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Biomedical subjects

R C Heading

Publications and source records attributed to R C Heading.

At least 73 records · Page 4Linked to original sources
PubMed1987

Effect of omeprazole on lower oesophageal function in normal subjects.

In a double-blind crossover study, lower oesophageal sphincter pressure (LOSP) and distal oesophageal motility were studied in eight healthy volunteers following a single intravenous dose of omeprazole or placebo. Lower oesophageal sphincter pressure was determined before and at intervals up to 120 min after intravenous administration of 40 mg omeprazole or placebo. No effects on LOSP or distal oesophageal motility were observed.

Adult↗
PubMed1987

Globus sensation is not due to gastro-oesophageal reflux.

Oesophageal manometry and prolonged ambulatory pH monitoring were performed in 47 patients with the globus sensation, 48 control subjects and 28 patients with documented oesophagitis. Globus patients also underwent video-recorded barium examination and rigid endoscopy. Manometry was normal in 38 of the globus group (94%). The mean percentage time below pH 4 was 4.16 in controls, 5.11 in globus patients (NS) and 18.54 in oesophagitis patients (P less than 0.0005). Oesophageal acid exposure did not correlate with sex, smoking or heartburn and correlated with age only in oesophagitis patients (P less than 0.001). Biopsy showed mild laryngitis in 2 globus patients and distal oesophagitis in 6 (13%). Abnormal oesophageal acid exposure and distal oesophageal dysmotility are not aetiological factors in the majority of patients with globus pharyngis.

Adult↗
PubMed1987

Daytime gastro-oesophageal reflux is important in oesophagitis.

Fifty two patients were studied to investigate the patterns of gastro-oesophageal reflux during ambulatory pH monitoring and the relationship of reflux to presence and severity of oesophagitis. Twenty nine had evidence of oesophagitis which was graded according to severity. Acid exposure (pH less than 4) was calculated in each case for the total study period, the recumbent and upright periods, and the three hour period after the evening meal. Exposure in the upright period correlated closet (r=0.92: p less than 0.001) with that during the total period. Recumbent exposure correlated with both upright and postprandial exposure (p less than 0.001). Acid exposure during all four periods correlated significantly with the severity of oesophagitis, but postprandial acid exposure correlated best and recumbent acid exposure least well. Although acid clearance in the total, recumbent and upright periods correlated with oesophagitis, postprandial clearance showed the closest relationship. Thus the magnitude of daytime reflux, especially postprandial reflux and acid clearance, is more closely related than nocturnal reflux to oesophagitis. The results do not support the contention that night time reflux is inherently more injurious than daytime reflux to the oesophageal mucosa.

Eating↗
PubMed1987

Transpyloric fluid movement and antroduodenal motility in patients with gastro-oesophageal reflux.

The pattern of transpyloric fluid movement and associated antroduodenal motility was compared in patients with gastro-oesophageal reflux (GOR) and healthy controls using real time ultrasonic imaging. A similar number of cyclical periods of antroduodenal motor activity (GOR 94 and control 91) was studied in each group. Mean antral cycle times and the frequency of occurrence of related proximal duodenal contractions (antroduodenal coordination) were similar. Transpyloric fluid movement occurred as a number of discrete episodes in each cycle. Gastroduodenal flow was more frequent in the GOR group (mean 2.7 +/- 0.4 episodes per cycle) than in controls (mean 1.7 +/- 0.3). The mean duration of these episodes in both groups was similar at around 2.5 seconds. Duodenogastric flow (reflux) was observed in many cycles (GOR 63%; controls 54%), but there was no difference in the mean number of episodes per cycle (GOR 0.79; control 0.74) or their mean duration (two seconds for both). Transpyloric fluid flow only occurs when a pressure gradient is created across the open pylorus. These observations indicate that in GOR the gastroduodenal pressure gradient is positive more frequently than in normal controls. Gastroduodenal liquid flow but not duodenogastric reflux differs in GOR patients and controls.

Body Fluids↗
PubMed1987

Salicylate induced exacerbation of ulcerative colitis.

