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Biomedical subjects

S R Achem

Publications and source records attributed to S R Achem.

13 recordsLinked to original sources
PubMed1997

Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux.

Gastroesophageal reflux (GER) occurs in 22-66% of patients with noncardiac chest pain (NCCP). Although open-label investigations have shown beneficial effects of antireflux therapy in NCCP, no double-blind, prospective, placebo-controlled studies have been conducted. The purpose of this study was to evaluate the effects of omeprazole compared to placebo in a prospective, double-blind, randomized trial of patients with NCCP and GER. Thirty-six consecutive patients with NCCP and GER documented by 24-hr ambulatory pH testing entered this study. The subjects were randomized to omeprazole, 20 mg by mouth twice a day (17 patients), or placebo (19 patients) for eight weeks. Patients on omeprazole obtained significantly more improvement in the fraction of chest pain days (P = 0.006) and severity (P = 0.032) when compared to placebo. More patients in the omeprazole group reported improvement in individual daily pain scores (81% vs 44%, P = 0.03) and individual severity scores (81% vs 50%, P = 0.057). Thirteen (81%) of the subjects in the treatment arm reported overall symptomatic improvement versus one (6%) in the placebo group (P = 0.001). The results of this study indicate that acid suppression with omeprazole effectively improves chest pain in patients with NCCP and GER.

Chest Pain↗
PubMed1993

Helicobacter pylori detection: a quality and cost analysis.

Histopathologic interpretation of hematoxylin and eosin (H&E)-stained endoscopic biopsies is a common method for identifying Helicobacter pylori. Few studies report the accuracy of this method, and none have compared costs of other diagnostic methods. In the clinical setting of a community hospital using standard diagnostic techniques, the purpose of this study were to determine 1) the comparative sensitivities and specificities of the H&E stain, the Warthin-Starry silver stain, the Giemsa stain, and the CLOtest; 2) the sensitivity and specificity of an "experienced" pathologist in identifying H. pylori by H&E stains, compared with a rotating pathology faculty; and 3) the time to diagnosis (turnaround time) and current patient charges for each diagnostic method. Bacterial identification by the silver stain (or a combination of other tests which were likely to compensate for false-positive and false-negative silver stains) were used as the diagnostic standard in evaluating 94 consecutive cases with the following results: The H&E stain interpreted by the rotating pathology staff was the least sensitive method and one of the least specific tests that were studied. The silver and Giemsa stains were equally sensitive in identifying H. pylori; the silver stain was more specific. The CLOtest was less sensitive than the silver and Giemsa stains, but was equally specific. CLOtest was similar in sensitivity to the H&E stain examined by the "experienced" pathologist, but was more specific. An experienced pathologist was significantly more sensitive than the rotating pathologists in evaluating H&E-stained slides. Therefore, if H&E stains are used to identify H. pylori, which is a common practice, it may be advantageous to use an experienced pathologist. The CLOtest was a simple, rapid, and cost effective substitute for H&E stains in the identification of H. pylori.

Biopsy↗
PubMed1993

The high frequency of upper gastrointestinal pathology in patients with fecal occult blood and colon polyps.

Colon polyps are commonly detected in the workup of fecal occult blood (FOB). It is, however, unclear whether colon polyps can adequately explain FOB. Our aim was to determine the frequency of upper gastrointestinal (UGI) pathology in patients with and without UGI symptoms and with and without risk factors for UGI pathology (such as smoking, drinking alcohol, taking nonsteroidal anti-inflammatory medications, or the presence of associated chronic diseases) who have colon polyps and FOB. Among our 67 study patients with colon polyps and FOB, 79% had associated UGI lesions. Presence or absence of UGI symptoms, risk factors associated with UGI lesions, and polyp characteristics such as size, location, number, and histology, did not appreciably affect this high frequency. Ulcers were the most common lesions in both symptomatic and asymptomatic patients. We conclude that patients with colon polyps found in the evaluation of FOB are likely to have concomitant UGI pathology, and UGI workup should be considered in both symptomatic and asymptomatic patients.

Colonic Polyps↗
PubMed1993

A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.

One hundred thirteen patients were randomized to receive either oral sodium phosphate (Fleet Phospho-Soda), lemon-flavored castor oil (Purge), or standard polyethylene glycol-based lavage solution (GoLYTELY) before elective colonoscopy. The study purpose was to confirm the efficacy of oral sodium phosphate and extend observations to include castor oil. Overall, patients reported that sodium phosphate and castor oil were easier to complete (p < 0.05). Scores for cleansing the entire colon as determined by endoscopists who were blinded to the cathartic agent were highest in patients receiving sodium phosphate (p < 0.02). Scores of left-colon cleansing for flexible sigmoidoscopy were equally high for the three methods. Scores for taste and symptom side effects were similar for each preparation. There were no recognized signs or symptoms of hypocalcemia in the sodium phosphate group. Because of the low cost of oral sodium phosphate combined with the lowest repeat endoscopy rate for inadequate cleansing, patient savings were projected to be $5000 per 100 patients at this center. Oral sodium phosphate is a cost-effective colonoscopy preparation that is better tolerated and more effective than the polyethylene glycol-electrolyte lavage solution or castor oil.

