Comparison of effects of ingested mediumand long-chain triglyceride on gallbladder volume and release of cholecystokinin and other gut peptides

In a double-blind, crossover study of the effect of ingested medium-chain triglyceride (MCT) and long-chain triglyceride (LCT) in six normal subjects, the gallbladder did not contract after ingestion of MCT but instead had significantly increased in volume at 2 hr after the meal. Plasma cholecystokinin (CCK) increased after the MCT meal, but gastrin, motilin, pancreatic polypeptide (PP), and GIP were unaffected. The long-chain triglyceride meal evoked a brisk and sustained gallbladder contraction, higher levels of CCK, and a significant increase in plasma PP and GIP levels.     

Effects of Hyperglycemia on Interdigestive Gastrointestinal Motility in Humans

Björnsson ES, Urbanavicius V, Eliasson B, Attvall S, Smith U, Abrahamsson H. Effects of hyperglycemia on interdigestive gastrointestinal motility in humans. Scand J Gastroenterol 1994;29:1096-1104.

Background: Gastrointestinal motility disorders are common in patients with diabetes mellitus. Recent studies indicate that hyperglycemia can affect gastric emptying and gastric motility in healthy subjects and diabetics.

Methods: The effect of acute hyperglycemia on gastrointestinal motility was studied with a manometric technique in healthy subjects. Seven individuals, four men and three women, 23-34 years old, were studied on 2 different days. On 1 of the days a 5-h registration was performed after an overnight fast. On another day and after an initial basal period, acute steady-state hyperglycemia was induced by intravenous glucose infusion for 90 min. Motility variables were evaluated in four segments: in the gastric antrum, the proximal duodenum, the distal duodenum, and the proximal jejunum.

Results: Fasting migrating motor complex rhythm including migration of phase III prevailed during hyperglycemia. Compared with euglycemia, the motility index in phase II was lower during hyperglycemia in all segments studied. In the antrum the difference was 62% (p <0.01); in the proximal duodenum, 37% (p < 0.01); in the distal duodenum, 44% (p < 0.05); and in the jejunum, 58% (p < 0.01). During hyperglycemia the prevalence of propagated contractions in phase II was significantly lower than during euglycemia both in the antrum and the proximal duodenum. In the last part of phase III in proximal duodenum most individual contractions were propagated in orad direction compared with early phase III. and this difference persisted during hyperglycemia. The number of long clusters was significantly increased during hyperglycemia as compared with euglycemia: 2.0 ± 0.6 per hour versus 0.4 ±0.14 (p<0.01). In late phase II plasma levels of motilin and pancreatic polypeptide were significantly decreased during hyperglycemia

Conclusion: Hyperglycemia not only reduces the motility in the stomach but also inhibits motility in both the duodenum and the jejunum. The results show that acute hyperglycemia has an important impact on small-intestinal motility.     

Effect of Helicobacter pylori Infection on Gastrointestinal Motility,Pancreatic Secretion and Hormone Release in Asymptomatic Humans

Background: Helicobacter pylori infection is associated with complex alterations of the gastric physiology in patients with ulcer disease or functional dyspepsia. We aimed at evaluating whether H. pylori infection is accompanied by changes in interdigestive and postprandial gastrointestinal motility, exocrine pancreatic secretion or hormone release in asymptomatic subjects. Methods: Nineteen healthy men (age range 26-35 years) were studied after 12 h fasting. Motor activity was recorded for a complete motor migrating complex cycle and two postprandial hours. Pancreatic enzyme secretion was evaluated using a standard duodenal perfusion technique. Plasma concentrations of gastrin, PP and motilin were determined at 15-min intervals. H. pylori infection was proved by serology and 13C-urea breath test. Results: Eight subjects (42%) were H. pylori positive. Interdigestive and postprandial gastrointestinal motility were similar in H. pylori positive and negative subjects. Interdigestive pancreatic secretion was increased in H. pylori positive subjects ( P < 0.05). Postprandial pancreatic secretion tended also to be higher in H. pylori positive subjects. H. pylori infection was associated with an increased postprandial release of gastrin ( P < 0.05) as well as with a slight increase of interdigestive gastrin release. The release of PP and motilin, as well as the interdigestive coordination between gastrointestinal motility, pancreatic secretion and hormone release, was not altered by H. pylori infection. Conclusions: H. pylori infection in asymptomatic subjects is associated with changes not only in gastric physiology but also in pancreatic function. This first reported link between H. pylori and the pancreas could have pathophysiological implications in pancreatic diseases and therefore deserves further study.     

