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Biomedical subjects

R J Adamek

Publications and source records attributed to R J Adamek.

At least 37 records · Page 2Linked to original sources
PubMed1997

Gastric dysrhythmias and delayed gastric emptying in patients with functional dyspepsia.

An association between dyspepsia, gastric motility disorders, and myoelectrical abnormalities has been noted. The objective of the present study was to investigate both antral myoelectrical activity and gastric emptying in patients with functional dyspepsia (FD). Electrogastrography (EGG) was performed in 25 adult patients with FD, which had been evaluated by score. After an overnight fast, for 1 hr in the pre- and postprandial state (370 kcal liquid-solid test meal) the following EGG parameters were determined: dominant frequency [DF (cpm)], DF (%) in the normal range (2-4 cpm), bradygastria (<2 cpm), tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to fasting power ratio (PR). The data were correlated to results obtained in 20 age- and gender-matched controls. In addition, in 17 consecutive patients the EGG data were compared to the gastric retention of radionuclides after 60 min (liquid-solid phase labeled with 99mTc colloid). Patients with FD revealed a preprandial increase in tachygastria compared to controls (P < 0.001). Of 17 FD, seven patients exhibited delayed gastric emptying (t60 retention >68%). These patients showed significantly more pre- and postprandial tachygastrias than patients with normal gastric emptying (P < 0.05). The dyspeptic symptomatology and H. pylori status did not correlate with EGG and radioscintigraphy. Patients with FD frequently reveal impaired gastric emptying and increased tachygastria, which may have pathophysiological significance in some of these patients.

Adult↗
PubMed1997

One-week low-dose triple therapy for Helicobacter pylori is sufficient for relief from symptoms and healing of duodenal ulcers.

AIM: To test the hypothesis that 1-week low-dose triple therapy for H. pylori is sufficient for relief from dyspeptic symptoms and healing of duodenal ulcers. METHODS: Fifty-nine out-patients with duodenal ulcers and positive rapid urease test participated in this randomized, double-blind, two-centre study. All patients were treated for 1 week with omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. In a double-blind fashion, patients were then randomly treated for another 3 weeks with either omeprazole 20 mg once daily or an identical-looking placebo. Patients were investigated endoscopically before treatment for H. pylori, after 2 weeks and after 4 weeks. H. pylori infection was assessed by a 13C-urea breath test at the time of enrollment and 4 weeks after cessation of any study medication. RESULTS: Fifty-two patients were included in the 'all patients treated' analysis of efficacy. The overall H. pylori cure rate was 96% (95% CI = 87-100%), with no difference between the treatment groups. After 2 weeks duodenal ulcer healing was confirmed in 91% (95% CI = 80-100%) of patients treated with omeprazole and in 76% (95% CI = 60-91%) in the placebo group (P = 0.14). After 4 weeks all ulcers had healed. Relief from dyspeptic symptoms and adverse events (13.8 and 16.7%) did not differ between the treatment groups. CONCLUSIONS: One-week low-dose triple therapy consisting of omeprazole, clarithromycin and metronidazole is a highly effective and well-tolerated approach to the cure of H. pylori infection in patients with a duodenal ulcer. Our data suggest that continuation of antisecretory drug therapy beyond anti-H. pylori therapy is actually excessive regarding relief from dyspeptic symptoms and healing of duodenal ulcers.

Anti-Bacterial Agents↗
PubMed1996

[The effect of lumbar relief orthoses with abdominal compression on esophago-gastrointestinal motility].

