Pantoprazole versus omeprazole in one-week low-dose triple therapy for curve of H. pylori infection.
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2-Pyridinylmethylsulfinylbenzimidazoles↗
Biomedical subjects
B Pfaffenbach
Publications and source records attributed to B Pfaffenbach.
[The effect of lumbar relief orthoses with abdominal compression on esophago-gastrointestinal motility].
OBJECTIVE: To investigate the effect of lumbar ortheses with abdominal compression on gastro-oesophageal reflux and gastrointestinal transit. PATIENTS AND METHODS: In a prospective study 20 consecutive patients with lumbar syndrome treated with lumbar orthesis (10 female, 10 male, median age 54.6 years) were investigated for gastro-oesophageal reflux, mouth-to-cecum transit time (MCT), and whole-gut transit time. Gastro-oesophageal reflux was assessed performing an ambulatory pH metering of the distal oesophagus over a period of 10 h with and without ortheses on two separate study days. After positioning of the pH catheter patients ingested a liquid-solid test meal labelled with 10 g lactulose and 750 g indigocarmine to determine MCT with the hydrogen breath test and whole-gut transit by the first appearance of indigocarmine in the stool. Dyspepsia was assessed by using a standardized questionnaire. RESULTS: Lumbar ortheses induced a significant increase in reflux time (pH < 4) (8.1 vs 4.1%), total number of reflux episodes (102.5 vs 69.5) and duration of longest reflux episode (6.0 vs 3.7 min) (P < 0.05). 12 patients with ortheses revealed an increase in relative reflux time (2.1-24.5%, median: 8.2%) more than two standard deviations compared to previously obtained normal values. In these patients during ortheses dyspeptic symptoms correlated significantly with reflux time (r = 0.6; P < 0.05). In contrast, MCT and whole-gut transit time in patients with and without ortheses did not differ significantly (85 vs 85 min; 10.2 vs 9.6 h). CONCLUSION: Lumbar ortheses with abdominal compression, nowadays frequently used in the lumbar syndrome, produce gastro-oesophageal reflux associated with dyspepsia. Gastrointestinal transit time is not affected, though.
Adult↗
[The 13C-acetate breath test for the noninvasive assessment of the gastric emptying of a liquid/solid test meal in diabetics].
OBJECTIVE: To test in a prospective study whether the non-invasive 13C-acetate test is suitable for measuring gastric emptying time with a liquid/solid test meal. (99m)technetium scintigraphy served as the reference method. PATIENTS AND METHODS: 18 consecutive type 2 diabetics with symptoms of gastroparesis (nine men, nine women; mean age 64 [45-76] years) were, after a nocturnal fasting period, given a liquid/solid test meal (370 kcal; 100 ml coffee; doubly marked with 75 mg 13C-acetate and 0.5 mCi 99mTc-colloid). At ten-minute intervals breath samples were taken over two hours and examined by mass spectometry for the 13CO2/12CO2 ratio. In parallel scintigraphy was performed for one hour at one-minute intervals. Gastric emptying half-life (t1/2) was calculated and the correlation between the two methods determined. In addition, the 13C-acetate breath test was performed on 20 healthy subjects to assess reproducibility (ten men, ten women; mean age 44.4 [23-77] years). RESULTS: Median t1/2 with the scintigraphy was 93.5 min, with the breath test 55 min, i.e. a significant correlation (r = 0.8; P < 0.001). Four of five patients with delayed gastric emptying by scintigraphy also showed delay (compared with the control group) in the breath test (median t1/2: 41 min; 95th percentile: 86 min). CONCLUSION: The 13C-acetate test correlated significantly with the results by scintigraphy. It can therefore be recommended as a non-invasive test for assessing gastric emptying time after a liquid/solid test meal in type 2 diabetics.
Acetates↗
Hepatic portal venous gas after transgastric EUS-guided fine-needle aspiration of an accessory spleen.
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Biopsy, Needle↗
Cure of Helicobacter pylori infection: role of duration of treatment with omeprazole and amoxicillin.
