RESUMO
On August 26 in 1753, Balthasar Neumann's wife wrote a letter to the Abbot of Neresheim describing her husband's disease one week after his death. This article outlines Neumann's medical history and builds connections towards the understanding of diseases in these times. As an example - and probably Neumann's ailment - the gastric cerarcinoma is discussed with special attention in this report.
Assuntos
Técnicas de Diagnóstico do Sistema Digestório/história , Neoplasias Gástricas , Alemanha , História do Século XVIII , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/história , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapiaRESUMO
BACKGROUND: The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. METHODS: Consecutive morbidly obese (BMI ≥ 35 kg/m2) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively. RESULTS: Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. CONCLUSIONS: The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.
Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Esôfago/fisiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Manometria , Obesidade Mórbida/complicações , Adulto , Técnicas de Diagnóstico do Sistema Digestório/história , Técnicas de Diagnóstico do Sistema Digestório/tendências , Transtornos da Motilidade Esofágica/epidemiologia , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/fisiopatologia , História do Século XXI , Humanos , Masculino , Manometria/história , Manometria/métodos , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Prevalência , Sensibilidade e EspecificidadeRESUMO
The European gastric test meal was widely used in The Mount Sinai Hospital in the 1890s and early 1900s, but was then abandoned diagnostically after the introduction of gastroscopy and radiology. The fundamental methodological advances of Franklin Hollander led to his quantitative formulation of the ionic concentrations of the gastric acid parietal and nonparietal components, followed by his insulin test for completeness of vagotomy.
