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A Thiede - One of the best experts on this subject based on the ideXlab platform.
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Variability in the composition of physiologic Duodenogastric Reflux
Journal of Gastrointestinal Surgery, 1999Co-Authors: K H Fuchs, Joern Maroske, Martin Fein, H Tigges, Manfred P Ritter, Johannes Heimlwcher, A ThiedeAbstract:Duodenogastric Reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, Duodenogastric Reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of Duodenogastric Reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of Duodenogastric Reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic Duodenogastric Reflux. A total of 70 episodes of Duodenogastric Reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile Reflux occurred separately from pancreatic enzyme Reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile Reflux ( P
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variability in the composition of physiologic Duodenogastric Reflux
Journal of Gastrointestinal Surgery, 1999Co-Authors: K H Fuchs, Joern Maroske, Martin Fein, H Tigges, Manfred P Ritter, J Heimbucher, A ThiedeAbstract:Duodenogastric Reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, Duodenogastric Reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of Duodenogastric Reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of Duodenogastric Reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic Duodenogastric Reflux. A total of 70 episodes of Duodenogastric Reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile Reflux occurred separately from pancreatic enzyme Reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile Reflux (P <0.01). Duodenogastric Reflux is a physiologic event with varying composition. Both bile and pancreatic enzyme Reflux frequently occur separately. These findings could explain the disagreement regarding assessment and interpretation of Duodenogastric Reflux in the past. Thus monitoring of Duodenogastric Reflux requires more than the detection of just one component.
K H Fuchs - One of the best experts on this subject based on the ideXlab platform.
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importance of Duodenogastric Reflux in gastro oesophageal Reflux disease
British Journal of Surgery, 2006Co-Authors: M Fein, J Maroske, K H FuchsAbstract:Background: Bile in the oesophagus occurs frequently in patients with gastro-oesophageal Reflux disease (GORD) and has been linked to Barrett's metaplasia and cancer. Although Duodenogastric Reflux is a prerequisite for bile in the oesophagus, little is known about its importance in GORD. Methods: Some 341 patients with GORD were assessed by simultaneous 24-h gastric and oesophageal bilirubin monitoring. Definitions of increased bilirubin exposure were based on the 95th percentiles in healthy volunteers. The relationship between gastric and oesophageal bilirubin exposure and the correlation with disease severity were analysed. Results: Of the 341 patients with GORD, 130 (38·1 per cent) had increased gastric and 173 (50·7 per cent) had increased oesophageal bilirubin exposure. Of the 173 patients with bile in the oesophagus, 89 (51·4 per cent) had normal and 84 (48·6 per cent) had increased gastric bilirubin exposure. Of these 84 patients, 75 (89 per cent) had oesophagitis or Barrett's oesophagus (P = 0·003). These effects were mainly related to differences in supine Reflux. Conclusion: Bile in the oesophagus originates from either normal or increased gastric bilirubin exposure. Patients with increased Duodenogastric Reflux are more likely to have oesophagitis or Barrett's oesophagus. These findings highlight the role of Duodenogastric Reflux as an additional factor in the pathogenesis of GORD. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Importance of Duodenogastric Reflux in gastro‐oesophageal Reflux disease
British Journal of Surgery, 2006Co-Authors: Martin Fein, J Maroske, K H FuchsAbstract:Background: Bile in the oesophagus occurs frequently in patients with gastro-oesophageal Reflux disease (GORD) and has been linked to Barrett's metaplasia and cancer. Although Duodenogastric Reflux is a prerequisite for bile in the oesophagus, little is known about its importance in GORD. Methods: Some 341 patients with GORD were assessed by simultaneous 24-h gastric and oesophageal bilirubin monitoring. Definitions of increased bilirubin exposure were based on the 95th percentiles in healthy volunteers. The relationship between gastric and oesophageal bilirubin exposure and the correlation with disease severity were analysed. Results: Of the 341 patients with GORD, 130 (38·1 per cent) had increased gastric and 173 (50·7 per cent) had increased oesophageal bilirubin exposure. Of the 173 patients with bile in the oesophagus, 89 (51·4 per cent) had normal and 84 (48·6 per cent) had increased gastric bilirubin exposure. Of these 84 patients, 75 (89 per cent) had oesophagitis or Barrett's oesophagus (P = 0·003). These effects were mainly related to differences in supine Reflux. Conclusion: Bile in the oesophagus originates from either normal or increased gastric bilirubin exposure. Patients with increased Duodenogastric Reflux are more likely to have oesophagitis or Barrett's oesophagus. These findings highlight the role of Duodenogastric Reflux as an additional factor in the pathogenesis of GORD. