RESUMEN
Bone marrow adipose tissue has not been studied in patients with inactive inflammatory bowel disease. We found that these patients have preserved marrow adiposity even with low bone mass. Factors involved in bone loss in active disease may have long-lasting effects but do not seem to affect bone marrow adiposity. INTRODUCTION: Reduced bone mass is known to occur at varying prevalence in patients with inflammatory bowel diseases (IBD) because of inflammation, malnutrition, and steroid therapy. Osteoporosis may develop in these patients as the result of an imbalanced relationship between osteoblasts and adipocytes in bone marrow. This study aimed to evaluate for the first time bone mass and bone marrow adipose tissue (BMAT) in a particular subgroup of IBD patients characterized by long-term, steroid-free remission. METHODS: Patients with Crohn's disease (CD; N = 21) and ulcerative colitis (UC; N = 15) and controls (C; N = 65) underwent dual X-ray energy absorptiometry and nuclear magnetic resonance spectroscopy of the L3 lumbar vertebra for BMAT assessment. RESULTS: Both the CD and UC subgroups showed significantly higher proportions of patients than controls with Z-score ≤-2.0 at L1-L4 (C 1.54%; CD 19.05%; UC 20%; p = 0.02), but not at other sites. The proportions of CD patients with a T-score Ë-1.0 at the femoral neck (C 18.46%; CD 47.62%; p = 0.02) and total hip (C 16.92%; CD 42.86%; p = 0.03) were significantly higher than among controls. There were no statistically significant differences between IBD patients and controls regarding BMAT at L3 (C 28.62 ± 8.15%; CD 29.81 ± 6.90%; UC 27.35 ± 9.80%; p = 0.67). CONCLUSIONS: IBD patients in long-term, steroid-free remission may have a low bone mass in spite of preserved BMAT. These findings confirm the heterogeneity of bone disorders in IBD and may indicate that factors involved in bone loss in active disease may have long-lasting effects on these patients.
Asunto(s)
Tejido Adiposo/patología , Médula Ósea/patología , Enfermedades Inflamatorias del Intestino/complicaciones , Osteoporosis/etiología , Absorciometría de Fotón/métodos , Adulto , Densidad Ósea/fisiología , Estudios de Casos y Controles , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/patología , Colitis Ulcerosa/fisiopatología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Enfermedad de Crohn/fisiopatología , Femenino , Cuello Femoral/fisiopatología , Articulación de la Cadera/fisiopatología , Humanos , Enfermedades Inflamatorias del Intestino/patología , Enfermedades Inflamatorias del Intestino/fisiopatología , Vértebras Lumbares/fisiopatología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Osteoporosis/patología , Osteoporosis/fisiopatología , Adulto JovenRESUMEN
In order to increase dietary folic acid intake and to improve nutritional status regarding folate by controlling homocysteine concentrations, ten patients with inflammatory bowel diseases (Crohn's disease in the colon and ulcerative colitis) received individualized nutritional guidance and were followed up as outpatients for 2 months. The following procedures were performed at the beginning of the study (T0), after 1 month (T1) and at the end of the study (T2): collection of anthropometric data (weight and height), dietary data (24 h diet recall), and blood under fasting condition for the determination of serum folic acid, homocysteine, C-reactive protein, and vitamin B12. Plasma folic acid deficiency was not detected but hyperhomocysteinemia was present in six individuals and C-reactive protein (CRP) was increased (>0.5 mg/dl) in seven patients. After the patients were instructed there was a significant increase in vitamin B6 intake (about 35%) and in folate intake (49.6%). Mean plasma levels of folic acid, homocysteine, and vitamin B12 did not change, but there was a significant decrease of CRP at T1, 0.36 mg dl(-1) on average (P = 0.01), which was maintained at T2. We conclude that the increased folate intake reported by this group of patients was not reflected in improved serum concentrations of folic acid and homocysteine. However, the guidelines for the patients probably induced them to choose a more adequate diet, providing nutrients that help control the inflammatory process.
