Brain noradrenergic systems modulate the ceco-colonic myoelectric activity in rats.

The role of the brain noradrenergic systems in the control of the ceco-colonic myoelectric activity was investigated in rats following lesions with intracerebroventricular (icv) or intracisternal (ic) injection of 6-hydroxydopamine (6-OHDA). Controls received the vehicle alone. The ceco-colonic myoelectric activity was recorded 3 weeks later in conscious rats chronically fitted with electrodes. After icv injection of 6-OHDA, lesions of rostral and caudal (spinal) noradrenergic systems were observed whereas only spinal noradrenergic systems were lesioned after ic injection. This differential pattern of lesions was followed by a differential pattern of ceco-colonic myoelectric activity. In fasted animals, a significant increase of the long spike burst (LSB) frequency (nb min-1) was observed after icv injection of 6-OHDA whereas no modification was observed after ic injection of the neurotoxic. After a 6-g pelleted rat diet, a significant increase of the LSB frequency was also observed in the icv lesioned group when compared to controls. No modification of the ceco-colonic noradrenergic innervation was observed, thus confirming the central selectivity of these lesions. Lesions of central noradrenergic systems modify the LSB frequency in rats; the rostral noradrenergic systems seem to play the major role.

Involvement of hypothalamic noradrenergic systems in the modulation of intestinal motility in rats.

Selective lesions of the noradrenergic systems of the paraventricular nucleus (PVN) of the hypothalamus with 6-hydroxydopamine (6-OHDA) lengthen the periodicity of the migrating myoelectric complex (MMC), an index of intestinal motility, in rats. These lengthening effects resemble those obtained after lesions of the locus coeruleus (LC), thus suggesting that noradrenergic terminals from LC to the PVN are involved in this modulation.

[Effects of propantheline on the motor activity of the normal human esophagus]. / Effets de la propanthéline sur l'activité motrice de l'oesophage chez l'homme normal.

The aim of this study was to examine the action of orally administrated propantheline bromide, an anticholinergic agent, on esophageal motor function. To evaluate these effects a double blind randomized study was carried out in ten normal volunteers. An optimal effective dose for each subject was determined according to the Sun and Shay method. Esophageal motor activity following dry and wet swallow was markedly altered by propantheline. This drug: a) dramatically lowered the peristaltic wave amplitude in the smooth muscle part of the esophagus (P less than 0.001); b) decreased the wave velocity in the proximal part of the smooth muscle (P less than 0.05), and c) increased the frequency of both the non peristaltic and repetitive waves (P less than 0.001). On the other hand propantheline weakly but significantly diminished the lower esophageal sphincter resting pressure (P less than 0.05). These results suggest that: a) the peristaltic function of the human esophageal smooth muscle is greatly dependent on muscarinic neurotransmission, and b) in patients with gastroesophageal reflux, orally as well as parenterally administrated anticholinergic agents are contraindicated.

[Esophageal motility in Raynaud's disease, systemic scleroderma and presclerodermal Raynaud's syndrome]. / Motricité oesophagienne au cours de la maladie de Raynaud, de la sclérodermie systémique et du syndrome de Raynaud présclérodermique.

Fifty-five consecutive subjects with Raynaud's phenomenon were submitted to esophageal manometry. According to the results of clinical examination and periungual capillaroscopy, they were divided into three groups: sixteen patients presented presclerodermal Raynaud's phenomenon, and nineteen, systemic sclerosis; twenty others had Raynaud's disease. Twenty volunteers formed the control group. Esophageal motor disorders were observed in the group with presclerodermal Raynaud's phenomenon, affecting the esophageal lower sphincter and the peristalsis of the body of the esophagus. In the group with systemic sclerosis, these motor disorders were associated with alterations in the amplitude and the duration of contractions. Esophageal motility was normal in subjects with Raynaud's disease. We can conclude that: 1) esophageal motor disorders can be seen in presclerodermal Raynaud's phenomenon. The kind of abnormalities observed at this stage of the disease are in favor of an early alteration of the neurogenic component of esophageal motility; 2) there is no relationship between esophageal motor disorders and Raynaud's phenomenon in scleroderma.

