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Impairment of gastrointestinal motility by nitrate administration: evaluation based on electrogastrographic changes and autonomic nerve activity.

BACKGROUND: Nitrates decrease the tone of the lower oesophageal sphincter, and may thus induce gastro-oesophageal reflux. AIM: In the present study, we evaluated electrogastrographic changes and heart-rate variability before and after the administration of nitrates. METHODS: In 15 patients with chest pain treated with nitrates, electrocardiography and percutaneous electrogastrography were performed before and after administration of nitrates. Autonomic nervous system function was evaluated by spectral analysis of heart-rate variability and serial changes in low frequency and high frequency power, and the low frequency/high frequency ratio were compared. Electrogastrograms were analysed by obtaining peak power amplitudes and their dominant frequencies. RESULTS: After the administration of nitrates (isosorbide dinitrate), high frequency power, an index of parasympathetic nervous activity, was significantly decreased, whereas the low frequency/high frequency ratio, an index of sympathetic nervous activity, was significantly increased. The mean peak amplitude of the electrogastrogram significantly increased postprandially both before and after treatment. After isosorbide dinitrate treatment, however, mean peak amplitudes after a meal were significantly lower than those obtained before treatment. The mean dominant frequency of the electrogastrogram did not vary before and after treatment. CONCLUSIONS: The present study suggests that nitrates inhibit gastrointestinal motility by decreasing autonomic nervous activity.

Aged↗

Alterations in gastrointestinal motility during postoperative acute corticosteroid withdrawal.

Patients receiving exogenous corticosteroids may develop iatrogenic adrenal insufficiency, with resultant nausea, emesis, and abdominal distension if perioperative "stress steroid" dosages are inadequate. To investigate these gastrointestinal disturbances, motility measurements were obtained using perfused catheters in 10 dogs before steroid treatment (control), during administration of high-dose corticosteroids, and daily during 5 days of abrupt withdrawal. Withdrawal was characterized by a significant disruption in normal antral, duodenal, and jejunal motility with a prolongation of the migrating motor complex (MMC) and phases I and II, but not III (I = quiescence, II = irregular activity, and III = regular activity). Retrograde giant contractions (RGCs), giant migrating contractions (GMCs), and/or "intestinal fibrillation" were also observed during the first two withdrawal days. Adrenal weights and morphology did not change. We conclude: (1) high-dose corticosteroids can induce profound adrenal suppression in dogs without morphologic changes within 3 weeks; (2) high-dose steroid administration enhances gastrointestinal motility; and (3) acute withdrawal causes disappearance or shortening of MMC and the development of RGCs and GMCs with associated emesis.

Adrenal Insufficiency↗

Tachykinin receptors in gastrointestinal motility.

For a long time research on the action of TKs on gastrointestinal tissue has been demonstrating the importance of the TKs as non-cholinergic stimulators of motility in most parts of the mammalian gastrointestinal tract. The past years witnessed the development of TK agonists and antagonists selective for the various receptor types, which prompted a wealth of new insight into the pharmacology and molecular biology of the TK receptors. This knowledge now allows a more specific elucidation of the role of TKs and their receptors in the various aspects of gastrointestinal motility, not only in normal tissue but also under pathological conditions.

Amino Acid Sequence↗

[An experimental study of the gastrointestinal motility in conscious dogs with strain gauge force transducers].

