermint lozenge for 30 min. Specimens were collected under oil, kept on ice, and analyzed within 30 min. Saliva flow in milliliters per minute and capacity for acid neutralization (CAN) in microequivalents acid per milliliter saliva were analyzed on all samples. The known effect of PRO to inhibit both basal saliva flow and STIM flow and CAN was seen. In contrast, the selective antimuscarinic PIR did not significantly decrease saliva flow or CAN. CIM, RAN, and MET did not significantly effect salivary function, but both CIM and RAN showed a tendency to increase CAN. Oral BET had no detectable effect on salivary function.

Adult↗
PubMed1987

Radiographic evaluation of esophagus immediately after pneumatic dilatation for achalasia.

Forty-one (98%) of 42 patients with achalasia of the esophagus had pneumatic dilatation performed successfully using the Brown-McHardy dilator. One to four dilatations (mean, 1.9) were done on each patient with inflation pressures of 8-15 psi (mean, 11.1 psi). Immediately after the procedure, all patients were examined radiographically by injection of contrast material into the lower esophagus through a nasoesophageal tube. Two immediate and two delayed perforations occurred. Six intramural hematomas were noted, five of which resolved spontaneously. The luminal diameter at the esophagogastric junction increased from a mean of 4.2 mm before dilatation to 7.5 mm following treatment. Four patients with previous Heller myotomy were dilated without complications. Perforation was more common in patients with a minimal change in the esophagogastric diameter. Thirty-five patients (85%) improved symptomatically within several days following pneumatic dilatation. Excluding patients with perforation, the postdilatation appearance of the lower esophagus poorly correlated with clinical response.

Adolescent↗
PubMed1987

Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus.

Placebo-controlled trials are not available to assess the efficacy of smooth muscle relaxants in the treatment of painful esophageal motility disorders. Therefore, we compared the effects of oral nifedipine (10-30 mg t.i.d.) and placebo in 20 patients (mean age 50 yr) with chronic noncardiac chest pain and the nutcracker esophagus in a 14-week double-blind crossover study. Compared to placebo, nifedipine significantly decreased distal esophageal contraction amplitude (mean +/- SEM, 198 +/- 11 mmHg to 123 +/- 9 mmHg; p less than 0.005), as well as duration and lower esophageal sphincter pressure. Nifedipine, however, was no better than placebo in the relief of daily chest pain frequency, severity, or index (frequency X severity) as assessed by patient diaries. Despite these disappointing results, long-term follow-up (mean, 16.6 mo) suggests these patients do improve. Mean daily chest pain index significantly (p less than 0.005) decreased from 10.3 +/- 2.0 at the beginning of the study to 3.2 +/- 0.8 at follow-up. Prescription drug use and physician visits for chest pain also significantly decreased. Distal esophageal contraction pressures significantly fell during the long-term follow-up but there was poor correlation with chest pain improvement. This study suggests that identification of the esophagus as the cause of chest pain coupled with supportive intervention may be more effective than drug therapy in improving these patients' chest pain.

Administration, Oral↗
PubMed1987

The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia.

We studied the effects of three smooth muscle relaxants on lower esophageal sphincter (LES) pressure and radionuclide esophageal emptying in 15 untreated patients with achalasia. LES pressures were determined before and after the administration of normal saline subcutaneously, terbutaline sulfate subcutaneously, nitroglycerin sublingually, and aminophylline intravenously. All smooth muscle relaxants significantly decreased LES pressures when compared with normal saline controls and pretreatment baseline pressures (p less than 0.01). However, in normal saline controls, LES pressure actually increased over time (p less than 0.01). Control radionuclide esophageal emptying studies were performed in all patients. Subsequent esophageal emptying studies were carried out only in patients responding to smooth muscle relaxants by decreasing LES pressures by greater than or equal to 25% (terbutaline sulfate, n = 8; nitroglycerin, n = 7; and aminophylline, n = 4). Significant improvement in esophageal emptying was observed after nitroglycerin and terbutaline sulfate (p less than 0.05) but not after aminophylline. We conclude that in patients with achalasia (a) terbutaline sulfate, nitroglycerin, and aminophylline can significantly decrease LES pressure; (b) resting LES pressures vary over time; and (c) terbutaline sulfate and nitroglycerin significantly improve esophageal emptying in some subjects.

