Oro-cecal transit time: influence of a subsequent meal

BACKGROUND: Small intestinal and oro-cecal transit time (OCTT) is determined for clinical diagnostics and research purposes. Experimental protocols used vary with respect to the inclusion of a subsequent meal during the test period. This study was conducted to elucidate whether the ingestion of a subsequent meal during the test period influences the OCTT of the test meal. MATERIALS AND METHODS: The OCTT of a liquid test meal, measured with the lactose-[(13)C]ureide breath test, was compared between four groups of healthy volunteers (n = 36) who consumed the subsequent meal at different time points. Also, the OCTT was determined twice in eight subjects; a subsequent meal was ingested after 180 min (test A) and after 360 min (test B). RESULTS: An apparently meal-related increase in median OCTT was observed. The OCTT of the eight volunteers measured in test A (210; 210-349 median; quartiles) was significantly shorter than that found in test B (345; 300-375 min, P = 0.016). As result of the ingestion of the subsequent meal at 180 min the OCTT was shortened by 90; 64-116 min in 7/8 subjects. CONCLUSION: These data indicate that the ingestion of a subsequent meal affects the OCTT of a liquid test meal. This phenomenon could be explained by the increased intestinal motility in response to a meal, and should be taken into account when designing protocols for measurements of the OCTT and in the interpretation of small intestinal absorption studies.     

The role of colonic metabolism in lactose intolerance

Lactose maldigestion and intolerance affect a large part of the world population. The underlying factors of lactose intolerance are not fully understood. In this review, the role of colonic metabolism is discussed, i.e. fermentation of lactose by the colonic microbiota, colonic processing of the fermentation metabolites and how these processes would play a role in the pathophysiology of lactose intolerance. We suggest that the balance between the removal and production rate of osmotic–active components (lactose, and intermediate metabolites, e.g. lactate, succinate, etc.) in the colon is a key factor in the development of symptoms. The involvement of the colon may provide the basis for designing new targeted strategies for dietary and clinical management of lactose intolerance.     

轮状病毒感染与继发婴幼儿乳糖不耐受的相关分析

目的评价尿半乳糖检测在轮状病毒感染引起的婴幼儿腹泻中的应用价值。方法天津市儿童医院2013年1月1日至12月31日收治的轮状病毒感染患儿210例纳入轮状病毒感染腹泻组,另48例细菌感染腹泻患儿纳入细菌感染性腹泻组,47例症状性腹泻患儿纳入症状性腹泻组。3组患儿均进行尿半乳糖检测,并比较3组患儿乳糖不耐受阳性率。分析210例轮状病毒感染患儿的季节分布情况。结果轮状病毒主要侵犯1岁以下婴幼儿,且全年均有感染发生,尤其好发于11~12月,轮状病毒腹泻患儿并发乳糖不耐受阳性率高于细菌感染性腹泻组和症状性腹泻组(P<0.05)。结论轮状病毒感染性腹泻患儿应及早做尿半乳糖检测,及时停饮母乳或牛乳,采用去(或低)乳糖饮食,以免延误病情。     

继发性乳糖不耐受症与轮状病毒性肠炎的关系分析

目的探讨轮状病毒性肠炎与继发性乳糖不耐受的关系。方法对200例轮状病毒性肠炎患儿用醋酸铅加氢氧化氨法检测粪乳糖、pH值。粪乳糖大于或等于++,pH<5.5为乳糖不耐受症,将200例患儿分为治疗Ⅰ组及治疗Ⅱ组,粪乳糖阴性为对照组。结果 200例轮状病毒性肠炎中粪乳糖大于或等于++,pH<5.5,138例,其中年龄小于或等于6个月32例,≤1岁68例,≤2岁36例,≤3岁2例。治疗Ⅰ组及治疗Ⅱ组临床症状与对照组比较差异有统计学意义(P<0.01),治疗Ⅰ组与对照组疗效比较差异无统计学意义(P>0.05),治疗Ⅱ组与对照组疗效比较差异有统计学意义(P<0.01)。结论轮状病毒性肠炎容易导致继发乳糖不耐受症,且年龄越小,越容易发生继发性乳糖不耐受症,去乳糖饮食治疗轮状病毒性肠炎继发性乳糖不耐受症疗效显著,对轮状病毒性肠炎患儿应检测粪乳糖及pH,及早发现继发性乳糖不耐受症。     