OBJECTIVES: To date, some studies have suggested that short-term therapy may be a promising therapeutic concept for the eradication of Helicobacter pylori. The primary objective of the present study was to elucidate the role of the duration of treatment in the cure of H. pylori infection. METHODS: Forty consecutive patients with H. pylori-positive peptic ulcer disease were randomly allocated to four study groups. The groups were treated with a 14-day course of 20 mg omeprazole b.i.d. orally combined with 2 g amoxicillin t.i.d. intravenously for 1 day (n = 10; six women, age range 40-84 yr), for 3 days (n = 10; five women, age range 29-74 yr), for 5 days (n = 10; five women, age range 21-82 yr), for 7 days (n = 10); five women, age 42-82 yr), respectively. Initially, a standardized clinical evaluation of symptoms and and upper GI tract endoscopy were performed for assessment of H. pylori infection of the gastric mucosa (biopsy urease test, specific culture, and histology). At least 4 wk after cessation of omeprazole medication, H. pylori eradication was evaluated either as described or with the help of the 13C-urea breath test. RESULTS: H. pylori eradication, defined as negative bacterial findings in urease test, culture, and histology or 13C-urea breath test at least 4 wk after discontinuation of omeprazole therapy, was achieved in one of 10 patients (10%) in the one-day group, none of 10 patients (0%) in the 3- and 5-day groups and six of 10 patients (60%) in the 7-day group. CONCLUSION: We conclude that short-term therapies with the proton pump inhibitor omeprazole and the antibiotic amoxicillin must be considered completely ineffective if performed as a short-term therapy for up to 5 days. A therapy duration of 7 days seems to mark a turning point in antibiotic effectiveness, with a rapid increase in eradication rates.
Adult↗
Gastric myoelectrical activity and gastric emptying in patients with progressive systemic sclerosis.
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Adult↗
[Does chronic alcohol drinking modify digestive gastrobiliary motility?].
In 23 chronic alcoholics and 23 controls gastric emptying, antral motility, fasting gallbladder volume and gallbladder emptying after a standardized, liquid fatty meal were investigated ultrasonically in order to assess the effect of chronic alcoholism on postprandial gastrobiliary motility. Only a subgroup of the alcoholics with signs of autonomic cardiovascular neuropathy (21.7%) exhibited a significant antral hypomotility and a tendency towards higher fasting gallbladder volumes. No significant differences between the study groups could be obtained for the other parameters. The duration and daily amounts of alcohol consumption were not significant different between patients with autonomic neuropathy and patients without autonomic neuropathy. Within the whole group of alcohol consumers the only significant correlation that was observed occurred between the fat induced gallbladder residual volumes and the amounts of daily alcohol consumption (r = 0.62, p < 0.05). However 19 of these 23 relative gallbladder residual volumes were within the normal range (95. percentile of the control group), indicating no major clinical relevance of this phenomenon. None of the motility parameters exhibited a significant correlation to the duration of alcohol consumption. From these results chronic alcohol consumption has no irreversible effects of clinical relevance on the postprandial gastrobiliary motility in the majority of patients in contrast to well documented reversible effects of acute alcohol consumption on gastric motility.
Adult↗
Endoscopic band ligation for treatment of post-polypectomy bleeding.
Endoscopic band ligation is a newly developed technique that has been proved to be an effective treatment of bleeding esophageal varices. Meanwhile, this technique also has been shown to be a successful method of controlling non-variceal upper gastrointestinal hemorrhage. Moreover, there are scattered reports about endoscopic band ligation for treatment of post-polypectomy hemorrhage. In this report, we describe the successful application of colonoscopic band ligation to control severe post-polypectomy colonic bleeding not responding to standard techniques.
Adenomatous Polyps↗
Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying.
