RESUMO
BACKGROUND: Several neurological disorders have been described in inflammatory bowel disease (IBD) patients, but their exact frequency is unknown. METHODS: We prospectively studied the prevalence of neurological disorders (especially peripheral neuropathy) in a group of 82 patients with Crohn's disease (CD, n = 31) or ulcerative colitis (UC, n = 51) from 2 Brazilian tertiary care university clinics and followed them through a period of at least 1 year. All patients were interviewed and had complete neurological evaluations. RESULTS: Large-fiber sensory or sensorimotor polyneuropathy (PN) was observed in 16.1% of the CD and 19.6% of the UC patients. PN was usually mild, predominantly symmetric, and distal with axonal involvement. One patient had demyelinating PN at the diagnosis of CD. Mild carpal tunnel syndrome was common in female UC patients. Sensory symptoms without electromyography abnormalities, suggestive of small-fiber neuropathy or subclinical myelopathy, affected 29% and 11.8%, respectively. After excluding other known etiological or contributory factors for PN, 13.4% of the IBD patients had otherwise unexplained large-fiber or small-fiber PN (7.3% with large-fiber SM PN). Nondebilitating headache was the most common neurological complaint. Three patients had ischemic strokes, 5 were epileptic, and 1 transient chorea. CONCLUSIONS: Neurological disorders, especially PN, are common in our Brazilian cohort of IBD patients. They are diverse, multifactorial, and more common in women. Despite the mild phenotype in most cases, attention should be given by the general practitioner and gastroenterologist since they are frequently undiagnosed. Further studies are necessary to confirm these findings in populations with different genetic and nutritional backgrounds.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Doenças do Sistema Nervoso Periférico/epidemiologia , Vigilância da População , Adulto , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
Preclinical and clinical studies show that gastrointestinal (GI) inflammation can evoke sensory changes occasionally far from the original inflammatory site. Animal models of colitis with either trinitrobenzenesulphonic acid (TNBS) or mustard oil (MO) produce distinct patterns of somatic and visceral sensory changes. We evaluated the effects of four doses of i.v. vincristine 150 µg kg(-1) (total of 600 µg kg(-1) ) treatment on the somatic (thermal nociceptive threshold) and colonic (morphological) changes induced by TNBS or MO in rats. TNBS and MO groups were further submitted to vincristine or saline pretreatments. TNBS induced somatic hypersensitivity, while MO induced somatic hyposensitivity (P < 0.05) when compared to the saline and ethanol control groups. Vincristine per se induced somatic hypersensitivity (P < 0.05). This effect was enhanced by TNBS and reversed by MO treatments. Although vincristine increased the colitis area (colonic weight length(-1) ratio) and the Morris' score in TNBS-treated rats, it did not alter the colitis area and even lowered the Morris' score in MO-treated rats. Compared to the saline (control) group, vincristine did not alter the colonic microscopic pattern. However, such lesions scores are higher (P < 0.05) in colitis groups induced by TNBS and MO, pretreated or not with vincristine. In conclusion, the somatic changes induced by different models of experimental colitis are diverse and modulated differently by vincristine.
