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PubMed1984

Electrophysiological study of vagal afferent and efferent units in conscious sheep.

Crossed-nerve anastomoses were performed to record activity of vagal efferents and afferents during regurgitation and eructation in conscious sheep. Following anastomoses of the central end of a vagus nerve to the peripheral end of a phrenic nerve, discharges in units of the diaphragm reinnervated by vagal efferent neurones were associated with contractions of the caudal oesophagus and of the rumen. During regurgitation in the course of rumination, discharges in oesophageal efferents consisted of a characteristic pattern of two bursts in a constant association with the additional phase of the reticular contraction and the more forceful inspiratory effort. Discharges in two types of units bore a temporal relation with the motor gastric cycles. Early units are interpreted as innervating pillars of the rumen and late units its dorsal wall. Regular patterns of discharge were recorded during successive A sequences of rumen contractions. In contrast, there was a variability of pattern of activity of efferents during B sequences: a constant time relationship was not observed between discharges of both types of units. During B sequences accompanied by eructation, the most characteristic pattern in gastric and oesophageal units had the following features: the impulses in the early units increased in frequency, outlasted the discharge in the late units by 1 s and ended when a brief discharge was recorded in an oesophageal unit at the time of eructation. It is suggested from the patterns of discharge observed in both gastric and oesophageal efferents that the orderly sequence which achieves regurgitation and eructation results from the central co-ordination of efferent output. Following anastomoses of the central root of the nodose ganglion to the peripheral end of the accessory nerve, discharges in units of the mastoido-humeral muscle reinnervated by vagal afferent axons were associated with contractions of the oesophagus and movements of the larynx during swallowing and regurgitation. Discharges in oesophageal afferents coming from the caudal oesophagus were coincident with discharges observed in the vagal efferent fibres innervating this part of the oesophagus. Afferents from the pharynx and the larynx were active at the same time as the nasopharynx and the glottis were demonstrated to be closed. Thus the major characteristics of the afferents the traffic of which has been recorded in cross-sutured sheep in the course of rumination is that their discharges are occurring at the same time as motor events are developing.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Symptomatic outcome after laparoscopic cholecystectomy.

AIMS: Patients with gallstones often present with multiple complaints. We wanted to study the major complaints of our patients undergoing laparoscopic cholecystectomy and the symptomatic relief afforded by the operation. METHODS: We studied 113 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy in a single surgical unit. Patients with proven common bile duct stones, obstructive jaundice, cholangitis, present or past associated abdominal pathology or cholecystoenteric fistula were excluded from the study. The mean follow up period was 18 months (range 10-22 months). A detailed account of the symptoms of gallstones, length of post-operative stay, persistence of symptoms, development of fresh symptoms and resumption of fat containing diet were assessed. RESULTS: The male to female ratio was 1:4. Common presenting symptoms were abdominal pain (96%), flatulence or feeling of fullness of abdomen (85%), heartburn (66%), belching (62%), sour eructation (52%), vomiting (48%) and nausea (45%). Mean postoperative hospital stay was 28 hours (range 9-68 hours). Biliary pain was relieved in 99% of patients after laparoscopic cholecystectomy (p < 0.001). The non-pain symptoms which are relieved significantly (p < 0.001) included nausea (98%), vomiting (96%) and sour eructation (92%) had better outcome than belching (64%) flatulence (61%) and heart burn (59%). None of the patients developed jaundice after cholecystectomy. Fresh symptoms that developed after laparoscopic cholecystectomy were heart-burn (6%), belching (3.5%), sour eructation (1%) and vomiting (0.5%). Post-cholecystectomy post-prandial diarrhoea occurred in 20% of the patients. The patients' appreciation of a satisfactory cosmetic result of operation scars was 100 percent. Fifteen female patients (13.5%) complained of increased weight gain of more than 5 kg after laparoscopic cholecystectomy [(p > 0.05; not significant (NS)]. CONCLUSION: Laparoscopic cholecystectomy significantly relieved symptoms of gall stone disease. Biliary pain, nausea, vomiting and sour eructations had better outcome compared to belching, flatulence and heartburn, which are also relieved in majority. Postcholecystectomy post-prandial diarrhea was a significant new symptom after cholecystectomy. Pre-operative flatulence and heartburn are risk factors for poor symptom relief. All patients should be pre operatively counselled about the risk of persistence of some non-pain symptoms after laparoscopic cholecystectomy.

