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PubMed1992

Gastrointestinal tract in the immunocompromised host: opportunistic infections and other complications.

In the decade since the early 1980s, the increasing use of immunosuppressive therapy for cancer and autoimmune disease, as well as for organ transplantation, has combined with the acquired immunodeficiency syndrome epidemic to increase greatly the incidence of opportunistic infections and other complications of the gastrointestinal tract. Consequently, barium fluoroscopic and cross-sectional imaging studies tailored to address these problems are no longer uncommon. Although overlap exists, there are radiographic patterns that can direct the diagnosis to an opportunistic infection and sometimes to a specific pathogen. This article describes and illustrates the radiographic findings of gastrointestinal superinfection with Candida albicans, cytomegalovirus, Cryptosporidium spp, herpes simplex virus, Mycobacterium tuberculosis, M avium-intracellulare, and human immunodeficiency virus. Other gastrointestinal tract complications of immunosuppression are discussed, including graft-versus-host disease following bone marrow transplantation, typhlitis, and pseudomembranous colitis.

AIDS-Related Opportunistic Infections↗
PubMed1981

Primary lymphoma of the gastrointestinal tract.

Twenty-two cases of primary lymphoma of the gastrointestinal tract are reported. These have been seen over the past 16 years and consist of seven gastric, 13 small bowel and two caecal lesions. This number represents 0.07% of the barium examinations of the stomach and small bowel, conducted over this period. All the cases were examined by the conventional barium meal or barium meal and follow-through examinations using non-flocculable barium. All the lymphomas were verified by histological examination. The cases are analysed as to clinical and radiological presentation, and the clinical and radiological diagnostic scores are assessed. There was a very poor diagnostic score on clinical grounds alone; a high diagnostic score for radiological examination of the stomach of 71%, contrasted with a low radiological score of 26% for the small bowel. The radiological features of lymphoma in the stomach and small bowel are described and the differential diagnosis discussed. To improve the diagnostic score on radiological examination, an awareness of gastrointestinal lymphoma is essential, as is a knowledge of the possible radiological changes. The barium examination should carefully search for these changes where lymphoma is clinically possible.

Adult↗
PubMed2000

Cubilin expression and posttranslational modification in the canine gastrointestinal tract.

Cubilin is an endocytic receptor of the apical brush border membrane that is essential for intrinsic factor-mediated cobalamin absorption in small intestine. However, cubilin is more highly expressed in kidney and yolk sac, and recent molecular characterization of the receptor has focused on these tissues. The aim of this investigation was to examine tissue-specific cubilin expression and posttranslational modifications with an emphasis on the gastrointestinal tract. Intrinsic factor-cobalamin binding activity, cubilin immunoreactivity, and cubilin mRNA levels were determined in multiple segments of canine gastrointestinal mucosa and other tissues. These aspects of cubilin expression varied in parallel, suggesting that the major determinant of regional cubilin expression in the gastrointestinal tract is modulation of cubilin mRNA. Cell fractionation indicated that ileal cubilin is not strongly membrane associated. An approximately 185-kDa brush border specific and two >400-kDa precursor forms of cubilin were identified. Asparagine-linked oligosaccharide modifications characterized by differential glycosidase digestion of affinity-purified cubilin from ileal mucosa and renal cortex differed, but ileal and renal intracellular cubilin comigrated on SDS-PAGE at approximately 400 kDa after oligosaccharide removal, thus reconciling previous conflicting size estimates of the cubilin polypeptide.

Animals↗
PubMed1979

Endogenous urea secretion into the sheep gastrointestinal tract.

Urea turnover and the proportion of endogenous urea secreted and excreted in the saliva, the bile, the pancreatic juice and the urine and directly across the wall of the digestive tract was studied in 6 experiments, after a single i.v. dose of labelled 15N, in two adult sheep weighing 49 and 50 kg, with permanent biliary and pancreatic fistulus and with an exteriorized right parotid duct. It was found that, of the total amount of endogenous urea secreted into the animals' digestive tract (0.2694+/-0.0138 mg/min/kg b.w.), 10.27+/-0.94% reached the contents in the saliva, 2.12+/-0.28% in the bile and 0.66+/-0.08% in the pancreatic juice, and that 86.95+/-2.1% was secreted into the gastrointestinal tract, across its wall, from the blood capillaries. Exogenous turnover amounted to 0.3228+/-0.192 mg/min/kg. Of the total amount of 476.6 mg i.v. injected 15N urea, 274.1+/-8.86 mg was excreted in the urine 5.1+/-0.9 mg in the bile, 3.19+/-0.06 mg in the pancreatic juice, 4.96+/-0.76 mg via the right parotid gland and 9.34+/-1.09 mg in the faeces. The results show that the quantitatively most important part of the recirculation of endogenous urea is its passage from the blood across the wall of the gastrointestinal tract into its contents.

