Showing papers in "Digestive Diseases and Sciences in 1982"
TL;DR: In this review, only complete disappearance of the gallstones is accepted as a successful result, since reduction of size during treatment does not guarantee that continued treatment will result in complete dissolution.
Abstract: Effectiveness Dissolution of Gallstones. In almost every report of treatment of patients with cholesterol gallstones with UDCA, the calculation of the success rate is based on the sum of the complete and partial dissolutions, in this review~ only complete disappearance of the gallstones is accepted as a successful result, since reduction of size during treatment does not guarantee that continued treatment will result in complete dissolution. Data from publications which do not distinguish between partial and complete dissolution in presenting the rate of successful treatment are therefore not included in the tabulations. Furthermore, some of the authors display their data in a way which makes it impossible to understand their results. This is attributable in no small measure to changes of dosage during the trial instead of continuing with a given dose in a given patient. Where the dose is stated in mg/kg/day, it was certainly not prescribed that way. The investigators prescribed the number of tablets or capsules to be taken daily, then calculated the dose on a weight basis. The smallest number of patients in any series was 12 (140), the largest 106 (145), the latter a multicenter study. The total number of patients entered in all series (Table 18) was 852, of whom 128 (15%) dropped out. Drop-outs are defined in this review as
328 citations
TL;DR: It is suggested that social learning may contribute to the etiology of irritable bowel syndrome but not peptic ulcer, and people who recalled being given gifts or special foods when they had a cold or flu as a child were more likely to exhibit chronic illness behavior.
Abstract: Chronic illness behavior is defined by frequent visits to physicians, multiple somatic complaints, and disability disproportionate to physical findings. The prevalence of chronic illness behavior in people with irritable bowel syndrome and peptic ulcer was studied in a telephone survey of 832 people from metropolitan Cincinnati. People with irritable bowel syndrome (8% of the sample) were more likely than people with peptic ulcer (10% of the sample), and also more likely than the general population, to have multiple somatic complaints, to view their colds and flus as more serious than those of other people, and to consult a physician for minor illnesses. People with peptic ulcer were not different from the rest of the population in these regards. Chronic illness behavior appears to be learned; people who recalled being given gifts or special foods when they had a cold or flu as a child were more likely to exhibit chronic illness behavior and also more likely to have irritable bowel syndrome. These results suggest that social learning may contribute to the etiology of irritable bowel syndrome but not peptic ulcer.
284 citations
TL;DR: It is suggested that loperamide may have a specific action on the anal sphincter, which may aid continence in patients who complain of diarrhea and fecal incontinence.
Abstract: We have investigated the effect of loperamide (4 mg tds) on the continence to a standard volume of rectally infused saline and anorectal manometry in 26 patients complaining of chronic diarrhea complicated by fecal incontinence and severe urgency. Each patient was treated for one week with loperamide (4 mg tds) and for one week with an identical placebo in a double-blind cross-over trial. Our results showed that as well as its established effects of improving stool consistency and reducing stool weight, frequency and episodes of incontinence and severe urgency, loperamide also significantly improved continence to a standard volume of rectally infused saline. This action was associated with an increase in the maximum basal sphincter pressure, an increase in the rectal volume required to abolish recovery of the rectoanal inhibitory reflex, and a reduction in rectal compliance. These results suggest that loperamide may have a specific action on the anal sphincter, which may aid continence in patients who complain of diarrhea and fecal incontinence.
255 citations
TL;DR: Serum iron concentration and percentage saturation of total iron-binding capacity were of little value in assessing iron status in either alcoholics or patients with hemochromatosis and in alcoholics with minimal liver disease serum ferritin concentrations did not reflect iron stores accurately, although with normal values iron overload is unlikely.
Abstract: Liver iron concentrations were determined in 60 alcoholics with liver disease of varying severity, 15 patients with untreated idiopathic hemochromatosis, and 16 control subjects with biliary tract disease. Mean liver iron concentrations (microgram/100 mg dry weight) were significantly greater in the alcoholics (156.4 +/- 7.8 (SEM); P less than 0.05) and in patients with idiopathic hemochromatosis (2094.5 +/- 230.7; P less than 0.01) than in control subjects (53.0 +/- 7.0). Liver iron concentrations of greater than 140 micrograms/100 were found in 17 alcoholics (29%) and in all 15 patients with idiopathic hemochromatosis. Liver iron concentrations greater than 1000 micrograms/100 mg were found in all patients with idiopathic hemochromatosis but in none of the alcoholics. In the alcoholics no relationship existed between liver iron concentrations and the amount of alcohol consumed daily, the length of the drinking history, the amount of beverage iron consumed daily, or the severity of the liver disease. Serum ferritin concentrations reflected iron stores in patients with hemochromatosis and in alcoholics with minimal liver disease. However, in alcoholics with significant liver disease serum ferritin concentrations did not reflect iron stores accurately, although with normal values iron overload is unlikely. Serum iron concentration and percentage saturation of total iron-binding capacity were of little value in assessing iron status in either alcoholics or patients with hemochromatosis. Measurement of the liver iron concentration clearly differentiates between alcoholics with significant siderosis and patients with idiopathic hemochromatosis.
