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PubMed1968

Bile salt and micellar fat concentration in proximal small bowel contents of ileectomy patients.

Studies were carried out to test the hypothesis that abnormal bile salt metabolism (interruption of the enterohepatic circulation) is responsible for steatorrhea in patients with ileal disease and (or) ileectomy.Duodenal bile salt concentration after a single, standard meal eaten at 8 a.m. was measured in 8 patients with ileectomy steatorrhea and compared with 11 normal control subjects and 7 hospitalized patients without gastrointestinal disease. Mean bile salt concentration was approximately half normal in the ileectomy group, but some of the patients fell well within the normal range, even on repeat studies. However, it was shown that the second and third meals eaten during a single day were associated with a marked depression of duodenal bile salt concentration in ileectomy patients, which suggested that the first meals in these patients flush out a large fraction of the bile salt pool. Simultaneously measured turnover studies with taurocholate-(14)C showed at t((1/2)) of 3.1 hr in these patients compared with 29.5 and 32 hr in two control subjects, proving that the enterohepatic circulation had indeed been interrupted by ileectomy. Hepatic synthesis can apparently partially reconstitute the bile salt pool during the overnight period. Additional studies were carried out to determine the relation between bile salt and micellar fat concentration in proximal small bowel contents after ingestion of the same standard meal. Below a bile salt concentration of 1.7 mg/ml, less than 0.8 mg/ml of lipid existed in the micellar phase of intestinal contents, whereas when bile salt concentration exceeded this level the amount of fat in the micellar phase rose progressively. Only 1 of 11 samples from three ileectomy patients had a micellar fat concentration > 0.8 mg/ml, whereas 33 of 42 samples from control subjects had micellar fat concentration > 0.8 mg/ml.Thus, abnormally low duodenal bile salt concentration during at least a portion of the day, with the associated depression of micellar fat, appears to be a major cause of decreased fat absorption in patients with ileectomy steatorrhea.

Adult↗

PubMedDate not supplied

[Experimental study of the effect of intravenous administration of sorbitol on bile excretion].

Experiments were made on dogs with chronic U-shaped gall bladder-duodenal fistulas. The animals received 10% sorbitol (0.6 g/kg) injections into the peripheral vein. Analysis of total bile acids cholesterol and total bilirubin in hourly portions of the bile showed that sorbitol known to produce a choleretic effect when administered enterally and intraduodenally failed to have a choleretic effect after intravenous injection.

Administration, Oral↗

PubMed1979

Identification of gallbladder typhoid carriers by a string device.

The efficiency of a gelatin capsule containing a nylon string for collection of duodenal specimens was investigated in carriers of Salmonella typhosa (typhi). Cultures of duodenal specimens obtained by means of the string capsule were compared with cultures of duodenal specimens obtained by a conventional duodenal tube and with stool cultures Duodenal contents obtained with either the string or tube were more often positive for S. typhosa than were stool cultures. The string, which is as efficient as tube collection but simpler and more comfortable, may be useful in identifying carriers of S. typhosa.

Adult↗

PubMed1976

The role of metoclopramide in peroral jejunal biopsy: a controlled randomized trial.

Metoclopramide is known to enhance gastric emptying and stimulate duodenal and small-intestinal peristaltic activity. The effect of the drug on peroral jejunal biopsy was examined in a controlled, double-blind, randomized trial. Forty-nine patients (24 females and 25 males) who required jejunal biopsy for diagnostic purposes were admitted to the study. All the biopsies were performed by the same operator using the Quinton multipurpose suction biopsy tube and applying the same technique. Twenty-four patients ranging in age from 18 to 67 years (mean 44.5) received placebo intravenously (sodium metabisulfite), and 25 patients from 16 to 73 years old (mean 39.9) received 10 mg of metoclopramide intravenously prior to the jejunal intubation. Objective parameters of the study were (1) time in minutes required for the intubation at the biopsy site, ie, the area at the ligament of Treitz, and (2) fluoroscopy time. Intubation time in the placebo group was 22.3 +/- 1.9 min (mean +/- SEM) vs 11.3 +/- 1.4 min in the metoclopramide group (P less than 0.001). Fluoroscopy exposure time was 2.47 +/- 0.25 in the placebo group vs 1.40 +/- 0.12 min in the metoclopramide group (P less than 0.001). Subjective clinical evaluation of the operator's assessment of the procedure was based on a 0-4 scale (much easier = 0, easier = 1, average = 2, harder = 3, and much harder = 4). Metoclopramide administration resulted in a significantly easier performance of the procedure (P less than 0.001) but did not influence patient tolerance. Three patients who received metoclopramide and one receiving placebo developed mild to moderate drowsiness of short duration. The results of this controlled trial indicate that metoclopramide significantly shortens the time required for jejunal biopsy and reduces fluoroscopy exposure. Its regulatory action on gastrointestinal motility contributes to the easier performance of a valuable diagnostic procedure.

