Morris Traube, M.D.

Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding
Khan, Abraham; Ren-Fielding, Christine; Traube, Morris
2011 Oct;45(9):775-779, Journal of clinical gastroenterology
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
— id: 137441, year: 2011, vol: 45, page: 775, stat: Journal Article,

Patients with Throat Symptoms on Acid Suppressive Therapy: Do They Have Reflux?
Khan, Abraham; Cho, Ilseung; Traube, Morris
2010 Feb;55(2):346-350, Digestive diseases & sciences
Purpose The aim of this study was to characterize the reflux events in patients with laryngeal symptoms unresponsive to proton pump inhibitor (PPI) therapy. Background Gastroesophageal reflux disease (GERD) is commonly implicated as the cause of laryngeal symptoms. Methods We retrospectively reviewed the pH/impedance records of 21 patients evaluated for persistent throat symptoms despite PPI therapy. They were compared to 30 others with typical reflux symptoms despite medication. Results Five of 21 (24%) patients in the 'throat group' had normal reflux values, 13 (62%) continued to have abnormal acid reflux, and three (14%) had abnormal nonacid reflux but normal acid reflux while on medication. These results did not differ from those with typical symptoms unresponsive to medication. Conclusion In patients with chronic laryngeal symptoms despite PPI therapy, a substantial minority have no reflux at all, but the majority have abnormal amounts of acid reflux despite their taking PPI medication
— id: 95042, year: 2010, vol: 55, page: 346, stat: Journal Article,

A Reversible Achalasia-Like Disorder Aft er Laparoscopic Adjustable Gastric Banding
Khan, A; Ren, C; Traube, M
2009 OCT ;104(2):S15-S15, American journal of gastroenterology
— id: 106463, year: 2009, vol: 104, page: S15, stat: Journal Article,

Lap-band impact on the function of the esophagus
Gamagaris, Zoi; Patterson, Carlie; Schaye, Verity; Francois, Fritz; Traube, Morris; Fielding, Christine J; Fielding, George A; Youn, Allison Heekoung; Weinshel, Elizabeth H
2008 Oct;18(10):1268-1272, Obesity surgery
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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
— id: 91869, year: 2008, vol: 18, page: 1268, stat: Journal Article,

The acid achalasia association
Traube, Morris
2002 Apr;34(4):382-384, Journal of clinical gastroenterology
— id: 49237, year: 2002, vol: 34, page: 382, stat: Journal Article,

Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients
Leder SB; Joe JK; Hill SE; Traube M
2001 Spring;16(2):79-82, Dysphagia
The biomechanics of the pharyngeal swallow in patients with a tracheotomy tube were investigated with manometry. Upper esophageal sphincter (UES) and pharyngeal pressure recordings were made with and without occlusion of the tracheotomy tube. Criteria for selection were ability to tolerate tracheotomy tube occlusion for both 5 minutes prior to and during the first manometric analysis, absence of surgery to the upper aerodigestive tract other than tracheotomy, and no history of oropharyngeal cancer or stroke. Aspiration was determined objectively by fiberoptic endoscopic evaluation of swallowing (FEES) immediately prior to manometric recording. Eleven adult individuals with tracheotomy participated; 7 swallowed successfully and 4 exhibited aspiration on FEES. The results indicated no significant effect of tracheotomy tube occlusion on UES or pharngeal pressures in either aspirating or nonaspirating patients. It was concluded that the biomechanics of the swallow as determined by UES and pharyngeal manometric pressure measurements were not changed significantly by tracheotomy tube occlusion in aspirating or nonaspirating patients. These results support previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status
— id: 49238, year: 2001, vol: 16, page: 79, stat: Journal Article,

Gastrointestinal complications
Steinlauf AF; Traube M
Medical complications during pregnancy Philadelphia : W.B. Saunders Co., 1999,
— id: 5304, year: 1999, vol: , page: 255, stat: Chapter,

Clostridium difficile colitis: a possible cause of unexplained elevation of serum alkaline phosphatase levels in patients with AIDS
Steinlauf AF; Traube M; Neitlich JD; Cooney EL
1998 May;26(5):1248-1249, Clinical infectious diseases
— id: 49239, year: 1998, vol: 26, page: 1248, stat: Journal Article,

Idiopathic and reflux-associated diffuse esophageal spasm: A lack of differentiation by manometry
Steinlauf, AF; Sandman, Y; Traube, M
1998 ;114(4):G3457-G3457, Gastroenterology
— id: 106436, year: 1998, vol: 114, page: G3457, stat: Journal Article,

Differentiation of achalasia from pseudoachalasia by computed tomography
Carter M; Deckmann RC; Smith RC; Burrell MI; Traube M
1997 Apr;92(4):624-628, American journal of gastroenterology
OBJECTIVES: The purpose of this study was to determine the computed tomography (CT) findings in idiopathic achalasia and in the pseudoachalasia of malignancy. METHODS: We identified 12 patients with the manometric diagnosis of achalasia who also had CT scans available for review: eight had idiopathic achalasia, and four had pseudoachalasia. As controls, we selected nine patients with endoscopically obvious esophageal cancer who also had CT scans. The CT scans were blindly reviewed to determine esophageal wall thickness, symmetry of the esophageal wall, presence of esophageal dilation or mass, and a radiological diagnosis. RESULTS: Six of the eight patients with achalasia had a dilated esophagus. Five had symmetric wall thickening >5 mm (range 7-10 mm) at the gastroesophageal junction. One patient with a 10-mm wall thickening was incorrectly diagnosed with a mass. All others were correctly diagnosed with achalasia. Three of the four patients with pseudoachalasia had esophageal dilation. Two had an obvious esophageal mass. The other two were given an indefinite diagnosis: one had asymmetric wall thickening (11 mm) at the gastroesophageal junction, and the other had symmetric thickening of 18 mm. Eight of the nine patients with obvious esophageal cancer had a mass on CT; the other patient had asymmetric wall thickening of 6 mm at the gastroesophageal junction and was given an indefinite diagnosis. CONCLUSIONS: Most achalasia patients have CT findings of esophageal dilation and mild, symmetric wall thickening. Therefore, symmetric esophageal wall thickening (<10 mm) should not dissuade one from the diagnosis of achalasia. Most pseudoachalasia patients have CT findings of esophageal dilation, more marked and/or asymmetric wall thickening, or mass. In this group, asymmetric or marked thickening (>10 mm) indicated pseudoachalasia. Therefore, CT can be helpful in differentiating between achalasia and the pseudoachalasia of malignancy
— id: 49241, year: 1997, vol: 92, page: 624, stat: Journal Article,