Animals↗
PubMed1980

The clinical value of the upper gastrointestinal tract roentgenogram series.

We studied the role of the upper gastrointestinal tract roentgenogram series (UGI) in the care of 483 ambulatory patients with varied abdominal complaints. The test was significantly abnormal about 20% of the time, rarely led to changes in therapy, and was ordered inappropriately 30% of the time (according to criteria devised by experts). Regardless of their test results, most patients' symptoms improved in the several months after the test. We created a simple rule, based on the patient's history, that would have led to a decrease in the number of inappropriately ordered tests without significantly compromising care. This decision rule may help to improve the utilization of the UGI by identifying patients who are unlikely to benefit from the test.

Digestive System↗
PubMed1982

Disorders of the gastrointestinal tract in children: consultation-liaison experience.

Disorders of the gastrointestinal tract are common in children. Fortunately, many are short-lived, related to infection, food intolerance, or specific etiology. Those that persist or recur require greater attention on the part of the physician and can require psychiatric consultation. The frequency of consultation will depend in large part on the psychosocial sophistication and philosophy of care of the referring physician. When consulted, the child psychiatrist can complement the medical care by examination in greater detail of the psychosocial environment of the child, the family, and by psychiatric evaluation of the child. Formulation of these factors may then point the way to more helpful management of the child and treatment. The most serious problems, such as regional ileitis and ulcerative colitis, require not only collaboration of pediatricians and child psychiatrist, but surgeons as well if patients are to receive optimum care.

Anxiety, Separation↗
PubMed1995

Prospective audit of mucosal biopsy specimens of the gastrointestinal tract.

AIMS: To determine why mucosal biopsy specimens of the gastrointestinal tract were taken and whether they were justified on clinical or pathological grounds. METHODS: A prospective audit of 190 consecutive biopsy specimens received in a university hospital histology department over six weeks. RESULTS: The 31 separate presenting symptoms included diarrhoea (34%), abdominal pain (16%) and rectal bleeding (15%). In 41% (78/190) the histology was normal, 28% (53/190) showed inflammatory changes and 11% 21/190) carcinoma. A clear justification for the procedure was identified in over 90% (171/190) of patients. In 36% (68/190) there was a change in patient management on receipt of biopsy reports and further investigations were ordered in 29% (55/190). The mean time taken to report biopsy specimens was 4.7 working days and there was no difference between the reporting time of a pathologist compared with a consultant or a trainee. CONCLUSIONS: There is no evidence that mucosal biopsy specimens are taken unnecessarily.

Adolescent↗
PubMed1990

Insulinlike growth factor I receptors in rabbit gastrointestinal tract. Characterization and autoradiographic localization.

Insulinlike growth factor I is a potent mitogen with insulinlike metabolic effects. Insulinlike growth factor I is synthesized in the liver, intestine, and other organs. Insulinlike growth factor I receptors are widely distributed and structurally similar to insulin receptors. Frozen sections of rabbit gastrointestinal tract were incubated in buffer containing 40 pmol/L [125I]insulinlike growth factor I. Binding was saturable, temperature- and time-dependent, and reversible. Saturation binding experiments showed a single class of high-affinity receptors (Kd = 0.9 nmol/L, Bmax = 0.36 pmol/mg protein). The IC50s for insulinlike growth factor I and insulinlike growth factor II were 3 nmol/L and 90 nmol/L, respectively; whereas insulin at 1-3 mumol/L displaced 50% of specific binding. Autoradiography of insulinlike growth factor I binding demonstrated significant differences in receptor density in gastrointestinal smooth muscle, epithelium of the esophagus, stomach, small intestine, and colon. These results indicate that a single class of specific, high-affinity insulinlike growth factor I receptors were distributed in muscular and mucosal layers of the entire rabbit gastrointestinal tract. Insulinlike growth factor I is likely to be an important local mediator of intestinal growth and metabolism.

Animals↗
PubMed1989

Cytomegalovirus infection in gastrointestinal tracts of patients infected with HIV-1 or AIDS.

