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Showing papers in "Gut in 1986"


Journal ArticleDOI
01 Aug 1986-Gut
TL;DR: The gastrointestinal transit of pharmaceutical dosage forms has been measured in 201 studies in normal subjects using gamma scintigraphy and has implications for the design of dosage forms for the sustained release of drugs in specific positions in the gastrointestinal tract.
Abstract: The gastrointestinal transit of pharmaceutical dosage forms has been measured in 201 studies in normal subjects using gamma scintigraphy. Solutions, small pellets, and single units (matrix tablets and osmotic pumps) were administered with different amounts of food in the stomach, ranging from fasted state to heavy breakfast. Gastric emptying was affected by the nature of the dosage form and the presence of food in the stomach. Solutions and pellets were emptied even when the stomach was in the digestive mode, while single units were retained for long periods of time, depending on the size of the meal. In contrast, measured intestinal transit times were independent of the dosage form and fed state. The small intestinal transit time of about three hours (mean +/- 1 h SEM) has implications for the design of dosage forms for the sustained release of drugs in specific positions in the gastrointestinal tract.

859 citations


Journal ArticleDOI
01 Jan 1986-Gut
TL;DR: A wide variety of non-gastrointestinal symptoms were significantly more common than in a group of 100 age, sex, and social class matched controls and may be indicative of a much more diffuse disorder of smooth muscle than has previously been appreciated.
Abstract: In 100 patients with irritable bowel syndrome a wide variety of non-gastrointestinal symptoms were significantly more common than in a group of 100 age, sex, and social class matched controls. Nocturia, frequency and urgency of micturition, incomplete bladder emptying, back pain, an unpleasant taste in the mouth, a constant feeling of tiredness and in women dyspareunia were particularly prominent (p less than 0.001). With reference to non-colonic gastrointestinal symptoms nausea, vomiting, dysphagia and early satiety were very common (p less than 0.0001). This symptom diversity was observed irrespective of whether the patient had a psychiatric disorder or not. Patients smoked more than controls (p = 0.02) drank more caffeine containing drinks (p = 0.03) and 26% had taken at least one week off work in the previous 12 months. Thirty three per cent of patients had a family history of irritable bowel syndrome. Cognisance of these diverse symptoms may prevent referral to the wrong medical specialty and inappropriate investigation. They may also be indicative of a much more diffuse disorder of smooth muscle than has previously been appreciated.

464 citations


Journal ArticleDOI
01 Jan 1986-Gut
TL;DR: A series of 64 women complaining of severe constipation was described, in each of whom delayed elimination of markers from the colon was demonstrated but a barium enema was normal as discussed by the authors.
Abstract: A series of 64 women complaining of severe constipation is described, in each of whom delayed elimination of markers from the colon was demonstrated but a barium enema was normal. All completed a detailed questionnaire and the responses are compared with those obtained in an age-matched series of healthy women with no bowel complaint. In each group 40 women also recorded in a manner suitable for analysis all food eaten over a period of seven days. The patients passed about one stool weekly with the aid of laxatives, and were greatly troubled by abdominal pain, bloating, malaise and nausea, to the extent that the symptoms were a major social disability and many lost time from work. Decreased bowel frequency and other symptoms were often first noticed around the age of puberty and slowly became worse until they were severe by the third decade. In a few, the symptoms began suddenly after an abdominal operation c-accident. Comparison with the control group showed no evidence that the patients had been underweight at any time or that they took less fibre; treatment with a bran supplement did not usually help them. The patients experienced rectal sensation before defaecation less often than the control subjects and they used digital pressure to assist defaecation more frequently. The women with constipation tended to have more painful and irregular menstrual periods, and there was an increased incidence of ovarian cystectomy and hysterectomy. Hesitancy in starting to pass urine was more common, as were some somatic symptoms such as cold hands or blackouts. Attention is drawn to this distinctive combination in young women of slow total gut transit time and a colon of normal width on barium enema, associated with abdominal, anorectal, gynaecological and somatic symptoms, as a disorder which can be disabling and particularly difficult to treat.

