Endoscopic anti-reflux procedures: what causes the clinical benefit?
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Endoscopy, Digestive System↗
Biomedical subjects
R Kuhlbusch
Publications and source records attributed to R Kuhlbusch.
Relief of reflux symptoms after endoscopic gastroplication may be associated with reduced esophageal Acid sensitivity: a pilot study.
BACKGROUND AND STUDY AIMS: Although the new endoscopic techniques for the treatment of gastroesophageal reflux disease (GERD) lead to marked clinical benefit, the underlying mechanism of this is unknown. MATERIALS AND METHODS: In this prospective study, the effect of endoscopic gastroplication was investigated in six patients with GERD, who were assessed before and 4 weeks after treatment. The effect on reflux symptoms, quality of life, proton pump inhibitor (PPI) consumption, reflux esophagitis, acid exposure, esophageal motility, lower esophageal sphincter pressure (LESP), and gastric emptying was measured. Esophageal acid sensitivity before and after treatment was investigated using a standardized acid provocation test, and compared with that of six age- and sex-matched healthy controls. RESULTS: Significant clinical benefit and discontinuation of PPI consumption after gastroplication was seen. Among the objectively measured parameters, only acid exposure was significantly reduced and gastric emptying significantly delayed. However, acid exposure remained pathologically high. Esophageal acid sensitivity was significantly reduced. The induction of heartburn and/or pain was abolished in four patients after gastroplication. In two patients the intensity of heartburn/pain was significantly reduced by 40 % or 60 %, and the time to provoke heartburn/pain significantly prolonged by 40% or 100%. CONCLUSION: These preliminary data suggest that the decrease of esophageal sensitivity to acid after endoscopic gastroplication is part of the mechanism responsible for the reduction of reflux symptoms.
Adult↗
Extraesophageal autonomic dysfunction in patients with achalasia.
A disagreement exists as to whether extraintestinal parasympathetic autonomic function is altered in patients with esophageal achalasia. Therefore, we assessed autonomic dysfunction in esophageal achalasia and considered the most relevant parameters of parasympathetic autonomic function in these patients. In a prospective study, heart rate variation and pupillary function were investigated in 15 patients with achalasia of the esophagus and in 15 controls by application of a battery of standardized autonomic function tests. Significant differences between patients and controls were detected for various parameters of heart rate variation and pupillometry. When compared to values obtained from large groups of healthy subjects, none of the controls but 11 patients had at least one abnormal parameter of parasympathetic autonomic function. It is suggested that in esophageal achalasia parasympathetic dysfunction that extends beyond the gastrointestinal tract can be frequently detected. This finding supports the view of a generalized alteration of the autonomic nervous system in achalasia.
Adult↗
[Hepatic encephalopathy: neuropsychological and neurophysiological diagnosis].
Hepatic encephalopathy (HE) is a metabolically induced, potentially reversible functional disorder of brain, that may occur during chronic and acute liver diseases. It is of special clinical relevance to identify latent or subclinical HE, when patients show no clinical signs, but exhibit changes of complex cerebral functions as well as subcortical psychomotor deficits in psychometric tests. Because patients experience significant limitations in everyday life and the presence of such deficits is of prognostic value concerning their life expectancy, detection of latent HE has clinical importance. Psychometric tests have gained most significance because they are easy to perform and demonstrate high sensitivity, being highest with the trail-making-test part B. Electrophysiological methods such as EEG, visual evoked potentials, and P300 currently have a secondary and complementary role. An integration of brain imaging and spectroscopic techniques, electrophysiological methods, and neuropsychological tests is necessary for a comprehensive description of the disturbance on functional and topographical level in the future.
Brain↗
Postprandial changes of electrical activity of the stomach after different meals.
