PubMed Health⌕ Search

Biomedical subjects

G Perdikis

Publications and source records attributed to G Perdikis.

41 records · Page 3Linked to original sources
PubMed1993

Comparison of an intravenous bolus of famotidine and Mylanta II for the control of gastric pH in critically ill patients.

The effects of the intravenous bolus administration of famotidine versus the administration of Mylanta II liquid every 2 hours on the pH of the gastric antrum, body, and fundus for 24 hours were compared in 10 critically ill patients admitted to the intensive care unit with isolated cranial trauma. Patients received 30 mL of Mylanta II every 2 hours via nasogastric tube for 24 hours, followed by administration of 20 mg of intravenous bolus famotidine every 12 hours for the subsequent 24-hour period. pH of the gastric antrum, body, and fundus was monitored continuously using a three antimony pH electrode/nasogastric tube assembly. Gastric pH data were analyzed for the percentage of time pH was less than 4 and median pH for the antrum, body, and fundus for each 24-hour period. The percentage of time pH was less than 4 was significantly less in the antrum and body of the stomach during famotidine therapy (8.9% +/- 3.6% and 24.9% +/- 6.9%, respectively) compared with Mylanta II (39.1% +/- 6.7% and 57.6% +/- 8.5%, respectively, both p < 0.005), but was not significantly different in the fundus (famotidine: 25.3% +/- 7.8%; Mylanta II: 28.3% +/- 6.5%). Median gastric pH for 24 hours was significantly greater in the antrum and body of the stomach during famotidine therapy (7.8 +/- 0.2 and 6.8 +/- 0.6, respectively) compared with Mylanta II (4.5 +/- 0.6 and 3.7 +/- 0.9, respectively, p < 0.005 and p < 0.01, respectively), but was not significantly different in the fundus (famotidine: 5.9 +/- 0.8; Mylanta II: 5.4 +/- 0.7). The data indicate that an intravenous bolus of famotidine every 12 hours is more effective than Mylanta II liquid every 2 hours administered via a nasogastric tube in maintaining gastric pH above 4 in critically ill patients. Famotidine produces a uniform increase in gastric pH throughout the stomach, whereas Mylanta II controls only proximal gastric pH, probably related to fundic pooling of antacid in the supine position.

Adult↗
PubMedDate not supplied

Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility.

Impaired esophageal body motility is a complication of chronic gastroesophageal reflux disease (GERD). In patients with this disease, a 360-degree fundoplication may result in severe postoperative dysphagia. Forty-six patients with GERD who had a weak lower esophageal sphincter pressure and a positive acid reflux score associated with impaired esophageal body peristalsis in the distal esophagus (amplitude <30 mm Hg and >10% simultaneous or interrupted waves) were selected to undergo laparoscopic Toupet fundoplication. They were compared with 16 similar patients with poor esophageal body function who underwent Nissen fundoplication. The patients who underwent Toupet fundoplication had less dysphagia than those who had the Nissen procedure (9% vs.44%; P=0.0041). Twenty-four-hour ambulatory pH monitoring and esophageal manometry were repeated in 31 Toupet patients 6 months after surgery. Percentage of time of esophageal exposure to pH <4.0, DeMeester reflux score, lower esophageal pressure, intra-abdominal length, vector volume, and distal esophageal amplitude all improved significantly after surgery. Ninety-one percent of patients were free of reflux symptoms. The laparoscopic Toupet fundoplication provides an effective antireflux barrier according to manometric, pH, and symptom criteria. It avoids potential postoperative dysphagia in patients with weak esophageal peristalsis and results in improved esophageal body function 6 months after surgery.

Deglutition Disorders↗
PubMedDate not supplied

Indications, technical modalities and results of the duodenal switch operation for pathologic duodenogastric reflux.

BACKGROUND/AIMS: Reflux gastritis is caused by the excessive reflux of alkaline duodenal content into the stomach and can lead to intractable symptoms. The main cause of pathologic duodenogastric reflux (DGR) is previous gastric surgery in which the pylorus is removed or rendered dysfunctional. The entity of abnormal DGR without previous gastric surgery is called "primary duodenogastric reflux". The main symptoms in these patients are severe upper abdominal pain, nausea and bilious vomiting. DGR remains very difficult to diagnose and treat. Investigations include endoscopy with histological examination, intragastric pH-monitoring, radionuclide scanning, gastric aspiration, antroduodenal manometry, and bile detection with special probes. Medical therapy is generally not helpful. Acid-blocking medications, sucralfate, prostaglandin E2 and cholestyramine used as an ion-exchange resin to bind bile salts do not usually improve symptoms. There is some evidence that ursodeoxycholate favorably affects symptoms but experience is limited. METHODOLOGY: Surgical therapy was initially performed on selected patients with intractable symptoms. A variety of operative procedures have been used to treat pathologic DGR but cause significant side effects through changes in the normal physiology of the foregut. DeMeester et al proposed a suprapapillary duodenojejunostomy succinctly called the duodenal switch procedure. It has been reported to maintain the integrity of the antro-pyloro-duodenal mechanism with great patient satisfaction. Between 1984 and 1995, 32 patients (9 men and 23 women), mean age 50 years (range: 30-77), required pancreaticobiliary diversion using the switch procedure for symptomatic gastritis related to abnormal primary DGR. Symptoms were evaluated with a symptom score using a detailed questionnaire. RESULTS: After a mean follow-up of 4 years (n = 32, range: 0.5-8.2), 94% of the patients had a good clinical outcome as defined by a significant reduction in pre-operative symptoms. There was no mortality. CONCLUSIONS: Suprapapillary Roux-en-Y duodenojejunostomy (duodenal switch procedure) is an effective surgical therapy in patients with pathologic primary DGR.

Adult↗
PubMedDate not supplied

Laparoscopic fundoplication: the alternative to long-term medical therapy for severe gastroesophageal reflux disease.

UNLABELLED: Gastroesophageal reflux disease is common. Fundoplication is very effective for those patients who fail medical therapy, particularly those with an incompetent lower esophageal sphincter. Open surgery is reported to achieve cure rates in excess of 90 percent. Laparoscopic fundoplication has been performed since 1991. The early experience with this procedure is reviewed. RESULTS: 1992 cases were reported in the literature. The mortality rate was 0.1 percent. Operative complications occurred as follows: 0.9 percent esophagogastric perforation rate; 0.6 percent bleeding rate (requiring transfusion); and 0.6 percent pneumothorax rate. No splenectomies were reported. 4.8 percent of patients required conversion to the open procedure. As experience with the procedure is gained this conversion rate decreases. Recurrent reflux postoperatively is 3.4 percent, but follow-up is short (range: 0 to 36 months; mean: two years). Dysphagia requiring dilatation occurs in 3.5 percent of patients. Gas bloat occurs in 0 to 24 percent of patients. These results compare favorably with the published results of medical therapy and the open fundoplication. CONCLUSIONS: The early experience with laparoscopic fundoplication appears promising and provides an attractive alternative to long-term medical therapy and to open surgery in appropriate patients. Long-term follow-up is awaited.

Fundoplication↗