Adolescent↗
PubMed1990

Symptomatic differentiation of duodenal from gastric fistulas in Crohn's disease.

Fistulization to the duodenum or stomach from a diseased segment of bowel in Crohn's disease is rare, with only 63 cases reported. We report an additional two cases of Crohn's disease with recurrent fistulization to the duodenum. Although one or both patients complained of pain, diarrhea, and/or weight loss at presentation, neither of them experienced vomiting or feculent eructation. A review of 46 of the 63 reported cases of gastric and duodenal fistulization indicated that patients with gastric fistulas commonly present with vomiting (39%), and with histories of feculent eructations or frank feculent vomiting (44%), but that patients with duodenal fistulas rarely present with vomiting (3.6%), and never have feculent vomiting or eructations. This difference is an important clue to the diagnosis and localization of upper gastrointestinal fistulas in Crohn's disease.

Adult↗
PubMed2005

Bloating and intestinal gas.

The most common symptoms associated with intestinal gas are eructation, flatulence, abdominal bloating, and distention. Aerophagia is an uncommon cause of eructation in which repetitive air swallowing results in belching, abdominal distention, and increased flatus. Few therapies have been shown to be effective in treating these symptoms. Eructation can be treated by decreasing excessive air swallowing. Occasionally, behavioral therapy and psychotherapy are employed. Bloating, distention, and other gas-related symptoms are common in functional gastrointestinal disorders; however, their pathophysiology is poorly understood. Additionally, evidence supporting the use of various available therapies in treating gas-related symptoms is either absent or poor. Dietary therapy may be effective in patients with excessive gas production. Excessive gas production, identified by increased flatus, may benefit from a low-carbohydrate diet. Many patients with gas-related symptoms have normal gas production but may have either impaired gas transport or transit through the gut or visceral hypersensitivity. Few studies have addressed the treatment of impaired gas transport.

Journal Article↗
PubMed2004

Rumen metabolites serve ticks to exploit large mammals.

Hard ticks spend most of their life isolated from passing vertebrates but require a blood meal to proceed to the next life stage (larva, nymph or adult). These opportunist ectoparasites must be capable of anticipating signals that render suitable hosts apparent. Large ungulates that tolerate a high ectoparasite burden are the favoured hosts of adult hard ticks. Ruminants, comprising the majority of ungulate species, must regularly eruct gases from the foregut to relieve excess pressure and maintain a chemical equilibrium. Through eructations from individuals, and particularly herds, ruminants inadvertently signal their presence to hard ticks. Here, we report that all adult hard tick species we tested are attracted to cud and demonstrate that these acarines possess olfactory receptor cells for the carboxylic acid, phenol and indole end-products of the rumen bioreactor. Compounds from each of these classes of volatiles attract ticks on their own, and mixtures of these volatiles based on rumen composition also attract. Appetence for rumen metabolites represents a fundamental resource-tracking adaptation by hard ticks for large roaming mammals.

Animals↗
PubMed1988

Ultrastructural study of the alveolar-capillary membrane and the tubular endoplasmic reticulum in alveolar type I cells of the caprine lung.

The ultrastructural features of alveolar type I cells of the goat lung were studied by using vascular perfusion and direct airway instillation of fixatives. The morphological features of smooth endoplasmic reticulum (SER) were characterized by measuring the diameter of individual SER tubules which conformed in size and appearance to the tubular endoplasmic reticulum (TER) already described in various types of epithelium. The TER appeared as large tubular aggregates in a palisade arrangement; these aggregates ramified into various areas of the extended cytoplasm of alveolar type I cells. The TER also existed as a mixture of short cisternae and vesicles, and glycogen alpha particles were present in the non-perikaryonic portion of the cell. The different forms of TER had varying relationships to the plasmalemma. The interchangable configurations seen in the structure of TER indicated the functional modalities of the cells and were comparable to similar structural modifications in electrolyte-secreting cells. The role of TER, microtubules, and large populations of endocytic vesicles in the alveolar type I cells in the goat lung is examined in the context of physiological eructation of rumenal gases and the absorption of electrolyte-rich fluids which escape into the lung at each eructation in ruminants.

