PubMed Health⌕ Search

Biomedical subjects

H Abrahamsson

Publications and source records attributed to H Abrahamsson.

At least 55 records · Page 3Linked to original sources
PubMed1996

Probiotic treatment of small intestinal bacterial overgrowth by Lactobacillus fermentum KLD.

The principle of using harmless bacteria for conquering pathogens has been used for many years. It has been used prophylactically against travellers' diarrhoea and for protection of recurrent pseudomembranous colitis. The aim of this study was to treat a chronic infectious condition, small intestinal bacterial overgrowth, by oral administration of a certain strain of Lactobacillus. 17 patients with long-standing bacterial overgrowth of the small intestine were included. The study was designed as a double-blind cross-over, where the patients were their own controls. The study was divided into 4 parts. (A) For the first 2 weeks placebo was given b.i.d. (B) For the next 4 weeks patients received either placebo or 10(10) Lactobacillus fermentum KLD b.i.d. (C) A wash-out period of 4 weeks followed. (D) Finally, for the second 4 week treatment period patients were crossed over to receive either lactobacilli or placebo. A hydrogen breath test with 50 g glucose was performed at the start and at the end of each period. Symptom scores were recorded on the last week of each period. The study was completed by 14 patients. Lactobacillus treatment showed no significant difference compared to placebo with respect to the results of the hydrogen breath test: 29 (3-95) vs 14 (3-129) ppm, (median and 10th and 90th percentiles), stool frequency: 14 (8-40) vs 12 (7-31) defecations/week. or symptom score: 12 (5-46) vs 17 (6-42) scores/week). High numbers of L. fermentum KLD in faecal samples were only seen in 2 patients. In conclusion, dosage with L. fermentum KLD in this study did not significantly alter the parameters investigated.

Aged↗
PubMed1995

Hyperinsulinaemia impairs gastrointestinal motility and slows carbohydrate absorption.

Experimental euglycaemic hyperinsulinaemia (insulin levels 46 +/- 4 mU/l) impaired the post-absorptive gastrointestinal motility in healthy individuals; the effect being particularly pronounced in the upper gastrointestinal tract (stomach and proximal duodenum). The postprandial gastric emptying, measured with a standardized 99mTc labelled meal, was also significantly delayed (t50 increased by 38% or 32 min). This was combined with a slower carbohydrate absorption (delay in peak blood glucose level about 40 min). Furthermore, during experimental hyperinsulinaemia higher blood glucose levels were seen at 120 min than at 60 min after food ingestion. This was not seen in any subject in the control study where only 0.9% NaCl was infused. Blood levels of the motility-stimulating hormone, motilin, were significantly lower during experimental hyperinsulinaemia. Thus, experimental hyperinsulinaemia impairs the gastrointestinal motility in both the postabsorptive and postprandial states. This effect is combined with a delayed carbohydrate absorption. Hyperinsulinaemia per se may thus lead to alterations in carbohydrate absorption and can also contribute to the gastrointestinal disturbances in diabetes.

Acute Disease↗
PubMed1995

Protein-losing enteropathy in an unusual form of sarcoidosis.

We describe a case of sarcoidosis associated with great gastrointestinal loss of proteins. It was hypothesized that the loss was caused by involvement of sarcoidosis in the gastrointestinal tract. The patient was a 39-year-old woman with sarcoidosis diagnosed at age 32 years. The protein-losing enteropathy was identified by the use of [51Cr]-albumin. An extensive investigation was performed, with biopsy specimens taken from all parts of the gastrointestinal tract, using upper gastrointestinal endoscopy, colonoscopy and the Crosby capsule technique. We could find no support for our hypothesis that the leakage of proteins was caused by involvement of sarcoidosis in the gastrointestinal tract. Thus, mechanisms other than direct inflammatory involvement of the gastrointestinal mucosa probably caused protein-losing enteropathy in this patient.

Adult↗
PubMed1995

Gastrointestinal motility disorders in patients with diabetes mellitus.

