[Carbohydrate malabsorption (fructose, sorbitol) and functional intestinal disorders].
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Colonic Diseases, Functional↗
Biomedical subjects
B Lembcke
Publications and source records attributed to B Lembcke.
[Therapy of pancreatogenic steatorrhea. Comparison of 2 acid-protected enzyme preparations].
In an open, randomised cross-over trial nine patients with severe exocrine pancreatic insufficiency and considerable steatorrhea (greater than 25 g fecal fat excretion daily) received for five days, after a treatment-free period of three days, two new acid-protected enzyme preparations: Kreon, three times six capsules daily, pellets of 1-2 mm diameter; Panzytrat 20.000, three times three capsules daily, microtablets of 2 mm diameter. Both preparations significantly decreased fecal weight and fecal fat excretion. With equivalent lipase dosage there was no difference in effect between the two preparations.
Adult↗
Detection of pancreatic steatorrhea by oral pancreatic function tests.
Pancreolauryl and NBT-PABA tests were performed in urine of 54 patients with exocrine pancreatic insufficiency and, additionally, in serum of 29 of these patients. All patients underwent a secretin-pancreozymin test and a 72-hr fecal fat analysis. Pancreatic steatorrhea occurred (with only three exceptions) when the pancreolauryl test revealed a T/C ratio [recovery of the fluorescein of the test (T) and the control (C) day] of less than 10, or when serum fluorescein concentrations were below 0.5 microgram/ml. The NBT-PABA test also showed a negative correlation between urinary PABA excretion or serum PABA concentration and fecal fat excretion, but there was no diagnostically useful cutoff limit indicating decompensation of exocrine pancreatic insufficiency. These findings indicate that the pancreolauryl test may facilitate clinical evaluation of patients with chronic pancreatitis by simultaneously assessing exocrine pancreatic insufficiency as a cause and predicting pancreatic steatorrhea as a sequel of maldigestion. In clinical practice, the pancreolauryl test can be used as a parameter for deciding whether to initiate pancreatic enzyme substitution if direct pancreatic function tests and fecal fat analysis are not available.
4-Aminobenzoic Acid↗
Malabsorption syndromes.
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Drug-Related Side Effects and Adverse Reactions↗
[The Resorption Study Group: theory and practice of malabsorption].
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Dietary Carbohydrates↗
Effect of somatostatin analogue (SMS 201-995, Sandostatin) on pancreatic secretion in humans.
The effect of the long-acting somatostatin analogue SMS 201-995 on exocrine pancreatic function and hormone release was investigated in a double-blind, placebo-controlled study in healthy subjects. SMS 201-995 was administered subcutaneously at a dose of 25 micrograms twice daily, and all tests were performed 30 minutes after the morning injection. Pancreatic enzyme secretion, gall bladder contraction, and cholecystokinin response after a Lundh meal were completely inhibited by SMS, while pancreatic enzyme secretion elicited by intravenous injection of secretin and pancreozymin was suppressed by 80 percent. The inhibitory effect of SMS on endogenous cholecystokinin release was fully operative on the sixth day of injection treatment, whereas the inhibitory effect on exogenous cholecystokinin injection significantly decreased after SMS administration for seven days, indicating desensitization of the end organ by somatostatin. The release of pancreatic polypeptide by a solid test meal is abolished by administration of 25 micrograms of SMS, the release of gastric inhibitory polypeptide is nearly completely suppressed, the response of insulin and C-peptide are significantly lowered, and the gastrin response is only slightly reduced.
Adult↗
Adaptive responses to pharmacological inhibition of small intestinal alpha-glucosidases in the rat.
Intestinal adaptation (small intestinal weight and length, weight of the caecum and of the residual colon) to feeding different doses (0-5-50-500 mg/kg bw) of the absorbable, competitive alpha-glucosidase inhibitors BAY m 1099 and BAY o 1248 for three, seven, or 28 days was studied in rats. With the highest dose of either inhibitor, a significant and time dependent growth of the caecum was observed. Under these conditions, caecal tissue polyamine concentrations (spermidine and spermine) were slightly higher after three, unaffected after seven and slightly decreased after 28 days. Comparing the trophic effect both of BAY m 1099 and BAY o 1248 with that of the almost unabsorbed glucosidase inhibitor acarbose in fed rats showed that caecal weight was higher in response to the absorbed compounds than in response to acarbose, while total caecal carbohydrate content was unaffected by the absorbed and about nine fold increased by the unabsorbed inhibitors. These findings suggest that acarbose may partially inhibit bacterial carbohydrate degradation in the caecum.
