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Biomedical subjects

O H Gilja

Publications and source records attributed to O H Gilja.

At least 37 records · Page 2Linked to original sources
PubMed1998

Timing of postprandial dyspeptic symptoms and transpyloric passage of gastric contents.

BACKGROUND: Patients with functional dyspepsia often experience early satiety and discomfort after a meal. The role of early gastric emptying in symptom generation is not known. Our aim was to relate timing of symptoms and early postprandial emptying in functional dyspepsia. METHODS: Twelve patients with functional dyspepsia were investigated during 3 min of fasting, during 3 min of ingesting 500 ml of a meat soup, and during the first 10 min postprandially by means of duplex sonography. RESULTS: Gastric emptying commenced on average 52 sec after the start of ingestion. Transpyloric movements of gastric contents unrelated to peristalsis (that is, alternating transpyloric emptying and reflux within a common chamber created by the terminal antrum, the pylorus, and the duodenal bulb) appeared before peristaltic-related emptying, which commenced after on average 116 sec. In all patients epigastric, meal-related discomfort was experienced after the commencement of transpyloric emptying, on average after 143 sec. A negative correlation was found between intensity of fullness and duration of presymptomatic transpyloric movements of gastric contents (that is, the duodenal 'tasting' period). CONCLUSIONS: The early occurrence of meal-related symptoms suggests that gastric distension is the main factor in symptom generation. However, the onset of symptoms after the commencement of gastric emptying suggests that intestinal tasting receptors are involved in symptom generation. The inverse relationship between the duration of the tasting period and symptom intensity suggests that the time allowed for duodenal tasting might be too short in patients with FD.

Adult↗
PubMed1998

Flow across the human pylorus soon after ingestion of food, studied with duplex sonography. Effect of glyceryl trinitrate.

BACKGROUND: By means of duplex sonography, gastric emptying can be related to antral motor activity. The aim of this study was to examine gastric emptying in relation to antral contractions during and immediately after ingestion of a liquid meal in healthy subjects and to study the effect of glyceryl trinitrate (GTN) on this early phase of gastric emptying. METHODS: Ten healthy, non-smoking men (median age, 36 years; range, 29-41 years) were studied twice on separate days, once without drug administration and once after taking a 0.5-mg sublingual GTN tablet 3 min before ingesting 500 ml of a meat soup (20 kcal; Toro). The subjects were investigated during 3 min of fasting, during 3 min of drinking the soup, and during the first 10 min postprandially. RESULTS: Transpyloric forward flow commenced on average 80 sec and 95 sec after the start of drinking the soup without and with GTN, respectively (P = NS). Non-contractile, pulsatile transpyloric flow (that is, pendulating, transpyloric flow not associated with antral contractions) occurred during episodes of concurrent relaxation of the terminal antrum, the pylorus, and the duodenal bulb. This type of flow occurred mainly just before the start of contractile, pulsatile transpyloric flow (associated with propulsive antral contractions). Initial non-contractile, pulsatile transpyloric flow before commencement of contractile, pulsatile transpyloric flow lasted longer with GTN (188 sec) than without GTN (25 sec) (P < 0.05). Consequently, contractile, pulsatile transpyloric flow commenced later with GTN (302 sec) than without (102 sec) (P < 0.05). CONCLUSIONS: Non-contractile transpyloric flow seems to be a physiologic phenomenon during the early phase of gastric emptying. GTN prolongs the initial phase of non-contractile, and delays the onset of contractile, pulsatile transpyloric flow.

Adult↗
PubMed1998

Imaging studies in dyspepsia.

Patients with functional dyspepsia have discomfort centred in the upper abdomen in the absence of oesophagitis, ulcer, cancer or other pathology which could have explained the dyspepsia. It is generally accepted that neither endoscopy, nor other imaging modalities give any positive findings supporting the diagnosis. However, recent investigations have shown that both endoscopic and ultrasonographic imaging show changes: erosive prepyloric changes (EPC) and accommodation abnormalities, respectively, in a high percentage of the patients. The diagnostic sensitivity and specificity of the changes are not yet known, but the fact that they are also seen in several other conditions characterised by dyspepsia, for instance in gallstone disease, may simply indicate that they are linked to epigastric discomfort in general, and not to a specific dyspeptic condition. Ultrasonographic imaging is a non-invasive, widely available, convenient, and reliable method for evaluation of gastric emptying, gastric motility, transpyloric flow and accommodation disturbances, which may play a crucial role in the pathogenesis of dyspepsia.

