Lita Tibbling

Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease.

In a study comprising 100 patients referred to a surgical clinic with symptoms suggestive of gastro-oesophageal reflux disease the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed a normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly correlated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensitivity for radiologic, manometric, and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

Dysphagia and its consequences in the elderly

This investigation was designed to study to what extent dysphagia in the elderly is accompanied by other chest symptoms and if it leads to a reduction in body weight and quality of life. To this end 796 persons, randomly taken from a population register, replied to a questionnaire concerning swallowing difficulties and other chest symptoms. Chest pain, heartburn, and regurgitation occurred significantly more frequently in subjects who admitted feelings of obstruction in the throat or chest during the ingestion of food (p<0.001) than in the rest, as did so-called heart problems (p<0.05). People with dysphagia had more often gained weight over the last 5 years than people without dysphagia (p<0.05). Psychosocial problems in those with dysphagia were given as anxiety at mealtimes and the wish to eat alone. Of those with dysphagia, 40% had consulted a physician, but despite this these patients had as many problems as those who had not seen a doctor. It is apparent that difficulty in swallowing in the elderly leads to physical and psychosocial problems that may reduce their quality of life.

Clinical Evaluation of Different Fluid-filled Systems for Oesophageal Manometry

In a clinical study of oesophageal manometry with fluid-filled catheters, both a non-perfused system and a perfused system with a syringe pump have been compared to a system with a low-compliance perfusion pump, which served as a reference. Significantly lower values of motility amplitudes, motility derivatives, and partly of LES pressures, and a time delay of up to 0.5 sec of the amplitude maximum were obtained with the non-perfused system and the system with a syringe pump in comparison to the low-compliance system. Since the oesophageal function can be erroneously evaluated by use of a non-perfused system or a perfused system with a syringe pump, such systems cannot be recommended for clinical use.

Influence of Body Position, Dry and Water Swallows, Smoking, and Alcohol on Esophageal Acid Clearing

Esophageal acid clearing in normal subjects was studied in different body positions, with an assessment of reproducibility, after dry and water swallows, after smoking, and after alcohol intake. A significant increase in the number of swallows to raise the distal esophageal pH to 5.0 was found in the head-down position (p less than 0.003), after smoking (p less than 0.003), and after alcohol intake (p less than 0.001). It is proposed that the outcome of the acid-clearing test reflects both the transporting capacity of the esophageal muscles and the production of saliva. The precision of the acid-clearing test is not satisfactory, which makes it unsuitable for use in individual cases. It seems, however, well fitted for evaluation of esophageal acid clearing in larger samples.

In vitro Lymphocyte Proliferation as Compared to Patch Test Using Gold, Palladium and Nickel

BACKGROUND A conventional lymphocyte transformation test (LTT) was compared to the commercially available MELISA (memory lymphocyte immunostimulation assay), a lymphoproliferative assay that has been suggested to be a valuable instrument for the diagnosis of metal allergy. Sensitivity and specificity of the two assays were calculated using a patch test as a reference method. METHODS 34 patients were patch-tested for gold sodium thiosulfate, palladium chloride and nickel sulfate, and the lymphocyte proliferation to these metals was tested in vitro using mononuclear cells from peripheral blood. RESULTS No significant differences regarding sensitivity and specificity were found between MELISA and conventional LTT. The sensitivity varied between 55 and 95% and the specificity between 17 and 79%. CONCLUSIONS The low specificity of the two in vitro assays suggests that they are not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.

Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography

Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests. Radiology performed on 14 of the 16 patients showed no evidence of organic lesions. Half the patients had abnormal findings at scintigraphy, with either bolus retention in the upper part of the esophagus or prolonged transit time as compared to a group of 20 asymptomatic subjects. Scintigraphy can be regarded as a valuable complement in the objective documentation of dysphagia when other diagnostic methods fail.

Effect of spasmolytic drugs on esophageal foreign bodies

Muscle spasm has been proposed as the cause for esophageal food impaction. The aim was therefore to treat esophageal foreign bodies with spasmolytic drugs influencing both striated and smooth muscles of the esophagus. A multicenter, placebo-controlled, doubleblind study of glucagon and diazepam was undertaken in 43 patients. The foreign body disimpacted in 9 of 24 patients given active substances and in 6 of 19 patients given placebo; there was no significant difference between these two groups. Almost all disimpactions occurred several hours after injection of the drugs. The hypothesis of muscle spasm as an important cause of esophageal obstruction was rejected. Medical therapies for food disimpaction other than spasmolytic drugs have to be investigated.

Double-Blind Crossover Study of Ranitidine and Placebo in Gastro-oesophageal Reflux Disease

The effect of 150 mg ranitidine twice daily was compared with placebo by the double-blind crossover technique (8 weeks twice) in patients with gastro-oesophageal reflux (paired comparison in 38 patients). Ranitidine was superior to placebo with regard to effect on symptoms, improvement of oesophagitis as assessed by endoscopy and biopsy, and decrease of oesophageal acid hypersensitivity. The symptomatic response to ranitidine was, however, unsatisfactory in more than half of the cases. When symptomatic responders taking ranitidine (R) were compared with non-responders (NR), there was no difference with regard to the severity of oesophagitis or frequency of positive acid perfusion tests before or after the 8-week treatment. NR were younger and more often had endoscopic signs of incompetence of the cardia and gastric prolapse. Ranitidine is an efficient drug in patients with reflux disease. It cannot be expected that mechanical problems in the hiatal region will be influenced by ranitidine, which is probably why half the patients did not respond.

Gastro-Oesophageal Reflux and Severity of Pulmonary Disease in Cystic Fibrosis

The correlation between oesophageal dysfunction (OD), pathologic gastro-oesophageal reflux (GOR), and severity of pulmonary disease was studied in 12 patients with cystic fibrosis (CF). They were interviewed about symptoms of OD and underwent 24-h pH recording in the oesophagus, oesophageal manometry combined with reflux provocation tests, the acid perfusion test, the acid clearance test, lung function tests, and scoring of the chest radiograph. Six of the 12 patients reported symptoms of OD. Abnormal GOR, as shown by 24-h pH monitoring of the oesophagus, was found in eight of them. Altogether 9 of the 12 participants had at least one pathologic oesophagus test result. Results of radiologic examinations of the oesophagus, performed in six patients, were pathologic. The four patients with the best chest radiograph scores and the best lung function had significantly less signs and symptoms of OD and GOR than the other eight patients. We conclude that OD, GOR, and pulmonary disease covariate in CF.

On the use of monocrystalline antimony pH electrodes in gastro-oesophageal functional disorders.

Monocrystalline antimony electrodes have been shown to be suitable for thein vivo determination of pH in blood, tissue and in the upper gastro-intestinal canal. Thanks to their small dimensions it has been possible to mount them into conventional manometry catheters for oesophageal investigation. The monocrystalline antimony pH electrode has several advantages over the conventional pH glass electrode; better accuracy, shorter rise time, smaller dimensions. The monocrystalline antimony electrode has been used for long-term registration of gastro-oesophageal reflux, for the oesophageal acid clearing test and for identification of the pH gradient zone between the gastric and oesophageal mucosa. Its use in combination with pressure sensors has added a new dimension to the diagnosis of functional disorders in the gastro-oesophageal region.