胃炎丸调整胃肠动力的临床与实验研究

为探讨胃炎丸治疗慢性胃炎在改善胃肠动力方面的作用，对33例慢性胃炎患者进行临床观察，并选择胃肠墨汁推进试验及胃酚红排空试验进行了动物实验。研究结果胃炎丸能明显改善症状，提高血清胃动素水平（P＜0．05）．促进胃排空，治疗前、后胃排空率分别为（20．1±6.1）％、（30．3±7．6）％（P＜0．05），从而有利于胃粘膜的修复。动物实验也证实胃炎丸具有提高小鼠胃肠墨汁推进运动及加快大鼠酚红的排空作用。提示胃炎丸能调整胃肠动力，改善胃的内环境，从而对慢性胃炎具有较好的治疗效果。     

The Influence of Induced Hyperglycaemia on the Characteristics of Intestinal Motility and Bile Kinetics in Healthy Men

Simultaneous recording of duodenal motility and biliary scintigraphy by continuous infusion of ^99mTc-dimethyl-iminodiacetic acid was performed in 16 healthy fasted men, of whom eight had an intravenous glucose bolus injection immediately after the passage of a duodenal phase III of the migrating motor complex (MMC). This was followed by a continuous intravenous infusion of glucose. Characteristics of the time-activity curves from the gallbladder area and intestinal area were related to phase activity of the duodenal MMC. The median duration of the entire MMC cycle was significantly shorter in the glucose group than in the group without glucose. The difference was caused by shortening of phase II. Spontaneous gallbladder emptying appeared in all eight subjects from the group without glucose but in only a single subject from the glucose group. The relative amount of liver bile diverted to the gallbladder in the entire cycle was significantly higher in the subjects who received glucose, and in four subjects all the hepatic bile was diverted to the gallbladder. The results demonstrate that induced hyperglycaemia exerts a pronounced effect on gastrointestinal motility and bile kinetics. Available evidence suggests that the effects are caused by a ‘medical vagotomy'.     

A Comparative Study of the Effects of Electroacupuncture and Moxibustion in the Gastrointestinal Motility of the Rat

We compared the outcomes of the stimulation of specific sets of acupoints with either acupuncture or moxibustion over peristalsis. Twenty-five plastic beads were orally administered in the stomach of the rats and 90 min later animals were sacrificed, the stomach and small intestine were opened, and the number of beads remaining in each segment was counted. Forty rats were immobilized for 20 min and stimulated at either abdominal or hindlimbs acupoints, with either electroacupuncture or moxibustion. Under this restraint (stress) condition electroacupuncture at hindlimb points or moxibustion at abdominal points significantly enhanced gastric emptying (P < 0.02) as well as intestinal motility compared with animals subjected only to immobilization and not stimulated with electroacupuncture or moxibustion. We conclude that the effects of different acupoints and modes of stimulation (electrical vs. moxibustion) over gastrointestinal motility in rats subjected to restraint-induced stress is not uniform and discuss the different neural pathways underlying these differences.     

Stereospecific Effects of Intraduodenal Tryptophan on Pyloric and Duodenal Motility in Humans

Edelbroek M, Sun W-M, Horowitz M, Dent J, Smout A, Akkermans L. Stereospecific effects of intraduodenal tryptophan on pyloric and duodenal motility in humans. Scand J Gastroenterol 1994;29: 1088-1095.

Background: L-Tryptophan delays gastric emptying in animals to a greater extent than D-tryptophan, but none of the possible motor mechanisms responsible for this stereospecific effect have been evaluated.

Methods: In 11 healthy volunteers antropyloroduodenal pressures were recorded in the fasted state with a sleeve/sidehole manometric assembly during 20-min intraduodenal infusions (2 ml-min^]) of isotonic L- AND D-tryptophan (50 mM, pH 5.7) and normal saline (pH 5.5), given in randomized order.

