Greger Lindberg | Karolinska Institutet (original) (raw)
Papers by Greger Lindberg
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Mar 8, 2007
Diseases of the Colon & Rectum, 1999
European Journal of Gastroenterology & Hepatology, Nov 1, 2005
Objectives The study explores, by the use of manometry, the frequency and severity of small intes... more Objectives The study explores, by the use of manometry, the frequency and severity of small intestinal involvement in patients with systemic sclerosis, and relates the manometric findings to clinical symptoms, radiology, and some intestinal regulatory peptides. Methods Stationary antroduodeno-jejunal manometry was used to study small bowel involvement in 10 patients with systemic sclerosis and dysmotility of the oesophagus or signs of malabsorption. Measurements were made during fasting, after a meal, and after octreotide administration and were then compared with a sex-matched control group of healthy individuals. Plasma samples were taken in order to analyse levels of motilin, peptide YY, cholecystokinin, and somatostatin. Results Manometry was abnormal, with signs of intestinal pseudo-obstruction in eight out of 10 patients. In the control group, one individual had an abnormal manometry, as a result of burst activity. The mean contractile amplitudes during fasting and periods after food, spontaneous phase III periods, and octreotide-induced activity complexes were significantly reduced in the systemic sclerosis group when compared with controls. None of the patients, including two with advanced manometric intestinal disturbances, had small intestinal dilatation when examined by radiography. The plasma peptide levels did not differ significantly between the two groups. Conclusions In eight out of 10 patients the manometric criteria for intestinal pseudo-obstruction were fulfilled, with a motility pattern consistent with both neuropathy and myopathy. The release of motility-regulating peptides was unaffected.
Scandinavian Journal of Gastroenterology, 1996
Background: Development of electrogastrography, the recording of gastric electric rhythm from cut... more Background: Development of electrogastrography, the recording of gastric electric rhythm from cutaneous electrodes, for clinical purposes has been hampered by methodologic problems and the lack of an ambulatory technique. We have evaluated a newly developed system for ambulatory electrogastrography. Methods: 24-Hour recordings were obtained from 30 healthy volunteers. We used digital filtering, a Hamming window, and spectral analysis to determine the dominant frequency of successive 256-sec segments of data. Results: Low-frequency noise disturbed the primary signal. After secondary filtering a stable normogastric (2 4 cpm) rhythm was present during a median of 49% (range, 3679%) of the recording time. The mean frequency of gastric electric activity varied from 2.92 2 0.15 cprn (mean 2 SD) at midday to 2.72 2 0.13 cprn in the late night. Conclusions: Ambulatory recording of electrogastrography needs technical improvement. The electrogastrogram shows a circadian variation in frequency.
CRC Press eBooks, Nov 6, 2018
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population pr... more Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and
PharmacoEconomics, 1994
This study compared the cost-effectiveness of 2 strategies for the treatment of reflux oesophagit... more This study compared the cost-effectiveness of 2 strategies for the treatment of reflux oesophagitis. In the first strategy, treatment began with ranitidine 300mg daily for 8 weeks. The alternative strategy began with omeprazole 20mg daily for 4 weeks, and continued with another 4 weeks of omeprazole 20mg daily if patients were unhealed after the first 4 weeks. Those who remained unhealed in both groups after 8 weeks oftreatment were administered omeprazole 40mg once daily for 4 weeks. The average cost of treatment and follow-up endoscopies per healed week was Swedish krona (SEK)1140 ($USI = SEK8) in the ranitidine group, whereas with omeprazole treatment the average cost per healed week was SEK622. The omeprazole strategy was more effective (6.75 healed weeks in a 12-week period) than ranitidine (3.71 healed weeks) and, despite a higher daily cost of treatment, omeprazole resulted in a lower average cost per patient. Sensitivity analysis showed that the conclusion regarding omeprazole being more cost-effective than ranitidine was insensitive to all reasonable changes in the cost parameters. Healing rates from 3 clinical trials also support the robustness of the conclusion in terms of the effect parameter.
