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Biomedical subjects

N W Read

Publications and source records attributed to N W Read.

At least 163 records · Page 9Linked to original sources
PubMed1989

Physiology of gastric emptying and pathophysiology of gastroparesis.

Current knowledge of the physiology of gastric emptying implicates a reservoir function for the gastric fundus, grinding and propulsive functions for the antrum, and the concept of the pylorus and duodenum as resistances to gastroduodenal flow. Although these areas differ markedly in their behavior, their contractile activities are coordinated in such a way that the delivery of nutrients to the small intestine occurs in an orderly and controlled manner. In this article we describe the functions of the gastric fundus, antrum, pylorus, and duodenum and how the contractile activities of these regions regulate gastric emptying, according to the composition of the meal and the physiologic and emotional state of the person. In addition we discuss the nature and possible mechanisms of the motor disturbances associated with abnormally slow gastric emptying.

Duodenum↗
PubMed1988

Does adding fibre to a low energy, high carbohydrate, low fat diet confer any benefit to the management of newly diagnosed overweight type II diabetics?

The effect of supplementing a low energy (roughly 5.0 MJ), high carbohydrate (180 g), low fat (roughly 25 g) diet with 10-15 g of either cereal fibre or guar gum was investigated in 24 newly diagnosed overweight non-insulin-dependent (type II) diabetics. The patients were divided into three treatment groups: one received a low fibre control diet throughout the study period of 20 weeks and the other received two supplements of cereal fibre and guar gum in a crossover manner. The nutrient content of the diets was kept constant throughout. Though patients taking the low fibre diet showed a smaller reduction in fasting plasma glucose concentrations over the first eight weeks than patients taking a high fibre diet, this difference was not evident at the end of 20 weeks; reductions in weight and glycated haemoglobin values were similar for each dietary regimen throughout the trial. There was little evidence that supplementing a low energy, high carbohydrate diet with fibre confers any therapeutic benefit to type II diabetics and no evidence that taking fibre as viscous polysaccharides is any more beneficial to overweight diabetics than taking a similar fibre supplement as cereal. On the contrary, guar gum caused more abdominal discomfort and flatulence than the other diets.

Blood Glucose↗
PubMed1988

Role of constipation and anal hypertonia in the pathogenesis of haemorrhoids.

The hypothesis that haemorrhoids result from chronic constipation was investigated by studying bowel habit, anal pressure profiles and anal compliance in 13 men and 10 women with prolapsing haemorrhoids, 12 women with severe constipation and 14 male and 11 female control subjects. Defaecation was less frequent in women than in men (P less than 0.01) but was independent of the presence of haemorrhoids. Patients with haemorrhoids and control subjects reported similar stool consistency and rarely admitted to straining. Severely constipated women complained of infrequent defaecation, straining at stool and hard motions, but none had prolapsing haemorrhoids. Haemorrhoids were associated with significantly longer anal high-pressure zones and significantly greater maximum resting pressures at all levels of anal distension (P less than 0.01), but minimum residual pressure during rectal distension and maximum squeeze pressure were not significantly different from control subjects. Maximum resting pressure was increased in patients of both sexes with haemorrhoids, but this reached statistical significance only in men (P less than 0.001). Constipated women had normal anal pressure profiles and maximum anal pressures. These data show that patients with haemorrhoids are not necessarily constipated but tend to have abnormal anal pressure profiles and anal compliance. Chronically constipated women do not necessarily have haemorrhoids but have normal anal pressure profiles and compliance. This casts doubt upon the hypothesis that haemorrhoids are caused by constipation.

Adult↗
PubMed1988

Effect of composition of gastric contents on resistance to emptying of liquids from stomach in humans.

