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The effects of dietary sucrose and the concentration of plasma urea and rumen ammonia on the degradation of urea in the gastrointestinal tract of cattle.

1. The rates of entry of urea into plasma, of urea degradation in the gastrointestinal tract, and the partition of that degradation between the rumen and post-ruminal tract were determined by use of [14C]urea and NaH14CO3 in Hereford steers receiving hay diets with or without sucrose. The concentrations of plasma urea and rumen ammonia were varied by infusions of urea into the rumen or abomasum. 2. For all diets, plasma urea concentration was related to urea entry rate, to degradation of urea in the whole gastrointestinal tract, and to its degradation in the post-ruminal tract, but the relationship with its degradation in the rumen was poor. 3. Degradation of urea in the rumen was related in a multiple regression in a curvilinear manner in three groups of diets (pasture-hay alone, pasture-hay--lucerne (Medicago sativa) mixtures, diets with sucrose), and negatively to rumen ammonia concentration for pasture-hay diets, and diets with sucrose. 4. Ruminal clearance of urea (rate of urea degradation per plasma urea concentration) was negatively related to the rumen ammonia concentration for steers given diets with sucrose, of pasture-hay with or without urea infusions. Provision of sucrose in the diet significantly increased clearance. 5. Enhanced urea degradation in the rumen associated with dietary sucrose supplements accounted for 0.4 of additional microbial N synthesis in the rumen. 6. The partition of transfer of urea to the rumen via saliva and through the rumen wall is discussed.

Ammonia↗

Primary gastrointestinal tract lymphoma--a clinico-pathological study of 28 cases.

A retrospective study of 28 patients with primary gastrointestinal tract lymphoma is presented. There were 27 cases of non-Hodgkin's lymphoma and one case of Hodgkin's disease. The patients with non Hodgkin's lymphoma of the gastrointestinal tract represented 10% of all non-Hodgkin's lymphoma cases seen at the Royal Adelaide Hospital/Institute of Medical and Veterinary Science complex over the six year survey period, 1972-1977. Of the patients with non-Hodgkin's lymphoma, 26 cases were diffuse type, and one case was nodular type. There was a M/F sex preponderance of 2 . 8/1, and 70% of cases were aged between 40 and 69 years. The commonest site was the stomach (19 cases), followed by small intestine (7 cases), and one case involved large intestine. At initial presentation, the disease was confined to the affected viscus (Stage IE) in seven patients (25%), and in 12 patients (43%) the disease involved viscus and regional lymph nodes (State IIE). The one patient with Hodgkin's disease had involvement of the large intestine, abdominal lymph nodes and bone marrow (Stage IV). This study was retrospective, and a management protocol was not employed. However, of the seven patients presenting with Stage IE disease, six cases had diffuse poorly differentiated lymphocytic lymphoma. Five of these patients were treated by surgical resection alone, and were in complete remission at follow-up of 66 to 103 months. In order to compare realistically the survival of different groups of patients with primary gastrointestinal lymphoma, we consider that a prospective multicentre clinical trial with comprehensive staging procedures, uniform histological classification and accepted management protocol is warranted.

Adult↗

Distinct expression of splice variants of neuronal nitric oxide synthase in the human gastrointestinal tract.

BACKGROUND & AIMS: Changes of neuronal nitric oxide synthase (nNOS) expression have been linked to several human gastrointestinal disorders such as achalasia, diabetic gastroparesis, and hypertrophic pyloric stenosis. They could be caused by differential transcriptional control or alternative splicing generating different nNOS proteins. The aims of this study were to characterize 5'-splice variants, promoter usage, and site-specific expression of nNOS in the human gastrointestinal tract. METHODS: 5'-Splice variants were characterized by immunoblotting, reverse-transcription polymerase chain reaction, 5'-rapid amplification of complementary DNA ends, and Southern blotting. Genomic analysis was performed by rapid amplification of genomic ends, followed by reporter gene assays. RESULTS: Six different 5'-splice variants of nNOS-messenger RNA were identified showing specific expressions at various sites of the human gastrointestinal tract. Three variants encode for nNOSalpha, which has a specific N-terminal PDZ/GLGF domain and interaction sites for regulatory proteins. Two variants encode for nNOSbeta and 1 for nNOSgamma, which both lack the protein-binding domains of nNOSalpha. In addition to 2 known first exons, a novel first exon of human nNOS with a separate functionally active downstream promoter and multiple binding sites for transcription factors was identified and characterized. CONCLUSIONS: Six 5'-mRNA splice variants of nNOS encoding 3 different nNOS proteins are expressed in the human gut. The differential expression of these proteins could be implicated in different biological functions.