Dyspepsia↗
PubMed1998

Gastric meal accommodation and symptoms in diabetes. A placebo-controlled study of glyceryl trinitrate.

OBJECTIVE: To study mechanisms behind postprandial symptoms in patients with diabetes mellitus and the effect of nitric oxide (NO) on gastric accommodation and symptoms in these patients. DESIGN: A double-blind, placebo-controlled, randomized trial was designed in 20 patients with type 1 diabetes (10 male and 10 female, aged 35.3 +/- 7.6 years). METHODS: 0.5 mg sublingual glyceryl trinitrate (GTN), a donor of exogenous NO, or placebo was administered 5 min prior to a 500 ml soup meal. Gastric accommodation of the meal was assessed by abdominal ultrasound. Accommodation in proximal stomach was visualized in a sagittal area (Psa) and a frontal diameter (Pfd) and accommodation in distal stomach was visualized in a sagittal area of the antrum (Asa). Symptoms were assessed using visual analogue scales. RESULTS: Psa correlated significantly (r = 0.57, P = 0.015) with perception of fullness 5 min after the meal, whereas Pfd correlated significantly (r = 0.67, P = 0.004) with nausea at 15 and at 25 min after the meal. Asa correlated (r = 0.50, P = 0.05) with pain at 5 min, 10 min (r = 0.50, P = 0.05) and 25 min (r = 0.68, P = 0.007). GTN had no significant effect on Psa or Pfd, but reduced significantly (P = 0.05) Asa (1 3.5 +/- 4.5 cm2 with GTN vs 16.1 +/- 4.3 cm2 with placebo). GTN increased significantly (P = 0.04) the intragastric proximal/distal meal distribution ratio (proximal/distal sagittal area), but had no significant effect on symptom scores. CONCLUSION: In patients with diabetes, a large proximal stomach is associated with perception of fullness and a large antrum is associated with perception of pain after a meal. Sublingual administration of GTN prior to the meal decreases the antral area and improves the intragastric meal distribution, but fails to improve symptoms.

Cross-Over Studies↗
PubMed1997

Intragastric distribution and gastric emptying assessed by three-dimensional ultrasonography.

BACKGROUND & AIMS: Three-dimensional (3D) ultrasound imaging of the total stomach volume has not yet been achieved. The aim of this study was to investigate whether a magnetic position sensor system for acquisition of 3D ultrasonograms could be used to determine gastric emptying rates and intragastric distribution. METHODS: A system for position and orientation measurement was interfaced to an ultrasound scanner. In vitro accuracy was evaluated by scanning a porcine stomach. Fourteen volunteers, with a median age of 35 years, were scanned fasting and postcibally by two-dimensional (2D) and 3D ultrasound after ingesting a 500-mL soup meal. RESULTS: This 3D system yielded a strong correlation (r = 0.997) between true and estimated volumes in vitro. The limits of agreement were -9.1:70.1 mL in the volume range 1200-1900 mL. The intersubject variability of the total gastric volumes ranged from 12.5% to 46.0%, less than for antral area variability. The average half-emptying time was 22.1 +/- 3.8 minutes. Intragastric distribution of the meal, expressed as proximal distal volume, varied on average from 3.6 +/- 2.1 (5 minutes postpradially) to 2.7 +/- 1.9 (30 minutes postprandially). CONCLUSIONS: This 3D ultrasound system using magnetic scanhead tracking showed excellent in vitro accuracy, calculated gastric emptying rates more precisely than by 2D ultrasound, and enabled estimation of intragastric distribution of a soup meal.

Adult↗
PubMed1997

Effect of glyceryl trinitrate on gastric accommodation and symptoms in functional dyspepsia.

