Biomedical subjects

R E Clouse

Publications and source records attributed to R E Clouse.

At least 91 records · Page 5Linked to original sources

PubMed1990

Pill-induced esophageal strictures: clinical features and risk factors for development.

Clinical data from five subjects with pill-induced esophageal strictures and from the English-language literature on pill-induced esophageal damage were reviewed to determine risk factors for stricture development and to characterize this complication. Including our five cases, 195 patients with pill-induced damage and 39 patients with pill-induced strictures have been reported to date. Seventy-eight percent of the strictures were located in the proximal or mid-esophagus. Potassium chloride or quinidine preparations were incriminated in 60% of cases and were more likely to produce stricture than other medications commonly associated with esophageal damage (e.g., tetracycline). Older age, male gender, left atrial enlargement, ingestion of sustained-release formulations, and prior esophageal structural abnormality were all more commonly present in the subset with strictures (p less than 0.05 for each), even after appropriately controlling for medication. A logistic regression analysis revealed that older age and ingestion of sustained-release formulations were the most significant independent factors associated with stricture development (p less than 0.0001 for each). These findings indicate that stricture formation from pill-induced esophageal damage is dependent upon host-related factors as well as the caustic nature of the pill.

Age Factors↗

PubMed1990

The relation of ulcerative colitis to psychiatric factors: a review of findings and methods.

The authors reviewed all known English-language literature on the association between psychiatric factors and ulcerative colitis to ascertain the evidence for such an association and evaluate the methods used in these studies. Most of the 138 studies contained serious flaws in research design, such as lack of control subjects, unspecified manner of data collection, and absence of diagnostic criteria. Analysis revealed that methodological flaws were significantly related to the finding of a positive association between psychiatric factors and ulcerative colitis. Seven studies represented solid systematic investigation, and all seven failed to find such an association.

Adult↗

PubMed1990

Relationship of psychiatric illness to impotence in men with diabetes.

Clinical data from 37 adult males with diabetes mellitus (insulin dependent, n = 22; non-insulin dependent, n = 15) who had undergone psychiatric diagnosis and peripheral nerve conduction studies were reviewed to determine whether psychiatric illness was significantly related to complaints of sexual dysfunction. Main-effects testing revealed that impotence was associated with both neuropathy (P less than 0.01) and psychiatric illness (P less than 0.001). Logistic regression analysis was then used to determine the independent relationships of these two variables with impotence. After controlling for the effects of neuropathy, psychiatric illness (generalized anxiety disorder and depression) remained significantly associated with sexual dysfunction (P less than 0.01). These data allow for the hypothesis that psychiatric illness may be an important contributor to impotence in diabetic men, as it is in nondiabetic men, even when neuropathic complications of the disease are present.

Adult↗

PubMed1989

Accuracy of abbreviated manometry in detecting esophageal motility abnormalities.

We determined whether an abbreviated motility study that is commonly employed in clinical esophageal manometrics was as accurate as an extended manometric evaluation in detecting abnormalities in the esophageal body. One hundred patients underwent both abbreviated (stationary catheter, 10 wet swallows) and extended manometries (stepwise catheter withdrawal, 62 +/- 1 wet swallows). Classification by the two techniques was identical in 83 patients. Abbreviated manometry failed to recognize nine abnormal motility patterns. The abbreviated method was least accurate in the identification of intermittent and focal motility abnormalities (sensitivity = 0.50). Misclassifications were related to catheter position and not solely to differences in the total number of swallows. Of the individual wave parameters measured by each method, detection of multipeaked contraction waves was the most discrepant (R = 0.59). These findings indicate that abbreviated esophageal manometry is reasonably well correlated with a more extended method in detecting esophageal motility disorders and, because of its relative simplicity, appears appropriate for use in clinical practice. Errors related to stationary recording port positions may interfere with the overall accuracy of the abbreviated technique.

Deglutition↗

PubMed1989

Perineural and intraneural inflammatory infiltrates in the intestines of patients with systemic connective-tissue disease.

Intestinal biopsy specimens were examined from patients with connective-tissue diseases who had symptoms that were thought to represent early gastrointestinal involvement by the disease. Specimens from the small and large intestines contained eosinophils and mast cells, in close association with Meissner's and Auerbach's plexuses. The intimate association of mast cells and eosinophils in various stages of activation and degranulation with nerves was confirmed by electron microscopy. These cells, particularly the eosinophil with its neurotoxic potential, in close proximity to the intramural nerves may contribute to the recognized motor disorders in patients with scleroderma and similar connective-tissue diseases.

Adult↗

PubMed1989

Gastrointestinal symptoms in diabetic patients: lack of association with neuropathy.

