Search PubMed⌕ Search

Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 91 records · Page 5Linked to original sources
PubMed1998

Experimental study of acid burden and acute oesophagitis.

BACKGROUND: The relationship of the pH of oesophageal refluxate and its pepsin content to injury of oesophageal mucosa remains unclear. A study was made of the earliest morphological alterations in the oesophageal mucosa secondary to varying concentrations of hydrochloric acid with or without pepsin. METHODS: Adult cats had varying concentrations of acid with and without 1 per cent porcine pepsin infused into the oesophagus through a paediatric feeding tube placed 5 cm above the oesophagogastric junction at a rate of 1 ml/min for 30 min. At autopsy 24 h later, the oesophagus was removed intact and scored by an expanded modification of a previously published histopathological scoring system. This included estimates of the intensity and distribution of four morphological features: basal cell hyperplasia (BCH), intraepithelial leucocytes (IELs), subepithelial leucocytes and ulcers. Each of these four categories was scored from 0 to 4, with a maximum injury score of 16. RESULTS: Mean(s.e.m.) scores were as follows: pH 1, 15.0(1.0); pH 1 with pepsin, 13.3(1.4); pH 2, 15.3(0.7); pH 2 with pepsin, 11.7(1.1); pH 3, 1.8(1.6); pH 3 with pepsin, 3.7(1.9); pH 4 with or without pepsin, 0.6(0.2). Differences between pH 3 and 4 versus pH 1 and 2 were significant (P < 0.05). CONCLUSION: Injury to the oesophagus is more dependent on the pH of refluxate than on the presence of pepsin. Peptic injury appears to occur at a critical threshold of acid burden (pH < 3) as opposed to a graded level of injury based on a pH scale.

Acute Disease↗
PubMed1998

Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing.

PURPOSE: This study used simultaneous videomanometry to measure pressure characteristics in a group of patients with evidence of laryngeal and/or tracheal barium penetration, and to compare the results to those of one group of healthy volunteers and one group of patients with dysphagia but a normal barium swallow. MATERIAL AND METHODS: Videomanometry during barium swallowing was performed in 25 patients who showed penetration of barium into the laryngeal vestibule. Manometric abnormalities were determined by comparing these mean values with those of 25 healthy volunteers, and the frequency of manometric abnormalities was compared to that of 19 patients presenting with oropharyngeal dysphagia with a normal barium swallow. RESULTS: The frequency of abnormalities for four parameters (pharyngo-esophageal segment (PES) resting pressure, PES relaxation duration, pharyngeal peak pressure, pharyngeal contraction duration) differed significantly between the patients with penetration and those with normal barium studies. There was, however, no association between manometric abnormalities and the degree of barium penetration. CONCLUSION: The differences in manometric abnormalities between patients with laryngeal penetration and patients with normal barium swallows may be useful in identifying the mechanisms of laryngeal penetration.

Adult↗
PubMed1998

Influence of age and gender on gastroesophageal reflux in symptomatic patients.

Studies have reported that normal males have significantly more physiologic gastroesophageal reflux (GER) than women but little difference in reflux parameters is seen between younger and older normal individuals. The aims of this study were to investigate the influence of age and gender on GER in symptomatic patients. We reviewed 353 24-h pH studies performed in patients with reflux symptoms. The following parameters were assessed: % time pH < 4 of total, upright and supine periods; total reflux episodes; total reflux episodes > 5 min; longest reflux episode. These parameters were analyzed according to age and gender using non-parametric tests. The median age was 47 years and this was used as the cutoff between younger and older patients. Also, an elderly group (age > or = 65) was analyzed. Age did not influence % time pH < 4 for total, upright and supine periods. However, older symptomatic patients had longer reflux episodes. As with normal subjects, male patients had significantly (P < 0.05) more reflux than females, comparing median values for the percentage times pH < 4: total 4.7 vs 2.7%; upright 5.2 vs 3.3%; supine 1.2 vs 0.4%; total reflux episodes 63 vs 45; episodes > 5 min (2 vs 0) and longest reflux episode 9 vs 5 min. Therefore, different cutoff values may be necessary for males and females in diagnosing abnormal reflux.

Acid-Base Imbalance↗
PubMed1998

Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.

