Metal release profiles of orthodontic bands, brackets, and wires: an in vitro study.

AIM: The present study evaluated the temporal release of Co Cr, Mn, and Ni from the components of a typical orthodontic appliance during simulated orthodontic treatment. MATERIALS AND METHODS: Several commercially available types of bands, brackets, and wires were exposed to an artificial saliva solution for at least 44 days and the metals released were quantified in regular intervals using inductively coupled plasma quadrupole mass spectrometry (ICP-MS, Elan DRC+, Perkin Elmer, USA). Corrosion products encountered on some products were investigated by a scanning electron microscope equipped with an energy dispersive X-ray microanalyzer (EDX). RESULTS: Bands released the largest quantities of Co, Cr, Mn, and Ni, followed by brackets and wires. Three different temporal metal release profiles were observed: (1) constant, though not necessarily linear release, (2) saturation (metal release stopped after a certain time), and (3) an intermediate release profile that showed signs of saturation without reaching saturation. These temporal metal liberation profiles were found to be strongly dependent on the individual test pieces. The corrosion products which developed on some of the bands after a 6-month immersion in artificial saliva and the different metal release profiles of the investigated bands were traced back to different attachments welded onto the bands. CONCLUSION: The use of constant release rates will clearly underestimate metal intake by the patient during the first couple of days and overestimate exposure during the remainder of the treatment which is usually several months long. While our data are consistent with heavy metal release by orthodontic materials at levels well below typical dietary intake, we nevertheless recommend the use of titanium brackets and replacement of the band with a tube in cases of severe Ni or Cr allergy.

Long-term skeletal and dental effects of facemask versus chincup treatment in Class III patients : A retrospective study.

OBJECTIVES: To investigate the skeletal and dental changes during chincup versus facemask treatment, to compare the long-term effects of the two appliances, and to document the impact of each on treatment success. METHODS: In all, 61 patients with Class III syndrome were retrospectively analyzed at three examination times: 7.8 ± 1.7 years of age (T0, pretreatment), 9.6 ± 2.4 years of age (T1, posttreatment), and around 15-20 years later (T2, long-term follow-up). RESULTS: Significant changes of specific cephalometric parameters for all treatment times: T0-T1 (SNA, interbase and gonial angle, Björk's sum angle, maxillomandibular differential, and distance of upper lip to esthetic line), T1-T2 (NL-NSL, SNB, mandibular-body length, effective mandibular length, and effective maxillary length), and T0-T2 (mandibular-body length, effective mandibular length, effective maxillary length, maxillomandibular differential, SNB, ANB, gonial angle, Björk's sum angle, and Wits appraisal). The T1-T2 results illustrate that in both treatment groups the typical Class III growth pattern often reappeared after treatment, including gains in SNB angle, condylion-gnathion length, and gonion-menton distance. CONCLUSIONS: Either a facemask or a chincup may be effectively used to treat Class III malocclusion. There were differences in long-term stability. Maxillary development was similarly favorable in both groups of patients with successful outcome. The subgroup in whom chincup treatment had failed were mainly characterized by excessive mandibular growth, or lack of maxillary catch-up growth, with deterioration of the maxillomandibular relationship notably in the initial phase of treatment. Early chincup treatment did not have an adverse impact on the temporomandibular joints.

Retrospective 25-year follow-up of treatment outcomes in angle Class III patients : Early versus late treatment.

OBJECTIVES: To assess early versus late treatment of Class III syndrome for skeletal and dental differences. METHODS: Thirty-eight Class III patients treated with a chincup were retrospectively analyzed. Baseline data were obtained by reviewing pretreatment (T0) anamnestic records, cephalograms, and casts. The cases were assigned to an early or a late treatment group based on age at T0 (up to 9 years or older than 9 years but before the pubertal growth spurt). Both groups were further compared based on posttreatment data (T1) and long-term follow-up data collected approximately 25 years after treatment (T2). RESULTS: Early treatment was successful in 74% and late treatment in 67% of cases. More failures were noted among male patients. The late treatment group was characterized post therapeutically by significantly more pronounced skeletal parameters of jaw size relative to normal Class I values; in addition, a greater skeletal discrepancy between maxilla and mandible, higher values for mandibular length, Cond-Pog, ramus height, overjet, anterior posterior dysplasia indicator (APDI), lower anterior face height, and gonial angle were measured at T1. The angle between the AB line and mandibular plane was found to be larger at T0, T1, and T2, as well as more pronounced camouflage positions of the lower anterior teeth at T0. The early treatment group was found to exhibit greater amounts of negative overjet at T0 but more effective correction at T1. CONCLUSIONS: Early treatment of Class III syndrome resulted in greater skeletal changes with less dental compensation.