384 citations


Journal ArticleDOI
01 Jan 1986-Gut
TL;DR: The Crohn's disease activity index, a similar index devised for patients with ulcerative colitis, and other commonly used laboratory indicators of disease activity have been studied in 50 patients with colonic inflammatory bowel disease undergoing routine colonoscopic assessment and compared with the histological extent and activity of disease.
Abstract: The Crohn's disease activity index, a similar index devised for patients with ulcerative colitis, and other commonly used laboratory indicators of disease activity have been studied in 50 patients with colonic inflammatory bowel disease undergoing routine colonoscopic assessment and compared with the histological extent and activity of disease. There was only poor correlation between the colonoscopic or histological findings and the indices of disease activity studied, showing that these are not reliable measures of disease activity or extent at the tissue level.

333 citations


Journal ArticleDOI
01 Jul 1986-Gut
TL;DR: With electrogastrography in a heterogeneous group of patients with unexplained nausea and vomiting a subgroup can be discerned with abnormal myoelectrical activity which is related to these symptoms.
Abstract: Using cutaneous electrodes an electrogastrographic study was made of gastric myoelectrical activity in both the fasting and postprandial states in 48 patients with unexplained nausea and vomiting and in 52 control subjects. A gastric emptying study, using a radio-labelled solid phase meal, was carried out in 30 of these 48 patients. A follow up study was done after one year. In 48% of the patients abnormal myoelectrical activity was found which was characterised by: instability of the gastric pacemaker frequency; tachygastrias in both the fasting and postprandial states; the absence of the normal amplitude increase in the postprandial electrogastrogram. This last characteristic was correlated with a delayed gastric emptying of solids. The present study shows that with electrogastrography in a heterogeneous group of patients with unexplained nausea and vomiting a subgroup can be discerned with abnormal myoelectrical activity. Our findings suggests that this abnormal myoelectrical activity is related to these symptoms.

314 citations


Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: The clinical experience of oral metronidazole being effective in the treatment of antibiotic associated diarrhoea caused by C difficile colitis is supported and a potential role for intravenous metronIDazole in this disease is suggested.
Abstract: Faecal metronidazole and hydroxymetronidazole concentrations measured by high pressure liquid chromatography are reported during 10 episodes of Clostridium difficile colitis in nine patients. Bactericidal faecal concentrations were present in all patients with acute disease receiving oral or intravenous metronidazole, and all responded to therapy. Metronidazole and hydroxymetronidazole concentrations fell as the diarrhoea improved and neither substance was detectable in the faeces of five patients after recovery. This demonstration of intracolonic therapeutic concentrations of metronidazole supports the clinical experience of oral metronidazole being effective in the treatment of antibiotic associated diarrhoea caused by C difficile and also suggests a potential role for intravenous metronidazole in this disease.

305 citations


Journal ArticleDOI
01 Jun 1986-Gut
TL;DR: Patients with raised IgG antibody to C pyloridis were also shown to have significantly raised titres to other Campylobacter species, suggesting antigenic cross reactivity.
Abstract: Antibody titres to Campylobacter pyloridis in serum and gastric juice were estimated by an enzyme linked immunosorbent assay (ELISA) to whole organisms obtained from bacterial culture in 39 patients with non-ulcer dyspepsia Whereas 20 of the 21 patients with chronic gastritis had gastric C pyloridis, 17 patients with no C pyloridis had normal histology in the gastric antrum and body Significantly raised serum IgG and IgA antibody titres to C pyloridis were found in colonised patients with gastritis Patients with raised IgG antibody to C pyloridis were also shown to have significantly raised titres to other Campylobacter species, suggesting antigenic cross reactivity Gastric juice antibodies were also studied and IgA titres to C pyloridis were detected in a proportion of patients with gastritis, together with low levels of IgM, but no IgG

