[Dietetic principles after gastrectomy].
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Female↗
Biomedical subjects
U Armbrecht
Publications and source records attributed to U Armbrecht.
[Lambliasis: a cause of malabsorption and diarrhea?].
Multiple biopsies from the lower duodenum were obtained during endoscopy of 171 patients with dyspepsia, diarrhoea and/or suspected malabsorption. Histological evidence of lambliasis was obtained in six (3.5%). Antibiotic treatment with metronidazole, 250 mg two or three times daily for seven to 11 days (which had to be repeated in two cases), improved symptoms in four. In most of the patients "functional upper-abdominal symptoms" had been diagnosed after extensive examinations. In case of unclear upper-abdominal symptoms, chronic or chronic-recurrent diarrhoea and/or malabsorption lambliasis should be considered and histological examination of the duodenal mucosa undertaken.
Adult↗
The effect of cisapride on defaecation in normal human subjects--lack of effect on faecal excretion of water, fat, and bile acids.
In order to elucidate whether or not the increased stool frequency that occurs during cisapride treatment is a result of malabsorption of water, fat, and bile acids, 12 healthy volunteers were dosed with either tablets of placebo q.d.s. or tablets of 10 mg cisapride q.d.s. during two periods of 5 days in a double-blind, crossover study. Stool frequency, stool consistency, and side-effects were recorded each day. Total faecal mass, faecal water content, and faecal excretion of fat and bile acids were determined during the last 72 h of each study period. Mean daily stool frequency was 18.8% higher during cisapride [1.68 +/- 0.12 (S.E.M.)] administration than during placebo (1.42 +/- 0.12); P = 0.038. The stool consistency score increased by 11.8% towards softer stools during cisapride dosing (N.S.). There were no significant differences in total faecal mass (placebo 399.4 g/72 h; cisapride; 414.5 g/72 h), faecal water content (placebo; 75.6%: cisapride 76.2%), or faecal excretion of fat (placebo; 12.7 g/72 h: cisapride; 11.6 g/72 h) and total bile acids (placebo; 2212 mumol/72 h: cisapride; 2261 mumol/72 h). The side-effects reported during placebo were constipation (n = 3), and during cisapride meteorism (n = 4) and increased appetite (n = 2). The increased stool frequency during cisapride treatment is not caused by malabsorption of water, fat, or bile acids, but seems to be the consequence of a direct motor effect.
Adult↗
[Possibilities for use and limits of the H2 breath test in gastroenterologic diagnosis].
The H2 breath test is a non-invasive, safe, and - using modern analytical equipment - simple and non-expensive investigation, which reflects gastrointestinal bacterial fermentation of carbohydrate. It is widely used to study sugar malabsorption, and, with mainly scientific intent, also that of complex carbohydrates. The test plays an important role in the investigation of upper intestinal motility disturbances as it is suitable to monitor the orocaecal transit time. Furthermore, the test seems to offer valuable information for the study of upper intestinal bacterial overgrowth. However, a standardized test design for the latter purpose is lacking so far. The H2 breath test is an indirect investigation method and therefore requires careful consideration of multiple potentially interfering factors.
Breath Tests↗
[HIV testing in general practice].
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Germany, West↗
The benefit of pancreatic enzyme substitution after total gastrectomy.
The aim of the present study was to evaluate the effect of the pancreatic enzyme preparation Kreon on abdominal symptoms, bowel habits, faecal fat excretion and oro-caecal transit time in patients after total gastrectomy for carcinoma of the stomach with Roux-en-Y anastomosis. A hydrogen breath test was carried out in each patient to detect bacterial overgrowth. In a double-blind crossover trial, 15 patients were treated with either Kreon or placebo (3.6 g/day) in two test-periods each of seven days. During treatment with the active substance, the stool consistency became more solid (P less than 0.05). The number of bowel movements and the abdominal symptoms, however, remained statistically unchanged. Treatment with Kreon did not influence the oro-caecal transit time. Faecal fat excretion did not significantly decrease in the whole group of patients. However, in those patients with massive steatorrhoea (free and esterified fatty acids greater than 350 mmol/72 h; upper reference limit 60 mmol/72 h) a significant (P less than 0.05) reduction from a median excretion of 643 mmol/72 h to 501 mmol/72 h was seen. Such a decrease in faecal fat excretion did not occur in patients with steatorrhoea below this limit. Bacterial overgrowth or rapid upper intestinal transit were not over-represented in patients with a high-degree of steatorrhoea. We conclude that after total gastrectomy pancreatic enzyme substitution reduces massive steatorrhoea and improves stool consistency.
