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Biomedical subjects

A G Klauser

Publications and source records attributed to A G Klauser.

11 recordsLinked to original sources
PubMed1992

Three year follow up of patients with gastrooesophageal reflux disease.

Data on the natural course of gastrooesophageal reflux disease are sparse. One hundred and sixty six patients with typical reflux symptoms (heartburn and/or acid regurgitation) and pathologic pH monitoring (reflux time > 8.2% upright and/or > 3.0% supine) were studied. The patients were followed up by questionnaire and interview for a mean of 41 (seven to 86) months after diagnosis of reflux disease. Ten patients had died of diseases not reflux related. In 117 (75%) of the remaining 156 patients data on the course of gastrooesophageal reflux disease could be obtained. In 12 patients anti reflux surgery had been performed. Forty one (39%) of the remaining 105 patients have stopped taking medical therapy, in 13 of these patients symptoms had completely disappeared. Sixty four patients continued on medication (40 on demand, 24 regularly). When asked how their symptoms would be if they completely stopped medication, 71 patients considered their symptoms to be equal or worse and 21 patients to be improved as compared with the initial investigation. Patients with persisting symptoms at follow up had significantly more supine reflux (p < 0.05) at the initial pH monitoring as compared with patients with improved symptoms. The presence and grade of oesophageal erosions at initial endoscopy, duration of symptoms, age, sex, and smoking habits had no influence on the course of gastrooesophageal reflux disease. In conclusion, reflux symptoms disappear only in a minority of patients with proven gastrooesophageal reflux disease. More than half of all patients continue medication, either on demand or regularly. Severe supine reflux is an unfavourable prognostic factor.

Adult↗
PubMed1992

Abdominal wall massage: effect on colonic function in healthy volunteers and in patients with chronic constipation.

Colonic massage has been claimed to be an efficacious treatment for chronic constipation, though there are no studies to prove this. We therefore investigated the effect of abdominal wall massage on stool frequency and colonic transit time of radiopaque markers in 9 constipated patients (68 +/- 5 years, 5 female, colonic transit greater than 60 h) and in 7 healthy male volunteers (27 +/- 1.2 years) in a control phase and during a three week treatment phase with 9 sessions. Massage was performed as propulsive abdominal wall massage along the presumed course of the colon in an aboral direction (each session 20 min). Stool frequency did not change significantly from control to massage, neither in patients [0.59 +/- 0.08 to 0.68 +/- 0.09 defaecations per day, 95% CI control-massage (-0.23; 0.04)] nor in healthy volunteers 1.11 +/- 0.11 to 0.86 +/- 0.13, 95% CI (-0.01; 0.53)]. Total colonic transit times remained similar during the control and massage phase in patients (126 +/- 19 and 111 +/- 17 h, 95% CI (-11; 41)] and in healthy volunteers (40 +/- 7 and 38 +/- 6 h, 95% CI (-8; 13)]. Even when patients and healthy volunteers were statistically evaluated together, control and massage did not differ significantly. In patients, scores of well-being and stool consistency did not differ significantly during control and massage periods. So colonic massage does not change parameters of colonic function to a clinically relevant degree in healthy volunteers and constipated patients of the investigated age-groups.

Abdominal Muscles↗
PubMed1992

Simultaneous assessment of bolus transport and contraction parameters in multiple-swallow investigations.

A better understanding of scintigraphic findings may lead to a wider acceptance of esophageal transit studies. The purpose of this study, therefore, was to correlate standard manometric parameters with the quantitative and qualitative characteristics of liquid and semi-solid bolus transport. Twenty-nine patients were simultaneously investigated with esophageal scintigraphy and manometry. Single-swallow and sum-image data of six consecutive swallows were analyzed. No significant relationship between transit time and the velocity of the peristaltic wave could be identified, which suggests that factors other than peristaltic velocity (e.g., pharyngeal pump) essentially modulate esophageal transit. There was also no linear correlation between esophageal emptying and peristaltic amplitudes. Emptying was normal in patients with amplitudes greater than 30 mmHg and reduced in those with amplitudes less than 30 mmHg. This suggests that a threshold pressure greater than 30 mmHg is necessary to propel a test bolus adequately. Patterns in condensed images have been shown to specifically reflect the events in corresponding manometric recordings. Normal and different pathologic types of peristalsis presented analogous findings in both modalities. Thus, an analysis of the relationship between bolus transport and contraction parameters in simultaneous studies increases understanding of quantitative and qualitative scintigraphic results.

