Cancer of the Oesophagus in Transkei: An Investigation into the Dietary and Social Habits of the People of Transkei with the Intention of Casting Light on the Aetiology of Cancer of the Oesophagus within the Region

Transkei is a region of very high incidence of Cancer of the oesophagus (CO). Enquiry within the community revealed an unusual number of potential causes of injury to the oesophagus, the prevalence and extent of which were confirmed in opportunistic studies by questionnaire. The statistical relationship between CO and a large nunmber of potentially important factors in dietary and social habits was determined by iterative development of questionnaires for both CO patients and controls, culminating in a case-control study of 100 pairs. In the case-control study the following were significant: smoking, consumption of Solanum nigrum, consumption of Chenopodium album and use of traditional medicines were positively associated with CO; number of sheep kept, and total bought dietary fat were negatively associated with CO. Conditional logistic regression analysis of significant factors revealed relative risks of 3.6 for consumption of Solanum nigrum and 2.6 for smoking, both risks being significant. The wild vegetable Solanum nigrum has been identified as a probable carcinogen in Transkei, and a theory of pathogenesis is described which involves nutritional predisposition due to the staple diet, and carcinogenesis by substances which include tobacco and Solanum nigrum

24-Hour Measurement of Gastric pH in Rural South Africa

Background. Previous studies have established norms of 24-hour gastric pH profiles for western countries. This study was designed to establish the pattern for a rural African population with a high incidence of oesophageal cancer. Methods. After lower oesophageal manometry a probe was placed 10 cm distal to the lower oesophageal sphincter. We carried out 24-hour ambulatory monitoring of gastric pH on 59 healthy subjects. This was satisfactorily completed on 26 female and 18 male (age 21–64, median 35) subjects in the Transkei region of South Africa. Results. The mean 24 hour gastric pH was 2.84 and the mean night-time pH was 3.7. 40 volunteers recorded a night-time pH reaching over 4. 33 volunteers recorded a night-time pH over 7. Night-time alkalinisation was present for 136.4 minutes (25th centile 22.8, 75th centile 208.1) at pH4 or over, and 79.3 (2.5, 122.7) minutes at pH7 or over. Episodes of rapid alkaline rise were 17 (10, 47). 21.1% of these occurred while supine. 35 of 36 tested subjects were positive for H. pylori IgG. Conclusion. Gastric alkalinisation is common in Transkei, at a higher pH than that reported in other studies, and is sustained longer. Nighttime alkalinisation is frequent. This suggests a high level of duodenogastric reflux

FTIR-ATR studies of the sorption and diffusion of acetone:water mixtures in poly(vinyl alcohol)-clay nanocomposites

The simultaneous ingress of acetone and water into dried PVOH-claynanocomposites containing 2.5 wt% or 5 wt% of well dispersed Na-Cloisite, using FTIR-ATR, has been compared with that into pure PVOH films. The rate at which water and acetone moved through the PVOH films is significantly reduced (i) at high acetone concentrations and (ii) when clay is incorporated in the PVOH film. For example, it takes 9 min and 17 min for water and acetone, respectively, to saturate a 25 ± 5 μm PVOH film containing 2.5 wt% of well dispersed clay when the acetone:water ratio is 90:10 v/v compared with ca. 1 min for a pure PVOH film when the acetone:water ratio is 70:30 v/v. The presence of significant quantities of water in the PVOH (nanocomposite) films was necessary before acetone began to permeate the film. The acetone entering the evanescent field was always highly hydrated even if the water content of the reservoir in contact with the film was low. There was no substantial evidence that the presence of clay altered the way in which the PVOH interacted with the acetone:watermixtures. The clay only acted to increase the tortuosity of the path through the film to the ATR prism

Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world.

OBJECTIVE: Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. DESIGN: Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). RESULTS: Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. CONCLUSION: Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings.status: Published onlin

Normal values and regional differences in oesophageal impedance-pH metrics:a consensus analysis of impedance-pH studies from around the world

Objective: Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. Design: Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). Results: Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. Conclusion: Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings