Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is pertinent to ask what clinical conditions would geriatricians most want gastroenterologists to solve. I believe that the three most important are transfer dysphagia, constipation and diarrhea, and fecal incontinence. With transfer dysphagia, the older patient with central nervous system disease simply has forgotten how to swallow. Is it possible, with sensory retraining techniques, to make an impact upon this disabling problem? Although the healthy elderly appear to perceive constipation more often than they actually suffer from it, evacuation clearly is disturbed in hospitalized and nursing-home residents. Can we develop better prokinetic agents to alleviate this problem? Incontinence, more than any other gastrointestinal condition, leads to the transfer of patients from a protected home environment to a chronic-nursing facility. Can we study the pathophysiology of incontinence intensively, as Dr. Nicholas Read's group in Sheffield, England, has done, and develop approaches to managing this important problem? The presentations in this issue of Clinics in Geriatric Medicine may not provide all of the solutions for clinical problems in the elderly that we seek, but it should be a step in the right direction by making salient new information readily available.
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PMID:General perspectives on the aged gut. 185 54

Sucralfate (Sc) suspension 6 g/day and ranitidine (Rn) tablets, 150 mg, were compared in 125 patients in a double-blind, multicenter, endoscopically controlled trial in the treatment of reflux esophagitis. Inclusion criteria were symptomatic reflux (number and severity of attacks) and endoscopic evidence of esophagitis (grades 1 to 4). Clinical assessments were performed on entry, and at 4 and at 8 weeks, and endoscopy was repeated at 8 weeks. Sc suspension and Rn placebo or Sc placebo and Rn tablets were taken on waking and immediately before retiring at night. Of the 125 patients, 27 were withdrawn because of default (Rn = 4; Sc = 14), noncompliance (Rn = 1; Sc = 2), or the development of congestive cardiac failure (Rn = 1), diarrhea (Rn = 1; Sc = 1), nausea (Sc = 1), constipation (Sc = 1), and hematemesis (Sc = 1). Analysis was performed on the remaining 98 patients, 43 of whom had been treated with Sc and 55 with Rn. Heartburn, acid regurgitation, epigastric pain, dysphagia, and chest pain were relieved in 34% vs 40%, 67% vs 72%, 71% vs 57%, and 86% vs 63% for Sc and Rn, respectively. There was no significant difference between the two groups. Endoscopic healing occurred in 47% of the Sc- and in 31% of the Rn-treated patients (chi 2 = 2.50), and healing or improvement was noted in 81% of the Sc- and 64% of the Rn-treated patients. This difference approached statistical significance (chi 2 = 3.73). There was no obvious endoscopic benefit in 8 of the 43 and 20 of the 55 patients in the groups treated with Sc and Rn, respectively. Although the findings with sucralfate and ranitidine in patients with reflux esophagitis completing the trial suggest a benefit of these agents, the absence of a placebo control group and the high default rates, particularly for those receiving sucralfate, preclude any firm conclusions as to relative or specific efficacy of these agents in this condition.
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PMID:Reflux esophagitis therapy: sucralfate versus ranitidine in a double blind multicenter trial. 188 97

We have investigated the prevalence of gastrointestinal (GI) symptoms in 98 individuals with Parkinson's disease (PD) and in a control group of 50. Seventy-nine of those with PD were being treated with dopaminergic medications and 19 were untreated. Those symptoms occurring more frequently in PD patients than in controls included abnormal salivation, dysphagia, nausea, constipation, and defecatory dysfunction. Except for defecatory dysfunction, symptoms did not correlate with treatment but instead correlated with disease severity. This suggests that the GI symptoms of PD reflect direct involvement in the GI tract by the primary disease process.
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PMID:Gastrointestinal symptoms in Parkinson's disease. 205 6

The natural history of a moderate intoxication with botulin (probably type B) in six patients is presented and discussed. All patients complained of a persistent and almost complete failure of accommodation, and marked dryness of the mouth. Reduced lacrimation was also noticeable. A disturbance of efferent pupillary reaction was noted only in four patients, and resolved relatively early. On testing with highly diluted pilocarpine solution, a denervation hypersensitivity reaction of the sphincter pupillae was seen. An optic nerve lesion could not be demonstrated in any of the cases. Manifest involvement of the striated musculature, such as a bilateral lateral rectus palsy and ptosis, was found in only one patient. In four patients the presenting symptom was gastroenteritis. Other systemic symptoms were dysphagia, persistent constipation, problems with micturition, general malaise and postural symptoms. All of the patients made a full recovery at the latest after 10 weeks.
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PMID:[Botulism--observations on its course with emphasis on ophthalmologic symptoms]. 397 56

Systemic scleroderma involves the gastro-intestinal tract in over 50 p. 100 of cases, the commonest target organs being the oesophagus, the small intestine, the colon and the stomach in that order. The G-I symptoms of this collagenosis are all related to disorder of motility secondary to disturbances of innervation and then to atrophy of the smooth muscle and fibrous infiltration. Oesophageal involvement results in gastro-oesophageal reflux and/or dysphagia due to the lack of tonicity of the lower oesophageal sphincter and a reduction of peristalsis. Disease of the small intestine may cause pseudo-intestinal obstruction or a secondary malabsorption syndrome due to abnormal intraluminal bacterial flora. Colonic involvement causes severe constipation with formation of faecoliths. Finally, scleroderma may be complicated by an acute abdominal syndrome: occlusion due to diffuse reduction in small intestinal motility, peritonitis due to perforation of the small intestine, ileo-colonic infarction, gastro-intestinal haemorrhage complicating telangiectasia. Treatment is purely symptomatic: classical remedies for gastro-oesophageal reflux and its complications, and antibiotics for malabsorption syndromes.
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PMID:[Digestive localizations of scleroderma]. 652 55

