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Biomedical subjects

R J Brummer

Publications and source records attributed to R J Brummer.

At least 37 records · Page 2Linked to original sources
PubMed1999

The relation between antioxidant status and alterations in fatty acid profile in patients with Crohn disease and controls.

BACKGROUND: A diminished antioxidant defence and alterations in the fatty acid profile may play a role in the pathophysiology of inflammation in Crohn disease (CD). METHODS: Antioxidant status (serum antioxidant vitamins and minerals, glutathione peroxidase, and superoxide dismutase activity), disease activity, dietary intake, and the fatty acid profile in plasma and erythrocyte phospholipids were studied in patients with active CD (n = 12), inactive CD (n = 50), and controls (n = 70). Eight patients with active CD were re-evaluated during the subsequent phase of clinical remission. The relation between the variables was assessed by multiple linear regression. RESULTS: We observed a significantly diminished antioxidant status in patients with active CD compared with inactive CD and controls. Furthermore, the antioxidant defence was depleted in patients with inactive CD compared with controls. An aberrant fatty acid profile in plasma phospholipids was found in active and inactive CD compared with controls. Multivariate analysis showed that the plasma phospholipid fatty acid indices were significantly associated with several antioxidants (beta-carotene, vitamin E, and glutathione peroxidase) in CD patients but not in controls. CONCLUSION: The fatty acid profile in CD patients is significantly associated with disease activity and serum antioxidant concentrations. This observation, along with the diminished antioxidant defence in patients with active and inactive CD, indicates that antioxidants should be considered in the therapy of inflammation in CD.

Adult↗
PubMed1999

Nutrition and inflammatory bowel disease: an update.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic inflammatory process, the aetiology of which remains unknown. Nutrition may play an important role in the pathogenesis and treatment of IBD. The evidence regarding the role of specific dietary components in the pathogenesis of IBD is still inconclusive. Many studies have been subject to methodological limitations; studies of better design are necessary to confirm the hypothesis that nutritional factors may indeed play a role in the development of IBD. Several studies have reported nutritional and functional deficiencies in IBD patients, especially in Crohn's disease. It is, however, hard to discriminate between disease-induced and malnutrition-induced changes in nutritional parameters. Maintaining adequate nutritional status has been suggested to be beneficial to the course of the disease in IBD. Studies have provided further insight into the possible beneficial effects of nutritional supplementation as primary and adjunctive therapy in IBD. The effects of specific nutritional therapy may be caused by alterations in intestinal flora and hence in the production of intraluminal proinflammatory substances. Immunonutrients such as n-3 fatty acids and antioxidants may also play a role in the treatment of IBD. In this paper, the relation between nutritional aetiological factors, nutritional status and nutritional therapy is discussed in detail.

Antioxidants↗
PubMed1999

Fat intake and fatty acid profile in plasma phospholipids and adipose tissue in patients with Crohn's disease, compared with controls.

OBJECTIVES: Fatty acid metabolism is involved in the immune response and inflammation processes in patients with Crohn's disease (CD). Fatty acid changes may be relevant to the clinical course of the disease. The aim of this study was to compare the qualitative and quantitative fat intake and fatty acid composition of plasma phospholipids and adipose tissue in a defined population of CD patients with those in matched controls. METHODS: Dietary fat intake and fatty acid profile of plasma phospholipids and adipose tissue were assessed in two patient populations: 20 patients with recently diagnosed CD and 32 patients with longstanding (> 10 yr) CD clinically in remission, matched for age and gender with healthy controls. RESULTS: We observed no significant differences in quantitative or qualitative fat intake between CD patients and controls. Percentages of linoleic acid and alpha-linolenic acid in plasma phospholipids or adipose tissue were not significantly different between patients and controls. However, we observed a significantly (p < 0.05) lower percentage of the sum of the n-3 fatty acids, with significantly (p < 0.01) higher levels of clupanodonic acid (22:5n-3) and significantly (p < 0.05) lower levels of docosahexaenoic (22:6n-3) and arachidonic acid (20:4n-6). The aberrant fatty acid profile was more evident in patients with longstanding CD than in patients with recently diagnosed CD. CONCLUSION: The aberrant fatty acid profile found in these CD patients is a result of altered metabolism rather than of essential fatty acid malabsorption. The reported findings may be important in the pathophysiology of CD and hence in the choice of fatty acids to be used when therapeutic supplementation is considered in CD patients.

