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Biomedical subjects

M Bortolotti

Publications and source records attributed to M Bortolotti.

At least 19 recordsLinked to original sources
PubMed2003

Dilated intercellular spaces as a marker of oesophageal damage: comparative results in gastro-oesophageal reflux disease with or without bile reflux.

BACKGROUND: The dilation of oesophageal intercellular spaces, clearly apparent in transmission electron microscopy images, is a marker of cellular damage induced by acid. AIM: To analyse the presence of dilated intercellular spaces and to quantify the scores in controls and in patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux accompanied by erosive or non-erosive reflux disease. METHODS: Thirty-eight symptomatic patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux and 12 asymptomatic controls, classified on the basis of pH-metry and bilimetry, underwent endoscopy. Six tissue biopsies were taken from the normal mucosa for light microscopy and transmission electron microscopy evaluation. Dilated intercellular spaces were measured on photomicrographs of the specimens (at least 100 transects were measured for each patient). RESULTS: Twenty-two patients with gastro-oesophageal reflux disease had normal macroscopic mucosa but, at histology, five patients with erosive gastro-oesophageal reflux disease had mild oesophagitis and one had moderate oesophagitis. Seven patients with duodenal gastro-oesophageal reflux had normal mucosa, whilst three with erosive duodenal gastro-oesophageal reflux had mild oesophagitis at histology. At transmission electron microscopy, all controls had dilated intercellular spaces of less than 1.69 microm. Each symptomatic patient had a mean dilated intercellular space value and a mean value of the maximum dilated intercellular space at least three or more times greater than that in controls (P < 0.001). No statistical differences were observed between erosive and non-erosive oesophagitis. CONCLUSIONS: The dilated intercellular space is an extremely sensitive marker of damage in gastro-oesophageal reflux disease, duodenal gastro-oesophageal reflux and non-erosive reflux disease, and serves as the most appropriate marker of damage evaluation in non-erosive reflux disease reported to date. A mean dilated intercellular space of 0.74 micro m provides a cut-off score for damage. No quantitative or qualitative differences in dilated intercellular space scores were found between pure and mixed acid reflux.

Adult↗
PubMed2002

The treatment of functional dyspepsia with red pepper.

AIM: : To decrease the intensity of dyspeptic symptoms by impairing the visceral nociceptive C-type fibres with capsaicin, contained in red pepper powder. METHODS: : The study was performed on 30 patients with functional dyspepsia and without gastro-oesophageal reflux disease and irritable bowel syndrome. After a 2-week washout period, 15 patients received, before meals randomly and in a double-blind manner, 2.5 g/day of red pepper powder for 5 weeks, and 15 patients received placebo. A diary sheet was given to each patient to record, each day, the scores of individual and overall symptom intensity, which subsequently were averaged weekly and over the entire treatment duration. RESULTS: : The overall symptom score and the epigastric pain, fullness and nausea scores of the red pepper group were significantly lower than those of the placebo group, starting from the third week of treatment. The decrease reached about 60% at the end of treatment in the red pepper group, whilst placebo scores decreased by less than 30%. CONCLUSIONS: : Red pepper was more effective than placebo in decreasing the intensity of dyspeptic symptoms, probably through a desensitization of gastric nociceptive C-fibres induced by its content of capsaicin. It could represent a potential therapy for functional dyspepsia.

Adult↗
PubMed2002

Effect of Sildenafil on hypertensive lower oesophageal sphincter.

BACKGROUND: Sildenafil relaxes the muscle cells of the penis arterioles by inhibiting phosphodiesterase-type 5 (PD-5), inactivating the nitric oxide-stimulated cyclic guanosine monophosphate. We investigated whether this effect of Sildenafil is also displayed on the muscles of the hypertensive lower oesophageal sphincter (LES). METHODS: In 14 patients with symptomatic hypertensive LES, oesophageal motility was recorded by means of a low-compliance manometric system with five manometric ports for the oesophageal body and a sleeve for the sphincter. After a basal period of 60 min a tablet of Sildenafil 50 mg (group A; seven patients) or one of placebo (group B; seven patients) ground and dissolved in 20 cc of water was infused in the stomach, randomly and in double-blind manner. Recording continued for a further 60 min. Sphincter tone and pressure wave amplitude were measured each minute and the values averaged for each 5-min period for the post-infusion period of 60 min. The values of the whole post infusion period, the lowest values among the 5-min periods (nadir values) and the values of the last 5-min periods were compared with the basal values in each group, and those of group A were compared with the corresponding values of group B. RESULTS: Sphincter tone and wave amplitude showed after Sildenafil a significant decrease comparable that of the basal period and the placebo. The inhibitory effect reached its maximum 10 min after the infusion and lasted approximately 1 h. CONCLUSIONS: Sildenafil inhibits the lower oesophageal sphincter tone and pressure wave amplitude of patients with symptomatic hypertensive LES. These findings suggest a clinical application of PD-5 inhibitors in the treatment of spastic oesophageal motor disorders.