193 citations
TL;DR: This study supports previous findings which suggest that increasing levels of progesterone and estradiol affect gastrointestinal function and therefore may contribute to gastrointestinal symptoms that often occur in pregnant women.
Abstract: In order to evaluate the possible effects of pregnancy-associated sex steroids on gastrointestinal function, we determined gastrointestinal transit times and sex steroid levels in 15 women during the third trimester of their pregnancies and again 4–6 weeks following delivery when gastrointestinal function had symptomatically returned to normal. Gastrointestinal transit time from ingestion of a liquid lactulose meal to its delivery to the cecum was determined by monitoring breath hydrogen concentrations at 10-min intervals. Gastrointestinal transit times were significantly prolonged in the third trimester of pregnancy, when progesterone and estradiol levels were increased, compared to the postpartum period. This study supports previous findings which suggest that increasing levels of progesterone and estradiol affect gastrointestinal function and therefore may contribute to gastrointestinal symptoms that often occur in pregnant women.
190 citations
TL;DR: Comparisons of the symptoms and clinical signs associated with three reproducible appearances of the rectal mucosa show that the subdivision of hemorrhagic mucosae into those which bleed spontaneously and those which bleeding only on light touching or scraping is meaningful clinically.
Abstract: It has been widely assumed that the activity of ulcerative colitis is related to differences in mucosal appearances seen at sigmoidoscopic examination. We have tested this assumption by making comparisons of the symptoms and clinical signs associated with three reproducible appearances of the rectal mucosa. By cross-tabulating 222 observations of each of 10 symptoms and signs with these sigmoidoscopic appearances it has been shown that the subdivision of hemorrhagic mucosae into those which bleed spontaneously and those which bleed only on light touching or scraping is meaningful clinically. Sigmoidoscopic appearances seemed to correlate better with clinical disease activity than histological assessment, even when quantitative, of mucosal biopsies. On the basis of this study, four variables have been suggested which, in addition to the sigmoidoscopic appearances, could form the basis of regular clinical assessment or scoring.
182 citations
TL;DR: The findings indicate severe changes in the specificity of the intracellular membrane fusion process induced by supramaximal doses of a pancreatic secretagogue, which finally result in autodigestion of the pancreas.
Abstract: Infusion of supramaximal doses of cerulein induces acute edematous pancreatitis in the rat. Cannulation of the main pancreatic duct does not prevent the formation of the edema but reveals an almost complete reduction of pancreatic flow. Using freeze-fracture techniques and thin-section electron microscopy, earliest structural alterations were observed at membranes of zymogen granules and the plasma membrane. Fusion of zymogen granules among each other leads to formation of large membrane-bound vacuoles within the cytoplasm. These and individual zymogen granules fuse with the basolateral plasma membrane, discharging their content into the interstitial space. The findings indicate severe changes in the specificity of the intracellular membrane fusion process induced by supramaximal doses of a pancreatic secretagogue, which finally result in autodigestion of the pancreas.
153 citations
TL;DR: Gallbladder emptying may be abnormal in patients with gallstones and the explanation for this abnormality and its relationship to the development of gallstones has not been determined.
Abstract: In this study, gallbladder and gastric emptying were compared in 15 normal subjects and 15 patients with gallstones. A noninvasive technique which uses two gamma-emitting radiopharmaceutical agents to image the gallbladder and stomach simultaneously was employed. Technetium-99m-HIDA was used as a gamma-emitting marker for the gallbladder and indium-111-DTPA was mixed with a standard liquid meal in order to stimulate gallbladder emptying and to measure gastric emptying. In patients with gallstones, gallbladder emptying was diminished significantly compared to normal subjects. In contrast, emptying of the stomach was normal. The gallbladder emptying responses to octapeptide of cholecystokinin, administered either as bolus or infusion doses, were similar in normal subjects and patients with gallstones. These studies suggest that gallbladder emptying may be abnormal in patients with gallstones. The explanation for this abnormality and its relationship to the development of gallstones has not been determined.
