5-HT1-receptor agonist sumatriptan modifies gastric size after 500 ml of water in dyspeptic patients and normal subjects.

Sumatriptan, a 5-HT1-receptor agonist has been shown to delay gastric emptying of liquids and solids in humans. However, no data are available of the effect of sumatriptan on gastric adaptation after distension with liquids and on symptoms induced by gastric distension. In 23 normal subjects and 30 dyspeptic patients with normal upper gastrointestinal endoscopy and real-time ultrasonography, the transverse gastric proximal and distal area and sagittal axis of the proximal stomach were determined by real-time ultrasonography and computed tomography after 500 ml of water. The area was determined by real-time ultrasonography and computed tomography twice at times 48 hr apart. Thirty minutes before real-time ultrasonography, placebo or sumatriptam were give subcutaneously in a double-blind fashion. Epigastric pain, bloating, heartburn, and nausea were also monitored through an intensity score from zero to 10 performed during the test. In six dyspeptic patients, the gastric distension was performed also with real-time ultrasonography and computed tomography after placebo and hyoscine butyl-bromide, a quaternary anticholinergic agent. Real-time ultrasonography and computed tomography demonstrated that after sumatriptan there is a reduction in proximal and distal transverse area and an increase in the sagittal axis of the proximal stomach. Hyoscine butyl-bromide increased all gastric measurements. Among the symptoms evaluated, only nausea was significantly reduced by sumatriptan (P < 0.01). Sumatriptan modifies gastric size, with a reduction in the transverse section and an increase of the sagittal axis of the proximal stomach and improves the nausea induced by gastric distension in dyspeptic patients.

Effect of hyoscine N-butylbromide on gastroesophageal reflux in normal subjects and patients with gastroesophageal reflux disease.

OBJECTIVES: Recent studies have shown that atropine reduces gastroesophageal reflux in normal subjects and patients with gastroesophageal reflux. The aim of the study has been to assess the effects of an atropine derivative, hyoscine N-butylbromide in normal subjects and patients with gastroesophageal reflux disease by recording esophageal and gastric pH-metry for a 24-h period. METHODS: Ten normal subjects and 10 patients with gastroesophageal reflux disease were evaluated. PH-metry was performed using two glass pH flexible probes with distal incorporated electrodes. The two catheters were introduced nasally under fluoroscopy. One probe was positioned in the gastric body; the other was placed 5 cm above the lower esophageal sphincter which had been evaluated manometrically before the study. Recording lasted without interruption for 48 h. Patients and normal subjects were assigned to receive hyoscine N-butylbromide (10 mg p.o. t.i.d.) for 24 h followed by a placebo for another 24 h or vice versa in a random manner. The pH was analyzed for a total number of acid refluxes and percentage of the period with pH <4 in the esophagus and the mean gastric pH in 24 h, before and after treatment with hyoscine N-butylbromide. RESULTS: The number of reflux episodes was significantly greater with hyoscine N-butylbromide in comparison with a placebo in patients with gastroesophageal reflux disease and normal subjects (p < 0.02). The percentage of time with pH <4, was also significantly greater in patients with gastroesophageal reflux disease and in controls (p < 0.05). The mean 24-h gastric pH after hyoscine N-butylbromide was not different from placebo in gastroesophageal reflux disease and controls. CONCLUSIONS: Hyoscine N-butylbromide, an anticholinergic agent, increases the total number of esophageal acid refluxes in patients with gastroesophageal reflux disease and in controls, therefore it is not recommended in the treatment of gastroesophageal reflux disease.

Role of antimicrobial susceptibility testing on efficacy of triple therapy in Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori treatment failure may be due to resistance to macrolides and 5-nitroimidazoles. AIM: To test whether a preliminary in vitro susceptibility test of H. pylori to tinidazole and clarithromycin and a consequent specific regimen could improve the eradication rate. METHODS: A total of 109 consecutive H. pylori-positive patients with dyspeptic symptoms were included. At endoscopy, biopsy from the antrum was obtained for H. pylori culture and antimicrobial susceptibility testing. Fifty-six patients were treated with omeprazole, tinidazole and clarithromycin for 10 days (group OTC) and 53 patients received therapy on the basis of the susceptibility test (group SUSC). Treatment success was evaluated by the 13C-urea breath test 1 month after the end of therapy. RESULTS: Eight patients dropped out. Overall primary resistance to clarithromycin, tinidazole and both antibiotics was 13%, 33% and 4%, respectively. In group OTC, H. pylori was eradicated in 81% and 75% of patients by per protocol and intention-to-treat analysis, respectively. Per protocol and intention-to-treat eradication rates for group SUSC were 98% and 91% (P < 0.05 vs. group OTC). CONCLUSIONS: These data show that in H. pylori infection, antibiotic therapy based on the results of culture and susceptibility testing gives, in comparison to standard therapy, a significant improvement in eradication rate.

Gastric emptying of a solid-liquid meal measured with 13C octanoic acid breath test and real-time ultrasonography: a comparative study.

OBJECTIVES: The 13C octanoic acid breath test (OBT) has been proposed as a reliable noninvasive test to measure gastric emptying. OBT has been compared with scintigraphy; however, there are no data comparing it with gastric emptying measured with real-time ultrasonography (RUS) The aim of the study was to correlate gastric emptying of a solid-liquid meal, with OBT and RUS simultaneously evaluated in a group of normal volunteers. METHODS: A total of 14 normal subjects ingested a standard test meal (one scrambled egg with two slices of white bread, 10 g of butter, and 300 ml of tap water). The egg yolk was mixed with 0.1 ml of 13C octanoic acid. Breath samples for 13CO2 analysis were collected in breath bags and were analyzed by means of isotope-selective nondispersive infrared spectrometry (IRIS). RUS was simultaneously performed by calculating the antral area following a previous validated method. Breath samples and antral area were taken at baseline and every 15 min after the meal during the first 2 h and every 30 min for another 2 h. Lag time (Tlag) and gastric half emptying time (T(1/2)) were calculated for OBT and RUS. Data were analyzed by the Student's t test for paired data, correlation coefficient, and regression line. RESULTS: The results show a statistically significant longer Tlag and T(1/2) for OBT in comparison with RUS (p < 0.001). A significant correlation and positive regression line was computed between OBT and RUS for Tlag and for T(1/2). CONCLUSIONS: Our results show that OBT overestimates gastric emptying parameters of a solid-liquid meal in comparison with RUS. However, both techniques give data in good correlation. Because OBT is less operator-dependent than RUS, it may be useful in comparative gastric emptying studies.

Short- and long-term effect of glyceryl trinitrate (GTN) ointment 0.2% and 2% on anal canal pressure in patients with chronic anal fissures.

Controversial data are available on the duration of action of glyceryl trinitrate after acute and chronic application on anal canal pressure. Our aim was to assess the effect of glyceryl trinitrate at 0.2% and 2% on anal canal pressure before and after eight weeks of treatment. Anal canal pressure was evaluated in 12 patients with chronic anal fissures with an electronic probe with three recording sites before and after the application of glyceryl trinitrate, 120 mg on the external anal verge. Six patients received glyceryl trinitrate at 0.2% and six at 2%. Glyceryl trinitrate 0.2% and 2% equally reduce basal anal canal pressure in all three recording sites (P < 0.001) with major effect on the inner site of the canal toward the rectum, for a 60-min period. Eight weeks after application, the effect of glyceryl trinitrate was unchanged. In conclusion, glyceryl trinitrate ointment at 0.2% and 2%, equally reduces anal canal pressure for 60 min and this effect is kept unchanged after eight weeks of application.

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.

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.