Effect of an intensive lifestyle intervention on the prevalence of metabolic syndrome and its components among overweight and obese adults.

BACKGROUND: Despite the fact that up to a third of the global population has metabolic syndrome (MetS), it has been overlooked in clinical settings. This study assesses the impact of a physician-supervised nonsurgical weight management program on the prevalence of MetS and its key indicators. METHODS: Four-hundred seventy-nine overweight and obese participants aged 19 years or older were included in a prospective longitudinal study. Changes in MetS and its key indicators were assessed using the binomial exact, chi-square and Wilcoxon signed-rank tests in an intent-to-treat study population. Differences in age strata were assessed using a generalized linear model. RESULTS: Fifty-two percent of participants (n = 249) had MetS at baseline. Prevalence of MetS decreased steadily with significant changes from baseline observed at weeks 13 (31.8%, P < 0.0001), 26 (28.7%, P < 0.0012) and 39 (21.6%, P < 0.0002); changes from baseline were observed at week 52 as statistically significant (16.7%, P < 0.0012). Improvements in anthropometrics and levels of key indicators of MetS were observed throughout the study. CONCLUSION: These findings confirm that weight loss is inversely associated with prevalence of MetS and its key indicators among overweight and obese individuals. Future studies may benefit from a larger sample size and better retention (ClinicalTrials.gov ID: NCT03588117).

Effect of sucralfate and an aluminum hydroxide gel on gastric emptying of solids and liquids.

Our purpose was to investigate whether an aluminum-containing compound (sucralfate) and an aluminum-containing antacid (Amphojel; Wyeth Laboratories), both of which are commonly used in peptic ulcer disease, affect gastric emptying. Gastric emptying was studied in ten healthy subjects with the double isotope technique to assess simultaneous emptying rates of the solid and liquid components of a meal. 99mTechnetium sulfur colloid-labeled chicken liver served as the solid component and 111indium diethylenetriamine penta-acetic acid-labeled water was the liquid component. In a randomized, double-blind fashion, 1 gm sucralfate and 30 ml aluminum hydroxide gel were compared with placebo on separate days. Subjects ate the isotope-labeled test meal after dosing, and gastric emptying was monitored for 3 hours by a gamma-camera interfaced with a computer. There was no significant change in gastric emptying of either solids or liquids after sucralfate. The aluminum hydroxide gel slowed the gastric emptying rate for solids more than did the placebo, but this difference was significant only at the intervals of 165 and 180 minutes after the meal. We conclude that aluminum in the form of therapeutic doses of sucralfate does not delay gastric emptying of solids or liquids in normal subjects, while the larger amount of aluminum in therapeutic doses of the antacid gel has some slowing effect on gastric emptying of the solid components of a meal.

Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature.

Twenty-two patients with colonic arterio-venous malformations (AVM) are reported and 218 other cases in the English literature are reviewed. Of our patients, 16 (73%) underwent right hemicolectomy because of repeated episodes of rectal bleeding or iron-deficiency anemia. Ten (63%) of these patients have remained in good health with no further evidence of intestinal bleeding after surgery. In six (37%) recurrent episodes of rectal bleeding or iron deficiency anemia have gone unexplained despite thorough work-up including repeat arteriography. Our experience and that in the literature suggests: 1. Most AVM's (78%) occur in the cecum or right colon, the jejunum being the next most common site. 2. Patients with AVM's tend to be elderly with a strong history of cardiovascular disease. A potential association between aortic stenosis, intestinal bleeding, and AVM's is suggested. However, prospective studies are needed to confirm this relationship. 3. In younger patients AVM's tend to occur at atypical sites such as the small bowel. 4. Surgical removal of an AVM cannot be expected to be uniformly curative. The causes of recurrent bleeding after surgery include: incomplete resection of the initial AVM, occult AVM's missed on arteriography and left behind at surgery, and the appearance of new AVM's postoperatively. The cause of bleeding in many patients with recurrence however, remains undiagnosed despite repeat angiography.

Value of a single forceps biopsy of colonic polyps.

The accuracy of colonoscopic biopsies in predicting the histological diagnosis of colonic polyps removed at colonoscopy or at laparotomy was studied. Forty-two patients were colonoscoped before the removal of 50 polyps. A single fractional biopsy was obtained from each lesion with the standard endoscopic biopsy forceps and was compared to the final histological diagnosis of each excised lesion. Thirteen (26%) of the singular fractional biopsies did not demonstrate the significant histological features of the excised polyps. These tiny biopsies do not adequately represent the entire polyp. Moreover, the 2- to 3-mm size of the biopsy does not permit the study of the central submucosal area of the polyp stalk, the critical area for assessing invasive malignancy. Histological examination of a completely excised polyp is essential for accurate diagnosis and appropriate therapy.

Ocular manifestations of inflammatory bowel disease.