Adult↗
PubMed2001

Effects of sildenafil on esophageal motility of normal subjects.

Sildenafil shows an intense and prolonged inhibitory effect on the smooth muscle cells of corpus cavernosum arterioles by blocking phosphodiesterase type 5 that inactivates the nitric oxide-stimulated cyclic guanosine monophosphate. We investigated if this inhibitory effect is also displayed on smooth muscle cells of the esophagus. In 16 normal subjects (9 men and 7 women, mean age 34 years, range 22-56) esophageal motility was recorded by means of a low-compliance manometric system with side holes for the esophageal body and a sleeve for the lower esophageal sphincter (LES). After a basal period of 60 min, a tablet of sildenafil 50-mg ground and dissolved in water was infused in the stomach in eight subjects (group A) and a placebo tablet in the other eight subjects (group B), randomly and in a double-blind manner; the recording continued for another 60 min. LES tone and postdeglutitive residual pressure, as well as amplitude, propagation velocity, and onset latency of contractions were measured each minute, the values averaged every 5 min, and the mean of the entire basal and postinfusion periods was calculated. The postinfusion values were compared with the basal values in each group and with the corresponding values of the other groups. The percent variations of postinfusion values with respect to basal values were also compared. Sildenafil induced a statistically significant decrease of LES tone, residual pressure, wave amplitude, and propagation velocity and a significant increase of onset latency of pressure waves in comparison with the values of the basal period and placebo. The inhibitory effect reached its maximum 10-15 min after the infusion and lasted about 1 hr. In conclusion, sildenafil markedly inhibits the motor activity of the esophageal musculature by decreasing LES pressure, wave amplitude, and propagation velocity and increasing the onset latency of pressure waves.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2001

Sildenafil inhibits gastroduodenal motility.

BACKGROUND: Sildenafil shows an intense and prolonged inhibitory effect on the smooth muscle cells of corpus cavernosum arterioles by blocking phosphodiesterase-type 5, which inactivates the nitric oxide-stimulated cyclic guanosine monophosphate. AIM: To investigate whether this inhibitory effect is also displayed on the musculature of the gastroduodenal tract. METHODS: In 16 normal subjects, antroduodenal motility was recorded by means of a low-compliance manometric system. Ten minutes after the appearance of a phase III of the migrating motor complex, a tablet of sildenafil 50 mg, dissolved in 20 mL of water, was infused in the gut of eight patients, or a placebo in the other eight patients, randomly and in a double-blind manner, continuing the recording for 90 min. The frequency and amplitude of antral and duodenal waves, measured during the first 60 min after infusion in the two groups, were compared statistically. In addition, the duration of antral and duodenal phases I, and the number of phases III occurring during the whole 90 min after infusion, were compared in the two groups. RESULTS: Antral and duodenal wave frequency and amplitude were significantly lower during the first 60 min after sildenafil administration. Both antral and duodenal phases I were significantly longer after sildenafil than after placebo, and the number of phases III which occurred during the 90 min after sildenafil was significantly lower than after placebo. CONCLUSIONS: Sildenafil inhibits interdigestive motor activity of the antrum and duodenum.

Adult↗
PubMed2001

Abnormal esophagocardiac reflex in patients with non-cardiac chest pain.

As the mechanoreceptor stimulation of the esophagus activates an esophagocardiac inhibitory reflex, with possible cardiac hypokinetic arrhythmias, we investigated whether patients with non-cardiac chest pain have this reflex, which could represent a source of risk in predisposed individuals during the intraesophageal balloon distension test. Electrocardiogram readings were recorded in nine patients with non-cardiac chest pain (group A), the esophageal origin of which was diagnosed with cardiac and esophageal examinations, in 10 patients with hyperkinetic esophageal motor disorders without chest pain (group B), and in eight normal subjects used as controls (group C), after swallowing solid boluses and during intraesophageal balloon inflation at 100 mmHg for 10 s. The percent variation of the R-R interval from its mean basal value to its highest value observed after stimulation was calculated. Solid swallows induced an increase in heart rate followed by a decrease that was significantly higher in group B than group C, while group A was not significantly different from group C. Balloon inflation induced a significant decrease in heart rate in all groups, but in group A the degree of decrease was significantly lower than in groups B and C. In conclusion, esophageal wall distension, either as a result of solid bolus or balloon inflation, elicits an inhibitory esophagocardiac reflex that is higher than normal in patients with hyperkinetic esophageal motor disorders without pain and lower than normal in patients with non-cardiac chest pain of esophageal origin, who, consequently, have nothing to fear from this procedure.