[Polydipsia, increasing fatigue and a huge mediastinal tumor in a 49-year-old woman]. / Polydipsie, zunehmende Müdigkeit und große mediastinale Raumforderung bei einer 49-jährigen Patientin.

A 49-year-old woman presented with unspecific symptoms including polydipsia, increasing fatigue for several weeks, and vague abdominal pain. Serum calcium (5.30 mmol/l; normal range 2.00-2.60) and parathyroid hormone levels (> 2500.0 ng/l; normal range 15.0-68.0) were extremely elevated. Imaging studies showed a huge mediastinal tumor. Based on these findings a hypercalcemic crisis caused by primary hyperparathyroidism was diagnosed. After intensive care treatment and further diagnostic procedures, the patient's parathyroid adenoma was removed by parathyroidectomy. The postoperative course was uneventful.

Remodelling of the palatal dome following rapid maxillary expansion (RME): laser scan-quantifications during a low growth period.

OBJECTIVES: To evaluate changes in the palatal vault after rapid maxillary expansion (RME) with bonded splint appliances. SETTING AND SAMPLE POPULATION: The sample comprised 24 children (12 boys and 12 girls) with mixed dentition (mean age 8.3 years; range 6.4-10.4 years). MATERIALS AND METHODS: Following expansion, the splint appliance was used as a retainer for 6 months and then removed. Study casts were taken before RME (T0) and when the appliance was removed (T1). Then, 3D laser scans were taken to build complete 3D jaw models. Frontal cross sections were constructed at 53-63, 55-65 and 16-26, exported as coordinates, and finite element calculated to quantify their area, width and height. Maxillary length was also determined. RESULTS: Paired t-tests indicated statistically significant increases in the average palatal width (T1-T0=6.53-6.79 mm) and cross-sectional area (T1-T0=20.39-21.39 mm2) after RME (p<0.001). However, small but statistically significant reductions were observed in palatal height (T1-T0=-0.49 mm, only at 55-65; p<0.001) and length (T1-T0=-0.54 mm; p<0.01). Linear regression analysis showed statistically significant (p<0.001) direct correlations between the widths and respective cross-sectional areas. Age did not influence any measurement. The reliability of the measurements was examined with an intraclass correlation coefficient (ICC). We found an ICC>0.99 (p<0.001) for all tested parameters. CONCLUSIONS: Rapid maxillary expansion distinctly increased mean palatal widths and cross-sectional areas. However, palatal height (55-65) and maxillary length decreased to a small extent.

Comparative bond strength of new and reconditioned brackets and assessment of residual adhesive by light and electron microscopy.

An average rate of bracket loss of between 4.7 and 6 per cent is to be expected in daily clinical orthodontic practice during a typical 2 year treatment period. For reasons of economy, detached brackets are commonly reattached after sandblasting to remove adhesive, or replaced with used brackets reconditioned by specialist companies. In the present study, sandblasting and specialist bracket-reconditioning procedures were systematically compared by comparative shear testing of rebonded, reconditioned, and new brackets (n = 160) using light- and chemically cured adhesives. Statistical analysis was carried out with Kruskal-Wallis and Mann-Whitney tests. The mean bond strength of reconditioned brackets was, in each case, lower than that of new brackets, with the lowest value obtained with sandblasted brackets. This nevertheless exceeded the minimum recommended value of 5-8 MPa. Bond strength was generally higher with chemically than with light-curing adhesive; the chemically curing adhesive provided bond strength on previously bonded enamel higher than the light-curing adhesive on intact teeth. Consistent with this, the results of the adhesive remnant index (ARI) demonstrated improved bonding with the chemically curing than the light-curing adhesive to the bracket base. Despite resulting in a weaker bond strength compared with new brackets, sandblasting brackets accidentally detached during orthodontic treatment will generally allow effective reattachment to be achieved. Bond strength can be improved with the use of a chemically cured adhesive. Used brackets reconditioned by specialist companies provide a second alternative to new brackets and higher bond strengths than sandblasted brackets.

