RESUMO
BACKGROUND: Acute changes in blood glucose concentration affect gastrointestinal motor and sensory function. Tone and distensibility contribute to intact rectal function. AIMS: To test the effects of duodenal glucose (euglycemic hyperinsulinemia), intravenous glucose (hyperglycemic hyperinsulinemia), and saline (euglycemic normoinsulinemia as control) on rectal perception and compliance in response to tension-controlled rectal distension. METHODS: During duodenal glucose at 2 kcal min(-1), marked hyperglycemic clamp (approximately 13 mmol L(-1)), or saline as control, responses to fixed-tension rectal distension, applied by means of a computerized tensostat, were compared randomized on three separate days in eight healthy subjects. RESULTS: At discomfort level (score 3 on the 0-4 rectal score scale), perception of rectal distension was significantly higher during euglycemic hyperinsulinemia (45 +/- 3 g cm(-2) tolerance) and significantly lower during hyperglycemia (83 +/- 4 g cm(-2) tolerance), both reaching significance versus control (64 +/- 6 g cm(-2) tolerance; P < 0.05). At this level, no relevant variations of rectal compliance were seen, which were 10.3 +/- 1 mL mmHg(-1) during duodenal glucose, 9.5 +/- 1 mL mmHg(-1) for the group with hyperglycemia, and 9.7 +/- 2 mL mmHg(-1) for the control. CONCLUSION: Duodenal glucose provokes rectal hypersensitivity whereas acute hyperglycemia contributes to rectal hyposensitivity. Despite different rectal tenso-sensitivity, rectal compliance remains virtually unchanged. Any dysfunction may cause rectal complaints.
Assuntos
Duodeno/metabolismo , Duodeno/fisiopatologia , Glucose/metabolismo , Hiperglicemia/metabolismo , Hiperglicemia/fisiopatologia , Reto/fisiopatologia , Doença Aguda , Adulto , Análise de Variância , Feminino , Técnica Clamp de Glucose , Teste de Tolerância a Glucose , Humanos , Masculino , Sensação , Estatísticas não ParamétricasRESUMO
E. coli strain Nissle 1917 (EcN) is a probiotic clinically used with various indications. However, especially at the beginning of treatment, some patients report abdominal bloating. In a prospective, randomized, double-blind study in 30 healthy individuals we assessed the influences of EcN on intestinal gas dynamics and abdominal sensation. After one week without medication volunteers orally received 2.5-25 x 10(9) colony-forming units of EcN or placebo per day for 21 days. EcN was well tolerated and did not significantly affect abdominal symptoms, stool frequency or stool consistency. During gas challenge at different days no difference in the perception scores (range from 0 = no perception to 6 = pain) was observed between the two groups: the mean perception score was 1.2 (SD 0.2) in the EcN group and 1.4 (SD 0.2) in the placebo group. EcN had no relevant influence on intestinal gas dynamics.
Assuntos
Escherichia coli , Gases , Intestinos/fisiologia , Probióticos/administração & dosagem , Abdome/fisiologia , Adulto , Defecação/fisiologia , Dieta , Método Duplo-Cego , Escherichia coli/classificação , Feminino , Flatulência/epidemiologia , Trânsito Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Patients with slow-transit constipation (STC) have delayed colonic transit for solid und liquid bowel contents but intestinal gas handling has not been studied so far. Different nutrients influence motor and sensory gut function. We hypothesized that, in patients with STC, alteration of regulatory mechanisms may result in impaired intestinal gas dynamics. On 3 separate days, validated gas challenge was performed in 10 STC patients and 10 volunteers during duodenal saline, lipids, or intravenous glucose. During saline only 60% +/- 8% of gas was cleared by STC patients after 60-min gas infusion, vs. 91% +/- 2% by controls (P < 0.001). Acute hyperglycemia or lipids did not change intestinal gas dynamics in these patients (saline infusion), but compared to healthy subjects, significant intestinal gas retention occurred. In STC, disturbances of intestinal gas dynamics include basal intestinal gas retention, and this is virtually not affected by acute hyperglycemia or duodenal lipids.
Assuntos
Doenças Funcionais do Colo/etiologia , Constipação Intestinal/complicações , Gases/metabolismo , Trânsito Gastrointestinal/fisiologia , Adulto , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/fisiopatologia , Colonoscopia , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Diagnóstico Diferencial , Vias de Administração de Medicamentos , Duodeno , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Motilidade Gastrointestinal/fisiologia , Trânsito Gastrointestinal/efeitos dos fármacos , Glucose/administração & dosagem , Humanos , Lipídeos/administração & dosagem , Pessoa de Meia-Idade , Sensação , Cloreto de Sódio/administração & dosagem , Edulcorantes/administração & dosagemRESUMO
BACKGROUND: Especially in patients with functional intestinal disorders, impaired intestinal gas transit can be involved in abdominal symptom generation. We have previously demonstrated an acceleration of intestinal gas clearance in health during acute fasting hyperglycemia and hypothesize that in patients with functional abdominal bloating this mechanism may fail. METHODS: In 14 healthy subjects and 14 patients with functional abdominal bloating we compared effects of acute fasting hyperglycemia (approximately 12 mmol/l) and during euglycemia (control studies) on intestinal gas dynamics. Gas was infused into the jejunum (12 ml/min) for 120 min while rectal gas evacuation was continuously measured; perception and abdominal girth changes were separately evaluated. RESULTS: Marked hyperglycemia accelerated gas evacuation (-98 (53) ml 1 h intestinal gas retention) in health. In patients with functional abdominal bloating, marked hyperglycemia failed to accelerate gas transit and intestinal gas retention developed (421 (116) ml 1 h intestinal gas retention, p < 0.05 vs. health) which results in increased abdominal symptoms (perception score >3) and abdominal distension (>3 mm girth increment) as compared with control subjects (p < 0.05 for both). CONCLUSION: Intestinal gas clearance is delayed in patients with functional abdominal bloating and the increase in gas clearance during acute hyperglycemia in healthy volunteers does not occur in these patients.