In patients with progressive systemic sclerosis (PSS) suffering from chronic dyspepsia the stomach may be affected by this disease. The objective of this study was to investigate both antral myoelectrical activity and gastric emptying in PSS patients. Electrogastrography (EGG) was performed in 17 PSS patients (16 female, one male, median age 58 years, range 32-74 years) with chronic dyspepsia. After an overnight fast during one hour in the fasting and one hour in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electrical activity was measured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG parameters including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute [cpm]), bradygastria (< 2 cpm) and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects. In addition, the data were compared to gastric retention of the radionuclide at 60 min measured by simultaneous scintigraphy. The PSS patients did not reveal electrical disturbances. They even exhibited a significant postprandial decrease in DFIC, bradygastria, and tachygastria (ns) compared to healthy subjects. Over 50% of the PSS patients showed a delayed gastric emptying. However, EGG did not correlate to radioscintigraphy significantly. Our results reflect an absent relationship between antral myoelectrical activity in EGG and gastric emptying. Therefore, electrogastrography is unsuitable to assess gastric involvement in PSS.
Adult↗
[Eosinophilic gastroenteritis in food allergy].
A 23-year-old woman suffered from chronic abdominal pain, nausea and diarrhea. The clinical symptoms particularly increased after ingestion of several foods. Laboratory investigation revealed a moderate eosinophilia in peripheral blood, elevated serum IgE-level and specific IgE against food allergens in radioallergosorbent testing. The patient exhibited exsudative ascites with eosinophiles. CT scan revealed a thickened wall of the small bowel. There was no evidence of a parasitic or extraintestinal disease. Endoscopically, the gastrointestinal tract appeared normal. Histological examinations of biopsies of the gastrointestinal tract led to the diagnosis of eosinophilic gastroenteritis. Under an elimination diet the patient is symptom-free since 16 months without ascites.
Adult↗
[Short-term triple therapy with pantoprazole, clarithromycin and metronidazole for the healing of Helicobacter pylori infection].
In a prospective study 27 patients (13 women, 14 men; mean age 62 [45-83] years) with Helicobacter (H.) pylori associated disease received over 7 days pantoprazole (40 mg twice daily), clarithromycin (500 mg twice daily) and metronidazole (500 mg twice daily). Six patients had gastric ulcer, 4 duodenal ulcer, 4 erosive gastritis, 6 erosive duodenitis and 7 had H. pylori-positive functional dyspepsia. Pre-treatment oesophago-gastro-duodenoscopy was combined in 4 patients with antral and in 4 others with body-of-stomach biopsies to demonstrate H, pylori (urease test, specific culture and histology). The H. pylori status was checked with the 13C-urea breath test 4 weeks after the end of treatment. In addition, 9 patients with peptic ulcer were examined endoscopically at least 2 weeks after onset of the treatment to check for any healing of the ulcers, 25 of the patients completed the study according to the protocol. The H. pylori eradication rate was 100% (25 of 25 patients), while the "intention to treat" analysis gave a rate of 92.6% (25 of the 27 patients). The peptic ulcers were found to be healed in all 9 patients who had been endoscoped. One woman developed a reversible stomatitis, but the drug treatment did not have to be stopped. -These findings indicate that short-term triple treatment in the described manner is efficacious in curing H. pylori infection and any peptic ulcer. It is thus a highly promising treatment of H. pylori-associated diseases.
2-Pyridinylmethylsulfinylbenzimidazoles↗
[Electrogastrography in diagnosis of gastric motility disorders].
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Computer Graphics↗
Electrogastrography in healthy subjects. Evaluation of normal values, influence of age and gender.
Electrogastrography (EGG) permits measurements of the gastric electrical activity. However, normal values of electrical activity are poorly defined. In addition, limited data are available on the effect of age and gender. Therefore, in 40 healthy subjects (age range: 19-90 years) normal values for several EGG parameters were assessed after an overnight fast for 1 hr in the fasting and fed state after ingestion of a standardized solid-liquid meal. The electrical signals were captured by a pair of surface electrodes sonographically placed on the skin overlying the gastric antrum. The dominant electrical frequency was predominantly in the defined normal frequency range between 2 and 4 cycles per minute (cpm) (P < 0.001) and was higher in the postprandial than in the preprandial period (3.1 cpm vs 2.8 cpm, P = 0.02). The instability of the electrical rhythm calculated by a dominant frequency instability coefficient (DFIC) was postprandially lower than in the fasting state (P = 0.04). The electrical power (amplitude) increased postprandially (postprandial to fasting power ratio = 2.4). To evaluate the influence of age and gender on normal values the subjects were divided into four groups (median age: male, 28 and 69 years; female, 25 and 67 years). The most parameters did not differ significantly between the groups. However, DFIC was different between the groups (P < 0.05), with elderly women revealing lowest DFIC. In conclusion, normal values for several EGG parameters evaluated in this study should be included in the analysis of gastric electrical activity. The magnitude of electrical frequency and power are not influenced by age and gender, whereas the instability of the electrical frequency is influenced by these factors.
