Feedback system for control of abdominal compression in oesophageal investigations.
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Equipment Design↗
Biomedical subjects
L Tibbling
Publications and source records attributed to L Tibbling.
Computerized scintigraphy of oesophageal bolus transit in asthmatics.
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Adult↗
Diagnostic value of questionnaires regarding angina pectoris and oesophageal dysfunction in patients with chest pain.
Questionnaires aimed at detecting angina pectoris and oesophageal dysfunction (OD) were used in 281 patients with central chest pain of a type which gave suspicion of ischaemic heart disease (IHD). Signs of IHD were found in 208 patients (74%), 172 of whom had a positive angina pectoris questionnaire. The sensitivity of the questionnaire regarding the diagnosis of IHD was 83%, the specificity 48% and the predictive accuracy 82%. OD was found in 137 of the of the 281 patients (49%). "Do you often have heartburn" was the question which distinguished the OD and non-OD groups the best (p less than 0.001). The sensitivity of this question in detecting OD was 34%, the specificity 93% and the predictive accuracy 82%. In conclusion, the diagnostic value of the angina pectoris questionnaire was limited by a low specificity and the diagnostic value of the oesophageal questionnaire by a low sensitivity in these patients with chest pain.
Angina Pectoris↗
Angina-like chest pain in patients with oesophageal dysfunction.
Effort-related chest pain and chest pain fulfilling the criteria of the Rose questionnaire for angina pectoris are often used as evidence for coronary heart disease. In patients with different kinds of oesophageal dysfunction (OD) the frequency of chest pain of angina-like type was studied and compared to that in the general population. Eighty per cent of patients with hiatal hernia at oesophageal manometry had chest pain, 63% of which was effort-related. In 217 patients with a positive acid perfusion test, i.e. the provoked heart burn or pain is the same as that experienced in daily life, 82% had a history of chest pain. The chest pain was effort-related in 70% and in almost half of the cases their chest pain was classified as angina pectoris according to the Rose questionnaire. Since angina-like chest pain is a predominant symptoms in patients with OD and OD is far more common than angina pectoris due to myocardial ischemia in the general population, it is reasonable to assume that the oesophagus and not the heart is the most common source of angina-like chest pain.
Angina Pectoris↗
The acid perfusion test as differential diagnostic aid in patients with chest pain.
A short review of the literature of the acid perfusion test is first given. Data from 67 patients with chest pain investigates with an acid perfusion test during ECG-surveillance in close connection to an exercise test are then presented. Arrhythmias or ST-T changes on ECG were not induced by the acid infusion. Six patients had a "positive related" acid perfusion test which in this context means that they recognized the chest discomfort elicited by the acid infusion as that which had brought them to the exercise test. The acid perfusion test in close connection to an exercise test is in selected patients a safe and useful technique for establishing whether or not the symptoms have an oesophageal component.
Diagnosis, Differential↗
Oesophageal dysfunction and angina pectoris in a Swedish population selected at random.
From an urban Swedish population, samples of 25 and 55 year old men and women were examined with questionnaires, oesophageal manometry including acid perfusion test. An exercise ECG was performed in 55 year old men with anginalike pain. Oesophageal dysfunction (OD) defined as either a hiatal hernia, severe dysmotility or a positive related acid perfusion test was found in 12% of the younger population and in 29% of the older one. The frequency of angina pectoris according to the Rose questionnaire was 5% in the 25 year olds and 13% in the 55 year olds. OD was found in 44% of the older male group with angina pectoris at history. In the angina group objective signs of ischemic heart disease was found in 32%. At interview by a cardiologist in connection with exercise ECG, the angina pectoris diagnosis as assessed by questionnaire was reduced to 4% in the 55 year old men. In this group objective signs of ischemic heart disease or a history of myocardial infarction (CHD) were found in 94%. The others, classified by a physician as possible or no angina pectoris had a lower rate of CHD of 25% and 13% respectively. The angina pectoris group diagnosed according to Rose questionnaire contains more people with OD than with CHD. The diagnosis angina pectoris as ischemic heart disease should therefore not be set on the history alone.
Adult↗
Oesophageal function and chest pain in male patients with recent acute myocardial infarction.
Oesophageal function and symptoms were investigated in 52 male patients 2-6 months after an acute myocardial infarction. Oesophageal function was tested by manometry, pH recording and acid perfusion test. Signs of oesophageal dysfunction (OD) were found in 17 patients (33%). This frequency did not differ significantly from that in a random male population sample, but was lower than in a group of male coronary care unit patients with no signs of a new or earlier myocardial infarction at discharge from hospital (p less than 0.05). All but two patients affirmed chest pain by questionnaire. At a verbal interview, 38 patients (73%) had a history of angina pectoris after discharge from hospital. Thirty-five (92%) of these patients had an ischaemic ECG reaction and/or recurrence of their anginal chest pain during the exercise test, one of them also had evidence of oesophageal origin of his chest pain. There were no signs of OD in the remaining three patients with a history of angina pectoris. Therefore, OD does not constitute a common problem in the differential diagnosis of anginal chest pain in patients with recent myocardial infarction.
