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At least 91 records · Page 5Linked to original sources
PubMed1998

Cisapride 20 mg b.i.d. provides symptomatic relief of heartburn and related symptoms of chronic mild to moderate gastroesophageal reflux disease. CIS-USA-52 Investigator Group.

OBJECTIVE: We evaluated the efficacy and safety of a twice-daily dosage regimen of cisapride 20 mg in relieving the symptoms of mild-moderate gastroesophageal reflux disease (GERD) in patients with moderate intensity heartburn and no history of erosive esophagitis. METHODS: After a 2-wk, single-blind, placebo run-in period, 398 patients who continued to experience moderate intensity heartburn were randomized to either placebo (n = 196) or cisapride 20 mg (n = 202) twice daily for 4 wk. RESULTS: Compared with placebo, cisapride significantly reduced scores for daytime and nighttime heartburn (p < 0.001), total regurgitation (p < 0.001), eructation (p = 0.04), and early satiety (p = 0.04). Cisapride 20 mg b.i.d. was also superior to placebo in reducing total use of rescue antacid medication (p < 0.001); reducing, in concordance analyses, daytime and nighttime heartburn with antacid usage (p < 0.001); increasing the percentage of heartburn-free days and antacid-free nights (p < 0.5); and increasing the percentage of patients self-rated as having minimal or better symptomatic improvement (p = 0.01). Cisapride 20 mg b.i.d. was well tolerated. The most common adverse event in the cisapride group was diarrhea, reported by 10% of patients, compared with an incidence of 4% in the placebo group. CONCLUSION: Cisapride 20 mg b.i.d. was shown to be effective and safe for the short-term treatment of daytime and nighttime heartburn and for other symptoms associated with mild-moderate GERD.

Adolescent↗
PubMed2003

Belching: dyspepsia or gastroesophageal reflux disease?

OBJECTIVES: Eructation (belching) is a common symptom seen in clinical practice. Because either belching or heartburn may result from transient lower esophageal sphincter relaxations, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). In this retrospective study we evaluated the prevalence of belching in dyspepsia and GERD and the relation of belching to acid reflux events documented by pH monitoring. METHODS: We examined the prevalence, frequency, and severity of belching and other GERD symptoms by use of standardized questionnaires in 180 GERD patients (group A) and 78 dyspeptic controls (group B) referred for evaluation at our institution. GERD was defined as either endoscopic esophagitis (or Barrett's esophagus) or positive DeMeester score (>14.2) on pH monitoring or both. Dyspeptic patients had normal endoscopy and pH studies. We also analyzed the relationship of belching to acid reflux events during the 24-h period of pH studies. RESULTS: Of 180 GERD patients, 132 (70%) reported belching during pH monitoring, versus 63 of 78 dyspeptic patients (80%) (p = ns). Similarly, 163 of 180 GERD patients (90%) reported heartburn versus 64 of 78 of dyspeptic patients (82%) (p = ns). Review of symptom questionnaires revealed no significant difference in belching severity between groups. However, heartburn and acid regurgitation were significantly more severe among GERD patients. There was a significantly higher correlation of both heartburn and belching with acid events in patients with GERD compared with patients with dyspepsia. In addition, although both belching and heartburn were significantly improved in patients with GERD, belching scores remained unchanged after proton pump inhibitor (PPI) therapy in patients with dyspepsia. CONCLUSIONS: Belching is as common and as severe in patients with dyspepsia as it is in patients with GERD. Belching and heartburn in GERD patients are more likely correlated with episodes of pathological acid reflux. Because belching cannot be clinically used as a discriminatory symptom, ambulatory pH monitoring should be considered to elucidate the relationship of belching to acid reflux in patients with dyspepsia or GERD.

Case-Control Studies↗
PubMed1998

Calculation of the buffering capacity of bicarbonate in the rumen and in vitro.