Asunto(s)
Proteína C-Reactiva/metabolismo , Ácido Fólico/administración & dosificación , Homocisteína/sangre , Enfermedades Inflamatorias del Intestino/dietoterapia , Adulto , Antropometría , Dieta , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/sangre , Masculino , Persona de Mediana Edad , Estado Nutricional , Vitamina B 12/sangre , Adulto JovenRESUMEN
Current medical curricula devote scarce time for practical activities on digestive physiology, despite frequent misconceptions about dyspepsia and dysmotility phenomena. Thus, we designed a hands-on activity followed by a small-group discussion on gut motility. Male awake rats were randomly submitted to insulin, control, or hypertonic protocols. Insulin and control rats were gavage fed with 5% glucose solution, whereas hypertonic-fed rats were gavage fed with 50% glucose solution. Insulin treatment was performed 30 min before a meal. All meals (1.5 ml) contained an equal mass of phenol red dye. After 10, 15, or 20 min of meal gavage, rats were euthanized. Each subset consisted of six to eight rats. Dye recovery in the stomach and proximal, middle, and distal small intestine was measured by spectrophotometry, a safe and reliable method that can be performed by minimally trained students. In a separate group of rats, we used the same protocols except that the test meal contained (99m)Tc as a marker. Compared with control, the hypertonic meal delayed gastric emptying and gastrointestinal transit, whereas insulinic hypoglycemia accelerated them. The session helped engage our undergraduate students in observing and analyzing gut motor behavior. In conclusion, the fractional dye retention test can be used as a teaching tool to strengthen the understanding of basic physiopathological features of gastrointestinal motility.
Asunto(s)
Educación de Pregrado en Medicina/métodos , Educación de Pregrado en Medicina/normas , Motilidad Gastrointestinal/fisiología , Aprendizaje , Estudiantes de Medicina , Vigilia/fisiología , Animales , Humanos , Aprendizaje/fisiología , Masculino , Ratas , Ratas WistarRESUMEN
Dipyrone (metamizole), acting through its main metabolites 4-methyl-amino-antipyrine and 4-amino-antipyrine, has established analgesic, antipyretic, and spasmolytic pharmacological effects, which are mediated by poorly known mechanisms. In rats, intravenously administered dipyrone delays gastric emptying (GE) of liquids with the participation of capsaicin-sensitive afferent fibers. This effect seems to be mediated by norepinephrine originating from the sympathetic nervous system but not from the superior celiac-mesenteric ganglion complex, which activates ß2-adrenoceptors. In rats, in contrast to nonselective non-hormonal anti-inflammatory drugs, dipyrone protects the gastric mucosa attenuating the development of gastric ulcers induced by a number of agents. Clinically, it has been demonstrated that dipyrone is effective in the control of colic-like abdominal pain originating from the biliary and intestinal tracts. Since studies in humans and animals have demonstrated the presence of ß2-adrenoceptors in biliary tract smooth muscle and ß2-adrenoceptor activation has been shown to occur in dipyrone-induced delayed GE, it is likely that this kind of receptors may participate in the reduction of smooth muscle spasm of the sphincter of Oddi induced by dipyrone. There is no evidence that dipyrone may interfere with small bowel and colon motility, and the clinical results of its therapeutic use in intestinal colic appear to be due to its analgesic effect.