Alternative Splicing↗

Primary and metastatic diseases in malignant melanoma of the gastrointestinal tract.

In this review, the gastrointestinal (GI) manifestations of malignant melanoma including primary mucosal melanoma of the GI tract and metastatic melanoma to the GI tract are discussed. Although malignant melanoma most commonly arises in the skin, primary melanomas can also arise from the mucosal epithelial lining of the gastrointestinal tract. The vast majority of gastrointestinal melanoma is metastatic from a cutaneous primary; however, there is evidence that melanoma can arise de novo from within certain areas of the gastrointestinal system. The sporadic nature and small numbers of patients reported in the literature with mucosal melanomas have prevented a good understanding of the pathogenesis, natural history, and optimal treatment of this uncommon presentation of melanoma.

Diagnosis, Differential↗

Changes of enzyme activities recognized in lymphocytes from patients with carcinoma of the gastrointestinal tract.

Adenosine triphosphatase (ATPase) activity and acid phosphatase activity in lymphocytes from patients with carcinoma of the gastrointestinal tract were determined in order to investigate whether or not changes in these enzyme activities has any relation to the immune reactivity of carcinoma-bearing patients. In patients with a performance status of more than 60%, the mean value of the total ATPase activity in lymphocytes differed little from that in controls, but the mean value of the oligomycin-sensitive ATPase activity decreased as compared to that in the controls. On the other hand, the mean values of the activities of both free and total acid phosphatase in lymphocytes increased as compared to those in controls. The mean values of the activities of both ATPase and acid phosphatase in lymphocytes from patients whose performance status was less than 50% decreased as compared to those from controls and patients whose performance status was more than 60%. The change of the activities of both ATPase and acid phosphatase in lymphocytes has relation to that of the immunological parameters of the patients with carcinoma of the gastrointestinal tract. These results indicate that both ATPase and acid phosphatase in lymphocytes may play an important role in the immune mechanism.

Acid Phosphatase↗

Immunohistochemical study of the distribution of endocrine cells in the gastrointestinal tract of the lesser mouse deer (Tragulus javanicus).

The occurrence and distribution of endocrine cells in the gastrointestinal tract of the lesser mouse deer, Tragulus javanicus, were studied immunohistochemically. Fourteen types of endocrine cells immunoreactive for serotonin, somatostatin, enteroglucagon, pancreatic glucagon, bovine pancreatic polypeptide (BPP), gastrin, substance P, motilin, gastric inhibitory polypeptide (GIP), cholecystokinin (CCK), methionine-enkephalin-Arg6-Gly7-Leu8 (MENK-8), secretin, neurotensin, peptide tyrosine tyrosine (PYY) and chromogranin were revealed. Chromogranin-, serotonin-, somatostatin- and enteroglucagon-immunoreactive cells were detected in all regions examined, while pancreatic glucagon-immunoreactive cells, except in the proper gastric gland region, were not found in other regions of the gastrointestinal tract. Few BPP-immunoreactive cells in either the proper gastric gland or pyloric gland regions and abundant gastrin-immunoreactive cells in the pyloric gland region were observed. Restricted distributions of substance P-, GIP-, gastrin-, motilin-, CCK-, MENK-8-, secretin-, neurotensin- and BPP-immunoreactive cells in the small intestine, and BPP-, substance P-, PYY- and motilin-immunoreactive cells in the large intestine were noted. The important findings include the presence of BPP-immunoreactive cells in the abomasum, pancreatic glucagon-immunoreactive cells in the proper gastric gland region, and substance P- and motilin-immunoreactive cells in the large intestine. It is suggested that the distribution pattern of gut endocrine cells in the lesser mouse deer is more similar to that in the pig than in the domestic ruminants so far reported.

Abomasum↗

Nitric oxide concentration in the gas phase of the gastrointestinal tract in man.