Adult↗
[Intraindividual reproducibility of ultrasound detection of gastrobiliary motility parameters and CCK incretion after a standardized, liquid, fat-containing test meal].
AIM AND METHODS: Gastric emptying, antral mobility, fasting gallbladder volumes, gallbladder emptying rates, and CCK incretion following a standardized liquid fatty meal were investigated in 14 healthy young volunteers (seven women and seven men) on two separate study days. In the seven young women, taking oral contraceptives, one study day was in the oestrogen phase and the other in the gestagen phase of their menstrual cycle. RESULTS: There was good intraindividual reproducibility of the different sonographic gastrobillary motility parameters and the postprandial CCK incretion in both sexes (coefficients of reliability between 0.80 and 0.98). A significant effect of the menstrual cycle phase in young women was not evident. Instead of this a wide interindividual range of motility parameters, especially of gastric residual volumes in young women, could be obtained. There was no close correlation between gastric emptying rates or the amounts of the fat induced cholecystokinin incretion and gallbladder emptying rates, indicating the relevance of additional cholecystokinin-independent preduodenal mechanism for the regulation of physiological digestive gallbladder emptying.
Adult↗
Antral myoelectric activity, gastric emptying, and dyspeptic symptoms in diabetics.
BACKGROUND: Electrogastrography (EGG) enables the cutaneous measurement of gastric electric activity. An association between electric abnormalities and gastrointestinal motility disorders has been shown. The primary objective of this study was to investigate whether diabetic gastroparesis could be predicted by EGG. METHODS: EGG was performed in 18 insulin-treated type-II diabetics (9 female, 9 male; median age, 64 years; range, 45-76 years) with chronic dyspepsia. After an overnight fast, during 1 h in the fasting and 1 h in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electric activity was captured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG variables including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute (cpm)), bradygastria (< 2 cpm), and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated by fast Fourier transform. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects (10 female, 10 male; median age, 68 years; range, 53-90 years). In addition, the data were compared with the percentages of retention of the radionuclide in the stomach at 60 min, and lag times measured by simultaneous scintigraphy. RESULTS: The EGG values obtained in diabetics did not differ significantly from those in healthy subjects and did not correlate with radioscintigraphy (p > 0.05). Moreover, the EGG values in diabetics with delayed gastric emptying (about 40%) did not differ from data in diabetics without gastroparesis. Furthermore, whereas dyspepsia correlated significantly with radioscintigraphy, no correlation with EGG could be found. CONCLUSIONS: Electrogastrography seems to be unsuitable for assessment of motility disorders in type-II diabetics.
Aged↗
Endosonographically guided transduodenal and transgastral fine-needle aspiration puncture of focal pancreatic lesions.
Mass lesions of the pancreas can be clearly visualized by endoscopic ultrasonography. For the differentiation of benign from malignant mass lesions, however, cytological examination is still recommended. As transcutaneous fine-needle biopsies have a limited diagnostic value, we have evaluated the efficiency of transmural (trangastral, transduodenal) endosonographically guided fine-needle aspiration (EUS-guided FNA) puncture for cytological confirmation of such pancreatic mass lesions. EUS-guided FNA puncture was performed in 11 patients with focal pancreatic solid lesions. In 4 patients a malignant mass lesion and in 2 patients a benign lesion were correctly identified by EUS-guided FNA puncture, while in 4 patients a false benign diagnosis was established and in 1 patient with a malignant mass lesion a sufficient cytological sample could not be obtained. Histological confirmation or rejection of the cytological diagnosis gained by EUS-guided FNA puncture was obtained in all patients by surgical biopsy or resection. It is concluded that transmural EUS-guided FNA puncture-with the application of a curved-array EUS transducer scanning parallel to the axis of the endoscope-is a new approach to the cytological diagnosis of pancreatic mass lesions. However, the of flexible puncture needles with a short needle tip-destined for multiple use-results in a considerable amount of false-negative diagnoses, as the needle tip frequently can only be advanced into the margin of the lesion. New prototypes of aspiration needles with an extending steel are presently under study for improved transmural EUS-guided FNA puncture.
