Gastroenterology services: a regional review.
Explore the source record for details and available documents.
Catchment Area, Health↗
Biomedical subjects
M Atkinson
Publications and source records attributed to M Atkinson.
A frequency-duration index (FDI) for the evaluation of ambulatory recordings of gastro-oesophageal reflux.
Oesophageal pH monitoring has been undertaken in 20 symptomatic patients and 20 normal subjects for periods of 24 hours at work and in the home using a pH sensitive radiotelemetry capsule and a portable receiving system. There was no correlation between symptoms and endoscopic findings in symptomatic patients. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24 hour ambulatory study (P less than 0.002). A frequency-duration index for the evaluation of recordings is described which was significantly greater in symptomatic patients than in normal subjects during both day (P less than 0.002) and night (P less than 0.008) periods of recording. Discrimination between the two groups was more clearly seen using the frequency-duration index compared to either the frequency of reflux episodes or the cumulative duration of acid reflux.
Adult↗
Comparison of the Eder-Puestow and Celestin techniques for dilating benign oesophageal strictures.
The Celestin and Eder-Puestow methods of dilating benign oesophageal strictures have been compared prospectively in a randomised trial. One hundred and thirty three dilatations were performed on 72 patients. There was no significant difference between the two techniques with regard to the long term relief of symptoms. Celestin dilatation was quicker, less likely to cause pharyngeal trauma, and less damaging to guide wires. It could not be used, however, in those patients in whom only a short length of guide wire could be passed through the stricture.
Deglutition Disorders↗
Influence of the vagus nerve upon the reflex control of the lower oesophageal sphincter.
In 24 control patients the lower oesophageal sphincter responded to graded increments in intra-abdominal pressure by a significant and sustained rise in tone. This response was abolished by atropine and was also absent in nine of 11 patients who had previously undergone truncal vagotomy for duodenal ulcer but not in the remaining two who had recurrent ulceration. In six patients studied after proximal gastric vagotomy a variable response was seen. Gastric efferent vagal function was assessed by a combined insulin/pentagastrin gastric secretory test and did not correlate closely with the lower oesophageal sphincteric response to increased intra-gastric pressure. These findings are explicable if it is assumed that truncal vagotomy interrupts the afferent limb of a reflex arc regulating lower oesophageal sphincteric tone.
Abdomen↗
Selective fetal malnutrition: the effect of nicotine, ethanol, and acetaldehyde upon in vitro uptake of alpha-aminoisobutyric acid by human term placental villous slices.
Intrauterine growth retardation (IUGR) is often associated with either tobacco smoking or ethanol abuse during pregnancy, and the two habits usually coexist. We tested the hypothesis that nicotine is placentotoxic, thereby contributing to tobacco-associated IUGR. In vitro uptake of alpha-aminoisobutyric acid (AIB) by normal human placental slices was examined in the presence of nicotine, 0.2-20 microM. Significant (p less than 0.05) reductions in AIB uptake were observed for nicotine, 2.5-20 microM, with a linear dose-response. Since ethanol, and its major metabolite, acetaldehyde, have previously been shown to impair human placental uptake of AIB, these two substances were tested for synergism with nicotine. No interaction was observed between nicotine (0.2 microM) and ethanol (1,000 mg/dl). An increased inhibition was observed for the combination of nicotine (0.2 microM) and acetaldehyde (500 microM), but two-way analysis of variance indicated that the effects are additive, rather than synergistic. It is concluded that nicotine inhibits term human placental transport of the actively transported, nonmetabolized amino acid, AIB. Such placentotoxicity may be a contributing factor in tobacco-associated IUGR. Abuse of ethanol concurrent with tobacco smoking by a pregnant woman may be more detrimental to placental amino acid transport than either substance alone.
Acetaldehyde↗
Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinal-tract bleeding.
We studied the effects of tranexamic acid (an antifibrinolytic agent) and cimetidine on acute upper-gastrointestinal-tract bleeding in a double-blind randomized placebo-controlled trial in 775 patients with hematemesis or melena or both. Mortality was significantly reduced in patients receiving either tranexamic acid (mortality, 6.3 per cent) or cimetidine (7.7 per cent), as compared with patients receiving placebo (13.5 per cent) (P = 0.0092 for tranexamic acid vs. placebo, P = 0.045 for cimetidine vs. placebo). Ninety-nine patients were withdrawn before the code was broken, mainly because their primary illness was considered not to be due to acute upper-gastrointestinal-tract bleeding. Mortality among those withdrawn was high (22 per cent), and their exclusion reduced death rates to 4 per cent in those given tranexamic acid, 8 per cent in those given cimetidine, and 11 per cent in those given placebo (P = 0.0072 for tranexamic acid vs. placebo, P greater than 0.50 for cimetidine vs. placebo). The reduced mortality associated with tranexamic acid was detectable at both participating hospitals and in most of the main subgroups of patients classified according to site of bleeding. However, treatment with this agent was not associated with any decrease in the rate of rebleeding or the need for operation.