Asunto(s)
Ampirona/farmacología , Antiinflamatorios no Esteroideos/farmacología , Antipirina/farmacología , Dipirona/farmacología , Vaciamiento Gástrico/efectos de los fármacos , Animales , Bloqueo Nervioso Autónomo , Dipirona/administración & dosificación , Ratas , Ratas WistarRESUMEN
We evaluated the effects of cyclooxygenase-2 (COX-2) selective inhibitors, COX-1 selective inhibitor, or COX non-selective inhibitor on gastric emptying and intestinal transit of liquids, and evaluated the effect of a COX-2 selective inhibitor on gastric tonus (GT). Male Wistar rats were treated per os with saline (control), rofecoxib, celecoxib, ketorolac, rofecoxib + ketorolac, celecoxib + ketorolac, or indomethacin. After 1 h, rats were gavage-fed (1.5 mL) with the test meal (5% glucose solution with 0.05 g mL(-1) phenol red) and killed 10, 20 or 30 min later. Gastric, proximal, medial or distal small intestine dye recovery (GDR and IDR, respectively) were measured by spectrophotometry. The animals of the other group were treated with i.v. valdecoxib or saline, and GT was continuously observed for 120 min using a pletismomether system. Compared with the control group, treatment with COX-2 inhibitors, alone or with ketocolac, as well as with indomethacin increased GDR (P < 0.05) at 10-, 20- or 30-min postprandial intervals. Ketorolac alone did not change the GDR, but increased the proximal IDR (P < 0.05) at 10 min, and decreased medial IDR (P < 0.05) at 10 and 20 min. Valdecoxib increased (P < 0.01) GT 60, 80 and 100 min after administration. In conclusion, COX-2 inhibition delayed the gastric emptying of liquids and increased GT in rats.
Asunto(s)
Inhibidores de la Ciclooxigenasa 2/farmacología , Vaciamiento Gástrico/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Estómago/efectos de los fármacos , Animales , Celecoxib , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/patología , Indometacina/farmacología , Isoxazoles/farmacología , Ketorolaco/farmacología , Lactonas/farmacología , Masculino , Pirazoles/farmacología , Ratas , Ratas Wistar , Estómago/patología , Sulfonamidas/farmacología , Sulfonas/farmacologíaRESUMEN
Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infra-junctional area was similar for patients and controls: 23% (range: 20-30) vs 27% (range: 19-30%; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.
Asunto(s)
Unión Esofagogástrica/fisiopatología , Vaciamiento Gástrico/fisiología , Reflujo Gastroesofágico/fisiopatología , Adulto , Estudios de Casos y Controles , Unión Esofagogástrica/diagnóstico por imagen , Femenino , Reflujo Gastroesofágico/diagnóstico por imagen , Reflujo Gastroesofágico/etiología , Motilidad Gastrointestinal/fisiología , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Ácido Fítico , Cintigrafía , Factores de TiempoRESUMEN
AIM: In the present study we evaluated the effects of gastric myenteric denervation using benzalkonium chloride (BAC) on the time for gastric emptying, as well as gastric secretion, and mucosal epithelial cell size and population in rats. METHODS AND RESULTS: Wistar rats were treated with topical serosal application of BAC to the stomach. Control animals received saline. Ninety days after surgery, gastric emptying time, gastric acid secretion and serum gastrin levels were studied. Next, the animals were sacrificed and the stomachs were removed, fixed in formalin and histologically processed for histomorphometry of the height, area and volume of the glandular portion, and volume and population of mucous, chief, parietal, G- and labelled cells. BAC animals showed a significant delay in gastric emptying and an increase in gastric acid secretion and serum gastrin levels. These animals also presented a significant reduction of myenteric neuron number, hypertrophy of parietal and chief cells, hyperplasia of G cells and an increase in the gastric mucosa area. CONCLUSION: The absence of the myenteric plexus seems to protect the stomach from the hyperplastic effects of hypergastrinemia. Gastric food stasis may act as a factor triggering morphological and functional alterations of the gastric epithelium. Although gastric food stasis is a common finding in medical practice, its physiopathological consequences are poorly understood and have not been frequently discussed in the literature.