[Gastric emptying of a solid-liquid meal in normal subjects: validity of the labeling (99mTc) of chicken liver by a multipuncture technic]. / Vidange gastrique d'un repas solide-liquide chez le sujet normal: validité du marquage (99mTc) du foie de poulet par la technique de multiponction.

For gastric emptying studies of a solid-liquid meal by the scintigraphic method, a valid isotope labeling method for each phase of the meal must be obtained. The aim of this study was to validate a simple chicken liver labeling method in normal subjects by multipuncture technic with 99mtechnetium. Labeling according to Meyer's method was chosen as a reference. Simultaneously, a study of the quality of liquid phase labeling by 111indium was done. The labeling process quality for each phase of the meal was assessed: a) in vitro, after incubation of the meal with human gastric juice (n = 12); b) in vivo, after meal ingestion and sequential collection of gastric contents by aspiration (n = 4). Furthermore, in 8 healthy volunteers, gastric emptying curves of the solid and liquid phases of the meal were determined scintigraphically and compared. Our results showed: a) for the solid phase: a good specificity of the marker, which was assessed in vitro and in vivo, after liver labeling with multipuncture technique (89 p. 100 and 92 p. 100 after 180 min, respectively); b) for the liquid phase: a good specificity of the marker in vitro and a poor specificity in vivo (82 p. 100 and 27 p. 100 after 180 min, respectively); c) similar half-gastric emptying times and cumulative percentages for the solid and liquid phases with both liver labeling methods. In conclusion, the multipuncture technique for chicken liver labeling may be used for gastric emptying studies in humans.

Scintigraphic study of duodenogastric reflux. Value of a computerized image-subtraction method.

Duodenogastric reflux (DGR) could be implicated in several esophageal and gastric diseases. Establishing its pathophysiological role however is difficult because of the problems in the demonstration and quantification of DGR episodes. The aim of this study was to improve a scintigraphic method of detection and quantification of DGR episodes during the postprandial period in man. The study was carried out in 14 control subjects (7 males and 7 females, median age = 25 years, range: 22-35 years). As scintigraphic recording was continuous during 150 min, all DGR episodes were revealed. In order to improve visual detection of DGR episodes, images were treated by a computerized image subtraction method. The visual detection limit of DGR episodes determined by comparison to test images was 0.6 p. 100 of the dose injected intravenously or 17 microCi. A DGR episode was demonstrated in one of the 14 control subjects. The quantity of refluxed liquid was estimated, in this case, at 30 microCi, and the duration of the reflux greater than 2 min. Continuous scintigraphic recording in association with a computer based technique of image subtraction seems to improve scintigraphic performance in the study of DGR episodes under pathological conditions.

[Diagnostic value of gastric pHmetry in duodenogastric reflux]. / Valeur diagnostique de la pHmétrie gastrique au cours du reflux duodéno-gastrique.

Several studies have been performed to examine the problem of diagnosing gastroduodenal reflux (GDR). No single method is widely accepted. The aim of this work was to evaluate the diagnostic value of gastric pHmetry in this regard. A gastric aspiration probe attached to a combined glass electrode was placed in the stomach of 24 patients, with its distal tip located between 9 and 12 cm below the cardia. One ml samples of gastric juice were taken from 8 of the patients every 30 min for 15 h and as well as, every time a spontaneous alkalinization (SA) (defined by a pH greater than or equal to 4 for at least 1 min) was observed. The pH of each sample was measured by colorimetry whereas the concentration of total biliary acids (CTBA) was evaluated by the fluorimetric method (Kit Sterognost 3 alpha Flu); pH value measured via the intragastric electrode during aspiration was also recorded (protocol A). Continuous gastric aspiration was carried out in the remaining 16 patients for the entire duration of the test (6 h) which was divided into periods of 20 min. Apart from the parameters evaluated during protocol A, the percentage of time during which the stomach had a pH greater than or equal to 4 was recorded, as well as the quantity of total biliary acids collected over the 20 min periods (protocol B). Correlation studies were carried out using the Kendall tau and Spearman tests. Percentages were compared using the chi 2 test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ambulatory recording of esophageal pH over a 24-hour period in a population of 27 control subjects: analysis of technical and methodological factors influencing results]. / Enregistrement ambulatoire du pH oesophagien pendant 24 heures dans une population de 27 témoins: analyse des facteurs techniques et méthodologiques influençant les résultats.

