Prokinetics in the treatment of gastro-oesophageal reflux disease. International symposium. Paris, France, 5 September 1996.
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Barrett Esophagus↗
Biomedical subjects
M Wienbeck
Publications and source records attributed to M Wienbeck.
Postprandial gastric relaxation in achalasia.
BACKGROUND: In achalasia the incidence of autonomic neuropathy is increased, indicating that achalasia is not a disease of the oesophagus only. Little information is available concerning the function of the stomach in achalasia. We compared the postprandial gastric fundus relaxation in patients with achalasia to that of healthy controls. METHODS: In six patients with achalasia and six healthy controls postprandial fundus relaxation after a liquid test meal (500 ml, 500 kcal) was studied using an intragastric bag connected to an electronic barostat. The postprandial gastric relaxation was measured as an increase of intragastric bag volume; bag pressure was set at a constant level of 1 mmHg above the intra-abdominal pressure. All data are given as means +/- SEM, and the Mann-Whitney test was used for statistical analysis. RESULTS: The intragastric volume before ingestion of the test meal was not different between groups. The maximum relaxation in patients with achalasia was significantly lower than in controls (132+/-46 ml vs 238+/-70 ml, P< 0.02). Postprandial relaxation was diminished and shortened in patients with achalasia as compared with controls. Similarly, the area under the volume curve was significantly smaller in patients with achalasia than in controls (29.8+/-28.9 ml/h vs 102.9+/-58.4 ml/h, P< 0.03) consistent with a diminished postprandial relaxation. CONCLUSION: Patients with achalasia show a decreased postprandial gastric relaxation compared with healthy controls. We hypothesize that the neural damage in achalasia is not restricted to the oesophagus, but also involves the proximal stomach.
Adult↗
The effect of cisapride on dysmotility-like functional dyspepsia: reduction of the fasting and postprandial area, but not of the postprandial antral expansion.
OBJECTIVE: To test the effect of cisapride on symptom score and on fasting and postprandial antral area in patients with dysmotility-like functional dyspepsia compared with controls. METHODS: Nineteen consecutive patients with dysmotility-like functional dyspepsia (13 females, six males, aged 18-79 y) and 12 control subjects (six females, six males, aged 19-68 y) were investigated. A symptom score including six upper digestive symptoms rated from 0 to 3 was applied. The patients received in a randomized order cisapride 10 mg t.i.d. (n = 10), or placebo (n = 9) for 3 days. The controls also received cisapride (n = 6) or placebo (n = 6) in the same way. The antral area in fasting condition and immediately after a semiliquid test meal (250 ml, 342 kcal) was assessed by real-time ultrasonography in front of the aorta and mesenteric vein. The measurements were carried out before starting and after finishing the trials with cisapride and placebo. RESULTS: The symptom score (mean +/- SD) was 7.1 +/- 2.4 in dysmotility-like functional dyspepsia vs 0.5 +/- 0.2 in controls (P < 0.0001). The fasting antral area was 4.5 +/- 0.9 cm2 in dysmotility-like functional dyspepsia vs 2.2 +/- 0.2 cm2 in controls (P < 0.0001). Postprandial antral area was also larger in dysmotility-like dyspepsia than in controls (6.2 +/- 1.0 vs 3.0 +/- 0.3 cm2, Pb= 0.0001). Symptom score correlated with fasting antral area in dysmotility-like functional dyspepsia (rb= 0.38, Pb= 0.05). Cisapride decreased the symptom score to 4.5 +/- 2.5 (P = 0.0009) and placebo to 5.3 +/- 2.4 (P = 0.02). Cisapride significantly reduced the fasting antral area and the postprandial antral area in the dyspeptic group, but not in the control group. Postprandial antral expansion was not influenced by cisapride. Placebo did not change the sonographic parameters in both groups. CONCLUSIONS: In dysmotility-like functional dyspepsia, fasting and postprandial antral areas are wider than in controls. Despite a good placebo response, cisapride is effective in improving the symptoms in dysmotility-like functional dyspepsia, associated with the reduction of fasting and postprandial antral areas.
Adolescent↗
["Alternative" therapy methods in functional disorders of the gastrointestinal system].
