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Gastrointestinal symptoms, motility, and transit after the Roux-en-Y operation.

Roux-en-Y patients have symptoms that vary from almost none to inability to tolerate oral feedings. This study was designed to determine whether there is a relationship between a patient's symptoms and the function of the gastric remnant or the Roux-limb. Gastric remnant and Roux-limb emptying were studied in eight patients with technetium-99m-labeled oatmeal and Roux-limb motor activity was measured with a water-perfused manometry system. We found that gastric emptying was rarely significantly slowed, but emptying of the Roux-limb was delayed in several patients. We also found that there was a rough correlation between the patient's symptoms and the degree of abnormal motility found in the Roux-limb. There is no known reason for these abnormalities in Roux-limb function in some patients after a Roux-en-Y, but our finding of worse abnormalities in those who had multiple previous gastric surgeries suggests that the symptoms and dysfunction may be related to the number of surgeries, as well as to the type of surgery.

Adult↗

Late increase in acetaminophen concentration after overdose of Tylenol Extended Relief.

We report a case demonstrating a late increase in acetaminophen concentration after ingestion of Tylenol Extended Relief (extended-release acetaminophen; McNeil Consumer Products) along with drugs known to slow gastrointestinal motility. Coingestants that slow gastrointestinal motility are known to affect the interpretation of serum drug concentrations. However, this case illustrates potentially significant differences between extended-release and immediate-release acetaminophen and demonstrates an exception to the current manufacturer recommendation for the use of the Rumack-Matthew nomogram in this setting.

Acetaminophen↗

Therapeutic agents used in the treatment of calf diarrhea.

This article discusses various therapeutic agents that have been used in the treatment of calf diarrhea, such as antibiotics, modulators of intestinal motility, gastrointestinal protectants and absorbents, astringents, agents affecting secretion, steroids, antiadhesives, antitoxins, and monoclonal antibodies. The roles of nutrition and the administration of colostrum following onset of diarrhea are also discussed.

Animal Nutritional Physiological Phenomena↗

Pranlukast, a leukotriene receptor antagonist, prolongs the duration of the migrating motor complex in dogs.

Current information on the effects of leukotriene receptor antagonists on gastrointestinal motility and their mechanisms of gastrointestinal side effects are unknown. Our study aimed to answer the question whether the leukotriene inhibition induced by Pranlukast alters the normal gastrointestinal contraction patterns, and whether any motility abnormalities found explain the gastrointestinal side effects of these types of medications. Seven dogs were used after implanting force transducers in the body and antrum of the stomach, duodenum, and jejunum to monitor gastrointestinal motility. Pranlukast was given orally to each dog at the end of the migrating motor complex during fasting experiments and 30 min after a standard meal during the fed stage, with continuous monitoring. The migrating motor complex was significantly prolonged, especially during phase I of 208.5 +/- 15.4 min (P < 0.05) at 30 mg/kg and of 280.3 +/- 12.5 min (P < 0.05) at 60 mg/kg, compared with controls (93.5 +/- 5.5 min). A significant reduction in the postprandial motility index was also noticed at 60 mg/kg (445.20 +/- 31.30 g x min; P < 0.001) compared to controls (728.20 +/- 26.76 g x min). In conclusion, we are the first to demonstrate that Pranlukast produces a significant inhibitory effect on gastrointestinal motility, which could explain in part some of the side effects observed with these types of drugs.

Animals↗

Variability in cimetidine absorption and plasma double peaks following oral administration in the fasted state in humans: correlation with antral gastric motility.

The role of gastrointestinal motility and pH in determining cimetidine bioavailability as well as double peaks in plasma profiles following oral administration, in the quiescent or active phase of antral motility, to humans in the fasted state was examined. Plasma cimetidine-time curves did not show the presence of double peaks in any subject following intravenous administration. The incidence of double peaks was 73% following oral administration and was independent of antral migrating motility complex phase. Further, it was found that oral administration of cimetidine in the quiescent phase resulted in significantly higher bioavailability and in other pharmacokinetic parameters compared to that obtained following administration in the active phase. Excellent linearity in plots of motility peaks vs. plasma peaks with slopes close to unity were evident for both quiescent (r(2)=0.93) and active phase (r(2)=0.97) administration. A total of 14 peaks out of 22 (10 subjects, 64%) and 20 out of 27 peaks (11 subjects, 74%), were accounted for in quiescent and active phase oral administration, respectively. The proximal occurrence of plasma peaks to antral motility peaks typical of phase III contractions strongly implies that motility patterns may be responsible for secondary maxima following oral cimetidine administration in the fasted state.