Diffuse pagetoid squamous cell carcinoma in situ of the esophagus: a case report
Chu P; Stagias J; West AB; Traube M
1997 May 15;79(10):1865-1870, Cancer
BACKGROUND: In Western countries, esophageal squamous cell carcinoma is usually advanced at presentation and is rarely diagnosed in situ. The authors studied an in situ squamous cell carcinoma that occupied the entire mucosa of a 9 cm length of esophagus, causing dysphagia for solid food in a woman aged 68 years. METHODS: The esophagectomy specimen contained a circumferential region of depressed tan mucosa in the middle and lower thirds, bordered above and below by normal squamous mucosa, without ulcer, stricture, or mass. The entire lesion was submitted for histology and evaluated with immunostains for cytokeratins and markers of Paget's cells, p53 mutation, and proliferation. RESULTS: The lesion involved 45 cm2 of mucosa. Large, atypical cells with frequent mitoses occupied the basal layers of the squamous epithelium and were often separated from more superficial maturing cells by acantholysis. Pagetoid spread of tumor cells into nonneoplastic surface and gland duct epithelium was prominent. The tumor cells expressed cytokeratins of low molecular weight, p53 gene product, and proliferating cell nuclear antigen (PCNA), but lacked markers usually seen in Paget's cells in the breast or vulva. No invasion was evident. CONCLUSIONS: This extensive in situ squamous cell carcinoma of the esophagus resulted from pagetoid spread of tumor cells. These cells had a phenotype suggestive of origin from primitive epidermal stem cells and also had overexpressed p53 and PCNA, but they lacked the capacity to penetrate the basement membrane. Flat, erythematous areas of esophageal mucosa seen during endoscopy could represent early squamous cell carcinoma and should be biopsied
— id: 49240, year: 1997, vol: 79, page: 1865, stat: Journal Article,

Radiologic and manometric study of the gastroesophageal junction in dysphagia aortica
Sundaram U; Traube M
1995 Dec;21(4):275-278, Journal of clinical gastroenterology
This article reports radiologic and manometric findings in dysphagia aortica, with particular attention to the gastroesophageal (GE) junction. Records of three patients, ages 70-78 years, with clinical/radiologic dysphagia aortica were compared to those in control groups. Subsequently, manometric findings of such vascular compression were sought in 10 consecutive patients > or = 65 years old with dysphagia. The three patients with dysphagia aortica had radiologic/endoscopic evidence for compression at the GE junction. Manometric studies, performed in two of them, showed evidence at the GE junction for superimposed rhythmic contractions at 60-72/min (maximum amplitudes, 35 mm Hg), consistent with vascular compression. One patient had marked elevation of 'sphincter' pressure to 110 mm Hg and 'poor relaxation' of the 'sphincter.' One of 10 patients with dysphagia had rhythmic contractions of 20 mm Hg; a barium study subsequently showed aortic compression at the GE junction. There are characteristic manometric findings that may help to identify symptomatic vascular compression of the esophagus in the elderly
— id: 49242, year: 1995, vol: 21, page: 275, stat: Journal Article,

Instrumental esophageal perforation: chest film findings
Panzini L; Burrell MI; Traube M
1994 Mar;89(3):367-370, American journal of gastroenterology
The aim of this study was to evaluate plain film findings of the chest in instrumental esophageal perforation. We hypothesized that such 'clean' perforations, often detected early, would be associated with a low frequency of abnormal plain film findings. Fifteen patients with instrumental esophageal perforation were identified, and their records and radiographs were reviewed. Twelve (80%) of the patients had abnormalities suggestive of perforation. The most common (60%) abnormality seen was pneumomediastinum. The second most common (33%) finding was a density adjacent to the descending aorta in the left cardiophrenic angle, resulting in loss of contour of the descending aorta at the level of the left diaphragm. We concluded that plain films, even when taken shortly after instrumentation, provide useful information regarding the presence of esophageal perforation
— id: 49245, year: 1994, vol: 89, page: 367, stat: Journal Article,

Vascular compression of the esophagus: a manometric and radiologic study
Stagias JG; Ciarolla D; Campo S; Burrell MI; Traube M
1994 Apr;39(4):782-786, Digestive diseases & sciences
This study was undertaken to determine the prevalence of vascular compression in manometric tracings and to determine whether these findings had any clinical significance. Vascular compression, defined as a localized area of elevated intraesophageal resting pressure > 4 mm Hg with superimposed cyclic pressure spikes with a frequency of 60-100/min, was noted in 55 of 241 consecutive tracings. The groups with and without vascular compression were similar with regard to mean age, sex, and prevalence of dysphagia. Radiographs were available for 29 of the 55 and showed compression in 18, but there was no relationship with the manometric findings, except for a trend towards finding a positive esophagogram with amplitudes > 16 mm Hg. Eleven tracings showed absent 'relaxation' of this elevation of pressure in response to swallows, and five of six available esophagograms showed a corresponding area of compression. We conclude that manometric evidence of vascular compression is common and generally has no clear relationship with esophagographic findings or dysphagia. However, the combined findings of marked increases in pressure and absence of relaxation in response to swallows may indicate evidence for a vascular cause of dysphagia
— id: 49244, year: 1994, vol: 39, page: 782, stat: Journal Article,

Difficulties in the diagnosis of pseudoachalasia
Tracey JP; Traube M
1994 Nov;89(11):2014-2018, American journal of gastroenterology
OBJECTIVES: We undertook this study to determine the utility of various clinical findings and tests in the diagnosis of pseudoachalasia. METHODS: We reviewed the clinical, endoscopic, esophagographic, CT, and manometric findings of five patients with pseudoachalasia of malignancy. These patients were identified from our large group of 206 patients with manometrically diagnosed achalasia who were seen over the past 8 yr. For each pseudoachalasia patient, the two consecutively seen patients with idiopathic achalasia were chosen to comprise a control group. RESULTS: The pseudoachalasia patients, as compared to the control group, had shorter duration of dysphagia (9.6 +/- 8.6 months vs 54.3 +/- 44.2 months, p < 0.05). They had similar weight loss (15.6 +/- 12.8 lbs vs 14.3 +/- 18.4 lbs, p = NS), but weight loss/time, where time is months of symptoms, was greater in the pseudoachalasia group (1.8 +/- 1.8 lbs/month vs 0.5 +/- 0.5 lbs/month, p < 0.05). There was, however, substantial overlap between the groups in all these parameters. Barium esophagography failed to reveal cancer in any of the pseudoachalasia patients. There was difficult passage of the endoscope through the gastroesophageal junction in all patients with pseudoachalasia, but endoscopic biopsy diagnosed cancer in only two of them. CT scans gave no clear evidence of malignancy in any patient, although three scans had nonspecific findings that, in retrospect, probably indicated malignancy. There were no distinguishing manometric findings. CONCLUSIONS: When pseudoachalasia is suspected on the basis of a constellation of findings, such as advanced age, rapid weight loss, and difficulty in passing the endoscope through the gastroesophageal junction of a nondilated esophagus, negative findings on biopsy and CT scans should not lead to a false reassurance of a benign disorder, and repeated biopsy and scans or surgical exploration may lead to the diagnosis of pseudoachalasia
— id: 49243, year: 1994, vol: 89, page: 2014, stat: Journal Article,

Achalasia. Short-term clinical monitoring after pneumatic dilation
Ciarolla DA; Traube M
1993 Oct;38(10):1905-1908, Digestive diseases & sciences
Although concern about perforation has led physicians to perform pneumatic dilation for achalasia with routine contrast radiography immediately afterwards and with hospitalization, the need for these precautions has not been demonstrated. In contrast, we have routinely performed pneumatic dilations without contrast studies or hospitalization, and we hereby present our experience. During a recent six-year period, 110 pneumatic dilations were performed, and 71 of the last 73 were performed as outpatients with about 5-8 hr of clinical monitoring. Detailed review of 100 records showed that only 15 patients underwent contrast studies because of pain or fever. Perforation occurred in seven of the 15 patients, all of whom underwent surgery successfully. Short-term follow-up in patients who did not sustain perforation showed good or excellent results in 82%. Thus, it has been our experience that pneumatic dilation could be safely performed in achalasia without routine use of contrast studies or hospitalization
— id: 49246, year: 1993, vol: 38, page: 1905, stat: Journal Article,

Stridor from tracheal obstruction in a patient with achalasia
Panzini L; Traube M
1993 Jul;88(7):1097-1100, American journal of gastroenterology
We present a case of respiratory compromise from mechanical compression of the trachea by the distended esophagus in a patient with achalasia. Our patient was unusual because of young age, male sex, and family history of achalasia. We review the literature on this unusual complication of achalasia
— id: 49248, year: 1993, vol: 88, page: 1097, stat: Journal Article,

Outcome after perforation sustained during pneumatic dilatation for achalasia
Schwartz HM; Cahow CE; Traube M
1993 Aug;38(8):1409-1413, Digestive diseases & sciences
Although esophageal perforation complicates about 5% of pneumatic dilatations performed for achalasia, little is known about associated hospital and long-term courses. In order to assess the outcome of such patients undergoing emergency surgery for repair, records of seven patients sustaining perforation during pneumatic dilatation were compared to those of five patients undergoing elective myotomy during the same period. In perforation patients, mean intervals following the procedure were 3.6 hr to administration of antibiotics and 9.6 hr to surgery. The perforation and elective myotomy groups had similar mean durations of operation (3.8 vs 3.3 hr), intensive care stays (2 vs 1 days) and hospitalization (12 vs 11 days); perforation patients had a significantly longer mean interval from surgery to oral intake (7 vs 5 days). Postdischarge long-term outcomes were alike in the groups. It is concluded that patients with perforation from pneumatic dilatation that is recognized and treated promptly have outcomes that are comparable to those of patients who undergo elective myotomy
— id: 49247, year: 1993, vol: 38, page: 1409, stat: Journal Article,

Manometric characteristics in idiopathic and reflux-associated esophageal spasm
Campo S; Traube M
1992 Feb;87(2):187-189, American journal of gastroenterology
Ancillary manometric findings, e.g., high amplitude contractions, repetitiveness, or elevated lower esophageal sphincter (LES) pressure, have been reported in diffuse esophageal spasm (DES). However, two recent changes in DES have been noted: 1) it has been redefined as increased simultaneous contractions, with intermittent peristalsis, and 2) there has been more attention to reflux-associated DES. Therefore, our aims were to characterize the ancillary findings in currently defined DES and to determine whether these occurred in both idiopathic and reflux-associated DES. Records of 31 patients with DES (greater than 25% simultaneous contractions) were reviewed. Independent of manometry, some patients could be subclassified as idiopathic (N = 7; no heartburn; normal endoscopy or acid perfusion test) or reflux-associated (N = 10; heartburn; positive endoscopy). Both low and high LES pressures and contraction amplitudes were seen. Repetitive contractions were seen in nearly all patients, and segmental aperistalsis, dropped waves, or distally nonpropagated waves were seen in more than half. These findings were generally observed in both types of DES. This study of DES 1) confirms the high prevalence of repetitive contractions, 2) deemphasizes high LES pressure and contraction amplitude, 3) extends the findings to include other types of peristaltic dysfunction, and 4) indicates that manometric findings per se do not allow clear differentiation of idiopathic from reflux-associated DES
— id: 49251, year: 1992, vol: 87, page: 187, stat: Journal Article,

