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Biomedical subjects

A J Smout

Publications and source records attributed to A J Smout.

At least 19 recordsLinked to original sources
PubMed1998

Proximal gastric motor activity in response to a liquid meal in type I diabetes mellitus with autonomic neuropathy.

Disordered gastric emptying occurs in 30-50% of patients with diabetes mellitus. Although the rate of gastric emptying is dependent on the integration of motor activity in different regions of the stomach, there is limited information about the function of the proximal stomach in diabetes mellitus. In the present study the response of the proximal stomach to a liquid meal was examined in eight diabetic patients with autonomic neuropathy and gastrointestinal symptoms and in 10 healthy volunteers, using an intragastric bag connected to an electronic barostat. Postprandial relaxation of the proximal stomach was measured as an increase of intragastric bag volume at a constant pressure level of 1 mm Hg above the intraabdominal pressure. During the experiment the blood glucose levels were maintained within the euglycemic range. Before ingestion of the meal the intragastric bag volume was larger in the diabetic patients than in the healthy volunteers, 234.4 +/- 29.1 ml vs 155.3 +/- 15.3 ml (P = 0.06). The maximum volume was not different in diabetics compared to the healthy controls (386.3 +/- 45.2 ml versus 399.0 +/- 35.2 ml). However, the maximum volume increase was significantly less in diabetics (143.7 +/- 38.6 ml) compared to the controls (231.4 +/- 30.5 ml, P < 0.04). Bloating was inversely correlated with the volume changes, which suggests that impaired relaxation of the proximal stomach may play a role in the genesis of this sensation. In conclusion, this study shows a lower fasting fundal tone and a decrease in volume change of the gastric fundus after a nutrient drink in patients with autonomic neuropathy due to type I diabetes mellitus. These abnormalities may play a role in the abnormal distribution of food, disordered liquid gastric emptying, and in the genesis of the sensation of bloating observed in these patients.

Autonomic Nervous System Diseases↗
PubMed1998

Function of the proximal stomach after Nissen fundoplication.

BACKGROUND: After Nissen fundoplication patients frequently report upper abdominal (dyspeptic) symptoms. Theoretically, these symptoms may be the result of changes in function of the proximal stomach as induced by fundoplication. METHODS: In this case-control study the response of the proximal stomach to both distension by an air-filled bag and a liquid meal were evaluated with the use of a barostat. In 12 patients after fundoplication and 12 healthy volunteers (age- and sex-matched) perception of symptoms was evaluated during both bag distension and liquid meal stimulus. RESULTS: The minimal distending pressure required to overcome the intra-abdominal pressure was significantly different between patients and controls (mean(s.e.m.) 9.34(0.26) versus 6.73(0.43) mmHg; P < 0.001). There was no difference between groups in either the fasted state, volume-pressure curve (compliance) or total symptom score. After ingestion of the liquid meal the adaptive relaxation in the fundoplication group was significantly less than that in controls (mean(s.e.m.) 150(29.2) versus 244(34.8) ml; P = 0.04). CONCLUSION: This study showed that after Nissen fundoplication compliance of the proximal stomach is no different from that in healthy volunteers. Postprandial relaxation of the proximal stomach is decreased and this abnormality may be involved in the pathogenesis of reported dyspeptic symptoms.

Adult↗
PubMed1998

Effect of meal temperature on the frequency of gastric myoelectrical activity.

It was hypothesized that the transient post-prandial decrease of the dominant frequency in the electrogastrogram (EGG) is related to the temperature of the meal. In a randomized three-period cross-over design. EGG recordings were made in 10 healthy volunteers. A liquid meal (36 kcal, 300 mL) was ingested at either 4, 37 or 55 degrees C. The changes in the dominant EGG frequency that occurred in the first 25 min postprandial were calculated using running spectrum analysis. After the meal a transient shift in frequency was seen, which was significantly greater after the cold meal than after the other meals (P < 0.001), with a greater decrease in the dominant frequency (4 degrees C: -0.75 [-0.92(-)-0.68], 37 degrees C: -0.34 [-0.51(-)-0.18], 55 degrees C: -0.30 [-0.45(-)-0.12] cpm; P = 0.020) and a longer duration (4 degrees C: 16 [13-19], 37 degrees C: 12 [6-14], 55 degrees C: 5 [3-8] min; P = 0.014). No differences were found between the 37 degrees C and 55 degrees C meals, the power ratios or the number of dysrhythmias. The magnitude of the postprandial shift in frequency of gastric myoelectrical activity depends on the temperature of the meal. Meal temperature should be taken into account in studies on postprandial gastric motility.

