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Distribution of glutaminase and glutamine synthetase activities in the human gastrointestinal tract.

1. The activities of the two key enzymes involved in glutamine metabolism, glutaminase and glutamine synthetase, were measured in mucosal biopsies taken from different sites throughout the human gastrointestinal tract, from oesophagus to rectum. 2. The specific activity of glutamine synthetase was highest in the stomach (4.5 nmol glutamine formed per minute per mg of protein), but both small and large intestine and the oesophagus had little synthesizing capacity (less than 0.3 nmol of glutamine formed per minute per mg of protein). 3. Glutaminase specific activity was highest in the small intestine (53 nmol glutamate formed per minute per mg of protein by duodenal mucosa), intermediate in the large intestine and lowest in the oesophagus and stomach (less than 13 nmol of glutamate formed per minute per mg of protein). 4. The glutamine concentration in the mucosa was lower in the duodenum than in the colon (0.62 and 0.95 mmol/kg wet weight respectively), but both were much lower than the measured K(m) values of glutaminases obtained from these sites (3.8 and 4.0 nmol/kg wet weight respectively). 5. The concentration of glutamine in saliva, stomach juice, bile and duodenal juice suggests that very little glutamine passes into the gastrointestinal tract via these secretions. 6. The study provides the most complete information on the distribution of glutamine synthetase and glutaminase along the human gastrointestinal tract, and suggests that (i) both the small and large intestines have a high potential for glutamine metabolism, but little synthesizing capacity, thus both must derive their glutamine from other sources, and (ii) neither the stomach nor the oesophagus have a high glutaminase activity, although the stomach has substantial capacity to synthesize glutamine. The distribution of the enzymes along the gastrointestinal tract may help rationalize the use of glutamine for treating diseases that affect different parts of the gastrointestinal tract.

Adult↗

Long-term results of upper respiratory syndrome surgery and gastrointestinal tract medical treatment in 51 brachycephalic dogs.

OBJECTIVES: After a first clinical study showing a high prevalence of gastrointestinal tract diseases in brachycephalic dogs presented for upper respiratory syndrome, a prospective study was performed to determine the influence of medical treatment for gastrointestinal tract disorders associated with upper respiratory syndrome surgery. METHODS: The gastrointestinal tract and respiratory disorders of 61 brachycephalic dogs presented for upper respiratory syndrome were evaluated. Together with surgery of the upper respiratory tract, a specific gastrointestinal medical treatment was administered. A minimal follow-up of six months was required for inclusion. RESULTS: Palatoplasty with rhinoplasty was the most common surgical correction (88.5 per cent). The mortality rate in the perioperative period was 3.3 per cent. Minor complications accounted for 26.2 per cent of cases. No aspiration pneumonia was encountered. A sufficient follow-up was obtained in 51 dogs. The improvement was judged by the owners as excellent or good in 88.3 per cent of the respiratory disorders and in 91.4 per cent of the gastrointestinal disorders. Clinically, a statistically significant improvement was obtained for both respiratory and gastrointestinal disorders. CLINICAL SIGNIFICANCE: In comparison with other studies, digestive tract medical treatment combined with upper respiratory surgery seems to decrease the complication rate and improve the prognosis of dogs presented for upper respiratory syndrome.

Airway Obstruction↗

[Neuroendocrine tumors of gastrointestinal tract in own material].

Neuroendocrine tumors are rare gastrointestinal tract disorders, in which diagnosis and treatment are often difficult. The aim of the paper is to present two cases of patients with neuroendocrine tumor of gastrointestinal tract, who underwent surgical procedure in II Department of General and Gastroenterological Surgery of Medical University of Białystok in 2005. A 63-year-old female patient with primary diagnosis of neuroendicrine tumor metastases in liver was not successfully investigated for primary tumor in the preoperative period. The laparotomy procedure indicated the malignant neuroendocrine tumor in the terminal ileum and metastases to the liver and to the greater omentum. The right hemicolectomy and liver metastatic segment VII and VIII resection were performed. The neurological disturbances of obscure origin were observed in the postoperative period and the patient suddenly died on the 15(th) day after surgery. A 57-years-old male patient was operated on for lymph node recurrence of gastric tumor. Pathologic examination of tissue sample revealed the diagnosis of carcinoid. The patient underwent subtotal gastric resection for a pyloric ulcer, diagnosed as Adenocarcinoma G2 pT2N0M0 6 years before. Liver and abdominal node metastases, confirmed by octreoscan, were observed after lymphadenectomy, The treatment of somatostatin analogues (LAR octreotide) was used. In spite of therapy the patient died. The authors present their own experiences and show the preoperative diagnostic difficulties in patients with neuroendocrine gastrointestinal tumors. Unexpected neurological complications in the treatment course were described.

