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PubMed1991

Persistent diarrhea and fecal shedding of retroviral nucleic acids in children infected with human immunodeficiency virus.

Gastrointestinal dysfunction is a serious problem in many children infected with human immunodeficiency virus (HIV), the etiology of which has not been clearly defined. Quantitative nucleic acid amplification was used to study the correlation between shedding of HIV nucleic acids and gastrointestinal symptoms in HIV-infected infants and children. Many with HIV infection and persistent diarrheal disease shed HIV nucleic acids in their feces, as did an HIV-infected patient without apparent diarrheal disease. HIV nucleic acids were not found in feces of non-HIV-infected individuals. Intestinal infection with HIV appears to be important in the pathophysiology of gastrointestinal dysfunction in infants and children with HIV infection. Furthermore, the fecal shedding of HIV may play a role in HIV transmission in environments prone to high levels of fecal-oral contamination.

Base Sequence↗
PubMed1999

Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus.

Although relatively frequent. diabetic involvement of digestive tract motility has not been investigated extensively in different organs. The authors studied esophageal, gastric, and gallbladder motor function in 35 type 2 (noninsulin-dependent) diabetic patients to determine the extent of gut involvement. Of these patients, 27 (77%) had peripheral neuropathy, 12 (34%) had both peripheral and autonomic neuropathy, and 22 (63%) had gastrointestinal symptoms. Esophageal manometric abnormalities were recorded in 18 patients, and delayed radionuclide emptying of the esophagus was documented in 16 patients, with a 83% concordance between the two tests. Scintigraphic gastric emptying of solids was delayed in 56% of patients, whereas gallbladder emptying after cholecystokinin stimulation was reduced in 69% of them. In 74% of patients at least one of the viscera under investigation showed abnormal motor function; however, only 36% of patients displayed involvement of the three organs. Gastrointestinal symptoms, duration and therapy of diabetes, previous poor glycemic control, and retinopathy did not correlate with the presence or the extent of motor disorders. Neuropathy was not predictive of gastrointestinal involvement and its extent; however, when motor abnormalities were present in patients with neuropathy, these were usually more severe. Gastrointestinal motor disorders are frequent and widespread in type 2 diabetics, regardless of symptoms. Autonomic neuropathy has a poor predictive value on motor disorders (0.75 for the esophagus, 0.5 for the stomach, 0.8 for the gallbladder), thus suggesting the coexistence of other pathophysiologic mechanisms.

Adult↗
PubMed2006

Gastrointestinal motility and glycemic control in diabetes: the chicken and the egg revisited?

Upper gastrointestinal dysfunction occurs frequently in diabetes and potentially contributes to both abdominal symptoms and impaired glycemic control; conversely, variations in blood glucose concentration reversibly affect gut motility in humans. In this issue of the JCI, Anitha et al. report apoptosis of rodent enteric neurons under hyperglycemic conditions, both in vitro and in vivo, associated with impaired PI3K activity and preventable by glial cell line-derived neurotrophic factor. These observations add to recent insights gained from animal models regarding the etiology of diabetic gastrointestinal dysfunction, but investigators must strive to translate animal data to human diabetes.

Animals↗
PubMed2004

Routine cesarean delivery does not improve the outcome of infants with gastroschisis.