We describe a model to calculate the buffering capacity of bicarbonate in the rumen. The addition of NaHCO3 results in the release of CO2 from solution and eventually from the rumen via eructation. This process directly neutralizes ruminal acidity. The degree to which the process continues depends on the partial pressure of CO2 in the gas phase, the pH, and a constant (7.74), according to the Henderson-Hasselbalch equation: pH = 7.74 + log([HCO3-]/pressure of CO2 in atmospheres). The addition of NaHCO3 to buffer solutions and ruminal fluid under high pressure of CO2 increased pH as predicted. The buffering capacity of ruminal fluid under CO2 was greater at low pH than was previously determined by titration in air. In contrast, in vitro systems in which CO2 is not permitted to escape may result in reduced buffering capacity. In vitro systems in which excess CO2 may escape (under N2 gas pressure) may result in uncontrolled pH elevation. Dilution of ruminal fluid under constant pressure of CO2 decreased ruminal pH as predicted by the model. The pH under different pressures at equilibrium and the buffering capacity are easily calculated for in vitro and in vivo systems.

Animals↗
PubMed1979

Gastrocolic fistula as a complication of benign gastric ulcer.

The symptoms, diagnosis, and management of three patients with gastrocolic fistula secondary to benign peptic ulcer disease are reviewed. To our knowledge, this brings the total of such cases reported in the literature to 50. The most frequent symptoms were abdominal pain, weight loss, diarrhea, and vomiting followed by anemia, foul eructations, and fecal vomiting. Barium meal demonstrated the fistula in about 70% of the patients, whereas barium enema examination demonstrated the fistula in nearly all of them. The diagnostic workup should rule out the possibility of a malignant cause for the fistula. The surgical management of these patients consists of the one-stage, when possible, resection of the involved portion of the antrum and the fistula of the transverse colon with appropriate reconstruction of gastrointestinal continuity. An increased awareness of the benign cause of some gastrocolic fistulas is necessary to avoid unduly extensive surgery in these cases.

Adult↗
PubMed1985

The floppy Nissen fundoplication. Effective long-term control of pathologic reflux.

In 1976 we defined a technique of "floppy" Nissen fundoplication (FNF) that prevented experimental pathologic reflux without preventing gaseous eructations or vomiting (normal reflux) when appropriate. This report describes the one- to eight-year follow-up of the 77 patients operated on since that time. The FNF has been completely effective in preventing pathologic reflux in 75 of 77 patients and has been partially effective in two others who are now subjectively asymptomatic. Adverse side effects were reported by two patients, one with gas-bloat and one with inability to belch or vomit. The lower esophageal sphincter pressure of patients postoperatively was increased to low normal values from a mean of 8.94 +/- 1.66 to 14.31 +/- 0.7 mm Hg (normal, 21.2 +/- 4.2 mm Hg). Since FNF does not cause greatly increased lower esophageal sphincter pressure, the inference that the FNF prevents reflux by altering the physiology of a reflux event is supported. In conclusion, the floppy fundoplication has been an effective operation with a low incidence of adverse side effects and without a tendency for late failure.

Adult↗
PubMed1993

Intragastric bile acid and symptoms in patients with an intrathoracic stomach after oesophagectomy.

Bile acid concentration and symptoms were evaluated in 24 patients after total oesophagectomy and gastric pull-up. Patients were randomly allocated to receive pyloroplasty or not. After operation all were followed for a minimum of 6 months. Bile acid concentration in the gastric juice was estimated. The mean(s.d.) bile acid concentration 6 months after surgery was similar in patients with and without pyloroplasty (34.9(30.1) and 25.0(24.2) mg/dl respectively). Postprandial discomfort and bilious eructations were the two most commonly observed symptoms in both groups. Other features noted were vomiting, anaemia and anorexia. These did not however seem to be related to intragastric bile acid concentration of individual patients in either group and occurred irrespective of whether pyloroplasty was performed or not.

Adolescent↗
PubMed2002

A phase II trial of daily perillyl alcohol in patients with advanced ovarian cancer: Eastern Cooperative Oncology Group Study E2E96.