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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computerized identification of pathologic Duodenogastric Reflux using 24 hour gastric ph monitoring
Annals of Surgery, 1991Co-Authors: K H Fuchs, T R Demeester, Ronald A. Hinder, Hubert J Stein, Antony P Barlow, Naresh C GuptaAbstract:: Duodenogastric Reflux is a naturally occurring sporadic event, the incidence, occurrence, and detrimental effects of which have been difficult to assess. The reliability of 24-hour gastric pH monitoring to detect Duodenogastric Reflux was studied. Central to the use of pH monitoring for this purpose is confidence in its ability to measure and display pH data in a way that reflects changes in the gastric pH environment with sufficient sensitivity. To test this the gastric pH of 10 dogs was measured in the fasting state, after feeding, and after pentagastrin stimulation. The antrum was more alkaline in the fasting state (p less than 0.01) and the display of data by frequency distribution graph was sensitive enough to reflect induced pH changes. To test the consistency of gastric pH at a given position, simultaneous 24-hour gastric monitoring was performed in 12 normal subjects with two probes placed at either 5 or 10 cm below the lower esophageal sphincter. Only at the 5-cm position did the two probes read within 1 pH unit of each other more than 90% of the time. Based on these principles, gastric pH monitoring was performed 5 cm below the lower esophageal sphincter in 30 normal subjects and 11 patients, fulfilling Ritchie's clinical criteria for pathologic Duodenogastric Reflux. The data obtained was arranged into 71 variables and subjected to discriminant analysis. Sixteen variables were identified, each with a corresponding coefficient to be used as a multiplier to derive a score. A score of more than +2.2 indicated a high probability of pathologic Duodenogastric Reflux. The test was applied to a validation population consisting of 10 additional normal subjects and 10 patients meeting Ritchie's criteria. All normal subjects had a normal score and all but one (90%) of the patients had an abnormal score. When compared to O-diisopropyl iminodiacetic acid (DISIDA) scintigraphy in another group of 22 normal subjects and 60 patients, 24-hour gastric pH monitoring was superior in the detection of pathologic Duodenogastric Reflux. The study shows how the application of computer technology can be used to diagnose pathologic Duodenogastric Reflux in patients with complex foregut complaints.
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Intragastric pH pattern analysis in patients with Duodenogastric Reflux.
Digestive diseases (Basel Switzerland), 1990Co-Authors: K H Fuchs, T R DemeesterAbstract:The intention of the present study was to apply 24-hour intragastric pH monitoring as a diagnostic tool for the detection of pathologic Duodenogastric Reflux. Therefore, an evaluation system was developed which is able to recognize and quantify specific intraluminal gastric pH patterns regarding their specificity for the disease. pH parameters, stored during 24 h and processed, according to the evaluation system, were obtained for a healthy control population (n = 30) and for patients with pathologic Duodenogastric Reflux (n = 11). These data were subjected to computerized discriminant analysis to identify pH changes with a high probability of resulting from pathologic Duodenogastric Reflux. The computer analysis identified 16 discriminating pH parameters to separate a physiologic pH pattern from a 24-hour intragastric pH pattern with a high probability of being associated with pathologic Duodenogastric Reflux.
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intragastric ph pattern analysis in patients with Duodenogastric Reflux
Digestive Diseases, 1990Co-Authors: K H Fuchs, T R DemeesterAbstract:The intention of the present study was to apply 24-hour intragastric pH monitoring as a diagnostic tool for the detection of pathologic Duodenogastric Reflux. Therefore, an evaluation system was devel
K H Fuchs - One of the best experts on this subject based on the ideXlab platform.