OBJECTIVE: To investigate the effect of lumbar ortheses with abdominal compression on gastro-oesophageal reflux and gastrointestinal transit. PATIENTS AND METHODS: In a prospective study 20 consecutive patients with lumbar syndrome treated with lumbar orthesis (10 female, 10 male, median age 54.6 years) were investigated for gastro-oesophageal reflux, mouth-to-cecum transit time (MCT), and whole-gut transit time. Gastro-oesophageal reflux was assessed performing an ambulatory pH metering of the distal oesophagus over a period of 10 h with and without ortheses on two separate study days. After positioning of the pH catheter patients ingested a liquid-solid test meal labelled with 10 g lactulose and 750 g indigocarmine to determine MCT with the hydrogen breath test and whole-gut transit by the first appearance of indigocarmine in the stool. Dyspepsia was assessed by using a standardized questionnaire. RESULTS: Lumbar ortheses induced a significant increase in reflux time (pH < 4) (8.1 vs 4.1%), total number of reflux episodes (102.5 vs 69.5) and duration of longest reflux episode (6.0 vs 3.7 min) (P < 0.05). 12 patients with ortheses revealed an increase in relative reflux time (2.1-24.5%, median: 8.2%) more than two standard deviations compared to previously obtained normal values. In these patients during ortheses dyspeptic symptoms correlated significantly with reflux time (r = 0.6; P < 0.05). In contrast, MCT and whole-gut transit time in patients with and without ortheses did not differ significantly (85 vs 85 min; 10.2 vs 9.6 h). CONCLUSION: Lumbar ortheses with abdominal compression, nowadays frequently used in the lumbar syndrome, produce gastro-oesophageal reflux associated with dyspepsia. Gastrointestinal transit time is not affected, though.

Adult↗
PubMed1996

[The 13C-acetate breath test for the noninvasive assessment of the gastric emptying of a liquid/solid test meal in diabetics].

OBJECTIVE: To test in a prospective study whether the non-invasive 13C-acetate test is suitable for measuring gastric emptying time with a liquid/solid test meal. (99m)technetium scintigraphy served as the reference method. PATIENTS AND METHODS: 18 consecutive type 2 diabetics with symptoms of gastroparesis (nine men, nine women; mean age 64 [45-76] years) were, after a nocturnal fasting period, given a liquid/solid test meal (370 kcal; 100 ml coffee; doubly marked with 75 mg 13C-acetate and 0.5 mCi 99mTc-colloid). At ten-minute intervals breath samples were taken over two hours and examined by mass spectometry for the 13CO2/12CO2 ratio. In parallel scintigraphy was performed for one hour at one-minute intervals. Gastric emptying half-life (t1/2) was calculated and the correlation between the two methods determined. In addition, the 13C-acetate breath test was performed on 20 healthy subjects to assess reproducibility (ten men, ten women; mean age 44.4 [23-77] years). RESULTS: Median t1/2 with the scintigraphy was 93.5 min, with the breath test 55 min, i.e. a significant correlation (r = 0.8; P < 0.001). Four of five patients with delayed gastric emptying by scintigraphy also showed delay (compared with the control group) in the breath test (median t1/2: 41 min; 95th percentile: 86 min). CONCLUSION: The 13C-acetate test correlated significantly with the results by scintigraphy. It can therefore be recommended as a non-invasive test for assessing gastric emptying time after a liquid/solid test meal in type 2 diabetics.

Acetates↗
PubMed1996

Cure of Helicobacter pylori infection: role of duration of treatment with omeprazole and amoxicillin.

OBJECTIVES: To date, some studies have suggested that short-term therapy may be a promising therapeutic concept for the eradication of Helicobacter pylori. The primary objective of the present study was to elucidate the role of the duration of treatment in the cure of H. pylori infection. METHODS: Forty consecutive patients with H. pylori-positive peptic ulcer disease were randomly allocated to four study groups. The groups were treated with a 14-day course of 20 mg omeprazole b.i.d. orally combined with 2 g amoxicillin t.i.d. intravenously for 1 day (n = 10; six women, age range 40-84 yr), for 3 days (n = 10; five women, age range 29-74 yr), for 5 days (n = 10; five women, age range 21-82 yr), for 7 days (n = 10); five women, age 42-82 yr), respectively. Initially, a standardized clinical evaluation of symptoms and and upper GI tract endoscopy were performed for assessment of H. pylori infection of the gastric mucosa (biopsy urease test, specific culture, and histology). At least 4 wk after cessation of omeprazole medication, H. pylori eradication was evaluated either as described or with the help of the 13C-urea breath test. RESULTS: H. pylori eradication, defined as negative bacterial findings in urease test, culture, and histology or 13C-urea breath test at least 4 wk after discontinuation of omeprazole therapy, was achieved in one of 10 patients (10%) in the one-day group, none of 10 patients (0%) in the 3- and 5-day groups and six of 10 patients (60%) in the 7-day group. CONCLUSION: We conclude that short-term therapies with the proton pump inhibitor omeprazole and the antibiotic amoxicillin must be considered completely ineffective if performed as a short-term therapy for up to 5 days. A therapy duration of 7 days seems to mark a turning point in antibiotic effectiveness, with a rapid increase in eradication rates.