Symptoms suggesting gastrointestinal motor dysfunction were determined in 114 diabetic subjects (type 1 and type 2) to see if they were most significantly related to diabetic neuropathy or to psychiatric illness. Presence of neuropathy was established using peripheral nerve conduction studies and objective tests of autonomic function. Affective and anxiety disorders were determined with a structured interview and standard diagnostic criteria. Symptoms were reported by the subsets of subjects with and without neuropathy, ranging in prevalence from 8% to 35%. Log-linear analysis indicated that each group of symptoms (upper gastrointestinal symptoms, altered bowel habits, and abdominal discomforts) was more significantly associated with psychiatric illness (p less than 0.01 for each) than with peripheral neuropathy (p greater than 0.2 for each). In this study, where anxiety and depression were prevalent, no symptom group was significantly associated with autonomic neuropathy once the effects of psychiatric illness on the analysis were taken into account (p greater than 0.2 for each). These findings suggest that gastrointestinal symptoms occurring in diabetic patients are poorly related to neuropathic complications and may often represent gastrointestinal syndromes commonly associated with psychiatric illness.

Adult↗

PubMed1989

Mucosal thickening adjacent to gastric malignancy: association with epidermal growth factor.

A high false negative rate from endoscopic forceps biopsy is well-known in gastric carcinoma. The initial aim of the present study was to determine whether possible thickening of adjacent nontumorous mucosa by nonspecific or specific trophic factors could contribute to this observation; 167 gastrectomy specimens (77 carcinomas, 14 lymphomas, 76 gastric ulcers) were examined and mucosal thickness measured. Mean thickness of uninvolved mucosa near carcinoma (1.4 +/- 0.08 mm, mean +/- SEM) and near lymphoma (1.5 +/- 0.1 mm) was in each case significantly greater than mucosal thickness near ulcer (1.14 +/- 0.05 mm) or at a distance in the same specimen (P less than 0.01 for each comparison). A subset of specimens representing 20% of carcinomas, showed marked mucosal thickening (2.01 +/- 0.05 mm) above the control mean. Immunohistochemical evaluation for intratumoral epidermal growth factor content (EGF) correlated with mucosal thickness in all groups examined (R = 0.67). Immunostaining for EGF receptor showed similar patterns of expression to those of EGF. EGF and EGF receptor contents were also correlated with depth of invasion when possible. In conclusion, the mucosal thickening adjacent to gastric malignancy may well contribute to the insensitivity of endoscopic forceps biopsy. More importantly, the higher tumor EGF and EGF-receptor contents seen in these lesions may prove to be a useful marker of biologic behavior and predictor of prognosis in these tumors.

Biomarkers, Tumor↗

PubMed1988

Depression and the reporting of diabetes symptoms.

The relationship of diabetes symptoms to current mood and general metabolic control was studied. Symptoms commonly associated with poorly controlled diabetes (e.g., thirst, polyuria, weight loss) were measured in 114 patients with diabetes mellitus (type 1 = 57, type 2 = 57). Scores for these individual symptoms were correlated with glycosylated hemoglobin (HbA1) and depression as measured by the Beck Depression Inventory (BDI). HbA1 was poorly correlated (r less than 0.2) with nine of the eleven symptoms and made a significant independent contribution only to the reporting of polyuria (p = 0.04). In contrast, depression was moderately correlated with nine symptoms and had a significant effect on the reporting of two of three hyperglycemic symptoms, five of six hypoglycemic symptoms, and both nonspecific symptoms of poor control (p less than 0.05 for each). We conclude that many reported symptoms often attributed to diabetes are more related to depressive mood than to a conventional clinical measure of blood glucose control. Diabetes symptoms may be unreliable indicators of poor metabolic control when features suggestive of depression are present.

Adult↗

PubMed1988

Depression in adults with diabetes. Results of 5-yr follow-up study.

Little is known about the course of affective illnesses in patients with diabetes or in other physically ill patients. We report a follow-up study of 37 diabetic adults with major depression (according to DSM-III), 28 (76%) of whom were located and reinterviewed 5 yr after the index evaluations. At follow-up, 18 (64%) of the 28 depressed patients had experienced an episode of major depression within the previous 12 mo; 12 of these patients satisfied diagnostic criteria for depression at the time of reevaluation. The 18 patients with recurrent depression had a mean of 4.2 depressive episodes over the 5-yr period. An additional 4 patients met criteria for current dysthymic disorder, bringing the number to 22 (79%) of the total patients ill with affective disorder during the 5-yr follow-up period. In contrast, the likelihood of symptomatic affective disorder was only 10% over the same follow-up period in a comparison group of diabetic subjects without depression at the index evaluation (P less than .001). Occurrence of depressive episodes appeared independent of diabetes complications because both the depressed and comparison groups had similar rates of neuropathy, retinopathy, and nephropathy. These data suggest that the natural course of depression in diabetes is malevolent, possibly more so than depression in the medically well.

