Calcium absorption from milk in lactase-deficient subjects.

Intestinal calcium absorption from milk containing lactose (+) and from another containing glucose (-) was studied in eight patients with normal lactase (NL) and seven lactase-deficient (LD) subjects to determine if lactase deficiency is implicated in Ca absorption. The results were compared with data obtained from Ca ingestion in a water solution. Ca absorption was measured by a double-isotope technique and the kinetic indices were obtained by a deconvolution method. With (-), Ca absorption was identical in NL and LD subjects and slightly higher than with water solution (15%, NS). With (+), Ca absorption in NL subjects was identical with that from water solution; in LD subjects it increased (23%, p less than 0.02). These data indicate that: Ca is absorbed equally well from milk as from water solution; (+) favors Ca absorption in LD subjects, which suggests that milk ingestion might be encouraged in LD subjects to avoid Ca deficiency; and (-) should be a valuable alternative for lactose-intolerant patients.

Glycaemic response and hydrogen production to blenderised and polymeric enteral nutrition formulas.

Complete enteral nutrition preparations include blenderised formulas based on natural foods with some fibre content and also low-residue polymeric formulas. This study examines the effect of the different fibre content of two commercial formulas (6.4 g/l and 0.25 g/l) on glycaemic and insulin response and hydrogen production in the colon during constant rate administration in 11 normal subjects. No difference in serum glucose and insulin levels was found. No rise in hydrogen production was detected with either formula suggesting no carbohydrate malabsorption. The quantity or nature of fibre present in blenderised formulas does not modify the pattern of carbohydrate absorption compared to a low-residue polymeric formula. However, this does not preclude other possible physiological effects of fibre content upon gastrointestinal motility and function.

[Effects of chronic pancreatitis on salivary secretion]. / Effets de la pancréatite chronique sur la sécrétion salivaire.

In chronic pancreatitis, increased concentrations of Na+ and Cl- in sweat have been attributed to increased parasympathetic drive. It was postulated that similar changes might occur in saliva. To avoid masking increased parasympathetic drive, saliva was collected without stimulation. In patients with chronic pancreatitis, there were significant increases of concentrations of Na+ and Cl- in basal salivary concentrations. These differences disappeared when salivary secretion was stimulated with citric acid. Anatomic or neurologic modification of the salivary glands seemed unlikely as stimulated concentrations did not differ from those in the control subjects. Perfusion of cholecystokinin (CCK) did not modify concentrations of Na+ or Cl-. Parasympathetic blockade reduced salivary secretion in both patients and controls (p less than 0.001). As tubular absorption of Na+ and Cl- was constant and the volume of saliva was diminished, it followed that there was a reduction in Na+ and Cl- salivary output. As amylase secretion is under sympathetic control, atropine had little effect other than increasing the salivary amylase concentration. The secretory modifications observed with atropine were the same in both patients and control subjects, as the increased parasympathetic drive of the patients was blocked.

[Influence of chronic renal failure on the D-xylose test in man]. / Influence de l'insuffisance rénale chronique sur le test au D-xylose chez l'homme.

The aim of this study was to investigate the effect of chronic renal insufficiency on absorption, distribution and elimination of D-xylose which was chosen as a "test substance". Pharmacokinetic analysis was based on eighteen D-xylose tests carried out either by the enteral or parenteral route in a randomized fashion on nine patients suffering from chronic renal insufficiency. These results were compared with those obtained in healthy volunteers. The renal clearance was simultaneously measured with the 51Cr-EDTA test. In the experimental conditions the intestinal absorption of D-xylose was not modified qualitatively (absorption rate) nor quantitatively (systemic availability). Inspite of this, the maximal concentration of the D-xylose was higher in these patients and was reached later than in healthy volunteers. This fact should be taken into consideration when interpreting the results of a D-xylose test in patients suffering from chronic renal insufficiency.

Mechanism of pancreatic growth induced by pancreatico-biliary diversion in the rat. Inhibition by proglumide, benzotript, and ranitidine.

Pancreatico-biliary diversion (PBD) stimulates pancreatic growth in the rat. The present experiment was designed to investigate the mechanism of this phenomenon. The potential roles of endogenous CCK, gastrin, and secretin were studied. Hormone measurements by specific RIA's show that PBD was associated with higher CCK plasma concentrations and, conversely, with lower gastrin circulating levels. Secretin and pancreatic polypeptide were unaffected by PBD. Seven days' subcutaneous administration of proglumide (1000 mg/kg/day), benzotript (100 mg/kg/day), two CCK and gastrin receptor antagonists, and Ranitidine (100 mg/kg/day) resulted in a significant inhibition of PBD-induced pancreatic growth, assessed by measurements of pancreatic weight, DNA, RNA and protein content. These results suggest, therefore, that CCK plays a central role in the development of the pancreatic adaptive response to PBD.

