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Biomedical subjects

G Stacher

Publications and source records attributed to G Stacher.

At least 55 records · Page 3Linked to original sources
PubMed1993

Gastric emptying, body weight and symptoms in primary anorexia nervosa. Long-term effects of cisapride.

In a double-blind trial, 12 out-patients with primary anorexia nervosa received, for six weeks, either 10 mg cisapride or placebo, three times a day. Cisapride accelerated gastric emptying of a radiolabelled semisolid meal in all six patients; five gained weight and symptoms of gastric retention ameliorated in four. With placebo, three of six had emptying enhanced, four gained weight, and one's symptoms improved. For another six weeks, all patients received cisapride. In five of the patients who had received cisapride, emptying further accelerated or remained stable; in one it slowed. Of the six patients who received placebo, four had emptying accelerated, five gained weight, and symptoms improved in four. Longer administration of cisapride may, by enhancing gastric motor activity, alleviate symptoms of retention and thus help to change eating behaviour.

Adult↗
PubMed1992

Scintigraphic quantitation of gastrointestinal motor activity and transport: oesophagus and stomach.

For the recognition and characterisation of oesophageal motor disorders, manometry represents the most reliable tool but yields no information on bolus transport. The transport can be quantitated by radionuclide techniques. The patient is positioned supine beneath a gamma-camera and instructed to swallow a radiolabelled bolus in a single gulp. Using a marker over the cricoid and the activity in the stomach as landmarks, regions of interest are drawn representing the upper, middle and lower third of the oesophagus and the gastric fundus. Activity-time curves enable one to recognise the clearance patterns in these regions. In combination, manometric and radionuclide transit studies recognise a higher number of motor disorders than either procedure alone. Radionuclide methods also are the most reliable and sensitive to quantitate gastric emptying. Procedure, meal size and composition as well as patient position must be standardised and correction techniques applied. The emptying of solid and liquid meal constituents can be evaluated concomitantly. Solids start to empty only after a lag phase of varying extent. With semi-solid meals, which are emptied at the same rate as solid meals of identical composition in the postlag phase, the recording time can be considerably shorter. Besides gastric emptying, the amplitude, frequency and propagation velocity of antral contractions can be recorded using serial images of short frame time and specially devised analytic techniques.

Colloids↗
PubMed1992

Effects of the prodrug loperamide oxide, loperamide, and placebo on jejunal motor activity.

This crossover, double-blind study investigated the effects of single oral doses of the prodrug loperamide oxide, which is reduced gradually to loperamide in the intestine, and loperamide on jejunal motor activity in 12 fasting healthy men. Five minutes after a phase III of the migrating motor complex (MMC), 2 mg loperamide oxide, 4 mg loperamide oxide, 4 mg loperamide, or placebo were administered. Thereafter, motor activity 10-30 cm abroad the ligament of Treitz was recorded with five catheter orifices at 3-cm intervals over 4 hr. Number of contractions and area under curve increased significantly with 4 mg loperamide and 4 mg loperamide oxide, the increases with loperamide oxide occurring more gradually. Placebo and 2 mg loperamide oxide had no discernible effects. With both 4 mg loperamide and 4 mg loperamide oxide, phase I of the MMC was slightly prolonged and phase II and the time from drug administration to the onset of the first phase III slightly shortened. The percentage of aborally propagated contractions in phase II increased with all active treatments, whereas the occurrence of phases III was not altered.

Administration, Oral↗
PubMed1992

Esophageal motor disorders: videofluoroscopic and manometric evaluation--prospective study in 88 symptomatic patients.

Esophageal motor disorders are best evaluated with manometry, which, however, is time-consuming and not generally available. The authors prospectively investigated the yield of videofluoroscopy in detection of esophageal motor disorders in comparison with that of manometry. Eighty-eight patients with dysphagia, globus sensation, noncardiac chest pain, or progressive systemic sclerosis underwent both manometry and videofluoroscopy at 0-32-day intervals. Videofluoroscopy was performed with one swallowing study in the upright position and up to three swallowing studies in the prone oblique position. Manometric diagnoses of achalasia (n = 15), diffuse esophageal spasm (n = 1), nonspecific esophageal motor disorders (n = 44), and adynamic esophagus (n = 9) were made. Videofluoroscopically, 87% of the patients with achalasia, the one patient with diffuse spasms, 73% of the patients with nonspecific esophageal motor disorders, and all of the patients with adynamic esophagus received a correct diagnosis, for an overall sensitivity of 80%. The radiographic specificity was 79%. The authors conclude that videofluoroscopy is a valuable and reasonably sensitive technique for screening for esophageal motor disorders.

Adolescent↗
PubMed1992

Oesophageal pH-metry: should meals be standardized?