Acta Paediatrica, Apr 9, 2013
South African Gastroenterology Review, Nov 1, 2005
Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Sw... more Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Swallowing Stages by Phase Food enters oral cavity Mastication and bolus formation Tongue elevates and propels bolus to pharynx Soft palate elevates to seal nasopharynx Larynx and hyoid bone move anterior and upward Epiglottis moves posteriorly and downwards to close Respiration stops Pharynx shortens Upper esophageal sphincter relaxes Bolus passes to esophagus Esophageal contracts sequentially Lower esophageal sphincter relaxes Bolus reaches stomach Oral Phase Oro-pharyngeal Phase Esophageal Phase WGO-OMGE Practice Guideline Dysphagia - January 2004: Final Version 1. DEFINITION Dysphagia either refers to the difficulty someone may have with initiating ..
Best Practice & Research in Clinical Gastroenterology, Jun 1, 2019
New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The maj... more New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases to be a functional disorder and becomes a genuine motility disorder. Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility. Chronic intestinal pseudo-obstruction is the end-stage of a large number of very rare disorders in which failed peristalsis is the common denominator. Nutritional needs and symptom control are essential in the management of pseudo-obstruction. Home parenteral nutrition is life saving in more than half of patients with chronic intestinal pseudo-obstruction.
Neurogastroenterology and Motility, Sep 16, 2013
High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has alrea... more High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has already become an established technique for esophageal manometry where it has replaced water-perfused and station pull-through manometry. Spatiotemporal plots with color coding of pressure have greatly facilitated the analysis of esophageal peristalsis. Although suitable for the length of the esophagus, the solid-state catheter is insufficient for the study of longer segments of the gastrointestinal tract. A new technique with fiber-optic sensors has made it possible to construct catheters with 72-144 sensors. Studies of colonic motility have revealed that the most common motor pattern of the colon is a peristaltic contraction that travels 7-10 cm in the retrograde direction. Earlier studies using low-resolution manometry with 7-45 cm between sensors led us to erroneous conclusions regarding direction and frequency of contractions and they largely missed both antegrade and retrograde contractions traveling short distances. Fiber-optic high-resolution manometry holds promise for greatly improving our understanding of gut motor physiology and hopefully also our understanding of patients with symptoms of disordered gut motility.
Scandinavian Journal of Gastroenterology, Mar 1, 1983
Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagno... more Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagnostic hypotheses formed on the basis of initial data--history, physical findings, and results of routine laboratory tests--enabled the clinician to adopt a single-target strategy in 75 patients and a multi-target strategy in 61 patients. Four patients died very early in the course of events and another four were excluded from analysis because they were judged not to benefit from further investigations. The single-target strategy, in which the clinician explored one diagnostic hypothesis only, often led to a short diagnostic process (mean, 11 days), and in 89% of the patients the clinician's hypothesis was correct. In the multi-target strategy several diagnostic hypotheses were evaluated. In these patients the correct diagnosis was included in the first set of hypotheses in 84%, and the mean duration of the diagnostic process was 25 days. Patients with cholestatic jaundice presented the most difficult diagnostic problem, and most of these were investigated by a multi-target strategy. The possibility of an extrahepatic obstruction often forced the clinician to use invasive procedures to rule out this diagnosis. Considerable time was spent in observing the clinical course and waiting for investigations to be carried out. To reduce the investigative cost, controlled studies of diagnostic value and optimal order of investigations are warranted.
