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At least 343 records · Page 19Linked to original sources
PubMed1992

Variability of migrating motor complex in humans.

Fasting gastrointestinal motility in the human is characterized by the regular cycling activity of the migrating motor complex (MMC). Our purpose was to define the variability of the MMC within and between a group of six healthy subjects studied for 6-9 hr over six separate days with a perfused catheter system. A total of 88 phase III events was observed during 255 hr of recording in this group. The mean MMC cycling time varied significantly between subjects (range 113-230 min, P less than 0.001), and variation within subjects also was wide (SD range 58-70 min). Seventy-one percent of phase III events commenced in the gastric antrum, 18% in the proximal duodenum, 10% in the distal duodenum, and 1% in the proximal jejunum. For each subject, the velocity of propagation of phase III decreased significantly (P less than 0.001), and phase III duration increased significantly (P less than 0.001), with increasing distance from the os. In the antrum, phase I was predominant, and significant (P less than 0.006) variation between subjects was noted for percentage of MMC cycle occupied by phase I (overall mean +/- SD 55 +/- 23%). Phase II was predominant in both duodenum and jejunum (mean range 70-80%), and no significant variation was noted between subjects for percentage of MMC occupied by phase II. We conclude that human MMC activity varies widely between individuals and within the same individual when studied on separate days.

Adult↗
PubMed1985

Enteroclysis in the diagnosis of chronic unexplained gastrointestinal bleeding.

In a six-year period (1977-83), lesions were identified by enteroclysis in 26 patients with melena or recurrent gastrointestinal bleeding undiagnosed by other modalities. These included nine Meckel's diverticula, three metastatic lesions, three primary carcinomas, one lipoma, four leiomyomas, five surgically created blind pouches, one carcinoid, and one idiopathic dilatation of the ileum. Our experience suggests that, when the standard diagnostic procedures used to investigate chronic gastrointestinal blood loss are unrevealing, enteroclysis should be performed. The method is fast, accurate, is done in one sitting, and can be productive in the diagnostically difficult patient.

Adenocarcinoma↗
PubMed2006

Therapeutic strategies for the management of delayed gastric emptying after pancreatic resection.

BACKGROUND: Delayed gastric emptying (DGE) is one of the most troublesome postoperative complications following pancreatic resection. Not only does it contribute considerably to prolonged hospitalization, but it is also associated with increased postoperative morbidity and mortality. METHODS: We performed an electronic and manual search of the international literature for studies dealing with the treatment of DGE following pancreatic resection using the Medline database. The search items used were "delayed gastric emptying," "pancreaticoduodenectomy," "Whipple procedure," "pylorus-preserving pancreaticoduodenectomy," and "complications following pancreatic resection" in various combinations. RESULTS: A number of studies were identified regarding possible therapeutic alternatives for the treatment of DGE. From the class of prokinetic regimens, most studies seem to support the use of erythromycin. However, its use has not gained wide acceptance. Regarding the operative technique, both standard Whipple and pylorus-preserving pancreatic resection carry similar rates of DGE. Billroth II type-like gastrointestinal reconstruction is the most widely accepted method and is associated with lower rates of DGE. Reoperations for managing severe DGE were very rarely reported. CONCLUSIONS: The incidence of DGE in high-volume centers specialized in pancreatic surgery is well below 20%, thus following the improved rates that have been reported in the last decade regarding mortality and length of hospital stay after pancreatic surgery. DGE mandates a uniform definition and method of evaluation to achieve homogeneity among studies. Standardization of the operative technique, as well as "centralizing" pancreatic resections in high-volume centers, should aid to improve the occurrence of this bothersome postoperative complication.

Cisapride↗
PubMed2006

Effects of intragastric L-arginine administration on proximal stomach tone under basal conditions and after an intragastric diet.

Nitric oxide (NO) plays an important role as a nonadrenergic, noncholinergic inhibitory neurotransmitter in the GI tract. Our study aims were to investigate the effect of a single intragastric L-arginine (L-Arg) administration, as a source of NO, on proximal stomach tone in basal and postintragastric administration of a polymeric diet in humans and to evaluate concomitantly the effect on antral area as an indirect assessment of gastric emptying. Eight healthy volunteers were studied in a randomized double-blind crossover study after, respectively, 15 g L-Arg, 30 g L-Arg, or placebo administered in the stomach through a gastric tube. The drug administration was followed by a polymeric diet infusion (500 ml/500 kcal) at a rate of 250 ml/hr. Gastric tone variations were recorded with an electronic barostat, gastric emptying was concomitantly estimated by repeated ultrasound measurements of antral area, and symptoms were recorded throughout the experiment.L-Arg administration was associated with significantly higher increases in barostat bag volumes at both dosages, 30 g (117+/-16 ml) and 15 g (67+/-15 ml), compared to placebo (46+/-11 ml; P < 0.05). In response to the polymeric diet the 30-g L-Arg challenge was associated with a smaller increase in intrabag volume, whereas postinfusion final volumes did not differ in the three treatment conditions. Antral areas were not different at any time of measurement among the three challenges. Bloating and diarrhea were observed after 30-g L-Arg administration in five subjects of eight. Short-term L-Arg administration was able to induce proximal stomach relaxation that allowed a secondary response to enteral feeding only at the 15-g dosage. This 15-g dosage was as well tolerated as the placebo and was associated with no significant changes in gastric emptying patterns.

