Relationship between anal canal diameter and pressure evaluated simultaneously by endosonography and manometry in normal human subjects.

The study investigated the relationship between anal canal size and anal canal pressure measured simultaneously by anal endosonography and an electronic pressure probe. Twelve normal subjects were studied. Anal endosonography was performed using a 7.5-Mhz rotating transducer of 2-5 cm focal length covered with a sylastic balloon filled with degassed water (25 ml). During anal endosonography an electronic manometric probe was passed along the side of the probe and positioned in the anal canal. The ultrasonic image was frozen when maximal anal pressure was seen at basal, squeeze, and minimal pressure during straining. An image was also obtained at maximal anal relaxation after rectal distension with a balloon filled with 150 ml air. The results showed that anal canal pressure was significantly and linearly correlated with anal canal diameter (P < 0.001).

Proximal and distal gastric distension in normal subjects and H. pylori-positive and -negative dyspeptic patients and correlation with symptoms.

Aim of the study was to analyze gastric distension with water in H. pylori-positive and -negative dyspeptic patients and normal subjects and the correlation with symptoms. Twenty dyspeptic patients and 19 normal subjects were studied. H. pylori was determined in each dyspeptic patient with the rapid urea test at endoscopy. Gastric distension was evaluated by real-time ultrasonography with the ingestion of stepwise-increasing amounts of water up to a total of 600 ml. During distension, the symptom score was evaluated as well. The proximal stomach was significantly smaller in dyspeptic patients than in healthy controls, at 100-600 ml water (P<0.01). A larger distal stomach was observed at 500 and 600 ml of water (P<0.01). The score of bloating and fullness was greater in dyspeptics than in controls at 300 and 600 ml of water distension. The symptoms score was linearly correlated with proximal and distal gastric measurements in dyspeptic patients and in controls. No significant difference was found in dyspeptic patients regarding the H. pylori status. In conclusion, dyspeptic patients show a defective adaptation of the whole stomach to water distension and an increased symptom perception score as compared to controls. H. pylori infection does not seem to be a determining factor in these observed findings.

Effect of nitric oxide on propagated clusters of spontaneous motor waves in an ex vivo rabbit intestinal preparation.

The aim of this study was to determine whether nitric oxide can play a role in regulating the propagation of spontaneous motor activity in a rabbit intestinal preparation completely excluded from any central and vascular connection. Experiments were done on nine rabbits of either sex, weighing 2.5 +/- 0.5 kg (mean +/- SD). After one week of semiliquid diet the animals were sacrificed and a segment including the stomach, duodenum and part of the jejunum was removed and placed into a single chamber organ bath containing 1 L of oxygenated Krebs' solution. Four strain gauges connected to a Dynograph Recorder were sutured on the serosal surface 10 cm apart starting from the gastric antrum to the distal duodenum. Once the motor activity was stabilized, N-nitro-L-arginine methyl-ester (L-NAME) was added to the bath at increasing concentration from 10(-7) to 10(-4) M. Spontaneous motor activity was recorded, characterized by the cycling occurrence of bursts of waves, starting from the stomach and propagating to the descending duodenum. L-NAME at higher concentrations reduced the time interval between the bursts of waves with a concomitant increase in the propagation velocity of the motor activity. No change in the frequency of waves was detected. The effect of L-NAME was prevented by the administration of L-Arginine. This study suggests an important role for the nitric oxide pathway in the distal propagation of the spontaneous motor activity of the alimentary tract.

Increase of swallows before onset of phase III of migrating motor complex in normal human subjects.

The aim of our study was to analyze the relation between the deglutitive activity and fasting esophageal and gastric motility in normal subjects. Fifteen healthy subjects (9 males, 6 females) with a mean age of 42 years (range 19-65) were studied. A 24-hr pH-manometric recording was performed using a probe with four solid-state recording sites 10 cm apart, placed so as to record the motor activity of esophageal body, lower esophageal sphincter (LES) or distal part of the esophagus, and gastric antrum. An additional probe with one recording site was placed in the pharynx to evaluate swallowing. A pH electrode was also placed at 5 cm above the sphincter. Data were transferred to a personal computer and analyzed using specific software. Subjects received two meals during the recording session. MMCs were almost exclusively recorded during the nighttime. A mean of 2 +/- 0.94 (SD) MMC per subject was detected with a mean (+/- SD) interval, between each cycle, of 86.11 +/- 34.53 min. During the 30 min preceding gastric phase III, the number of swallows showed an increase that reached statistical significance 5 min before the onset of phase III. A similar pattern was observed for the area under the curve (AUC) of the esophagus and LES. In conclusion deglutition and esophageal motility vary with the MMC, suggesting that the deglutitive activity is part of the interdigestive motility pattern.