Experiments were conducted in normal healthy volunteers to investigate whether factors other than the intragastric pressure induced by tonic contraction of the gastric fundus could regulate the gastric emptying of liquids. The emptying of solutions of different osmolality and composition from the stomach was measured, while maintaining the intragastric pressure constant with a barostat system that employed an external reservoir. Preliminary experiments showed a linear relationship between intragastric pressure and emptying rate, but indicated that a normal intragastric pressure of 7 cm water would be insufficient by itself to maintain normal emptying. When intragastric pressure was maintained at 20 cm water, an isotonic solution of 30 mM glucose in saline (278 mosm/kg) emptied at a rate of 49.9 +/- 0.5 ml/min (mean +/- SEM, N = 11). Milk (284 mosm/kg) and a hyperosmolar solution of 30 mM glucose in saline (586 mosm/kg) significantly reduced the emptying rate. These results suggest that factors other than the intragastric pressure induced by fundic contraction regulate the rate at which liquids empty from the stomach and that the slower emptying of hyperosmotic solutions or solutions containing fat could be brought about in part either by an increased resistance of the pylorus and possibly the duodenum or a reduction in the effectiveness of an antroduodenal pump.

Adolescent↗
PubMed1988

Regulation of gastric emptying by ileal nutrients in humans.

Studies were carried out in 25 healthy male volunteers to investigate the effect of ileal infusion of solutions of different nutrient composition and osmolality on the profiles of a radiolabeled solid meal emptying from the stomach. Ileal infusion of a 50% corn oil emulsion or a 20% oleic acid emulsion slowed the rate of gastric emptying compared with ileal infusion of isotonic saline (0.9%). In contrast, infusion of either hypertonic saline (430 mosmol), distilled water, or isotonic solutions containing protein hydrolysate (8 g%) or glucose (50 mM) had no effect on the gastric emptying profile. These experiments support the hypothesis that the presence of unabsorbed lipid or fatty acids in the distal small intestine may delay gastric emptying, but suggest that sugars and proteins are ineffective. As infusion of both protein hydrolysates and lipid into the ileum can delay small bowel transit in humans, the data suggest that ileal regulation of gastric emptying and small bowel transit may be mediated by different mechanisms.

Adult↗
PubMed1988

Impaired colonic fermentation of carbohydrate after ampicillin.

The aim of this study was to investigate the effect of ampicillin on the ability of the human colon to ferment carbohydrate. The effect of ingesting a drink containing 20 g of lactulose on stool output and breath hydrogen production was measured in 13 normal volunteers before and during administration of ampicillin (2 g/day). Small bowel and whole gut transit times were also measured to exclude any direct effect of ampicillin on motor activity. Ingestion of lactulose did not increase stool weight or frequency under control conditions, but during administration of ampicillin, lactulose caused increases in stool weight (p less than 0.02) and frequency (p less than 0.01), in the percentage of unformed stools (p less than 0.001), and in the excretion of galactose and fructose in stool samples collected from 2 volunteers. Administration of ampicillin also significantly reduced the area under the breath hydrogen profile (p less than 0.03). Mouth-to-cecum transit of the lactulose drink was prolonged during ampicillin ingestion (p less than 0.01) but there was no significant change in the whole gut transit time. These results suggest that ampicillin impairs colonic fermentation of carbohydrate and a diet high in unabsorbable carbohydrate increases the risk of antibiotic-associated diarrhea.

Adult↗
PubMed1988

Motor activity of the gastric antrum, pylorus, and duodenum under fasted conditions and after a liquid meal.

Because the mechanisms that control the movement of food and digestive juices across the human pylorus are not completely understood, the aim of this study was to document the normal patterns of pressure activity in the antrum, pylorus, and duodenum and the associated pH changes in 9 healthy volunteers. Studies were carried out under fasting conditions and after ingestion of 300 ml of chocolate milk, using a unique 11-channel intraluminal probe that incorporated a sleeve sensor positioned across the pylorus and pH electrodes situated in the terminal antrum and proximal duodenum. The most common motor pattern recorded under fasting conditions consisted of regular coordinated contractions, most of which (a) involved the antrum and duodenum, (b) showed evidence of propagation through two or more adjacent channels, and (c) were associated with transient reductions in duodenal pH and transient elevations in antral pH. Ingestion of milk changed the motor pattern to one that was composed of pressure waves, which were confined to the pylorus with few or no pressure waves in the terminal antrum or proximal duodenum. Isolated pyloric pressure waves were gradually replaced by propagated antroduodenal contractions, which eventually occurred at a regular frequency that was higher than that observed under fasting conditions. After ingestion of milk, only the coordinated contractions were associated with transient reductions in duodenal pH. Isolated pyloric pressure waves were also observed under fasting conditions just before or just after phase III of the migrating motor complex, and 17% of these were accompanied by episodes of duodenal acidification.

