[Functional disorders of the intestines. Diagnosis, evolution and prognosis, treatment].
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Biomedical subjects
Publications and source records attributed to G Bommelaer.
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Distomatosis caused by Fasciola hepatica is fairly common in France. It is due to the ingestion of contaminated watercress or wild dandelions. Fever is frequent. Jaundice and liver pain are inconstant. The disease is often revealed by an isolated eosinophilia. Ultrasonography and/or computerized tomography are useful to evaluate the hepatic lesions. The diagnosis is confirmed by the finding of eggs in the stools or by serological tests. Numerous other flukes may infect people living overseas and particularly in South-East Asia. Clonorchis sinensis and other Opisthorchidae are responsible for distomatosis of the liver and digestive tract. Several types of intestinal distomatosis may also be acquired. Paragonimiasis (a pulmonary fluke) is particularly frequent in that part of the world. The diagnosis rests on the finding of eggs in the stools (digestive tract distomatosis) or in the airways (paragonimiasis) or on serological tests. The prognosis has been improved by treatment with praziquantel, a drug which in most cases stops the development of the disease within a few days.
Based on recent epidemiologic studies of functional intestinal disorders, we have attempted to answer the following two questions: a) what is the prevalence of functional intestinal disorder in the Western world, b) are there epidemiologic variations in the different modes of symptomatic presentation of functional intestinal disorders? The overall prevalence of functional intestinal disorders in the Western world ranges between 17 and 23 percent according to the country considered, and is between 14 and 18 percent for the irritable bowel syndrome and 4 to 8 percent for painless constipation. The "irritable intestine" group is characterized by a sex ratio of close to one, a median age near 40, a strong influence of stress on symptoms, and the frequency of complaints such as nausea, vomiting, migraine, and pyrosis. The syndrome is seen in active subjects, who believe that they are "sick", and as such, seek medical advice often. Anxiety and depression are frequently encountered. Patients are often athletes, smokers, and have diarrhea. On the other hand, "painless constipation" is characterized by a high prevalence of women and age over 50. Often these subjects do not have any active professional activity. Stress-related and extradigestive symptoms are rare. They do not consider themselves "sick" and do not seek medical advice very often. Conversely, they use laxatives frequently. Individualization of epidemiologically different groups suggests that the pathophysiology may differ between the two groups and perhaps that there are specific therapeutic and diagnostic approaches accordingly.
Buprenorphine, (Temgesic), a N-cyclopropylmethyl derivative of oripavine, is both an agonist and antagonist of morphine. Its effect on the motility of the sphincter of Oddi (SO) in humans have been investigated by endoscopic manometry (EM). Buprenorphine leads to a significant decrease in the amplitude of SO contraction waves without altering other parameters. Thus, it has no morphine-like effect on SO motility, but it does act like a partial antagonist of morphine in reducing the amplitude of SO contraction waves.
The tip of an intraluminal probe was positioned in the cecum, and before and after a standard meal (greater than 800 kcal), the rapid myoelectrical activity of the right, the left, and the rectosigmoid colon in six healthy subjects was recorded. In each colonic site, we recorded two different patterns of spike bursts: Short spike bursts and long spike bursts, as previously described. We observed no difference in either the duration or the amplitude of the two kinds of spike bursts among the three different parts of the colon. Before the meal, the number of long spike bursts was lower in the right than in the left colon (P less than 0.01) and than in the rectosigmoid (P less than 0.01). After the meal, a significant activity increase in long spike bursts lasted 20 min in the right colon (P less than 0.001), 100 min in the left colon, and in the rectosigmoid (P less than 0.001-P less than 0.05). This activity was always significantly less intense in the right colon than in the two other sites (P less than 0.001-P less than 0.01) and was less marked in the left colon than in the rectosigmoid (P 0.01-P less than 0.05). The short spike burst activity remained unchanged. These results provide evidence for the heterogeneity of motility in the different parts of the colon, with a relative hypomotility of the right colon compared to the left colon and the rectosigmoid in the healthy human.