Twenty-four hour pH monitoring is used increasingly as a technique for diagnosis of gastro-esophageal reflux (GER). The Synectics recording apparatus (Stockholm, Sweden) was used in 27 ambulatory control subjects in order to: identify the variations of the data-dependent factors (electrodes, buffer solutions, calibration, placement of esophageal electrode). The consequences of these variations were evaluated by studying the measurement deflection after 24 h, baseline variations, and a comparative double pH esophageal recording with reference equipment for 3 h postprandial; to provide normal values for several parameters of GER measurement under the conditions of this study (total number of reflux, number of reflux episodes longer than 5 min, duration of the longest reflux, percentage of time during which pH was less than 4.0). Important interindividual variations were observed. When interpreting the results provided by this type of apparatus, one should take into account these large variations due, first, to the technique used and second, to the conditions of ambulatory recording.

[Barrett's esophagus, gastroesophageal acid reflux and duodenogastric reflux during the digestive and postprandial period]. / Endobrachyoesophage, reflux gastro-oesophagien acide et reflux duodénogastrique en période inter-digestive et post-prandiale.

Pathologic gastroesophageal acid reflux appears to be involved in the pathogenicity of Barrett's esophagus. The possible pathogenic role of duodenogastric reflux, however, has been suggested by several studies. The aim of this prospective study was to assess the prevalence of acid or duodenogastric reflux in patients with Barrett's esophagus. Nine patients with histologically proven Barrett's esophagus (mean length: 7.7cm; range: 2-13 cm) were studied by esophageal manometry and 24 hour pHmetry. Duodenogastric reflux was measured in the interdigestive period by aspiration and during the postprandial period using an isotopic method. The results of these different investigations were compared with healthy volunteers (n = 20 to 27). Three patients had complicated Barrett's esophagus (Barrett's ulcer: n = 2, high-grade dysplasia: n = 1). The results of the different investigations showed that a) all patients had abnormal acid exposure and an esophageal motor dysfunction (decrease in lower esophageal sphincter pressure, amplitude and duration of contractions and increase in percentage of peristaltic dysfunction); b) none of the patients had any pathologic duodenogastric reflux neither in the interdigestive nor in the postprandial period. These results a) confirm the high prevalence of acid reflux in patients with Barrett's esophagus, b) show that bile or pancreatic secretions are not involved in the pathogenicity of Barrett's esophagus.

[Churg-Strauss syndrome with rectal localization and exudative enteropathy]. / Syndrome de Churg et Strauss avec localisation rectale et entéropathie exsudative.

The authors report the case of a 61-year old patient with a Churg-Strauss syndrome revealed by abdominal pain. Investigations showed a diffuse inflammatory digestive tract involvement, documented by endoscopy associated with protein-losing enteropathy. Deep rectal biopsy revealed vasculitis in an otherwise macroscopically normal rectum. Faced with acute and life-threatening course of disease, emergency medical treatment with steroids and cyclophosphamide led to rapid regression of clinical, biological and radiological abnormalities.

[Is the intestinal lavage with a solution of mannitol effective in the prevention of post-hemorrhagic hepatic encephalopathy in patients with liver cirrhosis? Results of a randomized prospective study]. / Le lavage intestinal par une solution au mannitol est-il efficace dans la prévention de l'encéphalopathie hépatique post-hémorragique chez le malade atteint de cirrhose?

