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At least 1,009 records · Page 56Linked to original sources
PubMed2000

Indicators of postpyloric feeding tube placement in children.

OBJECTIVE: To determine the validity of five indicators (color, pH, and concentrations of bilirubin, pepsin, and trypsin in aspirated gastrointestinal secretions) in predicting postpyloric placement of feeding tubes in critically ill children. DESIGN: Prospective, observational study. SETTING: University teaching hospital. PATIENTS: A total of 96 gastrointestinal aspirates were obtained from 53 children requiring placement of a nasoenteric feeding tube. INTERVENTIONS: Feeding tubes were aspirated by applying suction with a 20-mL syringe. Repeat aspirates from the same patient were obtained on different days. All aspirations were performed within 30 mins of obtaining a radiograph to assess tube position. MEASUREMENTS AND MAIN RESULTS: Aspirates were inspected visually for color. pH and bilirubin concentrations were determined at the bedside by using reagent strips. Pepsin and trypsin concentrations were measured spectrophotometrically in a research laboratory. The sensitivity, specificity, predictive values, and efficiency for each indicator and their 95% confidence intervals were determined based on the position of the feeding tube on the radiograph. Aspirate pH > or =6 had the lowest positive predictive value (76%, range 67% to 85%) but high negative predictive value (94%, range 89% to 99%) for determining postpyloric positioning of the feeding tube. Bilirubin concentration > or =5 mg/dL (> or =86 micromol/L) had the highest positive predictive value (96%, range 91% to 100%) and lowest negative predictive value (88%, range 81% to 95%). Overall efficiency was best for the appearance of a clear yellow aspirate color (93%, range 88% to 98%), pepsin concentration < or =20 microg/mL (94%, range 89% to 99%), and trypsin concentration > or =50 microg/mL (94%, range 89% to 99%). CONCLUSIONS: Simple bedside assessment of gastrointestinal aspirate color, pH, and bilirubin concentration is useful for predicting feeding tube position. Use of these tests may reduce the number of radiographic studies needed to confirm postpyloric positioning. Laboratory-determined pepsin and trypsin concentrations predict tube position with a high degree of accuracy. Development of simple and inexpensive bedside tests for the detection of gastrointestinal enzymes may be useful.

Adolescent↗
PubMed1994

Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo.

OBJECTIVE: To compare the frequency of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. DESIGN: Prospective, randomized study. SETTING: Intensive care unit in a university hospital. PATIENTS: Twenty-six adult patients. All patients were mechanically ventilated and were at risk of developing stress ulceration. INTERVENTIONS: Patients were randomized to receive either sucralfate (2 g every 8 hrs) (group 1) via the nasogastric tube (flushed with 10 mL of sterile water) or 20 mL of sterile water every 8 hrs (group 2) via the nasogastric tube. MEASUREMENTS AND MAIN RESULTS: At the time of intensive care unit admission, the frequency of stress (acute) erosions (as assessed with the endoscope) was 21.7%. No ulcers were detected. By day 3, the frequency had increased to 37.5% in group 1 and 88.9% in group 2. Mucosal deterioration was more likely in the patients treated with placebo (water) (p < .05). In total, seven patients developed acute ulceration in group 2 compared with only one patient in group 1 (p < .05). The frequency of gastric colonization with aerobic Gram-negative bacilli was 25.6% in group 1 and 28.6% in group 2. Only one retrograde nosocomial pneumonia developed (group 1). CONCLUSION: Based on our findings, we strongly recommend the adoption of sucralfate as opposed to no prophylaxis in the prevention of acute upper gastrointestinal ulceration.

Adult↗
PubMed1999

Push enteroscopy.

Push enteroscopy has superseded sonde enteroscopy principally because of its ability to provide therapy, as well as diagnosis. An overtube limits gastric looping and allows deeper jejunal insertion. A working channel allows therapeutic intervention. The technique is increasingly used to the diagnosis and treatment of small intestinal disorders, particularly in obscure gastrointestinal bleeding. The wider acceptance of push enteroscopy into routing practice requires further clinical effectiveness data.