[Can antibiotic-associated diarrhea be prevented?]. / Peut-on prévenir les diarrhées associées aux antibiotiques.

Post-antibiotic diarrhea is common but rarely serious. The chief cause is changes in the normal intestinal flora. Decrease in the number of bacteria leads to maldigestion of carbohydrates, resulting in osmotic diarrhea. Disappearance of the flora encourages the emergence of resistant strains, e.g. Clostridium difficile. General measures concern the prescription of antibiotics and the use of probiotics. The latter restore and replace the normal flora and prevent more than half of all cases of diarrhea, in particular serious forms and pseudo-membranous colitis. Antibiotics are not accompanied by any complication in 80% of instances. Probiotics should be used in high risk patients: elderly, seriously ill or hospitalised for long periods.

[Prevention of ulcer disease]. / Prophylaxie de la maladie ulcéreuse.

H2-receptor antagonists, sucralfate, pirenzepine and antacids are effective, when given prophylactically, in preventing relapse of peptic ulcer. H2-receptor antagonists and sucralfate are the most widely used and are virtually free of side effects. Cessation of smoking, a balanced diet and a calm life-style are also part of the prophylaxis. The incidence of relapse is reduced by 50-80% over a period of 1-2 years. The economic and clinical benefits of prophylaxis are shown. It is indicated in cases of chronic, relapsing ulcers; complicated ulcers; in medically compromised subjects and in those with heavy responsibilities. Prophylaxis is unduly costly when given after a first episode of peptic ulcer or when episodes are infrequent. For patients with one or two episodes a year the decision to give prophylaxis depends on the patient's wishes. Prophylaxis of stress-induced haemorrhagic lesions depends on the securing of an intragastric pH greater than 3.5-5, usually achieved by hourly administration of antacids. Methylated prostaglandins and H2-receptor antagonists can prevent drug induced peptic lesions. Under the protection of one of these drugs it is possible to continue antiinflammatory treatment at the lowest possible dose.

[Clinical approach to the diagnosis of persistent diarrheas]. / Approche clinique du diagnostic des diarrhées persistantes.

The differential diagnosis of chronic diarrhea is often difficult and necessitates a two-step evaluation: (1) classification as to the clinical type of diarrhea (accelerated transit time, lesional, metabolic); (2) once the type of diarrhea is ascertained, search for the causative factor. The clinical classification is within the general practitioner's capability, whereas step two is more a matter for the specialist.

[Follow-up of colorectal cancers]. / Surveillance des cancers colo-rectaux.

Recurrence of colorectal carcinoma after curative surgery amounts to 30-40%. It is more frequent with deep penetration of the cancer, in young or old patients and in high risk groups. Familial polyposis, ulcerative colitis, Lynch's syndromes, and past history of adenoma or cancer are the best examples. The follow-up is effective if strict protocols are used, with frequent examinations. However, they are costly in comparison with results. Colonoscopy is essential for surveillance of the large bowel. Clinical evaluation, ultrasonography and CEA are useful for extra-colonic deposits.

[Do ulcerogenic pepsins exist? Characterization of polymorphism of human pepsins]. / Les pepsines ulcérogéniques existent-elles? Caractérisation du polymorphisme des pepsines humaines.

Studies on the role of pepsin in the pathogenesis of peptic ulcer are hampered by lack of suitable methods for the separation, characterization and quantification of different forms of pepsin. As a contribution toward solving this problem, we have developed several electrophoretic systems which exhibit a high resolving power for pepsins and their precursors, pepsinogens. When human gastric juices were fractionated by discontinuous electrophoresis at pH 3.7 in polyacrylamide gel, pepsin was resolved into as many as 20 distinct forms: 3 major isoenzymes (C, A4, A3), 4 less abundant isoforms (C', A6, A4', A3' or A2), 8-10 minor isoforms of pepsin A1 and at least 3 dimeric isoforms of pepsin A (Ad). All the pepsin components were identified by means of bidimensional electrophoresis. Pepsinogens from gastric mucosa were separated by discontinuous electrophoresis at pH 5.5 in the first dimension, then converted to pepsins in the gel by acidification and resolved by electrophoresis at pH 3.7 in the second dimension. Based on discontinuous electrophoresis at low pH, a much needed method was elaborated for the quantification of different forms of pepsin(ogen) within the stomach. This technique will allow detailed clinical studies which may provide insight into the question whether or not there are specific forms of pepsin that are associated with peptic ulcer.