Adult↗
PubMed1998

A novel portable perfused manometric system for recording of small intestinal motility.

The development of solid-state catheters with miniature pressure transducers and portable dataloggers with a large memory capacity has allowed recording of gastrointestinal motility in ambulant subjects. Developments in silicone rubber extrusion technology made it possible to build a perfused manometric system, using a perfused manometric assembly requiring a low volume of perfusate. In the present study the feasibility of recording and automated analysis of small intestinal motility using a perfused multiple lumen manometric system was evaluated in seven healthy volunteers. Pressures were recorded from 12 sideholes arranged in four clusters spaced at 10-cm intervals from the catheter tip. Each channel was perfused at 0.15 mL min-1 with degassed water by a portable, low-compliance, perfusion pump. The 12 sidehole recording channels were connected to external transducers mounted on a belt. Pressure data were stored in two dataloggers. Motility was recorded in the sitting (30 min), and supine (30 min) position, during walking (30 min) and postprandially (90 min). Using purpose-built software baseline variations were corrected for and manometric variables (number of pressure waves, mean amplitude and motility index) calculated. Bench testing of the manometric assembly showed a median baseline pressure offset of 4.2 kPa (range 3.7-10.1) and upon occlusion a rise rate of 27.8 kPa sec-1 (range 19.7-30.8). Changes in body position affected baseline pressures so that compared to the supine position changes in baseline pressure varied between 1.5 +/- 0.7 kPa and 1.9 +/- 0.6 kPa during sitting (P < 0.02), and between 1.7 +/- 0.7 kPa and 1.5 +/- 0.9 kPa during walking (P < 0.03). Manometric recordings obtained during the fasting period showed an increase in small intestinal motor activity during walking. In the postprandial period no differences in motility variables were observed within one cluster and in time. Recording of small intestinal motility with a multiple-channel silicone rubber manometric assembly with a portable perfusion system is a feasible technique which is relatively inexpensive. Computer-assisted data processing allows for adequate elimination of artefacts and automated numerical analysis.

Adult↗
PubMed1998

Is the sensitivity to gastric acid inhibition Helicobacter pylori status-dependent?

BACKGROUND: Recent studies using 24-h intragastric pH monitoring suggest that treatment with a proton-pump inhibitor is less effective in Helicobacter pylori-negative than in H. pylori-positive subjects. AIM: To survey and discuss the available information on the interaction between H. pylori status and the sensitivity to inhibition of gastric acid secretion. METHODS: Literature review. RESULTS: Upon cure of the infection in H. pylori-positive subjects (healthy controls and duodenal ulcer patients), the effect of omeprazole on gastric pH decreases significantly. The findings indicate that H. pylori or H. pylori-related gastritis augments the sensitivity to proton-pump inhibitors. Preliminary information suggests that the sensitivity to H2-receptor antagonists might be less dependent on H. pylori status. The mechanisms through which H. pylori or the H. pylori-associated gastritis leads to increased sensitivity to acid inhibition have not been fully elucidated. It has been hypothesized that the gastritis associated with H. pylori infection plays a role, since the mucosal inflammatory infiltrate can release acid inhibitory cytokines. Another possible mechanism involves the production of acid neutralizing substances by H. pylori, in particular ammonia. Ammonia might also interfere with the activity of the H+/K+-ATPase pump. Finally, H. pylori has been shown to produce fatty acids that inhibit the proton pump. CONCLUSIONS: An interaction exists between H. pylori status and sensitivity to acid inhibition. This interaction has important clinical implications. In H. pylori-negative patients, current dosing with a proton-pump inhibitor may result in insufficient acid control for optimal treatment of gastro-oesophageal reflux disease (GORD). In future studies on treatment and the natural course of GORD, H. pylori status must be taken into account.

Enzyme Inhibitors↗
PubMed1997

The roles of excessive gastro-oesophageal reflux, disordered oesophageal motility and decreased mucosal sensitivity in the pathogenesis of Barrett's oesophagus.

Barrett's oesophagus is often considered an end stage of gastro-oesophageal reflux disease. In its pathogenesis increased oesophageal acid exposure, disturbed oesophageal motility and decreased oesophageal mucosal sensitivity are thought to be of importance. In this review the role of each of these factors will be discussed and an update of the recent literature will be given.

