ABSTRACT
The relationship between reflux esophagitis and hiatal hernia was studied using fiberoptic endoscopy. Of 293 patients having upper-gastrointestinal endoscopy during an 18-month period, 64 (22%) had a hiatal hernia and 38 (13%) had esophagitis. Half the patients with a hiatal hernia had esophagitis, whereas the vast majority (84%) of patients with esophagitis had a concomitant hiatal hernia. The association between esophagitis and hiatal hernia was highly significant (P less than 0.0001). There was no statistically significant association between the size of the hiatal hernia and the degree of esophagitis on endoscopy. A permissive role of hiatal hernia in the genesis of reflux esophagitis is suggested.
Subject(s)
Esophagitis, Peptic/etiology , Hernia, Diaphragmatic/complications , Hernia, Hiatal/complications , Endoscopy , Esophagitis, Peptic/diagnosis , Esophagitis, Peptic/physiopathology , Esophagogastric Junction/physiopathology , Fiber Optic Technology , Hernia, Hiatal/physiopathology , HumansSubject(s)
Esophageal Diseases , Esophagus , Deglutition , Deglutition Disorders/diagnosis , Deglutition Disorders/therapy , Esophageal Achalasia/diagnosis , Esophageal Achalasia/therapy , Esophagogastric Junction , Esophagus/anatomy & histology , Esophagus/physiology , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Manometry , Pressure , Scleroderma, Systemic/diagnosis , Spasm/diagnosis , Spasm/therapySubject(s)
Amebiasis/transmission , Giardiasis/transmission , Homosexuality , Adult , Amebiasis/drug therapy , Giardiasis/drug therapy , Humans , Male , United StatesABSTRACT
In 15 patients with uncomplicated gastric ulcers, basal and peak gastric acid outputs and fasting serum gastrin levels were studied before and after healing. The mean basal acid output [4.0 +/- 1.3 (SEM) mEq H+/hr], the mean peak acid output (29.5 +/- 5.1 mEq H+/hr), and the mean fasting serum gastrin level (80.3 +/- 16.7 pg/ml) in these patients did not change significantly with healing. Failure of gastric secretory function to change with healing suggests that mucosal resistance factors are more important than gastric acid secretion in the pathogenesis of a gastric ulcer.
Subject(s)
Gastric Juice/metabolism , Gastrins/blood , Stomach Ulcer/metabolism , Humans , Male , Stomach Ulcer/etiology , Stomach Ulcer/physiopathologyABSTRACT
The relationship of Raynaud's phenomenon (RP) to the degree of esophageal motility dysfunction was evaluated in 12 patients with scleroderma. Motility abnormalities of the smooth muscle esophagus were quantitated using a motility index (MI). MI of the scleroderma patients differed significantly from controls. No relationship was noted between the extent of motility abnormality and the duration or severity of the RP. A nearly uniform finding was the absence of coordinated esophageal peristalsis, occurring regardless of the duration or severity of the RP. The study demonstrates that it is not possible to predict the degree of esophageal motility dysfunction in scleroderma based on RP alone. The disease may have two different and independent pathogenetic components. One component is closely linked to RP and involves impairment of neuromuscular electrical transmission. The other component (independent of RP) involves progressive loss of muscle strength in the distal esophagus and in the lower esophageal sphincter.
Subject(s)
Esophageal Diseases/etiology , Raynaud Disease/etiology , Scleroderma, Systemic/complications , Esophagogastric Junction/physiopathology , Humans , Middle Aged , Peristalsis , Pressure , Scleroderma, Systemic/physiopathologyABSTRACT
Ten laryngectomees underwent esophageal motility studies to assess the effect of laryngectomy on esophageal function. When these patients are compared with controls, marked derangements in esophageal motility were noted in the upper esophageal sphincter (UES) and in the body of the esophagus. Lower esophageal sphincter (LES) function did not differ significantly from the controls. Dysphagia developed postoperatively in five of the ten laryngectomees. This preliminary analysis suggests that esophageal motility disturbances may be relatively frequent after laryngectomy and that these disturbances may be clinically significant. The theoretical basic for the motility abnormalities and areas of future research are discussed.
Subject(s)
Deglutition Disorders/etiology , Laryngectomy/adverse effects , Aged , Deglutition Disorders/physiopathology , Esophagus/physiopathology , Humans , Male , Middle AgedABSTRACT
The manometric and cineradiographic features of 14 patients with oropharyngeal dysphagia are described. Failure of the upper-esophageal sphincter (UES) to relax completely and incoordination of UES relaxation with pharyngeal contraction were noted as was poor initiation of swallows and disorganization of pharyngeal contraction. The relative merits of cine esophagography and esophageal manometry in evaluating oropharyngeal dysphagia are assessed, and a functional classification for this disorder is proposed. Clinical improvement in 4 of 5 patients who underwent UES myotomy for severe intractable dysphagia did not always correlate with improvement in manometric and cine studies.