Adult↗
PubMed1996

Endoscopic band ligation for treatment of post-polypectomy bleeding.

Endoscopic band ligation is a newly developed technique that has been proved to be an effective treatment of bleeding esophageal varices. Meanwhile, this technique also has been shown to be a successful method of controlling non-variceal upper gastrointestinal hemorrhage. Moreover, there are scattered reports about endoscopic band ligation for treatment of post-polypectomy hemorrhage. In this report, we describe the successful application of colonoscopic band ligation to control severe post-polypectomy colonic bleeding not responding to standard techniques.

Adenomatous Polyps↗
PubMed1996

Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying.

In patients with progressive systemic sclerosis (PSS) suffering from chronic dyspepsia the stomach may be affected by this disease. The objective of this study was to investigate both antral myoelectrical activity and gastric emptying in PSS patients. Electrogastrography (EGG) was performed in 17 PSS patients (16 female, one male, median age 58 years, range 32-74 years) with chronic dyspepsia. After an overnight fast during one hour in the fasting and one hour in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electrical activity was measured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG parameters including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute [cpm]), bradygastria (< 2 cpm) and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects. In addition, the data were compared to gastric retention of the radionuclide at 60 min measured by simultaneous scintigraphy. The PSS patients did not reveal electrical disturbances. They even exhibited a significant postprandial decrease in DFIC, bradygastria, and tachygastria (ns) compared to healthy subjects. Over 50% of the PSS patients showed a delayed gastric emptying. However, EGG did not correlate to radioscintigraphy significantly. Our results reflect an absent relationship between antral myoelectrical activity in EGG and gastric emptying. Therefore, electrogastrography is unsuitable to assess gastric involvement in PSS.

Adult↗
PubMed1996

[Eosinophilic gastroenteritis in food allergy].

A 23-year-old woman suffered from chronic abdominal pain, nausea and diarrhea. The clinical symptoms particularly increased after ingestion of several foods. Laboratory investigation revealed a moderate eosinophilia in peripheral blood, elevated serum IgE-level and specific IgE against food allergens in radioallergosorbent testing. The patient exhibited exsudative ascites with eosinophiles. CT scan revealed a thickened wall of the small bowel. There was no evidence of a parasitic or extraintestinal disease. Endoscopically, the gastrointestinal tract appeared normal. Histological examinations of biopsies of the gastrointestinal tract led to the diagnosis of eosinophilic gastroenteritis. Under an elimination diet the patient is symptom-free since 16 months without ascites.

Adult↗
PubMed1995

[Severe pneumonitis as a complication of low-dose methotrexate therapy in psoriasis-associated polyarthritis].

A 71-year-old woman with psoriasis-associated rheumatoid arthritis had for 15 months been treated with methotrexate (5 mg/week orally). Four weeks before admission she had developed dyspnoea and cough. On admission her axillary temperature was 38.2 degrees C, the white cell count was normal. Erythrocyte sedimentation rate (50/90 mm), lactate dehydrogenase activity (449 U/l) and the creatinine level (1.33 mg/dl) were all elevated. Blood gas analysis revealed partial respiratory impairment (pO2 52 mm Hg), and the chest X-ray demonstrated bilateral interstitial-alveolar changes. Despite antibiotics the temperature continued to rise, and on the 11th day a blood eosinophilia of 4% was noted. The bronchial mucosa was normal on bronchoscopy, and transbronchial biopsy showed only minor interstitial fibrosis, occasional macrophages and lymphocytes. Cultures of the lavage-fluid were negative. As methotrexate pneumonitis was suspected the drug was discontinued and prednisolone administered (50 mg daily for 3 days, gradually reducing over 7 days). The symptoms quickly improved, and blood gas analysis and the X-rays became normal. The patient was discharged symptom-free after 30 days.

Acute Disease↗
PubMed1995

[Short-term triple therapy with pantoprazole, clarithromycin and metronidazole for the healing of Helicobacter pylori infection].