Aged↗
The effect of the M1-selective telenzepine on esophageal acid exposure in healthy volunteers.
In order to study the effect of the new M1-selective antimuscarinic compound telenzepine on physiological esophageal acid exposure, ten healthy volunteers underwent a 24-hour esophageal pH-monitoring during a one week treatment with either tablets containing telenzepine 3 mg nightly or placebo in a double-blind cross-over trial. Side-effects were recorded, and stimulated salivary output was assessed. Using a cut-off pH less than 4, under telenzepine a significant reduction of reflux time and of maximum reflux duration was observed in supine position. Using a cut-off pH less than 2, reflux time was reduced during and after meals, number of refluxes was decreased during meals, and esophageal clearance was improved with telenzepine in supine position. Telenzepine reduced salivary output significantly on day 4 and on day 7. From the results it can be concluded that the drug is not contraindicated in peptic ulcer patients with heartburn. As telenzepine reduces gastroesophageal reflux time during and after meals and in supine position it may be tried as adjuvant treatment in esophageal reflux disease.
Adult↗
Causes of malabsorption after total gastrectomy with Roux-en-Y reconstruction.
Malabsorption after total gastrectomy and Roux-en-Y reconstruction was studied in 11 patients. Absorption of fat, xylose and lactose was tested and the orocaecal transit time was radiologically determined. Bacterial colonization of the small intestine was studied by culturing jejunal juice and indirectly with a hydrogen breath test. Ten patients lost weight postoperatively and six had diarrhoea. All 11 had steatorrhoea with mean faecal fat excretion 289 +/- 55 (SEM) mmol free and esterified fatty acids/72 h (upper reference limit 60 mmol/72 h). Low xylose absorption was found in only one patient and low lactose absorption in none. The median orocaecal transit time was only 110 minutes (less than or equal to 60 min in 4 cases). Postoperative weight loss showed significant inverse correlation with orocaecal transit time. Bacterial overgrowth of the small intestine was found in four patients. The cause of malabsorption was assumed to be rapid intestinal transit in four patients and bacterial overgrowth in four others, leaving three in whom pancreatic understimulation is suggested as the reason for steatorrhoea.
Aged↗
Nutrient malassimilation after total gastrectomy and possible intervention.
Malnutrition is common after total gastrectomy. Different pathophysiological reasons have been reported. We have investigated malabsorption in patients after total gastrectomy and Roux-Y esophagojejunostomy, analyzing the orocecal transit time, the bacterial flora of the upper intestine, and the small intestinal carbohydrate fermentation. Furthermore, we studied the benefit of pancreatic enzymes in this condition. The orocecal transit time was found to be short in 5/11 patients. In 4/11 patients upper intestinal bacterial overgrowth was probable. In the remaining 3/11 patients with steatorrhea, pancreatic dysfunction, due to understimulation, was suspected to be the reason for malassimilation. A subsequent double-blind, cross-over trial on supplementary treatment with pancreatic enzymes was performed in 15 patients. This treatment did not significantly reduce the degree of steatorrhea in these patients.
Aged↗
Hydrogen (H2) breath excretion in peptic disease before and during treatment with ranitidine.
Gastric juice pH, bacterial flora, and the H2 breath excretion were studied in patients treated with 150 mg ranitidine twice daily. The intragastric pH and bacterial contents rose during therapy. Before treatment upper respiratory tract bacteria were found in 4 of 23 patients and after 4 weeks of medication in 15 of 23. The median bacterial concentration was increased (p less than 0.01) and in five patients included bacteria normally found in the colon. Prolonged therapy for up to 12 weeks (n = 8) did not further change the bacteriologic pattern. Prophylactic treatment for 1 year (n = 3) showed gastric bacteria in high concentration, including Pseudomonas, in one patient. Postprandial H2 production remained unchanged after 4 (n = 23) and 12 (n = 7) weeks of therapy. In two of three patients treated prophylactically H2 excretion was increased after 1 year of medication. We conclude that acid reduction with ranitidine causes changes of the intragastric bacterial flora similar to those with other acid-reducing drugs in equipotent doses. The unchanged H2 breath test result after 4 and 12 weeks of treatment contradicts small-intestinal bacterial overgrowth. The elevated H2 excretion in two of the three patients after 1 year of treatment suggests the importance of a time factor in small-intestinal bacterial colonization.
