Gastric emptying and orocecal transit time in pregnancy

Purpose. To evaluate the effects of pregnancy on gastrointestinal function, we determined gastric emptying time, orocecal transit time, and fasting gastrointestinal hormone levels (cholecystokinin, gastrin, pancreatic polypeptide, neurotensin) in 11 women with mild dyspeptic symptoms during the first and third trimesters of their pregnancies, and again 4–6 months after delivery. Methods. After the women ingested a disaccharide solution, orocecal transit time was determined by monitoring breath hydrogen concentrations at 10-min intervals, and values were compared with the postpartum value. Ultrasound examinations of gastric emptying were performed during the same intervals. Results. The half-emptying time and the final gastric emptying time did not differ in the first and third trimesters and postpartum, but gastrointestinal transit time was significantly longer in the third trimester of pregnancy than postpartum ([100.0 min (range, 50.5–240.0 min] vs 70.0 min [range, 40.5–240.0 min; P < 0.05]), respectively. Mean plasma pancreatic polypeptide values were lower in the third trimester of pregnancy than postpartum, and a negative correlation was observed between pancreatic polypeptide levels and transit time in the third trimester (r = −0.65; P = 0.0261). The plasma levels of other gastrointestinal hormones did not differ in the various periods studied. Conclusions. Our study shows that, despite evident dyspeptic symptoms, there were no significant alterations in gastric emptying or orocecal transit time during the first trimester of pregnancy. Conversely, in the third trimester, orocecal transit time was significantly longer. Received: October 6, 2000 / Accepted: February 23, 2001     

Lactulose hydrogen breath test in orocecal transit assessment

Orocecal transit time can be studied easily using the hydrogen breath test with lactulose, but the method has some important limitations. The orocecal transit time of 10 patients suffering from irritable bowel syndrome was measured twice, at a one-week interval, by breath test and scintigraphy simultaneously using an aqueous solution of 20 g lactulose containing 74 MBq of [^99mTc]DTPA. Abdominal radioactivity and alveolar hydrogen values obtained every 5 min were noted and used to obtain the following: orocecal transit time by the two methods; ileocecal lactulose flow; total and per gram of lactulose hydrogen production; mean hydrogen concentration during the right colon filling; and measurement error of the breath test with respect to the scintigraphy. In the case of the breath test, the orocecal transit time intrapatient reproducibility was better (coefficient of variation =13.5%) when a hydrogen threshold increment of 5 ppm was used; the best correlation with the scintigraphic measurement was observed at this threshold (r=0.90,P<0.001). The breath test overestimated orocecal transit time with the error correlating negatively and significantly with the total hydrogen production and, particularly, the mean hydrogen concentration (r=0.79,P<0.01): for a mean hydrogen concentration of more than 15 ppm, the error was negligible, while within this value there was a noticeable overestimation. To conclude, the lactulose hydrogen breath test is capable of giving an accurate measurement of orocecal transit time if a hydrogen threshold increment of 5 ppm is chosen and if the mean hydrogen concentration in the first 30 min of the right colon filling is taken into account.     

Oral naloxone antagonizes loperamide-induced delay of orocecal transit

Orocecal transit time was determined by the lactulose hydrogen breath test in nine healthy volunteers after administration of placebo, loperamide (16 mgper os), and loperamide (16 mgper os) followed by oral naloxone at doses of 16 and 32 mg. The four tests were performed in double-blind conditions and in random sequences. Transit time (mean,sd) after loperamide (128.8 min, 32.9) was significantly increased (P<0.05) compared with placebo (85.5 min, 35.7), loperamide followed by naloxone 16 mg (88.8 min, 46.2), and loperamide followed by naloxone 32 mg (84.4 min, 40.6). These results show that the peripheral opioid agonist loperamide delays orocecal transit in healthy subjects and that naloxoneper os at adequate doses antagonizes this effect.     