Patients with functional disorders of the gastrointestinal tract often respond poorly to standard therapeutic regimes. Therefore, "alternative" forms of treatment (e.g. homocopathy, acupuncture, phytotherapy, diet modifications, psychotherapy, hypnosis) often come into play. Critical assessment of these forms of therapy is difficult: placebo response is high in functional disorders of the gastrointestinal tract and usually no placebo-controlled studies are available to prove the efficacy of these forms of therapy. Up to now no data was able to prove the efficacy of homoeopathy and phytotherapy, and the efficacy of acupuncture has to be questioned. In contrast to this, hyponosis, psychotherapy and some forms of diet modification seem to be useful at least in some patients with functional disorders of the gastrointestinal tract.
Acupuncture Therapy↗
[Portal vein thrombosis after occlusion of a transjugular intrahepatic portosystemic stent-shunt (TIPSS). Shunt dilatation with subsequent local and systemic thrombolysis].
HISTORY AND CLINICAL FINDINGS: A transjugular intrahepatic portosystemic stent shunt (TIPSS) had been implanted to lower the portal hypertension in a 56-year-old man with alcoholic liver cirrhosis and several bleedings from fundal varices. A shunt revision with dilatation became necessary one year later. Recently the patient had gained 8 kg in weight in 3 weeks and his abdomen had become distended. The patient's general condition (height 179 cm, weight 82.9 kg) was clearly reduced. He had marked ascites, the liver was enlarged to 17 cm below the costal margin and the right lung base was dull on percussion. INVESTIGATIONS: Abdominal sonography detected marked ascites and liver cirrhosis with splenomegaly. Duplex sonography failed to demonstrate any flow in the shunt, indicating its occlusion. TREATMENT AND COURSE: At retrograde dilatation of the stent a fresh thrombosis was noted in the right branch of the portal vein and a partial one in the main trunk. Recanalization was achieved locally 10 mg and systemically 100 mg recombinant tissue plasminogen activator (r-tPA). Hepatic vein pressure measurements before and after the thrombolysis demonstrated a significantly lower hepatic venous occlusion gradient, and the portal hypertension had been reduced by about 45%. The ascites gradually resolved. CONCLUSION: Combined local and systemic thrombolysis was successful in recanalizing portal vein thrombosis after TIPSS.
Ascites↗
Eradication of Helicobacter pylori in peptic ulcer disease with amoxycillin, 2.0 g, and omeprazole, 80 or 120 mg: a prospective randomized trial.
BACKGROUND: The appropriate dose of proton pump inhibitors needed for eradicating Helicobacter pylori by dual therapy is still controversial. DESIGN: The study was conducted as a single-blind, single-centre trial. METHODS: Fifty-four patients with active duodenal ulcers were treated with amoxycillin tablets, 750 mg three times daily, and omeprazole, either 40 mg twice daily (group 1) or 40 mg three times daily (group 2), for 14 days in a prospective randomized trial. H. pylori eradication was assessed 10 weeks after starting treatment. Biopsies were taken for rapid urease tests and histological analysis and 13C-urea breath tests were ordered. RESULTS: In both groups ulcer healing was complete in 96.3% of patients after 10 weeks. Ten weeks after starting treatment, Helicobacter pylori was eradicated in 76.9% of the patients in group 1 and 74.1% of those in group 2, as shown by rapid urease tests and histological analysis. In the subgroup of fully compliant patients (n = 49) the eradication rates were 80% and 79.2%, respectively. Hyperacidity significantly reduced the eradication rates. Patients showing successful H. pylori eradication were significantly older (59 +/- 14.0 years vs. 49 +/- 15.6 years; P = 0.025). Eradication rates were lower in smokers than in non-smokers (36.4% vs. 83.9%; P = 0.006). CONCLUSION: It is concluded that higher omeprazole doses should be reserved for younger patients and smokers; in others they are not needed.
Adult↗
Gastric emptying in liver cirrhosis. The effect of the type of meal.