Adipose Tissue↗
PubMed1998

High incidence of inflammatory bowel disease in The Netherlands: results of a prospective study. The South Limburg IBD Study Group.

PURPOSE: To gain recent epidemiologic information about inflammatory bowel disease in The Netherlands, a prospective study over four years (1991-1995) was performed. METHODS: The incidence of inflammatory bowel disease and its subgroups was examined using standardized reports of newly diagnosed patients. A separate study compared the Inflammatory Bowel Disease Registration and computerized diagnostic files of a subgroup of general practitioners with the aim of estimating completeness of case ascertainment. RESULTS: The following mean incidence rates (per 100,000 inhabitants and year) were found: 6.9 (95 percent confidence interval, 5.9-7.9) for Crohn's disease, 10 (95 percent confidence interval, 8.7-11.2) for ulcerative colitis (23 percent of these with ulcerative proctitis), and 1.1 (95 percent confidence interval, 0.7-1.5) for indeterminate colitis. In the age category 20 to 29 years, the incidence rate of Crohn's disease with small-bowel involvement was higher in females than in males. In extended ulcerative colitis, a male preponderance was observed in the older age groups. Estimated case ascertainment was 78 percent. CONCLUSIONS: Compared with recent studies in neighboring countries, the observed age and gender standardized incidence rates are high in the south of The Netherlands. Completeness of case ascertainment might have contributed to this observation; however, case ascertainment was low in ulcerative proctitis. In the study area, differences in age and gender standardized incidence rates and in disease localizations could be compatible with an influence of environmental risk factors.

Adolescent↗
PubMed1998

Retrograde approach to pharyngo-esophageal obstruction.

BACKGROUND: The entrance of the esophagus has to be identified for treatment of a pharyngo-esophageal obstruction. If transoropharyngeal identification is unsuccessful, a retrograde approach might be indicated. METHODS: By way of a mini-laparotomy and gastrotomy, a flexible gastroscope can be passed into the esophagus. In one patient with a Zenker's diverticulum, a guidewire was inserted through the accessory channel of the gastroscope and passed through a stenosis, caused by marked hypertrophy of the cricopharyngeal muscle, into the oral cavity. Thereafter antegrade dilatation and laser assisted myotomy could be performed. In another patient with a membranous obstruction of the esophageal entrance due to radiotherapy, the occlusion was perforated transoropharyngeally and bluntly dilatated guided by the light from the gastroscope. RESULTS: In both cases the esophageal passage was restored. No complications occurred as a result of the procedures. CONCLUSIONS: The retrograde approach may be a good alternative when antegrade identification of the esophageal entrance fails.

Aged↗
PubMed1998

Gut permeability, intestinal morphology, and nutritional depletion.

Nutritional depletion increases the risk for postoperative complications. The intestinal barrier may be important in the underlying pathophysiologic mechanism. In this study, 26 patients were evaluated to determine whether nutritional depletion was related to gut integrity and intestinal morphology. Nutritional depletion was estimated by calculating percentage ideal body weight (PIB) or percentage ideal fat free mass (PIFFM). To assess gut integrity, a lactulose/mannitol (L/M) test was performed. Duodenal biopsies were taken, and villous height, crypt depth, number of IgA-producing plasma cells, intraepithelial lymphocytes (IELs), and proliferating index were determined. The L/M ratio was increased, and villous height was decreased in depleted patients. Depletion was not associated with differences in the number of immune cells or proliferating index. The number of IgA-producing plasma cells was positively correlated with the L/M ratio. This study shows that nutritional depletion is associated with increased intestinal permeability and a decrease in villous height.

Adult↗
PubMed1998

Effects of growth hormone treatment on visceral adipose tissue.

It is now evident that an increased amount of intra-abdominal (visceral) adipose tissue is associated with an impaired metabolic profile, increasing the risk of CVD and NIDDM. Visceral obesity also appears to be associated with impaired GH action. GH replacement therapy in patients with GHD, or GH treatment of viscerally obese individuals, is able to induce a profound reduction in the amount of visceral adipose tissue and to improve the metabolic profile.