Results: Intraduodenal L-tryptophan increased basal pyloric pressure (p < 0.05), whereas D-tryptophan had no effect. In contrast, l- and D-tryptophan both stimulated (p < 0.05) localized phasic pyloric pressure waves, and there was no significant difference in the responses. The number of duodenal pressure waves was greater during infusion of L-tryptophan than during D-tryptophan (p<0.05).

Conclusion: We conclude that intraduodenal tryptophan has stereospecific effects on pyloric and duodenal motility. Although the precise contribution of these differential effects to gastric emptying remains to be clarified, they may be partialK responsible for the differences in gastric emptying of D-tryptophan and L-tryptophan.     

砂仁对大鼠胃肠运动及神经递质的影响

目的：探讨砂仁的促胃肠动力作用机制。方法：32只Wistar大鼠随机分为砂仁组及对照组,分别给大鼠灌服砂仁水提液或蒸馏水1、6h后,以葡聚糖蓝－2000为胃肠内标记物观察大鼠胃肠动力变化,放射免疫分析法测定血,胃窦及空肠组织胃动素（MTL）、P物质（SP）、血管活性肠肽（VIP）的含量变化。结果：灌服砂仁水提液1、6h后,大鼠胃肠动力显著增强,血浆,胃窦及空肠组织中MTL、SP的含量明显增加,但VIP的含量无明显改变,上述变化均灌服砂仁水提液1h后为显著（P＜0．01）,6h后有减弱趋势（P＜0．05）。结论：砂仁的促胃肠动力作用可能与血及胃肠道MTL、SP含量的增加有关,VIP可能未参与砂仁的促胃肠动力作用。     

Effect of Preinjury Large Bowel Emptying on the Inhibition of Upper Gastrointestinal Motility After Spinal Cord Injury in Rats

Spinal cord transection (SCT) inhibits gastrointestinal motility in rats. We evaluated the effect of preinjury large bowel emptying on this phenomenon. Male Wistar rats (N = 52) were fasted for 24 or 48 hr with water ad libitum and pretreated with lactose (0.8 g) or saline. Next, laminectomy followed or not by complete SCT between T4 and T5 vertebrae was performed. Phenol red recovery in the stomach and proximal, medial, and distal small intestine was determined 1 day later. In animals submitted to 24 hr fasting + saline, SCT increased gastric recovery by 42.8% decreased medial small intestine recovery by 56.2%, while 48 hr fasting + saline or 24 hr fasting + lactose prevented the inhibition of gastric emptying (GE) in SCT animals. The 48 hr fasting + lactose prevented the inhibition of both GE and gastrointestinal transit. SCT-induced inhibition of upper gastrointestinal motility may involve enhancement of inhibitory reflexes, which can be prevented by large bowel emptying.     

Inhibitory Effects of Sildenafil on Small Intestinal Motility and Myoelectrical Activity in Dogs

Previous studies have shown that sildenafil inhibits the esophageal motility in both humans and animals. The aim of this study was to investigate the effects of sildenafil on intestinal myoelectrical activity and motility. The study was composed of 2 experiments and performed in 7 healthy female dogs with a duodenal cannula 20 cm beyond pylorus (19–26 kg). The first experiment was designed to study the effects of sildenafil on intestinal myoelectrical activity and it included 2 sessions each consisting of 30-minute baseline, 15-minute posttreatment (placebo or 100 mg sildenafil) and 90 minutes after a liquid meal. Intestinal myoelectrical activity was recorded during the entire experiment period. The second experiment was aimed to investigate the effect of sildenafil on intestinal motility and was performed immediately after a solid meal. Intestinal motility was measured by a manometric catheter inserted into the small intestine via the duodenum cannula for 30 minutes at baseline and 60 minutes after sildenafil. Sildenafil significantly reduced the amplitude but had no effect on the frequency and regularity of the intestinal myoelectrical activity. Sildenafil significantly inhibited postprandial intestinal contractions. Although the frequency of the contractions was not altered, the mean area under the curve was significantly reduced during the first 30 minutes (P < .03) and second 30 minutes after sildenafil (P < .03); the power of intestinal contractile activities was also significantly reduced during the first 30 minutes (P < .0004) and second 30 minutes after sildenafil (P < .0003) in comparison with baseline. In conclusion, sildenafil inhibits the amplitude of both intestinal contractile activity and intestinal slow waves.     

