Biomedical subjects

M Bortolotti

Publications and source records attributed to M Bortolotti.

At least 19 recordsLinked to original sources

PubMed1992

"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists.

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.

Aged↗

PubMed1992

Return of esophageal peristalsis after nifedipine therapy in patients with idiopathic esophageal achalasia.

This study was carried out to demonstrate the possible return of esophageal peristalsis in patients affected by esophageal achalasia chronically treated with sublingual nifedipine and to investigate which parameters are correlated with the return of peristalsis. Thirty-two patients were treated with sublingual nifedipine 10-20 mg taken 30 min before meals. A clinical and manometric evaluation was performed before and after 6 months of therapy. Before treatment, in no patient was peristaltic activity recorded. After 6 months, peristalsis was observed in six patients. In this group, no pretreatment manometric parameter was different from that of the remaining achalasic patients; only the clinical history of dysphagia was significantly shorter (p < 0.001) and the esophageal diameter significantly less (p < 0.001). In conclusion, chronic treatment with sublingual nifedipine can induce a return of esophageal peristalsis in patients with a short clinical history of disease and slightly dilated esophagus.

Administration, Sublingual↗

PubMed1992

Interdigestive gastroduodenal motility in patients with ulcer-like dyspepsia: effect of ranitidine.

Interdigestive gastroduodenal motility was studied manometrically in 16 patients with ulcer-like dyspepsia due to hypersecretory gastroduodenitis (group A) and in a control group of 6 healthy subjects (group B). After a basal recording period sufficient to record at least two activity fronts (AF) of the migrating motor complex (MMC) of the gastroduodenal tract, we administered 100 mg of ranitidine intravenously to 8 patients of group A (group A1), and the same dose of ranitidine to the remaining 8 patients of group A (group A2) after pretreatment with cimetidine 200 mg i.v. to block the acid secretion. The interdigestive motility of patients with hypersecretory gastroduodenitis is characterized by a decrease in frequency and duration of the activity fronts of MMC, which may play a role in the pathogenesis of mucosal lesions. Ranitidine induced premature and prolonged activity fronts in all patients without antisecretory pretreatment, and in the majority of patients in whom the acid secretion was previously blocked.

Duodenitis↗

PubMed1991

["Esophageal" angina and angina pectoris].

In the last few years the non cardiac angina-like chest pain has encompassed more and more agitation not only in many patients but also in cardiologists, gastroenterologists and psychologists, as it involves socio-economic, pathophysiologic and therapeutic problems. The socio-economic aspect is well explained by the fact that in the USA at least 200,000 patients a year suffering from non cardiac angina-like chest pain, even when coronary arteriography has demonstrated normal coronary vessels, nevertheless continue to require cardiologic examinations and, if no one has clearly demonstrated the origin of their pain, they continue to live as invalids in constant fear of myocardial infarction. The discovery that the esophagus may be one of the causes of chest pain in these patients presenting with a previous diagnosis of "atypical" angina pectoris, unfortunately cannot resolve definitively the problem. An association of esophageal angina in patients with angina pectoris treated for long periods of time with Ca-antagonists and nitroderivatives has been described. In addition, the provocative or spontaneous tests to demonstrate the esophageal origin of chest pain give only a "likely" and not a "definite" diagnosis of esophageal angina. This also means to no "gold standard" text exist. Lastly, the "likely" diagnosis of esophageal angina is made in only about 50% of patients leaving the problem of the remaining 50% unanswered. These uncertainties induce some psychologists to assert that the cause of non cardiac angina-like chest pain is in the head ("panic disorder") and not in the esophagus, where the observed motor disorders should be an epiphenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗

PubMed1991

[Ambulatory manometry].

