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Biomedical subjects

D B Silk

Publications and source records attributed to D B Silk.

At least 19 recordsLinked to original sources
PubMed2001

The effect of a polymeric enteral formula supplemented with a mixture of six fibres on normal human bowel function and colonic motility.

BACKGROUND AND AIMS: Fibres with varying fermentability may improve bowel function during enteral feeding. Two studies in healthy volunteers aimed to 1) investigate effects of Nutrison Multi Fibre (NMF) on gastrointestinal function, and 2) compare effects of NMF administered orally and nasogastrically on distal colonic motor activity. METHODS: (1) Ten subjects were randomly assigned to 3x7 days self-selected diet (SSD), 2 litres Nutrison Standard (NS), or 2 l NMF. Objective and subjective indices were measured. (2) Two groups (n=6) received 2x250 ml boluses of NMF 2 hourly either nasogastrically or orally. Distal colonic motility was measured for 8 h (3 pre/5 post) first bolus. RESULTS: Whole gut transit time was prolonged during NS (P<0.05) compared with SSD or NMF. Stool wet weight was higher during SSD (P<0.05) than during NS or NMF. Bowel frequencies were comparable. NMF was well tolerated. 2. Colonic activity index was maintained after oral administration with no associated diarrhoea. Activity index decreased after nasogastric bolus (P<0.05), but recovered to higher than fasting levels (P<0.05). 5 subjects had watery stools. CONCLUSIONS: Oral NMF is well tolerated, normalises whole gut transit time and maintains colonic motility. Recovery of colonic activity after nasogastric bolus suggests a putative protective effect of NMF over a longer period of feeding.

Administration, Oral↗
PubMed2001

Impact of irritable bowel syndrome on personal relationships and working practices.

OBJECTIVE: To determine the impact of irritable bowel syndrome on personal relationships and working practices. PATIENTS AND METHODS: A 60-item questionnaire about personal relationships, working practices and treatment was sent to 3090 subscribers of the IBS Bulletin, a quarterly educational publication. A total of 1855 completed questionnaires were returned. Analysis was restricted to 1597 questionnaires (86.1%), returned by respondents in whom the diagnosis of irritable bowel syndrome had been made by a general practitioner or hospital specialist. RESULTS: Of these respondents, 57% were aged 55 or over and the male to female ratio was 1:3.4. On average, respondents had suffered from irritable bowel syndrome for 16.6 years, with 57% reporting their symptoms daily, 25% weekly and 14% monthly. Of the married or cohabiting respondents, 19% stated that their partner experienced difficulties in having a personal relationship with them and 45% stated that irritable bowel syndrome interfered with their sex life. Irritable bowel syndrome had caused 12% of respondents to give up work altogether, while 47% of employed respondents reported having lost time off work, although only 35% of these respondents gave irritable bowel syndrome as the reason. In contrast employers, when informed of the diagnosis of irritable bowel syndrome, accepted these symptoms as a valid reason for absence in 61% of instances. Over half of those employed (53%) suffered embarrassment using toilets at work and 32% stated that irritable bowel syndrome had stopped them from applying for promotion or a new job. At the time of completing the questionnaire, 80% of respondents were actually taking some form of treatment. Smooth-muscle relaxants and fibre supplements remained the commonest treatments prescribed. CONCLUSION: Irritable bowel syndrome impacts significantly on personal relationships and working practices. Items that stimulate responsiveness in the areas of personal relationships and working practices should be included in the construction of disease-specific questionnaires used to assess the impact of new treatments for irritable bowel syndrome on health-related quality of life.

Adult↗
PubMed2000

In-patient assessment of difficult diarrhoea.

'Diarrhoea' remains a common problem presented to gastroenterologists. Assessment of the history will in most cases point to the investigations that will distinguish between organic and functional causes and lead to diagnosis. There exists a small group of patients either in whom there may be difficulties in distinguishing between organic and functional causes, or in whom a diagnosis of factitious diarrhoea is suspected. These patients should be admitted for a short in-patient assessment and undergo an analysis of 72-h stool weights. If these are less than 225 g/ day a functional cause should be suspected. If they are raised, then further investigations to exclude a factitious cause should include analysis of fluid balance, stool osmolality and stool electrolyte and creatinine content. A laxative screen should also be performed according to available quality control guidelines.