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Rat gastric surfactant has been studied by fluorescence polarization, both in a basal state and after an aspirin challenge. Gastric surfactant appeared as a very viscous molecular organisation of phospholipids and was disorganised by low, non ulcerogenic, concentrations of aspirin. The method presented herein allows one to study the human gastric surfactant under physiological and pathological condition and should help in the design of synthetic surfactants for a therapeutical purpose.
Assuming that acidic degradation of lipase was the major cause of failure for the correction of steatorrhea by pancreatic extracts, we compared the in vitro and in vivo activities of a fungal lipase (FL) (Rhizopus arrhizus) with classical porcine pancreatic extract (Eurobiol). The choice of FL was determined by its two optimum pH (3.5 and 7.4). Five factors known to modify lipase activity were tested: pH, biliary acids colipase, trypsin and albumin. Bioavailability was measured by using a double intubation method in 13 patients with severe pancreatic insufficiency. Each enzymatic preparation was given during a test meal in a randomized and cross-over fashion. Results of the in vitro study showed that FL differed from pancreatic lipase by the following properties: better resistance in acidic solution, inhibition by biliary salts, absence of effect of colipase and rapid degradation by trypsin. In vivo the percentage of lipase activity recovered was 14.2 +/- 10.6 p. 100 for FL and 56 +/- 50 p. 100 for the classical pancreatic preparation. Compared with placebo significant differences in the recovery rate of lipolytic activity were observed with the pancreatic preparation only and started at the 40th min after the end of the test meal. These results showed that lack of degradation in acidic milieu is not the only valuable criterion for the choice of an efficient lipase preparation. The role of other potential factors such as gastric emptying as well as proteolytic degradation of the enzyme should be considered as well.
The aim of this work was to answer the two following questions: 1) is there any difference between the right colonic, the left colonic, and the rectosigmoid motility? 2) does the rectosigmoid junction (radiological and endoscopic entity) exhibit a specific motility pattern? Colonic motility was assessed by electromyography. We used an intraluminal probe supporting 15 groups of 3 ring electrodes. Inside the probe a lead pellet was placed opposite each electrode. The probe was inserted through the colon by colonoscopy. A visual analysis of the signal was performed and we distinguished: Long Spike Bursts (LSB) activity (propagating in oral or aboral direction or not propagating) from Short Spike Bursts (SSB) activity as previously described. Twenty patients suffering from the irritable bowel syndrome included in a subgroup defined as abdominal pain, were studied, and two groups were defined as follows: the tip of the probe was positioned in the caecum in 9: group "Right colon" patients. An electrode was specifically located on the rectosigmoid junction in 15: group "Junction" patients. In the "Right colon" group, the postprandial increase of LSB activity in the rectosigmoid lasted longer than in the right and left colons. During the postprandial period, the right colon exhibited a lower LSB activity than the rectosigmoid (p less than 0.01). After the meal LSB activity propagating in aboral direction was increased in the right colon while it was inhibited in the rectosigmoid. LSB activity propagating in the oral direction was increased both in the right colon and rectosigmoid after the meal. In the "Junction" group, we observed a specific myoelectrical activity at the rectosigmoid junction.(ABSTRACT TRUNCATED AT 250 WORDS)
The characteristics and the prevalence of functional bowel disorders in the general French population are unknown. Based on an epidemiological inquiry in a random population of 1,200 persons who were not seeking care, residents in our country we established: the prevalence of symptoms suggestive of functional bowel disorders; the epidemiological differences between symptomatic subgroups which included abdominal pain with or without bowel dysfunction, diarrhea and constipation. The amount of cases and the prevalence in each subgroup were: abdominal pain, 165, 13.8 p. 100, painless constipation, 75, 6.3 p. 100, diarrhea, 10, 0.8 p. 100. As a whole, functional bowel disorders occurred in 20 p. 100 of our population. The "irritable bowel syndrome" group defined as abdominal pain and/or diarrhea differ from normal subjects by the following higher frequency of age under 50, subjects in active duty, antecedents of diverticulosis, influence of stress on symptoms, nausea, vomiting, migraines, pyrosis and number of visits to a doctor. However neither the sex-ratio nor professional occupation were relevant. The constipation group differed from normal because of the higher frequency of female sex, antecedents of hiatus hernia, use of laxatives but not because of age nor by the number of associated symptoms. In conclusion, functional bowel disorders occurred in 20 p. 100 of our population; two subgroups were clearly different from an epidemiological point of view, the irritable bowel syndrome (13 p. 100) and constipation (7 p. 100); therefore these two groups deserve a specific physiopathological, psychological and therapeutic approach.