303 citations


Journal ArticleDOI
01 Dec 1986-Gut
TL;DR: The differentiating effect ofbutyrate on colon carcinoma cells may be relevant to the presence of butyrate in the colonic contents and the relationship between short chain fatty acids and fibre intake.
Abstract: The effects of short chain fatty acids on a colon carcinoma cell line, LIM1215, have been studied. Of the four short chain fatty acids tested only butyrate at 1 mmol/l and 10 mmol/l and acetate at 10 mmol/l had significant effects on this cell line. The addition of butyrate to growth medium affected the growth rate and the production of alkaline phosphatase, dipeptidyl peptidase IV and carcinoembryonic antigen. Butyrate at a final concentration of 1 mmol/l increased the doubling time of the cells from 26 hours to 72 hours and decreased the cloning efficiency of the cells from 1.1% to 0.054%. Alkaline phosphatase concentrations increased rapidly in cells cultured in 1 mmol/l butyrate reaching peak levels after four days with alkaline phosphatase concentrations increasing more than six-fold. Levels of dipeptidyl peptidase IV and carcinoembryonic antigen were also increased after culture in butyrate containing medium. The number of alkaline phosphatase containing and dipeptidyl peptidase IV containing cells increased markedly in butyrate containing cultures. In contrast the number of mucus containing cells decreased in cultures grown in medium containing butyrate. This differentiating effect of butyrate on colon carcinoma cells may be relevant to the presence of butyrate in the colonic contents and the relationship between short chain fatty acids and fibre intake.

281 citations


Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: A prospective double blind controlled trial was undertaken to examine the role of metronidazole as an adjunct to corticosteroids in the management of severe ulcerative colitis, and results do not support the routine use of intravenous metronIDazole in the treatment of severe Ulcerative Colitis.
Abstract: A prospective double blind controlled trial was undertaken to examine the role of metronidazole as an adjunct to corticosteroids in the management of severe ulcerative colitis. Thirty nine patients with severe ulcerative colitis were randomised on admission to hospital to receive either intravenous metronidazole 500 mg eight hourly (19 patients) or an identical intravenous placebo (20 patients). The two groups were similar with respect to age, sex, and the extent of colitis. In addition all patients received a standard intravenous regimen consisting of methyl prednisolone 16 mg six hourly and parenteral nutrition together with a twice daily hydrocortisone 100 mg enema. Treatment was continued for five days when the patients were formally assessed. Fourteen of 19 patients (74%) receiving metronidazole and 14/20 (70%) receiving placebo were substantially improved, or in remission at the end of five days. Five patients treated with metronidazole and six with placebo had no improvement and all proceeded to urgent colectomy with no operative mortality. There were three late deaths, one in the metronidazole and two in the placebo group. These results do not support the routine use of intravenous metronidazole in the treatment of severe ulcerative colitis.

258 citations


Journal ArticleDOI
01 Nov 1986-Gut
TL;DR: The studies show that non-steroidal anti-inflammatory drugs disrupt the intestinal barrier function in man and suggest that the morphological correlates of the damage may reside at the level of the intercellular junctions.
Abstract: Intestinal permeability was estimated in healthy subjects after ingestion of aspirin (12+12 g), ibuprofen (400+400 mg) and indomethacin (75+50 mg) at midnight and an hour before starting a 51chromium labelled ethylenediaminetetraacetate absorption test Intestinal permeability increased significantly from control levels following each drug and the effect was related to drug potency to inhibit cyclooxygenase Intestinal permeability increased to a similar extent after oral and rectal administration of indomethacin showing that the effect is systemically mediated Prostaglandin E2 decreased intestinal permeability significantly but failed to prevent the indomethacin induced increased intestinal permeability These studies show that non-steroidal anti-inflammatory drugs disrupt the intestinal barrier function in man and suggest that the morphological correlates of the damage may reside at the level of the intercellular junctions

