ABSTRACT
On August 26 in 1753, Balthasar Neumann's wife wrote a letter to the Abbot of Neresheim describing her husband's disease one week after his death. This article outlines Neumann's medical history and builds connections towards the understanding of diseases in these times. As an example - and probably Neumann's ailment - the gastric cerarcinoma is discussed with special attention in this report.
Subject(s)
Diagnostic Techniques, Digestive System/history , Stomach Neoplasms , Germany , History, 18th Century , Humans , Male , Stomach Neoplasms/diagnosis , Stomach Neoplasms/history , Stomach Neoplasms/pathology , Stomach Neoplasms/therapyABSTRACT
BACKGROUND: The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. METHODS: Consecutive morbidly obese (BMI ≥ 35 kg/m2) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively. RESULTS: Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. CONCLUSIONS: The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.
Subject(s)
Diagnostic Techniques, Digestive System , Esophagus/physiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Manometry , Obesity, Morbid/complications , Adult , Diagnostic Techniques, Digestive System/history , Diagnostic Techniques, Digestive System/trends , Esophageal Motility Disorders/epidemiology , Esophageal Motility Disorders/etiology , Esophageal Motility Disorders/physiopathology , Esophageal pH Monitoring , Female , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/physiopathology , History, 21st Century , Humans , Male , Manometry/history , Manometry/methods , Middle Aged , Obesity, Morbid/diagnosis , Obesity, Morbid/epidemiology , Obesity, Morbid/physiopathology , Prevalence , Sensitivity and SpecificityABSTRACT
The European gastric test meal was widely used in The Mount Sinai Hospital in the 1890s and early 1900s, but was then abandoned diagnostically after the introduction of gastroscopy and radiology. The fundamental methodological advances of Franklin Hollander led to his quantitative formulation of the ionic concentrations of the gastric acid parietal and nonparietal components, followed by his insulin test for completeness of vagotomy.
