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J Isolauri

Publications and source records attributed to J Isolauri.

At least 19 recordsLinked to original sources
PubMed2001

Dysphagia and oesophageal clearance after laparoscopic versus open Nissen fundoplication. A randomized, prospective trial.

BACKGROUND: An increase in postoperative dysphagia has been reported after laparoscopic fundoplication. Our aim was to compare laparoscopic Nissen-Rossetti fundoplication to open fundoplication regarding oesophageal clearance and dysphagia in a prospective, randomized study. METHODS: Twenty-eight consecutive patients with objectively observed gastro-oesophageal reflux disease referred to operative treatment were randomized to laparoscopic (13) or open (15) fundoplication. A standard formula was used in pre- and postoperative interview. Oesophageal clearance was measured by liquid bolus radionuclide transit before and 3 days, 1 month and 1 year after fundoplication. Endoscopy was done preoperatively and 1 year after the operation. RESULTS: Heartburn, regurgitation and ooesophagitis were cured with equal effectiveness (p = 0.001). New-onset dysphagia was observed in nine (69%) of the patients in the laparoscopic group and in nine (60%) in the open group during the first postoperative month. Food impaction occurred in four (31%) cases after laparoscopic and in two (13%) after open surgery (ns). One year after the operation, one patient (8%) in both groups had more than mild symptoms. Oesophageal radionuclide transit remained normal after open fundoplication, but after the laparoscopic procedure oesophageal clearance was disturbed--only one patient did not have a pathologic result during the first postoperative month. One year after the operation, clearance was normal. CONCLUSIONS: After laparoscopic operation, a tendency to more severe new-onset dysphagia was observed, and oesophageal clearance was transiently disturbed. Efforts should be made to minimize postoperative swallowing and clearance disturbances after laparoscopic fundoplication in order to get the full value out of otherwise more rapid recovery.

Deglutition Disorders↗
PubMed1999

Antireflux surgery enhances gastric emptying.

OBJECTIVE: To evaluate the influence of antireflux surgery on gastric emptying. DESIGN: Nonrandomized controlled trial 3 months before and after surgical intervention. SETTING: Secondary and tertiary referral center. PATIENTS AND CONTROL SUBJECTS: Twenty consecutive patients (7 women, 13 men), mean age 49.2 years, with symptomatic, objectively confirmed gastroesophageal reflux disease and 10 healthy control subjects (3 women, 7 men), mean age 37.3 years. INTERVENTION: Laparoscopic or open Nissen fundoplication (in 1 case Toupet 180 degrees posterior hemifundoplication). MAIN OUTCOME MEASURES: Gastric emptying scintigraphy, using solid food, in control subjects and patients 3 months before and 3 months after the operation; time to halving of the maximal activity and the activity remaining at 60, 100, and 120 minutes. RESULTS: Preoperative symptoms included pyrosis in 19 of 20 patients and regurgitation in 18. Three months postoperatively, 19 patients were symptom-free. The mean time to halving of the maximal activity decreased from 113 to 78 minutes (P = .001). Delayed gastric emptying was found postoperatively in 3 patients, compared with preoperative values, using activity at 60, 100, 120 minutes and the mean time to halving of the maximal activity as the variables. Compared with control subjects, gastric emptying was slower in patients preoperatively and faster postoperatively, but the difference was not statistically significant. CONCLUSION: Gastric emptying is enhanced after antireflux surgery, along with cessation of symptoms and healing of esophagitis.

Adult↗
PubMed1998

Late results of paraoesophageal hiatus hernia repair with fundoplication.

BACKGROUND: Most published reports on results of surgical treatment for paraoesophageal hiatus hernia have been based on patient questionnaires, and seldom included endoscopy or barium meal examinations. METHODS: Eight pure and 14 mixed-type paraoesophageal hernias were evaluated a median of 37 (range 2-241) months after surgical repair. An antireflux procedure was done in 19 cases. Before operation all had endoscopy or barium meal (20 and 19 patients respectively); after operation 19 had endoscopy and 12 also had barium meal examination. Oesophageal 24 h pH monitoring was done in five cases before surgery, and in 11 afterwards. RESULTS: Preoperative symptoms of reflux were reported by 18, and were often accompanied by dysphagia, postprandial vomiting or epigastric pain. Symptoms improved after operation, and 21 of the 22 patients were satisfied with the result. At follow-up examination, a recurrent hernia was found in eight of the 19 patients examined. Four of these hernias were sliding, two were mixed type and two purely paraoesophageal. DISCUSSION: Recurrence of symptoms was associated with persistence of reflux rather than hernia recurrence. Concomitant antireflux procedure is recommended in all operations for mixed-type hiatus hernia, but it should also be considered for purely paraoesophageal hernia if reflux cannot be excluded before operation, or if retro-oesophageal dissection is needed.

