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Biomedical subjects

B E Kolts

Publications and source records attributed to B E Kolts.

At least 19 recordsLinked to original sources
PubMed1997

Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux.

Gastroesophageal reflux (GER) occurs in 22-66% of patients with noncardiac chest pain (NCCP). Although open-label investigations have shown beneficial effects of antireflux therapy in NCCP, no double-blind, prospective, placebo-controlled studies have been conducted. The purpose of this study was to evaluate the effects of omeprazole compared to placebo in a prospective, double-blind, randomized trial of patients with NCCP and GER. Thirty-six consecutive patients with NCCP and GER documented by 24-hr ambulatory pH testing entered this study. The subjects were randomized to omeprazole, 20 mg by mouth twice a day (17 patients), or placebo (19 patients) for eight weeks. Patients on omeprazole obtained significantly more improvement in the fraction of chest pain days (P = 0.006) and severity (P = 0.032) when compared to placebo. More patients in the omeprazole group reported improvement in individual daily pain scores (81% vs 44%, P = 0.03) and individual severity scores (81% vs 50%, P = 0.057). Thirteen (81%) of the subjects in the treatment arm reported overall symptomatic improvement versus one (6%) in the placebo group (P = 0.001). The results of this study indicate that acid suppression with omeprazole effectively improves chest pain in patients with NCCP and GER.

Chest Pain↗
PubMed1993

Helicobacter pylori detection: a quality and cost analysis.

Histopathologic interpretation of hematoxylin and eosin (H&E)-stained endoscopic biopsies is a common method for identifying Helicobacter pylori. Few studies report the accuracy of this method, and none have compared costs of other diagnostic methods. In the clinical setting of a community hospital using standard diagnostic techniques, the purpose of this study were to determine 1) the comparative sensitivities and specificities of the H&E stain, the Warthin-Starry silver stain, the Giemsa stain, and the CLOtest; 2) the sensitivity and specificity of an "experienced" pathologist in identifying H. pylori by H&E stains, compared with a rotating pathology faculty; and 3) the time to diagnosis (turnaround time) and current patient charges for each diagnostic method. Bacterial identification by the silver stain (or a combination of other tests which were likely to compensate for false-positive and false-negative silver stains) were used as the diagnostic standard in evaluating 94 consecutive cases with the following results: The H&E stain interpreted by the rotating pathology staff was the least sensitive method and one of the least specific tests that were studied. The silver and Giemsa stains were equally sensitive in identifying H. pylori; the silver stain was more specific. The CLOtest was less sensitive than the silver and Giemsa stains, but was equally specific. CLOtest was similar in sensitivity to the H&E stain examined by the "experienced" pathologist, but was more specific. An experienced pathologist was significantly more sensitive than the rotating pathologists in evaluating H&E-stained slides. Therefore, if H&E stains are used to identify H. pylori, which is a common practice, it may be advantageous to use an experienced pathologist. The CLOtest was a simple, rapid, and cost effective substitute for H&E stains in the identification of H. pylori.

Biopsy↗
PubMed1993

The high frequency of upper gastrointestinal pathology in patients with fecal occult blood and colon polyps.

Colon polyps are commonly detected in the workup of fecal occult blood (FOB). It is, however, unclear whether colon polyps can adequately explain FOB. Our aim was to determine the frequency of upper gastrointestinal (UGI) pathology in patients with and without UGI symptoms and with and without risk factors for UGI pathology (such as smoking, drinking alcohol, taking nonsteroidal anti-inflammatory medications, or the presence of associated chronic diseases) who have colon polyps and FOB. Among our 67 study patients with colon polyps and FOB, 79% had associated UGI lesions. Presence or absence of UGI symptoms, risk factors associated with UGI lesions, and polyp characteristics such as size, location, number, and histology, did not appreciably affect this high frequency. Ulcers were the most common lesions in both symptomatic and asymptomatic patients. We conclude that patients with colon polyps found in the evaluation of FOB are likely to have concomitant UGI pathology, and UGI workup should be considered in both symptomatic and asymptomatic patients.

Colonic Polyps↗
PubMed1993

A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.

One hundred thirteen patients were randomized to receive either oral sodium phosphate (Fleet Phospho-Soda), lemon-flavored castor oil (Purge), or standard polyethylene glycol-based lavage solution (GoLYTELY) before elective colonoscopy. The study purpose was to confirm the efficacy of oral sodium phosphate and extend observations to include castor oil. Overall, patients reported that sodium phosphate and castor oil were easier to complete (p < 0.05). Scores for cleansing the entire colon as determined by endoscopists who were blinded to the cathartic agent were highest in patients receiving sodium phosphate (p < 0.02). Scores of left-colon cleansing for flexible sigmoidoscopy were equally high for the three methods. Scores for taste and symptom side effects were similar for each preparation. There were no recognized signs or symptoms of hypocalcemia in the sodium phosphate group. Because of the low cost of oral sodium phosphate combined with the lowest repeat endoscopy rate for inadequate cleansing, patient savings were projected to be $5000 per 100 patients at this center. Oral sodium phosphate is a cost-effective colonoscopy preparation that is better tolerated and more effective than the polyethylene glycol-electrolyte lavage solution or castor oil.

