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At least 811 records · Page 45Linked to original sources
PubMed1984

Motility of the terminal ileum and ileocecal sphincter in healthy humans.

Factors controlling the transit of contents between the ileum and cecum should be important determinants of intestinal function; however, the dynamics of the ileocecal region remain largely unexplored in healthy humans. Accordingly, prolonged recordings of intraluminal pressure were obtained from the distal ileum, across the ileocecal sphincter, and from the proximal colon of healthy adults. In one set of studies, 16 subjects each contributed 6 h of basal, fasting recordings; in 2 of the 16, postprandial patterns were also recorded. In a second set, 6 fasting subjects were studied for a total of 120 h. Less than 10% of interdigestive cycles (migrating motor complexes) reached the ileocecal sphincter. The remainder faded out and merged into an active, apparently random pattern of pressure waves that became more intense closer to the sphincter. Discrete, short bursts of phasic pressures migrated rapidly for long distances in the distal ileum and a unique peristaltic wave also migrated rapidly, though infrequently, through the region. Tonic pressures were recorded across the ileocecal sphincter but were present only during the passage of phasic pressure waves; basal tone was minimal. We believe these are the first prolonged observations of motility from the ileocecal sphincter of healthy humans. These descriptions provide insights into and a basis for further studies of a largely unexplored area of the human bowel.

Action Potentials↗
PubMed1993

Percutaneous endoscopic drainage gastrostomy in the treatment of gastrointestinal obstruction from intraperitoneal malignancy.

We evaluated the effectiveness of a percutaneous technique for placement of a drainage gastrostomy. Progressive dilatation of the abdominal and gastric walls was used to place a Malecot catheter (28 French). Endoscopic guidance assured proper placement and assisted in the dilatation. Fourteen drainage gastrostomy tubes were placed in 12 patients. The tube could not be placed in on additional patient with tumor infiltration into the anterior gastric wall. No surgical complications occurred, but there was one postoperative complication, peritonitis treated with antibiotics without catheter removal. All catheters provided unobstructed drainage and decompression of gastrointestinal obstruction. Percutaneous endoscopic drainage gastrostomy seems to be an effective means of palliating small-bowel obstruction and its complication rate appears low. This method may be suitable to replace open laparotomy techniques for gasrostomy placement.

Drainage↗
PubMed1997

Gallbladder motility and cholecystokinin secretion during continuous enteral nutrition.

OBJECTIVES: During total parenteral nutrition, gallbladder motility is impaired, resulting in sludge and stone formation. Little is known about gallbladder motility during prolonged enteral nutrition. METHODS: We studied gallbladder motility during continuous enteral nutrition (CEN) in nine hospitalized patients with active inflammatory bowel disease. The patients received a polymeric diet (2000 kcal/24 h) by CEN through a nasogastric tube for a prolonged period. Gallbladder volumes were obtained daily by ultrasonography, starting from day 0 (before CEN) and on 7 consecutive days during CEN. At days 0, 1, 4, and 7, the gallbladder response to i.v. cholecystokinin (CCK-33; 0.5 Ivy Dog unit/kg/h) was studied. Plasma CCK levels were determined at regular intervals by radioimmunoassay. RESULTS: No significant differences were observed on day 0 between patients and a group of nine healthy control subjects in fasting gallbladder volumes (19.4 +/- 2.3 and 19.6 +/- 2.4 cm3, respectively) and gallbladder contraction during CCK infusion (56 +/- 14% and 69 +/- 7%, respectively). During CEN, from day 1 to day 7, mean gallbladder volume remained significantly (p < 0.05) reduced compared with fasting gallbladder volume, and mean plasma CCK levels remained significantly (p < 0.05) increased compared with fasting levels. Although gallbladder volume was significantly reduced during CEN, the gallbladder contractile response to CCK was not affected; at days 1, 4, and 7, gallbladder contraction was 36-57%. CONCLUSIONS: During CEN, 1) gallbladder volume is significantly reduced and plasma CCK levels are significantly increased, 2) these effects are sustained over time (7 days), and 3) the gallbladder remains responsive to exogenous CCK. These results indicate that gallbladder contractility and gallbladder responsiveness to CCK are preserved during prolonged CEN in patients with inflammatory bowel disease.

Adult↗
PubMed1998

Outcome of long-term enteral feeding.

In the past two decades, many technical advances have made tube enteral feeding much more comfortable and acceptable to patients and their families. This has greatly expanded the use of this therapy, both in clinical conditions where it was traditionally prescribed and in many other diagnoses. This expanded use raises important questions about how much enteral nutrition is being used, the medical outcome in different clinical conditions, and the quality of life experienced by long-term therapy users. This article addresses these outcome issues for patients in the nonhospital setting.

Adaptation, Physiological↗
PubMed1986

Green vomiting in the first 72 hours in normal infants.

From June 1980 to September 1984, forty-five newborns (weight greater than or equal to 2000 g), initially presumed normal, were seen with bilious vomiting in the first 72 hours and were prospectively followed up. Nine (20%) required surgical intervention, five (11%) had nonsurgical obstruction such as meconium plug or left microcolon, and the remaining 31 (69%) had idiopathic bilious vomiting. Infants with idiopathic bilious vomiting had a benign transient course and resumed feedings by 1 week of age; 30 of the 31 had normal or nonspecific findings on initial plain abdominal roentgenogram. Specific findings on the initial plain abdominal roentgenogram were noted in five infants, and four (80%) of these had a lesion requiring surgical intervention; 56% (5/9) of neonates with surgical lesions had normal or nonspecific findings on the plain abdominal roentgenograms. None developed bowel ischemia or midgut infarction secondary to a volvulus as they were identified by contrast studies shortly after the initial episode of bilious vomiting. Although the majority of "normal" neonates with bilious vomiting do not have a surgical lesion, this study indicates that 56% of surgical cases will be missed if contrast studies are not done.