BioMed Research International, 2017
The aim of our study was to compare patients with irritable bowel syndrome (IBS) and healthy cont... more The aim of our study was to compare patients with irritable bowel syndrome (IBS) and healthy controls regarding the expression of toll-like receptors 2, 4, 5, and 9 (TLR2, TLR4, TLR5, and TLR9), the primary mucosal receptors of bacterial components, in small and large bowel mucosa. Methods. We analysed biopsies from jejunum and sigmoid colon of 22 patients (17 females) with IBS aged 18-66 (median: 39) years and 14 healthy volunteers (12 females) aged 22-61 (median: 42) years. Eight patients had constipation-predominant IBS (C-IBS), 7 had diarrhoea-predominant IBS (D-IBS), and 7 had IBS without predominance of constipation or diarrhoea. We analysed mRNA levels for TLRs using quantitative PCR and distribution of TLRs in mucosa using immunohistochemistry. Results. We found increased mRNA expression of TLR4 (mean fold change 1.85 ± 0.31 versus 1.0 ± 0.20; < 0.05), TLR5 (1.96 ± 0.36 versus 1.0 ± 0.20; < 0.05) and TLR9 (2.00 ± 0.24 versus 1.0 ± 0.25; < 0.01) but not of TLR2 in the small bowel mucosa from patients with IBS compared to the controls. There was no significant difference in mRNA levels for TLRs in colon mucosa between patients and controls. Conclusion. Upregulation of TLR4, TLR5, and TLR9 suggests the involvement of bacteria or dysregulation of the immune response to commensal flora in small bowel mucosa in IBS patients.
Neurogastroenterology and Motility, Oct 1, 2006
Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC)... more Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta‐analysis. Eighty‐one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed‐effects model. Meta‐analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta‐analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.
Scandinavian Journal of Gastroenterology, 1999
Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux ... more Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.
Neurogastroenterology and Motility, Sep 21, 2015
Immune reactivity to luminal antigens may have a role in the development of D-IBS • We compared s... more Immune reactivity to luminal antigens may have a role in the development of D-IBS • We compared serum levels of LPS, soluble CD14 (sCD14), and flagellin antibodies between 88 patients with different subtypes of IBS and 106 healthy controls. We used ELISA for sCD14 and antiflagellin IgG and limulus amebocyte assay for LPS • Patients with D-IBS have higher serum levels of LPS and antibodies to flagellin, but lower levels of sCD14 compared to controls. The serum level of antiflagellin antibodies was found to correlate with the patients' selfreported anxiety score.
PharmacoEconomics, May 1, 1992
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Mar 8, 2007
Diseases of the Colon & Rectum, 1999
European Journal of Gastroenterology & Hepatology, Nov 1, 2005
Objectives The study explores, by the use of manometry, the frequency and severity of small intes... more Objectives The study explores, by the use of manometry, the frequency and severity of small intestinal involvement in patients with systemic sclerosis, and relates the manometric findings to clinical symptoms, radiology, and some intestinal regulatory peptides. Methods Stationary antroduodeno-jejunal manometry was used to study small bowel involvement in 10 patients with systemic sclerosis and dysmotility of the oesophagus or signs of malabsorption. Measurements were made during fasting, after a meal, and after octreotide administration and were then compared with a sex-matched control group of healthy individuals. Plasma samples were taken in order to analyse levels of motilin, peptide YY, cholecystokinin, and somatostatin. Results Manometry was abnormal, with signs of intestinal pseudo-obstruction in eight out of 10 patients. In the control group, one individual had an abnormal manometry, as a result of burst activity. The mean contractile amplitudes during fasting and periods after food, spontaneous phase III periods, and octreotide-induced activity complexes were significantly reduced in the systemic sclerosis group when compared with controls. None of the patients, including two with advanced manometric intestinal disturbances, had small intestinal dilatation when examined by radiography. The plasma peptide levels did not differ significantly between the two groups. Conclusions In eight out of 10 patients the manometric criteria for intestinal pseudo-obstruction were fulfilled, with a motility pattern consistent with both neuropathy and myopathy. The release of motility-regulating peptides was unaffected.