乳果糖氢呼吸试验测定口-盲肠传递时间

目的测定功能性消化不良（ＦＤ）和肠易激综合征（ＩＢＳ）患者口－盲肠传递时间（ＯＣＴＴ）．方法应用乳果糖氢呼吸试验（ＬＨＢＴ）测定了正常人１３例，ＦＤ２０例和ＩＢＳ（其中１５例主诉腹泻，１６例主诉便秘）３１例患者的ＯＣＴＴ．结果正常人ＯＣＴＴ为９５４±１９６ｍｉｎ，ＦＤ患者（９９２±２４５ｍｉｎ）与正常人比较无显著性差异（Ｐ＞００５），但其中５例动力障碍型ＦＤ的ＯＣＴＴ则显著延长（１２９０±１２０ｍｉｎ，Ｐ＜００１），以便秘为主的ＩＢＳ患者ＯＣＴＴ显著延长（１５４４±５５７ｍｉｎ，Ｐ＜００１），以腹泻为主的ＩＢＳ患者ＯＣＴＴ显著缩短（７３１±２２２ｍｉｎ，Ｐ＜００５）．结论ＦＤ和ＩＢＳ患者存在小肠动力学异常，ＬＨＢＴ可作为辅助检查小肠动力学异常的手段之一．     

Cisapride decreasing orocecal transit time in patients with nonalcoholic steatohepatitis

Introduction With the development of economy, there has been an increasing prevalence of nonalcoholic fatty liver disease (NAFLD)in China.[1] Along with viral liver disease and alcoholic liver disease, NAFLD has become one of the three primary liver diseases in the Chinese population. According to the Brunt criteria, nonalcoholic steatohepatitis (NASH) is defined when lobular inflammation or perisinusoidal fibrosis is present on histological examination.[2] Previously NASH was conside…     

Identical orocecal transit time and serum motilin in hyperthermia and normothermia

Fever, exercise, and exposure to a hot environment can all cause symptoms of gastrointestinal dysfunction as they elevate body temperature. Nonetheless, the link between hyperthermia per se and these symptoms is unknown. To test the functional significance of increased body temperature, we investigated the influence of substantial passive hyperthermia on orocecal transit in 12 young, healthy men. Transit time was determined by a consistent rise in H₂ concentration in a rebreathing apparatus after oral ingestion of 0.7 g lactulose/kg body weight. Lactulose was given in combination with a 350-ml liquid meal (360 kcal). After raising core temperature in warm water to 38.3° C, orocecal transit time was identical to control (90±13 min at 38.3° C, 92±13 min at 37.1° C). While hyperthermia did elevate heart rate and minute ventilation, serum motilin, gastrin, and cortisol were similar in the two conditions. The failure of a passive core temperature rise to alter mouth-to-cecum transit suggests that this aspect of alimentary function is independent of body temperature.     

Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome

BACKGROUND & AIMS: This study evaluated the effects of a partial 5-hydroxytryptamine (5-HT)(4) agonist, tegaserod, on gastric small bowel and colonic transit in constipation-predominant irritable bowel syndrome (IBS). METHODS: After a 1 week run-in period, 24 patients with constipation-predominant IBS were randomized to 1 week of tegaserod, 2 mg twice daily, or placebo treatment. Scintigraphic gastric emptying, small bowel transit, and colonic transit were determined before administration of study drug and after 1 week on the medication. Colonic transit was also measured using radiopaque markers and a single radiograph on day 5. RESULTS: Gastric emptying was unaltered by tegaserod. Proximal colonic filling at 6 hours, a measure of orocecal transit, was accelerated by tegaserod (70.4% +/- 1.3% [mean +/- SEM] vs. placebo, 46.4 +/- 1.9; P = 0.015). Proximal colonic emptying half-time and geometric center at 48 hours were also accelerated by tegaserod compared with baseline, but not compared with placebo. Mean colonic transit time was similar in both groups at baseline and after drug administration (tegaserod, 59.5 +/- 2.1 hours; placebo, 62.1 +/- 2.1 hours). CONCLUSIONS: Tegaserod accelerates orocecal transit, tends to accelerate colonic transit, and deserves further study in patients with constipation-predominant IBS.     

