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Nutritional support teams increase percutaneous endoscopic gastrostomy uptake in motor neuron disease

World Journal of Gastroenterology 2012年第44期18卷 6461-6467页

作者： Lin Zhang Leanne Sanders robert JL fraser Nutrition and Dietetic Department Flinders Uni- versity of South Australia Bedford Park 5042 South Australia Australia Department of Nutrition and Dietetics Repa- triation General Hospital Daw Park 5041 South Australia Aus- tralia School of Medicine Flinders University of South Australia Bedford Park 5042 South Australia Australia

AIM:To examine factors influencing percutaneous endoscopic gastrostomy(PEG) uptake and outcomes in motor neuron disease(MND) in a tertiary care ***:Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died,were *** were extracted for demographics(age and gender),disease characteristics(date of onset,bulbar or peripheral predominance,complications),date and nature of discussion of gastrostomy insertion,nutritional status [weight measurements,body mass index(BMI)],date of gastrostomy insertion and subsequent progress(duration of survival) and quality of life(QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)].In addition,the type of clinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team(involved in providing nutrition input viz Gastroenterologist,Speech Pathologist,Dietitian) and other(involved in non-nutritional aspects of patient care).Factors affecting placement and outcomes including length of survival,change in weight and QoL were ***:Case records were available for all 86 patients(49 men,mean age at diagnosis 66.4 years).Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting ***-six patients reported ***-one patients had undergone gastrostomy *** major indications for PEG placement were dysphagia and weight *** patients required immediate full feeding,whereas 17 patients initially used the gastrostomy to supplement oral intake,4 for medication administration and 1 for *** the PEG regime met 73% ± 31% of the estimated total energy requirements,increasing to 87% ± 32% prior to *** was stabilization of weight in patients undergoing gastrostomy [BMI at 3 mo(22.6 ± 2.2 kg/m 2) and 6 mo(22.5 ± 2.0 kg/m 2) after PEG placement compared to

关键词：运动神经元疾病营养支持胃肠病内镜摄取 PEG 影响因素生活质量

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Impact of bolus volume on small intestinal intra-luminal impedance in healthy subjects

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World Journal of Gastroenterology 2010年第17期16卷 2151-2157页

作者： Nam Q Nguyen Laura K Bryant Carly M Burgstad robert J fraser Daniel Sifrim Richard H Holloway Department of Gastroenterology & Hepatology Royal Adelaide HospitalAdelaide 5000Australia Investigation and Procedures Unit Repatriation General HospitalDaw Park 5041Australia Department of Medicine Centre for Gastroen-terological ResearchK.U.LeuvenLeuven 3000Belgium

AIM: To assess the impact of bolus volume on the characteristics of small intestinal (SI) impedance ***: Concurrent SI manometry-impedance measurements were performed on 12 healthy volunteers to assess the pattern of proximal jejunal fluid bolus movement over a 14 *** subject was given 34 boluses of normal saline (volume from 1 to 30 mL) via the feeding tube placed immediately above the proximal margin of the studied segment.A bolus-induced impedance event occurred if there was > 12% impedance drop from baseline,over ≥ 3 consecutive segments within 10 s of bolus injection.A minor or major imped-ance event was defined as a duration of impedance drop < 60 s or ≥ 60 s,***: The minimum volume required for a detectable SI impedance event was 2 mL.A direct linear relationship between the SI bolus volume and the occurrence of impedance events was noted until SI bolus volume reached 10 mL,a volume which always produced an impedance flow *** was a moderate correlation between the bolus volume and the duration of impedance drop (r = 0.63,P < 0.0001) and the number of propagated channels (r = 0.50,P < 0.0001).High volume boluses were associated with more major impedance events (≥ 10 mL boluses = 63%,3 mL boluses = 17%,and < 3 mL boluses = 0%,P = 0.02).CONCLUSION: Bolus volume had an impact on the type and length of propagation of SI impedance events and a threshold of 2 mL is required to produce an event.

