Search PubMed⌕ Search

Biomedical subjects

E E Soffer

Publications and source records attributed to E E Soffer.

At least 37 records · Page 2Linked to original sources
PubMed1997

Small bowel manometry: short or long recording sessions?

The study of small bowel motility in humans is commonly done by one of two techniques: short-term recording in a stationary patient or long-term recording in an ambulatory patient. To compare the diagnostic yield of short- and long-term manometric studies of small intestinal motility, we reviewed all prolonged records performed in our center over the years. Long-term studies that included less than 6 hr of recording during fasting or less than 5 hr during sleep and short-term studies using the perfused tube technique were excluded, leaving 91/121 tracings suitable for review. We analyzed the first 3 hr of the fasting period and the first 2 hr of the postprandial period on one occasion and the whole tracing on another; the fasting, postprandial and sleep period were analyzed separately. This allowed us to compare short and long recording sessions in the same patient. The two analyses agreed in 81/91 of the cases. In 7/10 patients a study was diagnosed as abnormal in the short recording but was considered normal after review of the long recording, while the opposite occurred in the remaining three. Periods of sleep and fasting contributed similarly to the change in diagnosis. In another 6 patients with equivocal abnormalities during the short period, the long period helped to establish the diagnosis of normality with confidence. Most of the improvement in the long-term study came from extension of the studies during fasting to 6-7 hr from 3 hr. Long-term records of small bowel motility, including study during sleep enhance the diagnostic accuracy of the test. Accuracy can be improved also simply by prolonging the recording during fasting.

Abdominal Pain↗
PubMed1997

Meal-induced secretion of gastrointestinal regulatory peptides is not affected by sleep.

UNLABELLED: The mechanisms responsible for the disruption of the migrating motor complex (MMC) by feeding are not fully understood. Sleep reduces the duration of the postprandial or fed pattern of motility in the intestine. This study was set out to determine if this effect is associated with sleep-induced changes in the secretion of regulatory peptides in response to food. METHODS: Duodenojejunal motility was studied in 15 healthy ambulant subjects for 2 consecutive days. On one day identical solid meals were consumed in the morning and late in the evening, the latter followed by sleep. On the other day, identical liquid meals were infused into the stomach and the duodenum in the morning and late in the evening, the latter after the onset of sleep. Plasma concentrations of gastrin, neurotensin, peptide YY (PYY), pancreatic polypeptide (PP), motilin and glucose were monitored before and after meals. Sleep significantly shortened the duration of the fed pattern after the solid meal and even more so after the liquid meal. The plasma concentrations of all peptides, except motilin, increased significantly following each meal. Blood glucose levels rose after each meal, the changes being similar with all meals. Food-induced gastrointestinal regulatory peptides secretion and intestinal absorption of glucose are not affected by sleep. The vagal response to a meal, as indicated by PP release, is intact during sleep. The results support the importance of neural mechanisms in the modulation of the postprandial pattern of intestinal motility.

Adult↗
PubMed1995

Scintigraphic evaluation of small bowel transit in healthy subjects: inter- and intrasubject variability.

OBJECTIVES: This study was performed to evaluate inter- and intrasubject variability of small bowel transit time and the effect of age and sex on transit in the small bowel. METHODS: Ten young subjects (five females) and nine elderly subjects (four females) were studied. Small bowel transit time was assessed by scintigraphic method using 99mtechnetium-sulfur colloid-labeled eggs. To evaluate intrasubject variability, 10 subjects underwent a second study on a later occasion. RESULTS: Mean small bowel transit time was 220.9 +/- 49 min with a range of 131 to 322 min, with no significant difference between the young and elderly groups or between sexes. There was a good intraobserver and interobserver reproducibility within the same test (r = 0.92 and r = 0.85, respectively). There was a significant biological variability between the first and the second studies, which was true whether the studies were processed independently (r = 0.43) or whether identical regions of interest were applied (r = 0.50). CONCLUSION: The normal range of small bowel transit time is wide in normal subjects; and there is a significant intrasubject biological variability for small bowel transit time. These findings should be kept in mind when using scintigraphic techniques for assessment of patients with motility disorders or when using the test repeatedly in the same subject in the evaluation of therapeutic measures. The results do not seem to be affected by age or sex.

