[The value of botulinum toxin injection in treatment of achalasia].
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Botulinum Toxins↗
Biomedical subjects
S F Hoeft
Publications and source records attributed to S F Hoeft.
Normal esophageal body function: a study using ambulatory esophageal manometry.
OBJECTIVE: The objective of this study was to establish normative ambulatory manometric data for contractions and contraction propagation in three levels of the esophagus. METHODS: Twenty-five healthy volunteers underwent simultaneous ambulatory 24 h manometry. Concomitant 24 h pH studies were performed to exclude the presence of increased esophageal acid exposure. Pressures were recorded over a complete circadian cycle while patients continued with their normal lifestyles including eating and sleeping. Data were analyzed with a software program that was previously modified and validated and that enables quantitation of contractions in terms of efficacy. RESULTS: The frequency of contractions was lowest during sleep, was increased when awake, and was highest during meals. Contraction amplitude increased during meals, providing a greater propulsive force for bolus transport. Similarly, the prevalence of peristaltic waves varied according to different physiologic states, ie., while eating, upright, awake, and sleeping. An increased amplitude and prevalence of peristalsis resulted in an increase in manometric efficacy during meals. CONCLUSIONS: This study provides normative data for ambulatory manometry for comparison when studying patients with disease.
Adult↗
Selection of patients for curative or palliative resection of esophageal cancer based on preoperative endoscopic ultrasonography.
OBJECTIVE: To assess the accuracy of pretreatment staging and the potential of using endosonographic findings to select patients for curative or palliative resection by comparing the preoperative endosonographic and computed tomographic (CT) findings with the histology of the surgical specimen. METHODS: Forty-two patients referred to our clinic with esophageal carcinoma underwent preoperative upper endoscopy with biopsy, endosonography, thoracic CT, and abdominal CT. Based on endoscopic ultrasonographic findings, patients with early-stage disease underwent en-bloc esophagogastrectomy, whereas those with advanced disease had a palliative transhiatal esophagectomy. Exceptions included patients with poor physiologic reserve who were treated by the transhiatal route. RESULTS: In eight patients, we were unable to pass the ultrasonographic endoscope. Seven of these eight had transmural tumors with nodal involvement on histologic study. Tumor length, based on endosonographic measurements, was correctly predicted in 34 patients (85%). Extent of wall penetration was accurately predicted in 26 (76%) of the 34, and regional lymph node status was accurately predicted in 28 (82%) of the 34. Of the patients with sonographic wall penetration, 80% had histologic evidence of one or more positive nodes. Using the WNM staging system, endoscopic ultrasonography correctly staged the cancer in 68% of the patients. Three patients were treated with an inappropriate procedure. CONCLUSION: Endosonography is a reliable method for the preoperative staging and selection of patients for curative or palliative resection. Endosonographic wall penetration appears to be a critical factor in determining tumor spread.
Adult↗
Is Barrett's metaplasia the source of adenocarcinomas of the cardia?
OBJECTIVE: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. DESIGN: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. SETTING: A university department of surgery that specializes in esophageal diseases. PATIENTS: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. MAIN OUTCOME: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients. RESULTS: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 +/- 1.8 cm vs 7.4 +/- 3.4 cm, P < .01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. CONCLUSIONS: Adenocarcinomas located at the gastroesophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a barrett's origin for half of the adenocarcinomas arising at this location.
Adenocarcinoma↗
The effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease.
The outcome of Nissen fundoplication in patients with a nonspecific motility abnormality compared with the outcome in patients with normal motility is unknown. One hundred consecutive patients who underwent primary Nissen fundoplication were evaluated before and a median of 50 months after operation, with emphasis on the presence of a preoperative motility disorder and its relationship to preoperative and postoperative symptoms. Compared with patients who had normal motility, patients with a nonspecific motility abnormality had a greater prevalence and severity of heartburn and regurgitation before operation. These patients also had a greater esophageal exposure to gastric juice on pH monitoring as a result of poorer esophageal clearance function. The prevalence and severity of preoperative dysphagia was not related to the presence of a motility disorder. A 90% or a 95% actuarial success rate was achieved in the relief of heartburn and regurgitation over a 96-month period in patients with and without a motility abnormality. The overall actuarial success rate was 93%. Dysphagia was rarely caused or made more severe by the procedure; if present before the operation, it was relieved in most patients. The prevalence of persistent postoperative dysphagia was similar in patients with and without a motility abnormality. The success of Nissen fundoplication in properly selected patients is not affected by the presence of a nonspecific motility disorder.