Achalasia and hiatal hernia
Goldenberg SP; Vos C; Burrell M; Traube M
1992 Apr;37(4):528-531, Digestive diseases & sciences
Several reports have emphasized the rarity of hiatal hernia in achalasia, despite the lack of inherent incompatibility of the two conditions and despite the relatively high frequency of hiatal hernia in the general population. We reviewed the radiographs of 71 of 94 consecutive patients with manometrically proven achalasia referred to Yale-New Haven Hospital. Unequivocal hiatal hernia was seen in 10 (14.1%) patients and was seen in nine of 35 (25.7%) patients 51 years old or more. Review of the radiographic reports from these 10 patients indicated that only two were properly recognized as showing both achalasia and hiatal hernia. All five patients who underwent pneumatic dilatation had excellent results. We conclude that hiatal hernia in achalasia is frequently unrecognized and underreported but is not rare, with a frequency probably similar to that of the general population
— id: 49249, year: 1992, vol: 37, page: 528, stat: Journal Article,

Esophageal motor dysfunction years after radiation therapy
Seeman H; Gates JA; Traube M
1992 Feb;37(2):303-306, Digestive diseases & sciences
Well-known complications of radiation to the esophagus are acute esophagitis and strictures. Although radiologic studies have demonstrated motor abnormalities after radiation treatment, clinical aspects have not been described adequately, nor have manometric evaluations been reported. Clinical presentation of dysphagia long after treatment also has not been reported. We describe herein three patients who presented with dysphagia years after radiation therapy. Radiographic, endoscopic, histologic, and manometric studies supported our conclusion that these patients suffered from radiation-induced esophageal motor dysfunction. This report indicates the need, in the proper setting, to consider radiation-induced motor dysfunction as a cause of dysphagia even decades after radiation treatment
— id: 49250, year: 1992, vol: 37, page: 303, stat: Journal Article,

Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings
Goldenberg SP; Burrell M; Fette GG; Vos C; Traube M
1991 Sep;101(3):743-748, Gastroenterology
Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs, and with the presence of chest pain. However, no study using current manometric techniques has compared manometric, radiographic, and clinical findings in vigorous and classic achalasia or questioned the usefulness of making this distinction. Fifty-four cases involving patients with achalasia whose radiographic and manometric studies were performed within 6 months of each other were available for review. Patients with vigorous achalasia (n = 17), defined by amplitude greater than or equal to 37 mm Hg, and patients with classic achalasia (n = 37), defined as amplitude less than 37 mm Hg, had substantial overlap in radiographic parameters of esophageal dilation, tortuosity, and tertiary contractions. Manometric properties of repetitive waves and lower esophageal sphincter pressure and clinical aspects of chest pain, dysphagia, heartburn, and satisfactory responses to pneumatic dilation were similar in both forms of achalasia. A separate analysis of patients with mean contraction amplitude greater than 60 mm Hg revealed similar findings. It is concluded that use of amplitude as a criterion for classifying achalasia is arbitrary and of dubious value
— id: 49253, year: 1991, vol: 101, page: 743, stat: Journal Article,

Hiccups and achalasia
Seeman H; Traube M
1991 Nov 1;115(9):711-712, Annals of internal medicine
— id: 49252, year: 1991, vol: 115, page: 711, stat: Journal Article,

On drugs and dilators for achalasia
Traube M
1991 Mar;36(3):257-259, Digestive diseases & sciences
— id: 49254, year: 1991, vol: 36, page: 257, stat: Journal Article,

The spectrum of the symptoms and presentations of gastroesophageal reflux disease
Traube M
1990 Sep;19(3):609-616, Gastroenterology clinics of North America
The symptoms and presentations of gastroesophageal reflux disease are rather numerous. These include the typical symptoms, such as heartburn, regurgitation, water brash, or dysphagia. However, reflux may also be responsible for such symptoms as hoarseness, pulmonary aspiration, or asthma. It may also be an important cause of noncardiac chest pain. Thus, gastroesophageal reflux disease may be considered a disease with more than just 'esophageal' symptoms
— id: 49255, year: 1990, vol: 19, page: 609, stat: Journal Article,

Lower esophageal sphincter dysfunction in diffuse esophageal spasm
Campo S; Traube M
1989 Aug;84(8):928-932, American journal of gastroenterology
Although lower esophageal sphincter (LES) dysfunction has been reported in patients with diffuse esophageal spasm, recent changes in manometric criteria for spasm and for LES relaxation suggested a need for reassessment. Moreover, LES relaxation in reflux-associated spasm has not been reported previously. On clinical criteria and independent of manometric findings, 22 patients with spasm were assigned to either idiopathic (I-DES, N = 9) or reflux-associated spasm (R-DES, N = 13) groups. Patients who underwent manometry for chest pain (C-NL, N = 10) or reflux (R-NL, N = 10) and had normal peristalsis served as control groups. Percent LES relaxation was significantly reduced in both spasm groups, and R-DES had significantly lower percent relaxation than I-DES. Post-deglutitive nadir sphincter pressure was significantly greater in R-DES than in I-DES. Duration of relaxation was normal in I-DES, but was significantly decreased in R-DES. This study indicates that 1) LES relaxation may be impaired in I-DES patients meeting current criteria for spasm, 2) the impairment in I-DES is primarily in 'amplitude' of relaxation, i.e., percent relaxation and nadir pressure, but not duration, 3) LES relaxation may also be impaired in R-DES, and 4) the impairment in R-DES is to a greater degree than in I-DES patients and may be seen in both 'amplitude' and duration of relaxation. This study shows that there is a spectrum of sphincter dysfunction in patients with esophageal spasm. It also suggests that there may be separate mechanisms for LES relaxation in R-DES patients, one with impaired relaxation and the other with near complete relaxation, 'transient' or otherwise, to allow for reflux
— id: 49257, year: 1989, vol: 84, page: 928, stat: Journal Article,

