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Biomedical subjects

L Tibbling

Publications and source records attributed to L Tibbling.

At least 37 records · Page 2Linked to original sources
PubMed1991

Dysphagia, an unrecognized handicap.

The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20-44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p = 0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p = 0.001). Denial of dysphagia (N = 18), concealment of dysphagia (N = 18), and lack of confirmation by the patient's physician (N = 15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N = 13), security (N = 16), work capacity (N = 8), exercise (N = 7), and leisure time (N = 6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.

Adolescent↗
PubMed1991

Dysphagia and its consequences in the elderly.

This investigation was designed to study to what extent dysphagia in the elderly is accompanied by other chest symptoms and if it leads to a reduction in body weight and quality of life. To this end 796 persons, randomly taken from a population register, replied to a questionnaire concerning swallowing difficulties and other chest symptoms. Chest pain, heartburn, and regurgitation occurred significantly more frequently in subjects who admitted feelings of obstruction in the throat or chest during the ingestion of food (p less than 0.001) than in the rest, as did so-called heart problems (p less than 0.05). People with dysphagia had more often gained weight over the last 5 years than people without dysphagia (p less than 0.05). Psychosocial problems in those with dysphagia were given as anxiety at mealtimes and the wish to eat alone. Of those with dysphagia, 40% had consulted a physician, but despite this these patients had as many problems as those who had not seen a doctor. It is apparent that difficulty in swallowing in the elderly leads to physical and psychosocial problems that may reduce their quality of life.

Aged↗
PubMed1991

Foreign bodies in the esophagus. A study of causative factors.

Two hundred and twenty-nine patients were studied in an attempt to determine the main causative factors behind their having a residual foreign body in the esophagus. Strictures were present in 13%. Fifty-two percent of the patients with stricture had been hospitalized more than once for treatment of foreign body impaction; this was the case in only 8.5% of the rest of the patients (p less than 0.001). More than half of the patients aged 15 years or younger had a foreign body in the hypopharynx. This location was extremely uncommon in adults (p less than 0.001). The hypothesis of spasm distal to an esophageal foreign body as the cause for obstruction in patients without esophageal stricture was supported by the following findings: spontaneous disimpaction occurred in more than one-third of the patients and became more frequent as time progressed; 63% of 16 patients given spasmolytic drugs experienced spontaneous disimpaction of the foreign body; half of the patients had the foreign body in the proximal esophagus distal to the narrower passage of the upper esophageal sphincter; foreign body impaction in the esophagus turned out to be a once-only event in 86% of the patients; and 21% of the patients had a disorder of the central nervous system and had been hospitalized significantly more often because of food impaction than the other patients. The findings indicate that adults with a history of impaction of foodstuff lacking sharp bones and who do not have stricture suffer food impaction because of spasm of the esophageal smooth muscle, and can be treated accordingly.

Adolescent↗
PubMed1991

Oesophageal speech after laryngectomy: a study of possible influencing factors.

52 patients with laryngeal carcinoma were studied before and after laryngectomy with regard to what factors might influence the development of oesophageal speech. The investigations consisted of oesophageal manometry, a follow-up interview and a review of surgical approaches and radiotherapy. 43% of the patients achieved socially acceptable oesophageal speech, 22% were able to speak single words, and 35% had no oesophageal speech at all. 61% had post-operative dysphagia. Age was the only factor which significantly correlated to intelligible speech. The intraoesophageal pressure during oesophageal phonation exceeded in all cases the low PO-HPZ pressure after operation. The extension of surgery and radiation field, severity of dysphagia, alcohol and smoking habits, and mental condition did not differ between the 3 groups of oesophageal speech. It was concluded that the rather complicated process of acquiring oesophageal speech is much more dependent on learning ability which decreases with age than on various kinds of motor dysfunction after laryngectomy.

Adult↗
PubMed1991

Gastro-oesophageal reflux and severity of pulmonary disease in cystic fibrosis.

The correlation between oesophageal dysfunction (OD), pathologic gastro-oesophageal reflux (GOR), and severity of pulmonary disease was studied in 12 patients with cystic fibrosis (CF). They were interviewed about symptoms of OD and underwent 24-h pH recording in the oesophagus, oesophageal manometry combined with reflux provocation tests, the acid perfusion test, the acid clearance test, lung function tests, and scoring of the chest radiograph. Six of the 12 patients reported symptoms of OD. Abnormal GOR, as shown by 24-h pH monitoring of the oesophagus, was found in eight of them. Altogether 9 of the 12 participants had at least one pathologic oesophagus test result. Results of radiologic examinations of the oesophagus, performed in six patients, were pathologic. The four patients with the best chest radiograph scores and the best lung function had significantly less signs and symptoms of OD and GOR than the other eight patients. We conclude that OD, GOR, and pulmonary disease covariate in CF.

