Identification of Sliding Hiatus Hernia by High-Resolution Manometry and Upper Gastrointestinal Endoscopy in Patients with Gastro-Oesophageal Reflux Disease.

BACKGROUND/AIM: The aim of this study was to compare high-resolution manometry (HRM) and upper gastrointestinal (GI) endoscopy as diagnostic utilities in detecting a sliding hiatus hernia in patients with gastro-oesophageal reflux disease (GORD) symptoms. MATERIAL AND METHODS: For both diagnostic modalities, the data obtained from 31 patients (20 females; mean age 48.2) who qualified for Nissen fundoplication were analysed using oesophageal pressure topography in line with the Chicago Classification. Confirmation of hiatus hernia during the surgery was considered the gold standard. HRM protocol involved 10 consecutive boluses of 10 mL of water. RESULTS: Sliding hiatus hernia was confirmed intraoperatively in 29 out of 31 patients. In 14 patients, hiatus hernia was detected in HRM, while 19 patients were found to have hiatus hernia by upper GI endoscopy before surgery. No false positive results were obtained in HRM, while 15 false negative results were shown. In upper GI endoscopy, false positive data were observed in 1 patient, while false negative results were found in 10 patients. Thus, the sensitivity of HRM in detecting hiatus hernia was 48% (95%CIs: 29-67%), and sensitivity of upper GI endoscopy was 66% (95%CIs: 46-82%). It was not possible to assess the specificity of HRM or upper GI endoscopy because only 2 of 31 patients had no hiatus hernia during fundoplication (gold standard). False negative results (sensitivity) were not significantly different between compared diagnostic modalities HRM and upper GI endoscopy (52% vs. 34%, respectively, p = 0.29). CONCLUSIONS: Due to poor sensitivity, both modalities, i.e., HRM and upper GI endoscopy, are not reliable tools to diagnose sliding hiatus hernia in patients with GORD symptoms.

Sweet, Salty, and Umami Taste Sensitivity and the Hedonic Perception of Taste Sensations in Adolescent Females with Anorexia Nervosa.

OBJECTIVE: The aim of this study was to perform analysis of sensitivity to sweet, salty, and umami tastes based on three measurement methods and of the hedonic perception of taste sensations in adolescent females with anorexia nervosa (AN). The aim of the research was to confirm the results of other authors in terms of the perception of sweet and salty taste in patients with AN, and then develop knowledge about the perception of umami taste, which is still insufficiently studied. METHOD: A total of 110 females with an age ranging from 13 to 19 years, including 50 newly diagnosed patients with a restrictive subtype of AN and 60 healthy controls participated in gustatory research involving analyses of taste perception (recognition thresholds, ability to identify the taste correctly, taste intensity, and hedonic response) applying the sip and spit method. RESULTS: Females with AN showed reduced sensitivity to salty taste and increased sensitivity to umami taste and, more often than healthy controls, wrongly classified the taste of solutions with a low sucrose concentration. Patients with AN assessed the sodium chloride and monosodium glutamate tastes less negatively than did control participants, and they did not show differences in their hedonic assessment of sucrose. CONCLUSIONS: The taste sensitivity alterations in females with AN demonstrated in this paper do not entail decreased hedonic assessment of taste experiences. Based on our results, we cannot consider the observed variation in taste sensitivity in patients with AN to be a factor that increases their negative attitude toward food consumption.

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication.

