Adaptive changes in postprandial motility after intestinal resection and bypass

An electromyographic technique was used to study the changes in postprandial motility induced by jejunal and ileal resection and jejunal bypass (50% reduction of total length of small bowel). Electrodes were implanted in rats throughout the intestine. Compared to control animals, the duration of postprandial interruption of the myoelectric complex (DIMC) was rapidly increased after jejunal resection, more gradually augmented after jejunal bypass, and remained constant after ileal resection. The frequency of occurrence of spike bursts during the postprandial period was significantly decreased in the short remaining proximal segment after jejunal resection and was not changed in the ileum. The jejunal bypass induced no change in the frequency throughout the remaining bowel. Ileal resection was followed by a decrease on the jejunum. The percentage of slow waves superimposed by a spike burst remained constant after jejunal resection and bypass but was significantly decreased after ileal resection on the whole remaining intestine. These results show important modifications in postprandial motor activity of the small bowel, which appear rapidly after jejunal resection, more gradually after jejunal bypass, and which are less pronounced after ileal resection. This electromyographic study emphasizes the role of intestinal motility in the development of adaptation after small bowel resection or bypass.     

Influence of intestinal microecology in the development of gout or hyperuricemia and the potential therapeutic targets

Gout and hyperuricemia are common metabolic diseases. Patients with purine metabolism disorder and/or decreased uric acid excretion showed increased uric acid levels in the blood. The increase of uric acid in the blood leads to the deposition of urate crystals in tissues, joints, and kidneys, and causes gout. Recent studies have revealed that imbalance of the intestinal microecology is closely related to the occurrence and development of hyperuricemia and gout. Disorder of the intestinal flora often occurs in patients with gout, and high purine and high fructose may induce the disorder of intestinal flora. Short-chain fatty acids and endotoxins produced by intestinal bacteria are closely related to the inflammatory response of gout. This article summarizes the characteristics of intestinal microecology in patients or animal models with hyperuricemia or gout, and explores the relationship between intestinal microecology and gout or hyperuricemia from the aspect of the intestinal barrier, intestinal microorganisms, intestinal metabolites, and intestinal immune system. We also review the current status of hyperuricemia treatment by targeting intestinal microecology.     

The Effect of Polyacrylic Acid Polymers on Small-Intestinal Function and Permeability Changes Caused by Indomethacin

Non-steroidal anti-inflammatory drug (NSAID)-induced increased small-intestinal permeability appears to be a prerequisite for the development of NSAID enteropathy, which is a cause of much morbidity in patients with rheumatoid arthritis. We assessed, with a combined absorption-permeability test, the effects of Carbopol® (a polyacrylic acid polymer capable of increasing mucus strength and viscosity) on intestinal function and whether it protected against indomethacin-induced increased intestinal permeability. Using a test solution of 3-0-methyl-D-glucose, D-xylose, L-rhamnose, and ⁵¹Cr-labelled ethylenediaminetetraacetic acid with 5-h urine collections for marker analyses, we tested 16 subjects, as base line, after 20 ml Carbopol 4 times daily for 4 days, after indomethacin alone (75 + 75 mg), and after coadministration of Carbopol and indomethacin. Carbopol had no significant effect on the permeation or absorption of the test substances. Indomethacin increased intestinal permeability significantly, and this was unaffected when Carbopol was coadministered with indomethacin, showing that Carbopol does not limit the immediate damage of NSAIDs on the small intestine.     

