Validation of the Mayo Dysphagia Questionnaire.

While multiple instruments characterize upper gastrointestinal symptoms, a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. Therefore, we constructed and validated the Mayo Dysphagia Questionnaire (MDQ). The 27 items of the MDQ underwent content validity, feasibility, concurrent validity, reproducibility, internal consistency, and construct validity testing. To assess content validity, five esophageal subspecialty gastroenterologists reviewed the items to ensure inclusion of pertinent domains. Feasibility testing was done with eight outpatients who refined problematic items. To assess concurrent validity, 70 patient responses on the MDQ were compared to responses gathered in a structured patient-physician interview. A separate group of 70 outpatients completed the MDQ twice to assess the reproducibility of each item. A total of 148 patients participated in the validation process (78 [53%] men; mean age 62). On average, the MDQ took 6 minutes to complete. A single item (odynophagia) tested poorly with a kappa value of <0.4. Otherwise, the majority of concurrent validity kappa values were in the good to excellent range with a mean of 0.63 (95% CI 0.22-0.89). The majority of reproducibility kappa values were also in the good to excellent range with a median kappa value of 0.76 (interquartile range: 0.67-0.81). Cronbach's alpha values were excellent in the range of 0.86-0.88. Spearman rank correlation coefficients to assess construct validity were also excellent in the range of 0.87-0.98. Thus, the MDQ is a concise instrument that demonstrates overall excellent concurrent validity, reproducibility, internal consistency, and construct validity for the features of esophageal dysphagia.

Utilising multichannel intraluminal impedance for diagnosing GERD: a review.

The diagnosis of gastroesophageal reflux is sometimes challenging, especially when symptoms are unresponsive to high-dose acid suppression. With the advent of new technology it is possible to detect and quantify nonacid or weakly acidic reflux. Multichannel intraluminal impedance (MII), introduced over 10 years ago, is gaining popularity as a reflux detection tool. The ability to detect nonacid or weakly acidic reflux events, aerophagia, and to discern true reflux events from swallows could make it more a powerful tool than pH detection alone. This is a review of the role of MII as it pertains to the diagnosis of GERD and related disorders. Studies done on normal subjects and in GERD reveal that nonacid or weakly acidic reflux occurs frequently. Several studies have been published that document types and frequency or reflux episodes comparing pH to MII. pH electrodes fail to detect the majority of nonacid or weakly acidic reflux events. MII has revealed nonacid reflux to be less common in untreated GERD subjects than in normal subjects. GERD subjects have greater degrees of liquid-type reflux events compared to normal subjects who have more gas-type reflux events. In treated GERD subjects and normal subjects, proton pump inhibitors do not seem to decrease the amount of reflux but render the reflux nonacid or weakly acidic in nature. Recently work evaluating atypical symptoms of GERD with MII has been published.

Supraesophageal reflux: validation of a symptom questionnaire.

OBJECTIVE: To develop and validate a questionnaire for supraesophageal manifestations of reflux (SER) that will facilitate its study in clinical and research settings. STUDY DESIGN: The Supraesophageal Reflux Questionnaire (SERQ) and previously validated Reflux Symptom Index (RSI) were subjected to multiple types of validity testing, including content validity, concurrent validity, reproducibility, and predictive validity. RESULTS: The concurrent validity and reproducibility of both instruments was good to excellent for most items tested. The predictive validity of the SERQ was superior to the RSI when it included the covariates of history of sinusitis, use of over-the-counter antacid medications, age, gender, and body mass index. CONCLUSIONS: The SERQ will serve as both a useful clinical and research tool by offering not only SER symptom information, like the RSI, but also information about the patient's medical history and medication usage that will facilitate use of the SERQ in research protocols. EBM RATING: B-2b.

Risk factors for non-cardiac chest pain in the community.