Segmental high amplitude peristaltic contractions in the distal esophagus
Freidin N; Mittal RK; Traube M; McCallum RW
1989 Jun;84(6):619-623, American journal of gastroenterology
High amplitude peristaltic contractions in the distal esophagus ('nutcracker esophagus') is the most common manometric disorder seen in patients with noncardiac chest pain. Although this abnormality is found in the distal esophagus, the definition regarding its precise level in the esophagus is unclear. A careful analysis of 99 consecutive manometric tracings performed during a 1-yr period revealed that in patients with noncardiac chest pain and/or dysphagia, the location of the abnormal esophageal contractions varied: 1) in 11 patients the esophageal contractions were abnormal at 2 cm, as well as 7 cm, above the lower esophageal sphincter (LES); 2) the abnormality was limited to the 2-cm location above the LES in six patients; and 3) was confined to the 7-cm location above the LES in five patients. If the conventional criteria of averaging the distal esophageal contraction amplitudes at 2 and 7 cm above the LES were adopted, six of the 11 patients with segmental esophageal contraction abnormality would not have been identified. We suggest that, by inspection of each location of the distal esophagus separately, localized high amplitude contractions can be identified, and the distal 2 cm segment of the esophagus should be routinely included in the manometric evaluation
— id: 49259, year: 1989, vol: 84, page: 619, stat: Journal Article,

The hypertensive lower esophageal sphincter. Manometric and clinical aspects
Freidin N; Traube M; Mittal RK; McCallum RW
1989 Jul;34(7):1063-1067, Digestive diseases & sciences
Controversy exists as to whether the hypertensive lower esophageal sphincter (HLES) represents a clinical motility disorder of the esophagus or is merely the right-sided expression of a normal distribution curve. In the present study we describe 16 patients with HLES, defined as a lower esophageal sphincter (LES) pressure of greater than or equal to 40 mm Hg (mean + 3 SD of controls) with normal peristalsis. All of the patients suffered from chest pain and nine from dysphagia. Delayed bolus transit at the gastroesophageal junction was demonstrated in four patients by radiography. Manometric studies showed that during swallowing the LES residual pressures were significantly greater (9.2 +/- 5.0 mm Hg) than observed in normal controls (1.8 +/- 2.2 mmHg) (mean +/- 1 SD). However, the percent LES relaxation in patients did not differ significantly from controls. Clinical improvement was associated with pharmacological or mechanical reduction of resting LES pressure with an accompanying fall in the nadir pressure. These observations suggest that HLES may have clinical and pathophysiological significance and that evidence for the entity should be sought during manometric studies in the clinical laboratory
— id: 49258, year: 1989, vol: 34, page: 1063, stat: Journal Article,

Primary non-Hodgkin's lymphoma of the esophagus
Nagrani M; Lavigne BC; Siskind BN; Knisley RE; Traube M
1989 Jan;149(1):193-195, Archives of internal medicine
Squamous cell carcinoma and adenocarcinoma constitute the majority of malignancies of the esophagus. Although lymphoma may involve any part of the gastrointestinal tract either primarily or secondarily, esophageal involvement is rare. We describe two cases of primary esophageal non-Hodgkin's lymphoma and review the literature, with particular attention to roentgenographic studies, esophagoscopic findings, and endoscopic biopsy results
— id: 49262, year: 1989, vol: 149, page: 193, stat: Journal Article,

The diagnosis and misdiagnosis of achalasia. A study of 25 consecutive patients
Rosenzweig S; Traube M
1989 Apr;11(2):147-153, Journal of clinical gastroenterology
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
— id: 49260, year: 1989, vol: 11, page: 147, stat: Journal Article,

Nonsurgical management of esophageal perforation from pneumatic dilatation in achalasia
Swedlund A; Traube M; Siskind BN; McCallum RW
1989 Mar;34(3):379-384, Digestive diseases & sciences
Perforation of the esophagus is a well-described complication of pneumatic dilatation in patients with achalasia. Although successful management of these patients without surgical intervention has been reported, little follow-up data exist. We report the successful nonsurgical management of esophageal perforation after pneumatic dilatation in three patients. Manometric and radionuclide esophageal emptying studies in these patients showed satisfactory results after the dilatations despite the occurrence of perforation, and the excellent symptomatic response has been maintained during a follow-up period ranging from one to four years
— id: 49261, year: 1989, vol: 34, page: 379, stat: Journal Article,

The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study
Traube M; Dubovik S; Lange RC; McCallum RW
1989 Oct;84(10):1259-1262, American journal of gastroenterology
Utilizing the rationale that the calcium channel blocker nifedipine decreases lower esophageal sphincter pressure, we performed a double-blind, placebo-controlled, crossover trial of sublingual nifedipine in achalasia, a disorder whose treatment depends on reduction in lower esophageal sphincter pressure. Ten patients participated in this trial, completed diaries, underwent manometric determinations of lower esophageal sphincter pressure, and had testing of esophageal emptying rates by a solid-meal radionuclide method. Nifedipine, titrated to a dose of 10-30 mg before meals, was well tolerated. Compared with placebo, nifedipine significantly reduced the frequency of dysphagia, but some symptoms of dysphagia, regurgitation, or nocturnal cough were still present most days. Nifedipine significantly reduced lower esophageal sphincter pressure by 28%, a value approximately one-half that achieved by successful pneumatic dilatation or myotomy. Esophageal emptying rates, as determined by the radionuclide method, were unchanged by nifedipine. We concluded that 1) nifedipine reduces symptoms of achalasia, but substantial symptoms do remain during such therapy; 2) the suboptimal effect results from the limited, although statistically significant, effect of nifedipine on reduction of lower esophageal sphincter pressure; and 3) although we believe that nifedipine may be recommended as treatment for achalasia in the subset of patients whose overall medical condition places them at high risk for forceful dilatation or surgery, it cannot be recommended as a standard alternative to these other modalities
— id: 49256, year: 1989, vol: 84, page: 1259, stat: Journal Article,