Characteristics of intestinal tuberculosis in ultrasonographic techniques

Objective. There is a paucity of data on the sonographic criteria for the diagnosis of intestinal tuberculosis. The purpose of this study was to further characterize the potential sonographic signs of intestinal tuberculosis and to increase the diagnostic sensitivity and specificity of ultrasound. Material and methods. Seven patients with a final diagnosis of gastrointestinal tuberculosis and a control group of 18 patients suffering from tuberculosis limited to the lungs were prospectively evaluated for sonographic criteria of intestinal tuberculosis and the findings were compared with those in 50 healthy controls. Results. The following signs of intestinal tuberculosis were detectable: asymmetric thickened bowel wall (100%), intramural abscesses (86%), fistula (43%), extramural abscesses (29%), mesenteric thickening (29%), “white bowel” sign (29%), hypoechoic edema of Kerckring's folds with mesenterial thrombosis (14%), enlarged mesenteric lymph nodes with inhomogeneous echotexture and circumscribed hypoechoic spots <3 mm (86%), ascites (29%) and enlarged spleen (14%). These signs were exclusively present in patients with intestinal tuberculosis as compared with patients with tuberculosis limited to the lungs or with healthy controls. We could confirm the endoscopically reported right-sided prevalence of these wall thickenings. In contrast to the reported literature, a much higher prevalence of these sonographic signs was found as they were present in all patients. Six of 7 patients (86%) showed enlarged mesenteric lymph nodes. This was particularly interesting as mesenteric lymph nodes have not been described as being enlarged in the majority of other differential diagnoses of the ileocecal region. Conclusions. The combination of bowel-wall thickening of the ileocecal region with intramural abscesses with or without fistula, abscesses and mesenteric thickening accompanied by enlarged mesenteric lymph nodes was highly predictive of intestinal tuberculosis.     

Effects of psychological stress on small intestinal motility and bacteria and mucosa in mice

AIM: To investigate the effects of psychological stress on small intestinal motility and bacteria and mucosa in mice, and to explore the relationship between small intestinal dysfunction and small intestinal motility and bacteria and mucosa under psychological stress. METHODS: Sixty mice were randomly divided into psychological stress group and control group. Each group were subdivided into small intestinal motility group (n= 10), bacteria group (n = 10), and D-xylose administered to stomach group (n= 10). An animal model with psychological stress was established housing the mice with a hungry cat in separate layers of a two-layer cage. A semi-solid colored marker (carbon-ink) was used for monitoring small intestinal transit. The proximal small intestine was harvested under sterile condition and processed for quantitation for aerobes (Escherichia coli) and anaerobes (Lactobacilli). The quantitation of bacteria was expressed as Iog10(colony forming units/g). D-xylose levels in plasma were measured for estimating trie damage of small intestinal mucosa. RESULTS: Small intestinal transit was inhibited (39.80±9.50% vs 58.79±11.47%,P<0.01) in mice after psychological stress, compared with the controls. Psychological stress resulted in quantitative alterations in the aerobes (E.coli). There was an increase in the number of E coli in the proximal small intestinal flora (1.78±0.30 log10(CFU/g) vs 1.37±0.21 log10(CFU/g), P<0.01), and there was decrease in relative proportion of Lactobacilli and E.coli of stressed mice (0.53±0.63 vs 1.14±1.07,P<0.05), while there was no significant difference in the anaerobes (Lactobacilli) between the two groups (2.31±0.70 log10 (CFU/g) vs 2.44±0.37 log10(CFU/g), P>0.05). D-xylose concentrations in plasma in psychological stress mice were significantly higher than those in the control group (2.90±0.89 mmol/L vs 0.97±0.33 mmol/L, P<0.01). CONCLUSION: Small intestinal dysfunction under psychological stress may be related to the small intestinal motility disorder and dysbacteriosis and the damage of mucosa probably caused by psychological stress.     

Comparison of Four Markers of Intestinal Permeability in Control Subjects and Patients with Coeliac Disease

Bjarnason I, Maxton D, Reynolds AP, Catt S, Peters TJ, Menzies IS. Comparison of four markers of intestinal permeability in control subjects and patients with coeliac disease. Scand J Gastroenterol 1994;29:630-639

Background: Controversy surrounds the issue of intestinal permeability in patients with coeliac disease, polyethylene glycol 400 indicating reduced and di-/mono-saccharide urine excretion ratios and ^5lCr-labeled ethylenediaminetetraacetic acid (EDTA) indicating increased permeability.

Methods: We assessed the suitability of polyethylene glycol 400, L-rhamnose, lactulose, and ⁵¹Cr-EDTA as markers of intestinal permeability by assessing urine excretions after simultaneous intravenous instillation of these markers and after oral administration in normals and patients with coeliac disease.

