Background: The relationship between symptom severity and objective evidence of gastro-oesophageal reflux disease (GORD) after medical and surgical treatment has recently been questioned. This study aimed to compare the symptomatic and physiological response (as measured by pHmetry) to the treatment of GORD by proton pump inhibitors (PPIs) and by laparoscopic antireflux surgery, and to examine the relationship between the patient's subjective and objective response to treatment of GORD.Methods: Seventy patients underwent 24-h oesophageal pH measurement and DeMeester symptom assessment (for heartburn and regurgitation, grade 0-3) while off medical treatment, while taking PPIs and after laparoscopic fundoplication.Results: The median percentage total time with oesophageal pH<4 off treatment, during medical treatment and after fundoplication was 9.5, 4.3 and 0.5 per cent respectively. After medical treatment 30 patients became asymptomatic although 18 of these still had pathological reflux on pH testing. Of the 19 patients who remained symptomatic after surgery only two had pathological acid reflux.Conclusion: The symptomatic response of patients to either PPIs or antireflux surgery is a poor indicator of successful treatment in terms of reduced lower oesophageal acid exposure. A high proportion of patients whose symptoms are improved by PPIs still have pathological levels of acid reflux. Conversely, most patients who complain of reflux symptoms after antireflux surgery have no evidence of residual reflux on pHmetry.

Citrate phosphate buffer liquid adjusted to different pH values was used to investigate the gastric emptying profiles in human using simultaneous monitoring by electrical impedance tomography (EIT) and pH sensitive radiotelemetry capsule. No interference was observed between the two methods during data acquisition periods. A positive correlation between methods from the pooled data was demonstrated. Statistical moments analysis demonstrated a significant delay in the onset of gastric emptying and also the mean gastric residence time of the pH 3 buffer liquid (34.7–46.7 min) when compared with pH 7 buffer liquid (14.4–22.5 min). These data suggest that the negative feedback gastrin related response to acidity of the liquid was high. However, incorporation of an acid suppression compound (ranitidine), as part of the control study showed that the EIT imaging of this buffer could be successfully performed under normal physiological conditions. When 450 ml pH 7 buffer liquid was measured, no significant difference in gastric emptying rate was observed. This study demonstrated that, citrate phosphate buffers can be used as an alternative test liquid for EIT monitoring, and that pH has a systematic effect on gastric emptying and the lag phase.

Octreotide has been used to treat HIV-associated diarrhea. We aimed to assess the effect of octreotide on small intestinal motility in a group of HIV infected individuals with chronic diarrhea. Small intestinal motility was measured continuously for 48 hr by ambulatory strain gauge manometry in 12 HIV seropositive subjects with chronic diarrhea. During the second 24-hr period, intravenous octreotide was administered (100 μg every 8 hr). Postprandial and nocturnal fasting motility data were compared before and during administration of octreotide. Octreotide was associated with increased numbers of migrating motor complexes (MMCs) (7.25 vs 4.92, P = 0.03), and a relative decrease in the duration of phase II (22% vs 49.8, P = 0.03) during nocturnal fasting activity. Postprandial activity was absent in half of the subjects and the duration significantly reduced in the remainder. In conclusion, octreotide has a significant effect on small intestinal motility in HIV-infected individuals with diarrhea, which may influence intestinal transit.

Measurements of luminal pH in the normal gastrointestinal tract have shown a progressive increase in pH from the duodenum to the terminal ileum, a decrease in the caecum, and then a slow rise along the colon to the rectum. Some data in patients with ulcerative colitis suggest a substantial reduction below normal values in the right colon, while limited results in Crohn's disease have been contradictory. Determinants of luminal pH in the colon include mucosal bicarbonate and lactate production, bacterial fermentation of carbohydrates and mucosal absorption of short chain fatty acids, and possibly intestinal transit. Alterations in these factors, as a result of mucosal disease and changes in diet, are likely to explain abnormal pH measurements in inflammatory bowel disease (IBD). It is conceivable that reduced intracolonic pH in active ulcerative colitis impairs bioavailability of 5-aminosalicylic acid from pH dependent release formulations (Asacol, Salofalk) and those requiring cleavage by bacterial azo reductase (sulphasalazine, olsalazine, balsalazide), but further pharmacokinetic studies are needed to confirm this possibility. Reports that balsalazide and olsalazine may be more efficacious in active and quiescent ulcerative colitis, respectively, than Asacol suggest that low pH may be a more critical factor in patients taking directly pH dependent release than azo bonded preparations. Reduced intracolonic pH also needs to be considered in the development of pH dependent colonic release formulations of budesonide and azathioprine for use in ulcerative and Crohn's colitis. This paper reviews methods for measuring gut pH, its changes in IBD, and how these may influence current and future therapies.

