Lege Artis Medicinae

[PATHOPHYSIOLOGY, DIAGNOSIS AND THERAPY OF THE EXTRAOESOPHAGEAL MANIFESTATIONS OF GASTRO-OESOPHAGEAL REFLUX DISEASE]

ROSZTÓCZY András

MARCH 19, 2007

Lege Artis Medicinae - 2007;17(03)

[Recently, considerable interest has been focused on the extra-oesophageal manifestations of gastro- oesophageal reflux disease. Vago-vagal reflex mechanisms have been shown to play a leading role in the pathogenesis of the extra-oesophageal manifestations. In addition, proximal reflux and subsequent chemical irritation of the respiratory tract mucosa are important factors in the development of respiratory symptoms. In contrast to the uncomplicated cases of gastrooesophageal reflux disease, the recognition of these variations may pose a diagnostic challenge right because of the lack of typical symptoms. Successful diagnosis rests with the cooperation of the general practitioner, the specialist observing the extra-oesophageal symptom and the gastroenterologist. The establishment of the pathogenic role of gastro-oesophageal reflux may require verification by oesophageal functional tests. Treatment is based on long-term administration (for at least 3 months if respiratory symptoms are present) of an increased-dose proton pump inhibitor. In the long term, laparoscopic anti-reflux surgery is a realistic alternative to medical treatment in suitable patients. Dietary and life-style education of patients has an important complementary role in the successful long term management.]

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Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.