Adenocarcinoma↗

[Balloon catheter dilatation of lower gastrointestinal tract stenoses: long-term results].

AIM: Benign stenosis of the lower gastrointestinal tract usually develops, due to complication of a surgical intervention or sometimes because of other inflammatory bowel processes. Their reoperation is technically difficult and risky. Therefore the authors use a balloon catheter dilatation in the treatment of lower gastrointestinal tract stenosis since 1985. METHODS: First a guide wire is passed colonoscopically, then under X-ray control a double lumen balloon catheter, or directly through the channel of the endoscope a single or double lumen balloon catheter is introduced into the stenosis, which is then gradually dilated to 12-25 mm diameter. The applied pressure is 1.5-3 atm. Result of the dilatation can be judged from the decreased indentation of the balloon, and from increased diameter of stenosis at colonoscopic, or sometimes colonographic follow up. RESULTS: Between January of 1985 and July of 2001 they performed 123 dilatation on 52 patients. The causes of stenoses were in 40 cases postoperative stenosis, in 5 Crohn disease, in 2 ulcerative colitis, in 1 ischemic stenosis, and in 3 scar of the anus. From all stenosis cases 4 were localised to the anus, 40 to the rectum, 7 to the colon, and 1 to the terminal ileum. Due to the dilatation the average diameter of the stenosis was increased from 7.2 (1-14) mm to 19.7 (14-25) mm. Following the dilatation in 42 patients out of 52 the colonoscope was passed through the stenosis. Colostomies were closed in 11 cases out of 17. In 4 patients the subileus state ceased, and all of our 3 patients colo-cutan fistula healed rapidly. 16 out of 52 patients re-operation was proposed. One patient had fever as complication which was treated with antibiotics. CONCLUSIONS: Dilatation of benign stenosis of the lower gastrointestinal tract with balloon catheter is an effective method, which in most of the cases (69%) will stop the obstructive symptoms and in the long run therefore surgery can be avoided.

Adult↗

The gastrointestinal tract in critical illness: nutritional implications.

PURPOSE OF REVIEW: Recognition that the gastrointestinal tract is a key element of the immune system has led to a greater interest in understanding its role as a central figure in host defenses. Biologic systems that are perturbed by any destabilizing stimulus are known to respond by adaptive strategies in an attempt to maintain or return to global homeostasis. In critically ill patients, the gut has previously been described as a promoter of progression to sepsis and multi-organ failure. However, with better understanding of gastrointestinal tract mucosal immunity, we are now provided with a new arsenal to combat nosocomial infection and significantly impact return to health. RECENT FINDINGS: In this review we focus on five key topics in the rapidly expanding landscape of knowledge on the gastrointestinal tract in the critical care setting. These include a discussion of probiotic therapy, now the new frontier of immuno-nutrition, the concept of ischemia/reperfusion injury and changes in gut permeability, anti-oxidant and micronutrient therapy, blood glucose regulation, and enhancement of gut motility, all in the intensive care setting. SUMMARY: Ongoing research in nutritional support in both normal and pathologic gastrointestinal function and response to injury has opened the door to several new opportunities for enhancing rapid recovery in critical care.

Antioxidants↗

Emerging questions regarding eosinophil's role in the esophago-gastrointestinal tract.

