The American journal of gastroenterology
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Am. J. Gastroenterol. · Nov 1993
Comparative StudyDifferences in manometry and 24-H ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease.
In this study, our objective was to examine prospectively, by endoscopy and histology of the esophageal mucosa, the severity of reflux esophagitis and any possible correlation between endoscopic and histological findings on the one hand, and manometric and 24-h ambulatory pH-metry measurements on the other. Forty-two patients with gastroesophageal reflux were prospectively examined. The results were compared with those of 18 healthy controls. Methods used were: 1) upper alimentary endoscopy and grading of severity of esophagitis, 2) esophageal mucosa biopsies, to estimate severity of esophagitis on histology, 3) standard esophageal manometry, by using a water perfused catheter with four side holes, and 4) standard 24-h ambulatory esophageal pH-metry. ⋯ The severity of esophagitis as determined by both endoscopy and histology was significantly inversely related to the amplitude (p < 0.001) and duration (p < 0.01) of esophageal peristalsis at 5 cm proximal to LES; it was significantly related to the pH-metry total composite score (p < 0.001 for endoscopy, p < 0.05-0.01 for histology), the total reflux time (p < 0.001 for endoscopy, p < 0.01 for histology), the duration of longest reflux episode (p < 0.001 for endoscopy, p < 0.01 for histology), the number of reflux episodes lasting more than 5 min (p < 0.05 for endoscopy), and the frequency-duration index of reflux episodes (p < 0.001 for endoscopy, p < 0.01 for histology). Furthermore, strength reduction of peristalsis (< 60 mm Hg x s) was associated with acid exposure greater than 40%, in esophagitis patients. We conclude that the severity of reflux esophagitis, not only through endoscopy but also histologically, is related to the amount of reflux, as expressed by the duration and frequency of the reflux episodes. A very high amount of reflux is in turn associated with impairment of the esophageal body motility, as expressed by the amplitude and strength of esophageal body peristalsis.
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Am. J. Gastroenterol. · Oct 1993
Review Case ReportsAcute gastric volvulus: pathogenesis, diagnosis, and treatment.
A 61-yr-old women presented with vomiting, abdominal pain, and distention. Nasogastric and endoscopic decompression failed to relieve her distention. ⋯ The patient underwent gastric resection with anterior gastropexy followed by an uncomplicated postoperative course. This paper discusses the etiology, anatomic definition, and therapeutic options in patients with acute gastric volvulus.
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Am. J. Gastroenterol. · Sep 1993
Obesity and weight reduction do not influence gastric emptying and antral motility.
A dual radioisotope technique was used to measure gastric emptying of a mixed solid and liquid meal in 30 obese (> 125% of ideal body weight) subjects and 23 age- and sex-matched nonobese control subjects. Gastroduodenal motility studies were also performed on seven obese and 10 nonobese subjects to compare postprandial antral motility. ⋯ Gastric emptying rates before and after substantial weight reduction were similar. We conclude that neither gastric emptying nor antral motility appear to be abnormal in morbidly obese subjects; neither does gastric emptying appear to be affected by substantial acute weight reduction.
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Am. J. Gastroenterol. · Aug 1993
Comparative StudyDiagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding.
To assess the clinical yield of colonoscoping in patients who present with rectal bleeding, persistent abdominal pain, or change in bowel habits in the absence of bleeding. ⋯ Patients with persistent nonbleeding GI symptoms, including abdominal pain and change in bowel habits, have almost as high a yield of colorectal neoplasia as those with rectal bleeding.
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Am. J. Gastroenterol. · Jul 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialRanitidine 300 mg at bedtime is effective for gastric ulcers: a 12-wk, multicenter, randomized, double-blind, placebo-controlled comparison. The Ranitidine 300 mg HS Gastric Ulcer Study Group.
Ranitidine 150 mg twice daily is effective for the treatment of gastric ulcers. We proposed that ranitidine 300 mg once daily would also be effective. In a randomized, double-blind, placebo-controlled, multicenter, parallel-group study, adults with an endoscopically verified acute gastric ulcer > or = 5 mm were treated with either ranitidine 300 mg (n = 183) or placebo (n = 178) at bedtime for up to 12 wk. ⋯ Throughout the 12-wk study, ranitidine 300 mg was significantly more effective than placebo in relieving pain (p < 0.05), with ranitidine-treated patients also using fewer antacid tablets. Ranitidine 300 mg had a safety profile similar to that of placebo. We conclude that ranitidine 300 mg at bedtime is safe and effective for healing acute gastric ulcers.