255 citations


Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: The capacity to absorb fructose in 10 healthy adults was investigated by means of hydrogen breath analysis and it was concluded that in the healthy state the absorption capacity of fructose given alone ranges from less than 5 g to more than 50 g.
Abstract: The capacity to absorb fructose in 10 healthy adults was investigated by means of hydrogen breath analysis. Fructose absorption was quantified with lactulose standards. Significant hydrogen production (greater than or equal to 20 ppm rise of breath hydrogen) was found after challenge with 10% solutions of 50, 37.5, 25, 20, and 15 g fructose in eight, seven, five, four and one subjects, respectively. One subject showed malabsorption after a 10 g dose and possibly also 5 g fructose. In contrast, no malabsorption could be detected in any of the 10 subjects after ingestion of 100 g, 75 g, or 50 g sucrose or a mixture of 50 g glucose and 50 g fructose. After ingestion of mixtures of 50 g fructose +25 g glucose and 50 g fructose +12.5 g glucose malabsorption was present in three and seven subjects, respectively. Symptoms during all challenges were mild, or absent. It is concluded that in the healthy state the absorption capacity of fructose given alone ranges from less than 5 g to more than 50 g. The absorption capacity of fructose given as sucrose is much higher. Glucose stimulates fructose uptake in a dose dependent fashion. The possible existence of more than one intestinal transport system for fructose is considered. The elucidation of the clinical relevance of the findings is important.

Journal ArticleDOI
01 May 1986-Gut
TL;DR: Although patients with severe, acute, non-infective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet, there were no differences in the operation or mortality rates between the groups.
Abstract: In a prospective, randomised clinical trial, 47 patients with severe, acute, non-infective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.

Journal ArticleDOI
01 Nov 1986-Gut
TL;DR: Based on the severity of abnormality of serum aspartate aminotransferase, bilirubin, and prothrombin time on admission a prognostic index was derived which enabled complete separation of fatal and nonfatal cases and when used in a further nine index cases correctly predicted the outcome.
Abstract: As the results of treatment in Wilson's disease are so dependent on the stage at which penicillamine therapy is started, the antecedent history in 34 patients with Wilson's disease was analysed with particular respect to the earliest manifestations of the disease. Lethargy and anorexia (70%) jaundice (56%) and abdominal pain (48%) were the commonest symptoms and less common were intellectual deterioration (22%) and recurrent epistaxes (22%). The duration of symptoms before diagnosis ranged from five days to three years (mean 10.5 months) and in only five of the patients was the diagnosis established before referral. Analysis of the physical signs at presentation showed hepatomegaly (81%) and splenomegaly (70%) to be common and the only signs which were significantly more common in the 13 fatal cases were jaundice and ascites. In three of these and in one other patient who survived the clinical course was exceptionally severe and was indistinguishable from fulminant hepatic failure. Based on the severity of abnormality of serum aspartate aminotransferase, bilirubin, and prothrombin time on admission a prognostic index was derived which enabled complete separation of fatal and nonfatal cases and when subsequently used in a further nine index cases correctly predicted the outcome. Two further cases found to have indices in the fatal category did well after liver transplantation, which needs to be considered as soon as the diagnosis is established in cases with such severe liver damage.

Journal ArticleDOI
01 Feb 1986-Gut
TL;DR: La cause du saignement est the presence d'une artere de dimensions anormalement grandes situee dans the sous-muqueuse en contact etroit avec the muqueuse.
Abstract: Presentation de 6 cas et revue de 101 observations. La cause du saignement est la presence d'une artere de dimensions anormalement grandes situee dans la sous-muqueuse en contact etroit avec la muqueuse. Le site le plus frequent est proche de la jonction œsophagogastrique, surtout dans la petite courbure. Le diagnostic est possible par gastroscopie d'urgence

Journal ArticleDOI
01 Feb 1986-Gut
TL;DR: The finding that mean transit time was more highly correlated with faecal form than any of the other bowel function measurements could be of practical importance.
Abstract: Bowel function was assessed in 51 subjects: 10 women and seven men who habitually consumed an omnivorous, vegetarian, or vegan diet. The subjects on these diets had a mean intake of fibre of 23 g, 37 g, and 47 g respectively. Mean transit times were variable and not significantly different between the groups. Vegans, however, had a greater frequency of defecation and passed softer stools. All measurements of bowel function were significantly correlated with total dietary fibre. As dietary fibre increased mean transit time decreased, stool frequency increased and the stools became softer. Men produced a greater quantity of softer, less formed faeces than women. During the luteal phase of the menstrual cycle women excreted harder stools and had a significantly longer mean transit time. The finding that mean transit time was more highly correlated with faecal form than any of the other bowel function measurements could be of practical importance.

Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: It is shown that in patients with cirrhosis, the degree of liver failure may be a determinant for the haemodynamic responses to drugs acting on portal hypertension.
Abstract: Systemic and splanchnic haemodynamics were studied in patients with cirrhosis who had been classified in three groups (A, B, and C) according to the degree of liver failure (modified Pugh's classification). In patients of group A, cardiac index was significantly lower than that of group C and systemic vascular resistance was higher, but not significantly so, than that of patients with liver failure. Wedged hepatic venous pressure was significantly lower in the former group than in the latter. In patients in group B, corresponding values fell between those of groups A and C. Azygos blood flow averaged 0.477 +/- 0.242 l/min (mean +/- SD) in group A and it was significantly lower than in groups B and C (0.642 +/- 0.224 and 1.061 +/- 0.476 l/min, respectively). In the three groups, acute administration of propranolol induced statistically significant changes in systemic and splanchnic haemodynamics. In patients of group C but not of group B, the mean value of azygos blood flow after propranolol remained significantly higher than in group A. Moreover, the fraction of azygos blood flow to cardiac output decreased in groups A and B while slightly increased in group C. This study shows that in patients with cirrhosis, the degree of liver failure may be a determinant for the haemodynamic responses to drugs acting on portal hypertension.

Journal ArticleDOI
01 Jun 1986-Gut
TL;DR: The incidence and concentration of methane-producing bacteria in tap water enema samples of 130 individuals taken before sigmoidoscopy showed that the incidence of methanogens in concentrations of 10(7)/g dry weight of faeces or greater in patients with diverticulosis was significantly greater than in normal patients.
Abstract: This study determined the incidence and concentration of methane-producing bacteria in tap water enema samples of 130 individuals taken before sigmoidoscopy. The number of subjects classified in five major colonic groups were as follows: normal colon 36, diverticulosis 57, inflammatory bowel disease 11, colon polyps 34, and colon cancer 11. Some patients were placed in more than one category. Ninety four of the subjects or 72% had methanogenic bacteria ranging in concentration from 6 to about 3 X 10(10)/g dry weight of faeces. The predominant methanogen in all groups was Methanobrevibacter smithii. Chi-square analysis showed that the incidence of methanogens in concentrations of 10(7)/g dry weight of faeces or greater in patients with diverticulosis (58%) was significantly greater than in normal patients (25%). High methanogen concentrations are associated with excretion of methane in the breath.

Journal ArticleDOI
01 Feb 1986-Gut
TL;DR: Significant delay in the elimination of midazolam and decreased psychomotor function in patients with severe alcoholic liver disease is shown and Caution is needed in using this drug for premedication in such patients before endoscopy.
Abstract: Midazolam kinetics and psychomotor function were studied after an intravenous dose of 0.075 mg/kg body weight in seven patients with alcoholic cirrhosis and eight control patients. Four of the seven cirrhotics died of complications of their liver disease within six months of the study. The metabolism of midazolam was significantly impaired in the cirrhotic patients (p less than 0.025). These patients also had evidence of greater sedation than the control group for up to six hours after the dose was administered (p less than 0.05). The clearance of midazolam did not correlate significantly with the serum albumin, or bilirubin, or with the kinetics of antipyrine, or indocyanine green. This study shows significant delay in the elimination of midazolam and decreased psychomotor function in patients with severe alcoholic liver disease. Caution is needed in using this drug for premedication in such patients before endoscopy.