Adult↗
PubMed1994

Misoprostol is effective treatment for patients with severe chronic constipation.

To assess the efficacy of misoprostol in the treatment of patients with severe chronic constipation, nine such patients were enrolled in a double-blind, randomized, crossover study of misoprostol (1200 micrograms/day) or placebo, that lasted three weeks. During this period each patient received the drug for one week and placebo for another with a week washout period in between. A colonic transit study, using radiopaque markers, was performed during each of the treatment weeks, while the number of stools and their total weight was recorded by each patient for the appropriate periods. Colonic transit time was significantly and consistently decreased by misoprostol compared to placebo [66 hr +/- 10.2 vs 109.4 hr +/- 8.1 (P = 0.0005)]. Misoprostol significantly increased the total stool weight per week [976.5 g +/- 288.8 vs 434.6 g +/- 190.5 (P = 0.001)] and also significantly increased the number of stools per week compared to placebo [6.5 +/- 1.3 vs 2.5 +/- 0.11 (P = 0.01)]. The incidence of abdominal pain was similar in both groups. We concluded that misoprostol, during a short trial period, proved effective in increasing the frequency and weight of bowel movements and decreasing colonic transit time in patients with severe chronic constipation. It may be used as a therapeutic measure to treat such patients.

Adult↗
PubMed1994

Intestinal dysmotility in patients with sphincter of Oddi dysfunction. A reason for failed response to sphincterotomy.

Sphincter of Oddi dysfunction (SOD) is associated with abdominal pain and is treated by sphincterotomy. Of 215 patients who underwent biliary sphincterotomy for SOD in our institution, 26 reported no improvement and 25 of those were found to have pancreatic sphincter dysfunction and subsequently underwent pancreatic septotomy. Nine patients remained symptomatic after the second intervention. Six of those nine patients, and seven of the 16 patients who improved after the septotomy, agreed to undergo an ambulatory duodenojejunal (DJ) manometry. DJ manometry was abnormal in four of the six symptomatic patients but only in one of seven patients who became asymptomatic after endoscopic treatment. We conclude that the persistence of symptoms after endoscopic ablation of the biliary and pancreatic sphincters is associated with abnormal intestinal motility, which may explain in part the lack of response to the endoscopic treatment.

Abdominal Pain↗
PubMed1994

Morphology and pathology of radiation-induced esophagitis. Double-blind study of naproxen vs placebo for prevention of radiation injury.

Radiation-induced esophagitis can cause substantial morbidity. Experiments in lab animals have shown that pretreatment with indomethacin protects the esophagus from radiation damage. We conducted a prospective, double-blind, randomized trial of naproxen vs placebo in patients undergoing thoracic radiation therapy for lung cancer. Twenty-eight patients were enrolled, of which 26 completed the study. Sixteen patients were given a short course of radiation (30 Gy/10 fractions/2 weeks), and 10 patients were given a longer course and a larger dose (40-50 Gy/25 fractions/5 weeks). Half of the irradiated patients were treated with naproxen, 375 mg, taken orally twice a day, and half were given an identical placebo. All patients were given ranitidine 300 mg, taken orally once a day. Study drugs were taken throughout the course of radiation. Endoscopy with esophageal biopsies and brushings was performed before and on the last day of treatment. Patients kept a daily diary for symptom scoring. Symptoms such as chest pain, dysphagia, odynophagia, and/or heartburn were reported in 15 patients from both subgroups, resulting in diet restriction to liquids only in eight patients and requiring temporary discontinuation of radiation therapy in one of them. Approximately half the patients in each subgroup developed esophagitis, usually mild and usually limited to the proximal esophagus. Severity of symptoms was not proportional to the severity of esophagitis. Candidiasis was documented in eight patients, but only four had symptoms that were severe in one. We conclude that acute radiation injury to the esophagus is observed in approximately half the patients receiving radiation therapy and can result in substantial morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Double-Blind Method↗
PubMed1994

Effect of graded exercise on esophageal motility and gastroesophageal reflux in nontrained subjects.