1-Deoxynojirimycin↗
Effect of the somatostatin analogue sandostatin (SMS 201-995) on gastrointestinal, pancreatic and biliary function and hormone release in normal men.
The effect of the long-acting somatostatin analogue Sandostatin (SMS 201-995) on intestinal absorption and propagation (mouth-to-caecum transit time; MCTT), on pancreatic secretion and on gall bladder contraction after direct (secretin-pancreozymin test) and indirect stimulation (Lundh meal), and on meal-induced responses of seven gastrointestinal regulatory peptides has been investigated. In a double-blind cross-over study, 9 healthy volunteers completed two 7-day periods with subcutaneous injections of either placebo or 25 micrograms SMS 201-995 twice daily. Mean faecal fat excretion was increased to 19.2 g/day and MCTT was three times longer during the SMS period. After duodenal infusion of a mixture containing D-galactose, D-xylose and triglycerides, SMS 201-995 significantly reduced the serum concentrations of D-galactose but increased serum levels of D-xylose. After 6 days of pretreatment, SMS 201-995 completely suppressed duodenal trypsin, lipase and bilirubin increases in response to endogenous stimulation by a Lundh meal. Concomitantly, cholecystokinin (CCK) release and gall bladder contraction were almost abolished. Compared with placebo, SMS 201-995 significantly diminished pancreatic amylase, trypsin and lipase output after stimulation with CCK, while the secretion of fluid and bicarbonate in response to secretin was unchanged. This inhibition of enzyme response was significantly more marked after a single injection of the analogue than after pretreatment for 7 days and did not reach the level of exocrine pancreatic insufficiency. CCK-induced gall bladder contraction was significantly inhibited by a single dose of 25 micrograms SMS 201-995 but not after 7 days of pretreatment with the somatostatin analogue.
Adult↗
Raised fecal fat concentration is not a valid indicator of pancreatic steatorrhea.
The hypothesis that fecal fat concentration (FFC; g fat/100 g wet stool weight) should be higher in pancreatic steatorrhea than in steatorrhea due to gastrointestinal disease was investigated. Fecal weight and fat excretion were measured in 59 patients with pancreatic steatorrhea and in 53 patients with nonpancreatic steatorrhea. A further 42 patients were studied who had normal fecal fat excretion but exocrine pancreatic insufficiency proven by a secretin-pancreozymin test along with 31 patients with well-defined gastrointestinal disease but without steatorrhea. The control group consisted of 184 subjects without evidence for malabsorption. FFC was significantly higher in patients with pancreatic compared to those with nonpancreatic steatorrhea. However, because of the almost identical concentrations in patients with steatorrhea due to celiac sprue (FFC 10.5 +/- 4.3%, mean +/- SD) and those with pancreatic steatorrhea (FFC 11.5 +/- 4.7%), FFC was of no value for the differential diagnosis between pancreatic and nonpancreatic steatorrhea.
Celiac Disease↗
[Diagnosis in malabsorption syndromes--which tests are really necessary?].
The symptoms of the malabsorption syndrome are uniformly weight-loss, diarrhea and/or steatorrhea for which symptoms numerous etiological factors could be responsible: biliary and pancreatic diseases, inborn and acquired intestinal diseases, sequelae of operations (post-gastrectomy syndrome), metabolic and autoimmune diseases and several drugs. Accordingly, the spectrum diagnostic tools is rather broad and often confusing, comprising simple methods like measurement of faecal weight up to complicated radioactive or morphological techniques. In the present paper the available diagnostic procedures are grouped together and evaluated according to their importance, practicability and sensitivity in hospital and praxis. It turns out that simple laboratory techniques are sufficient for the majority of patients with malassimilation syndrome which have been specifically dealt with. However, in numerous cases a more detailed and specific diagnostic investigation is necessary in which single findings as a whole reflect the picture of the underlying disease. Only the knowledge of these rare investigational techniques will prompt the involved physician to transfer the patient with the unknown cause of malabsorption syndrome to a specialized medical centre.
Adult↗
Clinical value of dual-isotope fat absorption test system (FATS) using glycerol [125I]trioleate and glycerol [75Se]triether.