Effects of Growth Hormone Deficiency and Recombinant Growth Hormone Therapy on Postprandial Gallbladder Motility and Cholecystokinin Release

In addition to cholecystokinin, other hormones have been suggested to be involved in regulation of postprandial gallbladder contraction. We aimed to evaluate effects of growth hormone (GH) on gallbladder contractility and cholecystokinin release. Gallbladder and gastric emptying (by ultrasound) and cholecystokinin release were determined before and after 6 months of recombinant human GH (rhGH) therapy in 12 patients with GH deficiency, after either a mixed (n = 5) or a liquid (n = 7) meal. Basal postprandial gallbladder contraction was severely impaired (19 +/- 2 and 26 +/- 3% of fasting volume after mixed and liquid meal, respectively). Histology and cholecystokinin sulfation patterns in duodenal biopsies from two patients were normal. After 6 months of rhGH therapy, fasting gallbladder volumes increased (from 20.8 +/- 0.9 to 25.9 +/- 1.1 mL, P < 0.05) and postprandial gallbladder emptying was restored (70 +/- 6 and 70 +/- 7% of fasting volume after mixed and liquid meal, respectively), without change of gastric emptying. Cholecystokinin secretion after a mixed meal and gallbladder sensitivity to cholecystokinin were significantly enhanced during rhGH replacement compared to the basal state. Postprandial cholecystokinin release, gallbladder responsiveness to cholecystokinin, and gallbladder emptying are severely impaired in the absence of GH. Reversibility during GH suppletion suggests its involvement in regulation of gallbladder contractility.     

Postprandial gallbladder motility and plasma cholecystokinin at regular time intervals after injection of octreotide in acromegalics on long-term treatment

The increased risk of gallstone formation in acromegalics treated with the somatostatin analog octreotide has been related to an impaired gallbladder emptying. To determine the duration of these inhibitory effects, meal-stimulated gallbladder motility, plasma cholecystokinin (CCK), and pancreatic polypeptide (PP) were measured in five acromegalics treated for 6–32 months with 200–300 g octreotide daily. Meal tests were performed 45 min, 8 hr and two weeks after the last 100-g subcutaneous dose. Results were compared with those in normal subjects. Integrated postprandial gallbladder contraction (–125±194 cm³/120 min) and integrated PP secretion (–0.1±0.2 nmol/liter/120 min) were completely suppressed in the 45-min study, but significantly improved (P<0.05) when measured 8 hr (1376±322 cm³/120 min and 3.0±1.0 nmol/liter/120 min) and two weeks (1437±263 cm³/120 min and 10.6±1.6 nmol/liter/120 min) after the last dose of octreotide. The integrated gallbladder contraction in acromegalics at 8 hr was comparable to that at two weeks and to that in normal subjects, but the integrated PP response at 8 hr was significantly smaller (P<0.05 vs two weeks and vs normals). Integrated plasma CCK secretion at 45 min (0.13±0.06 nmol/liter/120 min) was not statistically significantly different from the response at 8 hr (0.15±0.02 nmol/liter/120 min) and from that in normal subjects, but it was significantly increased at two weeks after cessation of octreotide (P<0.05 vs 45 min and 8 hr). In conclusion, during long-term octreotide treatment in acromegalics, initial abolishment of postprandial gallbladder emptying is completely reverted to normal values 8 hr after the last subcutaneous dose. No major differences in postprandial plasma CCK at 45 min and at 8 hr were observed when compared with normal subjects, whereas plasma PP responses were diminished.     

