The loss of adipose tissue during energy restriction may be accompanied by a loss of lean body mass, including bone mass. Because most of the body lead burden is in the skeleton, we studied the effects of weight loss on the concentrations of lead in bone, blood and several organs in rats with prior but not current lead exposure. Concentrations of the essential divalent metals calcium, copper, iron, magnesium and zinc were also determined for comparison with lead. Lead-exposed rats (n = 25) were randomly assigned to one of three treatment groups: weight maintenance (WM), moderate weight loss (MWL) or substantial weight loss (SWL). For the two last-named groups, food intake was restricted for 4 wk to 70 and 40% of that of the WM group. Lead concentrations did not differ significantly (ANOVA, P > 0.05) among the three groups for blood, brain and bone. Significantly higher liver lead concentrations were observed in the SWL rats than in the WM and MWL groups. In general, organ concentrations of calcium, copper, magnesium and zinc were either lower or did not differ in the groups losing weight compared with the WM group. In contrast, organ Iron concentrations of the SWL group were higher than those of the other groups except in brain where there were no significant differences. The total liver content of lead was highest in the SWL group, but the lead content of other organs did not differ among the treatment groups. The contents of calcium, copper, magnesium and zinc generally were lower in the MWL and SWL groups than in the WM group in the liver and some of the other organs. The results demonstrate that weight loss can increase the quantity and concentration of lead in the liver, even in the absence of continued lead exposure. The data also demonstrate considerable differences among organ divalent metals in response to weight loss.

Summary Background Laryngopharyngeal reflux (LPR) has been linked with irritable bowel syndrome (IBS). Functional colonic, upper gastrointestinal (GI) and LPR symptoms often coexist and all improve with osmotic laxative therapy. Reflux scintigraphy demonstrates direct contamination of the airway by refluxate. Aims Evaluate the clinical utility of reflux scintigraphy in managing LPR. Assess the effect of osmotic laxatives combined with acid suppression on both functional GI and LPR symptoms. Methods Forty consecutive patients referred over 6 months with functional colonic symptoms and significant LPR with a reflux symptom index (RSI)> 13 were followed prospectively. All patients underwent pre‐treatment reflux scintigraphy and gastroscopy with assessment of their reflux finding score (RFS). RSI and RFS were reassessed at ENT follow‐up at a median of 5 months. Functional GI symptoms and RSI were reassessed at a median of 17 months. Results Thirty‐nine of 40 (97.5%) demonstrated reflux into their oropharynx on reflux scintigraphy. The majority had minimal typical reflux symptoms (55%) and their LPR was refractory to acid suppression alone (62.5%). Short‐term combination therapy reduced both the RSI (22.6‐17.2, P < .01) and RFS (12.3‐7.7, P < .01). Longer term treatment reduced the RSI further (22.6‐9.2, P < .01) correlating strongly with improvement in functional GI symptoms. Conclusions LPR occurs frequently amongst IBS patients without typical reflux symptoms. Reflux scintigraphy is useful to both diagnose and optimise treatment of LPR. Reducing colonic distension with osmotic laxatives improves both functional GI and LPR symptoms.

The role of gastroesophageal reflux disease (GERD) in the aetiology of laryngopharyngeal reflux (LPR) is poorly understood and remains a controversial issue. The 24-hour impedance monitoring has shown promise in the evaluation of LPR but is problematic in pharyngeal recording. We have shown the utility of scintigraphic studies in the detection of LPR and lung aspiration of refluxate. Correlative studies were obtained in patients with a strong history of LPR and severe GERD. Methods: A highly selected sequential cohort of patients with a high pre-test probability of LPR/severe GERD who had failed maximal medical therapy were evaluated with 24-hour impedance/pH, manometry and scintigraphic reflux studies. Results: The study group comprised 34 patients (15 M, 19 F) with a mean age of 56 years (range: 28-80 years). The majority had LPR symptoms (mainly cough) in 31 and severe GERD in 3. Impedance bolus clearance and pH studies were abnormal in all patients in the upright and supine position. A high rate of non-acid GERD was detected by impedance monitoring. LOS tone and ineffective oesophageal clearance were found in the majority of patients. Scintigraphic studies showed strong correlations with impedance, pH and manometric abnormalities, with 10 patients showing pulmonary aspiration. Conclusion: Scintigraphic studies appear to be a good screening test for LPR and pulmonary aspiration as there is direct visualisation of tracer at these sites. Impedance studies highlight the importance of non-acidic reflux and bolus clearance in the causation of cough and may allow the development of a risk profile for pulmonary aspiration of refluxate.

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