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Biomedical subjects

S A Müller-Lissner

Publications and source records attributed to S A Müller-Lissner.

At least 19 recordsLinked to original sources
PubMed1996

Functional diagnostic work-up in patients with irritable bowel syndrome.

The first aim of the study was to find a cause of symptoms in patients suffering from "irritable bowel syndrome" using diagnostic tests aimed at functional disorders of lower gut. A second aim was to test, whether the presence of irritable bowel syndrome (or, synonymously, absence of classic organic disease) can be predicted by specific symptoms. 134 consecutive patients (50 +/- 16 SD years, range 17 to 88, 94 women) presenting in our gastroenterological outpatient department with abdominal pain and altered bowel habits were included. A conventional diagnostic work-up aimed at classic organic diseases and, if negative, a functional diagnostic work-up aimed at gastrointestinal malfunction such as dietary fibre trial, functional proctoscopy, defecography, colonic transit of radiopaque markers, anorectal manometry, and lactose tolerance test were done. A classic organic disease was found in only 15 of 134 patients by conventional diagnostic tests. Functional diagnostic work-up yielded a diagnosis in 70 of the remaining 119 patients that else would have been labeled to suffer from IBS (25 slow transit constipation, 20 disordered defecation, nine low fibre intake, and nine lactose intolerance among them). When symptoms were evaluated with a standardized questionnaire, "constipation" and the "necessity of straining to open bowels" were very specific for functional bowel disorder (92% and 100%), but sensitivity of both symptoms was only about 60%. The so-called "Manning criteria" had a very low prevalence in our sample and so were not discriminatory. Since in more than half of the patients with "irritable bowel syndrome" a specific diagnosis can be reached, functional tests should be considered in such patients. The symptom "constipation" in patients with lower gut complaints predicted a functional disorder rather than a classic organic disease with a high specificity.

Adolescent↗
PubMed1995

Empiric therapy for gastroesophageal reflux disease.

BACKGROUND: In the absence of highly specific symptoms and without esophageal erosions, long-term pH monitoring is necessary for diagnosing gastroesophageal reflux disease. This method, however, is not generally available. OBJECTIVE: To determine whether gastroesophageal reflux disease can be diagnosed empirically by acid suppression in patients with normal results of endoscopy. METHODS: We studied 33 consecutive outpatients with pathologic findings on pH monitoring who had symptoms compatible with gastroesophageal reflux disease and normal results of esophagogastroduodenoscopy, particularly a normal appearance of the esophageal mucosa. The severity of symptoms was graded on a visual analog scale from 1 to 10 by the patient. The patients were treated for at least 7 days with either ranitidine, 150 mg twice daily (patients 1 through 10), omeprazole, 40 mg/d (patients 11 through 21), or omeprazole, 40 mg twice daily (patients 22 through 33). A reassessment of symptoms and second pH monitoring were performed during the last day of treatment. RESULTS: Omeprazole, 40 mg/d, significantly reduced the severity of symptoms from 7.1 (range, 4 to 9) to 3.7 (0 to 8) and the reflux measure mean acidity from 0.98 mmol/L (0.21 to 76 mmol/L) to 0.02 mmol/L (0 to 0.47 mmol/L). Omeprazole, 40 mg twice daily, significantly reduced the severity of symptoms from 6.8 (3 to 10) to 0.6 (0 to 2) and the mean acidity from 0.38 mmol/L (0.13 to 8.5 mmol/L) to 0.01 mmol/L (0 to 0.14 mmol/L). Both doses of omeprazole were superior to ranitidine, 150 mg twice daily. When a 75% reduction of symptoms was defined as positive, the "omeprazole test" with 40 mg twice daily had a sensitivity of 83.3%, whereas the sensitivity with 40 mg/d was only 27.2%. CONCLUSION: In practice, the diagnosis of gastroesophageal reflux disease can be ruled out if symptoms do not improve with a limited course of high-dose proton pump inhibitors.

Adult↗
PubMed1995

The effect of hormones and peptides involved in water balance on rat colonic motility in vitro.

