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Biomedical subjects

C H Malbert

Publications and source records attributed to C H Malbert.

At least 37 records · Page 2Linked to original sources
PubMed1997

Spatial patterns of fasting and fed antropyloric pressure waves in humans.

1. Gastric mechanics were investigated by categorizing the temporal and spatial patterning of pressure waves associated with individual gastric contractions. 2. In twelve healthy volunteers, intraluminal pressures were monitored from nine side hole recording points spaced at 1.5 cm intervals along the antrum, pylorus and duodenum. 3. Pressure wave sequences that occurred during phase II fasting contractions (n = 221) and after food (n = 778) were evaluated. 4. The most common pattern of pressure wave onset along the antrum was a variable combination of antegrade, synchronous and retrograde propagation between side hole pairs. This variable pattern accounted for 42% of sequences after food, and 34% during fasting (P < 0.05). Other common pressure wave sequence patterns were: purely antegrade-29% after food and 42% during fasting (P < 0.05); purely synchronous-23% fed and 17% fasting; and purely retrograde-6% fed and 8% fasting. The length of sequences was shorter after food (P < 0.05). Some sequences 'skipped' individual recording points. 5. The spatial patterning of gastric pressure wave sequences is diverse, and may explain the differing mechanical outcomes among individual gastric contractions. 6. Better understanding of gastric mechanics may be gained from temporally precise correlations of luminal flows and pressures and gastric wall motion during individual gastric contraction sequences.

Adult↗
PubMed1997

Measurement of gastric emptying by intragastric gamma scintigraphy.

Gastric emptying is usually measured in animals and humans by dilution/sampling or external scintigraphy. These methods are either time consuming or require expensive equipment. The capacity of a miniature gamma counter positioned in the stomach to measure emptying of liquid and solid meals was evaluated. In eight conscious pigs fitted with gastric and duodenal cannulae, gastric emptying of saline (500 mL), dextrose (20%, 500 mL), porridge (300 g) and scrambled eggs (300 g), all labelled with 3.5 MBq 99mTC, was evaluated. When positioned in the antrum the probe was unable to quantify gastric emptying. In contrast, measurements of the fractional emptying of saline over 4-min periods by the probe positioned in the corpus and quantification of radioactivity in the duodenal effluent correlated closely (r = 0.88, P < 0.05). Gastric emptying (50% emptying time) of saline and both solid meals measured by the probe was not significantly different from quantification of the duodenal effluent volume. No difference was observed also for the dextrose meal but only while gastric acid secretion was suppressed by omeprazole. We conclude that an intragastric gamma counter permits measurement of gastric emptying of homogeneous meals provided meal stimulation of gastric secretion was not extensive. This was possible probably by monitoring emptying from the proximal stomach.

Animals↗
PubMed1996

Preservation of normal gastric emptying following gastric surgery by use of a muscle bridge.

BACKGROUND: Maintenance of descending antral intramural pathways may be important in normal functioning of the pylorus after pylorus-preserving gastrectomy. METHODS: We examined the effect of a 1-cm bridge of muscle as a means of maintaining pyloric connection to antral intramural motor control pathways in 10 pigs. Antropyloroduodenal pressures and transpyloric flow were measured during gastric emptying of saline before and after either total or subtotal transection and reanastomosis of antrum. RESULTS: Complete antral transection shortened the time interval between antral and subsequent pyloric lumen occlusion, significantly reducing total gastric emptying and volume of transpyloric flow pulses. Subtotal transection maintained pre-transection timing and was associated with normal patterns of transpyloric flow and emptying. CONCLUSIONS: Our results indicate that a muscle bridge is capable of maintaining normal gastric emptying and the coordination of antral with pyloric contractions. We propose that antropyloric coordination is maintained by transmission of neural signals through the muscle bridge.

Anastomosis, Surgical↗
PubMed1995

Gastric but not duodenal motor effects of oral erythromycin are dose related.

There has been increasing interest in the potential use of erythromycin as a prokinetic agent, despite limited data on the effect of oral administration on gastrointestinal motility. We have now evaluated, in 15 conscious pigs fitted with strain gauges, the response of (i) basal gastric motility and (ii) gastric motility during inhibition with intraduodenal triglycerides infusion to increasing doses of oral erythromycin. In the basal state, erythromycin led to dose-dependent increases in both the amplitude (10-30 mg kg-1) and the frequency (10-55 mg kg-1) of gastric contractions. The corpus was more responsive than the antrum, with an increase in amplitude at lower doses. The amplitude of the duodenal contractions was also improved but not in a dose-dependent manner. Gastroduodenal coordination was unchanged regardless of the dose of erythromycin. Following inhibition of gastric motility, a dose of erythromycin below 45 mg kg-1 increased both the amplitude of gastric contractions and the gastroduodenal coordination, although individual doses produced smaller increases in amplitude than in the basal state. These results suggest that erythromycin has a different mechanism of action in the stomach compared with the duodenum. The reduced effectiveness of large doses of erythromycin has important therapeutic implications.