polysomnogram.The apnea/hypopnea index (AHI; number of apneas and hypopneas per hour of sleep) was calculated.RESULTS: Forty-one consecutive patients that were referred for sleep evaluation were enrolled into the study.Of those, 29 (26M, mean age 54.8_+2.1,range 34-78)were found to have OSA.Twenty-two (76%) reported typical heartburn and 20 (69%) acid regurgitation (24 -83% had both or either symptoms), Twelve (55%) of the heartburn sufferers reported at least 10 years duration, 12 (55%) at least once a week frequency and 15 (68%) moderate to severe heartburn symptoms.Seventeen (77%) stated that heartburn awakened them during the night.The mean BMI was 31.6_1.3(weight/height 2) and the mean AHI was 24.1 -+3.7.Regression analysis revealed that GERD severity is a significant predictor of AHI (p=0.015),adjusted for gender and BMI.For every unit in GERD severity, there was a 12.6 gain in AHI.CONCLUSIONS: GERD symptoms are common in patients with OSA.GERD symptom severity, independent of BMI and gender, is a significant predictor of OSA severity. 2182

Prolonged ambulatory esophageal manometry was recorded in 19 patients (12 male, 7 female) aging 45.3 +/- 11.3 years (range 24-62) with the indeterminate form of Chagas' disease (seropositive, without symptoms), using a 3-channel catheter incorporating a LES sensor (sphinctometer) and 2-body motility channels 7.5 cm apart (Gaeltec, Scotland) and a digital data logger (MMS, Holland). Data were analyzed for the incidence, amplitude and duration of esophageal contractions and wave type (peristaltic, simultaneous, incomplete and retrograde) and compared with published data for normal control. No significant abnormalities of contractility were detected. Fourteen (74%) patients had one or more wave-type abnormalities: impaired peristalsis in 12 (63%), incomplete contractions in 13 (68%), and simultaneous contractions in 6 (31%).

Objective. The aim of this study was to measure lower esophageal sphincter pressure, sphincter length, and esophageal motility in patients with dental erosion and compare the results with measurements made in patients without gastroesophageal reflux or dental erosion.Study design. Lower esophageal sphincter length and esophageal motility were measured in 39 patients (age range, 15-74 years) with dental erosion through use of static esophageal pressure monitoring; the data were compared with those from 10 control subjects (age range, 26-46 years) with nonparametric statistical tests.Results. Median lower esophageal sphincter pressure was 9 mmHg (range, 0-26 mmHg) in the patients with erosion and 9.5 mmHg (range, 0-14 mmHg) in the controls; there was no statistically significant difference between the two subject groups. Similarly, there was no statistically significant difference in esophageal length between the subject groups. There was a statistically significant difference between the groups (P = .01) in the measurement of esophageal motility; the median value was 8% (range, 0% to 100%) in the patients with erosion and 0% (range, 0% to 18%) in the controls.Conclusions. It appears that esophageal motility in patients With dental erosion is more likely to be associated with low amplitude changes than with sphincter pressure alone. Poor esophageal motility may therefore be a risk factor in regurgitation erosion.