Respiratory excretion of hydrogen and methane in Italian subjects after ingestion of lactose and milk

Lactose malabsorption, by the breath hydrogen test, and lactose intolerance (presence of symptoms) were studied in twenty healthy Italian subjects after intake of 12.5, 25 and 50 g lactose, whole milk and low-lactose milk. A rise in respiratory concentration of hydrogen (greater than 20 ppm) (malabsorption) was found in fifteen subjects after 50 g lactose, in thirteen after 25 g and in seven after 12.5 g. Symptoms generally occurred in subjects presenting a rise in respiratory hydrogen excretion, but such a rise was often observed without symptoms. Thirteen subjects presented symptoms after 50 g lactose, but only three after 25 g and one after 12.5 g. Whole milk (500 ml) gave a lower incidence of lactose malabsorption than 25 g lactose (7/20 versus 13/20, P less than 0.05) and more subjects developed symptoms (7/20 versus 3/20, NS). Low-lactose milk produced no malabsorbers and one intolerant. Breath methane was detected constantly in seven subjects and in three on some of the days of observation. Respiratory methane excretion generally appeared to be unrelated to lactose ingestion.     

Effect of ceftriaxone on intestinal transit time

Ceftriaxone reduces gallbladder and ileal contractility. Many studies have shown that ceftriaxone causes biliary sludge and pseudolithiasis. However, its effect on intestinal transit time has not been investigated. This study aimed to investigate the effect of ceftriaxone on intestinal transit time. Sixteen rats were examined in two groups: The study group (group A, n = 8) was administered with 100 mg/kg ceftriaxone intramuscularly for 7 days. The control group (group B, n = 8) was administered with intramuscular distilled water for 7 days. On the seventh day, a mixture of 2 ml barium and saline was given orally to both groups. Barium transit was evaluated using serial digital X-ray images. The stomach was full and the transition into the small intestine loop was observed in all rats at 45 min in both groups. At the 2nd hour, colonic transition was observed in two rats in group A (2/8, 25%) and in seven rats in group B (7/8, 87.5%). At the 4th hour, five (62.5%) rats in group A had transverse colonic transition, and all rats in group B (8/8, 100%) had transverse and/or left colonic transition. At the 6th hour, no rat in group A had rectal transition, and all rats in group B (8/8, 100%) had complete passage of colonic contrast material. Ceftriaxone significantly prolongs the small intestine transit time, large intestine transit time, and total intestinal transit times.     

The 13C/2H-glucose test for determination of small intestinal lactase activity

To diagnose hypolactasia, determination of lactase enzyme activity in small intestinal biopsy material is considered to be the golden standard. Because of its strongly invasive character and the sampling problems, alternative methods have been looked for. We analysed the 13C-glucose response in serum after consumption of 25 g of naturally enriched 13C-lactose. As an internal standard, 0.5 g of 2H-glucose was added and the 2H-glucose response in serum was measured simultaneously. The studies were performed in healthy volunteers with a background of genetically determined lactase nonpersistence (n = 12; low lactase activity) and lactase persistence (n = 27; high lactase activity). The results were compared with those of the lactose hydrogen breath test, the lactose 13CO2 breath test and the previously described 13C-lactose digestion test. After consumption of 13C-lactose and 2H-glucose, the mean ratio 13C-glucose/2H-glucose concentration in serum at 45-75 min was 0.26 +/- 0.09 in the low lactase activity group and 0.93 +/- 0.17 in the high lactase activity group (P < 0.01). Threshold of the ratio between digesters and maldigesters was calculated as 0.46. Accuracy of the new test was superior to all other tests. We conclude that the 13C/2H-glucose test has the potential of determining the small intestinal lactase activity in vivo and of estimating the amount of lactose which is digested in the small intestine.     

