Larger regional volume of the thalamus in diarrhea-predominant irritable bowel syndrome: a cross-sectional study.

As a relay center between the cerebral cortex and various subcortical brain areas, the thalamus is repeatedly associated with the dysfunction of brain-gut interaction in patients with irritable bowel syndrome (IBS). However, the regional morphological alterations of the thalamus in IBS are not well defined. We acquired structural magnetic resonance data from 34 patients with IBS and 34 demographically similar healthy subjects. Data processing was performed using FMRIB's Integrated Registration and Segmentation Tool (FIRST). Volumetric analysis and surface-based vertex analysis were both carried out to characterize the morphology of the thalamus and other subcortical structures. Our results suggested that the majority (31 cases) of the patients with IBS had diarrhea-predominant symptoms. Volumetric analysis revealed a larger normalized volume of the right thalamus and left caudate nucleus in patients with IBS than in healthy controls. Surface analysis indicated that the difference arose mainly from the laterodorsal nucleus of the right thalamus, and the body of the left caudate nucleus. In addition, patients with IBS had different hemispheric asymmetries of the thalamus (rightward) and caudate nucleus (leftward) from controls (leftward for the thalamus and rightward for the caudate nucleus). In general, our results indicated that patients with diarrhea-predominant IBS had enlarged thalamus and caudate nucleus volumes, as well as altered hemispheric asymmetries of these two structures, compared with healthy controls. The neuroimaging evidence of these structural alterations helps clarify the underlying pathophysiology of diarrhea-predominant IBS.

Screening and identification of proteins mediating senna induced gastrointestinal motility enhancement in mouse colon.

AIM: To isolate the proteins involved in pharmacologic action of senna extract (SE) from mouse gastrointestinal tract and to explore the molecular mechanism of gastrointestinal motility change induced by SE. METHODS: SE was administrated to mice by different routes. Gastrointestinal motility of mice was observed using cathartic, gastrointestinal propellant movement experiments and X-ray analysis. Mouse model for gastrointestinal motility enhancement was established through continuous gastric administration of SE at progressively increased dose. At 3 h and week 3, 4, 6 and 10, morphological changes of gastrointestinal tissues were found under light microscope. Ultrastructural changes of intestinal and colonic tissues at week 6 were observed under transmission electron microscope. The colonic proteomic changes in model mice were examined by two-dimension polyacrylamide gel electrophoresis with immobilized pH gradient isoelectric focusing to screen the differentially expressed proteins, and their molecular masses and isoelectric points were determined. Two N-terminal sequences of the samples were also determined by mass spectrometry. RESULTS: SE (0.3g) caused diarrhea after gastric administration in 1-6h and enhanced gastrointestinal propellant (65.1+/-7.5%; 45.8+/-14.6%, P<0.01) in mice, but intramuscular and hypodermic injection had no cathartic effect. X-ray analysis of gastrointestinal motility demonstrated that gastric administration of SE enhanced gastric evacuation and gastrointestinal transferring function. At 3 h and week 3 and 4 after gastric administration of SE, light microscopic examination revealed no apparent change in gastrointestinal mucosal tissues, but transmission electron microscopic examination revealed inflammatory changes in whole layer of intestinal and colonic wall. Twenty differential proteins were detected in the colonic tissues of the model mice by two-dimensional electrophoresis, and the N-terminal amino acid sequences of two proteins were determined. CONCLUSION: SE causes diarrhea and enhances gastrointestinal motility through digestive tract administration. Long-term gastric administration of SE induces inflammatory changes and cell damage in the whole gastrointestinal tract. The differential proteins screened from the colonic tissues of the model mice might mediate the enhancing effect of SE on gastrointestinal motility.

The role of enteroclysis in the diagnosis of unexplained gastrointestinal symptoms: a prospective assessment.