BACKGROUND/AIMS: The study aimed to determine pre- and post-fundoplication esophagogastric junction (EGJ) pressure and esophageal peristalsis by high-resolution manometry (HRM) in patients with gastroesophageal reflux disease (GERD). METHODS: Pre-operative and post-operative HRM data from 25 patients with GERD were analyzed using ManoView version 2.0.1. with updated software for Chicago classification and pressure topography. The study involved swallowing water boluses of 10 mL in the upright position. RESULTS: Significant increase of mean basal EGJ pressure and minimal basal EGJ pressure was found in post-operative as compared with pre-operative patients (P < 0.05 and P < 0.001, respectively). Integrated relaxation pressure (IRP) reached higher values in post-operative patients than in pre-operative patients (P < 0.001). Intra-bolus pressure (IBP) was significantly higher (P < 0.05) and contractile front velocity (CFV) was slower (P < 0.01) in post-operative patients than in pre-operative patients. Moreover significant increase of distal contractile integral (DCI) was found in post-operative patients (P < 0.05). Hiatal hernia was detected by HRM in 11 pre-operative patients. Fifteen out of 25 post-operative patients complained of dysphagia. CONCLUSIONS: Fundoplication restores the antireflux barrier by reinforcing EGJ basal pressures, repairing hiatal hernias, and enhances peristaltic function of the esophagus by increasing DCI. However slight IRP elevation found in post-fundoplication patients may result in bolus pressurization and motility disorders.

Alterations in taste perception as a result of hyperbaric oxygen therapy.

The present study evaluates the effect of hyperbaric oxygen therapy on taste sensitivity, hedonic perception of taste, and food preferences. The studied groups included 197 people in total (79 in the study group; 118 in the control group). All patients from the study group were treated with hyperbaric oxygen therapy due to chronic non-healing wounds. The control group consisted of healthy people, who did not receive hyperbaric oxygen therapy. The taste intensity, recognition thresholds, and hedonic perception were examined using gustatory tests. The aqueous solutions of sucrose for sweet, sodium chloride for salty, citric acid for sour, quinine hydrochloride for bitter, and monosodium glutamate for umami taste were used. The participants fulfilled the questionnaire to examine pleasure derived from eating certain types of dishes. Gustatory tests and analyses of the pleasure derived from eating in the study group were carried out before the first exposure to hyperbaric oxygen and then at the end of therapy, after at least 25 sessions of treatment. In the control group, examination of perception of taste sensations was conducted only once. The results of comparing patients with non-healing wounds with healthy people are characterized by reduced taste sensitivity. After participation in hyperbaric oxygen therapy, the improvement in perception of taste sensations and changes in hedonic evaluation have occurred among patients with non-healing wounds. In terms of food preference, a decreased desire for eating sweet desserts, chocolate, and crisps was observed in those patients who received hyperbaric oxygen therapy.

Taste and appetite disorders of chronic hepatitis C patients.

OBJECTIVE: Decreased appetite is one of the main factors that influences quality of life of patients with chronic liver diseases. The reason for appetite disorders remains unclear but taste perturbations are one of the postulated causes. The potential role of taste alterations and, connected to these, appetite disorders in chronic hepatitis C (CHC) patients are poorly investigated. The aim of this study was to evaluate potential taste alterations (dysgeusia) including all five tastes (sweet, salty, bitter, sour and umami) in CHC patients. METHODS: Forty CHC patients (16 men and 24 women) infected with genotype 1 hepatitis C virus participated in this study. All the patients had a compensated liver disease and were being treated with any agents. One hundred and ten healthy volunteers were matched to the patients by age and sex. The study included gustatory tests (taste recognition threshold, taste intensity with hedonic perception) and analysis of the pleasure derived from eating. RESULTS: In CHC patients, the recognition threshold of umami taste was increased (P<0.01) and the intensity of sweet taste perception was higher (P<0.05). The hedonic response did not differ between the groups. A significant increase in declared pleasure derived from eating (P<0.001 to P<0.05) was also observed. Some differences in case of the patients with more advanced disease were also found. CONCLUSION: Alterations in taste, especially umami and sweet taste disorders, may alter real food perception and lead to a reduction in food intake in some CHC patients.

[Changes in food preferences in pregnant women]. / Zmiana upodoban pokarmowych u kobiet w ciazy.