Asunto(s)
Vaciamiento Gástrico , Mucosa Gástrica/fisiología , Gastrinas/sangre , Estómago/fisiología , Animales , Compuestos de Benzalconio , Células Principales Gástricas/patología , Detergentes , Ácido Gástrico/metabolismo , Determinación de la Acidez Gástrica , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Células Secretoras de Gastrina/patología , Hiperplasia , Desnervación Muscular/métodos , Músculo Liso/inervación , Músculo Liso/fisiología , Plexo Mientérico/efectos de los fármacos , Tamaño de los Órganos , Células Parietales Gástricas/patología , Ratas , Ratas Wistar , Estómago/inervaciónRESUMEN
Gastric antral dysmotility has been implicated in the pathogenesis of indomethacin-induced gastric damage, but the relationship between gastric motor abnormalities and mucosal lesions has not been extensively studied. We investigated whether changes in gastric tone and gastric retention correlate with mucosal lesions and neutrophil migration in indomethacin-induced gastric damage in rats. Indomethacin, either 5 or 20 mg/kg (INDO-5 and INDO-20), was instilled into the stomach, and then gastric damage, neutrophil migration, gastric tone and gastric retention were assessed 1 or 3 h later. Gastric damage was calculated as the sum of the lengths of all mucosal lesions, and neutrophil migration was measured by assaying myeloperoxidase activity. Gastric tone was determined by a plethysmometric method, and gastric retention of either saline or Sustacal was evaluated by a scintigraphic method. Gastric damage was detectable 3 h after either INDO-5 or INDO-20, but not after 1 h. Neutrophil migration was significantly higher 3 h after INDO-20 as compared with INDO-5 or control group, but not after 1 h. Values of gastric tone 1 and 3 h after either INDO-5 (1 h = 1.73+/-0.07 ml; 3 h = 1.87+/-0.03 ml) or INDO-20 (1 h = 1.70+/-0.02 ml; 3 h = 1.79+/-0.03 ml) were significantly lower than in controls (1 h = 1.48+/-0.05 ml; 3 h = 1.60+/-0.06 ml). Gastric retention of saline was higher 1 h after INDO-5 (58.9+/-3.3%) or INDO-20 (56.1+/-3.1%) compared to control (45.5+/-1.7%), but not after 3 h. There were no differences concerning gastric retention of Sustacal between the various groups. Indomethacin induced decreased gastric tone and delayed gastric emptying, which precede mucosal lesion and neutrophil infiltration. These results indicate that there is no relationship between these gastric motor abnormalities and mucosal lesion in indomethacin-induced gastropathy.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacología , Vaciamiento Gástrico/efectos de los fármacos , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/patología , Indometacina/farmacología , Infiltración Neutrófila/efectos de los fármacos , Animales , Masculino , Tono Muscular/efectos de los fármacos , Ratas , Ratas WistarRESUMEN
Gastric dysrhythmias, such as tachy- or bradygastria, have been reported in patients with functional dyspepsia (FD), but their role in symptom production is uncertain. It is also not known whether gastric dysrhythmias in these patients can be elicited by physiological gastric distension with a meal. We investigated the relationships between symptoms after ingestion of different volumes of water following a test meal and gastric dysrhythmias in FD patients. Fourteen patients with dysmotility-like FD and 13 healthy volunteers underwent paired electrogastrography (EGG) studies. Fasted subjects ingested 150 ml of yoghurt with either 150 ml (low volume) or 300 ml (high volume) water in random order. Fasting and fed EGGs with monitoring of symptoms were performed in both studies. Ten FD patients (71.4%) reported upper abdominal discomfort and bloating after the low volume meal, but only one (7.1%) presented an abnormal EGG (dominant frequency in the 2-4-cpm range: 58%). Following the high volume meal, 7 patients (50%) had symptoms, but none had EGG abnormalities. No significant differences were found between FD patients and controls for any of the EGG variables, in any test. In FD patients with postprandial symptoms, the percentage of the EGG dominant frequency in the normal range (median, 84.6%; range, 76.0-100.0%) was similar (P>0.20) to that in those without symptoms (88.5%; 75.0-100.0%). We conclude that disturbances of gastric myoelectrical activity are unlikely to play a role in the origin of postprandial upper abdominal discomfort and bloating in dysmotility-like FD.