OBJECTIVE: This was a phase II study of perillyl alcohol in the treatment of advanced ovarian cancer. The primary endpoint was to evaluate the 6-month progression-free rate of perillyl alcohol as compared with historic controls. Secondary objectives were to evaluate the objective response rate, time to progression and survival, dropout rate, and number of cycles administered; define the qualitative nature of acute and chronic toxicities; and evaluate the effect of perillyl alcohol on triglycerides and total, HDL, and LDL cholesterol levels. Methods. Women who had received prior platinum-based therapy and had residual or recurrent disease were eligible. Perillyl alcohol was administered orally, four times daily, at a dose of 1200 mg/m(2). This was repeated until disease progression or unacceptable toxicity was experienced. RESULTS: The 6-month progression-free rate was 17%. None of the patients achieved a complete or partial response. The median progression-free survival was 1.7 months. The median overall survival was 9.1 months. Compliance was greater than 90% but gastrointestinal toxicity (grade 1-2 nausea, satiety, eructation in 70%) and fatigue (grade 1-2 in 40%) were common and limited the ability to escalate the dose from 1200 to 1500 mg/m(2). CONCLUSION: Perillyl alcohol administered at this dose and formulation did not exhibit signs of extending the time-to-progression in patients with advanced ovarian carcinoma.

Aged↗
PubMed1994

Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia.

The effects of the administration of 50 mg of guggulipid or placebo capsules twice daily for 24 weeks were compared as adjuncts to a fruit- and vegetable-enriched prudent diet in the management of 61 patients with hypercholesterolemia (31 in the guggulipid group and 30 in the placebo group) in a randomized, double-blind fashion. Guggulipid decreased the total cholesterol level by 11.7%, the low density lipoprotein cholesterol (LDL) by 12.5%, triglycerides by 12.0%, and the total cholesterol/high density lipoprotein (HDL) cholesterol ratio by 11.1% from the postdiet levels, whereas the levels were unchanged in the placebo group. The HDL cholesterol level showed no changes in the two groups. The lipid peroxides, indicating oxidative stress, declined 33.3% in the guggulipid group without any decrease in the placebo group. The compliance of patients was greater than 96%. The combined effect of diet and guggulipid at 36 weeks was as great as the reported lipid-lowering effect of modern drugs. After a washout period of another 12 weeks, changes in blood lipoproteins were reversed in the guggulipid group without such changes in the placebo group. Side effects of guggulipid were headache, mild nausea, eructation, and hiccup in a few patients.

Adult↗
PubMed1987

[Pathophysiology, clinical aspects and rational diagnosis of gastroesophageal reflux disease and axial hiatal hernia].

Low pressure or inappropriate relaxation of the lower esophageal sphincter, disturbances in esophageal peristalsis and delayed gastric emptying are the most important pathogenetic factors of reflux disease. In general, retrosternal and also epigastric and pharyngeal burning or pain are the leading symptoms, but in mild disease eructation may become the major complaint. Diagnosis is usually made on the basis of a typical history and the results of endoscopy. 24-h-pH-recording is indicated in inconclusive endoscopy, chest pain of unknown origin and preoperative evaluation. Manometry may be indicated to exclude systemic sclerosis.

Esophagogastric Junction↗
PubMed1994

Double-blind dose-response multicenter comparison of fedotozine and placebo in treatment of nonulcer dyspepsia.

The efficacy and safety of the peripheral kappa-receptor agonist fedotozine was investigated in a double-blind, placebo-controlled, dose-ranging study involving 146 patients with nonulcer dyspepsia (NUD). After a two-week washout, patients were assigned to one of four groups to receive either placebo or fedotozine three times a day at doses of 10, 30, or 70 mg for six weeks. Analysis of mean symptom intensity scores showed that the 30-and 70-mg doses of fedotozine were superior to placebo in relieving postprandial fullness, bloating, abdominal pain, and nausea. Eructation and early satiety were marginally affected. The 30-mg dose was significantly more effective than placebo in reducing the total symptom score. Eight-two mostly minor adverse effects were recorded, but no significant differences in distribution emerged between placebo and treatment groups. The number of withdrawals declined significantly as a function of increasing dose. These results indicate that 30 mg three times a day is the minimal effective dose of fedotozine in the treatment of NUD symptoms and that this treatment is safe.

Adult↗
PubMed1980

Duodenal ulcer disease in chidren.