Age Factors↗
PubMed1975

The effect of somatostatin on the response of GLI to the intraduodenal administration of glucose, protein, and fat.

The effects of somatostatin on GLI release during the absorption of intraduodenally administered glucose, casein hydrolysate and longchain triglycerides were studied in conscious dogs. Whereas, after an intraduodenal glucose load, GLI rose promptly in saline-infused control experiments to a peak of 5 ng/ml (SEM +/- 4) in 60 minutes, significantly lower values were observed during somatostatin infusion (P less than 0.025 -- 0.05). A similar reduction in the magnitude of the GLI response to intraduodenally administered casein hydrolysate (P less than 0.05) and fat (p less than 0.05) was observed.

Animals↗
PubMedDate not supplied

Pediatric interventional radiology: current practice and innovations.

The purpose of this article is to provide an update of pediatric interventional procedures for the interventionalist, and especially for those who treat children infrequently. Most pediatric interventional procedures are modifications of techniques devised for adults, in that some are unique to pediatrics. These are stressed in the presentation.

Arteriovenous Malformations↗
PubMed1999

Gastric acidity and duodenogastric reflux during nasojejunal tube feeding in mechanically ventilated patients.

OBJECTIVE: In order to prevent gastric microbial overgrowth, which may complicate nasogastric feeding, administration of nutrients more distally into the gut has been advocated in intensive care patients, as it offers the advantage of keeping the stomach empty and acid. In this study, we assessed the impact of jejunal feeding upon gastic pH in a group of mechanically ventilated, critically ill patients, with special focus on duodenogastric reflux as a possible cause of gastric alkalinization during jejunal nutrition. DESIGN: Prospective experimental study. SETTING: Multidisciplinary intensive care unit of a university hospital. PATIENTS AND METHODS: Gastric pH was recorded by continuous pHmetry over a 4-h period of fasting followed by a 4-h period of nasojejunal feeding at 100 kcal/h in 21 mechanically ventilated, critically ill patients. To determine the contribution of duodenogastric reflux to modifications of gastric acidity, the diet was traced with [(111)In] DTPA (pentetic acid) in 11 of these 21 patients; gastric contents were aspirated every 30 min, then analysed for measurement of radioactivity, glucose, and bile acid concentration. MEASUREMENTS AND RESULTS: Median intragastric pH increased slightly from 1.59 (1.20-2.73; interquartile range) (fasting) to 2.33 (1.65-4.64) (feeding) (p = 0.013), and the length of time that the pH was 4 or above increased from 1 (0-24) to 9 (0-142) min (p = 0.026). The variability of pH values and the number of acute alkalinization episodes did not change between the two phases. In 10 of 11 patients in which the diet was labeled with [(111)In] DTPA, reflux was documented at a given time of the feeding period. Bile acid concentrations in the stomach increased from 392 (61-1076) (fasting) to 1446 (320-2770) micromol/l (feeding) (p = 0.010) and mean glucose concentration increased from 59 (28-95) to 164 (104-449) mg/dl (p = 0.006). CONCLUSION: Duodenogastric reflux is common in mechanically ventilated critically ill patients with nasojejunal feeding tubes. It occurs both during fasting and during nasojejunal feeding. During nasojejunal feeding, moderate alkalinization of the gastric contents occurs as a result of bile and nutrient reflux.

Adult↗
PubMed2006

Characterization of the human upper gastrointestinal contents under conditions simulating bioavailability/bioequivalence studies.

PURPOSE: This study was conducted to compare the luminal composition of the upper gastrointestinal tract in the fasted and fed states in humans, with a view toward designing in vitro studies to explain/predict food effects on dosage form performance. METHODS: Twenty healthy human subjects received 250 mL water or 500 mL Ensure plus (a complete nutrient drink) through a nasogastric tube and samples were aspirated from the gastric antrum or duodenum for a period up to 3.5 h, depending on location/fluid combination. Samples were analyzed for polyethylene glycol, pH, buffer capacity, osmolality, surface tension, pepsin, total carbohydrates, total protein content, and bile salts. RESULTS: Following Ensure plus administration, gastric pH was elevated, buffer capacity ranged from 14 to 28 mmoL L-1 DeltapH-1 (vs. 7-18 mmol L-1 DeltapH-1), contents were hyperosmolar, gastric pepsin levels doubled, and surface tension was 30% lower than after administration of water. Post- and preprandial duodenal pH values were initially similar, but slowly decreased to 5.2 postprandially, whereas buffer capacity increased from 5.6 mmol L-1 DeltapH-1 (fasted) to 18-30 mmol L-1 DeltapH-1 (p<0.05). Postprandial surface tension in the duodenum decreased by >30%, bile salt levels were two to four times higher, luminal contents were hyperosmotic, and the presence of peptides and sugars was confirmed. CONCLUSIONS: This work shows that, in addition to already well characterized parameters (e.g., pH, and bile salt levels), significant differences in buffer capacity, surface tension, osmolality, and food components are observed pre-/postprandially. These differences should be reflected in test media to predict food effects on intralumenal performance of dosage forms.

Adult↗