Results: After intravenous administration the 24-h urine excretion of polyethylene glycol 400, L-rhamnose, lactulose, and ⁵¹Cr-EDTA was 40%, 72%, 93%, and 97%, respectively. There was no significant difference between controls and patients with coeliac disease. Oral administration of the markers in an iso- and hyperosmolar test solution demonstrates reduced permeation due to an osmotic retention effect of lactulose. In contrast, hyperosmolar glycerol increases permeation of all markers except L-rhamnose. Timing of urines and altering osmolality is important for the behaviour of individual markers but does not enhance the discrimination between controls and patients when the differential urine excretion of lactuIose/L-rhamnose is used. The sensitivity of the urine excretion ratio of Iactulose/L-rhamnose was comparable to that of ⁵¹Cr-EDTA used by itself. Whereas lactulose/L-rhamnose and ⁵¹Cr-EDTA showed increased intestinal permeability in coeliac disease, the permeation of polyethylene glycol was reduced. Permeation of the markers did not correlate significantly with jejunal histology. Conclusions: Correlations of marker permeation rates with test dose osmolality in controls and patients with coeliac disease shows a variable lack of conformity, suggesting that the markers may permeate the intestine by different routes, which are affected to a different extent in coeliac disease.     

Effect of pacing on small intestinal motor activity and hormonal response in dogs

In seven beagle dogs with a Thiry-Vella loop, the effect of pacing on small intestinal motor activity was examined by means of extraluminal strain gauge force transducers. Recordings were obtained from the loop and from the remaining small intestine. Our study showed that pacing of the loop results in a significant reduction of the motility of the loop in the overnight fasted state (up to 39%), during loop feeding (up to 55%), and oral feeding (up to 39%); a similar reduction of the motility of the remaining small intestine (up to 43%); and a significant postprandial increase of insulin (9.0 U/ml) and decrease of glucagon (94 pg/ml). The motility reduction of the loop and of the remaining small intestine as well as the anabolically improved pancreatic endocrine function (shown by an increase of the insulin — glucagon ratio) suggests that this form of pacing could be of benefit for motility disorders with decreased transit time.The present study was supported by Deutsche Forschungsgemeinschaft.     

Postischemic intestinal motility in rat is inversely correlated to length of ischemia

An inverse correlation between postischemic gastrointestinal motility and the length of intestinal ischemia was found in an animal model. Intestinal ischemia was caused without concurrent laparotomy and for a predetermined time period (ischemia time) by pulling on an external nylon thread that was threaded through a double-lumen catheter. This catheter was passed into the abdominal cavity to encircle the superior mesenteric artery. Gastrointestinal motility was determined by the introduction of a color-marked meal into the animal's stomach and the measurement of the proportionate length of the small bowel filled with it (transit index). This simple and reliable animal model can also be used for the evaluation of techniques and pharmacological manipulations aimed at modulation of the effects of intestinal ischemia on intestinal motility and its consequences.     

Short-term intestinal ischemia-reperfusion alters intestinal motility that can be preserved by xanthine oxidase inhibition

While the effects of transient intestinal ischemia on mucosa have been well investigated, less is known about its effect on motor function. An experimental study was designed to investigate the effects of ischemia–reperfusion (I/R) on intestinal motility and intestinal muscular microcirculation. Wistar albino rats were divided into four groups: (1) baseline, (2) sham operation, (3) I/R, and (4) I/R with allopurinol pretreatment. Ischemia was induced by clamping the superior mesenteric artery (SMA) for 10 min. Gastroanal transit time (GATT) was measured with serial x-rays after instillation of barium sulfate to the stomach. Intestinal muscular microcirculation was evaluated by determining the number of carbon-perfused intestinal muscular microvessels (CPIMM). I/R prolonged GATT and decreased CPIMM significantly (P < 0.01). Pretreatment with allopurinol prevented prolongation of GATT and returned the number of CPIMM to the level of sham treatment (P < 0.01). In conclusion, reperfusion after 10 min of SMA ischemia alters intestinal motility. The no-reflow phenomenon plays an important role in this alteration of motility. Administration of allopurinol before reperfusion preserves intestinal motility by preventing the occurrence of no-reflow phenomenon.     