We have previously shown that restriction of water intake decreased stool frequency and stool weight in volunteers. The aim of this study was to investigate whether these effects of thirst could be mediated by an action of systematically released hormones on colonic smooth muscle. Using isolated colonic smooth muscle strips the effect of arginine-vasopressin (AVP), angiotensin II (ANG II) and aldosterone on rat colonic motility in vitro was investigated. AVP (10(-12)-10(-10) mol/l) and aldosterone (3 x 10(-10)-3 x 10(-8) mol/l) and physiological hormonal concentrations of ANG II (10(-13)-10(-10) mol/l) had no effect on either basal activity, direct stimulation of colonic smooth muscle or neurally stimulated contractions using carbachol 10(-7)-3 x 10(-5) mol/l or neurally stimulated contractions using electrical field stimulation at various stimulation frequencies (1-10 pps, 1 ms, 40 V). ANG II in higher concentrations (10(-7)-10(-6) mol/l) increased basal activity and neurally mediated contractions. Accordingly, ANG II (10(-6) mol/l) caused a prestimulation but did not increase the maximum contractile effect of carbachol. The response to ANG II was not affected by atropine (10(-6) mol/l). TTX (10(-6) mol/l) and N-nitro-L8-arginine (L-NNA) (3 x 10(-4) mol/l) stimulated basal muscular activity but did not affect the maximum contractile effect of ANG II. Systemic serum concentrations of AVP, aldosterone and ANG II are presumably not involved in thirst-induced colonic motility changes. The ANG II effect in higher concentrations is mediated by a direct stimulatory smooth muscle effect and/or by facilitating neuronal liberation of acetylcholine.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone↗
PubMed1995

Effects of long-term treatment with anthranoids and sodium picosulphate on the contents of vasoactive intestinal polypeptide, somatostatin and substance P in the rat colon.

OBJECTIVE: To examine the effects of chronic treatment and a single high-dose application of anthranoids and sodium picosulphate on the neuropeptide content of the rat colon. DESIGN AND METHODS: Over a 6-month period, eight groups of rats were each given one of the following: sennosides or sodium picosulphate in low daily doses (10 and 2.5 mg/kg/day, respectively), in high daily doses (40 and 10 mg/kg/day, respectively), and in high twice-weekly doses (30 and 7.5 mg/kg/day, respectively); high daily doses of danthron (500 mg/kg/day); and vehicle (tragacanth 0.5%) only. Four further groups of rats each received a single dose of vehicle or a high dose of one of the three laxatives. All rats were killed 48 h after the last dose. The ascending and descending colon were removed and separated into mucosa, submucosa, and muscularis externa. Vasoactive intestinal polypeptide (VIP), somatostatin, and substance P were extracted by boiling and homogenizing the tissue in acetic acid, and their levels were determined using validated radioimmunoassays. RESULTS: After long-term treatment with high doses of sennosides and danthron, but not after a single high-dose administration, there was a significant reduction in mucosal levels of VIP and somatostatin and in submucosal levels of somatostatin of both colonic segments, as well as in the level of VIP in the muscularis externa of the descending colon. Substance P levels remained unaffected. Sodium picosulphate had no effect. CONCLUSIONS: Chronic treatment with anthranoids in high doses, but not with sodium picosulphate, reduces VIP and somatostatin levels in the rat colon. This may represent damage to the enteric nervous tissue or a pharmacological effect of the anthranoids, causing decreased synthesis or increased breakdown of these peptides.

Animals↗
PubMed1995

The influence of arginine-vasopressin on stool output and gastrointestinal transit time in healthy volunteers.