Rapid maxillary expansion screws on the test bench--a pilot study.

In order to apply high, short-term forces during rapid maxillary expansion (RME) to the sutures of the maxilla with minimum loss of force and without causing unwanted side-effects (dentoalveolar tipping, etc.), the appliance should be as rigid as possible. The retention arms of the RME screws, representing a particularly vulnerable and stressed weak point of RME appliances, were the focus of this laboratory technical study. Retention arms of 16 types of RME screws comprising four arms and one with eight arms were examined using a three-point bending test. According to their ability to absorb the applied bending loads, the screws were classified in product groups from 1 (highest) to 6 (lowest). Fifteen of the tested retention arms (stainless steel), despite having the same diameter (1.48-1.49 mm), differed up to 69.81 per cent between the highest (288.0 N) and lowest (169.6 N) maximum force parameters and up to 66.40 per cent between the highest (3325.9 N/mm(2)) and lowest (1998.7 N/mm(2)) maximum bending stress parameters. Due to optimum formability, though reduced rigidity, a titanium screw for nickel-sensitive patients (group 6) displayed the lowest force and bending tension values. The stainless steel double arms of the eight-arm screw device welded on both ends displayed the highest force data. The mean ductilities of the groups with the most and least rigid single steel arms differed by 22.77 per cent. Statistical analysis using the Pearson correlation coefficient revealed a significant indirect correlation between ductility and both maximum force (r = -0.780, P < 0.001) and maximum bending stress (r = -0.778, P < 0.001). The SUPERscrews, the Tiger Dental four-arm screw (group 1), and the eight-arm screw displayed the highest capacity to absorb an applied bending load. The screws in groups 3-6 appear acceptable for RME during the pre-pubertal period, whereas in the pubertal and post-pubertal period, groups 1 and 2 are sufficient. In early adulthood only the screws in group 1 and especially the eight-arm screw seem advisable, as mechanical demands increase with age.

In vitro release of phosphoric acid ester from self-etching primer.

Self-etching primers have simplified the process of direct bonding of dental resins, by eliminating the rinsing step after etching in conventional bonding, for example. Although it is generally assumed that all of the applied self-etching primer is incorporated into the resin, the possibility that a substantial amount remains free and extractable into a person's saliva has not been investigated. The aim of the present study was to examine this issue by bonding brackets to extracted teeth with self-etching primers under controlled conditions and determining the proportion of the applied phosphoric acid ester that is subsequently extractable by high-performance liquid chromatography. Approximately half of the applied acid ester was extractable and thus not integrated into the polymeric network following standard light curing. This was reduced to 40% when the curing time was doubled. Acid ester leaching was a rapid process that was essentially completed within an hour.

Indirect bonding--a new transfer method.

The aim of this in vitro study was to investigate both shear bond strength (SBS) by shear testing of indirectly bonded brackets, and the accuracy of a new transfer method, the Aptus bonding device (ABD). For comparison, the SBS of directly bonded brackets in two experimental arrangements was also measured. The precision of the positioning of the indirect bracket transfer was assessed by photographic superimposition and three-dimensional (3D) measurement of the bracket positions on the working and plaster models using a 3D laser scan. Statistical analysis was carried out by means of descriptive and explorative data using the SPSS program. To compare groups, a one-factor analysis of variance and post hoc tests (Tukey-HSD) were used. The level of significance was set at P < 0.05. SBS using indirect and direct bonding, with the same experimental arrangement and the same adhesives (Concise and Transbond), showed no significant differences. For direct bonding, using only one adhesive (Transbond), lower values were observed, but they were only statistically significant for the premolar teeth. The clinically required minimum bond strength of 6 MPa was achieved in all groups. Superimposition of the photographs of the indirectly bonded upper labial segment brackets showed no deviations. The results of the 3D measurement of the positions of the brackets on the working and plaster models only yielded small deviations (0.15 mm along the X-axis in the centre, 0.17 mm along the Y-axis, and 0.19 mm along the Z-axis). The ABD is a useful adjunct to bond placement and does not compromise bond strength.