The purpose of this study was to investigate whether sublingual glyceryl trinitrate influences the size of the proximal stomach and postprandial symptoms in patients with functional dyspepsia. Twenty patients with functional dyspepsia were included in a double-blind, placebo-controlled crossover study with sublingual glyceryl trinitrate. All patients were scanned twice on consecutive days, receiving either placebo or 0.5 mg glyceryl trinitrate randomly 5 min prior to ingestion of 500 ml meat soup. Total symptoms, pain, nausea, and bloating were scored on a visual analog scale before and after the meal. Standardized ultrasonograms were obtained 1, 10, and 20 min postprandially of the proximal and distal stomach. The proximal stomach was larger in the sagittal section at 1 min postcibally (26.5 +/- 3.9 vs 24.8 +/- 4.9 cm2, P = 0.036) and 10 min postprandially (22.0 +/- 5.1 vs 19.8 +/- 5.3 cm2, P = 0.009) after administration of glyceryl trinitrate compared with placebo, whereas a tendency was observed after 20 min (18.7 +/- 5.5 vs 17.3 +/- 5.7 cm2, P = 0.076). The corresponding changes in the frontal diameters were 8.3 +/- 1.1 vs 7.8 +/- 1.2 cm (P = 0.067) after 1 min, 7.2 +/- 0.9 vs 6.4 +/- 0.8 cm (P = 0.001) after 10 min, and 6.3 +/- 1.1 vs 5.6 +/- 1.2 cm (P = 0.016) after 20 min. The area of the distal stomach was not different (P > 0.31) in the two groups. After administration of glyceryl trinitrate, the patients reported less pain (P = 0.048) and nausea (P = 0.023) 5 min postprandially, but this effect was reduced 15 min later. Total symptom score was improved by glyceryl trinitrate treatment (P < 0.042). Sublingual glyceryl trinitrate improves accommodation of the proximal stomach to a meal and reduces postprandial symptoms in a group of patients with functional dyspepsia.

Administration, Sublingual↗
PubMed1997

Common pathogenetic mechanisms in symptomatic, uncomplicated gallstone disease and functional dyspepsia: volume measurement of gallbladder and antrum using three-dimensional ultrasonography.

Following cholecystectomy for uncomplicated gallstone disease (GS) some patients experience persistent symptoms suggesting an underlying functional disorder. To study this phenomenon, we have compared symptomatic GS with functional dyspepsia (FD) patients and healthy individuals (C) with respect to putative pathogenetic mechanisms. Gallbladder and gastric antrum volumes were estimated with three-dimensional (3D) ultrasonography before and 10 min after ingestion of 500 ml meat soup in 18 patients with GS. Volume estimation was performed digitally after interactive manual tracing and organ reconstruction in three dimensions. Respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Abdominal symptoms were assessed by interview. The results were compared to previously published data in patients with FD and C investigated with the exact same methods. No significant differences were found between groups with respect to fasting gallbladder or gallbladder emptying. Antral volumes both fasting (P < 0.05) and postprandially (P < 0.01) were larger in GS and FD than in C. The soup meal induced dyspeptic symptoms in 2/18 (11%) of C, 12/18 (67%) of GS and 15/17 (88%) of FD patients (P < 0.001). Compared with C, both GS and FD patients had significantly decreased vagal tone (P < 0.001). There was no significant difference between GS and FD patients with respect to antral volume, vagal tone, or symptoms. We concluded that both gallstone and functional dyspepsia patients are characterized by dyspeptic symptoms in response to ingestion of 500 ml of meat soup, a wide gastric antrum, low vagal tone, but normal gallbladder size and emptying. Thus, patients with symptomatic, uncomplicated gallstone disease and functional dyspepsia seem to have common pathogenetic mechanisms.

Adolescent↗
PubMed1997

Virtual reality in surgical practice in vitro and in vivo evaluations.

This paper describes a method for the acquisition and integrative processing of laparoscopic and endoluminal ultrasound images. We used a stepping motor attached to a stabilizing rig, interfaced to the laparoscope, or the ultrasound probe. 360 degrees laparoscopic scenes were constructed during minimally invasive surgery, and three-dimensional reconstructions were made of related ultrasound data. Integration of 360 degrees panoramas with geometric ultrasound models could be displayed as interactive scenes. This resulted in a better demonstration of the surgical field and topographic anatomy. In conclusion, this type of visualizations may be used in virtual reality simulations for documentation, education and in operative planning.

Computer Simulation↗
PubMed1996

[High frequency ultrasonography of the gastrointestinal wall].

If an ultrasound probe comes close to the area of interest, high ultrasound frequencies can be applied. Endoscopic ultrasonography is performed by means of echoendoscopes or miniature probes using ultrasound frequencies between 7 and 30 MHz. A high frequency ultrasound image of the normal gastrointestinal wall usually shows five layers corresponding closely to the histological layers of the wall. Corrections have to be made, however, for interface echoes between layers with different acoustic impedances. We describe studies performed with the aim of correlating ultrasound images of the normal and diseased gastrointestinal wall with the histology. Ultrasound images of the normal gastrointestinal wall and pathological changes like ischemia, ulcers, tumours and inflammation are presented.

Gastric Mucosa↗
PubMed1996

Impaired accommodation of proximal stomach to a meal in functional dyspepsia.

