Search PubMed⌕ Search

Biomedical subjects

R M Valori

Publications and source records attributed to R M Valori.

18 recordsLinked to original sources
PubMed2001

The significance of cagA(+) Helicobacter pylori in reflux oesophagitis.

BACKGROUND: Helicobacter pylori is a gastroduodenal pathogen associated with ulceration, dyspepsia, and adenocarcinoma. Recent preliminary studies have suggested that H pylori may be protective for oesophageal adenocarcinoma. In addition, strains of H pylori identified by the presence of the cytotoxin associated gene A (cagA) are shown to have a significant inverse association with oesophageal adenocarcinoma. Given that cagA(+) H pylori may protect against oesophageal carcinoma, these strains may be protective for oesophagitis, a precursor of oesophageal carcinoma. AIMS: The aim of this study was to investigate the association between cagA(+) H pylori and endoscopically proved oesophagitis. PATIENTS: The study group included 1486 patients attending for routine upper gastrointestinal tract endoscopy. METHODS: At endoscopy the oesophagus was assessed for evidence of reflux disease and graded according to standard protocols. Culture and histology of gastric biopsy specimens determined H pylori status. The prevalence of cagA was identified by an antibody specific ELISA (Viva Diagnostika, Germany). RESULTS: H pylori was present in 663/1485 (45%) patients and in 120/312 (38%) patients with oesophagitis. Anti-CagA antibody was found in 499/640 (78%) H pylori positive patients. Similarly, anti-CagA antibody was found in 422/521 (81%) patients with a normal oesophagus and in 42/60 (70%) with mild, 24/35 (69%) with moderate, and 11/24 (46%) with severe oesophagitis. The risk of severe oesophagitis was significantly decreased for patients infected with cagA(+) H pylori after correction for confounding variables (odds ratio 0.57, 95% confidence interval 0.41-0.80; p=0.001). CONCLUSIONS: These results suggest that infection by cagA(+) H pylori may be protective for oesophageal disease.

Adult↗
PubMed2001

Reducing community dyspepsia drug costs: a controlled trial.

BACKGROUND: Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs. AIM: To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS: A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS: Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8-69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of pound1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION: A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy.

Aged↗
PubMed1999

A comparison of six commercial kits for Helicobacter pylori detection.

The British Society of Gastroenterologists suggests that dyspeptic patients under 45 years of age should be screened serologically for Helicobacter pylori infection, to reduce endoscopy workload. We have compared the sensitivity, specificity, and predictive value of six commercial serological kits intended for pre-endoscopy screening for H. pylori with histopathology and culture in 82 dyspeptic patients, 35 of whom were H. pylori positive. The kits' sensitivities were as follows: Bio-Rad GAP 100%, Helico-G 100%, Premier 97%, and Pyloriset EIA-G 94%. Poor specificity of the ELISA kits--Bio-Rad GAP 67%, Helico-G 67%, Premier 85%, and Pyloriset EIA-G 76%--was due to previous treated or cleared H. pylori infection. Allowing for previously documented H. pylori infection or peptic ulcer improved specificity--Bio-Rad GAP 84%, Helico-G 84%, Premier 100%, and Pyloriset EIA-G 90%. The Pyloriset Dry latex kit had a higher specificity (86%) but a lower sensitivity (75%) than the Oxoid latex kit (specificity 70%, sensitivity 94%). The qualitative Premier Launch kit had the best overall results (and was the easiest ELISA to perform). Reliable serological diagnosis of H. pylori is now suitable for screening dyspeptic patients.

Adult↗
PubMed1997

Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia.