Adolescent↗

PubMed1983

Effect of a transpyloric tube on gastric emptying and duodenogastric reflux in the dog.

The effect of a transpyloric tube on duodenogastric reflux and on gastric emptying was studied in dogs with either an intact pylorus, a Heineke-Mikulicz pyloroplasty, or an extramucosal circular pylorectomy. In fasting dogs, duodenogastric reflux was 10 times smaller than after feeding a liquid lipid meal. A transpyloric tube increased the reflux rate in fasting, but not in fed dogs, while pylorectomy increased reflux rate and intragastric accumulation of a duodenal marker in fed, but not in fasting dogs. It is concluded, therefore, that in the dog (1) methods to measure duodenogastric reflux should not involve the necessity to position a transpyloric tube and (2) the pylorus and adjacent structures are involved in keeping duodenogastric reflux at a low level.

Animals↗

PubMedDate not supplied

Non-absorbable antibiotics and small bowel bacterial overgrowth.

The normal gastrointestinal flora includes no more than 10(3) organisms/ml of gastric aspirate and no more than 10(5) organisms/ml of duodenal or jejunal juice. The organisms are primarily gram-positive and aerobic bacteria. In particular anatomical or functional predisposing conditions, an abnormal colonization takes place in the small bowel with microbial concentrations > or = 10(7)/ml of aspirate and with a predominance of anaerobes and coliforms. At times this small bowel bacterial overgrowth remains asymptomatic, but more often leads to a true malabsorption syndrome with symptoms, such as diarrhoea, weight loss and megaloblastic anemia. The most accurate procedure for confirming the presence of this condition is represented by the bacterological analysis of the jejunal aspirate. The routine use of this method is, however, notably hindered by the need for intubation of the patient and by the lack of laboratories suitably equipped for anaerobe culture. As an alternative to this complex procedure, numerous non-invasive tests have been perfected over the last few years, including the glucose- or lactulose- H2 breath test. The main aim of the treatment of the small bowel bacterial overgrowth is the suppression of the bacterial colonization using antimicrobial therapy. Among the local-action non-absorbable antibiotics, rifaximin, was shown to have bactericidal activity against aerobes and anaerobes bacteria, such as bacteroides, lactobacilli and clostrides. In controlled clinical trials the antibiotic has demonstrated therapeutic efficacy in bacterial origin diarrhoea, in porto-systemic encephalopathy, in diverticulosis and, finally, in small bowel bacterial overgrowth.

Bacterial Infections↗

PubMedDate not supplied

Placement of a duodenal feeding tube via gastrostoma with fiberoptic bronchoscope.

We report a case of esophageal disruption that required a duodenal feeding tube. Because of collapse of the gastric outlet secondary to severe emaciation, several attempts to place a tube into the duodenum via gastrostoma had ended in failure. We finally were able to accomplish it with the aid of a fiberoptic bronchoscope and a Swan-Ganz catheter. The procedure is described and discussed.

Adult↗

PubMed1990

Relative absorption of the two enantiomers of terbutaline after duodenal administration.

The absorption of the two enantiomers of terbutaline, (+)-terbutaline and (-)-terbutaline, and of the racemate, (+/-)-terbutaline, has been studied in six healthy volunteers using a newly developed intestinal perfusion technique. The area under the plasma concentration curve for the (-)-enantiomer was more than twice that for the (+)-enantiomer. The data demonstrate a clear difference in absorption efficiency between (-)- and (+)-terbutaline, but further studies are required to establish whether (-)-terbutaline influences the absorption of (+)-terbutaline.

Adult↗

PubMed1992

Vagally mediated feeding responses to phloridzin infusion in the rabbit.

Rabbits were infused with the plant glycoside, phloridzin, which blocks absorption of glucose across a number of bodily tissues. Feeding was dramatically increased in the first 0.5 h following phloridzin infusion into either the duodenum or the hepatic-portal vein of intact rabbits. Food intake covaried inversely with glycemic levels after phloridzin infusion into the hepatic-portal vein, but rabbits did not show a systematic relationship between blood glucose levels and food intake following duodenal infusion of phloridzin. When administered into the general circulation via the jugular vein, phloridzin did not elicit feeding. Finally, vagotomized rabbits did not show the hyperphagic response to phloridzin that was observed in intact rabbits. It was concluded that the feeding response to phloridzin is vagally mediated and appears to be induced by glucose transport inhibition at some peripheral site.