Gastrointestinal mean transit times in young and middle‐aged healthy subjects

To investigate the effects of age and gender on gastric, small intestinal and colonic mean transit times, a study was conducted in 32 healthy volunteers: eight young women (22–30 years), eight young men (20–28 years), eight middle‐aged women (43–51 years) and eight middle‐aged men (38–53 years). After ingestion of a meal containing ¹¹¹Indium‐labelled water and ^99mTechnetium‐labelled omelette imaging of the abdomen was performed at intervals of 30 min until all radioactivity was located in the colon and henceforth at intervals of 24 h until all radioactivity had cleared from the colon. Gastric, small intestinal and colonic mean transit times were calculated. The gastric, small intestinal and colonic mean transit times were significantly longer in women. Ageing was shown to accelerate the gastric and small intestinal transit significantly. In the group of men the colonic mean transit time was unaffected by age, but middle‐aged women had a significantly slower colonic transit than young women. We therefore conclude that both age and gender have to be considered when reference values for gastric, small intestinal and colonic mean transit times have to be established.     

Proximal and distal gut hormone secretion in slow transit constipation

BACKGROUND: It has been suggested that slow transit constipation might be part of a panenteric disorder. Gastrointestinal peptides are involved in regulation of motility. DESIGN: In the present study we have evaluated whether plasma levels of proximal and distal gut hormones in the fasting state, and for 120 min after a solid meal in 29 patients with slow transit constipation are different from those obtained from 29 healthy controls. Plasma levels of the gut hormones cholecystokinin, gastrin, pancreatic polypeptide, motilin, neurotensin and peptide YY were determined using sensitive radioimmunoassays. In the patient group, oro-caecal transit time was determined by means of the hydrogen breath test on a separate test day. The results of transit were related with postprandial hormone secretion. RESULTS: Fasting plasma levels of cholecystokinin and pancreatic polypeptide were significantly (P < 0.05) increased in constipated patients. Postprandially, secretion of pancreatic polypeptide and cholecystokinin was significantly (P < 0.05) increased in the patients, while secretion of peptide YY was significantly (P < 0.05) reduced. Plasma motilin levels were not different between patients and controls. Altered postprandial hormone secretion was mainly observed in constipated patients with prolonged oro-caecal transit time. CONCLUSIONS: In patients with slow transit constipation, fasting and postprandial secretion of proximal gut hormones apart from motilin is increased and of distal gut hormones decreased, especially in those with severely delayed intestinal transit.     

蚌埠市市区葡萄糖调节受损情况调查分析

目的:了解蚌埠市市区葡萄糖调节受损(IGR)发病率及其分布特征。方法:采取整群随机抽样方法,对蚌埠市区25～75岁人群进行横断面调查。结果:(1)总糖耐量受损(IGT)、总空腹血糖受损(IFG)发病率分别为6.7%、1.2%,标化率为6.9%、1.1%。IGT伴IFG发病率仅为0.2%。(2)男性总IGT、IFG发病率分别为8.1%、1.2%,女性IGT、IFG发病率分别为5.5%、1.2%。总IGT发病率在男女之间差异有统计学意义(P<0.05)。(3)超重、肥胖人群中总IGT、IFG发病率均明显高于体质指数正常人群(P<0.05)。中心性肥胖人群中总IGT、IFG发病率均明显高于无中心性肥胖人群(P<0.05)。高血压人群中IGT、IFG发病率均明显高于无高血压人群(P<0.01)。(4)干部、科技人员IGR发病率均高于工人(P<0.05)。(5)IGT、IFG人群冠心病、脑血管病的发病率显著高于正常糖耐量(NGT)人群(均P<0.05)。IGT、IFG视网膜病变、微量白蛋白尿发病率均高于NGT人群,其中IGT与NGT人群微量白蛋白尿发病率差异有显著性(P<0.05)。结论:蚌埠市市区IGT发病率呈快速增长趋势,应加强对老年人及脑力劳动者的糖尿病健康教育;需重视IGR阶段的心脑血管疾病与微血管病变。     

Combined LDI/SAT test to evaluate intestinal lactose digestion and mucosa permeability