Adult↗
PubMed1997

Long-term comparison of antireflux surgery versus conservative therapy for reflux esophagitis.

OBJECTIVE: The purpose of the study was to evaluate the long-term symptomatic and endoscopic outcome in gastroesophageal reflux disease with erosive esophagitis, comparing conservative with operative management. METHODS: The study comprised 105 of 120 patients consecutively referred for severe reflux symptoms to the gastroenterologic outpatient department of a teaching hospital, where erosive esophagitis was confirmed endoscopically. If conservative management (modified lifestyle and medication) failed to relieve symptoms and heal the esophagitis, antireflux surgery (Nissen fundoplication) was undertaken. Follow-up (median, 10.9 years) evaluation of all patients included comprehensive, standardized interviews; self-scoring of symptoms at the time of referral and currently; and observations at endoscopy. RESULTS: Nissen fundoplication was performed on 37 of the 105 patients. At follow-up of these 37 patients, (31) 84% had no or only occasional mild heartburn, (33) 89% were free from erosive esophagitis, and (2) 5% were taking H2 antagonists or omeprazole. The corresponding figures in the 68 patients with only conservative treatment were (36) 53%, (31) 45%, and (14) 21%. The mean change in symptom score between referral time and follow-up was 5.7 in the surgically treated group and 1.7 in the nonsurgically treated group. Fifteen new cases of Barrett's metaplasia were found at follow-up. CONCLUSIONS: In gastroesophageal reflux disease with erosive esophagitis, surgical treatment gave results subjectively and objectively superior to those from conservative management.

Adult↗
PubMed1997

Lifetime costs of surgical versus medical treatment of severe gastro-oesophageal reflux disease in Finland.

BACKGROUND: Gastro-oesophageal reflux disease (GERD) can be effectively treated pharmacologically or surgically. As GERD is often a chronic condition, we compared the long-term costs of medical and surgical management. METHODS: The medical regimens were ranitidine (150 or 300 mg/day), omeprazole (20 or 40 mg/day), and lansoprazole (30 mg/day), with costs calculated for total life expectancy after diagnosis and for one-third of that time. Costs for open or laparoscopic surgery (Nissen fundoplication) included pre- and post-operative investigations, sick leave, and calculated financial loss due to fatal outcome. RESULTS: Costs were lowest with ranitidine, 150 mg/day, for one-third of the patient's lifetime and highest with lifelong omeprazole, 40 mg/daily. The cost of open or laparoscopic operation was less than that of lifelong daily treatment with proton pump inhibitors or ranitidine, 300 mg daily. CONCLUSION: In Finland, antireflux surgery for GERD is cheaper than lifetime treatment with proton pump inhibitors.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Incidence of antireflux surgery in Finland 1988-1993. Influence of proton-pump inhibitors and laparoscopic technique.

BACKGROUND: The advent of proton-pump inhibitors, and subsequently of the laparoscopic technique, can be assumed to have influenced the use of antireflux surgery in gastro-oesophageal reflux disease. METHODS: Data on antireflux operations carried out in Finland in 1988-93 were obtained from national statistics, and the number of operations performed laparoscopically in 1993 was ascertained by a questionnaire to all relevant units. The rates per 100,000 population in the catchment areas were calculated. RESULTS: Antireflux surgery almost always implied fundoplication. During 1993, 784 fundoplications and 43 other antireflux procedures were performed in Finland (total population around 5 million). The fundoplication rate per 100,000 population rose from 8.8 to 15.4 between 1988 and 1993. The increase was minimal (8.1-8.2) in 1990-91 when the first proton-pump inhibitor, omeprazole, was introduced, but remarkably greater (12.8-15.4) in 1992-93, when the laparoscopic technique became popular. Differences in fundoplication rates were six to tenfold between health service districts and even larger between hospitals. CONCLUSIONS: The numbers of antireflux operations in Finland were almost static when proton-pump inhibitors were introduced, but rapidly increased after the advent of the laparoscopic technique. Remarkable discrepancies were found in the incidence of fundoplication between different areas and hospitals.

Adolescent↗
PubMed1997

Natural course of gastroesophageal reflux disease: 17-22 year follow-up of 60 patients.