Journal ArticleDOI
01 Jul 1986-Gut
TL;DR: Crohn's disease results in subfertility, but medical advice against pregnancy may be partly responsible for this reduction in fertility, but patients practised contraception less than controls and a significantly greater proportion of these failed to become pregnant compared with controls.
Abstract: Two hundred and seventy five patients with Crohn's disease from five countries were interviewed. Each patient was matched with a control of the same age. Of the 275 women with Crohn's disease 224 had been married at some time compared with 208 controls. The mean age at marriage was 23 years. Diagnosis of Crohn's disease was made five years later and the survey was conducted on average 16 years after marriage. Cases and controls had a similar obstetric study before diagnosis. After diagnosis there was a significant reduction in the number of children born to patients (0.4) compared with controls (0.7). Crohn's disease did not increase the rate of miscarriage or Caesarean section but prematurity was more common in patients (16%) than controls (7%). The site of disease at diagnosis did not affect these findings. Medical advice against pregnancy may be partly responsible for this reduction in fertility, but patients practised contraception less than controls and a significantly greater proportion of these (42%) failed to become pregnant compared with controls (28%). Crohn's disease results in subfertility.

Journal ArticleDOI
01 Sep 1986-Gut
TL;DR: It is concluded that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis and ultrasound does not appear to be an adequate method for determining pancreatic necrosis.
Abstract: One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.

Journal ArticleDOI
01 Oct 1986-Gut
TL;DR: It is concluded that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause.
Abstract: The endoscopic features of the gastric mucosa in patients with cirrhosis have not been systematically investigated In these patients, we observed an endoscopic aspect, consisting of multiple small erythematous areas, outlined by a subtle yellowish network (resembling a mosaic), mainly located in the proximal part of the stomach We tested the value of this sign by comparing two groups: 100 patients with portal hypertension due to cirrhosis, and 300 control patients without signs of liver disease or portal hypertension This endoscopic pattern was observed in 94 of the patients with cirrhosis, whereas oesophageal varices were seen in 78 only In contrast, only one patient of the control group had this aspect Moreover, this sign was also found in seven of eight patients with non cirrhotic portal hypertension, but was seen neither in 100 patients with chronic alcoholism but without liver disease, nor in 10 cirrhotic patients with end-to-side portacaval shunts These endoscopic changes might be because of mucosal and/or submucosal oedema and congestion highlighting the normal areae gastricae pattern and related to raised portal pressure We conclude that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause

Journal ArticleDOI
01 Jan 1986-Gut
TL;DR: Secretory and tissue damaging properties of crude C difficile toxins were found to be due to toxin A, and secreted fluid contained less protein of plasma origin.
Abstract: The effect of purified toxin A and partially purified toxin B on rabbit ileum and colon was investigated. Toxin A caused tissue damage which was followed by permeability changes and fluid accumulation in both tissues. Toxin A did not increase the permeability of the colon to the extent observed for ileum; secreted fluid contained less protein of plasma origin. Toxin B had no effect on either tissue. Secretory and tissue damaging properties of crude C difficile toxins were found to be due to toxin A.

Journal ArticleDOI
01 Jun 1986-Gut
TL;DR: Commentaire a propos de cette bacterie qui peut provoquer des infections chroniques dont on a trouve recemment le role pathogene possible dans les ulcerations gastro-duodenales.
Abstract: Commentaire a propos de cette bacterie qui peut provoquer des infections chroniques dont on a trouve recemment le role pathogene possible dans les ulcerations gastro-duodenales