In order to delineate the clinical value of a dual-isotope fat absorption test system (FATS) using glycerol [75Se]triether as lipid-phase marker and glycerol [125I]trioleate as the test lipid, fecal isotope ratios from single stools (and a 72-hr stool homogenate) were compared to quantitative fecal fat excretion. The study included 11 patients without and 24 patients with steatorrhea. With a figure of 0.8% as the upper limit of normal, the test was a reliable indicator of steatorrhea with 87.5% sensitivity and 81.8% specificity; efficiency was 85.7%. Related to a prevalence of steatorrhea of 45.9% as the mean value of 1269 consecutive 72-hr specimens investigated for steatorrhea during 1978-1982, the positive (negative) predictive value of the FATS is 80.3% (87.2%). With 2% as the upper limit of normal, no false positive results ensued. It is concluded that a two-step interpretation of the FATS (0.8% limit and 2% limit) may be regarded a valid qualitative index for steatorrhea. The FATS isotope ratio using single stools correlated well with FATS ratios in the 72-hr stool homogenates (r = 0.97). FATS therefore allows a convenient estimate of steatorrhea from measuring single stools. As a quantitative measure of fecal fat excretion, the FATS is unreliable.
Adult↗
Pancreatic calcifications: no indicator of severe exocrine pancreatic insufficiency.
Pancreatic calcifications are believed to occur only in advanced stages of exocrine pancreatic insufficiency. This belief has been reevaluated by correlating the results of the secretin-pancreozymin test, fecal fat analysis, and the presence of pancreatic calcifications on plain abdominal x-rays in 79 patients with chronic pancreatitis. Exocrine pancreatic insufficiency was classified as slight, moderate, or severe according to the results of the function tests, and pancreatic calcifications were assessed semi-quantitatively (grades 1-3) by an independent examiner. The results showed that severe exocrine pancreatic insufficiency did occur even in the absence of calcifications. Calcifications were more frequently detected with increasing severity of exocrine pancreatic insufficiency. The qualitative demonstration of pancreatic calcification was, however, not an indicator of severe, decompensated exocrine pancreatic insufficiency (50% false-positive results). It is concluded that pancreatic calcification is not necessarily an indicator of severe exocrine pancreatic insufficiency, and vice versa. Comparison between the results of tests for endocrine pancreatic function and plain abdominal x-ray showed such similarity that it can also be concluded that pancreatic calcifications are no indication of abnormal endocrine function, and vice versa.
Calcinosis↗
How safe is small bowel biopsy?
This retrospective, controlled study covers data from the medical records of 298 hospitalized patients, who, during the period 1972-1982, had 1,007 hydraulic small bowel biopsies removed on 342 occasions. The main complication was hemorrhage (drop in hemoglobin concentration greater than or equal to 2 g/100 ml) in 1.5% of the investigations. In one case (0.3%) transfusions were required. One other patient (0.3%) needed laparotomy following perforation. No deaths due to jejunal biopsy were observed in our series. Four patients (1.2%) developed transient temperature greater than or equal to 38 degrees C in response to the biopsy. The final diagnosis 'small bowel bacterial overgrowth' in three of these patients suggests that bacteremia was the cause of postbiopsy fever, and that bacterial overgrowth predisposes to this complication of jejunal biopsy. Neither the number of biopsies (n = 1-20), nor the performance of repeat investigations in the same patient, nor the year of investigation, nor nutritional status showed any correlation to the development of complications.
Adult↗
Functional reserve capacity of the exocrine pancreas.
The functional reserve capacity of the pancreas, as reflected by the absence of steatorrhea, was correlated with the results of a secretin-pancreozymin test (SPT) in 47 patients with exocrine pancreatic insufficiency due to chronic pancreatitis. The results indicate that a severe reduction in enzyme output (but not in bicarbonate concentration and output) is usually associated with steatorrhea. However, there were a number of patients with steatorrhea despite only moderate enzyme output impairment, while others had normal fat excretion but severely reduced enzyme secretion. Thus, the degree of impaired pancreatic function, as measured by the SPT, cannot be predicted by the presence of steatorrhea; vice versa, a moderately abnormal SPT does not exclude the presence of pancreatic steatorrhea. Therefore, for a sophisticated evaluation of the functional reserve capacity of the exocrine pancreas, both the SPT and fecal fat analysis are considered necessary. The correlation between impaired glucose tolerance and exocrine pancreatic function was poor.
Adolescent↗
Therapy of pancreatogenic steatorrhoea: does acid protection of pancreatic enzymes offer any advantage?