Asunto(s)
Dispepsia/fisiopatología , Vaciamiento Gástrico/fisiología , Complejo Mioeléctrico Migratorio/fisiología , Periodo Posprandial/fisiología , Estómago/fisiopatología , Adulto , Estudios de Casos y Controles , Electrodiagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Dipyrone (metamizole), acting through its main metabolites 4-methyl-amino-antipyrine and 4-amino-antipyrine, has established analgesic, antipyretic, and spasmolytic pharmacological effects, which are mediated by poorly known mechanisms. In rats, intravenously administered dipyrone delays gastric emptying (GE) of liquids with the participation of capsaicin-sensitive afferent fibers. This effect seems to be mediated by norepinephrine originating from the sympathetic nervous system but not from the superior celiac-mesenteric ganglion complex, which activates β2-adrenoceptors. In rats, in contrast to nonselective non-hormonal anti-inflammatory drugs, dipyrone protects the gastric mucosa attenuating the development of gastric ulcers induced by a number of agents. Clinically, it has been demonstrated that dipyrone is effective in the control of colic-like abdominal pain originating from the biliary and intestinal tracts. Since studies in humans and animals have demonstrated the presence of β2-adrenoceptors in biliary tract smooth muscle and β2-adrenoceptor activation has been shown to occur in dipyrone-induced delayed GE, it is likely that this kind of receptors may participate in the reduction of smooth muscle spasm of the sphincter of Oddi induced by dipyrone. There is no evidence that dipyrone may interfere with small bowel and colon motility, and the clinical results of its therapeutic use in intestinal colic appear to be due to its analgesic effect.
Asunto(s)
Animales , Ratas , Antiinflamatorios no Esteroideos/farmacología , Ampirona/farmacología , Antipirina/farmacología , Dipirona/farmacología , Vaciamiento Gástrico/efectos de los fármacos , Bloqueo Nervioso Autónomo , Dipirona/administración & dosificación , Ratas WistarRESUMEN
BACKGROUND/OBJECTIVES: Reduced food intake, appetite loss and alteration of ghrelin and PYY(3-36) secretion have been suggested to have a function in the loss of body weight commonly observed after gastrectomy. The objective of this study was to investigate the circulating concentrations of ghrelin and PYY(3-36) and their relationships with food intake, appetite and resting energy expenditure (REE) after gastrectomy plus vagotomy. SUBJECTS/METHODS: Seven patients with total gastrectomy (TG), 14 with partial gastrectomy (PG) and 10 healthy controls were studied. Habitual food intake and REE was assessed; fasting and postprandial plasma total ghrelin, PYY(3-36) concentrations and appetite ratings were determined after ingestion of a liquid test meal. RESULTS: Differently from PG and controls, fasting ghrelin correlated with REE, and a higher energy intake was observed in the TG group. Fasting plasma ghrelin concentrations were lower in TG compared with controls, and no ghrelin response to the meal was observed in either PG or TG. Fasting plasma PYY(3-36) concentrations were not different among the groups. There was an early and exaggerated postprandial rise in PYY(3-36) levels in both PG and TG groups, but not in controls. No effect of ghrelin or PYY(3-36) concentrations was observed on hunger, prospective consumption or fullness ratings. CONCLUSIONS: Total ghrelin and PYY(3-36) do not seem to be involved with appetite or energy intake regulation after gastrectomy plus vagotomy. Ghrelin secreted by sources other than stomach is likely to have a function in the long-term regulation of body weight after TG.
