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Biomedical subjects

Gerald Holtmann

Publications and source records attributed to Gerald Holtmann.

At least 19 recordsLinked to original sources
PubMed2006

Ablation of connexin43 in smooth muscle cells of the mouse intestine: functional insights into physiology and morphology.

Connexin43 (Cx43) gap-junction channels are highly abundant in intestinal smooth muscle but their functional impact has not been studied so far. Here, we have aimed to elucidate the functional role of Cx43 in the tunica muscularis of the mouse intestine in vivo. Transgenic mice with conditional deletion of Cx43 in smooth muscle cells (SMC) were generated. Histological investigations by immunofluorescence analyses and organ-bath recordings to assess the contractility of intestinal tissue strips were carried out. Measurements of gastrointestinal transit and of the visceromotor response by utilizing a standardized colorectal distension model to quantify alterations of visceral sensory function were also performed in SMC-specific Cx43 null mice and control littermates. Histologically, we found thickening of the tunica muscularis and a 13-fold increase of neutrophil infiltration of the gastrointestinal wall of SMC-specific Cx43 null mice. These animals also exhibited a decrease of 29% in gastrointestinal transit time. In contrast, the visceromotor response to a standardized colorectal distension was elevated, as was the contractility in SMC-specific Cx43 null mice, compared with controls. Thus, SMC-specific ablation of Cx43 in mice leads to morphological and functional alterations of the intestinal tunica muscularis, to gastrointestinal motor dysfunction and to altered visceral sensory function.

Animals↗
PubMed2006

Public speaking stress-induced neuroendocrine responses and circulating immune cell redistribution in irritable bowel syndrome.

OBJECTIVES: Augmented neuroendocrine stress responses and altered immune functions may play a role in the manifestation of functional gastrointestinal (GI) disorders. We tested the hypothesis that IBS patients would demonstrate enhanced psychological and endocrine responses, as well as altered stress-induced redistribution of circulating leukocytes and lymphocytes, in response to an acute psychosocial stressor when compared with healthy controls. METHODS: Responses to public speaking stress were analyzed in N = 17 IBS patients without concurrent psychiatric conditions and N = 12 healthy controls. At baseline, immediately following public speaking, and after a recovery period, state anxiety, acute GI symptoms, cardiovascular responses, serum cortisol and plasma adrenocorticotropic hormone (ACTH) were measured, and numbers of circulating leukocytes and lymphocyte subpopulations were analyzed by flow cytometry. RESULTS: Public speaking led to significant cardiovascular activation, a significant increase in ACTH, and a redistribution of circulating leukocytes and lymphocyte subpopulations, including significant increases in natural killer cells and cytotoxic/suppressor T cells. IBS patients demonstrated significantly greater state anxiety both at baseline and following public speaking. However, cardiovascular and endocrine responses, as well as the redistribution of circulating leukocytes and lymphocyte subpopulations after public speaking stress, did not differ for IBS patients compared with controls. CONCLUSIONS: In IBS patients without psychiatric comorbidity, the endocrine response as well as the circulation pattern of leukocyte subpopulations to acute psychosocial stress do not differ from healthy controls in spite of enhanced emotional responses. Future studies should discern the role of psychopathology in psychological and biological stress responses in IBS.

Adrenocorticotropic Hormone↗
PubMed2006

Severity of mucosal inflammation as a predictor for alterations of visceral sensory function in a rat model.