Adult↗
PubMed1988

Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal.

The postprandial motor activity of the antrum, pylorus, and duodenum in 15 healthy volunteers was compared with the profiles of emptying of the solid and liquid components of a meal. The liquid component of the meal emptied rapidly in an exponential manner, whereas the solid remained in the fundus of the stomach until approximately 80% of the liquid had emptied and then emptied in a linear manner. The onset of solid emptying was associated with an increase in the rate of occurrence of antral pressure waves (p less than 0.05), and the half-time for solid emptying (t1/2 - lag period) was inversely correlated (p less than 0.05) with the rate of coordinated contractions involving the antrum. The substitution of 25% dextrose in normal saline as the liquid component of the meal increased the half-time for liquid emptying from a median of 8 to 40 min (p less than 0.01), increased the lag period for solid emptying from 40 to 87 min (p less than 0.01), and increased the rate of occurrence of isolated pyloric pressure waves during the solid lag phase from 7 to 58/h (p less than 0.05), but did not affect the slope of solid emptying or the rate of coordinated contractions involving the antrum during the solid emptying period.

Adolescent↗
PubMed1988

The mechanics of the anal sphincter complex.

The anal sphincter complex consists of circumferentially arranged muscle fibres, which surround a relatively thick anal lining. This apparatus was modelled mechanistically as two concentric homogeneous isotropic linear elastic cylinders. The inner cylinder (anal lining) was considered to be thick walled, while the outer (the circular muscle) was assumed to be thin walled. The model predicts that the anal sphincter tension varies linearly with luminal diameter. This prediction was confirmed experimentally under normal conditions as well as during external sphincter contraction and internal sphincter relaxation. Under conditions of negligible hoop stress in the anal lining the model also predicts that the intra-luminal pressure falls to zero before the luminal diameter reaches zero. Hence, an autoregulatory mechanism of anal cushion thickening, as the luminal pressure falls to zero, to produce anal closure was proposed. Deficiencies in this autoregulation mechanism may explain anal incontinence and the obstructed defaecation often found in subjects with haemorrhoids.

Adult↗
PubMed1988

The effect of guar gum on the distribution of a radiolabelled meal in the gastrointestinal tract of the rat.

1. The effect of addition of guar gum (5 and 10 g/l) to a radiolabelled, homogenized, baked-bean test meal on the distribution of that meal in the gastrointestinal tract was investigated in groups of male rats killed at 25, 50, 100, 200, 300 and 400 min after gavage. 2. Addition of 5 and 10 g guar gum/l significantly increased the proportion of the meal remaining in the stomach at 25 and 50 min after gavage (P less than 0.01). 3. The heads of the control meal and meals containing guar gum reached the distal intestine within 25 min after gavage but radioactivity was not observed in the caecum until 100 min after administration of each of the meals. Addition of guar gum (5 and 10 g/l) delayed caecal filling even though the head of each meal reached the caecum at the same time after gavage. 4. The geometric centres of guar-gum-containing meals were proximal to that of the control meal at all times after gavage. 5. The observed delay in the passage of a guar-gum-containing meal through the stomach and small intestine is probably due to the viscous nature of the meal resisting the propulsive and mixing effects of the gastrointestinal contractions, thereby reducing access of the glucose to the absorptive epithelium. This could contribute to the observed reductions in postprandial glycaemia seen in previous studies after incorporating guar gum into a meal.

Animals↗
PubMed1988

The relation between bacterial degradation of viscous polysaccharides and stool output in human beings.

