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Biomedical subjects

H L Smart

Publications and source records attributed to H L Smart.

34 records · Page 2Linked to original sources
PubMed1987

Abnormal vagal function in irritable bowel syndrome.

Alimentary and cardiac autonomic nervous function was assessed in 25 patients with the irritable bowel syndrome. The vagally mediated increase in lower oesophageal sphincter pressure induced by abdominal compression was below that of 25 controls in 13 patients. Efferent vagal function, assessed by the ratio of peak acid output after insulin-induced hypoglycaemia to maximal acid output after pentagastrin, was subnormal in 7 of 23 patients. Pulse rate variability with deep respiration was subnormal in 6 of 23 patients. Abnormality in these tests did not correlate closely with the presence of oesophagitis at endoscopy or with that of gastro-oesophageal reflux on pH monitoring. Thus abnormalities in autonomic nervous reflexes might account for the frequent occurrence of gastro-oesophageal reflux and may be involved in the production of disordered gastrointestinal motility in irritable bowel syndrome.

Adult↗
PubMed1987

Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation.

Radiotelemetric ambulatory 24 hour oesophageal pH measurement was carried out in 17 patients with symptomatic manometrically proven achalasia before and after pneumatic dilatation. Before dilatation an abnormally high percentage acid exposure time was present but typical episodes of gastro-oesophageal reflux occurred in only one patient. In nine patients who had a oesophageal food residue these values were significantly greater than those found in the remaining patients without retained food. Analysis of oesophageal food residues revealed that the low pH was predominantly caused by lactic acid. These findings indicate that preoperative oesophageal pH studies do not offer a valid means of selection of patients in whom an antireflux procedure should be combined with cardiomyotomy. Repeat studies one week after pneumatic dilatation showed a fall in the acid exposure time in patients with initial food residue presumably resulting from improved oesophageal emptying after treatment. A significant rise in acid exposure time after dilatation was seen in those patients without initial food residue presumably resulting from gastro-oesophageal reflux after therapeutic disruption of the lower oesophageal sphincter. Troublesome symptoms of gastro-oesophageal reflux were, however, uncommon after bag dilatation.

Adolescent↗
PubMed1987

Vagal function in achalasia of the cardia.

Autonomic nervous function in achalasia of the cardia was assessed by measuring the response of the lower oesophageal sphincter to abdominal compression, the gastric secretory response to insulin-induced hypoglycaemia and the pulse rate variability with deep respiration. Twenty-eight patients with symptomatic achalasia and 24 age and sex-matched control subjects were studied. Rise in intra-abdominal pressure normally causes a rise in lower oesophageal pressure through a vagally-mediated mechanism. Before treatment this response was unimpaired in eight of 10 patients with achalasia. A sub-normal response was found in eight of 10 patients who had previously had pneumatic dilatation of the cardia and in three of four who had had a cardiomyotomy. These abnormalities reflected the effect of treatment in disrupting the sphincter rather than impairment of its innervation. The gastric acid secretory response to insulin-induced hypoglycaemia, expressed as a ratio of that to pentagastrin, was normal in each of the nine patients studied. Pulse rate variability with deep respiration, a test of cardiac vagal function, was normal in 22 of 25 patients studied. It is concluded that in achalasia the vagal trunks appear functionally intact and that the myenteric plexus lesion rarely affects the responsiveness of the lower oesophageal sphincter to increase in intra-abdominal pressure.

Adult↗
PubMed1986

Gastro-oesophageal reflux in the irritable bowel syndrome.

Symptomatic assessment and oesophageal investigations were done in 25 consecutive patients with the irritable bowel syndrome attending a gastroenterological clinic. Symptoms of gastro-oesophageal reflux, dysphagia, and a globus sensation were significantly commoner than in a control group of fracture clinic patients. Ambulatory oesophageal pH monitoring showed clearly abnormal reflux in 11 of 22 patients (50%). Nine patients had macroscopic endoscopic changes and a further 11 biopsy changes alone, of oesophagitis which was thus present in 80% overall. Lower oesophageal sphincter pressure was significantly less in irritable bowel patients than in age and sex matched controls, but upper oesophageal sphincter pressure was comparable in the two groups and disordered peristalsis was not found. Oesophageal symptoms in the irritable bowel syndrome are mainly caused by gastro-oesophageal reflux predisposed to by a subnormal lower oesophageal sphincter pressure, rather than by oesophageal spasm.

Adult↗
PubMed1986

Alternative medicine consultations and remedies in patients with the irritable bowel syndrome.

The use of alternative medicine was assessed by questionnaire in 96 patients with irritable bowel syndrome, 143 patients with organic upper gastrointestinal disorders and 222 patients with Crohn's disease of comparable age and sex. Significantly more patients with the irritable bowel syndrome (16%) had consulted practitioners of alternative medicine about their condition than had patients in either of the other groups. Similarly, significantly more irritable bowel syndrome patients said they would consult an alternative medicine practitioner (41%) if conventional treatment failed. Current usage of alternative medicine remedies was significantly greater in the irritable bowel syndrome patients (11%) than in patients with Crohn's disease (4%) and tended to be greater than in patients with organic upper gastrointestinal disorders (6%). This study has shown that the use of alternative medicine is common in patients with irritable bowel syndrome and this does not appear to be explicable in terms of the nature, chronicity or refractoriness to treatment of symptoms.

Acupuncture Therapy↗
PubMed1986

Late outcome of bleeding gastric ulcers.