Dynamic manometry is a new technique which allows an esophageal or gastrointestinal motility recording by means of a portable recorder for a period of 24 hours. It consists of a probe with microtransducers to pick up the pressure variations of the gut lumen and a portable recorder where the pressure signals are amplified and are recorded in analogic or digital form. At the end of the examination the manometric data are transferred in the memory of a computer which afterwards provides analysis, visualization and printing of the tracing. In some system the pressure parameters are automatically calculated (mean frequency, amplitude, duration and propagation of waves, Motility Index, ect) for each period of observation (interdigestive and digestive, diurnal and nocturnal, etc). The ideal equipment, unfortunately, is not available at the moment and some of those commercially available may have particular advantages that others do not and vice versa. In this respect some economic and technical considerations should be made, ranging from their high cost to the vulnerability of some of their components, difficulty in recording the sphincter activity, unreliability incompleteness or excessive complexity of some software etc. However, the main difference of dynamic against stationary manometry consists of the fact that gut motor activity is recorded in a patient not lying in a hospital bed but during the normal life activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗

PubMed1991

Abnormalities of gastrointestinal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux disease.

In 11 children (mean age 44.2 months) with symptoms suggesting upper intestinal dysfunction (nonulcer dyspepsia), in nine children (mean age 27.3 months) with gastroesophageal reflux (GER) disease, and in seven controls (mean age 20.4 months) we investigated fasting [for 3 hr or until two migrating motor complexes (MMC) were observed] and fed (90 min) antroduodenal motility by means of perfused catheter system; furthermore, we measured both gastric emptying of a radiolabeled milk formula and fasting duodenogastric reflux during manometry by assessing bile salt concentration in gastric aspirates. No structural abnormalities of gastrointestinal tract and organic disorders were detected in the patients. In a high proportion of both groups of patients we found manometric abnormalities of interdigestive and fed motor patterns that were not seen in the controls: absence of antral phase III of MMC; significant decrease of antral and/or duodenal motor activity during fasting and/or fed periods; abnormal propagation or configuration of MMC phase III that was significantly shorter than in controls; bursts of sustained fasting and/or fed phasic duodenal activity, frequently uncoordinated with adjacent gut segments. When compared to controls, the mean intragastric concentration of bile salts during all MMC phases and the mean 1-hr percent gastric activity of the radiolabeled milk were significantly higher in the two groups of patients. We conclude that in a high proportion of children with nonulcer dyspepsia and of children with GER disease, gastrointestinal manometry may reveal significant irregularities of antral and duodenal motility, which are associated with increased duodenogastric reflux and delayed gastric emptying.

Bile Acids and Salts↗

PubMed1991

Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia.

A study was carried out in 30 patients affected by a mild or moderate degree of oesophageal achalasia to compare the clinical and manometric effects of sublingual nifedipine and pneumatic dilatation. Sixteen patients were dilated twice with Rider-Moeller dilators and 14 were treated with sublingual nifedipine 10-20 mg 30 minutes before meals. A manometric evaluation was performed before and six months after starting treatment. The clinical evaluation (according to Vantrappen's criteria) was performed every three months for a mean follow up of 21 months. In both groups of patients a significant (p less than 0.001) fall in lower oesophageal sphincter pressure was observed after treatment and excellent or good clinical results were observed in 75% of dilated patients and in 77% of patients treated with nifedipine. One patient could not tolerate nifedipine. No complications were observed after dilatation. It is concluded that longterm treatment with sublingual nifedipine and pneumatic dilatation are equally effective in the treatment of oesophageal achalasia of mild or moderate degree.

Administration, Sublingual↗

PubMed1991

Gastric emptying and interdigestive antroduodenal motility in patients with esophageal scleroderma.

The study was carried out on two groups of patients with esophageal scleroderma (LES pressure less than 5 mm Hg and amplitude of smooth muscle pressure waves less than 10 mm Hg): one group included patients with mild (group M) and the other severe (group S) gastroesophageal reflux (GER) diagnosed by ambulatory esophageal pH monitoring. Nine normal subjects were used as controls. Antroduodenal motility was recorded by means of manometry for 200-300 min after an overnight fast and the gastric emptying (T1/2) of a semisolid meal was measured utilizing a scintigraphic method. Patients of group S showed a significantly lower incidence of migrating motor complex activity fronts, as well as a more delayed gastric emptying, compared with those of group M. The reason that patients with the same degree of esophageal motor impairment have different degrees of GER may lie in the fact that the concomitant impairment of gastrointestinal interdigestive cyclic clearing activity and the delay in gastric emptying may allow a larger quantity of material to remain stagnant in the gastric lumen, readily available for gastroesophageal reflux.

