Biomedical subjects
T D Bolin
Publications and source records attributed to T D Bolin.
Comparison of an in vitro faecal hydrogen test with the lactulose breath test: assessment of in vivo hydrogen-producing capability in Burmese village children.
In the assessment of carbohydrate malabsorption, it is important to determine if patients with a flat breath hydrogen (H2) response to an absorbable carbohydrate challenge are capable of producing H2. We compared the reliability of a rapid faecal incubation system with the lactulose breath test to assess in vivo H2 production in 64 children. Overall, 70% of subjects were in vivo H2-producers, with breath H2 peaks greater than 10 parts per million within 3 h of ingesting 10 g of the non-absorbable disaccharide lactulose. Faecal specimens from the 64 children had a mean (SE) pH of 5.0 (0.077). Faecal homogenates were incubated with lactulose at both the initially measured faecal pH and at neutral pH. In predicting a normal in vivo H2-producing ability (sensitivity), the faecal H2 test was correct in only 22% (faecal pH) to 44% (pH7) of cases. In predicting an abnormal lactulose breath test result (specificity), faecal homogenate analysis was correct in 53% of cases, at both faecal and neutral pH. These findings indicate that the faecal hydrogen test is unsuitable as a screening test for in vivo H2 production.
Absorption of carbohydrate from rice in Ascaris lumbricoides infected Burmese village children.
With the objective of determining the relationship between ascariasis and carbohydrate absorption from rice, breath hydrogen tests (BHT's) were performed in two study populations of Burmese village children. Using a rice test meal, breath hydrogen peaks greater than 10 ppm above baseline within 4 hours (indicating rice malabsorption) were seen in 24 out of 55 (44 per cent) Ascaris lumbricoides infected children and 3 out of 18 (17 per cent) non-infected children (age 18-59 months). In another ascaris endemic village 139 children (age 36-108 months) underwent a rice meal BHT. Seventy children had been regularly dewormed for 2 years (single dose levamisole 50 mg every 3 months) whilst 69 children had been dewormed once in 2 years, 6 weeks before breath testing. Regularly dewormed children showed a lower prevalence of rice malabsorption (33 per cent) compared to the control group (54 per cent) (P < 0.05). These findings suggest that malabsorption of carbohydrate from rice can occur during Ascaris lumbricoides infection in children.
In vitro hydrogen production by enteric bacteria cultured from children with small bowel bacterial overgrowth.
Lactulose breath hydrogen test and Enterotest string test were carried out simultaneously on 19 children 3-5 years old. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log10 organisms per ml. Most of these bacteria did not produce hydrogen in vitro. Hydrogen production (greater than 100 ppm) was observed with the following bacteria: Bacteroides (5%), clostridia (8%), anaerobic corynebacteria (5%), Escherichia coli (67%), Lactobacillus (8%), Staphylococcus (8%), and Streptococcus (9%). The following bacteria did not produce hydrogen in vitro: Actinobacter, Actinomyces, anaerobic cocci, Bifidobacterium, Fusobacterium, micrococci, Neisseria, Sarcina, and Veillonella. This study suggests that in the diagnosis of small bowel bacterial overgrowth using lactulose breath hydrogen test, it is important to consider that patients with a flat breath hydrogen response to a carbohydrate challenge during the first 60 min may be infected with enteric bacteria which are not capable of producing H2.
Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese (Myanmar) village children.
