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At least 289 records · Page 16Linked to original sources
PubMed1992

Mechanisms of airway protection and upper esophageal sphincter opening during belching.

The mechanisms of airway protection, upper esophageal sphincter (UES) opening, and their coordination during belching were studied with a concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of videoendoscopic recordings revealed that glottal function during gastric and esophageal belching was similar and consisted of vocal cord adduction resulting in closure of intoitus to trachea, followed by anterior-caudad movement of the glottis, followed by slitlike or triangular UES opening. When a belch episode was associated with an intragastric pressure increase, in addition to the above features, there was approximation of arytenoids to the base of the epiglottis before the UES opened. Duration of vocal cord closure during belches induced by 40 ml intraesophageal air injection was significantly longer than belches induced by 20 ml (P less than 0.01). Vocal cord closure preceded the UES opening invariably. Analysis of videofluoroscopic recordings showed that hyoid bone movement during belching had a distinctive pattern different from its movement during swallowing. UES opening started generally when the hyoid bone was pulled anteriorly. Anterior hyoid excursion of 0.78 +/- 0.1 cm during belching was significantly shorter than its excursion of 1.8 +/- 0.09 cm during swallowing (P less than 0.01). We conclude that glottal closure is an integral component of both esophageal and gastric belch reflexes that prevents aspiration of regurgitated material into the airway. Glottal closure mechanism during belching has two tiers of closure: 1) vocal cord closure and 2) aryepiglottic approximation. Glottal and UES functions are closely coordinated during belching, and finally, during belching, UES is pulled open after its relaxation.

Adult↗
PubMed1995

Mechanism and timing of nasopharyngeal closure during swallowing and belching.

The mechanism(s) of nasopharyngeal closure (NPC) and its temporal relationship with other biomechanical events during swallowing and belching were studied in seven healthy volunteers, aged 26-39 yr, by concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of the videoendoscopic recordings showed that deglutitive NPC consisted of elevation of the soft palate and adduction of the superior pharyngeal constrictor muscle. Videofluoroscopy identified only the palatal elevation clearly. During belching, however, only palatal elevation occurred. Deglutitive NPC ranged between 0.73 and 0.94 s (0.8 +/- 0.04 SE), with a tendency to be longer with larger swallowed volumes. Onset of NPC was identified earlier endoscopically than as seen fluoroscopically. Complete NPC preceded the arrival of barium bolus into the pharynx, and this pattern was seen for all volumes tested. Manometric onset of upper esophageal sphincter (UES) relaxation was seen before the onset of NPC, but the physical opening of the UES as seen fluoroscopically occurred after complete closure of the nasopharynx. We conclude the following: 1) The mechanism of NPC during swallowing and belching is different. During swallowing, NPC has two tiers of closure, palatal elevation and superior pharyngeal muscle adduction; during belching only palatal elevation occurs. 2) NPC is tightly coordinated with other biomechanical events during swallowing and belching.

Adult↗
PubMed1986

Intestinal gas formation and the use of breath measurements to monitor the influence of diet and disease.

With the development of sophisticated physiological and biochemical analytical techniques and intestinal gas analysis, both direct, e.g. Argon washout and indirect, e.g. breath measurements of H2 and labelled CO2 derived from intestinal metabolism, greater understanding of the influence of diet on intestinal gas production and the development of diagnostic procedures for identifying causes of malabsorption have evolved. The use of stable isotopes and different probe molecules will see even greater developments in this field in the years ahead.

Air↗
PubMed1992

Cigarette smoking and gastroesophageal reflux disease.

Proposed pathophysiologic mechanisms relating gastroesophageal reflux disease to cigarette smoking are reviewed. Acute experiments have shown that smokers have chronically diminished lower esophageal sphincter (LES) pressure and that periods of smoking are associated with an increased rate of reflux events. Reflux occurred primarily by the 'abdominal strain mechanism' rather than by transient LES relaxation. Smoking also caused chronically diminished salivary function that results in prolonged acid clearance time. Thus, smoking potentially increases esophageal acid exposure, both by increases in the number of reflux events, and a prolongation of the esophageal acid clearance time.