INTRODUCTION: Pregnant women frequently show significant changes in their eating habits. The aim of the study was to evaluate the pleasure derived from the consumption of selected food groups in women during the first and second trimester of pregnancy. MATERIAL AND METHODS: The studied group included 64 healthy women, aged 23-38. 32 women were in the first trimester of pregnancy and 32 women in the second trimester. The food preference interviews were conducted by the presentation of colourful photographs showing selected food groups. Then each participant answered the following question: "How much pleasure do you take from this food?". The results were recorded on a linear analogue scale. The women evaluated the pleasure they derived from food before pregnancy and in the first or second trimester of pregnancy. RESULTS: The women in the first trimester of pregnancy, showed a lower preference for eggs, sweets, pasta, red meat, fast food, salty snacks, spicy food, and seafood as compared to their preferences before the pregnancy. The women in the second trimester declared a significantly higher preference for chicken soup, fruit and sour food, and rated the taste of beef and pork, spicy food and salty snacks as less pleasurable than before the pregnancy. CONCLUSIONS: The first trimester of pregnancy is a period of decreased pleasure derived from food, whereas the perception of food in the second trimester is characterized by a general hedonic dimension similar to that from before the pregnancy. Both in the first and the second trimester of pregnancy women show a lower preference for beef and pork, spicy food and salty snacks.

[Salt taste perception in people above the age of 50]. / Odbiór smaku slonego u osób po 50 roku zycia.

INTRODUCTION: Doctors claim that salt intake should be reduced, which, taking into consideration the popularity of salt-rich food, can be a real challenge. So far it has not been determined what makes the reduction of salt intake so difficult, especially in elderly people. MATERIALS AND METHODS: The subject of the study was a group of 239 persons (107 women, 132 men), aged 18-34, and a group of 100 persons (54 women and 46 men), aged 51-73. All participants were healthy non-smokers. Salt taste intensity as well as hedonic taste perception of water NaCl solutions (concentrations 0.18%, 0.36% and 0.90%) were examined by means of gustometry examination. The samples were tasted by means of the sip and spit method. RESULTS: People above the age of 50, as compared to the younger group (18-34) showed lower intensity of salt taste perception with all applied concentrations of NaCl solutions (p < 0.001), as well as a higher hedonic response (0.18%, p < 0.01; 0.36% and 0.90%, p < 0.001). In the group of people above the age of 50, women perceived the salt taste of 0.18% NaCl solution with less intensity than men (p < 0.05) and responded with more intensity (p = 0.05) to the hedonic taste perception of 0.36% NaCl solution. CONCLUSIONS: In the process of aging, the salt taste intensity is decreased and the hedonic response to salt taste is increased which may result in higher salt intake. The changes are more significant in women above the age of 50 than in men.

Assessment of serum visfatin levels in girls with anorexia nervosa.

OBJECTIVE: Visfatin (VISF) is a recently described peptide regulating the process of adipocyte differentiation. Only one pilot study of VISF expression in the fat tissue and its circulating concentrations in a small group of patients with anorexia nervosa (AN) have been published, yet. DESIGN AND PATIENTS: Cross-sectional assessment of VISF serum concentrations in 195 girls aged 11-18·9 years with AN (n = 87), eating disorders not otherwise specified (NOS; n = 17), simple obesity (OB; n = 30), and healthy controls (H; n = 61). MEASUREMENTS: Blood samples were collected during the fasting state between 7:00 am-8:30 am. VISF serum concentrations were determined using enzyme immunoassay. Comparisons of VISF levels between groups were performed. RESULTS: Mean serum VISF concentrations in girls with AN and NOS were significantly lower than those in the H and OB groups. Serum VISF concentrations were higher in the OB than in the H groups. When were calculated per body mass index (BMI), VISF concentrations were significantly lower in the AN, NOS, and OB groups than in healthy controls. Among participants with a normal BMI, serum VISF concentrations correlated positively with BMI (r = 0·27; P < 0·05). In the OB group, a significant, negative correlation between BMI and VISF levels (r = -0·38; P = 0·04) was observed. CONCLUSIONS: Compared with healthy girls, serum VISF concentrations are decreased in girls with AN. Conversely, obese girls have elevated VISF levels. When calculated per BMI (VISF/BMI), the results in AN and OB groups were lower than in healthy participants.

[Influence of a high-carbohydrate meal on taste perception]. / Wplyw spozycia posilku wysokoweglowodanowego na percepcje smaku.