Adult↗
PubMed2000

Effects of sildenafil on esophageal motility of patients with idiopathic achalasia.

BACKGROUND & AIMS: Sildenafil shows an intense and prolonged inhibitory effect on the smooth muscle cells of the human corpus cavernosum by blocking phosphodiesterase type 5 that destroys nitric oxide-stimulated cyclic guanosine monophosphate. We investigated if sildenafil possesses a similar effect on the esophageal musculature of patients with achalasia, where there is an impairment of nitric oxide production similar to that of functional impotence. METHODS: In 14 patients affected by achalasia with an esophageal diameter of </=5 cm, esophageal motility was recorded with a low-compliance manometric system. After a basal period of 30 minutes, a 50-mg tablet of sildenafil dissolved in water was infused in the stomach in 7 patients and one of placebo in the other 7 patients, randomly and in double-blind manner, continuing the recording for 60 minutes. RESULTS: Lower esophageal sphincter tone, residual pressure, and wave amplitude after sildenafil showed a significant decrease compared with both the basal period and the placebo group, with a marked interpatient variability. The inhibitory effect reached its maximum (about -50%) 15-20 minutes after the infusion and lasted <1 hour. Propagation of pressure waves was not modified by sildenafil. CONCLUSIONS: Sildenafil inhibits the contractile activity of the esophageal musculature of patients with achalasia, decreasing lower esophageal sphincter tone and residual pressure as well as contraction amplitude.

Adult↗
PubMed2000

Twenty-four hour ambulatory antroduodenal manometry in normal subjects (co-operative study).

Circadian antroduodenal motor activity was studied in 40 normal subjects by means of a portable recording system consisting of a computerized data logger and a probe with microtransducers. The quantitative and qualitative characteristics of contraction events during the interdigestive and digestive periods, as well as during the awake and asleep periods, were analysed. The composition and timing of meals and night recumbence were standardized. In spite of the high interindividual variability in motor parameters, significant differences in the characteristics of interdigestive and digestive periods between waking and sleep states were found. This paper confirms the existence of a circadian variation in antroduodenal motor activity and provides reference values from a large series of normal subjects that can be used for statistical comparisons with those obtained from patients recorded with the same method.

Adolescent↗
PubMed2000

Effect of clarithromycin on esophageal motility.

As clarithromycin (CLA), an antibiotic commonly used for Helicobacter pylori eradication, stimulates gastroduodenal motility, we investigated whether it also stimulates esophageal motility. In 15 normal subjects, esophageal motility was recorded using a low-compliance manometric system with two ports in the esophageal body, one port in the lower esophageal sphincter (LES), and five ports in the antroduodenal tract to monitor the occurrence of phases I-III of the migrating motor complex. Thirty minutes after the occurrence of a duodenal phase III, we infused intravenously, randomly, and in a double-blind manner, CLA 100 mg in five subjects (group A), CLA 250 mg in five subjects (group B), and normal saline in the remaining five subjects (group C). LES tone and post-deglutitive residual pressure, as well as the amplitude and duration of the esophageal contractions, were measured each minute and averaged over a post-infusion period of 30 min. Both group A and B showed a LES tone significantly higher than that of group C after CLA infusion, whereas the post-deglutitive residual pressure was not significantly different from that of group C. The LES tone of group B was significantly higher than that of group A. Group B, but not group A, showed a wave amplitude and duration significantly higher than that of group C. In conclusion, CLA is able to stimulate LES tone and esophageal contractions with a dose-related effect.

Adult↗
PubMed2000

Dose-related stimulatory effect of clarithromycin on interdigestive gastroduodenal motility.

