This investigation was designed to study to what extent dysphagia in the elderly is accompanied by other chest symptoms and if it leads to a reduction in body weight and quality of life. To this end 796 persons, randomly taken from a population register, replied to a questionnaire concerning swallowing difficulties and other chest symptoms. Chest pain, heartburn, and regurgitation occurred significantly more frequently in subjects who admitted feelings of obstruction in the throat or chest during the ingestion of food (p less than 0.001) than in the rest, as did so-called heart problems (p less than 0.05). People with dysphagia had more often gained weight over the last 5 years than people without dysphagia (p less than 0.05). Psychosocial problems in those with dysphagia were given as anxiety at mealtimes and the wish to eat alone. Of those with dysphagia, 40% had consulted a physician, but despite this these patients had as many problems as those who had not seen a doctor. It is apparent that difficulty in swallowing in the elderly leads to physical and psychosocial problems that may reduce their quality of life.
In a study comprising 100 patients referred to a surgical clinic with symptoms suggestive of gastro-oesophageal reflux disease the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed a normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly correlated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensitivity for radiologic, manometric, and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.
Muscle spasm has been proposed as the cause for esophageal food impaction. The aim was therefore to treat esophageal foreign bodies with spasmolytic drugs influencing both striated and smooth muscles of the esophagus. A multicenter, placebo-controlled, double-blind study of glucagon and diazepam was undertaken in 43 patients. The foreign body disimpacted in 9 of 24 patients given active substances and in 6 of 19 patients given placebo; there was no significant difference between these two groups. Almost all disimpactions occurred several hours after injection of the drugs. The hypothesis of muscle spasm as an important cause of esophageal obstruction was rejected. Medical therapies for food disimpaction other than spasmolytic drugs have to be investigated.
Background: A conventional lymphocyte transformation test (LTT) was compared to the commercially available MELISA® (memory lymphocyte immuno-stimulation assay), a lymphoproliferative assay that has been suggested to be a valuable instrument for the diagnosis of metal allergy. Sensitivity and specificity of the two assays were calculated using a patch test as a reference method. Methods: 34 patients were patch-tested for gold sodium thiosulfate, palladium chloride and nickel sulfate, and the lymphocyte proliferation to these metals was tested in vitro using mononuclear cells from peripheral blood. Results: No significant differences regarding sensitivity and specificity were found between MELISA and conventional LTT. The sensitivity varied between 55 and 95% and the specificity between 17 and 79%. Conclusions: The low specificity of the two in vitro assays suggests that they are not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.
The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20-44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p = 0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p = 0.001). Denial of dysphagia (N = 18), concealment of dysphagia (N = 18), and lack of confirmation by the patient's physician (N = 15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N = 13), security (N = 16), work capacity (N = 8), exercise (N = 7), and leisure time (N = 6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.
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