Journal ArticleDOI
01 May 1986-Gut
TL;DR: The findings suggest that constipation or slow colonic transit might increase the chance of supersaturated bile and hence of gall stones.
Abstract: There is considerable evidence that the level of deoxycholic acid in the bile influences biliary cholesterol saturation. Deoxycholic acid is formed in the colon and absorbed slowly. Hence changes in colonic transit rate might influence biliary deoxycholic acid and the cholesterol saturation of bile. When 14 constipated subjects took standardised senna tablets for six weeks in a dose sufficient to lower mean whole gut transit time from 134 to 54 hours, deoxycholic acid as a proportion of biliary bile acids fell from 25.9 +/- 8.6 to 17.2 +/- 8.3% (p less than 0.0001) and deoxycholic acid pool measured by isotope dilution fell from 0.64 +/- 0.34 to 0.45 +/- 0.29 g (p less than 0.0001). In those subjects (n = 8) whose bile was initially supersaturated with cholesterol, the saturation index fell from 1.40 +/- 0.22 to 1.20 +/- 0.19 (p = 0.02). Conversely, when 12 normal volunteers took loperamide capsules sufficient to cause symptomatic constipation and to prolong mean transit-time from 48 to 103 hours, the deoxycholic acid pool increased from 0.40 +/- 0.24 to 0.57 +/- 0.17 g (p = 0.008). The percentage deoxycholic acid did not alter significantly, because the estimated total bile acid pool expanded (from 1.98 +/- 0.61 to 2.81 +/- 0.48 g; p less than 0.001), presumably because of loperamide slowing down small bowel transit. Despite this expansion of the bile acid pool, loperamide increased the cholesterol saturation index from 1.10 +/- 0.31 to 1.20 +/- 0.32 (p = 0.01). Changes in colonic transit rate alter the size of the deoxycholic acid pool and bile cholesterol saturation. These findings suggest that constipation or slow colonic transit might increase the chance of supersaturated bile and hence of gall stones.

Journal ArticleDOI
01 Aug 1986-Gut
TL;DR: The data suggest that most patients with Crohn's disease have a latent pulmonary involvement andBronchoalveolar lavage lymphocytes subpopulations were quite variable, and serum angiotensin converting enzyme was lower than in controls.
Abstract: We have investigated the following pulmonary related parameters in 22 patients with Crohn's disease who were free of clinical pulmonary symptoms and had normal chest roentgenograms and in 25 controls: serum angiotensin converting enzyme, pulmonary function tests, bronchoalveolar lavage (lymphocyte count and subpopulations, macrophage viability and superoxide anion release by macrophages) and pulmonary scannings. Serum angiotensin converting enzyme was lower in Crohn's disease (14.1 +/- 5.1) than in controls (25.2 +/- 4.7) (p less than 0.001). Twelve of 22 Crohn's disease (54%) had a bronchoalveolar lavage lymphocytosis (greater than 18% alveolar lymphocytes). Bronchoalveolar lavage lymphocytes subpopulations were quite variable. Twelve of 17 Crohn's disease (71%) had an increase spontaneous and/or stimulated superoxide anion production by alveolar macrophages. Six of 12 Crohn's disease (50%) had an increase physiologic dead space in the upper part of their lung against one of 11 controls (9%). These data suggest that most patients with Crohn's disease have a latent pulmonary involvement.

Journal ArticleDOI
01 Apr 1986-Gut
TL;DR: The mantle zones of the B cell follicles in human Peyer's patches were surrounded by B cells which did not express surface IgD but which mostly expressed surface immunoglobulin of the IgM and/or IgA1 isotype, and cells expressing surface IgG or IgA2 were detected.
Abstract: We have used immunoperoxidase techniques to characterise the Peyer's patches in human terminal ileum. The mantle zones of the B cell follicles in human Peyer's patches were surrounded by B cells which did not express surface IgD but which mostly expressed surface immunoglobulin of the IgM and/or IgA1 isotype. Few cells expressing surface IgG or IgA2 were detected. Cells with cytoplasmic immunoglobulin of all isotypes except IgD were present in the dome regions of the Peyer's patches as well as in the lamina propria. There was little evidence of traffic of immunoglobulin synthesising cells across the high endothelial venules. T cells were seen to surround the lymphoid follicles. They were most concentrated on the serosal aspect around the high endothelial venules. Cells with macrophage-like morphology were present in both the lamina propria and the dome region of the follicles; those in the lamina propria containing lysozyme and those in the dome region S100 protein. The results are discussed in relation to the generation and dissemination of antibody producing cells in human gut.