Endoscopy, Digestive System↗
PubMed2006

[Effect of sarpogrelate in enteral feeding of patients with gastroesophageal reflux (GER)].

AIM: Enteral feeding of patients who are unable to eat or drink because of neurological disorders finally undergo percutaneous endoscopic gastrostomy (PEG) or nasogastric tube feeding. Their most common serious complication is aspiration pneumonia. Our objectives were to evaluate the effect of sarpogrelate (a 5-HT2A receptor blocker) on gastroesophageal reflux (GER) in these patients. METHODS: This study was performed in 5 elderly patients, aged 70-87 years with neurological disorders (stroke 4, post herpes encephalitis 1), on PEG or nasogastric feeding for 5 weeks-1 year. A 48-hour esophageal pH study was performed using the Degitrapper pH400 (Medtronic Co.). The pH monitor catheter was passed into the esophagus transnasally and positioned with the pH electrode 5cm above the lower esophageal sphincter. During the first 24 hours drug no drug was given, and during the next 24 hours we gave 100mg sarpogrelate 3 times. We analyzed the frequency of acid reflux (when the pH in the esophagus become less than 4.0 for more than 5 seconds, we defined this is 1 episode of acid reflux), frequency of acid reflux and mean pH values between drug-on and drug-off periods. An upright position was maintained for two hours after each meal. RESULTS: When the results of pH monitoring during two half days (from 7 pm to 7 am: 12 hours) was compared between drug-on term and drug-off term, mean pH value was statistically elevated from 6.0 +/- 0.2 (drug-off) to 6.5 +/- 0.4 (drug-on) (mean +/- SD, p< 0.05). Frequency and the total time of acid reflex showed no difference between the two periods. CONCLUSION: Treatment with sarpogrelate might be effective in patients with GER by blocking activated serotonin receptor in the gastrointestinal system.

Aged↗
PubMed1988

Pharmacokinetics and estimated bioavailability of amoxicillin in mares after intravenous, intramuscular, and oral administration.

The pharmacokinetics and estimated bioavailability of amoxicillin were determined after IV, intragastric, and IM administration to healthy mares. After IV administration of sodium amoxicillin (10 mg/kg of body weight), the disposition of the drug was best described by a 2-compartment open model. A rapid distribution phase was followed by a rapid elimination phase, with a mean +/- SD half-life of 39.4 +/- 3.57 minutes. The mean volume of distribution was 325 +/- 68.2 ml/kg, and the mean body clearance was 5.68 +/- 0.80 ml/min.kg. It was concluded that frequent IV administration of sodium amoxicillin would be required to maintain therapeutic plasma concentrations of amoxicillin, and thus, the use of this dosage form should be limited to the initiation of treatment or to intensive care situations. After intragastric administration of amoxicillin trihydrate (20 mg/kg), 5% cherry-flavored suspension, the drug was rapidly, but incompletely, absorbed and rapidly eliminated (mean half-life of the decline phase of the plasma amoxicillin concentration-time curve, 51 minutes). The mean estimated bioavailability (fractional absorption) of the administered dose was 10.4%, and the mean peak plasma amoxicillin concentration was 2.73 micrograms/ml at 1.5 hours after dosing. In one horse with clinical signs of abdominal discomfort and diarrhea, the absorption of amoxicillin from the gastrointestinal tract was delayed and the fraction absorbed was increased. It was concluded that this oral dosage form could be recommended only for the treatment of infections caused by bacteria that are highly susceptible to amoxicillin, that frequent dosing would be necessary, and that absorption may be inconsistent in horses with gastrointestinal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1984

The non-invasive measurement of urea kinetics in normal man by a constant infusion of 15N15N-urea.

A two-pool model is described for the non-invasive measurement of urea kinetics in man. The isotope, 15N15N-urea, was given until an isotopic steady state was reached in urine and the time taken to achieve this is defined. During an isotopic steady state, a comparison was made of the effect of giving the isotope orally, intravenously and intragastrically; no differences were found between the different routes. Measurements of enrichment were made on excretion products in urine. In six normal adults with a protein intake of 200 mg N/kg/d, the urea production rate was 139 +/- 15 mg N/kg/d, 70 per cent of which was excreted in urine. Of the 34 mg N/kg/d produced by hydrolysis of urea in the gastrointestinal tract, 41 per cent was resynthesized to urea, and about 48 per cent was available for other synthetic processes.