Assuntos
Colite/tratamento farmacológico , Colite/patologia , Colo/efeitos dos fármacos , Colo/patologia , Limiar da Dor/efeitos dos fármacos , Vincristina/farmacologia , Vincristina/uso terapêutico , Animais , Antineoplásicos Fitogênicos/farmacologia , Antineoplásicos Fitogênicos/uso terapêutico , Modelos Animais de Doenças , Interações Medicamentosas , Masculino , Mostardeira , Óleos de Plantas , Ratos , Índice de Gravidade de Doença , Ácido TrinitrobenzenossulfônicoRESUMO
Sildenafil slows down the gastric emptying of a liquid test meal in awake rats and inhibits the contractility of intestinal tissue strips. We studied the acute effects of sildenafil on in vivo intestinal transit in rats. Fasted, male albino rats (180-220 g, N = 44) were treated (0.2 mL, iv) with sildenafil (4 mg/kg) or vehicle (0.01 N HCl). Ten minutes later they were fed a liquid test meal (99m technetium-labeled saline) injected directly into the duodenum. Twenty, 30 or 40 min after feeding, the rats were killed and transit throughout the gastrointestinal tract was evaluated by progression of the radiotracer using the geometric center method. The effect of sildenafil on mean arterial pressure (MAP) was monitored in a separate group of rats (N = 14). Data (medians within interquartile ranges) were compared by the Mann-Whitney U-test. The location of the geometric center was significantly more distal in vehicle-treated than in sildenafil-treated rats at 20, 30, and 40 min after test meal instillation (3.3 (3.0-3.6) vs 2.9 (2.7-3.1); 3.8 (3.4-4.0) vs 2.9 (2.5-3.1), and 4.3 (3.9-4.5) vs 3.4 (3.2-3.7), respectively; P < 0.05). MAP was unchanged in vehicle-treated rats but decreased by 25% (P < 0.05) within 10 min after sildenafil injection. In conclusion, besides transiently decreasing MAP, sildenafil delays the intestinal transit of a liquid test meal in awake rats.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Esvaziamento Gástrico/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Inibidores de Fosfodiesterase/farmacologia , Piperazinas/farmacologia , Sulfonas/farmacologia , Animais , Modelos Animais de Doenças , Mucosa Intestinal/metabolismo , Intestinos/efeitos dos fármacos , Masculino , Purinas/farmacologia , Ratos , Citrato de Sildenafila , TecnécioRESUMO
1 To evaluate the effect of high spinal cord transection (SCT), between T4 and T5, on the mean arterial pressure (MAP) and heart rate in animals anaesthetized with different anaesthetic agents: ether (n = 12), 20% urethane, 1.2 g kg(-1) (n = 12), 2% tri-bromide-ethanol, 200 mg kg(-1) (n = 12); chloral hydrate and urethane, 75 and 525 mg kg(-1) respectively (n = 12). 2 In the animals anaesthetized with ether or urethane, SCT caused an immediate major drop in MAP, with hypotension and bradycardia throughout the next 10 min. In the animals anaesthetized with urethane + chloralose or tri-bromide-ethanol, SCT transiently increased MAP with subsequent hypotension and bradycardia. 3 In summary, the haemodynamic changes after complete, high SCT are anaesthetic agent dependent. Further research about the exact mechanisms responsible for these diverse autonomic changes is warranted.
Assuntos
Anestésicos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Traumatismos da Medula Espinal/fisiopatologia , Animais , Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Masculino , Ratos , Ratos Wistar , Vértebras TorácicasRESUMO
Sildenafil slows down the gastric emptying of a liquid test meal in awake rats and inhibits the contractility of intestinal tissue strips. We studied the acute effects of sildenafil on in vivo intestinal transit in rats. Fasted, male albino rats (180-220 g, N = 44) were treated (0.2 mL, iv) with sildenafil (4 mg/kg) or vehicle (0.01 N HCl). Ten minutes later they were fed a liquid test meal (99m technetium-labeled saline) injected directly into the duodenum. Twenty, 30 or 40 min after feeding, the rats were killed and transit throughout the gastrointestinal tract was evaluated by progression of the radiotracer using the geometric center method. The effect of sildenafil on mean arterial pressure (MAP) was monitored in a separate group of rats (N = 14). Data (medians within interquartile ranges) were compared by the Mann-Whitney U-test. The location of the geometric center was significantly more distal in vehicle-treated than in sildenafil-treated rats at 20, 30, and 40 min after test meal instillation (3.3 (3.0-3.6) vs 2.9 (2.7-3.1); 3.8 (3.4-4.0) vs 2.9 (2.5-3.1), and 4.3 (3.9-4.5) vs 3.4 (3.2-3.7), respectively; P < 0.05). MAP was unchanged in vehicle-treated rats but decreased by 25 percent (P < 0.05) within 10 min after sildenafil injection. In conclusion, besides transiently decreasing MAP, sildenafil delays the intestinal transit of a liquid test meal in awake rats.