White wine and beer induce gastro-oesophageal reflux in patients with reflux disease.

BACKGROUND: An induction of gastro-oesophageal reflux has been reported after ingestion of alcoholic beverages in healthy volunteers. However, it is unknown whether reflux in gastro-oesophageal reflux disease patients will be enhanced by the ingestion of alcoholic beverages. AIM: To investigate the effects of wine and beer on postprandial reflux in reflux patients. METHODS: Twenty-five patients (reflux oesophagitis 15, non-erosive reflux disease 10; 18 men and seven women) drank 300-mL white wine (n = 17), 500-mL beer (n = 8), or identical amounts of tap water (controls) together with a standardized meal in a randomized order. pH-measurement was carried out during three postprandial hours by pH-metry and the percentage of time pH < 4 was calculated. RESULTS: Both alcoholic beverages increased reflux compared with water [wine 23% (median), water 12%, P < 0.01; beer 25%, water 11%, P < 0.05]. Between wine and beer, no difference in reflux induction was obtained. The reflux induction was seen in patients with (23%, P < 0.01) and without reflux oesophagitis (22%, P < 0.05) and in both sexes (women 23%, men 25%, P < 0.05 each). CONCLUSIONS: Ingestion of commonly consumed alcoholic beverages such as wine and beer induces gastro-oesophageal reflux in gastro-oesophageal reflux disease patients. Therefore, these patients should be advised to avoid the intake of large amounts (> or = 300 mL) of these beverages.

A comparative in vitro study of the strength of directly bonded brackets using different curing techniques.

The aim of this study was to compare, by shear testing, the bond strengths after 1 and 24 hours of a light-cured resin (Enlight) and a light-cured glass ionomer cement GIC (Fuji Ortho LC) using various polymerization lamps (halogen, high performance halogen, xenon, and diode) for the direct bonding of brackets. The self-curing resin (Concise) was used as the control. The analysis was carried out using the SPSS program. For group comparison purposes, the single factor variance analysis (ANOVA) and the post-hoc test (Tukey's HSD) were used. The level of significance was established at P < 0.05. When comparing two mean values the t-test for independent random samples was employed. All polymerization lamps achieved the minimum bond strength of 5-8 MPa. With Enlight LV, bond strength was dependent on curing time (the halogen lamp achieved the highest bond strength of 10.0 MPa, P < 0.001, with a curing time of 40 seconds. The other lamps showed similar results) and on the mode of cure (the highest bond strength values were achieved by four-sided curing, P= 0.04). Fuji Ortho LC, on the other hand, was independent of the duration of light curing and the type of lamp used. The bond strengths of the resin-modified glass ionomer cement (RMGIC) were similar to or somewhat higher than those achieved with light-cured composite resin (P = 0.039) when lamps with short polymerization times were used, but were significantly lower (P< 0.001) when compared with the self-curing composite adhesive. After 24 hours, the bond strengths of all adhesives showed a significant increase: Enlight 19 per cent, Fuji Ortho LC 6.6 per cent, Concise 16 per cent. Bond failure occurred for Enlight at the bracket-composite resin adhesive interface in 90 per cent and with Concise in 57 per cent. However, Fuji Ortho LC showed far more cohesive and mixed failures, indicating an improved bond between bracket and cement.

A comparative study of polymerization lamps to determine the degree of cure of composites using infrared spectroscopy.

The aim of this study was to compare polymerization lamps of various technologies (halogen, high performance halogen, xenon, i.e. plasma arc, as well as diode lamps) to determine the degree of polymerization of composite probes using Fourier-transform infrared (FTIR) spectroscopy. To observe the light-induced curing reaction under a bracket, an attenuated total reflection (ATR)-FTIR was used. The results showed that the recommended curing times for all the polymerization lamps tested were adequate for successful polymerization of the composite used (degree of conversion approximately 60 per cent, which did not exceed 66 per cent after longer curing times). However, even after very long curing times, delayed curing of the composite must be taken into consideration as there was a decrease of approximately 10 per cent in FTIR band intensities (1637 and 3104 cm(-1)). ATR-FTIR spectroscopy showed that when bonding brackets with materials cured by light, uncured areas remain in the centre of the lowest layer of the adhesive.

Effect of caloric density of a meal on lower oesophageal sphincter motility and gastro-oesophageal reflux in healthy subjects.