Discrepancies Between Effects of Recombinant Human Growth Hormone on Absorption and Secretion of Water and Electrolytes on the Human Jejunum Compared to Results Reported on Rat Jejunum

Previous studies in rats showed that the administration of recombinant human growth hormone markedly increased intestinal absorption of electrolytes and water and suggested that growth hormone would be a useful antidiarrheal agent. We therefore examined the effect of recombinant human growth hormone on the human jejunum in vivo, using a triple lumen nonabsorbable marker technique. Healthy subjects were studied on two different test days, one as a control and a second where recombinant human growth hormone was injected subcutaneously in a dose of 100 g/kg. With this dose we achieved equal or higher growth hormone serum levels than in previous rat studies. However the administration of recombinant human growth hormone did not stimulate absorption or inhibit secretion of water and electrolytes in the human jejunum in vivo. We believe that the discrepancy between humans and rats is most likely due to the species difference rather than to differences in methods that were used. Therefore recombinant human growth hormone cannot be considered a useful proabsorptive antidiarrheal agent in humans.     

唐山市农村小学生肠道致病原感染情况调查

采用随机方法确定唐山市农村小学生肠道致病原感染调查的调查学校和调查对象,采集粪样,用生理盐水涂片法、碘液涂片法、饱和盐水浮聚法检查肠道寄生虫,同时检查肠道致病菌。调查对象共433人,433份粪样中仅检出3例粪类圆线虫和2例结肠内阿米巴;肠道致病菌阳性101份,阳性率为22.75%,其中产碱杆菌阳性5例,乙型副伤寒杆菌阳性78例,伤寒杆菌阳性6例,痢疾杆菌阳性7例,其他5例。唐山市农村小学生肠道寄生虫感染率较低,但是肠道致病菌的感染率较高。     

Misoprostol reduces indomethacin-induced changes in human small intestinal permeability

This study examined whether indomethacin-induced increases in small intestinal permeability in man are prevented by concomitant administration of a prostaglandin analog (misoprostol). Twelve male volunteers were tested as baseline, following misoprostol alone (200 g, at –16, –12, –8.5, –4, –1.5, and +4 hr); following indomethacin alone (75 mg, at –8; 50 mg, –1 hr); and following coadministration of misoprostol and indomethacin as specified above. A 100-ml test solution containing 3-O-methyl glucose (0.2 g), D-xylose (0.5 g),l-rhamnose (1.0 g), and [⁵¹Cr]EDTA (100 Ci) was ingested at 8 AM, and a 5-hr collection made for marker analysis to assess active and passive carrier-mediated transport and trans- and intercellular permeation, respectively. Indomethacin increased the permeation of [⁵¹Cr]EDTA selectively, and this increase was significantly reduced by the coadministration of misoprostol. These changes were mirrored by changes in [⁵¹ Cr]EDTA-L-rhamnose urine excretion ratios, which indicates that paracellular permeability was specifically altered. This study supports the suggestion that NSAIDs alter intestinal permeability by a mechanism involving reduced prostaglandin synthesis and indicates that coadministration of misoprostol with NSAIDs may reduce the frequency and severity of NSAID-induced small intestinal inflammation.     

急诊小肠镜联合DSA诊断小肠间质瘤合并出血1例

小肠间质瘤常以消化道出血为首发症状,急诊小肠镜联合DSA诊治小肠间质瘤合并消化道出血,两者互为补充,是一种安全、有效的诊治方法。     

肠道微生态与人类疾病关系的研究进展

肠道微生态系统复杂多样,不同种群微生物之间相互依存、相互制约,从而达到一种稳定的微生态平衡状态。一旦失衡,将可能导致一系列的病理生理反应,从而引发疾病。因此肠道微生态与人类多种疾病的发生、发展密切相关。探明肠道微生态与人类疾病之间的关系,对认识和治疗各种疾病至关重要。本文就肠道微生态及其参与人类疾病发生发展过程的最新研究进展进行综述。     

