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  • 1
    Electronic Resource
    Electronic Resource
    Neuronal activity in nucleus ambiguus during deglutition and vocalization in conscious monkeys (1994)
    Springer
    Experimental brain research 100 (1994), S. 29-38 
    Details
    ISSN: 1432-1106
    Keywords: Nucleus ambiguus ; Oropharyngeal swallow ; Vocalization ; Ventral medullary swallowing center ; Larynx ; Monkey
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Extracellular recordings were made from the nucleus ambiguus in three conscious Macaca nemestrina monkeys during spontaneous vocalizations and swallows. The temporal relationship of neuronal activity to swallowing was inferred through correlation with the thyroarytenoid electromyographic (EMG) activity. Videofluoroscopic analysis of a fourth monkey during swallows of barium-impregnated fruit juice established the temporal relationship between swallowing and thyroarytenoid EMG activity. Of 691 cells recorded from the nucleus ambiguus and its adjacent area, the neuronal activity of 80 cells showed modulation during swallowing. Sixty-two cells were classified as “active” cells, with increased activity in relation to swallowing, while 18 cells were classified as “suppressed” cells, with tonic activity that reduced with swallowing. A continuum of latency was seen between the onset of modulation of these cells and the onset of swallowing, from “early” before the swallow to “late” after the swallow onset with most of the cells (44 cells) showing modulation near the onset of the swallow. A majority (37) of the 62 active swallowing-related cells also discharged with vocalization, but they demonstrated a lower discharge frequency and a longer burst duration during swallowing. Of the 18 suppressed swallowing-related cells, 11 cells discharged phasically with the respiratory cycle and may be a part of the ventral medullary respiratory center. This chronic awake primate model would preserve the many sensory inputs that may modify the oropharyngeal swallow and may better approximate human physiology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00227276
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  • 2
    Electronic Resource
    Electronic Resource
    Failure to find luxotonic responses for single units in visual cortex of the rabbit (1980)
    Springer
    Experimental brain research 39 (1980), S. 11-16 
    Details
    ISSN: 1432-1106
    Keywords: Visual cortex ; Rabbit ; Primate ; Spontaneous activity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The firing frequency of a population of 213 units in striate and circumstriate cortex of the moderately restrained rabbit was studied under the influence of alternating 1-min periods of darkness versus steady, diffuse, featureless illumination. The intent was to determine whether luxotonic responses, so prominent in striate cortex of primates, are indeed absent in rabbits. Such was the case, there being only transient occurrences in three units where the continuing rate of discharge in darkness was double that in the light. There were, however, much more modest differences in rate of continuing discharge in light versus darkness, and for 46% of the units discharging 〉 1/s this difference exceeded 10% and/or 1/s. The rate of discharge in any case did not provide a reliable index as to the characteristics of a unit's receptive field in response to patterned visual stimuli. The nature and function of luxotonic activity in primates still not being understood, it cannot be decided whether its absence in rabbits represents a true qualitative or merely a quantitative difference between species.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00237064
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  • 3
    Electronic Resource
    Electronic Resource
    The effects of tegaserod (HTF 919) on oesophageal acid exposure in gastro-oesophageal reflux disease (2000)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 14 (2000), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Tegaserod (HTF 919), a 5-HT4 receptor partial agonist, has prokinetic effects that might be useful in decreasing acid reflux in gastro-oesophageal reflux disease (GERD).〈section xml:id="abs1-2"〉〈title type="main"〉Methods:To investigate the potential clinical utility of tegaserod in GERD, a five-period crossover study (balanced Latin square) was designed to evaluate the efficacy of 4 b.d. doses of tegaserod vs. placebo. Four-hour manometry (1 h fasting and 3 h postprandial) with continuous recording of lower oesophageal sphincter pressure and distal oesophageal pH, was performed at the end of each 2-week treatment period in 19 patients with mild-to-moderate GERD. Recordings were scored for mean lower oesophageal sphincter pressure, number of transient lower oesophageal sphincter relaxations, and distal oesophageal acid exposure.