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Biomedical subjects

R C Spiller

Publications and source records attributed to R C Spiller.

103 records · Page 6Linked to original sources
PubMed1987

Delayed mouth-caecum transit of a lactulose labelled liquid test meal in patients with steatorrhoea caused by partially treated coeliac disease.

Mouth-caecum transit time (M-CTT) of a lactulose labelled liquid test meal has been measured in 27 coeliac patients and 10 healthy controls using the breath hydrogen technique. Although all patients were urged to maintain a gluten free diet, not all did, and there was, therefore, a wide range in the severity of fat malabsorption within the patient group. Gastric emptying of a 113Indium DTPA-labelled liquid test meal was also assessed in separate studies on six healthy controls and 11 of the coeliac patients. Fasting breath hydrogen concentrations and the response to lactulose, as assessed both by the rate of rise, and the peak breath hydrogen concentration reached, showed no difference between coeliacs and controls, regardless of the presence or absence of steatorrhoea. Mouth-caecum transit time in the 16 coeliac patients with steatorrhea (faecal fat greater than 7 g/24 h) was, however, significantly prolonged being 158 +/- 18 minutes (mean +/- SEM), compared with 70 +/- 9 minutes for the controls (p less than 0.02), and 83 +/- 15 minutes for the 11 coeliacs without steatorrhoea (p less than 0.002). Mouth-caecum transit time in the coeliac patients was linearly related to the 24 hour faecal fat excretion, r = 0.55, n = 27, p less than 0.01. Slow mouth-caecum transit in the coeliacs with steatorrhoea was not caused by delayed gastric emptying as the t1/2 for coeliacs with steatorrhoea was within the normal range. Coeliacs with delayed mouth-caecum transit had impaired insulin release but the postprandial profiles of the other peptides measured (cholecystokinin, GIP, secretin, motilin, neurotensin, enteroglucagon, and peptide YY) were all within the normal range in this group of partially treated coeliac patients.

Adult↗
PubMed1987

Jejunal water and electrolyte absorption from two proprietary enteral feeds in man: importance of sodium content.

Jejunostomy losses of Na+ and water during enteral nutrition after massive intestinal resection may be severe. We have attempted to analyse this practical problem by using an in vivo perfusion technique in healthy volunteers to study Na+, water and nutrient absorption from a short (25 cm) segment of jejunum during perfusion of an isotonic solution of the elemental diet Vivonex. Further solutions made from the amino acid and carbohydrate components of Vivonex were also perfused in part I of the study in order to determine the causes of the marked Na+ and water secretion seen during Vivonex perfusion. Low initial Na+ concentration was found to be the major determinant of net Na+ secretion, initial Na+ concentration correlating significantly with Na+ absorption (r = 0.95, n = 7 p less than 0.001). Water absorption correlated with net absorption of NaCl (r = 0.82, n = 7 p less than 0.01). There was, however, a better correlation with total absorption of NaCl plus amino acids (r = 0.99, n = 7, p less than 0.01). In part II of the study separate isotonic solutions of NaCl, glucose, and the polymeric diet, Ensure were also studied. Net sodium secretion occurred during glucose and Ensure perfusion, as predicted from their low Na+ concentration. Owing to rapid sucrose absorption from Ensure there was substantial luminal disappearance of osmotically active particles and hence marked water absorption, which was accurately predicted using the regression equation for water absorption derived in part I, substituting sucrose absorption for amino acid absorption. We conclude that the marked Na+ and water secretion observed during Vivonex perfusion is not a unique property of this amino acid based diet but is due to its low Na+ content.

Amino Acids↗
PubMed1986

Decreased fluid tolerance, accelerated transit, and abnormal motility of the human colon induced by oleic acid.