The association between inflammation of the eyes and the intestine is not often recognized by ophthalmologists. We report two patients who developed peripheral corneal ulcers, episcleritis, and scleritis just prior to the onset of Crohn's disease. The severity of the eye disease paralleled that of the intestinal symptoms, and both conditions subsided after treatment with topical steroids, oral prednisone, oral sulfasalazine, and hydrocortisone retention enemas. Inflammatory bowel disease should always be included in the differential diagnosis of scleritis and uveitis, as the patient may be benefited greatly by appropriate, early therapy of this gastrointestinal disorder.

Scintigraphic determination of the effect of metoclopramide and morphine on small intestinal transit time.

To determine if a scintigraphic method could detect pharmacologic changes in small intestinal transit time (SITT), 10 male volunteers were studied at baseline and after intravenously administered metoclopramide (10 mg) and morphine (8 mg). Five of these volunteers were studied with the hydrogen breath test method for comparison. For each of the scintigraphic studies, the volunteers were positioned supine under a large-field-of-view gamma camera after ingesting an isosmotic lactulose solution containing 99mtechnetium-diethylenetriaminepentaacetic acid (DTPA). Data were collected and stored in a computer. Both gastric emptying and SITT were determined. SITT was 81 +/- 11 min (mean +/- S.E.M.; N = 10) during baseline studies, was decreased significantly to 50 +/- 6 min (N = 10; P less than 0.01) after metoclopramide, and was increased significantly to 161 +/- 15 min (N = 8; P less than 0.01) after morphine. Baseline mean values were 86.3 +/- 15 min (N = 15) for the hydrogen breath tests, 47 +/- 8 min (N = 5) for metoclopramide, and 183 +/- 16 min (N = 5) for morphine. For gastric emptying, there was no significant difference in percentage emptying at 1 hr for baseline and metochopramide (82 +/- 5% vs. 88 +/- 4%). Morphine prolonged gastric emptying at 1 hr to 63 +/- 8%. We conclude that the scintigraphic method for measuring SITT permits accurate investigation of the pharmacologic effects on intestinal motility and, in addition, may be a useful research and clinical method for SITT determination.

Sucralfate delays gastric emptying of liquids and solids in duodenal ulcer patients.

Gastric emptying studies were performed on nine healthy volunteers and ten duodenal ulcer (DU) patients utilizing a dual radionuclide technique to assess simultaneously emptying rates of liquid (111In labeled water) and solid (99mTc sulfur colloid labeled chicken liver) components of a meal. One gram of sucralfate was compared to placebo in separate days in a randomized double-blind crossover fashion. Subjects ingested the radiolabeled test meal 1 h after receiving medication, and gastric emptying was monitored for 3 h using a gamma camera interfaced with a computer. We found that DU patients had significantly faster gastric emptying of solids (P less than 0.05) compared to normals on the placebo days, while liquid emptying rates were similar. Sucralfate, in the DU patients, significantly (P less than 0.05) slowed gastric emptying of water from 20 to 40 min and emptying of the solid component from 100-160 min after the meal compared to placebo. In normal subjects, gastric emptying of liquids and solids was not significantly affected by sucralfate. We conclude that slowing of gastric emptying, possibly mediated through aluminum ions, occurs in DU patients on sucralfate. This may be one mechanism by which sucralfate enhances healing and decreases recurrence of duodenal ulcer.

Campylobacter enterocolitis.

We report four patients with bloody diarrhea and colitis from Campylobacter fetus subspecies jejuni. Two patients had dogs with Campylobacter fetus in their stools. All patients responded rapidly and completely to erythromycin therapy. Campylobacter fetus subspecies jejuni is now a relatively common cause of enterocolitis, more common than salmonella or shigella. When the organism causes short-lived water diarrhea, a definitive diagnosis is not necessary. In a patient with bloody diarrhea and acute colitis, the clinician should pursue Campylobacter fetus as a potential offender, recognizing that acute colitis from Campylobacter fetus is clinically and and pathologically indistinguishable from any other acute colitis.

Scintigraphic determination of small intestinal transit time: comparison with the hydrogen breath technique.

The hydrogen breath test was used as a standard against which a scintigraphic method for determination of small intestinal transit time was evaluated and compared. A total of 19 male volunteers ranging in age from 23 to 28 yr participated in the study. The subjects ingested an isosmotic lactulose solution containing 99mtechnetium-diethylenetriaminepentaacetic acid (Sn) and then remained supine under a large field of view gamma-camera that interfaced with a computer system. Data were visually analyzed and then quantified to determine gastric emptying and small intestinal transit time. The small intestinal transit time ranged from 31 to 139 min with the scintigraphic method and 30 to 190 min with the hydrogen breath test (r = 0.77). The mean small intestinal transit time for 20 individual determinations with the scintigraphic method, 73.0 +/- 6.5 min (mean +/- SEM), was similar to the results from the hydrogen breath test technique, 75.1 +/- 8.3 min. Thirteen volunteers underwent two studies with the scintigraphic method separated by intervals ranging from 2 days to 8 wk. Individual variations in small intestinal transit time were significantly correlated with individual variations in gastric emptying (p less than 0.05). We conclude that the scintigraphic method allows accurate determination of gastrocecal time and is a noninvasive technique which may be a useful clinical test for small intestinal transit time as well as for providing information on the pathophysiology and pharmacology of intestinal motility.