Animals↗

PubMed1999

Guanidino group is involved in the stimulation of exocrine pancreatic secretion by protamine in normal and chronic bile-pancreatic juice-diverted rats.

We previously demonstrated that the feeding of guanidinated casein, whose lysine residues are converted to homoarginine, stimulates pancreatic secretion much higher than that of intact casein in chronic bile-pancreatic juice (BPJ)-diverted rats, which suggests that the guanidino group is involved in BPJ-independent enhancement of pancreatic secretion. However, the role of the guanidino group in the protein for the enhancement of pancreatic secretion has not been clarified. In this study, we examined the stimulation of pancreatic secretion by a arginine rich dietary protein, protamine (25, 50 mg/ml), and then determined whether the guanidino group in protamine was responsible for the secretory responses in normal and BPJ-diverted rat by comparison with pancreatic secretion between intact and deguanidinated protamine. The deguanidinated protamine was prepared by converting arginine residues of salmon protamine to ornithine using heated hydrazine (conversion rate of arginine residue was 87%). In normal rats, pancreatic protein and chymotrypsin secretion were stimulated in dose-response fashion after a duodenal instillation of native protamine solution (25, 50 mg in 1 ml). In chronic BPJ-diverted rats, native protamine (25 mg) maximally stimulated pancreatic protein and protease secretion. In contrast, deguanidinated protamine (50 mg in 1 ml) did not stimulate pancreatic secretion in both normal and BPJ-diverted rats. In addition, the duodenal administration of arginine, which is equal to the amount contained in 50 mg of native protamine, had no effect on pancreatic secretion in both rats. These results suggest that a naturally occurring protein, protamine, stimulates pancreatic secretion by a luminal BPJ-independent mechanism and that the guanidino group in this protein is responsible for stimulating pancreatic secretion in BPJ-diverted rats.

Amino Acids↗

PubMed2005

Establishment of a pig model with enteric and portal venous drainage of pancreatoduodenal transplantation.

AIM: To establish the pig model of pancreatoduodenal transplantation with enteric drainage (ED) and portal venous drainage (PVD). METHODS: Forty-six hybrid Landrace pigs were divided into two groups (donors and recipients) randomly, and pancreatoduodenal allotransplantation was performed. Donors were perfused via abdominal aorta without clamping the portal venous outflow with UW solution at 80-100 cm H2O after heparinization. Whole pancreato-duodenal grafts were harvested with segments of abdominal aorta and portal vein, and shaped under 4 degrees UW solution. Then, end-to-end anastomosis was performed with the donor iliac artery bifurcation Y graft to the recipient superior mesenteric artery and celiac artery. Furthermore, type I diabetes model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesentery vein. Meanwhile, end-to-side anastomosis was performed with the donor common iliac artery bifurcation Y graft to the recipient abdominal aorta, and side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. Levels of plasma glucose, insulin and glucagon were measured during the operation and on the 1st, 3rd, 5th, and 7th d after operation. RESULTS: Pancreatoduodenal allotransplantation was performed on 23 pigs of which 1 died of complication of anesthesia. The success rate of operation was 95.6%. Complications of operation occurred in two cases in which one was phlebothrombosis with an incidence of 4.6%, and the other was duodenojejunal anastomotic leak with an incidence of 4.6%. The level of plasma glucose decreased within 30 min, after removal of pancreas and recovered on the 2nd d after operation. The level of plasma insulin and glucagon increased within 30 min after removal of pancreas and recovered on the 2nd d after operation. Rejection occurred on the 1st d and reached the worst level on the 7th d after transplantation, without change of plasma insulin and glucagon or clinical symptoms of rejection. CONCLUSION: Pancreatoduodenal transplantation in pigs can treat type I diabetes. ED and PVD can keep the function of endocrine in normal. The technique of pancreatoduodenal transplantation with ED and PVD may pave the way for the further application of pancreas transplantation in clinic.

Animals↗

PubMed1985

A continuous manometric study of the human pylorus.

