Night-time and daytime atypical manifestations of gastro-oesophageal reflux disease: frequency, severity and impact on health-related quality of life.

BACKGROUND: Respondents with gastro-oesophageal reflux disease (GERD) report having a variety of atypical manifestations. The relationship between these manifestations and disease severity, night-time GERD and functioning has not been determined. AIM: To determine if atypical manifestations are related to increased disease severity, night-time GERD and decreased functioning. METHODS: A web survey among US adults was conducted, using a validated GERD screener. Frequency of night-time and daytime typical symptoms (acid regurgitation and heartburn) and atypical manifestations were assessed. Respondents were classified as night-time GERD or daytime GERD based on typical symptom frequency. Prevalence of frequent atypical manifestations (> or =2 days or nights/week) was assessed. RESULTS: Gastro-oesophageal reflux disease cases had a higher prevalence of each atypical manifestation (P < 0.05 for all) compared with controls. Night-time GERD respondents had a higher prevalence of atypical manifestations compared with daytime GERD respondents (P < 0.05 for most manifestations) and the prevalence of atypical manifestations increased with GERD symptom severity (P < 0.05 for most). Those with atypical manifestations reported lower functioning scores (P < 0.05 for most). CONCLUSIONS: Respondents with typical GERD symptoms commonly report atypical manifestations, especially those with night-time symptoms and those with greater underlying GERD severity. Respondents with GERD and atypical manifestations had more impaired functioning than those with typical symptoms only.

Consequences of frequent nocturnal gastro-oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity.

BACKGROUND: Effects of frequent nocturnal symptoms of gastro-oesophageal reflux disease (GERD-FNS) on health-related quality of life (HRQOL) and work productivity are not well documented. AIM: To assess symptom severity, production loss, and HRQOL among employed adults with and without GERD-FNS. METHODS: Using several validated outcome measures in a web survey design, GERD was pre-specified as GERD Symptom and Medication Questionnaire score >9, and > or =1 episode of heartburn or acid regurgitation during the preceding week. GERD-FNS patients were those reporting > or =2 symptom-nights during the previous week; their outcomes were compared with those of patients having minimal or no nocturnal symptoms (GERD-NNS) and vs. non-GERD controls. RESULTS: Data were collected from 1002 GERD patients (476 GERD-FNS, 526 GERD-NNS) and 513 controls. Severe symptoms were more common, sleep abnormalities were more frequent (P < 0.0001) and SF-36 scores lower (P < 0.05, all scores) among GERD-FNS patients vs. GERD-NNS patients. GERD-related work loss was greater among those with GERD-FNS vs. GERD-NNS (P < 0.0001). Work loss and functional limitations were more pronounced when comparing GERD-FNS cases vs. non-GERD controls. CONCLUSION: Employed adults with frequent nocturnal GERD report more severe symptoms, and are associated with impaired sleep, HRQOL and work productivity compared with controls and patients with minimal or no nocturnal symptoms.

The burden of illness of gastro-oesophageal reflux disease: impact on work productivity.

BACKGROUND: The impact of gastro-oesophageal reflux disease on work productivity has become increasingly important, as the symptoms of gastro-oesophageal reflux disease affect individuals in their productive years of life. AIMS: To assess the impact of gastro-oesophageal reflux disease on reduced work productivity and to identify the predictors of reduced productivity. METHODS: A sample of employed individuals reporting chronic heartburn was selected from US household mail survey respondents. Heartburn severity and frequency were recorded using a diary, and work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire for Patients with Symptoms of Gastro-oesophageal Reflux Disease. Predictors of reduced productivity were evaluated. RESULTS: Over 30% of heartburn sufferers reported reduced productivity. Individuals with symptoms of gastro-oesophageal reflux disease (n = 1003) reported 6.0% reduced productivity attributable to symptoms. Over 48% of respondents with severe symptoms reported reduced productivity, compared with 40% and 12% of respondents with moderate and mild symptoms, respectively. Using logistic regression, severity, a younger age and nocturnal symptoms were associated with increased odds of reduced productivity. In those reporting nocturnal heartburn, medication use and sleep interference increased the odds of reduced productivity. CONCLUSIONS: Reduced work productivity is seen in a large proportion of subjects on prescription medication for gastro-oesophageal reflux disease. Symptom severity and nocturnal heartburn are significantly associated with reduced work productivity, particularly when nocturnal heartburn interferes with sleep.

