SEARCH · PubMed Health

Results for “gastrointestinal dysfunction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources

PubMed1984

Necrotizing enterocolitis in very low birthweight infants: a four-year experience.

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long-term survivors, six (15%) were found to have a disability at 2 years of age, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very low birthweight infants were associated with a favourable short- and long-term outcome.

Bacterial Infections↗

PubMed2004

Intestinal microflora in patients with liver cirrhosis.

OBJECTIVE: Patients with liver cirrhosis have varying degrees of imbalance of the intestinal flora and probiotics can improve some of the symptoms of gastrointestinal dysfunction in these patients. In the present study, blood ammonia, fecal pH, fecal ammonia, and plasma endotoxin were measured after administration of two kinds of probiotics in order to detect the changes in intestinal flora. METHODS: Six bacteria and yeast were cultured and the colony forming units were counted. Fifty cirrhotic patients were randomized to receive probiotic capsules containing Bifidobacterium, Lactobacillus acidophilus and Enterococcus, or probiotic capsules containing Bacillus subtilis and Enterococcus faecium for 14 days. Fecal flora, pH and ammonia, blood ammonia (detected by test paper) and plasma endotoxin (detected by LAL test kits) were measured before and after the treatment. RESULTS: Patients with liver cirrhosis had varying degrees of imbalance of the intestinal flora as shown by a decrease in the Bifidobacterium count (10.04 +/- 0.78 vs 9.48 +/- 1.13, P < 0.05). The severity of the imbalance was matched by that of liver dysfunction, with the most serious imbalance observed in Child-Pugh C patients. Both types of probiotic increased the Bifidobacterium count (9.46 +/- 1.09 vs 10.30 +/- 1.11, 9.81 +/- 0.62 vs 10.44 +/- 1.08, respectively, P < 0.05) and reduced the levels of fecal pH and fecal and blood ammonia (P < 0.05). Probiotics containing B. subtilis and E. faecium reduced the level of endotoxin in cirrhotic patients with endotoxemia (0.0876 +/- 0.0117 Eu/mL vs 0.0685 +/- 0.0246 Eu/mL, P < 0.05). CONCLUSIONS: Patients with liver cirrhosis have an imbalance of intestinal bacteria flora. Probiotics effectively increased the Bifidobacterium count and reduced the level of fecal pH and fecal and blood ammonia.

Ammonia↗

PubMed1999

Gastrostomy tubes in patients with recurrent gynaecological cancer and intestinal obstruction.

OBJECTIVE: Women with recurrent gynaecological cancers who are not suitable for exenterative surgery commonly present with gastrointestinal dysfunction. This paper is a retrospective review of the use of gastrostomy tubes in such women. METHODS: We performed a chart review of women with recurrent gynaecological cancer who had a gastrostomy tube placed between January 1991 and April 1998. RESULTS: Thirty-nine women (mean age 53.2 years, range 17-82) had a gastrostomy tube placed. Twenty-eight (72%) had ovarian cancer, eight (21%) had cervical cancer, two had endometrial cancer and one had vaginal cancer. In 14 women a gastrostomy tube was placed as the sole procedure for palliation (11 elective, 3 emergency). In the remaining 25 women, who underwent major surgery, a gastrostomy tube was placed in anticipation of, or in the presence of, significant intestinal distension and expected prolonged post-operative ileus. Eleven women (28%) died without leaving hospital after their operation (median 11 days, range 2-36). All but one of the 28 women who left hospital had satisfactory oral intake. Twenty-one women (54%) died with the gastrostomy tube in place (median 28 days, range 2-157) and 18 (46%) had the gastrostomy tube removed (median 14.5 days, range 9-180), 13 of whom (33%) have since died (median 167 days, range 77 days-7 years). Five women (13%) are alive (median 2.2 years, range 10 months-4.5 years). There were no problems which required the gastrostomy tube to be removed. CONCLUSION: Gastrostomy tubes have an important role in the treatment of women with recurrent gynaecological cancer, allowing gastric drainage and decompression without the disadvantages of nasogastric tubes.

Acute Disease↗

PubMed1997

Caecal disease in equids.