Eleven cases of chronic duodenal ulcer in children were subjected to surgical treatment in a period of 7 years. The diagnosis was based on typical peptic ulcer symptoms, hyperchlorhydria, and barium meal x-ray studies delineating a duodenal bulb deformity with an ulcer crater in 8 patients. Three cases of duodenal ulcer perforation in infants were diagnosed at aparotomy for peritonitis with pneumoperitoneum. All the patients hailed from the rgion of Assam, India, where peptic ulcer is prevalent. A positive family history of peptic ulcer in 5 patients, blood group O in 7 patients, and the regional diet were considered to be predisposing factors. Medical treatment consisting of a bland diet, sedatives, antispasmodics, and a brief hospital stay failed to provide permanent relief of symptoms. Truncal vagotomy with a drainage procedure was done in 8 patients with no deaths. However, simple closure of the perforation in the 3 infants resulted in fatalities due to fulminant septicemia. The patients were followed up for 1-8 years. Six patients had permanent relief of symptoms. Two patients occasionally complained of epigastric fullness and eructation. They showed normal growth, gain in weight and hemoglobin levels, and had no recurrence. We believe that operative treatment is preferable to medical management of chronic duodenal ulcer in children.

ABO Blood-Group System↗
PubMed1992

Dysphagia in Huntington's disease: a 16-year retrospective.

Degenerative diseases of the basal ganglia are commonly complicated by dysphagia. In 35 patients with Huntington's disease (HD), a hereditary neurodegenerative basal ganglia disease characterized by chorea, dementia, and emotional changes, an extensive battery of clinical and radiologic procedures helped to identify numerous abnormalities of deglutition. The results permitted the classification of our patients with HD into hyperkinetic (HD-h) or rigid-bradykinetic (HD-rb) groups. Although the two groups share multiple abnormalities, statistically significant intergroup differences were observed. Clinical assessment of the HD-h cohort (30 patients) demonstrated rapid lingual chorea, swallow incoordination, repetitive swallows, prolonged laryngeal elevation, inability to stop respiration, and frequent eructations. In the HD-rb group (five patients), frequently observed abnormalities included mandibular rigidity, slow lingual chorea, coughing on foods, and choking on liquids. Videofluoroscopic swallowing studies (VFSS) using a variety of barium-impregnated foods and liquids confirmed the abnormalities noted on the clinical assessment. Respiratory and laryngeal chorea, pharyngeal space retention, and aspiration were also identified. Numerous compensatory techniques introduced during videofluoroscopy benefited all patients.

Activities of Daily Living↗
PubMed1989

Gastric fistulas in Crohn's disease. Report of cases.

Nine cases of gastric fistula occurring in patients with Crohn's disease were treated at The Mount Sinai Hospital over the past three decades. Six cases were found in a review of 1480 patients with Crohn's disease admitted between 1960 and 1983. Three others seen at this institution outside the time frame of the author's study have also been included. Among six new cases, five with cologastric fistula occurred among 907 patients with Crohn's disease involving the colon (0.6 percent), while only one with ileogastric fistula was encountered among 1211 patients with ileal disease (0.08 percent). Fistulas between the stomach and colon always originated in an area of colitis, usually passing from distal transverse colon to greater curvature, but occasionally from midtransverse colon to antrum. The only pathognomonic clinical features were feculent vomiting, eructations, or odor. Diagnosis usually was made by barium enema or, less frequently, by upper gastrointestinal series; rarely, the gastric fistula was found unexpectedly at surgery. The conventional and recommended therapy is colectomy with wedge excision of the stomach. Medical treatment with 6-mercaptopurine has been completely successful in one patient and intermittently successful in a second patient.

Adult↗
PubMed2006

Superior mesentric artery compression syndrome.

Superior Mesenteric Artery Syndrome is an atypical cause of high intestinal obstruction seen frequently in patients with rapid weight loss or immobilization in a body cast (\also called CAST Syndrome). The SMA impinges on the third part of the duodenum immediately after originating from the anterior aspect of aorta, making an abnormally narrow angle with the later. Intestinal obstruction results causing characteristic symptoms like postprandial epigastric pain, eructations, fullness and vomiting. Here we report such a case of SMA syndrome in a patient with history of rapid loss of weight.

Child↗
PubMed2005

Preventive treatment of nephrolithiasis with alkali citrate--a critical review.