OBJECTIVE: Contradictory reports have been published on gastric emptying in patients with liver cirrhosis. The differences have been attributed to differences in the innervation of the stomach or in the behaviour of the gastric wall. The type of test meal used may, however, have its importance. We looked for the role of the test meal in the assessment of gastric emptying in cirrhosis. DESIGN: In a prospective study, we included 15 patients with liver cirrhosis who had no symptoms of autonomic neuropathy, portal hypertensive gastropathy or antral vascular ectasia and 15 controls. In these subjects we estimated the gastric emptying and varied the type of test meals. METHODS: An ultrasonographic method was used for the estimation of gastric emptying. Antral area was monitored in the aorto-mesenteric plane in the fasting condition and at 0, 15, 30, 45, 60 min after a test meal. Each patient was tested twice on 2 consecutive days in randomized order with a liquid meal (220 kJ) and a semisolid meal (1472 kJ). RESULTS: Fasting antral areas (mean +/- SD) had similar size in both groups with both meals. Gastric emptying (expressed by the area under the curve and half-time (T1/2)) of the semisolid meal was not different in cirrhosis (2347 +/- 1648) compared to controls (2840 +/- 1983). Postprandial antral distension was also similar in both groups (312.2 +/- 133.6% in cirrhosis vs. 397.9 +/- 155.6% in controls). But emptying of the liquid meal was accelerated in the cirrhotic patients with respect to the area under the curve (AUC: 882 +/- 548) and half-time (12 +/- 2 min) vs. controls (AUC: 1863 +/- 1088, P<0.01; T1/2: 18 +/- 7 min, P<0.05). Postprandial antral distension with the liquid meal was decreased (299.4 +/- 76.5% vs. 431.5 +/-154.0%, P<0.01, in controls). CONCLUSION: These data suggest that in patients with liver cirrhosis free of autonomic neuropathy and without portal hypertensive gastropathy or vascular antral ectasia, gastric emptying of liquid low calorie meals is accelerated. The gastric emptying of a semisolid meal richer in calories is normal. Thus, the physical and chemical properties of a meal are major determinants of gastric emptying and may account for the large divergence of results hitherto published on this topic.
Adolescent↗
Motility in irritable-bowel syndrome.
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Colonic Diseases, Functional↗
Re: anxiety in patients submitted to endoscopy.
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Adult↗
[Reflux esophagitis: manometry and Ph measurement].
Manometry and pH-metry are essential in the examination of functional disturbances of the esophagus. Proven indications for manometry are dysphagia of unknown origin and noncardiac chest pain; in reflux esophagitis manometry is used for measuring pressure of the lower esophageal sphincter and detecting motility disorders of the esophageal body, pH-metry is used as long-term pH-metry to quantify gastroesophageal reflux during day and night; furthermore long-term pH-metry is important in the classification of atypical esophagitis. Recording gastroesophageal reflux and esophageal motility may influence planning of therapy and predict prognosis. Before antireflux surgery manometry and pH-metry are useful in judging the clearance mechanisms of the esophagus. Used critically, manometry and pH-metry can be very helpful as cost-effective diagnostic tools in the long-term therapy of reflux esophagitis.
Esophageal Motility Disorders↗
24-hour oesophageal motility in gastro-oesophageal reflux disease (GORD): increased occurrence of simultaneous contractions.
Impaired oesophageal peristalsis may play a major pathogenetic role in gastro-oesophageal reflux disease (GORD). Therefore 55 patients with suspected GORD were studied simultaneously by ambulatory 24-hour pH and pressure monitoring with three pressure transducers (3, 8 and 13 cm above the lower oesophageal sphincter) in order to to test for a relationship between oesophageal motility and GOR. Twenty-one patients (38%) had pathological reflux; these patients had significantly more simultaneous contractions than patients without pathological GOR (30.1 +/- 3.3% vs. 19.0 +/- 1.8%, P = 0.002, mean +/- SEM). Further analysis revealed a significant difference between groups in the occurrence of simultaneous contractions in the mid-oesophagus (33.7 +/- 3.8% vs. 23.9 +/- 1.8%, P = 0.012), but not in the distal oesophagus (34.4 +/- 2.7% vs. 33.9 +/- 3.1%, P = 0.90). In addition, a moderate but highly significant correlation between the rate of simultaneous contractions and reflux time was found (r = 0.463, P = 0.0005). Mean amplitude and mean duration of the contractions were no different between groups, neither in the proximal (43.4 +/- 3.3 mmHg vs. 44.9 +/- 1.9 mmHg, P = 0.68 and 2.4 +/- 0.2s vs. 2.5 +/- 0.1s, P = 0.50, respectively) nor in the distal oesophagus (48.8 +/- 4.6 mmHg vs. 54.2 +/- 3.4 mmHg, P = 0.34 and 3.0 +/- 0.2s vs. 2.9 +/- 0.2s, P = 0.71, respectively). It was concluded that pathological GOR is associated with an increased occurrence of simultaneous contractions in the mid, but not in the distal, oesophagus.
