1.The Upper Esophageal Sphincter Distensibility Index Measured Using Functional Lumen Imaging Probe Identifies Defective Barrier Function of the Upper Esophageal Sphincter
Lucie F CALDERON ; Meredith KLINE ; Marc HERSH ; Kevin P SHAH ; Suprateek KUNDU ; Andrew TKACZUK ; Nancy MCCOLLOCH ; Anand S JAIN
Journal of Neurogastroenterology and Motility 2022;28(3):463-473
Background/Aims:
The mechanism via which supra-esophageal symptoms are generated is unclear. We assessed upper esophageal sphincter (UES) function in novel fashion using functional lumen imaging probe (FLIP) topography. We hypothesize that symptoms related to aspiration of esophageal contents may be associated with a more distensible UES.
Methods:
FLIP and reflux symptom index score data from patients undergoing diagnostic evaluation for an esophageal complaint over a 10-month period were analyzed retrospectively. UES distensibility on FLIP was studied at 40-70 mL volumes with in-depth analysis at 50 and 60 mL. Symptoms were compared between patients with low, middle, and high UES-distensibility index (UES-DI). Receiveroperating characteristic analysis was performed to determine associations between the UES-DI and individual reflux symptom index symptom item scores.
Results:
One hundred and eleven subjects were included. Overall, the associations between UES-DI and symptoms that could be related to supra-esophageal aspiration were strongest at the 50 mL FLIP volume. Choking item score was highest in the high UES-DI group (2.8) vs 1.4 (P < 0.001) in the middle UES-DI and 1.1 (P = 0.004) in the low UES-DI groups. Similarly, the cough item score was highest in the high UES-DI group (2.7) vs 1.5 (P = 0.009) and 0.9 (P = 0.002) groups.
Conclusion
A higher UES-DI measures defective barrier function which could may be the main pathophysiology that generates supra-esophageal symptoms.
2.A prospective, randomized, open label, single-centre study for assessment of safety and effectiveness of recombinant human insulin 30/70 + insulin glulisine compared to recombinant human insulin NPH + regular in the management of type 2 diabetes mellitus patients in the Philippines.
Leilani B MERCADO-ASIS ; Mary Jane TANCHEE-NGO ; Erick S MENDOZA ; Ashish MANE ; Anand VASAM ; Agam SHAH ; Rishi JAIN
Journal of Medicine University of Santo Tomas 2019;3(1):260-269
Background:
The high prevalence of type 2 diabetes mellitus (T2DM) in the Philippines has burdened the health care system. Therefore, we compared the
standard of care Insulin 30/70 + Insulin Glulisine
(Arm B) to a traditional insulin regimen NPH Insulin
+ Regular Insulin (Arm A) to test the concept that
both insulin regimens provide comparable effectiveness and safety in real-world practice.
Methods :
This is a ‘proof-of-concept,’ prospective,
randomized, open label pragmatic study of 40
consecutive Filipino T2DM patients from October
2015 to June 2016. The primary endpoint was a
reduction in HbA1c at 12 weeks. The secondary
endpoints were changes in Fasting Plasma Glucose
(FPG), Post Prandial Glucose (PPG), Capillary Blood Sugar (CBS), weight and insulin dose at 12 weeks.
ANCOVA and Fisher’s exact tests were used.
Results :
Patients in treatment arm A showed comparable glycemic control to arm B as measured by
reductions in HbA1c (2.89% vs. 2.67%; P = 0.657),
FPG (65.94 vs. 46.71 mg/dl; P = 0.57), PPG (76.49
vs. 86.96 mg/dl; P = 0.271) and CBS (115.15 vs.
145.95 mg/dl; P = 0.420). Both treatment arms reported similar weight gain (1.92 vs. 1.22 kg), experienced similar incidence of hypoglycemia (7 vs. 6
patients) and adverse events (AE) (8 vs. 8 patients).
Conclusion
The traditional combination of NPH
Insulin + Regular Insulin offers comparable glycemic control and tolerance as the standard of care
without any new safety signals in the Filipino T2DM
population. With a lower price, it can be one of the
strategies to reduce the fi nancial burden of antidiabetic treatment.
Insulin, Isophane
;
Insulin
;
Diabetes Mellitus, Type 2