Using the keywords "urolithiasis and citrate treatment", "nephrolithaisis and citrate treatment", "kidney stones and citrate treatment", a Medline search revealed 635 articles published between 1 January 1966 and 1 December 2004. For the present analysis, only studies meeting all of the following criteria were included: (1) publications in English or German, (2) studies on preventive alkali citrate treatment in patients with calcium oxalate, uric acid and infection stone disease, (3) clinical studies including at least ten subjects, and (4) treatment phases of at least 1 week duration. A total of 43 studies met the inclusion criteria and were further subclassified according to intermediate or ultimate endpoints as well as to study design. With stone recurrence as the ultimate endpoint, 21 uncontrolled studies in almost 1,000 patients demonstrated a reduction in stone forming rate by 47-100%. In four randomized controlled trials including 227 patients, 53.5% on alkali citrate vs 35% on placebo remained stone-free after at least 1 year of treatment (P<0.0005). Similar values (66% vs 27.5% for alkali citrate vs placebo, P<0.0005) were obtained in 104 patients from two randomized trials with dissolution/clearance of residual stones as endpoint. Unfortunately, up to 48% of alkali citrate treated patients left the studies prematurely, primarily due to adverse effects such as eructation, bloating, gaseousness or frank diarrhea.

Alkalies↗
PubMed2003

Sigmoidoduodenal fistula as a rare complication of colonic carcinoma: report of a case.

We report a very unusual case of malignant sigmoidoduodenal communication. To the best of our knowledge, this is the first documentation of this entity in the English language literature. A 76-year-old man presented with weakness, severe weight loss, foul-smelling eructations, anemia, constipation, and episodes of diarrhea. A sigmoidoduodenal fistula was found by barium enema, and a diagnosis of ulcerative colonic adenocarcinoma was made from the colonoscopy findings. Thus, we performed sigmoid colectomy with resection of the fistula and the involved anterior wall of the third duodenal part, followed by primary closure of the duodenal defect. Histological examination confirmed a Dukes' B (Stage II - T(4)N(0)M(0)) colonic adenocarcinoma, and the excision margins of the resected duodenal specimen were clear. We gave adjuvant chemotherapy with 5-fluorouracil and leucovorin. The patient is still alive and disease-free, 2 years postoperatively.

Adenocarcinoma↗
PubMed1987

The primary-secondary rumen contraction and gas expulsion in sheep (Ovis aries).

1. Sheep rumens were insufflated with nitrogen to 5, 10, 15 and 20 cm HOH pressure and sustained at each pressure for 5 min. 2. Measurements included rumen motility, reticulorumen myoelectrical activity, eructation frequency and volume, and changes in tracheal pressure. 3. Associated with elevated intrarumen pressure was a previously unreported type of rumen contraction on which gas expulsion occurred, the primary-secondary contraction. 4. Gas expulsion volume was similar on primary-secondary and secondary contractions. 5. The maximum rumen contraction rate per min was 4-5 for secondaries and 1-2 for primary-secondaries. 6. Irrespective of the sustained initial pressure, resting intrarumen pressure was reached within 5 min.

Animals↗
PubMed2006

Prebiotic effects of neoagaro-oligosaccharides prepared by enzymatic hydrolysis of agarose.

To investigate the prebiotic properties of neoagaro-oligosaccharides (NAOS), obtained from enzymatic hydrolysis of agarose, the in vitro and in vivo effects of NAOS on bacterial growth were studied. In vitro NAOS were found to be highly resistant to enzymes of the upper gastrointestinal tract, which remained intact after 24h incubation with different amylolytic enzymes. NAOS significantly stimulated the growth of bifidobacteria and lactobacilli in Man-Rogosa-Sharp (MRS) medium, anaerobically. Compared with fructo-oligosaccharides (FOS), 1% (w/v) NAOS promoted the specific growth rate of beneficial bacteria by about 100%. The decreases of media pH with NAOS were almost the same as that with FOS. In vivo, NAOS significantly increased the numbers of lactobacilli and bifidobacteria (P<0.05) in fresh feces or cecal content while reducing putrefactive microorganisms. Mice fed with 2.5% (w/v) NAOS for 7 days had larger increases in colonic beneficial bacteria population than those fed with even 5% (w/v) FOS for 14 days. No side effects, such as eructation and bloating, were found. Interestingly, NAOS with higher degrees of polymerization (DP) showed better prebiotic activity. These results indicated that NAOS had great prebiotic effect, which could be beneficial to the host.

Animals↗