Regurgitation Of Stomach Contents Research Articles

Prevalence of Gastroesophageal Reflux Disease among Diabetic Patients at Sharif Medical City Hospital, Lahore, Pakistan

Background: Diabetes mellitus has been linked to various gastrointestinal motility disorders, including gastroesophageal reflux disease (GERD).This study aimed to determine the proportion of GERD in patients with diabetes mellitus.Method: This descriptive cross-sectional study was conducted at the medical outpatient department of Sharif Medical City Hospital, Lahore, from October to December, 2020. Patients previously diagnosed with type II diabetes were included using non-probability consecutive sampling, and the GERDQ questionnaire was used to determine the frequency. IBM SPSS statistics version 23 was used for the analysis of data.Results: Of the 273 participants, 183 (67.0%) were male and the mean age was 51.13±12.8 years. The mean duration of diabetes was 6.97±4.76 years and oral hypoglycemic agents were used by 133 (48.7%) participants. Overall, 133 (48.7%) of the participants had GERD with a mean GERDQ score of 10.8(±1.4).Conclusion: Almost half (48.7%) of the participants have GERD; the most common symptom is regurgitation of stomach contents. Awareness should be raised, and early screening should be done to prevent long-term complications.

Gastroesophageal reflux disease - from the point of view of a gastroenterologist, otolaryngologist and surgeon.

Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.

A Case of Acute Esophageal Necrosis in a Patient With Multiple Sclerosis

Introduction: Acute esophageal necrosis (AEN) is a rare syndrome with incidence of .01 to .28% on endoscopic series and mortality of 32%. Known as “Black Esophagus,” it's characterized endoscopically by circumferential black mucosa ending abruptly at the gastroesophageal junction. It has been postulated that precipitating events include hypoperfused states and gastric outlet obstruction with concurrent esophageal reflux. Case: A 77-year-old Caucasian female with remote history of peptic ulcer disease and progressive multiple sclerosis (MS) presented with diffuse abdominal pain, nausea, and vomiting. Urinalysis was suggestive of a urinary tract infection (UTI) and she was discharged on five-days of cephalexin. She delayed taking cephalexin and returned four days later with fatigue, worsening dysphagia, and melena. She was hypotensive and labs revealed leukocytosis, acute blood loss anemia, and acute kidney injury. Urine culture grew extended-spectrum beta lactamase producing multi-drug resistant proteus mirabilis. She was admitted for septic and hypovolemic shock secondary to multi-drug resistant UTI and suspected upper gastrointestinal bleeding. Ertapenem was started in light of the resistance and sensitivity pattern of the causative organism. Upper endoscopy revealed diffuse mucosal changes characterized by black discoloration throughout the esophagus and obstructive duodenal ulcer with adherent clot (Figure 1). Endoscopic findings and presentation was consistent with AEN. She improved with vasopressor support, fluid resuscitation, and 14-days of ertapenem. Discussion: AEN is a multifactorial syndrome with notable morbidity. Risk factors include alcohol abuse, hypertension, male gender, diabetes, dyslipidemia, malnourishment, and chronic kidney disease. The most common presentation is upper GI hemorrhage but dysphagia, chest and epigastric pain can also occur. Diagnosis is made endoscopically and histologic confirmation of tissue necrosis is recommended but not required. Treatment involves management of inciting insult(s), acid suppression with intravenous proton pump inhibitor therapy and “nil per os.” A video swallow study revealed mild oral and moderate pharyngeal dysphagia that was attributed to MS. Dysphagia and regurgitation of stomach contents from gastric outlet obstruction predisposed patient to hypovolemia. Septic shock and an obstructive duodenal ulcer with blood loss anemia culminated to promote the development of AEN.1793 Figure 1. Black discoloration of mucosa in the upper third of the esophagus (A), and the middle third of the esophagus (B), normal mucosa at the gastroesophageal junction as seen in retroflexion (C), and duodenal bulb ulcer (D).

Optimization of high density long duration transportation of silver carp (Hypophthalmichthys molitrix) and rui (Labeo rohita) fingerlings