OBJECTIVES: The aim of this study was to evaluate the usefulness of whole gut irrigation with a mannitol solution in the prevention of hepatic encephalopathy in patients with cirrhosis and bleeding oesophageal or gastric varices. METHODS: The randomized prospective study included 40 patients with a mean age of 59.6 +/- 9.6 years. Bleeding was controlled by a Blakemore or Linton haemostatic tube, in all cases. The patients were divided into a "mannitol" group (n = 20) treated by whole gut irrigation with a 5 L solution containing 40 g/L of mannitol, and a "control" group (n = 20). The two groups did not differ for age, sex, aetiology of cirrhosis or gastrointestinal bleeding, Child-Pugh classification, delay of minimum fare or the number of transfused blood units. The onset of hepatic encephalopathy was investigated within the first 48 hours after the beginning of gastrointestinal bleeding. The grade of hepatic encephalopathy was established using an index with 4 criteria (mental status, asterixis, number connection test, arterial ammonia concentrations), each with 5 grades of severity. RESULTS: There were no adverse side-effects in the mannitol group. The incidence of hepatic encephalopathy (5 vs 30%) and the length of hospitalization (8.2 +/- 2.3 vs 13.6 +/- 3.1 days) were significantly decreased in the mannitol group (P < 0.05). Mortality was not different between the 2 groups (P = 0.4). CONCLUSION: Whole gut mannitol irrigation appears to be an effective, simple, inexpensive, well tolerated technique in the prevention of hepatic encephalopathy after variceal bleeding in patients with cirrhosis.

[Can early recurrent hemorrhage in gastroduodenal ulcer be predicted?]. / Peut-on prédire la récidive hémorragique précoce des ulcères gastroduodénaux?

OBJECTIVE: To evaluate clinical, biological and endoscopic predictive factors of early recurrent bleeding from gastric or duodenal ulcers. PATIENTS AND METHODS: Seventy six patients (26 females and 50 males) with a mean age of 65.9 years (SD = 17.2) were included in a prospective study. Among the 76 patients, there were 39 NSAIDs users (51.3%). An endoscopy was performed systematically until 12 hours after admission. Treatment modalities were identical for all patients. The predictive value of 11 factors was evaluated through an univariate and multivariate analysis. RESULTS: Three factors had independent significant predictive value: a) the number of blood units used to treat a shock and to increase the haemoglobin level up to 100 g/L (P < 0.05); b) "high endoscopic risk" of recurrent bleeding including Forrest Ia, IIa and IIb ulcers (P < 0.05); c) a non steroidal anti-inflammatory treatment was associated with no recurrent bleeding contrary to the other factors (P < 0.05). Based on a second multivariate analysis including clinical factors only, a predictive score was calculated: 5 + number of blood units -5 x (NSAID = 0/1). The cut off point with maximum discrimination was 6 (specificity = 79.6%; sensitivity = 77.2%). CONCLUSION: A combination of clinical and endoscopic factors is useful to predict ulcer recurrent bleeding. Our clinical predictive score is interesting because of its simplicity. Its predictive value is of interest but have to be evaluated in another sample of patients.

[Campylobacter pylori: diagnostic value of the urease test during endoscopy]. / Le Campylobacter pylori: valeur diagnostique de l'uréase test pratiqué en salle d'endoscopie.

The aims of this prospective study were a) to evaluate the diagnostic value of the urease test for the detection of C. pylori in gastric biopsy specimens, b) to specify the prevalence of C. pylori in a sample of 74 patients from the Grenoble area undergoing upper gastrointestinal endoscopy, c) to analyze the density of bacteria according to the biopsy site (antrum, body, edges of ulcer), d) to demonstrate any possible correlation between the histologic state of the antral and body mucosa and the presence of C. pylori. An antral biopsy was taken for the urease test during endoscopy. Biopsies were also taken from the body, the antrum and the edges of gastric or duodenal ulcers for bacterial and histologic studies, and urease test in the bacterial laboratory. The sensitivity and the specificity of the urease test during endoscopy varied according to the delay in observation of the color change. They were 0.81 and 0.84, respectively, at 2 h 30. The sensitivity and specificity of the urease test in the bacterial laboratory were 0.67 and 0.95, respectively, for the same delay. The global prevalence of C. pylori was 51 p. 100: it was 42 p. 100 in the absence of ulcer, 67 p. 100 in the presence of gastric ulcer, and 71 p. 100 in the presence of duodenal ulcer (p less than 0.05 compared to the group without ulcer).(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastric emptying of a solid-liquid meal in gastroesophageal reflux in adults]. / Vidange gastrique d'un repas solide-liquide au cours du reflux gastro-oesophagien chez l'adulte.

