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Patient Awareness of Dietary and Lifestyle Measures in Gastroesophageal Reflux Disease
Kašpar, Vojtěch ; Hrabák, Petr (advisor) ; Švestka, Tomislav (referee)
Background: The importance of adherence to dietary and lifestyle changes for gastroesophageal reflux disease (GERD) is well known. The question is whether patients of gastroenterology clinics are well informed about these interventions. Aims: The main aim of the work was to investigate the level of awareness of patients about dietary and lifestyle changes for GERD using knowledge questions. The secondary goals were to find out where the patients most often acquire their current information about dietary and lifestyle changes and what the patients would like to be more educated about. Methods: Data were obtained using a questionnaire from 33 respondents from gastroenterology departments. Data collection took place in the Faculty Polyclinic of the General University Hospital in Prague, in the Fourth Department of Internal medicine of the General University Hospital in Prague and The Military University Hospital in Prague. The obtained informations were analyzed using Microsoft Excel. Results: The research revealed that the average awareness score based on the evaluation of the knowledge questions in the questionnaire was 71 %. The average number of wrong answers per 1 respondent was 7 out of a total of 24 possible correct answers. The most common source from which patients have information about...
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Manometry and its use in patients with a diagnosis of globus faryngeus
Gregová, Daniela ; Bitnar, Petr (advisor) ; Hep, Aleš (referee)
Introduction The main aim of this study is to present a complex review comprising etiological factors, diagnostic options and therapeutic methods related to globus pharyngeus, a persistent or intermittent sensation of a lump or foreign body in the throat. The second purpose is to investigate the reciprocal relationship between motor control with musculoskeletal system and pressure changes in the esophagus, especially in the upper esophageal sphincter. Methods 37 patients participated in the study. 24 of them suffered globus pharyngeus and 13 were patients with GERD but without the symptoms of globus pharyngeus. Because of the complex physiology of esophageal function and the inability of conventional manometry to fully describe this complexity, we found High-Resolution Manometry as a useful device for accomlishing the referred task. Patients were examined in four different postural situations which had to be modified when the attitude wasn't tolerated. The examination was followed by manual physiotherapy and exercises targeted to influence postural alignment. 10 patients with globus pharyngeus who agreed with a control manometry examination were familiarized with the results as a form of biofeedback. Results On the basis of the results of this research, it can be concluded that a high pressure...
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New diagnostic methods in bronchology
Votruba, Jiří ; Daneš, Jan (advisor) ; Marel, Miloslav (referee) ; Pešek, Miloš (referee)
The aim of this work has been the development and optimization of methods for early diagnosis of lung cancer, their utility and integration into daily practice. Firstly, we developed a device for measurement of endobronchial temperature (thermobronchoscopy) and found significant difference in endoluminal temperature above tumors and infiltrated lymph nodes compared to healthy regions. We further designed an appliance for near infrared spectroscopy of the bronchial mucosa and identified spectroscopic features useful for localization of solitary pulmonary nodule. The use of the appliance improved yield of endobronchial biopsy compared to endobronchial ultrasound. In the next part of the study, we describe further techniques for early diagnosis of lung cancer including endobronchial ultrasound, optical coherence tomography, confocal fluorescence microendoscopy, reflectance spectroscopy, autofluorescence bronchoscopy, fluorescence bronchoscopy, and narrow band imaging with concise introduction of our experience gained in several pilot projects. Next, we showed the utility of measurement of acetic acid in exhaled air as a promising biomarker for non-invasive identification of patients with symptomatic acid gastroesophageal reflux. Lastly, we demonstrated significant difference in radiation dose in HRCT...
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Viscerosomatic relations in physiotherapy
KUKLOVÁ, Monika
The Assignment's aim is to clarify the definition of referred pain and the issues of viscerosomatic and somatovisceral relations. Relations between internal organs and the musculoskeletal system have been known for a long time, but in practice it is often overlooked even though in some cases there is a proven track of viscerosomatic equations and concrete reflection changes helping to set the right diagnosis and therapy. Also, it may be an internal problem that seems as a musculoskeletal issue, in that case a patient is sent for the rehabilitation that does not result the desired relief and pain remains. Therefore, it is needed to examine the internal organs and send the patient for further checks in order to find out the right diagnosis on time and overcome a significant damage to patient's health (for instance a late diagnosis of tumour disease). On the other hand, the patient may think their problem is internal, but after the thorough examination there is no evidence of such pathology. It results that the patient is perceived as a hypochondriac and/or their problems are psychosomatic. In that case based on the differential diagnosis, it is critical to consider the relations between the musculoskeletal and internal systems. If the root problem is caused in the musculoskeletal system, the right physiotherapy can result a desired relief of the patient and also help the internal problems. The thesis in a theoretical part elaborates on the definition of these relations and the referred pain. Furthermore, it aims to clarify the issue of visceral patterns and describe the most frequent diagnoses within viscerosomatic and somatovisceral relations and the possibilities of their treatment. Two case reports are presented in the practical part. The first case study elaborates on a patient with gastroesophageal reflux and the second case study is about a patient with dysmenorrhea.