The effects of graded exercise on esophageal motility and gastroesophageal reflux were evaluated in nine nontrained subjects, using a catheter with three strain-gauge transducers connected to a solid-state datalogger and an ambulatory intraesophageal pH monitor. Subjects exercised on a stationary bike at 45%, 60%, 75%, and 90% of peak O2 uptake (VO2 max). Durations of exercise sessions and rest periods varied among subjects. Studies were performed after an overnight fast and subjects received only intravenous infusion of 5% glucose solution during the study. Plasma concentrations of gastrin, motilin, glucagon, pancreatic polypeptide (PP), and vasoactive intestinal peptide (VIP) were determined at rest and before and after each exercise session. The duration, amplitude, and frequency of esophageal contractions declined with increasing exercise intensity, and the differences were significant (P < or = 0.05) for all three variables at 90% VO2 max. The number of gastroesophageal reflux episodes and the duration of esophageal acid exposure were significantly (P < or = 0.05) increased during exercise at 90% VO2 max. Plasma regulatory peptide concentrations showed no significant changes between rest and the various exercise sessions. Thus, exercise has profound effects on esophageal contractions and gastroesophageal reflux, which are intensity dependent. These effects were not mediated by the hormones measured. The results were similar to those observed in highly trained athletes, suggesting that the effects of exercise on esophageal function are similar in trained and nontrained subjects performing at similar percentages of VO2 max, even though the absolute levels of exercise achieved in each group are different.

Adult↗
PubMed1993

Effect of misoprostol on postprandial intestinal motility and orocecal transit time in humans.

We measured the effect of misoprostol (M), a PGE1 analog, on duodenojejunal postprandial motor activity and orocecal transit in eight healthy volunteers. Intestinal motility was studied by an intraluminal catheter with three strain gauge transducers connected to a solid-state datalogger, and transit time was measured by a hydrogen breath test. Subjects were studied for two consecutive days and fed twice a day with a similar, 600-kcal meal. Misoprostol (M) at 800, 400, or 200 micrograms or placebo were taken orally before every one of the four meals. Transit time was measured after the morning meal on both days, after ingestion of either 800 micrograms of M or placebo. On four occasions, following M, the normal fed pattern was not established and the migrating motor complex (MMC) was not interrupted by the meal. In all other occasions, when the higher doses of M were given, the first 1-2 hr after the meal revealed a hypoactive bowel. This effect was inconsistently seen following 200 micrograms of M. Orocecal transit time was consistently and significantly shorter after M than placebo: 48.3 +/- 9.5 min vs 104.4 +/- 4.8 min, P < 0.0001. Four subjects had diarrhea during the study. We conclude that misoprostol, particularly at higher doses, has a profound effect on intestinal postprandial motility and results in accelerated transit time. The motility changes induced by M may be responsible, in part, for its effect on transit.

Adult↗
PubMed1993

Effect of graded exercise on esophageal motility and gastroesophageal reflux in trained athletes.

We evaluated the effect of graded exercise on esophageal motility and gastroesophageal reflux. We studied eight trained cyclists using a catheter with three strain-gauge transducers connected to a solid-state datalogger and an ambulatory intraesophageal pH monitor. Each study lasted 4 hr during which subjects exercised on a stationary bike for 1 hr at 60% of peak O2 uptake (O2 max), 45 min at 75% of O2 max, and for 10 min at 90% of O2 max. Subjects rested 1 hr before exercise (control period) and for 30 min between exercise sessions. Studies were performed after an overnight fast and subjects received only intravenous infusion of 5% glucose solution during the study. Plasma concentrations of gastrin, motilin, glucagon, pancreatic polypeptide (PP), and vasoactive intestinal peptide (VIP) were determined at rest and before and after each exercise session. The duration, amplitude, and frequency of esophageal contractions declined with increasing exercise intensity, and the differences were significant (P < or = 0.05) for all three variables at 90% O2 max. The number of gastroesophageal reflux episodes and the duration of esophageal acid exposure were significantly (P < or = 0.05) increased during exercise at 90% O2 max. Plasma hormone concentrations showed no significant changes between rest and the various exercise sessions. Thus, exercise has profound effects on esophageal contractions and gastroesophageal reflux which are intensity dependent. These effects are not mediated by the hormones measured.