Asunto(s)
Apetito , Metabolismo Basal , Ingestión de Energía , Gastrectomía , Ghrelina/sangre , Péptido YY/sangre , Vagotomía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Adulto JovenRESUMEN
Disturbed gastric contractility has been found in manometric studies in patients with gastro-oesophageal reflux disease (GORD), but the pathophysiological role of this abnormality is unclear. We aimed at assessing postprandial gastric antral contractions and its relationships with gastric emptying and gastro-oesophageal reflux in GORD patients. Fasted GORD patients (n = 13) and healthy volunteers (n = 13) ingested a liquid meal labelled with 72 MBq of 99mTechnetium-phytate. Gastric images were acquired every 10 min for 2 h, for measuring gastric emptying half time. Dynamic antral scintigraphy (one frame per second), performed for 4 min at 30-min intervals, allowed estimation of both mean dominant frequency and amplitude of antral contractions. In GORD patients (n = 10), acidic reflux episodes occurring 2 h after the ingestion of the same test meal were determined by ambulatory 24-h oesophageal pH monitoring. Gastric emptying was similar in GORD patients and controls (median; range: 82 min; 58-126 vs 80 min; 44-122 min; P = 0.38). Frequency of antral contractions was also similar in both groups (3.1 cpm; 2.8-3.6 vs 3.2 cpm; 2.4-3.8 cpm; P = 0.15). In GORD patients, amplitude of antral contractions was significantly higher than in controls (32.7%; 17-44%vs 23.3%; 16-43%; P = 0.01), and correlated positively with gastric emptying time (R(s) = 0.58; P = 0.03) and inversely with the number of reflux episodes (R(s) = -0.68; P = 0.02). Increased amplitude of postprandial gastric antral contractions in GORD may comprise a compensatory mechanism against delayed gastric emptying and a defensive factor against acidic gastro-oesophageal reflux.
Asunto(s)
Reflujo Gastroesofágico/diagnóstico por imagen , Reflujo Gastroesofágico/fisiopatología , Contracción Muscular/fisiología , Periodo Posprandial/fisiología , Antro Pilórico/diagnóstico por imagen , Antro Pilórico/fisiología , Adolescente , Adulto , Femenino , Vaciamiento Gástrico/fisiología , Humanos , Masculino , Persona de Mediana Edad , Peristaltismo/fisiología , Cintigrafía/métodos , Estómago/diagnóstico por imagen , Estómago/fisiologíaRESUMEN
A natural magnetic resonance imaging (MRI) contrast based on the pulp of a fruit "Euterpe Olerácea", popularly known as Açaí, was investigated. T1 and T2 contrasted images shown the effects of the contrast agent increasing the ability to visualize the contour of segments of the gastrointestinal tract.
RESUMEN
Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infra-junctional area was similar for patients and controls: 23 percent (range: 20-30) vs 27 percent (range: 19-30 percent; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Unión Esofagogástrica/fisiopatología , Vaciamiento Gástrico/fisiología , Reflujo Gastroesofágico/fisiopatología , Estudios de Casos y Controles , Unión Esofagogástrica , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico , Motilidad Gastrointestinal/fisiología , Concentración de Iones de Hidrógeno , Compuestos de Organotecnecio , Ácido Fítico , Factores de TiempoRESUMEN
Gastric dysrhythmias, such as tachy- or bradygastria, have been reported in patients with functional dyspepsia (FD), but their role in symptom production is uncertain. It is also not known whether gastric dysrhythmias in these patients can be elicited by physiological gastric distension with a meal. We investigated the relationships between symptoms after ingestion of different volumes of water following a test meal and gastric dysrhythmias in FD patients. Fourteen patients with dysmotility-like FD and 13 healthy volunteers underwent paired electrogastrography (EGG) studies. Fasted subjects ingested 150 ml of yoghurt with either 150 ml (low volume) or 300 ml (high volume) water in random order. Fasting and fed EGGs with monitoring of symptoms were performed in both studies. Ten FD patients (71.4 percent) reported upper abdominal discomfort and bloating after the low volume meal, but only one (7.1 percent) presented an abnormal EGG (dominant frequency in the 2-4-cpm range: 58 percent). Following the high volume meal, 7 patients (50 percent) had symptoms, but none had EGG abnormalities. No significant differences were found between FD patients and controls for any of the EGG variables, in any test. In FD patients with postprandial symptoms, the percentage of the EGG dominant frequency in the normal range (median, 84.6 percent; range, 76.0-100.0 percent) was similar (P > 0.20) to that in those without symptoms (88.5 percent; 75.0-100.0 percent). We conclude that disturbances of gastric myoelectrical activity are unlikely to play a role in the origin of postprandial upper abdominal discomfort and bloating in dysmotility-like FD.
