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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 109 records · Page 6Linked to original sources
PubMed1997

Evaluation of the antireflux mechanism following laparoscopic fundoplication.

BACKGROUND: Laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastro-oesophageal reflux disease (GORD), but the underlying motility mechanisms that explain the success of this operation remain unclear. METHODS: Twenty patients with a history of GORD underwent stationary oesophageal manometry and prolonged ambulatory pH monitoring, both before and 3 months after fundoplication. RESULTS: Eighteen patients were completely cured of reflux symptoms and stopped all antireflux medication after operation. After fundoplication there was a significant increase (P < 0.01) in median resting lower oesophageal sphincter (LOS) pressure and length. Median residual LOS pressure during swallow-induced LOS relaxation also increased significantly after operation (P < 0.01). The number of reflux episodes decreased from a median of 48 to 3 after fundoplication (P < 0.01). The time at pH less than 4 decreased from 5.7 to 0 per cent in the supine position (P < 0.01), and from 9.8 to 0.2 per cent while upright (P < 0.001). CONCLUSION: Early subjective results at 3 months following laparoscopic antireflux surgery show improved symptoms. One of the mechanisms underlying the antireflux action of fundoplication is an increase in median residual LOS pressure at the gastro-oesophageal junction. This may be a purely mechanical effect of the fundic wrap extrinsic to the LOS.

Adult↗
PubMed1997

Comparison of lower oesophageal sphincter pressure measurement using circumferential vs unidirectional transducers.

UNLABELLED: Average values from unidirectional (UND) transducers have traditionally been used in standard manometric evaluation of lower oesophageal sphincter pressures (LOSPs). A single circumferential (CMF) transducer has recently become popular. Our aim was to compare LOSP measurements made using the two techniques. Ten healthy volunteers were intubated with a Konigsberg manometry catheter containing five solid-state transducers (four unidirectional at 90 degrees angles radially and 2.5-cm intervals and one circumferential, 3 cm distal). LOSP was measured using the station pull-through technique in the supine and upright positions with Synectics Polygram software for computerized analysis. Mean UND pressures were plotted against CMF pressures and a linear regression and correlation analysis was performed. A similar analysis was done for LOS length. A significant difference (P < 0.01) was found between mean (+/- SE) supine and upright LOSPs for both mean UND (20.21 +/- 1.36 vs 15.56 +/- 1.28 mmHg) and CMF (20.41 +/- 1.96 vs 16.17 +/- 1.61 mmHg); however no difference was shown between supine and upright lengths. There was a high degree of correlation between LOSP (r = 0.83) and a weaker correlation (r = 0.65) between LOS lengths when measured by CMF and UND transducers. CONCLUSION: UND and CMF transducers provide identical measurements when evaluating the LOS.

Adolescent↗
PubMed1997

Exclusion of the meal period improves the clinical reliability of esophageal pH monitoring.

Meal period exclusion from 24-h pH testing allows better separation between controls and patients with gastroesophageal reflux disease. We reviewed the results of 24-h pH studies of 350 patients with reflux symptoms. They were divided into two groups based on the 95th percentile of the total percentage of time when pH was < 4 for healthy persons in our laboratory. Thus group A consisted of 212 patients with symptoms and normal acid exposure and group B consisted of 138 patients with symptoms and abnormal acid exposure. The change in upright reflux excluding the meal period was calculated for each patient. Meal period exclusion resulted in opposite effects for the two groups of patients, with a change in median upright reflux of -0.6% for group A and +0.5% for group B (p < 0.0001). After meal exclusion, five patients were reclassified as having reflux, with four (80%) of these responding to antireflux therapy. Nine other patients were recategorized as not having reflux after meal exclusion. Only one of seven patients (14%) for whom data were available responded to treatment (two patients were lost to follow-up). We recommend meal period exclusion from pH analysis because it improves the clinical reliability of esophageal pH monitoring.

Adolescent↗
PubMed1997

Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension.

Graded intraesophageal balloon distension (IEBD) has been utilized in the past to evaluate esophageal pain thresholds. With use of a technique that we have found to provide reproducible results for pain thresholds, two groups of normal individuals without esophageal symptoms or diabetes were studied. Group 1 included 10 "young" (age < 65 yr) individuals (mean age 27 yr, range 18-57 yr). Group 2 included 17 individuals age 65 yr or greater (mean age 72.5 yr, range 65-87 yr). Catheters with latex balloons (Wilson-Cook) were used in all 27 subjects with the balloon located 10 cm above the lower esophageal sphincter. Sequential inflations of 2-ml increments were performed until a total volume of 2 ml above the point of pain or to a maximum of 30 ml was reached. A series of two sequential inflations were performed on each subject on the day of the testing, and the mean value was taken to indicate pain threshold volumes for all 27 subjects. In the group of elderly volunteers, 5 subjects felt no pain even at the maximum inflatable volume of the balloon (30 ml) and were assigned a maximum threshold value of 30 ml. Mean pain threshold volumes for the young subjects was 17 +/- 0.8 ml of air (+/- SE) and for the elderly subjects was 27 +/- 1.4 ml (P < 0.01 and 95% confidence interval = 7.1-13.3). Our conclusion is that IEBD results in the esophagus indicate an age-related decrease in human visceral pain threshold.