To assess the effect of a late-evening, high-fat meal on nocturnal supine gastro-oesophageal reflux, eight healthy volunteers (aged 20 to 38 years) underwent two ambulatory oesophageal pH-metry recordings, the first after a standardized light meal at 1930 h and the second after a high-fat meal including peppermint and chocolate, at 2130 h. Between 2300 and 0700 h, when subjects were supine, the median acid exposure time (percentage recording with pH less than 4) increased from 0.0% (range, 0.0-6.8%) after the standardized meal to 7.9% (0.0-17.8%) after the high-fat meal (p = 0.031). Similarly, the median number of reflux episodes increased from 0 (0 to 11) after the standardized meal to 7 (0 to 26) after the high-fat meal (p = 0.031). Reflux occurred after both meals, but, in general, persistent nocturnal reflux was observed only after the high-fat meal. Thus, the analysis of oesophageal pH recordings should consider the effects of meal composition and timing on oesophageal acid exposure.

Adult↗
PubMed1991

Slow gastric emptying induced by high fat content of meal accelerated by cisapride administered rectally.

The evaluation of agents potentially accelerating gastric emptying in gastric stasis syndromes is time-consuming. Since a previous study showed that emptying is slowed after antecedent fat ingestion and intravenous cisapride abolishes this effect, we investigated whether emptying delayed by fat incorporated into a meal is reversed by cisapride and thus could serve as a model for such evaluations. Twelve healthy males received, under double-blind conditions, 30 mg cisapride rectally or placebo, and 3 hr thereafter a semisolid meal of low (9.2 g) or high (37.9 g) fat content. The sequence of combinations placebo/low-fat meal, placebo/high-fat meal, and cisapride/high-fat meal was randomized. Gastric emptying and antral motility were recorded scintigraphically. After placebo/high-fat, emptying was significantly slower (P less than 0.05) than after placebo/low-fat. After cisapride/high-fat, emptying was significantly faster (P less than 0.01) than after placebo/high-fat and similar to that after placebo/low-fat. Antral motility was little affected. The slow emptying of a high-fat meal thus seems a suitable model for the evaluation of prokinetic drug effects.

Administration, Rectal↗
PubMed1991

Lack of systematic effects of the 5-hydroxytryptamine 3 receptor antagonist ICS 205-930 on gastric emptying and antral motor activity in patients with primary anorexia nervosa.

1. The 5-hydroxytryptamine 3 receptor antagonist, ICS 205-930, has been reported to have potent effects on gastric smooth muscle and to enhance gastric emptying in animals, but findings in man have been inconsistent. 2. This study investigated the effects of ICS 205-930 on gastric emptying of an isotopically labelled semisolid 1168 kJ meal and on antral contractility in patients with primary anorexia nervosa, a condition frequently associated with impaired gastric motor function. 3. Thirteen female patients (age 18-39 years, median 22 years; percentage of ideal body weight 52-90%, median 66%) participated each in two studies, in which 0.15-0.18 mg kg-1 ICS 205-930 or placebo were infused i.v. in crossover, double-blind fashion. Gastric emptying and antral contractility were recorded scintigraphically for 50 min. 4. ICS 205-930 did not affect gastric emptying: the mean percentage of meal remaining in the stomach after 50 min (69.6% +/- 3.2 s.e. mean) was nearly identical to that after placebo (70.7 +/- 3.3%). 5. Amplitude, frequency and propagation velocity of antral contractions differed only little after ICS 205-930 and placebo, respectively. 6. The results show that ICS 205-930 has no effect on the impaired gastric motor activity in primary anorexia nervosa and thus provide further evidence that the compound does not have prominent prokinetic effects in man.

Adult↗
PubMed1991

[Psyche and gastrointestinal diseases: hypotheses and facts].

The notion that the development of certain gastrointestinal disorders and diseases can, at least in part, be ascribed to specific psychological characteristics of the patient, to an antecedent psychologically important event or to an unconscious conflict, is very popular both in the public and the medical profession. One of its earliest formulations was the conversion theory forwarded by Sigmund Freud, who assumed that the accumulation of a traumatic and unabreacted quota of affect induced defense or repression and caused a somatic conversion of emotion, i.e., a transformation into bodily symptoms. Subsequently, disorders such as globus sensation, diffuse oesophageal spasms and achalasia, the latter misconceived as "cardiospasm", were viewed as conversion symptoms. However, it has become clear that these disorders are the consequence of organic lesions and not of conversion. Similarly, concepts of an aetiological role of a specific psychological factor, a specific conflict, of certain affective states or live events and of "inappropriate perpetuations of organ reactions adaptive to, or protective against, some stress in human life" could not be verified. Although psychological characteristics and states have been shown to affect normal gastrointestinal function, there is no evidence to suggest that such influences can lead to gastrointestinal disorders or diseases. The fact that the validity of the concepts claiming such aetiological relationships remained to be tested has been repressed to such an extent in some quarters that these concepts still are advocated so as if they had been proven since long.