Animals↗
PubMed1997

Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus.

BACKGROUND: Hyperglycaemia delays gastric emptying, both in healthy controls and in patients with diabetes mellitus. The effect of hyperglycaemia on antroduodenal motility in diabetes has not yet been studied. AIM: To investigate the gastrointestinal motor mechanisms involved in the hyperglycaemia induced retardation of gastric emptying in patients with type I diabetes mellitus and autonomic neuropathy. In eight diabetic patients antroduodenal manometry was performed simultaneously with scintigraphic measurement of emptying of a mixed solid-liquid meal, during euglycaemia (5-8 mmol/l glucose) and hyperglycaemia (16-19 mmol/l glucose), on separate days, in random order. RESULTS: Hyperglycaemia decreased the cumulative antral motility index from 38.3 (range 24.2-47.6) to 30.8 (range 17.3-38.1) (p = 0.025) and reduced the number of antral pressure waves propagated over > or = 4.5 cm (p = 0.04). Duodenal phase III-like activity was seen irrespective of the glycaemic state (in three patients during euglycaemia and in four patients during hyperglycaemia). Hyperglycaemia significantly affected gastric emptying of the solid meal: it prolonged the lag phase from 20.0 minutes to 28.5 minutes (P = 0.02), increased the 50% emptying time from 73.5 minutes to 104.5 minutes (p = 0.03), and increased the percentage of isotope remaining in the stomach after 120 minutes from 33.5% to 46.5% (p = 0.02). The cumulative antral motility index was correlated with the 50% emptying time (r = 0.75, p = 0.02) during euglycaemia, but not during hyperglycaemia (r = 0.28, P = 0.31). Liquid emptying was not influenced by the blood glucose concentration. CONCLUSIONS: Hyperglycaemia reduces postprandial antral contractile activity and its organisation in patients with type I diabetes and autonomic neuropathy. These changes in antroduodenal motility are likely to constitute the mechanism through which gastric emptying of solids is delayed during high blood glucose concentrations in these diabetic patients.

Adult↗
PubMed1997

Effects of oral erythromycin on fasting and postprandial antroduodenal motility in patients with type I diabetes, measured with an ambulatory manometric technique.

OBJECTIVE: The aim of this double-blind crossover study was to evaluate the effects of oral erythromycin (250 mg t.i.d.) on fasting and postprandial gastrointestinal motility and gastrointestinal symptoms in patients with type I diabetes. RESEARCH DESIGN AND METHODS: Antroduodenal motility was recorded with an ambulatory manometric technique for a 20-h period, including a high-caloric high-fat dinner and a low-caloric low-fat breakfast and a long fasting period, after 2 weeks erythromycin and placebo treatment in 12 patients with type I diabetes. During the manometric study, plasma glucose concentrations were assessed by frequent self-testing. Gastrointestinal symptoms were scored daily to assess the severity of the symptoms (range 0-3). RESULTS: Oral erythromycin decreased the migrating motor complex cycle length from 118.9 +/- 46.0 to 86.2 +/- 25.3 min (P = 0.03) by shortening phase II from 68.7 +/- 23.5 to 48.5 +/- 19.4 min (P < 0.05). The total number of duodenal phase III increased from 48 to 62 (P = 0.075). However, the degree of antral participation to duodenal phase III did not increase. Erythromycin significantly decreased the duration of the postprandial period after dinner (from 417.0 +/- 137.9 to 348.8 +/- 93.8 min, P = 0.04). During this shorter postprandial period, the number of antral contractions (P < 0.01) and the antral motility index increased (P < 0.03), and early phase III activity at the level of the duodenum was abolished. In diabetic patients with antral hypomotility, after dinner, the mean symptom score improved significantly, from 2.07 +/- 0.86 to 1.52 +/- 0.63 (P = 0.018). CONCLUSIONS: This ambulatory antroduodenal manometric study showed that oral erythromycin (250 mg t.i.d.) improves both fasting and postprandial antroduodenal motor activity after a high-caloric meal in patients with type I diabetes. Furthermore, in diabetic subjects with postprandial antral hypomotility, erythromycin reduces dyspeptic symptoms.

Administration, Oral↗
PubMed1996

Source modeling of esophageal evoked potentials.