Nitric oxide (NO) has been implicated in various aspects of physiological regulation in the gastrointestinal tract. Hence, measurement of luminal NO concentrations is of interest for studying physiological and pathophysiological alterations in NO generation; however, at present, no reliable measurement techniques are available. Here we describe novel approaches for measurement of NO concentrations directly in the gas phase of the stomach and colon in healthy subjects and patients. Studies were conducted in young healthy volunteers (n = 13), intensive care patients (n = 8) and patients undergoing gastroscopy (n = 8) or colonoscopy (n = 8). NO concentrations were measured by chemolumininescence detection in air obtained through a nasogastric tube, after inflation into the stomach of a defined volume of air, or directly in the air suctioned from the endoscope. The mean NO concentration obtained from the stomach of healthy volunteers studied under baseline conditions was 18.0 +/- 2.8 (SEM) p.p.m. Day-to-day reproducibility of NO measurements was high. Tube feeding with a nitrite- and nitrate-free feeding solution left gastric NO concentrations unchanged, but standardized bicycle exercise caused an approximately 30% decrease in NO levels. NO concentrations in intensive care patients were approximately 2 log cycles lower than in healthy volunteers. NO levels in the colon were similar to those in the stomach. We have described two readily applicable techniques for direct, uncontaminated measurement of NO concentrations in the lumen of the gastrointestinal tract. Our finding of a striking reduction in gastric NO concentrations in intensive care patients requires further study.

Adult↗

Presence, distribution, and pharmacological effects of neuropeptide Y in mammalian gastrointestinal tract.

The quantitative distribution of neuropeptide Y (NPY) immunoreactivity has been determined along the length of the gastrointestinal tract in three mammalian species; rat, pig, and guinea pig. The peptide was shown to be present in all regions studied and in all three species. Exceptionally high concentrations were found in the region of the lower esophageal sphincter. Pretreatment of rats with 6-hydroxydopamine depleted NPY concentrations by 30-40%, indicating that NPY is colocalized in part with adrenergic nerves. Characterization of the NPY immunoreactivity by high-pressure liquid chromatography revealed a single major peak. NPY immunoreactivity derived from rat extracts eluted consistently earlier from the column than synthetic porcine standard, indicating minor species differences. Pharmacological studies using longitudinal muscle from guinea pig terminal ileum demonstrated that NPY caused a dose-dependent inhibition of the electrically stimulated, neurally mediated contraction of longitudinal smooth muscle. This suggested that NPY may act presynaptically to inhibit cholinergic transmission. The effects of various NPY fragments were also tested on the same preparation. The C-terminal fragments were active but were considerably less potent than NPY, while the free acid form of NPY and N-terminal fragment (1-19) were completely inactive. Thus, this study has demonstrated the presence of NPY in the gastrointestinal tract of various species, particularly within the lower esophageal sphincter. The pharmacological actions of the peptide suggest a role in the control of nonvascular smooth muscle tone.

Animals↗

Equilibration and passage of water in the gastrointestinal tract of cattle in relation to estimating body water by compartmental kinetic models.

The volume of water in the rumen of four steers was increased (P less than .01) 47% when the level of ground cobs in the diet fed to the steers was changed from 10% to 50%. The difference in gut water content due to diet was not accurately (P greater than .10) estimated by deuterium oxide dilution using either one-, two- or three-compartmental models. Gut water was overestimated and empty body water underestimated when calculated by two-compartment models. The proportions of total body water within each compartment of a three-compartment model were quite variable among steers. When the two-compartment model was solved on the basis of measurements taken from either compartment, different compartment volumes were obtained. This indicated that the two-compartment model did not accurately describe the water equilibration process. Water in the contents of the proximal duodenum and terminal ileum equilibrated with blood in 30 min (range, 10 to 75 min), fecal water equilibrated in 4.3 h (range, 1.7 to 6.7 h) and water in rumen contents equilibrated in 8.3 h (range, 3.8 to 12.5 h). Diet did not affect (P greater than .10) equilibration time or the mean retention time of water in the gastrointestinal tract. Mean retention time was much longer than equilibration time; thus, the equilibration of water in the gastrointestinal tract contents was primarily dependent upon movement of water across the gut mucosa and not upon the flow of water through the gut. One-third of the water in the contents of the gastrointestinal tract was located outside the rumen. Compartmental modeling based only upon D2O disappearance from blood did not enable either gut water or rumen water to be accurately estimated.

Animals↗

Current endosonographic possibilities in the upper gastrointestinal tract.