AIM: The aim of the study was to investigate the response of the electrical activity of the stomach (electrogastrogram, EGG) to meals, different with respect to consistency, nutrient and caloric composition. METHODS: EGG was recorded in ten healthy volunteers for 30 min before and 45 min after a meal. All subjects received three different meals: A standard 500 kcal solid, a 500 cc isocaloric liquid diet of identical composition (55% carbohydrates, 15% protein, 30% fat) or 500 cc water. Data were analyzed off-line for postprandial changes. RESULTS: Water as well as liquid diet induced a significant postprandial decrease, while solid food induced a slight initial decrease and a subsequent marked increase of the dominant frequency above the fasting level. The response to the solid meal was significantly different from both tap water and liquid diet, but there was no difference between liquid diet and water. All meals significantly increased the signal power with a more sustained effect over time for the liquid diet and water than the solid meal. CONCLUSION: EGG changes seem to be more dependent on the consistency than the caloric and nutrient composition. Because of the dissociation between the timing of EGG changes and the known emptying kinetics, EGG changes seem to reflect other gastric functions rather than being associated with gastric emptying.
Adult↗
Comparison between intraluminal multiple electric impedance measurement and manometry in the human oesophagus.
Conventional oesophageal manometry and intraluminal electrical impedance measurement were simultaneously applied in eight healthy volunteers to study the effect of wet and semisolid bolus viscosities on oesophageal motility and bolus transit. Contraction front velocity measured by electrical impedance and manometry were identical for wet and semisolid swallows and highly associated. Bolus front velocity as measured by electrical impedance was significantly faster than contraction front velocity in both wet and semisolid swallows. Bolus front velocity during semisolid swallows was significantly slower compared to wet swallows. It is concluded that intraluminal electrical impedance measurement is a reliable technique to detect oesophageal motility as well as to differentiate between transit of wet and semisolid bolus consistencies.
Adult↗
Prevalence of lactose malabsorption among patients with functional bowel disorders.
To investigate the prevalence of lactose malabsorption among patients with functional gastrointestinal disturbances we prospectively evaluated all patients referred to a gastrointestinal outpatient clinic over a period of 18 months. All patients had a breath hydrogen test following oral lactose in addition to the standard diagnostic procedures. In 37 of the total of 64 patients no organic cause of the gastrointestinal complaints was found. In 9 of these 37 patients (24%) the breath hydrogen test indicated lactose malabsorption. Three to 6 month later most of the patients with lactose malabsorption showed a significant reduction of gastrointestinal complaints after they had maintained a lactose-poor diet. In comparison, patients with functional disturbances but without lactose malabsorption reported nor or only minor improvement of symptoms; most of these patients had consulted another physician since the last visit in the clinic.
Breath Tests↗
Age and sex and anorectal manometry in incontinence.
Although the prevalence of fecal incontinence is greater in women compared with men and in elderly subjects compared with younger subjects, data regarding the influence of age and sex on anorectal performance in continent and incontinent patients are conflicting. The authors, therefore, investigated age- and gender-related changes in anal resting and squeeze pressure as well as in sphincter relaxation after rectal balloon distention in 75 patients with fecal incontinence of different pathogenesis and in 99 continent patients by multichannel anorectal manometry. As a group, incontinent patients usually exhibit lower pressure profiles than do continent patients regardless of age and gender; however, both the resting pressure of the internal anal sphincter and the voluntary contractile pressure of the external anal sphincter are decreased with age, and both are lowered in women compared with men. Sphincter relaxation and perception of gastrointestinal events are not altered in incontinent patients, and they are not different between men and women or between elderly and younger patients.
Adult↗
[Anal sphincter function and recto-anal continence].
Recto-anal continence results from a complex interplay of motor, sensory and anatomical continence mechanisms. Accordingly, fecal incontinence may be due to motor defects, sensory defects, neurological defects, or defects of the reservoir function of the ano-rectum. In a study in 16 patients with fecal incontinence and 16 continent controls the question was examined, to which extent disturbances of the motor function of the internal and external anal sphincter contribute to the pathogenesis of fecal incontinence. Basal and squeeze anal sphincter pressures were not different in incontinent and continent patients. However, 8/16 incontinent patients showed no or only an insufficient increase of external anal sphincter function while squeezing. It is concluded that disturbances of the motor function of the anal sphincters contribute to fecal incontinence in only about one half of the patients. In addition, the pressure increase of the sphincters during squeezing is of more importance for recto-anal continence than the absolute height of the muscular force of the anal sphincters.
Adult↗