Evoked potentials can be recorded from the scalp after stimulation of the esophagus by balloon distension. The purpose of this study was to estimate the number and localization of sources contributing to the esophageal evoked potential (EEP). The EEP was recorded from 32 scalp electrodes in 5 healthy subjects. Spatio-temporal dipole modeling was performed in the time interval from 185 msec to 525 msec after stimulation (mean values). The EEP was best explained by the combined activity of 1 dipole located relatively high in the midline and 2 lateral dipoles. Given the anatomical projection of esophageal sensory fibers and the location of these dipoles the sources were probably located in the cingulate gyri and insular cortex. There was no evidence that sources in the lower brain-stem contributed to the scalp recorded EEP.

Adult↗
PubMed1996

Objective determination of pH thresholds in the analysis of 24 h ambulatory oesophageal pH monitoring.

In 24 h oesophageal pH monitoring, pH 4 is widely but arbitrarily used as the threshold between reflux and non-reflux pH values. The aim of the study was to define pH thresholds objectively, based on Gaussian curve fitting of pH frequency distributions. Single-channel 24 h oesophageal pH monitoring was performed in 26 healthy volunteers and 26 patients with pathological gastro-oesophageal reflux, and five-channel pH-metry was performed in 14 healthy volunteers and 14 patients. The calculated pH thresholds varied between healthy volunteers from 5 center dot 0 to 6 center dot 4 in the upright position and from 4 center dot 5 to 5 center dot 7 in the supine position, but were constant between different oesophageal recording sites. In 15 and nine patients (single-channel and five-channel pH-metry respectively), pH thresholds could not be determined at the distal oesophageal sites. However, the calculated pH thresholds in the proximal oesophagus were in the same range as in the control subjects. The authors conclude that the use of the conventional threshold of pH 4 leads to underestimation of the extent of gastrooesophageal reflux, but are reluctant to advocate the use of higher thresholds in clinical practice.

Adult↗
PubMed1996

Small intestinal motor abnormalities in patients with functional dyspepsia demonstrated by ambulatory manometry.

AIMS/METHODS: In 30 patients with functional dyspepsia and in 20 healthy volunteers, ambulatory duodenojejunal manometry was performed to examine the interdigestive and postprandial small intestinal motility patterns in relation to symptoms. RESULTS: In the fasting state, the number of migrating motor complex cycles mean (SEM) was significantly lower in patients, especially in patients with dysmotility-like dyspepsia, than in control subjects (3.8 (0.4), 2.6 (0.5), and 5.3 (0.7) cycles, respectively; p < 0.05), due to a longer duration of phase II. Non-propagated and retrogradely propagated phase III activity was more prevalent in patients than in control subjects (48% v 15%; p = 0.020). During phase II and after dinner no differences were found in contraction incidence, mean amplitude or motility index. However, 1 1/2 hours after completing breakfast the motility index was higher in patients at all three recording levels (p < 0.05). Burst activity was more prevalent in patients than in control subjects (22% v 6% of the subjects; p = 0.003). In 41% of the patients the symptom index was > 75%. CONCLUSIONS: These results suggest that small intestinal motor abnormalities, especially during fasting, participate in the pathogenesis of symptoms in patients with functional dyspepsia. Ambulatory manometry of the small intestine is a valuable tool to demonstrate these abnormalities in outpatients pursuing their daily activities.

Adult↗
PubMed1996

Prevalence of esophageal disorders in patients with chest pain newly referred to the cardiologist.

STUDY OBJECTIVE: The prevalence of esophageal disorders (dysmotility and/or gastroesophageal reflux) in patients with chest pain newly referred to a cardiologic clinic is unknown. The aims of our study were to investigate the prevalence of esophageal abnormalities in these patients and to assess the value of medical history in predicting the origin of the patient's chest pain. DESIGN: We evaluated 28 consecutive patients who were newly referred to the cardiologist because of angina-like chest pain. Patients with evidence of severe myocardial ischemia were excluded. Cardiologic evaluation included medical history, physical examination, ECG, and exercise testing; further cardiologic workup was carried out only when considered necessary. Gastroenterologic evaluation consisted of medical history, esophageal manometry, endoscopy, and 24-h ambulatory monitoring of esophageal pH and pressure. MEASUREMENTS AND RESULTS: In five patients a diagnosis of ischemic coronary artery disease was made. In only two of these five patients, the cardiologic history strongly suggested a cardiac origin of the pain. Twelve patients had a pathologic 24-h pH profile, four of whom also had reflux esophagitis. Ten patients had symptomatic reflux. In only three of these ten patients, the history was judged to be indicative of an esophageal origin of the chest pain. No motility disorders were found. CONCLUSIONS: Thirty-six percent of the patients with chest pain newly referred to a cardiologic out-patient clinic have symptomatic gastroesophageal reflux. Neither cardiologic nor gastroenterologic history data have a high predictive value with respect to the origin of the chest pain.