Adolescent↗
PubMed1990

Bronchial asthma and acid reflux into the distal and proximal oesophagus.

The prevalence of pathological gastro-oesophageal reflux in children and adolescents with asthma was studied by 24 hour two level oesophageal pH monitoring in 42 subjects aged 9-20 years with moderate or severe bronchial asthma. The importance of oesophagobronchial nerve reflexes and of aspiration of gastric acid as triggers in asthma was assessed by studying whether episodes of reflux into the distal and into the proximal oesophagus were followed by asthma attacks. Twenty-one subjects (50%) had a pathological total reflux time in the distal oesophagus and six (16%) in the proximal oesophagus. Nine patients had pathological gastro-oesophageal reflux into the distal oesophagus together with symptoms of asthma during the day on which the recording took place. In three of them the episodes of asthma symptoms were significantly correlated with preceding episodes of reflux into the distal oesophagus, and in one subject to reflux into the proximal oesophagus. We conclude that pathological gastro-oesophageal reflux is common in children and adolescents with asthma, but it seems to provoke symptoms of asthma in only a few. Symptoms of asthma were more often elicited by exposure of the distal oesophagus to gastric acid, possibly by a vagal reflex, than by aspiration of gastric juice.

Adolescent↗
PubMed1989

Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study.

Forty eight patients with moderate to severe asthma were enrolled in a double blind crossover study designed to evaluate the effects of ranitidine treatment, 150 mg twice daily for four weeks, on gastro-oesophageal reflux, asthma control, and bronchial reactivity. All 48 had a history of reflux symptoms and 27 had in addition reflux associated respiratory symptoms. Thirty two patients had objective evidence of acid reflux on 24 hour pH monitoring (pH of less than 4 for more than 1% of the 24 hours) and 27 patients had a positive result in the acid perfusion test. Reflux symptoms were significantly improved after ranitidine treatment. Ranitidine treatment was associated with modest improvements in nocturnal asthma and daily use of inhaled bronchodilator drugs but there was no significant change in bronchial reactivity, lung function, peak flow, or the number of eosinophils in the blood. Comparisons between the effect of ranitidine treatment on asthma control were performed between patients with and without a history of reflux associated respiratory symptoms, with and without a positive result in the acid perfusion test, and with and without objective evidence of gastro-oesophageal reflux. A history of reflux associated respiratory symptoms was the only factor that predicted an improvement in asthma control after ranitidine treatment. These results indicate that antireflux treatment will produce only small improvements in asthma control in asthmatic patients with a history of gastro-oesophageal reflux.

Airway Resistance↗
PubMed1989

Esophageal acid perfusion, airway function, and symptoms in asthmatic patients with marked bronchial hyperreactivity.

It is believed that GER can trigger asthma by the stimulation of acid-sensitive receptors in the esophagus. The aim of this study was to determine whether esophageal acid stimulation in asthmatic patients can provoke clinically detectable bronchospasm and if a possible response is correlated to bronchial reactivity. Eight patients with chronic asthma and GER disease were investigated on three occasions with a histamine challenge test followed by acid provocation of the esophagus. Assessment of bronchial function was made by FEV1, chest auscultation, and respiratory symptoms. While symptoms and signs of bronchoconstriction induced by esophageal acid stimulation were not detected clinically on any occasion, there was a significant correlation between histamine reactivity and the subclinical bronchospasm following acid provocation. It is concluded that esophageal acid stimulation during daytime in the majority of asthmatic patients is not a strong and immediate trigger of asthma.

Aged↗
PubMed1988

Influence of theophylline on gastro-oesophageal reflux and asthma.

The aim of the study was to determine whether gastro-oesophageal (GO)-reflux was increased by normal maintenance doses of theophylline, and if so, whether this was detrimental to lung function in asthmatic patients with symptoms of reflux. In 25 patients with moderate or severe bronchial asthma and a history of respiratory symptoms aggravated by reflux, two consecutive oesophageal 24-h pH recordings were made, one with and the other without their ordinary dose of slow release theophylline. The theophylline treatment caused a significant increase in total reflux time and reflux symptoms but did not worsen the asthma. Patients with subtherapeutic serum levels showed significant improvement in lung function and those with therapeutic serum levels did not. It is concluded that theophylline, in view of its potential to exacerbate GO-reflux, should be used with caution as maintenance therapy in asthmatic patients with GO-reflux.