OBJECTIVE: To review the breed, age, gender, clinical and laboratory findings, treatment and outcome of horses with caecal disease presented to a referral centre. DESIGN: Retrospective study of 96 cases. PROCEDURE: The breed, age, and gender of the study population were compared with the corresponding hospital population for the same period. The means (+/- SD) for clinical and laboratory findings were recorded for each caecal disorder. Treatment was categorised as medical or surgical, and outcome was recorded. RESULTS: Caecal diseases included impaction (40% of total cases), rupture associated with concurrent unrelated disease (13%), rupture with parturition (9%), rupture with no associated disease (5%), infarction (11%), torsion (9%), abscess or adhesion (7%), tumour (3%), and miscellaneous conditions (3%). The breed or gender of affected horses did not differ from the hospital population, although horses > 15 years were more frequently represented (P < 0.05). This age group was specifically more predisposed to caecal impaction (P < 0.05), as were Arabian, Morgan, and Appaloosa breeds (P < 0.05). In horses with caecal impaction transrectal examination was the most useful diagnostic procedure; 90% of affected horses treated medically were discharged while horses treated by typhlotomy alone, or typhlotomy and blind end ileocolostomy, had survival rates to discharge of 71% and 86%, respectively. Horses with caecal rupture associated with concurrent un-related disease showed no signs of impending rupture; all were receiving phenylbutazone, all were euthanased, and 50% had caecal ulceration at necropsy. Of horses with caecal rupture with parturition 56% had prior dystocia; in two-thirds the site of rupture was the ileocaecal junction and all were euthanased. Horses with caecal rupture with no associated disease died or were euthanased; rupture was idiopathic. Horses with caecal infarction usually had signs of abdominal pain and abdominal fluid changes consistent with peritonitis; transrectal examination was nonspecific, and typhlectomy was successful in seven of eight horses. Horses with caecal torsion had signs of severe, acute abdominal pain and typhlectomy was successful in three of five horses. Diagnosis of caecal adhesion or abscess was assisted by transrectal palpation in two of seven horses and surgical treatment was successful in two of five horses. A caecal tumour was diagnosed in three horses aged 20 years or older that presented with chronic weight loss. Other caecal diseases were uncommon. CONCLUSION: Caecal disease is uncommon in equids but some specific features of the history and physical findings can alert the veterinarian to the possibility of caecal involvement in horses with gastrointestinal dysfunction. Medical or surgical therapy can be effective in horses where caecal rupture has not occurred.

Abscess↗

PubMedDate not supplied

A retrospective study of the use of total parenteral nutrition in dogs and cats.

The records of all dogs and cats receiving total parenteral nutrition (TPN) over a 43-month period were examined retrospectively. Dextrose, amino acids, lipids, electrolytes, and vitamins were administered by central venous catheter according to published nutrient recommendations; 72 dogs and 12 cats were studied, accounting for 380 patient days of TPN. Duration of TPN administration was 1-14 days with a mean of 4.5 days. Most animals required TPN because of gastrointestinal dysfunction, and more than half of them gained weight during TPN administration. Mechanical complications were frequent. Metabolic complications, especially lipid and glucose intolerance, were also commonly seen. Septic complications were the least frequently encountered, but resulted in patient morbidity and may have contributed to mortality. Most animals receiving TPN were returned to enteral nutrition and discharged. For critically ill animals unable to tolerate enteral alimentation, TPN can be supportive therapy in the treatment of the primary disease.

Animals↗

PubMed1994

Decreased cyclosporin A absorption after treatment with GoLytely lavage solution in rats.

Recently we observed a case in which the cyclosporin A absorption decreased after treatment with GoLytely lavage solution in a kidney transplant patient. In this study, we confirmed the decrease of the blood concentration of cyclosporin A after oral administration by GoLytely (Macrogol 3350) based on experiments with rats. The peak blood cyclosporin A concentration, and the area under the blood drug concentration-time curve from 0 to 24 h in the GoLytely-administered group were significantly lower than the control group. In the case of gastrointestinal dysfunction such as diarrhoea, or in treatment with laxatives such as GoLytely lavage solution, whole blood cyclosporin levels must be carefully monitored, and intravenous cyclosporin A may be more suitable for providing adequate immunosuppression.

