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At least 37 records · Page 2Linked to original sources

PubMed2000

Maximizing tolerance of enteral nutrition in severely injured trauma patients: a comparison of enteral feedings by means of percutaneous endoscopic gastrostomy versus percutaneous endoscopic gastrojejunostomy.

BACKGROUND: Intolerance of enteral nutrition interrupts caloric balance and increases hospital costs. This study proposes that enteral feeding by percutaneous endoscopic gastrojejunostomy (PEGJ) provides continuous uninterrupted nutrition with greater consistency than percutaneous endoscopic gastrostomy (PEG). METHODS: This prospective nonrandomly assigned study was conducted at a Level I trauma center from December of 1997 through October of 1998. All feeding tubes were placed by trauma/critical care surgeons for nutritional support. Feeding course was monitored for 14 days from time of tube placement. Demographic data and outcome variables compared were age, sex, Injury Severity Score, Abbreviated Injury Score, hospital length of stay, number of days to reach nutritional goal feedings, caloric goal, protein goal, cc/hr at goal, total parenteral nutrition usage, complications, and hospital charges. Statistical analyses used the independent samples t test, Cox regression, and Pearson chi2 with significance level set at 0.05. RESULTS: Patients receiving enteral nutrition by PEGJ reached nutritional goal sooner than patients who received enteral nutrition by PEG (p = 0.02). Thirty-seven of 46 PEGJ patients (80%) were at goal rate at day 3, whereas 28 of 43 PEG patients (65%) were at goal on day 3. Nine of 43 PEG patients (21%) and 3 of 46 PEGJ patients (7%) failed to reach goal within 14 days. CONCLUSION: This study suggests that enteral nutrition delivered by means of PEGJ is better tolerated than enteral nutrition delivered by means of PEG in trauma patients with no abdominal conditions that preclude percutaneous feeding tube placement.

Adolescent↗

PubMed1987

Enteric coated microspheres of pancreatin in the treatment of cystic fibrosis: comparison with a standard enteric coated preparation.

In an open, randomised crossover study enteric coated microspheres of pancreatin were compared with a standard preparation of enteric coated pancreatin over two consecutive 28 day treatment periods in 23 adults with steatorrhoea due to cystic fibrosis. Lipase intake was equal to the patients' previous requirements and was the same during the two months. Patients performed 72 hour faecal collections at the end of each month and completed diary cards daily throughout. Comparison of the month of treatment with enteric coated microspheres with the month of standard enteric coated tablets showed a significant increase in body weight on microsphere capsules (p less than 0.02). There was also a reduced frequency of bowel actions (p less than 0.001) and abdominal pain (p less than 0.05), and improvement in stool character (p less than 0.001) on microsphere capsules. Faecal fat excretion was reduced by 44% with the microsphere capsules (p less than 0.01), and 86% of patients showed an increased coefficient of fat absorption (mean increase 13%, 95% confidence limits 6.5-19.1%; p less than 0.001). Eighty one per cent of patients preferred microsphere capsules of the two treatments. Thus enteric coated microsphere capsules are more effective in treating steatorrhoea in cystic fibrosis than standard enteric coated tablets.

Adult↗

PubMed1981

Campylobacter as a cause of acute enteritis in children in South Australia. II. Clinical comparison with salmonella, rotavirus and non-specific enteritis.

The clinical features of 17 children with campylobacter enteritis were compared with 17 age- and sex-matched children with enteritis due to salmonella, rotavirus or those in whom there was no identifiable pathogen. Prominent clinical features of campylobacter enteritis included fever, diarrhoea, vomiting, blood in stools and periumbilical pain. Dehydration was uncommon, compared to rotavirus and non-specific enteritis. The acute illness was self-limited, in spite of prolonged asymptomatic faecal excretion of the organism. This prolonged carriage increases the risk of cross infection. No patient with campylobacter required antibiotic therapy. Recurrent epidoses of diarrhoea were seen in three children but on no occasion was campylobacter the cause. This study has demonstrated a marked similarity between campylobacter and salmonella enteritis, making clinical distinction virtually impossible. Bloody diarrhoea, a feature of bacterial infections, was absent in rotavirus and non-specific enteritis.