The effects of density (50, 55 and 60 kg fingerlings/drum of 200 litre) on the mortality and essential water quality variables were assessed for silver carp Hypophthalmichthys molitrix fingerlings in a simulated transport experiment. The second experiment involved the determination of the effects of knowing the optimum loading density 50 kg/drum fingerlings on the mortality and water quality in silver carp advanced fingerlings for standard 8 hours transport simulation. Six hours of simulation duration resulted in less than 1% mortality and 8 hours caused about 6%. Third experiment with highest density 60 kg/drum fingerlings at 500 g/l of advanced rui (Labeo rohita) fingerlings was used for a period of 6 hours since the quality of the transport medium was deteriorated due to regurgitated stomach contents. The fingerlings were unconditioned and fed. Level of immediate mortality was only nearly 3% at 6 hours of simulation duration. This study has clearly demonstrated that the optimum loading of silver carp fingerlings per drum is 50 kg. The minimum concentration of dissolved oxygen (DO) concentration for maximum survival is 2 mg/l for silver carp fingerlings. Silver carp advanced fingerlings can be transported for 8 hours duration by using 2 phenoxyethanol at the concentration of 115 μl/l with oxygen injection. Rui advanced fingerlings can be transported at 60 kg/drum (500 g/l) for 6 hrs duration even if the fingerlings are unconditioned.
 Dhaka Univ. J. Biol. Sci. 27(1): 9-16, 2018 (January)

Molecular analysis of stomach contents reveals important grass seeds in the winter diet of Baird's and Grasshopper sparrows, two declining grassland bird species.

We analyzed the diet of Baird’s Sparrow (Ammodramus bairdii) and Grasshopper Sparrow (A. savannarum) in three different sites and sampling periods across the Chihuahuan Desert in northern Mexico. DNA from seeds in regurgitated stomach contents was sequenced using NGS technology and identified with a barcoding approach using the P6 loop of the trnL intron as genetic marker. During each sampling period, we collected random soil samples to estimate seed availability in the soil seed bank. Due to the variability and size of the genetic marker, the resolution was limited to a family level resolution for taxonomic classification of seeds, but in several cases a genus level was achieved. Diets contained a high diversity of seeds but were dominated by a limited number of genera/families. Seeds from Panicoideae (from the genera Panicum, Setaria, Eriochloa, Botriochloa, and Hackelochloa) contributed for the largest part to the diets (53 ± 19%), followed by Bouteloua (10 ± 12%). Depending on the site and sampling period, other important seeds in the diets were Eragrostideae, Pleuraphis, Asteraceae, Verbena, and Amaranthus. The most abundant seeds were not always preferred. Aristida and Chloris were common in the soil seed bank but these seeds were avoided by both bird species. Baird’s and Grasshopper sparrows did not differ in seed preferences. This work highlights the importance of range management practices that favor seed production of Panicoideae and Bouteloua grasses to enhance winter habitat use and survival of Baird’s and Grasshopper sparrows in the Chihuahuan Desert.

Food habit of the endangered yellow-spotted newt Neurergus microspilotus (Caudata, Salamandridae) in Kavat Stream, western Iran

Diversity and abundance of macroinvertebrate fauna were simultaneously determined in selected benthic samples and in regurgitated stomach contents in Neurergus microspilotus in Kavat Stream (western Iran) during April and May 2012. The aim of this study was to determine the degree of reliance of this species to benthic macroinvertebrates during their reproductive season in aquatic habitat. Twenty-one taxa of macroinvertebrates were identified in the benthic samples while 19 taxa were presented in the regurgitated stomach contents. Data obtained from benthic samples showed that the most abundant macroinvertebrate groups included Lumbricidae (27.2%), Mycetophilidae (20.06%), Gammaridae (12.19%), and Plananariidae (9.3%). Data obtained from 45 stomach contents indicated that on average the highest importance values combining number, frequency, and volume for prey categories consumed included Mycetophilidae (14.03%), Baetidae (13.68%), Corbiculidae (12.57%), Gammaridae (10.8%), and Lumbricidae (9.34%). N. microspilotus also consumed small stones, plant materials, and their own eggs (0.91%). The analysis of selectivity in feeding using Ivlev’s index showed that the prey taxa that appeared to be preferred (E i > 0.5) were generally rare in the environment. Comparison between benthic macroinvertebrates and those taken by the newt demonstrates that although high similarity (Sorenson index of 78.94%) exists between the two communities, the dominance of the items taken by N. microspilotus (Simpson index = 0.32) is higher than that of the benthic community (Simpson index = 0.20) indicating that the newts rely on fewer number of species with higher proportion of individual prey items. Feeding habits of 45 N. microspilotus have shown that the newts rely extensively on Mycetophilidae, Baetidae, Corbiculidae, Gammaridae, and Lumbricidae as important food items for N. microspilotus.