关键词： Bolus volume Health Impedance Luminal flow Small intestine

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Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

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World Journal of Gastroenterology 2011年第10期17卷 1326-1331页

作者： Laura K Besanko Carly M Burgstad Reme Mountifi eld Jane M Andrews Richard Heddle Helen Checklin robert JL fraser Investigation and Procedures Unit Repatriation General Hospital Department of Gastroenterology and Hepatology Royal Adelaide Hospital Discipline of Medicine University of Adelaide Adelaide 5000 South Australia Australia Department of Medicine Flinders University of South Australia Bedford Park 5042 South Australia Australia

AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. METHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value < 0.05 was considered significant. RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

关键词：中老年人食管癌括约肌患者吞咽松弛毫米汞柱压力升高

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World Journal of Gastroenterology 2017年第15期23卷 2785-2794页

作者： Charles Cock Laura K Besanko Carly M Burgstad Alison Thompson Stamatiki Kritas Richard Heddle robert JL fraser Taher I Omari Investigation and Procedures Unit Repatriation General Hospital Department of Gastroenterology and Hepatology Flinders University of South Australia Gastroenterology Unit Women's and Children's Health Network Human Physiology School of MedicineFlinders University of South Australia

AIM To investigate the functional effects of abnormal esophagogastric(EGJ) measurements in asymptomatic healthy volunteers over eighty years of age. METHODS Data from 30 young controls(11 M, mean age 37 ± 11 years) and 15 aged subjects(9 M, 85 ± 4 years) were compared for novel metrics of EGJ-function: EGJcontractile integral(EGJ-CI), "total" EGJ-CI and bolus flow time(BFT). Data were acquired using a 3.2 mm, 25 pressure(1 cm spacing) and 12 impedance segment(2 cm) solid-state catheter(Unisensor and MMS SolarGI system) across the EGJ. Five swallows each of 5 m L liquid(L) and viscous(V) bolus were analyzed. Mean values were compared using Student's t test for normally distributed data or Mann Whitney U-test when non-normally distributed. A P value < 0.05 was considered *** EGJ-CI at rest was similar for older subjects compared to controls. "Total" EGJ-CI, measured during liquid swallowing, was increased in older individuals when compared to young controls(O 39 ± 7 mm *** vs C 18 ± 3 mm ***; P = 0.006). For both liquid and viscous bolus consistencies, IRP4 was increased(L: 11.9 ± 2.3 mm Hg vs 5.9 ± 1.0 mm Hg, P = 0.019 and V: 14.3 ± 2.4 mm Hg vs 7.3 ± 0.8 mm Hg; P = 0.02) and BFT was reduced(L: 1.7 ± 0.3 s vs 3.8 ± 0.2 s and V: 1.9 ± 0.3 s vs 3.8 ± 0.2 s; P < 0.001 for both) in older subjects, when compared to young. A matrix of bolus flow and presence above the EGJ indicated reductions in bolus flow at the EGJ occurred due to both impaired bolus transport through the esophageal body(i.e., the bolus never reached the EGJ) and increased flow resistance at the EGJ(i.e., the bolus retained just above the EGJ).CONCLUSION Bolus flow through the EGJ is reduced in asymptomatic older individuals. Both ineffective esophageal bolus transport and increased EGJ resistance contribute to impaired bolus flow.

关键词：老化食管阻抗 Manometry 压力 Esophagogastric 连接

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Subtypes of functional dyspepsia

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World Journal of Gastroenterology 2006年第17期12卷 2667-2671页

作者： Georgina Baker robert J fraser Graeme Young Department of Gastroenterology Repatriation General Hospital and Flinders Medical Centre Australia

机能性消化不良是通常与许多联系胃肠的症状和正常内视镜检查法联系的长期或周期性的上面的腹的疼痛或不快描述的一个普通临床的条件。到使合于标准基于研究的途径，一个起始的分类进潜水艇，组们被同意，基于症状的簇。然而，这些亚群... 详细信息

机能性消化不良是通常与许多联系胃肠的症状和正常内视镜检查法联系的长期或周期性的上面的腹的疼痛或不快描述的一个普通临床的条件。到使合于标准基于研究的途径，一个起始的分类进潜水艇，组们被同意，基于症状的簇。然而，这些亚群将与对特定的治疗顺从的不同 pathophysiologies 被联系的早期望没被认识到。一个分类基于最麻烦的症状被建议了，但是这的用途也是不清楚的。更最近的数据建议一些 pathophysiologic 机能障碍可以与特定的症状被联系那么为组织病人提供一个更好的工具。但是因为进致病的当前的卓见仍然太有限，这不能令人满意，这条途径仍然保持不完全。在结论，没有分类提供一条足够的基于处理的途径到机能性消化不良的症候群。作为后果治疗仍然保持大部分实验。