Absorptiometry, Photon↗
PubMed1998

Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission.

Malnutrition is observed frequently and is an important complication in patients with Crohn disease (CD). The pathophysiology of malnutrition in this disorder is complex. To obtain a comprehensive picture of nutritional status in patients with long-standing CD that was clinically in remission, we assessed four measures of nutritional status in 32 patients (18 women and 14 men) and 32 matched healthy control subjects: 1) body composition, 2) dietary intake, 3) biochemical indexes of nutrition, and 4) and muscle strength (as a functional index). Mean daily intakes of fiber and phosphorus were significantly lower in CD patients than in control subjects. Serum concentrations of several nutrients (beta-carotene, vitamin C, vitamin E, selenium, and zinc) and activity of the enzyme glutathione peroxidase were also significantly lower in CD patients, as were antioxidant status and serum concentrations of magnesium and vitamin D. Percentage body fat and hamstring muscle strength were significantly lower in male CD patients than in control subjects, whereas muscle strength of the quadriceps was preserved. In conclusion, this study showed a variety of nutritional and functional deficiencies in patients with long-standing CD in remission, especially in male patients with a high lifetime prednisone dose. A comprehensive nutritional assessment seems superior to the assessment of a single dimension of nutritional status.

Adult↗
PubMed1998

Modern life' in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors.

OBJECTIVE: The rising incidence of inflammatory bowel disease (IBD) since the Second World War coincides with profound changes of the dietary pattern. The aim of the study was to investigate the possible pathogenic role of some characteristic 'modern life' dietary factors in IBD. DESIGN: Case-control, studying risk factors in recently diagnosed cases, 290 with Crohn's disease and 398 with ulcerative colitis, compared with 616 population controls. Smoking, age, gender and education were taken into account by using logistic regression analysis. SETTING: Hospital cases and population controls. INTERVENTIONS: Questionnaires. MAIN OUTCOME MEASURES: Logistic regression-derived odds ratios. RESULTS: A positive association with cola drinks [OR: 2.2 (95% CI 1.5-3.1)], chewing gum [OR: 1.5 (95% CI: 1.1-2.1)] and chocolate consumption [OR: 2.5 (95% CI: 1.8-3.5)] and a negative association with citrus fruit consumption [OR: 0.5 (95% CI 0.3-0.7)] and the development of Crohn's disease were found. Consumption of cola drinks [OR: 1.6 (95% CI 1.1-2.3)] and chocolate consumption [OR: 2.5 (95% CI 1.8-3.5)] were positively associated with developing ulcerative colitis. There was a negative association between the intake of citrus fruits [OR: 0.5 (95% CI 0.4-0.8)] and 'having a stuffed pet' for a period longer than 5 years [OR: 0.6 (95% CI 0.4-0.9)] and developing the disorder. No association with the frequency of tooth brushing and developing IBD was found. CONCLUSION: All the nutritional items mentioned may be true risk factors or they just might be the expression of a modern life-style also involving other risk factors for the development of IBD which at the present are still unknown.

Adult↗
PubMed1997

Initial and chronic gastric acid inhibition by lansoprazole and omeprazole in relation to meal administration.

In a placebo-controlled, double-blind, multiple crossover study, the initial and chronic acid-inhibitory effect of lansoprazole 30 mg, orally administered half an hour before breakfast or immediately after breakfast, and of omeprazole 20 mg, administered postprandially, respectively, was investigated in 16 healthy volunteers, using ambulant 24-hr intragastric pH monitoring. On the first day of medication, only preprandially administered lansoprazole reduced acid secretion significantly (median 24-hr pH 3.0; P < 0.05). On day 15, the median 24-hr intragastric pH of lansoprazole preprandial (pH 4.1), lansoprazole postprandial (pH 4.3), and omeprazole postprandial (pH 3.3), respectively, differed significantly (P < 0.05) from placebo (pH 1.2). It is concluded that the interaction between food intake and lansoprazole administration only is important at the start of oral therapy. Lansoprazole taken before breakfast is effective even on the initial day of treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

The effect of a single rectal dose of cisapride on delayed gastric emptying.