OBJECTIVE: To elucidate the long-term course of conservatively managed gastroesophageal reflux disease without H2-antagonists or omeprazole. METHODS DESIGN: Clinical trial, uncontrolled. SETTING: Gastroenterological outpatient department of a teaching hospital. PATIENTS: Sixty of 87 patients consecutively referred for severe gastroesophageal reflux symptoms and with objectively proven pathological reflux. MEASUREMENTS: Esophagoscopy, esophagography, cinecardiography of cardiac region, standard reflux test, and confirmatory Bernstein-Baker test. Follow-up included a standardized interview, esophagoscopy with biopsy, and 24-h pH monitoring. RESULTS: At follow-up 17-22 yr after referral, symptoms were less than at the time of referral in 36 of the 50 nonoperated patients (six now symptom-free), were unchanged in five, and were worse in nine patients. Medication for reflux symptoms was no longer used by 34 of the nonoperated patients. The prevalence of erosive esophagitis fell from 40% at referral to 27% at follow-up endoscopy; 42% of the studied patients had pathological 24-h pH, and the endoscopies revealed six new cases of Barrett's metaplasia. Of the 41 nonoperated patients examined with both endoscopy and 24-h pH, 27 (66%) had erosive esophagitis and/or pathological pH values. Of the 10 operated patients, all had fewer symptoms at follow-up than they had at referral (nine were symptom-free). The prevalence of erosive esophagitis fell from 60% at referral to 10% at follow-up. One of the 10 patients had pathological 24-h pH at follow-up. Neither the presence of esophagitis or hiatal hernia nor the severity of symptoms at the time of referral predicted the course of the disease of the conservatively treated patients. CONCLUSIONS: The severity of the symptoms declines in the long term, but pathological reflux persists in most of the conservatively treated patients. Thus, the reflux itself is not self-limiting, and therapy should be designed with this in mind.

Adult↗
PubMed1997

Disruption of experimental fundic folds is prevented by interserosal scarring.

BACKGROUND: The main cause of recurrent reflux symptoms after Nissen fundoplication is disruption of the fundic wrap. Reoperation has shown a lack of scar tissue between the serosal surfaces of the fundic folds in these cases. METHODS: Attempts were made to induce serosal scarring during fundoplication performed in rabbits. In group 1 the serosal folds were attached to the upper fundus with three non-absorbable seromuscular sutures. In group 2 Teflon pledgets were placed between these sutures. Fibrin glue was injected between the folds in group 3 and polyglycolic acid mesh was inserted in group 4. RESULTS: When the rabbits were killed 6 months later, the serosa had unfolded and no macroscopic or microscopic scar tissue was found between the serosal surfaces, except in five of the six rabbits in group 3, in which fibronectin, laminin and collagen types I and III were present in interserosal scar tissue. CONCLUSION: Application of fibrin glue between the serosal surfaces of the fundic folds may prevent disruption of Nissen fundoplication.

Animals↗
PubMed1996

Enhanced absorption of macromolecules. A secondary factor in Crohn's disease.

We explored the function of the intestine's mucosal barrier to foreign antigen entry in Crohn's disease. Macroscopically and microscopically uninvolved areas of the small intestines of patients with Crohn's disease were examined. We studied 27 endoscopic biopsy samples from 17 patients with Crohn's disease and 14 samples from nine controls. The absorption and degradation of horseradish peroxidase (molecular weight 40,000 Da) were studied in Ussing chambers. The absorption of intact horseradish peroxidase was significantly increased in patients with moderate or severe Crohn's disease: 271 (95% confidence interval 119-616) ng/hr/cm2, but not in those with slight disease activity: 42 (18-98), compared with controls: 45 (32-64); F = 10.90, P = 0.0002. The transport rates of degraded horseradish peroxidase were comparable in the Crohn's disease samples and controls. Our results indicate that enhanced absorption of macromolecules is associated with clinical activation of Crohn's disease, and impairment of the mucosal barrier function is a secondary phenomenon in Crohn's disease.

Adult↗
PubMed1996

Tuberculous fistula of the esophagus.

BACKGROUND: Tuberculous involvement of the esophagus has been extremely rare during the past 40 years. It will be, however, more frequently encountered in the future, as the number of immunocompromised patients is growing. This condition is usually secondary to infection in other thoracic sites, such as lungs, larynx, or mediastinum. The diagnosis is difficult if the suspicion of tuberculosis is not raised. Dysphagia and cough after ingestion of fluids and food are common symptoms without any other specific signs in these patients. Diagnosis is based on combination of esophagography, esophagoscopy, bronchoscopy, and computed tomographic scan. METHODS: We present 3 patients with tuberculous fistulas of the esophagus. Two of our 3 patients were treated successfully with the combination of operation and antituberculous chemotherapy. Fistulas were resected and closed directly. Suture lines were secured with pedicled pleural flaps. RESULTS: Both patients who underwent operation recovered without complications. One patient died without definitive diagnosis and treatment. CONCLUSIONS: Treatment of tuberculous fistulas consists of operation and antituberculous chemotherapy, although antituberculous medication alone has been suggested to be effective if the diagnosis is early. However, operation is usually necessary to establish the correct diagnosis. Therefore, we believe that if the cause of the esophageal fistula cannot be verified, thoracotomy should be performed. If the fistula is left untreated the consequences are usually fatal.