Diet and trophic niche of Macrourus spp. (Gadiformes, Macrouridae) in the Ross Sea region of the Southern Ocean

Both Macrourus caml and M. whitsoni are probably abundant and widespread in the Ross Sea region at depths between approximately 500 and 2100 m. We present the analysis of stomach contents (including regurgitated stomach contents) from an undifferentiated mixture of 33 specimens of these species (henceforth Macrourus spp.) in the Ross Sea region of the Southern Ocean. Samples of stomach contents were obtained from the Ross Sea slope (between about 71° and 73° S) and on the Scott Island and seamount chain. Overall, amphipods were the dominant prey found in Macrourus spp. stomachs with an index of relative importance (IRI) of 43%. About half the amphipods were Eurythenes gryllus and about half could not be identified. Based on stable isotope results, unidentified amphipods were probably herbivorous rather than carnivorous. Other important prey were copepods (especially for fish with total length less than 30 cm), krill (mainly Euphausia superba for larger fish) and fishes (Pleuragramma antarcticum and Gymnoscopelus opisthopterus). Minor prey found in stomachs included isopods, mysids, salps and polychaetes, with rocks and fragments of coral, echinoderm and shell also found. Stomach contents data provide evidence of both pelagic and benthic feeding. Carbon and nitrogen stable-isotope analysis of 161 Macrourus spp. muscle tissue samples from the Ross Sea slope, Admiralty and Scott seamounts and two parts of the Pacific-Antarctic fracture zone (near 65° S) are presented. Nitrogen isotope results (δ15N = 10.6 ± 1.0‰, mean ± SD) were generally consistent with stomach contents. Carbon isotope results (δ13C = −24.7 ± 0.8‰) were consistent with Southern Ocean residence but higher than phytoplankton values (−29.9 ± 1.2‰). We found that Macrourus spp. in the Ross Sea region have a trophic level of 3.8 ± 0.3, placing them well below the top of the food chain. Trophic level of Macrourus spp. was significantly affected by location and by size of fish (especially for fish less than 30 cm), whereas sex, fatness and bottom depth were not significant.

Diet of South Polar Skua Chicks in Two Areas of Sympatry with Brown Skua

Abstract. The food provided to South Polar Skuas (Stercorarius maccormicki) chicks was determined at two Antarctic sites where South Polar Skuas breed sympatrically with Brown Skuas (S. antarcticus). At Harmony Point on Nelson Island, 16 samples of regurgitated stomach contents were analyzed, all contained remains of penguin chicks (mostly soft tissues), which constituted the bulk of the contents, while only two samples had fish or krill remains. These South Polar Skuas had access to penguin colonies, where they hunted chicks or fed on fresh carcasses. However, at Half Moon Island, only two out of nine samples contained minor amounts of penguin remains while fish were the major dietary resource. The high fish content in their diet may indicate a preference for marine rather than terrestrial resources or be the result of competition with Brown Skuas. The variability in food items evidenced by the differences in regurgitated stomach contents indicates that South Polar Skuas may have a trophic plasticity tha...

The proseal™laryngeal mask airway: a review of the literature

To analyze and summarize the published literature relating to the ProSeal LMA (PLMA): a modification of the "classic LMA" (cLMA) with an esophageal drain tube (DT), designed to improve controlled ventilation, airway protection and diagnosis of misplacement. Articles identified through Medline and EMBASE searches using keywords "Proseal", "ProSeal" and "PLMA". Hand searches of these articles and major anesthetic journals from January 1998 to March 2005. Searches identified 59 randomized controlled trials or clinical studies and 79 other publications. Compared to the cLMA, PLMA insertion takes a few seconds longer. First attempt insertion success for the PLMA is lower, but overall success is equivalent. Airway seal is improved by 50%. The DT enables early diagnosis of mask misplacement, allows gastric drainage, reduces gastric inflation and may vent regurgitated stomach contents. Evidence suggests, but does not prove, that the correctly placed PLMA reduces aspiration risk compared with the cLMA. PLMA use is associated with less coughing and less hemodynamic disturbance than use of a tracheal tube (TT). Comparative trials of the PLMA with other supraglottic airways favour the PLMA. Clinicians have extended the use of the PLMA inside and outside the operating theatre including use for difficult airway management and airway rescue. The PLMA has similar insertion characteristics and complications to other laryngeal masks. The DT enables rapid diagnosis of misplacement. The PLMA offers significant benefits over both the cLMA and TT in some clinical circumstances. These and clinical experience with the PLMA are discussed.