151 citations
TL;DR: Under acute dosage conditions, development of mucosal damage by indomethacin was paralleled by the reduction in prostaglandin production, showing that while ulcerogenic drugs reduce the mucosal and plasma prostaglandsins levels in parallel with their ulcerogenicity, this relationship does not always hold for drugs with low ulcersogenic activity.
Abstract: Experiments were performed in pigs to examine the relationship between the effects of various nonsteroid antiinflammatory drugs on gastric (fundic) mucosal content of prostaglandin (PG) E2 and 6-keto-PGF1α, and the development of damage to the fundic mucosa under acute and chronic dosage conditions. Oral administration of a single dose of indomethacin (5 mg/kg) caused an almost immediate reduction in mucosal potential difference, followed at 5–15 min by ultrastructurally observed damage to mucosal capillaries, mucous, and parietal cells; efflux of Na+, K+, and Cl− ions into the gastric lumen with an apparent loss of luminal H+ ions; and a statistically significant reduction (from 10–60 min) in fundic prostaglandin content. Thus, under acute dosage conditions, development of mucosal damage by indomethacin was paralleled by the reduction in prostaglandin production. Repeated oral dosage of aspirin, indomethacin, sulindac, or diclofenac to pigs for 10 days significantly reduced gastric mucosal as well as plasma prostaglandin levels, coincident with the development of severe gastric mucosal damage. The relatively less irritant drugs, flufenamic acid, azapropazone and fenclofenac, failed to significantly decrease gastric mucosal content of prostaglandins, although these drugs have been reported to inhibit prostaglandin synthesisin vitro and also were found to reduce the prostaglandin plasma levels in animals receiving these drugs. Another drug with low irritancy, meseclazone, markedly decreased both mucosal and plasma levels of prostaglandins. The results show that while ulcerogenic drugs reduce the mucosal and plasma prostaglandins levels in parallel with their ulcerogenicity, this relationship does not always hold for drugs with low ulcerogenic activity.
143 citations
TL;DR: Dietary composition may be a major determinant of the fasting-fed motor balance in man because the duration of interruption of the gastric interdigestive pattern by meals depends on their nutrient content.
Abstract: Fasting gastrointestinal motor and hormone patterns were studied in 11 healthy volunteers. Cyclic motor activity was present in all subjects during fasting, but the duration and site of onset of each cycle were variable, even in the same subject. Fasting gastrin, GIP, and glucagon levels remained low and constant during the 8-hr study, while plasma motilin levels exhibited cyclic variation in 7 of the 11 subjects. Achlorhydria (induced with cimetidine in 5 of the 11 subjects) did not alter the pattern of fasting motor activity or plasma motilin. In the remaining six subjects, the effect of liquid nutrient meals was examined. Ingestion of a sodium chloride bolus failed to disrupt fasting cyclic activity, while all nutrient-containing solutions inhibited gastric phase-2 motor activity, the duration of inhibition being longest for the mixed and lipid meals. All nutrient meals released GIP, while only protein and mixed meals released gastrin, and the lipid meal released motilin. Our study confirms the rhythmicity of interdigestive motor cycles in man and demonstrates their lack of dependence on gastric acid secretion and some relationship to motilin cycles in certain individuals as determined by radioimmunoassay. Transition from fasting to fed pattern (after liquid meals) is characterized by the inhibition of phasic gastric pressure changes in the antrum and the development of irregular activity in the intestine, similar in pattern to fasting phase 2. Because the duration of interruption of the gastric interdigestive pattern by meals depends on their nutrient content, we conclude that dietary composition may be a major determinant of the fasting-fed motor balance in man.
139 citations
TL;DR: It is concluded that mild irritants, and exogenous PGs inhibit the formation of gastric lesions by necrotizing agents, at least in part, by mucosal generation of PGs.
