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PubMed1982

A method for the accurate measurement of isotope ratios of chenodeoxycholic and cholic acids in serum.

A method for the extraction of bile acids from serum is described that enables the stable isotopic content of chenodeoxycholic acid and cholic acid to be determined accurately to levels as low as the natural 13C abundance. The method uses Sep-Pak C18 reverse phase cartridges both for extraction and purification procedures. Free bile acids, bile acid conjugates, and 3-monosulfated bile acid conjugates are recovered in high yield from the Sep-Pak in methanol-water 75:25 after first removing impurities with hexane and methanol-water 40:60 washes. Other important features of the method include the use of enzymatic rather than alkaline hydrolysis of bile acid conjugates, the use of ammonia as the reagent gas for chemical ionization mass spectrometric measurement of isotopic ratios, and the exclusion of all extraneous components in the final sample from the ion source. This method should be applicable to kinetic studies of bile acids using bile acids labeled with stable isotopes and serum measurements, and provides an alternative sampling point in the enterohepatic circulation to conventional duodenal bile samples requiring intubation.

Acetylation↗
PubMed1982

Inhibition of pentagastrin-stimulated gastric acid secretion by upper intestinal hyperosmolality in chronic gastric fistula rats.

The effects of upper small intestinal perfusion with iso-osmolar or hyperosmolar polyethylene glycol (PEG) solutions on maximal gastric acid secretion stimulated by intravenous pentagastrin was investigated in Sprague-Dawley rats. The animals were provided with a chronic gastric fistula, a gastroenterostomy and a 4-cm duodenal loop anastomosed end-to-side to the jejunum. The oral end of the duodenal loop was closed and intubated for infusion of various solutions. Saline was infused in the control experiments, 2 ml h-1. In the test experiments, saline was replaced with PEG, 300, 900 or 1,200 mosm.kg-1. Duodenal perfusion with iso-osmolar PEG, 300 mosm-kg-1, did not alter maximal acid secretion. Duodenal perfusion with hyperosmolar PEG 900 or 1,200 mosm.kg-1 significantly inhibited the stimulated 2-hour acid output by 47 and 48% respectively (p less than 0.01). Indomethacin, an inhibitor of the prostaglandin synthesis, did not alter the stimulated acid secretion, and the inhibitory influence on acid secretion of duodenal perfusion with PEG 1,200 mosm.kg-1 as not affected by the drug.

Animals↗
PubMed2005

Effect of the type of dietary fat on biliary lipid composition and bile lithogenicity in humans with cholesterol gallstone disease.

OBJECTIVE: The effect of the type of dietary fat on bile lipids and lithogenicity is unclear. This study compared the effects of two dietary oils that differed in fatty acid profile on biliary lipid composition in humans. METHODS: Female patients who had cholesterol gallstones and were scheduled for elective cholecystectomy were studied. For 30 d before surgery, subjects were kept on diets that contained olive oil (olive oil group, n = 9) or sunflower oil (sunflower oil group, n = 9) as the main source of fat. Gallbladder bile and stones were sampled at surgery. After cholecystectomy, duodenal samples were collected by nasoduodenal intubation during fasting and after administration of mixed liquid meals that included the corresponding dietary oil. Duodenal and gallbladder bile samples were analyzed for cholesterol, phospholipids, and total bile acids by established methods. Individual bile acid conjugates in gallbladder bile were measured by high-performance liquid chromatography. Gallstones were analyzed by semiquantitative polarizing light microscopy. RESULTS: Despite marked differences in the absolute concentration of biliary lipids and total lipid content, manipulation of dietary fat ingestion did not influence the cholesterol saturation or the profile of individual bile acids in gallbladder bile obtained from patients who had gallstones. All but one subject had mixed cholesterol stones. A cholesterol saturation index of hepatic bile in fasted cholecystectomized patients was similar in both dietary groups and indicative of supersaturation. In response to the test meal, the cholesterol saturation index decreased significantly in patients given the olive oil diet, reaching values lower than one at 120 min postprandially. In contrast, hepatic bile secreted by patients who consumed sunflower oil appeared supersaturated (cholesterol saturation index >1.5) throughout the experiment. CONCLUSIONS: Our results suggest that the type of dietary fat habitually consumed can influence bile composition in humans. In gallbladder, this influence was noted in the presence of more concentrated bile in the olive oil group. However, this was not translated into a modification of cholesterol saturation, which is likely due to the fact that cholesterol gallstones were present by the time the dietary intervention started. The finding that a typical postprandial variation in hepatic bile lithogenicity occurred only in olive oil patients was revealing. While keeping in mind the methodologic limitations of this part of the study, some gastrointestinal and metabolic mechanisms for this effect are discussed.

Adult↗
PubMed2001

Self-expanding coil stent with a long delivery system for palliation of unresectable malignant gastric outlet obstruction: a prospective study.