Adult↗
PubMed1991

Which pH threshold is best in esophageal pH monitoring?

Two questions were examined, namely, 1) whether pH 4 is really the optimal threshold for the definition of acid gastroesophageal reflux, and 2) to what extent shifting of the upper limits of normal affects sensitivity and specificity of 24-h pH monitoring. To answer these questions, we studied 74 patients with proven reflux disease and 37 asymptomatic volunteers, using ambulatory 24-h esophageal pH monitoring. Gastroesophageal reflux was defined as episodes with esophageal pH of less than the threshold values 3.0, 3.5, 4.0, 4.5, or 5.0, respectively. For each of these pH thresholds, the percentage time with esophageal pH below the threshold was calculated separately for periods of upright and supine body position. Two-dimensional receiver-operating-characteristic (ROC) analysis was used to define upper limits of normal. A maximum of sensitivity, specificity, and rate of correct decisions (all 89%) was obtained using pH 4 for the definition of gastroesophageal reflux, although other pH thresholds were not much worse. On the basis of pH 4, the upper limits of normal could be shifted around the "optimal upper limit of normal" within a certain limit without considerable loss of accuracy of pH monitoring. This may explain the divergences between upper limits of normal obtained by different laboratories. In conclusion, 1) the threshold pH 4 should further be used for the definition of acid gastroesophageal reflux, and, 2) within certain limits, shifting of the upper limits of normal has little effect on the accuracy of pH monitoring in gastroesophageal reflux disease.

Adolescent↗
PubMed1990

Symptoms in gastro-oesophageal reflux disease.

Symptomatology was evaluated in 304 patients referred for 24 h oesophageal pH monitoring. Of several symptoms thought to be related to gastrooesophageal reflux disease (GORD), only heartburn (68% vs 48%) and acid regurgitation (60% vs 48%) occurred in more of the patients with GORD (as determined by pH monitoring) than of those with normal pH monitoring. When heartburn or acid regurgitation clearly dominated the patient's complaints, they had very high specificity (89% and 95%, respectively) but low sensitivity (38% and 6%) for GORD. A third of the patients reported such inconclusive symptomatology at history-taking that no preliminary diagnosis about the presence or absence of GORD could be made. In the remaining 200 patients, a clinical diagnosis by history had a sensitivity of 78% and specificity of 60%. A discriminant analysis of symptoms was inferior to a history taken by an experienced gastroenterologist.

Esophagus↗
PubMed1990

Behavioral modification of colonic function. Can constipation be learned?

We challenged the two hypotheses: first, that defecation can be suppressed for an extended time, and second, if so, that this has an effect on upper colonic motility. Thus we studied 12 male volunteers with conditions of identical nutrition and patterns of physical activity over a two-week period, where one week with normal defecation and one week with voluntary prolonged suppression of defecation followed each other in randomized order. Frequencies of defecation, stool weights, total and segmental colonic transit times (using radiopaque markers) were compared. Frequency of defecations and stool weights were lower during suppressed defecation [8.9 +/- 0.66 vs 3.7 +/- 0.41 (mean +/- SE) bowel movements per week, P = 0.003, and 1.30 +/- 0.09 vs 0.98 +/- 0.13 kg/week, P = 0.01]. Total transit times were increased from 28.8 +/- 4.4 to 53.1 +/- 4.3 hr, P = 0.004. Segmental transit times were increased in the rectosigmoid (from 8.83 +/- 3.6 to 32.1 +/- 5.6 hr, P = 0.04) and right hemicolon (from 14.5 +/- 0.9 hr to 19.7 +/- 1.5 hr, P = 0.02) by suppression of defecation. We conclude that defecation habits may induce changes in colonic function such as those seen in constipation and that functional anorectal outlet obstruction may, probably by reflex mediation, affect the right colon.

Adaptation, Physiological↗
PubMed1990

Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode?