BACKGROUND/PURPOSE: The optimal mode of delivery for infants with gastroschisis is controversial. The authors compared the outcomes of infants with gastroschisis born vaginally (VD) or by cesarean section (CS). METHODS: A retrospective analysis of infants with gastroschisis born between 1990 and 2000 was performed. Assessment included patient demographics, respiratory distress, method of closure, number of surgeries, presence of atresia, feeding parameters, parenteral nutrition days (TPN), time to full feeding (FPO), mortality, and length of stay (LOS). Subgroup analyses were performed for those infants requiring cesarean section for fetal distress. Student's t test/analysis of variance (ANOVA) or chi2/Fisher's Exact tests were used for statistical analysis. Logistic and linear regression analyses were also performed. RESULTS: One hundred thirteen patients were studied (82 VD and 31 CS). No statistical difference existed between the VD and CS groups for perinatal complications, method of closure, number of surgeries (1.6 each), TPN (40.6 v 46.0 days), FPO (40.4 v 47.1 days), mortality (9.7 v 6.5%) and LOS (53.4 v 61.7 days). CS was associated with increased stenosis (25.8 v 4.9%; P =.003), gastrointestinal dysfunction (25.8 v 11.0%; P =.049), and respiratory distress (16.1 v 3.7%; P =.035). Many of these differences did not persist when infants undergoing CS for fetal distress were excluded from the analysis. However, regression analysis identified CS as an independent risk factor for the development of respiratory distress at birth (odds ratio, 7.11; CI, 1.06 to 47.7), with a trend to increased gastrointestinal dysfunction (odds ratio, 4.35; CI, 0.77 to 24.61). CONCLUSIONS: The routine use of CS for infants with gastroschisis is not supported by our results because equivalent outcomes were observed with both modes of delivery. CS may be a necessary intervention for fetal distress.

Cesarean Section↗
PubMed1984

Familial amyloidosis with polyneuropathy. Aspects of the relationship between gastrointestinal symptoms, EMG findings, and malabsorption studies.

Fifty-two patients with a confirmed diagnosis of familial amyloidosis with polyneuropathy living in northern Sweden were investigated. Gastrointestinal symptoms, mainly in the form of changed bowel habits, were found in 47 patients. Symptoms of polyneuropathy of the peripheral nerves usually preceded the gastrointestinal symptoms, but in 12 patients gastrointestinal dysfunction started either before or simultaneously with the neurological symptoms. Steatorrhea was found in 30 patients (58%) and an impaired D-xylose absorption in 52%. Diarrhea, anal incontinence, and a high degree of peripheral denervation indicating a severer disease were related to the presence of steatorrhea. The results of oral lactose and glucose tolerance tests were essentially normal. The results suggest that the main reason for the gastrointestinal dysfunction is a disruption of the gut autonomic nervous system rather than a barrier to the absorption of nutrients across the intestinal wall.

Adult↗
PubMed2005

Mortality trends of HIV-infected patients after the introduction of highly active antiretroviral therapy: analysis of a cohort of 3,322 HIV-infected persons.

INTRODUCTION: The implementation of highly active antiretroviral therapies (HAART) has reduced the mortality attributed to the human immunodeficiency virus (HIV) infection. Variation in the specific causes of death has also changed since the implementation of these therapies. METHODS: A prospective study was performed in 3322 HIV-infected persons enrolled in Puerto Rico between 1992 and 2003. We measured the mortality rates and the causes of death as listed in the death certificate and analyzed the variation as a function of the antiretroviral therapy (ART) use. Statistical analyses were performed to evaluate differences. RESULTS: The study found that persons treated with HAART had significantly lower mortality risk than ART-naïve persons, regardless of gender and the use of injecting drugs. AIDS-defining conditions as a cause of demise were less frequently reported in patients with HAART. Gastrointestinal dysfunction, sepsis, metabolic abnormalities, and non-Kaposi neoplasms were more frequently reported as causes of death in patients treated with HAART. Hepatic failure as cause of death was also more frequent in these patients. The variation in the mortality trends was similar in both genders and according to the presence or absence of intravenous drug use. CONCLUSIONS: Highly active antiretroviral therapies (HAART) is associated with significant reduction in mortality and an increment in gastrointestinal dysfunction, sepsis, non-Kaposi neoplasms, and metabolic disorders as listed causes of death. Adverse and toxic profile of ART, along with the potential synergy of concomitant conditions, may accelerate these trends. Continued mortality surveillance of HIV/AIDS is imperative to follow the epidemic changes.