Bepridil abolishes exercise-induced regional contractile dysfunction in dogs

The effects of bepridil, a calcium antagonist, on hemodynamic parameters and regional contractile function were investigated in six dogs trained to submit to five treadmill exercise cycles consisting of 4 min of running and 11 min of recovery. The animals were chronically instrumented with a microtip manometer in the left ventricle, two pairs of piezoelectric crystals for sonomicrometry and a hydraulic occluder around the circumflex branch of the left coronary artery and arterial and venous catheters. Experiments were started 1 week after surgery. After a warming-up exercise the vessel was partly stenosed by external filling of the hydraulic occluder. Stenosis was considered adequate and maintained when hemodynamic and functional parameters were virtually unchanged at rest, but episodes of comparable regional contractile dysfunction of the area perfused by the stenosed artery occurred in response to exercise in five subsequent runs; the same degree of stenosis was used for the experiments with bepridil. After two runs with comparable regional contractile dysfunction bepridil was infused intravenously at a dosage of 2 mg/kg per 5 min. The exercise-induced dysfunction was minimally improved in the 1st post-drug run but completely abolished during the 2nd and 3rd post-drug runs. This marked improvement may be partly attributable to the hemodynamic effects of this drug, namely a diminished increase in heart rate and left ventricular end-diastolic pressure and even a reduction in end-diastolic segment length during exercise. These results support the findings of initial clinical trials and suggest a beneficial effect of bepridil in the treatment of exercise-induced angina pectoris in man.     

Reproducibility of orocecal transit time and hydrogen production measured by breath tests]

The hydrogen breath test after a lactulose oral load in the fasting period is currently used to measure mouth to cecum transit time (MCTT). However, the reproducibility of this test is poor, and normal values are very scattered. The aim of the study was to determine the reproducibility of hydrogen breath test for MCTT measurement and hydrogen production after administration of 2 disaccharides: lactulose and lactitol ingested in the fasting state and postprandial period. Twelve healthy volunteers (6 men and 6 women; mean age = 34.6 +/- 9.6 years) were studied eight times in a random order, each disaccharide being studied twice in the fasting state and twice in the postprandial period. In the later, lactulose or lactitol was ingested 30 min after a liquid meal completely absorbed (400 kcal; glucide: 55 p. 100, lipid: 30 p. 100, protein: 15 p. 100; 400 ml of Inkopeptide). The MCTT was significantly increased with both disaccharides in the postprandial period as compared with the fasting state (P less than 0.0001). There was nos significant correlation between the 2 measurements of the MCTT in the fasting state, in contrast, the 2 measurements of the MCTT were closely related in the fed state (r = 0.62, P less than 0.05, et r = 0.79, P less than 0.003 for lactulose and lactitol respectively). During both periods no significant difference was found in the MCTT between lactulose and lactitol. As well, hydrogen production did not differ between the 2 disaccharides, but was significantly increased in the postprandial period, and in non methane producers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of misoprostol on postprandial intestinal motility and orocecal transit time in humans

We measured the effect of misoprostol (M), a PGE₁ analog, on duodenojejunal postprandial motor activity and orocecal transit in eight healthy volunteers. Intestinal motility was studied by an intraluminal catheter with three strain gauge transducers connected to a solid-state datalogger, and transit time was measured by a hydrogen breath test. Subjects were studied for two consecutive days and fed twice a day with a similar, 600-kcal meal. Misoprostol (M) at 800, 400, or 200 g or placebo were taken orally before every one of the four meals. Transit time was measured after the morning meal on both days, after ingestion of either 800 g of M or placebo. On four occasions, following M, the normal fed pattern was not established and the migrating motor complex (MMC) was not interrupted by the meal. In all other occasions, when the higher doses of M were given, the first 1–2 hr after the meal revealed a hypoactive bowel. This effect was inconsistently seen following 200 g of M. Orocecals transit time was consistently and significantly shorter after M than placebo: 48.3±9.5 min vs 104.4±4.8 min,P<0.0001. Four subjects had diarrhea during the study. We conclude that misoprostol, particularly at higher doses, has a profound effect on intestinal postprandial motility and results in accelerated transit time. The motility changes induced by M may be responsible, in part, for its effect on transit.A preliminary report of this work was given at the annual meeting of the American Gastroenterological Association, May 1991, and was published as an abstract inGastroenterology 100:496, 1990. This study was supported in part by Searle.     