GI symptoms (sxs) are reportedly common in diabetes and are usually attributed to autonomic neuropathy.Recent studies have demonstrated that acute changes in the blood glucose concentration affect the perception of GI sensations.Thus, we hypothesised that GI symptoms would be associated with poor glycemic control.Methods: 15,000 adults, randomly chosen from the electoral roll, were mailed a questionnaire (response rate 60%) containing questions on the frequency of troublesome GI sxs within the last 3 months (not at all/rarely vs sometimes/often/very often), diabetes status, length of disease, diabetes treatment (insulin only; insulin +tablets; tablets only; diet only) and self-reported glycemic control (very good/good/average/poor/very poor).The prevalence of 16 individual sxs and five sx complexes (Esophageal: heartburn/dysphagia; Upper dysmotility : early satiety/fullness/bloating/nausea/vomiting; Any bowel sx: diarrhealloose stools/ urgencylincontinence/ constipation/hard stools/anal blockage; Diarrhea: >3 bowels per day/urgency/loose stools; Constipation: <3 bowels per weeklbard or lumpy stools/anal blockage) were compared.Type 1 diabetes was defined as age of onset <30 yrs and current insulin use.The data was analysed using logistic regression, adjusting for age and sex.Results are reported as odds ratios (OR) with 95% CI.Results: 423 subjects (5%) reported diabetes.Of these, 5% (21 subjects) had type 1 diabetes, 19% used insulin, and 49% and 31%, respectively, were treated by tablets or by diet alone.228 subjects (56%) reported good/very good glycemic control.142 (35%) and 36 (9%) subjects reported average control and poor/very poor control, respectively.Prevalence of all 16 GI sxs (except for vomiting) and the five sx complexes was strongly associated with poor glycemic control, independent of age and sex: Esophageal: OR 2.3 (1.6-3.4);Upper dysmotility : OR 2.0 (1.3-2.9);Any bowel sx: OR 2.4 (1.6-3.6);Diarrhea: OR 1.8 (1.2 -2.7); Constipation: OR 2.3 (1.5-3.4).Length of diabetes (>5 or 10 years), type of diabetes (type 1 vs type 2) or diabetes treatment did not predict sx frequency.Early satiety (OR 1.8, 1.1-3.0),heartburn (OR 1.7, 1.1-2.7),and diarrhea or constipation (OR 1.7, 1.1-2.7)were independently associated with poor glycaemic control, when adjusted for age and sex in stepwise logistic regression.Conclusion: The prevalence of GI symptoms in diabetes, in particular those associated with dysmotility of the GI tract, are strongly associated with poor glycemic control.

Introduction: Oesophageal manometry and 24hr pH studies are used to assess patients with symptoms of GORD and non-mechanical dysphagia.After investigation patients may not commence therapy until review in the out patient clinic which may involve a variable delay.Aim: To assess the

Background: A pH-dependent formulation of 5-aminosalicylic acid (5ASA) requires exposure to pH> 7.0 for at least 30 minutes for complete dissolution to occur in vitro (Riley SA, Br J Clin Pharmacol 1988;26:1737). It has been suggested that low colonic luminal pH in patients with ulcerative colitis (UC) may impair the release of 5-ASA from these capsules. Aim: To compare gut luminal pH and transit time in normal controls and in patients with UC taking a 5-ASA preparation. Methods: Using a standardised ambulatory and dietary protocol, 4 normal controls and 8 patients with active UC had gut pH and segmental transit recorded by a freefall pH-sensitive radiotelemetry capsule(RTC). Results: See Table (mean and (SD) are shown). In all subjects small bowel pH rose as the RTC passed distally and exceeded pH 7.0 for at least 4 hours. There was no difference in mean colonic pH between healthy controls and UC patients. However, low pH «5.5)in the left colon was found in 2 patients, both with active distal UC. Transit time of the RTC through the small bowel was similar for controls and UC patients. RTC transit in UC through the left colon was slower than through right (p< 0.03). Conclusion: We have confirmed that colonic pH is sometimes low and shown that left colonic transit is prolonged in patients with active Uc. Using the RTC as a marker of transit, small bowel pH appears to be sufficiently high for a long enough time to ensure complete dissolution of a pH-dependent capsule containing 5-ASA.