Administration, Oral↗

The immunomodulation of enteric neuromuscular function: implications for motility and inflammatory disorders.

Gastrointestinal motility and sensory perception are altered in a variety of mucosal inflammatory conditions of the gut, ranging from peptic esophagitis to ulcerative colitis. Studies in animal models now clearly indicate a causal relationship between the presence of mucosal inflammation and altered sensory-motor function. In many instances, these changes occur in the absence of any discernible encroachment of the deeper neuromuscular layers by the inflammatory infiltrate, which remains largely within the lamina propria. Accordingly, attention has focused on local sources of mediators, and recent studies indicate that smooth muscle cells and enteroglia are sources of and targets for cytokines such as interleukin 1 beta and interleukin 6. In several instances, neuromuscular dysfunction persists after mucosal inflammation has subsided; this state may be maintained by locally produced mediators. Studies also show the ability of enteric muscle to modulate lymphocyte function via major histocompatibility complex II-restricted antigen presentation. Clinical observation and experimental data also suggest that nerves modulate intestinal inflammation via local release of proinflammatory neuropeptides (substance P) and via the activation of extensive circuits that may involve the brain. Taken together, these findings provide plausible explanations for a variety of clinical scenarios ranging from inflammatory bowel disease to pseudo-obstruction syndromes and subgroups of functional bowel disorders.

Adjuvants, Immunologic↗

[Thyroid-intestinal motility interactions summary].

Thyroid diseases may be related to gastrointestinal motility symptoms. Such symptoms can vary in degree and, sometimes, are the only clue of a thyroid disease or, at least, the first. The mechanism by which the thyroid hormones can influence gastrointestinal motility, even if not still completely elucidated, can be found in a synergism between a direct effect of the thyronins and an indirect effect mediated by cathecolamines on the muscle cell receptors. Neck discomfort and dysphagia are common findings in patients with thyroid diseases. Hyper- and hypothyroidism can impair esophageal motility, modifying pharyngo-esophageal structure and/or muscular function and interacting with the neuro-humoral regulation of the esophageal peristalsis. Oesophageal motility alterations, observed in patients affected by small non-toxic goiter, are less understandable. At the gastro-duodenal level, basic and postprandial electric rhythm alterations have been observed in hyperthyroid patients, often associated with delayed gastric emptying, too. In such patients, the autonomous nervous system dysfunction may even modify the neuro-hormonal mutual regulation (vagal influence decrease) of the gastro-duodenal myoelectric activity. Hypothyroidism may cause a delay of the gastric emptying too, but such pattern may also be related to an associated autoimmune disease or to an independent chronic modification of the gastric mucosa. Diarrhoea and malabsorption are common findings together with hyperthyroidism, whereas constipation is frequently observed in hypothyroidism. The clinically most demanding situation is certainly the secondary chronic intestinal pseudo-obstruction syndrome, which involves the bowel in most cases, but may also show up by means of a mega-small bowel or a mega-duodenum, or even all of the above. In conclusion it may be stated that: 1) thyroid diseases may be related to symptoms due to digestive motility dysfunction. 2) Any segment of the gastrointestinal trait may be involved. 3) The typical clinical manifestations of the thyroid illnesses may be borderline, missing or concealed by other intercurrent illnesses, especially in the elderly patients. 4) Motility-related digestive symptoms may conceal an underlying, easily misdetected, thyroid disease and must be therefore carefully analyzed.

Esophageal Motility Disorders↗

Role of thyrotrophin releasing hormone and corticotrophin releasing factor in stress related alterations of gastrointestinal motor function.

There is a growing body of experimental and clinical evidence to indicate that stress influences gastrointestinal motility. The most common pattern of gastrointestinal motor alterations induced by a variety of different stress factors is that of delayed gastric emptying and accelerated colonic transit. Central administration of corticotrophin releasing factor mimics both of these effects. This review focuses on the effects of two centrally acting peptides known to influence gastrointestinal motility and transit in experimental animals: thyrotrophin releasing hormone and corticotrophin releasing factor. The biological actions of these peptides are discussed in relation to the motility changes and pathways involved in their actions.