关键词：功能性消化不良病理生理学鉴别诊断疾病管理

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Proximal gastric motility in critically ill patients with type 2 diabetes mellitus

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World Journal of Gastroenterology 2007年第2期13卷 270-275页

作者： Nam Q Nguyen robert J fraser Laura K Bryant Marianne Chapman Richard H Holloway Department of Gastroenterology Hepatology and General Medicine Royal Adelaide Hospital South Australia Investigation and Procedures Unit Repatriation General Hospital South Australia Anaesthesia and Intensive Care Royal Adelaide Hospital South Australia

AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long- standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure? (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years). RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients (P < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients. CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non- diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.

关键词：胃病糖尿病气压调节器症状治疗方法

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Decoupling between Plant Productivity and Growing Season Length under a Warming Climate in Canada’s Arctic

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American Journal of Climate Change 2016年第3期5卷 334-359页

作者： Wenjun Chen Paul Zorn Lori White Ian Olthof Yu Zhang robert fraser Sylvain Leblanc Canada Centre for Remote Sensing Natural Resources Canada Ottawa Canada Parks Canada Agency Gatineau Canada Wildlife Landscape Science Directorate Environment Canada Ottawa Canada

Given the short duration of growing season in the Arctic, a strong correlation between plant productivity and growing season length (GSL) is conventionally assumed. Will this assumption hold true under a warming climate? In this study, we addressed the question by investigating the relationship between net primary productivity of leaves (NPPleaf) and GSL for various tundra ecosystems. We quantified NPPleaf and GSL using long-term satellite data and field measurements. Our results indicated that the relationship was not significant (i.e., decoupled) for 44% to 64% of tundra classes in the southern Canadian Arctic, but significant for all classes in the northern Canadian Arctic. To better understand the causes of the decoupling, we further decomposed the relationship into two components: the correspondence of interannual variations and the agreement of long- term trends. We found that the longer the mean GSL for a tundra class, the poorer the correspondence between their interannual variations. Soil moisture limitation further decoupled the relationship by deteriorating the agreement of long-term trends. Consequently, the decoupling between NPPleaf and GSL would be more likely to occur under a warming climate if the tundra class had a mean GSL > 116 (or 123) days with a dry (or moist) soil moisture regime.

关键词： Net Primary Productivity Growing Season Length Arctic Tundra Decoupling Remote Sensing Soil Moisture Regime

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Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

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World Journal of Gastroenterology 2006年第4期12卷 582-587页

作者： robert J fraser Marc Ritz Addolorata C Di Matteo Rosalie Vozzo Monika Kwiatek robert Foreman Brendan Stanley Jack Walsh Jim Burnett Paul Jury John Dent Department of Medicine University of AdelaideSouth Australia Department of Gastroenterology Royal Adelaide HospitalAdelaide South Australia Vascular Unit Royal Adelaide Hospital AdelaideSouth Australia Gastrointestinal Investigation Unit Repatriation General Hospital Daw Park South Australia Vascular Unit Repatriation General Hospital Daw Park SouthAustralia

瞄准：在跟随选任的腹的主动脉瘤(AAA ) 修理外科的病人调查远侧的小肠活动性和类脂化合物吸收。方法：九个病人(年老的 35-78 年；身体团索引(BMI ) 范围：23-36 kg/m (2 )) 为 AAA 修理，和七个健康控制题目外科以后(20-50 年；BMI ... 详细信息