The effects of short term lipid infusion on plasma and hepatic bile lipids in humans

BACKGROUND: Patients on parenteral nutrition have an increased incidence of gall bladder sludge and gallstone disease, thought to be related to bile stasis. Intravenous lipid emulsions, especially those containing medium chain triglycerides, have also been shown to have a lithogenic effect on the composition of bile in the gall bladder. AIMS: To determine whether lipid infusion influences hepatic bile composition in patients with an indwelling T tube following cholecystectomy and choledochotomy. METHODS: In eight patients undergoing the above surgical procedure, the time at which effects of the interrupted enterohepatic circulation were minimal was determined. Twenty two cholesterol gallstone patients with bile fistula were then randomised to receive an infusion of a lipid emulsion containing either long chain triglycerides or a mixture of long and medium chain triglycerides. RESULTS: Lipid infusion resulted in a significant increase in plasma levels of triglycerides and phospholipids. Both lipid emulsions caused an increase in hepatic biliary cholesterol level and cholesterol saturation index, but this effect was more pronounced with medium chain triglycerides. The fatty acid composition of biliary phospholipids showed a significant enrichment of linoleic acid by both lipid infusions. CONCLUSIONS: Infusion of triglycerides causes lithogenic changes in hepatic bile composition in humans, the lithogenic effect of infusion of medium chain triglycerides being more pronounced than that of long chain triglycerides. This effect, coupled with gall bladder stasis, may be responsible for the increased risk of biliary sludge and gallstone formation in patients on long term lipid infusion.     

Effect of Dai-kenchu-to on Gastrointestinal Motility Based on Differences in the Site and Timing of Administration

The purpose of this study was to investigate the effects of the herbal medicine dai-kenchu-to on gastrointestinal motility based on differences in the administration site and timing. We sutured strain-gauge transducers to the stomach (three), duodenum (one), jejunum (one), ileum (one), and colon (two) and inserted indwelling tubes into the stomach, jejunum, and proximal colon of beagles. Dai-kenchu-to was administered to each site during the fasting or fed state. During the fasting state, the prokinetic effects of dai-kenchu-to were evident at all administration sites. The effects were attenuated during the fed state. With intracolonic administration, a contraction similar to the giant migrating contraction-like contraction was induced during the fasting and the fed state, and defecation occurred. Despite the differences in administration site and timing, no contraction complex appeared orad to the administration sites. These results indicate that the prokinetic effects of dai-kenchu-to differ with the site or timing of administration.     

Effects of intravenous and intraduodenal fat on jejunal motility and on plasma cholecystokinin in man

The effects of intravenous and intraduodenal fat on jejunal motility were studied in nine normal volunteers. Using a nitrogen hydraulic infusion system, recording was performed continuously during 4 hr of fasting and 5 hr of 100 ml/hr infusion of fat (Intralipid 10%) given either intraduodenally (group ID) or intravenously (group IV) and 9 hr after the end of fat administration successively. The two experiments were performed at seven-day intervals in random order. In six of the nine subjects, a third experiment, in which 20 g of cholestyramine was given by mouth during intraduodenal fat infusion (group ID + C), was carried out. Venous blood samples were drawn for measurement of serum triglyceride levels and radioimmunoassay of plasma cholecystokinin. Intraduodenal fat, alone or plus cholestyramine, induced a significant reduction in incidence of phase III of the migrating motor complex. Intravenous fat reduced the incidence of phase III. However, this reduction was significant only during the last 3 hr of fat infusion, corresponding to the highest serum triglyceride concentration. In the three groups, fat infusion induced a significant increase in duration of phase II, leading to a postprandial-like pattern. Plasma cholecystokinin increased significantly in the three groups during fat administration, with a significant positive correlation between serum triglyceride concentration and plasma cholecystokinin in the group IV. The data suggest that, in addition to its known inhibitory effects on activity fronts when acting luminally, fat given intravenously may inhibit phase III activity. The effects in both instances may be mediated in part by cholecystokinin.Dr. C. Guedon is the recipient of a research grant from Smith Kline and French S.A. awarded by French Gastroenterological Society. Supported by M.R.T. grant 83.C.0451 (J.A.C.).     