OBJECTIVE: It was asked whether continuous infusion of arginine-vasopressin (AVP) could decrease stool output and gastrointestinal transit time in healthy volunteers. DESIGN: Randomised single blind cross-over-design. SUBJECTS: 5 healthy male volunteers. INTERVENTIONS: Continuous s.c. infusion of AVP (7.5 micrograms/d) for one week vs. 0.9% NaCl-solution (placebo). Some days before the experiment started, the volunteers underwent a two-day-thirsting-period (< 500 ml/day). MEASUREMENTS: AVP-levels in serum, urine output, AVP-urine-excretion, stool frequency, stool weight, colonic transit time. RESULTS: As compared to saline infusion both serum-levels of AVP and AVP-excretion in urine were about four times higher during AVP-infusion whereas they were doubled during thirsting. Accordingly urine output was lower when AVP-levels were high. Parameters of colonic motility did not differ significantly (stool frequency 6.8 +/- 0.8/week for placebo vs. 6.8 +/- 0.5/week during AVP, stool weight 200.3 +/- 25.0 g/d vs. 210.6 +/- 21.1 gld, total colonic transit 22.9 +/- 7.0 hours vs. 25.7 +/- 5.8 hours). CONCLUSION: 1. AVP is well absorbed when applied subcutaneously. 2. AVP in the dosage given has no major influence on stool output and gastrointestinal transit time in healthy volunteers.

Adult↗
PubMed1995

Cisapride in chronic idiopathic constipation: can the colon be re-educated? Bavarian Constipation Study Group.

OBJECTIVE: To investigate whether dose tapering and, potentially, withdrawal of cisapride is possible without loss of therapeutic effect. PATIENTS: A total of 119 patients with chronic constipation (less than three spontaneous, i.e., not laxative-induced, stools per week). DESIGN: Randomized double-blind study. METHODS: Group A (n = 56) was treated with cisapride 20 mg twice daily for 12 weeks. Treatment was continued for a further 12 weeks during which the patients were allowed to take a maximum of four tablets containing 5 mg cisapride each (maximum daily dose, 20 mg). Group B (n = 63) was treated with cisapride 20 mg twice daily for 6 weeks and then with cisapride 10 mg for 6 weeks. Treatment was then stopped and follow-up was continued for a further 12 weeks. RESULTS: Stool frequency was increased in both groups during active treatment and was not reduced when the dose was decreased from 20 mg to 10 mg twice daily in group B but was maintained in group A. Laxative intake fell by 50% in both groups, but this effect was maintained during follow-up in group A only. Group A patients took nearly the maximum dosage of cisapride tablets allowed during follow-up (3.3 tablets per day +/- 0.2 SEM). CONCLUSION: This study confirmed the efficacy of cisapride in chronic idiopathic constipation. Dose tapering below 15-20 mg per day, however, does not appear to be possible.

Adult↗
PubMed1995

Polyethylene glycol 4000 for slow transit constipation.

Slow transit constipation is notoriously difficult to treat. We tested whether polyethylene glycole 4000 (PEG) improves slow transit constipation. Eight female outpatients with symptoms of constipation and a colonic marker transit of more than 60 h were included (age 46 +/- 4y, duration of complaints 17 +/- 3y) in a randomised controlled cross-over study. During a 6-week placebo and 6-week PEG-phase (60g PEG/d) the following parameters were measured: 1. subjective well-being with respect to defeacation on a visual analogue scale (-8 cm very bad, +8 cm very good), 2. in the first 5 weeks of each phase, average dose of sodium picosulfate (prescribed as only allowed laxans, dose adjusted and protocolled on a diary by patient) 3. stool frequency, 4. colonic transit of radiopague polythene pellets in the last week of each phase (the use of laxative was strictly prohibited in this last week). Both subjective and objective parameters of colonic function improved significantly. Visual analog scale ratings improved from -4.65, [-8; 0.5] to 4.65, [-8; 7.5]cm (median, range) (p = 0.028), the self-administered dose of sodium picosulfate decreased from 4, [0; 37] to 0, [0; 11] drops per day (p = 0.028), stool frequency increased from 3.1, [1; 30] to 11, [2; 33] defeacations per week (p = 0.017), and total colonic transit decreased from 91, [67; 116] to 43 h, [17; 76]h (p = 0.017). In conclusion, PEG improves colonic function in patients with slow transit constipation subjectively and objectively. PEG should be considered as an additional option in patients refractory to established forms of treatment.

Adult↗
PubMed1994

Interobserver agreement in defecography.

