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At least 595 records · Page 33Linked to original sources

Persistence of abnormal gastrointestinal motility after operation for Hirschsprung's disease.

OBJECTIVE: Recent studies in patients with Hirschsprung's disease (HD) suggest that morphological abnormalities of the intramural intestinal plexuses are not restricted to the colon. In this report, symptoms and objective tests of gastrointestinal (GI) motor dysfunction were determined long after operative treatment to see whether evidence of a more widespread and relevant motility disturbance could be detected. METHODS: Twenty-one children were available for study an average of 6.6 yr after surgery for HD. All of these patients underwent evaluation of bowel frequency per week, total GI transit time (TGTT), and a scintigraphic gastric emptying test using solid food; anorectal manometry and segmental colonic transit times were performed in a subset of patients. Results were compared with findings in appropriately matched controls. RESULTS: Frequency of defecation per week in patients with HD after surgery was not different from that in control children, but TGTT was significantly longer (p < 0.01). Percentage retention of gastric isotope at 60 min exceeded the normal range in 12 of 21 (57.1%) patients, and colonic transit was abnormal in all six children studied. Symptoms persisted in two-thirds of patients postoperatively, and transit abnormalities were more common in the symptomatic subset (p = 0.026). CONCLUSIONS: Our data show that, in a subset of patients with HD, GI motor dysfunction persists long after surgical correction. The heterogeny of basic defects responsible for HD could provide the substrate for these motor abnormalities that, in turn, seem at least partially responsible for continuation of the symptomatic state.

Adolescent↗

Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia.

This study aimed to compare fasting and postprandial gastrointestinal motor patterns in patients with ulcer and non-ulcer dyspepsia. Forty five subjects were studied: 10 with uncomplicated gastric ulcer, eight with uncomplicated duodenal ulcer, 18 with chronic idiopathic dyspepsia, and nine healthy asymptomatic controls. Gastrointestinal fasting and postprandial motor patterns were recorded using a low compliance perfusion technique. The interdigestive antral cumulative motility index, computed for 30 minutes before the appearance of duodenal activity fronts, and the number of activity fronts with an antral component were significantly less in patients with ulcers and those with non-ulcer dyspepsia compared with asymptomatic controls. The patient groups also had a reduced antral motor response to a solid-liquid test meal compared with healthy controls. Intestinal motor abnormalities (bursts of non-propagated phasic pressure activity and discrete clustered contractions) were recorded in a minority of patients, all with associated irritable bowel symptoms. In conclusion, antral hypomotility is a frequent but nonspecific motor abnormality in dyspepsia; abnormal motor patterns of the small bowel are less frequent and seem to be confined to patients with concomitant irritable bowel syndrome.

Adolescent↗

[Effects of dingduwan on electric activities of gastrointestinal smooth muscle and effect of gastrointestinal motility].

Dingduwan (DDW) is a Chinese herbal medicine. Method of modified synchronous recording was used to study the electric activities of gastrointestinal (GI) smooth muscle and the effect of GI motility treated by DDW. A dosage of 3.5 g/kg for ingestion in rats markedly increased the average amplitude of GI slow wave, the total amplitude of GI motion, the rate of GI slow wave and intestinal motion (P < 0.05), but it had no significant effects on the frequency of gastroelectric slow wave and gastric motility (P < 0.05). DDW in the dosage of 5.2 g/kg for ingestion markedly promoted the recovery of intestinal intussusception in mice (P > 0.05). The results showed that DDW markedly increased the intestinal electricity and motility more than that of stomach.

Animals↗

Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity.

Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity.

Colon↗

Different actions of intravenous ethanol on basal (= interdigestive) secretion of gastric acid, pancreatic enzymes and bile acids and gastrointestinal motility in man.

The action of an intravenous infusion of ethanol (10% v/v; given in a dose of 300 mg kg-1 body weight for 30 min followed by 3 mg kg-1 min-1 for 2 hr) on the basal (= interdigestive) gastrointestinal motor activity and the basal gastric acid, pancreatic amylase and bile acid secretion was determined in 6 healthy human volunteers. Ethanol did not affect the duration of the interdigestive motor complex and the output of bile acids into the duodenum. Ethanol significantly (P less than 0.05) stimulated the gastric acid output by about 2.2-fold and inhibited the pancreatic amylase output by about 43% as compared to control experiments in which an intravenous infusion of 0.15 M NaCl was given. Ethanol did not alter the mean plasma levels of gastrin and pancreatic polypeptide as compared to prestimulatory values and to control experiments. In conclusion, these results show that intravenous ethanol given in a moderate dose stimulates gastric acid output and inhibits pancreatic amylase output in fasting non-alcoholic human beings. The mechanism(s) of these different actions of ethanol is unknown since release of gastrin or pancreatic polypeptide by ethanol does not account for the observed effects of intravenous ethanol.

Adult↗

Gastrointestinal motility disorders in patients with diabetes mellitus.

Disturbed gastric and small intestinal motility is an often overlooked clinical problem. Delayed gastric emptying of liquid and/or solid food in patients with type 1 and type 2 diabetes (gastroparesis diabeticorum) occurs in approximately 50% of the patients. Also, the interdigestive gastric and small intestinal motility is often affected. There is only a weak correlation between symptoms and objectively measurable motor disturbances. Patients with severe upper gastrointestinal symptoms usually have disturbed motility, but most patients with impaired motility are asymptomatic. Recent studies have clearly shown that, in addition to autonomic neuropathy, acute metabolic derangements are likely to contribute to disturbed motility. Elevated glucose levels impair gastric and small intestinal motility during fasting and after food intake. Hyperinsulinemia per se has effects similar to hyperglycaemia on the stomach and small bowel, and may be a mediator of the effects of hyperglycaemia in healthy subjects. The impact of insulin on motility in diabetic patients is still unclear. Treatment of the gastric motility disorder should include a stabilization of gastric emptying. Different therapeutic modes may be useful, e.g. application of prokinetic drugs and optimizing the metabolic situation.

Biliary Tract↗

Multiple intraluminal electrical impedancometry for recording of upper gastrointestinal motility: current results and further implications.

This review focuses on current aspects of the novel technology of multiple intraluminal electrical impedance measurement. It presents methodological features, summarizes current results, and discusses potential implications for further research. The impedance technique assesses a bolus transport and its associated peristalsis. Validation studies showed a good analogy between physically deduced impedance characteristics and characteristics derived from cineradiography and manometry. From the impedance tracings, it is possible to distinguish between resting states, bolus transit, and wall contraction. Characteristics of a peristaltic wave can be obtained. In human studies, esophageal and small intestinal peristaltic patterns can quantitatively and qualitatively be assessed. A high resolution recording of bolus movements with interesting details of transport and mixing can be obtained. On the basis of several prior characterized impedance tracings duodenal contractile patterns have been classified, and the interdigestive and postprandial states characterized. For reflux evaluation the impedance technique was especially useful for the detection of nonacid gastroesophageal reflux, which is not detectable by pH monitoring. In summary, the main impact of the impedance technique is its capability to characterize esophageal and intestinal chyme transport. Important data on luminal chyme transport have been obtained. This technique is developing into an interesting investigative tool to complement standard techniques for study of upper GI motility, in particular for basic research.

Cineradiography↗