Administration, Oral↗
PubMed1993

Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux.

A review of our 402 motility records of patients undergoing evaluation of noncardiac chest pain identified 40 patients with the diagnosis of nutcracker esophagus. Gastroesophageal reflux was found in 13 of 20 patients (65%) who underwent pH studies, and endoscopy detected one patient with erosive esophagitis. Thus, at least 14 (35%) of our nutcracker esophagus patients had evidence of reflux. Twelve of these subjects agreed to enter an open-label therapeutic trial. After 8 wk of intensive antireflux treatment with high doses of ranitidine or omeprazole, repeat 24-h pH studies and endoscopy demonstrated normalization of pH parameters and healing of esophagitis in all patients. Ten (83%) patients obtained significant symptomatic improvement in frequency of pain episodes, number of days with pain, and pain severity. However, repeat manometry showed normalization of motor findings in only two (18%) patients. These observations warrant further placebo-controlled trials. Until more information is available, the results of this study suggest that gastroesophageal reflux should be excluded in patients with noncardiac chest pain and nutcracker esophagus before initiation of smooth muscle relaxant therapy.

Adult↗
PubMed1993

Segmental versus diffuse nutcracker esophagus: an intermittent motility pattern.

The most common esophageal motility abnormality in patients with noncardiac chest pain is nutcracker esophagus. Most investigators regard nutcracker esophagus as a diffuse process involving the distal esophagus. Others consider it a segmental disturbance affecting isolated regions of the distal esophageal smooth muscle. This study compared the prevalence, clinical features, consistency, and manometric course of patients with either segmental high-amplitude peristaltic contractions (SHAPC) or those with the traditional diffuse contraction abnormalities termed nutcracker esophagus (NE). We particularly sought to determine whether patients with SHAPC represent an early spectrum evolving into a more diffuse contraction disorder--NE. The prevalence and clinical features of patients with either motility disturbance were similar. Thirty-nine percent of our patients had abnormally high peristaltic amplitude in locations of the proximal esophagus not previously described. Follow-up manometric studies demonstrated that only 53% of patients in the NE and 20% with SHAPC retained the same manometric diagnosis. In addition, 33% of patients in the NE group and 40% of the SHAPC group permutated into each other. These findings indicate that patients with SHAPC do not represent an early process subsequently evolving into a more diffuse contraction abnormality. Rather, the motility pattern of high-amplitude peristaltic contractions--segmental or diffuse--constitutes a labile marker associated with noncardiac chest pain.

Chest Pain↗
PubMed1992

Current medical therapy for esophageal motility disorders.

Treatment of patients with an esophageal source of chest pain remains a challenging problem. Although a variety of measures--including nitrates, anticholinergics, sedatives, calcium channel antagonists, esophageal dilation, and psychological reassurance--are available for the management of esophageal chest pain, none has emerged as the treatment of choice. Studies of nitrate preparations for the treatment of painful motility disorders are limited by a small number of patients and the lack of randomized, placebo-controlled investigations. The efficacy of anticholinergic drugs in hypercontractile esophageal motility disorders has not been reported. In the only prospective placebo-controlled trial using an anti-depressant, trazodone was superior to placebo in relieving symptoms in patients with a variety of esophageal motility disorders. Conflicting results have been described in placebo-controlled trials of the calcium channel antagonists nifedipine and diltiazem in patients with "nutcracker esophagus" or diffuse spasm. Information about the efficacy of verapamil and hydralazine is limited. Esophageal dilation has been useful in selected patients. For many patients, esophageal chest pain may be associated with gastroesophageal reflux. Treatment of these patients with nitrates, calcium channel antagonists, or anticholinergics may aggravate their reflux. The mechanisms of esophageal chest pain remain unknown. Recent studies have suggested that abnormal motility may not be the only factor associated with chest pain. An important number of patients have behavioral abnormalities, increased nociception, impaired coronary vasodilatory reserve, or a diffuse abnormality of smooth muscle. Research into rational therapy for chest pain patients should take into account the contribution of these other factors.

Chest Pain↗
PubMed1992

Pseudotumoral hepatic tuberculosis. Atypical presentation and comprehensive review of the literature.