To determine whether the presence of unabsorbed fat in the colon altered colonic motility, intraluminal pressures were recorded in the terminal ileum and proximal colon, and serial 1-min gamma camera scans were obtained while test solutions labeled with diethylenetetramine pentaacetic acid chelate of indium 111 were infused into the middle portion of the ascending colon. Seven subjects received a control solution, and 6 subjects received an emulsion of oleic acid (4.3 g/100 ml). Oleic acid accelerated colonic transit; isotope accumulated in the rectosigmoid faster in the first 120 min (4343 +/- 1175 cpm) than it did during control infusion (1236 +/- 348 cpm; p less than 0.01). Accelerated transit of oleate was accompanied by high amplitude (greater than 60 mmHg, range 60-95 mmHg), prolonged (greater than 10 s, range 10-48 s), propagated pressure waves; they originated near the ileocecal junction at a median frequency of 1.3 times/hour (mean 4.1, range 0.4-15.7). These were associated with a narrow image of the ascending colon on scintiscan and movement of 65.9% +/- 6.5% of counts from the ascending to transverse colon over the succeeding 4 min. A similar sequence was seen only once in 33 h of infusion with control solutions (p less than 0.01). Associated with these responses, the total volume of infusate tolerated before defecation was less with oleate than with control solutions (311 +/- 21 ml vs. 1049 +/- 71 ml; p less than 0.01). Long-chain fatty acids stimulated unusual motor patterns and reduced the reservoir function of the ascending colon; these effects may contribute to the diarrhea of patients with fat malabsorption.

Adult↗
PubMed1986

Scintigraphic measurements of canine ileocolonic transit. Direct and indirect effects of eating.

Eight dogs were equipped with ileal catheters, 50 cm proximal to the ileocolonic junction, and serosal electrodes at 5, 25, 55, 100, and 150 cm. Transit was assessed by injecting a bolus of 99mTc-diethylenetriamine pentaacetic acid through the ileal catheter and following isotope movements by serial, 4-min scintiscans. Isotope was injected in separate studies: during phase I of an interdigestive myoelectrical cycle, 10 min before a meal, and or 2 or 4 h after a meal (600 ml, 385 kcal, thickened with 4 g guar). At another time, mouth-to-colon transit of the same meal was measured by labeling it with 111In-diethylenetriamine pentaacetic acid and scanning at hourly intervals for 11 h. Transit of isotope through the terminal ileum and entry into the colon was characteristically erratic; long periods of immobility were interspersed with sudden "bolus" movements. In the fasting studies, most sudden movements occurred while phase III (migrating motor complex) of the interdigestive myoelectrical cycle migrated through the last 50 cm of ileum. Passage of a single migrating motor complex through the terminal ileum propelled about one-half the dose of isotope into the colon; complete clearance of the ileum required two or more migrating motor complexes. Immediately after the meal, ileal movements increased transiently; however, these were followed by a period of quiescence. Overall, the time for 50% of the counts to enter the colon was not different when isotope was injected 10 min before the meal from when the injection was made 2 h postprandially (207 +/- 16 min and 162 +/- 25 min, respectively). However, transit of isotope injected 4 h postprandially was significantly faster (91 +/- 13 min). In the fed state, some bolus movements could be related to specific patterns of ileal motility; however, the majority occurred during apparently random "fed-type" motility. In part II, meal marker accumulated faster in the colon after 3-4 h, suggesting that the rapid ileocecal transit at 4 h postcibal was due to increased flow of chyme through the ileum at this time.

Animals↗
PubMed1985

Influence of protein composition and hydrolysis method on intestinal absorption of protein in man.

An intestinal perfusion technique has been used in normal human subjects to investigate the influence that starter protein composition and hydrolysis procedure have on absorption of amino acid residues from partial enzymic hydrolysates of whole protein. Five starter proteins were studied. Three (egg albumin, casein/soy/lactalbumin, and lactalbumin) were hydrolysed by papain, a second lactalbumin starter protein, and a meat/soy/lactalbumin blend were hydrolysed by a porcine pancreatic enzyme system. Irrespective of starter protein composition or hydrolysis method used, four amino acid residues (threonine, glutamic acid, phenylalanine, and histidine) were absorbed significantly faster from all hydrolysates compared with absorption from their equivalent free amino acid mixtures. In contrast, both starter protein composition and hydrolysis method influenced absorption characteristics of up to nine other amino acid residues.

Adult↗
PubMed1984

Inhibition of jejunal water and electrolyte absorption by therapeutic doses of clindamycin in man.

A steady-state perfusion technique has been used in vivo in normal subjects to show that at concentrations occurring during therapeutic use (500 mg/1, 1.1 mmol/l) the antibiotic clindamycin reversibly inhibits bicarbonate-stimulated water and electrolyte absorption from the human jejunum. Lactose-stimulated water and electrolyte absorption was not affected by the addition of clindamycin at the same concentration. Clindamycin-induced malabsorption of water and electrolytes may contribute significantly to the diarrhoea that occurs during clindamycin therapy in the absence of pseudomembranous colitis.

Adolescent↗
PubMed1984

The ileal brake--inhibition of jejunal motility after ileal fat perfusion in man.