Asthma↗
PubMed1988

24-hour oesophageal two-level pH monitoring in healthy children and adolescents.

Two-level pH recording in the oesophagus was performed for 24 h in 28 healthy schoolchildren between 9.3 and 17.3 years of age, to obtain reference values for reflux studies. The pH probes were placed 5 and 15 cm above the lower oesophageal sphincter by means of the manometric technique. A standardized acid-free diet was given on the day of recording. A drop in pH to 4.0 or below was regarded as reflux. The normal upper limit of total reflux time was 1.0% at the lower oesophageal level. Mean reflux time was about three times shorter at the upper level than at the lower, which indicates the importance of exact positioning of the pH probe.

Adolescent↗
PubMed1988

Esophageal body motor disturbances in gastroesophageal reflux and the effects of fundoplication.

Thirty-seven patients with gastroesophageal reflux disease (GERD) were included in an esophageal manometry study before and six months after fundoplication. The motility pattern of the body of the esophagus in the patient group was compared with that of 15 healthy controls. No differences in swallowing amplitudes were found between patients with different degrees of esophagitis or between GERD patients and controls. Peristaltic activity was slightly impaired in patients with endoscopic esophagitis compared with controls. No correlation was found between dysphagia and chest pain symptoms on the one hand and on peristaltic pattern and swallowing amplitudes on the other. It was concluded that conventional esophageal manometry has little to contribute to the investigation of symptoms such as non-burning chest pain and dysphagia in GERD. Effective anti-reflux surgery eliminates these symptoms with little influence on the esophageal motility pattern.

Adult↗
PubMed1988

Gastro-oesophageal reflux and nocturnal asthma.

Gastro-oesophageal (GO) reflux is believed to be a possible cause of nocturnal asthma. The aim of this study was to see if there is any correlation between the incidence of GO-reflux at night and nocturnal asthma. Thirty-seven adult patients with a history of nocturnal asthma for more than one hundred days a year and of reflux disease were evaluated using 24 h pH-monitoring of the oesophagus and measurement of peak expiratory flow (PEF) rate every hour when awake. Half of the patients suffered from severe GO-reflux at night, whilst the other half had no nocturnal reflux. Respiratory symptoms and inhalation of beta-2 agonists were recorded during the night and PEF was recorded when the patients awoke in the morning. A significant correlation was found between reflux at night and the degree of bronchial obstruction in the early morning, but not between night-time reflux and nocturnal respiratory symptoms. It would appear that GO-reflux in most asthmatics is neither a strong nor immediate trigger factor in nocturnal asthma, although it does seem to influence bronchial obstruction during the night as was demonstrated by a low morning-PEF value.

Asthma↗
PubMed1987

Cyanide concentrations in blood after cigarette smoking, as determined by a sensitive fluorimetric method.

Using the sensitive fluorimetric method described here, we evaluated the determination of blood cyanide as a method for monitoring exposure to tobacco smoke. The mean concentration of cyanide in blood from eight nonsmokers was 0.098 (SD 0.036) mumol/L. The concentration of cyanide in blood of smokers who had refrained from smoking for at least 2 h before sampling peaked immediately after the subjects smoked a cigarette, then rapidly declined, with a half-life of about 4 min. Its rapid disappearance from blood makes cyanide an unsuitable marker of exposure to tobacco smoke. Because the ability of patients with hepatic dysfunction to detoxify cyanide has been presumed to be impaired, we monitored the concentrations of cyanide in the blood of four patients with severe hepatic insufficiency who smoked a cigarette. The rate of elimination of cyanide from blood after smoking was only slightly less in these patients than in the controls, and the difference was not statistically significant.

Adult↗
PubMed1987

Gastro-oesophageal reflux and triggering of bronchial asthma: a negative report.

The aim of this study was to investigate whether a direct causal relationship exists between gastro-oesophageal (GO) reflux episodes and bronchial asthma. Forty-two patients with moderate or severe asthma and pathological GO-reflux were examined using a 24-h pH test at a proximal and a distal level of the oesophagus. Respiratory symptoms and the use of extra beta-2 agonist metered dose inhaler were recorded in a standardized protocol, and peak expiratory flow (PEF) was recorded once an hour until the patient went to bed. No association was found between reflux at either the proximal or the distal level of the oesophagus and bronchial symptoms or PEF reductions. We conclude that GO-reflux does not play an important role as an immediate trigger factor in bronchial asthma.

Adult↗