In a prospective study 27 patients (13 women, 14 men; mean age 62 [45-83] years) with Helicobacter (H.) pylori associated disease received over 7 days pantoprazole (40 mg twice daily), clarithromycin (500 mg twice daily) and metronidazole (500 mg twice daily). Six patients had gastric ulcer, 4 duodenal ulcer, 4 erosive gastritis, 6 erosive duodenitis and 7 had H. pylori-positive functional dyspepsia. Pre-treatment oesophago-gastro-duodenoscopy was combined in 4 patients with antral and in 4 others with body-of-stomach biopsies to demonstrate H, pylori (urease test, specific culture and histology). The H. pylori status was checked with the 13C-urea breath test 4 weeks after the end of treatment. In addition, 9 patients with peptic ulcer were examined endoscopically at least 2 weeks after onset of the treatment to check for any healing of the ulcers, 25 of the patients completed the study according to the protocol. The H. pylori eradication rate was 100% (25 of 25 patients), while the "intention to treat" analysis gave a rate of 92.6% (25 of the 27 patients). The peptic ulcers were found to be healed in all 9 patients who had been endoscoped. One woman developed a reversible stomatitis, but the drug treatment did not have to be stopped. -These findings indicate that short-term triple treatment in the described manner is efficacious in curing H. pylori infection and any peptic ulcer. It is thus a highly promising treatment of H. pylori-associated diseases.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

Electrogastrography in healthy subjects. Evaluation of normal values, influence of age and gender.

Electrogastrography (EGG) permits measurements of the gastric electrical activity. However, normal values of electrical activity are poorly defined. In addition, limited data are available on the effect of age and gender. Therefore, in 40 healthy subjects (age range: 19-90 years) normal values for several EGG parameters were assessed after an overnight fast for 1 hr in the fasting and fed state after ingestion of a standardized solid-liquid meal. The electrical signals were captured by a pair of surface electrodes sonographically placed on the skin overlying the gastric antrum. The dominant electrical frequency was predominantly in the defined normal frequency range between 2 and 4 cycles per minute (cpm) (P < 0.001) and was higher in the postprandial than in the preprandial period (3.1 cpm vs 2.8 cpm, P = 0.02). The instability of the electrical rhythm calculated by a dominant frequency instability coefficient (DFIC) was postprandially lower than in the fasting state (P = 0.04). The electrical power (amplitude) increased postprandially (postprandial to fasting power ratio = 2.4). To evaluate the influence of age and gender on normal values the subjects were divided into four groups (median age: male, 28 and 69 years; female, 25 and 67 years). The most parameters did not differ significantly between the groups. However, DFIC was different between the groups (P < 0.05), with elderly women revealing lowest DFIC. In conclusion, normal values for several EGG parameters evaluated in this study should be included in the analysis of gastric electrical activity. The magnitude of electrical frequency and power are not influenced by age and gender, whereas the instability of the electrical frequency is influenced by these factors.

Adult↗
PubMed1995

[Ultrasound detection of gastric antrum motility--evaluating a simple semiquantitative method].

AIM: This study was carried out to evaluate a simplified sonographic technique for the sonographic analysis of antral motility. METHOD: For this purpose the percentage of visually complete contractions (estimated reduction of the antral area > 50%)/2 minutes was compared to the mean amplitude (%) and the mean velocity (%/s) of the contractions. RESULTS: The percentage of complete contractions was closely correlated to both the mean amplitude (r = 0.97, p < 0.0001) and the velocity (r = 0.92, p < 0.0001) of the antral contractions. CONCLUSION: Since the simplified technique is regardless to a postprocessing unit, which is not available in many sonolayers, it could be recommended as a valid routine screening method for the detection of antral motility disorders.

Adult↗
PubMed1995

Esophageal motility disorders and their coexistence with pathologic acid reflux in patients with noncardiac chest pain.

