Morris Traube

Bio: Morris Traube is an academic researcher from New York University. The author has contributed to research in topics: Esophagus & Achalasia. The author has an hindex of 9, co-authored 15 publications receiving 351 citations.

Effects of nifedipine in achalasia and in patients with high-amplitude peristaltic esophageal contractions

Abstract: We studied the esophageal effects of nifedipine in 20 patients with achalasia (20 mg sublingually) and nine patients with high-amplitude peristaltic esophageal contractions (nutcracker esophagus) (20 mg orally). In patients with achalasia, nifedipine decreased lower esophageal sphincter (LES) pressure by approximately 30%. In ten patients with achalasia, plasma nifedipine concentrations were 45.3 +/- 17.7 and 57.4 +/- 12.8 ng/mL (means +/- SEM) at 30 and 60 minutes, respectively, after drug administration. In patients with nutcracker esophagus, nifedipine decreased LES pressure by approximately 50% and contraction amplitude in the body of the esophagus by approximately 25%. After comparison was made with our previous results in normal subjects, we concluded that (1) nifedipine decreased LES pressure in patients with achalasia to a similar extent to that noted in normal subjects; (2) plasma concentrations measured after 20 mg of nifedipine given sublingually to achalasic patients were similar to those found under similar circumstances in normal subjects; and (3) nifedipine decreased LES pressure and contraction amplitude in patients with nutcracker esophagus to a greater extent than was found in normal subjects. These results suggest that double-blind, placebo-controlled clinical trials of nifedipine in the treatment of achalasia or nutcracker esophagus are indicated.

Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding.

Abstract: Background Although esophageal dilation after laparoscopic adjustable gastric banding (LAGB) has been reported, the effect of banding on esophageal peristalsis, including the development of aperistalsis and its potential reversibility, have received only little attention. Goals Our aim was to report our experience with 6 patients who developed manometric evidence of esophageal aperistalsis after LAGB. Study We retrospectively reviewed the clinical, manometric, and radiologic data of 6 patients referred between September 2005 and June 2007 to our Center for Esophageal Disease for evaluation of dysphagia or heartburn that developed after LAGB, and in whom manometric studies showed aperistalsis. Patients had the fluid in the band completely removed (N=5) or had the band removed (N=1). Reversibility of esophageal aperistalsis was then assessed. Clinical follow-up was obtained from 2009 to early 2010. Results Six patients (all female, age range, 37 to 55 y old) were evaluated because of dysphagia or heartburn after LAGB and had complete aperistalsis on manometry. Five of the 6 patients had manometry after removal of all the fluid from the band (N=4) or after surgical removal of the band (N=1). Two patients had partial return of peristalsis, 1 had normal peristalsis, and 2 others had continued aperistalsis but did show clinical improvement. Another patient had improvement of radiologic esophageal dilation but declined repeat manometry. Conclusions LAGB can cause an achalasia-like esophageal aperistalsis that may be reversible. Gastroenterologists caring for bariatric patients need be aware of this pseudoachalasia, as the treatment of such patients differs from those with primary achalasia.

The diagnosis and misdiagnosis of achalasia: a study of 25 consecutive patients

Abstract: An impression that achalasia remains an elusive diagnosis led us to review our recent experience From August 1, 1985 to March 31, 1987, we saw 25 patients with "previously untreated" achalasia for consultation and/or treatment Data was extracted from review of their records Achalasia was the initial diagnosis in only 12 patients The others were given diagnoses of gastroesophageal reflux (4), presbyesophagus (2), esophageal spasm (2), psychiatric disorders (2), and combination of various disorders (3) In the latter patients, various diagnostic studies were either inappropriately delayed or misinterpreted, so that incorrect diagnoses were given Errors in diagnosis led to further inappropriate testing and therapies We conclude that: (a) achalasia remains an elusive diagnosis in current practice, (b) errors in diagnosis are related to delay in obtaining appropriate studies or misinterpretation of such studies, and (c) this delay leads to persistent symptoms and ineffective and/or inappropriate therapies

Lap-band impact on the function of the esophagus.

Abstract: The laparoscopic adjustable gastric band (LAGB) has been widely used to treat morbid obesity. There is conflicting data on its long-term effect on esophageal function. Our aim was to assess the long-term impact of the LAGB on esophageal motility and pH-metry in patients who had LAGB who had normal and abnormal esophageal function at baseline. Consecutive patients referred for bariatric surgery were prospectively enrolled. A detailed medical history was obtained, and esophageal manometric and 24-h pH evaluations were performed in standard fashion preoperatively and 6 and 12 months postoperatively; patients served as their own controls. Twenty-two patients completed manometric evaluation. Ten patients had normal manometric parameters at baseline; at 6 months, mean lower esophageal sphincter (LES) residual pressure increased significantly from baseline (3.9 ± 2 vs. 8.9 ± 4 mmHg, p = 0.014). At 12 months, the mean peristaltic wave duration increased from 3.6 ± 1 at baseline to 6.8 ± 2 s, p = 0.025 and wave amplitude decreased during the same period (98.7 ± 22 vs. 52.3 ± 24, p = 0.013). LES pressure and percent peristalsis did not differ significantly pre- and post-LAGB. Twelve patients had one or more abnormal manometric findings at baseline; at 12 months, LES pressure in these 12 patients decreased significantly (31.1 ± 10 vs 23.6 ± 7, p = 0.011) and wave amplitude was significantly reduced (125.9 ± 117 vs 103 ± 107, p = 0.039). LES residual pressure did not change significantly pre- and post-LAGB. Twenty-two individuals were evaluated for impact of Lap-Band on esophageal acid exposure. Sixteen of these patients had normal esophageal pH-metry values at baseline and had no significant changes in 12 months in any pH-metry measurement. Six patients had abnormal pH-metry values at baseline. Among these patients, time with pH < 4.0 and Johnson/DeMeester score did not change significantly during follow-up. There was a significant decrease in the number of reflux episodes from baseline to 6 months (159 ± 48 vs. 81 ± 61, p = 0.016). Abnormal manometric findings are frequently encountered post-LAGB. Increases in LES residual pressure and peristaltic wave duration were the most significant changes. LAGB is not associated with an increase in total esophageal acidification time. Further evaluation of the clinical significance of manometric abnormalities is warranted.