Assuntos
Animais , Masculino , Ratos , Pressão Sanguínea/efeitos dos fármacos , Esvaziamento Gástrico/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Inibidores de Fosfodiesterase/farmacologia , Piperazinas/farmacologia , Sulfonas/farmacologia , Modelos Animais de Doenças , Intestinos/efeitos dos fármacos , Intestinos/metabolismo , Purinas/farmacologia , TecnécioAssuntos
Infartos do Tronco Encefálico/patologia , Imagem de Difusão por Ressonância Magnética , Infartos do Tronco Encefálico/diagnóstico , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Grau de Desobstrução Vascular , Artéria Vertebral/patologia , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/patologiaRESUMO
We studied the effect of complete spinal cord transection (SCT) on gastric emptying (GE) and on gastrointestinal (GI) and intestinal transits of liquid in awake rats using the phenol red method. Male Wistar rats (N = 65) weighing 180-200 g were fasted for 24 h and complete SCT was performed between C7 and T1 vertebrae after a careful midline dorsal incision. GE and GI and intestinal transits were measured 15 min, 6 h or 24 h after recovery from anesthesia. A test meal (0.5 mg/ml phenol red in 5 percent glucose solution) was administered intragastrically (1.5 ml) and the animals were sacrificed by an iv thiopental overdose 10 min later to evaluate GE and GI transit. For intestinal transit measurements, 1 ml of the test meal was administered into the proximal duodenum through a cannula inserted into a gastric fistula. GE was inhibited (P<0.05) by 34.3, 23.4 and 22.7 percent, respectively, at 15 min, 6 h and 24 h after SCT. GI transit was inhibited (P<0.05) by 42.5, 19.8 and 18.4 percent, respectively, at 15 min, 6 h and 24 h after SCT. Intestinal transit was also inhibited (P<0.05) by 48.8, 47.2 and 40.1 percent, respectively, at 15 min, 6 h and 24 h after SCT. Mean arterial pressure was significantly decreased (P<0.05) by 48.5, 46.8 and 41.5 percent, respectively, at 15 min, 6 h and 24 h after SCT. In summary, our report describes a decreased GE and GI and intestinal transits in awake rats within the first 24 h after high SCT
Assuntos
Ratos , Masculino , Animais , Ingestão de Líquidos/fisiologia , Esvaziamento Gástrico/fisiologia , Trânsito Gastrointestinal/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Pressão Sanguínea/fisiologia , Ratos WistarRESUMO
We evaluated the effects of fundectomy and pyloroplasty on the delay of gastric emptying (GE) and gastrointestinal (GI) transit of liquid due to blood volume (BV) expansion in awake rats. Male Wistar rats (N=76, 180-250 g) were first submitted to fundectomy (N=26), Heinecke-Mikulicz pyloroplasty (N=25) or SHAM laparotomy (N=25). After 6 days, the left external jugular vein was cannulated and the animals were fasted for 24 h with water ad libitum. The test meal was administered intragastrically (1.5 ml of a phenol red solution, 0.5 mg/ml in 5 percent glucose) to normovolemic control animals and to animals submitted to BV expansion (Ringer-bicarbonate, iv infusion, 1 ml/min, volume up to 5 percent body weight). BV expansion decreased GE and GI transit rates in SHAM laparotomized animals by 52 and 35.9 percent (P<0.05). Fundectomy increased GE and GI transit rates by 61.1 and 67.7 percent (P<0.05) and prevented the effect of expansion on GE but not on GI transit (13.9 percent reduction, P<0.05). Pyloroplasty also increased GE and GI transit rates by 33.9 and 44.8 percent (P<0.05) but did not prevent the effect of expansion on GE or GI transit (50.7 and 21.1. percent reduction, P<0.05). Subdiaphragmatic vagotomy blocked the effect of expansion on GE and GI transit in both SHAM laparotomized animals and animals submitted to pyloroplasty. In conclusion 1) the proximal stomach is involved in the GE delay due to BV expansion but is not essential for the establishment of a delay in GI transit, which suggests the activation of intestinal resistances, 2) pyloric modulation was not apparent, and 3) vagal pathways are involved.