Cost-effectiveness of proton-pump inhibitors for maintenance therapy of erosive reflux esophagitis.

The relative cost-effectiveness of proton-pump inhibitors (PPIs) in the maintenance therapy of erosive reflux esophagitis was studied. Decision analysis was used to model the cost-effectiveness of PPIs on the basis of clinical trial results. Management decisions in the model were based on published U.S. guidelines and recommendations. Probability estimates were derived from a systematic review of the literature. The model's base-case scenario compared rabeprazole, lansoprazole, and omeprazole for the prevention of symptom recurrence over one year. Meta-analyzed estimates of efficacy were derived from trials by using a generalized logistic regression model with random effects. Medical costs for hospitalization, procedures, and office visits reflected 2000 Medicare payment; drug costs were based on 2000 average wholesale prices. Average costs per patient were comparable among the PPIs (rabeprazole, $1414; lansoprazole, $1671; and omeprazole, $1599). Rabeprazole prevented symptom recurrence in 86% of rabeprazole recipients, versus 68% for lansoprazole and 81% for omeprazole, and yielded the lowest average cost-effectiveness ratio (rabeprazole, $1637 per recurrence prevented; lansoprazole, $2439; and omeprazole, $1968). The model was robust to changes in key variables. When evaluated by decision analysis over a wide range of assumptions, rabeprazole was comparable to other PPIs in terms of cost and offered improved effectiveness for maintenance therapy of erosive reflux esophagitis.

Effect of nectar composition and nectar concentration on honey bee (Hymenoptera: Apidae) visitations to hybrid onion flowers.

Floral nectar characteristics of nine inbred lines of onion (Allium cepa L.) were examined to determine their influence on the attractiveness of the onion flowers to honey bees (Apis mellifera L.). Potassium concentrations and sugar concentrations of the nectar did not significantly correlate with the number of bee visits received by an umbel. The average amount of nectar produced by both the umbels and the individual florets was significantly positively correlated with the number of bee visits. Our results suggest that selection for flowers with high nectar production may lead to a higher rate of pollination of the onion seed crop.

Traffic-related injury hospitalizations among California elderly, 1994.

Traffic-related injuries among the elderly are a growing concern in most developed and many developing countries. To better understand injuries sustained by the elderly in the traffic environment, hospitalizations for traffic-related injuries among those aged 64 and over in California in 1994 were examined to determine incidence and characterize injuries. Both injury incidence and injury severity increased as age increased over 64. Males were more likely to be injured as drivers of motor vehicles, but females were more likely to be injured as passengers. Fractures and internal injuries represented 72.3% of all primary diagnoses, and total hospital charges exceeded $140 million. Efforts to reduce traffic-related injuries in the elderly and to reduce injury severity will be increasingly important as the elderly comprise a larger proportion of the population.

Deposition of Aliphatic Suberin Monomers and Associated Alkanes during Aging of Solanum tuberosum L. Tuber Tissue at Different Temperatures.

The effect of temperature on suberization of potato tuber tissue was measured by diffusive resistance and quantitative chemical procedures. The optimum temperature for formation of aliphatic suberin monomers and development of resistance to water vapor conduction was 26.4 degrees C whereas alkane synthesis was optimal at 18.6 degrees C. Low temperatures (<16.6 degrees C) reduced suberin monomer production more than alkane synthesis.

Composition of Lipid-derived Polymers from Different Anatomical Regions of Several Plant Species.

The composition of the aliphatics of the protective cuticular polymers from different anatomical regions from several plant species was determined by combined gas-liquid chromatography and mass spectrometry of the depolymerization products derived from the polymers. The polymer from the aerial parts of Vicia faba showed similar composition; dihydroxypalmitic acid was the major (>85%) component of the cutin covering leaves, petioles, flower petals and stem with smaller amounts of palmitic acid and omega-hydroxy palmitic acid. On the other hand, the chief components of the polymer from the tap root were omega-hydroxy C(16:0) and C(18:1) acids and/or the corresponding dicarboxylic acids. The positional isomer composition of the dihydroxy C(16) acids was shown to be dependent upon anatomical location, developmental stage, and light. Apple cutin from rapidly expanding organs (flower petal and stigma) was shown to contain predominately C(16) family acids whereas the C(18) family dominated in cutin of slower growing organs (leaf and fruit). The composition of the aliphatic components of cutin found in the seed coats of pea, corn, barley, and lettuce was found to be similar to that of the cuticular polymer of the leaves in each species.