Journal ArticleDOI
01 Jul 1986-Gut
TL;DR: The use of alternative medicine is common in patients with irritable bowel syndrome and this does not appear to be explicable in terms of the nature, chronicity or refractoriness to treatment of symptoms.
Abstract: The use of alternative medicine was assessed by questionnaire in 96 patients with irritable bowel syndrome, 143 patients with organic upper gastrointestinal disorders and 222 patients with Crohn's disease of comparable age and sex. Significantly more patients with the irritable bowel syndrome (16%) had consulted practitioners of alternative medicine about their condition than had patients in either of the other groups. Similarly, significantly more irritable bowel syndrome patients said they would consult an alternative medicine practitioner (41%) if conventional treatment failed. Current usage of alternative medicine remedies was significantly greater in the irritable bowel syndrome patients (11%) than in patients with Crohn's disease (4%) and tended to be greater than in patients with organic upper gastrointestinal disorders (6%). This study has shown that the use of alternative medicine is common in patients with irritable bowel syndrome and this does not appear to be explicable in terms of the nature, chronicity or refractoriness to treatment of symptoms.

Journal ArticleDOI
01 Nov 1986-Gut
TL;DR: The concentration of bile acid in solution in the faecal water may be more relevant to colonic mucosal damage than total bile Acid concentration.
Abstract: A single pass perfusion system was used in anaesthetised, restrained rats to examine the effect of changing the composition of the perfusion fluid on the damage caused to the colonic epithelium by deoxycholic acid. Damage to the colonic surface was monitored with light microscopy, transmission and scanning electron microscopy and with measurements of deoxyribonucleic acid and carbohydrate in the perfusate. New scoring techniques for monitoring alterations in surface epithelium of light microscopy sections were used. The damaging effect of 5 mM deoxycholic acid to the colonic epithelium is inhibited by lowering the pH of the perfusion fluid from 7.9 to 5.5, or by increasing the calcium concentration from 0 to 4 mM. This inhibition is shown to be because of a decreased amount of bile acid in solution. Thus it is not the total concentration of deoxycholic acid in the colon that is responsible for the colonic damage, but the concentration in solution. Although extrapolation to the human situation must be made with caution, the concentration of bile acid in solution in the faecal water may be more relevant to colonic mucosal damage than total bile acid concentration.

Journal ArticleDOI
01 Jan 1986-Gut
TL;DR: A duplex scanner which consists of a real time two dimensional scanner and a pulsed Doppler flowmeter was used to measure superior mesenteric blood flow in 70 healthy subjects, finding neither significant difference in flow between sexes, nor correlation between flow and age.
Abstract: A duplex scanner which consists of a real time two dimensional scanner and a pulsed Doppler flowmeter was used to measure superior mesenteric blood flow in 70 healthy subjects. By processing the Doppler shift signals, the instantaneous average Doppler shift frequency and then the instantaneous average velocity of the flow rate were calculated. Both diameter of the vessel and angle between vessel and beam were measured from real time imaging. The mean (+/- standard error of the mean) of the superior mesenteric blood flow was 517 +/- 19 ml/min. There was neither significant difference in flow between sexes, nor correlation between flow and age (r = 0.042). The mean of coefficients of variability were 6.8% over the short term, and 8.2% in long term studies.

Journal ArticleDOI
01 Sep 1986-Gut
TL;DR: This is the first study to provide objective evidence that patients with irritable bowel syndrome may have a disorder of smooth muscle or its innervation that is not confined to the gastrointestinal system.
Abstract: Urodynamic studies were carried out on 30 patients with irritable bowel syndrome and 30 matched controls. Fifty per cent of the irritable bowel patients compared with only 13% of the control group had evidence of bladder dysfunction (p = 0.006). In the irritable bowel group detrusor instability was observed in 10 patients compared with only one control subject (p = 0.008). A steep cystometrogram occurred in five irritable bowel patients and three controls (NS). Detrusor instability was most common in patients with a bowel habit characterised by alternating constipation and diarrhoea. This is the first study to provide objective evidence that patients with irritable bowel syndrome may have a disorder of smooth muscle or its innervation that is not confined to the gastrointestinal system.