Transient inflammation is known to alter visceral sensory function and frequently precede the onset of symptoms in a subgroup of patients with irritable bowel syndrome (IBS). Duration and severity of the initial inflammatory stimulus appear to be risk factors for the manifestation of symptoms. Therefore, we aimed to characterize dose-dependent effects of trinitrobenzenesulfonic acid (TNBS)/ethanol on: (1) colonic mucosa, (2) cytokine release and (3) visceral sensory function in a rat model. Acute inflammation was induced in male Lewis rats by single administration of various doses of TNBS/ethanol (total of 0.8, 0.4 or 0.2 ml) in test animals or saline in controls. Assessment of visceromotor response (VMR) to colorectal distensions, histological evaluation of severity of inflammation, and measurement of pro-inflammatory cytokine levels (IL-2, IL-6) using enzyme-linked immunosorbent assay (ELISA) were performed 2h and 3, 14, 28, 31 and 42 days after induction. Increased serum IL-2 and IL-6 levels were evident prior to mucosal lesions 2h after induction of colitis and persist up to 14 days (p<0.05 vs. saline), although no histological signs of inflammation were detected at 14 days. In the acute phase, VMR was only significantly increased after 0.8 ml and 0.4 ml TNBS/ethanol (p<0.05 vs. saline). After 28 days, distension-evoked responses were persistently elevated (p<0.05 vs. saline) in 0.8 and 0.4 ml TNBS/ethanol-treated rats. In 0.2 ml TNBS/ethanol group, VMR was only enhanced after repeated visceral stimulation. Visceral hyperalgesia occurs after a transient colitis. However, even a mild acute but asymptomatic colitis can induce long-lasting visceral hyperalgesia in the presence of additional stimuli.

Abdominal Muscles↗
PubMed2006

Psychological stress and the severity of post-inflammatory visceral hyperalgesia.

OBJECTIVES: Lowered visceral sensory thresholds are a key finding in at least a subgroup of patients with functional bowel disorders. Stress and inflammation contribute to this altered visceral sensory function. We aimed to elucidate the role of repetitive stress and acute mucosal inflammation, alone and in combination, on sensory function. METHODS: In randomized order, trinitrobenzenesulfonic acid (TNBS) plus the equal amount of ethanol or saline were instilled into the colorectum of female Lewis rats. Colorectal distensions (CRD) were performed with a barostat device (3 min/40 mmHg); to quantify the visceromotor response (VMR) to CRD, electromyographic activity (EMG) of the abdominal muscles was recorded. In randomized order, equal numbers of both treatment groups underwent either seven days (1 h/day) repetitive water avoidance stress (WAS) or sham WAS. CRD's were conducted 28 days later. Colonic tissue samples were obtained to characterize inflammation and blood samples were taken at day 28 to measure plasma IL-2 levels by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared to controls (662+/-114 microV) TNBS (1081+/-227 microV), WAS (1366+/-125 microV) and the combination of both (1477+/-390 microV) significantly augmented the VMR to CRD. TNBS and/or WAS caused significant inflammatory changes at day 5, while only TNBS+WAS also showed signs of mucosal inflammation on day 14 and significantly elevated IL-2 levels on day 28. CONCLUSIONS: Stress and inflammation cause long lasting alterations of visceral sensory function. Concomitant stress further increases post-inflammatory visceral hyperalgesia.

Abdominal Muscles↗
PubMed2006

A placebo-controlled trial of itopride in functional dyspepsia.

BACKGROUND: The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with anti-acetylcholinesterase [corrected] effects, in patients with functional dyspepsia. METHODS: Patients with functional dyspepsia were randomly assigned to receive either itopride (50, 100, or 200 mg three times daily) or placebo. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia (as assessed by the Leeds Dyspepsia Questionnaire), patients' global assessment of efficacy (the proportion of patients without symptoms or with marked improvement), and the severity of pain or fullness as rated on a five-grade scale. RESULTS: We randomly assigned 554 patients; 523 had outcome data and could be included in the analyses. After eight weeks, 41 percent of the patients receiving placebo were symptom-free or had marked improvement, as compared with 57 percent, 59 percent, and 64 percent receiving itopride at a dose of 50, 100, or 200 mg three times daily, respectively (P<0.05 for all comparisons between placebo and itopride). Although the symptom score improved significantly in all four groups, an overall analysis revealed that itopride was significantly superior to placebo, with the greatest symptom-score improvement in the 100- and 200-mg groups (-6.24 and -6.27, vs. -4.50 in the placebo group; P=0.05). Analysis of the combined end point of pain and fullness showed that itopride yielded a greater rate of response than placebo (73 percent vs. 63 percent, P=0.04). CONCLUSIONS: Itopride significantly improves symptoms in patients with functional dyspepsia. (ClinicalTrials.gov number, NCT00272103.).

Adolescent↗
PubMed2006

Functional gastroduodenal disorders.

