Biomedical subjects
S Boesby
Publications and source records attributed to S Boesby.
Ketanserin versus placebo in carcinoid syndrome. A clinical controlled trial.
Seven patients, four women and three men, with a median age of 64 years (range, 53-74 years) were randomized to treatment with either ketanserin, 40-160 mg daily, or placebo. The study included 13 treatment periods with ketanserin and 13 with placebo. All patients had typical symptoms, with flushing as their main complaint. The diagnosis had been verified histologically. All had elevated excretion of 5-hydroxy-3-indoleacetic acid in urine. During the trial ketanserin reduced the number of flushing attacks in five patients (p less than 0.05). Diarrhoea was reduced in two patients. No side effects were observed. Ketanserin seems valuable for the symptomatic relief in the carcinoid syndrome.
Effect of domperidone on gastro-oesophageal function in normal human subjects.
The aim of the study was to investigate gastro-oesophageal function in normal volunteers after oral administration of domperidone as a single dose (20 mg). The study was designed as a double-blind cross-over investigation. Ten healthy men (aged 27-50 years; median, 30) joined the study. Oesophageal function tests were performed, starting 1.5 h after intake of domperidone or placebo. Gastro-oesophageal sphincter pressure was measured with a perfused catheter system and a continuous pull-through technique. No changes in sphincter pressure were found. Peristaltic pressure amplitude in the body of the oesophagus and the duration and velocity of peristalsis were measured after wet swallows (bolus 5 ml of water). No changes were found. Intragastric pH did not change significantly after domperidone. No effect of domperidone on the results of a standard acid-clearing test could be found. Plasma concentrations of domperidone did not correlate with any of the other variables. In conclusion, domperidone given orally in a dose that has been shown to accelerate gastric emptying does not influence gastro-oesophageal sphincter pressure or peristaltic activity in the normal oesophagus.
Effect of cimetidine and carbenoxolone on cysteamine-induced ulcers: a study of gastric mucosal histamine and histamine formation capacity in rat.
Cysteamine-induced ulcers in rat were used to study the effect of ulcer-healing agents with different modes of action on ulcer formation and mucosal histamine. Male Wistar rats were divided into 5 groups. Group I had cysteamine injection; group II had cimetidine followed by cysteamine injection; group III had carbenoxolone before cysteamine injection; group IV had carbenoxolone as group III and cimetidine and cysteamine injections; group V had saline injections (controls). In group I 20/29; group II 17/30; group III 15/29; and group IV 23/30 developed ulcers. No significant differences were found. No ulcers were found in group V. Comparison between all groups and controls showed an increase in gastric mucosal histamine and HFC. The increase in histamine was related to ulcer formation. Duodenal and oesophageal histamine did not change significantly. Gastric mucosal histamine and HFC were directly correlated.
Haemobilia and haemoperitoneum. A complication of a solitary gallstone.
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Gastric mucosal histamine, histamine formation capacity (HFC) and plasma gastrin after cysteamine administration.
Cysteamine administration is followed by stomach and duodenal ulcers in rats. We aimed to establish a time relationship between changes in gastric mucosal histamine, histamine formation capacity (HFC) and plasma gastrin after cysteamine administration. Up to 4 h after cysteamine s.c., no ulcers were found. Plasma gastrin rose after cysteamine and was higher than in controls 2h after injection. Mucosal histamine fell after 4h; no other significant changes were found in mucosal histamine and HFC. A direct correlation was found between plasma gastrin and HFC in both controls and after cysteamine. It is suggested that the changes indicate that cysteamine releases gastrin, which increases HFC and thus histamine. The fall in histamine seems to indicate utilization of histamine in acid production.
Effect of cysteamine on gastroduodenal mucosal histamine in rat.
Cysteamine administration to rats is followed by a high incidence of peptic ulceration. The aim of the present study was to investigate the effect of cysteamine on gastric and duodenal mucosal histamine and gastric mucosal histamine formation capacity. After a four hour fast, cysteamine in doses of 50, 100, 200, 300, 400, and 500 mg/kg bodyweight was injected subcutaneously to male Wistar rats; saline injection was used as control. After 24 hours the animals were killed; the stomach and duodenum were removed and examined for ulceration. Mucosal biopsies were taken for histamine studies. Gastric and duodenal ulceration tended to appear with increasing incidence with higher doses. A direct correlation was found between the dose of cysteamine and gastric mucosal histamine (p less than 0.02), and duodenal mucosal histamine (p less than 0.05). Further, a direct relationship was found between gastric mucosal histidine decarboxylase activity and the dose of cysteamine (p less than 0.05). Gastric mucosal histamine and histidine decarboxylase activity showed a direct correlation (p less than 0.001). Gastric and duodenal mucosal histamine and gastric mucosal histamine formation capacity were higher in rats with ulcers than in controls and rats without ulcers. In rat, cysteamine induces dose related changes in mucosal histamine and histidine decarboxylase activity. These changes are related to ulcer formation; histamine may be involved in the pathophysiology of cysteamine induced ulcer formation.