Adult↗
PubMed1991

Percutaneous transluminal coronary angioplasty in hypothyroidism.

PURPOSE: To determine the risks of percutaneous transluminal coronary angioplasty (PTCA) in hypothyroid individuals. PATIENTS AND METHODS: In a retrospective cohort study, 13 patients with primary hypothyroidism were identified among 382 consecutive PTCA cases in 1987. Twenty-two euthyroid PTCA control subjects and 13 hypothyroid patients who underwent coronary artery bypass surgery (CAB) were identified for comparison. RESULTS: Hypothyroid and euthyroid PTCA patients had similar mean ages, numbers of prior and recent acute myocardial infarctions, diseased coronary arteries, coronary arteries dilated, and serum cholesterol levels. There were no significant differences in procedure-related mortality (0% versus 0%); coronary artery dissection (23% versus 23%); reocclusion (8% versus 5%); bradycardia (0% versus 0%); heart failure (0% versus 5%); hypotension (31% versus 27%); myocardial infarction (8% versus 0%); gastrointestinal dysfunction (0% versus 0%); neuropsychiatric disturbance (15% versus 9%); hyponatremia (23% versus 23%); hypothermia (0% versus 0%); or fever (15% versus 5%). Hematoma formation tended to be more frequent in the hypothyroid group (38% versus 18%, p = 0.18). Similar results were obtained when the subgroup of more severely hypothyroid patients (thyrotropin level more than 20 mU/L, n = 7) was examined. Compared to hypothyroid CAB patients, hypothyroid PTCA patients had less incidence of heart failure (0% versus 31%, p less than 0.025); neuropsychiatric disturbance (15% versus 54%, p less than 0.025); hyponatremia (23% versus 62%, p less than 0.05); gastrointestinal dysfunction (0% versus 23%, p less than 0.025); and fever (15% versus 62%, p less than 0.001). CONCLUSION: PTCA can be performed in hypothyroid patients without increased mortality or major morbidity, and when appropriate, may be preferred to bypass surgery for coronary revascularization in patients intolerant of full thyroid hormone replacement.

Angioplasty, Balloon, Coronary↗
PubMed2001

Paraneoplastic gastrointestinal motor dysfunction: clinical and laboratory characteristics.

OBJECTIVES: The aim of this study was to describe the clinical, manometric, and serological characteristics of 12 patients with paraneoplastic GI motor dysfunction and to assess the contributory role of diagnostic tests. METHODS: Twelve patients diagnosed with malignant tumors and GI motor dysfunction were identified at the Mayo Clinic from 1985 to 1996. RESULTS: Cancers identified were: nine small cell lung carcinoma (SCLC), one anaplastic lung adenocarcinoma, one retroperitoneal lymphoma, and one ovarian papillary serous adenocarcinoma. GI symptoms preceded the tumor diagnosis in all cases of SCLC (mean, -8.7 months, range, -1 to -24 months, n = 9). The diagnosis of a malignant tumor preceded the onset of GI symptoms in the three patients with other neoplasms (6, 12, and 24 months). Five of the nine patients found to have SCLC had no evidence of tumor on initial chest x-ray. One or more paraneoplastic autoantibodies were found in 10 of the 11 patients tested by autoimmune serology. Type 1 antineuronal nuclear antibody (ANNA-1 or anti-Hu) was detected in eight of the nine patients with SCLC (one patient was not tested). The patient with ovarian carcinoma had type 1 Purkinje cell cytoplasmic antibody (PCA-1 or anti-Yo). N-type calcium channel antibodies were found in one patient with SCLC, one with a retroperitoneal B cell lymphoma, and one with ovarian carcinoma. Gastric emptying was delayed in 89% (eight of nine tested) and 80% (four of five tested) had esophageal dysmotility. Autonomic reflex tests were abnormal in the seven patients tested. CONCLUSIONS: The diagnosis of paraneoplastic GI motor dysfunction requires a high index of clinical suspicion. A panel of serological tests for paraneoplastic autoantibodies, scintigraphic gastric emptying, and esophageal manometry are useful as first-line screening tests. Seropositivity for ANNA-1, PCA-1, or N-type calcium channel-binding antibodies should prompt further evaluation for an underlying malignancy even when routine imaging studies are negative.