Assuntos
Animais , Masculino , Ratos , Volume Sanguíneo , Esvaziamento Gástrico , Fundo Gástrico/cirurgia , Trânsito Gastrointestinal , Piloro/cirurgia , Ratos Wistar , Fatores de TempoRESUMO
We have previously demonstrated that blood volume (BV) expansion decreases saline flow through the gastroduodenal (GD) segment in anesthetized rats (Xavier-Neto J, dos Santos AA & Rola FH (1990) Gut, 31: 1006-1010). The present study attempts to identify the site(s) of resistance and neural mechanisms involved in this phenomenon. Male Wistar rats (N = 97,200-300 g) were surgically manipulated to create four gut circuits: GD, gastric, pyloric and duodenal. These circuits were perfused under barostatically controlled pressure (4 cmH2O). Steadysate changes in flow were taken to reflect modifications in circuit resistances during three periods of time: normovolemic control (20 min), expansion (10-15 min), and expanded (30 min). Perfusion flow rates did not change in normovolemic control animals over a period of 60 min. BV expansion (Ringer bicarbonate, 1 ml/min up to 5 percent body weight) significantly (p<0.05) reduced perfusion flow in the GD (10.3 + 0.5 to 7.6 + 0.6 ml/min), pyloric (9.0 + 0.6 to 5.6 + 1.2 ml/min) and duodenal (10.8 + 0.4 to 9.0 + 0.6 ml/min) circuits, but not in the gastric circuit (11.9 + 0.4 to 10.4 + 0.6 ml/min). Prazosin (1 mg/kg) and yohimbine (3 mg/kg) prevented the expansion effect on the duodenal but not on the pyloric circuit. Bilateral cervical vagotomy prevented the expansion effect on the pylorus during the expansion but not during the expanded period and had no effect on the duodenum. Atropine (0.5 mg/kg), hexamethonium (10 mg/kg) and propranolol (2 mg/kg) were ineffective on both circuits. These results indicate that 1) BV expansion increases the GD resistance to liquid flow, 2) pylorus and duodenum are important sites of resistance, and 3) yohimbine and prazosin prevented the increase in duodenal resistance and vagotomy prevented it partially in the pylorus.
Assuntos
Ratos , Animais , Masculino , Volume Sanguíneo , Duodeno/efeitos dos fármacos , Antagonistas Adrenérgicos alfa/farmacologia , Ratos WistarRESUMO
The present study evaluates the effect of blood volume expansion on the gastrointestinal transit of a charchoal meal (2.5 ml of an aqueous suspension consisting of 5 percent charcoal and 5 percent gum arabic) in awake male Wistar rats (200-270 g). On the day before the experiments, the rats were anesthetized with ether, submitted to left jugular vein cannulation and fasted with water ad libitum until 2 h before the gastrointestinal transit measurement. Blood volume expansion by iv infusion of 1 ml/min Ringer bicarbonate in volumes of 3, 4 or 5 percent body weight delayed gastrointestinal transit at 10 min after test meal administration by 21.3-26.7 percent (P<0.05), but no effect was observed after 1 or 2 percent body weight expansion. The effect of blood volume expansion (up to 5 por cento body weight) on gastrointestinal transit lasted for at least 60 min (P<0.05). Mean arterial pressure increased transiently and central venous pressure increased and hematocrit decreased (P<0.05). Subdiaphragmatic vagotomy and yohimbine (3 mg/kg) prevented the delay caused by expansion on gastrointestinal transit, while atropine (0.5 mg/kg), L-NAME (2 mg/kg), hexamethonium (10 mg/kg), prazosin (1 mg/kg) or propranolol (2 mg/kg) were ineffective. These data show that blood volume expansion delays the gastrointestinal transit of a charcoal meal and that vagal and yohimbine-sensitive pathways appear to be involved in this phenomenon. The delay in gastrointestinal transit observed here, taken together with the modifications of gastrointestinal permeability to salt and water reported by others, may be part of the mechanisms involved in liquid excess management