Conflict, Psychological↗
PubMed1990

Symptoms of achalasia in young women mistaken as indicating primary anorexia nervosa.

The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations. Misinterpretation of esophageal symptoms may occur not only as a consequence of inadequate history taking and of being biased by a patient's emaciation, age, and gender, which leads to view certain aspects of the patient's history and behavior as suggesting a pathologic attitude towards eating and body weight, but also as a consequence of a misinterpretation of the symptoms as indicative of an eating disorder by the patients themselves. In some cases a disordered attitude toward eating and body weight may develop together or coexist with achalasia. The clinical evaluation of patients with symptoms suggestive of anorexia nervosa but also of bulimia nervosa should include the taking of a thorough history regarding swallowing and vomiting in order to recognize a possible esophageal motor disorder.

Adult↗
PubMed1990

Effects of the 5-HT3 receptor antagonist ICS 205-930 on fat-delayed gastric emptying and antral motor activity.

1. The selective 5-HT3 receptor antagonist, ICS 205-930 (Sandoz), has been reported to have potent effects on gastric smooth muscle in vivo and to enhance gastric emptying in animals and in man. 2. This study investigated the effects of ICS 205-930 on fat-delayed gastric emptying of a semisolid meal and antral motor activity in humans. 3. Twelve healthy men participated in each of three studies in which 10 or 20 mg of ICS 205-930 or placebo were infused i.v. in a random double-blind fashion. Gastric emptying and antral motor activity were studied scintigraphically. 4. Gastric emptying was not altered after 10 mg but slower after 20 mg of ICS 205-930 than after placebo. Emptying after 20 mg of ICS 205-930 was significantly slower than after 10 mg of ICS 205-930. 5. Antral contraction amplitude was slightly lower after 20 mg of ICS 205-930 than after placebo, whereas the effects of 10 mg ICS 205-930 did not differ from those of placebo. 6. The results suggest that the investigated doses of ICS 205-930 have only slight effects on gastric motor activity of healthy young men, with 20 mg reducing the rate of emptying.

Adult↗
PubMed1990

Fat preload delays gastric emptying: reversal by cisapride.

1. Meals empty more slowly when they contain fat. 2. This study investigated whether an intragastric fat preload in comparison with a water preload affected gastric emptying of a semisolid meal and antral motor activity, and whether cisapride reversed such effects. 3. Twelve healthy subjects were studied under three conditions each: (A), preload of 50 ml water orally; (B) and (C), preload of 50 ml cream (20 g fat). After preloads, subjects reclined right sided for 20 min. Thereafter, placebo in conditions (A) and (B) and 10 mg cisapride in (C) were administered i.v. in a random double-blind fashion and subjects ingested a semisolid radiolabelled 1150 kJ meal. Gastric emptying and antral motor activity were recorded scintigraphically for 50 min using a dual-headed gamma camera. 4. Gastric emptying was significantly slower (P less than 0.005) after fat preload and placebo than after water preload and placebo. Cisapride administered after fat preload abolished the delaying effect of the fat preload (P less than 0.001). 5. Antral contraction amplitudes after fat preload and placebo were higher (P less than 0.01) than after water preload and placebo as well as fat preload and cisapride at the start of recording and decreased slightly thereafter, whereas slight increases occurred in the other conditions. Frequency and propagation velocity of contractions were not differently affected. 6 Gastric emptying is delayed after prior fat ingestion and this effect is abolished by cisapride.

Adult↗
PubMed1990

Effects of the 5-HT3 receptor antagonist, ICS 205-930, on oesophageal motor activity and on lower oesophageal sphincter pressure: a double-blind cross-over study.

The selective 5-HT3 receptor antagonist, ICS 205-930 (Sandoz), has potent effects on gastrointestinal motor activity in vitro and in vivo. This double-blind, crossover study compared the effects of 20 mg of ICS 205-930 infused intravenously with those of a placebo on the motor activity of the oesophageal body and the lower oesophageal sphincter (LOS). Each of twelve healthy young men participated in two recording sessions one week apart. Oesophageal pressures were recorded using a catheter assembly with orifices 2, 5, 8, 11, and 14 cm above the oral border of the LOS and a Dent sleeve for measurement within the LOS. During and after the infusion of ICS 205-930, amplitude and duration of swallow-initiated contractions in the smooth muscle oesophagus increased slightly, the area under the curve as a measure of contraction strength being significantly greater than after placebo (P less than 0.05). LOS resting pressure increased slightly during ICS 205-930 infusion and was significantly higher than it was in the case of the placebo (P less than 0.001). Propagation velocity of contractions, incidence of tertiary contractions and relaxation of LOS upon swallowing remained unaffected. ICS 205-930 was well tolerated. It is concluded that ICS 205-930 has slight but distinct stimulatory effects on contraction strength in the smooth muscle oesophagus and LOS resting pressure.