We describe a 40-year-old black North American woman with isolated hepatic tuberculosis and an incidentally elevated alkaline phosphatase. Imaging studies of the liver showed a lesion suggesting primary or metastatic disease, which turned out to be the so-called pseudotumoral form of hepatic tuberculosis. We believe this is the first case recorded in the English language literature of isolated hepatic tuberculosis manifesting first as an incidentally elevated alkaline phosphatase. It seems to be the third documented case in the English literature of a patient with this rare form of tuberculous involvement without systemic manifestations. The patient responded to antituberculous therapy and is healthy 4 years after treatment.

Biopsy, Needle↗
PubMed1990

Esophagoatrial fistula with previous pericarditis complicating esophageal ulceration. Report of two cases and a review of the literature.

Sixteen cases of nontraumatic left atrial-esophageal fistulas have been reported previously. These fistulas usually result from chronic peptic esophagitis or cancer. The diagnosis is suggested by the triad of chronic dysphagia, hematemesis, and acute neurologic signs. There may be cardiac manifestations such as pericarditis, atrial fibrillation, or shock. An unusual feature of these fistulas is systemic embolization of food, air, or septic necrotic debris which may result in sudden central nervous system symptoms. All reported cases resulted in death due to hemorrhage, although there was often a variable time interval between the onset of hematemesis and the patient's death. The authors report two additional cases in which an episode of pericarditis preceded fistula development. Based on these 18 cases, the spectrum of esophagoatrial fistulas is reviewed, as well as the signs which may herald fistula development.

Aged↗
PubMed1990

Disposition of bupropion in healthy volunteers and subjects with alcoholic liver disease.

Bupropion hydrochloride is a new monocyclic antidepressant. In humans, its disposition results in the formation of three major metabolites: the morpholinol metabolite, the erythroamino alcohol, and the threoamino alcohol metabolite. Bupropion's disposition was monitored following a single oral 200 mg dose in eight healthy volunteers and eight age- (44.5 +/- 8.4 years) and weight- (77.4 +/- 6.7 kg) matched volunteers with alcoholic liver disease. This latter group is of interest because the incidence of depression is more frequent in alcoholics than in the general population, and the liver is the major route of elimination for cyclic antidepressants. The mean elimination half-life of the morpholinol metabolite was significantly prolonged in subjects with alcoholic liver disease (32.2 +/- 13.5 vs. 21.1 +/- 4.9 hours (p less than 0.05), while the differences in bupropion (17.3 +/- 8.6 hours vs. 16.5 +/- 10.4 hours for healthy subjects and subjects with alcoholic liver disease, respectively), erythroamino alcohol (26.1 +/- 13.3 hours vs. 29.8 +/- 6.9 hours for healthy subjects and subjects with alcoholic liver disease, respectively), and threoamino alcohol (25.5 +/- 8.6 hours vs. 23.4 +/- 10.7 hours for healthy subjects and subjects with alcoholic liver disease, respectively) were minimal. Mean area under the plasma concentration time curves for bupropion and metabolites were increased in subjects with alcoholic liver disease; however, clear differences between means of these small groups did not emerge, probably due to the increased variability of bupropion pharmacokinetics in these subjects. As a therapeutic agent for the treatment of depression in chronic alcoholics who may consume alcohol in combination with their antidepressant therapy, the lack of sedation with bupropion could be advantageous.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Diarrhea associated with severe hypoalbuminemia: a comparison of a peptide-based chemically defined diet and standard enteral alimentation.

To demonstrate a relationship between diarrheal incidence and the onset of hypoalbuminemia developing as a result of acute protein-calorie malnutrition and severe catabolism, we initially studied two patients who had developed severe hypoalbuminemia (less than 2.5 g/dl) and diarrhea on a variety of enteral diets. Each patient was placed on a peptide enteral formula at a rate of infusion equivalent to that used during the previous 24 h. Diarrheal volumes decreased significantly from greater than 1500 to less than 100 ml/day and from greater than 4000 to 800 ml/day. We subsequently studied 12 patients in a randomized, prospective fashion to confirm our previous observations. Seven patients received a peptide enteral formula, and five received a standard isotonic enteral formula as a control. The patients were monitored for a minimum of 2 wk or until serum albumin levels reached 3 g/dl. Nutritional variables were measured initially and every 4 days for the duration of the study. Of the patients receiving the isotonic feeding, only one of five completed the study period without diarrhea. Two patients died unrelated to the feeding, and three patients developed severe diarrhea within 48 h of institution of the study. Of the seven patients receiving the peptide feeding, six completed the study period without diarrhea. One patient had a large stool volume initially which decreased by day 2 of the study. We conclude that a peptide enteral formula is well tolerated in patients with severe hypoalbuminemia when compared to a standard isotonic enteral formula. The ability to provide enteral nutrition in a form that is well tolerated in hypoalbuminemia patients may obviate the need for parenteral nutrition routinely in these patients.