Adult↗
The effect of gastric secretion on orocoecal transit time measured with the hydrogen (H2) breath test.
Orocoecal transit time was studied by means of a hydrogen (H2) breath test after a standard meal in patients with peptic disease before and during treatment with ranitidine, in patients with gastric achlorhydria, and in healthy acid-secreting volunteers. Treatment with ranitidine prolonged the orocoecal transit time in patients with peptic disease from 201.9 +/- 18.3 (SEM) to 242.3 +/- 18.3 min (p less than 0.05). Also in patients with achlorhydria, the orocoecal transit time was prolonged (276.2 +/- 20.3 min), compared to the control group of healthy acid-secreting volunteers (213.5 +/- 15.7 min), (p less than 0.05). The orocoecal transit time did not correlate with gastric bacterial concentrations in the groups investigated, nor with the subjects' age. It was not correlated to the pH in the gastric juice of acid-secreting individuals, either with or without treatment. As gastric emptying was not evaluated in this study, it is impossible to state whether gastric stasis or inhibited small bowel motility, or both, cause the delayed transit in achlorhydria and during treatment with ranitidine. We suggest that the reduction of gastric juice volume could be the cause.
Achlorhydria↗
The value of the hydrogen (H2) breath test for the diagnosis of bacterial overgrowth in gastric achlorhydria.
Sixteen healthy volunteers, 23 patients with peptic disease, and 38 patients with achlorhydria were investigated with bacterial cultures from gastric juice and a hydrogen (H2) breath test after a standard meal. In acid-secreting subjects upper respiratory tract bacteria were found in 6/39. In every single achlorhydric patient gastric bacterial concentrations were above log 10 5.7/ml. Fecal flora was found in 22/38. The patient with fecal organisms were significantly older than those without (p less than 0.05). The H2 breath test revealed low postprandial carbohydrate fermentation in acid secretors and in achlorhydrics with no fecal flora. The lowest H2 production was found 90 and 120 min after the meal. In achlorhydrics with fecal organisms the mean H2 concentration at these times of measurement was elevated (p less than 0.05). Assuming that a mean H2 concentration at 90 and 120 min above 19 ppm (mean in healthy volunteers at 90 and 120 min + 2 SD) is pathological, the association of fecal bacteria in gastric juice and a "positive" H2 breath test is highly significant (P less than 0.001). Fecal bacteria in the gastric juice would indicate small-intestinal fermentation with a probability of 81%. A gastric culture negative for fecal organisms would predict a "negative" H2 breath test with a probability of 91%.
Achlorhydria↗
[Current status of PMMA intraocular lens sterilization].
One possible reason for the "toxic lens syndrome" may be the method of IOL sterilization used. Advantages and disadvantages of wet and dry sterilization techniques are discussed. Ethylene oxide remnants in IOL optics were measured using headspace chromatography. The influence of gamma radiation on PMMA lens optics was studied by spectrometry.
Ethylene Oxide↗
Assessment of orocoecal transit time by means of a hydrogen (H2) breath test as compared with a radiologic control method.
The definition of the orocoecal transit time by means of the hydrogen (H2) breath test is not unequivocal. In this study the orocoecal transit time as measured with an H2 breath test was compared with that obtained with a radiologic method. Two definitions of orocoecal transit time by the H2 breath test were evaluated: the time from eating to the first of three consecutively rising H2 values, and the interval to H2 values 50% above 'small-bowel level'. Transit times measured in accordance with both definitions were closely correlated to that obtained with the radiologic method (A, r = 0.84; B, r = 0.90; for both, p less than 0.001), but transit time measured by definition A gave shorter values than the radiologic method (p less than 0.05). The mean transit time in patients with constipation was significantly longer than that in normal subjects and patients with functional diarrhoea (p less than 0.05). There was a significant correlation between the difference in transit time measured with the H2 breath test and the radiologic method and the transit time measured by the control method. This may indicate that rapid transit is associated with a delayed 'colonic' rise in H2 levels and slow transit with an early H2 rise.
