[New ideas concerning the origin of upper gastrointestinal system hemorrhages].
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Alpha-2 receptor activation mediates the inhibition of a number of gastrointestinal functions including gastric and intestinal secretions. Alpha-2 receptors are located in the brain and presynaptically on cholinergic nerve terminals; activation of either inhibits vagus nerve activity. Intestinal secretions are inhibited by postsynaptic alpha-2 receptors located on intestinal epithelial cells. Agents which selectively activate alpha-2 receptors in the gut may therefore be beneficial in treating gastric ulcers and diarrheal states. Two such agents which activate alpha-2 receptors in the gut are WHR-1370A [1-n-butoxy-3-(2,6-dimethylphenylcarbamoyl) guanidine hydrochloride] and lidamidine. WHR-1370A is a potent gastric antisecretory and antiulcer agent which inhibits the release of acetylcholine from the vagus nerve. WHR-1370A's activity is blocked by yohimbine. Lidamidine is a clinically effective antidiarrheal agent. Lidamidine's response is partially inhibited by yohimbine in animal diarrheal models. Alpha-2 agonists represent a new class of drugs which have a promising future in the treatment of gastrointestinal disorders.
BACKGROUND/AIMS: The diagnostic value of enteroclysis in patients with obscure gastrointestinal bleeding of small bowel origin was evaluated. Further diagnostic approaches in patients in whom enteroclysis did not yield a source for bleeding are discussed. METHODS: A total of 62 patients with gastrointestinal bleeding of obscure origin were retrospectively evaluated by enteroclysis. Patients in whom a specific pathology could not be identified on enteroclysis were further followed-up clinically and by laboratory examinations. Recurrent gastrointestinal bleeding had been considered an indication for further diagnostic evaluation. RESULTS: Accurate cause of the pathology which may explain the source of bleeding was achieved via enteroclysis in 29 of the patients. Of the pathologies, most were inflammatory bowel disease (n=18), followed by neoplasms (n=4), malabsorption (n=3) and miscellaneous disorders (n=4). Thirty-three patients had normal findings on enteroclysis. Six patients were diagnosed as angiodysplasia on angiography and nine patients had either gastritis or duodenitis. A final diagnosis to explain the source of bleeding could not be achieved in 18 cases. CONCLUSION: Enteroclysis provides essential information in gastrointestinal bleeding of obscure origin and its role in the diagnosis should not be undermined. Recurrent and consistent GI bleeding should be considered an indication for further diagnostic evaluation.
An athlete's ability to reach maximum performance is a direct result of physical and muscular performance, muscular and systemic stress tolerance, control and regulation of immune function, and adaptation to physical stress. In this complex sense, the gastrointestinal (GI) tract is also part of the system that controls and regulates adaptation and regeneration of the athlete. A well-balanced GI immune system and an optimized immune competence may protect the athlete from harmful pathogens; it may also protect against dietary as well as inhaled antigens. However, under conditions of mechanical and biochemical stress, the integrity of the GI mucosal block, particularly the epithelial hood, can be damaged, leading to a pathological uptake of toxic or immunogenic substrates. This may occur in endurance athletes, since gut symptomatology, nausea, vomiting, pain, bloating, diarrhea, cramping, and bleeding can be observed in up to half of all participants in endurance events. In addition, composition of stool and fecal microflora in endurance athletes has shown that there may be a specific need for nutritional support for mucosal immunity in highly trained but chronically stressed athletes. Proper diet during training and competition is a significant factor in guarding against GI symptoms and exercise-induced gastrointestinal side effects that may compromise immune competence and physical performance. The present review presents some important suggestions on the possible role of the GI tract in human performance and stress tolerance, and offers new insights about the influence of food quality on the immune system of the gut.
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