Several studies concerning the relationships between gastroesophageal reflux (GOR), gastric emptying and esophageal motility are available. So far, results have been contradictory. The purpose of this work was to study gastric emptying in patients with GOR; to search for simultaneous esophageal motility disorders and to specify their type and frequency; to establish a potential relationship between motor disorders of the esophagus and the stomach in these patients. Thirty-two consecutive patients were selected according to clinical criteria, i.e. presence of at least two of the three characteristic symptoms of GOR, and the data of a three-hour post-prandial pH-metry. Gastric stasis related clinical manifestations (nausea, post-prandial vomiting, sensation of abdominal distension or of post-prandial epigastric fullness) were also searched for in all patients. A gastroscopy allowed to score esophagitis in each case. All patients, including adult controls underwent an esophageal manometry as well as a radionuclide determination of gastric emptying, after isotopic labelling of the solid (S) and liquid (L) phases of a test meal. The results showed that there was no significant modification of gastric emptying of the S and L phases of the meal in the group of patients with GOR whatever the intensity of the reflux, judged on the pH-metry results and the endoscopic data. Thus the average time of gastric half-emptying of S and L was respectively 115 and 52 min for the patients vs 111 and 51 min for the control group. As well, no correlation was found between the gastric emptying parameters and the presence or absence of clinical signs of gastric stasis or the amplitude of esophageal contraction waves. On an individual basis, two patients showed a significant decrease in gastric emptying of either the S or L phases without any attendant modification in the kinetics of the other. These results suggest that, in the adult, gastric emptying cannot be considered to be a determining factor of GOR and there are no diffuse motility disorders of the upper digestive tract during this illness.

[Severe and recurrent digestive hemorrhage: an uncommon form of colonic schistosomiasis]. / Hémorragie digestive grave et récidivante: une forme exceptionnelle de bilharziose colique.

Schistosoma mansoni infection is frequent in certain areas of the world in which it is endemic. It is characterised by colonic and hepatic lesions. Gastrointestinal hemorrhages due to rupture of esophageal varices in case of hepatic involvement or moderate rectal bleeding due to colonic involvement may also be observed. We report a case of colonic Schistosoma mansoni infection presenting exclusively with recurrent episodes of serious gastrointestinal hemorrhage without hepatic lesions. All diagnostic investigations were negative. The diagnosis was only established on histological examination of the operative left hemicolectomy carried out with the utmost emergency for the serious recurrent hemorrhage. Histological examination revealed the presence of mucosal micro-ulcers, capillary neovascularization in the submucosa and serosa, and the presence of fibrous nodules and giant cell granulomas surrounding the eggs of Schistosoma mansoni in the serosa. This case is original by its clinical presentation and the difficulty to diagnose the Schistosomiasis.

Chronic gastritis: prevalence in the French population. CIRIG.

Chronic gastritis (CG) which can be associated with severe complications, is a frequent phenomenon in gastroenterological practice. No data concerning the prevalence of GC are available in France. The aim of this study was to evaluate the prevalence of CG on biopsy specimens in the French population. All outpatients coming from different towns of seven French areas and undergoing an upper endoscopy on one or two randomly selected consecutive days were included in the study. A case report form was filled out and 5 biopsy specimens were taken from the fundus and antrum. Pathologists graded the specimens on the basis of Whitehead's classification. Seven hundred and forty-two patients were enrolled by 102 private gastroenterologists. Mean age was 53 years; 52% were males. Endoscopically, the gastric mucosa was abnormal in 53%. Superficial and atrophic CG was diagnosed in 53% of cases. Superficial gastritis was observed in 101 patients (14%), antral chronic atrophic gastritis (CAG) in 189 (26%) and fundic CAG in 17 (2%). Patients with CAG were significantly older than the other patients. There were more smokers and heavy alcohol drinkers in the group of CAG patients. Endoscopy and histology were in accordance in only 55.2% of the patients: most cases of CAG were not detected by endoscopy. These results are similar to other studies in European populations. The principal pattern among the various types of gastritis was CAG. The other forms were rare. Autoimmune gastritis was uncommon in this French population (4% of the CAG patients).