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Tegaserod (1 mg/day and 4 mg/day) caused a more than 50% decrease in acid exposure in the postprandial period in patients with abnormal acid exposure, although only the 1 mg/day tegaserod treatment elicited statistically significant decreasing (P 〈 0.05) for the entire treatment group (percentage time for which pH 〈 4: placebo=13%; 1 mg/day dose=5%; 4 mg/day dose=8%). A decreased number of reflux episodes was demonstrated with both the 1 mg/day and 4 mg/day tegaserod doses. There was no apparent effect on mean lower oesophageal sphincter pressure, whilst transient lower oesophageal sphincter relaxations frequency decreased in the 1–2.5 h post-dose.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions:Tegaserod in a dose of 1 mg/day causes a significant decrease in postprandial oesophageal acid exposure. The reduction in oesophageal acid exposure with tegaserod treatment may result from enhanced oesophageal acid clearance, improved gastric emptying, and/or reduced transient lower oesophageal sphincter relaxations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2000.00854.x
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  • 4
    Electronic Resource
    Electronic Resource
    A comparative study of cisapride and ranitidine at controlling oesophageal acid exposure in erosive oesophagitis (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 9 (1995), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The severity of gastro-oesophageal reflux disease is generally considered to be related to the extent of oesophageal acid exposure. Current therapies include antisecretory and prokinetic agents. We compared two of these, ranitidine and cisapride, in their ability to lower oesophageal acid exposure in patients with erosive oesophagitis. Methods: Seven patients with Savary–Miller's grade II–IV oesophagitis and with oesophageal contact time ± 8% were studied. Mean lower oesophageal sphincter pressure was 4.6 mmHg. Oesophageal acid contact time was 25.6 ± 5.6%. Each patient received ranitidine 150 mg b.d., ranitidine 150 mg q.d.s., or cisapride 10 mg q.d.s. in a randomized 3-way cross-over design. Intra-oesophageal pH was monitored during 24 h for each of these treatments in a controlled hospital environment, while consuming a high fat, high calorie diet. Results: Cisapride and ranitidine at both doses decreased the acid contact time and the number of reflux episodes. However, a minority of patients treated with ranitidine, and none with cisapride, diminished their oesophageal acid contact time to a normal value of 〈 5%. No treatment significantly decreased nocturnal acid exposure. Conclusion: In patients with severe gastro-oesophageal reflux disease both cisapride and ranitidine demonstrably lower oesophageal acid exposure, but neither therapy predictably normalizes it.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1995.tb00436.x
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  • 5
    Electronic Resource
    Electronic Resource
    New trials of pharmacological therapy for endoscopy-negative gastro-oesophageal reflux disease (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 11 (1997), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Gastro-oesophageal reflux disease describes patients with disease due to gastro-oesophageal acid reflux regardless of the presence or absence of oesophagitis. In patients with endoscopy-positive reflux disease, symptoms and complications occur due to reflux in association with clear-cut oesophagitis, that is, mucosal breaks evident in the distal oesophagus with endoscopy. On the other hand, in patients with endoscopy-negative reflux disease, symptoms and complications due to reflux occur in the absence of clear-cut mucosal breaks. Most investigations of reflux disease therapy have focused on endoscopy-positive disease. This is, at least in part, owing to the relative ease and reproducibility of disease staging; both disease severity and resolution can be endoscopically defined and graded. These studies indicate that erosive oesophagitis is a chronic condition, subject to relapse within 6 months following the cessation of healing therapy in as many as 80% of patients. Both the potency of anti-secretory therapy required for healing and the certainty of relapse are proportional to the severity of endoscopically-defined oesophagitis. Few reliable data exist on treatment efficacy in endoscopy-negative disease because of a paucity of data on its natural history and inconsistency in defining outcome measures. Nonetheless, disease morbidity, with its associated impairment in quality of life, is determined by symptoms of reflux disease, irrespective of the presence or absence of oesophagitis, and symptom control is a prime objective of therapy for reflux disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1997.tb00795.x
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  • 6
    Electronic Resource
    Electronic Resource
    Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial (2000)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 14 (2000), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The pharmacologic profile of the new proton pump inhibitor esomeprazole has demonstrated advantages over omeprazole that suggest clinical benefits for patients with acid-related disease.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:1960 patients with endoscopy-confirmed reflux oesophagitis (RO) were randomized to once daily esomeprazole 40 mg (n=654) or 20 mg (n=656), or omeprazole 20 mg (n=650), the standard recommended dose for RO, for up to 8 weeks in a US, multicentre, double-blind trial. The primary efficacy variable was the proportion of patients healed at week 8. Secondary variables included healing and heartburn resolution at week 4, time to first resolution and sustained resolution of heartburn, and per cent of heartburn-free days and nights. Safety and tolerability were also evaluated.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Significantly more patients were healed at week 8 with esomeprazole 40 mg (94.1%) and 20 mg (89.9%) vs. omeprazole 20 mg (86.9%), using cumulative life table estimates, ITT analysis (each P 〈 0.05). Esomeprazole 40 mg was also significantly more effective than omeprazole for healing at week 4 and for all secondary variables evaluating heartburn resolution. The most common adverse events in all treatment groups were headache, abdominal pain and diarrhoea.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:Esomeprazole was more effective than omeprazole in healing and symptom resolution in GERD patients with reflux oesophagitis, and had a tolerability profile comparable to that of omeprazole.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2000.00856.x
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  • 7
    Electronic Resource
    Electronic Resource
    Review article: oesophageal pH monitoring – technologies, interpretation and correlation with clinical outcomes (2005)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 22 (2005), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Using a simple ‘test’ to diagnose gastro-oesophageal reflux disease is difficult because accurately measuring gastric refluxate and correlating reflux events with symptom episodes is complex. This paper reviews the safety, tolerability and diagnostic accuracy of Bravo (Medtronic, Shoreview, MN, USA), ambulatory oesophageal pH monitoring technology.Catheter-based pH electrodes inhibit patients’ normal activity, and can yield erroneous results because of placement or subsequent migration of the probe or errors in the thermal compensation algorithm that is requisite for antimony pH electrodes. Bravo pH studies reliably discriminated oesophagitis patients from controls, but are less discriminatory in endoscopy-negative gastro-oesophageal reflux disease patients. The Bravo system can be accurately placed using endoscopic landmarks and pH studies demonstrated more accurate in vivo pH recording than with a catheter-based system. The Bravo system detected fewer reflux events of short duration compared with a catheter-based system. Studies examining the correlation between reflux events and symptoms have not yet been conducted using the Bravo system.In conclusion, the Bravo system offers a more user-friendly ambulatory pH monitoring technique that more accurately records pH compared with a catheter-based system. More research is needed to determine whether the detection of reflux events with Bravo will provide a good correlation with symptom episodes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2005.02710.x
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  • 8
    Electronic Resource
    Electronic Resource
    Review article: gastro-oesophageal reflux disease as a functional gastrointestinal disorder (2004)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 20 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Gastro-oesophageal reflux disease encompasses a family of disorders united by a common pathogenesis: the excessive reflux of gastric contents. The best defined disorder is oesophagitis, but it is now evident that proton pump inhibitor therapy can resolve oesophagitis in virtually every case. The same cannot be said for gastro-oesophageal reflux disease symptoms, however, thus moving the frontier to symptom control. Endoscopy-negative reflux disease is a heterogeneous group, no longer bound by the common denominator of endoscopic findings. In fact, three distinct patient subgroups emerge: (i) individuals who in essence have oesophagitis, but are either in remission or simply fail to meet the endoscopic criteria; (ii) patients with hypersensitivity to oesophageal stimuli; and (iii) patients with ‘functional heartburn’ whose symptoms are not related to reflux. Given this heterogeneity, it is not surprising that the efficacy of antisecretory drugs is less impressive. This has led to new therapeutic approaches beyond acid control: mucosal protective agents, either central nervous system or peripherally acting compounds aimed at normalizing hyperalgesia, and reflux inhibitors and serotonergic agents, such as tegaserod.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.02185.x