Acute Disease↗

PubMed1998

A case of split notochord syndrome: presence of dorsal enteric diverticulum adjacent to the dorsal enteric fistula.

Like umblical enteric remnants (eg, umblical sinus and omphalomesenteric fistula), enteric remnants can be seen on the dorsal aspect of the body (dorsal enteric sinus, dorsal enteric fistula IDEF], dorsal enteric diverticulum) in conjunction with complete cleft of the vertebral column. Complete cleft of the vertebral column associated with gastrointestinal tract and central nervous system anomalies is known as "split notochord syndrome" (SNS). The authors present an unreported variant of SNS having dorsal enteric diverticulum adjacent to the DEF. The patient died 17 days after surgical repair.

Abnormalities, Multiple↗

PubMed1988

The development expression of the rat alpha-vascular and gamma-enteric smooth muscle isoactins: isolation and characterization of a rat gamma-enteric actin cDNA.

We have isolated and characterized two cDNA clones from whole rat stomach, pRV alpha A-19 and pRE gamma A-11, which are specific for the alpha-vascular and gamma-enteric smooth muscle isoactins, respectively. The rat gamma-enteric smooth muscle actin contains a single amino acid substitution of a proline for a glutamine at position 359 of the mature peptide when compared with the chicken gizzard gamma-actin sequence (J. Vandekerckhove and K. Weber, FEBS Lett. 102:219, 1979). Sequence comparisons of the 5' and 3' untranslated (UT) regions of the two smooth muscle actin cDNAs demonstrate that these regions contain no apparent sequence similarities. Additional comparisons of the 5' UT regions of the two smooth muscle actin cDNAs to all other known actin sequences reveal no apparent sequence similarities for the rat gamma-enteric isoactin within the 15 base pairs of sequence currently available, while the rat alpha-vascular isoactin contains two separate sequences which are similar to sequences within the 5' UT regions of the human and chicken alpha-vascular actin genes. A similar comparison of the 3' UT regions of the two smooth muscle actins demonstrates that the alpha-vascular isoactins do not contain the high degree of cross-species sequence conservation observed for the other isoactins and that the gamma-enteric isoactin contains an inverted sequence of 52 nucleotides which is similar to a sequence found within the 3' UT regions of the human, chicken, and rat beta-cytoplasmic isoactins. These observations complicate the apparent cross-species conservation of isotype specificity of these domains previously observed for the other actin isoforms. Northern blot analysis of day 15 rat embryos and newborn, day 19 postbirth, and adult rats demonstrates that the day 15 rat embryo displays low to undetectable levels of smooth muscle isoactin mRNA expression. By birth, the stomach and small intestine show dramatic increases in alpha-vascular and gamma-enteric actin expression. These initially high levels of expression decrease through day 19 to adulthood. In the adult rat, the uterus and aorta differ in their content of smooth muscle isoactin mRNA. These results demonstrate that the gamma-enteric and alpha-vascular isoactin mRNAs are coexpressed to various degrees in tissues which contain smooth muscle.

Actins↗

PubMed1991

Origins of the insect enteric nervous system: differentiation of the enteric ganglia from a neurogenic epithelium.

The enteric nervous system (ENS) of the moth Manduca sexta is organized into two distinct cellular domains: an anterior domain that includes several small ganglia on the surface of the foregut, and a more posterior domain consisting of a branching nerve plexus (the enteric plexus) that spans the foregut-midgut boundary. Previously, we showed that the neurons of the posterior domain, the enteric plexus, are generated from a large placode that invaginates from the caudal lip of the foregut; subsequently, the cells become distributed throughout the enteric plexus by a sequence of active migration. We now demonstrate that the neurons of the anterior domain, the cells of the enteric ganglia, arise via a distinct developmental sequence. Shortly after the foregut has begun to form, three neurogenic zones differentiate within the foregut epithelium and give rise to chains of cells that emerge onto the foregut surface. The three zones are not sites of active mitosis, as indicated by the absence of labelling with a thymidine analogue and by clonal analyses using intracellularly injected dyes. Rather, the zones serve as loci through which epithelial cells are recruited into a sequence of delamination and neuronal differentiation. As they emerge from the epithelium, the cells briefly become mitotically active, each cell dividing once or twice. In this manner, they resemble the midline precursor class of neural progenitors in the insect central nervous system more than neuroblast stem cells. The progeny of these zone-derived precursors then gradually coalesce into the ganglia and nerves of the anterior ENS. Although this reorganization results in some variability in the precise configuration of neurons within the ganglia, the overall morphology of the ganglia is highly stereotyped, consisting of cortical layers of cells that surround a ventral neuropil. In addition, a number of the neurons within the frontal and hypocerebral ganglia express identifiable phenotypes in a manner that is similar to many cells of the insect central nervous system. These observations indicate that the differentiation of the enteric ganglia in Manduca involves an unusual combination of features seen during the formation of other regions of the nervous system and, as such, constitutes a distinct program of neurogenesis.

