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Biomedical subjects

A Hep

Publications and source records attributed to A Hep.

At least 19 recordsLinked to original sources
PubMed2006

[Laparoscopic procedure according to Heller].

Oesophageal achalasia is a rare disorder. For patients in good overall condition, surgical management--myotomy--is one of the treatment options. This study describes the technique of laparoscopic myotomy sured by partial antireflux cuff. 35 patients were operated. Only in 3 cases, further follow-up was required for dysphagia. None of the patients required re-operation. No serious peroperative or postoperative complications were recorded. Importance of peroperative oesophagogastroscopy in assessment of adequate extent of myotomy and in excluding perforations of the oesophageal mucosa is put forward.

Adult↗
PubMed2005

[The relation of GERD, bronchial asthma and the upper respiratory tract].

UNLABELLED: Gastroesophageal reflux disease (GERD) is one of the most common diseases affecting upper gastrointestinal tract. It is a chronic disease, whith stadily growing incidence and prevalence in west countries during last 30 years. GERD is caused by pathologic gastroesophageal reflux (GER). GERD includes endoscopically positive, endoscopically negative and extraesophageal reflux disease. Extraesophageal symptoms of GERD have been of a growing attention and discussion during last few years. The most discussed topics are the relation of GERD and bronchial asthma (BA), chronic cough and symptomatology from ear, nose and throught (ENT) regions, but also non - cardial chest pain and many others. AIM: In our clinic we ran a 5 years study which aim was to evaluate the presence of GERD in patients with bronchial asthma, chronic cough and affections from ENT regions. To assess if 3 months GERD treatment would improve lung function, subjective complaints (cough) and GERD control in asthmatics; if this treatment would allow to step - down with antiasthma medication. To assess if 3 months GERD treatment can improve objective and subjective assessments in patients with chronic cough and findings in ENT regions. As for GERD, we evaluated the improvement of pH and subjective complaints (pyrosis). METHODS: We examined 86 patients with different severity of bronchial asthma, 54 patients with chronic cough and 31 patients with ENT symptoms. All patients underwent 24 hour esophageal pH metry, spirometry with lung function evaluation and objective ENT examination by flexible laryngoscopy. In case of pathologic finding on 24 hour pH-metry 3 months full antireflux treatment with proton pump inhibitors (PPI) and prokinetics was introduced. After 3 months of GERD treatment we performed control 24 hour esophageal pH metry, control spirometry and ENT examination by flexible laryngoscopy. Patients were asked to make their subjective symptoms assessments. RESULTS: We found that GERD prevalence in patients with respiratory symptoms was very high. Three months GERD treatment improved lung function (FEV1) with statistical significance (p = 0.0319), and so improved GERD control (in 60.7% of patients with high statistical significance p = 0.0009). Subjective complaints (cough) also improved in most patients. 3 months GERD treatment did not allow to step down with maintenance BA therapy according to GINA guidelines, but it enabled to decrease the rescue medications in 50% of patients. Patients with chronic cough can benefit from GERD treatment as cough improved in 75.8% of patients. CONCLUSION: Objective findings as well as subjective complaints improved in 75% of patients with ENT symptomatology. GERD control (DeMeester score and pyrosis if present) was highly statistically significant in all three groups of patients. It is necessary to mention, that there is a high presence of nocturnal acid breakthrough (NAB) in patients with respiratory symptoms: 30.3 % in patients with bronchial asthma, 63.6 % in patients with chronic cough and 45 % of patients with ENT manifestations.

Adult↗
PubMed2004

[What has changed in knowledge of etiopathogenensis, diagnostics and therapy of gastroesophageal reflux over last 15 years?].

An incidence of gastroesophageal reflux disease (GERD) in population is continuously increasing. A probable etiology, except anatomical changes (such as hiatus hernia, transient lower esophageal sphincter relaxation etc.), can also include a change in life style For diagnostic purposes upper endoscopy and in unclear cases esophageal pH-metry is used. From an etiopathogenetic point of view, besides reflux of acidic content, the alkaline content and night change in production of hydrochloric acid during treatment with proton pump blockers (PPI) are considered to be important too. Attention should be paid to extraesophageal signs of GERD. In treatment prevail PPI, in resistant cases and in younger patients fundoplications are considered, and, also therapeutic endoscopy becomes more important (application of gel prostheses, electricity to cardiac part followed with scaring or ligatures).