A numerically important group of patients with functional gastrointestinal disorders have chronic symptoms that can be attributed to the gastroduodenal region. Based on the consensus opinion of an international panel of clinical investigators who reviewed the available evidence, a classification of the functional gastroduodenal disorders is proposed. Four categories of functional gastroduodenal disorders are distinguished. The first category, functional dyspepsia, groups patients with symptoms thought to originate from the gastroduodenal region, specifically epigastric pain or burning, postprandial fullness, or early satiation. Based on recent evidence and clinical experience, a subgroup classification is proposed for postprandial distress syndrome (early satiation or postprandial fullness) and epigastric pain syndrome (pain or burning in the epigastrium). The second category, belching disorders, comprises aerophagia (troublesome repetitive belching with observed excessive air swallowing) and unspecified belching (no evidence of excessive air swallowing). The third category, nausea and vomiting disorders, comprises chronic idiopathic nausea (frequent bothersome nausea without vomiting), functional vomiting (recurrent vomiting in the absence of self-induced vomiting, or underlying eating disorders, metabolic disorders, drug intake, or psychiatric or central nervous system disorders), and cyclic vomiting syndrome (stereotypical episodes of vomiting with vomiting-free intervals). The rumination syndrome is a fourth category of functional gastroduodenal disorder characterized by effortless regurgitation of recently ingested food into the mouth followed by rechewing and reswallowing or expulsion. The proposed classification requires further research and careful validation but the criteria should be of value for clinical practice; for epidemiological, pathophysiological, and clinical management studies; and for drug development.

Child↗
PubMed2006

A combination of peppermint oil and caraway oil attenuates the post-inflammatory visceral hyperalgesia in a rat model.

OBJECTIVE: Visceral hyperalgesia plays a pivotal role in manifestation of symptoms in patients with functional gastrointestinal disorders. In clinical studies combined treatment of peppermint- and caraway oil significantly reduced symptoms. Thus, the aim of this study was to characterize the effects of peppermint- and caraway oil, individually and in combination, on visceral nociception in a rat model of post-inflammatory visceral hyperalgesia. MATERIAL AND METHODS: On day 28, male Lewis rats (n=80) were randomized to treatment with a rectal administration of trinitrobenzene sulphonic acid (TNBS)/ethanol or physiological saline solution. To quantify the visceromotor response to a standardized colorectal distension, bipolar electrodes were implanted into the external oblique musculature, just superior to the inguinal ligament for electromyographic recordings on day 3. On day 0, baseline measurement was performed. Thereafter, oral treatment with peppermint- or caraway oil or combination treatment was started and continued for 14 consecutive days. After 7 and 14 days of treatment a colorectal distension was performed. Colonic tissue samples were obtained on days 0, 7 and 14 to assess histological alterations due to the different treatment groups and the influence of different compounds. RESULTS: After a single instillation of TNBS/ethanol persistent elevation of the visceromotor response at all different time-points was observed, although colonic mucosa was completely normal. After 14 days of combined treatment with peppermint- and caraway oil, a reduced visceromotor response of up to 50% compared to placebo was detected in TNBS/ethanol pretreated animals. In contrast, neither peppermint- nor caraway oil had a significant effect on post-inflammatory visceral hyperalgesia. In saline-treated controls there was no significant difference in the visceromotor response. CONCLUSIONS: These data show that combined treatment with peppermint- and caraway oil modulates post-inflammatory visceral hyperalgesia synergistically. The exact mechanisms have to be further investigated.

Administration, Rectal↗
PubMed2006

Hypothesis driven research and molecular mechanisms in functional dyspepsia: the beginning of a beautiful friendship in research and practice?

There is accumulating evidence of a genetic predisposition in at least a subset of patients with functional GI symptoms. Hence, hunting for genes in irritable bowel syndrome and functional dyspepsia has become fashionable of late. Unfortunately, as in other fields, replication of gene association studies has most often been problematic. In this issue of the Journal, independent corroboration of an association of dyspepsia with GNbeta3 is reported. Other carefully selected putative genes including polymorphisms in the alpha2A adrenoreceptor, the serotonin reuptake transporter, and the 5-HT1A receptor were not associated. The study raises three key questions all considered in this editorial: (a) if GNbeta3 is truly associated with functional and uninvestigated dyspepsia, why might this be the case, (b) what molecular mechanisms may be of most relevance, and (c) perhaps most importantly, does or will this finding translate into clinical practice in terms of diagnosis or treatment? New knowledge of gene associations like GNbeta3 and their pathophysiological relevance may ultimately lead to better targeted therapy as well as new disease modifying treatments.