Animals↗

PubMed2004

Alternative method for enteric coating of HPMC capsules resulting in ready-to-use enteric-coated capsules.

The aim of this study was to develop an alternative method for enteric coating of HPMC capsules that avoids the sealing step before coating, resulting in ready-to-use enteric-coated capsules for the use in retail or hospital pharmacy or R&D sections of pharmaceutical industry and for the production of enteric-coated heat and moisture sensitive biomaterials. HPMC caps and bodies 00 (Vcaps, Capsugel) were coated separately in a fluid bed apparatus prior to filling (GPCG-1, Glatt) with Eudragit L30D-55 or Eudragit FS 30 D (Röhm), Aqoat AS-HF (Shin-Etsu) and Sureteric (Colorcon), using an optimised coating process. The coated bodies were filled and closed with the coated caps without encountering problems of coating damage. The release in 0.1N HCl after 2h from capsules coated with Eudragit L30D-55, Eudragit FS 30 D, Aqoat AS-HF and Sureteric was 0.6+/-.03, 0.6+/-0.3, 1.2+/-0.2 and 7.3+/-1.9%, respectively. The alternative method was reproducible and offered a way to overcome the time-consuming and expensive sealing step required using the conventional coating procedure. The obtained enteric-coated HPMC capsules can be stored (un)-filled for at least 6 months without loosing enteric properties.

Capsules↗

PubMed1999

GABA(A) receptor subunit messenger RNA expression in the enteric nervous system of the rat: implications for functional diversity of enteric GABA(A) receptors.

GABAergic neurons occur in the myenteric plexus and submucosa and their innervations of the gut, where GABA stimulates motor neurons, and non-neural cells via "central type" GABA(A) receptors. These receptors occur on half of the neurons in the rat intestine. The GABA(A) receptor is a ligand-gated chloride channel constructed from different subunit families (alpha, beta, gamma, delta, epsilon). In rat these exist as subtypes, alpha1-6, beta1-3, gamma1-3 and delta, defining the clinically relevant pharmacological features of GABA(A) receptors. However, the identity, distribution, and abundance of enteric GABA(A) receptor subunits are unknown. To identify and map the regional expression of GABA(A) receptor subunit messenger RNAs in the enteric nervous system, we assayed enteric RNA from the ileum of Sprague-Dawley rats by reverse transcription-polymerase chain reaction for alpha1-6, beta 1-3, gamma1-3, and delta subunit messenger RNAs. Subunit messenger RNA localization, was probed by in situ hybridization. Reverse transcription-polymerase chain reaction analysis of RNA from myenteric and submucosal nerve layers revealed the expression alpha1, alpha3, beta2, beta3, gamma1 and gamma3 subunit messenger RNAs. Little alpha4 and alpha6 and no alpha2, beta1, gamma2 or delta subunit messenger RNA were detected. In situ hybridization revealed that transcripts for alpha1, alpha3, alpha5 and beta2 subunits occur in both myenteric and submucous ganglia. However, beta3 messenger RNA was found only in myenteric plexus. The gamma1 subunit messenger RNA was also restricted to the cells in the myenteric plexus while gamma3 was found in cells of both nerve layers. In this study of the subunit messenger RNA expression profile of GABA(A) receptors within the enteric nerve layers we show an abundant, diverse and widespread distribution that is unique in comparison to the CNS. The distinctive and heterogeneous distribution of enteric GABA(A) subunits may be important in the integration of neural control of gut function.