The purpose of this prospective study performed at a non-university hospital was to assess the role of enteroclysis in the diagnosis of unexplained gastrointestinal symptoms such as abdominal pain, gastrointestinal bleeding, and chronic diarrhea done following inconclusive imaging or endoscopic procedures. 184 consecutive patients were subjected to enteroclysis over 25 months. 84 (46%) had abdominal pain, 52 (28%) gastrointestinal bleeding, and 48 (26%) chronic diarrhea. Findings were categorized as normal and abnormal (subdivided into main, i.e., explanatory of symptoms; and secondary, i.e., not explanatory of symptoms). Main findings were further divided into those exclusively detected by enteroclysis and those confirmed by this procedure. Normal enteroclysis investigations were obtained in 159 (86%) patients and abnormal in 25 (14%). Main findings were present in 19 (10%) patients, in ten (5%) of them exclusively detected by enteroclysis. Secondary findings were present in six (3%) patients, also detected only by enteroclysis. The highest rate of main findings exclusively detected by enteroclysis related to patients with chronic diarrhea (8%), compared with 6% and 2% with abdominal pain and gastrointestinal bleeding, respectively. For the inspection of the small bowel, enteroclysis shall remain the gold standard for detecting abnormal findings in the small bowel until user-friendly enteroscopes are developed.

Radiological bile acid absorption test 75SeHCAT in patients with diarrhoea of unknown cause.

PURPOSE: The purpose with this study was to investigate the usefulness of the 75SeHCAT test in patients suffering from "functional" diarrhoea and to disclose earlier radiological investigations performed in the course of disease. MATERIAL AND METHODS: Twenty patients with chronic diarrhoea of unknown cause were investigated with the 75SeHCAT test. The cholestyramine test and an estimation of oro-caecal transit time (OCTT) were also performed in 13 and 10 patients respectively. RESULTS: Ten patients had low 7-day retention (< or = 15%). Nine of these were tested with cholestyramine and 8 showed complete relief from the diarrhoea. The cholestyramine test had no effect on the 4 patients with normal bile acid retention. No correlation was found between the retention of 75SeHCAT and OCCT. A total of 80 inconclusive gastrointestinal barium examinations were performed during the course of disease. CONCLUSION: Pathological bile acid retention, studied with the radiological 75SeHCAT test, is common in patients with diarrhoea of unknown cause. The test should be performed earlier in the course of disease in order to prevent unnecessary radiological investigations and to reduce patient suffering and distress.

The role of radiology in Campylobacter enterocolitis.

A series of 18 patients with diarrhoea and positive stool cultures for Campylobacter jejuni is presented. The most important radiological features were thickening of ileal mucosal folds, of interhaustral indentations and of the ileocaecal valve, lymphoid hyperplasia and microulcerations. Radiology, as well as endoscopy, are both nonspecific in Campylobacter jejuni enterocolitis. The importance of radiology is to exclude more typical features of other causes of inflammatory bowel diseases. Moreover, before the result of the stool culture is available, the radiological features should suggest the suspicion of an acute infectious enterocolitis by Campylobacter jejuni as possible diagnosis.

Diarrhea associated with sand in the gastrointestinal tract of horses.

Four horses with diarrhea had radiographic evidence of large quantities of sand in the gastrointestinal tract. Initially, none of the horses had sufficient fecal sand quantity to suggest sand enteropathy. Diarrhea resolved in all horses within 2 days of oral administration of psyllium hydrophilic mucilloid. Historically, all 4 horses had lost weight or had difficulty maintaining weight. After treatment was administered, the horses either gained weight or were easier to maintain in good condition.

Use of a gamma-labeled bile acid (75SeHCAT) as a test of ileal function. Methods of improving accuracy.

