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Biomedical subjects

B T Cooper

Publications and source records attributed to B T Cooper.

At least 73 records · Page 4Linked to original sources

Small intestinal permeability to mannitol, lactulose, and polyethylene glycol 400 in celiac disease.

Mannitol (molecular weight 182), lactulose (342), and polyethylene glycol 400 (range 242-550) absorption was studied in 25 controls, 22 untreated celiacs, and 13 treated celiacs. Untreated celiacs absorbed less mannitol and more lactulose than controls. Absorption of higher as well as lower molecular-weight polyethylene glycols was reduced in untreated celiac disease. Absorption returned towards normal on treatment. Polyethylene glycol and lactulose absorption was enhanced by administering them in a hypertonic solution. Polyethylene glycol 400 but not lactulose or mannitol was lipid soluble in vitro. It was concluded that the mucosa in untreated celiac disease was more "leaky" than normal. Polyethylene glycol 400 absorption data suggested that its absorption may largely be determined by its lipid solubility and was decreased in celiac disease because of the reduced surface area of the small intestine. Polyethylene glycol 400 cannot be recommended as a suitable marker for permeability studies of the small intestine.

Adult↗

Small intestinal permeability to sugars in patients with atopic eczema.

Absorption of lactulose and mannitol was measured in eleven patients with atopic eczema and lactulose/mannitol excretion ratios were calculated. Mean lactulose absorption was increased in the patients with exzema and their excretion ratios were higher than those of controls. There was no correlation between either eczema extent or severity and the excretion ratio. We conclude that small intestinal passive permeability is increased in some patients with atopic eczema.

Adolescent↗

Abnormal small intestinal permeability to sugars in patients with Crohn's disease of the terminal ileum and colon.

The absorption of lactulose and mannitol in 20 patients with Crohn's disease limited to the ileum or colon was studied, and lactulose/mannitol excretion ratios were calculated. The results were compared to those from 16 normal controls and 6 patients with ulcerative colitis. The 13 patients with ileal Crohn's disease had significantly higher lactulose/mannitol excretion ratios than the controls (p less than 0.01) or ulcerative colitics (p less than 0.01). Similarly, the 7 patients with Crohn's disease limited to the colon had significantly higher excretion ratios than the controls (p less than 0.01) or ulcerative colitics (p less than 0.01). The results provide support for the concept that Crohn's disease may be more extensive than is apparent macroscopically.

Adolescent↗

Lymphoma risk in coeliac disease of later life.

From 314 patients with coeliac disease, 20 patients were found to have developed a lymphoma. The incidence of lymphoma was much greater in the 6th, 7th and 8th decades of life than in the previous two decades. In 12 patients, the lymphoma was diagnosed within 4 years of the diagnosis of their coeliac disease and there were significantly more of these lymphomas appearing in coeliacs diagnosed between 51 and 80 years, who made up 23% of the series, than in those diagnosed between 21 and 50 years. We conclude that lymphoma is particularly a complication of older coeliacs and that coeliacs newly diagnosed at more than 50 years of age should be more closely followed up for they have a 1 in 10 chance of harbouring a lymphoma.

Adult↗

Effects of vasoactive intestinal peptide and pancreatic polypeptide in rabbit intestine.

The effects of porcine vasoactive intestinal peptide (VIP) and bovine pancreatic polypeptide (PP) on jejunal, ileal, and colonic fluid transport were studied in the rabbit. VIP produced secretion in the small intestine (jejunum greater than ileum) but did not affect absorption in the colon. PP had no secretory effects in jejunum, ileum, or colon. The small intestinal secretion induced by VIP was not associated with raised cAMP concentrations in the mucosa; this suggests that the secretory effects of VIP in vivo are mediated by a mechanism other than stimulation of adenylate cyclase.

Animals↗

Serum lysozyme activity in coeliac disease: a possible aid to athe diagnosis of malignant change.

Serum lysozyme activities were measured in 34 control subjects, 13 untreated adult coeliac patients, 21 adult coeliac patients on gluten-free diet, and eight coeliac patients with a histiocytic lymphoma. Serum lysozyme activities were raised in three untreated patients, three patients treated with a gluten-free diet, and in only two patients with coeliac disease and lymphoma. Serum lysozyme estimations cannot be recommended as an aid to the diagnosis of lymphoma in patients with coeliac disease.

Adult↗

Hymenolepiasis: an unusual cause of diarrhoea in Western Europe.