Gastroesophageal Reflux↗
PubMed2003

Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study.

Botulinum toxin (BT) injection is an alternative treatment of achalasia. The aim of the study was to examine outcomes of patients treated with BT in the Czech Republic. Since 1997, 49 patients with achalasia have been treated with BT. We prospectively evaluated the effect of BT injection on 41 patients during a median follow-up of 24 months (range 9-62). Esophageal manometry was performed before and at 3-5 months after the injection. In 16 patients, BT was injected from the antegrade angle only (subgroup A), in 15 patients, BT was injected from both retrograde and antegrade angles (subgroup B) and, in 10 patients, BT injection was combined with subsequent balloon dilatation (subgroup C). Immediate clinical response was achieved in 93% of patients. Clinical remission was sustained beyond 3 months in 83% of patients (responders). Fourteen responders (41%) did not experience a relapse during the median of 22 months. Twenty responders (59%) experienced symptomatic relapse approximately 8 months after the injection. Ten relapsers underwent BT reinjection, five (50%) of them were asymptomatic for another 14 months. The remaining five (50%) patients reported a second relapse approximately 6 months after the reinjection. Median duration of the symptom-free period was 11.5 months after the first BT injection, and 10.5 months after the second (P = 0.21). We did not find any significant predictor of a favorable outcome; responders tended to be older and to have a lower basal lower-esophageal-sphincter pressure. Patients in subgroup C were more likely to be in remission at 1 and 2 years as compared with patients in subgroup A. BT injection is an effective treatment of achalasia in the short term. However, almost 70% of patients experience a relapse within 2 years. BT injection should therefore be reserved for patients at risk for more invasive procedures or for patients who prefer this treatment.

Adolescent↗
PubMed2002

[Barrett's esophagus].

Barrett's oesophagus is a premalignant metaplastic change of the oesophageal mucosa. Due to its relationship with oesophageal reflux disease and the development of adenoma-carcinoma of the oesophagus the problem arouses increasing interest. In the wide pathogenesis of the disease most probably the composite effect of the refluxed HCl content and duodenal juices play a part. In the diagnosis in addition to fundamental methods--endoscopy and histology--increasingly chromoendoscopy and fluorescent endoscopy are involved. Dispensarization of patients is essential and depends on the degree of pathohistological epithelial changes. Treatment of Barrett's oesophagus can be divided into conservative, where the drug of choice are proton pump inhibitors, and surgical treatment. Promising is endoscopic ablation of the epithelium in combination with subsequent antisecretory therapy.

Barrett Esophagus↗
PubMed2001

[Pathologic gastroesophageal reflux in patients with bronchial asthma].

Gastrooesophageal reflux (GER) and asthma bronchiale are frequent diseases. Asthma affects some 3-10% of adults. Gastrooesophageal reflux is present in some 45-89% asthmatic patients. Symptoms of GER are not only gastrooesophageal, and recently increased attention is focused on extraoesophageal symptoms where in particular the relationship of GER and asthma or chronic cough is investigated. At our clinic we implemented a pilot study with the objective to monitor the presence of pathological GER in patients with asthma and to assess whether antireflux therapy will influence the respiratory complaints of the patients. The group was formed by 14 patients selected at random with different severity of asthma and different symptoms of GER. The patients had a baseline examination evaluating the presence of GER (24-hour pH metry) and pulmonary function (FEV1). In case of a pathological GER the patients were treated by antireflux therapy and then check-up examinations were made. It was found that after treatment of GER in patients with asthma in particular subjective symptoms improved such as cough and pyrosis which leads to a substantial improvement of the quality of life. On the other hand reflux treatment did not exert a basic effect on pulmonary functions and it was not possible to reduce the medication of asthma.

Adult↗
PubMed2001

[Importance of assessment of Helicobacter pylori antigen in faeces].

Diagnostic methods for the detection of Helicobacter pylori (H.P.) can be divided into invasive and non-invasive ones. Among non-invasive methods we can include now also detection of H.P. antigen in faeces. The objective of our study was to evaluate the sensitivity ans specificity of the test when monitoring the eradication therapy, as compared with another non-invasive test and to test the method in common clincal practice. H.P. positivity was based on the result of the histological examination and CLO test. Repeatedly samples of faeces were collected to detect H.P. antigen in faeces before the onset of and after eradication treatment. For detection of H.P antigen the commercial Premier Platinum HpSa set was used which was developed on the principle of enzyme immunoanalysis. From the assembled data the sensitivity value (87.1%) and specificity values (88.5%) was calculated. The test correlates well with the results of the CLO test, histological examination and the breath test and is thus a suitable method for the detection of H.P. positive subjects as well as for checking the success of eradication treatment of H.P.