Interdigestive motor complex (IMC) from the stomach to the ileum and colonic migrating motor complex (CMMC), and the effects of motilin and PYY to them were studied in conscious dogs with strain gauge force transducers (SG). In fasted dogs, IMC cycle times were 100.5 +/- 7.5 min in from the antrum to the ileum and propagation velocity of the small intestine was fastest in the proximal jejunum (4.85 +/- 0.81 cm/min), slowest in the distal ileum (0.81 +/- 0.08 cm/min). The duration of postprandial interruption of motor complex (DIMC) was longer in the antrum and duodenum in 8 dogs of the twelves than the middle and lower intestines. Ileo-colonic propagation rates of IMC that reached to the terminal ileum were 95/116 (81.9%), but the frequency of CMMCs was about 4 times higher than that of IMCs. Each colonic motor complex were classified into four patterns, such as aboral migrating complex (A), oral migrating complex (O), discrete complex (D) and giant migrating contractions (G), and the starting point of migrating complex was marked with -, like A, O or G. Thus, independency index (I I) in each site was defined as: I I = (sum of number of A, O, G and D)/(total number of colonic motor complex). I I was highest in colon 1 (70-80%) and next in colon 4. Motilin (0.5 microgram/kg.hr) elicited IMC like activities in the antrum, duodenum and proximal jejunum, but no effects in the middle and lower small intestine, and the colon. PYY infusion caused dose dependent inhibitions of IMC in the antrum and duodenum, but no effects in the below intestines as same as motilin. These findings suggest that IMCs are basal rhythms of gastrointestinal motility and IMCs occurring from the antrum to the proximal jejunum are more sensitive to the factors as eating or gut peptides.

Animals↗

[The sono-capsule: a new method for measuring gastrointestinal motility].

PURPOSE: We developed a noninvasive procedure using ultrasound and a specially designed capsule to permit determination of transit times in the gastrointestinal tract. METHODS: The ultrasound capsule consisted of a latex balloon of 1 cm diameter filled with water and containing a solid metal ball. After ingestion the marker was visualised in the gastrointestinal tract at defined intervals using conventional ultrasound machines. The various transit times were determined in 10 healthy volunteers. RESULTS: On account of its artifact-in-artifact structure (cystic configuration and reverberation), the ultrasound capsule was first detected in the stomach without any difficulty. During its further passage through the gastrointestinal tract the location of the capsule in the small and large bowel could be identified on the basis of the surrounding plicae circulares and haustrations. The mean oropyloric transit time was 2.4 hours; passage through the small bowel took 1.5 to 3 hours, and pyloro-anal transit times between 6 and 10 hours. CONCLUSION: the ultrasound capsule is a suitable method for investigating the gastrointestinal transport. It is non-invasive and does not expose the patient to radiation.

Adult↗

Stimulating action of KW-5139 (Leu13-motilin) on gastrointestinal motility in the rabbit.

1. The gastrointestinal motor stimulating action of the motilin analogue, KW-5139 (Leu13-motilin), was investigated both in the anaesthetized rabbit and in rabbit isolated smooth muscle tissues. 2. KW-5139 (0.3-10 micrograms kg-1, i.v.) produced motor stimulating actions in the gastric antrum, ileum and descending colon, the excitatory responses of which were initiated at the same time but declined with different time courses. The rank order of the excitatory response was: descending colon > or = gastric antrum >> ileum. 3. Atropine (1-3 mg kg-1, i.v.) or naloxone (1 mg kg-1, i.v.) completely suppressed the excitatory response to KW-5139 in the gastric antrum, but only partially attenuated that in the descending colon. This suggests that the mechanism of the excitatory response is different in the gastric antrum and the descending colon, and that cholinergic neural pathway is involved in the response of the gastric antrum. 4. KW-5139 (0.1 nM-1 microM) caused concentration-dependent contractions of the gastric antrum, duodenum, jejunum, ileum and the descending colon in vitro. In the rabbit intestine, the contractile response to KW-5139 was strongest in the duodenum and weakest in the ileum. 5. The contractile response to KW-5139 in the intestinal segments were not affected by tetrodotoxin, but were decreased by verapamil, or pretreatment with a high concentration of porcine motilin, confirming the involvement of motilin receptors in the response to KW-5139. 6. The present results suggest that the rabbit is a suitable species for the investigation of motilin on gut motility, because of the high responsiveness of the descending colon as well as the upper gastrointestinal tract.

Animals↗

Differential effects of metoclopramide and zetidoline on gastrointestinal motility.