All gastrointestinal tract biopsy specimens from 190 patients positive for HIV-1 or with AIDS were reviewed to assess the prevalence of cytomegalovirus (CMV) infection, morphology of infected cells, and the associated histopathological features. Eighteen patients (10 (7.7%) of 129 HIV antibody positive and eight (13.1%) of 61 with AIDS) had CMV identified in 35 biopsy specimens from the following sites: oesophagus (n = 3); stomach (n = 6); small intestine (n = 4); colorectum (n = 18) and perianal area (n = 4). Eleven patients had CMV alone as the potential cause of symptoms and in seven there were coexistent pathogens or Kaposi's sarcoma. The appearance and type of infected cells at different sites was highly variable. Immunocytochemical techniques and electron microscopic examination were performed to confirm the presence of CMV antigen and CMV virus particles and to exclude the possibility of an adenovirus producing similar cytopathic changes. It is important to recognise the different morphological forms of infected cells, and the use of immunocytochemical techniques is recommended in patients at risk for CMV or in whom CMV infection is suspected.

Acquired Immunodeficiency Syndrome↗
PubMed1975

Relationships in Canada between mortality from tumours of the gastrointestinal tract and marital status.

The mortality from tumours of the gastrointestinal tract in the Canadian population in 1970-72 was 16% higher in single than in married men (on the basis of age-adjusted rates), 25% higher in widowed men and 28% higher in divorced men. All these differences were unlikely to be due to chance. The rates were 4% higher for single women, 14% higher for widows and 22% higher for divorced women, compared with the married. The differences for single and divorced women were not significant. Substantial excess mortality was found in the unmarried for tumours of the mouth, pharynx and esophagus, and rectum; for tumours of the stomach and colon the excess was small or nonexistent. This variation between sites suggests that systematic errors in the census data used as denominators are not responsible for the high mortality for the unmarried from certain tumours. The effect is found in conditions for which treatment can have made little difference (e.g., a 75% excess mortality for tumours of the esophagus in single men compared with married) and in conditions for which differences in the use of medical facilities may have been important (e.g., a 44% excess mortality for tumours of the rectum in widowers).

Aged↗
PubMed1994

Efficacy of injectable abamectin against gastrointestinal tract nematodes and lungworms of cattle.

Efficacy of abamectin against gastrointestinal tract nematodes and lungworms of cattle was determined in 4 experiments. The first 2 experiments were controlled trials in which efficacy was determined at necropsy in calves with either experimentally induced (n = 14) or naturally acquired (n = 16) infections. Half the calves in each experiment were treated with abamectin (200 micrograms/kg of body weight, SC), and half were left untreated as controls. Efficacy was > 99% against adult stages of Dictyocaulus viviparus, Haemonchus placei, Ostertagia ostertagi, Trichostrongylus axei, Cooperia punctata, Trichuris discolor, and C oncophora, and was 92.4% against Nematodirus helvetianus. The second 2 experiments were clinical trials in which efficacy was determined by fecal egg count reduction in naturally infected yearling heifers (n = 75) or 2-year-old heifers (n = 75). Within replicates of 5, 4 heifers were assigned at random to treatment with 200 micrograms of abamectin/kg and 1 was left untreated as a control. Abamectin was 100% effective in eliminating strongylate nematode eggs from the feces of these heifers. In all experiments, adverse reactions were limited to small, clinically unimportant injection site swellings in 29% of abamectin-treated calves. Abamectin was judged to be safe and effective in these trials.

Animals↗
PubMed1978

Influence of the autonomic nervous system on the release of vasoactive intestinal polypeptide from the porcine gastrointestinal tract.

1. The release of vasoactive intestinal polypeptide from the gastrointestinal tract in response to stimulation of the vagus nerves, the splanchnic nerves and to intra-arterial infusion of acetylcholine (ACh) was examined in pigs. 2. Stimulation of the vagus nerves caused an abrupt increase in the release of vasoactive intestinal polypeptide. The amount of the peptide released depended on the frequency at which the nerves were stimulated. Maximum release was obtained at 8 Hz. 3. Atropine and beta-adrenergic blocking agents failed to diminish the vagally induced release of vasoactive intestinal polypeptide, while the response was completely blocked by hexamethonium and increased after alpha-adrenergic blockade and after splanchnicotomy. 4. Intra-arterial infusion of ACh closely imitated the response to vagal stimulation, but the release of vasoactive intestinal polypeptide induced by ACh was abolished by atropine. 5. Stimulation of the splanchnic nerves caused a decrease in the release of vasoactive intestinal polypeptide, an action which was annulled by alpha-adrenergic blockade, but still present after the adrenal glands were isolated from the circulation. The inhibitory effect of splanchnic stimulation significantly diminished the vagally induced release of vasoactive intestinal polypeptide. 6. The results demonstrate a dual innervation with opposing effects on the neurones containing vasoactive intestinal polypeptides. The possible physiologic implication of this finding is discussed.