Disturbed gastric and small intestinal motility is an often overlooked clinical problem. Delayed gastric emptying of liquid and/or solid food in patients with type 1 and type 2 diabetes (gastroparesis diabeticorum) occurs in approximately 50% of the patients. Also, the interdigestive gastric and small intestinal motility is often affected. There is only a weak correlation between symptoms and objectively measurable motor disturbances. Patients with severe upper gastrointestinal symptoms usually have disturbed motility, but most patients with impaired motility are asymptomatic. Recent studies have clearly shown that, in addition to autonomic neuropathy, acute metabolic derangements are likely to contribute to disturbed motility. Elevated glucose levels impair gastric and small intestinal motility during fasting and after food intake. Hyperinsulinemia per se has effects similar to hyperglycaemia on the stomach and small bowel, and may be a mediator of the effects of hyperglycaemia in healthy subjects. The impact of insulin on motility in diabetic patients is still unclear. Treatment of the gastric motility disorder should include a stabilization of gastric emptying. Different therapeutic modes may be useful, e.g. application of prokinetic drugs and optimizing the metabolic situation.

Biliary Tract↗
PubMed1995

Interdigestive gastroduodenal manometry in humans. Indication of duodenal phase III as a retroperistaltic pump.

To elucidate the specific function of the three phases (I-III) of the migrating motor complex (MMC) by manometry, detailed analysis of individual pressure waves in the proximal duodenum was performed. Twenty healthy subjects (10 men and 10 women of whom 11 were tube-naive) underwent computerized manometry for 5 h during fasting followed by 45 min after a meal using an 8-channel water perfused catheter. Three recording points were in the antrum, three in the proximal duodenum (2 cm apart), one in the distal duodenum and one in the proximal jejunum. In all subjects at least one phase III (median 2) was observed during the 5-h fasting recording. In the proximal duodenum the mean proportion of retrograde pressure waves, out of all propagating waves, was significantly increased in the last part of phase III (85 +/- 9%, mean, SE), compared with early phase III (6 +/- 5%), late phase II (5 +/- 4%) and the feeding phase (10 +/- 5%), irrespective of gender or previous tube-experience. The median length of the MMCs was 108.5 min. There was no statistically significant difference between men and women or between tube-naive and tube-experienced subjects for the duodeno-jejunal motility indices of phase II and phase III, nor for duration or migration of phase III. The postprandial motility index of the small intestine was increased compared with the interdigestive late phase II, particularly in the jejunum (P < 0.02). The last part of the duodenal interdigestive phase III in healthy subjects shows the feature of a retrosperistaltic pump. This cyclic sequence of retropropagation coincides with the reported rapid alkalinization of the duodenal bulb and the gastric antrum occurring in early antral phase I.

Adult↗
PubMed1995

The migrating motor complex--the motor component of a cholinergic enteric secretomotor programme?

The role of cholinergic nerves in the cyclic activation of interdigestive motility and secretion was studied in 23 healthy volunteers. Net fluid transport in a distal duodenal segment and the release of pancreaticobiliary secretions into the duodenal lumen, were measured with a triple lumen perfusion technique. Interdigestive motor activity was recorded with a low-compliance pneumohydraulic system, and the transmural potential difference (PD) was measured as an on-line marker of electrogenic anion secretion. Transport parameters were related to the migrating motor complex (MMC) in the control situation and after the administration of atropine (0.01 mg kg-1 body wt, i.v.). The early part of the MMC cycle was characterized by low motor activity, low release of bile and pancreatic juice into the duodenal lumen, a slightly lumen positive transmural PD, and a non-significant net fluid absorption ('absorptive mode'). Under control conditions, motor activity and pancreaticobiliary secretions subsequently increased and there was a shift in net fluid transport and transmural PD in the secretory direction ('secretory mode'). Furthermore, there was a significant correlation between contraction frequency, a more lumen negative PD, and the magnitude of net fluid secretion. After the administration of atropine, the secretory mode was abolished, but there was still a significant correlation between contraction frequency and transmural PD. In conclusion, cholinergic neurones seem to mediate the shift from the absorptive to the secretory mode in the human distal duodenum. The antisecretory effect of atropine may be the result of inhibition of motilin release, reduced activation of tension-sensitive intramural secretory pathways, or blockade of cholinergic neurones to the secreting epithelium.