Suberization: inhibition by washing and stimulation by abscisic Acid in potato disks and tissue culture.

Wounding of potato (Solanum tuberosum L.) tubers results in suberization, apparently triggered by the release of some chemical factor(s) at the cut surface. Suberization, as measured by diffusion resistance of the tissue surface to water vapor, was inhibited by mm concentrations of indoleacetic acid, unaffected by mm concentrations of traumatic acid, severely inhibited at mum concentrations of cytokinin, but stimulated by abscisic acid (ABA) at 10(-4)m. Thorough washing of potato disks up to 3 to 4 days after cutting resulted in severe inhibition of suberization as measured both by diffusion resistance and by the amount of the octadecene diol generated by hydrogenolysis (LiAlH(4)) of the tissue. Disks washed after 4 days did not show any inhibition of suberization. High performance liquid chromatographic analysis of the wash from fresh potato disks showed that about 14 ng of ABA was released into the wash per g of tissue. The amount of ABA released increased with time up to 4 to 6 hours of washing. The maximal amount of ABA was washed out after aging for 24 hours and after 2 days of aging ABA could no longer be found in the surface wash of the disks. Addition of ABA to the media of potato tissue cultures resulted in suberin formation whereas control cultures contained little suberin. The effect of ABA on suberization in the tissue cultures was shown to be linearly concentration-dependent up to 10(-4)m and a linear increase in suberin formation was seen up to about 8 days of culture growth on the media containing 10(-4)m ABA. From these results it is proposed that during the early phase of wound-healing ABA plays a role in triggering a chain of biochemical processes which eventually (in about 3 to 4 days) result in the formation of a suberization-inducing factor, responsible for the induction of the enzymes involved in suberin biosynthesis.

Chemical Composition and Ultrastructure of Suberin from Hollow Heart Tissue of Potato Tubers (Solanum tuberosum).

The disorder of potato tubers (Solanum tuberosum var. Russet Burbank) called "hollow heart" is manifested by the occurrence of hollow regions in internal parts of the tuber. The structure and composition of the suberin from the tissue lining of these internal cavities were determined by gas chromatography and mass spectrometry of the LiAlH(4)-hydrogenolysis products. Identification of octadecene-1,18-diol as the major component and the presence of hexadecane-1,16-diol and very long chain (>C(18)) alcohols in the hydrogenolysate showed that the suberin lining the internal cavities is quite similar to that found in the periderm of external wounds and the natural skin. Electron microscopic examination showed similar lamellar structure for the suberin of hollow heart, external wound periderm, and the natural skin of potato tubers. The results show that suberin can develop in a tissue which is not exposed to the external environment.

Biochemistry of Suberization: Incorporation of [1-C]Oleic Acid and [1-C]Acetate into the Aliphatic Components of Suberin in Potato Tuber Disks (Solanum tuberosum).

Biosynthesis of the aliphatic components of suberin was studied in suberizing potato (Solanum tuberosum) slices with [1-(14)C]oleic acid and [1-(14)C]acetate as precursors. In 4-day aged tissue, [1-(14)C]oleic acid was incorporated into an insoluble residue, which, upon hydrogenolysis (LiA1H(4)), released the label into chloroform-soluble products. Radio thin layer and gas chromatographic analyses of these products showed that (14)C was contained exclusively in octadecenol and octadecene-1, 18-diol. OsO(4) treatment and periodate cleavage of the resulting tetraol showed that the labeled diol was octadec-9-ene-1, 18-diol, the product expected from the two major components of suberin, namely 18-hydroxyoleic acid and the corresponding dicarboxylic acid. Aged potato slices also incorporated [1-(14)C]acetate into an insoluble material. Hydrogenolysis followed by radio chromatographic analyses of the products showed that (14)C was contained in alkanols and alkane-alpha,omega-diols. In the former fraction, a substantial proportion of the label was contained in aliphatic chains longer than C(20), which are known to be common constituents of suberin. In the labeled diol fraction, the major component was octadec-9-ene-1,18-diol, with smaller quantities of saturated C(16), C(18), C(20), C(22), and C(24)-alpha,omega-diols. Soluble lipids derived from [1-(14)C]acetate in the aged tissue also contained labeled very long acids from C(20) to C(28), as well as C(22) and C(24) alcohols, but no labeled omega-hydroxy acids or dicarboxylic acids were detected. Label was also found in n-alkanes isolated from the soluble lipids, and the distribution of label among them was consistent with the composition of n-alkanes found in the wound periderm of this tissue; C(21) and C(23) were the major components with lesser amounts of C(19) and C(25). The amount of (14)C incorporated into these bifunctional monomers in 0-, 2-, 4-, 6-, and 8-day aged tissue were 0, 1.5, 2.5, 0.8, and 0.3% of the applied [1-(14)C]oleic acid, respectively. Incorporation of [1-(14)C]acetate into the insoluble residue was low up to the 3rd day of aging, rapid during the next 4 days of aging, and subsequently the rate decreased. These changes in the rates of incorporation of exogenous oleic acid and acetate reflected the development of diffusion resistance of the tissue surface to water vapor. As the tissue aged, increasing amounts of the [1-(14)C]acetate were incorporated into longer aliphatic chains of the residue and the soluble lipids, but no changes in the distribution of radioactivity among the alpha-omega-diols were obvious. The above results demonstrated that aging potato slices constitute a convenient system with which to study the biochemistry of suberization.