PURPOSE OF REVIEW: Eosinophilic inflammation of the gastrointestinal tract is either increasing in frequency or being better recognized. Whichever is the case, clinical needs to meet this new challenge include establishing diagnostic criteria, identifying the natural history and determining effective, tolerable treatments. RECENT FINDINGS: During the last 5 years, the emergence of eosinophilic esophagitis stimulated many case series; the new frontiers relate to understanding disease pathogenesis and maintenance treatments. Eosinophilic gastrointestinal diseases involving the rest of the gastrointestinal tract pose new challenges in understanding the role of eosinophils in intestinal dysmotility and protein loss. SUMMARY: This review will focus on new clinical developments in the field of eosinophilic gastrointestinal diseases and the contribution of basic studies in understanding eosinophils impact on gastrointestinal inflammation.

Animals↗

Upper gastrointestinal tract infections in AIDS. AIDS GIT Group.

Upper gastrointestinal tract infection in AIDS is a complex multifactorial process. The approach to diagnostic evaluation can be based upon knowledge of the large spectrum of bacteria, viruses and protozoa involved. The availability of effective therapy is the most decisive factor in determining the duration of upper gastrointestinal tract infections in AIDS patients. Awareness of the clinical, epidemiological, immunological and therapeutic aspects should help to direct the diagnostic evaluation of these patients and to highlight areas of research.

Acquired Immunodeficiency Syndrome↗

Deposition of circulating antigen--antibody complexes in the gastrointestinal tract of rabbits with chronic serum sickness.

The possible role of circulating immune complexes (IC) in the production gastrointestinal lesions was studied in rabbits with chronic serum sickness (CSS) induced by multiple daily injections of bovine serum albumin (BSA). All rabbits generating a marked antibody response developed IC glomerulonephritis. In approximately 50% of these rabbits granular deposits of BSA, rabbit IgG, and C3 were also found in the gastrointestinal tract. The immune deposits in the gastrointestinal tract were mainly present in the vessel walls, close to the intestinal glands and the surface epithelium, and between the smooth muscle cells. This was accompanied by slight to moderate edema of the mucosa and the submucosa and mild infiltration of inflammatory cells. Electron-densedeposits were found in a pattern corresponding to that observed for BSA, rabbit IgG, and C3. Degranulated neutrophils, basophils, and mast cells were noticed in the interstitium. The presence in the same areas of granular deposits of BSA, IgG, and C3, corresponding to electron-dense deposits, suggests that the deposits contain BSA-anti-BSA complexes. These findings show that in rabbits with CSS circulating IC may localize and induce injury in the gastrointestinal tract.

Animals↗

Multifocal granular cell tumors of the gastrointestinal tract.

Granular cell tumors infrequently appear in the gastrointestinal tract. Lesions have been reported in all segments from the esophagus to the rectum, but no previous reports have identified simultaneous lesions in various segments. We describe a patient with granular cell tumors of the esophagus, stomach, appendix, and cecum. Our case emphasizes the need to evaluate the entire gastrointestinal tract when a single lesion is identified. The radiographic approach and pathological characteristics are discussed. Therapeutic alternatives are presented.

Adult↗

[Neuroendocrine tumors of the gastrointestinal tract].

The diffuse neuroendocrine cell system of the gastrointestinal tract gives rise to the neuroendocrine neoplasms. The WHO classification distinguishes between well differentiated neuroendocrine tumors of benign or uncertain behavior, well differentiated neuroendocrine carcinomas of low grade malignancy and poorly differentiated neuroendocrine carcinomas of high grade malignancy. The well differentiated neuroendocrine tumors and carcinomas correspond to the carcinoids of earlier classifications. Further biological and prognostic classification of these neoplasms must consider the localization of the tumors within the gastrointestinal tract. This system allows a clinically relevant diagnosis and includes all so far known tumor entities.

Carcinoid Tumor↗

[New approaches in obesity treatment: the gastrointestinal tract as an endocrine organ].