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  • 9
    Electronic Resource
    Electronic Resource
    Review article: is stringent control of gastric pH useful and practical in GERD? (2004)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 20 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: As the relative efficacy of therapeutic agents in the treatment of gastro-oesophageal reflux disease is related to how consistently and completely gastric acid secretion is suppressed, intragastric pH monitoring is a useful tool in stratifying therapies. If there is no acid in the stomach, there can be none to reflux into the oesophagus. Comparative crossover studies have shown consistently that once-daily esomeprazole (40 mg) provides more effective and longer lasting intragastric acid control than any other proton pump inhibitor currently available in healthy subjects and patients with gastro-oesophageal reflux disease. However, esomeprazole maintained intragastric pH 〉 4 for ≥ 16 h in only about 55% of individuals tested. Thus, if more complete acid suppression is desirable, twice-daily proton pump inhibitor therapy may be advantageous.One such scenario is in patients with Barrett's metaplasia. Data from the ProGERD study suggest that, for each Los Angeles grade of oesophagitis, the healing rate for patients with Barrett's metaplasia is 10–30% less than that for non-Barrett's patients, being as low as 53% in patients with Los Angeles grade D oesophagitis. Also relevant to the Barrett's metaplasia population are studies on the oesophageal mucosa, which show that effective acid suppression favours differentiation and decreases epithelial cell proliferation. Both considerations argue for more intensive gastric acid inhibition than can be achieved with once-daily therapy, leading to experimentation with twice-daily proton pump inhibitor regimens.A randomized, double-blind, three-way crossover study compared esomeprazole 40 mg once daily with esomeprazole 20 mg and 40 mg twice daily and found that both twice-daily regimens were superior, maintaining intragastric pH 〉 4 for 73%[95% confidence interval (CI), 67–79%] and 80% (95% CI, 75–86%) of the day, respectively, compared with 59% (95% CI, 54–65%) of the day with esomeprazole 40 mg once daily, arguing that a twice-daily regimen may be the preferred strategy for patients with Barrett's metaplasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.02135.x
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  • 10
    Electronic Resource
    Electronic Resource
    Operative manometry and endoscopy during laparoscopic Heller myotomy (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 1015-1020 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Achalasia — Myotomy — Laparoscopy — Manometry — Esophagus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: We report our initial experience using operative esophageal manometry as an adjunct to endoscopy to determine the completeness of esophagogastric high-pressure zone (HPZ) obliteration during laparoscopic Heller myotomy. Methods: Between July 1997 and October 1998, we performed laparoscopic Heller myotomies in 20 patients (eight male, 12 female; median age, 41 years). Mean duration of symptoms was 3.2 ± 2.6 years (r= 0.5–11), and 45% of the patients had received prior dilation or toxin injection. A 16-channel esophageal manometry catheter was placed prior to anesthesia, with sites crossing the lower esophageal sphincter (LES). An endoscope was passed intraoperatively to localize the squamocolumnar junction, and the myotomy was performed. While the translucency was imaged in the area of the incision, we determined the adequacy of myotomy by visual assessment of LES and gastric cardia opening in response to endoscopic air insufflation. Manometry was then performed to detect any potential residual high pressure at the myotomized esophagogastric junction (EGJ). If it was found, the locus of persistent pressure was identified by probing along the myotomy, and residual muscle fibers were cut to yield a minimum pressure at the EGJ. Results: A persistent HPZ was identified after the initial myotomy in 10 of 20 patients (50%). A Dor fundoplasty completed the operation. The mean operating time was 2.6 ± 0.5 h (median, 2.5; r= 2–3.5 h), and the mean hospital stay was 1.6 ± 1 days (median, 1, r= 1–5 days). The mean LES pressure was 2 ± 3 mmHg immediately postmyotomy (p 〈 0.001 compared with preoperative value). Of 20 patients, only two have reported recurrence of dysphagia (10%). One had a recurrent HPZ on manometry, and one developed esophagitis, which resolved with omeprazole. Conclusions: Our initial experience suggests that operative esophageal manometry is a useful adjunct to upper endoscopy during laparoscopic Heller myotomy, quantitatively assuring obliteration of the nonrelaxing LES and HPZ.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901159
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