The possibility that malabsorbed fat passing through the human ileum exerts an inhibitory feedback control on jejunal motility has been investigated in 24 normal subjects by perfusing the ileum with a fat containing solution designed to produce ileal luminal fat concentrations similar to those in steatorrhoea (30-40 mg/ml). Mean transit times through a 30 cm saline perfused jejunal segment were measured by a dye dilution technique. Thirty minutes after ileal fat perfusion, mean transit times rose markedly to 18.9 +/- 2.5 minutes from a control value of 7.5 +/- 0.9 minutes (n = 5; p less than 0.05). This was associated with an increase in volume of the perfused segment which rose to 175.1 +/- 22.9 ml (control 97.6 +/- 10.3 ml, n = 5; p less than 0.05). Transit times and segmental volumes had returned towards basal values 90 minutes after completing the fat perfusion. Further studies showed that ileal fat perfusion produced a pronounced inhibition of jejunal pressure wave activity, percentage duration of activity falling from a control level of 40.3 +/- 5.0% to 14.9 +/- 2.8% in the hour after ileal perfusion (p less than 0.01). Ileal fat perfusion was associated with marked rises in plasma enteroglucagon and neurotensin, the peak values (218 +/- 37 and 68 +/- 13.1 pmol/l) being comparable with those observed postprandially in coeliac disease. These observations show the existence in man of an inhibitory intestinal control mechanism, whereby ileal fat perfusion inhibits jejunal motility and delays caudal transit of jejunal contents.

Adult↗
PubMed1983

Recurrent gastrointestinal bleeding of obscure origin: report of 17 cases and a guide to logical management.

Seventeen patients with chronic obscure gastrointestinal bleeding presenting over a 5-year period are described. While representing only 6 per cent of the total number of admissions due to gastrointestinal haemorrhage they required a disproportionate amount of medical attention, including 67 admissions, 73 radiological and 56 endoscopic procedures and transfusion of a total of 198 units of blood. The diagnoses included 5 cases of recurrent acute upper gastrointestinal erosions, 7 small bowel abnormalities and 4 colonic lesions, with 1 patient undiagnosed. Eight arteriovenous malformations (AVM) were demonstrated angiographically and one Meckel's diverticulum identified by a 99Tcm pertechnetate scan. There were 5 cases in which laparotomy yielded the final diagnosis and in one of these peroperative endoscopy of the small bowel was required. On the basis of our experience and a review of other series, a logical plan of investigation is described for such difficult cases.

Adult↗
PubMed1983

The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases.

Biopsies from 60 patients with dyspepsia and endoscopically abnormal first part of duodenum were examined. The main endoscopic findings were duodenitis (35 cases), chronic ulceration (eight) and abnormal mucosal patterns (17). The latter included mucosal atrophy, thickening, irregularity, nodularity and polypoid formation. The main histological findings were duodenitis (40), gastric metaplasia (42) and gastric heterotopia (seven). The first two were commonly seen together. Heterotopia was not associated with inflammation. Good correlation existed between endoscopic and histological findings.

Adult↗
PubMed1982

Heterotopic gastric tissue in the duodenum: a report of eight cases.

Eight patients with intraduodenal gastric heterotopic are described. Seven were under investigation for x-ray-negative dyspepsia, and one presented with repeated attacks of hematemesis. As all of these cases were diagnosed by the use of upper-gastrointestinal endoscopy and biopsy under direct vision, it is likely that more widespread use of these techniques will lead to an increase in the reported incidence of a condition previously thought to be rare.

Aged↗
PubMedDate not supplied

Use of ethanol-induced tumor necrosis to palliate dysphagia in patients with esophagogastric cancer.

Eleven patients with dysphagia caused by inoperable, unresectable, or recurrent esophagogastric cancer were treated by endoscopic injection of ethanol (with or without per-oral dilation) to induce tumor necrosis. Prior to treatment, patients had a mean dysphagia grade of 3. After one treatment, dysphagia grade had improved to a mean of 1.5. An optimum dysphagia grade (mean, 0.9) was achieved after a mean of 1.6 injection treatments. Treatments were repeated as symptoms recurred, with a mean period between repeat treatments of 32 days (median, 26). There were no complications associated with ethanol-induced tumor necrosis (ETN). Mean patient survival was 140 days (median, 109). These results suggest that ETN has considerable potential for palliation of malignant dysphagia in selected patients.

Aged↗