Adult↗
PubMed1992

Effect of meal composition and sham feeding on duodenojejunal motility in humans.

The disruptive effect of meals of different fat content and caloric value and of sham feeding on the interdigestive migrating motor complex (IDMMC) was studied in eight healthy subjects using an ambulatory recording system that allowed continuous monitoring of small bowel motility for three consecutive days. The durations of fed pattern were not significantly different between meals of 800 kcal/50% fat, 400 kcal/50% fat, and 800 kcal/25% fat, but were significantly longer compared to IDMMC cycle length and sham feeding. The latter two were not significantly different. On a separate day, five subjects consumed a meal of 400 kcal/9% fat and a second one of 800 kcal/50% fat. The duration of the fed pattern following the high fat meal was significantly longer than the low fat one. Sham feeding significantly increased plasma concentrations of gastrin and neurotensin (NT), but did not affect those of cholecystokinin (CCK), insulin, and peptide YY (PYY). The various variables of the IDMMC were not different during the two nights of the study, and velocity of migration of phase III during the first day and both nights was similar. We conclude that the duration of the fed pattern depends, in part, on the composition of the meal. Sham feeding, resulting in an increase in both plasma gastrin and NT concentrations, does not disrupt the IDMMC. When using thin probes, IDMMC is stable during prolonged recording.

Adult↗
PubMed1991

Effect of exercise on intestinal motility and transit in trained athletes.

We measured the effect of exercise, at different intensities, on duodenojejunal motor activity in eight trained, ambulant cyclists, using a catheter with two strain gauge transducers connected to a solid-state data logger. Orocecal transit time was measured by H2 breath test. Subjects were studied for two consecutive days and fed twice a day with a similar, 860-kcal meal. Control recordings on the first day were made at rest and a naloxone infusion was given after the evening meal. On the second day, the athletes exercised after meals for 20 min at 80% of peak O2 uptake (VO2max) and naloxone was infused during the second session. On separate days, five subjects exercised for 3 h at 60% VO2max and for 10 min at 90% VO2max. Plasma concentrations of beta-endorphin were determined before and after exercise. The fed pattern was interrupted by an activity front during 2 of 16 sessions of exercise at 80% VO2max, in the presence of naloxone, and 5 of 8 sessions at 90% VO2max, with and without naloxone. It was not affected by exercise at 60% VO2max. Orocecal transit was not affected by intense exercise. The results show that exercise can affect intestinal postprandial motor activity. The effect is intensity related and may not be mediated by opioids.

Adult↗
PubMed1990

Relationship between enteric migrating motor complex and the sleep cycle.

To address the question of synchrony between two major biorhythms with a similar periodicity, the cortical rapid eye movement (REM)/non-REM sleep cycle and the enteric migrating motor complex (MMC cycle), we recorded upper small bowel motor activity and sleep activity during nocturnal and diurnal sleep in six healthy subjects. Motility was measured continuously using a fine (2.2 mm OD) and relatively comfortable nasojejunal probe with two pressure-sensitive microtransducers positioned under fluoroscopic control on either side of the ligament of Treitz. Sleep stages were recorded while the subjects slept in a sleep laboratory. Each subject was studied twice; once during normal nocturnal sleep and then after acute reversal of sleep by advancing the time of going to bed by 4 h each night for three nights. The total duration of sleep was similar for diurnal and nocturnal sleep. There was a significantly higher number of REM episodes (P less than 0.001) and REM sleep stage shifts (P less than 0.02) during diurnal (reversed) sleep. During sleep (both diurnal and nocturnal) there was a significant reduction in the MMC cycle length (P less than 0.02, P less than 0.03) and the duration of phase II of the MMC (P less than 0.009, P less than 0.02). The distribution of MMCs among sleep stages and REM sleep was consistent with a random distribution. These data show that periodic activity in the gut is modulated by the presence or absence of sleep, but they also are consistent with the hypothesis that the two cycles are independent and that one is not contingent upon the other.