Effects of a new fluid fish oil concentrate, ESKIMO-3, on triglycerides, cholesterol, fibrinogen and blood pressure

Eskimos have a very low incidence of cardiovascular disease, at least in part due to a high intake of n-3 fatty acids. ESKIMO-3 is a new stabilized (insensitive to oxidation) fluid fish oil concentrate, 30 ml of which contains an amount of eicosapentaenoic acid and total n-3 fatty acids equivalent to the daily intake among Eskimos. Thirty-three volunteers, healthy or with coronary artery disease, were given ESKIMO-3, at a dose of 15 or 30 ml d-1, corresponding to 2.7 or 5.4 g of eicosapentaenoic acid d-1, or placebo oil, for a period of up to 6 months. ESKIMO-3 had a pronounced dose-dependent effect on several risk factors for coronary artery disease. Intake of one tablespoon (15 ml) daily for 6 months significantly reduced levels of triglycerides (-64%), total cholesterol (-8%), plasma fibrinogen (-23%) and diastolic blood pressure (-9%). Bleeding time was unchanged. Intake of two tablespoons daily for 4 weeks increased plasma eicosapentaenoic acid levels by 490%, and decreased arachidonic acid by 20%. The HDL concentration increased by 21%. No change in the above mentioned variables was observed after intake of placebo oil.     

Effects of nutrients on gastrointestinal motility and gastric emptying after Billroth-I gastrectomy in dogs

We wanted to clarify the way in which nutrients influence gastrointestinal motility and gastric emptying following distal gastrectomy with Billroth-I gastroduodenostomy. Four gastrectomized dogs were equipped with extraluminal strain gauge transducers. Gastric emptying was measured radiographically. Four intact dogs were used as controls for emptying studies. Following gastrectomy, gastric emptying of both acaloric and nutrient meals was rapid in the initial period of the experiments. Gastric outflow was supported by propagating duodenal contractions. Compared with control dogs, the early emptying of nutrient meals was accelerated. In the following period, nutrients markedly slowed gastric emptying compared with acaloric meals due to a segmenting contractile pattern of the duodenum and a significant diminution of gastrointestinal motility. Results suggest that after Billroth-I gastrectomy (1) the control of gastric emptying by nutrients acts too late to slow the initial enhanced gastric outflow, and (2) the duodenal contractile patterns influence gastric emptying.The study was supported by the Deutsche Forschungsgemeinschaft, grant Eh 64/3-1.     

Effects of Medium-Chain and Long-Chain Triglycerides on Antroduodenal Motility and Small Bowel Transit Time in Man

Medium-chain triglycerides are known to inducediarrhea, possibly resulting from accelerated intestinaltransit. We performed antroduodenal manometry andlactulose hydrogen breath testing simultaneously in eight healthy subjects in order to determinethe effects of intraduodenally administered medium-chaintriglycerides (MCT) and long-chain triglycerides (LCT)on gastrointestinal motility and small bowel transit time. LCT (15 mmol/hr) induced a fedmotor pattern. In contrast, during MCT, in bothequimolar (15 mmol/hr; MCT-1) and equicaloric (30mmol/hr; MCT-2) amounts comparable to LCT,interdigestive motility was preserved but with a significantly (P <0.05) shorter MMC cycle length (MCT-1, 65 ± 7min; MCT-2, 53 ± 6 min) compared to control(saline infusion; 127 ± 14 min). Duodenocecaltransit time (DCTT) was significantly (P < 0.05) accelerated during administrationof MCT (MCT-1, 56 ± 6 min; MCT-2, 69 ± 9min) and was not affected by LCT (105 ± 13 min)when compared to control (101 ± 9 min). Inconclusion: MCT, in contrast to LCT, preserve interdigestive motility with a shorterMMC cycle length and accelerate DCTT.     

强力抑酸剂对人胃胆囊动力的影响及其相关机制研究

本文采用核素胃排空法及胆囊超声法观察了短期服用奥美拉唑(20mg/日,7天)对正常人与反流性食管炎患者胃,胆囊排空的影响。结果显示,用药后正常组和反流组餐后2小时胃排空率分别从64.1±7.6％和68.0±4.5％降至28.9±6.4％和29.8±5.5％(P值均<0.001),胆囊最大排空率也分别从89.4±1.7％和74.7±1.9％降至65.6±4.7％和50.5±5.0％(P值也均<0.001),胆囊持续收缩排空的时间明显缩短。进一步的研究表明,用药后基础和餐后的SST、VIP、CCK水平无明显改变,但餐后PP释放显著减少(P<0.05)。抑酸后血浆PP释放显著减少,说明迷走胆碱能神经张力下降,可能是胃、胆囊动力改变的重要原因之一,我们认为强力抑酸不宜长期单独用于反流性食管炎治疗,与促动力药物合用比较合理。