The iridium/iridium oxide electrode to in vivo measurement of oesophageal and gastric pH

An iridium-iridium oxide electrode for in vivo pH measurement of the distal oesophagus is described. It is small and flexible so it is well accepted by patients for long-term pH monitoring. The electrode also offers the possibility of including another electrode and/or a pressure sensor for simultaneous detection of two or more parameters—gastric pH or oesophageal pressure for example. A clinical study was performed on 15 healthy volunteers and the results were checked on a DGC Nova 4/s computer, showing less than 0.005% of tension in mV out of the established range in a period of 24 h pH monitoring. The volunteers' results were compared with the normal values obtained by DeMeester using a glass electrode on a similar, healthy group of American patients and no significant differences were observed.

Owing to its small size, reliability, fast response to pH changes, durability and its easy storage, the Ir/IrO₂ electrode is ideal for long-term pH monitoring of the upper gastro-intestinal tract.     

Ask-Upmark Kidney and Tubulointerstitial Nephritis in a Woman with Severe Renal Failure

Abstract

Ask-Upmark kidney is a rare diagnosis of segmental hypoplasia in pediatric population clinically characterized by severe hypertension potentially treatable with partial to total nephrectomy. Although originally was described only as a congenital anomaly, recent data suggest to be caused by vesicoureteral reflux, either in utero or in early childhood and pyelonephritis. The case we reported indicates that Ask-Upmark kidney should be considered as potential cause of hypertension and renal failure both in children and adults. The renal biopsy is necessary for early diagnosis and may consent to normalize blood pressure with nephrectomy; however, if renal damage is severe and progressive with tubulointerstitial nephritis, surgical management is excluded and renal transplant should be considered.     

兰索拉唑联合莫沙必利对胃食管反流患者的胃食管动力学及胃电活动指标的影响

目的分析兰索拉唑联合莫沙必利对胃食管反流患者的胃食管动力学及胃电活动指标的影响。方法选取2010年1月-2012年1月收治的136例胃食管反流患者为研究对象,将患者随机分为对照组和观察组各68例,对照组给予兰索拉唑治疗,观察组在对照组基础上加用莫沙必利。将两组患者治疗前与治疗后2周、4周、12周的胃食管动力学指标及胃电参数进行比较。结果观察组治疗后2周、4周、12周的胃食管动力学指标及胃电参数均明显优于对照组,且观察组治疗后胃食管动力学指标及胃电参数呈进行性升高(P0.05)。结论兰索拉唑联合莫沙必利对胃食管反流患者的胃食管动力学及胃电活动指标的影响较大,治疗效果较好。     

经口食管-胃底套扎术治疗胃食管反流病20例

目的:探讨以反酸和烧心为主的胃食管反流病经口内镜下食管-胃底套扎术疗效。方法:对以反酸和烧心症状为主的20例胃食管反流病(GERD)患者,经经验性PPI治疗有效、24h食管pH监测、胃镜检查后,行经口食管-胃底套扎术治疗,随访观察疗效。结果:经口食管-胃底套扎术后14例(70%)48h内即见症状明显缓解,尤其以烧心症状为主者。随访12个月,治疗后症状评分明显下降,与治疗前比较,差异有统计学意义(表1).13例(65%)3～6个月逐渐停药,6例(30%)药物维持,药量明显减少,症状明显减轻,1例(5%)自觉症状无明显改善。治疗过程中无穿孔、出血等严重并发症,无死亡病例。结论:内镜下食管-胃底套扎术治疗对以反酸、烧心症状为主的GERD,大部分患者症状可迅速缓解,不需长期药物维持治疗,并维持症状减轻或消失。此操作方法经济、简单、微创、安全、见效快。     

Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring,scintigraphy, and endoscopy