Adult↗

PubMed1988

Anxiety and gastrointestinal illness.

The substrate for modulation of the gastrointestinal tract by anxiety and other psychiatric disorders is provided by our knowledge of central nervous system control mechanisms of gastrointestinal functions. Recent experiments that examine the gastrointestinal response to acute stress amplify prior work and confirm that central stimuli, viz. emotional stress, can produce measurable gastrointestinal changes. These changes are not uniformly predictable on the basis of knowledge of the control mechanisms, alone. Acute stress experiments cannot be directly extrapolated to anxiety disorders and their relationship to gastrointestinal illness; careful physiologic studies in these more chronic disorders are sparse. Anxiety disorders and other psychiatric illnesses are particularly common in patients with the functional bowel diseases. This heterogeneous group of gastrointestinal diseases remains fertile territory for examining emotion-gut relationship on a biologic level.

Anxiety Disorders↗

PubMed1987

Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial.

Twenty-nine patients with esophageal symptoms and contraction abnormalities of the esophageal body completed a 6-wk, double-blind, placebo-controlled trial of trazodone (100-150 mg/day). Measures of esophageal and psychologic symptoms were completed at entry and at each follow-up visit. Esophageal manometry was repeated at the termination of the trial. Upon completion of the treatment, patients receiving trazodone (n = 15) reported a significantly greater global improvement than those receiving placebo (n = 14; p = 0.02). Although a variable clinical response was observed, the trazodone group had less residual distress over esophageal symptoms compared with the placebo group (59% +/- 9% vs. 108% +/- 19%, p = 0.03). Manometric changes observed during the course of the trial were not influenced by treatment nor by clinical response. Remarkable reductions in ratings of chest pain were reported by both treatment groups, emphasizing the importance of controlled trials when studying this patient population. We conclude that low-dose trazodone therapy can be of benefit in the management of symptomatic patients with esophageal contraction abnormalities. In addition, our findings support recent observations that manometric abnormalities characterizing this patient group may not be solely responsible for symptoms.

Adolescent↗

PubMed1987

Esophageal physiology: normal and abnormal motor function.

The physiological controls of esophageal motor function are complex. Despite the relatively simple-appearing contraction waves of the esophagus compared with other gastrointestinal organs, the fascinating interaction of the CNS with the nerve cells in the esophagus itself has delayed complete understanding of esophageal peristalsis. The list of recognized modulating influences, particularly on the smooth muscle components, continues to expand. Although there are many studies concerning normal esophageal motor function, the pathophysiological mechanisms of motor dysfunction in many of the common motility disorders remain obscure.

Central Nervous System Diseases↗

PubMed1986

Gastrointestinal symptoms of patients with esophageal contraction abnormalities.

Nonesophageal, gastrointestinal symptoms were sought from consecutive patients referred for esophageal manometry in order to determine the prevalence of such symptoms in relation to manometric diagnosis. Reports by 103 patients with esophageal contraction abnormalities, a cluster of manometric findings which includes the "nutcracker esophagus" and diffuse esophageal spasm, were compared to those by patients with the achalasia pattern (21 patients) and scleroderma esophagus (19 patients). A history of persistent (greater than 3 months) bowel habit abnormality requiring medical attention was reported by 19% of those with contraction abnormalities and 26% of those with scleroderma esophagus but by no patient with achalasia (P less than 0.05 for both compared to achalasia). Patients with contraction abnormalities had complained to physicians of more gastrointestinal symptoms and had more often been diagnosed as having the irritable bowel syndrome than those with achalasia. We conclude that, with regard to gastrointestinal symptoms, patients with esophageal contraction abnormalities more closely resemble patients with a motility disorder which has the potential for diffuse symptomatic gastrointestinal involvement (scleroderma) than those with a motility disorder restricted to the esophagus (achalasia). These findings add support to the argument that functional gastrointestinal syndromes may be representative of diffuse neuromuscular derangement in the gastrointestinal tract.

Adult↗

PubMed1986

Hiatus hernia and esophageal contraction abnormalities.