Adult↗
PubMed1986

Gastric processing and emptying of fat.

This study was undertaken to determine whether fat leaves the stomach within or bound to the surface of particles of solid food. We studied gastric emptying of fat in 6 human subjects and in 6 dogs with Roux-en-Y duodenojejunostomies so that chyme leaving the stomach could be collected free of bile and pancreatic enzymes. Humans were studied with a duodenal multilumen tube so that phase-specific, nonabsorbed markers in the meal could be tracked with corresponding, phase-specific markers perfused into the duodenum. In this way, we observed the separate time-courses of gastric emptying of the aqueous and solid phases, as well as the extracellular fat (ECF) and intracellular fat (ICF) phases of the meal. In the dogs, all chyme leaving the stomach was collected from a Roux-en-Y fistula and was analyzed directly for aqueous, solid, ECF, and ICF markers in the meal. In both the humans and the dogs, the aqueous phase emptied promptly, whereas the solid, ECF, and ICF phases emptied together, in parallel, after an initial lag. In humans, 22% of the ECF versus 51% of the ICF (p less than 0.02) emptied on or in the solid food particles. In dogs, 81% of the ECF emptied as an oil, 13% emptied on the solid particles, and only 6% emptied as a stable, aqueous emulsion. Sixty-six percent of the ICF emptied in the solid food particles, 20% as a stable, aqueous emulsion, and 14% as an oil. We conclude that most of the ICF empties within the solid food phase, whereas most of the ECF empties as an oil phase.

Animals↗
PubMed1986

Bile reflux is increased in cigarette smokers.

The effect of cigarette smoking on gastric emptying, gastric secretion, and bile salt reflux was measured in 19 healthy habitual cigarette smokers (greater than or equal to 20 cigarettes per day) and 18 nonsmokers. They were studied both in the fasting state and after being fed a mixed liquid meal. Ten of the smokers were studied twice, when smoking and when not, in randomized order. Smokers had lower basal gastric secretion rates than nonsmokers irrespective of actually smoking or not. In smokers, bile salt reflux and postprandial gastric bile salt concentration were higher than in nonsmokers even when not actually smoking (p less than 0.01). Smoking during the experiment slowed gastric emptying, and increased bile salt reflux rate and gastric bile salt concentration (p less than 0.01). It is concluded that cigarette smoking has both chronic and acute effects on gastric function, and that bile salt reflux may contribute to the increased incidence, and lower healing rate, of gastric ulcers in smokers.

Adult↗
PubMed1989

Aortoesophageal fistula arising as a complication of prolonged nasogastric tube placement.

Aortoesophageal fistula is a rare disorder that may result from many causes. In this report, we describe the unique case of a 71-year-old woman who developed an aortoesophageal fistula following prolonged placement of a nasogastric tube. The presence of dense fibrous adhesions between the aorta and esophagus may have facilitated the development of aortoesophageal fistula in this patient.

Aged↗
PubMed2004

A prospective cohort study of feeding needle catheter jejunostomy in an upper gastrointestinal surgical unit.

BACKGROUND & AIM: Feeding jejunostomy is recommended to facilitate early enteral nutrition after major upper gastrointestinal surgery. We aimed to determine the benefits and risks associated with routine practice of feeding needle catheter jejunostomy (NCJ) in high-risk upper gastrointestinal surgery. METHOD: This is a prospective consecutive cohort study of 84 patients underwent feeding NCJ over a 3 years period in an Upper Gastrointestinal Surgical Unit. RESULTS: Feeding NCJ was placed after two-stage oesophago-gastrectomy in 24 patients (28.6%), after gastrectomy in 29 patients (34.5%), after liver resections in 7 patients (8.3%), pancreatic resection in 6 patients (7.1%), bile duct reconstruction in 8 patients (9.5%) and other operations in 10 patients (12%). The mean (SE) estimated nutritional requirement per 24 h was 1791 (31)kcal. Eighty-two patients (98%) started enteral feed on day 1 after surgery. Fifty-seven patients (68%) achieved the target nutritional requirements in 3 days. Four patients were discharged home on jejunal feed whilst only two patients required parenteral nutrition support. The rest tolerated full oral diet. There was no procedure related mortality. The morbidity related to feeding tube and feeding were 12.9% and 20%, respectively. CONCLUSIONS: Routine practice of feeding NCJ is safe. Their benefits outweigh the risks in a specialist centre.

Catheterization↗