The gastrointestinal tract, besides digesting and processing nutrients, is now regarded as an endocrine organ able to modulate appetite, satiety, and carbohydrate metabolism. Several enteroendocrine cells produce numerous peptides codifying either orexigenic (ghrelin, orexins) or anorexigenic signals (pancreatic polypeptide, peptide YY, cholecystokinin, amylin, bombesin homologs, apolipoprotein A-IV, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, oxyntomodulin), which interact in a complex network with other peripheral signals of energy balance and with different neuropeptides involved in the central control of appetite and energy homeostasis. The growing knowledge of the actions of these gastrointestinal peptides on appetite regulation and carbohydrate metabolism, and subsequent synthesis of analogs, particularly those derived from amylin and incretins, herald a new era in the therapy of 2 closely related diseases, obesity and type 2 diabetes mellitus.

Anti-Obesity Agents↗

[Examination of endoscopical ultrasonography (EUS) on carcinoid tumors of gastrointestinal tract].

In order to clarify the usefulness of EUS in the diagnosis of gastrointestinal carcinoid tumor, we examined 15 patients, who had carcinoid tumors of gastrointestinal tract (stomach: 5, duodenum: 2, rectum: 8), on the diagnosis in quality and depth by comparing endoscopical ultrasonography (EUS) with resected specimen. Carcinoid tumors of gastrointestinal tract were detected as homogenous hypoechoic tumors with sharp border in all site by EUS. Especially, it was characteristic that 14 of the 17 lesions (82%) which invaded into submucosa were mainly located in the third layer, and the second layer covered the tumor at the foot, and near the top, it touched the tumor and got indistinct. We decided the depth of invasion by comparing the hypoechoic tumor with normal structure of 5 layers. The accuracy rate was 88%. In conclusion, EUS was thought to be useful in the diagnosis and choice for treatment of carcinoid tumors of gastrointestinal tract.

Adult↗

[Effects of acute hypobaric hypoxia on the distribution of somatostatin contents in lower gastrointestinal tract of rats].

OBJECTIVE: To examine the effects of acute hypobaric by hypoxia on the distribution of Somatostatin (SS) contains in lower gastrointestinal tract of rats. METHOD: 36 Wistar [correction of Wister] male rats were divided into 6 groups. Three were control groups, three were ulcerous groups. Each group contains ground, 5000 m above sea level and 10000 m above sea level. SS contents were determined with radioimmunoassay [correction of radioimmunoassy] methods. RESULT: Statistically significant difference was exhibited among each group. There was no significant difference of SS contents in each altitude between model and control. SS contents were significantly increased in intestine of control in 5000 m groups, in caecum in 5000 m groups, compared with that in ground (P<0.05). It was also significantly increased in intestine of model in 5000 m groups, in caecum in 5000 m groups, compared with that in ground (P<0.01). SS contents was significantly increased in caecum of model in 10000 m groups compared with that in ground (P<0.05). Except this, There was no significant difference of ss contents in lower gastrointestinal tract among each group. CONCLUSION: SS contents in lower gastrointestinal tract were significantly increased in acute hypobaric hypoxia rats. This result suggested that ss contents in lower gastrointestinal tract may play an important protective role in acute hypobaric hypoxia rats.

Altitude↗

Gastrointestinal imaging in AIDS--luminal gastrointestinal tract.

Barium radiography of the gastrointestinal tract in patients with AIDS can assist in the evaluation of numerous problems including dysphagia, odynophagia, diarrhea, abdominal pain, symptoms of intermittent obstruction, and/or gastrointestinal bleeding. It can localize disease, evaluate complications, guide endoscopic biopsy, and monitor the progress of therapy.

Acquired Immunodeficiency Syndrome↗

Calcitonin gene-related peptide-alpha receptor binding sites in the gastrointestinal tract.

Calcitonin gene-related peptide-alpha (CGRP alpha) is a putative neurotransmitter in the brain and in peripheral tissues. Quantitative receptor autoradiography was used to localize and quantify the distribution of specific binding sites for radiolabeled human CGRP alpha in the canine gastrointestinal tract. The canine gastrointestinal tract was chosen as a model since it is similar in both size and structure to the human gastrointestinal tract. In the stomach CGRP alpha binding sites were localized to smooth muscle cells in the muscularis mucosa and muscularis externa, the smooth muscle and endothelium of medium and small arteries, neurons in the myenteric plexus, mucosal epithelial cells and the germinal centers of lymph nodules. In the intestines, the prominent cells types expressing CGRP alpha receptors were myenteric neurons and the germinal centers of lymph nodules. Since previous studies have demonstrated that CGRP-containing sensory neurons innervate the muscularis externa in the stomach and since CGRP alpha receptors are expressed by smooth muscle cells in the muscularis externa, these results suggest that sensory neurons may directly regulate gastric motility by releasing CGRP. In correlation with previous physiological data, the present study suggests that CGRP is involved in the regulation of a variety of gastrointestinal functions including gastric motility, mucosal ion transport, hemodynamics, digestive enzyme secretion, neuronal excitability, and the inflammatory and immune response.