Animals↗

Effect of vanilloid drugs on gastrointestinal transit in mice.

1. We have studied the effect of capsaicin, piperine and anandamide, drugs which activate vanilloid receptors and capsazepine, a vanilloid receptor antagonist, on upper gastrointestinal motility in mice. 2. Piperine (0.5 - 20 mg kg(-1) i.p.) and anandamide (0.5 - 20 mg kg(-1) i.p.), dose-dependently delayed gastrointestinal motility, while capsaicin (up to 3 mg kg(-1) i.p.) was without effect. Capsazepine (15 mg kg(-1) i.p.) neither per se affected gastrointestinal motility nor did it counteract the inhibitory effect of both piperine (10 mg kg(-1)) and anandamide (10 mg kg(-1)). 3. A per se non effective dose of SR141716A (0.3 mg kg(-1) i.p.), a cannabinoid CB(1) receptor antagonist, counteracted the inhibitory effect of anandamide (10 mg kg(-1)) but not of piperine (10 mg kg(-1)). By contrast, the inhibitory effect of piperine (10 mg kg(-1)) but not of anandamide (10 mg kg(-1)) was strongly attenuated in capsaicin (75 mg kg(-1) in total, s.c.)-treated mice. 4. Pretreatment of mice with N(G)-nitro-L-arginine methyl ester (25 mg kg(-1) i.p.), yohimbine (1 mg kg(-1), i.p.), naloxone (2 mg kg(-1) i.p.), or hexamethonium (1 mg kg(-1) i.p.) did not modify the inhibitory effect of both piperine (10 mg kg(-1)) and anandamide (10 mg kg(-1)). 5. The present study indicates that the vanilloid ligands anandamide and piperine, but not capsaicin, can reduce upper gastrointestinal motility. The effect of piperine involves capsaicin-sensitive neurones, but not vanilloid receptors, while the effect of anandamide involves cannabinoid CB(1), but not vanilloid receptors.

Alkaloids↗

Methods of assessing motility of the digestive system in children.

The study of gastrointestinal motility in children has evolved during the past 25 years. Miniaturization of tools for collecting data has created opportunities to study the maturation of gastrointestinal motility patterns in infants and complaints of abdominal pain, nausea, diarrhea, constipation and distention in children. Available methods, indications for testing, and data evaluation of pediatric esophageal, gastrointestinal, and colonic motility and manometric tests are discussed.

Catheterization↗

Preoperative intraluminal application of capsaicin increases postoperative gastric and colonic motility in rats.

In a model to investigate postoperative gastrointestinal motility with strain gauge transducers in awake rats, we tested the effects of intraluminal capsaicin infusion into the cecum 2 days or 14 days prior to abdominal surgery. Acute infusion of capsaicin into the cecum for 30 minutes increased the gastric, small intestinal, and colonic motility index by up to 115%, 34%, and 59%, respectively, compared to vehicle infusion. Intraluminal capsaicin infusion 2 days prior to abdominal surgery significantly increased the intraoperative gastric and colonic motility index by 166% and 100%, respectively, compared to vehicle, but had no effect on small intestinal motility. The postoperative decrease in gastric or colonic motility was completely prevented by capsaicin pretreatment, representing a 73% and a 72% increase in the motility index during the first postoperative hour and a 40% and a 29% increase in the motility index during the second postoperative hour compared to vehicle, whereas the postoperative decrease in small intestinal motility was not altered by capsaicin pretreatment. In contrast, intraluminal capsaicin infusion 14 days prior to abdominal surgery had no effect on postoperative inhibition of gastrointestinal motility. Our results suggest that capsaicin-sensitive visceral afferent C-fibers, presumably of the submucosa, play an important role in mediating postoperative ileus. Intraluminal capsaicin does probably ablate these nerve fibers temporarily, with no systemic side effects observed with the use of the tail flick test as a measure of skin nociception.

Animals↗

Recovery of gastrointestinal tract motility and myoelectric activity change after abdominal surgery.