Almost 15 years after its introduction endosonography is an important technique in a wide range of gastrointestinal diseases. Two types of dedicated echoendoscopes are commercially available each with their own advantages. Thinner instruments with higher resolutions, that will go through a normal endoscope are currently in development. With these probes differentiation between T1 and T in situ will be possible in the near future. Characterization of 'submucosal' lesions in the upper gastrointestinal tract is a field in which ES is the most reliable technique for determining the origin of these lesions. Also submucosal vessels are easily visualized and ES is acquiring an important role in the investigation of portal hypertension. ES is the most accurate staging technique for oesophageal and gastric carcinoma as well as for gastric lymphoma. T- and N-staging results are superior to CT scanning, although ES is not very reliable in individual lymph nodes. Therefore a lot of effort is put into obtaining cytological samples from lesions outside the gastrointestinal tract. It is now possible to get cytological proof of mediastinal lymph nodes through ES-guided fine needle aspiration biopsy. It seems that low grade malignant gastric lymphomas show a typical picture on ES, which may help in selecting treatment. The future will bring us higher resolution images and three-dimensional reconstruction is already being investigated. This last technique will probably become a standard preoperative investigation in oesophageal carcinoma before the century is over.

Digestive System↗

The gastrointestinal tract as polyamine source for tumor growth.

It has previously been demonstrated that decarboxylation of ornithine in tumors, and the oxidative splitting of N1-acetylspermidine in tumor and normal tissues, are important sources of putrescine. Both these sources are utilised by tumors and other tissues with a high demand for polyamines to ensure their polyamine requirement. Consequently, combined treatment of tumor-bearing animals with an inhibitor of ornithine decarboxylase (e.g. alpha-difluoromethylornithine) and polyamine oxidase (e.g. N,N'- bis-allenylputrescine) has an antitumoral effect superior to that of either drug alone. In the present work, it was demonstrated that the alimentary tract is a third important source of polyamines which maintains tumor growth. Gastrointestinal polyamines are of alimentary origin, and are also formed by aerobic and anaerobic microorganisms. They can be reduced by feeding a polyamine deficient diet together with antibiotics that are suitable for decontaminating the gastrointestinal tract. This treatment combined with the administration of the mentioned inhibitors of ornithine decarboxylase and polyamine oxidase completely prevents Lewis lung carcinoma from growing, and prolongs considerably the average life span of L1210 leukemia mice. The results of the polyamine analyses of tumors, leukemia cells and tissues are compatible with the notion that the effective blocking of the three main putrescine sources (intracellular decarboxylation of ornithine, formation of putrescine from N1-acetylspermidine, and the gastrointestinal tract) produces a very strong cytostatic effect. It is expected that the clinical efficacy of polyamine antimetabolites can be considerably improved by measures analogous to those applied in this pilot study.

Animals↗

Sites of organic acid production and pattern of digesta movement in the gastrointestinal tract of swine.

Twelve swine were used to assess the movement of fluid and particulate digesta through their gastrointestinal tracts and to determine the diurnal variations in organic acid levels for various segments of the tract. Animals were fed twice daily at 12-hour intervals. Fluid (polyethylene glycol and chromium-labeled ethylenediamine-tetraacetic acid) and particulate markers (2 mm OD, and 2 mm and 1 and 2 cm long) were administration of markers. The gastrointestinal tract was divided into 12 segments for measurements of markers, pH, volatile fatty acids (VFA), and lactic acid (LA) contents. The data indicated a rapid evacuation of the fluid and the smaller particles from the stomach and their relatively rapid passage through the small intestine and cecum. There was, however, prolonged retention of both fluid and particulate markers first in the ascending and then in the descending colon. Larger particles (2 cm) were retained in the stomach throughout much of the 60-hour experimental period. LA levels were observed 8 hours postfeeding. The highest levels of VFA in gastric contents averaged 20 mmoles/liter. Gastrointestinal pH values showed significant changes with time postfeeding only within the stomach, where they did not reflect the changes in LA of VFA concentrations. VFA constituted 92% of the organic acids present in the large intestine. Their concentrations varied markedly with time (150-230 mmoles/liter), but the VFA at all times constituted the major anions in the large intestinal contents. The results demonstrated that digesta can be retained for prolonged periods of time in that swine stomach and colon. The high concentrations of organic acids also indicated that substantial degrees of microbial digestion of carbohydrates occurred at both sites.

