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Biomedical subjects

P Enck

Publications and source records attributed to P Enck.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Prevalence of fecal incontinence and degree of information possessed by family physicians and health insurance].

Previous investigations have demonstrated that the prevalence of fecal incontinence ranges between 1.5 and 5% in the general population. It is, however, known that only a small portion of these patients consult a doctor for the complaints. To investigate the prevalence of fecal incontinence in Germany and to determine the reliability of epidemiological data from different sources, we distributed a questionnaire to healthy controls. In addition, two samples of patients were drawn from a local health insurance organization. Finally, the family physicians of incontinence patients from a specialized outpatient clinic which are covered by this health plan (AOK) were interviewed for whether they had noted the incontinence symptoms and had reported them to the health plan. It is shown that approximately 5% of people suffer from occasional incontinence, but that only 1.5% shown severe incontinence excluded fecal soiling. In patients with various disorders, the prevalence ranges between 0.2 and 0.35% according to health insurance data. However, in only about 75% of cases, the family physicians knew about the symptom, and in less than 50% of cases they had informed the health insurance. Epidemiological data, thus, contain a detection bias leading to an underestimation of the true prevalence of fecal incontinence.

Adult↗
PubMed1990

Sensory and motor function in the maintenance of anal continence.

Anorectal function was prospectively evaluated in 43 consecutive patients with fecal incontinence and in 19 healthy volunteers using manometry and electrical stimulation of the anoderm. Both anorectal motor and sensory function was impaired in incontinent patients as compared with healthy controls. Further statistical analysis identified four subgroups of patients showing different pathomechanisms of fecal incontinence: severe combined anorectal motor and sensory dysfunction, isolated anal sphincter dysfunction, isolated anorectal sensory dysfunction, and combined dysfunction of the internal anal sphincter and impaired anorectal sensitivity. These data support the hypothesis that sensory function of both the rectum and the anal canal is an important and independent factor in the preservation of continence.

Adult↗
PubMed1990

Motility changes in primary achalasia following pneumatic dilatation.

The changes in esophageal motility after pneumatic dilatation were evaluated prospectively in 51 patients with achalasia. The patients were evaluated for a median of 14 months. Pneumatic dilatation led to a clinical improvement in 41 patients. On manometric evaluation, a significant decrease in lower esophageal sphincter pressure was observed (28.4 +/- 14.9 mmHg vs. 13.5 +/- 7.2 mmHg; p = 0.001); the resting pressure of the esophageal body dropped from 4.8 +/- 4.2 mmHg above gastric baseline to 0.1 +/- 3.9 mmHg below gastric baseline. After therapy, peristaltic activity was present in 10/51 (20%) patients; in 1 case, complete relaxation of the lower esophageal sphincter was recorded. Treatment-induced motility changes could not be predicted by clinical history or the lower esophageal sphincter pressure before or after therapy. However, the resting pressure of the esophageal body before and after therapy was significantly lower in these patients in whom peristalsis recurred after therapy than in patients with an unchanged motility pattern. The reappearance of peristaltic activity after pneumatic dilatation was unrelated to lower esophageal sphincter pressure. In conclusion, motility disturbances of the esophageal body in patients with achalasia do not simply reflect the functional obstruction of the lower esophageal sphincter. These findings support the hypothesis that achalasia is not a distinct motility disturbance but should be regarded as part of a broad spectrum of different interrelated esophageal motility disorders.

Air↗
PubMed1990

Tolerance for rectosigmoid distention in irritable bowel syndrome.

Two hypotheses were tested: (a) lowered tolerance for balloon distention of the rectosigmoid in patients with irritable bowel syndrome is caused by a psychological tendency to exaggerate the painfulness of any aversive stimulus, and (b) contractions elicited by balloon distention are responsible for pain reports. Tolerance for stepwise distention of a balloon in the rectosigmoid was compared with tolerance for holding one hand in ice water in 16 irritable bowel patients, 10 patients with functional bowel disorder who did not satisfy restrictive criteria for irritable bowel, 25 lactose malabsorbers, and 18 asymptomatic controls. Contractile activity was measured 5 cm above and 5 cm below the distending balloon. Psychometric tests were used to assess neuroticism, anxiety, and depression, and a standardized psychiatric interview was administered. Patients with irritable bowel syndrome had significantly lower tolerance for balloon distention but not ice water, and balloon tolerance was not correlated with neuroticism or other psychological traits measured. Rectosigmoid and rectal motility were also not related to tolerance for balloon distention. Both hypotheses were rejected. A peripheral mechanism such as altered receptor sensitivity may be the cause of distention pain in irritable bowel syndrome.