Acute Disease↗
Pneumatic dilatation in achalasia.
To assess the value of pneumatic dilatation of the cardia, 63 patients with achalasia have undergone a total of 107 Rider-Moeller dilatations over the last six years. There was a marked improvement in swallowing immediately after dilatation in all but two patients, there were no deaths attributable to the procedure and serious complications were rare (1.6% of patients). The first 50 cases have been followed from nine to 73 months after their initial dilatation (mean follow-up 29.7 months). Twenty nine patients (58%) have not required a further dilatation, 19 patients (38%) required between one and three further dilatations and two patients (4%) required four more dilatations. Continuing need for further dilatation was significantly greater in those patients aged under 45 years than in those aged 45 or more at the time of their initial dilatation (p less than 0.001). Cardiomyotomy was necessary in five patients (10%), because of poor response to pneumatic dilatation; all five cases were under 45 years old at their initial dilatation. Pneumatic dilatation is a safe and effective treatment for achalasia, particularly in the older patient, and in our opinion should be the initial treatment for all patients with achalasia, reserving surgical cardiomyotomy for those who do not respond to several dilatations.
Adolescent↗
Type III glycogenosis presenting as liver disease in adults with atypical histological features.
Two cases of type III glycogen storage disease are reported in adults; the occurrence of cirrhosis in one case illustrates the potential development of chronic liver disease in this condition. The other was the oldest patient with this condition found in a review of published reports. Electron microscopy of peripheral blood leucocytes to demonstrate excess glycogen was found to be a quick and useful aid to diagnosis. Histology of these adult cases showed a distribution of hepatocyte vacuolation which has not been previously recorded.
Adult↗
Selective fetal malnutrition: the effect of in vivo ethanol exposure upon in vitro placental uptake of amino acids in the non-human primate.
In vitro uptake (45 and 90 minutes) of amino acids, alpha-amino isobutyric (AIB) and valine (VAL), was measured in six placentae from the nonhuman primate, Macacca fascicularis. Three of the pregnant primates were chronically treated with ethanol before and throughout pregnancy (CHR); one during the last trimester only (LT); and two were controls (C). Compared to the C placentae, the LT placenta had significantly decreased uptake only for AIB at 45 min: 33.4 +/- 6.8% reduction (mean +/- S.E.) (P less than 0.05). In contrast, the CHR placentae demonstrated significantly reduced uptake (P less than 0.01) for both amino acids at both time points. Percent reduction at 45 and 90 min: AIB, 35.2 +/- 6.5% and 32.6 +/- 5.6% and VAL, 38.7 +/- 2.9% and 22.1 +/- 4.1%. The results indicate that chronic in vivo ethanol exposure impairs the in vitro placental uptake of two actively transported amino acids, using an animal with a placenta almost identical to the human.
Aminoisobutyric Acids↗
Gastrointestinal complications of diabetes mellitus.
Explore the source record for details and available documents.
Diabetes Complications↗
Non-steroidal anti-inflammatory drugs and benign oesophageal stricture.
Drug histories were obtained from 76 patients at the time of initial Eder-Puestow dilatation for benign oesophageal stricture. Six patients had consumed drugs known to cause oesophageal ulceration (emepronium bromide and potassium preparations). Of the remaining 70 patients, 22 had regularly taken a non-steroidal anti-inflammatory drug before the onset of dysphagia compared with 10 patients in a control group matched for age and sex; this difference was significant (p less than 0.02). Non-steroidal anti-inflammatory drugs may have a causative role in the formation of oesophageal stricture in patients with gastro-oesophageal reflux, in whom they should be prescribed with caution.
Administration, Topical↗
Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: controlled trial in 1037 patients.
A study was conducted to find whether the higher diagnostic yield of endoscopy compared with barium radiography improves management or survival in patients with acute upper gastrointestinal bleeding. A total of 1037 patients were entered into a randomised study comparing the outcomes after each investigation. The diagnostic yield in patients who underwent endoscopy was 73% (382 of 526 cases) and in those examined by radiography 55% (280 of 511 cases). A fifth of the patients in the radiology group and a tenth of those in the endoscopy group subsequently underwent the alternative investigation; in most cases, however, no additional diagnostic information was obtained. Operation rates were similar in two groups, though patients in the endoscopy group were generally operated on sooner. Mortality rates were also similar in the two groups, though postoperative mortality was higher in the endoscopy group. Endoscopy may be a more accurate means of diagnosis than radiography, but it offers no short-term benefits in management.