Animals↗

Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate.

A bloody nasogastric aspirate is believed to imply active upper gastrointestinal tract bleeding, while a nonbloody yellow-green nasogastric aspirate that contains duodenal secretions suggests the absence of bleeding proximal to the ligament of Treitz. To validate these beliefs, physicians were asked to predict the presence of active gastrointestinal tract bleeding and whether bile was present in a nasogastric aspirate obtained immediately before endoscopy in 73 episodes of bleeding in 62 patients. A relationship was found between the physician's assessment of the presence of active bleeding demonstrated endoscopically and the appearance of the nasogastric aspirate. However, the sensitivity and specificity were low (79% and 55%, respectively). No association between the assessment of bile in the nasogastric aspirate and the presence of bile acids was demonstrated. These data do not support the placement of a nasogastric tube to determine whether or not a patient is bleeding, the location of the bleeding, and whether endoscopy should be performed.

Bile↗

17 beta-Hydroxysteroid dehydrogenase type 2 expression and enzyme activity in the human gastrointestinal tract.

The 17 beta-hydroxysteroid dehydrogenases (17 beta HSDs) play an important role in the regulation of intracellular levels of biologically active sex steroid hormones in various human tissues. To date, eight distinctive 17 beta HSD enzymes have been cloned and characterized in humans. Among these isoenzymes, 17 beta HSD type 2 (17 beta HSD2) catalyses the conversion of testosterone into androstenedione and/or oestradiol into oestrone in various tissues, and it has thus been suggested to be involved in the biological inactivation of these sex steroids. The human gastrointestinal tract and liver are considered as the principle sites of inactivation and metabolism of various forms of orally administered sex steroids. We therefore examined 17 beta HSD2 expression and activity in human adult non-pathological gastrointestinal tract in order to clarify further the biological significance of this enzyme. A total of 80 specimens (40 from males and 40 from females) of normal oesophageal, stomach, duodenal, ileal, colonic and rectal tissues were examined for immunohistochemistry. Altogether, 17 tissue specimens were used for enzyme assay, and eight for RNA analysis. 17 beta HSD2 activity was detected in the stomach, duodenum, ileum, colon and rectum. 17 beta HSD2 mRNA was most abundant in the small intestine. 17 beta HSD2 immunoreactivity was localized almost exclusively to the absorptive epithelium, which may be involved in the inactivation of excessive endogenous and exogenous active sex steroids. Results from the present study thus suggest that the human gastrointestinal tract is an important sex steroid metabolizing organ in humans.

17-Hydroxysteroid Dehydrogenases↗

Properties of the Ames Salmonella mutants lodged in the gastrointestinal tract of gnotobiotic rats.

An association of the histidine auxotroph of Salmonella typhimurium (strain TA1538) within the gastrointestinal tract of otherwise germ-free Sprague-Dawley rats is maintained during observations for up to 7 months. The bacteria exceed concentrations of 10(7)/g in the forestomach and exceed concentrations of 10(8)/g in the lower bowel and feces. When carcinogens are ingested, the number of revertants in the feces increases. The ingestion of structurally related compounds which are not mutagenic to the bacteria in vitro and for which no evidence of carcinogenicity exists does not increase the number of revertants in the feces. The numbers of salmonella are increased by the addition of Lactobacillus plantarum and Bacteroides fragilis but the salmonella disappear from the gastrointestinal tract when the rats are conventionalized. With the additional flora, there is a decrease in the number of revertants appearing in the feces in response to a given dose of carcinogen. This decrease may reflect an effect of the flora on the activity of the metabolic pathway responsible for the presence of the ultimate carcinogen or it may simply be an effect on the salmonella mutants themselves.

Animals↗

Fluoride absorption from the gastrointestinal tract of rats.