Previous manometric studies of the pylorus in humans have yielded conflicting data. These interstudy variations may be the result of differences in technique. It is also possible that pyloric pressure shows cyclic variations with the interdigestive motility complex. Pyloric pressure was monitored continuously for 300 min in 6 healthy men by means of a Dent sleeve. Gastroduodenal activity was measured simultaneously by using a perfused catheter system with two antral and two duodenal ports. With this method the pylorus was shown to have no elevation in basal pressure above baseline duodenal pressure during phase III. Basal pyloric pressure varied between subjects in phases I and II, being elevated in some but not in others. Subjects restudied on a separate day often showed a different pattern of activity. Pyloric pressure increased gradually in response to duodenal acidification. This response was blocked by pretreatment with naloxone. The pylorus also showed phasic activity, which was maximal in phase III. This phasic activity could not be distinguished from that of the adjacent antrum and duodenum. In conclusion, pyloric pressure patterns showed marked variation within and between subjects. These variations may explain some of the differences between previous studies.

Adult↗

PubMed1995

Effects of duodenal and distal ileal infusions of glucose and oleic acid on meal patterns in rats.

The mechanisms mediating the anorexic effects of nutrients in the proximal and distal small intestine are not clearly understood. We determined the dose-dependent effects of duodenal and distal ileal infusions of glucose and oleic acid on meal patterns in ad libitum feeding rats. Rats with cannulas in both the duodenum and ileum received a 2-h infusion of glucose (0, 800, 1,600, 3,200, 6,400, or 12,800 mumol/h) or oleic acid (0, 48, 240, 640, or 1,280 mumol/h) into the duodenum or ileum at the start of the dark period, and meal patterns were monitored for 4 h. Cumulative food intake was inhibited dose dependently by ileal as well as duodenal infusion of both glucose and oleic acid. Ileal glucose was more inhibitory than duodenal glucose, whereas duodenal oleic acid was more inhibitory than ileal oleic acid. Duodenal glucose and oleic acid inhibited feeding by decreasing meal frequency; ileal oleic acid decreased only meal size, whereas ileal glucose reduced both meal size and frequency. We interpret these results to suggest that ileal oleic acid and glucose suppress feeding by different mechanisms and that these mechanisms differ from those mediating the anorexic responses to oleic acid and glucose in the duodenum.

Animals↗

PubMed1987

Carcinoma of the ampulla of Vater. The role of endoscopic drainage.

Endoscopically placed biliary endoprostheses were used to treat obstructive jaundice in 71 patients with ampullary carcinoma. Successful placement of an endoprosthesis was achieved in 68 patients (95.8%). Bilirubin declined in 67 patients (98.5%). There was no procedure-related mortality. Twenty-two patients (31%) received further surgical therapy, and 47 received an endoprosthesis as their only therapeutic intervention. In the latter group, bilirubin normalized in 44 of 46 patients surviving longer than 30 days (95.7%). Mean survival was 466 days (median 410, range 23-1515), which compares favorably with surgical palliation. Complications mainly involved clogging of the endoprosthesis, which was easily treated endoscopically and, more significantly, duodenal stenoses secondary to continued tumor growth in almost 25% of the patients. Although endoscopic drainage is a safe and effective method of relieving biliary obstruction in patients with ampullary carcinoma, we feel it should be reserved for poor surgical candidates and for those patients with a limited life expectancy due to metastatic disease.

Adenocarcinoma↗

PubMed1991

Changes of duodenal pH and pancreatic exocrine function after upper G-I intraluminal ethanol administration.

Using 3 outbred dogs with pancreatic, gastric and jejunal fistulas, we examined changes in pancreatic exocrine secretion, duodenal pH and plasma CCK concentration after intragastric or intrajejunal administration of ethanol. Intragastric administration of 20% or 40% ethanol significantly lowered the pH in the duodenal cavity, and pancreatic fluid secretion and bicarbonate excretion were stimulated. Intrajejunal administration of ethanol elicited stronger responses. Plasma CCK concentration was not changed or was only slightly lowered by ethanol administration in the digestive tract. It is assumed that stimulation of pancreatic exocrine secretion was mediated by the secretion of gastric acid.

Animals↗

PubMed1999

Digestion and absorption of 2 fat emulsions with different droplet sizes in the human digestive tract.