Animals↗
PubMed2001

Intestinal Gas.

The most common symptoms associated with intestinal gas are excessive eructation, flatulence, and abdominal bloating and distention. Unfortunately, few therapies have been shown to be effective in treating these symptoms. Excessive eructation can be treated by decreasing excessive air swallowing. Bloating and gaseous distension can improve in some patients by avoiding foods containing partially digested or absorbed polysaccharides, by taking replacement enzymes (such as alfa-galactosidase or lactase), or by taking antibiotics directed toward altering the colonic flora. Activated charcoal or prokinetic agents (such as tegaserod and metoclopramide) also can be effective options in some patients. For noxious odor associated with flatus, bismuth subsalicylate or the charcoal cushion may improve patients' symptoms.

Journal Article↗
PubMed2004

Treatment of Excessive Intestinal Gas.

Symptoms of excessive intestinal gas may be related to eructation, excessive or odoriferous gas evacuation, and/or abdominal symptom attributed to gas retention. Patients with aerophagia and excessive eructation can be usually retrained to control air swallowing, but if present, basal dyspeptic symptoms may remain. Patients with excessive or odoriferous gas evacuation may benefit from a low-flatulogenic diet. In patients with gas retention due to impaired anal evacuation, anal incoordination can be resolved by biofeedback treatment, which also improves fecal retention, and thereby reduces the time for fermentation. Other patients complaining of abdominal symptoms that they attribute to intestinal gas, probably have irritable bowel syndrome or functional bloating, and their treatment options specifically targeting gas-related symptoms basically include prokinetics and spasmolytics. There is no consistent evidence to support the use of gas-reducing substances, such as charcoal or simethicone.

Journal Article↗
PubMed1992

Transdiaphragmatic pressure measurement in cattle: technical data.

Techniques and methods required for accurate and reproducible measurements of transdiaphragmatic pressure (Pdi), were studied in seven-week and five-month-old calves. Since reliable pleural pressure measurement in cattle has already been described, separate experiments were conducted to compare retrodiaphragmatic pressures measured (i) with balloon-catheters and needle catheters, (ii) before and after eructation and (iii) in the ruminal and in the peritoneal cavities. Whereas respiratory-induced pressure changes were equally transmitted throughout the rumen content, a marked anteroposterior damping was observed as the recording site in the abdominal cavity was moved away from the diaphragm (P < 0.0001). It was concluded that the most appropriate and accurate way to measure Pdi changes in polygastric animals is to measure the pressure changes existing in the mid-thoracic portion of the oesophagus and in the liquid content of the rumen with balloon-tubing units. Neither growth- and diet-related rumen enlargement nor eructation, which are two typical characteristics of ruminants, altered the reliability of retrodiaphragmatic pressure measurements in the two age groups studied.

Abdomen↗
PubMed1985

Effect of ruminal CO2 on gas exchange and ventilation in the Hereford calf.

The contribution of ruminal CO2 to gas exchange measurements and ventilation was determined in four rumen-fistulated Hereford steers at rest and during exercise. The calves were exercised at 1.4 and 2.2m X s-1 under three treatments: 1)full rumen with fistula sealed, 2) full rumen with fistula open, and 3) empty rumen. Measurements also were made at rest while flushing the empty rumen with either 100% N2 or a mixture of 50% CO2-50% N2. O2 consumption, CO2 production (Mco2), and ventilation were measured by collecting the expired gas. Absorption across the ruminal epithelium during rest increased Mco2 by 3%, whereas absorption and eructation together increased Mco2 by 15%. The respiratory exchange ratio (R) was significantly different among the three treatments at rest, but no differences were observed in R among the treatments during exercise. No changes were observed in minute ventilation among the three conditions, but a decrease in respiratory frequency and an increase in tidal volume occurred when the rumen was empty. These changes in ventilatory pattern may have been due to a decrease in body temperature when the rumen was empty. When the empty rumen was flushed with 50% CO2, Mco2 was increased 21% over the value observed when flushing with 100% N2. CO2 of fermentation origin is added to the expired gas by both eructation and absorption and has a significant effect on R in the resting animal, but no effect on R during exercise.