There is a recently formulated hypothesis that metoclopramide (MCP) may stimulate gastrointestinal (GI) motility via an antagonistic action on presynaptic, release modulating muscarinic receptors. We have tested this hypothesis by comparing MCP and zetidoline (ZTD), another putative presynaptic muscarinic antagonist, in various GI motility assays. The muscarinic and dopamine receptor binding affinity was also measured. Both MCP and ZTD acted as stimulants of electrically induced twitches of the isolated guinea-pig ileum and as antagonists of the inhibitory effects of intermittent exposure to cholinomimetics on the same preparation. In vivo, MCP significantly accelerated GI transit in mice and gastric emptying in rats. In contrast, ZTD had no effect on these in vivo parameters. Thus MCP and ZTD seem to act on the isolated guinea-pig ileum as presynaptic muscarinic antagonists. However, this mechanism apparently does not contribute to stimulation of GI motility in vivo.

Animals↗

Gastrointestinal motility and disease in large animals.

An understanding of the relationship between gastrointestinal (GI) motility and disease is imperative for the proper treatment of large animal patients, especially as new therapeutic agents become available. However, the abundance of information that has become available in the last 2 decades makes gaining this understanding a formidable task. This article summarizes the changes in GI motility caused by some common diseases and conditions encountered in large animal practice, such as GI obstruction, postoperative ileus, resection and anastomosis, diarrhea, endotoxemia, GI parasitism, hypocalcemia, and pregnancy.

Animal Diseases↗

Gastrointestinal motility disorders in scleroderma.

After the skin, the gastrointestinal tract is the second most common target of systemic sclerosis. The major clinical manifestations include gastroesophageal reflux, small bowel bacterial overgrowth, malnutrition, and intestinal pseudoobstruction. Treatment is symptomatic and supportive. Gastroesophageal reflux can usually be adequately managed with prokinetic drugs, omeprazole, and judicious use of antireflux surgery. If Barrett's esophagus is present, periodic endoscopic monitoring for development of dysplastic changes or adenocarcinoma is indicated. Bacterial overgrowth usually responds to rotating antibiotics and prokinetic drugs. Malnutrition and intestinal pseudoobstruction remain the major problems and often home total parenteral nutrition is required. Intestinal pseudoobstruction occurs in two phases: an early, neuropathic phase may respond to prokinetic drugs (metoclopramide, cisapride, octreotide, and erythromycin) and dietary modification (low-residue diets, vitamin supplementation). In the late myopathic phase, therapy is usually ineffective. Treatment consists of nutritional support. Careful manometric and radiographic localization of affected segments of stomach and small and large intestines may allow judicious surgical resection or venting procedures to reduce symptoms in this unfortunate group of patients.

Digestive System↗

Gastroduodenal peptic ulcers, duodenal adhesions, and upper gastrointestinal motility disturbances in patients who have undergone cholecystectomy.

The frequency of duodenal and gastric ulcer disease, the thickness of the pyloric muscle, and adhesions of the duodenum were evaluated in a routine, consecutive, prospective autopsy series of 100 patients, and the length of the pyloric canal, adhesions of the duodenum, and motility disturbances in the upper gastrointestinal series were studied in a separate radiologic material of 69 symptomatic patients with cholecystectomy in their history. Both series were compared with matched unoperated controls. The frequency of active gastric ulcers and ulcer scars was observed to be increased and that of active duodenal ulcers and ulcer scars decreased among the cholecystectomized patients in the autopsy series (p = 0.01 in both cases). This difference was not as pronounced when only active ulcers were included, but for active duodenal ulcers the difference was still significant (p = 0.04). One-fourth of the cholecystectomized patients but none of the controls had severe adhesions of the duodenum. In the autopsy series the thickness of the pyloric muscle and in the radiologic series the length of the radiologic pyloric canal were thickened/lengthened in an average of 26%/11% in patients who had undergone cholecystectomy (p less than 0.001 and p less than 0.10, respectively). The lengthening of the pyloric canal was in significant positive correlation with the motility disturbance/adhesion score of the upper gastrointestinal series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