Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia

Article Abstract:

During normal swallowing, there are progressive waves of relaxation and contraction of the muscles in the esophagus (the tube through which food travels between the mouth and stomach) that push ingested food through the esophagus into the stomach. In the condition called esophageal achalasia, there is persistent narrowing of a segment of the esophagus near its entry point into the stomach (lower esophageal sphincter). This results in difficult swallowing, loss of appetite, and dilation of the esophagus. The traditional treatments for this condition are cutting the constricted band of muscle or dilating the esophagus mechanically using a tube inflated with air (pneumatic dilatation). More recently, drugs such as nitro derivatives and calcium antagonists have shown promise in the treatment of esophageal achalasia. To compare the effectiveness of treatment using the calcium antagonist nifedipine with pneumatic dilatation (inflation with air of an inserted inflatable distending device), a prospective study was carried out with 30 patients suffering from mild or moderate esophageal achalasia. Sixteen patients underwent pneumatic dilatation and the remaining 14 were given nifedipine 30 minutes before each meal. Patients were monitored every three months to determine the severity of regurgitation, swallowing difficulties, pain, and weight loss for an average of 21 months following treatment onset. Evaluation of the extent of recovery using a device that measured pressure at the lower esophageal sphincter was performed six months after treatment. In both groups, there was a significant decrease in esophageal sphincter pressure. "Good" or "excellent" clinical results were obtained in 75 percent of the patients undergoing dilatation and 77 percent of the nifedipine-treated patients. Hence, treatment with the calcium antagonist nifedipine and pneumatic dilation are equally effective treatments for esophageal achalasia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Nifedipine, Deglutition, Achalasia

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Successful control of bleeding from gastric antral vascular ectasia (watermelon stomach) by laser photocoagulation

Article Abstract:

Vascular ectasia of the gastric antrum is a condition in which the blood vessels of the upper part of the stomach become dilated and bleed easily. This can result in a profound loss of blood and subsequent anemia. The condition is often improperly diagnosed as gastritis (inflammation of the stomach), which it resembles. Treatment of the bleeding is quite difficult, and there is no universally accepted therapeutic strategy for dealing with the condition. A case is reported of a 42-year-old woman with a 10-year history of cirrhosis of the liver who was diagnosed as having anemia. Following a negative pregnancy test, she was treated with oral iron supplements. The condition worsened, and she was hospitalized with severe anemia, ascites (fluid collected in the abdomen) and splenomegaly (enlargement of the spleen). It was initially thought that the anemia resulted from esophageal varices (bleeding from swollen veins in the esophagus; a condition often seen in patients with cirrhosis). This condition was treated, but the anemia worsened. A reevaluation of her condition with further diagnostic procedures correctly identified gastric antral vascular ectasia. A laser was used to photocoagulate (stop the flow of blood by the application of laser energy) the blood vessels in the afflicted region. This led to a remission of the symptoms for over a year, at which time she suffered another episode of bleeding, resulting from recurrence of the vascular ectasia. An additional course of laser photocoagulation was given, and the condition has been in remission for almost two years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Hemorrhage, Liver cirrhosis, Stomach, Lasers in medicine, Medical lasers

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Manometric evaluation of the interdigestive antroduodenal motility in subjects with fasting bile reflux, with and without antral gastritis

Article Abstract:

The motor activity of the antroduodenal portion of the gastrointestinal system was measured in patients with fasting bile reflux, a condition caused when a fluid secreted by the liver (bile), instead of passing out of the body, has a backward or return flow (reflux). For this study, bile reflux patients were divided into two groups: one with antral gastritis, an inflammation affecting the antrum of the stomach, and one without. No differences in motility (movement) pattern were noted between the two groups, suggesting that motor abnormalities are not caused by gastritis, but may come before its onset. Delayed motor activity increases the backward flow of fluid produced by the duodenum (duodenogastric reflux), but since no correlation was demonstrated between delayed motor activity and sores in the stomach mucous (gastric mucosal lesions), other mechanisms must cause the sores.

Gastrointestinal system, Gastroenteritis, Gastrointestinal motility, Gastritis, Biliary tract diseases

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