INTRODUCTION: Taste sensitivity varies greatly in individuals and depends on many external and metabolic conditions. MATERIAL AND METHODS: The studied group consisted of healthy, non-smoking 41 women and 40 men, aged 19-29. The volunteers were examined in fasting state and after a high-carbohydrate meal. Taste sensitivity to sweet, salty and sour as well as hedonic response to taste were examined by means of gustometry examination recommended by Polski Komitet Normalizacyjny (Polish Committee for Standardization). RESULTS: It has been shown that in women the meal did not influence the intensity of sweet taste perception of saccharose solutions or the hedonic response to taste, whereas in men it caused a statistically significant decrease in the intensity of taste perception and in the hedonic response to the sweet taste of suprathreshold saccharose solutions. The meal did not influence the salty taste perception in a statistically significant way, neither in men nor in women. After the meal, the women perceived the sour taste with more intensity than in fasting state, whereas in men such influence was not observed. CONCLUSIONS: 1. The consumption of a high-carbohydrate meal influences the sweet and sour taste perception and the effect is sex-dependent: - in men, both the taste sensitivity to saccharose and the hedonic response to sweet taste were decreased, whereas in women such influence was not observed; - in women, the taste sensitivity to citric acid increased and the hedonic response to sour taste decreased, whereas in men such influence was not observed. 2. There is negative correlation between the intensity of taste perception and the hedonic response to the sweet taste both in men and in women after a high-carbohydrate meal, whereas in fasting state such correlation was not observed.

Expression, localization and systemic concentration of vascular endothelial growth factor (VEGF) and its receptors in patients with ulcerative colitis.

Vascular endothelial grow factor (VEGF) promotes angiogenesis by activating the specific receptors KDR and Flt-1. We investigate the expression of genes encoding VEGF and its receptors KDR and Flt- 1 by RT-QPCR reaction using Quanti Tect SYBR Green RT-PCR in patients with active and inactive ulcerative colitis (UC) and control subjects. The localization and level of VEGF protein and its receptors protein in intestinal tissue were estimated by immunohistochemistry. VEGF concentration in serum and plasma was determined by ELISA. We found a significant increase of VEGF gene expression and increase expression of genes encoding receptor Flt-1 in patients with active UC when compared with controls, but KDR was present in trace amount. VEGF and Flt-1 proteins were colocalized in enterocytes as well as in endothelium and muscularis layer of the intestine. The specific staining reaction for VEGF protein as well as for Flt-1 protein was significantly higher in active UC compared with controls. Serum level of VEGF was significantly higher in active UC patients as compared with inactive UC patients as well as with controls. The plasma VEGF level was found to be significantly higher in active UC patients as compared with controls. The increase of gene expression as well as protein level for VEGF and its receptor in UC - inflamed colon, and VEGF action via Flt-1 receptor may have a functional role in UC. Increased VEGF levels in both serum and plasma in active UC patients may reflect VEGF overexpression in intestinal inflammatory tissue.

Assessment of serum apelin levels in girls with anorexia nervosa.

CONTEXT: Pilot studies in rats have suggested that apelin (APE) is involved in the control of appetite and food intake. APE is secreted in the organs involved in the control of hunger and satiety: the stomach, hypothalamus, and fat tissue. Anorexia nervosa (AN) is an eating disorder that represents a good biological model of chronic fat tissue atrophy in humans. To date, there are no reports of APE expression in the fat tissue and its circulating concentrations in patients with AN. OBJECTIVE: Our objective was to assess serum APE concentrations in girls with AN. DESIGN, PARTICIPANTS, AND SETTING: APE-36 and APE-12 serum concentrations were evaluated in 87 Polish girls with restrictive AN, in 61 healthy (H) controls, 17 girls with no otherwise specified eating disorders (NOS), and 30 girls with simple obesity (OB). RESULTS: Mean serum APE-36 and APE-12 concentrations in patients with AN and NOS were significantly lower than in the H and OB groups. However, no differences between AN, H, and NOS groups were observed when APE concentrations were calculated per body mass index (BMI). In participants with normal BMI, serum APE-36 (r = 0.35) and APE-12 (r = 0.37) concentrations correlated positively with BMI. CONCLUSIONS: We conclude that compared with H controls, serum APE-36 and APE-12 concentrations decreased as a result of fat tissue depletion in patients with AN. Conversely, obese adolescents had elevated APE-36 and APE-12 due to excessive fat mass as well as increased APE production in adipose tissue.