OBJECTIVE: To investigate the relationship between fedstate gastrointestinal tract (GI) function and upper GI myoelectric changes seen after abdominal surgery. DESIGN: Twenty-one adult female mongrel dogs underwent either an open cholecystectomy, a laparoscopic cholecystectomy alone, or a laparoscopic cholecystectomy with peritoneal injury (n = 7 for each group). Bipolar recording electrodes were placed on the antrum and 3 sites of the proximal small intestine to record fasting myoelectric data each morning postoperatively. Solid-phase, technetium Tc 99m gastric emptying studies were performed on postoperative days 1 and 2. Radiopaque markers were ingested just before operation, and the excreted markers were counted using x-ray films of the feces. MAIN OUTCOME MEASURES: Postoperative fasting GI myoelectric activity, gastric emptying, and intestinal transit time. RESULTS: Migrating motor complexes (MMCs) in the small intestine were observed in 33.3% and 75.0% of the dogs on postoperative days 1 and 2, respectively. Gastric dysrhythmias were observed in 23.8% and 45.0% of the dogs on postoperative days 1 and 2, respectively. No relationship between type of surgery and the presence of MMCs or gastric dysrhythmias was noted. Gastric emptying was delayed on postoperative day 1 and was unrelated to the presence of MMCs. Transit time was not significantly delayed in dogs without MMCs on postoperative day 1 compared with that in dogs with MMCs on that day. The presence of gastric dysrhythmias did not affect transit time studies. CONCLUSION: Fasting GI myoelectric activity, including the return of MMCs and the presence of gastric dysrhythmias, does not accurately predict fed-state gastrointestinal GI function following abdominal surgery.

Abdomen↗

Effect of duodenectomy on gastric motility and gastric hormones in dogs.

OBJECTIVE: To test the hypothesis that the duodenum is required to coordinate interdigestive insulin secretion with gastrointestinal motility and to determine whether duodenectomy alters the interdigestive cycles of plasma motilin and insulin levels and their relations to insulin secretion and motility. METHODS: Adult mongrel dogs were chronically implanted with force transducers in the stomach, duodenum, and upper jejunum to monitor contractile activity. Eight healthy mongrel dogs were divided into control and duodenectomized dogs. Insulin secretion, gastrointestinal motility, and plasma concentrations of motilin during the interdigestive period were measured in normal and duodenectomized dogs. RESULTS: After duodenectomy, no obvious phase III contractions were seen in the gastric antrum, but migrating phase III contractions were seen in the upper jejunum. The plasma motilin concentration did not fluctuate as it does in normal dogs, and remained low. After duodenectomy, insulin secretory cycles were not coordinated with either cycles of interdigestive motility or the plasma concentration of motilin. Exogenous motilin administration stimulated endogenous insulin release significantly compared with saline-treated controls. The contractile response of the stomach to exogenous motilin after duodenectomy was similar to that of intact dogs. CONCLUSIONS: Duodenectomy disrupts the relation between cycles of both interdigestive gastrointestinal motility and insulin secretion. These effects of duodenectomy may be attributable to interruption of the duodenopancreatic neural connections, hormonal abnormalities, or loss of vagus-sensitive humoral factors. The duodenum, which stores motilin, seems to play an important role in the relations between gastric migrating motor complexes and the concomitant increase of insulin secretion in fasted dogs. The mechanism responsible for the effect of motilin in both duodenectomized and normal dogs may involve a cholinergic pathway.

Animals↗

Gastric emptying and gastrointestinal transit of liquid throughout the first month after thoracic spinal cord transection in awake rats.

Spinal cord transection (SCT) inhibits gastrointestinal motility in awake rats. We studied the gastric emptying (GE) and gastrointestinal transit of liquid throughout the first month after thoracic SCT. Male Wistar rats (N = 66) were submitted to laminectomy followed or not by complete SCT between T4 and T5 vertebrae. Phenol red recovery in the stomach, proximal, mid-and distal small intestine was determined 1, 7, 10, 15, and 30 days thereafter. Gastric recovery increased by 51.2 and 38.9% and mid-intestinal recovery decreased by 45.5 and 66.6% at one and seven days after SCT (P < 0.05). Proximal small intestine recovery increased by 45.9% 10 days after SCT but no inhibition of gastrointestinal motility was observed thereafter. Stool output significantly decreased in the first seven days after SCT (P < 0.05). In summary, gastrointestinal motility in awake rats is inhibited throughout the first 10 days after thoracic SCT but not thereafter.