Antigens, Bacterial↗
PubMed2000

[Barrett's esophagus].

Barrett's esophagus is a pre-malignant change in esophageal mucosa. Its relation to the reflux disease of the esophagus and the origin of adenocarcinoma (which currently has an increasing incidence) experiences its renaissance. The pathogenesis of this disease is based on the composite effect of reflux contents of hydrochloric acid and duodenal juices. In addition to endoscopy and histology, chromoendoscopy and fluorescent endoscopy are gradually starting to be put into diagnostic routine practice. The control of patients is a necessity which depends on the degree of pathohistological changes within the epithelium. The therapy of the Barrett's esophagus can be either conservative which is currently carried out by proton pump inhibitors or surgical. Ablation of epithelium in combination with a subsequent long-term antisecretory therapy appears to be a promising treatment. (Ref. 23.)

Barrett Esophagus↗
PubMed2000

[Is complex therapy of achalasia using botulinum toxin combined with balloon dilatation an effective approach?].

BACKGROUND: Achalasia (ACHL) is not a very frequent disease and its etiology is still unclear. In addition to the oldest therapeutical approach represented by myotomy, two conservative methods are commonly used--balloon dilatation and application of botulotoxin. So far, both methods have been used only separately, and their effects have been compared. Literature provides no evidence of the renewal of oesophageal propulsive peristalsis in result of conservative treatment. OBJECTIVES: The aim is to use both approaches subsequently within a short period of time, in order to potentiate their effects and at the same time to reduce the risk of possible complications. METHODS: The group was formed by 9 patients. Achalasia was diagnosed by flow manometry. Pseudoachalasia was excluded endoscopically and endosonographically. The treatment included application of 250 J of botulotoxin (Dysport) into the region of the lower oesophageal sphincter, and balloon dilatation which was applied 7 days later. Following this treatment, patients were observed for 24 hours. The clinical and manometric examinations were performed in 3-month intervals. RESULTS: All patients felt significantly better after treatment. The clinical state in two patients required the performance of Heller's myotomy. After 1 year, evident clinical and manometric improvement was observed in 7 patients. The longest improvement so far lasted for 36 months. The treatment has renewed the propulsive oesophageal peristalsis in two women. CONCLUSION: The treatment of primary achalasia by means of combining the application of botulotoxin (Dysport) and balloon dilatation is effective, and it is possible to assume that the clinical remission will last longer than that in result of separate use of just one of the methods. The synchronous treatment of functional blocks in the cervical and thoracic regions of the spine and continuous rehabilitation can participate in the favourable clinical effect. The renewal of primary peristalsis of the oesophagus was achieved in two out of 9 patients. No such change has been either manometrically verified or described in literature. (Fig. 5, Tab. 1, Ref. 39.)

Adult↗
PubMed2000

[Treatment of hemorrhoids from the viewpoint of the gastroenterologist. Personal experience with the Ginkor Fort preparation].

Pathological changes in hemorhoid plexes are frequently occurring mainly in elderly. In development of this disease are mainly involved changes in the vessel wall, pressure changes in basin, disturbances in passage of stool and also infectious disease. Instead of the correction of the life-style in therapy are used locally-acting drugs whose basis are local anesthetics, spasmolytics, antiflogistics, antipruriginostics and corticoids in many combinations. The main aim of the orally administered drugs is influence of the vessel-wall tone, decrease of the capillary permeability, circulation betterment, decrease of the oedema and blockage of the inflammatory mediators. In the group of 45 patients is documented benefit in use of Gincor-fort in dose of 2 cps bid in first week and 2 cps daily in the second week of the treatment. We presume that this drug can influence all of above mentioned factors during the acute hemorrhoidal attack.

Acute Disease↗
PubMed2000

Dynamic esophageal scintigraphy in patients with achalasia.