Adult↗

PubMed1990

The esophagus as a possible cause of chest pain in patients with and without angina pectoris.

In a series of 18 patients with angina pectoris, in whom treatment over at least 3 years with nitroderivatives and Ca-antagonists had become partially ineffective on chest pain, and in 18 patients with angina-like non-cardiac chest pain, the following examinations were carried out: upper gut x-ray and endoscopy, acid perfusion test, esophageal manometry, 24-hour esophageal pH monitoring associated with Holter recording. The presence or absence of coronary insufficiency was established by means of scintigraphic and ECG tests, Holter monitoring and coronary arteriography. In both groups the majority of patients had abnormal esophageal function, but in patients with angina pectoris treated for a long period of time the motility changes were prevalently reflux-related. With respect to the origin of chest pain, the esophagus was found to be the likely cause in 4 patients with angina pectoris, and the probable cause in another 10 of the same group; it was the likely cause in 7 patients without angina pectoris, and the probable cause in another 7 of the same group. As nitroderivatives and Ca-antagonists decrease the LES tone and the amplitude of esophageal pressure waves, long-term treatment with these drugs may be taken into account in the genesis of gastro-esophageal reflux and related changes, including esophageal pain.

Angina Pectoris↗

PubMed1989

Laryngospasm and reflex central apnoea caused by aspiration of refluxed gastric content in adults.

Two patients with attacks of choking caused by aspiration of gastric contents in the laryngotracheal tube are presented. One had such severe attacks of respiratory arrest, that tracheostomy was done. The common symptoms of gastro-oesophageal reflux such as pirosis, acid regurgitation, or retrosternal burning were absent in both patients and upper gut radiological and endoscopic examinations were negative. Histology of the oesophageal mucosa showed a deep chronic eosophagitis, and the 24-hour pH-monitoring of the upper oesophagus showed frequent gastro-oesophageal refluxes. Manometry showed hypotonic lower oesophageal sphincter with marked alterations of peristalsis. In the patient with tracheostomy a 24 pH monitoring of the hypolaryngeal zone showed decreased pH at the time of choking attacks. In the other patient further investigations showed that amyotrophic lateral sclerosis was the cause of the oesophageal motility disorder. An intense antireflux treatment abolished the respiratory attacks in both patients.

Airway Obstruction↗

PubMed1989

Interdigestive gastroduodenal motility in patients with active and inactive duodenal ulcer disease.

The interdigestive gastroduodenal motility was studied by means of a manometric probe in 6 patients with active duodenal ulcer and acid hypersecretion, in 6 patients with ulcer disease in remission (inactive) and normosecretion and in 8 healthy subjects with normosecretion. After a basal recording period sufficient to record at least two activity fronts of the migrating motor complex (MMC), an intraluminal infusion of isotonic NaHCO3 was carried out for 180 min in patients with active duodenal ulcer, whereas in patients with ulcer in remission an HCl solution was infused for 180 min. Patients with active duodenal ulcer showed a basal motility with a longer than normal MMC cycle and a shorter than normal activity front, while patients with ulcer in remission showed a cyclic motor activity not significantly different from that of normal subjects. The NaHCO3 infusion in patients with active ulcer restored a near-normal motility, whereas the HCl infusion in patients with ulcer in remission induced a motility similar to that of patients with active ulcer. These data indicate that the increase in gastric acid secretion is responsible for the decrease in frequency and duration of MMC activity fronts, which have the function of cyclically clearing the gastroduodenal lumen. Consequently, acid and bacteria may remain a longer than normal time in contact with the gastroduodenal mucosa, which, in this manner, may be greatly exposed to the risk of peptic lesions.