BACKGROUND: Patients with gastro-oesophageal reflux disease are advised to avoid the ingestion of large meals. In healthy volunteers, a relationship between the amount of postprandial gastro-oesophageal reflux and the volume of a liquid meal has been demonstrated. AIM: To evaluate whether the amount of postprandial gastro-oesophageal reflux is also related to the calorie content of a meal, a second parameter that will be reduced by avoidance of the ingestion of large meals. METHODS: Twelve healthy volunteers (six female, 19-31 years) received two solid-liquid meals with either 842 kcal (solid 582 kcal, liquid 260 kcal) or 582 kcal (31% reduction) in a randomized order. The nutritional components (10% fat, 76% carbohydrates, 14% protein) and the volume of the meals were identical in both meals. The lower oesophageal sphincter pressure was measured continuously in the first postprandial hour with a Dent sleeve, and pH-metry was performed for 3 h postprandially with a glass electrode in the distal oesophagus. Blinded to the type of ingested meal, we calculated the mean lower oesophageal sphincter pressure, the frequency of transient lower oesophageal sphincter relaxations, the number of reflux episodes, and the fraction of time for which pH < 4. RESULTS: A similar decrease in lower oesophageal sphincter pressure was observed after ingestion of the high calorie meal (median 10.9 mmHg, range 4.8-16.7 mmHg) and low calorie meal (median 9.9 mmHg, range 3.9-18.4 mmHg). No difference in the number of transient lower oesophageal sphincter relaxations (high calorie: median 9 per hour, range 5-13 per hour; low calorie: median 7 per hour, range 0-14 per hour) and of reflux episodes (high calorie: median 12 in 3 h, range 3-22 in 3 h; low calorie: median 12 in 3 h, range 3-30 in 3 h) was registered after intake of both types of meal. Additionally, no difference was identified regarding the fraction of time for which pH < 4 between the high calorie (mean 2.3%, 0.2-23.7%) and low calorie meal (3.3%, 0.5-17.8%). CONCLUSION: Reducing the caloric density of a meal neither influences postprandial lower oesophageal sphincter pressure nor decreases gastro-oesophageal reflux in healthy volunteers. Thus, the amount of gastro-oesophageal reflux induced by ingestion of a meal seems to depend on the volume but not on the caloric density of a meal.

Effect of white wine on esophageal peristalsis and acid clearance.

BACKGROUND: In a previous study it was demonstrated that white wine reduces the lower esophageal sphincter pressure and induces gastroesophageal reflux characterized by reflux episodes of long duration. In the present study, it was evaluated whether wine disturbs esophageal peristalsis and acid clearance. METHODS: Twelve healthy volunteers (7F, 23-37 years) received 300 ml white wine (8% vol/vol; WW), an ethanol solution (8% vol/vol; ET) or tap water (WA) together with a standardized meal in a random order. Acid clearance was tested by instillation of 15 ml 0.1 N HCI into the distal esophagus. The number of swallows (dry swallow every 30 sec) were counted until pH rose again above 5. Five wet swallows (5 ml) were applied to test primary peristalsis and five insufflations of 20 ml of air were performed to test secondary peristalsis. Each test was done immediately after and 60 min after ingestion of the beverages. RESULTS: A significantly higher number of swallows were needed to clear the esophagus immediately after ingestion of wine (P < 0.01; median number: WW 12; ET 8; WA 7) due to an increase in the frequency of failed, simultaneous, and low-amplitude contractions. The frequency of triggered secondary contractions was decreased (P < 0.02; WW 70%; ET 100%; WA 100%) and the latency between air injection and onset of secondary peristalsis was prolonged (P < 0.05; WW 9 sec; ET 7 sec; WA 6 sec) immediately after ingestion of white wine. Wet swallow induced primary peristalsis was not influenced by wine. No significant differences in the measured parameters were seen 60 min after ingestion of the three beverages. CONCLUSION: White wine disturbs temporarily esophageal clearance due to a disturbance of triggering secondary peristalsis and due to an increase in ineffective contractions. The ethanol content alone is not responsible for the effects of white wine on esophageal peristalsis and acid clearance.

Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects.