Animals↗

PubMed1997

The use of an enteral expert system in the prescription of enteral formulas in a university hospital.

A personal computer-based expert system has been developed for the prescription of enteral formulas based on patient-need characteristics. Two hundred twelve inpatients in a university hospital setting were prospectively evaluated to compare the identity and cost of the enteral formula prescribed by the expert system with the identity and cost of the enteral formula prescribed by the ward team. Two hundred seven patients had complete data to allow analysis. There was a mean cost savings (+/-SD) of $1.18 +/- 7.69/d for each patient using the expert system compared with the MD-prescribed formula (P = 0.023). We project that the use of this program would save $27,564/y in our hospital (an average of 23,360 patient/days of enteral feeding per year). We conclude that the use of an expert system can be cost-effective in the prescription of enteral formulas for hospitalized patients.

Adult↗

PubMed1977

Plasma prednisolone levels from enteric and non-enteric coated tablets estimated by an original technique.

1 A quantitative thin layer chromatographic technique for the estimation of plasma prednisolone levels has been devised with a minimum level of estimation of 10 ng/ml. 2 A comparative study of the absorption of 5 and 10 mg prednisolone from enteric and non-enteric coated tablets (5 mg) was carried out in healthy subjects. 3 Mean plasma half-life and peak plasma concentrations obtained from the non-enteric coated preparation agree well with previous studies in normal subjects reported by other investigators using competitive protein binding or radioimmunoassay techniques. Intersubject variability in bioavailability was noted. 4 Enteric coating increased the lag time before prednisolone appeared in the blood but did not alter the bioavailability of prednisolone compared to the equivalent dose of the non-enteric coated tablet.

Adult↗

PubMed1997

Enteral or parenteral nutrition? Pro-enteral.

There is a convincing evidence for the superiority of enteral nutrition as compared with parenteral In critically ill and injured patients. The general objectives of providing nutritional support in the critically ill is to persevere body functions that are functioning normally and to facilitate recovery of those that are failing. The specific objective for enteral nutrition is, however, preservation and restoration of the gastrointestinal structure and function. Today, early enteral nutrition is an integral part of the acute management of critically ill patients. It is no longer a therapy which can be started "if" necessary just to prevent malnutrition. Early enteral nutrition can be successfully carried out in virtually all critically ill patients also after major abdominal surgery and in acute pancreatitis. There are very few contraindications for using enteral nutrition and severe complications are rare. Parenteral nutrition, on the other hand, is associated with increased incidence of infectious complications and is rarely indicated in critically ill patients.

Abdomen↗

PubMed1989

[Clinical trial of T-3262 on acute enteritis. Japan Research Committee of T-3262, Research Group for Acute Infectious Enteritis].

For the purpose of evaluation of clinical efficacy, safety and usefulness on acute infectious enteritis (bacillary dysentery, and enteritis caused by Salmonella spp., Campylobacter spp., enteropathogenic E. coli, and so on), T-3262, a newly developed pyridone-carboxylic acid derivative, was administered to a total of 136 patients and carriers. In addition, in vitro antibacterial activity of T-3262 was determined against the clinical isolates, and compared with those of nalidixic acid (NA), pipemidic acid (PPA), enoxacin (ENX), norfloxacin (NFLX) and ofloxacin (OFLX). The daily dose of 450 mg of T-3262 was administered orally three times after meals for 5 days, with the exception of 7 day administration against Salmonella enteritis. A total of 89 cases were evaluated; 23 with Shigella spp., 30 with Salmonella spp., 15 with Campylobacter spp., 6 with enteropathogenic E. coli, and 15 cases with the other pathogens or pathogen-negative. The efficacy on clinical symptoms judging from duration of fever, and duration of diarrhea and abnormal stool character was 100% in all the enteritis except enteropathogenic E. coli enteritis, in which it was 50% (n = 2). Concerning bacteriological response, elimination of the causative organisms from the feces was 100% in Shigella spp. (n = 19), Salmonella spp. (n = 30), and enteropathogenic E. coli (n = 6), although 64.3% in Campylobacter spp. (n = 14). As an adverse effect, epigastric discomfort was observed in one (0.8%) of 130 cases. Deteriorations in laboratory findings were seen in five (6.2%) of 81 cases, consisting of two with elevated GOT and GPT, two with elevated GPT, and one with increased eosinophils count, although they were all slight in degree. MICs of T-3262 which inhibited 90% of the isolates of Shigella spp, Salmonella spp., and Campylobacter spp., were 0.025, 0.05, and 0.78 microgram/ml, respectively. These values were lowest among the quinolone derivatives tested, except that the MIC90 against Campylobacter spp. was the same as that of ofloxacin.