The oral administration of mesalazine (5-aminosalicylic acid) resulted in the exacerbation of ulcerative colitis in two patients intolerant to sulphasalazine whose colitis had previously been quiescent. Although sulphasalazine intolerance is usually attributable to the sulphapyridine moiety, the possibility of salicylate sensitivity should be considered in colitic patients who fail to respond appropriately to sulphasalazine or who experience abdominal pain or diarrhoea while taking the drug.

Adult↗
PubMed1986

Is gastric emptying abnormal in duodenal ulcer?

To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.

Achlorhydria↗
PubMed1986

Clinical value of radionuclide oesophageal transit measurement.

We have reviewed our experience of 150 patients to assess the clinical value of radionuclide oesophageal transit measurements in relation to established oesophageal motility investigations. Achalasia and conditions characterised by incoordinate oesophageal motor activity were detected with equal frequency by manometry and radionuclide transit measurement. Radionuclide transit measurements identified abnormalities not detected by manometry in 18 patients, and manometry was abnormal in 26 patients with normal radionuclide studies, including all patients with nutcracker oesophagus and most with hypertensive lower oesophageal sphincter. The overall sensitivity of radionuclide transit measurements in detecting oesophageal dysmotility was 75%, the sensitivity of manometry was 83% and that of conventional barium radiology 30%. We conclude that radionuclide transit measurement is a useful test for patients with suspected oesophageal motility disorders. Although it has limitations as a screening test, it provides additional information which complements oesophageal manometry.

Adolescent↗
PubMed1985

The oesophagus as a cause of recurrent chest pain: which patients should be investigated and which tests should be used?

Investigations of the oesophagus were undertaken in 50 consecutive patients who presented with recurrent chest pain thought to be non-cardiac in origin after cardiological assessment. An oesophageal disorder was demonstrated in 60%, gastro-oesophageal reflux and diffuse oesophageal spasm being the two commonest entities. However, routine contrast radiology and upper gastrointestinal endoscopy revealed abnormalities in only a minority of patients. Patients with non-cardiac chest pain of uncertain origin should initially undergo endoscopy. If no major abnormalities are detected radionuclide oesophageal transit studies, oesophageal manometry, and ambulatory monitoring of oesophageal pH should be carried out.

Adolescent↗
PubMed1985

Gastric emptying after anterior lesser curve seromyotomy and posterior truncal vagotomy.

Anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV) provides a simple, safe and expeditiously performed method of denervating the parietal cell mass, whilst preserving the pylorus. Dumping and diarrhoea are uncommon after this procedure. Gastric emptying has been assessed after ASPTV and other elective operations for duodenal ulcer. Liquid and solid phase gastric emptying studies were performed in control subjects (17), patients before and at least six months after ASPTV (14), vagotomy and pyloroplasty both without (8) and with (6) diarrhoea, vagotomy and gastroenterostomy (11), and Polya gastrectomy (7). There was no delay in emptying time for liquids or solids between ASPTV patients and controls. With the exception of an increase in the early emptying of liquids (P = 0.02) after ASPTV, gastric emptying was not different from normal. After truncal vagotomy and pyloroplasty in patients without diarrhoea the gastric emptying of solids, but not of liquids, was markedly increased (P = 0.00001), whereas in those with diarrhoea both liquid and solid phase emptying were markedly increased (P less than 0.001). When gastroenterostomy was used as the drainage procedure both phases of emptying were increased. After Polya gastrectomy, both early and late emptying of liquids and solids were increased (early phase P less than 0.05, overall emptying P less than 0.001).

Diarrhea↗
PubMed1985

Coordinated motor activity of the human gastroduodenal region.

Using real-time ultrasonic imaging, and a test meal of 500 ml of dilute orange juice, we have studied the temporal relationships among contractions of the terminal antrum, pylorus, and proximal duodenum of 22 normal subjects. A total of 259 cyclical periods of motor activity were observed. Individual mean gastroduodenal cycle times ranged from 17.9 to 29.6 seconds (2.0-3.3 cycles/min). Terminal antral contractions (TACs) were observed in 98% of cycles and pyloric closure invariably occurred at the midpoint of these contractions. The pylorus then opened as the terminal antrum relaxed and remained open until the next TAC. Only 67% of TACs were associated with contractions of the proximal duodenum (DC), but 94% of these occurred about 1 sec (range 1 sec before to 2 sec after) after pyloric closure. Only 6% of DCs were ectopic, in that their occurrence was apparently uncoordinated with the TACs. Our observations demonstrate that after ingestion of a test meal, the human terminal antrum, pylorus, and proximal duodenum usually contract in a sequential coordinated manner, presumably under the control of the gastric slow wave. No evidence of independent pyloric closure was obtained.