The relationship of hiatus hernia to esophageal motility pattern was examined in patients referred for evaluation of esophageal symptoms. Results from standard esophageal motility studies were compared with findings on barium radiography of the upper gastrointestinal tract. Of 169 patients without radiographic evidence of esophagitis, 53 (31 percent) had normal motility of the esophageal body, whereas 116 (69 percent) demonstrated esophageal contraction abnormalities, a classification that includes the pattern of diffuse esophageal spasm at the severest extreme. Hiatus hernia was significantly more common in those with contraction abnormalities (25 percent) than in those with normal patterns (8 percent) (p = 0.01). Hiatus hernia increased in prevalence with increasing severity of contraction abnormalities, such that hiatus hernia was present in nearly half of patients with the pattern typifying diffuse esophageal spasm. Thus, hiatus hernia and esophageal contraction abnormalities are associated once other associations with hiatus hernia (e.g., esophagitis and scleroderma) have been excluded. These findings may help explain the recognized relationship of esophageal symptoms to hiatus hernia in patients without significant gastroesophageal reflux.

Esophageal Diseases↗

PubMed1986

Correlation of esophageal motility abnormalities with neuropsychiatric status in diabetics.

Esophageal motility abnormalities, neuropathy, and psychiatric illness were independently determined in 30 patients with type 1 or type 2 diabetes mellitus to clarify the interrelationship of these findings in diabetics. Fifteen patients (50%) were found to have esophageal contraction abnormalities, a specific cluster of manometric derangements. Diagnoses of depression, dysthymia, or generalized anxiety disorder were made in 87% of those with contraction abnormalities but in only 21% of the patients with normal manometric patterns (p = 0.002). Log-linear analysis confirmed that this association was independent of neuropathy effects (p less than 0.001). Several changes in individual manometric parameters related to neuropathy alone were appreciated only when the patients with psychiatric illness were excluded from the analysis. These data indicate that some of the esophageal neuromuscular dysfunction observed in diabetics is independent of neuropathy yet is strongly associated with psychiatric disorder. Such findings help to clarify the discrepant relationship of motility disturbances to neuropathy noted in prior reports. We conclude that consideration should be given to psychiatric illness as well as to neuropathy when interpreting manometric features suggestive of autonomic dysfunction in diabetic patients.

Adult↗

PubMed1986

Psychiatric illness in diabetes mellitus. Relationship to symptoms and glucose control.

The lifetime prevalence of psychiatric illness was determined in 114 patients with diabetes mellitus (types I and II) who were selected randomly from patients undergoing diabetes evaluations at a large medical center. The relationship of psychiatric illness to diabetic control was studied using glycosylated hemoglobin (HbA1) and self-report measures of metabolic symptoms. Seventy-one percent of the patients had a lifetime history of at least one criteria-defined psychiatric illness; affective and anxiety disorders were the most common diagnoses. A significant difference (p = .02) in mean glycosylated hemoglobin levels was observed comparing patients with a recent psychiatric illness (mean = 10.8%) to those never psychiatrically ill (mean = 9.6%). These psychiatrically ill patients also reported more symptoms of poor metabolic control and more distress associated with these symptoms than did patients never psychiatrically ill (p less than .0001 for both). The overall report of diabetes symptoms was unrelated to HbA1 (p = .25) and was influenced primarily by the recent presence of psychiatric disorder (p less than .0001). We conclude that emotional illness is associated with both poorer metabolic control and the increased report of clinical symptoms of diabetes.

Adult↗

PubMed1986

Use of the Diagnostic Interview Schedule in patients with diabetes mellitus.

In routine clinical practice and in research interviews like the Diagnostic Interview Schedule (DIS), symptoms attributed to physical illness are excluded from contributing positively toward psychiatric diagnoses. The maximal rate of underdiagnosis which results from this diagnostic rule was determined in 114 patients with diabetes mellitus. When symptoms attributed to diabetes (total = 296, mean = 2.6 per patient) were discounted, 256 diagnoses were made. Eighteen additional diagnoses (a 6.7% increase) were appreciated when these excluded symptoms were considered as psychiatrically significant; however, only two of these new diagnoses were given to patients previously without a psychiatric diagnosis. The authors concluded that the DIS is sensitive in its detection of psychiatric illness in diabetes and perhaps other physical illnesses as well.

Adult↗

PubMed1986

The relationship of psychiatric disorder to gastrointestinal illness.

The definition of psychiatric illness by specific criteria has provided a new method for examining the relationship of certain gastrointestinal (GI) diseases to psychiatric disorder. Using this technique, researchers have found that rates of psychiatric diagnosis in patients with certain functional GI syndromes and Crohn's disease exceed those found in the general population and in comparably ill control groups. Timing of onset of both sets of symptoms (GI and psychiatric) suggests that the functional syndromes generally follow or coincide with the onset of psychiatric symptoms, whereas the onset of Crohn's disease is more independent. A relationship of psychiatric illness to other GI disease is suspected based on results of psychometric testing or on less structured attempts at psychiatric diagnosis employed in earlier studies. Psychiatric diagnosis by criteria definition may play an important role in more clearly understanding any relationship of psychiatric disorder to somatic GI disease as the applications of this scientific technique are expanded.

Adult↗