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PubMed2006

[The pathophysiology of irritable bowel syndrome: inflammation and motor disorder].

Irritable bowel syndrome (IBS) is one of the most common disorders and a heterogeneous condition in view of symptoms and underlying mechanisms. Though underlying causes of pathophysiologic changes remain unclear, low grade mucosal inflammation and abnormal intestinal motility are accepted mechanisms which alter gut function and generate symptoms of IBS. First, before 1980s, abnormal colonic and rectal motor functions were regarded as the main pathophysiology of IBS, but only 25-75% of IBS patients have apparent motor abnormalities which differ from the motor functions in normal controls. So, various gastrointestinal motility tests were not indicated for the diagnosis of IBS. The high-amplitude propagating contractions of colon in IBS patients may be related to the visceral pain perception. Second, the low grade mucosal inflammation may be involved in the pathophysiology of visceral hypersensitivity. Post infectious IBS (PI-IBS) occupied 6-17% of the total IBS and some previous prospective studies reported that 7-33% of acute bacterial enteritis patients developed IBS after 6-12 months of infection. The relative risk of IBS in the gastroenteritis cohort was 11.9 and the strongest risk factor is the duration of diarrhea. After enteritis event, the increased number of immunocytes, mast cells and large amount of lymphocytes infiltration were revealed in mucosa and enteric nervous system of the gut. Beside the inflammatory cells, enterochromaffin cells, cytokines and inducible nitric oxide may be related to the pathophysiologic mechanism of PI-IBS. Lastly, the abnormalities in the gastrointestinal autonomic nervous system can induce constipation or motor disorders, but further research should elucidate it.

Gastrointestinal Motility↗
PubMedDate not supplied

[Bariatric pacing. A new frontier for the treatment of severe obesity].

A new bariatric procedure, gastric myo-electrical stimulation, has been developed. The Implantable Gastric Stimulator (IGS) induces satiety while avoiding the morbidity and mortality of the common restrictive malabsorptive or combination restrictive or malabsorptive procedure. The procedure does not alter normal anatomy. Advantages of IGS therapy are simplicity, a more rapid procedure, a safer procedure and the absence of nutritional side effects associated with some bariatric operations. The devices consists of a stimulation lead implanted in the gastric wall, connected to an electronic pulse generator (Transcend IGS, Transneuronix Inc, Mt. Arlington, NJ, SA) implanted subcutaneously into the abdominal wall. The lead is implanted by laparoscopy into the muscular layer of the lesser curvature of the stomach at the end of the pes anserinus area. The generator is connected (proper connection, was confirmed via radio frequency programming), and implanted subcutaneously. The mechanism of action of the IGS therapy requires a concomitant program of diet and lifestyle modifications in order to optimise the results.

Bariatric Surgery↗
PubMed2006

Peripheral mechanisms of intestinal dysmotility in rats with salsolinol induced experimental Parkinson's disease.

Gastrointestinal dysmotility in Parkinson's disease (PD) has been attributed in part to peripheral neurotoxine action. Our purpose was the evaluation of the salsolinol effect on intramuscular interstitial cells of Cajal (ICC), duodenal myoelectrical activity (DMA) and vagal afferent activity (VAA) in rats with experimental PD. Twenty rats were divided into 2 equal groups. Experimental PD was produced in one group by 3 weeks of the intraperitoneal salsolinol injections (50 mg/kg/day), whereas the 2-nd group served as control. DMA and VAA were recorded in both groups during fasting and stepwise--gastric distension (GD) of 10 ml. Subsequently fragments of duodenum were removed and intramuscular ICC were assessed as c-Kit antigen percentage in the duodenal muscular zone. Analyses of the fasting DMA and VAA recordings didn't reveal differences between the compared groups. During GD increase of DMA dominant frequency (p=0.04) and VAA frequency (p<0.01) was observed in the controls whereas in the salsolinol group both parameters remained unchanged. Image analysis of duodenum revealed decreased c-Kit expression in the salsolinol-injected animals (p=0.05). The results of our study may suggest the direct effect of salsolinol on both ICC and neuronal pathways of gastro-duodenal reflexes.

Animals↗
PubMed2006

[Effect of modified xiaoyao powder on electrogastrographic picture and pharmacokinetic characteristics of ferulic acid in patients with functional dyspepsia of gan-qi stagnation with pi-deficiency syndrome type].