Adult↗
PubMed1999

Comparison of the effects of a high-fat and high-carbohydrate soup delivered orally and intragastrically on gastric emptying, appetite, and eating behaviour.

To investigate the effects of fat and carbohydrate on appetite, food intake and gastric emptying with and without the influence of orosensory factors, a group of nine healthy, fasted male subjects took part in two separate paired experiments involving high-fat and high-carbohydrate radiolabelled soup preloads. In the first experiment subjects received direct intragastric isocaloric infusions of either a high-fat tomato soup or a high-carbohydrate tomato soup (400 kcal in 425 mL) over 15 min, on two occasions. In the second paired experiment subjects ingested the same high-fat and high-carbohydrate soup over 15 min. In both experiments ratings of hunger and fullness were recorded over a period of 135 min and gastric emptying was measured by scintigraphy. Food intake was evaluated from a test meal (yoghurt drink) given 2 h after the end of the soup infusion/ingestion. When soup was administered intragastrically (Experiment 1) both the high-fat and high-carbohydrate soup preloads suppressed appetite ratings from baseline, but there were no differences in ratings of hunger and fullness, food intake from the test meal, or rate of gastric emptying between the two soup preloads. When the same soups were ingested (Experiment 2), the high-fat soup suppressed hunger, induced fullness, and slowed gastric emptying more than the high-carbohydrate soup and also tended to be more effective at reducing energy intake from the test meal. The results of these studies demonstrate that orosensory stimulation plays an important role in appetite regulation, and also indicate that subtle differences in orosensory stimulation produced by particular nutrients may profoundly influence appetite and gastrointestinal responses.

Adult↗
PubMed1999

Fluid therapy in mature cattle.

Fluid therapy is practical and beneficial when properly administered to cattle. Mature cattle are more frequently alkalotic than acidotic, so nonalkalizing solutions are usually indicated. Exceptions include cattle with choke, carbohydrate engorgement, diabetes mellitus, and occasionally, renal disease, diarrhea, and fatty liver/ketosis. Many dehydrated cattle need supplemental potassium and calcium as well as sodium, chloride, and water. Intravenous administration is indicated in patients with obstructive gastrointestinal disease and those with severe dehydration. Oral or intraruminal administration is less expensive and, often, very effective.

Acidosis↗
PubMed2004

Gastrointestinal decompression after excision and anastomosis of lower digestive tract.

AIM: To discuss the clinical significance of postoperative gastrointestinal decompression in operation on lower digestive tract. METHODS: Three hundred and sixty-eight patients with excision and anastomosis of lower digestive tract were divided into two groups, i.e. the group with postoperative gastrointestinal decompression and the group without postoperative gastrointestinal decompression. Clinical therapeutic outcome and incidence of complication were compared between two groups. Furthermore, an investigation on application of gastrointestinal decompression was carried out among 200 general surgeons. RESULTS: The volume of gastric juice in decompression group was about 200 mL every day after operation. Both groups had a lower girth before operation than every day after operation. No difference in length of the first passage of gas by anus and defecation after operation was found between two groups. The overall incidence of complications was obviously higher in decompression group than in non-decompression group (28% vs 8.2%, P<0.001). The incidence of pharyngolaryngitis was up to 23.1%. There was also no difference between two groups regarding the length of hospitalization after operation. The majority (97.5%) of general surgeons held that gastrointestinal decompression should be placed till passage of gas by anus, and only 2.5% of surgeons thought that gastrointestinal decompression should be placed for 2-3 d before passage of gas by anus. Nobody (0%) deemed it unnecessary for placing gastrointestinal compression after operation. CONCLUSION: Application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce gastrointestinal tract pressure and has no obvious effect on preventing postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial to the recovery of patients without undergoing gastrointestinal decompression.

Adult↗
PubMed1993

Assessment of upper gastrointestinal motility in the cancer-associated dyspepsia syndrome.