The Invasive Round Goby ( Neogobius melanostomus) in the Diet of Nestling Double-crested Cormorants ( Phalacrocorax auritus) in Hamilton Harbour, Lake Ontario

Populations of the invasive round goby ( Neogobius melanostomus) have expanded dramatically since their discovery in the Laurentian Great Lakes in 1990. The abundance of these fish and possible competitive displacement of native species from aquatic food webs suggest that they will become an important prey item for predatory birds and sport fish. To date, there is very little information on the predation of round gobies by piscivorous birds in the Great Lakes. We used an abdominal palpation technique to stimulate regurgitation by double-crested cormorant ( Phalacrocorax auritus) chicks in ground nests from colonies in Hamilton Harbour, western Lake Ontario, during the 2002 nesting season. We collected and identified all fish species present in regurgitated boluses. For tree-nesting birds, we collected fish that were regurgitated and fell to the ground as a result of targeted disturbance of particular nest trees. At all locations and times, alewife ( Alosa pseudoharengus) was the most abundant fish species present by a large margin. The second most abundant species was the round goby, which was present in the regurgitated stomach contents of chicks in a total of 18 percent of nests surveyed, and made up 1.8 to 11 percent of all individual fish specimens identified. Our results show that the round goby is already an important food item for breeding cormorants in Hamilton Harbour, despite relatively recent establishment of goby populations in western Lake Ontario. Fish species of sport or commercial interest were detected in our samples with extremely low frequency (< 0.1%).

Natural history of two colubrid snakes, Elaphe quadrivirgata and Rhabdophis tigrinus, on Yakushima Island, southwestern Japan

AbstractSurveys on the natural history of two diurnal colubrid snakes, Elaphe quadrivirgata and Rhabdophis tigrinus, were made on Yakushima Island, Japan. Two color morphs, normal striped and melanistic, were observed in E. quadrivirgata, and the frequency of the latter morph was significantly greater in 1998 (83.3%) than in 1981 (56.4%). Regurgitated stomach contents of E. quadrivirgata consisted solely of reptilian prey, and the skink Eumeces latiscutatus was by far the most frequent prey item. This result makes a sharp contrast to those of previous studies dealing with populations of this species in central and northern Japan, where the snake preys mainly on anurans. On the other hand, examination of stomachs of R. tigrinus yielded only anuran prey. In Elaphe quadrivirgata, both snout-vent length and body mass in the Yakushima population were smaller than those in a population from central Japan, whereas the size variables for the Yakushima population appeared greater than those in the central Japanese population in R. tigrinus. Body temperature was significantly higher in E. quadrivirgata than in R. tigrinus.

The regurgitation of stomach contents in trawl caught whiting, evidence of a predator size effect

The rate of regurgitation of food from the stomachs of trawl caught whiting Merlangius merlangus was negatively correlated with fish size. Increased musculature of the oesophageal sphincter in larger fish may enable them to resist the forced expulsion of their stomach contents to a greater extent.

The regurgitation of stomach contents in trawl caught whiting, evidence of a predator size effect

The rate of regurgitation of food from the stomachs of trawl caught whiting Merlangius merlangus was negatively correlated with fish size. Increased musculature of the oesophageal sphincter in larger fish may enable them to resist the forced expulsion of their stomach contents to a greater extent.

ASTHMA AND GASTROESOPHAGEAL REFLUX IN INFANTS AND CHILDREN

Gastroesophageal reflux (GER) is a term that describes the intermittent regurgitation of stomach contents into the esophagus. This term has been applied to physiologic or functional reflux and GER disease (GERD). GERD includes the spectrum of associated signs and symptoms associated with this condition, some of which have been recognized because of improved technologic and diagnostic capabilities. 19

Overview of the treatment of rumination disorder for adults in a residential setting

Rumination, or the chewing and re-swallowing of regurgitated stomach contents, can be found in up to 10% of institutionalized individuals with severe or profound mental retardation. Serious physical consequences, including death, can result from the disorder. Unfortunately, rumination can be subtle and difficult to observe and often continues untreated. Additionally, the research literature has provided divergent results without clear treatment guidance for clinicians. We present an overview of the history of rumination, a review of the literature on its etiology and treatment, and recommendations for future research.

How important are pelagic preys for the kelp gull during chick-rearing at the South Shetland Islands?

An analysis of pellets regurgitated indicated adult kelp gulls (Larus dominicanus) on the South Shetland Islands consumed predominantly intertidal prey, whereas previous studies at Antarctic Peninsula sites have reported kelp gulls consuming predominantly pelagic species. The pellets collected at Nelson Island during the chick-rearing period indicated that the limpet Nacella concinna was their most frequent prey, followed by carrion, gammariids, snails and krill. Fish were scarcely represented. Also, regurgitated stomach contents of chicks showed that limpets and carrion were the most frequent food items, accounting for 70% of the mass. However, gammariids were particularly important by number. Significant differences were observed in the overall comparison of the diet as reflected by the two sampling methods. In general, the importance of pelagic prey was negligible when compared to intertidal or scavenged prey. Our results differ greatly from those reported for the Antarctic Peninsula, where chicks were almost exclusively fed with the pelagic fish Pleuragramma antarcticum. These differences could be related to the abundance of pelagic resources in southernmost latitudes, and/or to the presence of more extensive intertidal foraging areas at the South Shetland Islands.

