Gastroesophageal reflux in bronchial asthma patients. A clinical note

The objective is to correlate the symptoms of gastroesophageal reflux with the results of esophageal reflux with the results of esophageal pH metry in asthmatic patients. A prospective study was carried out in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia [KSA], during the period January 2000 through to February 2001, whereby 50 patients [34 females and 16 females] with primary diagnosis of bronchial asthma were consecutively enrolled, their mean age + SD was 38.01 + 9.8 years. Twenty-two subjects who were not suffering from asthma or gastroesophageal reflux [GER] [13 females and 9 males] constituted the control group. A questionnaire was administered to all participants and demographic data; asthma and GER symptoms were obtained. Esophageal manometry was performed, whereby the location, length and resting pressure of the lower esophageal sphincter [LES] were determined, pH catheter was inserted nasogastrically, and ambulatory pH data over 24 hours were collected. Pulmonary function tests were also performed. Twenty-two [44%] patients with asthma had a Demeester score greater than 14.7 and were therefore diagnosed as having pathological GER. Accordingly, the asthma patients were divided into 2 groups, asthma patients with GER [n=22] and those without GER [n=28]. Multiple logistic regression analysis revealed that age did not significantly influence occurrence of GER, but it indicated that hoarseness of voice and nocturnal symptoms were significant predictors for the presence of GER in asthmatic patients, hence, the probability of having GER in an asthma patient is nearly 8 times if he/she has nocturnal symptoms and about 7 times if they have hoarseness of voice. However 36.4% of asthmatic patients diagnosed by esophageal ph metry as having GER did not complain of heartburn and hoarseness of voice; such as the reflux was silent. The frequency of GER among 50 patients with asthma reporting to KFHU, Al-Khobar, KSA is 44%. The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. Patients with difficult to treat asthma should be subjected to esophageal pH metry since a substantial proportion of them may have silent reflux

Upper gastrointestinal disorders in renal failure: experimental and clinical studies

Understanding upper gastrointestinal disorders in patients with chronic renal failure requires the correlation of experimental and clinical studies. The importance of the kidney for elimination of gastrointestinal peptides is reflected by elevated plasma levels of gastrin, secretin, cholecystokinin [CCK], gastric inhibitory polypeptide [GIP], vasoactive intestinal peptide [VIP], motilin, somatostatin and neurotensin in renal failure. Generally gastric acid secretion is reduced in uraemia, and normalized or increased by regular haemodialysis and renal transplantation. Gastritits, which may be haemorrhagic or erosive, occurs in about half of the patients with chronic renal failure maintained on dialysis; nodular duodenitis and oesophagitis have also been reported, but the claim of increased incidence of peptic ulcers is questionable. Reports of gastroduodenal angiodysplasia as a source of bleeding in patients with chronic renal failure also needs substantiation. Upper gastrointestinal haemorrhage after renal transplantation occurs mainly from peptic ulcers probably resulting from corticosteroid administration

Duodenal ulcers in the Eastern Region of Saudi Arabia

Using a method that involves corrections for pyloric losses and duodenogastric reflux, we determined gastric acid secretion in 36 control subjects [25 males and 11 females] and 58 patients with duodenal ulcer [44 males and 14 females]. Most of the study subjects were Saudi, except for nine Yemenis. Mean basal and pentagastrin-stimulated or maximal acid outputs in male controls were 1.78 +/- 1.49 +/- 7.91 mmol/h, respectively; in female controls the corresponding values were 1.76 +/- 2.02 +/- 4.33 mmol/h, with maximal secretion positively correlating with height, weight, and lean body mass [LBM], and negatively with age. In the duodenal ulcer group, mean basal and maximal acid outputs for men were 3.81 +/- 3.42 and 27.08 +/- 9.54 mmol/h and for women, 1.55 +/- 2.37 18.60 +/- 7.53 mmol/h. Maximal acid secretion correlated positively with height, weight, LBM, and duration of illness. In male patients with duodenal ulcer, mean basal and stimulated acid secretion were significantly higher than in the male controls, the proportion of being 20.45%. In women the differences were of borderline significance. Men secreted more acid than women, and when maximal secretion was standardized for height, this sex difference disappeared. Heights standardization did not affect the differences in acid secretion between patients with duodenal ulcer and controls. Our results confirmed the well-known association of blood group O with duodenal ulcer and revealed a significant association of this disease with family history of peptic ulcer. The prevalence of smoking is significantly higher among male patients with duodenal ulcer than among male control subjects. Although chronic cigarette smoking was not observed to elevate acid secretion in male patients with duodenal ulcer, it was observed in the male control subjects. This findings was confirmed after height standardization by positive correlation of gastric acid secretion parameters with the number of cigarettes smoked per day and the duration of the habit in years