Abstract: This study was designed to determine the role of mucosal generation of prostaglandins (PGs) in the ability of mild irritants (20% ethanol or 5% NaCl) to protect against the formation of mucosal lesions caused by necrotizing agents (100% ethanol or 25% NaCl) or acidified aspirin (ASA). Mild irritants protected against damage from necrotizing agents but not from ASA. This protection was accompanied by increased mucosal generation of PGE2 and PGI2-like substances. Exogenous PGE2 and PGI2 applied topically to the gastric mucosa in a nonantisecretory dose greatly inhibited the formation of lesions induced by either necrotizing agents or ASA. Pretreatment with indomethacin, which suppressed the generation of mucosal PGs augmented formation of lesions by necrotizing agents and partly counteracted the protective effect of mild irritants. We conclude that mild irritants, and exogenous PGs inhibit the formation of gastric lesions by necrotizing agents, at least in part, by mucosal generation of PGs.
TL;DR: It is suggested that branched-chain amino acids may reverse coma either by competing with brain entry of the aromatic amino acid or by metabolically decreasing free tryptophan and ammonia.
Abstract: A controlled study was carried out in two groups of 20 patients with cirrhosis of the liver and deep coma in order to compare the efficacy of intravenous branched-chain amino acid solutions in 20% glucose (group A) vs lactulose plus glucose in isocaloric amount (group B). There were 3 drop-outs from each group. Plasma amino acids and ammonia were assayed at fixed intervals throughout the 10-day observation period. Routine tests were assayed daily. Complete mental recovery was obtained in 70% of patients in group A and in 47% in group B. The difference was not significant, likely due to the lack of placebo group. With the exception of free tryptophan/all competing amino acids ratio, the modifications in plasma amino acid levels showed no correlation with the clinical course under either treatment. Ammonia, like free tryptophan, decreased significantly upon mental recovery, paralleling the clinical course throughout the study. In conclusion, branched-chain amino acids are at least as effective as lactulose in deep hepatic coma. It is suggested that branched-chain amino acids may reverse coma either by competing with brain entry of the aromatic amino acid or by metabolically decreasing free tryptophan and ammonia.
TL;DR: It is found that there is no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population, and personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulceratives colitis at the time of interview.
Abstract: Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.
TL;DR: The results suggest that long-acting somatostatin analogs could be of value in the symptomatic treatment of diarrhea in pancreatic cholera.
Abstract: The effects of somatostatin on diarrhea and on small intestinal flow of water and electrolytes (slow-marker perfusion technique) in a patient with pancreatic cholera are reported. Continuous intravenous infusion of somatostatin (8 micrograms/kg/hr) suppressed the diarrhea, but a rebound was observed after somatostatin. Infusion of somatostatin at the same dosage decreased the ileal fluid flow rate to within control values. This effect was mainly due to a sharp reduction in the rate fluid entered the jejunum, but was also due to a suppression of the abnormal water and electrolyte secretion in the proximal jejunum. Secretion in the rest of the small bowel remained unchanged. Somatostatin did not noticeably alter the high preinfusion plasma level of prostaglandin E1, but decreased the initially high plasma concentration of vasoactive intestinal peptide to normal values. These results suggest that long-acting somatostatin analogs could be of value in the symptomatic treatment of diarrhea in pancreatic cholera.
TL;DR: In this paper, the effect of the addition of sodium bicarbonate, aluminum hydroxide, magnesium hydroxides, calcium carbonate, or cimetidine to supplemental pancreatic enzyme therapy was investigated in patients with severe exocrine pancreatic insufficiency.
Abstract: The effect of the addition of sodium bicarbonate, aluminum hydroxide, magnesium hydroxide, calcium carbonate, or cimetidine to supplemental pancreatic enzyme therapy was investigated in patients with severe exocrine pancreatic insufficiency. Steatorrhea was reduced with the administration of three enzyme tablets with meals (73 vs 29 g/24 hr). The coadministration of enzyme tablets with either sodium bicarbonate (16.6 g/24 hr, P = 0.08), or aluminum hydroxide (18.4 g/24 hr, P = 0.029) yielded a greater reduction in steatorrhea than enzymes alone (29 g/24 hr). Neither magnesium-aluminum hydroxide (36.3 g/24 hr, P = 0.22), nor calcium carbonate (39.0 g/24 hr, P = 0.029), improved efficacy of enzyme therapy and, in fact, tended to enhance steatorrhea. With the administration of cimetidine there was no significant effect on steatorrhea compared to enzymes alone (32.1 vs 29 g/24 hr, P greater than 0.3). Intraduodenal lipase activity following test meals was found to be a poor predictor of the effectiveness of antacid therapy in improving the efficacy of supplemental enzymes.
TL;DR: These studies indicate that the LES in man has beta2-adrenergic receptors that mediate a reduction in pressure, and the magnitude of LES pressure reduction in patients with achalasia suggests that this drug may be of therapeutic benefit.