BACKGROUND: Non-cardiac chest pain is a common and expensive condition. Risk factors for non-cardiac chest pain are poorly understood and lack description in the USA community. AIM: To explore risk factors and health-seeking behaviour in non-cardiac chest pain in a USA community. METHODS: Olmsted County, MN subjects who reported at least monthly or severe chest pain in response to a validated questionnaire were compared with controls. All the Mayo Clinic medical records were reviewed; those with cardiac disease or relevant organic conditions were excluded. RESULTS: Of 2118 eligible subjects, 1524 (72%) returned a questionnaire, 389 subjects (26%) reported any chest pain and 186 (12.2%) at least monthly or severe chest pain. Of these, 62 were excluded for a cardiac diagnosis or another organic cause. Thus, 124 subjects (9.1%, 95% CI: 7.6-10.8%) reported at least monthly or severe non-cardiac chest pain, of which 65 (52.4%) had frequent reflux symptoms. Independent risk factors for non-cardiac chest pain were obesity (OR 3.0, 95% CI: 1.64-5.50), family history of reflux (OR 2.8, 95% CI: 1.73-4.32), previous cigarette use (OR 2.0, 95% CI: 1.27-3.18), aspirin use (OR 1.5, 95% CI: 1.00-2.31) and use of antiarthritis medicines (OR 2.0, 95% CI: 1.27-3.16). Compared with subjects with non-cardiac chest pain and associated gastro-oesophageal reflux symptoms, subjects with non-cardiac chest pain without associated gastro-oesophageal reflux symptoms were less likely to have a family history of reflux, more likely to be younger, and less likely to be obese. Compared with controls, subjects with non-cardiac chest pain without gastro-oesophageal reflux symptoms were younger (OR 0.97, 95% CI: 0.95-0.99), reported higher somatic symptom scores (OR 1.1, 95% CI: 1.08-1.73) and were more likely to be obese (OR 2.6, 95% CI: 1.15-5.93). CONCLUSIONS: Recurrent or severe non-cardiac chest pain is common in the community. Half of the people with significant non-cardiac chest pain have frequent reflux symptoms, thus, risk factors for non-cardiac chest pain are similar to risk factors for gastro-oesophageal reflux disease. People with non-cardiac chest pain without reflux symptoms have a slightly different risk factor profile.

Regional differences in oesophageal motor function.

We tested the hypotheses that oesophageal bolus transit and motor function vary regionally, with bolus viscosity and with body position. In healthy volunteers, we measured the bolus head advance time, bolus presence time and bolus transit time in the proximal and distal oesophagus using water and viscous materials. We compared concurrent manometric responses. Bolus head advance time, bolus presence time and bolus transit time were longer in the distal oesophagus during water and viscous swallows in the upright and supine positions. The total bolus head advance time and transit time, measured across the entire oesophageal body, were shorter for water than viscous swallows. The amplitudes of peristaltic pressure waves were lower for viscous swallows, and varied as a function of region. These studies demonstrated true functional differences between the proximal and distal oesophagus using multichannel intraluminal impedance and that the viscosity of the bolus is a determinant of oesophageal function.

Adult age comparisons in the processing of event frequency information.

The usual superiority in frequency-of-occurrence judgments of younger vs. older subjects was hypothesized to result from greater strategic encoding of the materials conveying frequency information. A subject-paced, visual search task was designed to control nontarget word encoding. Relative frequency judgments for the nontarget word pairs were equally accurate for younger and older subjects, and performance of both groups was above chance. Results suggest that strategic cover-task encoding can induce age differences in incidental frequency processing. Consistent with a nonoptimal as opposed to an optimal view, automatic processes require only minimal capacity for above-chance performance, but additional strategic resources can increase performance. When such additional resources are used more by younger than by older subjects, the former are better in frequency performance.

Wimmera rye grass toxicity in Western Australia.

Outbreaks of Wimmera rye grass toxicity in the south-west of Western Australia, and the associated distribution of Wimmera rye grass parasitised by Anguina sp and Corynebacterium sp were investigated. Between 1970 and 1974, 58 outbreaks occurred on 26 farms in sheep and cattle grazing pasture, cereal crop, stubble, screenings, or hay containing parasitised Wimmera rye grass. Morbidity rates up to 77% were observed. Clinical signs were characterised by staggering, collapse, periods of convulsions and other nervous signs, often followed by death. A pale, friable liver and haemorrhages in different organs were the most constant gross autopsy findings, but no specific histopathological changes were observed. Symptomatic treatment of affected animals and agronomic control measures attempted by farmers were unsuccessful in controlling the disease.

Failure of methylprednisolone to protect lead-sensitized rats against endotoxin.

Methylprednisolone, in doses that protect normal rats against endotoxin, has no effect in lead-sensitized rats.