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New diagnostic methods in bronchology
Votruba, Jiří ; Daneš, Jan (advisor) ; Marel, Miloslav (referee) ; Pešek, Miloš (referee)
The aim of this work has been the development and optimization of methods for early diagnosis of lung cancer, their utility and integration into daily practice. Firstly, we developed a device for measurement of endobronchial temperature (thermobronchoscopy) and found significant difference in endoluminal temperature above tumors and infiltrated lymph nodes compared to healthy regions. We further designed an appliance for near infrared spectroscopy of the bronchial mucosa and identified spectroscopic features useful for localization of solitary pulmonary nodule. The use of the appliance improved yield of endobronchial biopsy compared to endobronchial ultrasound. In the next part of the study, we describe further techniques for early diagnosis of lung cancer including endobronchial ultrasound, optical coherence tomography, confocal fluorescence microendoscopy, reflectance spectroscopy, autofluorescence bronchoscopy, fluorescence bronchoscopy, and narrow band imaging with concise introduction of our experience gained in several pilot projects. Next, we showed the utility of measurement of acetic acid in exhaled air as a promising biomarker for non-invasive identification of patients with symptomatic acid gastroesophageal reflux. Lastly, we demonstrated significant difference in radiation dose in HRCT...
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Diaphragm in the role of external esophageal sphincter - spirometric - manometric study
Veličková, Barbora ; Bitnar, Petr (advisor) ; Šnajdauf, Martin (referee)
The aim of this thesis is to present a complex information about the etiology, diagnosis and treatment of gastroesophageal reflux disease (GERD) and to further elucidate the function of the diaphragm as the external esophageal sphincter and as a part of the antireflux barrier in patients with GERD. The study included 87 patients with verified GERD. Patients were subjected to a set of postural and respiratory maneuvers - caudal position of chest, abdominal breathing and measuring of the maximal respiratory pressures, all performed on the basis of tolerance to position and maneuver. The high-resolution manometry (HRM) was chosen to record the changes in pressure in the lower esophageal sphincter and for the measurement of respiratory pressures was used the spirometric system MasterScope. It was found that postural and respiratory maneuvers, that activate the diaphragm, increase the pressure in the EGJ. The most significant increase occurred during the maximal inspiratory maneuver, which increased LES pressure up to 261.2 %. The results also show that patients with GERD have reduced the strength of respiratory muscles, especially inspirational muscles. Reaching only 66.5 % of predicted PImax. We have demonstrated that patients with GERD have significantly lower diaphragm muscle strength, what...
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Manometry and its use in patients with a diagnosis of globus faryngeus
Gregová, Daniela ; Bitnar, Petr (advisor) ; Hep, Aleš (referee)
Introduction The main aim of this study is to present a complex review comprising etiological factors, diagnostic options and therapeutic methods related to globus pharyngeus, a persistent or intermittent sensation of a lump or foreign body in the throat. The second purpose is to investigate the reciprocal relationship between motor control with musculoskeletal system and pressure changes in the esophagus, especially in the upper esophageal sphincter. Methods 37 patients participated in the study. 24 of them suffered globus pharyngeus and 13 were patients with GERD but without the symptoms of globus pharyngeus. Because of the complex physiology of esophageal function and the inability of conventional manometry to fully describe this complexity, we found High-Resolution Manometry as a useful device for accomlishing the referred task. Patients were examined in four different postural situations which had to be modified when the attitude wasn't tolerated. The examination was followed by manual physiotherapy and exercises targeted to influence postural alignment. 10 patients with globus pharyngeus who agreed with a control manometry examination were familiarized with the results as a form of biofeedback. Results On the basis of the results of this research, it can be concluded that a high pressure...
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Physiotherapy for gastroesophageal reflux
ŠIRMAROVÁ, Jitka
This thesis deals with the issue of etiology and gastroesophageal reflux disease (GERD). It has been proved that the locomotor system affects occurrence of this disease in many aspects therefore, apart from the primary care of gastroenterologists and general practitioners, treatment using physiotherapeutic techniques becomes significant. Sphincter mechanism at the lower end of the oesophagus being the most important anti-reflux barrier in terms of function is described in the theoretical part in detail. Possible ways and factors involved in occurrence of gastroesophageal reflux and then current treatment of gastroesophageal reflux disease are mentioned. The other part of the theoretical part is aimed at: relations between the internal organs and locomotor system, the diaphragm function and its relation to occurrence of GERD, and possibilities of rehabilitation treatment of patients with this disease. The goal of the theoretical part was to provide a research on the current situation. The practical part was prepared by means of a qualitative research. The tested set consisted of three patients diagnosed with GERD being treated at the Gastroenterological Ward in České Budějovice Hospital. Patients? anamneses were taken and kinesiological testing was done. Similarly, all three patients were identified with a disorder of trunk stabilization. Upon this, individual therapies were proposed and carried out, which was the goal of the practical part, too. Physiotherapy was aimed at: affecting the position of the rib cage and improving its dynamics while breathing, training of breathing stereotype, activation of the abdominal wall, affecting the stabilizing function of legs, exercises in developmental series and modified positions, Jacobson's progressive muscle relaxation, and affecting reflexive changes using soft techniques. The research issue was whether the symptoms of GERD could be affected by treatment of functional disorders of the locomotor system in a positive way. There were certain changes in the kinesiological testing (e.g. change in the activity of lower and upper fixators of scapulae with relaxation of the trapezius, releasing the rigidity of the chest, affecting the dynamic stability of the body) during a three-month therapy. However, functional disorders were not affected that much so any described symptoms of GERD could be changed. The results of the therapy were limited by motivation, attitude and patients? metal state. Not only the internal organ but also the locomotor system probably plays a role in occurrence of the reflux; but also psyche, and all these parts of a human being affect each other. Therefore the treatment of a multifactorial disease such as GERD should be comprehensive. Apart from physiotherapy, metal area, too, and all factors should be treated at the same time, which requires interdisciplinary cooperation unfortunately lagging behind.
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