Synthesis of Suberin during Wound-healing in Jade Leaves, Tomato Fruit, and Bean Pods.

The structure and composition of the aliphatic monomers of the polymeric material deposited during wound-healing of tomato fruit, bean pods, and Jade leaves were examined. After removing the cuticle-containing layer of tissue, the wounds were healed for 14 days and the resulting surface layer was excised, lyophilized, solvent-extracted, and depolymerized by hydrogenolysis with LiAlH(4) or transesterified with BF(3) in methanol. The products obtained by the chemical depolymerization were subjected to thin layer chromatography and combined gas chromatography and mass spectrometry. The major aliphatic components isolated from the hydrogenolysate of the wound polymer produced by tomato fruit were hexadecane-1,16-diol and octadec-9-ene-1,18-diol, which were shown to be derived from a 1:1 mixture of omega-hydroxy and dicarboxylic acids of the appropriate chain length by LiAlH(4) reduction. Also identified in the wound polymer were long chain (>C(20)) fatty acids and alcohols. This monomer composition is typical of suberin polymers and is in sharp contrast with that of the cutin of tomato fruit which contains dihydroxy C(16) acid as the major aliphatic component. The hydrogenolysis of the wound material from bean pods gave octadecene-1,18-diol as the major aliphatic component, and smaller amounts of hexadecane-1,16-diol and long chain alcohols. Similar treatment of the normal cuticular tissue of these pods gave hexadecane triol, as well as C(16) and C(18) alcohols. Hydrogenolysis of wound material from the Jade leaves gave octadecene-1,18-diol, C(16) and C(22) diols, as well as alcohols from C(16) to C(26), whereas similar treatment of the cutin-containing tissue from these leaves gave C(16) triol as the major aliphatic component. Thus, the major aliphatic monomers of the polymeric material deposited during the wound-healing of bean pods and Jade leaves are very similar to those of suberin, although the natural protective polymer of these tissues is cutin. From these results, it is concluded that suberization is a fundamental process involved in wound-healing in plants, irrespective of the chemical nature of the natural protective polymer of the tissue.

Structure, gas chromatographic measurement, and function of suberin synthesized by potato tuber tissue slices.

The polymeric material (suberin) of the wound periderm of potato tuber slices was analyzed after depolymerization with LiAIH(4) in tetrahydrofuran or BF(3) in methanol with the use of thin layer chromatography, chemical modification, and combined gas-liquid chromatography and mass spectrometry. Fatty acids (C(16) to C(26)), fatty alcohols (C(16) to C(26)), octadec-9-ene-1, 18-dioic acid, and 18-hydroxy-octadec-9-enoic acid were identified to be the major components. Based on the structural information that the two bifunctional C(18) molecules constituted a major portion of suberin, a gas chromatographic method of measuring suberization was developed. This method consisted of hydrogenolysis of powdered tissue followed by thin layer chromatography and gas chromatographic measurement of octadecene-1, 18-diol as the trimethylsilyl ether. With this assay it was shown that the development of resistance to water loss by the tissue slices was directly proportional to the quantity of the bifunctional C(18) molecules, thus providing evidence that a function of suberin is prevention of water loss.