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PubMed2002

High prevalence of toxin A-negative toxin B-positive Clostridium difficile in hospitalized patients with gastrointestinal disease.

The incidence of Clostridium difficile toxin A-negative toxin B-positive in hospitalized patients with severe gastrointestinal disease was evaluated. Of 530 stool specimens tested in parallel by two immunoassay tests, Tox A and Tox A/B (TechLab, Inc., Blacksburg, VA), 422 produced negative results on both tests. One hundred eight specimens (20.4%) tested positive by Tox A/B assay, and only 47 of them were also positive by Tox A. The 61 specimens with discrepant results were confirmed to be positive for toxin B by tissue culture cytotoxicity assay. Furthermore, 3 of the 422 specimens that were negative by enzyme immunoassay tested positive by cytotoxicity assay. The sensitivity and specificity of the Tox A/B test were 95.3% and 100%, respectively, with negative and positive predictive values of 99.3% and 100%, respectively, and a correlation rate of 99.4%. The high prevalence (56.5%) of specimens from symptomatic patients having detectable toxin B, but undetectable toxin A emphasizes the importance of using diagnostic tests that include toxin B. Furthermore, our data support the potential role of toxin B in the pathogenesis of toxigenic Clostridium difficile.

Bacterial Proteins↗
PubMed2006

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria.

BACKGROUND: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. OBJECTIVE: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. METHODS: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as "gold" standard. RESULTS: Males constituted 53.4% of subjects and mean age was 45 years (+/- 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. CONCLUSION: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses.

Adolescent↗
PubMed1974

Design and evaluation by nitrogen balance and blood aminograms of an amino acid mixture for total parenteral nutrition of adults with gastrointestinal disease.

This study was undertaken to assess the efficacy of an amino acid mixture formulated for intravenous use from estimates of requirements for essential amino acids of human adults, and from data previously derived from a study using casein hydrolysate as the amino acid source. This mixture contained 39.4% essential amino acids, with glycine, alanine, arginine, histidine, and proline selected to supply the nonessential nitrogen. Nitrogen balance and blood aminograms were measured in six adult patients with gastrointestinal disease, fed intravenously for 1 wk at each of three levels of amino acid intake, while all other nutrients were constant and adequate in relation to body weight. Four of the patients were then fed 1.0 g/kg of egg or meat protein orally for 1 wk at the end of the 3 wk study, while all nutrients other than the amino acids were fed intravenously. Average nitrogen balances of -0.8, 0.5, and 2.2 g/day were observed when the amounts of amino acids infused were 0.25, 0.5, and 1.0 g/kg, respectively. Fasting levels of threonine, glycine, cystine, methionine, isoleucine, tryptophan, and arginine, but not of the other amino acids, increased with the increment in input, although the levels were generally lower than normal. The increase in blood concentration observed during infusion was similar for each of the essential amino acids, indicating that the supply of each of the amino acids was much better balanced for utilization than casein hydrolysate. However the blood aminograms did suggest that some changes in composition of the mixture for the malnourished adult were desirable, such that the amino acid mixture resembled that needed by the normal growing child. Nitrogen balance in the four patients fed orally with high-quality protein averaged 2.0 g/day, showing that an amino acid mixture given intravenously, provided it is well-balanced, can be utilized as efficiently as protein given orally. It is concluded that the prediction of oral requirements for amino acids should be combined with observations on changes in blood aminograms during infusion over a range of amino acid input in the development of amino acid mixtures for intravenous feeding.

Adult↗
PubMedDate not supplied

New trends in non-absorbable antibiotics in gastrointestinal disease.

Numerous antibiotics have been used for several years in the treatment of intestinal diseases, the majority belonging to the class of aminoglycosides. These are effective against gram-positive and some gram-negative bacteria, above all aerobes, and do not therefore cover the entire range of microorganisms responsible for intestinal infections. With these antibiotics, moreover, it is not possible to exclude intestinal absorption which can lead to serious side effects. Other intestinal antibiotics, however, such as Vancomycin, have a restricted spectrum of action which limits their use. This study analyzes the pharmacological characteristics of a new non-absorbable antibiotics with particularly interesting properties from a clinical pharmacokinetic and pharmacodynamic point of view: Rifaximin. This drug has an extremely broad spectrum of action covering all intestinal germs, and its absorption is practically zero. The results of some controlled clinical studies in gastrointestinal diseases are examined, such as the treatment of infectious diarrhoea, of acute or chronic portal-caval encephalopathy and of diverticular disease of the colon. The possible role of Rifaximin in some intestinal diseases, such as small bowel bacterial overgrowth and Crohn's disease and ulcerative colitis, is also analyzed.

Bacterial Infections↗
PubMed1998

A simple method for carbohydrate-deficient transferrin measurements in patients with alcohol abuse and hepato-gastrointestinal diseases.