Cancer patients experience many gastrointestinal symptoms which may lead to weight loss. Assessment of gastrointestinal motility may contribute to our understanding of these symptoms and suggest rational therapeutic approaches to the anorexia-cachexia syndrome. We have evaluated a simple, inexpensive, well-tolerated test of upper gastrointestinal motility in patients with advanced cancer. One-centimetre portions of radiopaque nasogastric tubing were ingested with food. Six hours later, a flat-plate abdominal x-ray was obtained to determine the marker placement. Patients were evaluated for gastrointestinal symptoms. Those with more symptoms, particularly early satiety, had a greater incidence of reduced upper gastrointestinal motility.

Adult↗
PubMed1997

The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient.

A retrospective analysis of prospectively collected data was performed to compare the frequency of upper gastrointestinal bleeding (GIB) in seriously burned patients treated with either cimetidine and antacids or enteral nutrition for ulcer prophylaxis. Five hundred and twenty-six seriously burned patients admitted to the burn intensive care unit of the BG Trauma Centre Ludwigshafen during a 4-year period were included into the study. All patients admitted to the burn unit from 1989 to 1991 received i.v. cimetidine (400 mg q4) for ulcer prophylaxis. If the intragastric pH dropped below 3.5, gastric pH was titrated with antacids up to > or = 4 via nasogastric tube. During the second 2-year period (1992-1993) early enteral nutrition alone was regarded to be ulcer protective and no further interventions for ulcer prophylaxis were routinely performed. Signs of overt upper GIB were monitored and documented through the entire study period. The overall occurrence rate of upper GIB in the cimetidine/antacids (C/A) group (n = 253) was 8.3 per cent with six cases of serious bleeding in five patients (1.98 per cent). In the enteral nutrition (EN) group (n = 273) the overall incidence of GIB was 3.3 per cent with two cases of serious bleeding (0.73 per cent). There were no deaths directly related to ulcer haemorrhage. The difference in the overall frequency of overt GIB between the groups studied was statistically significant (< 0.05). In our experience, early enteral nutrition is effective in the prevention of stress haemorrhage in the upper gastrointestinal tract. Additional medicinal prophylaxis is not required in burn patients.

Administration, Oral↗
PubMed2001

Enteral versus parenteral nutrition: a pragmatic study.

Controversy persists as to the optimal means of providing adjuvant nutritional support. The aim of this study was to compare enteral nutrition (EN) and parenteral nutrition (TPN) in terms of adequacy of nutritional intake, septic and nonseptic morbidity, and mortality. This was a prospective pragmatic study, whereby the route of delivery of nutritional support was determined by the attending clinician's assessment of gastrointestinal function. Patients considered to have inadequate gastrointestinal function were given TPN (group 1), while those deemed to have a functioning gastrointestinal tract received EN (group 2). Patients in whom there was reasonable doubt as to the adequacy of intestinal function were randomized to receive either TPN (group 3) or EN (group 4). The trial setting was a large district general hospital with a dedicated nutrition team. A total of 562 patients were included in the study (331 males; median age 67 y). Gastrointestinal function on entry into the study was considered inadequate in 267 patients who were given TPN (group 1) and adequate in 231 whom received EN (group 2). There was clinical uncertainty about the adequacy of gut function in 64 patients (11.4%) who were randomized to receive either TPN (group 3, 32 patients) or EN (group 4, 32 patients). The incidence of inadequate nutritional intake was significantly higher in group 4 compared with group 3 (78.1% versus 25%, P < 0.001). Complications related to the delivery system and other feed-related morbidity were significantly more frequent in both EN groups compared with the respective TPN groups. EN was associated with a higher overall mortality in both nonrandomized and randomized patients. There were no significant differences observed in the incidences of septic morbidity between patients receiving TPN and those given EN. EN is associated with a higher incidence of inadequate nutritional intake, complications related to the delivery system, and other feed-related morbidity than TPN. There is no evidence from this study to support a difference between the two modalities in terms of septic morbidity. Patients in whom there is reasonable doubt as to the adequacy of gastrointestinal function should be fed by the parenteral route.

Adult↗
PubMed1998

A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients.