Scandinavian Journal of Gastroenterology, 1996
Background: Development of electrogastrography, the recording of gastric electric rhythm from cut... more Background: Development of electrogastrography, the recording of gastric electric rhythm from cutaneous electrodes, for clinical purposes has been hampered by methodologic problems and the lack of an ambulatory technique. We have evaluated a newly developed system for ambulatory electrogastrography. Methods: 24-Hour recordings were obtained from 30 healthy volunteers. We used digital filtering, a Hamming window, and spectral analysis to determine the dominant frequency of successive 256-sec segments of data. Results: Low-frequency noise disturbed the primary signal. After secondary filtering a stable normogastric (2 4 cpm) rhythm was present during a median of 49% (range, 3679%) of the recording time. The mean frequency of gastric electric activity varied from 2.92 2 0.15 cprn (mean 2 SD) at midday to 2.72 2 0.13 cprn in the late night. Conclusions: Ambulatory recording of electrogastrography needs technical improvement. The electrogastrogram shows a circadian variation in frequency.
CRC Press eBooks, Nov 6, 2018
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population pr... more Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and
PharmacoEconomics, 1994
This study compared the cost-effectiveness of 2 strategies for the treatment of reflux oesophagit... more This study compared the cost-effectiveness of 2 strategies for the treatment of reflux oesophagitis. In the first strategy, treatment began with ranitidine 300mg daily for 8 weeks. The alternative strategy began with omeprazole 20mg daily for 4 weeks, and continued with another 4 weeks of omeprazole 20mg daily if patients were unhealed after the first 4 weeks. Those who remained unhealed in both groups after 8 weeks oftreatment were administered omeprazole 40mg once daily for 4 weeks. The average cost of treatment and follow-up endoscopies per healed week was Swedish krona (SEK)1140 ($USI = SEK8) in the ranitidine group, whereas with omeprazole treatment the average cost per healed week was SEK622. The omeprazole strategy was more effective (6.75 healed weeks in a 12-week period) than ranitidine (3.71 healed weeks) and, despite a higher daily cost of treatment, omeprazole resulted in a lower average cost per patient. Sensitivity analysis showed that the conclusion regarding omeprazole being more cost-effective than ranitidine was insensitive to all reasonable changes in the cost parameters. Healing rates from 3 clinical trials also support the robustness of the conclusion in terms of the effect parameter.
Acta Paediatrica, Apr 9, 2013
South African Gastroenterology Review, Nov 1, 2005
Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Sw... more Extracted from text ... The South African Gastroenterology Review ? November 2005 9 GUIDELINES Swallowing Stages by Phase Food enters oral cavity Mastication and bolus formation Tongue elevates and propels bolus to pharynx Soft palate elevates to seal nasopharynx Larynx and hyoid bone move anterior and upward Epiglottis moves posteriorly and downwards to close Respiration stops Pharynx shortens Upper esophageal sphincter relaxes Bolus passes to esophagus Esophageal contracts sequentially Lower esophageal sphincter relaxes Bolus reaches stomach Oral Phase Oro-pharyngeal Phase Esophageal Phase WGO-OMGE Practice Guideline Dysphagia - January 2004: Final Version 1. DEFINITION Dysphagia either refers to the difficulty someone may have with initiating ..
Best Practice & Research in Clinical Gastroenterology, Jun 1, 2019
New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The maj... more New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases to be a functional disorder and becomes a genuine motility disorder. Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility. Chronic intestinal pseudo-obstruction is the end-stage of a large number of very rare disorders in which failed peristalsis is the common denominator. Nutritional needs and symptom control are essential in the management of pseudo-obstruction. Home parenteral nutrition is life saving in more than half of patients with chronic intestinal pseudo-obstruction.
Neurogastroenterology and Motility, Sep 16, 2013
High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has alrea... more High-resolution manometry using catheters with 36 solid-state sensors spaced 1 cm apart has already become an established technique for esophageal manometry where it has replaced water-perfused and station pull-through manometry. Spatiotemporal plots with color coding of pressure have greatly facilitated the analysis of esophageal peristalsis. Although suitable for the length of the esophagus, the solid-state catheter is insufficient for the study of longer segments of the gastrointestinal tract. A new technique with fiber-optic sensors has made it possible to construct catheters with 72-144 sensors. Studies of colonic motility have revealed that the most common motor pattern of the colon is a peristaltic contraction that travels 7-10 cm in the retrograde direction. Earlier studies using low-resolution manometry with 7-45 cm between sensors led us to erroneous conclusions regarding direction and frequency of contractions and they largely missed both antegrade and retrograde contractions traveling short distances. Fiber-optic high-resolution manometry holds promise for greatly improving our understanding of gut motor physiology and hopefully also our understanding of patients with symptoms of disordered gut motility.