Effect of fat emulsion (Fabuless) on orocecal transit time in healthy men

Background. Given the growing prevalence of overweight and related health consequences, there is increased interest in the search for novel dietary strategies for weight control. A food ingredient, an emulsion based on palm and oat oil (Fabuless, previously known as Olibra), has been associated with short-term reductions of food intake, induction of satiety, alternation in the satiety hormones, as well as long-term effects on weight control. The mechanism by which it can exert these effects is so far unclear, though it has been suggested that the “ileal break” may play a role in increasing gastrointestinal transit time. The aim of this study was to investigate the effects of this stable fat emulsion on orocecal transit time in healthy men. Material and methods. In a controlled, double-blind, cross-over-designed study, 15 healthy men (aged 20–59 years, body mass index (BMI) 22–28), randomly allocated to two treatments, consumed the stable fat emulsion or a milk fat in yoghurt during two days of investigation, with an interval of 1 week. Orocecal transit time was determined by following blood sulfapyridine levels, which is a metabolite of salazopyrine in the colon. Results. A statistically significant delay in the appearance of sulfapyridine in serum was obtained after active treatment versus control treatment, corresponding to a 45-min longer orocecal transit time due to fat emulsion consumption. Conclusions. This study provides the first evidence to suggest that this stable fat emulsion may affect the ileal brake mechanism by slowing down the gastrointestinal transit time, which might explain the weight control and appetite suppression previously observed in association with this emulsion.     

Evidence of prolonged orocecal transit time and small intestinal bacterial overgrowth in acromegalic patients

CONTEXT: Gastrointestinal abnormalities in acromegaly include dolichomegacolon, slow colonic transit, and increased prevalence of colonic polyps. Conversely, no data are available on the small intestine. OBJECTIVE: The aim of the study was to investigate the orocecal transit time (OCTT) and the presence of small intestinal bacterial overgrowth (SIBO). PATIENTS: A total of 41 acromegalic patients and 30 sex- and age-matched control subjects entered the study. Acromegalic patients were classified according to the medical treatment with somatostatin analogs as "treated" (n = 22) and "untreated" (n = 19), whereas according to the disease control, as "controlled" (n = 17), "uncontrolled" (n = 10), and "partially controlled" (n = 14). Patients and controls completed a questionnaire and underwent a standardized 10-g lactulose hydrogen breath test to determine the OCTT and presence of SIBO. SIBO-positive patients underwent eradication with rifaximine. RESULTS: An increased prevalence of SIBO (18 of 41 vs. 1 of 30; P < 0.0001) and a significantly delayed OCTT (169.53 +/- 8.15 vs. 107.25 +/- 6.56 min; P < 0.0001) were evidenced in patients compared with controls. No significant statistical differences were found between "treated" or "untreated" patients positive for SIBO or between "controlled," "partially controlled," and "uncontrolled" patients. OCTT was significantly delayed in "treated" vs. "untreated" patients (183.21 +/- 9.01 and 158.89 +/- 6.38, respectively; P = 0.02) and in patients compared with controls (105.75 +/- 6.34; P < 0.0001). Rifaximine eradicated SIBO in more than 50% of patients who underwent treatment. CONCLUSIONS: These data demonstrate for the first time that SIBO occurs more frequently in acromegalic patients, however, it can be successfully treated by a specific antibiotic. Medical therapy with somatostatin analogs does not affect SIBO prevalence. OCTT resulted significantly prolonged in both "treated" and "untreated" patients, suggesting that acromegaly determines per se an impairment of the intestinal motility. Indeed, disease control seems irrelevant on the delayed OCTT, suggesting that this alteration might be an irreversible complication of acromegaly, probably related to an autonomic intestinal disorder, as we have previously demonstrated at the cardiac level.     