Upper Esophageal Sphincter Function During Antegrade and Retrograde Transit

The striated musculature of the UES, along with the cricoid and thyroid cartilages, the hyoid bone, their ligaments, and the supra- and infrahyoid musculature form a functional unit that selectively controls the opening and closing of the esophageal inlet. At rest, upper esophageal tone acts as a barrier against both entry of air into the esophagus and regurgitation of materials coming from the proximal esophagus. However, reflexive responses of the sphincter offer no substantial protection against regurgitation of stomach contents that cause substantial esophageal distension. Although esophageal distention can experimentally induce sphincter contraction, this potential protective reflex against esophago-pharyngeal reflux has not been observed during spontaneous gastroesophageal reflux episodes. Furthermore, owing to the effects of gaseous distention, regurgitation may be more likely when acid and gaseous contents gastroesophageal reflux together. Modulation of the timing and the extent of sphincter opening during swallowing is intimately correlated with the volume and physical properties of the bolus, along with coordinated activity of the tongue, pharyngeal constrictors, and hyoid musculature, which suggests continuous sensory feedback throughout the pharyngeal swallow.

Acute Toxicity of Aflatoxin B1to Channel Catfish

Both oral and intraperitoneal (IP) administration of 12 mg aflatoxin B1 (AFB1) per kilogram of body weight caused regurgitation of stomach contents by channel catfish Ictalurus punctatus. Detoxification of AFB1 (ammoniation) significantly reduced the incidence of regurgitation. The 10-d median lethal dose (LD50; dose that is lethal to 50% of test organisms) for IPadministered AFB, in channel catfish averaging 19 g was 11.5 mg/kg of body weight, with a 95% confidence interval of 9.5–13.3 mg/kg. Gills, livers, kidneys, spleens, stomachs, and intestines of moribund fish injected with 12 mg AFB1/kg of body weight were extremely pale. Hematocrits, hemoglobin concentrations, and erythrocyte counts of moribund fish were about 10% of those values in control fish. Histological lesions in moribund fish included sloughing of intestinal mucosa and necrosis of hematopoietic tissues, hepatocytes, pancreatic acinar cells, and gastric glands. Spleens showed reduction in volume of the red pulp and reduction in number of leukocytes in the splenic corpuscles. Renal tubular lumens were dilated. Changes in hematocrits, hemoglobin concentrations, and erythrocyte and leukocyte counts of nonmoribund channel catfish following IP injection of 9 mg AFB1/kg of body weight were lowest between 48 and 72 h postinjection.

Measurement of regurgitation in feeding studies of predatory fishes

Regurgitation of stomach contents in the predatory perch and pike captured in gill nets could be readily identified and occurrence measured. Stomachs following regurgitation, as opposed to true ‘empty’ stomachs, were large, distended, with a thin wall and little internal ridging. The mean percentage of genuinely empty stomachs over a 22‐month period in perch was 20–21 % and in pike 7–10%. Regurgitation in perch was rare (&lt;9% stomachs), normally only partial and restricted to water temperatures &gt; 21°C: gill netting is therefore a legitimate means of sampling perch in food studies. In pike the sum of partial and complete regurgitation was important, with mean annual values in two lakes of 48 and 50%, and up to 84% in summer samples; it was related to water temperature (x) and described by the significant relationship y= 20.63+x 2.84, but was unrelated to fish length and gill net mesh size. Food studies of predatory fishes using gill nets as a capture method should take account of regurgitation. Further information is required on the extent of regurgitation when other sampling methods are used.

Gastroesophageal Reflux: Problem or Nuisance?

Gastroesophageal reflux (GER), the regurgitation of stomach contents into the esophagus, is common in infancy. If this occurs frequently, vomiting, esophagitis, failure to thrive, or respiratory problems can complicate this phenomenon. A thorough history and physical examination are essential for an accurate diagnosis. In addition, positive results in two of the following tests help to confirm the diagnosis of GER: barium swallow, esophageal pH monitoring, esophageal manometry, or radionuclide gastroesophagraphy. Optimal treatment includes positioning the infant in a 30-degree prone plane for 24 hours a day. Small, frequent, thickened feedings and pharmacotherapeutics remain controversial in the management of GER. Surgical intervention is indicated only when life-threatening complications occur, such as apnea or severe failure to thrive. The pediatric nurse practitioner plays a critical role in providing support to the family and closely monitoring the infant's growth and development.