BACKGROUND: Intestinal mucosal damage causes impaired digestive capacity and increased mucosal permeability. Quantification of damage can be used to improve treatment options. Currently, the Lactose Digestion Index (LDI) and the Sugar Absorption Test (SAT) are used for evaluation. The investigation studied whether both tests could be combined to provide a useful multifunctional test and whether measurements in blood (LDI) could be replaced by measurements in urine. MATERIALS AND METHODS: The LDI (25 g 13C-lactose, 0.5 g 2H-glucose), the SAT (5 g lactulose, 1 g L-rhamnose) and the LDI/SAT combination test were performed in seven lactose-digesting and eight lactose-maldigesting adults. Plasma glucose 13C-enrichment was determined by gas-chromatography/combustion/isotope ratio mass-spectrometry (GC/C/IRMS), 2H enrichment determined by gas-chromatography/mass-spectrometry (GC/MS) and urinary sugars by gas-chromatography (GC). RESULTS: The results of the separate LDI test were not different from those of the LDI/SAT in the lactose-digester group (0.82 +/- 0.06 vs. 0.81 +/- 0.09), nor in the lactose-maldigester group (0.36 +/- 0.12 vs. 0.35 +/- 0.06). A significant correlation was found between the 10-h urinary-lactose/lactulose ratio and the LDI (R2 = 0.71, P < 0.01). There were no differences in the lactulose/L-rhamnose ratio between lactose-digesters and lactose-maldigesters using both the SAT and LDI/SAT tests. CONCLUSION: The LDI/SAT test is a reliable method of measuring digestion and permeability simultaneously. The 10-h period urinary lactose/lactulose excretion ratio following lactose consumption reflects lactose digestive capacity.     

Factors controlling the intrasplenic transit of platelets

Abstract. The kinetics of ¹¹¹In labelled platelets have been investigated in human subjects using a gamma camera and computer system. Time activity curves were recorded over the spleen, chest and liver, following intravenous bolus injection of autologous radio-labelled platelets. Splenic blood flow expressed as the percentage of total blood volume entering the spleen in unit time, and intrasplenic platelet transit time were calculated from the time activity curves. Spleen size was recorded from the camera images. Splenic blood flow increased with increasing spleen size ( r = 0·56, P < 0·001). Platelet transit time showed an inverse relationship with a semi-quantitative estimate of splenic perfusion (i.e. splenic blood flow per unit volume spleen; r =– 0·64, P f< 0·001) but was not related to spleen size. At high rates of estimated splenic perfusion transit time appeared to reach a minimum value of about 7 min, whereas at low rates of estimated perfusion, transit time rose sharply to reach levels greater than 20 min. The effect of polycythaemia, taken to indicate high intrasplenic haematocrit on platelet transit time, was also investigated. Patients with secondary polycythaemia had elevated transit times (19 min SEM 1·6, n = 10) compared with primary polycythaemia (9.7 min SEM 0·8, n = 5) and normals (9·6 min SEM 0·5, n = 5). It was concluded that splenic perfusion was important in determining the duration of platelet transit.     

甲状腺功能亢进症患者糖耐量状态及胰岛B细胞功能的变化

目的探讨患者糖耐量情况和胰岛素水平变化,分析其原因。方法选取100例住院甲状腺功能亢进患者,并与50例健康人进行比较。所有入选者给予口服葡萄糖耐量试验（0GTr）,以了解其糖耐量和胰岛B细胞功能情况。结果（1）甲亢患者中糖尿病（DM）患病率为24．0％,糖调节受损患病率为28．0％（均为孤立性IGT）,总的糖代谢异常患病率为52．0％;（2）与健康对照组比较,甲亢伴糖代谢异常的患者存在胰岛B细胞功能缺陷。结论甲亢患者常合并糖代谢异常,尤其是餐后血糖增高,应常规进行0GTr,以早期发现这些合并糖代谢异常的患者并给予合理干预。     