BACKGROUND: Cisapride has an established prokinetic effect in patients with delayed gastric emptying. However, rectal administration of the drug might be preferred in patients with either dysphagia or nausea due to gastroparesis. AIM: To determine the effect of a single rectal dose of cisapride 60 mg on gastric emptying in patients with delayed gastric emptying. METHODS: Thirty-two patients (16 males, 16 females) with demonstrated delayed gastric emptying received a single dose of two suppositories containing either cisapride (2 x 30 mg) or placebo, according to a double-blind randomized crossover design. Three hours after administration of the suppositories, the patients received a radio-labelled test meal and radio-opaque markers for measurement of gastric emptying. RESULTS: The mean t1/2 after cisapride administration (76 min, 95% CI: 68-95) was significantly shorter (P = 0.005: n = 28, per-protocol analysis) than after placebo administration (104 min, 81-126). Four hours after ingestion of the meal significantly fewer radio-opaque markers remained in the stomach after cisapride than after placebo administration (P < 0.05). Mild to moderate adverse events, mainly involving the gastrointestinal tract, were reported in 10 patients (31%) after cisapride treatment and in four patients (13%) after placebo (N.S.: n = 32). CONCLUSION: A single suppository dose of cisapride 60 mg significantly accelerates gastric emptying of the solid phase of a meal and of radio-opaque markers in patients with previously demonstrated delayed gastric emptying.

Administration, Rectal↗
PubMed1997

Appendectomy and the risk of developing ulcerative colitis or Crohn's disease: results of a large case-control study. South Limburg Inflammatory Bowel Disease Study Group.

BACKGROUND & AIMS: Appendectomy has been pointed out as a protective factor for ulcerative colitis (UC). The aim of this study was to elucidate the role of appendectomy in inflammatory bowel disease (IBD). METHODS: Prevalent as well as incident cases with IBD were studied separately using a pairwise age- and sex-matched case-control study design. RESULTS: In 232 prevalent UC cases, the risk of developing UC was significantly lower after previous appendectomy (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15-0.80); subgroup analysis found a protective effect only in pancolitis (OR, 0.2; 95% CI, 0.02-0.7). In 208 patients with Crohn's disease (CD), the OR was not significantly increased but a positive association with appendectomy was observed in ileocecal disease. A significant larger proportion of appendectomies was performed close to the time of diagnosis. Smoking was not a confounding factor. No statistically significant associations were observed in incident IBD patients. Prevalent and incident patients taken together resulted in ORs of 0.44 (95% CI, 0.24-0.78) in UC and 1.65 (95% CI, 0.96-2.91) in CD. CONCLUSIONS: An overall protective role of appendectomy for UC was observed. The observations in CD suggest that appendectomy in some cases was a result of still undiagnosed CD.

Adolescent↗
PubMed1997

Deuterium and bromide dilution, and bioimpedance spectrometry independently show that growth hormone-deficient adults have an enlarged extracellular water compartment related to intracellular water.

GH has a strong influence on body composition. However, the effects of GH deficiency in adults on water compartments are not well understood. Therefore, extracellular water (ECW) and total body water were independently determined by deuterium and bromide dilution and by bioimpedance spectrometry in GH-deficient (GHD) adults and compared to those in controls, matched for age, sex, body weight, and height. The results show that the percent body fat was significantly (P < 0.05) higher, and total body water and intracellular water (ICW) were significantly lower in GHD adults for males, females, and both sexes combined. ECW was not significantly different between the two groups. ECW/ICW in GHD adults (0.42 +/- 0.03) was significantly (P < 0.01) higher than that in controls (0.39 +/- 0.02). There was a significant positive relation between the ECW/ICW ratio and the percent body fat. These results were confirmed by the bioimpedance spectrometry measurements.

Adult↗
PubMed1997

The relationship between lactose tolerance test results and symptoms of lactose intolerance.

