Biomedical subjects
M V Math
Publications and source records attributed to M V Math.
Low frequency of endoscopic esophagitis in Asian patients.
The aim of this study was to determine the frequency of endoscopic esophagitis in patients seen for upper gastrointestinal complaints in an Asian center. We studied a consecutive series of 11,943 patients undergoing diagnostic esophagogastroduodenoscopy at our unit over a 10-year period. Three hundred and eighty-nine patients (3.3%) had endoscopic esophagitis with no other significant lesion (primary esophagitis), whereas 143 (1.2%) had esophagitis associated with peptic ulcer or gastric or duodenal malignancy (secondary esophagitis). In contrast, peptic ulcer was diagnosed in 2,787 patients (23.3%) and gastric carcinoma in 286 (2.4%). The reported frequency of endoscopic esophagitis among patients undergoing endoscopy in Western countries varied from 9 to 23%. Our data therefore show that endoscopic esophagitis is much less common in Singaporean patients.
Midazolam as a sedative in esophageal manometry: a study of the effect on esophageal motility.
Midazolam 0.5 mg/kg was given intravenously as a sedative to 19 infants and children undergoing esophageal manometry after oral choral hydrate treatment. The lower esophageal sphincter pressure and motility were measured by manometry before and after midazolam injection. Midazolam did not change the lower esophageal sphincter pressure, blood pressure and respiratory rate of the subjects (p greater than 0.18), and the motility patterns. However, the mean heart rate increased by 5 beats/min after midazolam injection (p less than 0.05). One infant developed transient apnea, reversed promptly by intravenous flumazenil. Sedation occurred within 1 min after intravenous injection of the drug. No other side effects were noted. Midazolam is a relatively safe and effective sedative for accurate lower esophageal sphincter pressure measurement and esophageal manometry when a mild sedative such as choral hydrate does not work.
The diagnostic yield of upper gastrointestinal endoscopy in the investigation of anaemia.
Computer records of patients endoscoped over a 34-month period were studied to assess the diagnostic yield of gastrointestinal endoscopy in patients with anaemia. Patients with obvious gastrointestinal bleeding and known gastrointestinal pathology were excluded. On hundred and thirty-six patients were endoscoped for anaemia. Eighty-three of them (61%) had iron deficiency anaemia and 53 (39%) had other types of anaemia. The ages of the patients with iron deficiency anaemia (mean 56 years) were significantly lower than those of other anaemias (means 65 years), (p less than 0.003). Patient characteristics were otherwise comparable. There were significant endoscopic findings (ulcers, carcinoma and haemorrhagic or erosive gastritis) in 26 of 83 patients (31%) with iron deficiency anaemia, in 11 of 53 patients with other anaemias (21%) and 37 of 136 patients (27%) combined. Significant endoscopic findings were found in 506 of 2224 patients (23%) endoscoped during this period who were not anaemic, did not have obvious gastrointestinal haemorrhage and were not known to have gastrointestinal diseases. The diagnostic yield for iron deficiency anaemia was significantly higher than for the non anaemic group (p less than 0.05). There was no difference between the diagnostic yields of iron deficiency and other anaemias, other anaemias and the non anaemic group, or total anaemias and the non anaemic group. Gastrointestinal symptoms and history of analgesic or steroid usage did not appear to increase the incidence of gastrointestinal lesions in either iron deficiency anaemia or other anaemias. Twenty-three of 41 patients (56%) who had no cause for anaemia found at the end of all investigations were colonscoped.(ABSTRACT TRUNCATED AT 250 WORDS)
The site of recurrent duodenal ulcer.
The aim of this retrospective study was to determine the site of recurrent duodenal ulcer in relation to the site of the index ulcer. One hundred and thirty-five patients who had recurrent duodenal ulcer after documented healing of an index ulcer were studied. The recurrent ulcer was more likely to occur in the anterior bulb if the index ulcer was anterior (35 of 58 = 60%) than if the index ulcer was not anterior (29 of 77 = 38%, p less than 0.01). However, the likelihood of a recurrent ulcer on the posterior wall of the bulb was not significantly different whether the index ulcer was posterior (11 of 36 = 31%) or not (22 of 99 = 22%, p less than 0.24). Three of 20 patients (15%) who initially presented with bleeding bled again with their recurrent ulcers, compared with eight of 115 patients (7%) who first presented with dyspepsia only (p = 0.39). Thirteen patients were assessed independently by two endoscopists to determine ulcer site. Their assessments concurred for 12 (92%).
The influence of dialect group on peptic ulcer frequency amongst the Chinese in Singapore.
In Singapore, peptic ulcer is more common amongst Chinese than amongst Malays or Indians. Earlier work has suggested that, amongst female Chinese, Cantonese women are more susceptible to ulcer disease when compared to females of other dialect groups. The aim of the present study was to confirm or refute this possibility. The dialect group distribution of 897 Chinese patients with peptic ulcer (duodenal ulcer 601, gastric ulcer 296) was compared with that of non-ulcer dyspepsia patients and 1602 general medical patients attending the same medical units. The proportion of various dialect groups (including Cantonese) was similar in all patient groups. The proportion of ulcer patients presenting with haemorrhage was also similar in the different dialect groups. We conclude that no major dialect differences exist in peptic ulcer frequency amongst the Chinese in Singapore.
Effect of colloidal bismuth subcitrate on symptoms and gastric histology in non-ulcer dyspepsia. A double blind placebo controlled study.
