South African Gastroenterology Review, Nov 1, 2005
Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Sw... more Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Swallowing Stages by Phase Food enters oral cavity Mastication and bolus formation Tongue elevates and propels bolus to pharynx Soft palate elevates to seal nasopharynx Larynx and hyoid bone move anterior and upward Epiglottis moves posteriorly and downwards to close Respiration stops Pharynx shortens Upper esophageal sphincter relaxes Bolus passes to esophagus Esophageal contracts sequentially Lower esophageal sphincter relaxes Bolus reaches stomach Oral Phase Oro-pharyngeal Phase Esophageal Phase WGO-OMGE Practice Guideline Dysphagia - January 2004: Final Version 1. DEFINITION Dysphagia either refers to the difficulty someone may have with initiating ..
High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has alrea... more High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has already become an established technique for esophageal manometry where it has replaced water-perfused and station pull-through manometry. Spatiotemporal plots with color coding of pressure have greatly facilitated the analysis of esophageal peristalsis. Although suitable for the length of the esophagus, the solid-state catheter is insufficient for the study of longer segments of the gastrointestinal tract. A new technique with fiber-optic sensors has made it possible to construct catheters with 72-144 sensors. Studies of colonic motility have revealed that the most common motor pattern of the colon is a peristaltic contraction that travels 7-10 cm in the retrograde direction. Earlier studies using low-resolution manometry with 7-45 cm between sensors led us to erroneous conclusions regarding direction and frequency of contractions and they largely missed both antegrade and retrograde contractions traveling short distances. Fiber-optic high-resolution manometry holds promise for greatly improving our understanding of gut motor physiology and hopefully also our understanding of patients with symptoms of disordered gut motility.
Scandinavian Journal of Gastroenterology, Mar 1, 1983
Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagno... more Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagnostic hypotheses formed on the basis of initial data--history, physical findings, and results of routine laboratory tests--enabled the clinician to adopt a single-target strategy in 75 patients and a multi-target strategy in 61 patients. Four patients died very early in the course of events and another four were excluded from analysis because they were judged not to benefit from further investigations. The single-target strategy, in which the clinician explored one diagnostic hypothesis only, often led to a short diagnostic process (mean, 11 days), and in 89% of the patients the clinician's hypothesis was correct. In the multi-target strategy several diagnostic hypotheses were evaluated. In these patients the correct diagnosis was included in the first set of hypotheses in 84%, and the mean duration of the diagnostic process was 25 days. Patients with cholestatic jaundice presented the most difficult diagnostic problem, and most of these were investigated by a multi-target strategy. The possibility of an extrahepatic obstruction often forced the clinician to use invasive procedures to rule out this diagnosis. Considerable time was spent in observing the clinical course and waiting for investigations to be carried out. To reduce the investigative cost, controlled studies of diagnostic value and optimal order of investigations are warranted.
Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC)... more Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta‐analysis. Eighty‐one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed‐effects model. Meta‐analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta‐analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.
Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux ... more Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.
South African Gastroenterology Review, Nov 1, 2005
Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Sw... more Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Swallowing Stages by Phase Food enters oral cavity Mastication and bolus formation Tongue elevates and propels bolus to pharynx Soft palate elevates to seal nasopharynx Larynx and hyoid bone move anterior and upward Epiglottis moves posteriorly and downwards to close Respiration stops Pharynx shortens Upper esophageal sphincter relaxes Bolus passes to esophagus Esophageal contracts sequentially Lower esophageal sphincter relaxes Bolus reaches stomach Oral Phase Oro-pharyngeal Phase Esophageal Phase WGO-OMGE Practice Guideline Dysphagia - January 2004: Final Version 1. DEFINITION Dysphagia either refers to the difficulty someone may have with initiating ..
High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has alrea... more High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has already become an established technique for esophageal manometry where it has replaced water-perfused and station pull-through manometry. Spatiotemporal plots with color coding of pressure have greatly facilitated the analysis of esophageal peristalsis. Although suitable for the length of the esophagus, the solid-state catheter is insufficient for the study of longer segments of the gastrointestinal tract. A new technique with fiber-optic sensors has made it possible to construct catheters with 72-144 sensors. Studies of colonic motility have revealed that the most common motor pattern of the colon is a peristaltic contraction that travels 7-10 cm in the retrograde direction. Earlier studies using low-resolution manometry with 7-45 cm between sensors led us to erroneous conclusions regarding direction and frequency of contractions and they largely missed both antegrade and retrograde contractions traveling short distances. Fiber-optic high-resolution manometry holds promise for greatly improving our understanding of gut motor physiology and hopefully also our understanding of patients with symptoms of disordered gut motility.
Scandinavian Journal of Gastroenterology, Mar 1, 1983
Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagno... more Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagnostic hypotheses formed on the basis of initial data--history, physical findings, and results of routine laboratory tests--enabled the clinician to adopt a single-target strategy in 75 patients and a multi-target strategy in 61 patients. Four patients died very early in the course of events and another four were excluded from analysis because they were judged not to benefit from further investigations. The single-target strategy, in which the clinician explored one diagnostic hypothesis only, often led to a short diagnostic process (mean, 11 days), and in 89% of the patients the clinician's hypothesis was correct. In the multi-target strategy several diagnostic hypotheses were evaluated. In these patients the correct diagnosis was included in the first set of hypotheses in 84%, and the mean duration of the diagnostic process was 25 days. Patients with cholestatic jaundice presented the most difficult diagnostic problem, and most of these were investigated by a multi-target strategy. The possibility of an extrahepatic obstruction often forced the clinician to use invasive procedures to rule out this diagnosis. Considerable time was spent in observing the clinical course and waiting for investigations to be carried out. To reduce the investigative cost, controlled studies of diagnostic value and optimal order of investigations are warranted.
Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC)... more Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta‐analysis. Eighty‐one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed‐effects model. Meta‐analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta‐analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.
Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux ... more Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.
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