Gastro-oesophageal function in normal subjects after oral administration of ranitidine.
The aim of the study was to investigate gastro-oesophageal function in normal subjects after oral administration of 150 mg ranitidine as a single dose. The study was designed as a double blind crossover investigation. Ten healthy men, aged 26-49 years (median 29 years) joined the study. A series of oesophageal function tests were performed, starting 90 minutes after oral intake of ranitidine or placebo. Gastro-oesophageal sphincter pressure was measured using a perfused catheter system and a continuous pull-through technique. No changes in sphincter pressure could be demonstrated. Peristaltic amplitude in the body of the oesophagus as well as the duration and velocity of the peristalsis were measured after wet swallows (bolus 5 ml of water). We found no changes in these variables. Intragastric pH was measured and was higher after ranitidine than after placebo (p less than 0.005). Plasma ranitidine concentration did not correlate with intragastric pH. No effect of ranitidine could be demonstrated on the results of a standard acid clearing test. It is concluded that ranitidine, given orally in sufficient doses to suppress gastric acid secretion, does not influence gastro-oesophageal sphincter pressure or peristaltic activity in the oesophagus of normal subjects.
Oesophageal peristalsis in normal subjects. Influence of pH and volume during imitated gastro-oesophageal reflux.
Acid gastro-oesphageal reflux in normal human subjects is followed by oesphageal peristalsis. The aim of the present study was to investigate the influence of pH and volume during imitated reflux on oesophageal peristalsis. Fluid volumes of 2.5, 5, 10, and 15 ml (pH 1.0, 4.0, or 7.0) were instilled randomly in the lower end of the oesophagus in eight healthy subjects. Further, repeated instillations were carried out in one subject. Oesophageal pressures were measured 5, 10, and 15 cm oral to the gastro-oesophageal sphincter and in the pharynx, and pH 5 cm oral to the sphincter. Peristalsis confined to the oesophagus was found to be related to the volume of the instilled fluid, whereas pharynx-mediated peristalsis seemed to be related to the acidity of the fluid. It is concluded that peristalsis after imitated gastro-oesophageal reflux is influenced by both the volume and the acidity of the instilled fluid. Volume seems to initiate a local clearing mechanism, whereas low pH initiates pharynx-mediated peristalsis.
Results of Eder-Puestow dilatation in the management of esophageal peptic strictures.
Eder-Puestow dilatation of esophageal strictures is a safe procedure. The treatment is followed by symptomatic improvement, but the effect of dilatation on the patients' nutritional state has so far not been reported. We have reviewed 33 patients with benign esophageal stricture with special regard to the effect of dilatation on body weight. A total of 152 dilatations was carried out. All patients had dysphagia, 32 patients had heartburn and 20 had regurgitation. Hiatus hernia was present in 29 patients. Thirteen patients had antireflux surgery; 10 operations were performed before, and four during the dilatation period. One patient required no further dilatations after operation. Dilators greater than 35 FG were passed in 85% of the dilatations. No serious complications occurred. Patients were followed for up to 5 yr (mean follow-up: 27 months). The mean interval between dilatations was 7 months. Body weight was recorded before and one month after dilatation on 78 occasions. There was a significant overall weight increase of 0.78 kg 1 month after dilatation. The mean weight increase was greater after the first dilatation (1.06 kg) than after subsequent ones (0.6 kg). We found that Eder-Puestow dilatation in patients with benign esophageal stricture led to symptomatic improvement and was followed by an increase in body weight.
Spontaneous peristaltic activity in the oesophagus after imitated acid gastro-oesophageal reflux. A study in normal subjects.