Inability to maintain oral nutrition due to oropharyngeal dysphagia is common in patients with a variety of neurological and neuromuscular disorders and severely affects quality of life. Cricopharyngeal dilatation has been used as empiric therapy in these patients, but little data exist on symptom response and there is no data on the effect on the manometric characteristics of the upper esophageal sphincter (UES) and pharynx. We studied 10 patients with oropharyngeal dysphagia and either elevated upper esophageal sphincter resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. Dilatation therapy was performed with an 18-20 mm Savary dilator and manometry was repeated after an average period of 4 weeks. Nine out of 10 patients had improvement in dysphagia and have maintained oral nutrition for a mean follow-up of 13 months. UES residual pressure decreased in nine out of 10 patients and the group median value decreased significantly from 10.8 mmHg pretreatment to 5.7 mmHg after therapy (P < 0.05). UES resting pressure decreased in eight out of 10 patients and the group median value decreased from 82 to 43 mmHg (P < 0.05). Duration of relaxation did not change significantly. Videoradiography was normal in five out of nine responders to therapy. For selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilatation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure and/or increasing the duration and completeness of relaxation.

Aged↗
PubMed1998

Pneumatic balloon dilation in achalasia: a prospective comparison of balloon distention time.

OBJECTIVE: Duration of Inflation in pneumatic balloon dilatation as treatment of achalasia has been variable ranging from 15 s to 6 min. A 60 s duration appears to be most often used. We compared the efficacy of dilation of achalasia with either 6- or 60-s inflation duration using a Rigiflex dilator of 3.0 cm diameter. METHODS: Eighty-one consecutive patients were prospectively studied in a randomized fashion, 41 in the 60-s group (A) and 40 patients in the 6-s group (B). Mean age of group A was 43 +/- 16.2 yr and of group B was 40 +/- 16.4 yr. Symptoms of dysphagia, chest pain, heartburn, regurgitation, and night cough were evaluated at basal (before dilation), 1- and 6-month intervals after dilation in both groups. Barium swallow was done to assess esophageal emptying 1 wk before dilation and 5 min postdilation in both groups. RESULTS: Significant and sustained improvement was seen for all symptoms in both groups. In addition, the degree of improvement in symptom scores between the two groups was similar. Barium esophagram in both groups at basal and immediately postdilation showed significant improvement in barium emptying but there was no significant difference between the two groups, indicative of equal efficacy in both distention times. Two patients needed repeat dilatation in group A and one in group B, with one drop out from group A, who was lost to follow-up, and was excluded from the analysis. No perforation occurred. CONCLUSION: Short duration of pneumatic balloon dilatation (6-s) is as effective as longer duration (60-s) in treatment of achalasia.

Adult↗
PubMed1998

Normal patterns of acid exposure at the gastric cardia: a functional midpoint between the esophagus and stomach.

OBJECTIVE: Little is known about the normal anatomical patterns of acid exposure at the gastric cardia and its relationship to acid refluxed into the esophagus. In this study, pH patterns of the gastric cardia at baseline and during esophageal reflux were determined using ambulatory pH monitoring in normal volunteers. METHODS: Ten volunteers with normal distal esophageal acid exposure underwent 18-h ambulatory pH monitoring studies with pH leads placed 5 cm proximal, 5 cm distal, and 10 cm distal to the proximal border of the LES. RESULTS: Median LES length and pressure were 3.5 cm (range 2.5-4.5) and 28 mm Hg (18-48), respectively. Total cardia acid exposure was 45.2% with a wide range (1.0-76.1%) and was significantly different from esophagus (1.6; 0.2-5.9%) and stomach (87.5; 76.0-95.4%) (p < 0.001). Upright (49.8; 1.5-77.0%) and recumbent (31.4; 0-75.1%) cardia acid exposure were not different. Patterns of baseline cardia acid exposure were characterized by: 1) prolonged periods of no acid exposure; 2) isolated brief episodes of acid exposure with stepwise clearances similar to the esophagus; 3) sustained repetitive vacillations between low and neutral pH; or 4) prolonged periods with pH <4 in the cardia. The majority (86.4%) of cardia acid exposures were < 1 min. in duration most consistent with patterns B and C. Esophageal reflux occurred during sustained repetitive vacillations in cardia pH (48%), prolonged periods of cardia acid exposure (33%), or with single transient exposures of acid reflux into the cardia then the esophagus (19%) with stepwise clearance in both. CONCLUSION: 1) Cardia acid exposure is present at a level intermediate between that of the esophagus and stomach; it is most commonly transient but may be continuous, similar to the stomach. 2) Refluxed esophageal acid originates from a pool of acid distal to the cardia that then bathes the cardia in sustained, repetitive, or single acid exposures and occasionally travels into the esophagus.