Adult↗
PubMed1987

Esophageal radiography and manometry: correlation in 172 patients with dysphagia.

Radiographic and manometric examinations of the esophagus were correlated in 172 patients with dysphagia. Esophageal manometry was abnormal in 66 (38%), with diagnoses of nonspecific esophageal motor disorder (26), achalasia (19), nutcracker esophagus (12), diffuse esophageal spasm (seven), and scleroderma (two). Compared with manometry, radiographic sensitivities were 95% (18 of 19) for achalasia, 71% (five of seven) for diffuse esophageal spasm, and 46% (12 of 26) for nonspecific esophageal motor disorder. Nutcracker esophagus was not diagnosed specifically on the radiographic examination. Overall radiographic sensitivity was 56% (37 of 66) but increased to 89% by excluding nutcracker esophagus and nonspecific esophageal motor disorders. In 106 manometrically normal patients, radiographic specificity was 91% with 10 false-positive diagnoses of nonspecific motor disorder. We conclude that radiographic examination of the esophagus is useful in patients with dysphagia for evaluating functional esophageal abnormalities, although detection rates vary widely with the type of motor disorder.

Deglutition Disorders↗
PubMed1987

Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients.

Records from 910 patients referred to our clinical esophageal manometry laboratory for evaluation of noncardiac chest pain between January 1983 and December 1985 were reviewed and compared with records from 251 patients referred for dysphagia. Evaluation included baseline esophageal manometry, acid perfusion test, and edrophonium provocation. In the chest-pain group, 655 patients (72%) had normal esophageal motility and 255 (28%) had abnormal motility. Nutcracker esophagus was present in 48% of abnormal tracings, suggesting that it is a manometric marker for noncardiac chest pain. Of the total chest-pain group, 243 patients (27%) had their pain reproduced during provocative testing ("definite" esophageal pain); 192 patients (21%) had baseline manometric abnormalities but no pain during provocative testing ("probable" esophageal chest pain). The highest percentage of positive provocative responses (34%) occurred in patients with nutcracker esophagus on baseline manometry. Manometric abnormalities were statistically commoner (p less than 0.001) in patients with dysphagia, occurring in 53%. Achalasia (36%) and nonspecific esophageal motility disorders (38%) were the commonest abnormalities in this group, with nutcracker esophagus being infrequent (10%).

Acids↗
PubMed1987

Relationship of radionuclide liquid bolus transport and esophageal manometry.

Using simultaneous esophageal manometry and radionuclide transit studies, we compared liquid bolus transport with the various parameters of esophageal contractions. Study subjects included seven normal individuals, six patients with the "nutcracker esophagus" (mean distal peristaltic amplitude greater than 180 mm Hg), and three patients with spastic motility disorders. Manometric studies were performed when the subjects were in the basal state and after intravenous administration of edrophonium and atropine. Simultaneous radionuclide studies were done with subjects in the supine position by swallows of 250 mu Ci technetium Tc 99m sulfur colloid in 10 ml water. We found that normal liquid bolus transport (less than 15 seconds) is primarily dependent on the presence of a peristaltic wave front throughout the esophagus. Above a threshold pressure of 30 mm Hg, liquid transport was not affected by amplitude (33 to 500 mm Hg) or duration (3 to 15 seconds) of esophageal contractions. Repetitive wave forms also gave normal transit times as long as the wave front was peristaltic in onset. There was a significant inverse correlation (-0.65; P less than 0.001) between liquid transit time and peristaltic velocity. Prolonged radionuclide transport (30 to less than 50 seconds) was observed only with nonperistaltic contractions and very low amplitude (15 to 30 mm Hg) peristaltic waves.

Atropine↗