Animals↗
PubMed1995

Vagal control of pyloric resistance.

Pyloric resistance is probably a major factor regulating gastric emptying of liquids, but its nervous control is unknown. The role of efferent vagal pathways in pyloric resistance was evaluated in 13 anesthetized pigs. Pyloric resistance was assessed by simultaneous recording of gastropyloroduodenal motility and transpyloric flow during gastric emptying of saline. Cervical vagotomy suppressed all antral pressure events, increased the number of pressure events localized at the pylorus, and decreased the frequency of the flow pulses (P < 0.05), without affecting either pyloric resistance or the characteristics of flow pulses. Electrical stimulation of the cervical and the thoracic vagi both decreased pyloric resistance by about 60% and increased the stroke volume of flow pulses (P < 0.05). The reduced pyloric resistance was mainly related to an alteration of the temporal relationship between flow pulses and pyloric pressure events. These results indicate that vagal efferents could provide inhibitory inputs to pyloric resistance. A reduction in pyloric resistance contributes to the increased flow rate observed during vagal stimulation.

Animals↗
PubMed1994

Vagal control of transpyloric flow and pyloric resistance.

Vagal control of pyloric resistance was evaluated in anesthetised pigs by recording gastropyloroduodenal motility and transpyloric flow during emptying of a liquid nonnutrient meal. Vagotomy did not modify pyloric resistance or the characteristics of the flow pulses. Electrical stimulation of the distal stumps of cervical or thoracic vagus nerves decreased pyloric resistance and triggered flow pulses of large stroke volume. This was associated with increased fundic tone and pressurization of the antrum. Phentolamine but not propranolol reduced the responses to vagal stimulation. These observations demonstrate that reduced pyloric resistance is one mechanism by which vagal activation promotes transpyloric flow.

Animals↗
PubMed1994

Antropyloric modulation of transpyloric flow of liquids in pigs.

BACKGROUND/AIMS: The proximal stomach is considered as the main contributor to liquid emptying. The aim of this study was to investigate the capacity of the distal stomach to generate transpyloric flow pulses in the absence of the proximal stomach. METHODS: Concurrent motility and flow measurements were made in eight anesthetized pigs. Four animals had the proximal stomach excluded by creation of a mucosal septal pouch. RESULTS: Although major modifications of both flow pulse and motility patterns resulted from proximal stomach exclusion, emptying remained pulsatile and overall emptying rate unchanged. After proximal stomach exclusion, backflow disappeared and flow pulses occurred simultaneously with antral and pyloric pressure events, whereas flow pulses preceded the pressure events in intact animals. The frequency of flow pulses decreased after proximal stomach exclusion because the interval between gastroduodenal pressure events was longer. In contrast, there was an increase in the stroke volume of flow pulses attributable to a decrease in pyloric resistance. CONCLUSIONS: Exclusion of the proximal stomach does not modify the overall emptying rate, although the mechanisms responsible for emptying are modified. In particular, the stroke volume of individual pulses is greater.

Animals↗
PubMed1993

Duodenal pH dips as an index of transpyloric flow in conscious dogs.

BACKGROUND: To determine if duodenal pH fluctuations might be used as a valuable index of the occurrence of gastric chyme ejection, the transpyloric flow and pH in the duodenal bulb were monitored simultaneously in six dogs. METHODS: Transpyloric flow, monitored by a chronically implanted electromagnetic flowmeter, was represented by individual pulses of flow. Relations between the volume of these flow pulses and changes in duodenal pH were assessed both postprandially and during the increased gastric outflow that followed gastric loading of buffered saline solutions at pH 2 and 4. RESULTS: During fasting and gastric loading with buffered saline at pH 2, no consistent relationship between flow pulses and duodenal pH fluctuations was evident. After instillation of buffer solution at pH 4 and postprandially, the magnitude of duodenal pH fluctuations became proportional to the stroke volume of the flow pulses. The removal of bile from the proximal duodenum decreased the relationship. CONCLUSIONS: It is concluded that duodenal pH measured at 2 cm from the pylorus might be used postprandially as an index of the transpyloric flow rate of chyme.

Animals↗
PubMed1993

Mechanoreceptors sensitive to flow at the gastroduodenal junction of the cat.