OBJECTIVE: To prospectively evaluate the incidence of clinically significant bleeding, side effects, and cost of therapy in mechanically ventilated trauma patients at high risk for stress ulcers who received simplified omeprazole suspension (SOS). METHODS: Prospective, evaluative study in a Level I trauma center. Mechanically ventilated trauma patients admitted with at least one additional risk factor for stress ulcer development received SOS for stress ulcer prophylaxis. RESULTS: Sixty trauma patients were enrolled. The mean Injury Severity Score was 27.3. After starting SOS, there were no cases of clinically significant upper gastrointestinal bleeding related to stress ulceration. Baseline pH was 3.3, and mean gastric pH after SOS was increased to 6.7 (p < 0.005). There were no adverse effects thought to be related to omeprazole suspension. Incidence of nosocomial pneumonia after beginning SOS was 28.3%. The cost of acquisition plus administration of SOS was $13.13 per day, whereas the cost of drug acquisition alone was $3.83 per day. CONCLUSION: In a prospective, evaluative study of 60 trauma patients who required mechanical ventilation and had at least one additional risk factor for stress ulcer development, omeprazole suspension prevented clinically significant gastrointestinal bleeding, maintained excellent control of gastric pH, produced no toxicity, and was the least costly medication alternative.

Anti-Ulcer Agents↗
PubMed2003

Arginine, ornithine, and proline interconversion is dependent on small intestinal metabolism in neonatal pigs.

We have previously shown that arginine deficiency is exacerbated by the removal of dietary proline in orally, but not parenterally, fed piglets. Therefore, we hypothesized that the net interconversions of proline, ornithine, and arginine primarily occur in the small intestine of neonatal piglets. Ten intragastrically fed piglets received either intraportal (IP) or intragastric (IG) primed, constant infusions of [guanido-(14)C]arginine and [U-(14)C]ornithine + [2,3-(3)H]proline. By infusing amino acid isotopes via the stomach compared with the portal vein, we isolated small intestinal first-pass metabolism in vivo. During IP infusion, fractional net conversions (%) from proline to ornithine (0), ornithine to arginine (11 +/- 6), and ornithine to proline (5 +/- 1) were lower (P < 0.05) than during IG infusion (39 +/- 8, 18 +/- 6, and 42 +/- 12, respectively); we speculate that these data are due to the localization of ornithine aminotransferase to the gut. The balance of these conversions indicated a large synthesis of arginine (70.0 micromol. kg(-1). h(-1)) by the gut, with a corresponding degradation of ornithine (70.8 micromol. kg(-1). h(-1)) and no change in proline balance. Gut synthesis of arginine from proline (48.1 micromol. kg(-1). h(-1)) was 50% of its requirement, whereas proline synthesis from arginine (33.0 micromol. kg(-1). h(-1)) amounted to 10% of its requirement. Overall, arginine synthesis is more dependent on the gut than proline synthesis. In situations in which gut metabolism is compromised, such as during parenteral nutrition or gastrointestinal disease, arginine and proline are individually indispensable because their biosyntheses are negligible.

Animals↗
PubMed1985

Effect of ileal infusion of intralipid on gastrointestinal transit, ileal flow rate, and carbohydrate absorption in humans after ingestion of a liquid meal.

The effects of ileal infusion of Intralipid on the time required for a radiolabeled liquid starch meal to empty from the stomach and reach a point in the ileum that was 230 cm from the teeth and on the ileal flow rates and the degree of carbohydrate absorption were measured in 5 normal volunteers. The subjects were intubated with a four-lumen polyvinyl tube. Studies were carried out on consecutive days in random order. Infusion of fat into the ileum (a) slowed the transit of a liquid meal through the stomach, (b) delayed the arrival of the liquid meal in the ileum and increased its residence in the upper small intestine, (c) reduced the average flow of digesta through the upper small intestine and altered the pattern of flow, (d) reduced the volume of the meal entering the ileum, and (e) reduced the degree of carbohydrate absorption in the upper small intestine. These results suggest that the presence of fat in the ileum may have a profound influence on the digestion and absorption of a meal.

Adolescent↗