Analysis of Variance↗

PubMed1998

The gamma interferon gene knockout mouse: a highly sensitive model for evaluation of therapeutic agents against Cryptosporidium parvum.

Cryptosporidiosis is a serious disease in malnourished children and in people with malignancies or AIDS. Current rodent models for evaluating drug therapy against cryptosporidiosis have many limitations, including the need for a high inoculum, the absence of symptoms resembling those seen in humans, and the need to maintain exogenous immunosuppression. We have developed a gamma interferon knockout (GKO) mouse model with which to evaluate therapies against C. parvum and have used paromomycin for evaluation of this model. The GKO model offers considerable improvements over other systems, since it requires no additional immunosuppression and adult mice can be infected with as few as 10 oocysts (compared with 10(7) for SCID mice). Infected mice develop profound gastrointestinal dysfunction due to extensive infection and severe mucosal damage involving the entire small intestine. Clinical symptoms, which include depression, anorexia, weight loss, and wasting, result in death within 2 to 4 weeks. The time of death depends on the oocyst challenge dose. Paromomycin modulated parasitological and clinical parameters in highly predictable and significant ways, including prevention of death. In addition, examination of the extensively infected gut provided an important insight into the dynamics between a specific drug treatment, its impact on the extent and the site of parasite distribution, and clinical outcome. These uniform symptoms of weight loss, wasting, and death are powerful new parameters which bring this model closer to the actual disease seen in humans and other susceptible mammalian species.

Amebicides↗

PubMed2001

Identification of enteropathogenic Escherichia coli in simian immunodeficiency virus-infected infant and adult rhesus macaques.

Enteropathogenic Escherichia coli (EPEC) was recognized as a common opportunistic pathogen of simian immunodeficiency virus-infected rhesus macaques (Macaca mulatta) with AIDS. Retrospective analysis revealed that 27 of 96 (28.1%) animals with AIDS had features of EPEC infection, and EPEC was the most frequent pathogen of the gastrointestinal tract identified morphologically. In 7.3% of animals dying with AIDS, EPEC represented the sole opportunistic agent of the gastrointestinal tract at death. In 20.8% of cases, it was seen in combination with one or more gastrointestinal pathogens, including Cryptosporidium parvum, Enterocytozoon bieneusi, Mycobacterium avium, Entamoeba histolytica, Balantidium coli, Strongyloides stercoralis, cytomegalovirus, and adenovirus. Clinically, infection was associated with persistent diarrhea and wasting and was more frequent in animals that died at under 1 year of age (P < 0.001, Fisher exact test). The organism was associated with the characteristic attaching and effacing lesion in colonic tissue sections and produced a focal adherence pattern on a HEp-2 assay but was negative for Shiga toxin production as assessed by PCR and a HeLa cell cytotoxicity assay. A 2.6-kb fragment encompassing the intimin gene was amplified and sequenced and revealed 99.2% identity to sequences obtained from human isolates (GenBank AF116899) corresponding to the epsilon intimin subtype. Further investigations with rhesus macaques may offer opportunities to study the impact of EPEC on AIDS pathogenesis and gastrointestinal dysfunction.

AIDS-Related Opportunistic Infections↗

PubMed1992

Relevant aspects of physiology in chronic pancreatitis.

Specific points of physiology which are relevant for the understanding and management of chronic pancreatitis are focussed on. First, the regulatory factors of exocrine pancreatic secretion are described, discussing the role of the cholinergic system and of the classical gut hormones cholecystokinin and secretin. The association of upper gastrointestinal dysfunctions with a disturbed exocrine pancreatic response is also dealt with. Lastly, these changes are related to clinical consequences such as maldigestion or malabsorption.

Chronic Disease↗

PubMed1991

Chloral hydrate toxicity in a term infant.

Chlorate hydrate is commonly used for neonatal sedation, but blood levels are infrequently monitored, reflecting an underemphasis of acute toxic effects. This report describes a case of chloral hydrate toxicity in a term infant with cardiac, renal, neurologic, bladder and gastrointestinal dysfunction. The effects of exchange transfusion are described as well as pharmacokinetics.