BACKGROUND: The aim of this study was to determine which motility data of patients with noncardiac chest pain (NCCP) differ from those of controls on the basis of long-term manometry and to evaluate the coexistence of motility disorders and pathologic acid reflux. Further, motility disorders were tested as to whether they were secondary to acid reflux. METHODS: Combined long-term pH/manometry was performed in 95 patients with NCCP, using one pH-electrode and two pressure transducers. The motility data were compared with those of healthy controls (n = 40). In addition, an intraindividual patient-oriented motility analysis was performed. Evaluated were the amplitude, the duration in the distal and proximal esophagus, and the type of propagation, propulsive and simultaneous, of esophageal contractions. Ten patients with pathologic acid reflux and hypermotility disorders received 20 mg omeprazole twice daily and were investigated again 4 weeks after therapy began. RESULTS: The median distal pressure amplitude (39.4 versus 28.9 mmHg, p < 0.0001) and the median percentage of simultaneous contractions (18.5% versus 10%; p < 0.0001) were significantly higher in patients with NCCP than in controls. In addition, patients whose symptoms correlated with abnormal motility (n = 18) had a significantly higher median duration of contractions (3.8 sec versus 3.2 sec; p < 0.03) than controls Patients with pathologic acid reflux showed a higher median distal pressure amplitude (38.3 mmHg versus 28.9 mmHg; p < 0.0001) and median percentage of simultaneous contractions (18% versus 10%; p < 0.0001) than controls. Furthermore, a high rate of coexistence with hypermotility disorders was observed (64%). These disorders persisted after acid suppression therapy. CONCLUSIONS: Patients with NCCP differ from controls in their esophageal motility. Simultaneous contractions of increased amplitude and duration are pathologic. The intraindividual patient-oriented motility analysis is an appropriate evaluation method. Hypermotility disorders occur often in patients with pathologic acid reflux, but apparently they are not dependent on it.

Adult↗
PubMed1995

Antral myoelectric activity, gastric emptying, and dyspeptic symptoms in diabetics.

BACKGROUND: Electrogastrography (EGG) enables the cutaneous measurement of gastric electric activity. An association between electric abnormalities and gastrointestinal motility disorders has been shown. The primary objective of this study was to investigate whether diabetic gastroparesis could be predicted by EGG. METHODS: EGG was performed in 18 insulin-treated type-II diabetics (9 female, 9 male; median age, 64 years; range, 45-76 years) with chronic dyspepsia. After an overnight fast, during 1 h in the fasting and 1 h in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electric activity was captured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG variables including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute (cpm)), bradygastria (< 2 cpm), and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated by fast Fourier transform. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects (10 female, 10 male; median age, 68 years; range, 53-90 years). In addition, the data were compared with the percentages of retention of the radionuclide in the stomach at 60 min, and lag times measured by simultaneous scintigraphy. RESULTS: The EGG values obtained in diabetics did not differ significantly from those in healthy subjects and did not correlate with radioscintigraphy (p > 0.05). Moreover, the EGG values in diabetics with delayed gastric emptying (about 40%) did not differ from data in diabetics without gastroparesis. Furthermore, whereas dyspepsia correlated significantly with radioscintigraphy, no correlation with EGG could be found. CONCLUSIONS: Electrogastrography seems to be unsuitable for assessment of motility disorders in type-II diabetics.

Aged↗
PubMed1995

Endosonographically guided transduodenal and transgastral fine-needle aspiration puncture of focal pancreatic lesions.

Mass lesions of the pancreas can be clearly visualized by endoscopic ultrasonography. For the differentiation of benign from malignant mass lesions, however, cytological examination is still recommended. As transcutaneous fine-needle biopsies have a limited diagnostic value, we have evaluated the efficiency of transmural (trangastral, transduodenal) endosonographically guided fine-needle aspiration (EUS-guided FNA) puncture for cytological confirmation of such pancreatic mass lesions. EUS-guided FNA puncture was performed in 11 patients with focal pancreatic solid lesions. In 4 patients a malignant mass lesion and in 2 patients a benign lesion were correctly identified by EUS-guided FNA puncture, while in 4 patients a false benign diagnosis was established and in 1 patient with a malignant mass lesion a sufficient cytological sample could not be obtained. Histological confirmation or rejection of the cytological diagnosis gained by EUS-guided FNA puncture was obtained in all patients by surgical biopsy or resection. It is concluded that transmural EUS-guided FNA puncture-with the application of a curved-array EUS transducer scanning parallel to the axis of the endoscope-is a new approach to the cytological diagnosis of pancreatic mass lesions. However, the of flexible puncture needles with a short needle tip-destined for multiple use-results in a considerable amount of false-negative diagnoses, as the needle tip frequently can only be advanced into the margin of the lesion. New prototypes of aspiration needles with an extending steel are presently under study for improved transmural EUS-guided FNA puncture.

Aged↗