Autoimmune Diseases↗
PubMed1997

Predictive factors for neonatal morbidity in neonates with an umbilical arterial cord pH less than 7.00.

OBJECTIVE: Fewer than 50% of neonates with an umbilical arterial pH < 7.00 have neonatal complications. Our objective was to identify clinical predictive factors for adverse outcomes in this group of neonates. STUDY DESIGN: In this case-control study both cases and controls had an umbilical arterial cord pH < 7.00. Cases were defined as those neonates who had seizures, grade 3 to 4 intraventricular hemorrhage, gastrointestinal dysfunction, respiratory distress syndrome requiring intubation, sepsis, or death. Controls had an umbilical arterial cord pH < 7.00 and no complications. A multivariable prediction model was created, with variables having an association with adverse outcome by bivariate analyses, attempting to predict which neonates in this umbilical arterial pH range are at greatest risk for adverse outcomes. RESULTS: We identified 73 of 10,705 neonates born between July 1992 and October 1996 with an umbilical arterial cord pH < 7.00. Thirty-five neonates met our case definition, and the remaining 38 composed the control group. Cases had significantly lower arterial pH values and 1- and 5-minute Apgar scores, greater arterial base deficit values, and a higher incidence of abruptio placentae and maternal cocaine use. More cases were delivered before 34 weeks. There were three neonatal deaths, two cases of grade 3 or 4 intraventricular hemorrhage, five cases of gastrointestinal dysfunction, and four cases of neonatal seizures. In our predictive model for adverse neonatal outcome, an arterial base deficit > or = 16 mmol/L and a 5-minute Apgar score < 7 had a sensitivity and a specificity of 79% and 80.8%, respectively. CONCLUSION: Neonatal morbidity in neonates with an umbilical arterial cord pH < 7.00 can be predicted by a high arterial base deficit value and low 5-minute Apgar score.

Acidosis↗
PubMed1979

[Sensitivity to antibiotics and antibacterial preparations of conditionally pathogenic bacteria isolated from patients with gastrointestinal tract dysfunctions].

Sensitivity of 690 cultures of the conditionally pathogenic microbes of Enterobacteriaceae and Pseudomonadaceae to 17 drugs was studied with the agar diffusion method. It was found that 98.6 per cent of the cultures had multiple resistance to 2--10 drugs. Most of the cultures were resistant to erythromycin, carbenicillin and ampicillin. Different species of the conditionally pathogenic microorganisms were resistant to different numbers of the drugs. Thus, Ps. aeruginosa cultures were resistant to 6--10 drugs, the cultures of Citrobacter were resistant to 3--8 drugs and the cultures of Kl. pneumonia were resistant to 2--5 drugs. Levomycetin, tetracycline, streptomycin and biseptol proved to be the most active antibacterial drugs.

Anti-Bacterial Agents↗
PubMed1984

Myenteric plexus in streptozotocin-treated rats. Neurochemical and histochemical evidence for diabetic neuropathy in the gut.

Adrenergic, cholinergic, and serotoninergic nerves were studied in the myenteric plexus of ileum and colon from streptozotocin-treated rats, an animal model of juvenile-onset diabetes. In view of clinical reports implicating diabetic autonomic neuropathy as the cause of gastrointestinal dysfunction in diabetes mellitus, neurochemical and histochemical techniques were used to study changes in the innervation of the gut. In the myenteric plexus of the ileum from diabetic animals, adrenergic nerves displayed signs of degeneration and the brightness of fluorescence in serotoninlike immunoreactive nerves was lower. Cholinergic nerves, however, did not display any signs of reduction in the ileum, and both choline acetyltransferase and acetylcholinesterase activities per centimeter were increased. In contrast, in the proximal colon 8 wk after induction of diabetes, neurochemical assays revealed significant increases in noradrenaline and serotonin levels as well as choline acetyltransferase activity, although no obvious changes in the pattern of innervation could be detected histochemically. The results indicate that changes do occur in the innervation of the gut of the streptozotocin-diabetic model shortly after the induction of diabetes, although they differ significantly in the ileum and colon; these may be of relevance to the types of gastrointestinal dysfunction displayed in human diabetes.