Adult↗
PubMed1995

Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population.

Symptoms suggestive of gastro-oesophageal reflux disease are very common. The aim of the study was to assess the prevalence of these symptoms and factors influencing them in an unselected adult population. A questionnaire was mailed to a random sample of 2500 people aged > or = 20 years. The questions concerned heartburn, regurgitation, dysphagia, chest and upper abdominal pain, as well as medication and medical consultations for these symptoms. Of the 1700 (68%) responders, 9% had experienced heartburn on the day of response and 15%, 21% and 27% during the preceding week, month and year, respectively. The corresponding figures for regurgitation were 5, 15, 29 and 45%. During the past year 43% of the study group had had no such symptoms. Age, overweight, pregnancy and cigarette smoking significantly influenced the prevalence of symptoms. Using daily heartburn and/or regurgitation as dominant indicators 10.3% (95% CI 12-11.7) of the responders had gastro-oesophageal reflux disease. Medication (most commonly antacids) was used by only 16% of the symptomatic people, and only 5.5% had sought medical advice for symptoms during the past year. Thus, despite commonness of symptoms suggestive of gastro-oesophageal reflux disease only a minority of the individuals suffering from such symptoms use medication or have medical consultation.

Adult↗
PubMed1995

Two antireflux operations: floppy versus standard Nissen fundoplication.

The effects of fundic mobilization in Nissen fundoplication on belching ability, abdominal gas volume, bloating and flatus were assessed in a prospective, randomized study of 25 patients with refractory gastro-oesophageal reflux disease. Reflux was cured regardless of fundic mobilization. Subjective ability to belch was restored to preoperative in 73% of the patients with fundic mobilization, compared to 50% without. About 10% in both groups totally lost their ability to belch. Disturbance from flatus increased postoperatively slightly in both groups, but from bloating it remained the same or even diminished. The residual intra-abdominal radioactivity (median (interquartile range)) after provoked belching was preoperatively 8.9% (4.4-12.0) with and 13.2% (6.8-15.2) without fundic mobilization, compared to 36.7% (31.1-40.9) of the controls (P < 0.05). After fundoplication this residual activity was normalized in both study groups. Disturbance from postoperative bloating or flatus were not related to the ability of belching. Preoperatively symptomatic patients tended to have more complaints postoperatively. In conclusion, fundic mobilization restored belching ability slightly more effectively without compromising antireflux efficacy, but there did not seem to be any advantage regarding flatus or bloating.

Adult↗
PubMed1995

Barrett's oesophagus is not a risk factor for colonic neoplasia: a case-control study.

Previous uncontrolled studies have suggested that patients with Barrett's oesophagus have an increased risk of colonic neoplasia. The present study was undertaken to clarify the occurrence of colorectal neoplasms in patients with Barrett's oesophagus and asymptomatic controls. Colonoscopy in 72 consecutive patients with Barrett's oesophagus and in 27 controls, none with symptoms of colonic neoplasm, revealed colorectal adenoma(s) in 17 cases (24%) in patients with Barrett's oesophagus and in eight (30%) controls. All 34 adenomas were less than 2 cm in diameter, with 30 less than 1 cm. None was malignant. Using logistic regression model with occurrence of colonic adenoma as dependent and sex, age and occurrence of Barrett's oesophagus as explanatory variables, none of these was found to be a significant risk factor for the appearance of colonic adenoma. The study thus suggests that Barrett's oesophagus is not associated with increased risk of colorectal neoplasm. Colonoscopic surveillance of patients with Barrett's oesophagus is not justified.

Adenoma↗
PubMed1994

Barrett's esophagus after cardiomyotomy for esophageal achalasia.

Heller's myotomy for esophageal achalasia was performed on 64 patients in the 24 yr up to 1988. After follow-up averaging 13 yr, 46 patients were reexamined with endoscopy, biopsy, and manometry. Barrett's metaplasia of the distal esophagus was found in four patients 6, 13, 20, and 23 yr after the myotomy. These four also underwent ambulatory 24-h pH monitoring. They had the lowest distal esophageal sphincter pressures (1-5 mm Hg), and all four had symptoms of gastroesophageal reflux and pathologic pH values (< 4 in the distal esophagus for 32-62% of the total recording time). Because of heightened risk for the development of Barrett's metaplasia following cardiomyotomy for esophageal achalasia, with increased liability to carcinoma of the esophagus, regular endoscopic surveillance of these patients is advisable.

Adolescent↗
PubMed1993

Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis.

Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.

Adult↗