Pancreatic enzyme replacement may fail to achieve a beneficial effect because of enzyme inactivation by gastric acid. In this controlled randomized study, 8 hospitalized patients with severe exocrine pancreatic insufficiency and considerable steatorrhoea (greater than 15 g faecal fat/day) were treated with a conventional pancreatic enzyme preparation (Pankreon 700; 3 X 3 dragees daily), with (300 mg) and without cimetidine before meals, and with a new pH-sensitive enzyme preparation (Kreon; 3 X 6 capsules daily) comprising acid-protected granules. Both conventional enzyme replacement plus cimetidine, and acid-protected pancreatin were significantly (p less than 0.05) more effective than conventional enzyme therapy alone. Since both regimens are equally potent in overcoming gastric acid-induced enzyme inactivation, it is concluded that therapy with acid-protected pancreatin may simplify and improve treatment of exocrine pancreatic insufficiency in the presence of gastric hyper- or normo-acidity.
Celiac Disease↗
In vitro inhibition of rat small intestinal absorption by lipophilic organic cations.
Cationic, lipid-soluble organic compounds may interfere with cation-mediated membrane transport processes. Thus, small intestinal absorption may be influenced by lipophilic organic cations. Therefore a series of arylalkylamines was studied in the concentration range from 0.5 to 20 mmol/l for their effect on the transport of various monosaccharides and leucine in the rat small intestine in vitro by means of the tissue accumulation technique. Whereas the monophenyl substituted monoamines (e.g. benzylamine, 2-phenylethylamine, 3-phenylpropylamine) did not show a significant effect on the active transport, the corresponding omega,omega-diphenyl derivatives exhibited a strong inhibition of the active transport of the sugars and the amino acid. These monoamines and drugs of similar structure (e.g. benzoctamine, diphenydramine) exhibited a mixed or non-competitive type of inhibition which correlated quite well with their octanol-water partition coefficients. In contrast, di- or triamines (e.g. harmaline, imipramine, pyrilamine) revealed a rather pure competitive type of inhibition. These findings tentatively suggest a different mode of action on the active transport by lipid-soluble organic amines according to the molecular charge distribution. In addition, membrane vesicles were used to examine the effect of the different amines on the sucrase activity. Regarding the cation-dependent hydrolysis of sucrose, however, no distinct pattern developed.
Animals↗
Effect of 1-desoxynojirimycin derivatives on small intestinal disaccharidase activities and on active transport in vitro.
The influence of two new 1-desoxynojirimycin derivatives, BAY m 1099 and BAY o 1248, on rat small intestinal disaccharidases (sucrase, maltase, isomaltase, glucoamylase, lactase, trehalase) and alkaline phosphatase activity has been investigated in vitro. Both compounds are very potent alpha-glucosidase inhibitors. Tested in the range of 0.1-5.0 micrograms/ml, inhibition is strongest on sucrase (up to 97.1%) and glucoamylase (up to 96.7%). BAY m 1099 also reduced (up to 56.4%) beta-galactosidase (lactase) activity. For both inhibitors a competitive type of sucrase inhibition was demonstrated (Lineweaver-Burk plot). Affinity versus sucrase was unusually tight. The Ki of BAY m 1099 versus sucrase amounted to 1.14 x 10(-7) M and of BAY o 1248 to 6.92 X 10(-8) M (Dixon plot). Both inhibitors did not impair active transport of L-leucine or methyl-alpha-D-glucoside into everted rings of rat jejunum in vitro.
1-Deoxynojirimycin↗
Does an antifoaming agent improve the quality of abdominal ultrasonography? A double-blind study with special reference to the pancreas, the aorta and the para-aortic region.
To overcome the effects of intestinal gas which may be a problem for ultrasound examinations, a double-blind study was undertaken in 42 patients in whom the first ultrasound examination was unsatisfactory due to excessive intestinal gas. The patients received either a liquid dimeticon preparation over 24 hours (total dosage 480 mg) or a placebo. Criteria for the evaluation of the treatment were the ability to visualize the pancreas, the aorta and the para-aortic region at the second examination. The quality of the ultrasonic images was found to be improved in 52% of the controls by repetition and in 71% of the test substance group, the difference being not significant (p greater than 0.05). It is concluded that: It is worthwhile asking the patient to return for a second examination 24 hours later before resorting to invasive and/or expensive procedures when the first scan was of poor quality and liquid dimeticon has no significant defoaming effect in these patients.
Aorta↗