Adult↗
Update on the pathophysiology and management of gastro-oesophageal reflux disease: the role of prokinetic therapy.
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Drug Therapy, Combination↗
[Conservative therapy of fecal incontinence].
Fecal incontinence is not diagnosis, but a symptom which can result from multiple causes. Therefore, therapy should attempt to treat the underlying disorder whenever possible. If this is not possible, therapy becomes symptom oriented. Besides drug treatment anal biofeedback training is the most important basis of medical therapy. Except for special situations surgery is indicated only if medical therapy has failed.
Biofeedback, Psychology↗
[Cholestatic jaundice after ingestion of amoxicillin and clavulanic acid].
HISTORY AND FINDINGS: A 61-year-old woman fell ill with recurrent nausea, loss of appetite and tiredness. Five days later she noted increasing jaundice of skin and sclerae, pale stools and dark urine, and she developed itching over the whole body. Among biochemical tests alkaline phosphatase (537 U/l) and bilirubin (32.0 mg/dl) were markedly increased, while both GOT (102 U/l) and GPT (39 U/l) were only slightly elevated. Ultrasonography was normal and extrahepatic cholestasis appeared unlikely on endoscopic retrograde cholangiopancreatography. Cholestasis due to virus hepatitis was also excluded. It was only on repeated and direct questioning that the patient reported having taken three tablets daily of Augmentin (amoxicillin and clavulanic acid) for 12 days 5 weeks before the onset of symptoms. TREATMENT AND COURSE: After symptomatic treatment with Colestyramine (4 g three times daily), ursodeoxycholic acid (250 mg twice daily) and the antihistaminic Clemastine (1 g two times daily) the severe pruritus decreased quickly and alkaline phosphatase concentration became normal. At follow-up examination 4 and 8 weeks later the laboratory tests were normal. CONCLUSIONS: This report of Augmentin-induced cholestasis is not unique. It shows that previous drug intake must be carefully investigated in any case of cholestasis of unknown cause.
Amoxicillin↗
Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure.
The etiology of upper digestive complaints in uremic patients, which frequently cause morbidity, is unclear. By means of ultrasonography we studied the emptying of the gastric antrum in 15 patients suffering from end-stage renal disease and in 15 controls. In addition, we tested for autonomic neuropathy in the chronic renal failure (CRF) patients using cardiovascular tests. The antral filling and emptying of a semisolid standardized test meal was assessed by measuring cross-sectional areas of the antrum along the plane of the mesenteric vein at regular intervals after a semisolid test meal. Postprandial antral cross-sectional areas were similar in controls and in the total of the renal failure patients. CRF patients without autonomic neuropathy (4/15) showed hastened antral emptying as evidenced by significantly diminished postcibal antral expansion. Only the CRF subgroup with symptoms of both parasympathetic plus sympathetic autonomic neuropathy (6/15) had delayed antral emptying compared to controls as assessed by planimetry of the area under the curve in postprandial antral cross-sectional areas. The CRF subgroup with exclusively parasympathetic neuropathy (5/15) had antral emptying similar to the controls. The symptom score as assessed by a standardized questionnaire of the CRF group with autonomic neuropathy (11/15) correlated significantly both with the fasting antral cross-sectional area and inversely with antral expansion immediately after finishing the test meal. Antral emptying showed a trend towards an inverse relationship to the symptom score, which reached statistical significance only in the CRF subgroup with sympathetic plus parasympathetic autonomic damage.(ABSTRACT TRUNCATED AT 250 WORDS)
Autonomic Nervous System Diseases↗
Effects of nutrient solutions on concentration analysis of non-absorbable dilution markers--implications for studies of gastric emptying.