Adult↗
PubMed1998

Cisapride 20 mg b.i.d. provides symptomatic relief of heartburn and related symptoms of chronic mild to moderate gastroesophageal reflux disease. CIS-USA-52 Investigator Group.

OBJECTIVE: We evaluated the efficacy and safety of a twice-daily dosage regimen of cisapride 20 mg in relieving the symptoms of mild-moderate gastroesophageal reflux disease (GERD) in patients with moderate intensity heartburn and no history of erosive esophagitis. METHODS: After a 2-wk, single-blind, placebo run-in period, 398 patients who continued to experience moderate intensity heartburn were randomized to either placebo (n = 196) or cisapride 20 mg (n = 202) twice daily for 4 wk. RESULTS: Compared with placebo, cisapride significantly reduced scores for daytime and nighttime heartburn (p < 0.001), total regurgitation (p < 0.001), eructation (p = 0.04), and early satiety (p = 0.04). Cisapride 20 mg b.i.d. was also superior to placebo in reducing total use of rescue antacid medication (p < 0.001); reducing, in concordance analyses, daytime and nighttime heartburn with antacid usage (p < 0.001); increasing the percentage of heartburn-free days and antacid-free nights (p < 0.5); and increasing the percentage of patients self-rated as having minimal or better symptomatic improvement (p = 0.01). Cisapride 20 mg b.i.d. was well tolerated. The most common adverse event in the cisapride group was diarrhea, reported by 10% of patients, compared with an incidence of 4% in the placebo group. CONCLUSION: Cisapride 20 mg b.i.d. was shown to be effective and safe for the short-term treatment of daytime and nighttime heartburn and for other symptoms associated with mild-moderate GERD.

Adolescent↗
PubMed1998

Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors.

OBJECTIVES: It is our experience that many patients treated with proton pump inhibitors (PPI) b.i.d. recover acid secretion during the night. Our aim was to assess the efficacy of omeprazole and lansoprazole b.i.d. on nocturnal gastric acidity. METHODS: Three groups were studied with intragastric pH monitoring. Group 1 consisted of 17 patients with gastroesophageal reflux disease (GERD) taking omeprazole 20 mg b.i.d. Group 2 was 16 male volunteers taking omeprazole 20 mg b.i.d. and Group 3 comprised 12 volunteers taking lansoprazole 30 mg b.i.d. RESULTS: The percentages of time that subjects had pH < 4 were lower during supine than upright periods in Groups 1 and 3 (P < 0.01). Recovery of nocturnal acid secretion lasting > 1 h, termed acid breakthrough, occurred in three-fourths of all individuals within 12 h from intake of the evening dose of PPI. Median time to acid breakthrough for the whole group was 7.5 h. CONCLUSION: Nocturnal acid breakthrough occurs in a majority of patients and normal volunteers taking PPI b.i.d.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Imipramine decreases oesophageal pain perception in human male volunteers.

BACKGROUND: Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. AIMS: To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. METHODS: Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. RESULTS: Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p = 0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. CONCLUSION: Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect.

Adult↗
PubMed1998

Proximal and distal esophageal contractions have similar manometric features.

The human esophagus is composed of striated muscle proximally and of smooth muscle distally with a transition zone between the two. Striated muscle contracts much faster than smooth muscle. The change in pressure over time (dP/dt) of the contraction amplitude should therefore be higher in proximal than in distal esophagus, reflecting the presence of striated muscle proximally. There were 34 normal esophageal manometries of patients analyzed for swallow amplitude and dP/dt in the pharynx and esophagus. An additional 11 healthy controls were similarly studied. Amplitudes in pharynx and proximal and distal esophagus were not different. The mid-esophagus had a pressure trough (P < 0.001). The dP/dt in the pharynx was much higher than that in the esophagus (P < 0.001). The dP/dt of proximal and distal esophagus were of the same order of magnitude. The manometric behavior of the striated muscle portion of the proximal esophagus differs from that seen in the pharynx and shows similar characteristics to distal esophageal smooth muscle.

Adult↗
PubMed1997

Comparison of swallowing function in Parkinson's disease and progressive supranuclear palsy.