Adult↗
PubMed1995

Comparison between physiologic and erythromycin-induced interdigestive motility.

BACKGROUND: The last part of duodenal phase III of the migrating motor complex behaves as a retroperistaltic pump. We have compared the phase-III-like gastroduodenojejunal activity induced by erythromycin with the naturally occurring phase III, focusing on peristaltic patterns. The effect of two doses of erythromycin, 3 mg/kg/h and 12 mg/kg/h (in four subjects), or saline, given intravenously for 15 min, was studied in nine fasting healthy subjects (five men and four women). METHODS: Motility was recorded on three different days. On one day standard 5-h eight-channel antroduodenojejunal manometry was performed and saline infused 30 min after the first phase III. On the other two study days, erythromycin in the low or the high dose was infused and recording performed for another 2-h period. RESULTS: The low dose of erythromycin induced a phase III in the stomach in all subjects within 12.8 +/- 1.4 min. In contrast, the higher dose did not induce phase-III activity within the 1st h after infusion but induced marked antral pressure waves. The duration of the erythromycin-induced phase III and the naturally occurring antral phase III was 4.7 +/- 1.7 and 1.9 +/- 0.3 min, respectively (p < 0.01). The duration of the erythromycin-induced phase III in the proximal jejunum was 44% shorter than the spontaneous one (p < 0.01). The propagation velocity, from the proximal duodenum to the proximal jejunum, of the erythromycin-induced phase III was slower than that of the spontaneous phase III: 5.7 +/- 0.9 and 15.9 +/- 3.9 cm/min, respectively (p < 0.01). In the proximal duodenum the proportion of retrograde pressure waves (of all propagating waves) was about 10% in early phase III, increasing to about 85% in late phase III in both the spontaneous and erythromycin-induced phase III. In the proximal jejunum retrograde pressure waves were not observed in phase III. CONCLUSIONS: Erythromycin given in a low dose is very effective in inducing phase-III-like motility. The last part of duodenal phase III is characterized by retroperistalsis also when this motility phase is induced by erythromycin.

Adult↗
PubMed1995

Effects of insulin and beta-adrenergic blockade on the migrating motor complex in humans.

BACKGROUND: Interdigestive small-intestinal motility is suppressed by hyperglycemia and also by hyperinsulinemia per se. Since hyperinsulinemia may increase sympathetic activity, the present study was undertaken to ascertain to what extent insulin affects phase III of the migrating motor complex (MMC) and MMC-related duodenal retroperistalsis and whether beta-adrenergic receptors may mediate the effects of insulin. METHODS: Fasting motility was studied in eight healthy volunteers on three occasions with an eight-lumen perfused pressure catheter, with closely spaced recording points in the proximal duodenum. On the control day 5-h antroduodenojejunal manometry was performed. On another study day euglycemic hyperinsulinemic clamping was performed for 2 h after an initial basal recording. On a 3rd day motility was recorded during propranolol infusion, combined with a period of euglycemic hyperinsulinemia. RESULTS: During hyperinsulinemia complete absence of phase III of the MMC in the gastric antrum was observed, whereas 55% of the MMC had a gastric phase-III component on the control day. The duration of phase III in the proximal duodenum was decreased during hyperinsulinemia compared with the control period (p < 0.05). This inhibitory effect of insulin on the activity front was not prevented by beta blockade. Under control conditions the proportion of retroperistaltic pressure waves in the proximal duodenum was 13 +/- 8% in early phase III, increasing in late phase III to 79 +/- 15% (p < 0.01). Duodenal phase III during hyperinsulinemia showed a similar increase in retroperistalsis, from 4 +/- 4% in early phase III to 67 +/- 21% in late phase III (p < 0.01). The corresponding proportions during beta blockade were 16 +/- 10% and 86 +/- 14%, respectively. CONCLUSIONS: Hyperinsulinemia per se abolishes antral phase III and makes the duodenal phase III shorter but does not interrupt the distinct pattern of retroperistalsis in late phase III. Beta-adrenergic receptors seem not to be important for these effects of insulin or for the retroperistalsis in duodenal phase III.