Colon, Sigmoid↗
PubMed1990

[Radiologic diagnosis of anal incontinence].

Defaecography was performed in 47 consecutive patients with faecal incontinence. A gap in the anal canal with spontaneous leakage of contrast medium was observed in 19 patients and demonstrated a severe disturbance of sphincteric function. In 13 cases, an anorectal angle of more than 120 degrees that did not change during voluntary sphincter contraction and the missing dorsal impression of the anorectal junction indicated a damage of the puborectalis muscle. A rectocele was detected in 18 patients, an intussusception in 14 patients, and a complete rectal prolapse in 3 patients. Thus, mechanisms of faecal incontinence can be elucidated radiologically in more than one half of the patients examined. However, the high prevalence of a rectocele or an intussusception in patients with faecal incontinence causes doubt whether these alterations of rectal morphology are functionally relevant in the majority of patients with faecal incontinence.

Adult↗
PubMed1990

Prevalence of lactose malabsorption among patients with functional bowel disorders.

To investigate the prevalence of lactose malabsorption among patients with functional gastrointestinal disturbances we prospectively evaluated all patients referred to a gastrointestinal outpatient clinic over a period of 18 months. All patients had a breath hydrogen test following oral lactose in addition to the standard diagnostic procedures. In 37 of the total of 64 patients no organic cause of the gastrointestinal complaints was found. In 9 of these 37 patients (24%) the breath hydrogen test indicated lactose malabsorption. Three to 6 month later most of the patients with lactose malabsorption showed a significant reduction of gastrointestinal complaints after they had maintained a lactose-poor diet. In comparison, patients with functional disturbances but without lactose malabsorption reported nor or only minor improvement of symptoms; most of these patients had consulted another physician since the last visit in the clinic.

Breath Tests↗
PubMed1989

Cerebral responses evoked by electrical stimulation of rectosigmoid in normal subjects.

We used electroencephalographic methods to evoke and record cerebral responses to electrical stimulation of the rectosigmoid colon in eight healthy male volunteers, 20-40 years old. The stimulus was applied via a probe equipped with bipolar ring electrodes which were attached by suction to the mucosa. The probe was positioned 20 cm above the anus. Cerebral responses were recorded by EEG electrodes. Evoked potentials (EPs) in response to electrical stimulation consisted of a series of successive peaks and troughs in the EEG with good reproducibility within and between subjects. The shape and latencies of the intestinal EPs were comparable to other types of EPs reported before. It is concluded that reproducible EPs can be recorded from the scalp after electrical stimulation of the rectosigmoid. The similarity in appearance of these EPs to those previously reported suggests that visceral afferents were stimulated. The technique may become a useful tool to study visceral nervous connections to the brain in health and disease.

Adult↗
PubMed1989

Age and sex and anorectal manometry in incontinence.

Although the prevalence of fecal incontinence is greater in women compared with men and in elderly subjects compared with younger subjects, data regarding the influence of age and sex on anorectal performance in continent and incontinent patients are conflicting. The authors, therefore, investigated age- and gender-related changes in anal resting and squeeze pressure as well as in sphincter relaxation after rectal balloon distention in 75 patients with fecal incontinence of different pathogenesis and in 99 continent patients by multichannel anorectal manometry. As a group, incontinent patients usually exhibit lower pressure profiles than do continent patients regardless of age and gender; however, both the resting pressure of the internal anal sphincter and the voluntary contractile pressure of the external anal sphincter are decreased with age, and both are lowered in women compared with men. Sphincter relaxation and perception of gastrointestinal events are not altered in incontinent patients, and they are not different between men and women or between elderly and younger patients.