Adult↗
PubMed1984

The influence of adrenergic denervation on the response to feeding of the gastroenteropancreatic system in man.

The effect of adrenergic denervation on the metabolic and hormonal response to a standard meal was studied in six tetraplegic subjects (pre-ganglionic sympathectomy) and compared with six normal subjects. Gastric emptying, estimated by isotope scintiscanning, was similar in both groups. Following the meal the mean blood glucose and plasma insulin rose in both groups, but were higher and remained elevated for longer in the tetraplegic subjects. There were no significant differences in the secretion of pancreatic glucagon, enteroglucagon, gastric inhibitory peptide (GIP) and neurotensin between the two groups. The mean basal and post-prandial levels of pancreatic polypeptide and motilin were significantly higher in the tetraplegic group. This study confirms the presence of mild glucose intolerance in tetraplegic subjects which is not explicable on the basis of abnormal insulin or pancreatic glucagon secretion or abnormal gastric emptying. In addition the results provide evidence for a sympathetic inhibitory influence on the secretion of pancreatic polypeptide and motilin in man, which is probably adrenergically-mediated.

Adult↗
PubMed1984

Relationships of human antroduodenal motility and transpyloric fluid movement: non-invasive observations with real-time ultrasound.

To study the relationships between gastric antral and proximal duodenal motor activity, and the movement of liquid across the pylorus, 10 healthy volunteers were given a test meal of dilute orange juice and bran, and events at the gastric outlet monitored by real-time ultrasound. A total of 116 complete gastric peristaltic cycles were observed and in 86% of these, associated proximal duodenal contractions were seen. Transpyloric fluid movement, as reflected by the movement of the bran particles, occurred as brief episodes during the time when the pylorus was open. Distal flow, in episodes lasting 2-4 seconds, was seen to occur in 81% of the 116 complete cycles and 75% of these episodes occurred just after the relaxation of the terminal antrum, pylorus, and proximal duodenum. The remainder occurred shortly before the terminal antral contraction. Retrograde flow, in episodes of up to 5 seconds, occurred in 78% of observed cycles with the majority occurring immediately before contraction of the terminal antrum. Our findings indicate that transpyloric fluid movement occurs in brief episodes lasting a few seconds only and that retrograde flow across the pylorus occurs in normal subjects. This pattern of fluid movement can bear no direct relationship to a steadily advancing antral peristaltic contraction, nor be wholly attributable to constant intragastric pressure.

Adult↗
PubMed1984

Dermatitis herpetiformis: diagnosis, diet and demography.

We describe a long term study of 76 patients with dermatitis herpetiformis. Unlike patients with coeliac disease, where the peak incidence was during the first and fourth decades, no dermatitis herpetiformis patients presented in the first decade; also, there was a male preponderance in dermatitis herpetiformis which contrasts with the excess of females in coeliac disease. The apparent prevalence of dermatitis herpetiformis was 11 per 100 000 in our population; approximately one fifth of that of coeliac disease. Jejunal villous atrophy was present in 78% of our dermatitis herpetiformis patients, and a single jejunal biopsy was as effective at detecting this as the multiple biopsy technique. A majority of patients were able to stop, or radically reduce their dapsone or sulphapyridine treatment after the institution of a gluten free diet. Spontaneous remission of the skin lesion occurred in only two patients not receiving a gluten free diet. Gastric parietal or thyroid antibodies were detected in 38% of patients, and three cases of thyroid disease and two cases of pernicious anaemia were detected. Lymphoma developed in two patients, one being intestinal in origin. We conclude that a gluten free diet is of therapeutic benefit in dermatitis herpetiformis and that spontaneous remission is uncommon in those not on a diet. Despite patchiness of the enteropathy, a single jejunal biopsy is quite adequate to diagnose the presence of upper intestinal villous atrophy.

Adolescent↗