Vagal afferent activity was recorded from the cervical vagus simultaneously with intraluminal pressure and flow rate at the proximal duodenum, in cats anesthetized with pentobarbital sodium. Thirty-seven mechanoreceptors that adapted slowly to maintained pressure changes were found to be sensitive to the flow of saline through the pylorus. The passage of liquid was associated with an increase of pressure equal to one-tenth of that necessary to trigger a response of the receptors during the distension of a small balloon. The frequency of discharge was increased by the passage of liquid for positive back pressures < or = 1.5 kPa but not when back pressure was negative. The relationship between the discharge of the receptor and the flow rate was complex and showed an hysteresis. We conclude that there exist slowly adapting mechanoreceptors sensitive to distension of the duodenum that can also sense the passage of liquid.

Animals↗
PubMed1992

Pressure profile along the oesophagus during eructation in sheep.

The pressure profile along the oesophagus was recorded simultaneously with the flow rate of eructated gas in sheep to evaluate the oesophageal motor events leading to the relief of gas. All the eructation sequences started by a rise followed by a plateau of oesophageal pressure. The passage of gas at the tracheal level occurred during this plateau and not during the consecutive transient lowering of the oesophageal pressure. All eructation sequences ended by a peristaltic contraction of the oesophagus. The flow rate pattern of gas during eructation was affected by head position leading to different tensions of the oesophagus. We conclude that, despite the large volume of eructated gases, the eructation process is not significantly different in sheep compared to other animals. Therefore, by virtue of its unique physiological particularity, the sheep might be used as an experimental model for the evaluation of lower oesophageal sphincter (LOS) competence.

Animals↗
PubMed1992

Changes in antroduodenal resistance induced by Cisapride in conscious dogs.

The effects of Cisapride on gastric outflow/pressure relationships have been examined in conscious dogs. In the digestive state, after inhibition of emptying in the first 10 min, Cisapride accelerated gastric emptying for 110 min by increasing the volume (7.3 +/- 1.2 vs. 2.3 +/- 0.3 ml) rather than by decreasing the interval between flow pulses (4.9 +/- 0.2 vs. 4.5 +/- 0.1s). After non-nutrient gastric loading, Cisapride also first inhibited and then accelerated gastric emptying as the consequence of both a larger stroke volume (8.0 +/- 1.7 vs. 3.2 +/- 0.5 ml) and more frequent pulses (3.9 +/- 0.1 vs. 4.9 +/- 0.1 s). In both situations, Cisapride increased the amplitude of the antral/pyloric pressure waves. Antropyloroduodenal resistance increased substantially in the first 10 min after Cisapride then recovered to its control value. We conclude that stimulation of antropyloroduodenal motility by Cisapride can both impede and increase gastric emptying by changes in antroduodenal resistance.

Animals↗
PubMed1992

Nervous control of distension-induced relaxation of the porcine lower oesophageal sphincter.

The mechanisms involved in the relaxation of the lower oesophageal sphincter induced by distension of the oesophagus and different parts of the stomach, were studied in an anaesthetized porcine model. A computer technique was developed allowing on-line digitizing of lower oesophageal sphincter (sleeve device) and intragastric pressures. Basal sphincter tone was slightly reduced by truncal vagotomy, an effect which seemed to be reversed by sectioning of the vagosympathetic trunks in the neck. Balloon distension of the body of the oesophagus, relaxed the sphincter irrespective of the denervation procedures carried out. Distension of the whole stomach with increasing amounts of air induced a dose-dependent relaxatory lower oesophageal sphincter response, which was also closely associated with the subsequent increases in intragastric pressure. Denervation procedures did not alter this dose-response relationship. The importance of intramural mechanisms was illustrated by the abolition of distension-induced effects in most animals studied after transection of the gastro-oesophageal junction distal to the sphincter. Balloon distension of the antrum elicited a smaller but significant sphincter relaxation, but the mechanisms behind this response seemed to be more complex than after insufflation of air.

Animals↗
PubMed1991

Relationships between pressure and flow across the gastroduodenal junction in dogs.

Antroduodenal pressure events were measured simultaneously with transpyloric flow, in conscious dogs, to evaluate the role of mechanical factors modulating this flow. The relationships between pressure and flow across the gastroduodenal junction were never linear. During the interdigestive state, terminal antral contraction occurred 0.9 +/- 0.29 s after the onset of the gush of gastric contents. Hence, the highest flow rate occurred during the period of lowest resistance. After a meal, terminal antral contraction began 3.3 +/- 0.87 s before the flow of chyme, and resistance rose simultaneously with flow rate. The antroduodenal resistance was 10 times higher than during the interdigestive state (8.33 +/- 1.56 vs. 0.73 +/- 0.34 mmHg.ml-1.s). The pyloroduodenal resistance was always lower than the antropyloric one. It is concluded that, because of the temporal relationship between motor events and flow, pure resistive behavior of the junction occurred only after a meal.

Animals↗
PubMed1991

[Emptying of the abomasum in adult ruminants].