4-Quinolones↗

PubMed1996

Role of stool screening tests in diagnosis of inflammatory bacterial enteritis and in selection of specimens likely to yield invasive enteric pathogens.

The Leuko-Test yielded a negative predictive value of 98.4% when it was used to screen 325 patients for inflammatory bacterial enteritis and a negative predictive value of 99.4% when it was used to screen 416 stool specimens for those from which enteric pathogens would likely be recovered when cultured. Neither microscopy for fecal leukocytes nor an assay for fecal occult blood, alone or in combination, allowed for the reliable detection of invasive bacterial enteritis or the reliable selection of specimens for culture. When positive in the Leuko-Test, specimens collected from patients after the third day of hospitalization did not yield enteric pathogens when the specimens were cultured, and specimens collected from inpatients within the first 3 days of hospitalization or from outpatients did not contain Clostridium difficile toxin A. As a screening test, the Leuko-Test has the ability to generate rapidly a result which can support the presumptive diagnosis of inflammatory bacterial enteritis or which can be used to determine the suitability of stool specimens for bacteriologic culture.

Bacterial Infections↗

PubMedDate not supplied

Glutamate in enteral nutrition: can glutamate replace glutamine in supplementation to enteral nutrition in burned rats?

BACKGROUND: Glutamine (GLN) plays many important roles for the enterocytes in health and disease, but no liquid enteral products contain GLN because of its instability. We hypothesized that glutamate (GLU) may replace GLN in supplementation to an enteral diet, and compared the metabolic effect of GLU and GLN on the gut to each other. METHODS: Rats suffering from a 30% burn received an enteral diet containing 30% GLU (m/w to total amino acids; GLU group), 30% GLN (GLN group), or a standard amino acid formula (CTR group). After a 64-hour feeding period, the small intestine and the portal and arterial blood were harvested to observe portal and arterial amino acid levels, and glutaminase activity and glutathione in the jejunal mucosa. In another study, 3H uptake into the mucosal protein was examined after a massive dose injection of 3H-phenylalanine. RESULTS: Alanine, a product of GLN or GLU catabolism, significantly increased in the portal blood of the GLU group compared with the GLN group. In the gut mucosa of the GLU group, 3H uptake into protein and total glutathione were higher than those of other two groups. GLN did not elevate the glutaminase activity. Arterial GLU levels increased in the GLU group, however remained within safety limits. CONCLUSIONS: Enterally delivered GLU may be a preferable fuel for the enterocytes and enhance the mucosal protein synthesis. GLU probably can substitute for GLN in supplementation to an enteral diet regarding many roles GLN plays in the intestinal mucosa under stress situations.

Amino Acids↗

PubMed1989

Comparison of the gastrointestinal side effects of naproxen formulated as plain tablets, enteric-coated tablets, or enteric-coated granules in capsules.