OBJECTIVE: The reported effects of fatty meals on lower esophageal sphincter pressure (LESP) and gastroesophageal reflux (GER) are controversial. Therefore, the aim of the present study was to reevaluate the effect of isocaloric and isovolumetric low and high fat meals on LESP and GER. METHODS: Twelve healthy volunteers (six women, six men, 19 to 31 yr) received an isocaloric (842 kcal) solid-liquid (310 ml with 260 kcal) meal with either a low (10% fat, 14% proteins, 76% carbohydrates) or a high fat content (50% fat, 18% proteins, 32% carbohydrates) in a randomized, double-blinded fashion. The nutritional composition was identical for the solid and liquid part of the meals. In the first post-prandial hour LESP was recorded continuously using a Dent sleeve, and esophageal pH measurement was performed for 3 h postprandially with a glass electrode. We calculated the mean LESP, the frequency of transient LES relaxations (TLESR) and of reflux episodes (RE), the percentage of TLESR with GER, and the fraction time pH <4. RESULTS: For all parameters measured no difference was observed between the low and the high fat meal. Mean LESP amounted to a median of 10.7 mm Hg (range, 7.3 to 15.1 mm Hg) after the low fat meal and to 11.1 mm Hg (5.2 to 16.3 mm Hg) after the high fat meal. The frequency of TLESR (n/1 h) rated to 9 (5 to 13) and 8 (4 to 14), and of RE (n/3 h) to 12 (3 to 22) and 11 (1 to 30). The percentage of TLESR with GER were 37% (0 to 100) and 30% (0 to 78). The fraction time pH <4 amounted to 2.3% (0.2 to 23.7) and 1.8% (0.1 to 28.8) after the low and high fat meal, respectively. CONCLUSIONS: In healthy volunteers no difference in post-prandial LESP and GER was seen after a high fat meal compared with an isocaloric and isovolumetric low fat meal. Our results suggest that it is inappropriate to advise GER patients to reduce the fat content of their meals for symptom relief.

Effects of two anticholinergic drugs, trospium chloride and biperiden, on motility and evoked potentials of the oesophagus.

BACKGROUND: Anticholinergic drugs are known to impair the motor function of the oesophagus but their effects on the oesophageal afferent pathways are unknown. AIM: To determine the effects of a peripherally-acting (trospium chloride) and a centrally-acting (biperiden) anticholinergic drug on the motility and the evoked potentials of the oesophagus. METHODS: Nine healthy volunteers were randomized to receive 1.2 mg trospium chloride (TC), 5 mg biperiden (BIP) or saline i.v. Primary peristalsis was elicited by swallowing a 5 mL water bolus and secondary peristalsis by insufflation of 20 mL air, 10 times each. Oesophageal potentials were evoked by electrical stimulation in the distal and proximal oesophagus (30 stimulations at 0.4 Hz, two runs). RESULTS: Both anticholinergic drugs reduced by a similiar amount the contraction amplitudes (TC 17 mmHg, BIP 25 mmHg, saline 67 mmHg; P < 0.01) and the rate of secondary contractions (TC 60%, BIP 70%, saline 95%; P < 0.01). In contrast, only biperiden prolonged the latencies of the evoked potentials (N1 peak, distal oesophagus: BIP 191 ms, TC 102 ms, saline 101 ms; P < 0.01; P1 peak: BIP 322 ms, TC 161 ms, saline 144 ms; P < 0.01). CONCLUSIONS: Both anticholinergic drugs depress oesophageal motility, but only the centrally-acting anticholinergic drug biperiden modifies the oesophageal evoked potentials, suggesting a central cholinergic transmission of the oesophageal afferent pathways.

Different effects of white and red wine on lower esophageal sphincter pressure and gastroesophageal reflux.