AIMS: To test the hypothesis that gastric cancer presenting with uncomplicated dyspepsia is rare below the age of 55. PATIENTS AND METHODS: The area studied was the postcode defined catchment area of a district general hospital (Gloucestershire Royal) serving a population of 280,500. An open access endoscopy service has been available in this district for more than 17 years. All cases of gastric cancer during a seven year period (1986-92) were drawn from the local pathology database. The database of the neighbouring hospital and the South West Cancer Registry were searched for missed cases from the postcoded area. Hospital and general practitioner records were retrospectively reviewed with respect to duration of symptoms, and previous consultation and investigation for dyspepsia; and alarming symptoms and signs suggestive of underlying malignancy (unexplained recent weight loss, dysphagia, haematemesis or melaena, anaemia, previous gastric surgery, palpable mass, and perforation). RESULTS: Twenty five of 319 cases of gastric cancer detected during the seven year period were aged less than 55. Twenty four of these 25 patients presented with one or more suspicious symptoms or signs. Only one patient (4%) aged less than 55 presented with uncomplicated dyspepsia. In two patients there was a delay in diagnosis of more than six months after first presenting to the general practitioner. Both these patients had significant symptoms at presentation. CONCLUSION: Gastric cancer is rare below the of 55 (7.8% of all cases) and, even in the presence of established open access endoscopy, presents with suspicious symptoms or signs in 96% of cases. The age limit for screening uncomplicated dyspepsia can be raised safely to 55.

Age Distribution↗
PubMed1996

Measuring the meaning of life for patients with incurable cancer: the life evaluation questionnaire (LEQ).

Clinical observation, systematic research and popular anecdote indicate that, when confronted by death, people change the criteria by which they evaluate their lives. Questionnaires used routinely to assess quality of life in people with poor-prognosis cancer tend to be symptom-based and do not assess factors which become important when confronted by fatal illness, such as the meaning of life and the degree to which life has been enriched by the illness. To develop a questionnaire which would be sensitive to these areas, patients with incurable cancer and carers of such patients were interviewed in depth. Responses were reviewed by a panel of patients, clinicians and carers and formed into an inventory which was completed by 200 similar patients. Principal components analysis identified five dimensions: clearer perception of the meaning of life; freedom versus restriction of life; resentment of the illness; contentment with past and present life; past and present social integration. Only the most symptom-oriented scales (freedom, resentment) correlated with the Rotterdam Symptom Checklist. Scale scores showed that younger patients were more resentful of their illness, but also gained a clearer perception of the meaning of life. This questionnaire can evaluate psychological needs of people with incurable cancer which are neglected by existing instruments.

Age Factors↗
PubMed1996

Is saliva serology useful for the diagnosis of Helicobacter pylori?

BACKGROUND: The Cortecs Diagnostics Helisal Assay test is a quantitative immunoassay for salivary IgG antibodies against Helicobacter pylori. Saliva can be obtained simply with the kit in the general practitioners surgery. AIMS: To compare the new saliva serological test for H pylori with 'gold standard' evidence of H pylori infection (antral biopsy specimens for histology, culture, and urease test) and a new serum serological test. PATIENTS: Eighty six unselected dyspeptic patients undergoing endoscopy. METHODS: Each patient provided saliva and serum before endoscopy for H pylori serology, which was compared against 'gold standard' evidence of infection. RESULTS: Thirty two patients were H pylori positive by the 'gold standard' tests. At a cut off value of 0.15 EU/ml the saliva test had a sensitivity of 88% and a specificity of 71%, with a negative predictive value of 90%. If patients who were taking omeprazole or had recent antibiotics are excluded, the sensitivity is unchanged but the specificity increases to 79%. The serum test had a similar sensitivity of 85% but better specificity of 78%. CONCLUSION: Serum testing remains the best serological test for H pylori in the hospital setting. Saliva testing may have a role in epidemiological studies and in screening dyspeptic patients in general practice, especially in children in whom venesection is more difficult.

Antibodies, Bacterial↗
PubMed1991

Power of oesophageal peristalsis can be controlled voluntarily.

The hypothesis that oesophageal peristalsis can be modified voluntarily was explored. Six healthy male volunteers and eight female patients with angina like chest pain underwent oesophageal manometry. Each was asked to take a series of swallows, and to vary their size, in random order, by taking either a big gulp or a little swallow. None of the subjects experienced difficulty in doing so. In both groups the amplitude of oesophageal contractions were significantly greater after big gulps than little swallows (p less than 0.01) and this was true for wet (82.0 v 68.9 mmHg) and dry swallows (52.3 v 43.3 mmHg). For the patients' wet swallows the mean values were 73.0 and 56.0 mmHg. Thus, the amplitude of oesophageal peristalsis can be controlled voluntarily. This effect may account for some of the within subject variation in the amplitude of oesophageal contractions. During oesophageal manometry subjects should be encouraged to standardise the size of their swallows whenever possible. Patients with symptoms related to abnormal oesophageal peristalsis such as dysphagia, heartburn, and chest pain may benefit from biofeedback training.