In patients with functional dyspepsia, scanning by a novel ultrasonographic method was carried out to investigate postprandial accommodation of the proximal stomach. Twenty patients with functional dyspepsia and 20 controls were scanned fasting in a sitting position after drinking 500 ml meat soup. Images were recorded up to 25 min after the ingestion period using an ultrasound sector scanner with a 3.25-MHz transducer. The area in a sagittal section and the maximal diameter in a oblique frontal section were chosen as the main variables for calculating the emptying fraction of the proximal stomach, defined as: (aV2.5min - aVactual/aV2.5min. All subjects were asked to score total symptoms (1-9) provoked by the meal. From 7.5 to 25 min after the ingestion period the patients exhibited both smaller area in the sagittal section (P < 0.018) and shorter diameter in the frontal section (P < 0.046) compared with the healthy controls, and they suffered more symptoms in response to the meal (P = 0.002). Dyspeptic patients revealed higher emptying fractions (P = 0.0005, ANOVA), and H. pylori status did not influence the emptying fractions. Diagnostic sensitivity of the method at 20 min postprandially was 70% and the specificity was 65%. Patients with functional dyspepsia have impaired accommodation of the proximal stomach to a meal, temporarily related to symptom induction.

Adult↗
PubMed1996

Three-dimensional ultrasonography of the gastric antrum in patients with functional dyspepsia.

BACKGROUND: We have developed and validated a three-dimensional ultrasound system for transabdominal imaging. The aims of this study was to evaluate its applicability in scanning and volume estimation of the gastric antrum in humans. METHODS: Twenty patients with functional dyspepsia and 20 healthy controls, comparable with regard to gender, age, and smoking habits, agreed to be scanned while ingesting 500 ml of meat soup. A mechanical scanner with a 3.25-MHz transducer coupled to a tilting motor provided in 3 sec multiple images of the antrum during fasting and 1, 10, and 30 min postprandially. On a Unix work station planar contours of the antrum were selected and drawn manually before organ reconstruction and volume computation. RESULTS: Two volume scans of 160 could not be analyzed due to air in the antrum. Up to 5 cm proximal to the pylorus, volumes could be computed in 95% of fasting samples and in 98% of postprandial samples, versus 8% and 75%, respectively, up to 7 cm proximal to the pylorus. We found no significant differences in antral volumes between dyspeptic patients and controls, either fasting or postprandially. Fasting antral volumes in Helicobacter pylori-positive dyspeptics were smaller than in H. pylori-negative patients (P = 0.02). CONCLUSIONS: Three-dimensional ultrasonography by use of a tilting motor makes non-invasive volume estimation of the gastric antrum possible without making assumptions about its geometry. In the present material no difference was found in antral volumes between patients with functional dyspepsia and controls. It is possible that fasting antral volumes in dyspeptic patients are dependent on H. pylori status.

Adolescent↗
PubMed1996

Ultrasonography of the human stomach.

UNLABELLED: Improved technology and new systems have expanded the possibilities of using ultrasound in clinical gastroenterology. METHODS: Conventional real-time ultrasound was applied to the stomach in order to study motor activity and accommodation to meals. The antrum was imaged by various modalities of two- and three-dimensional ultrasonography, while duplex sonography was used for studying transpyloric flow. Miniature ultrasound probes and echo-endoscopes were employed for endoscopic ultrasound RESULTS: The examinations provided new information about contractions, distension, co-ordination of movements, and flow. Patients with functional dyspepsia were characterized by rapid emptying of the proximal stomach, wide gastric antrum, early commencement of transpyloric flow, and epigastric discomfort following ingestion of a meat soup. Endoscopic ultrasonography exposed detailed images of the gastric wall and adjacent structures of great importance in clinical decision-making. CONCLUSIONS: The new ultrasound methods have improved our diagnostic capabilities and opened new promising possibilities for further research in the field of motility.

Endosonography↗
PubMed1995

In vivo comparison of 3D ultrasonography and magnetic resonance imaging in volume estimation of human kidneys.

The objective of this study was to evaluate the accuracy of a three-dimensional ultrasound system (3D-US) compared with Magnetic Resonance Imaging (MRI) in volume estimation of human kidneys in vivo. Twenty healthy volunteers were scanned fasting in supine position with MRI and with a 3D-US. An ultrasound sector scanner with a mechanical transducer coupled to a tilting motor provided images of multiple sections of kidneys. A 3.25-MHz transducer was tilted through 88 degrees yielding 81 frames, and volume estimation was performed on a Unix workstation after manual contour indication. Data acquisition with MRI was performed by using a 1-T magnet. Eighteen included kidneys [mean +/- standard deviation (SD)] measured 155.7 +/- 26.4 mL (range 110.0-205.0 mL) by 3D ultrasound and 171.8 +/- 24.6 mL (range 127.5-211.0 mL) by MRI, yielding a good correlation (r = 0.82, p < 0.001) between the two methods. The mean difference was -16.1 +/- 15.6 mL (SD) and the limits of agreement were -49.0 mL. We conclude that this 3D-US is accurate in volume estimation of human kidneys in vivo.