Administration, Oral↗

PubMed2000

Insulin restores neuronal nitric oxide synthase expression and function that is lost in diabetic gastropathy.

Gastrointestinal dysfunction is common in diabetic patients. In genetic (nonobese diabetic) and toxin-elicited (streptozotocin) models of diabetes in mice, we demonstrate defects in gastric emptying and nonadrenergic, noncholinergic relaxation of pyloric muscle, which resemble defects in mice harboring a deletion of the neuronal nitric oxide synthase gene (nNOS). The diabetic mice manifest pronounced reduction in pyloric nNOS protein and mRNA. The decline of nNOS in diabetic mice does not result from loss of myenteric neurons. nNOS expression and pyloric function are restored to normal levels by insulin treatment. Thus diabetic gastropathy in mice reflects an insulin-sensitive reversible loss of nNOS. In diabetic animals, delayed gastric emptying can be reversed with a phosphodiesterase inhibitor, sildenafil. These findings have implications for novel therapeutic approaches and may clarify the etiology of diabetic gastropathy.

Animals↗

PubMed1987

Hypertension and intussusception.

Two unusual cases of intussusception in children less than a year old are presented. Each patient was brought to the author's attention because of altered level of activity, and both were found to be hypertensive. The hypertension resolved after the intussusception was reduced. Diagnosis of hypertension in children, when associated with gastrointestinal dysfunction, is discussed.

Humans↗

PubMed2004

Enhancing the response to parenteral nutrition in critical care.

Parenteral nutrition (PN) is an essential component in the support of critically ill patients with gastrointestinal dysfunction. Although PN cannot fully reverse hypermetabolism and accelerated skeletal muscle breakdown observed during periods of critical illness, it can prevent the adverse effects associated with malnutrition. The use of PN is not without complications, so care must be taken to ensure successful clinical outcomes with this complex therapy. Strategies have been developed by practitioners to promote safe practices with implementation of PN therapy and optimize a patient's response to PN. Identification of appropriate patient populations, strict glucose control, and manipulation of macro- and micronutrients are techniques being used to augment a patient's response to PN administration. This article will review the novel methods used to enhance benefits received from PN during critical illness.

Journal Article↗

PubMedDate not supplied

Blood vitamin levels of long-term adult home total parenteral nutrition patients: the efficacy of the AMA-FDA parenteral multivitamin formulation.

Although the AMA-FDA parenteral adult multivitamin formula is now widely used, there are no published data on the efficacy of this formulation in maintaining adequate vitamin nutriture in patients on long-term parenteral nutrition. Blood levels of its constituent nutrients were determined in 16 clinically stable home total parenteral nutrition patients with severe gastrointestinal dysfunction, the majority of whom had been on home total parenteral nutrition for 1 to 9 yr and most of whom were ingesting some food orally. The daily formula (MVI-12) was added to the basic total parenteral nutrition formula in 2-day batches; the vitamins were thus infused approximately 3 hr after preparation on day 1 and after 27 hr on day 2. The duration of infusions was from 8 to 16 hr. Blood was drawn approximately 36 hr after completion of the last vitamin infusion. Plasma, trichloroacetic acid-treated plasma, and whole blood were frozen until analyzed for the vitamins by microbiologic or chemical methods. All vitamin levels, except for vitamin D metabolites, were measured four times in each patient between the 4th and 36th wk while receiving daily MVI-12. Single determinations of 25-OH and 1:25 (OH)2 vitamin D were made in eight of the 16 patients between the 61st and 84th wk while on MVI-12. Repeat values during this extended period were also made on five of the patients for vitamins A and E. These values were compared with serum vitamin levels obtained on an earlier formulation (MVI concentrate, Berocca C, and folate each given twice weekly and B12 given once weekly). The AMA-FDA formula given daily maintained blood levels above the lower normal limits for most of its constituent vitamins and vitamin D metabolites for the great majority of stable home total parenteral nutrition adults with unexplained occasional exceptions. However, almost half of the vitamin A levels and some of the pantothenate and biotin values were above the normal range; these tended to be associated with the presence of renal disease. Ascorbic acid and thiamin levels tended to be clustered in the lower normal range. Because of evidence for loss of ascorbic acid standing in total parenteral nutrition solutions for 24 hr prior to infusion, it is recommended that the vitamin formulation be added to the total parenteral nutrition solution just prior to infusion.

