[Barrett's syndrome in achalasia of the esophagus].
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Biomedical subjects
Publications and source records attributed to M Wienbeck.
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Esophageal function was investigated by quantitative intraluminal pressure measurements in three patients with Behçet's disease. All three had motility disorders partially resembling those described in diabetics and partially those from patients with scleroderma. These motility disturbances may be secondary to a neurological involvement in Behçet's disease.
Behçet's disease is characterized by the triad of aphteous stomatitis, genital ulcerations and uveitis. This syndrome is thought to be a systemic disease with various unspecific manifestations, which may arise in other organs as well in a considerable number of cases. More than 50% of all patients do have gastrointestinal symptoms; erosive and ulcerative lesions are found primarily in the jejunum and colon. Case reports are given of 3 patients with Behçet's disease and gastrointestinal involvement; one of these patients died. All patients did have unspecific changes of esophageal motility.
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Alcohol drinking induces acute and chronic lesions of the GI tract; some other GI disorders do occur more frequently in drinkers than in other persons. Alcoholics suffer from gastroesophageal reflux, Barrett's syndrome, exophageal cancer and Mallory-Weiss syndrome as well as from hemorrhagic erosive gastritis more often than normal. It is still unsettled if chronic gastritis can be due to alcohol drinking. Alcohol inhibits to some degree the absorption of water, electrolytes, disaccharides and vitamin B12 in the small intestine; it may as well impair intestinal motility and cause diarrhea. Many aspects of the effects of alcohol on the GI tract still remain to be elucidated. The main stay of therapy is abstenence.
Embryonal development and anatomy of the liver are shortly discussed; they do explain collateral circulation in liver cirrhosis. A case report is given of a patient with umbilical collateral circulation (Cruveilhier-v. Baumgarten syndrome), exhibiting impressive clinical and radiological findings. Such an umbilical collateral circulation will develop in up to 21% of all patients with an intrahepatic block. This is only one variant - not prone to complications by the way - of a multitude of different portosystemic shunts in liver cirrhosis. Therefore it should not be talked about as an independent syndrome.
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ECG was recorded in 38 patients with achalasia of the esophagus before, during and after pneumatic dilatation. During the dilatation both marked increases as well as decreases of heart frequency were observed. The mean values of all patients remained virtually unchanged. The most frequent type of arrhythmia were ventricular extrasystolies (16 patients), whereas supraventricular extrasystolies (4 patients), second degree-av-block (2 patients) and av-dissociation (1 patient) occured infrequently. In none of our patients arrhythmia was critical, even in a patient with preexisting cardiac insufficiency. Thus, patients with achalasia of the esophagus are not endangered to a major degree by cardiac arrhythmia during pneumatic dilatation.
Esophageal webs are thin, eccentric stenoses of the lumen, which are easily detected and treated by endoscopy. This is illustrated by a case report of a lower esophageal web.
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The registration of resting pressures and motility activity has considerably increased our knowledge of the normal functioning of the esophagus. We have not jet solved all the methodological problems of manometry; however perfusion manometry, which is used today, has enabled us to make an exact cassification of functional disorders and adequate therapy. An understanding of the methodological problems involved is necessary for the correct use of the manometric method and the correct interpretation of its results. This precondition has not always been observed, especially in discussion of the gastro-esophageal closure mechanism, and has thu given rie to much confusion. An attempt at a critical evaluation should be the basis for future discussion.
Since circadian patterns of colonic motility are largely unknown the electrical activity of the colon musculature was recorded in 6 unanesthetized cats during day and night. All parts of the colon exhibited 6 patterns of electrical activity: spikes, oscillations, omnipresent regular slow waves, and three composite patterns, i.e. a minute-rhythmic activity, activity complexes of 1 to 18 minute duration and a nyctohemeral pattern. The circadian rhythm was different between the proximal and distal colon resulting in activity gradients. These were directed in an aborad direction from 7 to 9 a.m. and from 9 p.m. to midnight. Most of the defecations of the 6 cats occured in the late evening until 1 a.m. Spike activity of the distal colon predominated from 3 to 4 a.m. and from 11 a.m. to 5 p.m. It is concluded that a circadian rhythm exists in the motility of the cat colon. Differences in the activity between the proximal and the distal colon and resulting activity gradients may offer an explanation for the influences of the time of day on the timing of defecations.