Animals↗

The genetic diversity of lactic acid producing bacteria in the equine gastrointestinal tract.

Seventy-two lactic acid producing bacterial isolates (excluding streptococci) were cultured from the gastrointestinal tract of six horses. Two of the horses were orally dosed with raftilose to induce lactic acidosis and laminitis while the remaining four were maintained on a roughage diet. Near complete 16S rDNA was amplified by PCR from the genomic DNA of each isolate. Following RFLP analysis with the restriction enzymes MboI, HhaI and HinfI, the PCR products from the 18 isolates that produced L- and/or D-lactate were subsequently cloned and sequenced. DNA sequence analysis indicated that the majority of the isolates were closely related to species within the genus Lactobacillus, including Lactobacillus salivarius, Lactobacillus mucosae and Lactobacillus delbrueckii. Four isolates were closely related to Mitsuokella jalaludinii. Lactic acid producing bacteria (LAB) from the equine gastrointestinal tract was dominated by representatives from the genus Lactobacillus, but also included D-lactate-producing bacteria closely related to M. jalaludinii. Identification and characterization of LAB from the equine gastrointestinal tract should contribute to our understanding and management of fermentative acidosis, ulceration of the stomach and laminitis.

Acidosis↗

Accuracy of MDCT in predicting site of gastrointestinal tract perforation.

OBJECTIVE: The purpose of this study was to prospectively evaluate the accuracy of MDCT for preoperative determination of the site of surgically proven gastrointestinal tract perforations and to determine the most predictive findings in this diagnosis. SUBJECTS AND METHODS: We prospectively studied 85 consecutive patients with extraluminal air on MDCT who had surgically proven gastrointestinal tract perforations. All patients underwent surgery within 12 hours after MDCT was performed. Two experienced radiologists, blinded to the surgical diagnosis, reached a consensus prediction of the site of the perforation using the following eight MDCT findings: concentration of extraluminal air bubbles adjacent to the bowel wall, free air in supramesocolic or inframesocolic compartments, extraluminal air in both abdomen and pelvis, focal defect in the bowel wall, segmental bowel-wall thickening, perivisceral fat stranding, abscess, and extraluminal fluid. MDCT imaging results were compared with surgical and pathologic findings. Logistic regression analyses were performed to assess the significance of the different radiologic criteria. RESULTS: Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients. Logistic regression showed that concentration of extraluminal air bubbles (p < 0.001), segmental bowel wall thickening (p < 0.001), and focal defect of the bowel wall (p = 0.007) were strong predictors of the site of bowel perforation. CONCLUSION: MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.

Abdomen, Acute↗

Recent advances in diagnosis and therapy of neuroendocrine tumors of the gastrointestinal tract.

Neuroendocrine tumors of the gastrointestinal tract are rare tumors that can be classified as APU-Domas (amine precursor uptake and decarboxylation). They can be subdivided into the carcinoid tumors of the gastrointestinal submucosa and the islet cell endocrine tumors of the pancreas. Although the majority of tumors that become clinically apparent are malignant, they are frequently slow growing. Despite this, neuroendocrine tumors may generate disabling hormonal syndromes requiring aggressive treatment to achieve palliation. Recent advances in understanding the pathophysiology of these tumors has led to better radiographic imaging and more accurate localization techniques. Medical therapies with somatostatin analogues, omeprazole, and locoregional tumor ablation have made a positive impact on curative and palliative therapy. This review updates the recent efforts made in the radiographic imaging and therapeutics of the gastrointestinal neuroendocrine tumors.

Adenoma, Islet Cell↗