We studied the gastrointestinal side effects of three formulations of naproxen in 18 healthy male volunteers. In a Latin-square design crossover study, the subjects received 500 mg naproxen twice daily for 7 days as plain tablets, enteric-coated tablets, or enteric-coated granules in capsules. The 51Cr-EDTA absorption test was performed before and at the end of each drug period, to evaluate changes in the distal gut. The test dose was instilled distally in the duodenum to prevent lesions in the stomach from interfering with the evaluation. Upper endoscopy was performed at the same intervals, scoring changes in the middle and distal duodenum separately from findings in the stomach and duodenal bulb. The nature and severity of adverse effects were recorded for each treatment period. Non-parametric methods were used for statistical evaluation. All drugs induced a significant increase in 51Cr-EDTA absorption, but we did not detect any difference between the three formulations. All formulations were associated with a significant increase in all the endoscopic findings monitored. Enteric-coated tablets induced significantly less lesions than enteric-coated granules in the stomach and duodenal bulb, and an advantage over plain tablets was indicated. No difference was seen in the middle and distal duodenum. The proximal endoscopic scores were not correlated to those found in the middle and distal duodenum. Evaluation of the small and large bowel should probably be included in clinical studies of NSAIDs, but our findings suggest that the importance of transfer of mucosal lesions to the distal gut by enteric coating may have been overemphasized.

Adult↗

PubMed1985

Enhancing enteral nutrition delivery: development of an enteral preparation facility.

As a result of prospective reimbursement, departments of clinical dietetics must define and maintain the nutrition services offered in the most cost-effective manner. The processing, preparation, and provision of quality enteral hyperalimentation to patients provide an example of a nutrition service in which cost-saving measures can be employed. Saint Vincent Charity Hospital and Health Center, Cleveland, decided to evaluate and increase the efficiency of tube-feeding preparation, delivery, inventory, and purchasing because of an increased demand for those services. The evaluation process resulted in the development of an enteral preparation facility, a specialty kitchen located within the foodservice department, specifically designed for cost-effective preparation and dispensation of all enteral formulas. The effort required physical space reallocation and personnel retraining. Implementation of the enteral preparation facility has resulted in improved quality of enteral nutrition services and has significantly aided nutrition support and cost-containment efforts at the hospital.

Cost Control↗

PubMed1996

Hormonal response to enteral feeding and the possible role of peptide YY in pathogenesis of enteral feeding-related diarrhoea.

Diarrhoea is a common complication of enteral feeding. Previous studies have demonstrated a secretion of water and electrolytes in the ascending colon during intragastric but not intraduodenal enteral feeding. The cause of this secretion is likely to be neurohumoral in origin. This study was designed to examine the hormonal responses to enteral feeding. In vivo segmental colonic perfusion studies were undertaken. Before and at hourly intervals during these studies serum was taken for estimations of neurotensin (NT), pancreatic glucagon (PG), peptide YY (PYY) and vasoactive intestinal polypeptide (VIP). During fasting there was a median ascending colonic absorption of water in all groups. During feeding there was a net secretion in the ascending colon in both gastric groups and in the high load duodenal group, but not in the low load duodenal group. During these studies the PYY levels remained unchanged from fasting in the low and high load gastric groups. In the low and high load duodenal groups the PYY levels increased. The NT levels increased only in the high load duodenal group. There were no other changes in NT or in PG or VIP levels either between fasting and feeding, or between the gastric and duodenal groups. PYY is known to stimulate intestinal absorption. The absence of a rise during intragastric feeding may be important in the underlying mechanisms of enteral feeding-induced colonic secretion and hence enteral feeding-related diarrhoea.

Journal Article↗

PubMed2001

A prevalence survey for zoonotic enteric bacteria in a research monkey colony with specific emphasis on the occurrence of enteric Yersinia.

Transmissible pathogenic and opportunistic zoonotic enteric bacteria comprise a recognized occupational health threat to exposed humans from non-human primates (NHPs). In an effort to evaluate the occurrence of selected enteric organisms with zoonotic and biohazard potential in a research colony setting, we performed a prevalence study examining 61 juvenile and young adult rhesus macaques participating in a transplant immunology project. Primary emphasis was directed specifically to detection of pathogenic enteric Yersinia, less well-documented and reported NHP pathogens possessing recognized significant human disease potential. NHPs were surveyed by rectal culture during routine health monitoring on three separate occasions, and samples incubated using appropriate media and specific selective culture methods. Enteric organisms potentially transmissible to humans were subcultured and identified to genus and species. Significant human pathogens of the Salmonella/Shigella, Campylobacter, and enteric Yersinia groups were not isolated throughout the survey, suggesting prevalence of these organisms may generally be quite low.

Animal Technicians↗