Prolonged measurements of pH and peristalsis in the oesophagus do not enable quantitation of the reflux material. Eight healthy subjects underwent 12-h continuous pH and pressure recording in the oesophagus and, subsequently, recording of pH and spontaneous peristaltic activity after instillation of 0.1 N HCl. Volumes of 2.5, 5, 10, and 15 ml were instilled in the lower end of the oesophagus in randomized order. No relationship between volume and peristaltic activity could be demonstrated. A direct relationship between the change in pH after instillation and the peristaltic activity was demonstrated (r = 0.8052; p less than 0.001). The clearing efficiency was 0.3 pH units per peristaltic contraction. A similar relationship could be found between the change of pH during a spontaneous reflux episode and the following peristaltic activity (r = 0.5993; p less than 0.002). The clearing efficiency was 0.37 pH units per peristaltic contraction. It is concluded that low pH is the determining factor for eliciting oesophageal peristalsis.
Failures after surgical treatment of patients with hiatus hernia and reflux symptoms. A pathophysiological study.
Patients treated surgically for hiatus hernia and reflux symptoms may still have reflux symptoms at follow-up examination, even though relapse of the hernia cannot be demonstrated on X ray. In an attempt to explain the causes of surgical failures, a group of 13 patients with persisting reflux symptoms after a modified Belsey MK IV repair for sliding hiatus hernia and reflux symptoms underwent intraluminal oesophageal manometry, acid clearing test, and 12-h continuous pH recording in the lower part of the oesophagus. None of the patients had radiological relapse of the hernia. The results of these tests, pre- and post-operatively, were compared with the results obtained in a group of successfully treated patients and with normal subjects. No differences of clinical importance could be demonstrated between the two patient groups with regard to the preoperative test results. Postoperatively, the 'failures' had low sphincter pressure, prolonged acid clearing, and pathological acid reflux. The tests seem of little value in the prediction of symptomatic failures, but do to some extent explain the symptoms of surgical 'failures'.
Acid-sensitive oesophagus.
The aim of the present study was to investigate whether any differences could be demonstrated between patients with reflux symptoms and an acid-sensitive oesophagus (group I) (positive acid perfusion test) and a matched control group of patients with reflux symptoms and an acid-insensitive oesophagus (group II) (negative acid perfusion test) with respect to other oesophageal function tests (manometry, acid clearing and acid reflux (12-h continuous pH recording)). The two groups consisted of 47 and 46 patients, respectively. No differences were demonstrated between the two groups with respect to gastro-oesophageal sphincter pressure, acid-clearing ability, and acid reflux (irrespective of the criterion used for reflux). From the study it may be concluded that not only hydrochloric acid but other components of the reflux material may be responsible for producing symptoms of gastro-oesophageal reflux.
Intraluminal oesophageal manometry. Influence of pressure probe diameter.
The influence of the pressure-probe diameter on the values of gastro-oesophageal sphincter pressure, pharyngo-oesophageal sphincter pressure, and peak peristaltic pressure in the oesophageal body was investigated in eight healthy subjects. A low-compliance perfused pressure-measuring unit was used for the recordings. Three different probes were made with external diameters of 1.5 mm, 3.5 mm, and 4.5 mm. Sphincter pressures were measured in the resting state, and peristaltic pressures were measured during wet swallows. The pressure in the sphincter regions was found to depend on the diameter of the probe, whereas the peak peristaltic pressure amplitudes were independent of the probes used. The need for standardization of manometry equipment is emphasized.
[Surgical treatment of esophageal and cardial cancer].
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Gastro-oesophageal acid reflux and oesophageal peristalsis. Method for 12-hour simultaneous recording of pH and peristaltic activity in the oesophagus.
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Effect of metoclopramide on oesophageal peristalsis and gastro-oesophageal sphincter pressure. A study in normal subjects.
The aim of the present study was to measure the amplitude, the duration, and the velocity of the peristaltic pressure wave in the lower part of the oesophagus in the basal state and at different time intervals after oral intake of 10 and 20 mg metoclopramide. In addition, gastro-oesophageal sphincter pressure was measured in the basal state and 90 min after the intake of metoclopramide. The pressure studies were carried out in eight healthy subjects, using a pressure probe consisting of two open-tip polyethylene catheters that were fed by a capillary tubular system and connected to external pressure transducers. Sphincter pressure was measured (intermittent withdrawal), and the probe was positioned with the distal opening 5 cm orally to the sphincter. Dry and wet (bolus, 5 ml of water) swallows were made in randomized order in the basal state and at the time intervals after the intake of metoclopramide. Finally, the sphincter pressure measurement was repeated. No differences were seen with regard to the peristaltic activity: amplitude, duration, or velocity. Sphincter pressure rose from 12 to 19 mmHg after 10 mg (p less than 0.05) and from 13 to 20 mmHg after 20 mg metoclopramide (p less than 0.05). There were no significant differences between basal values and the response to 10 or 20 mg metoclopramide.