[Duodenogastric reflux: diagnostic approach and incidence in dyspeptic disorders]. / Reflux duodéno-gastrique. Approche diagnostique, incidence dans les troubles dyspeptiques.

Duodeno-gastric reflux might be responsible for a number of acute and/or chronic diseases of the oesophagus and stomach. However, no consensus has emerged from published clinical or experimental studies concerning the relationship between duodeno-gastric reflux and digestive tract disease. This inconsistency could be partly linked to the difficulties in detection and quantification of duodeno-gastric reflux episodes and, consequently, in differentiation between physiological and pathological reflux. A critical review of the different diagnostic methods is therefore submitted here. An application of duodeno-gastric reflux evaluation to the inter-digestive period in non-ulcerous dyspepsia was carried out. The preliminary results of this prospective study do not favor an immediate responsibility of a quantitatively abnormal fasting reflux in non-ulcerous dyspepsia. However, other applications of duodeno-gastric reflux analysis taking into account not only the quantitative aspect but also the composition of the reflux material, (selective bile acids, phospholipids, etc.) are necessary.

[Reduction of postprandial gastroesophageal reflux with sodium alginate in suspension. Multicenter pH study in 21 patients]. / Réduction du reflux gastro-oesophagien postprandial par l'alginate de sodium suspension. Etude pH-métrique multicentrique chez 21 malades.

The purpose of this study was to ascertain the pharmacological effectiveness of sodium alginate liquid in the treatment of gastroesophageal acid reflux. The pharmacological test selected was 3 hours postprandial oesophageal pH, because of the physico-chemical properties of this drug. Twenty-one patients of both sexes were included in this study. The initial pH measurement served both as inclusion criteria, by confirming the presence of gastric acid reflux, and as reference for the evaluation of the effect of sodium alginate liquid by a second pH determination after treatment. After treatment with sodium alginate liquid, the number and mean duration of episodes of reflux, as well as the time spent at each pH level, had significantly decreased as compared to the initial value. The gastroesophageal reflux score was significantly reduced during the second hour in recumbent posture, but none of the different parameters studied separately (number and mean duration of episodes of reflux and time spent at each pH level) was significantly decreased. This study demonstrates the pharmacological effectiveness of the drug during the post prandial period and indicates that it is more effective in upright than in supine position.

[Chronologic relationship between gastroesophageal reflux and asthma. Simultaneous study of the measured pH and respiratory function]. / Relation chronologique entre reflux gastro-oesophagien et asthme. Etude simultanée de la pH métrie et de la fonction respiratoire.

UNLABELLED: The aim of the study was: 1) to define the frequency of gastroesophageal reflux (GER) in asthmatics; 2) to study a possible relationship between episodes of GER and changes in airflow obstruction while maintaining as far as possible physiological conditions. Nineteen consecutive patients (aged 40.3 +/- 19 years) presenting with severe asthma requiring continuous treatment, were studied in a stable period. All treatments were stopped for 12 hours before the examination, except corticosteroids and sustained theophylline. Esophageal pH was measured continuously one hour before and three hours after a standardized meal. Respiratory function was measured every 30 minutes using a miniaturized spirometer which enabled the measurement of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1-VC ratio: 1) the frequency of pathological GER was defined by a Kaye's score greater than 90 and was 32%; 2) there was no significant correlation between the individual changes in FEV1 and different variables for the pH measured in the 30 mn before the measurement of bronchial obstruction (number of GER episodes, duration of GER, duration of the last GER episode, time of the last GER); 3) we have found no significant difference between the variation of FEV1 above or below 10% of the best FEV1 of each patient in relation to the quality (intensity, duration, delay) of GER episodes recorded 10 minutes before the spirometry. IN CONCLUSION: in severe asthmatics these results: 1) confirm the high frequency of pathological GER; 2) do not allow the establishment of a direct causal relationship between GER episodes and occurrence of a bronchial obstruction.