The object of the present study was to improve the accuracy of measurements of ileal function obtained by abdominal scanning and fecal counting after oral administration of the gamma-labeled bile acid 75seleno-homocholic acid-taurine (75SeHCAT), as current techniques do not distinguish between retention of the bile acid within the enterohepatic circulation from retention within the colon, and are also affected by incomplete stool collection when using the fecal method. We have therefore introduced the following modifications: (a) simultaneous ingestion of 51CrCl3 as a nonabsorbable correction marker for both the abdominal scanning and fecal counting methods; and (b) the use of 75SeHCAT counts over the gallbladder area on abdominal scanning, because these counts should be independent of colonic retention. We have studied 42 subjects, including 6 healthy controls, 6 ileal resection subjects, 15 ulcerative colitis patients, and 15 patients with unresected ileal Crohn's disease. Colonic retention (0%-68% per day) caused a variable overestimate of 75SeHCAT absorption. Corrected measurements of the fecal absorption index determined by a gamma-counter and of the abdominal absorption coefficient determined by a gamma-camera correlated well with each other (r = 0.92, p less than 0.0001), providing an internal validation of the 51CrCl3 modification. The fecal absorption index could also be determined from the carmine-rich stool collection of a single day, and this also correlated well with the abdominal absorption coefficient (r = 0.81, p less than 0.0001). Gallbladder scanning alone was simpler, involving only one isotope, but it correlated less well with the fecal absorption index than did the abdominal absorption coefficient (r = -0.64, p less than 0.001).

Behçet's syndrome in a family with inflammatory bowel disease.

Although the gastrointestinal and systemic features of Behcet's syndrome and inflammatory bowel disease overlap to a considerable extent, they are generally viewed as two distinct diseases. We evaluated three members of a family who have inflammatory bowel lesions, two of whom met criteria for Behcet's syndrome. The propositus had classic features of both Crohn's ileocolitis and Behcet's syndrome. A daughter, who never met criteria for Behcet's syndrome, had undergone colectomy for ulcerative colitis. A second daughter had classic features of Behcet's syndrome, including recurrent episodes of colitis with distinct aphthous ulcers in the colon. The findings in this family suggest that inflammatory bowel disease and Behcet's syndrome may be closely related and part of a spectrum of disease rather than distinct disease entities.

Cryptosporidiosis of the stomach and small intestine in patients with AIDS.

Cryptosporidiosis is a parasitic disease of the gastrointestinal tract that causes a choleralike diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). Review of barium studies of the stomach and small intestine in 16 AIDS patients with cryptosporidiosis showed that the studies were abnormal in 13. Of these, five had moderate or marked prominence of the mucosal folds, and eight had slight prominence. The jejunum was predominantly involved in nine; the entire small intestine was uniformly affected in the other four. Three of the 16 patients had moderate or marked dilatation of the small intestine. One had marked dilution of the barium, and one had marked fragmentation and flocculation of the barium. There was narrowing and rigidity of the gastric antrum in two patients. These radiographic findings are nonspecific, but are indicative of cryptosporidiosis in a patient with AIDS and protracted diarrhea.

Evaluation of ileal function using 23-selena-25-homotaurocholate, a-gamma-labeled conjugated bile acid. Initial clinical assessment.

23-Selena-25-homotaurocholate is a synthetic bile acid labeled with a gamma-ray-emitting radioisotope 75Se. It is readily measured using external detectors and is thus suitable for whole-body counting. Whole-body retention was measured at 0, 4, and 7 days after oral administration to normal controls and to patients with disease of the small intestine, colon, or ileocecal region. Whole-body retention of less than 25% of the administered radioactivity within 4 days is definitely abnormal, but there was overlap between normal and abnormal groups at this time. At 7 days, whole-body retention less than 12% is abnormal and greater than 19% is normal. Between these limits, values may represent minimal ileal dysfunction not demonstrable by older techniques. Excretion of 23-selena-25-homotaurocholate follows a biexponential curve. The faster component has a half-life similar to that of natural bile acid. It is uncertain whether the slower component represents a hitherto unrecognized slowly turning over pool of bile acid or is a metabolic product of 23-selena-25-homotaurocholate not yet identified in vitro. There is a significant relationship between the whole-body retention of 23-selena-25-homotaurocholate and total fecal and primary bile acids. 23-selena-25-homotaurocholate is simple and acceptable for investigating ileal function.

Laxative-induced diarrhoea: a continuing clinical problem.

Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.