Adult↗
PubMed1995

Gastric relaxation in response to a soup meal in healthy subjects. A study using a barostat in the proximal stomach.

BACKGROUND: Meal-induced relaxation of the proximal stomach can be investigated by means of a barostat. Using a standard liquid meat soup that elicits symptoms and a wide antrum in patients with functional dyspepsia, we aimed at finding the best meal size and fat load for studying gastric relaxation. METHODS: In the first trial 200 ml and 500 ml meat soup (1 g fat/200 ml) was given to six healthy individuals. In the second trial a constant volume of soup (200 ml) containing graded amounts of fat (1, 10, and 20 g/200 ml) was given to seven healthy individuals. Gastric relaxation was investigated for 1 h after consumption of the soup. A sagittal cross-sectional antral was assessed ultrasonographically every 10 min, and abdominal discomfort was scored. RESULTS: Overall, a positive response (volume increase of 30 ml or more within 5 min after consumption of the meal) was found in 26 of 30 (87%) investigations. Individual maximal responses ranged from 38 to 482 ml (mean, 180 ml +/- 128). Area under the time-volume curve (AUC) was similar after 200 and 500 ml soup (mean, 100 ml/30 min and 107 ml/30 min, respectively). AUC increased with increasing fat content, with a significant difference between the low-fat and high-fat meal (p < 0.05). The barostat bag induced fed-state antral contractions in most individuals (p < 0.001). There was a negative correlation between AUC and postprandial abdominal discomfort (p = 0.04). CONCLUSIONS: The barostat is a sensitive technique for detecting gastric relaxation, also in response to our standard meat soup meal. The postprandial relaxation response in healthy individuals in dependent on the fat content of the meal. The barostat bag may alter gastric motor activity. Abdominal discomfort after soup ingestion may be related to poor gastric relaxation.

Adult↗
PubMed1995

Monitoring postprandial size of the proximal stomach by ultrasonography.

The purpose of this study was to develop a sonographic method to monitor postprandial size of the proximal stomach. Twenty-three healthy persons were scanned in a sitting position with a 3.25 MHz transducer after ingestion of 500 ml meat soup. The area in a sagittal section and the maximal diameter in an oblique frontal section were chosen as standard measurements. The soup emptied from the proximal stomach in a linear manner (r = 0.99) and at a rate of 2.0 +/- 1.3%/min. Intraobserver error of the scans (mean +/- SD) was 5.6% +/- 2.3% and 9.5% +/- 4.5% for sagittal area and frontal diameter, respectively, and the corresponding interobserver error was 5.3% +/- 4.0% and 8.3% +/- 5.3%, respectively. This sonographic method demonstrated a moderate day-to-day variation, had low intra- and interobserver error, and allowed estimation of initial emptying fractions of the proximal stomach.

Adult↗
PubMed1995

Strain differentiation of Neisseria meningitidis by small-fragment restriction endonuclease analysis (SF-REA).

Following an outbreak involving 3 cases of serogroup B meningococcal disease in a rural part of Western Norway, 2 clinical and 99 carrier isolates of Neisseria meningitidis were examined by small-fragment restriction endonuclease analysis (SF-REA) using EcoRI, to determine its potential for strain differentiation. SF-REA characterized all isolates and provided reproducible results with acceptable inter-clonal differentiation. The results of SF-REA correlated well with those of serological typing and were used to determine clonal diversity and prevalence of invasive strains among the carrier isolates. SF-REA was also useful in demonstrating acquisition of a new carrier strain after eradication of the initial strain by ofloxacin. Thirty-one different restriction patterns/pattern complexes were recognized among the 101 isolates. The two clinical isolates had identical restriction patterns and showed > or = 90% similarity to those of six carrier isolates. In three out of six apparent treatment failures, successful eradication of the original strain by ofloxacin was demonstrated by SF-REA. SF-REA proved valuable in strain differentiation of Neisseria meningitidis, complemented serology, and characterized all isolates which could not be typified by serology.

Carrier State↗