Animals↗
PubMed2004

Efficacy and safety of pantoprazole versus ranitidine in the treatment of patients with symptomatic gastroesophageal reflux disease.

BACKGROUND/AIM: Gastroesophageal reflux disease (GERD) is a prevalent disease associated with a high symptom burden and a reduced quality of life. This multicenter, randomized, double-blind study compared relief from key GERD symptoms (heartburn, acid eructation, and pain on swallowing) and from other gastrointestinal symptoms (epigastric pain, vomiting, nausea, flatulence, retching, and retrosternal feeling of tightness) and safety profiles of the proton pump inhibitor pantoprazole and the H2 antagonist ranitidine in patients suffering from symptomatic GERD. METHODS: The patients [338 intention-to-treat (ITT) population; 284 per-protocol (PP) population] received 20 mg pantoprazole (once daily in the morning) plus ranitidine placebo (once daily in the evening; ITT n = 167, PP n = 136) or pantoprazole placebo (once daily in the morning) plus 300 mg ranitidine (once daily in the evening; ITT n = 171, PP n = 148) for 28 days. The primary efficacy criterion (ITT and PP populations) was relief from key GERD symptoms (heartburn, acid eructation, and pain on swallowing) after 28 days of treatment. Secondary criteria (PP) included relief from key GERD symptoms on day 14, relief from all gastrointestinal symptoms on days 14 and 28, and relief from key GERD symptoms on days 14 and 28. Safety evaluations included adverse events and laboratory assessments. RESULTS: Significantly more pantoprazole-treated patients were free from key GERD symptoms at day 28 (68.3%, n = 114) as compared with ranitidine-treated patients (43.3%, n = 74; 95% confidence interval for odds ratio 1.84-4.51). Pantoprazole was also significantly more efficacious in controlling all gastrointestinal symptoms of GERD. By day 28, 51.5% (n = 70) of the pantoprazole-treated patients were completely symptom free versus 31.1% (n = 46) of the ranitidine-treated patients (95% confidence interval for odds ratio 1.45-3.83). Both treatments were well tolerated. CONCLUSION: Pantoprazole is significantly superior to ranitidine in the treatment of key and associated gastrointestinal symptoms of GERD and is well tolerated.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

The efficacy of bismuth subsalicylate in relieving gastro-intestinal discomfort following excessive alcohol and food intake.

The safety and efficacy of bismuth subsalicylate in relieving the symptoms of gastro-intestinal distress due to excess ingestion of food and drink were evaluated in a randomized, double-blind, placebo-controlled, parallel-group study. Of the 132 healthy adult volunteers who were encouraged to overindulge in food and drink during a simulated cocktail/dinner party, 91 (68.9%) experienced symptoms of gastric distress and of these 43 were randomly assigned to receive bismuth subsalicylate and 48 placebo. Subjects took the formulation as needed every 30-60 min, with a maximum of eight doses during the 24-h study period. Subjects who received bismuth subsalicylate had significantly superior relief (P less than 0.01) of the individual symptoms of nausea, sense of fullness, heartburn, eructation, stomach pain and flatulence, as well as superior overall relief (P less than 0.02). The time between the first doses of medication and the attainment of good or excellent relief was also significantly shorter (P less than 0.01) in the bismuth subsalicylate-treated subjects for the individual symptoms of nausea, sense of fullness, heartburn and eructation. There were no adverse reactions.

Abdominal Pain↗
PubMed1985

[Completed calibrated fundoplication].

Complete fundoplication at present is the most effective surgical treatment of gastro-oesophageal reflux. However, it has a number of side-effects, including post-operative dysphagia, inability to eructate and painful gastric distension. Fifty-five patients were operated upon using a technique which comprises wide gastric release and fabrication of a tension-free valve around a 50F probe introduced through the mouth. After 1 year, 94% of patients were free of reflux and 22% had mild dysphagia. After 3 years, the proportion of reflux-free patients still was 94%; 12% suffered from mild dysphagia and 6% had problems with eructation. Thus, calibration of the oesophagus with a 50F probe reduces the side-effects of complete fundoplication while remaining effective against gastro-oesophageal reflux.