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Variability in the composition of physiologic Duodenogastric Reflux
Journal of Gastrointestinal Surgery, 1999Co-Authors: K H Fuchs, Joern Maroske, Martin Fein, H Tigges, Manfred P Ritter, Johannes Heimlwcher, A ThiedeAbstract:Duodenogastric Reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, Duodenogastric Reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of Duodenogastric Reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of Duodenogastric Reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic Duodenogastric Reflux. A total of 70 episodes of Duodenogastric Reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile Reflux occurred separately from pancreatic enzyme Reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile Reflux ( P
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variability in the composition of physiologic Duodenogastric Reflux
Journal of Gastrointestinal Surgery, 1999Co-Authors: K H Fuchs, Joern Maroske, Martin Fein, H Tigges, Manfred P Ritter, J Heimbucher, A ThiedeAbstract:Duodenogastric Reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, Duodenogastric Reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of Duodenogastric Reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of Duodenogastric Reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic Duodenogastric Reflux. A total of 70 episodes of Duodenogastric Reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile Reflux occurred separately from pancreatic enzyme Reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile Reflux (P <0.01). Duodenogastric Reflux is a physiologic event with varying composition. Both bile and pancreatic enzyme Reflux frequently occur separately. These findings could explain the disagreement regarding assessment and interpretation of Duodenogastric Reflux in the past. Thus monitoring of Duodenogastric Reflux requires more than the detection of just one component.
T R Demeester - One of the best experts on this subject based on the ideXlab platform.
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computerized identification of pathologic Duodenogastric Reflux using 24 hour gastric ph monitoring
Annals of Surgery, 1991Co-Authors: K H Fuchs, T R Demeester, Ronald A. Hinder, Hubert J Stein, Antony P Barlow, Naresh C GuptaAbstract:: Duodenogastric Reflux is a naturally occurring sporadic event, the incidence, occurrence, and detrimental effects of which have been difficult to assess. The reliability of 24-hour gastric pH monitoring to detect Duodenogastric Reflux was studied. Central to the use of pH monitoring for this purpose is confidence in its ability to measure and display pH data in a way that reflects changes in the gastric pH environment with sufficient sensitivity. To test this the gastric pH of 10 dogs was measured in the fasting state, after feeding, and after pentagastrin stimulation. The antrum was more alkaline in the fasting state (p less than 0.01) and the display of data by frequency distribution graph was sensitive enough to reflect induced pH changes. To test the consistency of gastric pH at a given position, simultaneous 24-hour gastric monitoring was performed in 12 normal subjects with two probes placed at either 5 or 10 cm below the lower esophageal sphincter. Only at the 5-cm position did the two probes read within 1 pH unit of each other more than 90% of the time. Based on these principles, gastric pH monitoring was performed 5 cm below the lower esophageal sphincter in 30 normal subjects and 11 patients, fulfilling Ritchie's clinical criteria for pathologic Duodenogastric Reflux. The data obtained was arranged into 71 variables and subjected to discriminant analysis. Sixteen variables were identified, each with a corresponding coefficient to be used as a multiplier to derive a score. A score of more than +2.2 indicated a high probability of pathologic Duodenogastric Reflux. The test was applied to a validation population consisting of 10 additional normal subjects and 10 patients meeting Ritchie's criteria. All normal subjects had a normal score and all but one (90%) of the patients had an abnormal score. When compared to O-diisopropyl iminodiacetic acid (DISIDA) scintigraphy in another group of 22 normal subjects and 60 patients, 24-hour gastric pH monitoring was superior in the detection of pathologic Duodenogastric Reflux. The study shows how the application of computer technology can be used to diagnose pathologic Duodenogastric Reflux in patients with complex foregut complaints.