Abstract: The effect of the beta2-adrenergic agonist, carbuterol, was studied on the lower esophageal sphincter (LES) pressure in normals and in patients with achalasia. In normals, the mean LES pressure decreased from 23.1 +/- 6.2 mm Hg (mean +/- SEM) to 16.0 +/- 5.0 mm Hg at a 4.0-mg dose of carbuterol (P less than 0.05). In patients with achalasia, the mean LES pressure decreased from 50.1 +/- 5.1 mm Hg to 22.7 +/- 2.4 mm Hg after a 4.0-mg dose of carbuterol (P less than 0.01). The duration of action following oral administration exceeded 90 min. These studies indicate that the LES in man has beta2-adrenergic receptors that mediate a reduction in pressure. The magnitude of LES pressure reduction in patients with achalasia suggests that this drug may be of therapeutic benefit.
TL;DR: In both patient groups good correlation between Raynaud's phenomenon and esophageal aperistalsis was found, and severe esphageal motility abnormalities are more often found in patients with MCTD than in those with SLE.
Abstract: We sought to correlate esophageal symptoms with esophageal motility abnormality in 17 patients with mixed connective tissue disease (MCTD) and in 14 patients with systemic lupus erythematosus (SLE). Heartburn and regurgitation were common symptoms (11/17) in patients with MCTD, and most of the (10/11) exhibited significant manometric abnormalities. Additionally, impairment of esophageal peristalsis was found in four of the remaining asymptomatic patients. Severe esophageal aperistalsis was noted in nine MCTD patients. Patients with SLE also frequently reported esophageal symptoms (8/14), but significant motility abnormalities were seen in only three cases. In both patient groups good correlation between Raynaud's phenomenon and esophageal aperistalsis was found. Our results reveal that, although esophageal symptoms are commonly present in patients with both MCTD and SLE, severe esophageal motility abnormalities are more often found in patients with MCTD than in those with SLE.
TL;DR: In the group of older subjects carbohydrate malabsorption was not accompanied by clinical determinants of undernutrition and should be considered when evaluating weight loss in old age and in fashioning nutritional programs for the elderly.
Abstract: Breath hydrogen (H2) analysis was utilized to determine whether intestinal absorption of carbohydrate might decline with age. Twenty-one healthy subjects (aged 65–89 years, mean age 79.1) and 19 control subjects (aged 20–64 years, mean age 35.6) were fed a meal containing 100 g carbohydrate after an overnight fast. Breath H2 concentrations were analyzed in samples collected intermittently by the end-expiratory technique. A rise in breath H2 concentration of 20 ppm over baseline was considered evidence of intestinal carbohydrate malabsorption: 7 of 21 aged and 0 of 19 control subjects excreted excess H2 (P<0.02). Further testing of subjects with meals containing 25–200 g carbohydrate demonstrated a progressive reduction in absorptive capacity with advancing age, while young controls absorbed up to 200 g carbohydrate in a meal. In the group of older subjects carbohydrate malabsorption was not accompanied by clinical determinants of undernutrition. Subtle carbohydrate malabsorption should be considered when evaluating weight loss in old age and in fashioning nutritional programs for the elderly.
TL;DR: The results indicate that early exploratory surgery is not indicated in patients with newly diagnosed achalasia who meet these criteria unless there is prior radiologic or endoscopic evidence for tumor.
Abstract: Three clinical criteria have been reported to distinguish patients with primary achalasia from patients with achalasia secondary to tumor invasion of the gastroesophageal junction. These criteria (age greater than 50 years, duration of symptoms less than one year, and weight loss greater than 15 pounds) are important because of their potential use for deciding between pneumatic dilation and exploratory surgery. In the present investigation we assessed the frequency of these criteria alone and in combination in 79 patients with primary and in two patients with secondary achalasia seen at our institution over a 91/2-year period. Our results indicate that while these criteria are highly sensitive and moderately specific, their predictive value for distinguishing secondary achalasia from primary achalasia is exceedingly low. For this reason, early exploratory surgery is not indicated in patients with newly diagnosed achalasia who meet these criteria unless there is prior radiologic or endoscopic evidence for tumor.
TL;DR: In this article, a controlled crossover clinical comparison of 40g/day and 80 g/day vegetable protein diets was performed on 10 cirrhotic patients with mild chronic portal-systemic encephalopathy.