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The purpose of this prospective study was to assess colonic myoelectric activity during fasting and after a test meal in patients with the Irritable Bowel Syndrome (IBS) and in control subjects. Colonic electromyographic activity was recorded using an intraluminal probe in 14 patients and in 8 controls. Only rapid electrical activity [i. e. Short Spike Bursts (SSB) and Long Spike Bursts (LSB)] was taken into account. In control subjects the test meal provoked a significant increase in LSB from 46.7 +/- 16.3 to 88.6 +/- 20.3 (p less than 0.001) but not in SSB. In IBS patients rapid myoelectrical activity was not significantly modified by food intake (47.2 +/- 10.3 vs. 62.2 +/- 10.9; NS). The increase of postprandial LSB activity was found to be significantly higher in controls than in IBS patients (41.8 +/- 7.6 vs. 12.9 +/- 8.4; p less than 0.05). These results showed that colonic myoelectrical activity in IBS patients is different from that of controls; such a difference could be useful in classifying IBS patients.
We report a case of a 56 year old woman who presented with a long history of chronic attacks of vomiting. On admission to hospital she was cachectic, and attempted parenteral nutrition induced coma. The illness was found to be due to citrullinaemia, a metabolic disorder of the urea cycle. Our patient is the oldest with this disorder so far described in the literature. The main points of the case and its investigation are outlined: hyperammonaemia, amino acid chromatogram, measurement of enzyme activity in skin and liver biopsy material. The therapeutic measures which led to cure are of particular interest.
Decreased pancreatic bicarbonate secretion may be responsible for the low duodenal pH in chronic pancreatitis as compared to the normal. We have therefore performed a 24-hour continuous duodenal pH recording in 7 patients with chronic pancreatitis and in 7 controls. The comparison of results, expressed as the percent of the time with pH under 3, 4, 5 or 6, shows that in chronic pancreatitis, the duodenal pH was significantly lower than in normal subjects, particularly during the postprandial periods. The lower pH found in pancreatitis, causing an impairement of the catalytic activity of endogenous or exogenous pancreatic enzymes could both contribute to malabsorption and decrease the efficacy of substitutive pancreatic extracts.
In dispersed acini from dog pancreas, exogenous derivatives of cAMP stimulated the amylase release; 8-Br-cAMP was a more potent stimulant than Bt2-cAMP, and induced a potentiation of the amylase release stimulated by cerulein. Both secretin and vasoactive intestinal peptide (VIP), increased cellular cAMP, with a greater potency for secretin, and supramaximal concentration of secretin plus VIP increased cellular cAMP to the same degree as that obtained with secretin alone. 125I-VIP-binding studies showed that in dog pancreatic acini there is a 95% decrease in the number of VIP-preferring receptors with minor changes in receptor affinity as compared to guinea-pig pancreas. The absence of effect between secretin or VIP and cerulein in stimulating amylase release could likely be explained by the low number in VIP-preferring receptors on dog pancreatic acini.
In a prospective study we have measured the lactoferrin level of duodenal juice under secretin plus caerulein pancreatic stimulation in 78 subjects. Subjects was divided in 4 groups as follows: 27 controls, 11 pancreatic disease without chronic pancreatitis (CP), 17 CP and 23 suspicions of CP. Lactoferrin was assayed by radial immunodiffusion and the level was referred to lipase activity. The test was considered as positive when lactoferrin (microgram/ml) X 100/lipase (U/ml) greater than 0.1. No one control subject had a positive test, 2 pancreatic cancers out of 4, 1 acute pancreatitis out of 7, 12 CP out of 17 had a positive test. The sensitivity (0.71) and the specificity (0.92) of the test do not allow us to propose this test as unequivocal in the diagnosis of CP.
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