Animals↗
PubMed2003

Postoperative ileus on a gynecologic oncology service--do abdominal X-rays have a role?

OBJECTIVE: The objective was to estimate the role of abdominal radiographs in the management of the patient with gastrointestinal dysfunction in the early postoperative period following intra-abdominal gynecologic surgery. METHODS: Hospital records were reviewed for 84 patients from the gynecologic oncology service having a clinical diagnosis of either ileus or bowel obstruction immediately after intra-abdominal gynecologic surgery. Patient history, clinical signs and symptoms, findings of plain radiographs, and clinical course were studied to determine whether plain abdominal radiographs were useful in the management of these patients. RESULTS: At least one set of abdominal X-rays was obtained for 56 (66.7%) patients, of which 24 (42.9%) were considered radiographically diagnostic. A lower preoperative American Society of Anesthesiologists (ASA) physical status score correlated with a greater likelihood of having abdominal films (P = 0.005). No single clinical finding correlated with either the decision to obtain films or X-ray diagnosis of ileus or bowel obstruction. Use of any nonsurgical treatment modality was not significantly different for patients who had films versus those who did not. Mean length of hospital stay was significantly prolonged for patients who had abdominal X-rays. Seven patients were subjected to reoperation; however, no association was found between X-ray diagnosis of ileus or bowel obstruction and the need for reoperation. CONCLUSION: Plain abdominal radiographs have little clinical utility in the evaluation of patients with gastrointestinal dysfunction in the early postoperative period following intra-abdominal gynecologic surgery. Diagnostic studies such as CT scanning or a GI contrast study may be more helpful in the management of these patients.

Female↗
PubMed1995

Enteral nutrition in the critically ill patient: a prospective survey.

OBJECTIVES: To describe current enteral nutrition-prescribing practices for critically ill patients, and to identify factors associated with initiation of, and tolerance to, enteral nutrition. DESIGN: A prospective, cohort study. SETTING: Two tertiary care medical-surgical intensive care units (ICU) in Ontario, Canada. PATIENTS: We enrolled 99 consecutive patients who were expected to stay in the ICU for > 3 days and who were unable to tolerate oral nutrition. We followed patients for 21 days or until they tolerated enteral nutrition, tolerated oral nutrition, were discharged from the ICU, or died. MEASUREMENTS AND MAIN RESULTS: We recorded time elapsed from ICU admission to initiation and tolerance of enteral feedings, and examined factors associated with these events. We defined tolerance as receiving 90% of estimated daily energy requirements for > 48 hrs without gastrointestinal dysfunction (i.e., high gastric residuals, vomiting, diarrhea, abdominal distention). Seventy-three (74%) of 99 patients were started on enteral feedings an average 3.1 days (range 1 to 18) after ICU admission. Of 26 patients never started on enteral nutrition, three (12.5%) patients eventually tolerated oral nutrition, 14 (54.0%) patients were discharged from the ICU, and seven (27.0%) patients died. Reasons for not initiating enteral nutrition included absence of bowel sounds (27.0%), high nasogastric drainage (16.9%), contraindication to enteral nutrition (16.7%), tolerance of oral nutrition (6.8%), and no apparent reason (5.1%). Abdominal surgery, use of vasoactive drugs, and admission to one hospital made initiation of enteral nutrition less likely, whereas presence of bowel sounds and admission to the other hospital made initiation of enteral nutrition more likely. Thirty-five (42.9%) of 73 patients started on enteral nutrition achieved tolerance of the regimen. The average time from ICU admission to tolerance of feedings was 5.8 days (range 1 to 14). Once started on enteral nutrition, the most common reasons for decreasing or discontinuing feedings included high gastric residuals (51.0%), mechanical feeding tube problems (15.4%), medical or surgical procedures (5.4%), and vomiting (5.1%). Use of paralytic agents and the presence of high gastric residuals were associated with intolerance. Of 38 patients who did not achieve tolerance, 20 (52.6%) patients were discharged from the ICU, eight (21.0%) patients died, and eight (21.0%) patients eventually tolerated oral nutrition. CONCLUSIONS: Enteral nutrition is not started in all eligible ICU patients. Approximately half of those patients receiving enteral nutrition achieved tolerance of the regimen. Gastrointestinal dysfunction causing intolerance to enteral nutrition is a common reason for not starting, or discontinuing, feedings.