Assuntos
Animais , Ratos , Masculino , Volume Sanguíneo/fisiologia , Carvão Vegetal , Trânsito Gastrointestinal/fisiologia , Pressão Sanguínea , Ratos Wistar , Fatores de TempoRESUMO
We have observed that acute blood volume expansion increases the gastroduodenal resistance to the flow of liquid in anesthetized dogs, while retraction decreases it (Santos et al. (1991) Acta Physiologica Scandinavica, 143:261-269). This study evaluates the effect of blood volume expansion and retraction on the gastric emptying of liquid in awake rats using a modification of the technique of Scarpignato (1980) (Archives Internationales de Pharmacodynamie et de Therapie, 246:286-294). Male Wistar rats (180-220g( were fasted for 16 h with water ad libitum and 1.5 ml of the test meal (0.5 mg/ml phenol red solution in 5 percent glucose) was delivered to the stomach immediately after random submission to one of the following protocols: 1) normovolemic control (N=22), 2) expansion (N=72) by intravenous infusion (1 ml/min) of Ringer-bicarbonate solution, volumes of 1,2,3 or 5 percent body weight, or 3) retraction (N-22) by controlled bleeding (1.5 ml/100g). Gastric emptying of liquid was inhibited by 19-51.2 percent (P<0.05) after blood volume expansion (volumes of 1,2,3 or 5 percent body weight). Blood volume expansion produced a sustained increase in central venous pressure while mean arterial presure was transiently increased during expansion (P<0.05). Blood volume retraction increased gastric emptying by 28.5-49.9 percent (P<0.05) and decreased central venous pressure and mean arterial pressure (P<0.05). Infusion of the shed blood 10 min after bleeding reversed the effect of retraction on gastric emptying. These findings suggest that gastric emptying of liquid is subject to modulation by the blood volume.
Assuntos
Masculino , Animais , Volume Sanguíneo/fisiologia , Sistema Digestório/metabolismo , Esvaziamento Gástrico/fisiologia , Pressão Venosa Central/fisiologia , Hemodinâmica , Infusões Intravenosas , Ratos Wistar , Fatores de TempoRESUMO
We determined the effect of acute extracellular fluid volume changes on saline flow through 4 gut segments (ileocolonic, ileal, ileocolonic sphincter and proximal colon), perfused at constant pressure in anesthetized dogs. Two different experimental protocols were used: hypervolemia (iv saline infusion, 0.9 per cent NaCl, 20 ml/min, volume up to 5 per cent body weight) and controlled hemorrhage (up to a 50 per cent drop in mean arterial pressure). Mean ileocolonic flow (N = 6) was gradually and significantly decreased during the expansion (17.1 per cent P<0.05) and expanded (44.9 per cent, P<0.05) periods while mean ileal flow (N = 7) was significantly decreased only during the expanded period (38 per cent, P<0.05). Mean colonic flow (N = 7) was decreased during expansion (12 per cent, P<0.05) but returned to control levels during the expanded period. Mean ileocolonic sphincter flow (N = 6) was not significantly modified. Mean ielocolonic flow (n = 10) was also decreased after hemorhage (retracted period) by 17 per cent (P<0.05), but saline flow was not modified in the other separate circuitis (N = 6,5 and 4 for ileal, ileocolonic sphincter and colonic groups, respectively). The expansion effect was blocked by atropine (0.5 mg/kg, iv) both on the ileocolonic (N = 6) and ileal (N = 5) circuits. Acute extracellular fluid volume retraction and expansion increased the lower gastrointestinal resistances to saline flow. These effects, which could physiologically decrease the liquid volume being supplied to the colon, are possible mechanisms activated to acutely balance liquid volume deficit and excess.