BACKGROUND/AIMS: The effect on interdigestive gastroduodenal motility of different doses of clarithromycin, an antibiotic commonly used for Helicobacter pylori eradication, has been investigated. METHODS: Gastroduodenal motility was recorded by means of a low-compliance manometric system in 15 healthy subjects. Thirty minutes after the first phase III of the migrating motor complex, clarithromycin (CLA) was infused intravenously at a dose of 100 mg in 5, 250 mg in 5 and 400 mg in 5 subjects, randomly and in a double-blind manner, continuing the recording for at least 1 h. A further study was carried out on 10 subjects, 5 of whom received 50 mg CLA and 5 normal saline with the same modalities. RESULTS: After 100 mg CLA a premature gastroduodenal phase III ensued in all cases, which showed a duration, propagation velocity and wave frequency not significantly different from the spontaneous one and was followed by a clear phase I. A premature gastroduodenal phase-III-like activity occurred in 3 cases of 250 mg CLA and 2 cases after 400 mg CLA, followed by a very short or absent phase I and characterized by a long duration of the antral phase III, while in the remaining cases a long-lasting sequence of about 1/min of antral waves propagated to the duodenum appeared, sometimes preceded by an antral phase-III-like activity not propagated to the duodenum. After 50 mg CLA a premature phase III appeared in 2 cases, while a not premature phase III appeared in 2 cases after saline. CONCLUSION: CLA shows a dose-related stimulatory effect on interdigestive gastroduodenal motility varying from the initiation of a typical phase III to a prolonged sequence of gastroduodenal coordinated waves. These motor effects of CLA suggest potential therapeutic applications.

Adolescent↗
PubMed1999

Effect of intravenous clarithromycin on interdigestive gastroduodenal motility of patients with functional dyspepsia and Helicobacter pylori gastritis.

Gastroduodenal motility of 16 patients complaining of functional dyspepsia and Helicobacter pylori gastritis was recorded by means of a low-compliance manometric system with four recording ports in the stomach and four in the duodenum. Clarithromycin (CLA) 250 mg (group A: 8 patients) or normal saline solution (group B: 8 patients) was infused intravenously randomly and in double-blind manner 30 min after the end of the first recorded activity front (AF) of the migrating motor complex or, in the absence of AFs, after 200 min of recording, continuing the recording until an AF was observed during the subsequent 200 min. CLA administration was followed by a typical gastroduodenal AF in a significantly higher number of patients than saline administration. In addition, the time-lag between the drug administration and the appearance of AFs was 22 min +/-7.4 (mean +/- SD), significantly shorter than after saline (109+/-56 min) and the CLA-related duodenal AFs showed a duration of 7.4 min +/-1.6 in group A, significantly longer than that of the spontaneous AFs (3.5 min +/-1), while in group B AF duration after saline was not significantly different from that of the spontaneous ones. In conclusion, clarithromycin is able to stimulate cyclic interdigestive gastroduodenal motility. This prokinetic property of clarithromycin is not unexpected because it is a macrolide like erythromycin, the prokinetic activity of which is well known, and could be utilized for therapeutic uses.

Adolescent↗
PubMed1999

Effect of a mineral water on gastric emptying of patients with idiopathic dyspepsia.

The antidyspeptic property of mineral waters has for many years been based on empirical data. In the present paper we evaluated the effects of one type of mineral water, Tettuccio water from Montecatini, on gastric emptying in patients with idiopathic dyspepsia. Fourteen subjects, eight patients with idiopathic dyspepsia and delayed gastric emptying at scintigraphy and six healthy subjects with normal gastric emptying were studied. The gastric emptying of mineral water was studied with a scintigraphic method and compared with that of tap water. In patients with idiopathic dyspepsia, gastric emptying of both waters was slower than in controls but the gastric emptying of mineral water was significantly faster than that of tap water, both in dyspeptic patients and in healthy subjects. In conclusion, this mineral water stimulates gastric emptying. Further studies are needed on the possible role of this water in the management of chronic idiopathic dyspepsia.

Adolescent↗
PubMed1998

Effects of oral clarithromycin and amoxycillin on interdigestive gastrointestinal motility of patients with functional dyspepsia and Helicobacter pylori gastritis.

BACKGROUND: Clarithromycin and amoxycillin are antibiotics commonly used in association for Helicobacter pylori eradication. Because this treatment, which lasts 1-2 weeks, is frequently associated with gastrointestinal symptoms, we investigated the effects of these antibiotics on gastrointestinal motility. PATIENTS AND METHODS: Gastroduodenal motility was recorded in 14 patients with functional dyspepsia and H. pylori gastritis by means of a low-compliance manometric system with four recording ports in the stomach and four in the duodenum. Two tablets of clarithromycin 250 mg (seven patients, clarithromycin group) or one of amoxycillin 1 g (seven patients, amoxycillin group), ground and dissolved in 20 mL of water, were given randomly and in double-blind manner 30 min after the end of the first activity front (AF) of the migrating motor complex (MMC) or, in the absence of AFs, after at least 200 min of recording. Recording continued until an AF was observed during the subsequent 200 min. RESULTS: Clarithromycin administration was followed by a typical gastroduodenal AF in a significantly higher number of patients than for amoxycillin administration. In addition, the time lag between clarithromycin administration and the appearance of AFs was 48 min +/- 8.5 (mean +/- s.d.), significantly shorter than after amoxycillin (121 min +/- 29). The clarithromycin-related duodenal AFs showed a duration of 6.6 min +/- 1.5, significantly longer than that of the spontaneous AFs (3.6 min +/- 1.2, P < 0.01), while the amoxycillin-related AFs were not significantly different from the spontaneous ones. CONCLUSION: Clarithromycin stimulated cyclic gastroduodenal motility, while amoxycillin was ineffective. It is likely that symptoms during the eradication treatment are due to this effect of clarithromycin.