PURPOSE: This study was designed to test the reproducibility of the diagnostic assessment of defecographies in patients with a suspected disorder of defecation. METHODS: To evaluate interobserver agreement, 100 defecographic series of patients with complaints suggesting a disordered defecation were evaluated independently by three observers with a standardized questionnaire. After six weeks, a random sample of 35 of 100 defecographies was evaluated a second time with clinical data provided (history, proctologic examination). To evaluate whether the position of residual volume in the rectum would affect agreement, patients with substantial retention either in the upper or lower rectum were also evaluated separately. RESULTS: Total agreement regarding rectocele and internal prolapse was 0.81 and 0.75, respectively (1.0 = complete agreement), and was significantly higher than chance agreement. Total agreement regarding residual volume in the rectum at the end of defecography and clinical relevance of findings was not different from chance agreement, providing clinical data did not significantly improve agreement. When residual volume was situated in the lower rectum, agreement regarding incompleteness of emptying and its clinical relevance was much better (0.93). CONCLUSIONS: Interobserver agreement is good regarding the deformation of the rectum during defecography but not different from chance agreement regarding the completeness of evacuation.

Adult↗
PubMed1993

What is behind dyspepsia?

The first aim of the present study was to determine the cause of dyspepsia after negative conventional diagnostic work-up. In such patients, an extended diagnostic work-up was performed including esophageal pH monitoring and manometry, gastric and hepatobiliary scintigraphy, and lactose tolerance test. In 88 of 220 dyspeptic patients (mean age 49 years, range 17-87; 114 women) presenting to our gastroenterological outpatient department, a cause for dyspepsia was found by conventional work-up. Thirty-one of the remaining patients did not enter extended work-up because of minor symptoms. In 47 of 101 patients entering extended work-up, a diagnosis was established (21 endoscopy-negative gastroesophageal reflux disease, 11 gastric stasis, 6 biliary dyskinesia, and 5 lactase deficiency among them). A second aim of the study was to determine whether clusters of symptoms such as "gastroesophageal reflux-like," "dysmotility-like," and "dyspepsia of unknown origin" reliably predict the groups of diseases suggested by these terms. This was not the case. In conclusion, in 40% of dyspeptic patients, a conventional diagnostic work-up led to a diagnosis that explained a patient's symptoms. After a negative conventional diagnostic work-up, an extended diagnostic work-up with functional tests yielded a possible explanation for their symptoms in 47% of patients. In such patients symptomatology was of little help for predicting the diagnosis.

Adolescent↗
PubMed1993

Adverse effects of laxatives: fact and fiction.

Laxatives are generally well tolerated and may be considered safe drugs. When taken at much higher than the recommended doses (laxative abuse) some side effects may occur (e.g. hypokalemia, metabolic alkalosis, renal tubular damage). It is controversial whether the laxatives currently used may lead to morphologic changes of the autonomous nervous system of the colon. Melanosis coli is due to pigment-laden macrophages within the submucosa. It occurs after long-term intake of anthraquinones and has no functional consequences. No case of 'cathartic colon' has been observed during the last few decades, and we can assume that it was probably caused by laxatives which are no longer in use.

Alkalosis↗
PubMed1993

How effective is nonlaxative treatment of constipation?

In almost any textbook of medicine so-called simple measures are proposed for treating constipation, such as increasing physical activity, drinking more fluid, triggering the gastrocolonic response by, e.g., drinking a glass of water or a cup of coffee, and bowel training. All of these have not been formally evaluated in constipated patients. Biofeedback training is useful for paradoxical puborectal contraction ('anismus'). Dietary fibre, e.g. in the form of wheat bran, increases stool weight and decreases colonic transit time. So every patient should have an empiric treatment with an adequate amount of fibre. Some patients, especially those with slow transit constipation and those with stasis in the right hemicolon, are not likely to respond to a therapy with bran, however.

Biofeedback, Psychology↗
PubMed1993

[Smoking and gastrointestinal function].

Aspects of gastrointestinal function pathogenetically related to peptic ulcer have been studied extensively. Even as to secretion of gastric acid and pancreatic bicarbonate a definite statement concerning the impact of smoking is difficult. Most of the available studies found that smoking increases acid secretion and decreases pancreatic secretion. This may, at least in part, explain the untoward effect of smoking in ulcer disease. Gastric emptying is slightly decreased by smoking. Gastro-oesophageal and duodenogastric reflux are obviously not influenced to a clinically relevant extent. With regard to the colon, we did not retrieve any relevant publications. In summary, in patients with ulcer disease there is one good reason more to discourage from smoking.