Esophagus↗
PubMed2007

Effect of antisecretory therapy on atypical symptoms in gastroesophageal reflux disease.

The effect of proton pump inhibitor (PPI) therapy on extraesophageal or atypical manifestations of gastroesophageal reflux disease (GERD) remains unclear. This study aimed to evaluate the prevalence of atypical manifestations in patients with acid reflux disease and the effect of PPI treatment. Patients with symptoms and signs suggestive of reflux were enrolled. Erosive esophagitis was stratified using the Los Angeles classification. Demographic data and symptoms were assessed using a questionnaire and included typical symptoms (heartburn, regurgitation, dysphagia, odynophagia), and atypical symptoms (e.g., chest pain, sialorrhea, hoarseness, globus sensation, chronic coughing, episodic bronchospasm, hiccup, eructations, laryngitis, and pharyngitis). Symptoms were reassessed after a 3-month course of b.i.d. PPI therapy. A total of 266 patients with a first diagnosis of GERD (erosive, 166; non-erosive, 100) were entered in the study. Presentation with atypical symptoms was approximately equal in those with erosive GERD and with non-erosive GERD, 72% vs 79% (P = 0.18). None of the study variables showed a significant association with the body mass index. PPI therapy resulted in complete symptom resolution in 69% (162/237) of the participants, 12% (28) had improved symptoms, and 20% (47) had minimal or no improvement. We conclude that atypical symptoms are frequent in patients with GERD. A trial of PPI therapy should be considered prior to referring these patients to specialists.

Adult↗
PubMed2000

An understanding of excessive intestinal gas.

Complaints of "excessive gas" from patients are very common but are difficult, if not impossible, for the physician to document. This review addresses the pathophysiology and management of such complaints, looking at the sources and routes of elimination, excessive eructation, bloating, and distention. In addition, common flatulence problems are summarized, including excessive flatus volume and noxious flatus.

Bismuth↗
PubMed1988

Elevated intra-rumen pressure and secondary rumen contractions in sheep (Ovis aries).

1. Sheep rumens were insufflated with nitrogen to 5, 10, 15, and 20 cm water pressure and sustained at each pressure for 10 min. 2. Measurements included rumen motility, reticulorumen myoelectric activity, eructation frequency and volume, changes in tracheal pressure and rumen contraction amplitude. 3. As intra-rumen pressure increased, contractions designated as special secondary contractions appeared. 4. At a pressure of approximately 15 cm water, most of the special secondary contractions became regular secondaries; therefore, the special secondaries were called pro-secondary contractions. 5. Increased intra-rumen pressure was associated with respiratory distress. The recovery phase following, rumen insufflation was accompanied by hyperpnea.

Animals↗
PubMed1976

Rates of production of methane in the rumen and large intestine of sheep.

1. An isotope tracer method for estimating methane production in sheep is described. 2. The technique was used to estimate methane produced in both the upper and lower digestive tract and to determine the routes by which it was excreted. 3. Four Merino ewes given lucerne chaff (33 g every hour) were used. 4. Total methane production rate was 21 +/- 1-1 (SE) ml/min; production in the rumen accounted for 87 +/- 1-2% of the total production; 95 +/- 1-4% of the methane produced in the rumen was excreted by eructation. 5. Of the methane produced in the lower digestive tract, 89 +/- 2-3% was excreted through the lungs and 11% through the anus.

Anal Canal↗
PubMed1996

Uses of hypnosis in the treatment of uncontrollable belching: a case report.

Uncontrollable belching is frequently benign in origin, but can be distressing in its psychosocial consequences. Physicians have little to offer in the way of medical treatment. This is a case report of a 71-year-old woman with incessant eructation of four months duration treated with brief psychotherapy utilizing hypnosis. The patient was symptom-free at termination, and this improvement was sustained at six month follow-up. This paper includes a detailed description of some of the hypnotic suggestions as well as a discussion of the factors that may have contributed to change.

Aged↗