"Segmental aperistalsis" of the esophagus: a cause of chest pain and dysphagia
Traube M; Peterson J; Siskind BN; McCallum RW
1988 Dec;83(12):1381-1385, American journal of gastroenterology
Although some patients with chest pain and dysphagia have manometric evidence of classic esophageal motor disorders, other patients with these symptoms may have only nonspecific findings of unknown importance. We describe five patients with chest pain and dysphagia in whom esophageal manometry showed a segment of esophagus with an increased frequency of simultaneous contractions associated with normal motility in the more proximal and distal esophagus. All patients had corresponding segmental abnormalities on video-esophagograms augmented with a solid bolus; in four patients, the solid bolus caused reproduction of symptoms during the esophagography. We conclude that 'segmental aperistalsis' may cause chest pain and dysphagia, and that the diagnosis may be made by careful manometric analysis of the entire esophagus, complemented by esophagography with a solid bolus
— id: 49263, year: 1988, vol: 83, page: 1381, stat: Journal Article,

Comparison of esophageal manometric characteristics in asymptomatic subjects and symptomatic patients with high-amplitude esophageal peristaltic contractions
Traube M; McCallum RW
1987 Sep;82(9):831-835, American journal of gastroenterology
The aim of this study was to examine systematically the manometric characteristics of symptomatic patients with high-amplitude peristaltic esophageal contractions, or the nutcracker esophagus (n = 20), in comparison to normal subjects (n = 30). In both normals and patients, amplitude and duration of contractions were more at 5 cm than at 10 cm above the lower esophageal sphincter. The patients differed significantly from normals not only in amplitude at 5 cm, but also at 10 cm and in duration at both sites. Bipeaked waves were seen more frequently in patients than in normals at either 5 or 10 cm above the sphincter. Two patients, but none of the normal subjects, had triple-peaked waves. Lower esophageal sphincter pressure was significantly elevated in patients as compared to normals. Although percent relaxation of the sphincter was the same in patients and normals, the postrelaxation residual, or nadir, sphincter pressure was higher in patients. We conclude that patients with high-amplitude peristaltic contractions may also have abnormalities in duration of contractions, percent bipeaked waves, triple-peaked waves, or in parameters of the lower esophageal sphincter
— id: 49264, year: 1987, vol: 82, page: 831, stat: Journal Article,

Surgical myotomy in patients with high-amplitude peristaltic esophageal contractions. Manometric and clinical effects
Traube M; Tummala V; Baue AE; McCallum RW
1987 Jan;32(1):16-21, Digestive diseases & sciences
High-amplitude peristaltic esophageal contractions, or the nutcracker esophagus, may be associated with chest pain or dysphagia. Medical treatment for this disorder is sometimes not satisfactory. We report the manometric and clinical effects of myotomy in four patients with high-amplitude peristaltic contractions who underwent surgery because of the severity of their symptoms and recalcitrance to various medical treatments. Manometry 1-5 years after surgery showed a reduction in amplitude, duration, and percent bipeaked waves at 5 and 10 cm above the lower esophageal sphincter. Peristalsis was abolished or decreased in the distal 10 cm of the esophageal body but was not affected more proximally. Lower esophageal sphincter pressure was decreased in all patients. The manometric changes were least marked in one patient, who was the only one who had some chest pain when last seen five years after myotomy. We conclude that in severely symptomatic patients with high-amplitude peristaltic contractions, myotomy results in marked manometric changes and marked clinical improvement. Patients with this disorder and whose chest pain is recalcitrant to extensive medical therapy may be successfully treated by surgical myotomy
— id: 49265, year: 1987, vol: 32, page: 16, stat: Journal Article,

Transition from peristaltic esophageal contractions to diffuse esophageal spasm
Traube M; Aaronson RM; McCallum RW
1986 Sep;146(9):1844-1846, Archives of internal medicine
A patient with dysphagia and chest pain was shown by manometry to have high-amplitude peristaltic esophageal contractions (nutcracker esophagus). Worsening symptoms over the next two years led to the performance of repeated manometric studies, which showed diffuse esophageal spasm. This demonstration of a transition from nutcracker esophagus to diffuse esophageal spasm lends further support for consideration of the nutcracker esophagus as a manometric disorder associated with chest pain or dysphagia. Furthermore, it suggests a pathophysiologic relationship between the nutcracker esophagus, a disorder with preserved peristalsis, and diffuse esophageal spasm, the classic dysmotility considered to be of neurogenic origin
— id: 49266, year: 1986, vol: 146, page: 1844, stat: Journal Article,

Correlation of plasma levels of nifedipine and cardiovascular effects after sublingual dosing in normal subjects
Traube M; Hongo M; McAllister RG Jr; McCallum RW
1985 Mar;25(2):125-129, Journal of clinical pharmacology
Only limited work has been reported about the relationships of cardiovascular effects and plasma concentrations of the calcium-channel blocker nifedipine. In this study, placebo and nifedipine in 10-, 20-, 30-, and 40-mg doses were administered sublingually to ten normal subjects with at least three days between dosing periods. Blood pressure and heart rate were monitored every 30 minutes for two hours, and blood samples were taken after each measurement for determination of plasma nifedipine concentration by a sensitive and specific gas chromatographic method. Systolic blood pressure fell significantly (P less than 0.05) although briefly after 10 mg, but the effect persisted with larger doses. Diastolic blood pressure fell significantly only after 30- or 40-mg dosing. Heart rate increased significantly after all doses of nifedipine with the effect lasting longer with higher doses. Systolic blood pressure measurements were significantly related to the log of the concurrently measured plasma nifedipine concentrations (r = -.82, P less than 0.001). Diastolic blood pressure was also related to log nifedipine concentration (r = -.69, P less than 0.01). Heart rate, too, was linearly related to the log of nifedipine plasma levels (r = .75, P less than 0.001). These data indicate that the hemodynamic effects observed after acute nifedipine administration may be used to estimate whether or not significant quantities of the drug are being absorbed and that the intensity of the hemodynamic effects may, therefore, serve as a bioassay to evaluate the appearance of drug in plasma in therapeutic quantities
— id: 49269, year: 1985, vol: 25, page: 125, stat: Journal Article,