Dyspepsia↗
PubMed2005

Understanding GERD symptoms in the clinical setting.

Gastroesophageal reflux disease (GERD) is a highly prevalent disorder which affects 10-30% of the population in Western countries. It is associated with risk of Barrett's esophagus and adenocarcinoma, although the risk is limited and many patients do not have progressive disease. Identification and treatment of GERD symptoms is the main target for the majority of patients with this disease. Since the grading of lesions and symptoms are two independent indicators of disease severity, these two main characteristics for GERD evaluation should be considered separately. Proper symptom assessment as a measure of the severity of disease and for the evaluation of treatment response is required, as are symptom assessment tools for practical clinical use.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

MR colonography in patients with incomplete conventional colonoscopy.

PURPOSE: To assess dark-lumen magnetic resonance (MR) colonography for the evaluation of colonic segments in patients in whom conventional colonoscopy could not be completed. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Within 24 hours of incomplete conventional colonoscopy, 37 patients (22 women, 15 men; age range, 25-63 years) underwent MR colonography. Contrast material-enhanced T1-weighted three-dimensional images were collected after rectal administration of water for colonic distention. Data from MR colonography were evaluated by two radiologists. With a three-point scale, image quality was characterized in terms of colonic distention (1 = good; 2 = moderate, diagnostic; and 3 = poor, nondiagnostic) and presence of artifacts (1 = none; 2 = moderate, diagnostic; and 3 = extensive, nondiagnostic). Depiction of colorectal disease was assessed according to the following colonic segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. RESULTS: Four patients had history of colorectal cancer, and each had undergone partial colonic resection of two segments. Hence, 214 segments were evaluated. Conventional colonoscopy failed in assessment of 127 of 214 potentially visible colonic segments in the 37 patients. MR image quality was rated diagnostic in 35 patients and permitted assessment of 206 of 214 potentially visible segments. Nondiagnostic image quality in two patients was attributed to inadequate distention of prestenotic colonic segments owing to high-grade tumor stenosis. All inflammation- and tumor-induced stenoses and all five polyps identified at conventional colonoscopy in poststenotic segments were correctly detected at MR colonography. However, MR-based assessment of prestenotic segments revealed two lesions suspected of being carcinoma, five polyps, and four segments affected by colitis. CONCLUSION: MR colonography proved reliable in evaluating the majority of colonic segments inaccessible with conventional colonoscopy. The identification of additional disease at MR colonography underscores the need for a second diagnostic step in the setting of incomplete conventional colonoscopy.

Adult↗
PubMed2004

Real-time high-resolution MRI for the assessment of gastric motility: pre- and postpharmacological stimuli.

PURPOSE: To determine the practicality of MRI using a new real-time sequence for the assessment of gastric motion, and quantify the effects of motility-modifying substances. MATERIALS AND METHODS: Six healthy volunteers ingested 400 mL of a high-calorie liquid nutrient. Two-dimensional real-time TrueFISP sequences were acquired for up to 30 minutes following the ingestion. The acquisition plane was chosen parallel to the axis of the gastric antrum. The examination was performed on three separate days with and without i.v. administration of 10 mg metoclopramide or 20 mg scopolamine. A motility index was calculated for each real-time data set. RESULTS: Delineation of the gastric lumen proved easy and robust. The intravenous application of motility-modifying agents resulted in significant changes in the motility index. The administration of metoclopramide resulted in an average increase of the index by a factor of 1.5, whereas the application of scopolamine led to a decrease of the index by a factor of 3.0. CONCLUSION: TrueFISP MRI performed well in depicting the gastric lumen and assessing gastric motility. Furthermore, we were able to evaluate and quantify the effect of motility-modifying agents. The noninvasive nature of MRI makes this imaging modality an attractive alternative to conventional invasive diagnostic tools for gastric motility disorders and monitoring of therapy.