Adult↗

PubMedDate not supplied

Partial peritoneal alimentation in an infant.

We provided partial peritoneal alimentation to a 1.69-kg 11-month-old premature infant who had no available central venous access, depleted peripheral venous access, and gastrointestinal dysfunction. A cuffed silastic catheter was surgically inserted into the suprahepatic space. An alimentation solution was continuously infused into the peritoneum for 28 days to supplement peripheral venous and nasogastric alimentation and contributed 42 +/- 15% of total calories daily. Weight gain was achieved, but complications included hypoglycemia, hypophosphatemia, intravascular dehydration, catheter site leakage, ascites, and hydrocele. At autopsy 11 months later, lipid accumulation was present in the upper peritoneum and the hilar regions of the lungs secondary to preexisting lymphatic obstruction. Partial peritoneal alimentation may be feasible when other access routes are inadequate, but lymphatic obstruction is a contraindication to the peritoneal administration of lipid emulsions.

Energy Intake↗

PubMedDate not supplied

Toward rational nutritional support of the human immunodeficiency virus-infected patient.

The acquired immunodeficiency syndrome and (human immunodeficiency virus) infection loom as our major public health priorities for at least the next two decades. Despite the recent exciting early development of vaccines and newer drug therapies, we are all faced with a reservoir of almost one-quarter million cases in the United States and several times that worldwide. Since the vast majority of HIV-infected patients develop AIDS, which is a chronic progressive disease that produces gastrointestinal dysfunction and wasting, development of rational strategies for nutritional support of these patients should also be a high priority.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Home parenteral nutrition in patients with a cancer diagnosis.

The clinical outcome for 1362 patients with active cancer managed on home parenteral nutrition (HPN) is compared with that of 122 patients with radiation enteritis ("cured" cancer) and 416 patients with Crohn's disease. This longitudinal clinical information was reported to the North American Home Parenteral and Enteral Nutrition Registry (Oley Foundation/A.S.P.E.N. joint project) between 1985 and 1989. The data shows that the number of active cancer patients on this therapy is increasing 13% per year. The annual survival rate is 25% for patients with active cancer, as compared with 88% for patients with radiation enteritis and 95% for patients with Crohn's disease. Although 50% of all active cancer patients starting HPN are dead within 6 to 9 months, the prognosis is somewhat better in children, and 20% of these active cancer patients appear to do well, returning to full oral nutrition and experiencing complete rehabilitation. These are presumed to be patients with a potentially curable cancer requiring super-aggressive treatment, which causes temporary severe gastrointestinal dysfunction. Adult active cancer patients have the same rehospitalization rate for HPN complications (once per year) as radiation enteritis and Crohn's disease patients. However, their rehospitalization rate for non-HPN complications is four times higher. This article reviews the factors that may explain the growth of HPN in active cancer patients and discusses some of the unanswered clinical questions that urgently need to be addressed to more effectively determine the appropriateness or inappropriateness of HPN management in the active cancer setting.

Adolescent↗

PubMed2001

Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit.

Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. The ideal requirements for each patient were calculated using the Harris-Benedict equation with an adjustment determined by the patient's diagnosis. We compared the amount of feed delivered with the daily requirements over a seven-day period Successful feeding was defined as the achievement of 90% of the ideal calorie requirement for two consecutive days. The mean calculated (+/- SD) energy requirement was 9,566 kJ (+/- 2,586). Patients received only 51% (SD 38) of their energy requirements throughout the study period. Only 10 patients (25%) were successfully fed for at least any two-day period in the seven days. Feeding was limited mainly by gastrointestinal dysfunction or by the need to fast the patient for medical, surgical and airway procedures. Success of feeding was not related to the use of sedative orparalysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.

Adolescent↗