Clinical Trials as Topic↗
Comparison of surgical and medical management of bleeding peptic ulcers.
During 1975-80, 908 patients admitted to Nottingham hospitals with gastrointestinal bleeding and found to have gastric or duodenal ulcers were analysed retrospectively for short-term outcome of treatment. Overall one-quarter of all patients underwent operation, but when the years 1975-7 were compared with 1978-80 the operation rate fell from one in three to just over one in five. Death rates were much lower in patients treated medically than in those who underwent operation, and the risks of operation were greater for patients with gastric ulcer. Less conventional operations were attended by greater mortality. Almost all patients who died during medical treatment and three-quarters of those who died after operation were over 65. No differences in age or clear variations in haemoglobin concentrations or transfusion requirements were found between the earlier and later periods. Reduction in operation rates had no appreciable effect on mortality, despite the accepted view that early operation is advisable.
Adult↗
Ethanol-associated selective fetal malnutrition: a contributing factor in the fetal alcohol syndrome.
The pathogenesis of the FAS, particularly the characteristic IUGR, may be due in part to ethanol-related placental injury. Ethanol and/ or acetaldehyde may impair placental transfer of nutrients essential for growth, e.g., amino acids. Such restriction could occur regardless of maternal nutritional status: selective fetal malnutrition. Impairment of placental nutrient transport at critical phases of fetal organogenesis could compound any direct fetotoxic effects of ethanol or acetaldehyde. The effect of ethanol upon human placental hormone synthesis and transport of vitamins, minerals, glucose, and nucleic acid precursors awaits further investigation. Similarly, potential interactions between ethanol and other xenobiotics commonly abused by alcoholics require clarification.
Amino Acids↗
Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system.
Gastro-oesophageal reflux has been assessed in 10 symptomatic patients and 10 asymptomatic normal subjects during a study period of 24 hours at work and in the home using a newly developed pH sensitive radiotelemetry capsule and a portable receiving system. Oesophageal pH was continuously monitored by the tethered radiotelemetry capsule and recorded with a portable receiver and a 24-hour cassette recorder, allowing the patient complete freedom of movement so that ambulatory studies could be undertaken during a normal working day. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24-hour studies at home (p less than 0.002). In both groups, reflux occurred more during the day than at night (p less than 0.01). Patients refluxed significantly more at home than when they were in hospital (p less than 0.01). Ambulatory outpatient oesophageal pH monitoring may be useful in the management of patients with atypical symptoms and may demonstrate significant reflux when inpatient investigations and endoscopy findings show minimal abnormality.
Adult↗
Guaiacol -- a new compound in the treatment of gastro-oesophageal reflux?
The effects on the oesophagus of an aromatic oil, guaiacol, has been examined in a group of 20 patients with reflux oesophagitis and also normal volunteers. This agent produced a rapid and sustained rise in resting lower oesophageal sphincter pressures and the peristaltic pressures induced in response to swallowing liquids. This compound may prove useful in the treatment of patients with reflux oesophagitis and other disorders of oesophageal motility.
Esophagitis, Peptic↗
Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.
Of one hundred and twenty-one patients with neoplastic obstruction of the oesophagus or cardia 118 underwent palliative intubation at fibreoptic endoscopy on a total of 135 occasions. Sixty had adenocarcinoma, 49 had squamous carcinoma, and in nine the oesophagus was involved by a growth arising elsewhere. Satisfactory swallowing ws restored in 112 patients. Thirteen patients died in hospital shortly after the procedure. Five fatal and 10 non-fatal perforations were sustained in 135 intubation procedures. Complications of tube function included food blockage on 26 occasions, tumour overgrowth on seven occasions, displacement on 16 occasions, disappearance of the tube in two patients, and late oesophageal perforation on nine occasions. Fifty-six patients survived for three months, 33 for six months, and 10 for a year after intubation. Comparison with series in the literature of patients who underwent surgical palliative intubation suggests that endoscopic palliation has lower mortality and morbidity, and an increased survival time, and is now the method of choice for palliation of oesophagogastric neoplasms.
Adenocarcinoma↗
Oesophageal stricture associated with emepronium bromide therapy.
Emepronium bromide, a drug used to control urinary frequency, has been reported as causing oesophageal ulceration but not stricture formation. This paper presents 3 cases in which the use of emepronium bromide preceded development of an oesophageal stricture and suggests that the drug played a causative role.
Aged↗