The contribution of the stomach and the small intestine to absorption of fluoride from the gastrointestinal tract was examined in rats. Fasted adult male rats weighing approximately 350 g were given 50 micrograms of fluoride in 1 ml of water by stomach intubation, with 14C-labeled polyethylene glycol as a marker of water movement through the gastrointestinal tract. Rats were killed at intervals up to 120 min, and the stomach, duodenum, jejunum, ileum, distal ileum and cecum were rapidly clamped and removed for fluoride analysis and 14C counting. Approximately 90% of the fluoride dose was absorbed in 120 min. Peak plasma fluoride concentration occurred 10 min after intubation and began to decline after 40 min as the rate of fluoride absorption slowed. Absorption from the stomach was derived from rates of gastric emptying and remaining fluoride. Even at 10 min after intubation, when the bulk of the fluoride remained in the stomach, only approximately 25% of fluoride absorption had occurred from the stomach and 75% from the small intestine. After 120 min, 19.8% of total fluoride absorption had occurred from the stomach. Although the stomach is unquestionably a significant site for fluoride absorption, its contribution is much smaller than that of the small intestine.

Animals↗

Effect of dietary fiber on microbial activity and microbial gas production in various regions of the gastrointestinal tract of pigs.

The microbial activity, composition of the gas phase, and gas production rates in the gastrointestinal tract of pigs fed either a low- or a high-fiber diet were investigated. Dense populations of culturable anaerobic bacteria, high ATP concentrations, and high adenylate energy charges were found for the last third of the small intestine, indicating that substantial microbial activity takes place in that portion of the gut. The highest microbial activity (highest bacterium counts, highest ATP concentration, high adenylate energy charge, and low pH) was found in the cecum and proximal colon. Greater microbial activity was found in the stomach and all segments of the hindgut in the pigs fed the high-fiber diet than in the pigs fed the low-fiber diet. Considerable amounts of O2 were found in the stomach (around 5%), while the content of O2 in gas samples taken from all other parts of the gastrointestinal tract was < 1%. The highest concentrations and highest production rates for H2 were found in the last third of the small intestine. No methane could be detected in the stomach or the small intestine. The rate of production and concentration of methane in the cecum and the proximal colon were low, followed by a steady increase in the successive segments of the hindgut. A very good correlation between in vivo and in vitro measurements of methane production was found. The amount of CH4 produced by pigs fed the low-fiber diet was 1.4 liters/day per animal. Substantially larger amounts of CH4 were produced by pigs fed the high-fiber diet (12.5 liters/day)(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗

[Iberogast: a modern phytotherapeutic combined herbal drug for the treatment of functional disorders of the gastrointestinal tract (dyspepsia, irritable bowel syndrome)--from phytomedicine to "evidence based phytotherapy." A systematic review].

Iberogast is a complex herbal preparation. As a fixed drug combination (9 constituents) it is composed of a fresh plant extract of Iberis amara and of extracts of 8 other dried herbal drugs ( Chelidonii herba, Cardui mariae fructus, Melissae folium, Carvi fructus, Liquiritiae radix, Angelicae radix, Matricariae flos, Menthae piperitae folium). The pharmacological effects as well as the therapeutic effectiveness, tolerability, and toxicity of Iberogast were experimentally and clinically recorded and documented using modern investigation tools. Both the experimental as well as the clinical studies indicated a regulatory influence of Iberogast on the whole gastrointestinal tract by a special dual action. While the included extracts of the dried herbal drugs have mainly spasmolytic properties, the fresh plant extract of Iberis amara has a tonic effect on the gastrointestinal tract. Depending on the predistension of the gastric or intestinal wall, the tonic or the spasmolytic effects of Iberogast prevail. Both the fresh plant extract of Iberis amara and the combined preparation of Iberogast were found to be toxicologically safe in therapeutically effective doses. For the estimation of the clinical effectiveness a systematic review was performed (data research: January 1970 to September 2002). As shown in controlled (according GCP standard) as well as supportive and uncontrolled clinical studies, the symptoms of functional dyspepsia and of irritable bowel syndrome (one controlled study and one observational study) could be significantly reduced by these herbal preparation in comparison to placebo. Two trials comparing Iberogast with the prokinetics metoclopramide and cisapride demonstrated a comparable therapeutic effectiveness of the herbal preparation and the prokinetics in the treatment of dyspepsia. Adverse events were rare and, with respect to frequency and spectrum, partly the same as found with placebo. Another advantage of Iberogast is that it targets only the gastrointestinal tract and the enteral nervous system, but not the central nervous system. Because of its special dual action, its clinically proven effectiveness, and its good tolerability, Iberogast may be a drug of first choice in the treatment of functional gastrointestinal diseases and their corresponding symptoms.

Brassicaceae↗