ObjectiveLimitations 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.DesignOf 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).ResultsConsensus 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.ConclusionNormal 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.

Solanum torvum is used in Cameroonian traditional medicine for the management of pain and inflammation. The present work assesses the pain-killing and anti-inflammatory properties of the aqueous extracts of Solanum torvum leaves. Acetic acid-and pressure-induced pains were reduced by this extract while carrageenan-induced inflammation was inhibited at various doses of the extract. The extract therefore has both analgesic and anti-inflammatory properties.

Acetylation and methylation semisynthesis of oleanolic acid (OA) isolated from Syzygium aromaticum L. yielded two compounds: 3-acetoxyoleanolic acid (3-AOA) and 3-acetoxy, 28-methylester oleanolic acid (3-A,28-MOA). Anti-inflammatory properties of these compounds were assessed using the serotonin and fresh egg albumin-induced inflammatory test models in male Wistar rats weighing 250-300 g. Furthermore, erythrocyte membrane-stabilizing property of these compounds was evaluated in the heat- and hypotonicity-induced in vitro hemolysis test models. The two semisynthetic compounds significantly (p < 0.05) inhibited albumin-induced inflammation better than OA and indomethacin from 1-5 h post administration. Both compounds were membrane stabilizing in heat-induced hemolysis test while only 3-AOA showed membrane-stabilizing effects in a hypotonic milieu. Semisynthesis of OA yielded two compounds which had better in vivo anti-inflammatory and in vitro membrane-stabilizing properties.

There is no current agreement on the cause of squamous cancer of the oesophagus in Africa, a major cause of morbidity and mortality in East and Southern Africa. The remarkable history is reviewed together with all recent evidence using a literature search. There are consistent and continuing associations with maize and with tobacco. Changes of type of maize, patterns of consumption and processing occurred around 1930, and a rapid rise of oesophageal cancer dated from that time. Tobacco has a worldwide association with cancer of the oesophagus, but there is a substantial minority of non-users in high incidence areas. Other carcinogens have come under suspicion, but there is evidence against any of these acting as the principal carcinogenic influence in Africa. Recent studies in Japan and in South Africa have shown an association between non-acid gastro-oesophageal reflux and squamous cancer of the oesophagus. There is no credible candidate for principal oesophageal carcinogen in Africa. There is good reason to look again at milled maize: its deficiencies, contaminations, and degenerative processes. Associations between diet, non-acid reflux and squamous cancer of the oesophagus merit further study.

Heteromorpha arborescens belongs to the family Apiaceae. It is commonly known as the parsley tree. One of its uses in the Eastern Cape Province of South Africa is for the treatment of abdominal pains. The therapeutic effects of the methanolic and aqueous root extracts of H. arborescens were investigated at two dose levels respectively on experimental models of pain and inflammation in rodents. The antinociceptive activity was evaluated using the hot-plate, abdominal constriction and formalin tests. The anti-inflammatory properties of these extracts were assessed using albumin and carrageenan as phlogistic agents. Both extracts produced significant (P<0.05, P<0.01) inhibition of thermal nociception induced by a hot plate. On chemical nociception induced by intraperitoneal acetic acid and subplantar formalin injection, both extracts significantly (P<0.05, P<0.01) decreased the number of writhing episodes and the licking time in a dose dependent manner. Treatment with the extracts at the same doses produced a significant (P<0.05, P<0.01) pain inhibition of the carrageenan induced inflammatory pain. Similarly, both extracts produced a significant (P<0.05, P<0.01) reduction of edema induced by albumin and carrageenan. These results suggest that both extracts of H. arborescens may act by inhibition of the mediators of inflammation. These findings seem to justify the use of the plant in traditional medicine in the management of pain and inflammation related diseases.