Adult↗
PubMed1987

Hypoalbuminemia as an indicator of diarrheal incidence in critically ill patients.

Recently, we noted that substantial numbers of critically ill patients admitted to a medical ICU developed diarrhea. We checked them for infectious, metabolic, and untoward medication effects, which were negative. We next considered a possible causal relation between reduced serum albumin and diarrhea. To document the frequency of diarrhea in this population, explore the relation between hypoalbuminemia and diarrhea, and make a preliminary assessment of a peptide-based, chemically defined diet in these catabolic patients, a study of consecutive medical ICU patients was begun. For each patient, we recorded the principal diagnosis, type of diet received, the frequency and volume of stool, and the serum albumin concentration at admission. When diarrhea developed, attention was paid to the serum albumin levels as well as the effects of various diets. Overall, 12 (34%) of 35 study patients developed diarrhea. No patient had a previous history of diarrhea, malabsorption, weight loss, or GI symptoms that may precede the onset of diarrhea. The stools from each patient with diarrhea were examined for enteric pathogens, ova and parasites, Clostridium difficile culture and cytotoxin assay, and qualitative stool fat, which were all negative. Every patient with a serum albumin level less than 2.6 g/dl developed diarrhea. No patient with a serum albumin level of 2.6 g/dl or greater developed diarrhea, regardless of the type of nutritional support received. Four of the 12 patients with hypoalbuminemia and diarrhea were placed on a peptide-based, chemically defined diet, after which their diarrhea resolved and their serum albumin concentrations increased.

Critical Care↗
PubMed1986

Peptide characterization of secretin preparations.

The present study was designed to examine and compare the peptide composition and relative immunochemical purity of GIH and Boots secretin preparations. Gastrointestinal peptides were measured by radioimmunoassay using antibodies to secretin, gastrin, immunoreactive cholecystokinin, vasoactive intestinal peptide, gastric inhibitory peptide, and somatostatin. Boots secretin was found to contain substantial quantities of gastrin, immunoreactive cholecystokinin, vasoactive intestinal peptide, gastric inhibitory peptide, and somatostatin. In contrast, GIH secretin contained only a very small amount of vasoactive intestinal peptide. GIH also contained approximately three to four times more secretin per unit as did Boots secretin. Intravenous infusion of Boots, but not GIH, secretin in seven healthy volunteers produced significant increases in venous plasma of all peptides. Results of these studies indicate that Boots secretin contains large and variable quantities of gastrointestinal peptides other than secretin and that the contents of both secretin and the other peptides vary among different lots. Because the quantity of these peptides is sufficient to increase significantly their blood levels and consequent biological effects, it is concluded that GIH is preferable to Boots secretin in the clinical evaluation of patients with suspected chronic pancreatitis or gastrinoma.

Adult↗
PubMed1986

Spontaneous bacterial peritonitis associated with an intrauterine device.

Intrauterine contraceptive devices (IUD) have been associated with the induction of chronic anaerobic endometritis as well as superimposition of exogenous sexually transmitted diseases and unilateral tubo-ovarian abscesses. We report an unusual case of spontaneous bacterial peritonitis in a patient with ascites and an IUD. Bacteriological data support the concept that the source of infection was a chronic mixed endometritis induced by prolonged use of an IUD (16 years). In the presence of ascites, a localized endometritis with its reservoir of bacteria provided the medium for systemic disease.

Ascites↗
PubMed1983

Simultaneous pancreatic, gastric and hormonal responses to 2-deoxyglucose in the conscious pig.

The effect of vagal stimulation induced by 2-deoxy-D-glucose (2DG) on gastric acid and pancreatic bicarbonate output, and portal gastrin and secretin concentrations, was assessed in conscious miniature pigs. Electrical vagal stimulation has previously been shown to induce profuse pancreatic water and bicarbonate secretion in anaesthetized pigs. Pigs in this study were surgically prepared with gastric and pancreatic fistulas and indwelling jugular and portal catheters. An intravenous bolus of 2DG (100 mg/kg body weight) caused a significant increase in both gastric acid and pancreatic bicarbonate output although the latter was about 50% of the reported response to electrical vagal stimulation. Portal gastrin concentration rose significantly after 2DG, but the portal secretin concentration did not change. The presence of secretin in the small intestine was confirmed by intrajejunal HCl infusion. Failure of portal secretin concentration to rise after 2DG infusion rules against a role for this hormone in the pancreatic response.

Animals↗