Asunto(s)
Persona de Mediana Edad , Humanos , Masculino , Femenino , Adulto , Dispepsia , Vaciamiento Gástrico , Complejo Mioeléctrico Migratorio , Periodo Posprandial , Estómago , Estudios de Casos y Controles , ElectrodiagnósticoRESUMEN
Gastric antral dysmotility has been implicated in the pathogenesis of indomethacin-induced gastric damage, but the relationship between gastric motor abnormalities and mucosal lesions has not been extensively studied. We investigated whether changes in gastric tone and gastric retention correlate with mucosal lesions and neutrophil migration in indomethacin-induced gastric damage in rats. Indomethacin, either 5 or 20 mg/kg (INDO-5 and INDO-20), was instilled into the stomach, and then gastric damage, neutrophil migration, gastric tone and gastric retention were assessed 1 or 3 h later. Gastric damage was calculated as the sum of the lengths of all mucosal lesions, and neutrophil migration was measured by assaying myeloperoxidase activity. Gastric tone was determined by a plethysmometric method, and gastric retention of either saline or Sustacal« was evaluated by a scintigraphic method. Gastric damage was detectable 3 h after either INDO-5 or INDO-20, but not after 1 h. Neutrophil migration was significantly higher 3 h after INDO-20 as compared with INDO-5 or control group, but not after 1 h. Values of gastric tone 1 and 3 h after either INDO-5 (1 h = 1.73 ± 0.07 ml; 3 h = 1.87 ± 0.03 ml) or INDO-20 (1 h = 1.70 ± 0.02 ml; 3 h = 1.79 ± 0.03 ml) were significantly lower than in controls (1 h = 1.48 ± 0.05 ml; 3 h = 1.60 ± 0.06 ml). Gastric retention of saline was higher 1 h after INDO-5 (58.9 ± 3.3 percent) or INDO-20 (56.1 ± 3.1 percent) compared to control (45.5 ± 1.7 percent), but not after 3 h. There were no differences concerning gastric retention of Sustacal« between the various groups. Indomethacin induced decreased gastric tone and delayed gastric emptying, which precede mucosal lesion and neutrophil infiltration. These results indicate that there is no relationship between these gastric motor abnormalities and mucosal lesion in indomethacin-induced gastropathy
Asunto(s)
Animales , Masculino , Ratas , Antiinflamatorios no Esteroideos , Vaciamiento Gástrico , Mucosa Gástrica , Indometacina , Infiltración Neutrófila , Tono Muscular , Ratas WistarRESUMEN
The effects of a fraction (T1) of Tityus serrulatus scorpion venom prepared by gel filtration on gastric emptying and small intestinal transit were investigated in male Wistar rats. Fasted animals were anesthetized with urethane, submitted to tracheal intubation and right jugular vein cannulation. Scorpion toxin (250 Ág/kg) or saline was injected iv and 1 h later a bolus of saline (1.0 ml/100 g) labeled with 99m technetium-phytate (10 MBq) was administered by gavage. After 15 min, animals were sacrificed and the radioactivity remaining in the stomach was determined. Intestinal transit was evaluated by instillation of a technetium-labeled saline bolus (1.0 ml) through a cannula previously implanted in the duodenum. After 60 min, the progression of the marker throughout 7 consecutive gut segments was estimated by the geometric center method. Gastric retention of the liquid test meal in rats injected with scorpion toxin (median: 88 percent; range: 52-95 percent) was significantly higher (P<0.02) than in controls (54 percent; 21-76 percent), an effect which was not modified by gastric secretion blockade with ranitidine. The progression of the isotope marker throughout the small intestine was significantly slower (P<0.05) in rats treated with toxin (1.2; 1.0-2.5) than in control animals (2.3; 1.0-3.2). Inhibition of both gastric emptying and intestinal transit in rats injected with scorpion toxin suggests an increased resistance to aboral flow, which might be caused by abnormal neurotransmitter release or by the local effects of venom on smooth muscle cells
