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Biomedical subjects

L Tibbling

Publications and source records attributed to L Tibbling.

At least 55 records · Page 3Linked to original sources
PubMed1986

Esophageal function, radiography, and dysphagia in Sjögren's syndrome.

Esophageal function and anatomy were investigated with manometry, acid perfusion test, acid clearing test, and x-ray in 11 patients with primary Sjögren's syndrome (SS) and in 11 with secondary SS. The manometric investigation revealed minor motor differences in the SS patients as compared to 16 controls, ie, shorter peristaltic contraction time of the whole esophagus, and faster peristaltic velocity preferably in the distal part of the esophagus, while the results from the reflux tests did not differ between patients and controls. Radiographic examination revealed upper esophageal webs in 10% (2/20), and hiatal hernia in 25% (5/20). The dysphagia as reported by 73% of the patients cannot be explained by webs or impaired motor function and is regarded to be secondary to lack of saliva, making the solid bolus passage difficult.

Adult↗
PubMed1986

Oesophageal function and symptoms in moderate and severe asthma.

Fifty-five children and adolescents, 8 to 19 years of age, with moderate or severe asthma, and 28 healthy volunteers, 11 to 16 years of age, were interviewed about oesophageal and bronchial symptoms and investigated with oesophageal manometry combined with pH-reflux tests, an acid perfusion test and an acid clearing test. Oesophageal dysfunction (OD) was significantly more common in asthmatic (60%) than in healthy (14%) subjects (p less than 0.01). Ten of 18 subjects (56%) with frequent nocturnal or morning asthma had a positive acid perfusion test as compared to 16% of patients with less severe asthma (p less than 0.01). Non-allergic asthma was not significantly more related to OD than was allergic asthma. Presence of OD was not related to present beta 2-stimulant or theophylline medication. Symptoms of OD had a sensitivity of 52% and a specificity of 100% regarding OD in the asthmatic subjects. In conclusion, asthma was frequently associated with OD. There is indirect evidence that OD, especially acid hypersensitivity of the oesophagus, can aggravate asthma.

Adolescent↗
PubMed1986

Electromyography of human oesophageal smooth muscle.

The aim was to study whether electromyography (EMG) activity is synchronous with oesophageal motor activity as assessed by manometry from the same oesophageal site. Patients with different motor disorders of the oesophagus and control subjects were investigated. EMG recordings were made by means of a suction capsule with silver/silver chloride spike electrodes. Slow EMG waves synchronous with respiration were recorded from the lower oesophageal sphincter and intermittently from the body of the oesophagus. Edrophonium increased spike discharges; atropine diminished or abolished spike discharges after swallowing. Swallowing caused a burst of spiking activity which began immediately after deglutition. Continuous sips of water produced constant EMG activity but no peristaltic contractions as seen by manometry. In a patient with scleroderma and aperistalsis, swallowing elicited vigorous electrical activity. The different EMG findings without simultaneous contractions at manometry are interpreted as a response to a swallow by the longitudinal muscle of the oesophagus.

Animals↗
PubMed1986

Double-blind crossover study of ranitidine and placebo in gastro-oesophageal reflux disease.

The effect of 150 mg ranitidine twice daily was compared with placebo by the double-blind crossover technique (8 weeks twice) in patients with gastro-oesophageal reflux (paired comparison in 38 patients). Ranitidine was superior to placebo with regard to effect on symptoms, improvement of oesophagitis as assessed by endoscopy and biopsy, and decrease of oesophageal acid hypersensitivity. The symptomatic response to ranitidine was, however, unsatisfactory in more than half of the cases. When symptomatic responders taking ranitidine (R) were compared with non-responders (NR), there was no difference with regard to the severity of oesophagitis or frequency of positive acid perfusion tests before or after the 8-week treatment. NR were younger and more often had endoscopic signs of incompetence of the cardia and gastric prolapse. Ranitidine is an efficient drug in patients with reflux disease. It cannot be expected that mechanical problems in the hiatal region will be influenced by ranitidine, which is probably why half the patients did not respond.

Adult↗
PubMed1986

Maintenance treatment with ranitidine compared with fundoplication in gastro-oesophageal reflux disease.

The study comprises 31 patients with gastro-oesophageal reflux disease who received 8 weeks' treatment with ranitidine. Sixteen of the patients received in addition maintenance treatment with ranitidine (150 mg twice daily) for another 6 months, and fundoplication was performed on 15 patients. There was a significant improvement in endoscopic and histologic findings, a decrease in gastric acid secretion, and a reduction of symptoms during short-term treatment with ranitidine. No further improvement was seen in any of the factors after half a year of ranitidine. After surgery the total reflux time during 24 h decreased to practically zero, all patients had normal endoscopic findings and negative acid perfusion tests, and reflux symptoms had disappeared completely. Anti-reflux surgery was superior to treatment with ranitidine. Reflux oesophagitis is therefore not improved any further by a half year's treatment with ranitidine beyond what is achieved with short-term therapy.

Adult↗
PubMed1986

Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease.

In a study comprising 100 patients referred to a surgical clinic with symptoms suggestive of gastro-oesophageal reflux disease the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed a normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly correlated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensitivity for radiologic, manometric, and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

Adult↗
PubMed1986

Oesophageal reflux tests, manometry, endoscopy, biopsy, and radiology in healthy subjects.