Effect of nifedipine on gastric emptying in normal subjects
Traube M; Lange RC; McAllister RG Jr; McCallum RW
1985 Aug;30(8):710-712, Digestive diseases & sciences
We studied the effects of the calcium-channel blocker, nifedipine, on solid and liquid phases of gastric emptying in 10 healthy male volunteers. Each subject underwent a dual-isotope radionuclide gastric emptying determination with and without the preadministration of nifedipine, 30 mg orally, given 20 min prior to ingestion of the test meal over 10 min, following which the subject lay supine under the gamma-counter for 2 hr. Blood samples for measurement of plasma nifedipine concentration were obtained at the time of drug administration and every 30 min throughout the gastric emptying determination. There was a threefold variation in the areas under the plasma nifedipine concentration vs time curve (AUC) obtained in these 10 subjects. Percent gastric retention of either the liquid (water) or the solid (chicken liver) marker was not significantly different after 30 mg oral nifedipine, as compared to the nontreatment day. We concluded that plasma nifedipine concentrations previously reported to be associated with significant esophageal motility effects in humans were not associated with effects on gastric emptying of either liquids or solids
— id: 49267, year: 1985, vol: 30, page: 710, stat: Journal Article,

Primary oesophageal motility disorders. Current therapeutic concepts
Traube M; McCallum RW
1985 Jul;30(1):66-77, Drugs
Various oesophageal manometric disorders have been associated with chest pain or dysphagia. The classic motility disorders are achalasia and diffuse oesophageal spasm. In achalasia, a disorder of aperistalsis in the oesophageal body and incomplete relaxation of the lower oesophageal sphincter, either surgical myotomy or pneumatic dilatation is an effective approach, although some investigators have suggested a role for pharmacological therapy. For the treatment of diffuse oesophageal spasm, a disorder of non-peristaltic motor activity in the oesophagus, various pharmacological approaches with nitrates, anticholinergics, and calcium antagonists have been used. In the presence of associated lower oesophageal sphincter dysfunction, bouginage or pneumatic dilatation may be indicated. Long oesophagomyotomy should be considered for those patients who fail to respond to these measures. Recent manometric techniques have led to the identification of patients with chest pain or dysphagia who have abnormalities of increased contractile amplitude ('nutcracker' oesophagus) or duration. An association with gastro-oesophageal reflux or with psychiatric disturbance has been suggested. Treatment directed towards these factors is indicated and may be supplemented by pharmacological intervention, e.g. by calcium antagonists or anticholinergics
— id: 49268, year: 1985, vol: 30, page: 66, stat: Journal Article,

Effects of nifedipine on esophageal motor function in humans: correlation with plasma nifedipine concentration
Hongo M; Traube M; McAllister RG Jr; McCallum RW
1984 Jan;86(1):8-12, Gastroenterology
We studied the effects of the calcium-channel blocker nifedipine on esophageal smooth muscle function in 10 normal volunteers. Lower esophageal sphincter pressure and relaxation and esophageal contraction amplitude, peristalsis, velocity, and duration after wet swallows were determined before and for 120 min after the sublingual/buccal administration of placebo and of nifedipine in doses of 10, 20, 30, and 40 mg. Blood samples for measurement of plasma nifedipine concentration were obtained at baseline and every 30 min during this 120-min period. Nifedipine led to decreases in sphincter pressure of 13.3%, 29.9%, 34.3%, and 35.1% as the dose was increased from 10 mg to 40 mg. These changes were significantly (p less than 0.05) different from baseline and placebo for the 20-, 30-, and 40-mg doses and were more sustained with the higher doses, lasting as long as 90 min. Contraction amplitude fell 5.3%, 5.9%, 13.5%, and 19.6% at the corresponding doses. These changes were significantly (p less than 0.05) different from baseline and placebo only for the 30- and 40-mg doses, with the effect lasting up to 60 min. Peak plasma nifedipine concentration ranged from 28.7 +/- 3.7 ng/ml (mean +/- SEM) after 10 mg to 138.7 +/- 43.7 ng/ml after 40 mg of the drug, and occurred at either the 30- or 60-min measurement. The mean percent of decrease in sphincter pressure and contraction amplitude in the esophageal body correlated (p less than 0.001) with plasma nifedipine levels. There were no changes in sphincter relaxation or in peristalsis, velocity, or duration of contraction with any dose of nifedipine. It is concluded that (a) nifedipine significantly decreases lower esophageal sphincter pressure and contraction amplitude in the body of the esophagus, (b) the effect on sphincter pressure requires a lower dose of nifedipine and is more marked than that on contraction amplitude, and (c) the effects on both sphincter pressure and contraction amplitude correlate with plasma nifedipine levels. Calcium-channel blockers such as nifedipine may have a role in the treatment of motility disorders of the lower esophageal sphincter or esophageal body, and further controlled clinical studies are indicated
— id: 49274, year: 1984, vol: 86, page: 8, stat: Journal Article,