The NIH Human Microbiome Project

Abstract: The Human Microbiome Project (HMP), funded as an initiative of the NIH Roadmap for Biomedical Research (http://nihroadmap.nih.gov), is a multi-component community resource. The goals of the HMP are: (1) to take advantage of new, high-throughput technologies to characterize the human microbiome more fully by studying samples from multiple body sites from each of at least 250 "normal" volunteers; (2) to determine whether there are associations between changes in the microbiome and health/disease by studying several different medical conditions; and (3) to provide both a standardized data resource and new technological approaches to enable such studies to be undertaken broadly in the scientific community. The ethical, legal, and social implications of such research are being systematically studied as well. The ultimate objective of the HMP is to demonstrate that there are opportunities to improve human health through monitoring or manipulation of the human microbiome. The history and implementation of this new program are described here.

Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension and related cardiovascular disorders.

Abstract: Various sections of the manuscript reviewed by: U. Elkayam, Department of Medicine, University of Southern California, Los Angeles, California, USA; H. Emanuelsson, Department of Medicine I, University of Goteborg, Goteborg, Sweden; K. Fox, National Heart Hospital, London, England; W.H. Frishman, Hospital of the Albert Einstein College of Medicine, Bronx, New York, USA; M.D. Gua1.1.i, Cattedra di Cardiologia, U niversita Degli Studi de Milano, Milan, Italy; J.R. Hampton, University Hospital, Queen's Medical Centre, Nottingham, England; CH. Kleinbloesem, Sylvius Laboratories, Leiden, The Netherlands; O. Lederballe Pedersen, Department of Internal Medicine I, Aarhus Amtssygehus, Aarhus, Denmark; P. Lichtlen, Medizinische Hochschule Hannover, Department of Cardiology and Cardiovascular Surgery, Hannover, Federal Republic of Germany; R.G. McAllister, Veterans Administration Medical Center Research Service, Lexington, Kentucky, USA; P. W. Serruys, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands; A.L. Soward, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands.

Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group.

Abstract: PURPOSETo evaluate incidence, time trends, geographic distribution, clinicopathologic presentation features, and prognostic factors for survival and relapse in gastrointestinal (GI) non-Hodgkin's lymphomas (NHLs).PATIENTS AND METHODSOver a 9-year period (1983 to 1991), 2,446 new NHL cases were recorded in a Danish population-based NHL registry (Danish Lymphoma Study Group [LYFO]). Of these, 306 (12.5%) were GI NHL (175 gastric, 109 intestinal, and 22 both sites). LYFO registry data were used for incidence rate (IR) assessment, and time-trend and geographic distribution analysis. Relative risk (RR) values for survival and relapse were identified by multivariate analysis.RESULTSThe mean annual, age-standardized IRs for gastric and intestinal NHL were 0.71/10(5) and 0.48/10(5) per year, respectively. Age-specific IRs for both localizations showed an exponential increase as a function of age. Time-trend analysis for the period 1983 to 1991 showed stable IRs for both localizations. Intestinal NHL was more freq...

Treating achalasia : From whalebone to laparoscope

Abstract: Objective.—To review the pathophysiology and management of achalasia.Data Sources.—Peer-reviewed publications located via MEDLINE using the search term esophageal achalasia (subheadings: complications, drug therapy, epidemiology, etiology, physiopathology, surgery, and therapy) published in English from 1966 to December 1997.Study Selection.—Of 2632 citations identified, 4.5% were selected for inclusion by authors' blinded review of the abstracts. New developments in the understanding of achalasia or reports of therapeutic efficacy in either controlled trials or uncontrolled consecutive series involving 10 patients or more observed for a year or longer were reviewed in detail.Data Extraction.—All 6 controlled therapeutic trials were included, and therapeutic efficacy in uncontrolled series was assessed by the authors extracting the patients with a good-to-excellent response from each study and calculating a pooled estimate of response rate with individual studies weighted proportionally to sample size.Data Synthesis.—Achalasia results from irreversible destruction of esophageal myenteric plexus neurons causing aperistalsis and failed lower sphincter relaxation. The only therapies that adequately compensate for this dysfunction for a sustained time are pneumatic dilation and Heller myotomy. The single controlled trial comparing these treatments found surgery superior to dilation (95% vs 51% nearly complete symptom resolution, P<.01). In uncontrolled trials pneumatic dilation (weighted mean [SD]) is 72% (26%) effective vs 84% (20%) for Heller myotomy. The limitation of dilation is a 3% risk of perforation; thoracotomy morbidity has been the major limitation of myotomy. Surgical morbidity has been sharply reduced by laparoscopic techniques.Conclusions.—Both pneumatic dilation and surgical myotomy are effective therapies for achalasia; laparoscopic Heller myotomy is emerging as the optimal surgical therapy.