Dysphagia is common in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Although it is believed to be more common in PSP, there are no controlled data and no comparison of swallowing function between these two disorders. Our aim was to assess dysphagia and swallow function in patients with PSP and PD. Seven patients with PSP were matched to seven patients with PD on the basis of disease duration. Self-rated dysphagia, movement disorder disability, modified barium swallow results, and abnormalities noted on manometry of the lower esophageal sphincter, esophageal body, upper esophageal sphincter, and pharynx were compared between the two groups. Neither severity nor duration of dysphagia differed between the two groups. Patients with PSP had a significantly greater degree of disability [median (range) Hoehn & Yahr score, 4 (3-5) vs. 2 (1-2); P < 0.002]. Manometric abnormalities were similar for the two groups. Oral-phase abnormalities on modified barium swallow were significantly more frequent in PSP (four patients with PSP vs. no patients with PD; p < 0.005). Pharyngeal abnormalities did not differ. Modified barium-swallow scores correlated well with self-reported dysphagia severity for patients with PSP (r = 0.93; p < 0.05) but not for those with PD (r = 0.42; p = NS). The frequency of abnormalities noted during the oral phase was significantly increased in PSP. It is hypothesized that the sensory information conveyed due to this may account for the better correlation between symptoms and swallowing abnormalities and the belief that swallowing problems are more common in PSP.

Barium↗
PubMed1997

An objective assessment of laparoscopic antireflux surgery.

BACKGROUND: Complicated gastroesophageal reflux disease (GERD) requires long-term medical therapy, which in some instances is incompletely effective or poorly tolerated. Additionally, there is concern about the consequences of prolonged acid suppression therapy. Surgical correction of GERD has been a therapeutic option for decades. With the advent of video-assisted laparoscopic surgery, antireflux surgery has had a resurgence in popularity. PATIENTS AND METHODS: Between October 1992 and June 1995, 20 patients who underwent laparoscopic antireflux surgery were completely studied preoperatively and 3 months postoperatively with 24-hour pH monitoring and esophageal manometry. Follow-up averaged 18 months. The indication for surgery was medically refractory disease in 75%, intolerance to medication in 10%, and concern regarding the consequences of long-term medical therapy in 15%. Two thirds of these patients had complicated GERD. RESULTS: Operative time averaged 4 hours. There was no conversion to an open procedure. There was no mortality. Two patients had recurrent reflux, for a failure rate of 10%. Overall, postoperative reflux episodes and percent of time pH was less than 4 dropped significantly. Lower esophageal sphincter function showed a statistically significant increase in mean postoperative resting pressure and residual sphincter pressure during swallowing. There was no change in motility postoperatively. CONCLUSIONS: Laparoscopic antireflux surgery is a safe, effective, therapeutic alternative in the management of gastroesophageal reflux disease.

Adult↗
PubMed1997

Gastroesophageal reflux disease in patients with columnar-lined esophagus.

Columnar-lined esophagus or Barrett's esophagus is closely associated with gastroesophageal reflux disease. Animal and human studies have shown not only acid but duodenogastroesophageal reflux acting in synergy with acid causes the most esophageal injury. Patients with Barrett's esophagus manifest typical and atypical symptoms of reflux. Ten percent to 25%, however, have clinically silent reflux. Early diagnosis is essential for this disease as it is a risk factor for the development of adenocarcinoma of the esophagus.

Animals↗
PubMed1997

Combined videomanometric identification of abnormalities related to pharyngeal retention.

RATIONALE AND OBJECTIVES: The authors determined the usefulness of performing videoradiography and pharyngeal solid-state manometry during barium swallow in dysphagic patients with pharyngeal retention. METHODS: Results were retrospectively analyzed of simultaneous videoradiography and manometry examinations in 14 patients with retention of barium in the pharynx. Twelve age-matched patients without retention served as a control group. RESULTS: Patients with retention regularly had less opening of the upper esophageal sphincter than patients without retention (7.6 vs 10.3 mm, respectively; P = .003). In patients with retention, the laryngeal elevation was lower (17.1 vs 23.8 mm, respectively; P = .001), and the resting pressure of the upper esophageal sphincter was significantly lower (42.4 vs 54.0 mm Hg, respectively; P = .04). The duration of upper esophageal sphincter relaxation was also shorter in patients with retention (374 vs 603 msec, respectively; P = .003). The peak pharyngeal contraction pressure was not significantly different. CONCLUSION: The constrictors play a minor role in the conveyance of the bolus through the pharynx. Pharyngeal shortening could be the most important mechanism in bolus transport.

Adult↗
PubMed1997

Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder.