Abstract: A controlled crossover clinical comparison of 40-g/day and 80-g/day vegetable protein diets vs a 40g/day meat protein diet plus neomycin-milk of magnesia (as control therapy) was performed on 10 cirrhotic patients with mild chronic portal-systemic encephalopathy. The 40-g vegetable protein diet had a high fiber volume and contained low methionine and low aromatic amino acids. The 80-g vegetable protein diet was rich in branched-chain amino acids and fiber, with a similar content of sulfur-containing amino acids as compared to the 40-g meat protein diet. Serial semiquantitative assessments were done, including mental state, asterixis, number connection tests electroencephalograms and blood ammonia levels. No patient developed deep coma while ingesting either vegetable protein diet or neomycin-milk of magnesia plus 40-g meat protein diet. A significant improvement in the number connection test times was observed during the 40-g vegetable protein diet (P<0.05) and during the 80-g vegetable protein diet (P<0.05) as compared to their previous 40-g meat protein-neomycin periods. In addition, during the period of 80-g vegetable protein diet, the patients showed a significant improvement in their electroencephalograms (P<0.05). The frequency of bowel movements significantly increased (P<0.05) during the 80-g vegetable protein diet period. During the 40-g vegetable protein diet, two cirrhotic-diabetic patients experienced hypoglycemia. Three patients complained of the voluminous 80-g vegetable protein diet. Patients with mild portal-systemic encephalopathy may be adequately controlled with vegetable protein diets as a single therapy.
TL;DR: The results seem to suggest that the bile acids may induce water secretion in the colon not only in small but also in large ileal resection, playing a critical role in determining the dihydroxy bile acid solubility in the fecal water.
Abstract: Bile acid fecal excretion and dihydroxy bile acid concentration in the fecal water of patients with large (N = 6) and small (N = 8) ileal resection, colectomy (N = 5), and healthy controls (N = 10) have been studied in order to evaluate the degree of bile acid malabsorption and the occurrence of bile acid diarrhea in intestinal resections of different extent. Bile acid malabsorption was severe in large ileal resections, mild in small ones, and slight in colectomy. The fecal pH seems to be a limiting factor in the occurrence of a bile acid diarrhea, playing a critical role in determining the dihydroxy bile acid solubility in the fecal water. These results seem to suggest that the bile acids may induce water secretion in the colon not only in small but also in large ileal resections.
TL;DR: In this paper, the case of a 23-year-old obese nonalcoholic woman who developed severe liver damage resembling alcoholic hepatitis and cirrhosis after multiple attempts at weight reduction was reported.
Abstract: The authors report the case of a 23-year-old obese nonalcoholic woman who developed severe liver damage resembling alcoholic hepatitis and cirrhosis after multiple attempts at weight reduction. It is suggested that repeated episodes of starvation and malnutrition can induce the development of alcoholic-like liver injury in some overweight patients. This report could serve as a warning against unbalanced and uncontrolled self-treatment of obesity.
TL;DR: The good correlation between glutamine and the sum of neutral amino acids found in the cerebrospinal fluid only in the presence of encephalopathy supports the hypothesis that brain glutamine may stimulate neutral amino acid transport across the blood-brain barrier.
Abstract: Plasma and cerebrospinal fluid amino acid levels were measured in 12 cirrhotic patients in grade 0 hepatic encephalopathy and 17 in grade 3–4 hepatic encephalopathy. In 5 of these patients amino acid determinations were performed during the evolution of the encephalopathy. No correlation was found between the degree of hepatic encephalopathy and the plasma amino acid imbalance. In the CSF of cirrhotic patients without encephalopathy, a significant increase was found in nearly all amino acids, including those known to not easily cross the blood-brain barrier; this suggests the presence of a nonspecific modification of the blood-brain barrier permeability. In patients with severe hepatic encephalopathy, the further increase only in cerebrospinal fluid aromatic amino acids and methionine levels suggests the presence of a selective stimulation of the neutral amino acid transport system across the blood-brain barrier. Finally, the good correlation between glutamine and the sum of neutral amino acids found in the cerebrospinal fluid only in the presence of encephalopathy supports the hypothesis that brain glutamine may stimulate neutral amino acid transport across the blood-brain barrier.
TL;DR: In this article, a double-blind controlled study compared cimetidine plus antacids as needed (prn) with placebo plus prn antaciders in healing aspirin-associated gastric ulcers during continued salicylate ingestion in 18 rheumatic disease patients over a 2-month period.