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clinical use of 24 hour gastric ph monitoring vs o diisopropyl iminodiacetic acid disida scanning in the diagnosis of pathologic Duodenogastric Reflux
Archives of Surgery, 1990Co-Authors: Hubert J Stein, T R Demeester, Ronald A. Hinder, Bethanne Lloyd, Karl H Fuchs, Stephen Attwood, Naresh C GuptaAbstract:• The efficacy of o-diisopropyl iminodiacetic acid (DISIDA) scanning was compared with that of computerized analysis of 24-hour gastric pH monitoring to diagnose excessive Duodenogastric Reflux in 22 normal volunteers and 106 consecutive patients with foregut symptoms. DISIDA scanning had a false-positive rate of 18% in the normal volunteers. Gastric pH monitoring showed an increasing prevalence of Duodenogastric Reflux in patients with increasing clinical evidence of this condition, which was not seen with DISIDA scanning. Both DISIDA scanning and gastric pH monitoring identified Duodenogastric Reflux in most patients who had had previous pyloroplasty or antrectomy. Only gastric pH monitoring, however, showed a significantly increased prevalence of Duodenogastric Reflux in symptomatic patients after previous cholecystectomy compared with those who had not undergone previous surgery. These data suggest that 24-hour gastric pH monitoring is superior to DISIDA scanning in identifying Duodenogastric Reflux as a cause of foregut symptoms. (Arch Surg. 1990;125:966-971)
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Intragastric pH pattern analysis in patients with Duodenogastric Reflux.
Digestive diseases (Basel Switzerland), 1990Co-Authors: K H Fuchs, T R DemeesterAbstract:The intention of the present study was to apply 24-hour intragastric pH monitoring as a diagnostic tool for the detection of pathologic Duodenogastric Reflux. Therefore, an evaluation system was developed which is able to recognize and quantify specific intraluminal gastric pH patterns regarding their specificity for the disease. pH parameters, stored during 24 h and processed, according to the evaluation system, were obtained for a healthy control population (n = 30) and for patients with pathologic Duodenogastric Reflux (n = 11). These data were subjected to computerized discriminant analysis to identify pH changes with a high probability of resulting from pathologic Duodenogastric Reflux. The computer analysis identified 16 discriminating pH parameters to separate a physiologic pH pattern from a 24-hour intragastric pH pattern with a high probability of being associated with pathologic Duodenogastric Reflux.
T R Demeester - One of the best experts on this subject based on the ideXlab platform.
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clinical value of endoscopy and histology in the diagnosis of Duodenogastric Reflux disease
Surgery, 1992Co-Authors: Hubert J Stein, Thomas C Smyrk, T R Demeester, J Rouse, R A HinderAbstract:BACKGROUND: The endoscopic observation of a bile lake in the stomach, antral gastritis, or ulcerations and the histologic finding of foveolar hyperplasia or chronic gastritis have been implicated as indicators of excessive Duodenogastric Reflux. The accuracy of these criteria was evaluated in 135 patients with nonspecific symptoms in the foregut suggestive of Duodenogastric Reflux and no evidence for alcohol- or drug-induced gastric mucosal injury. METHODS: The presence of excessive Duodenogastric Reflux was objectively determined by means of both gastric pH monitoring and cholescintigraphy with cholecystokinin stimulation. RESULTS: Endoscopy showed antral gastritis in 67 patients, gastric ulcers in 19, and a bile lake in the stomach in 39 (total of 135 patients). Of 90 patients who underwent biopsy, histologic findings showed foveolar hyperplasia in 26, chronic gastritis in 19, and active gastritis in 28 patients. The latter condition was associated with Helicobacter pylori in 20 patients. When gastric pH monitoring, cholescintigraphy, or both were used as "gold standard," the sensitivity, specificity, accuracy, and positive predictive value of endoscopic and histologic criteria to diagnose the presence of excessive Duodenogastric Reflux were poor except in the rare case of active gastritis but no Helicobacter pylori. CONCLUSIONS: The presence of Duodenogastric Reflux disease cannot be accurately diagnosed with endoscopic or histologic criteria. The diagnosis should be made with objective techniques, particularly when surgical therapy is considered.
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intragastric ph pattern analysis in patients with Duodenogastric Reflux
Digestive Diseases, 1990Co-Authors: K H Fuchs, T R DemeesterAbstract:The intention of the present study was to apply 24-hour intragastric pH monitoring as a diagnostic tool for the detection of pathologic Duodenogastric Reflux. Therefore, an evaluation system was devel