The effect of coffee on gastric emptying and oro-caecal transit time

BACKGROUND: The consumption of coffee allegedly induces or aggravates gastrointestinal symptoms. In order to investigate the effect of coffee on gastrointestinal motility we studied the effect of coffee on gastric emptying and oro-caecal transit time. METHODS: In a randomised, controlled, cross-over study gastric emptying and oro-caecal transit time were studied in 12 healthy volunteers, using applied potential tomography and lactulose hydrogen breath test, respectively. After 1 day of coffee abstinence and an overnight fast, coffee or the control drink (water) was drunk and 10 min thereafter a liquid nutrient meal was ingested together with lactulose. During 150 min, recordings were made with applied potential tomography and breath samples were taken every 5 min. Lag-phase duration and gastric half-emptying time were determined by two blinded observers. RESULTS: The lag-phase duration after coffee (median 19.8 min, range 6-47 min) was not significantly different from that after water (median 19.3 min, range 11-37.5), nor was the gastric half-emptying time (median 75.7 min, range 56-157.6 vs. median 83.4 min, range 64. 6-148.4). Likewise, coffee had no significant effect on oro-caecal transit time (median 135 min, range 60-270 vs. median 140 min, range 55-270). No significant correlation between any of these parameters and mean daily coffee intake was found. CONCLUSIONS: Coffee does not affect gastric emptying of a liquid meal or small bowel transit.     

护理干预对老年肥胖高血压患者糖代谢的影响

目的探讨护理干预对伴糖耐量异常的肥胖高血压病患者的影响。方法2003年起在我院门诊就诊的高血压且伴糖耐量异常的老年患者176例,分为干预组80例和对照组96例,经3~3.5年的护理干预及跟踪随访,将两组患者基本状况、临床生化指标、依从性及新发生糖尿病和心血管病的发生情况进行比较。结果干预组的依从性均明显高于对照组(P<0.01),在体重指数、腰围、餐后2 h血糖及胰岛素、胰岛素抵抗指数方面均较对照组明显降低(P<0.01);干预组2型糖尿病和心血管病的发生率也明显低于对照组。结论有效的护理干预对伴糖耐量异常的肥胖高血压病患者有着显著作用,有利于病情的控制,防止其进一步的发展,并能有效是降低2型糖尿疾病和心血管病的发生。     

两种不同重量及大小的胶囊内镜之间胃肠通过时间及全小肠检查完成率的对比*

目的探究两种不同重量及大小的胶囊内镜之间胃通过时间(GTT)、小肠通过时间(SBTT)及全小肠检查完成率(CR)是否不同。方法回顾性纳入因各种原因而接受了OMOM胶囊内镜检查或Miro Cam胶囊内镜检查(比OMOM胶囊更小且更轻)的患者,对比分析了这两种不同重量及大小的胶囊内镜的GTT、SBTT以及CR。结果共纳入1 448名符合条件的患者,其中OMOM组628例,Miro Cam组820例。总体上,在工作时间校正后SBTT和CR方面,两组之间差异无统计学意义(P0.05)。在克罗恩病或可疑克罗恩病患者中,OMOM组的GTT明显长于Miro Cam组[(53.4±52.6)min比(41.1±47.9)min,P=0.022)];在消化道出血患者中,OMOM组的GTT明显短于Miro Cam组[(42.1±44.8)min比(62.0±78.6)min,P=0.016]。结论总体来说,两种不同重量及大小的胶囊内镜之间的GTT、SBTT及CR没有明显差别,但在克罗恩病或可疑克罗恩病患者中,更轻且更小的胶囊内镜的GTT较短;而在消化道出血患者中,更轻且更小的胶囊内镜的GTT较慢。     

肾脏动静脉通过时间在肝移植术前肾功能评估中的应用

目的 探讨超声造影检测肾脏动静脉通过时间(RAVIT)对肝移植患者术前肾功能评价的应用价值.方法 对我院102例肝移植患者术前行肾脏超声造影检查,据临床症状分为肝硬化代偿期组、肝硬化失代偿期组和肝肾综合征组;选取健康人45例为对照组.造影后对肾门处肾动静脉主干内造影剂到达时间(AT)进行测定和差值分析.结果 肾动脉到达时间(BAAT)、肾静脉到达时间(RVAT)及RAVIT在肝硬化代偿期组和对照组间无明显差异(P＞0.05);肝硬化失代偿期组RATT、RVIT及RAVTT较肝硬化失代偿期组和对照组延长(P＜0.05);肝肾综合征组RATT、RVIT、RAVIT在4组中最长(P＜0.05).结论 RATT、RVTT及RAVTT可作为评价肝移植患者术前肾功能的参考指标.     