Breath hydrogen tests were performed after a rice meal (3 g of cooked rice/kg of body weight, equivalent to 1 g of carbohydrate/kg of body weight) on 256 village children (age range 1-59 months) who were known hydrogen (H2) producers. Anthropometric measurements were made every three months and growth rates were calculated. A breath H2 excretion pattern that suggested small bowel bacterial overgrowth (SBBO), which was recognized as a transient maximum level of 10 ppm or more at 20-, 40-, or 60-min breath samples following the rice meal, was present in 53 (20.7%) children, and was more frequent in children 36-47 and 48-59 months old. This breath H2 excretion pattern was detected in 48 (33.3%) of 144 children who were rice malabsorbers (greater than 10 ppm H2 above baseline values in one of the breath samples taken between 90 and 240 min), and in only five (4.5%) of 112 rice absorbers. Children who had SBBO had a high relative risk (10.7) of being rice malabsorbers. Rice malabsorbers have a high relative risk (59.7) of having faltered growth, accompanied by a large etiologic fraction (94%). This same risk (6.68) and an etiologic fraction of 62% exist in children with untreated SBBO. These findings emphasize the need for interventions aimed at reducing the prevalence of SBBO or similar conditions as detected by the breath H2 excretion pattern to prevent rice malabsorption and growth faltering.
A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese village children.
Breath hydrogen tests (BHTs) were performed on 340 Burmese village children aged 1-59 months. Normalization (correction of breath H2 values to a constant mean O2 level) eliminated the variations in H2 levels due to sleep, storage temperature, or duration of storage. After a 10 g lactulose test meal, 145 (42.6%) children produced less than 10 ppm H2 above basal values (non-H2 producers). Of 195 H2 producers, a pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth (SBBO)--recognized as a transient peak at the 20, 40, or 60 min breath samples following the lactulose test meal and distinguishable from the later colonic peak--was observed in 53 (27.2%), being significantly more frequent in male children, and exhibiting an age-prevalence pattern similar to that of acute childhood diarrhea in these villages. Diarrhea did not alter the state of H2 production (non-H2 producers remain non-H2 producers, and H2 producers remain H2 producers) although the magnitude of peak breath H2 changed.
Storage of methane breath-test samples in plastic syringes.
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Effect of short-term intermittent antibiotic treatment on growth of Burmese (Myanmar) village children.
To test the hypothesis that subclinical enteric infection (such as bacterial overgrowth), rice malabsorption, and growth faltering are causally linked, a field trial of low-dose, short-term, intermittent antibiotic treatment was carried out in 142 hydrogen-producing (by lactulose breath hydrogen test) Burmese village children aged 6-59 months. The children were randomly allocated treatment with metronidazole (20 mg/kg or 5 mg/kg daily), amoxycillin (25 mg/kg daily), or placebo given 1 week per month for 6 months. A cooked rice meal breath hydrogen test was done to classify the children as rice absorbers (RA) or rice malabsorbers (RM) before treatment and monthly on the day before each cycle of treatment. There were no differences between the treatment groups, so they were considered together. Factorial analysis showed that antibiotic treatment did not significantly affect the proportion of RM children. The only significant difference between antibiotic-treated and placebo-treated children's growth was in the subgroup of RM children aged 36-47 months; the antibiotic-treated children had significantly greater linear growth. In other age groups antibiotic treatment had no effect on growth.
Absorption of carbohydrate from rice in Burmese village children and adults.
Breath-hydrogen tests (BHTs) were performed on 310 Burmese village children aged 1-59 mo. After a 10-g lactulose test meal, 94 (30.3%) children produced less than 10 ppm H2 above basal values (nonhydrogen producers). Of 216 hydrogen producers, 210 were tested after a cooked rice meal (3 g cooked rice/kg body wt, equivalent to 1 g carbohydrate/kg body wt) with the BHT. Hydrogen peaks greater than or equal to 10 ppm above baseline concentrations were produced by 133 (66.5%) children who were defined as rice malabsorbers. Forty-three percent to 62% of children were less than or equal to -3 SD of the National Center of Health Statistics (NCHS) median weight-for-age and length-for-age and less than -2 SD of the NCHS median weight-for-length. There were no differences between rice absorbers (peak hydrogen less than 10 ppm above baseline) and rice malabsorbers in the allometric indices (the Ehrenberg index and the Dugdale index) of weight-for-length. Rice-carbohydrate malabsorption was also detected by BHTs in 26.7% of 86 school children (aged 5-15 y), 38.5% of 39 young adults (aged 15-39 y), and 50% of 34 older adults (aged 40-70 y).