Abstract: Little is known about healing or recurrence of aspirin-induced gastric ulcers if aspirin intake is continued. A double-blind controlled study compared cimetidine plus antacids as needed (prn) with placebo plus prn antacids in healing aspirin-associated gastric ulcers during continued salicylate ingestion in 18 rheumatic disease patients over a 2-month period. Healing occurred in 44% of the placebo and 56% of the cimetidine-treated patients (P>0.05). Subjects in both groups ingested potentially therapeutic doses of antacid. Ulcer size had an effect on healing rate, irrespective of treatment. Ninety percent of gastric ulcers 0.5 cm. Six of seven patients with unhealed ulcers at 2 months eventually healed medically at intervals of 6–26 months. Of 11 patients managed medically and followed endoscopically for a mean of 15 months after healing, only one had a recurrent ulcer. In conclusion, placebo and antacid therapy were as effective as cimetidine and antacids in healing ulcers over a 2-month period. In spite of continued aspirin intake, most benign gastric ulcers <0.5 cm in diameter heal medically in two months. Aspirin-induced ulcers≥1 cm in diameter are relatively resistant to therapy but can be healed with prolonged cimetidine and antacid treatment; once healed, recurrence rate is low with prophylactic therapy even with continued aspirin intake.
TL;DR: Balloon tamponade may be the method of choice for early control of bleeding from esophageal varices in patients referred to Prince Henry's Hospital with upper gastrointestinal bleeding.
Abstract: The use of balloon tamponade in the emergency control of bleeding from esophageal varices is controversial. This paper reports a prospective study over an 8-year period in which balloon tamponade has been the sole means employed for the early control of bleeding varices. During 1972–1980 all patients referred to Prince Henry's Hospital with upper gastrointestinal bleeding were admitted to a special unit. Ninety-one had bleeding esophageal varices, and 17 were admitted on one or more occasions for bleeding for a total of 132 admissions. After early endoscopy, balloon tamponade was used during 103 of these admissions with failure to control bleeding on six occasions; five of these patients died from hemorrhage and the sixth recovered after emergency portacaval shunt. Another patient died from rebleeding not treated by tamponade. Reinsertion of the balloon for rebleeding was necessary on 28 occasions with successful control in all cases. Balloon tamponade was not used during 29 admissions because bleeding had ceased or the patient was considered to have terminal liver disease. In this group there were four deaths from severe liver disease and hemorrhage. Balloon tamponade was used in 78% of admissions and controlled bleeding in more than 90% of patients. This suggests that tamponade may be the method of choice for early control of bleeding from esophageal varices.
TL;DR: Lipids are emptied more slowly than any other component of an ordinary meal, and this is not due only to layering of fat above water.
Abstract: We measured gastric emptying of fat and water from a solid-liquid meal in healthy volunteers using a tubeless scintigraphic method. Selenium-75 glycerol triether, incorporated in butter, was the lipid-phase marker, and technetium-99m, ingested with 250 ml water, the non-lipid-phase marker. In seven of these subjects we also measured the gastric emptying of solids and liquids with technetium-99m bound to cooked egg whites as the solid-phase marker and indium-111 ingested with 250 ml water as the marker of the solid and aqueous phases. Emptying and intragastric repartition of each marker were measured by detection of radioactivity changes over the abdominal area using a gammacamera. The stability and the specificity of the labeling was checked for each marker. Mean gastric emptying rate (expressed as percentage ingested marker emptied per hr) of lipids (17.4±2.4) was much lower than that of the rest of the meal (34.2±1.8) and slightly, but significantly, lower than that of solids (22.8±1.8). An intragastric layering of fat above nonlipids was observed only after the first postprandial hour and remained moderate. Thus, lipids are emptied more slowly than any other component of an ordinary meal, and this is not due only to layering of fat above water.
TL;DR: Cellulose and pectin added to a no-fiber diet were associated with significant differences in the number of villi in both the jejunum and the ileum, indicating changes in morphology are unlikely to be due to differing bile salt-binding capabilities of different fiber substances.
Abstract: Newly weaned rats fed 12 weeks on a diet containing no dietary fiber or no fiber except for 10% cellulose, maintained the leaf-like intestinal villous morphology present at weaning, as observed by scanning electron microscopy. In rats on a normal laboratory diet the jejunal morphology showed progression from the leaf-like villous pattern at weaning to broad-leafed, long-ridged villi of adulthood. Pectin added to a no-fiber diet caused structural changes similar to but less well developed than those changes in the rats on a standard diet. Striking differences were noted not only in the appearance of the intestinal villi but in the number of villi per square centimeter between those animals on no fiber or no fiber except cellulose and those animals on pectin or standard diets. Cholestyramine, a strong pharmacological bile salt-binding agent, when added to a no-fiber diet, did not promote development of the usual villous pattern, and the structure remained the same as that in rats on no-fiber and cellulose diets. Cellulose (no bile salt-binding capability) and pectin (weak bile salt-binding capability) added to a no-fiber diet were associated with significant differences in the number of villi in both the jejunum and the ileum. The observed changes in morphology are unlikely to be due to differing bile salt-binding capabilities of different fiber substances.
