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Biomedical subjects

E Corazziari

Publications and source records attributed to E Corazziari.

At least 73 records · Page 4Linked to original sources

Rectal sensitivity in chronic constipation.

Rectal sensitivity is often reduced in patients affected by chronic constipation, but it is not known whether this alteration differs according to the severity and the site(s) of the slowing of gastrointestinal transit. Moreover, it is not known whether alteration precedes or follows bowel complaints. In this study, perception of intrarectal distension was evaluated in 28 healthy controls, in 20 patients complaining of constipation and with a normal gastrointestinal transit time (less than 96 hr), and in 44 patients complaining of constipation and with a prolonged gastrointestinal transit time (greater than 96 hr). Within the latter group, perception to intrarectal distension was analyzed in patients with slowing of transit in the rectum only, in the colon only, and in both the rectum and the colon. In a subgroup of 22 patients, rectal sensitivity was evaluated before and after treatment. Rectal sensitivity was found to be reduced significantly in constipated patients; it was more severely reduced in patients with objective evidence of prolonged gastrointestinal transit time and with slow transit in the rectum. Rectal sensitivity improved in patients who responded to treatment and did not vary significantly in nonresponders.

Adolescent↗

Effect of glucagon on sphincter of Oddi motor activity.

In this study the effects of glucagon 1-29 peptide and the metabolically inactive portion glucagon 1-21 have been evaluated on sphincter of Oddi (SO) motor activity. A triple lumen catheter perfused by a minimally compliant infusion system was used to record intraoddian pressures at endoscopy. A strictly blind evaluation of tracings was performed. Neither peptide administration appeared to induce any relevant variation of SO resting pressure nor frequency, amplitude and duration of phasic contractions. Data of the present study would not support the use of glucagon whenever a spasmolytic effect on the SO is looked for.

Adult↗

Manometric measurement of human sphincter of Oddi length.

Length of biliary (CBD) and/or pancreatic (PD) sphincter of Oddi (SO) was measured during perendoscopic or intraoperative manometry in 21 control subjects and in 46 patients with biliary disease. When the high resting pressure (HPZ) and the phasic wave zone (PAZ) were considered, SO length was, in the control group, 9.5 +/- 0.5 mm (M +/- SE) and 9.4 +/- 0.6 mm at the level of the CBD-SO, and 7.7 +/- 0.6 mm and 6.9 +/- 0.5 mm at the level of the PD-SO. The physiological sphincter length appeared substantially shorter than the anatomical one, as reported in the literature. No significant differences were found between controls and patients with CBD stones. Endoscopic sphincterotomy without manometry reduced mean sphincter length length of the sphincterotomy was tailored to the manometric findings. Surgical partial sphincterotomy reduced sphincter length by only 46.7 +/- 10.3%.

Adult↗

Large-bowel transit in paraplegic patients.

Severe constipation often follows spinal cord injury. The aim of this study was to evaluate transit of contents through the large bowel in patients with paraplegia after a complete transverse lesion of the spinal cord. Transit through the right colon, left colon, and rectum was evaluated in 11 patients (eight males, 3 females; 17 to 63 years old) and data were compared with that of 37 healthy control subjects. In all patients there was either no, or abnormally low, transit at the level of the left colon and rectum. A minor degree of transit delay at the level of the right colon was also present in eight patients. These data indicate that constipation in patients with paraplegia is due to abnormal transit, mainly at the level of the left colon and rectum, and transection of the spine between the C-4 and T-12 vertebral levels causes alteration of large-bowel motor activity mainly at the level of the segments innervated by the parasympathetic fibers of the sacral outflow.

Adolescent↗

Laxative consumption in chronic nonorganic constipation.

We looked at laxative consumption and its relationship to bowel habits, total gastrointestinal transit time (TGITT), and symptoms in patients with chronic nonorganic constipation. Of the patients, 87.9% used laxative, 30% habitually. Laxative intake increased with age, so that habitual consumption was more frequent in patients with long-standing (greater than 10 years) constipation. Although habitual laxative users had a consistent trend toward lower bowel frequency and prolonged TGITT, no relationship was found among intake and observed bowel frequency, TGITT, or large bowel segmental transit time. Although laxatives induced more satisfactory or less difficult evacuations, they also caused diarrhea and mucus in the stool. Laxative consumption did not bring about any detectable improvement in the abdominal or extraabdominal symptoms usually associated with constipation.

Adolescent↗

Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity.

Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during endoscopic manometry and reported to range, in control subjects, from (M +/- SE) 3.0 +/- 0.6 to 7.5 +/- 0.7 c/min. Recently, high frequency (greater than 8 c/min) phasic contractions or absence of phasic activity were recorded in patients with postcholecystectomy or pancreatic complaints, possibly suggesting a sphincter of Oddi dysfunction. In the present study, sphincter of Oddi (biliary tract) phasic contractility was measured by perendoscopic manometry in 13 subjects without specific clinical symptoms of biliopancreatic disease and with a normal common bile and pancreatic duct at ERCP. Four T-tube patients with no evidence of common bile duct stones or papillary stenosis were studied for comparison (transductal sphincter of Oddi manometry). Basal frequency was found to range from 0 to 7 c/min (M +/- SE: 2.99 +/- 0.46) in perendoscopic manometry (85 min of recording time) and from 0 to 12 c/min (2.0 +/- 0.3) in transductal manometry (2546 min of recording time). Long lasting transductal recordings also showed that frequency of activity derived from the sphincter area varied cyclically in close relation with the duodenal migrating motor complex. It is concluded that the sphincter of Oddi in man is likely to participate in the interdigestive gastrointestinal motor activity and that short perendoscopic recordings may not be representative of the overall sphincter of Oddi activity.

Adult↗

Intraluminal pH and oesophageal motility in patients with gastro-oesophageal reflux.

The effect of intraluminal pH on motor activity of the lower oesophageal body was studied in patients with pathological gastro-oesophageal reflux. Liquid boluses with a pH range of 6.98-1.1, infused in the distal oesophagus of 21 patients during manometric recording of motor activity, elicited either secondary peristalsis or simultaneous contractions. Acid pH did not affect the threshold of distension required to elicit secondary peristalsis. Oesophageal responses to volumes of instillate did not differ in patients with normal and abnormal acid clearing test, nor in patients with a negative and positive acid perfusion test.

Adult↗

Melanosis of the rectum in patients with chronic constipation.

In patients with constipation the prevalence of melanosis in rectal biopsies was evaluated in an attempt to correlate its occurrence with laxative consumption and intestinal stasis. Melanosis was present in 58 percent of the patients and in none of a control group. Melanosis was present in 73.4 percent of patients consuming anthracene laxatives and in 26.6 percent of those not consuming anthracene laxatives (P less than 0.01). No correlation was found between the occurrence (and grading) of melanosis and pattern of transit through the large bowel, bowel movements, and duration of symptoms. Results of this study seem to indicate that intestinal stasis is not a cause of melanosis of the colon and rectum and confirm that melanosis may well be due only to the consumption of anthracene laxatives; melanosis coli does not appear to be a sensitive marker of impairment of motor function in the "cathartic colon."

Adolescent↗

Gastrointestinal transit time, frequency of defecation, and anorectal manometry in healthy and constipated children.

Total gastrointestinal transit time (TGITT), frequency of defecation, and anorectal manometry were evaluated in 63 pediatric patients referred for chronic nonorganic constipation; in 39, segmental transit times of the right and left colon and rectum were also measured. TGITT was significantly longer in chronically constipated children than in matched normal controls. Although bowel frequency was highly significantly correlated with TGITT in patients with prolonged transit time, not all children with prolonged TGITT had reduced bowel frequency. Moreover, not all children with constipation had prolonged TGITT. In children with idiopathic chronic constipation, slowing of intestinal transit occurred most frequently at the level of the distal colon and rectum. Anorectal motility variables were not significantly different in children with functional chronic constipation and in normal children. Maximal resting and pressure and mean intrarectal distending volume causing threshold inhibition in constipated patients did not significantly differ from the control values. Therefore, anorectal manometry did not detect relevant motor abnormalities in constipated children.

Anal Canal↗

Gastrointestinal transit time and anorectal manometry in children with fecal soiling.

Fifty-three children with chronic idiopathic constipation, 32 with fecal soiling and 21 without soiling, were investigated by total gastrointestinal transit time (TGITT) and anorectal manometry (ARM). TGITT and ARM were also performed, respectively, in 46 and 32 healthy subjects. Twenty-two of the 32 children with soiling were successfully managed by medical treatment and toilet training. TGITT was significantly longer in all constipated children than in normal children. Furthermore, some parameters of anorectal motility (threshold volume, amplitude of threshold inhibitory anal reflex) of the patients differed markedly from those measured in controls. Rectal compliance was significantly higher in children with fecal soiling than in children with constipation without soiling and healthy controls. In the successfully treated children, soiling disappeared, TGITT normalized, and anorectal variables changed significantly. It is concluded that TGITT is useful in assessing the degree of constipation. Electromanometry of the anorectum is of great help in the diagnosis of functional constipation by excluding aganglionosis; furthermore, it provides additional information allowing better understanding of the mechanisms involved in functional constipation in children.