Adult↗
PubMed1990

[Nuclear medicine measurement of the contractile activity of the stomach antrum using factor analysis].

The motor activity of the gastric antrum is difficult to record by manometric means and scintigraphic methods have proved unsatisfactory so far as no consistent relationship between antral contractile activity and gastric emptying rate could be detected. We investigated, using data recorded in 16 healthy human subjects after the ingestion of a semisolid standard meal, whether a newly developed method employing factor analysis would yield more meaningful and reproducible results. Factor analysis was applied to sequential scintigraphic images (3-s frame time) of the gastric antrum. The computed factor images and the respective factor curves are representative of distinct dynamic structures of the antrum. From the more or less sinusoidal excursions of the factor curves, which exhibited the 3 cycles per minute frequency characteristic for the stomach, amplitude, frequency and propagation velocity of antral contractions can be calculated. The amplitudes of the factor curves were used to calculate a contraction index. This contraction index was found to be correlated significantly negatively with the gastric half-emptying time of the ingested meal. The employed factor analytical approach thus seems a promising tool to further investigate the role of antral contractility in the process of gastric emptying.

Adult↗
PubMed1989

Effects of cisapride on postcibal jejunal motor activity.

In the jejunum of fasting humans, cisapride induces a phase 2-like, highly propagative motor pattern. This study investigated cisapride's effects on the fed pattern of the jejunum. Starting 5 min after a phase 3 of the migrating motor complex, 18 healthy men received 5 or 10 mg cisapride or placebo orally in random double-blind fashion and ingested meals containing 1000 and 4200 kJ, respectively. Jejunal pressures were recorded pneumohydraulically with five catheter orifices 10-30 cm aboard the ligament of Treitz. After the 4200-kJ meal, total number and number of propagated contractions as well as area under the curve increased significantly more than after 1000 kJ. Following the 1000-kJ but not the 4200-kJ meal, 10 mg cisapride increased total number of contractions, number of propagated contractions, mean amplitude, and area under curve significantly more than placebo. Fed-pattern duration increased with the meal's caloric content but was not influenced systematically by cisapride. In conclusion, cisapride stimulates jejunal motor activity and induces a propagative pattern after a 1000-kJ but not after a 4200-kJ meal, suggesting that it can produce no further stimulation when motor activity is near maximally enhanced already.

Adult↗
PubMed1989

Effects of a 5-hydroxytryptamine3 receptor antagonist (ICS 205-930) on colonic motor activity in healthy men.

1. ICS 205-930 (Sandoz) is a selective antagonist at 5-hydroxytryptamine3 receptors and exerts marked effects on gastrointestinal motility in animals. 2. This study investigated, under random double-blind conditions, the effects of 10 and 20 mg ICS 205-930 infused intravenously in comparison with placebo on colonic motor activity. 3. Twelve healthy men participated each in three studies in which they received, in random double-blind fashion, each of the treatments. Colonic pressures were recorded pneumohydraulically with four catheter orifices 20-40 cm from the anal verge. Treatments were administered after a basal 30 min. One hour later, subjects ingested a 4200 kJ meal and 90 min thereafter, 1 mg neostigmine was administered intramuscularly and recording continued for another 90 min. 4. After both doses of ICS 205-930, the number of contractions as averaged over the entire recording time was slightly but significantly higher than after placebo. 5. After 10 mg but not after 20 mg ICS 205-930, amplitude of contractions and area under the curve as averaged over the entire recording time were significantly higher than after placebo. 6. ICS 205-930 induced few and mild side effects, but significantly more self-rated drowsiness and tiredness than placebo.

Adult↗
PubMed1989

Diagnosis of gastroesophageal reflux disease.

The diagnosis of gastroesophageal reflux disease (GERD) is based primarily on the patient's symptoms and their evaluation. The most common symptoms, heartburn and acid regurgitation, when occurring daily, have a 60% predictive value for the diagnosis. The presence of esophagitis is established best by endoscopy, whereas the radiological examination is relatively insensitive and normal radiological findings never rule out esophagitis. Tests to evaluate the sensitivity of the esophageal mucosa to an acidic pH or to evaluate the strength of the lower esophageal sphincter as an antireflux barrier are valuable indicators of GERD, but only long-term, preferably 24-h, ambulatory pH measurements can provide information on incidence and duration of reflux and its relationships to the patient's symptoms and activities under physiological conditions. However, for practical and economical reasons, 24-h pH measurement should be applied only when symptoms are atypical and endoscopy was unrevealing.

Esophagitis, Peptic↗