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Title: The evaluation of oesophageal reflux
Author: Stoker, David L.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1990
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This thesis initially reviews the ancient and modern literature on the oesophagus, and its investigation. The current literature on reflux oesophagitis is evaluated, and modern concepts of aetiology are discussed. The five year endoscopic experience of reflux disease for the Portsmouth gastroenterologists is quantified, and it is shown that this is a widespread condition affecting all adult age groups, with a predilection for the elderly. The current gold standard test for acid reflux - 24 hours for pH testing - is evaluated. A new method of interpreting pH test results (the area under the curve) is compared with the more usual cumulative acid index. It is shown that the new method is no more accurate than the old, when trying to separate normal from abnormal pH test results, suggesting that factors other than acid may also be involved in the aetiology of reflux disease. Measurements are performed on samples of human oesophageal refluxate, looking at three other factors which may be implicated in reflux oesophagitis, namely bile salts, trypsin and pepsin. These factors are compared with the pH of the refluxate. It is shown that significant quantities of all three substances are present in the samples, across the pH range, rather than in the narrow pH bands expected. Bile salts are selected for further study. The development of a system for measuring bile reflux using an external gamma detector and 75SeHCAT labelled bile is outlined, and tested. It is shown that this system in insensitive as a measure of bile reflux, but is capable of monitoring the enterohepatic circulation. The developmental program for a new, internal gamma probe and portable monitoring system for use within the gastrointestinal tract is outlined. In vitro studies show this to be highly sensitive to 75SeHCAT, and 99TcmHIDA, despite its small size. The internal gamma probe is validated as a measure of bile reflux in human volunteers using a gamma camera for comparsion of results. In all cases studied, correlation between counts from the internal probe and gamma camera are shown to be positive, and are strongly suggestive that bile reflux is being measured. This system can therefore be regarded as the first effective portable bile reflux detector, with significant potential for the further study of reflux related disease.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available