The aim of this study was to determine the effect of colloidal bismuth subcitrate (De Nol) on symptoms and gastric histology in patients with non-ulcer dyspepsia. In a single centre trial, patients with food related upper abdominal pain not caused by ulcer disease were randomised to receive one tablet of colloidal bismuth subcitrate or matching placebo four times daily for eight weeks. Seventy three patients were entered and 51 completed the trial: 28 patients in the colloidal bismuth subcitrate group and 23 in the placebo group. Overall there was no difference between the two groups in terms of symptom relief. Among patients with histological gastritis (n = 23), however, those who took colloidal bismuth subcitrate used fewer antacid tablets (for three of four fortnightly periods) and were more likely to become asymptomatic (eight of 11 v three of 12, p less than 0.05); their gastritis was more likely to resolve (five of 10 v 0 of 12, p less than 0.025) and their gastric biopsies more likely to become negative for Helicobacter like organisms (eight of nine v 0 of 12, p less than 0.001) when compared with patients taking placebo. In contrast, patients who did not have gastritis in their index biopsies (n = 28) fared similarly whether they received colloidal bismuth subcitrate or placebo. Our results indicate that the administration of colloidal bismuth subcitrate benefited non-ulcer dyspepsia patients with gastritis but had no effect on those without.
Helicobacter pylori and gastritis in patients with peptic ulcer and non-ulcer dyspepsia: ethnic differences in Singapore.
Peptic ulcer occurs with different frequencies in the three main racial groups in Singapore. This study aimed firstly to determine the prevalence of Helicobacter pylori in peptic ulcer and non-ulcer dyspepsia patients of the different races and secondly, to assess the relation between H pylori, histological gastritis, patient diagnosis, and race. Gastric antral biopsy specimens from 1502 patients undergoing gastroduodenoscopy were studied and 892 (59%) were positive for H pylori. H pylori was strongly associated with gastritis: 873 of 1197 (73%) patients with gastritis were positive compared with 19 of 305 (6%) without gastritis (p less than 0.0001). The prevalences of H pylori and gastritis were similar in peptic ulcer patients of different races. Malay patients with non-ulcer dyspepsia, however, were less likely to be positive for H pylori (10 of 46 (22%] or to have antral gastritis (17 of 46 (37%] than Chinese (292 of 605 (48%) were positive for H pylori and 421 of 605 (70%) had gastritis) and Indians (35 of 61 (57%) were H pylori positive and 42 of 61 (69%) had gastritis). Patients with duodenal ulcer were more likely to be positive for H pylori than those with non-ulcer dyspepsia, even when subjects with gastritis were considered separately. While our results do not help to explain the observed racial differences in peptic ulcer frequency it may be that the pathophysiology of non-ulcer dyspepsia is different in the different races in Singapore.
Acid induced duodenal ulcer pain: the influence of symptom status and the effect of an antispasmodic.
The aims of this study were to determine whether the development of acid induced duodenal ulcer pain was influenced by the symptomatic status of the patient and whether the administration of an antispasmodic could abolish pain. One hundred millilitres of 0.1 N hydrochloric acid was infused onto the ulcer craters or scars of 143 duodenal ulcer patients on 168 occasions. Symptomatic patients were randomised to receive 40 mg of hyoscine intravenously before acid infusion, or to a control group. Typical ulcer pain developed in seven of 55 (13%) instances for non-symptomatic patients, 24/57 (42%) of control symptomatic patients, and 20/56 (36%) of symptomatic patients given hyoscine. (Asymptomatic group v control symptomatic group, p less than 0.005; control symptomatic group v hyoscine group, NS - 95% confidence limits 12% in favour of the control and 24% in favour of the hyoscine group). The results suggest that acid infusion seldom reproduces ulcer pain in non-symptomatic duodenal ulcer patients and that the pathogenesis of acid induced duodenal ulcer pain probably involves a mechanism other than spasm, as pain was not prevented by an anticholinergic.
Role of osmolarity in TPN-associated hepatobiliary dysfunction.
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Spontaneous resolution of gallstones in infants: role of hypocaloric oral feeding.
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Smoking and risk of gallstone disease.
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Dietary supplementation with pectin in the maintenance treatment of duodenal ulcer. A controlled study.
Patients with recently healed duodenal ulcers diagnosed by endoscopy were randomly allocated to receive 10 g apple pectin USP powder twice daily, 150 mg ranitidine at night, or one tablet matching ranitidine placebo at night for 6 months. Repeat endoscopy was performed at 6 months or if symptoms recurred. Eighty-three patients completed the study. Recurrences occurred in 23 of 27 (85%) patients taking pectin, 6 of 28 (21%) patients taking ranitidine, and 20 of 28 (71%) patients taking placebo. (Pectin versus placebo, NS; ranitidine versus pectin, p less than 0.00001; ranitidine versus placebo, p less than 0.0005). The average amount of pectin taken was 12.7 g/day in patients who relapsed and 12.4 g/day in those who did not. At the doses taken, therefore, dietary supplementation with pectin did not reduce the incidence of duodenal ulcer relapse.
Prophylaxis of postoperative biliary stasis.
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Increase in bile secretion after water ingestion in cholecystectomised patients.
The effect of water ingestion on bile secretion was investigated in nine cholecystectomised patients with T-tube biliary drainage. The effect of ingestion of a standard meal on bile secretion was also studied in these patients. Water ingestion produced a significant increase in bile secretion compared with fasting levels. This increase in bile secretion was comparable to that produced by a standard meal. Ingestion of water or meal did not produce any significant change in bile osmolality or sodium and potassium concentrations of bile.
Pruritus in diseases with cholestasis: pruritogen and serum bile acids.
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Pancreas and cholecystokinin.
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Gallbladder emptying after drinking water and its possible role in prevention of gallstone formation.
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