The aim was to study the exposure time of acid during 24 h at two different oesophageal levels in 15 healthy subjects and its relation to other kinds of oesophageal findings. Five centimetres above the lower oesophageal sphincter the total reflux time was 0.2% (0-1.3%), and at the 15-cm level it was 0.1% (0-0.7%). A standardized compression test during manometry and radiologic examination showed that no subject had reflux. Hiatus hernia was provoked at the radiologic examination in four subjects, one of whom also had a widened hiatus. At endoscopy, one subject had a hiatus hernia and slightly granulated oesophageal mucosa. Biopsy specimens showed slight basal cell hyperplasia in one case. Bleeding in the dermal papillae or a few intraepithelial leukocytes were seen in eight cases, findings that might be due to endoscopic trauma. Without any history of gastrointestinal disorders, gastrooesophageal reflux was minimal under standardized conditions, although hiatus hernia and mild changes in biopsy specimens could be seen.

Adult↗
PubMed1986

Gastric secretion and reflux pattern in reflux oesophagitis before and during ranitidine treatment.

Ranitidine (150 mg X 2) and placebo were given to 42 patients with reflux oesophagitis for 8 weeks by the double-blind crossover technique. Gastric secretion tests and 24-h pH monitoring at two different oesophageal levels were performed before and during the treatment periods. Gastric hypersecretion was present in 76%. Ninety-seven per cent had reflux for more than 1% of 24 h, and 67% for more than 4.2%. Ranitidine reduced basal and stimulated gastric acid output and secretion rates (p less than 0.001), total reflux time to the lower level (p less than 0.05), and number of reflux episodes to the upper and lower levels of the oesophagus in the supine position. Basal, maximal, and peak acid output, gastric secretion rates, number of reflux episodes, and total reflux time at the upper oesophageal level in the supine position were significantly more reduced in symptomatic responders than in non-responders. No correlation was found between ranitidine-induced reduction of gastric secretion and length of oesophageal reflux time.

Adult↗
PubMed1985

Oesophageal motility during acid-provoked heartburn and chest pain.

Oesophageal motility was studied in 59 patients before and again after prolonged acid perfusion. In group 1 (n = 16), who were asymptomatic during the acid perfusion, no significant motility differences were obtained by perfusion. In group 2 (n = 18), who had heartburn, and in group 3 (n = 25), who had angina-like chest pain during acid perfusion, significant (p less than 0.01-0.001) changes of motility were seen: these included higher peristaltic amplitude, longer contraction duration, and slower peristaltic velocity. In addition, patients in group 3 showed a decrease (p less than 0.01) of peristaltic propagation and had secondary wave activity more often (p less than 0.01) during acid perfusion. Significantly (p less than 0.01) more patients in group 3 showed secondary wave activity after acid perfusion than in group 2. Pretest motility investigation did not separate the two acid-sensitive groups from the acid-unsensitive one, whereas the investigation of the lower oesophageal sphincter (LOS) did. Thus, LOS incompetence was significantly (p less than 0.01) commoner in the two symptomatic groups than in the asymptomatic group. We suggest that the motility changes observed during acid perfusion are secondary to increased sensory stimulation from the oesophagus but are not the cause of the symptoms. However, nervous reflex reactions from other chest organs, such as the heart, may also explain the results.

Adult↗
PubMed1984

Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography.

Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests. Radiology performed on 14 of the 16 patients showed no evidence of organic lesions. Half the patients had abnormal findings at scintigraphy, with either bolus retention in the upper part of the esophagus or prolonged transit time as compared to a group of 20 asymptomatic subjects. Scintigraphy can be regarded as a valuable complement in the objective documentation of dysphagia when other diagnostic methods fail.

Adult↗
PubMed1984

Scintigraphy, radiography, and acid clearing in dysphagia patients after anti-reflux surgery.

Oesophageal emptying was studied with scintigraphy, radiography, and the acid clearing test (ACT) in 18 patients reporting dysphagia and previously operated on with fundoplication. Radiography with contrast medium, isodense with water, revealed abnormalities in either motility or emptying capacity in 39% (7/18). A A barium meal showed abnormalities--that is, a tight repair, disruption of the fundoplication, or recurrence of the hernia--in 56% (10/18). The ACT was prolonged in 40% (6/15) of the patients. Pathological findings at scintigraphy with a solid bolus were found in 67% (12/18). Even if scintigraphy with a solid bolus is the method that identifies the highest number of patients with impaired oesophageal function among the tests used, it cannot differentiate between functional and anatomical disorders. A barium meal examination is the method of choice when an anatomical disorder is suspected.

Adult↗
PubMed1982

Evaluation of a new method for abdominal compression for use in oesophageal investigation.

The use of conventional extra-abdominal compression with a constant cuff pressure was shown to give various pressures intra-abdominally in different subjects. A feedback system was therefore used, in which the extra-abdominal pressure is controlled by the intra-abdominal pressure. For an intra-abdominal pressure increase of 15 mm Hg the external cuff pressure in 20 subjects varied from 21 to 98 mm Hg. There was, however, an almost linear relationship between increased intra-abdominal pressure and cuff pressure. The extra-abdominal pressure required to obtain a certain intra-abdominal pressure also varied with the size of the cuff. To obtain relevant and comparable results in studies of hiatal incompetence and gastro-oesophageal reflux, the feedback system is recommended and the size of the intra-abdominal cuff should be stated.

Abdomen↗