Taste disturbances during therapy with pegylated interferon-alpha 2b and ribavirin in patients with chronic hepatitis C.

INTRODUCTION: The effectiveness of current standard therapy of chronic hepatitis C with pegylated interferon-alpha and ribavirin is unsatisfactory and associated with a variety of side effects. In addition to common side effects, appetite disorders and weight loss are universal problems that lead to decreased quality of life. The causes of appetite disorders are not known. The aim of the present study was to evaluate the influence of pegylated interferon-alpha 2b and ribavirin therapy on taste sensitivity, hedonic perception of taste sensations, and food preferences. MATERIAL AND METHODS: Nineteen chronic hepatitis C patients infected with genotype 1 HCV participated in the study. All patients received combined therapy with pegylated interferon-alpha 2b and ribavirin in adequate doses. The study included gustatory tests (taste recognition threshold and taste intensity with hedonic perception) using a gustometric method and an evaluation of the pleasure derived from eating. All examinations were performed before therapy and during the thirteenth week of therapy. RESULTS: After 12 weeks of therapy, patient sensitivity to salty and sweet was significantly decreased (p < 0.05), and bitter was described as being more unpleasant than before the therapy (p < 0.05). Also, the therapy decreased appetite without significant changes in patients' food preferences. CONCLUSIONS: We found multidirectional taste disturbances during treatment with pegylated interferon and ribavirin. The results may be useful in determining the role of taste in the development of appetite disorders in chronic hepatitis C patients treated with pegylated interferon and ribavirin.

Transforming growth factor-beta1 and its receptors in patients with ulcerative colitis.

Transforming growth factor-beta1 (TGF-beta1) plays a role in the pathogenesis of ulcerative colitis (UC) by activating its specific receptors (T beta RI-T beta RIII). We investigated the expression of genes encoding for TGF-beta1 and T beta RI-III using RT-QPCR in patients with active and inactive UC and non-IBD controls. The localization and level of TGF-beta1 protein in intestinal tissue was estimated by immunohistochemistry, and serum TGF-beta1 concentrations were determined using ELISA. We found a significant increase in TGF-beta1 gene expression and increase in the expression of genes encoding receptor T beta RI in patients with active UC when compared with controls. The expression of genes encoding T beta RII was found to be higher in patients with both active and inactive UC when compared to controls. Specific staining for TGF-beta1 in fibroblasts was significantly greater in both active and inactive UC as compared to controls. The serum concentration of TGF-beta1 was significantly higher in patients with active UC when compared with controls as well as in UC patients with left side/total colonic extension when compared with those with disease limited to rectum/rectosigmoid area. However, no correlation between TGF-beta1 serum concentrations and UC activity index was found. Increases in TGF-beta1 gene expression and its protein level, associated with altered TGF-beta1 receptor profile indicate a functional role for TGF-beta1 in intestinal inflammatory/repair processes in UC. Increases in TGF-beta1 serum concentrations correlate with extension of disease.

[Methods of taste sensitivity examination]. / Metody badan wrazliwosci smakowej.

Taste is the main sensory system that keeps a check on ingested food. Human beings are able to recognize five basic tastes: salty, sour, sweet, bitter and umami. Gustometry, including both gustometry with application of taste substances and electrogustometry, is the method of taste examination. There are various methods of applying taste substances during gustometry examination. The stimuli used in gustometry are: citric acid or hydrochloric acid (sour taste), caffeine or quinine hydrochloride (bitter taste), sodium chloride (salty taste), saccharose (sweet taste), monosodium glutamate (umami taste). Electrogustometry, widely used by clinicians to examine taste sensitivity, allows to estimate the functioning of taste by means of electric excitability thresholds determined through the response to the irritation of taste buds area with electrical current of different intensity. Electrogustometry is especially useful in estimating the efficiency of sensory pathways. However, if we want to examine taste sensitivity to individual taste categories we should use more laborious gustometry with the application of taste substances, which main advantage is the use of physiological stimuli.