OBJECTIVE: To investigate the mechanism of Modified Xiaoyao Powder (MXP) on electrogastrogram (EGG) and pharmacokinetic characteristics of ferulic acid (FA) in patients with functional dyspepsia (FD) of Gan-qi stagnation with Pi-deficiency syndrome type (FD-GP). METHODS: The study was conducted following method of pharmacodynamics and pharmacokinetics synchronous determination. The 20 patients with FD-GP and 21 healthy volunteers enrolled were orally administrated with MXP to observe the changes in symptom scores, EGG and pharmacokinetic characteristics of FA in patients using gastrointestinal analyzer and high performance liquid chromatography (HPLC) before and after treatment. RESULTS: After treatment, the symptom scores of patients significantly decreased (P < 0.01). EGG showed that the average amplitude of peak and dominant frequency, etc. at the monitoring points, including gastric body, lesser curvature and the near gastric antrum part of greater curvature, etc. were lower than the normal range, the changes were especially obvious and would be worsened after meals (P < 0.01). After treatment by MXP, all the above indexes were improved either before or after meals. The pharmacokinetic parameters of FA in patients of FD-GP before treatment were lower than those in the healthy control group (P < 0.05) and they were insignificant different by MXP comparing with those in the healthy control group. CONCLUSION: MXP is effective not only in improving clinical symptoms and EGG, but also on pharmacokinetic parameters of FD-GP patients.

Adult↗
PubMed2006

[Gastric myoelectrical activity in children and youth with dyspeptic symptoms].

THE AIM: of the study was to analyze gastric myoelectrical activity in children and youth with dyspeptic symptoms. MATERIAL AND METHODS: 113 children and youth aged 4.5 to 18 years (mean age 13.4 years) with dyspeptic symptoms were enrolled into the study. They were divided into 4 groups: group I--30 patients--without gastrooesophageal acid reflux GER (-) and Helicobacter pylori infection Hp (-), group II--35 patients, GER (+) Hp (-); group III--20 patients, GER (-) Hp (+); group IV --28 patients, GER (+) Hp (+). Gastrooesophageal acid reflux was recognized using 24-hour pH-metry. Helicobacter pylori infection was diagnosed based on histopathological examination of gastric body and/or antrum specimens, urease test and (or) C13 urea breath test. Gastric myoelectrical activity was performed using multichannel electrogastrography (Medtronic POLYGRAM NETTM). Six EGG electrodes were fixed on the subject's abdomen in standard places. Fasting EGG was recorded for 30 minutes followed by one hour postprandial recording after an ingestion of standard meal. Variables assessed were: dominant frequency (DF), the power of the dominant frequency (DP), percentage of bradygastria, normal, tachygastria and arrhythmia frequency, dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC) recorded from each channel (C1, C2, C3, C4) and average percentage slow wave coupling (%SWC) among channels. Comparisons were performed using Kruskal-Wallis's test. RESULTS: In comparison to group II GER (+) Hp (-) in group I GER (-) Hp (-) were recorded significantly higher percentage of bradygastria frequency in C1 and C2 (5% vs 2% and 4% vs. 1%) and postprandialy significantly higher percentage of arrhythmia in C4 (18% vs 13%). In comparison to group Ill GER (-) Hp (+) in group I GER (-) Hp (-) fasting were observed significantly lower dominant frequency (2.89 vs 3.07 cpm), higher percentage of tachygastria frequency in C1 (3% vs. 1%), lower percentage of arrhythmia frequency in C2 (20% vs 29%), higher DPIC in C4 (1.46 vs 1.27), higher average percentage %SWC 2-3 (70% vs 59%) and postprandialy lower DFIC in C4 (0.45 vs 0.54). In comparison to group IV GER (+) Hp (+) in group I GER (-) Hp (-) fasting were recorded lower percentage of arrhythmia frequency in C1 and C2 (18% vs 27% and 20% vs 30%) and postprandialy lower percentage of arrhythmia frequency in C2 (11% vs 17%) and lower DFIC in C2 (0.37 vs 0.48). In comparison to group Ill GER (-) Hp (+) in group II GER (+) Hp (-) fasting were observed significantly lower percentage of bradygastria frequency in C1 (2% vs 4%), higher DPIC in C2 (1.87 vs 1.28), higher average percentage %SWC 1-3 and 2-3 (71% vs 63% and 71% vs 59%) and postprandialy higher percentage of bradygastria frequency in C1 (5% vs 3%) and higher average percentage %SWC 3-4 (68% vs 58%). In comparison to group IV GER (+) Hp (+) in group II GER (+) Hp (-) fasting were recorded significantly higher percentage of normal frequency in C1 and C2 (76% vs 68% and 75% vs 67%) and higher average percentage %SWC 1-2 (77% vs 69%) and postprandialy significantly lower percentage of arrhythmia frequency in C1 (12% vs 18%). In comparison to group IV GER (+) Hp (+) in group Ill GER (-) Hp (+) fasting were observed significantly higher dominant frequency (3.07 vs. 2.87 cpm, p < or = 0.01) and lower percentage of tachygastria frequency in C1 (1% vs 2%) and postprandialy lower percentage of bradygastria frequency in C1 and C2 (3% vs 5% and 3% vs 5%) and lower DFIC in C2 (0.33 vs 0.48). CONCLUSION: In dyspeptic children and youth Helicobacter pylori infection and/ or gastrooesophageal acid reflux have influence on the gastric myoelectrical activity EGG abnormalities in patients with these diseases are varied, mostly preprandialy and recorded from proximal part of the stomach.