Adult↗
PubMed1996

Abnormalities of antroduodenal motility in type I diabetes.

OBJECTIVE: In the present study, a recently developed manometric technique was used to study antroduodenal motility in ambulant type I diabetic subjects. RESEARCH DESIGN AND METHODS: In 12 patients with type I diabetes, antroduodenal manometry was performed for 20 h during the fasting period and the postprandial period after a standardized dinner and breakfast. All patients had evidence of cardiac autonomic neuropathy and complained of dyspeptic symptoms. During the manometric study, the blood glucose levels were frequently monitored and kept close to euglycemia in the diabetic patients. The results were compared with 12 healthy control subjects. RESULTS: The migrating motor complex cycles observed in the diabetic subjects were longer than in the control subjects, 118.9 +/- 46.0 vs. 87.0 +/- 21.6 min (P < 0.05). This increase was attributable to a prolonged phase II, 78.0 +/- 35.5 vs. 37.7 +/- 18.5 min (P < 0.05). In the diabetic subjects, antral phase III was seen significantly less than in the control subjects, 16.7 vs. 43.3% (P < 0.005). In 50% of the diabetic patients, total absence of antral phase III was observed-this phenomenon was not seen in the healthy control subjects. After dinner, the antral motility index was less in diabetic subjects compared with the healthy volunteers, indicating antral hypomotility (P < 0.01). Six diabetic patients showed abnormal duodenal activity such as early recurrence of phase III and bursts after dinner. No significant differences in antral motility index or in duodenal motility patterns were observed after breakfast. Six diabetic patients complained of dyspeptic symptoms after dinner, whereas none had dyspeptic symptoms after breakfast. In 67% of the patients, nausea was reported after an early phase III or a burst. CONCLUSIONS: This study shows that prolonged ambulatory antroduodenal manometry is a feasible technique in patients. Recording multiple migrating motor complexes showed that interdigestive motor abnormalities of the stomach and duodenum are common in diabetic patients. Furthermore, it shows the occurrence of antral hypomotility and abnormal duodenal motility patterns after a high-calorie meal, with dyspeptic symptoms in diabetic patients being related to the composition of the meal.

Adult↗
PubMed1996

Gastro-oesophageal reflux disease in The Netherlands. Results of a multicentre pH study.

Information on the relationships between gastro-oesophageal reflux (GOR), reflux symptoms, hiatal hernia (HH) and oesophagitis, and the response to antisecretory treatment is lacking. In a multicentre study endoscopy, ambulatory 24-h pH monitoring and symptom assessment were carried out in 142 patients with symptomatic reflux disease before and during treatment with ranitidine. Using a randomized, double-blind design, patients took ranitidine 150 mg bid or 300 mg bid. Macroscopic oesophagitis (grade I or II) was found in 85 patients; the remaining 57 patients had normal oesophageal mucosa. A significant correlation was found between the presence of an HH and the presence of oesophagitis. Symptom scores were similar in patients with and without oesophagitis, and in patients with and without HH. Patients with oesophagitis had significantly greater oesophageal acid exposure during the night, and in the total 24-h period, but not during the day. Likewise, patients with HH had greater acid exposure during the night (p < 0.008). Both doses of ranitidine significantly decreased oesophageal acid exposure and the effect was independent of baseline acid exposure. Reflux symptoms cannot be used to differentiate between presence or absence of oesophagitis and/or HH. Reflux patients without oesophagitis have less night-time reflux. Ranitidine dose-dependently decreases oesophageal acid exposure, and the effect is independent of baseline reflux.

Chi-Square Distribution↗
PubMed1996

Low-amplitude distal esophageal spasm as a cause of severe dysphagia for solid food.

This case report presents a patient with progressive dysphagia, accompanied by weight loss, in the absence of organic disease. Esophageal motility studies initially failed to reveal a diagnosis. At simultaneous manometry and fluoroscopy, with bread/barium boluses, the diagnosis of esophageal spasm in a relatively weak esophagus was made. All conservative treatment modalities failed. Thoracoscopic myotomy resulted in partial field of symptoms. Finally, an esophagectomy was performed because of sever dysphagia accompanied by persisting weight loss.

Chronic Disease↗