Administration, Oral↗
PubMed1993

Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux.

A review of our 402 motility records of patients undergoing evaluation of noncardiac chest pain identified 40 patients with the diagnosis of nutcracker esophagus. Gastroesophageal reflux was found in 13 of 20 patients (65%) who underwent pH studies, and endoscopy detected one patient with erosive esophagitis. Thus, at least 14 (35%) of our nutcracker esophagus patients had evidence of reflux. Twelve of these subjects agreed to enter an open-label therapeutic trial. After 8 wk of intensive antireflux treatment with high doses of ranitidine or omeprazole, repeat 24-h pH studies and endoscopy demonstrated normalization of pH parameters and healing of esophagitis in all patients. Ten (83%) patients obtained significant symptomatic improvement in frequency of pain episodes, number of days with pain, and pain severity. However, repeat manometry showed normalization of motor findings in only two (18%) patients. These observations warrant further placebo-controlled trials. Until more information is available, the results of this study suggest that gastroesophageal reflux should be excluded in patients with noncardiac chest pain and nutcracker esophagus before initiation of smooth muscle relaxant therapy.

Adult↗
PubMed1993

Segmental versus diffuse nutcracker esophagus: an intermittent motility pattern.

The most common esophageal motility abnormality in patients with noncardiac chest pain is nutcracker esophagus. Most investigators regard nutcracker esophagus as a diffuse process involving the distal esophagus. Others consider it a segmental disturbance affecting isolated regions of the distal esophageal smooth muscle. This study compared the prevalence, clinical features, consistency, and manometric course of patients with either segmental high-amplitude peristaltic contractions (SHAPC) or those with the traditional diffuse contraction abnormalities termed nutcracker esophagus (NE). We particularly sought to determine whether patients with SHAPC represent an early spectrum evolving into a more diffuse contraction disorder--NE. The prevalence and clinical features of patients with either motility disturbance were similar. Thirty-nine percent of our patients had abnormally high peristaltic amplitude in locations of the proximal esophagus not previously described. Follow-up manometric studies demonstrated that only 53% of patients in the NE and 20% with SHAPC retained the same manometric diagnosis. In addition, 33% of patients in the NE group and 40% of the SHAPC group permutated into each other. These findings indicate that patients with SHAPC do not represent an early process subsequently evolving into a more diffuse contraction abnormality. Rather, the motility pattern of high-amplitude peristaltic contractions--segmental or diffuse--constitutes a labile marker associated with noncardiac chest pain.

Chest Pain↗
PubMed1992

Current medical therapy for esophageal motility disorders.

Treatment of patients with an esophageal source of chest pain remains a challenging problem. Although a variety of measures--including nitrates, anticholinergics, sedatives, calcium channel antagonists, esophageal dilation, and psychological reassurance--are available for the management of esophageal chest pain, none has emerged as the treatment of choice. Studies of nitrate preparations for the treatment of painful motility disorders are limited by a small number of patients and the lack of randomized, placebo-controlled investigations. The efficacy of anticholinergic drugs in hypercontractile esophageal motility disorders has not been reported. In the only prospective placebo-controlled trial using an anti-depressant, trazodone was superior to placebo in relieving symptoms in patients with a variety of esophageal motility disorders. Conflicting results have been described in placebo-controlled trials of the calcium channel antagonists nifedipine and diltiazem in patients with "nutcracker esophagus" or diffuse spasm. Information about the efficacy of verapamil and hydralazine is limited. Esophageal dilation has been useful in selected patients. For many patients, esophageal chest pain may be associated with gastroesophageal reflux. Treatment of these patients with nitrates, calcium channel antagonists, or anticholinergics may aggravate their reflux. The mechanisms of esophageal chest pain remain unknown. Recent studies have suggested that abnormal motility may not be the only factor associated with chest pain. An important number of patients have behavioral abnormalities, increased nociception, impaired coronary vasodilatory reserve, or a diffuse abnormality of smooth muscle. Research into rational therapy for chest pain patients should take into account the contribution of these other factors.

Chest Pain↗
PubMed1992

Pseudotumoral hepatic tuberculosis. Atypical presentation and comprehensive review of the literature.