Carbohydrate-deficient transferrin (CDT) is known to be increased in alcohol abuse. Several methods were developed for its measurement (e.g. isoelectric focusing with Western blotting or immunofixation, anion-exchange chromatography followed by immunoassays). We describe a greatly simplified isoelectric focusing technique which does not require immunofixation. CDT results obtained with this method were compared to other biological markers of alcohol abuse, i.e. mean corpuscular volume (MCV), aspartate aminotransferase (ASAT) and gamma-glutamyl-transferase (GGT), in 55 patients distributed in three groups (i.e. healthy control subjects, control patients suffering from various hepato-gastrointestinal diseases and alcohol abusing patients). Sensitivity and specificity were 33-89%, 61-57%, 89-49% and 83-100% for MCV, ASAT, GGT and CDT, respectively. We conclude that our method is highly suitable for routine clinical use.

Alcoholism↗
PubMed2003

Cannabinoids for gastrointestinal diseases: potential therapeutic applications.

Delta(9)-Tetrahydrocannabinol (the active ingredient of marijuana), as well as endogenous and synthetic cannabinoids, exert many biological functions by activating two types of cannabinoid receptors, CB(1) and CB(2) receptors. CB(1) receptors have been detected on enteric nerves, and pharmacological effects of their activation include gastroprotection, reduction of gastric and intestinal motility and reduction of intestinal secretion. The digestive tract also contains endogenous cannabinoids (i.e., the endocannabinoids anandamide and 2-aracidonylglycerol) and mechanisms for endocannabinoid inactivation (i.e., endocannabinoids uptake and enzymatic degradation). Cannabinoid receptors, endocannabinoids and the proteins involved in endocannabinoids inactivation are collectively referred as the 'endogenous cannabinoid system'. A pharmacological modulation of the endogenous cannabinoid system could provide new therapeutics for the treatment of a number of gastrointestinal diseases, including nausea and vomiting, gastric ulcers, irritable bowel syndrome, Crohn's disease, secretory diarrhoea, paralytic ileus and gastroesophageal reflux disease. Some cannabinoids are already in use clinically, for example, nabilone and delta(9)-tetrahydrocannabinol are used as antiemetics.

Animals↗
PubMed1986

Peptide YY abnormalities in gastrointestinal diseases.

Plasma concentrations of peptide YY (PYY), a newly isolated peptide produced by ileal and colonic endocrine cells, were measured in several groups of patients with digestive disorders after a standardized normal breakfast. Peptide YY levels were found to be grossly elevated in patients with steatorrhea due to small intestinal mucosal atrophy (tropical sprue). Basal levels in these patients were 79 +/- 18 pM, which was nearly 10-fold higher than those seen in healthy controls (8.5 +/- 0.8 pM). Patients with steatorrhea due to chronic destructive pancreatitis also had substantially increased basal PYY levels (47.5 +/- 6.3 pM), and their postprandial response was also greater than that of normal subjects. Moderately elevated plasma PYY concentrations were seen in patients with inflammatory bowel disease and patients recovering from acute infective diarrhea. In contrast, patients with diverticular disease, duodenal ulcer, and functional bowel disease had normal PYY responses. These changes in the secretion of PYY responses. These changes in the secretion, may shed light on the physiologic role of this newly discovered peptide and on intestinal adaptation to common digestive disorders.

Adult↗
PubMed1993

[The use of imaging procedures in gastrointestinal diseases with space-occupying lesions in children].

Sonography is gaining in importance for examination of childhood illnesses of the gastrointestinal tract. Disadvantages of ultrasound result from the gaseous elements naturally contained in the intestine. Tumors of the digestive tract can be best classified on the basis of their relationship to the tract wall and their intra- or extraluminal location. The type of echogenicity can also aid diagnosis. A differentiation between infectious pseudotumors and neoplasms is thus often possible when sonographic images are considered in combination with clinical and laboratory data. The systematic use of ultrasound also allows more precise application of endoscopy and other imaging techniques.

Child↗
PubMed1983

Actual role of pepsinogen group I in the study of upper gastrointestinal diseases.

The role of serum PG I in screening patients with chronic atrophic gastritis and gastric cancer, and in detecting peptic ulcer patients with high relapse risk, was ascertained in 276 subjects. Although not diagnostic per se, PG I was found to be under 20 micrograms/L in patients with chronic atrophic gastritis and in some gastric cancer or partially gastrectomized patients. In patients presenting with relapsing duodenal ulcer, PG I values were significantly higher than in the non-relapsing ones, but a satisfactory identification of all the duodenal ulcer patients with high relapse risk was not possible on this basis. Even the correlation between PG I and MAO was not accurate in every subject considered. These results suggest that the value of PG I is limited to assessing patients with upper gastrointestinal diseases in which a reduction of peptic secretion, and therefore of PG I in serum, is present.

Duodenal Ulcer↗