Adult↗
PubMed2004

Heartburn in primary care: problems below the surface.

Heartburn is a common physiological event often associated with an underlying occurrence of gastroesophageal reflux disease (GERD). Studies show that GERD is a highly prevalent and chronic condition that significantly impacts on the patient's quality of life (QoL) and, in the long term, increases the risk for developing esophageal adenocarcinoma, more commonly referred to as Barrett's esophagus. Data indicate that symptom severity is a poor predictor of either the presence of erosive mucosal lesions or the development of complications. Given that lifestyle modifications are often insufficient for long-term treatment of GERD, drugs that inhibit gastric acid production--such as the proton pump inhibitors (PPIs)--are now the most effective strategy. Although generally well tolerated, the potential of PPIs for interactions with other drugs needs to be considered. This review discusses the symptoms and risk factors associated with GERD, possible links to Helicobacter pylori infection, and effective treatment strategies within a primary care setting.

Antacids↗
PubMed2004

[Evidence-based medicine and phytotherapy for functional dyspepsia and irritable bowel syndrome: a systematic analysis of evidence for the herbal preparation Iberogast].

Functional gastrointestinal disorders like functional dyspepsia and irritable bowel syndrome are characterized by more or less specific symptoms and the absence of structural lesions to explain symptoms. Other studies suggest that abnormalities of specific gut function are linked to manifestation of symptoms. These abnormalities include disturbances of motility such as postprandial fundic relaxation, gastric emptying and disturbed visceral sensory function. The underlying pathophysiology is not fully understood. However, various studies point towards hereditary (or molecular) factors modified by environmental factors. Considering this broad spectrum of factors it is conceivable that treatments targeting a single mechanism are most likely to improve symptoms only in patients with a disturbance linked to this mechanism. Thus overall efficacy in the whole patient population is limited. Indeed, superiority of chemically defined treatments targeting a single receptor yield a benefit over placebo of between 10 and 15%. In recent years well-controlled studies have demonstrated superiority of specific herbal preparations. This in particular held true for combinations of various plant extracts or herbal extracts with a number of different active ingredients. However, efficacy of herbal treatment for functional GI disorders cannot be taken for granted and these drugs need to be rigorously tested for efficacy and safety. In this context, same standards apply as for conventional chemically defined medications.

Dyspepsia↗
PubMed2004

Molecular basis of functional gastrointestinal disorders.

There are a number of abnormalities of gastrointestinal function, including sensory and motor dysfunction, which are believed to play a role in the manifestation of symptoms in patients with functional gastrointestinal disorders (FGID). In addition, there is a remarkable psychiatric comorbidity. Family and twin studies have provided strong evidence for a clustering of FGID in families and an increased concordance in monozygotic compared to dizygotic twins. This points towards the role of one or more hereditary (genetic) factors. Considering these disorders of function and the psychiatric comorbidity, polymorphisms of adrenergic, opioidergic or serotonergic receptors as well as G-protein beta3 (GNB3) subunit gene polymorphisms (C825T) and polymorphisms of 5-HT transporter genes are suitable causes. In addition, mediators or regulators of mucosal inflammation may trigger events that ultimately result in the manifestation of FGID. Thus, relevant polymorphisms of genes with immunmodulating and/or neuromodulating features (OPRM1, IL-4, IL-4R, TNFalpha) may also play a role in the manifestation of FGIDs.

Animals↗
PubMed2004

IBS: a syndrome or many diseases?