Acetylcholine↗
PubMed1994

Method and apparatus for pressure-controlled distension of the lower gastrointestinal tract.

Despite the relevance of visceral perception in the lower gastrointestinal tract to clinical research, especially for diagnosis of functional diseases or neurological derangements of the bowel, precise techniques to evaluate these perceptual processes and mechanical properties of the bowel wall were lacking until recently. Such techniques must include the application of well-defined stimuli and the recording of physiological reactions. A probe was developed which causes minimal discomfort to the subject and is therefore suitable for psychophysical examinations. It can be easily modified for different applications. Stimuli are applied by inflating a balloon, which distends the colon or rectum wall. Prestretching of the balloon material before mounting it on the probe results in monotonic and flat pressure characteristics. Balloon volume is nearly independent from external pressure, within 5% under physiological conditions. Dynamic performance of the balloon is sufficient for studies on the influence of stimulus shape. A microcomputer-controlled pump-system presents precise stimuli within a wide range of volume and inflation rate. A stepping motor is the heart of this system and allows to define exact values for volume and pumping rate without the use of complicated controlling elements. Menu-driven programs allow complex stimulus shapes and sequences. The method and apparatus described above have been successfully used in clinical and basic psychophysiological studies.

Bias↗
PubMed2006

Improved detection and localization of lower gastrointestinal tract hemorrhage by subtraction scintigraphy: phantom analysis.

UNLABELLED: Acute lower gastrointestinal tract hemorrhage (LGIH) has significant morbidity and mortality outcomes. Although several causes of LGIH can be life threatening, most can be effectively treated; therefore, early detection and accurate localization of bleeding sites are critical for successful patient management. METHODS: This study was a phantom experimental study with a repeated-measures design. The minimum detectable bleeding rate, the minimum detectable bleed volume, the sensitivity for detection, and the time required for detection were determined and compared for conventional scintigraphy (CS) and 3 experimental techniques: reference subtraction scintigraphy (RSS), sequential subtraction scintigraphy (SSS), and alternate sequential subtraction scintigraphy (ASSS). RESULTS: The minimum detectable bleeding rates within the first hour were 0.05 mL.min-1 for CS and RSS, 0.1 mL.min-1 for ASSS, and 0.5 mL.min-1 for SSS. This study demonstrated minimum detectable bleed volumes of 2.2 mL for CS, 2.3 mL for RSS, 5 mL for ASSS, and 5 mL for SSS stratified to a "definitely present" certainty. No statistically significant difference was noted in the mean time to detection between CS and the subtraction techniques. Receiver-operating-characteristic analysis indicated that combining CS and RSS improved test performance and increased overall sensitivity to 75% from 68.3% for CS and 71.7% for RSS. CONCLUSION: Supplementing conventional datasets with RSS and ASSS may provide a useful tool that combines the advantages offered for lesion detectability by a high-contrast 99mTc-sulfur colloid study with the window of opportunity offered by 99mTc-labeled red blood cell scanning.

Erythrocytes↗
PubMed2006

Sulfation of the isoflavones genistein and daidzein in human and rat liver and gastrointestinal tract.

Phytoestrogens, in particular the isoflavone aglycones genistein and daidzein, are thought to be the bioactive components of soy. Like estrogens, isoflavones can be sulfur-conjugated. However, although isoflavones in the serum are found largely in the form of glucuronide and sulfur conjugates following soy consumption, little is known regarding the relative contributions of sulfotransferases in the liver and small intestine to isoflavone sulfation. Since the sulfates may be deconjugated in target tissues, circulating isoflavone sulfates may act as a source of tissue aglycones. In the current study genistein and daidzein sulfotransferase activities were measured in cytosol from human and rat liver and gastrointestinal tract. Isoflavone sulfation in the human gastrointestinal (GI) tract was correlated with activities towards substrates for previously characterized human sulfotransferases. Western blots of human cytosols were also conducted using antisera towards human sulfotransferases SULT1E1 and SULT2A1. Whereas rat liver was almost fourfold more active than small intestine in sulfation of genistein, in the human, activities in the two tissues were comparable. In contrast, intestinal sulfation of daidzein was comparable to hepatic sulfation in the rat and significantly greater in the human. Genistein and daidzein sulfation occurred throughout the human GI tract, but with a different distribution and different interindividual variability. Whereas genistein sulfation in the human GI tract correlated significantly with sulfation of the prototypical human phenolic sulfotransferase SULT1A family substrate 2-naphthol (r2 = 0.71), daidzein sulfotransferase activity did not correlate with activities towards any prototypical sulfotransferase substrate or with genistein sulfation. Our results suggest that metabolism in the human GI tract has an important role in the generation of potentially bioactive isoflavone sulfates and a major role for the human phenolic sulfotransferase SULT1A family in metabolism of genistein in the gut. However, human intestinal daidzein sulfation appears to be catalyzed by a separate enzyme.

