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Biomedical subjects

Kenneth R Devault

Publications and source records attributed to Kenneth R Devault.

5 recordsLinked to original sources
PubMed2006

Maintenance of healed erosive esophagitis: a randomized six-month comparison of esomeprazole twenty milligrams with lansoprazole fifteen milligrams.

BACKGROUND AND AIMS: The aim was to compare esomeprazole with lansoprazole for the maintenance of healed erosive esophagitis and resolution of gastroesophageal reflux disease-related symptoms in a United States population. METHODS: Patients who entered this double-blind, randomized, parallel-group, multicenter, maintenance trial had been treated and healed (no endoscopic evidence of erosive esophagitis) with esomeprazole 40 mg or lansoprazole 30 mg once daily (patients with Los Angeles grades C and D erosive esophagitis at baseline) or esomeprazole 40 mg (patients with Los Angeles grades A and B erosive esophagitis at baseline) and had no heartburn or acid regurgitation symptoms during the previous week. Patients were randomized to maintenance once-daily therapy with esomeprazole 20 mg (n = 512) or lansoprazole 15 mg (n = 514) for up to 6 months. Esophago-gastroduodenoscopies were done at months 3 and 6, and investigators assessed symptom severity at months 1, 3, and 6. Endoscopic/symptomatic remission was defined as no erosive esophagitis and no study withdrawal as a result of reflux symptoms. RESULTS: The estimated endoscopic/symptomatic remission rate during a period of 6 months was significantly higher (P = .0007) for patients who received esomeprazole 20 mg once daily (84.8%) compared with those who received lansoprazole 15 mg (75.9%). Most patients had no heartburn (383/462 and 369/466) or acid regurgitation (401/462 and 400/466) symptoms at 6 months, and there were no significant differences between treatments. Both treatments were well-tolerated. CONCLUSION: Esomeprazole 20 mg is more effective than lansoprazole 15 mg in maintaining endoscopic/symptomatic remission in patients with healed erosive esophagitis.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2002

Dilation after fundoplication: timing, frequency, indications, and outcome.

BACKGROUND: Dysphagia frequently develops shortly after fundoplication but is usually self-limited. This is an evaluation of the timing, frequency, indications, and outcome of dilation after fundoplication. METHODS: Two hundred thirty-three consecutive patients who underwent fundoplication were included. Preoperative motility, postoperative symptoms, endoscopic and radiographic data, timing and number of dilations, and caliber of the dilator used were evaluated in patients who required dilation. RESULTS: Twenty-nine of 233 (12.4%) patients underwent dilation(s). The mean time to dilation after surgery was 72 days (range 3 to 330 days). Ten of 29 (34.5%) required more than 1 dilation (mean 1.5, range 1 to 5). The mean diameter to which the fundoplication was dilated was 18.6 mm (range 15-20 mm). There were no complications. The indication for dilation was dysphagia in 20, chest pain 4, epigastric pain 1, globus 1, gas bloat 1, belching 1, and vomiting in 1 patient. Two patients were lost to follow-up. Dysphagia resolved with dilation in 12 of 18 (67%) patients. Of the 6 patients whose symptoms did not improve after dilation, 3 noted improvement after further surgery. Two patients with tight fundoplications still require periodic dilation. One patient had a stricture before surgery that persisted after surgery. Symptoms did not improve in any patient who underwent dilation for an indication other than dysphagia. CONCLUSIONS: Dilation after fundoplication was required in 12.4% of patients and was successful in most with dysphagia. Dilation shortly after surgery was safe and only a single dilation was required for most patients. Symptoms other than dysphagia did not respond to dilation.

Deglutition Disorders↗
PubMedDate not supplied

Dysphagia in aging.

Dysphagia is a common problem in older patients and is becoming a larger health care problem as the populations of the United States and other developed countries rapidly age. Changes in physiology with aging are seen in the upper esophageal sphincter and pharyngeal region in both symptomatic and asymptomatic older individuals. Age related changes in the esophageal body and lower esophageal sphincter are more difficult to identify, while esophageal sensation certainly is blunted with age. Stroke, Parkinson's disease, amyotrophic lateral sclerosis, Zenker's diverticula, and several other motility and structural disorders may cause oropharyngeal dysphagia in an older patient. Esophageal dysphagia can also be caused by both disorders of motility (achalasia, diffuse esophageal spasm, scleroderma and others) and structure (malignancy, strictures, rings, external compression, and others). Many of these disorders have an increased prevalence in older patients and should be sought with an appropriate diagnostic evaluation in older patients. The treatment of dysphagia in older patients is similar to that in younger patients, but more invasive therapies such as surgery may not be possible in some older patients making less aggressive medical and endoscopic therapy more attractive.

Aged↗