Adult↗
PubMed1989

Spontaneous noncardiac chest pain: value of ambulatory esophageal pH and motility monitoring.

We performed esophageal investigations in 20 patients suffering from noncardiac chest pain in order to assess the diagnostic value of short- versus long-term manometric and pH studies. Patients had baseline esophageal manometry with two provocative tests: a Bernstein test and an intravenous injection of edrophonium. On a separate occasion they had a 24-hr ambulatory esophageal pH and motility recording. The Bernstein test provoked chest pain in two patients, while edrophonium injection did not elicit pain in any of the patients. The ambulatory pH study helped to establish the esophagus as the likely source of pain in one patient, and the ambulatory motility one in another. In our experience, ambulatory pH and motility recordings have a low diagnostic yield in the evaluation of patients with noncardiac chest pain.

Adult↗
PubMed1989

Modulation of the duration of human postprandial motor activity by sleep.

We have measured the effect of the presence of food in the gastrointestinal tract on proximal small bowel motility during sleep. Motility was measured in eight healthy ambulant subjects using two strain-gauge microtransducers incorporated in a fine (2.5 mm OD) nasojejunal tube. The subjects ate a 540-cal evening meal (EM) on the first day. On the following day they ate an equicaloric meal (with similar proportion of carbohydrates, proteins, and fats) at lunch time (MM) and then another equicaloric late meal (LM) 15 min before going to bed. All subjects were asleep within 30 min of completing the LM. Postprandial activity was significantly (P less than 0.001) shortened after LM, but there was no difference in the postprandial motor activity after MM and EM. Migrating motor complex (MMC) cycle lengths were similar after MM, EM, and LM. There was no difference in the duration of phase II of the MMC cycle after MM, EM, and LM even though subjects were asleep during the MMC cycles after LM. The MMC propagation velocity after LM and EM was significantly (P less than 0.01, P less than 0.001, respectively) slower than the diurnal MMC propagation velocity after MM. In health, postprandial activity is diminished during sleep, whereas the consumption of a LM restores the phase II activity usually absent during sleep. A LM also abolishes the expected reduction in nocturnal MMC cycle length but maintains the circadian variation in the propagation velocity of the MMC cycle.

Adolescent↗
PubMed1989

Prolonged ambulant monitoring of human colonic motility.

The study of human colonic motility under physiological conditions has proved to be an elusive goal. We have used a two-stage pernasal technique to position sensors in the human colon for the prolonged monitoring of motility in freely ambulant subjects. Nine healthy volunteers were studied for a total recording time of 263 h, each study lasting between 13 and 48 (mean 29) h. Motor activity in all regions of the large bowel was characterized by scant and irregular contractions with infrequent bursts that did not conform to any pattern. No motor coordination was apparent between different regions of the large bowel. Contractile activity throughout the large bowel was reduced to a minimum during sleep and was enhanced on waking. Meals were an inconsistent stimulus to motor activity. The technique obviates the need for colonic preparation and allows complete freedom of the subjects throughout the study. In demonstrating the practical feasibility of this mode of studying the colon, these preliminary data highlight a requirement for the availability of appropriate equipment but raise questions about the design and use of such equipment and methods of data analysis.

Colon↗
PubMed1988

Effects of upper dorsal sympathectomy on esophageal motility in humans.

To evaluate the role of the sympathetic nervous system in modulating esophageal motility, esophageal manometry was performed on two groups of patients who underwent upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six patients sympathectomy was done by the supraclavicular approach, with removal of T2 and T3 ganglia. Manometry was performed before the operation and three weeks after it. In seven other patients sympathectomy was done by the axillary approach, with removal of T2-T4 ganglia. Manometry in this group was performed 28.4 +/- 22.4 months after the operation. Fifteen individuals with an intact sympathetic system served as controls. Manometric parameters evaluated were esophageal contraction amplitude and duration and lower esophageal sphincter pressure. The difference between the results obtained in the pre- and postoperative periods in the first group was not statistically significant. The differences between the two patient groups and between the patient groups and the control group were not statistically significant either. We conclude that upper dorsal sympathectomy does not affect esophageal motility in man.

Adolescent↗