Critical Illness↗
PubMed2003

Organ failure associated with severe acute pancreatitis.

AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure. METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology, extent of necrosis, infection of necrosis and mortality was analyzed. RESULTS: A total of 47 patients (63.5%) showed organ failure, 20 patients (27.0%) multiple organ failure, whereas 27 patients (36.5%) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0%) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P>0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P>0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P<0.05). The death of SAP was associated with multiple organ failure (P<0.005), pulmonary failure (P<0.005), cardiovascular dysfunction (P<0.05) and gastrointestinal dysfunction (P<0.05). CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.

APACHE↗
PubMed1982

Lower gastrointestinal tract dysfunction in patients receiving long-term hemodialysis.

Severe bowel dysfunction developed in 25 of 945 patients receiving long-term hemodialysis during a ten-year period. Colonic perforation occurred in 12 patients, six of whom died due to peritonitis. In seven instances, the perforation occurred spontaneously. Ten other individuals exhibited prolonged, severe adynamic ileus that progressed to colonic pseudo-obstruction in eight patients. Medical decompression (eight patients) and surgical bowel decompression (two patients) resulted in recovery in nine. Aluminum hydroxide gel, which was taken regularly by all patients, was associated with notable chronic constipation prior to the occurrence of bowel perforation or protracted adynamic ileus in 78% of these individuals.

Adult↗
PubMed1975

An open trial of naproxen in rheumatoid arthritis patients with significant esophageal, gastric, and duodenal lesions.

To confirm the reported lack of major gastrointestinal side effects of naproxen, we gave 58 patients with active rheumatoid arthritis and significant gastrointestinal disease therapeutic doses of naproxen while closely monitoring them for signs and symptoms of gastrointestinal dysfunction. All patients underwent upper gastrointestinal x-ray examinations at the start of the trail, and, when indicated, during the course of the study. Endoscopies were also performed when indicated. Forty patients had hiatus hernia and 35 had peptic ulcer (23 duodenal ulcer and 12 gastric ulcer). Twenty-six patients had a combination of hiatus hernia with either type of peptic ulcer. After 262 patient visits over a period of 52 weeks, 35 patients remained in the study, all having had more than six months of naproxen therapy in dosages ranging from 500 to 750 mg daily. In 33 of the 35, the response to naproxen had generally been good to excellent. Only seven patients dropped out of the trial because of complaints referable to side effects. There were no major related upper gastrointestinal side effects as monitored by continuing clinical evaluation, stool occult blood, comprehensive laboratory examination, and, where indicated, upper gastrointestinal x-ray studies. Approximately 70 per cent of the patients demonstrated efficacy on long-term naproxen therapy by subjective and objective parameters. Naproxen appears to be an efficacious and remarkably safe drug in the long-term therapy of rheumatoid arthritis, even in the presence of significant upper gastrointestinal symptomatology.

Anti-Inflammatory Agents↗