瞄准：在跟随选任的腹的主动脉瘤(AAA ) 修理外科的病人调查远侧的小肠活动性和类脂化合物吸收。方法：九个病人(年老的 35-78 年；身体团索引(BMI ) 范围：23-36 kg/m (2 )) 为 AAA 修理，和七个健康控制题目外科以后(20-50 年；BMI 变化：21-29 kg/m (2 )) 被学习。连续的远侧的小肠测压法为多达 72 h 被执行，在 fasting 并且肠内的的喂(Nutrison ) 的时期期间。记录为频率，起源，一些移植，和小肠的爆炸活动的方向被分析。类脂化合物吸收在病人的一个子集在第一天和第三个天柱子手术被估计用(13 ) C-triolein-breath 测试，并且与健康控制相比。题目收到了 50 mL 液体的 20-min 十二指肠内注入喂与 200 混合了 microL (13 ) C-triolein。结束吐气的呼吸样品为 6 h 被收集并且分析了为(13 ) 公司(2 ) 集中。结果：在近似、远侧的小肠的爆炸活动的频率比在健康题目在病人是更高的，在 fasting 和美联储条件(P<0.005 ) 下面。在病人，有反常地宣传的爆炸的一个更高的比例(71% 反常) ，它开始由 d 使正常化 3 (25% 反常) 外科以后。类脂化合物吸收数据为 d 上的七个病人是可得到的 d 上的 1 和四个病人 3 帖子外科。在病人， d 上的吸收 1 外科以后是健康控制的使遭到的一半(AUC (13 ) 公司(2 ) 1323+/-244 对 2646+/-365；P<0.05，分别地) ，并且被归结为五分之一个由 d 的健康控制的 3 (AUC (13 ) 公司(2 ) 470+/-832 对 2646+/-365；P<0.05，分别地) 。结论：近似、远侧的小肠的马达活动短暂地在主要外科以后立即在非常有病的病人被破坏，与远及回肠延长的反常活动性模式。这些马达骚乱可以贡献肠内的营养的损害吸收，特别当管腔内处理为有效消化是必要的时。

关键词：小肠疾病腹部疾病动脉瘤手术治疗

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Proximal gastric response to small intestinal nutrients is abnormal in mechanically ventilated critically ill patients

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World Journal of Gastroenterology 2006年第27期12卷 4383-4388页

作者： Nam Q Nguyen robert J fraser Marianne Chapman Laura K Bryant Richard H Holloway Rosalie Vozzo Christine Feinle-Bisset Department of Gastroenterology Hepatology and General MedicineRoyal Adelaide HospitalSouth Australia University Department of Medicine University of AdelaideSouth Australia Department of Intensive Care Royal Adelaide HospitalSouth Australia Department of Gastroenterology Hepatology and General MedicineRoyal Adelaide HospitalSouth Australia Department of GastroenterologyUniversity of AdelaideSouth Australia

瞄准：在非常有病的病人决定近似的胃的反应到小肠的营养素。方法：近似胃的活动性在 13 个非常有病的病人被测量(49.3 +/- 4.7 年) 并且 12 个健康志愿者(27.7 +/- 2.9 年) 用一种 barostat 技术。记录在基线被执行，在 60-min 期间 in... 详细信息

瞄准：在非常有病的病人决定近似的胃的反应到小肠的营养素。方法：近似胃的活动性在 13 个非常有病的病人被测量(49.3 +/- 4.7 年) 并且 12 个健康志愿者(27.7 +/- 2.9 年) 用一种 barostat 技术。记录在基线被执行，在 60-min 期间 intra 十二指肠的注入保证(2 kcal/min ) ，并且为跟随注入的 2 h。最小的扩张压力(MDP ) ， intra 袋子体积和底的波浪活动是坚定的。结果：MDP 在病人是更高的(11.7 +/- 1.1 对 7.8 +/- 0.7 毫米汞柱；P < 0.01 ) 。基线 intra 袋子体积在 2 个组是类似的。在健康题目，一“双性人形式”近似胃的体积反应被观察。在病人，近似胃的体积的起始的增加小、推迟，但是最后到达了类似于健康题目的最大的体积。在健康题目，近似胃的体积很快在滋养的注入以后回到了基线水平(中部 18 min ) 。相反，到基线的体积的恢复在非常有病的病人被推迟(中部 106 min ) 。在 6 个病人，体积没在滋养的注入以后回到基线水平 2 小时。在病人，底的体积波浪是不太经常的(P < 0.05 ) 并且有的更低的振幅(P < 0.001 ) ，与健康题目相比。结论：在重病，对小肠的滋养的刺激的近似胃的马达回答是反常的。

关键词：胃疾病小肠营养通风作用疾病

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Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

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World Journal of Gastroenterology 2007年第29期13卷 3909-3917页

作者： Adam Deane Marianne J Chapman robert J fraser Laura K Bryant Carly Burgstad Nam Q Nguyen Intensive Care Unit Royal Adelaide Hospital Adelaide South Australia Discipline of Medicine University of Adelaide and Investigation and Procedures Unit Repatriation General Hospital Adelaide South Australia Investigation and Procedures Unit Repatriation General Hospital Adelaide South Australia Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia

Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.

关键词：急诊肠道营养胃排空胃动力胃肠道激素胃复安红霉素

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