Adult↗
PubMed1989

Hospital patients who wear tinted spectacles--physical sign of psychoneurosis: a controlled study.

The wearing of tinted spectacles by patients is often said to be a marker of psychopathology but without supportive evidence. To investigate the validity of this observation the personalities of 20 medical hospital patients who wore tinted spectacles were compared, by means of a self-report inventory, with those of 20 controls who were age, sex, and diagnosis matched. There was a significant increase in the level of psychopathology in the tinted spectacle group, both in terms of an index of global psychological distress; the General Severity Index, and nine primary symptom dimensions measured by the inventory.

Adult↗
PubMed1986

Effects of different types of stress and of "prokinetic" drugs on the control of the fasting motor complex in humans.

Upper small bowel motility was continuously recorded for 36-48 h in 37 healthy ambulant volunteers using twin pressure-sensitive radiotelemetric capsules tethered in the small bowel. Each study began with a 24-h period that was free of applied stress. The second 24-h period included 7 h of intermittent psychological stress during the day and brief episodes of acute stress during the following night, except in the members of a control group to whom no stress was applied. Stress responses were assessed from cardiovascular status and self-reported visual analogue scales. Applied stress during the second day significantly inhibited the incidence of fasting migrating motor complexes compared with the first day; when no stress was applied there was no reduction in migrating motor complexes. Nocturnal stress was less effective in the inhibition of migrating motor complexes. All the stressors induced positive cardiovascular and subjective stress responses. The stress-induced inhibition of migrating motor complexes was reversed by oral metoclopramide; however, the drug did not reverse the cardiovascular or subjective response to stress. In contrast, domperidone did not inhibit the gastrointestinal effects of stress. Neither drug appeared to influence small bowel motility under normal conditions.

Adult↗
PubMed1986

Comparison of methodologies for the measurement of antroduodenal motor activity in the dog.

We have compared the abilities of intraluminal strain gauges and manometry to record motor activity from the antrum and duodenum of the anesthetized dog. Responses to intraarterial carbachol, vagal stimulation, and field stimulation recorded by these devices were compared to those registered by strain gauges sewn onto the overlying serosa. In the antrum, the perfused tube (PT) recorded 98% and 97% of field- and vagal-stimulated phasic contractions, respectively, compared with 83% and 90% (p less than 0.005) registered by the intraluminal tube-mounted strain gauges (TSGs). In contrast, in the duodenum there was no difference between the accuracy of these devices in recording phasic activity induced by field stimulation (PT 90% and TSG 87%). Similarly, there was no difference between the abilities of these devices to record tonic contraction induced by carbachol in the antrum (PT 87% and TSG 90%) or duodenum (PT 82% and TSG 87%). However, TSGs misrepresented the configuration of phasic or tonic contractions, producing bifid, negative, or biphasic contractions substantially more frequently than did PT (p less than 0.005). These results illustrate that the accuracy of these two commonly used techniques may be influenced by anatomic factors as well as by the type of contraction recorded.

Animals↗
PubMed1983

Receiving, decoding and noise limiting systems for a new pressure-sensitive ingestible radio telemetric capsule.

A new pressure-sensitive radiotelemetric capsule for recording intraluminal pressures within the human gastrointestinal tract has been developed; this capsule employs a pulsed mode of operation. Data recording as a pulse train greatly simplifies problems encountered hitherto in this field, but has produced the requirement for a decoding system which, on tape replay, will reproduce the original pressure change. A system is described here which, in addition to producing an analogue signal from the recorded pulse train, will also eliminate artefacts due to either spurious radio signals or variations in magnetic tape transport speed; it also provides a sensitive and accurate indication of transient signal loss.

Capsules↗
PubMedDate not supplied

Non-radiological investigation of pancreatic disease.

Pancreatic exocrine insufficiency is investigated by long established techniques: either by duodenal intubation studies, or by indirect functional methods. Serum markers and specific gastrointestinal hormones are available for the diagnosis of pancreatic inflammation, carcinoma, and rare pancreatic endocrine tumours. The clinical utility of these diagnostic tests is discussed in this article.

Amylases↗