indigo-carmine and Gastroesophageal-Reflux

Gastroesophageal reflux disease (GERD) is common in the Western world. Upper endoscopy is needed to characterize the disease. Barrett's esophagus as a complication of GERD is an established precancerous condition which can lead to adenocarcinoma in the distal esophagus. This review summarizes recent advances in the endoscopic characterization of Barrett's esophagus using magnification endoscopy and chromoendoscopy. Methylene blue, indigo carmine and acetic acid are commonly used dyes to facilitate diagnosis of Barrett's esophagus. Methylene blue is absorbed in the specialized columnar epithelium, which is pathognomonic for Barrett's esophagus. Indigo carmine and acetic acid are used as contrast stains to highlight the surface architecture. Currently, different dyes are used in conjunction with magnifying endoscopes to characterize specific surface patterns of Barrett's epithelium. However, the current proposed classifications are too complex relative to their clinical value. Nevertheless, simplification of these systems will occur over time with increased use of magnifying chromoendoscopy. The value of magnifying chromoendoscopy for clinical practice is not determined yet and currently under investigation. However, these techniques have significant potential to improve diagnostic accuracy in patients with Barrett's esophagus.

Topics: Acetic Acid; Coloring Agents; Esophagoscopy; Gastroesophageal Reflux; Humans; Indigo Carmine; Methylene Blue; Predictive Value of Tests; Radiographic Magnification

To investigate the effect of lumbar ortheses with abdominal compression on gastro-oesophageal reflux and gastrointestinal transit.. In a prospective study 20 consecutive patients with lumbar syndrome treated with lumbar orthesis (10 female, 10 male, median age 54.6 years) were investigated for gastro-oesophageal reflux, mouth-to-cecum transit time (MCT), and whole-gut transit time. Gastro-oesophageal reflux was assessed performing an ambulatory pH metering of the distal oesophagus over a period of 10 h with and without ortheses on two separate study days. After positioning of the pH catheter patients ingested a liquid-solid test meal labelled with 10 g lactulose and 750 g indigocarmine to determine MCT with the hydrogen breath test and whole-gut transit by the first appearance of indigocarmine in the stool. Dyspepsia was assessed by using a standardized questionnaire.. Lumbar ortheses induced a significant increase in reflux time (pH < 4) (8.1 vs 4.1%), total number of reflux episodes (102.5 vs 69.5) and duration of longest reflux episode (6.0 vs 3.7 min) (P < 0.05). 12 patients with ortheses revealed an increase in relative reflux time (2.1-24.5%, median: 8.2%) more than two standard deviations compared to previously obtained normal values. In these patients during ortheses dyspeptic symptoms correlated significantly with reflux time (r = 0.6; P < 0.05). In contrast, MCT and whole-gut transit time in patients with and without ortheses did not differ significantly (85 vs 85 min; 10.2 vs 9.6 h).. Lumbar ortheses with abdominal compression, nowadays frequently used in the lumbar syndrome, produce gastro-oesophageal reflux associated with dyspepsia. Gastrointestinal transit time is not affected, though.

Topics: Adult; Aged; Aged, 80 and over; Breath Tests; Coloring Agents; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Agents; Gastrointestinal Motility; Gastrointestinal Transit; Humans; Hydrogen; Hydrogen-Ion Concentration; Indigo Carmine; Lactulose; Low Back Pain; Male; Middle Aged; Orthotic Devices; Pressure; Prospective Studies