Acid-Base Equilibrium↗
PubMed1993

Body acupuncture: effect on colonic function in chronic constipation.

Acupuncture has been claimed to be an efficacious treatment for chronic constipation, though there are no studies to prove this. We therefore investigated the effect of body acupuncture on stool frequency and colonic transit time of radiopaque markers in 8 constipated patients (58 +/- 6 years, 3 female; vigorous straining necessary to open bowels without the use of laxatives for more than one year, total colonic marker transit > 60 h) in a control period and during a three weeks treatment period with six sessions. Acupuncture was performed as body acupuncture with electric needles (10 Hz, current titrated to individual threshold, 25 min each session) on acupuncture points Di4 [He Gu], Ma25 [Tian Shu], Le3 [Yuan], and B125 [Da Chang Yu]). Two patients dropped out during acupuncture because symptoms of constipation worsened. In the other 6 patients, stool frequencies and colonic transit times were not significantly different during control and acupuncture period (0.38 +/- 0.09 vs. 0.40 +/- 0.14 defecations per day +/- s.e.m., 95% confidence interval for the difference control minus acupuncture [-0.34; 0.30], and 97 +/- 17 vs. 108 +/- 24h, 95% Cl [-50; 27]). Segmental transit times for right and left hemicolon, and rectosigmoid colon did not differ significantly either. In conclusion, acupuncture as performed in this study does not influence objective parameters of colonic function to a clinically relevant degree.

Acupuncture Points↗
PubMed1992

Is the volume retained after defecation a valuable parameter at defecography?

The intention of this study was to correlate the retained volume at the end of defecography to certain defecographic findings and to the sense of incomplete emptying. In 170 defecographic series, the retained barium was estimated planimetrically. No particular defecographic finding determined a higher or lower amount of remaining volume, and the sense of incomplete evacuation did not depend on the amount of retained volume. Thresholds of urge and perception on anorectal manometry did not differ between patients with and without the feeling of incomplete evacuation. A rectocele, isolated or combined with an internal prolapse, caused the retained volume to be in the lowermost part of the rectum, whereas, in the case of an isolated intussusception, the remaining volume was located in the middle or higher part of the rectum. It is concluded that defecographic findings do not in general explain incomplete emptying or the sense of incomplete emptying, but they may determine the localization of the retained volume.

Adult↗
PubMed1992

Three year follow up of patients with gastrooesophageal reflux disease.

Data on the natural course of gastrooesophageal reflux disease are sparse. One hundred and sixty six patients with typical reflux symptoms (heartburn and/or acid regurgitation) and pathologic pH monitoring (reflux time > 8.2% upright and/or > 3.0% supine) were studied. The patients were followed up by questionnaire and interview for a mean of 41 (seven to 86) months after diagnosis of reflux disease. Ten patients had died of diseases not reflux related. In 117 (75%) of the remaining 156 patients data on the course of gastrooesophageal reflux disease could be obtained. In 12 patients anti reflux surgery had been performed. Forty one (39%) of the remaining 105 patients have stopped taking medical therapy, in 13 of these patients symptoms had completely disappeared. Sixty four patients continued on medication (40 on demand, 24 regularly). When asked how their symptoms would be if they completely stopped medication, 71 patients considered their symptoms to be equal or worse and 21 patients to be improved as compared with the initial investigation. Patients with persisting symptoms at follow up had significantly more supine reflux (p < 0.05) at the initial pH monitoring as compared with patients with improved symptoms. The presence and grade of oesophageal erosions at initial endoscopy, duration of symptoms, age, sex, and smoking habits had no influence on the course of gastrooesophageal reflux disease. In conclusion, reflux symptoms disappear only in a minority of patients with proven gastrooesophageal reflux disease. More than half of all patients continue medication, either on demand or regularly. Severe supine reflux is an unfavourable prognostic factor.

Adult↗