Eructation↗
PubMed2006

Behavioral treatment of chronic belching due to aerophagia in a normal adult.

Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the behavioral treatment of chronic belching due to aerophagia in an adult female. The collaborative application of single-participant design research helped identify open-mouth, diaphragmatic breathing and minimized swallowing as an effective intervention. Belching frequency was reduced from an average rate of 18 per 5-min interval during the baseline period to 3 per 5-min period after treatment. Results were maintained at an 18-month follow-up. Recommendations for the use of a brief treatment protocol with adults referred for chronic belching or other GI complaints attributed to aerophagia are discussed.

Adult↗
PubMedDate not supplied

Effect of guar gum added to the diet of patients with duodenal ulcer.

In a randomized, double-blind, controlled clinical study, the effects of 5 g of guar gum, a dietary fiber composed of galactose and mannose, or placebo added to the diet of 20 patients with duodenal ulcer for 1 wk each were examined. Ten patients derived evident benefit and five some help from guar gum, on comparing symptoms during administration of guar gum with those experienced earlier or during the placebo week, whereas four patients found that neither guar gum nor placebo had any effect (p less than 0.001). The beneficial effect was associated with increased feelings of repletion after meals. Patients with fewest symptoms benefited only slightly, or not at all, from guar gum. In one patient, guar gum abolished pain felt earlier and on placebo, but also caused severe gastric retention after meals. This patient had pyloric stenosis. In patients who were intolerant to berries, fruits, sugar, sweet rolls, and pizza these foodstuffs were better tolerated during guar gum administration. The diarrhea which occurs in some patients ingesting guar gum was avoided by giving low initial doses. In three patients unpalatability of guar gum was a minor complaint. It is concluded that guar gum is helpful to many patients with uncomplicated duodenal ulcer, but that it is harmful to those having increased gastric emptying, eg, pyloric stenosis patients, and that guar gum may exert its effects by increasing gastric emptying time.

Adult↗
PubMed1995

Methane emissions from cattle.

Increasing atmospheric concentrations of methane have led scientists to examine its sources of origin. Ruminant livestock can produce 250 to 500 L of methane per day. This level of production results in estimates of the contribution by cattle to global warming that may occur in the next 50 to 100 yr to be a little less than 2%. Many factors influence methane emissions from cattle and include the following: level of feed intake, type of carbohydrate in the diet, feed processing, addition of lipids or ionophores to the diet, and alterations in the ruminal microflora. Manipulation of these factors can reduce methane emissions from cattle. Many techniques exist to quantify methane emissions from individual or groups of animals. Enclosure techniques are precise but require trained animals and may limit animal movement. Isotopic and nonisotopic tracer techniques may also be used effectively. Prediction equations based on fermentation balance or feed characteristics have been used to estimate methane production. These equations are useful, but the assumptions and conditions that must be met for each equation limit their ability to accurately predict methane production. Methane production from groups of animals can be measured by mass balance, micrometeorological, or tracer methods. These techniques can measure methane emissions from animals in either indoor or outdoor enclosures. Use of these techniques and knowledge of the factors that impact methane production can result in the development of mitigation strategies to reduce methane losses by cattle. Implementation of these strategies should result in enhanced animal productivity and decreased contributions by cattle to the atmospheric methane budget.

Animal Feed↗
PubMed1986

Ruminal changes in monensin- and lasalocid-fed cattle grazing bloat-provocative alfalfa pasture.