Adult↗
Bronchial obstruction after oesophageal acid perfusion in asthmatics.
Fifteen patients with the combination of bronchial asthma and symptoms of gastro-esophageal reflux reproduced at endo-oesophageal acid perfusion (group 1) were investigated to detect bronchial obstruction, reflexly elicited from the distal oesophagus. Five patients with bronchial asthma but without symptoms of gastro-oesophageal reflux (group 2) and five patients with symptoms of gastro-oesophageal reflux but without respiratory symptoms (group 3) served as controls. The vital capacity (VC), the slope of the alveolar plateau (delta N2) and the closing volume (CV) were measured with the single breath nitrogen test before and after acid perfusion of the oesophagus, and again after antacid and glucose perfusion of the oesophagus. In group 1 a significant decrease of VC by 0.21 (P less than 0.001) and a significant increase of delta N2 by 0.9% (P less than 0.05) was seen while no change in CV was found. There was no change after acid perfusion in groups 2 or 3. After glucose and antacid the VC increased significantly in group 1 while no significant change was seen in delta N2 or CV. These findings were taken as indirect evidence of bronchial obstruction induced by the acid infusion. Since the changes were provoked in the sitting position and only in asthmatics with a positive acid perfusion test and since no patient complained of acid taste in the mouth it is unlikely that the bronchial obstruction was due to aspiration. A neural oesophago-bronchial reflex mechanism is suggested.
Adult↗
Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population.
The frequency of different kinds of oesophageal dysfunction (OD) as shown by manometry and acid perfusion test was investigated in a 55-year-old general population. OD was found in 34 +/- 8% (95% confidence interval). Seventeen per cent had signs of dysmotility, 14% of hiatal hernia, 6% of lower oesophageal sphincter (LES) hypotension, 5% had a positive acid perfusion test and 13% had more than one kind of OD. Symptoms of gastro-oesophageal reflux and chest symptoms were significantly more common in OD subjects than in subjects with normal oesophageal function. The oesophageal function tests had a capability in detecting 66% of subjects in the general population with heartburn or acid regurgitation, whereas they had a poor capability in detecting subjects with other oesophageal related symptoms. This investigation can therefore not answer the question whether our criteria for OD is clinically relevant or not. Irrespective of this, it is important to know the frequency of OD in the general population if the relevance of the OD frequency in hospital patient materials is to be evaluated.
Cross-Sectional Studies↗
Non-infarction coronary care unit patients. A three-year follow-up with special reference to oesophageal dysfunction and ischaemic heart disease as origin of chest pain.
Among 55 consecutive coronary care unit (CCU) patients with chest pain of unknown origin at discharge from hospital, signs of oesophageal dysfunction (OD) were found in 58% and signs of ischaemic heart disease (IHD) in 35% within 2-6 months. At a three-year follow-up, signs of OD were found in 62% and signs of IHD in 28%. Forty-six patients (84%) had experienced a pain similar to that which caused the CCU admission (i.e. the CCU chest pain). OD was regarded as the cause of the CCU chest pain in seven patients (13%) and as a possible cause in another nine (16%). IHD was regarded as the cause of the CCU chest pain in 17 patients (31%), four of whom had died from acute myocardial infarction during the follow-up period. All ten patients who developed coronary events, such as myocardial infarction or progressive angina pectoris, during the follow-up period had an ischaemic ECG reaction at exercise test 2-6 months after discharge from the CCU. IHD was found to be the predominant disease in terms of severity of symptoms and prognosis and was also recorded as the most common single cause of the CCU chest pain. Since OD was common and even caused severe chest pain in some patients, oesophageal origin should be considered in the differential diagnosis of chest pain in non-infarction CCU patients.
Aged↗
Oesophageal function in asthmatics.
The frequency of different kinds of oesophageal dysfunction (OD) namely hiatal hernia at manometry, dysmotility, hypotension of the lower oesophageal sphincter (LES) and positive acid perfusion test was investigated in 97 patients with bronchial asthma seen at a hospital clinic. Thirty-six patients had signs of hiatal hernia, 37 of dysmotility, 26 of LES hypotension and 23 had a positive acid perfusion test. Four per cent of all the asthma patients fulfilled four criteria for OD and 10%, 28% and 25% fulfilled three, two and one criteria respectively. The incidence of OD was significantly higher in patients with Exogenous (95%) than in patients with endogenous asthma (58%, P less than 0.01). The history of asthma in patients with OD was of significantly longer duration (mean 16.9 years) than that of the OD itself (mean 6.5 years, P less than 0.01). Productive cough and frequent wheezing were more common in patients with OD (46%) than in patients without (19%, P less than 0.01). Spirometric lung volumes did not differ between asthmatics with OD and those without. Asthmatics with OD seem therefore to suffer more from respiratory symptoms than asthmatics without OD.