BACKGROUND: White wine and beer induce gastroesophageal reflux (GER). We investigated the effects of white and red wine on lower esophageal sphincter pressure (LESP) and GER. METHODS: Twenty healthy volunteers received 300 ml white wine, red wine, or water together with a standardized meal. The LESP was continuously monitored with a Dent sleeve the 1st h postprandially, and the esophageal pH measured with a glass pH electrode. RESULTS: The LESP was decreased after intake of white wine (median, 14.9 mmHg; range, 5.6-19.5 mmHg) compared with red wine (20.4 mmHg; 13.1-22.3 mmHg; P < 0.05) and tap water (19.5 mmHg; 16.2-29.1 mmHg; P < 0.01). The fraction time esophageal pH <4 was increased after both alcoholic beverages compared with tap water (0.9%; 0.2-5.8%; P < 0.01 versus white wine, P < 0.05 versus red wine) with a greater fraction time after white wine (13.2; 0.3-58.1 ) than after red wine (2.3; 0.7-24.4; P < 0.05). The decreased sphincter pressure after white wine was accompanied by a change in the reflux pattern with increased 'stress reflux' and the occurrence of 'free reflux'. CONCLUSION: White wine and red wine exert different effects on LESP and GER.

Effect of smoking on the results of esophageal pH measurement in clinical routine.

Because data on the effects of smoking on gastroesophageal reflux are controversial, we evaluated the effect of smoking on the results of esophageal 24-hour pH-metry in clinical routine. Participants were 280 consecutive patients with symptoms suggestive of reflux disease, 78 smokers, and 202 nonsmokers. Of the smokers, 45 actually smoked during the pH measurement and 33 abstained from smoking. The frequency of reflux episodes, the fraction of time pH was < 4, and the percentage of abnormal 24-hour pH-metry results were compared among actual smokers, abstaining smokers, and nonsmokers. In actual smokers, the effect of smoking on gastroesophageal reflux was further analyzed by comparing the reflux frequency and the fraction of time that pH was < 4 for a 10-minute period before, during, and after smoking. We found no difference in reflux frequency and fraction of time that pH was < 4 among actual smokers, abstaining smokers, and nonsmokers, regardless of a normal or an abnormal pH-metry result. The percentage of patients with a pH-metry result indicating disease was similar in the three groups, at 53%, 52%, and 50%, respectively. Gastroesophageal reflux was not increased during smoking a cigarette or in the postsmoking period compared with the presmoking period. Neither being a smoker nor actually smoking a cigarette had a negative influence on gastroesophageal reflux. Thus smoking or abstaining from smoking does not modify the results of pH-metry in clinical routine.

The effect of decaffeination of coffee on gastro-oesophageal reflux in patients with reflux disease.

BACKGROUND: Patients with reflux disease often complain of heartburn after ingestion of coffee. Induction of gastro-oesophageal reflux has been demonstrated by pH-metry following the intake of coffee in healthy volunteers. The reflux was reduced when the coffee had undergone a decaffeination process. The aim of this study was to investigate the effect of decaffeination of coffee on reflux in patients with reflux disease. METHODS: Seventeen reflux patients underwent two osesophageal 3-h pH measurements. The patients received, in a double-blind study design in a randomized order, 300 mL of either regular or decaffeinated coffee together with a standardized breakfast. The fraction time oesophageal pH < 4 was calculated during the three postprandial hours. RESULTS: For regular coffee the fraction time was calculated to a median of 17.9% with a range of 0.7-56.6%. The fraction time was significantly reduced to 3.1% (0-49.9%) after ingestion of decaffeinated coffee. CONCLUSION: The amount of gastro-oesophageal reflux induced by the intake of regular coffee in patients with reflux disease can be reduce by the decaffeination of coffee.

Effect of erythromycin on postprandial gastroesophageal reflux in reflux esophagitis.

UNLABELLED: The macrolide antibiotic erythromycin has recently been reported to exert profound prokinetic properties. The aim of the study was to investigate the effect of erythromycin on postprandial gastroesophageal reflux in patients with reflux esophagitis. METHODS: In 16 patients with reflux esophagitis (according to Savary and Miller: grade I, n = 8; grade II, n = 4; grade III/IV, n = 4) two pH measurements, with and without erythromycin, were performed for three postprandial hours after lunch. Erythromycin was administered in a dose of 3.5 mg/kg intravenously just prior to lunch. RESULTS: With erythromycin, the median fraction time esophageal pH < 4 was significantly decreased (7.6% versus 18.1%; P < 0.05). This decrease was the result of a diminished frequency of reflux episodes (19 vs 25; P < 0.05) and a shortening of the median reflux duration (0.7 min vs 1.1 min; P < 0.05). CONCLUSIONS: Intravenous administration of erythromycin decreases postprandial gastroesophageal reflux in patients with reflux esophagitis.