[Gustometry usefulness for the evaluation of taste sense efficiency. Part I. The range of taste substances concentrations and the result of gustometry examination]. / Przydatnosc gustometrii swoistej do oceny sprawnosci zmyslu smaku. Czesc I. Zakres stezen substancji smakowych a wynik badania gustometrycznego.

UNLABELLED: There are various methods of taste substances application in gustometry examination. The Polish Committee of Standards (Polski Komitet Normalizacyjny--PKN) recommends the performance of sensitivity taste examinations with the use of method based on rinsing out the mouth with water solutions of taste substances (sip-and-spit method) at their growing concentrations. The aim of the present research was to assess the usefulness of taste substances dilutions, whose concentrations were consistent with guidelines of the PKN for the evaluation of the results of examination of sweet, salty and sour taste sensitivity. MATERIAL AND METHODS: 795 volunteers, i.e. 473 women and 322 men, aged 18-66, were the subject of study. RESULTS: The range of concentrations in sucrose solutions (0.34-12.00 g/l) as well as in sodium chloride solutions (0.16-2.00 g/l) were proper for examination in order to recognize taste threshold with the most volunteers. However, the use of concentrations in citric acid solutions (in the range 0.13-0.60 g/l) did not enable to investigate the taste sensitivity by reason of the large percentage of persons (85.2%) who correctly recognized the sour taste of the solution with the lowest citric acid concentration. The range of citric acid concentration (0.0036-0.2000 g/l) appeared to be more proper for examination of the sour taste sensitivity. CONCLUSION: The concentrations of sucrose and sodium chloride solutions recommended by PKN are proper for the examination of sweet and salty taste sensitivity with the use of sip-and-spit method however concentrations of citric acid solutions should be lower than recommended.

[Taste sensitivity to natrium chloride and saccharose in women and men of different age]. / Wrazliwosc smakowa na chlorek sodu i sacharoze u kobiet i mezczyzn w róznym wieku.

UNLABELLED: The gender and age influence on saccharose taste and sodium chloride taste sensitivity was tested in this work. MATERIAL AND METHODS: 275 volunteers, i.e. 161 women and 114 men, aged 18-55, participated in the study. All individuals were healthy and non-smoking. Serials dilutions of saccharose and sodium chloride were used to analyze sweet and salt taste sensitivity. The examination was performed according to the procedures established by the Polish Committee of Standards (PN-ISO 3972: 1998). The findings suggest no link between the gender and saccharose and sodium chloride taste sensitivity. However there is a link between taste sensitivity and age, i.e. taste sensitivity to sodium chloride decreases significantly whereas taste sensitivity to saccharose decreases slightly with age ofpopulation.

[Relationship between sweetness liking, taste sensitivity and sweetening habits in adults]. / Upodobanie do slodyczy a wrazliwosc smakowa i nawyk slodzenia u doroslych niepalacych.

The present work analyses the relationship between the sweetness liking and the age, gender, sweet taste sensitivity, hedonic response to low concentrations of the saccharose and the habit of sweetening in adults. 161 women and 114 men, aged 18-55, were the subject of this study. All individuals were healthy and non-smoking. In the study the volunteering subjects rated their individual sweetness liking by means of a scaling method with three categories: I like it very much, I like it moderately, I do not like it, and they quantified the amount of sugar they take with their tea or coffee. Also their date of birth, height and body mass were taken into consideration. The sweet taste sensitivity was marked with the use of the method correlating with PN-ISO 3972: 1998 norm, and the hedonic responses were analysed according to the three-point scale: pleasant, unpleasant, neutral. The findings suggest that the interrelation between the age and the sweetness liking in adults exists. No link between the gender, as well as hedonic response to low concentrations of saccharose and the degree of sweetness acceptance in adults was observed. The amount of sugar taken with tea or coffee was different in groups with different sweetness liking, however, the degree of the sweet taste sensitivity is not always a sufficient factor to determine the predicted sugar intake.