Adolescent↗
PubMed1992

Pacing the human stomach.

The aim of this study was to document the pattern of human gastric pacesetter potentials after abdominal operation and to determine whether the potentials could be paced by electrical stimuli. Ten patients undergoing cholecystectomy had temporary serosal electrodes positioned along the greater curvature of the stomach. Bipolar myoelectric recordings and attempts at electrical pacing were made after operation. On postoperative day 1, the pacesetter potentials had a regular frequency (3.2 +/- 0.1 cycles/min), and no gastric dysrhythmias were evident. The distal stomach of nine of ten patients could be entrained by pacing the proximal electrodes (forward pacing) to a maximal rate of 4.3 +/- 0.3 cycles/min (p less than 0.05 versus nonpacing) without a change in propagation velocity or direction. Backward pacing (maximum rate, 3.9 +/- 0.2 cycles/min) was possible in six patients. Forward pacing was successful by day 3 in only four of ten patients, and backward pacing was successful in none of ten patients. A meal given a median of 3.5 days after operation did not change the pacesetter potential frequency, rhythm, or direction of propagation, and three of ten patients had successful forward pacing after a meal. In conclusion, a regular pattern of gastric pacesetter potentials is present after cholecystectomy. The gastric pacesetter potentials can be paced with electrical stimuli, although refinements of the pacing electrodes or stimuli will be needed to achieve long-term pacing. Pacing holds promise as a potential treatment for gastric myoelectrical disorders.

Adult↗
PubMed1991

Prolonged manometric investigation of the colon in research on chronic constipation.

We studied the whole colonic motility for 24 hours in controls and in constipated patients. In the patient group we found a significant reduction in the colonic mass movements (6.1 +/- 0.9 vs 2.6 +/- 0.7 controls vs patients, respectively). The constipated patients showed a reduction of the colonic motor activity after the ingestion of a standard meal. Moreover, they showed, compared with controls, a significant reduction of postprandial mass movements. On the other hand we were not able to find the so-called rectal motor complex described by others. In conclusion, we believe that prolonged colonic manometry would become an important step when evaluating the pathophysiology of constipated patients, particularly of those not responding to standard treatment.

Colon↗
PubMed1991

Assessment of functional recovery after spinal cord injury in rats by reticulospinal-mediated motor evoked responses.

Auditory startle reflexes (ASR) and cortico-myoelectric evoked potentials (CMyEP) were investigated as possible tests of descending motor function in a rat spinal cord injury model. ASR, which consist of stereotyped myoelectric responses recorded in limb and axial muscles to brief loud tones, were found to provide a simple, objective, and reliable measure of motor recovery after spinal cord injury (SCI). While ASR are easily recorded in awake rats, they are blocked by anesthetics, and thus cannot be recorded during the acute injury period. ASR were compared with CMyEP, which can be recorded while the animal is anesthetized. CMyEP were found to produce large myoelectric responses in the vastus lateralis and tibialis anterior hindlimb muscles of the rat similar to ASR except that latencies were approximately 3 msec earlier. Both ASR and CMyEP tended to be bilaterally symmetric regardless of the stimulus configuration, and threshold for responses were the same for both muscles in both hindlimbs. The results suggest that CMyEP may be related to ASR and thus mediated partly by reticulospinal pathways. Evidence supporting this hypothesis is reviewed.

Animals↗
PubMed1991

[Effect of hyperosmotic solutions on duodenal motility: a mechanism of resistance or of propulsion to the luminal flow?].

Infusion of hyperosmotic solutions into the duodenum lead to increased motility. To investigate the mechanism of this effect, 9 healthy volunteers received small infusions of hypertonic (1250 mOsm/kg) NaCl or glucose. Intestinal motility was registered using manometric system with multiple lumens 3 cm apart. Nineteen glucose infusions did not modify intestinal motility. Of 43 NaCl infusions, motility was increased in 24, 7 of them with a typical migratory complex, phase III. In 17 cases, non propagated contractions increasing in a cephalo-caudal direction were noted. The latter may be related to delayed gastric emptying associated to hyperosmotic loads.

Adult↗
PubMed1991

[Computer analysis of motility of small intestine in the dog].