Adult↗
Effect of conservative treatment of oesophageal dysfunction on bronchial asthma.
Sixty-two patients with both bronchial asthma and oesophageal dysfunction (OD) were randomized into an OD treatment group and a control group. Patients in the treatment group were given advice and medication for their OD. No changes were made in their existing asthma therapy. Patients in the control group were told that there was a suspicion of OD which should be rechecked in 2 months. After 2 months the patients of the treatment group reported alleviation of their oesophageal and bronchial symptoms significantly more frequently than patients of the control group. Fewer signs of OD were found after treatment than before. Lung function tests did not differ between the group treated for 2 months and the control group but there was a significant reduction in consumption of beta-adrenergic stimulating drugs in the treatment group compared with the control group. In conclusion, treatment of OD improves not only oesophageal symptoms but also respiratory symptoms in asthmatic patients. OD should therefore be looked for in patients with bronchial asthma and treated whenever found.
Adult↗
Influence of coronary bypass surgery on oesophageal function and symptomatology.
The incidence of oesophageal dysfunction (OD) is higher in patients with coronary heart disease (CHD) than in a population sample. The hypothesis was raised that this finding is the result of a cardio-oesophageal reflex in which afferent pain impulses from the heart trigger dysfunction in the oesophagus. Twenty-three patients with CHD were examined before and 14+/-5(S.D.) months after coronary bypass surgery. Total relief of angina pectoris was attained in 6 patients and improvement in 16. One patient deteriorated. The incidence of OD was 52% before operation and 65% at the follow-up investigation (no significant difference). Symptoms related to the oesophagus, other than chest pain, were as frequent before as after operation. The findings do not support the contention that OD in patients with CHD is caused by a cardio-oesophageal reflex.
Angina Pectoris↗
Effect of time interval between swallows on esophageal peristalsis.
Esophageal peristaltic pressure amplitude, peristaltic incidence, speed of peristalsis, and wave duration were investigated as a function of swallow interval. In the distal half of the esophagus, the amplitude decreased at swallow intervals of 8 s and shorter. At intervals of 8 and 4 s, dropouts of contractions that were obtained were most frequent in the distal esophagus and for the 4-s interval. At continuous swallows no contractions were obtained below the upper esophageal sphincter until the end of the swallow sequence, after which a peristaltic wave of high amplitude propagated along the esophagus. The peristaltic speed increased toward a level 5 cm above the lower esophageal sphincter. The peristaltic wave duration was approximately the same in different parts of the esophagus and at different swallow intervals. The findings indicate an impairment of esophageal transport function by short swallow intervals.
Adult↗
[Hiatal hernia symptoms--reply].
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Diagnosis, Differential↗
Oesophageal dysfunction in non-infarction coronary care unit patients.
Oesophageal dysfunction (OD) is a common finding in patients discharged from a coronary care unit without definite diagnosis. Of 55 patients investigated with oesophageal manometry, acid perfusion test and exercise ECG, 32 had signs of OD and 19 signs of ischaemic heart disease (IHD). Symptoms such as heart burn, acid regurgitations, feeling of a lump in the throat, surfeitness after meals, chest pain at night, and relief of chest pain when lying with the head raised were significantly more common in patients with OD than in patients with normal oesophageal function. Chest pain was significantly more often provoked by effort, emotions or cold and more often relieved by nitroglycerine in patients with signs of IHD than in those without. These pain-provoking factors were, however, also common in patients with OD. A careful case history with specific inquiry directed at not only cardiac but also oesophageal symptoms is important in the differential diagnosis of chest pain.
Adult↗
Oesophageal symptoms and manometry in valvular heart disease.
A possible relationship between heart disease, oesophageal dysfunction (OD) and symptomatology was studied in 47 patients with valvular heart disease. They were investigated with oesophageal manometry and oesophageal acid perfusion test. OD was found in 32 percent of the patients. A local pressure increase in the middle part of the oesophagus, probably an effect of cardiac enlargement and compression of the oesophagus, was found at manometry in 38 percent. The incidence of OD and of oesophageal symptoms was the same in patients with and without oesophageal compression. We did not find any indications that valvular disease in itself provokes OD, nor that symptoms of chest pain and cough in patients with valvular heart disease are due to OD.
Adult↗
Frequency content of esophageal peristaltic pressure.
Fourier analysis of esophageal peristaltic pressure waves was performed by computer fast Fourier transform. The highest power spectral density was obtained in the frequency range below 1 Hz. The Fourier analysis showed spectral components up to about 12 Hz in the upper esophageal sphincter (UES). The significance of different frequency components was investigated by low-pass filtering at different cut-off frequencies. A reduction in the amplitude of UES contractions was obtained at a cut-off frequency of 4 Hz, whereas the cut-off frequency of 8 Hz did not show any distortion. For perfused manometry systems, only a low-compliance perfusion pump will have sufficient bandwidth for accurate recording of esophageal peristaltic pressures.
Adult↗