BACKGROUND: The extent of fat emulsification affects the activity of digestive lipases in vitro and may govern digestion and absorption of dietary fat. OBJECTIVE: We investigated the effect of the fat globule size of 2 enteral emulsions on fat digestion and assimilation in humans. DESIGN: Healthy subjects received intragastrically a coarse (10 microm) and a fine (0.7 microm) lipid emulsion of identical composition in random order. Gastric and duodenal aspirates were collected throughout digestion to measure changes in fat droplet size, gastric and pancreatic lipase activities, and fat digestion. Blood lipids were measured postprandially for fat assimilation. RESULTS: Despite an increase in droplet size in the stomach (2.75-6.20 microm), the fine emulsion retained droplets of smaller size and its lipolysis was greater than that of the coarse emulsion (36.5% compared with 15.8%; P < 0.05). In the duodenum, lipolysis of the fine emulsion was on the whole higher (73.3% compared with 46.3%). The overall 0-7-h plasma and chylomicron responses given by the areas under the curve were not significantly different between the emulsions, but the triacylglycerol peak was delayed with the fine emulsion (3 h 56 min compared with 2 h 50 min). CONCLUSIONS: Fat emulsions behave differently in the digestive tract depending on their initial physicochemical properties. A lower initial fat droplet size facilitates fat digestion by gastric lipase in the stomach and duodenal lipolysis. Overall fat assimilation in healthy subjects is not affected by differences in initial droplet size because of efficient fat digestion by pancreatic lipase in the small intestine. Nevertheless, these new observations could be of interest in the enteral nutrition of subjects suffering from pancreatic insufficiency.

Absorption↗

PubMed1996

Fat absorption is not complete by midgut but is dependent on load of fat.

Since the intubation study of B. Borgstrom, A. Dahlqvist, and G. Lundh (J. Clin. Invest. 36: 1521-1536, 1957) in humans, the completion of fat absorption within the proximal small intestine has been widely accepted. Based on this report, it has been assumed that the distal small intestine is exposed to fat only in the setting of pathology. This concept may be flawed, since completeness of fat absorption was calculated from the recovery of a water-soluble marker but the aqueous phase is now known to move independently from fat. To reexamine the question of whether fat absorption is complete by midgut, we measured the recovery of a fat-specific marker, 99mTc-thiocyanate, in a canine model equipped with duodenal and midgut fistulas. The fistulous output allowed for the measurement of the amount of fat entering the small intestine and the amount of fat entering the distal one-half of the small intestine. Emulsion meals containing 15 or 60 g of corn oil were tested. The importance of fat exposure of the distal one-half of the small intestine was further confirmed by comparing the fistulous fat recovery under two different patterns of exposure [allowing (ALL) or denying (150 cm) access to the distal small intestine]. We found that fat recovery depended on 1) the dose of fat (15 vs. 60 g; P < 0.0005), 2) the pattern of exposure (150 cm vs. ALL; P < 0.01), and 3) the fistulous position (duodenal vs. midgut; P < 0.005). Specifically, under a 150-cm exposure pattern, whereas 8.8 +/- 1.8 g (means +/- SE) of fat emptied into the duodenum after the 15-g fat meal, 32.6 +/- 3.2 g emptied after the 60-g fat meal. Correspondingly, although 3.5 +/- 1.5 g of fat were recoverable from the midgut fistulous output after the 15-g meal, a much larger amount, 17.1 +/- 5.6 g of fat, was recoverable and therefore not absorbed by the proximal one-half of the small intestine after the 60-g meal. The amount of fat recovery at each fistula was reduced when chyme was allowed access to the whole gut (by triggering fat-induced ileal brake). We conclude that the intestinal length required for fat absorption depends on the load of fat in the meal so that, even after usual meals, absorption of fat is not complete by midgut.

Absorption↗

PubMed1997

A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn's disease.

BACKGROUND & AIMS: Small bowel enteroclysis (SBE) has been suggested to be superior to the small bowel follow-through (SBFT) for diagnosing the presence and extent of Crohn's disease. The aim was to perform a prospective randomized study at a single university medical center comparing SBE with SBFT in patients with Crohn's disease. METHODS: Consecutive patients with known Crohn's disease were randomized to receive either SBE or SBFT as the initial study and had the alternate study performed within 2 weeks. RESULTS: Twenty-six patients were enrolled. The mean time between studies was 8.7 +/- 0.8 days. Both studies were normal in 7 cases. The SBE was negative in 3 cases with positive findings of Crohn's disease by SBFT. One of these cases was a false-positive SBFT. The SBE and SBFT were both diagnostic of Crohn's disease in 15 cases; in 6 cases there was uniform agreement regarding disease pattern. The SBFT more accurately reported mucosal detail (n = 3) and a greater number of fistulas (n = 2). The SBE missed duodenal disease (n = 4). CONCLUSIONS: In known Crohn's disease, the SBFT is the procedure of choice. It is safer, preferred by patients, and will not miss gastroduodenal disease, and when the result is normal, there is no need to perform SBE.

Administration, Oral↗