Anal Canal↗

Motor activity of the distal oesophagus and gastrooesophageal reflux.

The relationship between intraoesophageal pH value and motor activity of the lower oesophageal body and sphincter was investigated by simultaneous evaluation of intraluminal pressure and pH in 13 patients complaining of heartburn and regurgitation. One hundred and thirty one episodes of gastro-oesophageal reflux were recorded. One hundred and eighteen (90.1%) were preceded by a swallow (one to 12 seconds), 13 reflux episodes (9.9%) were not preceded by a swallow. Gastro-oesophageal refluxes preceded by swallow were accompanied by an equal number of normal and abnormal primary peristaltic sequences and, while recording at level of the lower oesophageal sphincter, occurred during inhibition of the sphincter. Frequency of abnormal primary peristalsis increased (p less than 0.01) during periods of low intraluminal pH (less than 5.0). An increase of at least 0.5 U in intraluminal pH occurred with 45.2% of normal primary peristalsis, 29.3% of abnormal primary peristalsis, 4.3% of secondary peristalsis, 3.5% of non-peristaltic contractions. The results of this study indicate that in patients with symptoms of reflux oesophagitis, gastro-oesophageal reflux appears to be related to swallow-induced lower oesophageal sphincter inhibition and not related to abnormal motor activity of the distal oesophageal body where an increased frequency of abnormal primary peristalsis appears to occur during low intraluminal pH and primary peristalsis appears to be the most important mechanism of oesophageal clearing.

Adolescent↗

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones.

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile duct stones; nine of whom had undergone cholecystectomy, and seven had gall bladder stones. Length and amplitude of the resting sphincter pressure as well as frequency, duration, amplitude, and propagating pattern of phasic contractions did not significantly differ in patients with and without common bile duct stones. Sphincter of Oddi motor activity did not appear to be influenced by the variation in the diameter of the common bile duct or by previous cholecystectomy.

Adult↗

Colonic electromyography in chronic constipation.

Myoelectric activity of the sigmoid has been studied in 12 patients with chronic nonorganic constipation and 10 control subjects. All patients showed total gastrointestinal transit time longer than 96 h, with left-colonic or rectocolonic slowed transit. Electrical and mechanical activity was recorded by means of an intraluminal probe with bipolar suction electrodes and open-ended tips. Two groups of frequencies of slow waves, a slower rhythm at approximately 3 cycles/min and a faster rhythm at approximately 6 cycles/min were recorded in patients and control subjects. The mean frequency of the slower rhythm was significantly (p less than 0.005) higher in patients with constipation than in control subjects, whereas the frequency of the faster rhythm and the incidence of both rhythms were similar in the two groups. Mechanical activity showed no difference in terms of motility index and percentage of activity between patients and control subjects. Results of the study indicate that patients with left colonic constipation show an increase in frequency of the slower colonic rhythm in the very segment in which slowing down of transit occurs. It is suggested that the higher slow-wave activity in the sigmoid induces an increase in segmenting contractions and therefore may be responsible for the slowing down of intestinal transit.

Chronic Disease↗

Effect of bombesin on lower esophageal sphincter pressure in humans.

Intravenous infusion of bombesin in humans results in increased serum gastrin levels and increased lower esophageal sphincter pressure. To differentiate a gastrin- from a nongastrin-mediated mechanism, the effect of intravenous bombesin infusion on lower esophageal sphincter pressure was studied in 5 healthy subjects and in 5 antrectomized patients. Lower esophageal sphincter pressure was recorded by three continuously perfused catheters with side-openings located 5 mm apart. Blood samples were taken at regular intervals during the study periods to assay gastrin and pancreatic polypeptide. Manometric tracings and blood samples were coded and evaluated blindly. Lower esophageal sphincter pressure increased during bombesin infusion both in normal and antrectomized subjects. The increase had a delayed onset and persisted after discontinuation of bombesin. No correlation was found between lower esophageal sphincter pressure and serum gastrin or pancreatic polypeptide values. These data indicate that the effect of bombesin on lower esophageal sphincter pressure is not gastrin or pancreatic polypeptide mediated.

Adult↗