Patients with irritable bowel syndrome (IBS) are characterized by a broad spectrum of gastrointestinal (GI) symptoms. These IBS-symptoms and symptoms of other functional GI disorders frequently overlap. Moreover, at least in patients with severe disease manifestations there is a remarkable psychiatric comorbidity. There is a number of abnormalities of GI functions including sensory and motor dysfunction that are believed to play a role for the manifestation of symptoms in patients with these functional gastrointestinal disorders (FGID). Family studies provide strong evidence for a clustering of FGID in families. Furthermore, twin studies clearly demonstrate an increased concordance in monocygotic compared to dicygotic twins. This points towards the role of one or more hereditary factors. Considering sensory and motor function as well as the psychiatric comorbidity, polymorphisms of adrenergic, opioidergic or serotonergic receptors as well as G-protein beta3 (GNB3) subunit gene polymorphism and polymorphisms of 5-HT transporter genes are suitable mechanisms for these abnormalities. Hence acute GI infections with a mucosal inflammation appear to trigger a cascade of events that ultimately results in the manifestation of FGID, it is reasonable to assume that functionally relevant polymorphisms of genes with immunmodulating and/or neuromodulating features (OPRM1, IL-4, IL-4R, TNFalpha) play a role. It has emerged that a number of various factors may contribute to the manifestation of functional GI disorders. The currently symptom based labels for functional GI disorders may be helpful to categorize patients and target therapy. However, various underlying pathophysiologies may cause similar symptom patterns. Thus, it is reasonable to anticipate that IBS will be dissected accordingly and our disease concepts will accept the irritable bowel syndrome as the clinical manifestation of a number of different disorders.

Gastrointestinal Diseases↗
PubMed2004

Determinants of health-related quality of life in patients with chronic liver diseases.

BACKGROUND AND AIMS: The study aims to assess influence of the liver disease, active medical and psychiatric comorbidities, and sociodemographic variables in the determination of health-related quality of life (HRQOL) measured by a generic and a liver-specific instrument in unselected patients with chronic liver disease. METHODS: Two hundred four of 255 consecutive patients (80%) with all stages of various liver diseases attending a tertiary-care center completed the following self-report questionnaires: sociodemographic questionnaire of the Competence Network Bowel Disease, morbidity list of the German Pain Questionnaire, the German version of the Hospital Anxiety and Depression Scale (HADS-D), and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) as generic instruments; and the German version of the Chronic Liver Disease Questionnaire (CLDQ) as a disease-specific HRQOL-instrument. RESULTS: Stepwise multiple regression showed that cause of liver disease, severity of disease (cirrhosis vs. no cirrhosis, Child-Pugh score), sex, age, and social class had no effect on HRQOL. Anxiety resp. depression scores >/= 11 in the German version of the HADS, indicating a probable psychiatric disorder, contributed independently to the impaired HRQOL in the total score of the CLDQ and the Physical and Mental Summary Scores of the SF-36 (P < 0.0001). Number of active medical comorbidities contributed independently to the reduced HRQOL in the total score of the CLDQ and the Physical Summary Score of the SF-36 (P < 0.0001). Furthermore, the SF-36 Mental Summary Score was influenced negatively by active cardiovascular comorbidity (P < 0.003). CONCLUSIONS: Psychiatric comorbidity and active medical comorbidity, and not severity of the liver disease according to Child-Pugh score, determine reduced HRQOL in patients with chronic liver diseases.

Chronic Disease↗
PubMed2004

Clinical presentation and personality factors are predictors of the response to treatment in patients with functional dyspepsia; a randomized, double-blind placebo-controlled crossover study.

The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained (functional) dyspepsia is unknown. We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy, while psychological disturbances would be associated with a less favorable response to treatment. Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial. Patients were treated for 4 weeks in a double-blind, placebo-controlled crossover trial starting in random order with either active drug (ranitidine, 150 mg b.d.) or placebo. Every 7 days, medication was switched from active drug to placebo, or vice versa. At entry, patient characteristics were assessed utilizing a semistructured standardized interview and standardized questionnaires, and weekly intensity of symptoms was assessed utilizing a visual analogue scale. Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50% at the end of the study period were categorized as responders. Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response. During treatment the symptom score decreased significantly, from 32.1 +/- 1.44 (SD) to 21.3 +/- 1.9 at the end of the trial (P < 0.001). Twenty of 75 were responders. High scores for somatization (OR, 3.6; 95% Cl, 1.2-11.4), anxiety (OR, 3.3; 95% Cl, 0.9-11.8), and reflux-like symptoms (OR, 5.3; 95% Cl, 1.7-16.7) were associated with response to treatment, while dysmotility-like symptoms were associated with an unfavorable response (OR, 0.3; 95% Cl, 0.1-0.9). Symptom pattern and psychological disturbances are independent predictors of treatment response. Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound.

Adult↗