Adult↗
PubMed1989

Cerebral responses evoked by electrical stimulation of the esophagus in normal subjects.

Cerebral responses to electrical stimulation of the esophagus were investigated in 11 healthy male volunteers, 20-40 yr old. The stimulus was applied via a probe equipped with bipolar ring electrodes. It was positioned in the middle and distal esophagus at 20 and 37 cm from the incisors, respectively, and sucked to the mucosa. Electrical stimuli (0.1-ms duration, different stimulus voltages) were applied at frequencies of 0.1-1.0 Hz or in randomized order. Cerebral responses to electrical stimulation were recorded after 20-40 stimulations and averaged on a time base of 1000 ms. Evoked potentials consisted of successive peaks and troughs in the averaged electroencephalogram with good reproducibility within and between subjects. Amplitudes of evoked potentials showed a significant reduction with electrical stimulation at 37 cm compared with 20 cm, and with stimulation frequencies of 0.5 and 1.0 Hz compared with 0.2 and 0.1 Hz. Evoked potentials from 37 cm showed longer latencies compared with those from 20 cm. Irregular stimulation and stimulation during mental distraction did not alter these responses. It is concluded that reproducible evoked potentials can be recorded from the scalp after electrical stimulation of the esophagus and that these are transferred centrally via vagal afferents. The technique may become a useful tool in the study of visceral nervous connections to the brain in health and disease.

Adult↗
PubMed1989

Repeated noninvasive measurement of gastrointestinal transit in rats.

A technique for repeated and noninvasive measurement of oro-cecal transit time in rats and other small animals is described. It is based on the incomplete digestion of carbohydrates such as lactose fed orally to the animals. Since the activity of the enzyme lactase is low in almost all species, lactose is fermented by colonic bacteria after it arrived in the cecum, thus producing hydrogen. Hydrogen is delivered to the lungs via the circulation and exhaled by the animal. An increase in breath hydrogen measured by means of an electrochemical cell or a gas-chromatograph indicates the arrival of the nutrient bolus in the cecum. The method can be used repeatedly in individual animals under various experimental conditions such as investigations of stress effects on gastrointestinal transit.

Animals↗
PubMed1989

Effects of cisapride on ano-rectal sphincter function.

To investigate the effects of cisapride, a motility-inducing agent, on ano-rectal sphincter functions, standard manometry was performed in 10 healthy male volunteers after 5 days on a 20-mg dose of cisapride in a placebo-controlled double-blind randomized crossover fashion. All subjects kept stool diaries during the experiment. Cisapride significantly increased stool frequency by adding soft and liquid stools; in addition, anal resting pressure was reduced with cisapride in seven of the 10 subjects; mean resting pressure decreased by 16%, while all other measurements were not altered. This suggests that cisapride may act directly on the smooth muscle of the internal anal sphincter. It also supports the view that enhanced defaecation in chronic constipation induced by cisapride may not be achieved by propulsive motor activity in the colon but also by a decreased anal sphincter tone.

Adult↗
PubMed1989

Stability of myoelectric slow waves and contractions recorded from the distal colon.

The stability of physiological activity in the distal colon was investigated by recording 5-6 hours in each of 6 healthy adults. Contractions and myoelectric slow waves were recorded from the sigmoid colon (25-30 cm from the skin surface) and rectum (10-15 cm), and pressure waves were recorded from the proximal small intestine. The activity index (sum of areas of all waves divided by recording time) varied by 200% to 800% across 4-min samples for all motility and myoelectric slow wave recordings. Spectral analysis indicated that contractile activity waxed and waned in a cycle with a period of 40-55 min in the colon and 64-80 min in the small intestine. Myoelectric slow wave activity in the colon cycled with a period of 30-40 min. Contractile activity in the sigmoid colon was correlated with similar activity in the rectum, but myoelectric slow wave activity in the colon was not correlated with myoelectric slow waves in the rectum. The frequency composition of contractions and slow waves was unstable over time.

Adult↗