Adult↗
PubMed1995

Duodenal secretomotor function in untreated coeliac disease.

BACKGROUND: The aim of the study was to characterize the epithelial transport properties of the distal duodenal mucosa in untreated coeliac disease. METHODS: The study was performed in 20 patients and in 22 healthy controls. Net fluid and bicarbonate transport was measured with a triple-lumen perfusion technique. Interdigestive motility was recorded by manometry, and the transmural potential difference (PD) was measured as an indicator of electrogenic anion secretion. RESULTS: In the patients a net fluid secretion was seen (-1.04 +/- 0.26 versus 0.12 +/- 0.11 ml/min x 10 cm in the controls; p < 0.01), and there was no significant net bicarbonate absorption (5.6 +/- 3.4 versus 27.5 +/- 4.4 mumol/min x 10 cm in the controls; p < 0.001). The epithelial transport rate varied with the interdigestive motility; a shift in the secretory direction was seen in late phase II of the migrating motor complex (MMC). Moreover, the MMC-related PD curve was significantly displaced in the lumen-negative direction (p < 0.001 versus controls). CONCLUSIONS: The results suggest that in untreated coeliac disease, active chloride secretion is enhanced, and Na+/H+ exchange is reduced. This remodelled mucosa still seems to respond to neurogenic stimuli, as suggested by the presence of MMC-related changes in secretion rate.

Adolescent↗
PubMed1994

Effects of hyperglycemia on interdigestive gastrointestinal motility in humans.

BACKGROUND: Gastrointestinal motility disorders are common in patients with diabetes mellitus. Recent studies indicate that hyperglycemia can affect gastric emptying and gastric motility in healthy subjects and diabetics. METHODS: The effect of acute hyperglycemia on gastrointestinal motility was studied with a manometric technique in healthy subjects. Seven individuals, four men and three women, 23-34 years old, were studied on 2 different days. On 1 of the days a 5-h registration was performed after an overnight fast. On another day and after an initial basal period, acute steady-state hyperglycemia was induced by intravenous glucose infusion for 90 min. Motility variables were evaluated in four segments: in the gastric antrum, the proximal duodenum, the distal duodenum, and the proximal jejunum. RESULTS: Fasting migrating motor complex rhythm including migration of phase III prevailed during hyperglycemia. Compared with euglycemia, the motility index in phase II was lower during hyperglycemia in all segments studied. In the antrum the difference was 62% (p < 0.01); in the proximal duodenum, 37% (p < 0.01); in the distal duodenum, 44% (p < 0.05); and in the jejunum, 58% (p < 0.01). During hyperglycemia the prevalence of propagated contractions in phase II was significantly lower than during euglycemia both in the antrum and the proximal duodenum. In the last part of phase III in proximal duodenum most individual contractions were propagated in orad direction compared with early phase III, and this difference persisted during hyperglycemia. The number of long clusters was significantly increased during hyperglycemia as compared with euglycemia: 2.0 +/- 0.6 per hour versus 0.4 +/- 0.14 (p < 0.01). In late phase II plasma levels of motilin and pancreatic polypeptide were significantly decreased during hyperglycemia. CONCLUSION: Hyperglycemia not only reduces the motility in the stomach but also inhibits motility in both the duodenum and the jejunum. The results show that acute hyperglycemia has an important impact on small-intestinal motility.

Adult↗
PubMed1993

Mechanisms behind cyclic changes in duodenal fluid transport in the fasting state.