Adolescent↗
Enzyme substitution in chronic pancreatitis: effects on clinical and functional parameters and on the hydrogen (H2) breath test.
Ten patients with chronic pancreatitis (with abdominal pain and/or diarrhoea) were treated in a double-blind multiple cross-over trial with Pankreon granules 20 g per day or placebo during three periods of one month each. Pain and bowel habits were recorded. Faecal fat and breath hydrogen (H2) excretion were analyzed during the last days of each treatment period. The pain score was initially low in all patients and was not affected by enzymes. The number of daily bowel movements was reduced from 3.16 to 2.32 (n.s.). Faecal fat excretion per 72 hrs was reduced from 357 +/- 158 mmol free fatty acid to 226 +/- 98 mmol (p less than 0.05). With placebo treatment H2 excretion (from 60 and 180 min after a standard breakfast) was significantly increased compared with 19 healthy volunteers (p less than 0.05). It was not significantly reduced by enzymes. In 28 comparisons the H2 output between 60 and 180 min was correlated to faecal fat. In eight patients the oro-coecal transit-time could be determined by the H2 breath test. The transit-time did not differ from that of ten healthy volunteers and remained unchanged by enzymes. Carbohydrate maldigestion occurs parallel to fat maldigestion in chronic pancreatitis, and is not sufficiently reduced by 20 g of pancreatic enzymes.
Adult↗
Serum lipase and assessment of pancreatic function.
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Adult↗
Hydrogen (H2) breath test and gastric bacteria in acid-secreting subjects and in achlorhydric and postgastrectomy patients before and after antimicrobial treatment.
Sixteen patients with pentagastrin-fast achlorhydria and 12 patients who had undergone Billroth II gastrectomy (at least 3 years previously) were compared with 10 acid-secreting volunteers and 13 patients with endoscopically proven peptic disease. The concentration and type of gastric bacteria were analysed in achlorhydrics, Billroth II patients, and patients with peptic disease. A 6-h hydrogen (H2) breath test after a standardized meal was performed in all subjects. The mean concentration of gastric bacteria was significantly higher in achlorhydrics and Billroth II patients than in patients with peptic disease. End-expiratory H2 excretion was elevated in achlorhydrics and Billroth II patients to levels significantly exceeding those of acid-secreting volunteers and patients with peptic disease. In achlorhydrics, total bacterial concentration in gastric juice was correlated to H2 excretion between 60 and 180 min after the meal. Treatment of achlorhydric and postgastrectomy patients with trimethoprim/sulphamethoxazole lowered H2 breath concentrations in both groups and reduced symptoms in achlorhydrics. Elevated end-expiratory H2 levels after a test meal indicate upper gastrointestinal bacterial overgrowth in achlorhydrics and in postgastrectomy patients.
Achlorhydria↗
The hydrogen (H2) breath test. Sampling methods and the influence of dietary fibre on fasting level.
Three end-expiratory breath hydrogen (H2) sampling methods were compared in a patient group (n = 12) and a laboratory staff group (n = 12) on two separate occasions. H2 samples obtained with each method showed significantly different concentrations (p less than 0.001) but no significant differences in coefficient of variation when individual triplicate samples were evaluated. There was a high correlation between the breath H2 concentrations obtained by the three methods (r = 0.93-0.96). Fasting breath H2 values after an overnight fast and an unrestricted diet the day before the investigation were compared with values obtained after an overnight fast and a low-fibre diet the day before the test in two patient groups (n = 39 and 39) with a comparable distribution of diagnoses and in one group of healthy volunteers (n = 17). Fasting breath H2 concentrations were significantly lower after a low-fibre diet in the patient groups (p less than 0.005) and in healthy volunteers (p less than 0.02). We conclude that each of the three end-expiratory sampling methods can be chosen for use in H2 breath tests depending on suitability and convenience and that a low-fibre diet the day before the H2 breath test lowers fasting breath H2 concentration.
Adult↗