Adolescent↗
PubMed2005

[Surgeries on gastrointestinal tract without components of donor's blood].

Results of surgical treatment without transfusion of donor's blood in 58 patients were compared with ones in 40 patients treated with allogenous transfusions. Blood-saving program included preoperative storage of autoplasma, acute normovolemic hemodilution, recombinant human erythropoietin and perftoran. Both groups of patients were similar by types of surgeries performed on gastrointestinal tract. Results of treatment in the study group (58 patients) were better: there were less postoperative complications; period of postoperative rehabilitation was shorter. It is demonstrated that it is possible to refuse allogenous hemotransfusion in 96.6% cases of traumatic surgeries on gastrointestinal tract.

Adult↗
PubMed1997

A case-control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder.

OBJECTIVE: To assess whether there are common malfunctions (e.g. of the autonomic nervous system and smooth muscle) that underlie disorders of the urinary and gastrointestinal tracts by determining whether there is an increased prevalence (i) of urinary symptoms in patients with irritable bowel syndrome (IBS) and (ii) of gastrointestinal symptoms in patients with idiopathic detrusor instability (IDI). PATIENTS AND METHODS: Questionnaires were sent to patients with a diagnosis of IBS or IDI who were seen in the Departments of Gynaecology, Gastroenterology and Urology at the John Radcliffe and Churchill Hospitals, Oxford, during the 3 year period 1993-1995. The questionnaires were also distributed to control patients who were recruited from the day-surgery unit of the Churchill Hospital. Of 236 questionnaires sent out, 168 replies were analysed; 64 from patients with IBS, 49 from patients with detrusor instability and 55 from controls. The questionnaire included questions about micturition and defecatory behaviour (frequency, regularity, urgency, continence, pain, and ease in passing urine and stools). RESULTS: Patients with IBS were more likely to experience certain urinary symptoms than controls (nocturia, urgency and some forms of urinary urge incontinence) and patients with IDI were as likely as patients with IBS to experience gastrointestinal symptoms more frequently than controls. Control patients showed an unexpectedly high probability of experiencing many of the gastrointestinal and urinary symptoms. CONCLUSIONS: The frequent occurrence of symptoms in control patients makes the significance of the results less clear, but the association between certain symptoms of urinary tract disorder and patients with IBS, and of symptoms of gastrointestinal tract disorder with patients with IDI, suggests that they may share some common underlying dysfunction.

Adult↗
PubMed1997

Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an underrecognized condition.

Sodium polystyrene sulfonate (Kayexalate) in sorbitol given as an enema or orally to treat hyperkalemia has been reported to induce intestinal necrosis in uremic patients. We studied the clinical and pathologic features of 15 patients in whom Kayexalate crystals were observed in specimens from gastrointestinal surgical resections (n = 9) or endoscopic biopsies (n = 7). Oral or nasogastric tube administration of Kayexalate in sorbitol was documented in 10 patients. Among 12 patients with colorectal specimens, necrosis was observed in nine patients (75%), represented by seven of eight surgical resection specimens and three of five endoscopic biopsy specimens. No other cause of colorectal necrosis apart from Kayexalate in sorbitol was apparent in seven patients, and four also had necrosis of the small intestine. Four patients with colonic necrosis in their initial resection specimen developed progressive necrosis of the small intestine or rectum, and five patients (56%) had fatal outcome within 1 day to 6 weeks. Kayexalate crystals were observed in upper gastrointestinal tract specimens from four patients, including one with hemorrhagic gastritis. Our findings provide additional evidence that Kayexalate in sorbitol administered orally or by nasogastric tube can produce necrosis in the gastrointestinal tract.

Adult↗