Administration, Oral↗
PubMed1997

24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus.

Absence of the peristaltic contractions in the esophageal body and the failure of the lower esophageal sphincter (LES) post-deglutitive relaxation are the major motor disturbances in patients with achalasia. These alterations are usually evidenced by means of stationary esophageal manometry, which is able to record changes over a brief period. The aim of this work has been to study the circadian esophageal motor activity of the esophageal body in patients with achalasia, using a non-perfused ambulatory manometry system. Ten patients with untreated esophageal achalasia (dilatation < or = 5 cm) had a 24-hour ambulatory esophageal manometry. The portable recording system consisted of a computerized data logger and a probe with four microtransducers 5 cm apart, the distal one being positioned 5 cm above the LES. A microtransducer, positioned 1 cm below the upper esophageal sphincter, recorded the swallow activity. Contractions frequency (n/min), mean amplitude (mmHg), mean duration of contraction (sec), percentage of contraction > 7 sec, percentage of multipeaked, repetitive and isolated contractions, and percentage of peristaltic and simultaneous sequences were evaluated and analysed during the following periods: meal-time (MT); upright (UP); supine night-time (NT). On the basis of the relationship with swallows the contraction events were classified as post-deglutitive or spontaneous. The data out of a group of 65 normal subjects were used as control. Student's t-test and Wilcoxon's rank-sum test were used for statistical analysis. Peristaltic sequences were detected in all patients, 27.8 +/- 12.6% of the total, and the 19.5 +/- 11.06% of these were complete. Moreover primary peristaltic sequences were present in 33.1 +/- 23.4% of all peristaltic sequences. In contrast to current trends, our results show surprisingly the presence of peristaltic activity in patients with achalasia (27.9% MT; 26.9% UP; 28.1% NT). We believe these results are related both to the use of an ambulatory system, which allows 24-hour monitoring and to the use of microtransducers, which are able to detect motor events with great accuracy. These motor events are usually not detectable by stationary perfused systems.

Adult↗
PubMed1997

Clinical and manometric effects of L-arginine in patients with chest pain and oesophageal motor disorders.

BACKGROUND/AIMS: Nitroderivatives are therapeutically effective in spastic disorders of the oesophagus through the generation of nitric oxide, a non-adrenergic non-cholinergic inhibitory neurotransmitter, but their use is limited by undesirable side effects and rapid appearance of drug tolerance. As nitric oxide "in vivo" is generated from L-arginine, an amino acid normally present in the diet and completely devoid of toxic effects, we administered the latter substance in patients with chest pain and oesophageal motor disorders of the spastic type to investigate if it is able to produce clinical and manometric effects similar to those manifested by nitroderivatives. METHODS: In eight patients affected by non cardiac chest pain and oesophageal motor disorders of a hypertonic-hyperkinetic type without pathologic gastro-oesophageal reflux, a solution containing L-arginine and a placebo solution were infused in random order and double blind manner during a manometric examination of the oesophagus, taking into account the spontaneous variations of oesophageal motility connected with the phases of the Migrating Motor Complex. Afterwards, in the same patients a solution containing L-arginine and a placebo solution were administered orally, in random order and double blind manner, each for a period of six weeks. The effect of each treatment on frequency and intensity of chest pain attacks and on nitroderivatives intake was recorded on a diary by the patients. RESULTS AND CONCLUSIONS: The intravenous administration of L-arginine did not show the typical inhibitory effect of nitroderivatives on lower oesophageal sphincter tone and on amplitude and duration of pressure waves, but the chronic oral intake of L-arginine significantly decreased the frequency and intensity of chest pain attacks, as well as the number of nitroderivative tablets taken for analgesic purposes, thus suggesting a possible therapeutic role of this substance in this kind of patient.

Adult↗