Diarrhea↗
PubMed1998

The effect of tacrolimus (FK506) on intestinal barrier function and cellular energy production in humans.

BACKGROUND & AIMS: The maintenance of the intestinal mucosal barrier may be energy dependent. Tacrolimus is a potent immunosuppressive drug that decreases mitochondrial adenosine triphosphate production and increases intestinal permeability in animals. METHODS: Twelve liver graft recipients receiving tacrolimus, 9 healthy volunteers, and 5 liver graft recipients not receiving immunosuppression underwent a combined absorption-permeability-mitochondrial function test using 5 g lactulose, 1 g L-rhamnose, 0.5 g D-xylose, 0.2 g 3-O-methyl-D-glucose, 1 mg/kg 2-keto[1-13C]isocaproic acid ([13C]KICA), and 20 mg/kg L-leucine. The respiratory quotient and resting energy expenditure were measured by indirect calorimetry. Tacrolimus pharmacokinetic profiles and levels of endotoxin and IgM and IgG endotoxin core antibodies were determined. RESULTS: Tacrolimus inhibited the decarboxylation of [13C]KICA, the resting energy expenditure, and the respiratory quotient in an exposure-dependent manner, suggesting an inhibition of mitochondrial respiration. Tacrolimus inhibited intestinal absorptive capacity in an exposure-dependent manner. Tacrolimus-treated patients had an increased intestinal permeability and significantly higher endotoxin levels compared with healthy volunteers. CONCLUSIONS: Tacrolimus inhibits cellular energy production in humans at clinically relevant doses. This is associated with an increased intestinal permeability, endotoxemia, and an impaired intestinal absorptive capacity.

Adolescent↗
PubMed1998

Perioperative nutrition: parenteral versus enteral.

Malnutrition has been shown to have an adverse effect on the clinical outcome of surgical patients. During the past 25 years, investigators have sought to determine whether clinical outcome can be improved by the administration of pre- or postoperative (perioperative) nutritional support. We conclude that the clinical outcome of severely malnourished surgical patients is improved by perioperative nutritional support and that this should be administered whenever possible via the enteral route. The clinical outcome of less severely malnourished surgical patients, including those who are normally nourished, can be improved by the administration of oral dietary supplements at a time in the postoperative period when patients are ingesting free fluids. Some of these patients may also benefit from early postoperative enteral tube feeding, but further work is required to determine the effects following different types of surgery before this is adopted for routine use. Parenteral nutrition is only indicated in the postoperative period when major complications occur in association with intestinal failure.

Dietary Supplements↗
PubMed1998

Intestinal motility.

This review covers the recent advances that have been made in intestinal motility. Failure to stimulate the cephalic response when enteral tube feeding via the nasogastric route is important in contributing to enteral tube feeding related diarrhoea, which cannot be initially overcome by the use of fibre containing feeds. Dysfunction of the nervous system and visceral hypersensitivity appear to be important in contributing to the symptoms associated with irritable bowel syndrome.

Colonic Diseases, Functional↗
PubMed1997

Collagenous colitis and cimetidine.

We report a case of a 62-year-old man who developed watery diarrhoea after starting treatment with cimetidine for dyspepsia. Macroscopically, sigmoidoscopy and colonoscopy were normal. Histology revealed features consistent with a diagnosis of collagenous colitis. The diarrhoea is responding to treatment with prednisolone and withdrawal of cimetidine. We conclude that the collagenous colitis may have been drug induced.

Antidiarrheals↗
PubMed1997

Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients.