Adult↗

PubMed1989

Interdigestive gastroduodenal motility in duodenal ulcer: role of gastric acid hypersecretion.

The interdigestive gastroduodenal motility was studied by means of a multilumen manometric probe in eight patients with active duodenal ulcer (group DU1) and in seven patients with hypersecretory gastroduodenitis (group GD). Both groups were selected on the basis of the presence of gastric acid hypersecretion. A group of five patients with non-active duodenal ulcer (group DU2) and a group of eight healthy subjects (group C) also were examined. Both of the latter groups were selected on the basis of the presence of normal gastric secretion. After a basal recording period of 200-300 min, in hypersecretory groups DU1 and GD, ranitidine was administered to decrease acid secretion; in normosecretory groups C and D2, impromidine was infused at two scalar doses to increase acid secretion. The basal recording showed in groups DU1 and GD a longer than normal time interval between consecutive activity fronts (AF) of the migrating motor complex (MMC cycle) and a shorter than normal percent of time occupied by AFs. In normal subjects and in DU2, the administration of the lowest dose of impromidine induced a motor pattern similar to that of the basal period of groups DU and GD, whereas the highest dose disrupted the MMC pattern that was replaced by an irregular motor activity. The results of this study indicate that duodenal ulcer with acid hypersecretion shows a marked inhibition of the MMC cycle that is not due to the ulcer itself, but to the increased acid secretion. In fact, the same motor pattern is observed in other hypersecretory states, both spontaneous and drug-induced, whereas DU with normal secretion showed a near normal motility. In active duodenal ulcer, the decreased incidence and duration of activity fronts may play a role in the pathogenesis of peptide ulcer, as it may impair the cyclic duodenal acid clearing, allowing a longer than normal contact of HCl with the duodenal mucosa.

Adult↗

PubMed1989

Esophageal electromyography in scleroderma patients with functional dysphagia.

Simultaneous recordings of myoelectric and manometric activities of the esophagus were made in two groups of patients with scleroderma. Group A consisted of patients who suffered from functional dysphagia that had appeared recently, and who had a normal size esophagus when examined radiographically. Patients in group B had complained of functional dysphagia for several years and showed a dilated hypotonic esophagus on x-ray. A control group of five normal subjects was also examined in the same manner. The study was carried out by means of a peroral probe with two pairs of suction-needle electrodes and two manometric side-hole catheters positioned at the same levels as the electrodes. Standard manometric examination of the esophagus was carried out in all patients. Normal subjects after each deglutition showed a propagated burst of spikes in correspondence with the ascending phase of the peristaltic wave, whereas, in the period between deglutitions, rare spikes and no pressure waves were recorded. Group A patients were characterized by the frequent appearance during the interdeglutitive period of spontaneous rhythmic sequences or bursts of spikes associated with pressure waves. In these patients, repetitive nonpropagated spike bursts with a higher than normal amplitude and duration were observed after deglutitions in association with high-amplitude nonpropagated repetitive pressure waves similar to those observed in diffuse esophageal spasm (DES). Five of the seven group B patients showed spike bursts and pressure waves with both amplitude and duration markedly lower than normal. The remaining two patients from group B presented no spike bursts or pressure waves at all. Standard manometry demonstrated findings equivalent to those obtained via electromyography (EMG) in all patients of group B and in only two patients of group A. In conclusion, the functional dysphagia of patients with scleroderma can be attributed to two different motor disorders. The first one is characterized by disorganized myoelectric hyperactivity and may have a manometric appearance similar to that of diffuse spasm. The second one is characterized by a marked decrease in myoelectric activity and corresponds to the classic manometric finding of scleroderma involvement of the esophagus. Both these myoelectric patterns seem to be related to subsequent stages of esophageal scleroderma involvement.

Adult↗

PubMed1988

Interdigestive gastroduodenal motor activity in subjects with increased gastric acid secretion.