In the adult ruminant, abomasal emptying is a permanent phenomenon depending upon meal volume. Intradian rhythm involving the motor pattern of the duodenum and circadian rhythm of unknown origin modulate the transpyloric flow rate. The fundic tone, antro-duodenal coordination and pyloric resistance regulate gastric outflow. The break-like function of the pyloric resistance involves chyme viscosity. Transpyloric flow rate is controlled by a hierarchy of extrinsic and intrinsic mechanisms triggered at the duodenal level. The vagus permanently inhibits the motility of the abomasum. A similar relationship is observed between the pyloric sphincter and duodenal motility. Removal of the pyloric ring leads to an increased food intake.

Abomasum↗
PubMed1989

Hyperphagia induced by pylorectomy in sheep.

In the hay-fed sheep, gastric (abomasal) contents are delivered continuously into the duodenal bulb at a mean flow rate of 210 ml per hour. The pylorus could behave as the site of origin of a feedback satiety signal by acting as a distal stomach sphincter limiting the abomasal emptying rate. This ability of the pyloric sphincter was confirmed by enhancement of abomasal outflow following either pylorectomy or pyloroplasty. In both cases, the subsequent reduction of the mean residence time of digesta in the abomasum was accompanied by an increase in the voluntary intake. The increase by 48% of food intake persisted several weeks after pylorectomy and was not only compensatory for the lower intake during recovery from surgery. Such an hyperphagia, obtained by removal of the ruminant herbivore pylorus, suggests the suppression at the antroduodenal junction level of a regulating factor affecting voluntary food intake by modulating the mean residence time of digesta in the abomasum.

Animals↗
PubMed1989

The effects of intake of lucerne (Medicago sativa L.) and orchard grass (Dactylis glomerata L.) hay on the motility of the forestomach and digesta flow at the abomaso-duodenal junction of the sheep.

1. The relations between food intake, reticulo-ruminal motility and abomasal digesta outflow were investigated in ewes receiving lucerne (Medicago sativa) v. orchard grass (Dactylis glomerata) hay. Abomasal digesta outflow was recorded continuously by means of an electromagnetic flowmeter probe inserted into a duodenal T-shape cannula and the motility using strain-gauge force transducers. Volumes and turnover rates of both rumen and abomasal liquid phases were measured by CrEDTA dilution. 2. The voluntary intake of lucerne was higher (60%) than that of orchard grass hay, and paralleled by an increased abomasal outflow (65%) corresponding to an increased number of gushes of digesta through the flowmeter probe: 129/h instead of 78/h on orchard grass hay. Abomasal motor activity was enhanced (35%), and periods of regular spiking activity were seen passing along the duodenum at a higher velocity for the lucerne diet than for the orchard grass diet. The increased abomasal outflow with lucerne hay was associated with a higher reticulo-ruminal turnover rate, but not abomasal turnover rate. Abomasal, but not reticulo-ruminal volume, was increased (30%) when lucerne hay was fed ad lib. 3. The total number of reticulo-ruminal contractions was increased by 6.6% when the dry matter entering the duodenum was increased by 70.6%, suggesting the level of voluntary intake, rather than reticulo-ruminal motility, as a major factor governing abomasal outflow in sheep. 4. More frequent passages of digesta, unrelated to duodenal contractions, were recorded in ewes receiving lucerne compared with orchard grass. Both a higher viscosity of the contents due to the addition of guar gum and the impairment of antroduodenal motility by 5-hydroxytryptophan were able to reduce the flow rate of orchard grass digesta, but did not affect the higher flow rate of lucerne digesta. The findings suggest that the high abomasal outflow in sheep fed on lucerne ad lib. is related to a low viscosity of the contents that are propelled, even in the case of antral contractions of low magnitude.

Action Potentials↗
PubMed1989

Duodenal bulb control of the flow rate of digesta in the fasted and fed dog.

1. Continuous measurement of the flow of digesta near the pylorus, and 5 cm aborally, was assessed in the conscious dog using a chronically implanted flowmeter. The patterns of flow were related to motor activity of the gastroduodenal junction. 2. Electromagnetic measurement of the flow was calibrated in vitro by means of a pulsatile pump. Validation was obtained in vivo by direct evaluation of the amount of chyme collected from an open duodenal cannula and indirectly by a dye-dilution technique. 3. After a 12 h fast, only small amounts of gastric contents were delivered into the duodenum. This transfer occurred during periods of irregular motor activity recorded along the gastroduodenal junction, which occupied less than 25% of the recording time. The patterns of flow near the pylorus and beyond the duodenal bulb were correlated to antral and duodenal contractions respectively. 4. After a meal, gastric emptying occurred intermittently and was related to enhanced antral motor activity beyond the duodenal bulb; digesta flowed in clusters of gushes which were related to the duodenal contractions. 5. It is concluded that the mechanical role of the duodenal bulb is to change the intermittent juxtapyloric flow of digesta into a uniform flow at the duodenal level.

Action Potentials↗