BackgroundThe effect of laparoscopic sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) has been a controversial issue. There have been limited studies on this aspect and most of the published studies are retrospective. Therefore, a prospective study was designed to objectively assess the problem. The objective of this study was to assess the impact of SG on symptoms of gastroesophageal reflux using questionnaire, endoscopy, and radionuclide scintigraphy.MethodsThirty-two patients undergoing laparoscopic sleeve gastrectomy were assessed for gastroesophageal reflux using Carlsson Dent Questionnaire and GERD questionnaire before and after surgery at three monthly intervals. They were also subjected to upper GI endoscopy (UGIE) and radionuclide scintigraphy both pre- and postoperatively.ResultsMean preoperative weight and body mass index were 126.5 kg and 47.8 kg/m2, respectively. Mean percent excess weight loss at 12 months was 64.3 ± 18.4. Both the Carlsson Dent Score (CDS) and Severity Score (SS) exhibited a decline from 2.88 to 1.63 (p<0.05) and 2.28 to 1.06 (p<0.05), respectively after 12 months. Radionuclide scintigraphy revealed a significant rise of GERD from 6.25% to 78.1% in the postoperative period (p<0.001). UGIE showed a rise in incidence of esophagitis from 18.8% to 25%; however, there was improvement in all patients except one in terms of reduction of severity of esophagitis.ConclusionPresence of GERD may not be considered as a contra-indication for sleeve gastrectomy. There is improvement of GERD as assessed by symptom questionnaires, as well as improvement in grade of esophagitis. The new onset GERD detected on scintigraphy may not be pathologic as there is a decrease in total acid production postsurgery; however, it still remains an important issue and needs long-term follow-up.     

小儿输尿管膨出症的治疗

目的探讨各种方法治疗输尿管膨出症的疗效,寻找影响预后的有关因素。方法 31例输尿管膨出症,男4例,女27例;左侧15例,右侧12例,双侧4例。其中单一输尿管膨出2例,重肾并输尿管膨出29例。VCU检查18例,3例发现中—重度反流,31例均行超声和IVU及CT检查。结果术后随访0.5～3 a,2例单一输尿管膨出症行膨出切除输尿管膀胱再植术,29例重肾中,4例经膀胱行输尿管膨出切除输尿管膀胱再植术。3例中—重度反流,2例行输尿管膨出切除加上半肾切除术,1例行上半肾切除术,术后因反流持续存在,需再次手术;其余22例均行上半肾切除术,术后2例因严重尿路感染行输尿管残端切除术。结论输尿管膨出的治疗应根据输尿管膨出的类型、肾功能、有无反流决定手术方式,对于大多数重肾,单纯上半肾切除预后良好,若术前VCU检查有中—重度返流,应行完全重建术。     

中西医结合法治疗胆汁反流性胃炎的临床疗效评价

目的：对中西医结合法治疗胆汁反流性胃炎的临床疗效进行分析。方法：选取胆汁反流性胃炎患者92例，随机分为对照组与观察组，各46例，对照组给予常规西药治疗，观察组在对照组基础上给予清胆和胃降逆方治疗，对比两组治疗效果。结果：观察组治疗总有效率显著高于对照组，治疗后临床症状评分显著低于对照组。结论：在胆汁反流性胃炎治疗中，采用中西医结合治疗疗效显著，可有效改善患者临床症状，值得在临床中推广。     

Dental erosion due to GERD in patients with developmental disabilities: case theory

Gastroesophageal reflux disease (GERD) is a common finding among individuals in our society. Unfortunately, the condition is even more prevalent in individuals with developmental disabilities. There are significant comorbidities that can affect the upper gastrointestinal tract. Erosion of tooth surfaces may be the first comorbidity that is detected in individuals unable to express physical discomfort associated with GERD. The dentist should be aware of these findings and able to refer the patient for medical management. In addition, an awareness of preventive regimens and restorative options is essential in maintaining a healthy dentition for these individuals.     

Reflux Disease,Gastrointestinal Ulcer or Weight Loss in Patients with COPD

ABSTRACT

Peptic ulcer disease, gastro-oesophageal reflux disease (GORD) and weight loss have been associated with chronic obstructive pulmonary disease (COPD). Many studies, especially on peptic ulcer and weight loss, are cross-sectional or were done back in the 1960s or 1970s. Our purpose was to learn more about GORD, ulcer, and weight loss in relation to COPD during long-term follow-up in recent years. We conducted a case-control and a follow-up study using the UK-based General Practice Research Database to assess and compare the prevalence and incidence of GORD, peptic ulcer and weight loss in patients with COPD and in COPD-free patients during the period 1995–2005. We identified 35,772 patients with COPD and the same number of COPD-free patients. Incidence rates of GORD, peptic ulcer and weight loss in COPD patients were 59.2, 14.8 and 134.0 per 10,000 person years, respectively. The risk of weight loss was increased in patients with COPD compared to COPD-free patients (1.81, 95% CI 1.61–2.02), while the risk of GORD (OR 1.19, 95% CI 1.00–1.40) or peptic ulcer (OR 1.24, 95% CI 0.92–1.66) were similar in both groups. The results provide further evidence that COPD is associated with weight loss, while there is no materially increased risk for ulcer or GORD associated with COPD.