Malabsorption of carbohydrate from rice and child growth: a longitudinal study with the breath-hydrogen test in Burmese village children.
Breath-hydrogen tests were performed after a rice meal (3 g cooked rice/kg body wt, equivalent to 1 g carbohydrate/kg body wt) at monthly intervals for 6 mo on 75 village children aged 1-59 mo who were known hydrogen producers. The overall rate for rice-carbohydrate malabsorption was 46.7% (range 37.3-56.0%). Anthropometric measurements were made every 3 mo and growth rates were calculated. Forty-six percent to 59% of children were less than or equal to -3 SD of the National Center for Health Statistics (NCHS) median weight-for-age and length-for-age and less than -2 SD of the NCHS median weight-for-length. Rice malabsorbers (ie, those with hydrogen peaks greater than or equal to 10 ppm above baseline concentrations) in the age groups 36-47 mo and 48-59 mo had statistically significant diminished growth expressed as percent gain in length per annum per child (p less than 0.02). Thus, rice malabsorbers had a deficit in linear growth of 2.7 cm/y (range 2.5-2.9 cm/y) for children aged 36-47 mo old and 1.9 cm/y (range 1.7-2.1 cm/y) for children aged 48-59 mo.
Sucralfate maintenance therapy in duodenal ulcer disease. A review.
There are a large number of patients with chronic duodenal ulcer disease who warrant long-term maintenance therapy to diminish the risk of recurrence and thereby the risk of further complications such as gastrointestinal bleeding. The efficacy of sucralfate has been compared with both placebo and histamine (H2)-receptor antagonists and sucralfate in a dose of 1 g twice a day or 2 g taken at night. It is a safe and effective medication in preventing duodenal ulcer recurrence. However, duodenal ulcer relapse rates always exceed 20 percent and frequently approach 50 percent, whether the therapy be H2-receptor antagonists or sucralfate, and the use of dosages that are half the healing dose seems irrational. It would therefore seem reasonable to continue maintenance therapy at the healing dose, whatever medication is used. Any increased costs for drugs should be outweighed by savings in indirect costs.
Human rectosigmoid electromyography: a new approach and some pitfalls.
A method has been developed to record directly myoelectrical activity from the smooth muscle of the colon of intact subjects using pairs of intramuscular wires. Discrete bursts of myoelectrical activity occurred at 4-20 per min. A small interelectrode distance in this method allows contamination of colonic myoelectrical activity by the electromyogram of skeletal muscle to be excluded. This artefact has not been considered in previous recordings of 'colonic' activity.
Herpes simplex and duodenal ulcer pathology.
An association between Herpes simplex Virus 1 (HSV-1) and duodenal ulcer disease has been suggested. Duodenal ulcers, like HSV-1 lesions, exhibit periodicity in recurrence. Several of the presently available anti-ulcer agents may have an antiviral action. Antibody titres in some studies have shown selective increases to HSV-1 in duodenal ulcer patients. The aim of this study was to determine whether a real association exists between HSV-1 and endoscopically proven duodenal ulcer or duodenal erosive disease. In a prospective study, 27 patients with either duodenal ulcer (16) or duodenal erosions (11) were studied in order to attempt isolation of HSV-1. Acute and convalescent sera were also taken and examined by an enzyme linked-immunoabsorbent assay system for antibody titres to HSV-1. Duodenal biopsies from a further 26 patients with duodenal ulcer or erosive disease were also examined retrospectively for HSV-1 by the immunoperoxidase technique. In no case of either duodenal ulcer or duodenal erosive disease was HSV-1 isolated by any of the above methods, nor was a relationship demonstrated by acute or convalescent HSV-1 antibody titres. Hence, this study does not support an association between HSV-1 and duodenal ulcer or erosive disease.
The effect of iron and protein deficiency on the development of acquired resistance to reinfection with Nippostrongylus brasiliensis in rats.