1. The relation between bacterial degradation of three viscous polysaccharides (guar gum, ispaghula and xanthan gum) by colonic bacteria in vitro and their effects on colonic function were investigated by comparing the results of anaerobic in vitro incubations with fresh faeces from seven healthy volunteers (measuring viscosity, pH and gas production) with the effects of feeding all three polysaccharides to the same volunteers for 1 week each (14-15 g/d) on faecal mass and whole-gut transit time. 2. Guar gum was rapidly fermented in vitro by faecal bacteria from all volunteers with concomitant loss of viscosity, reduction in pH and generation of gases. Ispaghula maintained its viscosity during incubation, but the pH fell significantly. The results of xanthan gum incubations showed considerable individual variation. 3. Only ispaghula significantly increased faecal mass, whilst none of the gums significantly affected stool frequency or transit time. Statistical analysis of the pooled results showed that although transit time and faecal output were inversely related, feeding viscous polysaccharides could influence these indices independently. Stool frequency was significantly correlated with the transit time, but not the faecal output. 4. Transit time was reduced by gum feeding to a significantly greater extent in those subjects whose faecal bacteria reduced or removed the viscosity of that gum, than in those subjects where the viscosity was maintained. In contrast, there was a smaller increase in faecal mass when the viscosity of the appropriate cultures was removed than when it was maintained or reduced. Increases in stool frequency were significantly associated with hydrogen production from in vitro cultures.

Adult↗
PubMed1988

Comparison of applied potential tomography and impedance epigastrography as methods of measuring gastric emptying.

Two new non-invasive methods of measuring gastric emptying, impedance epigastrography (IE) and applied potential tomography (APT) have been compared. Measurements in vitro showed that there is a good correlation between the square of the radius of a glass rod placed in the centre of a tank and values obtained by IE or APT. However, if the rod is moved anteriorly in the tank IE values increase markedly, whereas APT values are unchanged. Both APT and IE can be used to follow gastric emptying of liquid meals; however, the results obtained using APT are more reproducible and have a better correlation with those obtained simultaneously by scintigraphy. Neither method was able accurately to follow gastric emptying unless gastric acid secretion was inhibited by cimetidine.

Adult↗
PubMed1988

A comparative study of the effects on colon function caused by feeding ispaghula husk and polydextrose.

Polydextrose is a new soluble food ingredient which cannot be digested by intestinal enzymes and so may affect colonic function. Studies in healthy volunteers compared the effects of diet supplementation with 30 g/day polydextrose, a standard dose of 7 g/day ispaghula and two mixtures containing 2 g/day ispaghula with either 30 g/day polydextrose or 10 g/day polydextrose with a control period. During the 10-day periods, the mass, frequency and consistency of faeces were assessed as well as the whole-gut transit time, ease of defaecation, flatulence and palatability of the preparations. All preparations significantly increased the weekly faecal mass above control values (P less than 0.05) but there were no significant differences between the preparations. Transit time and stool frequency were not affected significantly by any of the preparations (P greater than 0.05). Both preparations supplying 30 g/day polydextrose softened stool consistency equally but the other preparations had no effect. All preparations caused flatulence and other gas-related problems but polydextrose caused more than ispaghula, even at the lowest dose of 10 g/day. More volunteers preferred taking the polydextrose drinks than the sachets of ispaghula which formed a viscous drink with water. Despite superior palatability and equally effective stool bulking, polydextrose is unlikely to be an alternative laxative to ispaghula because of the unacceptable levels of flatulence.

Adult↗
PubMed1988

Urological abnormalities in young women with severe constipation.