Prolonged recordings at different levels of the small intestine have become necessary in motility studies. This has increased the number of motor events that are registered. The direct measurement of the numerous contractions is time-consuming, monotonous and rutinary. The use of computer analysis of this activity has been small. It is our objective to report our experience with this technique. Simultaneous recordings of small intestine motility were obtained on a polygraph and in a computer with an analogue digital converse system. The following parameters were compared: frequency, amplitude, motility index, and area under the curve. Excellent correlation of results obtained by both methods was observed. Computer analysis reduced the relation recording time/analysis time from 1/1.2 to 1/0.08. In our experience, the study of intestinal motility with analogue digital technique is very efficient and exact.

Animals↗
PubMed1991

Motility disorders in the irritable bowel syndrome.

Specific abnormalities of colonic and small bowel motility are identifiable and associated with symptoms in IBS. Characteristic abnormalities in colonic motility include a prolonged increase in 3-cycles/min colonic motor activity after a meal, an exaggerated increase in 3-cycles/min motor activity in response to stressors and CCK, and increased visceral sensitivity and motor activity in response to balloon distention. Symptoms in patients with IBS correlate in some cases with the abnormal gastrocolonic response and with pain induced by distention at various sites in the colon. Small bowel motility abnormalities identified reproducibly in IBS include an increase in daytime jejunal DCCs, an increase in daytime ileal PPCs, and more frequent cycling of daytime MMCs (in diarrhea-predominant IBS only). DCCs and PPCs are strongly associated with symptoms in IBS, and PPCs associated with altered ileocecal transit may be an important mechanism of symptoms in some patients with IBS. Esophageal and gastroduodenal motility abnormalities are inconsistently identified in IBS, and most symptoms in IBS appear to be secondary to small bowel or colonic dysfunction. Because of the paroxysmal nature of these motor abnormalities in IBS, prolonged motility recordings are required to better understand the pathophysiology of this syndrome. Patients with IBS may have altered visceral sensation and changes in afferent reflex mechanisms that modulate GI motility. These patients do not have a generalized increase in pain perception, but may have a distinct sensitivity to visceral afferent stimulation in both gastrointestinal and other viscera. Whether the altered "setpoint" to visceral afferent stimulation in IBS is intrinsic to the smooth muscle of viscera or secondary to CNS and ANS modulation is not known. Many of the symptoms and abnormalities of small bowel and colonic motility in IBS probably result from these changes in afferent sensation and reflex mechanisms. These findings support the concept that IBS is an abnormality of intestinal motility in conjunction with a "sensitive" gut.

Colonic Diseases, Functional↗
PubMed1991

[Ambulatory manometry].

Dynamic manometry is a new technique which allows an esophageal or gastrointestinal motility recording by means of a portable recorder for a period of 24 hours. It consists of a probe with microtransducers to pick up the pressure variations of the gut lumen and a portable recorder where the pressure signals are amplified and are recorded in analogic or digital form. At the end of the examination the manometric data are transferred in the memory of a computer which afterwards provides analysis, visualization and printing of the tracing. In some system the pressure parameters are automatically calculated (mean frequency, amplitude, duration and propagation of waves, Motility Index, ect) for each period of observation (interdigestive and digestive, diurnal and nocturnal, etc). The ideal equipment, unfortunately, is not available at the moment and some of those commercially available may have particular advantages that others do not and vice versa. In this respect some economic and technical considerations should be made, ranging from their high cost to the vulnerability of some of their components, difficulty in recording the sphincter activity, unreliability incompleteness or excessive complexity of some software etc. However, the main difference of dynamic against stationary manometry consists of the fact that gut motor activity is recorded in a patient not lying in a hospital bed but during the normal life activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMedDate not supplied

Electrogastrography in neonates.

We recorded the electrical signals from bipolar electrodes placed on the abdomen of 7 adults and 10 newborn infants. Data were analyzed by visual inspection and by a wave analysis computer program with a fast Fourier transform. Waves of 3 cycles/min were recorded in adults, and similar 3 cycles/min waves were recorded in infants as well. The percentage of time of 3 cycles/min waves was lower in neonates (13.8% +/- 10.8%) than in adults (57.9% +/- 27.8%) (p < 0.01). Only an electrocardiogram superimposing the flat baseline was recorded in the remaining recording time. Spectral analysis confirmed the validity of the visual analysis, showing clear peaks at 0.05 Hz only when 3 cycles/min waves were visually present and motion artifact was absent. The electrode positions where percentage of time of 3 cycles/min waves was greatest were different for newborns and adults. There was no significant difference in the mean amplitude of the waves between groups. These facts indicate that the electrogastrogram of neonates is different from that of adults in terms of best electrode positions and percentage of time of 3 cycles/min waves.

Adult↗