Iron and protein deficiency delays the immunological rejection of Nippostrongylus brasiliensis from the small intestine of rats undergoing a primary infection with the parasite. In the present study, iron and protein deficiency significantly reduced acquired resistance to reinfection with N. brasiliensis. Repletion of deficient animals with iron and protein restored their capacity to mount an effective immune response to a secondary infection with the parasite. These results suggest that chemotherapy of helminthiasis should be integrated with nutritional supplementation.
Nippostrongylus brasiliensis infection in the rat: effect of iron and protein deficiency on the anthelmintic efficacy of mebendazole, pyrantel, piperazine, and levamisole.
The benzimidazole anthelmintics mebendazole and fenbendazole have been shown to be much less effective against Nippostrongylus brasiliensis infections in the rat on a combined iron and protein deficient diet. In the present experiments it was shown that the anthelmintic efficacy of mebendazole was significantly impaired in the rat on either an iron deficient or a protein deficient diet. Furthermore, iron and protein deficiency reduced the efficacy of the anthelmintics pyrantel and piperazine but not levamisole. The finding that nutritional deficiencies reduce anthelmintic efficacy may well be relevant to worm eradication programmes in iron deficient and protein calorie malnourished populations.
The diagnosis and treatment of functional disorders of the biliary tract.
An approach to the diagnosis and treatment of patients with presumed functional disorders of the biliary tract (biliary dyskinesia) is described. The current diagnostic criteria are pain compatible with biliary pain in the absence of gallstones and other organic gastrointestinal disease, or other disorders which might produce abdominal pain, together with reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Other diagnostic methods are described together with their limitations. The results of operation in 38 of 45 patients seen in this Unit during the past six years are presented. The results were poor in 20% of patients, but two-thirds of the group have had good results in the short term.
Operative liver biopsy abnormalities in patients with functional disorders of the biliary tract.
The group of conditions variously termed biliary dyskinesia, acalculous cholecystitis, biliary pain without stones, or functional disorders of the biliary tract, is poorly defined clinically, and no consistent pathological abnormalities have been previously described in patients with this diagnosis. In this paper we report histological abnormalities encountered in operative live biopsies in such patients. The criteria for the diagnosis of a functional biliary tract disorders were: pain typical of biliary pain, negative results of investigations for organic biliary tract or other gastrointestinal disease, and reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Twenty of 45 patients with a presumptive diagnosis satisfied these criteria, and had a wedge liver biopsy at the time of operation. The 20 liver biopsy specimens were compared in a blind fashion with similar ones taken from patients having diagnostic laparotomies; patients with stones confined to the gallbladder; patients with gallstone pancreatitis; and patients with proven common bile duct stones. The biopsy findings were found to be similar to those in the latter two groups. Thus the abnormalities were similar to those found in partial or intermittent biliary obstruction, and it is suggested that they may be due to intermittent increases in biliary pressure.
Histopathology in giardiasis: a correlation with diarrhoea.
There is controversy both in regard to the severity of small bowel mucosal damage attributable to giardiasis and to the causal relationship of these changes to the associated diarrhoea. In this series of 17 consecutive patients with giardiasis, small bowel histology and diarrhoea were independently assessed and compared. Disaccharidase assays were performed in 16 of these patients and a repeat biopsy obtained in seven cases. On histological examination the villous architecture varied from normal to sub-total villous atrophy. When these changes were compared with the severity of diarrhoea, a direct correlation was obtained, the more severe symptoms being associated with the more severe villous changes. Repeat biopsy after treatment demonstrated improvement in the histology which correlated with improvement in diarrhoea. Lactase activity was low in all patients with moderate or severe diarrhoea as well as in some patients with mild diarrhoea, two of whom had normal histology. This series demonstrates the occurrence of a spectrum of mucosal changes in giardiasis and supports the concept that these changes mediate the diarrhoea associated with this gut parasite.