Microbial and fermentation changes in the rumen in monensin- and lasalocid-fed cattle grazing bloat-provocative alfalfa pasture were studied using genetically bloat-susceptible, ruminally-cannulated adult cattle. Monensin at .66 and .99 mg/kg body weight daily reduced the severity of legume bloat by 41 and 73%, respectively. The same doses of lasalocid reduced bloat by 25 and 12%. Comparison of ruminal contents from animals before treatment with ruminal contents from antibiotic-treated animals showed no differences in pH, ammonia, soluble N, soluble carbohydrate, ethanol-precipitable slime and anaerobic bacterial counts. Monensin treatment decreased protozoal numbers and microbial activity, as evidenced by lower gas production from in vitro fermentation of ground alfalfa hay when compared to pretreatment. Lasalocid had no effect on protozoal counts and in vitro gas production. Addition of monensin or lasalocid (12 micrograms/ml) to in vitro fermentation of chopped, fresh alfalfa reduced microbial activity as evidenced by higher soluble N, lower ammonia concentration and decreased gas production. Monensin reduced the amount of ethanol-precipitable slime and protozoal numbers. Reduction in the severity of bloat when monensin was fed appears to be due to decreased protozoal numbers, which resulted in decreased gas production. Lasalocid did not reduce legume bloat because of its minimal effect on the ruminal protozoa.

Animal Feed↗
PubMed1985

Esophageal disorders in the etiology and pathophysiology of dyspepsia.

Dyspepsia may be caused by reflux esophagitis. We evaluated the symptoms of 45 patients aged 52 +/- 14 years who had a follow-up of 1 to 5 years. Endoscopy and histology demonstrated microscopic inflammation in 14, isolated mucosal defects in 12 and severe inflammation in 19 of the 45 patients. Belching was the leading symptom in patients with microscopic and severe esophagitis, heartburn in mild esophagitis. Upper abdominal pain, nausea and vomiting were present in 31%, 24% and 22% of the patients, respectively. Thus, reflux esophagitis is frequently accompanied by symptoms of dyspepsia which resemble those of other causes of dyspepsia. In contrast, disorders of gastric and intestinal motility may be associated with esophageal motor disturbances, particularly in gastric dysrhythmia, diabetic gastroenteropathy, irritable bowel syndrome, and idiopathic intestinal pseudo-obstruction. How much the esophagus contributes to the clinical symptomatology of dyspepsia awaits further elucidation.

Adult↗
PubMed1995

Two antireflux operations: floppy versus standard Nissen fundoplication.

The effects of fundic mobilization in Nissen fundoplication on belching ability, abdominal gas volume, bloating and flatus were assessed in a prospective, randomized study of 25 patients with refractory gastro-oesophageal reflux disease. Reflux was cured regardless of fundic mobilization. Subjective ability to belch was restored to preoperative in 73% of the patients with fundic mobilization, compared to 50% without. About 10% in both groups totally lost their ability to belch. Disturbance from flatus increased postoperatively slightly in both groups, but from bloating it remained the same or even diminished. The residual intra-abdominal radioactivity (median (interquartile range)) after provoked belching was preoperatively 8.9% (4.4-12.0) with and 13.2% (6.8-15.2) without fundic mobilization, compared to 36.7% (31.1-40.9) of the controls (P < 0.05). After fundoplication this residual activity was normalized in both study groups. Disturbance from postoperative bloating or flatus were not related to the ability of belching. Preoperatively symptomatic patients tended to have more complaints postoperatively. In conclusion, fundic mobilization restored belching ability slightly more effectively without compromising antireflux efficacy, but there did not seem to be any advantage regarding flatus or bloating.

Adult↗
PubMed1997

Belching, bloating, and flatulence. How to help patients who have troublesome abdominal gas.

Gaseous belching, bloating, and flatulence are common complaints. These symptoms may herald the onset of important and treatable gastrointestinal diseases or may represent functional bowel disorders. The clinical challenge is to identify a cause so as to exclude serious gastrointestinal diseases and provide symptomatic relief. Detailed history taking and examination provide the basis for appropriate testing that may provide vital clues. Among otherwise healthy patients, intolerance to lactose or other food items is a common source of symptoms. This cause can be evaluated noninvasively using the breath hydrogen test. A clear understanding of the underlying pathophysiology paves the way for a rational approach to treatment, such as withdrawal of an offending food item, enzyme supplementation, simple reassurance, or psychotherapy.

Colonic Diseases, Functional↗