Anorectal and urodynamic studies were carried out in 10 young women with severe constipation and the results compared with those obtained in controls. The lowest volumes that provoked a desire to defecate (constipated 200 +/- 50 v controls 110 +/- 10 [mean +/- SEM] ml: p less than 0.05), and a desire to micturate (constipated 560 +/- 40 v controls 295 +/- 15 [mean +/- SEM] ml: p less than 0.001), were significantly greater in constipated patients compared with controls. The maximum tolerable rectal volume (380 +/- 30 v 290 +/- 20 [mean +/- SEM] ml: p less than 0.05) and the bladder capacity (720 +/- 50 v 540 +/- 10 [mean +/- SEM] ml: p less than 0.001) were also increased in the constipated subjects compared with controls. Electromyographic studies show failure of relaxation of the external anal sphincter (EAS) on attempted defecation in all 10 patients; and eight of these patients actually contracted their EAS when they strained to defecate, causing a functional outlet obstruction. Urodynamic studies showed normal urinary flow rates, normal detrusor pressures and normal radiology during voiding. Thus, these studies suggest that constipated patients have an increase in capacity and a reduction in sensitivity in the urinary bladder as well as in the rectum, but showed no evidence of obstruction to urine flow.

Adult↗
PubMed1988

Evaluation of applied potential tomography as a new non-invasive gastric secretion test.

Applied potential tomography (APT) is a new, non-invasive technique that can yield sequential images of changes in the resistivity of gastric contents. Studies were performed to investigate the application of APT to measure gastric acid secretion. Experiments in 20 normal volunteers showed that changes in gastric resistivity were closely correlated with changes in the volume (r = 0.80), the acidity (r = 0.83) and the total conductivity of gastric contents (r = 0.87). Studies in 13 patients referred for a pentagastrin test showed that changes in gastric resistivity before pentagastrin were closely correlated with basal acid output measured on a separate occasion (r = 0.85, p less than 0.001), while changes in gastric resistivity after pentagastrin were correlated with maximal acid output (r = 0.58, p less than 0.05). Ingestion of alcohol by six normal subjects decreased gastric resistivity markedly, probably due to alcohol induced gastric acid secretion as it was prevented by cimetidine. Applied potential tomography is a safe non-invasive method of measuring gastric acid secretion. The equipment is simple to use, and the test is comfortable and acceptable to patients.

Adolescent↗
PubMed1988

Effect of meal temperature on gastric emptying of liquids in man.

Serial studies were carried out on six healthy volunteers (19-24 years) to investigate the effect of meal temperature [either 4 degrees C (cold), 37 degrees C (control) or 50 degrees C (warm)] on the rate of gastric emptying of a radiolabelled isosmotic drink of orange juice. The mean maximum intragastric temperature occurred 60 seconds after the onset of ingestion of the warm drink and reached 43.0 degrees C (0.4) mean (SD) while the mean minimum intragastric temperature occurred 45 seconds after the onset of ingestion of the cold drink and reached 21.2 degrees C (1.9). Intragastric temperature then returned to body temperature within 20-30 minutes of ingestion of the warm and cold drinks. Warm and cold drinks appeared to empty from the stomach more slowly than the control drink. The initial rate of gastric emptying of the cold drink was significantly slower than the control drink (p less than 0.05) and the difference in emptying rates between cold and control drinks were significantly correlated with the differences in intragastric temperatures (p less than 0.01). The difference in the initial emptying rates between warm and control drinks were not statistically significant.

Adult↗
PubMed1988

Comparisons of the effects on satiety and eating behaviour of infusion of lipid into the different regions of the small intestine.

Food intake and feelings of hunger and fullness were monitored in paired studies carried out in two groups of six healthy non-obese male volunteers during infusion of isotonic solutions of either a 50% corn oil emulsion or saline into the jejunum or into the ileum. Infusion of the lipid emulsion at a rate of 1.2 ml/min (4.9 kcal/min) into either the ileum or the jejunum significantly reduced the period of eating (p less than 0.01) and the quantity of food consumed (p less than 0.01), but neither affected the rates of drinking or the amount of fluid consumed. Infusion of the lipid emulsion into the jejunum also significantly reduced the sensations of hunger before the meal (p less than 0.05), and the rate of ingestion (p less than 0.01). Ileal infusion did not influence these indices. The results suggest that jejunal and ileal infusion of lipid reduces the size of the meal that could be consumed possibly by inhibiting gastric emptying. The alleviation of hunger before ingestion and the slower rate of eating, however, suggests that jejunal lipid activates an additional mechanism that influences the appetite centre in the hypothalamus directly.

Adult↗