Relationship between gastric and gallbladder emptying and refilling in normal subjects and patients with H. pylori-positive and -negative idiopathic dyspepsia and correlation with symptoms.

Gastric and gallbladder emptying and refilling was studied in 10 normal subjects and in 38 dyspeptic patients. H. pylori was determined in each dyspeptic on mucosal antral biopsy performed during endoscopy. Gastric and gallbladder emptying was evaluated by real-time ultrasonography. Normal subjects were evaluated after two solid-liquid meals of 340 kcal and 680 kcal. Dyspeptics were studied after the 340-kcal meal only. For each subject and patient, minimum gallbladder volume and percentage of gastric emptying at this point was determined. Gastric and gallbladder slope was also drawn, and the crossing point between the two slopes identified. In normal subjects with the 340-kcal and 680-kcal meal, minimum gallbladder volume occurred for a similar percentage of gastric emptying. The crossing point between the two slopes was computed at the same percentage of gastric and gallbladder refilling with both meals. With the 680-kcal meal, however, peak gallbladder contraction and the crossing point between the two slopes occurred significantly later than with the 340-kcal meal (P < 0.05). In dyspeptics with the 340-kcal meal, the parameters evaluated were similar to the ones computed in controls after the meal of 680-kcal, suggesting delayed gastric emptying and gallbladder refilling. The presence or absence of H. pylori and symptom score were not correlated with any of the parameters studied.

Short- and long-term omeprazole for the treatment and prevention of duodenal ulcer, and effect on Helicobacter pylori.

OBJECTIVE: This study analyzes the effect of short- and long-term omeprazole (OM) on duodenal ulcer healing, recurrence, and H. pylori status. METHODS: Patients affected by active duodenal ulcer were randomly allocated to treatment with OM 20 mg or 40 mg once daily for 4 wk. Subsequently, patients with healed duodenal ulcer were randomly assigned to one of the following three groups: OM 20 mg once daily for 12 months, OM 20 mg alternate days for 12 months, and no treatment. Endoscopy was performed at entry, at 4 wk, and after 4, 8, and 12 months. Two biopsy specimens from antrum, body, and fundus were taken for histology and search for H. pylori. One hundred and eighty patients with active duodenal ulcer were admitted. Ninety-one were treated with OM 20 mg once daily and 89 with OM 40 mg for 4 wk. RESULTS: The results at 4 wk show 92.8% patients healed with OM 20 mg and 95.1% at 40 mg (NS). In the second part of the study, 96 of the patients who healed at 4 wk (45 with OM 20 mg, and 51 with OM 40 mg) entered the long-term study. Thirty-six patients received OM 20 mg daily for 12 months, 35 OM 20 mg on alternate days for 12 months, and 25 patients no treatment. The results show a healing rate of 100%, 100%, and 95% with OM 20 mg daily, of 97%, 95%, and 93% with OM 20 mg on alternate days, and of 81%, 50%, and 40% (p < 0.01) with no treatment at 4, 8, and 12 months, respectively. H. pylori that was found in 97% of patients at entry, at 4 wk was found in 92.8% of patients treated with OM 20 mg and in 97.5% of patients treated with OM 40 mg (NS). In one-third of the patients, H. pylori disappeared from the antrum but was found in the fundus. A 30% reduction in the presence of H. pylori was seen in the group treated with 20 mg daily for 12 months. CONCLUSIONS: We conclude that both continuous and alternate-day long-term OM treatment at 20 mg are similarly efficacious in the prevention of duodenal ulcer recurrence. Healing active duodenal ulcers with 20 or 40 mg does not influence subsequent treatment. Long-term OM at 20 mg daily for 12 months suppresses H. pylori temporarily in one-third of the patients. In these patients however, H. pylori reactivates after the end of treatment.

Migrating motor complex recorded spontaneously and induced by motilin and erythromycin in an ex vivo rabbit intestinal preparation.

We investigated basal motility and the motor effects of motilin, erythromycin, and prostigmine on segments of rabbit gastrointestinal tract removed from extrinsic neural and vascular pathway and immersed in an oxygenated organ bath. Motility was recorded by means of four strain gauges sutured on the serosal surface of the segment. During basal recording, clusters of duodenal contractions that propagated distally, resembling phase III activity of migrating motor complex, were seen. Motilin (10(-6) M) and erythromycin (10(-6) M) induced a propagated cluster of contractions similar to the phase III recorded during the basal period. Prostigmine (10(-6) M) induced a simultaneous increase in gastric and small intestinal motility. Atropine (10(-5) M) prevented the motor effect of motilin, erythromycin, and prostigmine. Thus, MMCs do not appear to require central input for initiation and propagation. Motilin and erythromycin stimulate MMCs through an enteric cholinergic mechanism; therefore, the previously reported smooth muscle receptors for both substances were not apparent in the ex vivo preparation.