BACKGROUND: Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant short term benefits. AIMS: This study aimed firstly to re-evaluate these short term effects, and secondly to establish whether there are any long term benefits. SUBJECTS: One hundred patients admitted for elective moderate or major gastrointestinal surgery. METHODS: In the inpatient phase, patients were randomised to receive a normal ward diet postoperatively, or the same diet supplemented with an oral dietary supplement. In the outpatient phase, patients were further randomised to receive their home diet, or their home diet supplemented with the oral dietary supplement for four months. RESULTS: During the inpatient phase, patients treated with oral supplements had a significantly improved nutritional intake and lost less weight (2.2, 95% confidence interval (95% CI) 0.9 kg) compared with control patients (4.2 (0.78) kg, p < 0.001). Supplemented patients maintained their hand grip strength whereas control patients showed a significant reduction in grip strength (p < 0.01). Subjective levels of fatigue increased significantly above preoperative levels in control patients (p < 0.01) but not in the supplemented group. Twelve patients in the control group developed complications compared with four in the supplemented group (p < 0.05). In the outpatient phase, supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups. CONCLUSIONS: The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant benefits. These benefits, however, are restricted to the inpatient phase.

Adult↗
PubMed1996

Prolonged ambulatory small intestinal and colonic motility monitoring: potential in irritable bowel syndrome--first report of prolonged ambulatory oesophageal, small intestinal and colonic motility in the same patient.

Irritable bowel syndrome (IBS), which affects up to 25% of the population in western countries and accounts for up to 50% of referrals to gastroenterologist, remains mainly a diagnosis of exclusion. We have studied, for the first time, prolonged ambulatory motility recordings from the oesophagus, small intestine and colon of a patient who was referred to us with a 12-year history of abdominal pain and a presumptive diagnosis of IBS. The results indicated that the diagnosis was pseudo-obstruction syndrome rather than IBS. Wider clinical use of the new techniques of prolonged ambulatory intestinal motility monitoring in IBS would offer considerable potential not only in achieving a greater understanding of its pathophysiology but also in providing a more precise definition of clinical and therapeutic subgroups.

Colon↗
PubMed1996

Interchange between collagenous and lymphocytic colitis in severe disease with autoimmune associations requiring colectomy: a case report.

BACKGROUND: Collagenous colitis and lymphocytic colitis present with a similar clinical picture. Whether these conditions are separate entities or whether they represent different pathological stages of the same condition is an unresolved issue. PATIENT: This is a case of collagenous colitis following a fulminant course in which a colectomy was necessary. In the operative specimen the thickened collagen plate, which had been present only two weeks preoperatively had been lost and the pathology was of a lymphocytic colitis. Six months postoperatively this patient developed a CREST syndrome and primary biliary cirrhosis. CONCLUSIONS: This case shows the lability of the collagen plate and the common ground between collagenous and lymphocytic colitis, and presents evidence that these two conditions are different manifestations of the same disease. It also describes for the first time an association between collagenous colitis and CREST syndrome and primary biliary cirrhosis.

Autoimmune Diseases↗
PubMed1996

How long does it take to operate? The implications for in patient malnutrition.

The development of in-patient malnutrition often begins long before hospital admission. The aim of this retrospective study was to assess the time period taken from when patients first present to their General Practitioners to surgery. Patients undergoing elective intraabdominal surgery over a 3 month period in a district general hospital were divided into two groups: One for those with underlying gastrointestinal malignancy requiring resection (n = 27), and the other in those with chronic biliary disease requiring laparoscopic cholecystectomy (n = 24). Patients with malignant disease presented to the GP at a mean of 3.0 months (SD 2.4) after symptom onset, and those with biliary disease at 3.5 months (SD 2.6). Those with malignancy were then referred and seen by the hospital within a mean of 2.8 weeks (SD 1.3), investigated in 3.3 weeks (SD 2.3) and operated on within 2.7 weeks (SD 1.2). The group with biliary disease were seen in hospital at 6.2 weeks (SD 1.9), investigated in 7.5 weeks (5.8) and operated on at 7.6 weeks (SD 2.1). Overall, the length of time it took from symptom onset to surgery in those with malignant disease was 26 weeks (SD 19), and in those with biliary disease 65 weeks (SD 35). This time period will inevitably lead many patients to become malnourished prior to admission, and this may have implications on the incidence of complications and length of in-patient stay.

Aged↗