Gastrointestinal luminal contents may interfere with concentration analysis of non-absorbable dyes. However, non-absorbable markers are broadly used for studies of gastric emptying rates of nutrient solutions. This prompted us to evaluate the properties of non-absorbable markers to mark such nutrient solutions. In vitro concentrations of polyethylene glycol, phenol red, dextran blue, two anthroquinone dyes and inulin were determined spectrophotometrically in the presence or absence of a formula diet, single compounds of the diet or an oligo-peptide diet, and the reproducibility and validity of the analyses were evaluated. The presence of the formula diet or the oligopeptide diet seriously impaired the analyses of marker concentrations, whereas single nutrient compounds did not uniformly interfere. The analysis of polyethylene glycol and phenol red concentrations was impaired by proteins, while the analysis of inulin concentration was impaired by carbohydrates. Dextran blue and the anthroquinones were completely eliminated by protein-precipitation procedures. In conclusion, phenol red and polyethylene glycol should only be used as marker substances for protein-free meals or nutrient solutions, while inulin should not be used with meals or nutrient solutions containing carbohydrates. Marker dilution techniques cannot be recommended for measurements of gastric emptying rates of complete meals.
Coloring Agents↗
Esophageal motility disorders and their coexistence with pathologic acid reflux in patients with noncardiac chest pain.
BACKGROUND: The aim of this study was to determine which motility data of patients with noncardiac chest pain (NCCP) differ from those of controls on the basis of long-term manometry and to evaluate the coexistence of motility disorders and pathologic acid reflux. Further, motility disorders were tested as to whether they were secondary to acid reflux. METHODS: Combined long-term pH/manometry was performed in 95 patients with NCCP, using one pH-electrode and two pressure transducers. The motility data were compared with those of healthy controls (n = 40). In addition, an intraindividual patient-oriented motility analysis was performed. Evaluated were the amplitude, the duration in the distal and proximal esophagus, and the type of propagation, propulsive and simultaneous, of esophageal contractions. Ten patients with pathologic acid reflux and hypermotility disorders received 20 mg omeprazole twice daily and were investigated again 4 weeks after therapy began. RESULTS: The median distal pressure amplitude (39.4 versus 28.9 mmHg, p < 0.0001) and the median percentage of simultaneous contractions (18.5% versus 10%; p < 0.0001) were significantly higher in patients with NCCP than in controls. In addition, patients whose symptoms correlated with abnormal motility (n = 18) had a significantly higher median duration of contractions (3.8 sec versus 3.2 sec; p < 0.03) than controls Patients with pathologic acid reflux showed a higher median distal pressure amplitude (38.3 mmHg versus 28.9 mmHg; p < 0.0001) and median percentage of simultaneous contractions (18% versus 10%; p < 0.0001) than controls. Furthermore, a high rate of coexistence with hypermotility disorders was observed (64%). These disorders persisted after acid suppression therapy. CONCLUSIONS: Patients with NCCP differ from controls in their esophageal motility. Simultaneous contractions of increased amplitude and duration are pathologic. The intraindividual patient-oriented motility analysis is an appropriate evaluation method. Hypermotility disorders occur often in patients with pathologic acid reflux, but apparently they are not dependent on it.
Adult↗
[Do proton pump inhibitors after endoscopic control of acute ulcer hemorrhage have an advantage over H2 receptor antagonists?].
During a two year period (1992-1993) we investigated whether or not, after endoscopic therapy of bleeding ulcers, the suppression of gastric acid secretion with an administration of a proton pump blocker (Omeprazol) is more effective than the administration of H2-receptor antagonist (Ranitidin) with respect to prevention of recurrent bleeding episodes, frequency of surgical intervention and mortality. 106 patients (64 men, 42 women) were treated with the proton pump blocker and 126 patients (82 men, 44 women) received the H2-receptor antagonist. Patients were treated either with an initial dose of 80 mg Omeprazol followed by 3 x 40 mg Omeprazol i.v. or with a daily dose of 3 mg/kg body weight Ranitidin i.v. No significant differences could be detected between the two treatment regimes with respect to the parameters mentioned above. Rebleeding which could be controlled by endoscopic hemostasis occurred in 19.8% vs. 17.5% (Omeprazol/Ranitidin) of patients. Surgical intervention because of rebleeding was necessary on 8.5% vs. 8.7% of the patients. Mortality due to hemorrhage was 5.7% vs. 4.0%. From these results we conclude that, following endoscopic hemostasis of bleeding ulcers, Omeprazol has no advantage over Ranitidin using our dosage regimes.
Adult↗