ABSTRACT
BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.2% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , 2-Pyridinylmethylsulfinylbenzimidazoles , Anti-Ulcer Agents/therapeutic use , Benzimidazoles/therapeutic use , Enzyme Inhibitors/therapeutic use , Esophageal Diseases/pathology , Follow-Up Studies , Gastroesophageal Reflux/drug therapy , Korea/epidemiology , Omeprazole/analogs & derivatives , Prospective Studies , Proton-Translocating ATPases/antagonists & inhibitors , Treatment OutcomeABSTRACT
Studies on hepatic tuberculosis are rare in Korea except several case repots. This is the first report on hepatic tuberculosis confirmed by the peritoneoscopic liver biopsy in Korea. A 43-year-old man was admitted due to high fever and cough for l0 days. On physical examination moist rale was audible on the both lower lung fields and hepatomegaly was noted. Chest X-ray revealed multiple fine granularity scattered uniformly throughout the both lung fields compatible with miliary pulmonary tuberculosis. On blood chemistry, SGOT, SGPT and alkaline phosphatase were elevated. Peritoneascopy revealed multiple yellowish-white small nodules evenly acattered on the entire surface of the both lobes of the liver and the needle biopsy of the liver showed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis consistent with hepatic tuberculosis. The patient was treated with antituberculous medications. Chest X-ray 6 months after treatment revealed completely healed miliary pulmonary tuberculosis and on blood chemistry 200 days after therapy SGOT, SGPT and alkaline phosphatase were within normal limits.
Subject(s)
Adult , Humans , Alanine Transaminase , Alkaline Phosphatase , Aspartate Aminotransferases , Biopsy , Biopsy, Needle , Chemistry , Cough , Fever , Giant Cells , Hepatomegaly , Inflammation , Korea , Liver , Lung , Necrosis , Physical Examination , Respiratory Sounds , Thorax , Tuberculosis, Hepatic , Tuberculosis, PulmonaryABSTRACT
To evaluate the effect of alteration of left atrial pressure. volume and wall tension on the circulating plasma level of atrial natriuretic peptide(ANP), 15 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty(PMV). Hemodynamic measurements and plasma atrial natriuretic peptde levels were obtained before, immediately(5-10min) after and 24h after valvuloplasty, and echocardiographic left atrial size, wall tension and mitral valve area were measured bdfore and 24h after valvuloplasty. 1) Immediately after valvuloplasty, left atrial pressure, pulmonary atrial pressure and mean diastolic pressure gradient across the mitral valve decreased, and the mitral valve area by Gorlin's method increased, significantly. Plasma atrial natriuretic peptide level(atright and left atrium, pulmonary artery and aorta) rose significantly after balloon inflation. This rising may reflect a transient increase in left atrial pressure and volume expansion associated with mitral valve occlusion by balloon. 2) Twenty four after valvuloplasty, mitral valve area increased, and left atrial volume and wall tension decreased, significantly. Plasma atrial natriuretic peptide level(at right atrium, pulmonary artery and aorta) fell significantly, too. In conclusion, change of plasma atrial natriuretic peptide le.vel before and after percutaneous balloon mitral valvuloplasty reflect hemodynamic alteration of right and left atrium.
Subject(s)
Humans , Atrial Pressure , Blood Pressure , Echocardiography , Heart Atria , Hemodynamics , Hypertension , Inflation, Economic , Mitral Valve , Mitral Valve Stenosis , Plasma , Pulmonary ArteryABSTRACT
To evaluate the effect of alteration of left atrial pressure. volume and wall tension on the circulating plasma level of atrial natriuretic peptide(ANP), 15 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty(PMV). Hemodynamic measurements and plasma atrial natriuretic peptde levels were obtained before, immediately(5-10min) after and 24h after valvuloplasty, and echocardiographic left atrial size, wall tension and mitral valve area were measured bdfore and 24h after valvuloplasty. 1) Immediately after valvuloplasty, left atrial pressure, pulmonary atrial pressure and mean diastolic pressure gradient across the mitral valve decreased, and the mitral valve area by Gorlin's method increased, significantly. Plasma atrial natriuretic peptide level(atright and left atrium, pulmonary artery and aorta) rose significantly after balloon inflation. This rising may reflect a transient increase in left atrial pressure and volume expansion associated with mitral valve occlusion by balloon. 2) Twenty four after valvuloplasty, mitral valve area increased, and left atrial volume and wall tension decreased, significantly. Plasma atrial natriuretic peptide level(at right atrium, pulmonary artery and aorta) fell significantly, too. In conclusion, change of plasma atrial natriuretic peptide le.vel before and after percutaneous balloon mitral valvuloplasty reflect hemodynamic alteration of right and left atrium.