噬菌体对人肠道正常菌群生态平衡及耐药性的影响

肠道微生态是指寄生在宿主肠道内的微生物总称.随着人类微生物计划的开展,肠道微生态代表着人体内最复杂和种群数量最多的共生微生物生态系统,作为一个"微生物器官"被广泛研究.早期对肠道微生态的研究多集中在肠道细菌群落的结构和动态变化,往往忽略了噬菌体的存在.但是近年来因为抗生素的滥用,噬菌体在肠道中的作用日益得到重视.本文拟对肠道细菌,噬菌体,抗生素三者间的关系进行综述,阐述肠道微生物间协同进化的机理,为治疗肠道相关的疾病提供新思路.     

Plasma enteroglucagon levels in different models of intestinal resection in the rat

To assess the influence of the different intestinal segments on the plasma enteroglucagon level, three models of intestinal resection in the rat were studied (jejunal, ileal, 90%). The basal values for this peptide and those obtained after an infusion of intraduodenal glucose were compared. The results obtained in basal/post-glucose infusion were: 50% proximal (jejunum): 220/728 pg/ml; 50% distal (ileum): 10/233 pg/ml; and the middle 90%: 108/297 pg/ml. The glucose infusion produced a maximal response, permitting a better evaluation of the differences among the three resection models. The highest levels corresponded to the group in which the entire ileum was conserved.     

Intestinal pathophysiological and microbial changes in sickle cell disease: Potential targets for therapeutic intervention

There is a large therapeutic gap in the treatment of sickle cell disease (SCD). Recent studies demonstrated the presence of pathophysiological and microbial changes in the intestine of patients with SCD. The intestinal microbes have also been found to regulate neutrophil ageing and possible basal activation of circulating neutrophils. Both aged and activated neutrophils are pivotal for the pathogenesis of vaso-occlusive crisis in SCD. In this paper, we will provide an overview of the intestinal pathophysiological and microbial changes in SCD. Based on these changes, we will propose therapeutic approaches that could be investigated for treating SCD.     

胃黏膜肠上皮化生内镜诊断和分级的研究进展

胃黏膜肠上皮化生（gastric intestinal metaplasia,GIM）是一种癌前组织病理学改变,其临床意义在于对胃癌发生风险的提示,有着大面积肠上皮化生背景的胃黏膜具有较高的癌变风险;另外,不完全型GIM与肠型胃癌相关。因此,GIM的内镜下监测对及时发现和管理早期胃癌具有重要意义。可操作的GIM胃癌风险评估分级提供了较好地针对肠上皮化生的胃黏膜癌变风险评估,但每次评估需要标准的活检,增加了损伤风险,GIM内镜分级在此背景下被提出,但其应用受内镜诊断GIM的准确性和临床使用的便捷性所制约。笔者分析了各类内镜下诊断技术对GIM的诊断效果,结合人工智能辅助识别GIM面积,综述EGGIM评分的可行性。     

Crohn’s Disease in Norway — Clinical Features

A total number of 72 patients with typical Crohn’s disease has been reported for the whole country of Norway during the 8-year period 1956-63. No sex difference was found. The youngest patient was 14 years old. The average age at the time of diagnosis, 40.4 years, was higher than in previously published series of patients, The main symptoms observed in our patients were: abdominal pain in 86 per cent, diarrhea in 53 per cent, loss of weight in 40 per cent, fever in 33 per cent, subileus in 34 per cent, and ileus in 21 per cent. Gastrointestinal bleeding occurred in 19 per cent of the cases, an abdominal mass was palpated in 36 per cent, and fistulas occurred in 33 per cent of the patients. The disease was localized to the terminal ileum alone in 58 per cent, to terminal ileum and coecum in 21 per cent, and to proximal ileum and jejunum in 7 per cent of the cases. Jejunum alone was affected in 7 per cent and in 7 per cent ileum and segments of colon distal to coecum were affected. Forty-one patients were treated by primary resection, which was followed by good results in 84 per cent of the cases. Improvement occurred less frequently in the 16 patients treated with primary bypass operation.