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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

443 records · Page 25Linked to original sources
PubMedDate not supplied

Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows.

OBJECTIVE: Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients? MATERIAL AND METHODS: We examined 19 patients (12 men and 7 women, mean age 47 years, range 19-69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23-59 years). RESULTS: Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by +/- 2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high UES residual pressures, three with weak pharyngeal contractions, three with pharyngeal "spasms," seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination. CONCLUSIONS: Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.

Adult↗
PubMedDate not supplied

Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia.

The use of esophageal manometry seems to be increasing, but the utility of pharyngeal and upper esophageal sphincter (UES) manometry is not widely recognized. This article is intended to clarify this subject. Initially, we review the anatomy and physiology of this area. Most studies indicate that the manometry of the UES and pharynx provides useful information primarily in patients that have symptoms of oropharyngeal dysfunction. Oropharyngeal dysphagia has high morbidity, mortality, and cost. It occurs in one third of all stroke patients and is common in the chronic care setting; up to 60% of nursing home occupants have feeding difficulties, of whom a substantial portion have dysphagia. For patients with oropharyngeal dysphagia, as for those with esophageal dysphagia, barium swallow study and manometry are complimentary. Their combined use permits us to enhance the understanding of the pathophysiologic process that causes the patient's symptoms. Abnormalities have been noted in a variety of diseases, such as Parkinson's disease, oculopharyngeal muscular dystrophy, achalasia, and scleroderma. Thus, it is possible to determine the primary pathology that is causing the patient's dysphagia by analyzing the manometry results. Pharyngeal and UES manometry also has a value in evaluating patients who are candidates for myotomy or dilatation, as it can help identify patients with a prospective good outcome.

Deglutition Disorders↗
PubMedDate not supplied

Vigorous achalasia: original description requires minor change.

UNLABELLED: Vigorous achalasia was described in 1957 as a subset of achalasia with a higher contraction amplitude (>37 mm Hg), minimal esophageal dilatation, prominent tertiary contractions, and higher incidence of chest pain. GOALS: Ascertain the existence of a distinct achalasia group based on manometric, radiographic, and clinical grounds. STUDY: The records of 209 idiopathic achalasia patients seen over a 9-year interval were reviewed for duration and frequency of dysphagia, chest pain, heartburn, weight loss, and nocturnal symptoms, as well as for treatment outcome. Manometric tracings were reanalyzed for lower esophageal sphincter pressure (LESP), LES residual pressure, distal esophageal contraction amplitude, and presence of repetitive waves. Patients were subsequently divided into classic (amplitude < or =37 mm Hg) and vigorous (amplitude >37 mm Hg) achalasia groups. Esophagrams were reassessed blindly for esophageal diameter both in the upright and recumbent positions and presence of lumen-occlusive tertiary contractions. RESULTS: One hundred forty-four classic and 65 vigorous achalasia patients were identified. These groups were similar in age and gender, as well as duration of symptoms. Chest pain was equally prevalent in both groups. Lower esophageal sphincter pressure was higher ( p < 0.01) and repetitive waves more common ( p < 0.0001) in the vigorous achalasia group. Upright esophageal diameter was smaller ( p = 0.0003) and tertiary contractions more frequent ( p = 0.0004) in this group. CONCLUSION: The original manometric and radiographic description of vigorous achalasia is accurate. The incidence of chest pain is similar to that of patients with classic achalasia.

Case-Control Studies↗
PubMedDate not supplied

Ambulatory esophageal manometry in the evaluation of unexplained chest pain.

Ambulatory esophageal manometry is a relatively new technology, widely accepted as a research tool in the study of esophageal motility disorders. Its role as a clinical tool has been more controversial. This paper reviews current opinions regarding the use of this diagnostic tool, and attempts to summarize the advantages and shortcomings of this technology as it has been employed in the evaluation of unexplained chest pain.

Chest Pain↗
PubMedDate not supplied

Physiology and pathophysiology of the lower esophageal sphincter.

The physiologic factors controlling lower esophageal sphincter (LES) function are interrelated in a complex fashion and include the autonomic nerve supply, gastrointestinal hormones, and specific characteristics of the circular smooth muscle at the esophagogastric junction. It might be expected that a defect in any of these three controlling mechanisms would result in a clinically recognizable symptom complex. Abnormalities with either high or low LES pressure have been shown to relate to these specific aspects. Studies of the effects of various foods and other agents which decrease or increase LES pressure are of therapeutic interest in relating to patients with reflux symptoms. Decreases in LES pressure occurring after fat ingestion may explain a mechanism for many cases of fatty food intolerance. Pressure decreases after chocolate ingestion, after smoking, and after alcohol all have strong therapeutic implications in patients with chronic heartburn. Gastric alkalinization will increase pressure for up to one hour in patients with basal sphincter hypotension and reflux symptoms. Recent studies with drugs that work through the cholinergic mechanism have important therapeutic considerations. Anticholinergic agents produce definite decreases in LES pressure and are to provided in treatment of patients with reflux symptoms. On the other hand cholinergic drugs such as bethanechol have been shown to increase LES pressure in normal subjects and in patients with chronic sphincter incompetence. Recently, a double-blind therapeutic trial with bethanechol in patients with chronic heartburn has indicated that this drug, when given on regular basis, is an effective adjunct to therapy in these patients.

Anemia, Pernicious↗
PubMedDate not supplied

Gastroesophageal reflux induced by exercise in healthy volunteers.

The effects of different types of exercise on gastroesophageal reflux were evaluated during fasting and postprandially in 12 asymptomatic volunteers (7 men and 5 women; mean age, 28 years) using an ambulatory intraesophageal pH monitor. The 1-hour exercise period included stationary bicycling (aerobic exercise with little agitation of the body), running (aerobic exercise with a high degree of agitation of the body), and a weight routine (nonaerobic exercise). Each exercise was performed for 15 minutes with 5 minutes of rest between exercises. The weight routine consisted of five different exercises (sit-ups, bench press, sitting arm press, prone leg curls, and sitting leg press) chosen to compare upper-body vs lower-body exercise and supine vs upright position. Each exercise hour was preceded by a 1-hour baseline period on 2 days (fasting and postprandial). The results indicate that vigorous exercise can induce gastroesophageal reflux in normal subjects. Running induced the most reflux, and aerobic exercises with less bodily agitation (bicycle) produced less reflux and may offer an alternate form of exercise for patients with reflux. The weight routine induced gastroesophageal reflux in some subjects, although no particular exercise was associated with more reflux. Postprandial exercise showed a similar pattern of induced gastroesophageal reflux, although of greater amount.

Adult↗