Scandinavian Journal of Gastroenterology, Mar 1, 1983
Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagno... more Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagnostic hypotheses formed on the basis of initial data--history, physical findings, and results of routine laboratory tests--enabled the clinician to adopt a single-target strategy in 75 patients and a multi-target strategy in 61 patients. Four patients died very early in the course of events and another four were excluded from analysis because they were judged not to benefit from further investigations. The single-target strategy, in which the clinician explored one diagnostic hypothesis only, often led to a short diagnostic process (mean, 11 days), and in 89% of the patients the clinician's hypothesis was correct. In the multi-target strategy several diagnostic hypotheses were evaluated. In these patients the correct diagnosis was included in the first set of hypotheses in 84%, and the mean duration of the diagnostic process was 25 days. Patients with cholestatic jaundice presented the most difficult diagnostic problem, and most of these were investigated by a multi-target strategy. The possibility of an extrahepatic obstruction often forced the clinician to use invasive procedures to rule out this diagnosis. Considerable time was spent in observing the clinical course and waiting for investigations to be carried out. To reduce the investigative cost, controlled studies of diagnostic value and optimal order of investigations are warranted.
BioMed Research International, 2017
The aim of our study was to compare patients with irritable bowel syndrome (IBS) and healthy cont... more The aim of our study was to compare patients with irritable bowel syndrome (IBS) and healthy controls regarding the expression of toll-like receptors 2, 4, 5, and 9 (TLR2, TLR4, TLR5, and TLR9), the primary mucosal receptors of bacterial components, in small and large bowel mucosa. Methods. We analysed biopsies from jejunum and sigmoid colon of 22 patients (17 females) with IBS aged 18-66 (median: 39) years and 14 healthy volunteers (12 females) aged 22-61 (median: 42) years. Eight patients had constipation-predominant IBS (C-IBS), 7 had diarrhoea-predominant IBS (D-IBS), and 7 had IBS without predominance of constipation or diarrhoea. We analysed mRNA levels for TLRs using quantitative PCR and distribution of TLRs in mucosa using immunohistochemistry. Results. We found increased mRNA expression of TLR4 (mean fold change 1.85 ± 0.31 versus 1.0 ± 0.20; < 0.05), TLR5 (1.96 ± 0.36 versus 1.0 ± 0.20; < 0.05) and TLR9 (2.00 ± 0.24 versus 1.0 ± 0.25; < 0.01) but not of TLR2 in the small bowel mucosa from patients with IBS compared to the controls. There was no significant difference in mRNA levels for TLRs in colon mucosa between patients and controls. Conclusion. Upregulation of TLR4, TLR5, and TLR9 suggests the involvement of bacteria or dysregulation of the immune response to commensal flora in small bowel mucosa in IBS patients.
Neurogastroenterology and Motility, Oct 1, 2006
Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC)... more Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta‐analysis. Eighty‐one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed‐effects model. Meta‐analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta‐analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.
Scandinavian Journal of Gastroenterology, 1999
Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux ... more Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.
Neurogastroenterology and Motility, Sep 21, 2015
Immune reactivity to luminal antigens may have a role in the development of D-IBS • We compared s... more Immune reactivity to luminal antigens may have a role in the development of D-IBS • We compared serum levels of LPS, soluble CD14 (sCD14), and flagellin antibodies between 88 patients with different subtypes of IBS and 106 healthy controls. We used ELISA for sCD14 and antiflagellin IgG and limulus amebocyte assay for LPS • Patients with D-IBS have higher serum levels of LPS and antibodies to flagellin, but lower levels of sCD14 compared to controls. The serum level of antiflagellin antibodies was found to correlate with the patients' selfreported anxiety score.
PharmacoEconomics, May 1, 1992