Aged↗
The significance of electrogastrographically determined amplitudes--is there a correlation to sonographically measured antral mechanical contractions?
Cutaneous electrogastrography (EGG) allows the measurement of gastric electrical activity. An association of EGG with gastrointestinal motility disorders has been shown. Abnormalities of electrical rate or rhythm are accepted as the most important parameters in EGG. However, the reliability of the magnitude of electrical amplitude in the assessment of motility is discussed controversially. Therefore in a prospective study we investigated the relation between amplitude and antral contractions by means of ultrasonography. 8 healthy volunteers (4 men, 4 women, 24-31 years) ingested 400 ml carbonated mineral water after an overnight fast at two separate study days. Over a period of 10 min preprandial and 10 min postprandial small and intense antral contractions were measured employing sagittal antral planimetry. Simultaneous amplitudes were determined during contractions and at 1 min intervals (average amplitude) by cutaneous electrogastrography. Data were analyzed by Wilcoxon's rank sum test and Spearman rank correlation test. The coefficient of variation of the postprandial/preprandial amplitude ratio was nearly two times greater between subjects than between recordings in the same subject, which reflects a moderate intraindividual reproducibility. We found a significant increase in the average amplitude postprandially (p < 0.05). Although postprandial contractions (n = 243) predominated preprandial contractions (n = 127) significantly (p = 0.02), no significant correlation between the number of contractions and the average amplitude existed (R = 0.1; p = 0.7). Moreover the average amplitude did not differ from amplitudes during intense and small contractions significantly (p = 0.7; p = 0.1). The magnitude of the amplitude measured by EGG does not correlate with the mechanical gastral activity significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Non-invasive 13C octanoic acid breath test for measuring stomach emptying of a solid test meal--correlation with scintigraphy in diabetic patients and reproducibility in healthy probands].
The recently developed 13C-octanoic acid breath test allows the measurement of gastric emptying of solids. In this prospective study we wanted to investigate, whether the 13C-octanoic acid breath test using breath samples every half an hour is suitable in assessing gastric emptying in comparison to scintigraphy in diabetics. Furthermore, we examined the intraindividual reproducibility in healthy volunteers. 20 consecutive diabetics with clinical symptoms of gastroparesis received a solid double-labeled standard test meal. The meal consisted of 1 scrambled egg, labeled with 75 mg 13C-octanoic acid and 0.5 mCi 99mTc colloid, 50 g rye bread, 20 g butter, 200 ml orange juice; 280 kcal. Breath samples were taken at half hour intervals for 4 hours and analyzed for 13CO2 by isotope ratio mass spectrometry. Using a regression method gastric emptying half times (t 1/2) were determined and correlations to simultaneous 99mTc-scintigraphy were calculated. There was a moderate significant correlation of 13C-octanoic acid breath test t 1/2 and scintigraphic t 1/2 (R = 0.6; p = 0.008). The 13C-octanoic acid breath test t 1/2 obtained in 20 healthy volunteers measured at two separate days showed a coefficient of variation (VC), that was greater between subjects (VK = 42%) than between two measurements in the same subject (VK = 24%), which reflects a moderate intraindividual reproducibility. Taking breath samples every half an hour the 13C-octanoic acid breath test only reveals a moderate intraindividual reproducibility and a moderate correlation to scintigraphy in diabetics. For detailed assessment of solid gastric emptying in diabetics a 13C-octanoic acid breath test using shorter breath sampling intervals is recommended.
Aged↗