Nonspecific esophageal motility disorder (NEMD) is a vague category used to include patients with poorly defined esophageal contraction abnormalities. The criteria include "ineffective" contraction waves, ie, peristaltic waves that are either of low amplitude or are not transmitted. The aim of this study was to identify the prevalence of ineffective esophageal motility (IEM) found during manometry testing and to evaluate esophageal acid exposure and esophageal acid clearance (EAC) in patients with IEM compared to those with other motility findings. We analyzed esophageal manometric tracings from 600 consecutive patients undergoing manometry in our laboratory following a specific protocol from April 1992 through October 1994 to identify the frequency of ineffective contractions and the percentages of other motility abnormalities present in patients meeting criteria for NEMD. Comparison of acid exposure and EAC was made with 150 patients who also had both esophageal manometry and pH-metry over the same time period. Sixty-one of 600 patients (10%) met the diagnostic criteria for NEMD. Sixty of 61 (98%) of these patients had IEM, defined by at least 30% ineffective contractions out of 10 wet swallows. Thirty-five of these patients also underwent ambulatory esophageal pH monitoring. Patients with IEM demonstrated significant increases in both recumbent median percentage of time of pH <4 (4.5%) and median distal EAC (4.2 min/episode) compared to those with normal motility (0.2%, 1 min/episode), diffuse esophageal spasm (0%, 0.6 min/episode), hypertensive LES (0%, 1.8 min/episode), and nutcracker esophagus (0.4% 1.6 min/episode). Recumbent acid exposure in IEM did not differ significantly from that in patients with systemic scleroderma (SSc) for either variable (5.4%, 4.2 min/episode). We propose that IEM is a more appropriate term and should replace NEMD, giving it a more specific manometric identity. IEM patients demonstrate a distinctive recumbent reflux pattern, similar to that seen in patients with SSc. This finding indicates that there is an association between IEM and recumbent GER. Whether IEM is the cause or the effect of increased esophageal acid exposure remains to be determined.

Adult↗
PubMed1997

Effective gastric acid suppression after oral administration of enteric-coated omeprazole granules.

Omeprazole is inactivated by exposure to gastric acid and is formulated as a gelatin capsule containing enteric-coated granules that release the drug in alkaline medium. In clinical situations where patients are unable to take the capsule orally, the optimum means of administration is uncertain. Eleven normal volunteers were given omeprazole 20 mg every day for one week before breakfast in random order as either a 20-mg capsule with water or free enteric-coated granules with either 8 oz of orange juice, 8 oz of water with 2 Alka-Seltzer antacid tablets (aspirin free), or 1 teaspoon of apple sauce. On day 7 of each regimen, an 8-hr intragastric pH study was performed following omeprazole 20 mg and standard breakfast. The median percentage of time of gastric acid pH > 4 after an omeprazole capsule was 68.5 (25-100); after granules with orange juice 59 (43-100); after granules in Alka-Seltzer solution 63 (31-100), and after granules in apple sauce 65 (30-99), with no significant differences (ANOVA). The time for the gastric pH to reach <4' after having been above was also similar for all four regimens (ANOVA). Omeprazole granules administered orally in a variety of ways achieve gastric acid suppression as effectively as the intact capsule.

Administration, Oral↗
PubMed1997

Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux.

Gastroesophageal reflux (GER) occurs in 22-66% of patients with noncardiac chest pain (NCCP). Although open-label investigations have shown beneficial effects of antireflux therapy in NCCP, no double-blind, prospective, placebo-controlled studies have been conducted. The purpose of this study was to evaluate the effects of omeprazole compared to placebo in a prospective, double-blind, randomized trial of patients with NCCP and GER. Thirty-six consecutive patients with NCCP and GER documented by 24-hr ambulatory pH testing entered this study. The subjects were randomized to omeprazole, 20 mg by mouth twice a day (17 patients), or placebo (19 patients) for eight weeks. Patients on omeprazole obtained significantly more improvement in the fraction of chest pain days (P = 0.006) and severity (P = 0.032) when compared to placebo. More patients in the omeprazole group reported improvement in individual daily pain scores (81% vs 44%, P = 0.03) and individual severity scores (81% vs 50%, P = 0.057). Thirteen (81%) of the subjects in the treatment arm reported overall symptomatic improvement versus one (6%) in the placebo group (P = 0.001). The results of this study indicate that acid suppression with omeprazole effectively improves chest pain in patients with NCCP and GER.

Chest Pain↗