TL;DR: In this paper, a case of intramural gas is presented, where air or gas is seen within the gastric wall on x-ray, gastric emphysema, emphysemous gastritis, or pneumatosis intestinalis is diagnosed.
Abstract: Gas within the stomach wall is a rare occurrence. A case of intramural gas is presented. When air or gas is seen within the gastric wall on x-ray, gastric emphysema, emphysematous gastritis, or pneumatosis intestinalis is diagnosed. These classifications have become vague and contradictory. Gas in the gastric wall can only come from the environment or have been produced within the wall. Gastric emphysema and emphysematous gastritis refer to these situations, respectively. These classifications are expanded and pneumatosis intestinalis is deleted as a clinical or pathological diagnosis.
TL;DR: Intensive ABT was the most sensitive screening test for the presence of cirrhosis, especially in alcoholic patients, where it allowed a sharp distinction between cirrhotic and noncirrhotic cases.
Abstract: The determination of of 14CO2 in breath after oral administration of [14C]aminopyrine has been proposed as a quantitative liver function test. In order to shorten the procedure and avoid misinterpretations related to variable rates of intestinal absorption, the [14C]aminopyrine breath test (ABT) was performed after intravenous administration of [14C]aminopyrine in 21 controls and 89 patients with biopsy-proven liver disease. The specific activity of the first hour sample corrected for body weight (SA1) was the most discriminant expression of breath data. The SA1 value, expressed as the percentage of the administered dose, was 0.86 +/- 0.1% (mean +/- SD) in controls and significantly less in patients (0.46 +/- 0.31%). Low values were observed in patients with untreated chronic active hepatitis (0.16 +/- 0.13%), alcoholic cirrhosis (0.2 +/ 0.15%0, and untreated postnecrotic cirrhosis (0.47 +/- 0.17%). In contrast, normal values were obtained in chronic persistent hepatitis (0.86 +/- 0.13%) and 58% of noncirrhotic alcoholic liver diseases (0.83 +/- 0.27%). The results of duplicate studies were reproducible and SA1 correlated with other conventional liver function tests, including 45-min BSP retention. Among these, ABT was the most sensitive screening test for the presence of cirrhosis, especially in alcoholic patients, where it allowed a sharp distinction between cirrhotic and noncirrhotic cases. The results obtained in chronic hepatitis suggested that ABT may provide a reliable index of the activity of the disease. In our hands, intravenous ABT, performed over a 1-hr period, was a fast, sensitive, and discriminant liver function test.
TL;DR: This study demonstrates secretion of bicarbonate by the human stomach in vivo at a rate equivalent to 10–20% of basal acid secretion.
Abstract: Bicarbonate secretion by the stomach may play a role in gastric mucosal protection, and we have therefore examined bicarbonate secretion in the human stomach. Gastric bicarbonate production and contamination with salivary and duodenal bicarbonate was measured in healthy volunteers using an intubation technique. The stomach and duodenum were perfused with nonabsorbable markers and the pH, PCO2, marker, and amylase concentrations measured in 10-min gastric and duodenal aspirates. These measurements enabled calculation of gastric bicarbonate content and the amount of bicarbonate contributed by saliva and duodenogastric reflux. Acid secretion was suppressed by intravenous cimetidine. Validation studies demonstrated a good correlation between instilled and calculated recovered bicarbonate (r = 0.97, P less than 0.001, N = 6), and marker recovery was consistent in each subject. Over a 6-h period, gastric pH ranged from 6 to 7 and PCO2 from 20 to 40 mm Hg. Gastric bicarbonate output stabilized at 326--392 mumol/hr and mean bicarbonate concentration ranged from 2.3 to 20.0 mmol/liter. Approximately two thirds of this bicarbonate was free, 11% was derived from duodenogastric reflux, and 3% from swallowed saliva. This study demonstrates secretion of bicarbonate by the human stomach in vivo at a rate equivalent to 10--20% of basal acid secretion.