BACKGROUND: Dynamic esophageal scintigraphy has been proven as an efficient technique of diagnosis of esophageal dysmotility. METHODS: The authors monitored the transit velocity, anti-peristalsis and the retention of radioactivity in the esophagus by dynamic esophageal scintigraphy in a group of 50 patients (37 control patients and 13 patients with achalasia). RESULTS: They found a significantly longer period of radioactivity passage via the esophagus compared to the control group (p < 0.001%). CONCLUSIONS: We observed the statistically significant transit prolongation of radioactivity through the esophagus during dynamic esophageal scintigraphy (41.2 seconds) in our group of patients with achalasia compared to the control group (7.9 seconds). Anti-peristalsis and even the radioactivity retention have occurred statistically more frequently compared to the control group.

Journal Article↗
PubMed2000

[Dyspeptic complaints in diabetic patients].

Diabetes is a frequent metabolic disease which affects also the digestive tract. Functional disorders of the latter have a negative impact on the stabilization of diabetes. An important factor as regards motility is the blood sugar level. Subjective complaints of the patients frequently do not correlate with the objectively assessed functional state of the digestive tract. The authors remind of contemporary available diagnostic and therapeutic possibilities.

Diabetes Complications↗
PubMed1999

Radionuclide oesophageal transit scintigraphy--a useful method for verification of oesophageal dysmotility by cervical vertebropathy.

We followed up a group of 43 patients suffering from cervical vertebropathy. Dynamic scintigraphy revealed a significant prolongation of oesophageal transit time of 10 ml of labelled liquid (mean transit time, MTT) in comparison with a control group. Patients treated with acupuncture showed a significant reduction in MTT in comparison with patients receiving a placebo needle application. The group of patients treated with manipulative techniques showed in addition to symptom alleviation a significant reduction in MTT. Dynamic scintigraphy facilitates verification of oesophageal dysmotility in patients suffering from vertebropathy and enables the success of therapy to be readily monitored.

Acupuncture Therapy↗
PubMed1999

[Esophageal reflux disease--comments on confusion in terminology, diagnosis and therapy].

Oesophageal reflux disease is a serious condition with an impact on the entire population. The provoking factor of the disease is gastroesophageal reflux which itself is not a disease but a normal physiological process. Reflux is described as pathological it is damages the oesophagus and respiratory tract. Oesophageal reflux disease develpomeps when antiferlux mechanisms fail, it is the consequence of impaired motility where the crucial role is played by dysfunction of the lower oesophageal sphincter. The most frequent consequence and manifestation of gastrooesophageal reflux is reflux oesophagitis which may be macroscopically obvious (endoscopically positive) or detectable only on histological examination (endoscopically negative--microscopic). Symptoms of reflux disease do not correlate with the severity of the disease. Some cases of roflux eosophagitis may be symptom-free. The diagnosis of oesophageal reflux disease is based in particular on an aimed case-history, endoscopy, histology and pH-metry. An open problem remains the relationship of reflux disease and the presence of Helicobacter pylori infection. In tratment either selective treatment (one drug) is used or graded (upward or downward) treatment. The upward therapeutic strategy (strating treatment with proton pump inhibitors) is as a rule economically more effective than the traditional downward strategy (strating treatment with less intensely acting drugs). Tretment is of long-term (maintenance treatment) which may be medicamentous or surgical. In oesophageal reflux disease there still remain controversial areas which must be elcudated as its incidence is rising and it is considered a disease of the 21st century.

Gastroesophageal Reflux↗
PubMed1998

[Effect of H. pylori eradication regimes on the proliferation index of gastric mucosa].

Eradication regimes with the blocking agent of the proton pump and without it do not influence the activity of cell division after treatment of Helicobacter pylori (H.p.) when using cytoflowmetric evaluation. The non-significant difference in proliferation activity of the gastric mucosa after treatment of H.p. can be also a sign of more rapid repair of the gastric mucosa after elimination of the inflammatory elements.

Cell Division↗
PubMed1998

[Esophageal reflux disease--role of 24-hour pH measurement].

24-hour ph-metry of the oesophagus is a standard examination method in patients with reflux complaints. For objective evaluation of the record the following points are most important: 1. calibration of the instrument, 2. precise placement of the pH-probe, preferably under manometric control, 3. elimination of medication (inhibitors of proton pump, H-2 blockers, antacids, prokinetic preparations), 4. cooperation of the patient. A 24-hour record makes it possible to analyze in detail the type of reflux, and when using available software, also its quantity.

Gastric Acidity Determination↗