The relationship between distal duodenal motility, fluid transport and transmural potential difference (PD) was studied in 33 healthy volunteers. Motor activity was registered with a low-compliance pneumohydraulic system; one pressure channel also served as an intraluminal flowing electrode for registration of transmural PD. Net fluid and bicarbonate transport were measured with a triple lumen perfusion technique. The relation between net fluid transport (NFT) and transmural PD depended on the current phase of the migrating motor complex (MMC). In phase I and early phase II (low motor activity), a significant net fluid absorption was seen when the perfusate contained glucose (30 mM). If glucose was substituted with mannitol, NFT was not significantly different from zero and transmural PD was slightly lumen positive. In the early part of the MMC cycle (low motor activity), there was a significant correlation between a more lumen negative transmural PD and a higher net fluid absorption in individual experiments (r = -0.65; P < 0.01). In late phase II of the MMC cycle (high motor activity), NFT changed significantly in the secretory direction in both Krebs mannitol and Krebs glucose perfused segments, and the perfusate-related difference in transport rate was no longer statistically significant. In the Krebs mannitol group, transmural PD became significantly more lumen negative, and there was also a decrease in net bicarbonate absorption as well as a slight acidification of the luminal contents. The relationship between transmural PD and NFT was reversed, i.e. a more lumen negative PD was associated with a higher net fluid secretion in individual experiments (r = 0.82; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Inhibitory effects of terbutaline on human esophageal peristalsis and development of tolerance.

To investigate the inhibitory influence on esophageal motility of prolonged beta-2-adrenergic stimulation, esophageal peristalsis was studied in 10 volunteers. The beta-2 agonist terbutaline was given orally, 5 mg three times daily, for 10 days, and the subjects were studied before medication (basal), on days 3 and 10 during the medication, and 1 week after withdrawal of the drug. At each session esophageal peristaltic pressure, heart rate, and finger tremor were assessed. On the 3rd day of medication the peristaltic pressure was significantly decreased and heart rate and finger tremor significantly increased compared with basal values on day 0. On the 10th day of medication there was still a decrease in peristaltic pressure but less pronounced than on day 3 despite similar blood levels of terbutaline. It is concluded that oral medication with a beta-2 agonist initially inhibits esophageal peristalsis, but during continued medication the inhibitory effect on the esophagus decreases. The results indicate development of esophageal tolerance to beta-2-receptor stimulation in accordance with development of tolerance shown in extraintestinal organs.

Administration, Oral↗
PubMed1991

Malabsorption of fat after partial gastric resection. A study of pathophysiologic mechanisms.

The causes of fat malabsorption after gastric resection were studied in patients randomized to Billroth I gastroduodenostomy or Roux-en-Y gastrojejunostomy after antrectomy and selective gastric vagotomy for intractable prepyloric peptic ulcer. Eighteen patients were studied 2 years or more postoperatively. Assessment of food intake concerning protein, fat, carbohydrate, vitamins and minerals showed deficiency in seven cases, but without significant difference between the two operation types. Postoperative weight loss did not differ significantly between the two study groups, but the faecal excretion of fat was significantly larger (p less than 0.05) after gastrojejunostomy than after gastroduodenostomy. Since both the oro-caecal transit time and the breath excretion of hydrogen after a standardized test meal showed no intergroup difference, the results suggest that duodenal exclusion may be of particular pathophysiologic importance for the observed malabsorption of fat after gastric resection.

Anastomosis, Roux-en-Y↗
PubMed1990

Relationship between interdigestive duodenal motility and fluid transport in humans.

In 22 healthy volunteers distal duodenal fluid absorption was related to the interdigestive motility cycle. Fluid absorption was measured with a triple-lumen perfusion technique, and motility was registered with a low-compliance pneumohydraulic system. Pancreatic and biliary secretions were estimated by measurement of bilirubin and amylase release into the duodenal segment. Duodenal fluid absorption rate changed during the interdigestive motility cycle; the highest absorption rate was registered during phase I (low-motor activity) and absorption rate then decreased in parallel with increasing motor activity during phase II (r = -0.69, P less than 0.001). In late phase II a net fluid secretion was frequently registered, together with an increased release of bilirubin into the duodenal lumen. This pattern was seen during perfusion with both glucose-containing (30 mM) and glucose-free solutions. The results show that duodenal fluid absorption rate changes markedly during the interdigestive motility cycle. This effect may be a hydrodnamic phenomenon or may be due to activation of a neural secretory mechanism during phase II.

Adult↗