OBJECTIVE: A standard for the assessment of lactose malabsorption does not exist. As measured by lactose tolerance tests, insufficient increase in blood glucose or increased breath hydrogen (H2) excretion after lactose ingestion is regarded as pathological. In this study, we have tried to elucidate the relationship between lactose tolerance test results and symptoms after a lactose challenge. This relationship might be an indicator for the validity of the test. METHODS: In a prospective study, 309 consecutive patients with suspected lactose malabsorption underwent a lactose tolerance test. After consumption of 50 g of lactose, blood glucose and breath H2 concentrations were measured. During the test (240 min), the severity of bloating, flatulence, abdominal distention, and diarrhea were semiquantitatively scored as 0, 1, or 2. The individual sum of these four scores was calculated and denoted as the total symptom score (TSS). All subjects were classified according to their TSS to compare symptoms with peak breath-H2 concentration and change in blood glucose concentration, respectively. RESULTS: The glucose and breath H2 response were pathological in 51.1 and 39.5% of cases, respectively. A stepwise increase in TSS of 1 point was associated with a significant increase (p < 0.05) in mean peak H2 concentration. However, a significantly lower glucose increment compared with patients with a TSS of 0 was found only in patients with a TSS of 2 or 4. The mean symptom score differed significantly between the positive and negative breath tests (p < 0.001), but did not differ between the positive and negative glucose response results. CONCLUSIONS: This study shows that GI symptoms after a lactose challenge are strongly associated with the amount of H2 excretion. The relationship between the increase in glucose concentration and symptoms after a lactose load is less evident. Thus, the H2 breath test seems to be superior to the measurement of blood glucose increment as a diagnostic tool in lactose malabsorption, although the true predictive value of this test only can be determined after a period of dietary treatment.

Adult↗
PubMed1996

Effect of nizatidine 300 mg at night and omeprazole 20 mg in the morning on 24-hour intragastric pH and bacterial overgrowth in patients with acute duodenal ulcer.

The study investigated the effect of either nocturnal acid suppression by the H2 antagonist nizatidine 300 mg at night or prolonged acid suppression by the proton- pump inhibitor omeprazole 20 mg in the morning, during four weeks, on intragastric pH profile, occurrence of bacterial growth in gastric fluid and biopsies, and healing rate in 23 patients with an acute duodenal ulcer. The endoscopic healing rate did not differ significantly between the two treatment modalities. The 24-hr acid secretion was significantly more reduced by omeprazole than nizatidine (P < 0.002). After treatment by nizatidine and omeprazole, respectively, median 24-hr intragastric pH increased from 1.5 to 1.8 (P < 0.01) and from 1.5 to 6.1 (P < 0.01), respectively. Nighttime acid inhibition did not differ significantly. The difference in gastric bacterial colonization after either omeprazole or nizatidine did not reach significance. However, median 24-hr pH and the fraction of the day with pH < 3 and pH < 4 were significantly correlated to bacterial colonization of the gastric fluid (P < 0.05).

Acute Disease↗
PubMed1996

Comparison of different body composition models in acromegaly.

The aberrant body composition of 10 patients with active acromegaly was used to evaluate the validity and limitations of several models and methods to assess body composition. Body composition was determined using either a two-compartment model, dividing the body in a body fat (BF) compartment and a fat-free mass (FFM) compartment, or a four-compartment model in which the FFM compartment comprises the three following components: body cell mass, extracellular water and the fat-free extracellular solids. The measurement techniques consisted of anthropometry, bioelectrical impedance analysis (BIA)-applying various established regression equations-tritiated water dilution, whole body 40K-counting, and whole body computed tomography (CT). This latter method was used as the reference technique. Assessment of total body water using BIA - applying the RJL or Kushner equation-correlated significantly with the assessment using tritiated water dilution (P < 0.01). Body fat assessment using the two-compartment model based on either tritiated water dilution or BIA-applying the RJL or Lukaski equation-as well as body fat assessment using the four-compartment model based on tritiated water dilution and whole body 40K-counting were significantly correlated with body fat assessment using CT (P < 0.01) and resulted in good agreement with each other with respect to the absolute values of the body fat determination. BIA using other regression equations overestimated body fat by 7.2-13.7 kg. Whole body 40K-counting was significantly correlated with CT-determined muscle plus skin volume (P < 0.001). CT-calibrated anthropometric predictions significantly overestimated body fat. It is concluded that in patients with active acromegaly, the determination of body composition using either certain two-compartment models based on measurement of total body water or bioelectrical impedance, or a four-compartment model based on total body water and total body potassium measurements show good agreement with CT-determined body composition.

Acromegaly↗