We describe a 40-year-old black North American woman with isolated hepatic tuberculosis and an incidentally elevated alkaline phosphatase. Imaging studies of the liver showed a lesion suggesting primary or metastatic disease, which turned out to be the so-called pseudotumoral form of hepatic tuberculosis. We believe this is the first case recorded in the English language literature of isolated hepatic tuberculosis manifesting first as an incidentally elevated alkaline phosphatase. It seems to be the third documented case in the English literature of a patient with this rare form of tuberculous involvement without systemic manifestations. The patient responded to antituberculous therapy and is healthy 4 years after treatment.

Biopsy, Needle↗
PubMed1992

Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders.

In the manometric evaluation of patients complaining of chest pain, a nonspecific esophageal motor disorder is commonly identified. Yet, the clinical characteristics of these patients and stability of the manometric pattern with time have not been previously described. This study reports a 3.2-yr clinical and manometric follow-up of 23 patients with nonspecific esophageal motor disorder. These subjects were most commonly middle-aged women with long-standing, persistent, and debilitating clinical symptoms. Ninety-six percent (22/23) of our patients complained of chest pain; 65% (15/23) had dysphagia. In addition, 15 (65%) had evidence of reflux during ambulatory pH studies. Symptoms caused such concern that the patients frequently sought medical assistance to exclude serious diseases. Although the symptoms tended to persist, the motility patterns changed in some patients. Follow-up manometric studies were normal in 29%, and nonspecific esophageal motor disorder persisted in 57% of the patients. In three patients (14%), the pattern evolved into diffuse esophageal spasm. When symptoms were compared with these changes in follow-up manometric patterns, the correlation was poor. This observation suggests that additional mechanism(s) other than disturbed esophageal motility may be responsible for the symptoms seen in these individuals.

Adult↗
PubMed1987

Neuronal dysplasia and chronic intestinal pseudoobstruction: rectal biopsy as a possible aid to diagnosis.

We report a patient with an unusual cause of chronic intestinal pseudoobstruction, i.e., neuronal intestinal dysplasia. This disorder is characterized by hyperplasia of the nerve plexuses of the intestine or colon, or both. Detailed morphologic and manometric studies are provided. The discussion emphasizes the various motor abnormalities that may be found in chronic intestinal pseudoobstruction. We propose that rectal biopsy may be of value in the diagnosis of this unusual form of pseudoobstruction.

Aged↗
PubMed1985

Cimetidine-theophylline interaction: effects of age and cimetidine dose.

Influences of cimetidine dose and age on the cimetidine-theophylline interaction were evaluated. Group Y consisted of nine young adults, aged 22-35 years, and Group O of nine elderly adults, aged 60-74 years. Each subject completed three study phases in this randomized crossover study. During Phase A, oral dosing of 5 mg/kg theophylline was followed by 14 serial blood samples drawn over 36 h. Phases B and C involved the same procedures, but with oral cimetidine treatment of either 200 or 300 mg every 6 h, respectively. Theophylline pharmacokinetic parameters for Group Y, Group O, and Groups Y + O were calculated. Analyses of variance (ANOVA) for crossover design were performed for each variable. Intragroup interphase ANOVA results were interpreted using multiple range tests (Tukey's Q). Comparisons between groups were performed using two-sided Student's t tests (alpha = 0.05). Within each phase, the area under the concentration-time curve (AUC), elimination half-life (t1/2 el), clearance (Clp), and volume of distribution (Vd) of theophylline for the elderly subjects were not significantly different from those of the younger adults. Mean changes in AUC, t1/2 el, and Clp between Phases A and B for both Groups Y and O were highly significant (29.2 vs. 40.4, 36.7 vs. 44.8, and 25.9 vs. 29.8%, respectively). Further significant changes in those parameters were associated with 1.2 g/day of cimetidine (Phase C). Alterations of theophylline pharmacokinetics by cimetidine appear to be dose-related and are of similar magnitude in elderly and young healthy adults.

Administration, Oral↗
PubMedDate not supplied

Effect of cimetidine on serum uric acid concentration.

The effect of cimetidine therapy on serum uric acid concentration was studied in four healthy men with normal renal function. Beginning four days before the 16-day study, subjects were permitted no beverages containing caffeine or alcohol and no medications and were placed on a weight-maintenance, isocaloric, purine-free 152-meq-sodium diet. On days 1-12 one cimetidine 300-mg tablet was taken four times daily; on days 13-16 no cimetidine was taken. On each study day, serum uric acid and creatinine and urine uric acid and creatinine concentrations were determined. Daily mean values for serum uric acid, total uric acid excreted, and uric acid clearance were not significantly different from baseline. No significant change occurred in creatinine excreted or creatinine clearance. Cimetidine administration to healthy men with normal renal function did not significantly affect serum uric acid concentration or renal clearance of urate.

Adult↗