The subsequent progress of 152 patients treated medically in the Nottingham hospitals for bleeding gastric ulceration was analysed four to eight years later by the use of life tables. The overall cumulative rate of ulcer haemorrhage, perforation or related death was found to be 19%. Women had a greater rate than men (women 21%, men 14%) but this difference was not statistically significant. The risk of developing a recurrent complication fell with time in both groups. Women were older than men at the time of their index admission and women who suffered a late complication were significantly older than those remaining well at the end of the follow up period. No similar differences existed for men. The risk of having a late complication from a bleeding gastric ulcer compares favourably with that reported under similar circumstances for duodenal ulceration. Attempts to reduce the late complication rate should concentrate on those patients shown to be at a greater risk - that is, elderly women.

Actuarial Analysis↗
PubMed1986

24-hour intragastric pH: continuous monitoring or nasogastric aspiration?

Hourly gastric aspiration has commonly been used to assess the efficacy of antisecretory compounds. We have compared continuous ambulatory 24-hour pH monitoring using a radiotelemetry capsule with standard nasogastric aspiration. Eight studies were performed on four male duodenal ulcer patients in remission receiving either placebo or an antisecretory agent. A significant correlation was found between capsule and aspirate pH measurements (r = 0.88, p less than 0.01). Radiotelemetry capsule measurements clearly showed the onset of action of an antisecretory drug, and the buffering effect of food. Radiotelemetric pH monitoring is shown to be as good as gastric sampling in the measurement of 24-hour intragastric acidity, allows continuous measurement of pH during normal activity and can accurately assess the effect of drugs on gastric acidity.

Anti-Ulcer Agents↗
PubMed1986

Achalasia following gastro-oesophageal reflux.

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2-10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.

Adult↗
PubMed1986

Familial association between coeliac disease and ulcerative colitis: preliminary communication.

One hundred and twenty patients who were members of the Nottinghamshire Coeliac Group completed a questionnaire about the occurrence of coeliac disease, ulcerative colitis and Crohn's disease amongst first-degree relatives. Siblings were at a 20-fold risk of developing coeliac disease and a 15-fold risk of developing ulcerative colitis, and significantly increased risks for these two conditions were also seen in other family members. The relatives of patients with coeliac disease are at increased risk not only of developing coeliac disease but also ulcerative colitis. This provides further support for a possible role of a dietary allergen in the development of ulcerative colitis.

Adolescent↗
PubMed1986

Audit of surgical and pneumatic/hydrostatic treatment of achalasia in a defined population.

A retrospective survey was made of all the patients resident in the Nottingham area who presented with achalasia between 1959 and 1983. Initial treatment consisted of pneumatic bag dilatation in 26, hydrostatic bag dilatation in one and surgical cardiomyotomy in 22. Those treated by dilatation were older (mean age 52 years) than those treated by cardiomyotomy (mean age 42 years). Seven patients died without receiving active treatment because of old age and infirmity and in 6 this occurred before the introduction of endoscopic dilatation to the area. Initial treatment by cardiomyotomy was associated with a lower recurrence rate than treatment by bag dilatation but with a longer stay in hospital and a higher incidence of complications including empyema, chest infections and oesophageal stricture.

Aged↗
PubMed1985

The effects of sucralfate upon phenytoin absorption in man.

The possible influence of sucralfate on phenytoin absorption was investigated in a double-blind, placebo controlled study. Concomitant administration of 1 g sucralfate reduced the absorption of 300 mg phenytoin capsules by 20% as measured by the area under the curve from 0-48 h. This could be of significance in epileptic patients stabilised on phenytoin in whom sucralfate is used in ulcer treatment.

Adult↗
PubMed1985

Intravenous omeprazole rapidly raises intragastric pH.

Twenty four hour intragastric acidity was measured in five duodenal ulcer patients studied at least three times. The effects of different dosage regimens of intravenous omeprazole was compared with placebo. Mean intragastric acidity from 1000 to 0800 was 34.3 +/- 4.3 mmol/l on placebo. After omeprazole 80 mg at 0900 and 40 mg at 1700 mean acidity was 2.1 +/- 0.9 mmol/l and after omeprazole 80 mg at 0900 and 80 mg at 1700 it was 0.7 +/- 0.2 mmol/l. pH remained above 4.0 for about 80% of recordings with these regimens and for only 5% with placebo. Three of the five patients also received omeprazole 80 mg at 0900, 40 mg at 1700 and 40 mg at 0100 when pH remained above 4.0 for 90% of recordings with 99% inhibition of acidity. Omeprazole rapidly raised intragastric pH in all patients and maintained a gastric pH of greater than 4.0 for most of the time. Large doses of IV omeprazole were required compared with studies using the oral compound.

Adult↗
PubMedDate not supplied

TIPSS in the treatment of ectopic variceal bleeding.

BACKGROUND/AIMS: Bleeding from ectopic varices is a well recognized life-threatening complication of portal hypertension but the optimal treatment of this problem is yet to be established. METHODOLOGY: We retrospectively reviewed patients with ectopic variceal bleeding who underwent transjugular intrahepatic portosystemic shunting for recurrent bleeding not responding to conservative management. RESULTS: Over an eleven-year period we identified ten patients who underwent TIPSS for ectopic variceal hemorrhage. Six patients bled from rectal varices and four from stomal varices. TIPSS was successful in nine patients. The Childs-Pugh grade of the patients was A=3, B=3 and C=4. The follow-up period ranged from 7 days to 1380 days. Rebleeding occurred in three patients, two of whom died. The remaining patient had a blocked TIPSS and successfully underwent repeat stenting which re-established patency. Four patients (Childs B=2, Childs C=2) died within 60 days. All three patients with Childs A liver disease were alive at one year. CONCLUSIONS: TIPSS can be used effectively to treat ectopic variceal bleeding. Patients with Childs grade A liver disease appear to do well with TIPSS. Those with advanced liver disease (Childs B & C) have a uniformly poor outcome. In these patients ectopic variceal hemorrhage is likely to represent a terminal event.

Adult↗