Adolescent↗
PubMed1997

Recent developments in the manometric assessment of upper esophageal sphincter function and dysfunction.

Coordinated application of videoradiography and solid-state manometry provides insight into the pathophysiology of oropharyngeal dysphagia and helps direct appropriate therapies for a variety of conditions causing this symptom. Controlled evaluations of various treatment modalities, however, are lacking and therapy often remains primarily empiric. Despite this limitation, important strides have been made in the overall management of these patients during the past decade.

Deglutition Disorders↗
PubMed1997

Current medical treatment and indications for surgical referral for gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease (GERD) is a common problem in medical practice. Estimates are that 10% of the U.S. population will experience daily heartburn and up to 40% will have symptomatic GERD on a frequent basis. Current medical therapy allows physicians to provide complete symptom relief, maintain long-term symptom remission and prevent complications. New advances in minimally invasive surgical techniques have made antireflux surgery an attractive alternate for long-term management in selected patients. This article reviews current medical treatment and indications for surgical referral in GERD.

Enzyme Inhibitors↗
PubMed1996

Gastroesophageal reflux disease. Current strategies for patient management.

Gastroesophageal reflux disease is a chronic disease whose incidence is often underestimated. Approximately 10% of the population in the United States experience heartburn each day. In addition, as many as 50% of patients with unexplained chest pain, chronic hoarseness, or asthma may be suffering from gastroesophageal reflux disease. Disease severity ranges from occasional, mild heartburn to erosive esophagitis and its complications. Endoscopy and air-contrast barium radiography are important diagnostic tools. Esophageal pH monitoring can confirm excessive reflux in patients with atypical symptoms or in patients who do not respond to drug therapy. Depending on severity, gastroesophageal reflux disease may be managed through lifestyle modification, antacid and/or antirefluxant drugs, promotility (prokinetic) drugs, fundoplication, and/or acid-suppressant agents (eg, H2-receptor antagonists, proton pump inhibitors). Safety, effectiveness, patient compliance, and cost factors must be considered in determining the most appropriate long-term maintenance therapy.

Adult↗
PubMed1996

Health-related quality of life of patients with acute erosive reflux esophagitis.

One thousand one hundred forty-five patients with acute erosive reflux esophagitis participating in an eight-week double-blind, multicenter study of lansoprazole 15 mg daily, lansoprazole 30 mg daily, omeprazole 20 mg daily, and placebo responded to a health-related quality of life (HRQoL) questionnaire at baseline and at two, four, and eight weeks. At baseline, there were no HRQoL differences among the four study groups. However, all three active treatment groups improved statistically significantly more than placebo on most HRQoL scales at each follow-up. There were no statistically significant differences among the three active treatment groups at week 2, although in most instances lansoprazole 30 mg showed slightly more improvement. After week 2, benefits in all the study groups leveled off and remained constant. Greater acid suppression appeared to result in greater improvement in terms of HRQoL.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Upper esophageal sphincter and pharyngeal function and oropharyngeal (transfer) dysphagia.

Through the application of videoradiography and solid-state manometry, much insight has been gained into the pathophysiology of oropharyngeal dysphagia, and considerable guidance has been provided toward appropriate therapies for the multitude of conditions causing this symptom. As noted earlier, a multidisciplinary approach to these patients often provides the most effective diagnosis and treatment regimen. In the diagnostic evaluation, barium videoradiography and solid-state intraluminal manometry should be considered as complementary procedures, with each providing important aspects of the overall assessment of the swallowing mechanism. It is important to note that controlled evaluations of the various treatment modalities are lacking and that therapy, although directed by information provided by the radiographic and manometric assessment, is primarily empiric. Despite this limitation, great strides have been made in the overall management of these patients during the past decade.

Aged↗
PubMed1996

Excluding gastroesophageal reflux disease as the cause of chronic cough.

Gastroesophageal reflux disease (GERD) is recognized to be present in 10-20% of cases of chronic cough. Proving that it is the cause of the cough is more difficult. This problem is illustrated by way of a case report demonstrating that GERD can still be the cause, even when the patient is unresponsive to conventional use of proton pump inhibitors. In the commentary following the case history, we review the medical literature to confirm that GERD and cough may each precipitate the other. The role of esophageal pH monitoring in difficult cases of chronic cough is explored; we emphasize the use of pH monitoring while the patient is on therapy to prove or disprove the link.

Anti-Ulcer Agents↗