In 24-h esophageal pH monitoring, the electrode is usually positioned 5 cm above the manometrically localized esophagogastric junction. In order to replace esophageal manometry for this purpose, we tested whether the esophagogastric junction can be identified correctly by fluoroscopy or the determination of the pH-step between stomach and esophagus, compared with esophageal manometry. The distance from the nares to the esophagogastric junction was determined three times with each of the three methods in 46 patients and 14 volunteers. Fluoroscopy assumed the esophagogastric junction 1.23 +/- 0.23 cm (mean +/- SE) lower than the peak pressure point determined at manometry, pH-step only 0.45 +/- 0.16 cm. With pH-step, only one subject had a difference of more than 3 cm to the manometrically defined esophagogastric junction, whether gastroesophageal reflux disease (as proven by pH monitoring) was present or not. We conclude that the esophagogastric junction can usually be identified with sufficient accuracy by the measurement of the pH-step between stomach and esophagus. Fluoroscopy is far less accurate than pH-step, and should not be used.

Adult↗
PubMed1990

[Measurement of colon transit time].

Several methods have been described to measure colonic transit times. The physical properties of all types of markers used allow to analyze and quantify them in stool samples or in the colon. The selective measurement of colonic (ceco-anal) transit time requires complicated intubation techniques. For most purposes it is sufficient to approximate the colonic transit by the whole gut transit, since oro-cecal transit time usually is only about a tenth of whole gut transit time. For this purpose the marker can be administered orally. In order to measure segmental colonic transit times it is necessary to monitor the distribution of the markers within the colon. For that purpose scintigraphic techniques are suited, but they require special equipment and are time consuming. Radio-opaque pellets, in contrast, are cheap, easy to handle, and have no known side effects. The following procedure is recommended: the patient swallows a gelatin capsule which contains 20 radio-opaque pellets on each of 6 consecutive days at the same time when on day seven a single abdominal x-ray is obtained. Then, segmental and total colonic transit times can be calculated from the number of retained pellets.

Carmine↗
PubMed1990

Low fluid intake lowers stool output in healthy male volunteers.

Inadequate fluid intake is though to be one frequent cause of chronic constipation, although this has never been shown. In order to test whether fluid deprivation has an influence on colonic function, we studied eight healthy male volunteers (median age 23 y, range 21-28 y) with respect to stool frequency, stool weight and mean oroanal transit of radiopaque markers in a control week with a fluid intake of more than 2500 ml beverages per day and in a week with a fluid intake of less than 500 ml beverages per day. The two weeks followed each other in randomised order (with a wash out week in-between) and were standardised as to nutrition and physical activity. Stool frequency diminished from 6.9 +/- 0.9 to 4.9 +/- 0.3 (mean +/- SEM) defaecations per week (p = 0.041) and stool weight from 1.29 +/- 0.20 to 0.94 +/- 0.17 kg per week (p = 0.048) during fluid restriction. Mean oroanal transit times were similar in the two weeks. In conclusion, our study shows that a relatively short period of fluid deprivation decreases stool frequency and stool weight in healthy volunteers. Therefore, a low fluid intake may well be an aetiologic factor for chronic constipation in some patients and too low a fluid intake should be corrected. There is no evidence, however, that an increase of fluid intake within feasible limits has a beneficial effect on chronic constipation.

Adult↗
PubMed1989

Is long-term esophageal pH monitoring of clinical value?

Two hundred eighty-nine patients with various chest symptoms were studied by interview for the presence and type of symptoms, and by long-term esophageal pH monitoring for acid reflux. One hundred eighty of the patients also had upper gastrointestinal endoscopy. There was significant correlation between the results of all three methods. pH monitoring was more sensitive (92.9% vs. 81.0%) and specific (41.3% vs. 23.9%), and classified more patients correctly (55.6% vs. 37.2%), than an interview by an experienced gastroenterologist when esophageal erosions were regarded as "gold standard" for pathologic reflux. Of all patients, 31.5% had unclear symptoms and therefore could not be diagnosed by interview alone. Forty nine percent of these had pathologic reflux on pH monitoring. Among the patients, 72.3% who had symptoms typical of reflux disease also had a pathologic result at pH monitoring. It is concluded that most patients with unambiguous symptoms of esophageal reflux can correctly be diagnosed by interview, but that esophageal pH monitoring has a role in the management of patients with less characteristic chest symptoms.

Adult↗