Behavioral therapy is superior to follow-up without intervention in patients with supragastric belching-A randomized study.

BACKGROUND: Behavioral therapy (BT) has been proven effective in the treatment of supragastric belching (SGB) in open studies. The aim was to compare BT to follow-up without intervention in patients with SGB in a randomized study. METHODS: Forty-two patients were randomized to receive 5 sessions of BT, comprising diaphragmatic breathing exercises, or to follow-up without intervention. Patients were evaluated at 6 months, at which point the control group was also offered BT and evaluated after another 6 months. The frequency and intensity of belching and mental well-being were evaluated with a visual analog scale (VAS). Depression, anxiety, and health-related quality of life (HRQoL) were evaluated with four questionnaires: BDI, BAI, 15D, and RAND-36. KEY RESULTS: The frequency and intensity of SGB were significantly lower in the therapy group (n = 19) than in the control group (n = 18) at the 6-month control (p < 0.001). When all patients (n = 36) were evaluated 6 months after BT, in addition to relief in the frequency and intensity of belching (p < 0.001), mental well-being had also improved (p < 0.05). Of all 36 patients, 27(75%) responded to BT. Depression scores were lower after therapy (p < 0.05). Only minor changes occurred in anxiety and HRQoL. CONCLUSIONS AND INFERENCES: Behavioral therapy is superior to follow-up without intervention in patients with SGB in reducing belching and depression; it also improves mental well-being but has only a modest effect on anxiety and HRQoL.

Time has not passed for the tilt table test.

INTRODUCTION: The tilt table test is used for determining the loss of consciousness, and in the case of reflex syncope, for gaining insight into the circulatory mechanism. In 2015, all tilt tests within the Hospital District of Helsinki and Uusimaa (HUS) were performed in the clinical physiology unit of the HUS Medical Imaging Center at Peijas Hospital. METHODS: The patients' medical history, circulation monitor printouts, and medical reports were recorded from all tilt tests carried out during 2015. Positive tilt tests were classified according to the VASIS classification and the elapsed time to loss of consciousness was observed. RESULTS: Among a total of 133 patients, abnormal upright tolerance was found in 30 per cent of the patients. The average time to loss of consciousness was 35.2 minutes. The most common mechanism of syncope was mixed reaction (60.0%), whereas vasovagal reaction (22.5%), cardioinhibitory reaction (10.0%), and lacking stroke volume response (7.5%) were less common. CONCLUSIONS: Practices of referral for the tilt table test vary among the different units of HUS. In our material, the cardioinhibitory reaction was less common than in previous studies.

Help from habit reversal for supragastric belching.

Supragastric belching differs from common gastric belching. It can be detected by 24-hour intra-esophageal impedance monitoring. Belching is seldom the only symptom: reflux symptom is present in 95% and dysphagia in 65% of the patients. In supragastric belching, the air does not come from the stomach but instead from the esophagus. Belching is caused by the patient him/herself swallowing air into the esophagus. This voluntary but unconscious symptom is treated by therapy in which explaining the mechanism of belching for the patient and learning of correct diaphragmatic breathing technique play a central role. Habit reversal is utilized for teaching the patient to react correctly to preemptive symptoms.

[Rumination in a young woman]. / Nuoren naisen ruminaatio eli märehtiminen.

Rumination refers to bringing up undigested or partially digested food mass from the stomach into the mouth to be rechewed and ingested. This manner of digestion is characteristic of e.g. cattle, but exceptional and likely to cause symptoms for humans. This rare malfunction can be traced on the basis of accurate patient history and confirmed at a test meal by manometry and impedance measurement. Regurgitation may in some patients be triggered by gastroesophageal reflux or air suction into the esophagus caused by an unconscious movement of the pancreas. After the condition has been recognized, behavioral therapy should be primarily considered.

Signal quality in a three-channel ambulatory electrocardiographic monitoring system.

BACKGROUND: Ambulatory electrocardiographic recordings are not infrequently hampered by technical artefacts. Verification of good original signal level and an adequate number of ECG channels should enhance the quality. METHODS: Data from all three-channel (mV5, mV1, III) recordings in Peijas hospital during one-calendar year were prospectively collected. A total of 255 recordings (24 h n = 239, and 48 h n = 16) made for 247 patients were analysed. Relative signal strength number (integer scale 5-0) was registered during hook-up. Final quality of recordings were afterwards evaluated with a three-point semi-quantitative scale by an experienced physician. RESULTS: The signal strength number was adequate (>or=3) in all 241 available cases. Distribution of signal strength did not significantly vary between ECG channels. The overall quality of recordings was 'good' in three-fourth of the cases and only were they seldom 'poor'. Signal strength and quality ratings were not significantly interrelated. The quality was, as expected, better in 24 h recording than in 48 recordings, and it was also better in channel III than in channel mV5. CONCLUSIONS: The original signal strength level (impedance) is not a crucial fact in ambulatory electrocardiographic recordings as long as it is within (specified) acceptable limits. In terms of quality, a third (inferior) ECG channel is recommendable.

Oxygen desaturation during oesophageal manometry.

Eighteen generally fit clinical patients were monitored with pulse oximetry. Mean oxygen saturation levels were lower (P<0.05) during oesophageal manometry (97.7-97.3%) than before it (98.3%). Fourteen out of seventeen (successful) traces had short 4-8% desaturation episodes, and in worst cases there were 8-9 episodes. It seems, therefore, that even patients with no predisposing factors than perhaps smoking and mild bronchial asthma are vulnerable to some oxygen desaturation in oesophageal manometry.