Animals↗

A novel stable isotope breath test: 13C-labeled glycosyl ureides used as noninvasive markers of intestinal transit time.

OBJECTIVES: Breath tests are widely used for diagnosis and control of treatment efficacy. There is a need for breath test substrates that reflect intestinal transit times under various conditions. METHODS: We synthesized a new class of breath test substrates, 13C-labeled glycosyl ureides, which are specific markers for the action of colonic microbial flora. We then investigated their usefulness as markers of intestinal transit time. RESULTS: Bolus ingestion of 1 g lactose or cellobiose 13C-ureide resulted in bacterial cleavage of the N-glycosyl bond and subsequent urea hydrolysis. 13CO2 appeared in breath and was determined by gas-isotope-ratio-mass spectrometry. Label first appeared after 5-6 h, peak excretion occurred between 8-14 h, and the signal returned to baseline after 18-24 h. Metoclopramide (10 mg) administered 1 h before the substrate advanced the onset of the signal by 2.4 +/- 1.95 h (mean +/- SD; n = 7; p < 0.05) and the time of peak response by 0.8 +/- 1.44 h. Loperamide (16 mg) broadened the peak and delayed the time of breath signal onset by 1.0 +/- 2.78 h and peak excretion by 4.0 +/- 3.7 h (p < 0.05). CONCLUSIONS: The glycosyl ureide breath test reflected intestinal transit time and rapid changes in gastrointestinal motility. This test should be useful in the diagnosis of a variety of gastrointestinal motility disorders and in the development of drugs that affect gastrointestinal motility.

Adolescent↗

Serotonin involvement in the electroacupuncture- and moxibustion-induced gastric emptying in rats.

OBJECTIVE: Electroacupuncture (EA) as well as moxibustion stimulation has been reported to produce an excitatory effect on the gastrointestinal motility of the rat. Serotonergic neurons of the mioenteric and submucous plexus are major participants in the gastrointestinal physiology. Here, we compared the outcomes of the stimulation of a specific set of acupoints with either acupuncture or moxibustion on the gastrointestinal motility and the role of serotonin (5-HT) in this effect. METHODS: To analyze the role of 5-HT on the gastrointestinal motility of the rat, we studied the flow of 25 glass beads administered to the stomach, after treatment of the animals with a serotonin inhibitor (para-chlorophenylalanine [pCPA]). Acupuncture stimulation was performed on acupoints St-36 (Zusanli) and Sp-6 (Sanyinjiao), with electrical stimulation, or on acupoints Ren-10 (Xiawan), Ren-12 (Zhongwan) and St-25 (Tianshu), with moxibustion. Animals subjected to sham stimulation were used as controls in addition to naive, unstimulated animals. RESULTS: Stimulation of the hind limb (St-36 and Sp-6) and abdominal (Ren-10, Ren-12, St-25) acupoints resulted in effective gastric emptying, as compared with sham-stimulated animals. Pretreatment of animals with pCPA abolished either the response provided by acupuncture stimulation in animal groups subjected to hind limb acupoints or the response provided by moxibustion stimulation in abdominal acupoints. CONCLUSION: Our data suggest that moxibustion in the abdominal points and EA in the hind limb require an intact serotonergic pathway. In addition, we suggest that this involvement of serotonin is a general feature of the mediated effects of acupuncture on gastric emptying of the rat.

Acupuncture Points↗

Some aspects of the effects of PL-10.1.AK-15 on the gastrointestinal tract.

PL-10.1.AK-15 is an active fragment of a naturally occurring protein first isolated from human gastric juice. Among its other protective effects, PL-10.1.AK-15 has demonstrated a protective effect on the gastrointestinal tract. The aim of this study was to investigate the influence of PL-10.1.AK-15 on two functional parameters of gastrointestinal function: gastric acid secretion and gastrointestinal motility. Gastric acid secretion was assessed in male Wistar rats using a modified method of Shay, while gastrointestinal motility was assessed in male NMRI mice by charcoal propulsion. PL-10.1.AK-15 was given in three different doses (3, 10 and 100 micrograms/kg body weight) in accordance with the experimental protocol. The results of these experiments indicate that PL-10.1.AK-15 in the investigated doses had no influence on gastric acid secretion or gastrointestinal motility.

Animals↗