下消化道不适患者乳糖不耐受认知度的调查及对策

目的 了解下消化道不适患者对乳糖不耐受的认知度.方法 自行设计调查问卷,对250例患者进行乳糖不耐受的相关知识调查,并对饮牛奶后出现消化道不适症状者进行产生症状的原因调查.结果 3.6%患者知道乳糖不耐受症状,118例饮奶后出现不适患者中78.8%认为产生症状的原因是自身胃肠道功能不好.结论 下消化道不适患者对乳糖不耐...     

Prognostic and diagnostic value of global cerebral blood flow volume and cerebral transit time in acute stroke

Conventional duplex sonography is a well-established method for the assessment of the brain-supplying arteries in acute stroke. However, ultrasound (US) remains inconclusive in a significant number of stroke patients. Recently, two new US parameters, the cerebral transit time (cTT) and the global cerebral blood flow volume (CBF), have been introduced. In the present study, we investigated the diagnostic and prognostic value of both parameters in stroke patients. Conventional duplex examinations of the extra- and intracranial brain-supplying arteries and measurement of cTT and CBF were performed in 50 consecutive stroke patients within 24 h after symptom onset and compared with US findings in 22 age-matched healthy controls. Neurological deficits and the degree of disability were graded using several stroke scores, and were re-evaluated for outcome measure after 1 year. CBF and cTT were not assessable in 26% and 20% of the patients, respectively. Compared with the healthy control group, stroke patients showed a significant reduction of CBF and prolongation of cTT. More than 50% of patients with otherwise normal routine duplex examination had abnormal CBF or cTT findings. Furthermore, there was a strong correlation between the reduction of global CBF and the outcome after 1 year. Sonographic assessment of the CBF and cTT are additional parameters that might increase the diagnostic sensitivity of US in stroke patients, and may have prognostic relevance.     

Change in pulse transit time and pre-ejection period during head-up tilt-induced progressive central hypovolaemia

Objective Traditional vital signs such as heart rate (HR) and blood pressure (BP) are often regarded as insensitive markers of mild to moderate blood loss. The present study investigated the feasibility of using pulse transit time (PTT) to track variations in pre-ejection period (PEP) during progressive central hypovolaemia induced by head-up tilt and evaluated the potential of PTT as an early non-invasive indicator of blood loss. Methods About 11 healthy subjects underwent graded head-up tilt from 0 to 80°. PTT and PEP were computed from the simultaneous measurement of electrocardiogram (ECG), finger photoplethysmographic pulse oximetry waveform (PPG-POW) and thoracic impedance plethysmogram (IPG). The response of PTT and PEP to tilt was compared with that of interbeat heart interval (RR) and BP. Least-squares linear regression analysis was carried out on an intra-subject basis between PTT and PEP and between various physiological variables and sine of the tilt angle (which is associated with the decrease in central blood volume) and the correlation coefficients (r) were computed. Results During graded tilt, PEP and PTT were strongly correlated in 10 out of 11 subjects (median r = 0.964) and had strong positive linear correlations with sine of the tilt angle (median r = 0.966 and 0.938 respectively). At a mild hypovolaemic state (20–30°), there was a significant increase in PTT and PEP compared with baseline (0°) but without a significant change in RR and BP. Gradient analysis showed that PTT was more responsive to central volume loss than RR during mild hypovolaemia (0–20°) but not moderate hypovolaemia (50–80°). Conclusion PTT may reflect variation in PEP and central blood volume, and is potentially useful for early detection of non-hypotensive progressive central hypovolaemia. Joint interpretation of PTT and RR trends or responses may help to characterize the extent of blood volume loss in critical care patients. Chan GSH, Middleton PM, Celler BG, Wang L, Lovell NH. Change in pulse transit time and pre-ejection period during head-up tilt-induced progressive central hypovolaemia.