Asunto(s)
Animales , Ratas , Masculino , Vaciamiento Gástrico/efectos de los fármacos , Tránsito Gastrointestinal/efectos de los fármacos , Venenos de Escorpión/toxicidad , Inyecciones Intraperitoneales , Intestino Delgado/efectos de los fármacos , Ratas Wistar , Estadísticas no ParamétricasRESUMEN
Gastric emptying and small bowel transit of a liquid meal (sotonic dextrose) were assessed by a scintigraphic technique in 16 patients with Chagas'disease involving the esophagus and/or the colon, including one case with megajejunum, and in 10 control subjects. Initial gastric emptying was faster in the Chagas'disease group than in controls (gastric retention at 15 min, median and (range): 52% (15-86) vs 71% (43-97), P<0.01) although there was no significant difference in total gastric emptying (T1/2:20 min (4-132) vs 31 min (13-280), P>0.05). Both the front (time to reach the proximal small bowel: 2.5 min (2.5-8) vs 15 min (5-40), P<0.01) and the bulk of the meal (geometric center values at 15 min:1.8(1.2-2.4) vs 1.6(1.2-1.8), P<0.05) travelled faster through the proximal small bowel in Chagas'disease patients than in control subjects. There was no difference between the two groups concerning the time taken by the front of the meal to arrive to the caecum (110 min (15-180) vs 90 min (60-140), P>0.20), but a precise delineation of this region was possible in only less than half of the patients and controls. in the patient with megajujunum, a remarkable delay in the intestinal progression of the liquid meal was found. These results suggest that the diffuse lesion of the enteric nervous system in chronic Chagas'disease mainly affects the controlnof gastric emptying and leads to accelerated proximal small bowel transit of a liquid meal. Impairment of the intestinal progression of the liquid meal seems to occur only inn assocaition of the small bowel
Asunto(s)
Enfermedad de Chagas , Dieta , Fluidoterapia , Vaciamiento Gástrico , Tránsito Gastrointestinal , Intestino Delgado , Yeyuno , Cintigrafía , TecnecioRESUMEN
1. A randomized, double-blind, placebo-controlled trial was carried out to determine the efficacy of isosorbide dinitrate (ISD) on diasphagia in patients with Chagasic achalasia. 2. Twenty-three patients with Chagas' disease and dysphagia entered the study ans 20 (87%) complelted the two 7-day treatment periods. Subjects were given either 5 mg ISD (12 patients) or placebo (11 patients) by the sublingual route for the first 7 days. On the 8 th day, patients crossed over and began another 7-days period during which they received the opposite, identical-appearing tablets. 3. Scores attributed by uniformed investigators for the frequency and severity of dysphagia were signidicantly lower (P,0.05) following ISD treatment than after the placebo period or for the pretreatment condition. A significantly higher degree of improvement of dysphagia was experienced by the patients during ISD treatment than during the placebo period. Fourteen patients experienced meal-related headaches during ISD, but not placebo treatment. The extent of improvement in general well-being due to ISD was the same when the drug given in the first or second test period. 4. Our results indicate that ISD, 5 mg by the sublingual route, is effective in alleviating dysphagia in patients with Chagasic achalasia but its usefulness is limited by the high rate of headache as a side effect