The interdigestive gastroduodenal motor activity was studied in 7 patients with active duodenal ulcer and increased gastric acid secretion, in 7 patients with hypersecretory gastroduodenitis and in 7 subjects with normal acid secretion, in whom the increase in acid secretion was obtained by means of the intravenous administration of an H2 agonist, Impromidine. The gastroduodenal motor activity was recorded manometrically for about 200-300 min in basal conditions to obtain at least two subsequent activity fronts of the migrating motor complex (MMC cycle). Only in subjects with normal acid secretion was Impromidine administered at a dose of 2 micrograms/kg/h for 150 min followed by a dose of 10 micrograms/kg/h for another period of 150 min, to obtain, respectively, a submaximal and a maximal secretory response. Patients with spontaneous acid hypersecretion, with or without peptic ulcer, showed a longer than normal MMC cycle with a shorter than normal percent of time occupied by phase III. This motor activity was similar to that recorded in normal subjects during the increase in acid secretion induced by the lowest dose of Impromidine, whereas during the highest dose the gastroduodenal MMC was disrupted and replaced by an irregular motor activity.

Adult↗

PubMed1979

[Diagnosis of chronic reflux esophagitis. Role of endoscopic and histological examination].

Fibroendoscopic and histobioptic study of the distal oesophageal mucosa has been carried out in a series of patients suffering from gastro-oesophageal regurgitation. The regurgitation condition was verified and its extent established by means of anamnestic, spot-fluorographic and manometric-pHmetric investigations. On the basis of the analysis of relations between the extent of the oesophagitis assessed on the basis of endoscopy and that arising out of microscopic examination of the biopsy, it is concluded that there is no complete correspondence between the two techniques insofar as endoscopy can give false positive or false negative results. On the basis of these results and of those of functional investigations, histology is considered desirable even when the oesophageal mucosa is normal, if there are clinical and/or laboratory signs of gastro-oesophageal regurgitation.

Adult↗

PubMed1979

Prolonged manometric study of the gastroduodenal junction in man.

A study of the motor activity of the gastroduodenal (GD) junction has been carried out on 8 subjects by using an original probe provided with a suction cup, that allows not only a duodenogastric (DG) pull-though, but also a prolonged recording of the pyloric, antral and duodenal motor activity, in basal condition and after intraduodenal instillation of HCl 0.1 N and intravenous infusion of cerulein. The position of the probe was controlled with fluoroscopy and transmural potential difference. The DG pull-through did not show a zone of high pressure at the GD junction, but the prolonged study showed, during HC1 and cerulein administrations, a significant increase of the pyloric tonus.

Adult↗

PubMed1979

Pyloric reflux: a duodenal functional problem?

A manometric study of duodenal motor activity was performed in 8 duodeno-gastric (D.G.) reflux patients and in 5 healthy volunteers. The examination was done by an open-tip probe containing three catheters which was positioned in the descending portion of the duodenum. The evaluation of manometric data evidenced in D.G. reflux patients a Motility Index (M.I.) significantly higher than that of control subjects in all the three duodenal recording points both in basal conditions and after prostigmine stimulation. Evaluation of the percentage of coordinated waves showed that in D.G. reflex patients the waves had a frequency lower than that in normals. On the basis of these results we can conclude that the duodenum of patients with D.G. reflux exhibits hyperkinetic-dyskinetic disturbances suggesting an important role of the duodenum in determing D.G. reflux.

Adult↗

PubMed1978

Effect of highly selective vagotomy on gastric motor activity of duodenal ulcer patients.

The effect of highly selective vagotomy on the gastric emptying time of a food-barium meal and antral myoelectrical and manometrical activities was studied in two groups of duodenal ulcer patients: one with and another without delay in gastric emptying. Controls performed 1 and 3 months after operation showed that the group of patients with non-delayed preoperative gastric emptying kept a good emptying, only with sporadic, slight and transient disturbances of the gastric myoelectric activity. Conversely, the group of patients with delayed preoperative gastric emptying showed an increase in emptying time together with marked alterations in myoelectric and manometric activities.

Duodenal Ulcer↗