Comparison of effects of nifedipine, propantheline bromide, and the combination on esophageal motor function in normal volunteers
Hongo M; Traube M; McCallum RW
1984 Apr;29(4):300-304, Digestive diseases & sciences
Both intracellular calcium ions and neural input are important in esophageal smooth muscle contraction. The aim of this study was to compare the effects of well-tolerated doses of the calcium-channel blocker, nifedipine (20 mg sublingually/buccally) with the anticholinergic, propantheline bromide (15 mg orally) and the combination of these two agents on esophageal motor function. Seven healthy volunteers underwent manometric evaluation after nifedipine, propantheline bromide, the combination, and placebo on different days. Lower esophageal sphincter pressure decreased significantly (P less than 0.05 vs basal and placebo) by 32% after nifedipine, but fell only 21% after propantheline bromide. After the combination lower esophageal sphincter pressure fell by 45% (P less than 0.05 vs basal and placebo and nifedipine alone). Contraction amplitude in the body of the esophagus decreased significantly (P less than 0.05 vs basal and placebo) by 26% after propantheline bromide, but fell only 11% after nifedipine. The combination led to a decrease of 37% in contraction amplitude, but this was not significantly different from that obtained with propantheline bromide alone. No drug or combination had any effect on other manometric parameters. These data show that in the normal subjects studied with the above doses: (1) nifedipine has a greater effect than propantheline bromide on the lower esophageal sphincter; (2) propantheline bromide has a greater effect than nifedipine on esophageal contraction amplitude; and (3) the combination of nifedipine and propantheline bromide has an enhanced effect on both lower esophageal sphincter pressure and esophageal contraction amplitude
— id: 49273, year: 1984, vol: 29, page: 300, stat: Journal Article,

Effects of nifedipine in achalasia and in patients with high-amplitude peristaltic esophageal contractions
Traube M; Hongo M; Magyar L; McCallum RW
1984 Oct 5;252(13):1733-1736, JAMA
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
— id: 49271, year: 1984, vol: 252, page: 1733, stat: Journal Article,

Isolated hypertensive lower esophageal sphincter: treatment of a resistant case by pneumatic dilatation
Traube M; Lagarde S; McCallum RW
1984 Apr;6(2):139-142, Journal of clinical gastroenterology
We describe a patient with dysphagia and chest pain, whose sole esophageal manometric abnormality was an elevated lower esophageal sphincter pressure. A radionuclide esophageal emptying test showed prolongation of emptying. After bougienage and medications failed to give relief, pneumatic dilatation gave excellent subjective and objective results
— id: 49272, year: 1984, vol: 6, page: 139, stat: Journal Article,

Calcium-channel blockers and the gastrointestinal tract. American College of Gastroenterology's Committee on FDA related matters
Traube M; McCallum RW
1984 Nov;79(11):892-896, American journal of gastroenterology
— id: 49270, year: 1984, vol: 79, page: 892, stat: Journal Article,

High-amplitude peristaltic esophageal contractions associated with chest pain
Traube M; Albibi R; McCallum RW
1983 Nov 18;250(19):2655-2659, JAMA
Review of esophageal motility tracings performed during a three-year period yielded 112 patients who underwent the test because of chest pain of unclear etiology. Thirteen patients had high-amplitude peristaltic contractions. All 13 patients had pressurelike pain, ten had dysphagia, and six had symptoms of gastroesophageal reflux. The presence of an elevated lower esophageal sphincter pressure in five patients suggested a spectrum of hypertensive disorders of the esophagus variously affecting the body, the sphincter, or both. This latter subgroup responded to esophageal bougienage. Six patients had objective evidence for gastroesophageal reflux. These patients had at least partial relief from antireflux measures. High-amplitude peristaltic contractions should be considered in the differential diagnosis of noncardiac chest pain, since recognition of this entity can lead to appropriate management and symptom relief
— id: 49275, year: 1983, vol: 250, page: 2655, stat: Journal Article,

D-Lactic acidosis after jejunoileal bypass: identification of organic anions by nuclear magnetic resonance spectroscopy
Traube M; Bock JL; Boyer JL
1983 Feb;98(2):171-173, Annals of internal medicine
A 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. Serum L-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis of D-lactic acidosis was confirmed by a specific enzymatic assay for D-lactate. The D-lactic acidosis was cleared using antibiotic therapy, suggesting that D-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying organic acids in patients with unexplained acidosis. Neuropsychiatric symptoms in patients with short bowel syndrome may be associated with D-lactic acidosis
— id: 49276, year: 1983, vol: 98, page: 171, stat: Journal Article,

D-lactic acidosis after jejunoileal bypass
Traube M; Bock J; Boyer JL
1982 Oct 14;307(16):1027-1027, New England journal of medicine
— id: 49278, year: 1982, vol: 307, page: 1027, stat: Journal Article,

Systemic lymphoma initially presenting as an esophageal mass
Traube M; Waldron JA; McCallum RW
1982 Nov;77(11):835-837, American journal of gastroenterology
— id: 49277, year: 1982, vol: 77, page: 835, stat: Journal Article,

Meckel's diverticulum. An unusual case with ileal stricture
Traube M; Iswara K; Reddy RS
1981 Sep;76(3):291-296, American journal of gastroenterology
A 31 year-old man was seen with acute gastrointestinal bleeding. Superior mesenteric angiography revealed a vascular blush. This corresponded to an area of narrowing seen on the small bowel series. A diagnosis of malignant neoplasm was made preoperatively. At laparatomy, however, a Meckel's diverticulum with ulceration and stricture formation extending into the ileum was found. The histology showed gastric mucosa with ulceration. This report depicts small bowel narrowing secondary to Meckel's diverticulum
— id: 49279, year: 1981, vol: 76, page: 291, stat: Journal Article,

D-lactic acidosis in a man with the short-bowel syndrome
Oh MS; Phelps KR; Traube M; Barbosa-Saldivar JL; Boxhill C; Carroll HJ
1979 Aug 2;301(5):249-252, New England journal of medicine
— id: 49280, year: 1979, vol: 301, page: 249, stat: Journal Article,