BACKGROUND AND STUDY AIMS: Peroral intubation of a self-expanding metal stent is usually difficult in patients with unresectable malignant gastric outlet obstruction, because the delivery systems currently available are not long enough and cannot easily pass the angulated gastroduodenal structure. We carried out a prospective study to assess the efficacy of a coil stent with a newly developed long delivery system, for palliation of unresectable malignant gastric outlet obstruction. PATIENTS AND METHODS: In 29 patients with unresectable malignant gastric outlet obstruction, caused by gastric cancer (26 patients), pancreatic head cancer (two patients), or duodenal cancer (one patient), peroral intubation of a self-expanding nickel-titanium coil stent was attempted, using a lengthened delivery system of 150 cm, under endoscopic and fluoroscopic guidance. RESULTS: Management was successful in 26 of 29 patients (89.7 %) without immediate major complications. In one patient in whom peroral intubation failed, percutaneous intubation of the coil stent via percutaneous endoscopic gastrostomy was done. After insertion of the coil stent, food ingestion with symptomatic improvement with regard to vomiting was achieved in 26 of 27 patients (96.3 %), including the patient with percutaneous stent insertion. During the follow-up period, dysphagia and Karnofsky scores improved significantly. Stent migration occurred in two patients, and tumor ingrowth in another two; re-intervention was done successfully performed in two instances. The mean survival time was 124 days (range 34 - 310 days) in the 22 patients who had no need for re-intervention during follow-up; among these was a patient who experienced stent occlusion by food material, which was easily corrected with endoscopic flushing. CONCLUSIONS: Peroral intubation of a self-expanding coil stent using a long delivery system is a safe and effective palliative technique for unresectable malignant gastric outlet obstruction, and significantly improves the quality of life of patients.

Adult↗
PubMed1988

Effect of lactose hydrolysis on calcium absorption during duodenal milk perfusion.

A multi-lumen intubation system was used to study the absorption of calcium, glucose and galactose in 13 human subjects. The intubation was placed between the duodenum abdomen and proximal jejunum and the subjects were perfused with milk and lactase-supplemented milk. Lactose disappearance over a 20 cm length of intestine was used as the index of lactase activity. The subjects were assigned to one of two groups, lactase-normal and lactase-deficient. There was linear correlation between the absorption of calcium and lactose: lactase-deficient subjects absorbed less calcium than lactase-normal subjects. Perfusion with lactase-supplemented milk enhanced calcium absorption in lactase-deficient subjects but had no effect on that of normal lactase subjects. All subjects absorbed approximately the same percentage of perfused calcium (24%) when perfused with hydrolysed milk. These data indicate that the enhancement of calcium absorption is not a function of lactase per se, but of its hydrolytic products, glucose and galactose.

Adult↗
PubMed1981

Ursodeoxycholic acid ingestion after ileal resection. Effect on biliary bile acid and lipid composition.

The effect of ursodeoxycholic acid ingestion on biliary bile acids and biliary lipids was studied in six patients after ileal resection. All patients had bile acid malabsorption, as documented by increased breath and fecal excretion of 14C after oral administration of [1-14C] cholylglycine. Fasting duodenal bile was collected by intubation before and seven days after ursodeoxycholic acid administration (4 g/day), and biliary bile acid and lipid composition were determined. Ursodeoxycholic acid ingestion increased the percentage of ursodeoxycholic acid in bile tenfold (3.6 +/- 2.6% vs 38.6 +/- 12.0%) and decreased chenodeoxycholic acid in bile by approximately 40%. Before ursodeoxycholic acid ingestion, bile was supersaturated in all patients. After ursodeoxycholic acid ingestion, cholesterol saturation decreased in all six patients by an average of 43%, and bile became unsaturated in five. Ursodeoxycholic acid ingestion had no effect on stool frequency. We conclude that, as in subjects with an intact enterohepatic circulation, ursodeoxycholic acid therapy has litholytic potential in patients after ileal resection.

Bile↗
PubMed1995

Cholecystokinin (CCK) in the amino acid uptake and enzyme protein secretion by the pancreas in humans.

Activation of type A receptors by CCK or cerulein is known to stimulate pancreatic enzyme secretion, but its role in the amino acid (AA) consumption and enzyme synthesis remains unclear. In our study, we used loxiglumide, a potent CCK-A-receptor antagonist, to investigate the role of CCK-A receptors in pancreatic consumption of circulating AAs and enzyme secretion. Five healthy male volunteers were intubated with double-lumen duodenal tube, and duodenal aspirates were collected during 60-min basal periods and then during pancreatic stimulation with iv infusion of secretion (80 pmol/kg/h) plus cerulein (50 pmol/kg/h) during three consecutive 30-min periods. The same procedure was repeated, but secretin-cerulein infusion was combined with a constant dose of loxiglumide (20 mumol/kg/h). The volume and outputs of HCO3-, protein and enzymes (amylase and trypsin) in duodenal aspirates and gallbladder volume (by sonography) were determined at 30-min intervals. Plasma samples were drawn for total plasma AA assay by ninhydrin method to assess the pancreatic uptake of free AAs. Infusion of secretin plus cerulein caused a several-fold increase in the volume of duodenal aspirate and the outputs of HCO3-, protein, and enzymes. During those periods, plasma AA level decreased from initially 2.20 +/- 0.3 mmol/L to 1.09 +/- 0.3 mmol/L (p < 0.01) and the gallbladder volume from initially 28 +/- 8 mL to 2 +/- 0.4 mL. This increase in pancreatic secretory outputs was accompanied by significant increments in plasma insulin, glucagon, PP, and somatostatin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Indicators of the lithogenic properties of the bile: methods of their evaluation, clinical availability and informative value].

Duodenal bile taken by gastroduodenal intubation of patients with chronic calculous cholecystitis with intact gallbladder performance was investigated as was the bile taken in those with chronic acalculous cholecystitis or in those without clinical signs of cholecystitis and concurrent diseases. The bile was investigated for cholesterol, bile acids and lecithin levels. All the parameters obtained were used for computation of lithogeny parameters: Swell, Admirand-Small, Metzger, Thomas, Andrews and cholesterol-lecithin ratio. The study performed indicated that Swell's parameters of lithogeny and cholesterol-lecithin ratio displayed more precisely lithogeny of the bile, and could be determined more easily than other parameters.

Bile↗