A young Indian man presented in England with a 6-month history of diarrhoea which started just before leaving India. He was found to have tropical enteropathy and H. nana infestation, but while the infestation and symptoms disappeared with antihelminthic treatment, the tropical enteropathy persisted. Hymenolepiasis is not well recognised as a cause of diarrhoea amongst Asians in Western Europe.

Adult↗

GIP and insulin responses to oral glucose in coeliac patients before and after treatment.

The responses of plasma gastric inhibitory polypeptide (GIP) and insulin to oral glucose were studied in five patients with untreated coeliac disease. These patients were restudied after one year on a gluten-free diet. In the untreated patients, the blood glucose, serum insulin, and GIP levels were significantly lower than in the controls. After gluten withdrawal there was an improvement towards normality in the responses of blood glucose, serum insulin, and GIP. The results show that untreated coeliac disease is associated with abnormalities of intestinal and pancreatic hormone secretion and that these abnormalities are improved by gluten withdrawal.

Administration, Oral↗

Gastrointestinal bleeding, angiodysplasia of the colon and acquired von Willebrand's disease.

A 66-year-old man is reported who was found to have acquired von Willebrand's disease, which presented when the patient was 63 with iron deficiency anaemia and gastrointestinal bleeding. He subsequently bled from various sites in the gastrointestinal tract including an angiodysplasia of the right colon, which was successfully treated by right hemicolectomy. This is the second reported association between acquired von Willebrand's disease and angiodysplasia of the intestinal tract.

Aged↗

Malabsorption and macroamylasemia. Response to gluten withdrawal.

A 36 year old woman presented with malabsorption and macroamylasemia. The macroamylase was characterized and shown to be a complex of pancreatic amylase and immunoglobulin A(IgA). The patient had the clinical and histologic features of adult celiac disease, and responded to a gluten-free diet. The macroamylase complex disappeared from the serum after gluten withdrawal, a hitherto unreported finding in the syndrome of malabsorption and hyperamylasemia.

Adult↗

Celiac disease and malignancy.

Fifty-five patients with celiac disease and coexistent malignant disease (27 lymphoma, 28 other malignancies) are described. The important clinical features at presentation of lymphoma were weight loss, abdominal pain, diarrhea, profound weakness and fever, associated with anemia, raised ESR, hypoalbuminemia and steatorrhea. There were no specific features to enable earlier diagnosis. Radiology was unhelpful and in no case were malignant cells seen in the jejunal biopsy. Four of the lymphomas were Hodgkin's disease, none of which involved the bowel; the remainder were reticulum cell sarcoma, 17 of which involved the bowel. Definitive diagnosis prior to death was made in only 18 patients, of whom 16 survived from 2 to 226 days (mean, 76 days). Of the remaining two patients, one is still alive, while the other died 26 years after the original diagnosis of Hodgkin's disease. The possibility of lymphoma should be considered in those who present with celiac disease in middle life and in those who deteriorate for no apparent reason after a period of stability on a gluten-free diet. The index of suspicion for lymphoma in celiac disease should be high and early laparotomy be considered in patients with unexplained deterioration. Twenty-eight patients with 29 carcinomas and 3 other tumors are also described. The presentations of these malignancies were no different from their presentations in non-celiac patients, and their development did not provoke a relapse of celiac disease. Considering the whole series of 55 patients, there was little evidence for the view that malignancy itself was the cause of the flat jejunal mucosal appearances seen in these patients.

Adult↗

Association of coeliac disease and inflammatory bowel disease.

The association of coeliac disease and inflammatory bowel disease is rare, as only three individual cases have been reported. Four additional cases of the association are described. A review of the prevalence figures for the two disorders suggests that this is more than a chance association.

Adolescent↗

Gluten-sensitive diarrhea without evidence of celiac disease.

Eight adult female patients suffering from abdominal pain and chronic diarrhea which was often incapacitating and frequently nocturnal, had dramatic relief on a gluten-free diet and return of symptoms after gluten challenge. Previous nonspecific measures and a milk-free diet were ineffective. Multiple jejunal biopsies showed minor, but significant changes in cellularity which returned to normal on the gluten-free diet. Apart from a slight increase in jejunal cellularity, no immunological abnormalities were found after gluten challenge. Steatorrhea or other biochemical defects, common in celiac disease, were not found. It was concluded that these patients had a gluten-sensitive diarrhea, but had no evidence of celiac disease.

Adult↗