In the gastrointestinal tract the Nd YAG laser has proved to be effective in hemostasis and tumor therapy. Initial experience in the treatment of benign stenoses reveals excellent results for this new indication, too. From July 1983 to March 1984 six patients with non-neoplastic stenoses of the esophagus (3) or the rectosigmoid colon (3) were treated with a Nd YAG laser. The lumen only was 3-7 mm, the length of the stenoses up to 7 cm. In all cases narrowing was successfully treated to an easy definitive passage of the 13 mm endoscope. Such symptoms as dysphagia, constipation or tenesms disappeared and no complications were seen. Reopening of non-neoplastic stenoses with Nd YAG laser is an alternative method to present-day conservative or surgical measures, being practicable, effective and of low risk to the patient.
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PMID:[Photocoagulation using the Nd-YAG-laser in the treatment of non-neoplastic gastrointestinal stenosis]. 654 60

Toxicoinfectious botulism was proved to be the cause of a neuromuscular paralytic syndrome in foals and adult horses. In eight successive cases, Clostridium botulinum type B was isolated at necropsy. Foals were either found dead without premonitory signs of illness or, most often, they had signs of progressive and symmetric motor paralysis. Stilted gait, muscular tremors, and the inability to stand longer than 4 to 5 minutes were the salient clinical signs. Other clinical manifestations included dysphagia, constipation, mydriasis, and frequent urination. As the disease progressed, dyspnea with extension of the head and neck, tachycardia, and respiratory arrest occurred. Death occurred most often 24 to 72 hours after the onset of clinical signs. The most consistent postmortem findings were congestion and edema of the lungs and excessive pericardial fluid, which contained free-floating strands of fibrin. Gastric ulcers, foci of necrosis in the liver, abscesses in the navel and lungs, and wounds of the skin and muscle were predisposing sites for development of toxicoinfectious botulism.
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PMID:Toxicoinfectious botulism in foals and adult horses. 698 76

We reviewed the clinical features of 99 cases of infant botulism reported to the Centers for Disease Control from states other than California for the period 1976 to 1980. There were no toxin-specific differences in the distribution of ages at onset or sex of the cases. For 76 (76%) patients for whom data were available the most common presenting symptoms were poor feeding (43%) and constipation (24%). Weak suck, poor head control, floppiness, weakness in extremities, difficulty swallowing, altered cry and constipation were reported in over three-fourths of the infants for whom data were available. Loss of facial expression, extraocular muscle paralysis, dilated pupils and depression of deep tendon reflexes occurred significantly more frequently among infants with type B botulism than among those with type A botulism. Ventilatory assistance was required for 61% of infants receiving aminoglycosides after the onset of weakness compared to only 26% of those infants not receiving aminoglycosides (P = 0.01). Infant botulism presents a characteristic clinical picture and should be suspected when an infant presents with weakness.
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PMID:Clinical characteristics of infant botulism in the United States: a study of the non-California cases. 714 27

12 cases of food-borne botulism were registered in Sion, Switzerland, between 31 December, 1993 and 12 January, 1994. A type B toxin was isolated from the serum of one patient and from the incriminated ham. Clinical data of 10 male patients aged 21 to 54 years and some epidemiologic data are reported. The clinical course was mild to moderate with predominant autonomic and gastro-intestinal symptoms and signs: blurred vision (10 patients of 10), dry mouth with dysphagia (9/10), asthenia (7/10), diarrhea and/or constipation (7/10), nausea and vomiting (6/10), abdominal cramps (5/10), impaired sexual function (5/10), dilated pupils (4/10). Some discomfort (mainly blurred vision, asthenia and impaired sexual function) persisted for several months in most patients. Neuromuscular involvement was never the reason for seeking medical assistance and had often disappeared at the time of the first visit. Two patients were hospitalized, one for transient ileus of unknown origin and the second (first suspected case) for monitoring and infusion of trivalent equine botulinum antitoxin. This treatment was administered on day eight after intoxication and had no effect on this patient's outcome when compared with others. No patient died. Epidemiology, diagnosis, treatment and prognosis of botulism are discussed.
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PMID:[Epidemic of type B botulism: Sion, December 1993-January 1994]. 748 37

Quality of life (QOL) measurement may aid decision making in the treatment of patients with oesophageal cancer but must be clinically valid to be useful. This study considered if the European Organisation for Research and Treatment of Cancer QOL questionnaire, the QLQ-C30, showed differing results in two clinically distinct groups of patients with oesophageal cancer and also investigated the correlation between dysphagia grade and various scales of QOL. Patients treated by oesophagectomy reported significantly better physical, emotional, cognitive, and global health scores than those in the palliative treatment group. Patients who received palliative treatment had significantly worse pain, fatigue, appetite loss, constipation, and dysphagia. The correlations between dysphagia grade and each of the QOL scales and items in both groups of patients were poor. This questionnaire differentiates clearly between the two clinically distinct groups of patients, but to be an entirely appropriate indicator of QOL in patients with oesophageal cancer, an additional specific oesophageal module including a dysphagia scale is required.
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PMID:Quality of life measurement in patients with oesophageal cancer. 748 36


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