Deglutition Disorders↗
Pharyngeal swallowing. The major factor in clearance of esophageal reflux episodes.
OBJECTIVE: This study defined the clearance mechanisms of naturally occurring reflux episodes in normal subjects and patients with gastroesophageal reflux disease. SUMMARY BACKGROUND: Previous studies on acid clearance have been performed in the laboratory setting in supine subjects using acid instillation and stationary motility. The mechanisms of clearance have not been studied using ambulatory pH and motility monitoring. METHODS: A new system capable of monitoring simultaneously for 24 hours pharyngeal pressure, esophageal motility, and pH was used to study the clearance of naturally occurring reflux episodes in 10 normal subjects and 18 patients with gastroesophageal reflux disease. Esophageal contraction waves were classified as primary (i.e., initiated by a pharyngeal swallow) and secondary (i.e., unrelated to a pharyngeal swallow). RESULTS: A total of 1288 reflux episodes were analyzed, during which 2781 contraction waves occurred. Clearance (i.e., restoration of pH to > 4) occurred after primary peristalsis in 83% of reflux episodes. An additional 11% were cleared by pharyngeal swallows without an esophageal body response. Secondary waves were rare and when they occurred, only 19% were peristaltic. Secondary peristalsis cleared only 9 of the 1288 reflux episodes. Patients and normal subjects cleared reflux episodes similarly. Baseline swallowing frequency was 0.87/min during the daytime and increased to 2.59/min (p < 0.01) during daytime reflux episodes. Swallowing frequency in response to nighttime reflux episodes was less (1.42/min; p < 0.05). CONCLUSIONS: Pharyngeal swallowing is the most important mechanism for esophageal acid clearance. Secondary waves are rare, usually disorganized, and unimportant in clearing a reflux episode. During sleep, the mechanisms of clearance are depressed.
Adolescent↗
Value of physiologic assessment of foregut symptoms in a surgical practice.
BACKGROUND: The aim of this study was to evaluate the reliability of symptoms in the diagnosis of gastroesophageal reflux disease and esophageal motility disorders as assessed by functional tests. METHODS: In 365 patients referred for suspected esophageal functional disease, symptomatic assessment was compared with the results of esophageal manometry and ambulatory 24-hour pH monitoring of the distal esophagus. RESULTS: Based on the patients' chief complaint, the symptomatic diagnosis was gastroesophageal reflux (44%), esophageal motor disorder (26%), chest pain of esophageal origin (9%), reflux and aspiration (8%), and abdominal pathology (12%). The symptomatic diagnosis was considerably altered by the results of the esophageal function tests: gastroesophageal reflux and motility disorders were found in all symptomatic diagnostic groups and a large number of patients in each group tested normal. The sensitivity and specificity of symptom-based diagnoses for functional disease were low. CONCLUSIONS: The results of this study showed that symptoms are an unreliable guide of esophageal abnormality, illustrating the need for objective testing in these patients, particularly to avoid inappropriate medical or surgical therapy.
Adolescent↗
Manual verification of computer analysis of 24-hour esophageal motility.
The application of solid-state technology to intraesophageal pressure monitoring over an entire circadian cycle has resulted in large amounts of data that require computer analysis. Recently available commercial software has yet to be validated. The aim of this study was to compare the analysis of ambulatory esophageal manometry by an automated computer program with manual analysis and make the software modifications necessary to validate the automated system for clinical use. Computer-aided analysis of a large number of esophageal contractions recorded during ambulatory esophageal manometry was compared with manual analysis by four experienced physicians. Good correlations were found between manual and computerized measurements of contraction amplitude and duration (r = 0.99 and r = 0.73, respectively). Software modifications resulted in correct identification of 94% of contractions and correct classification of 93.3% of these waves as peristaltic or simultaneous. These results demonstrate that the evaluated program for automated analysis of ambulatory esophageal manometry is accurate and reliable for research and clinical applications.
Circadian Rhythm↗