山梨醇氢呼气试验测定口─盲肠通过时间及西沙比利对其影响的研究

目的对山梨醇氢呼气试验测定口─盲肠通过时间进行方法学研究，并观察西沙比利对健康人及患者口─盲肠通过时间的影响。方法以不同剂量的山梨醇作为试验糖并与泛影葡胺放射学方法进行对照。结果１５ｇ山梨醇的产氢率较高，副作用较少。山梨醇呼气氢试验测得的口─盲肠通过时间与泛影葡胺放射学方法的结果之间有显著的相关性（ｒ＝０．９１９）。十二指肠球部溃疡、慢性胃窦炎、肝硬化及糖尿病患者口─盲肠通过时间与正常对照组比较，差异有非常显著性（Ｐ均＜０．００１），服用西沙比利（１０ｍｇ，三次／日×３天），正常对照者、十二指肠球部溃疡、肝硬化及糖尿病患者口─盲肠通过时间显著缩短（Ｐ均＜０．００１）。结论（１）山梨醇呼气氢试验是简易、可靠、重复性好及非创伤性的测定口─盲肠通过时间的方法；（２）西沙比利可以显著缩短十二指肠球部溃疡、肝硬化及糖尿病患者的口─盲肠通过时间，其作用可能与加速胃排空，缩短小肠通过时间有关。     

Repeatability of lactulose hydrogen breath test in subjects with normal or prolonged orocecal transit

The within-subject repeatability of orocecal transit assessed with lactulose hydrogen breath test was evaluated in 15 healthy volunteers and 16 constipated or obese patients. The test was repeated twice in each subject. Mean (SD) transit time was 105 (63) and 103 (60) min in the first and second series of tests, respectively, showing that the first measurement did not affect the second. The within-subject repeatability of the test was related to the length of transit, the scatter of the differences between the first and second test being greater with the increase of the mean gastrointestinal transit time. The 95% coefficient of repeatability was 84 min for all measurements and 30 and 118 min, respectively, for transit times under and over 100 min. The lowest reproducibility of the test was found in constipated patients with prolonged orocecal transit.     

Modification of orocecal transit time of salazosulfapyridine by atropine and metoclopramide in healthy probands

The first appearance of sulpharyridine in plasma was investigated in nine healthy informed male volunteers. In a three way crossover design 6 g salazopyrin alone, together with metoclopramide (0.3 mg/kg i.m.) or atropine (0.01 mg/kg i.m.) were given. Sulphapyridine appears in the blood at the (means +/- S means) 6.2 h +/- 0.8 h (range: 3-11 h) in controls. Together with metoclopramide the first appearance is 3.6 h +/- 0.7 h (range: 2-8 h) and together with atropine these values are 8.1 +/- 0.8 h (range: 6-12 h). The differences are significant with p less than 0.05. The results show the pharmacological modification of motility in the gastrointestinal tract and in consequence the usefulness of salazopyridine to determine the transit time.     

Small intestinal bacterial overgrowth and delayed orocecal transit time in patients with cirrhosis and low-grade hepatic encephalopathy

Background

Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Gut-derived nitrogenous substances play a role in pathogenesis of HE. The present study was conducted to assess small intestinal bacterial overgrowth (SIBO) and prolonged orocecal transit time (OCTT) in cirrhosis and low-grade HE.

Methods

In cross-sectional prospective study, 75 patients were divided into 3 groups: group 1 (no HE, n = 31), group 2 (minimal HE, n = 29), and group 3 (early/grade 1 HE, n = 15). Minimal HE (MHE) was diagnosed when psychometric hepatic encephalopathy score (PHES) was ≤5. Early HE was diagnosed, according to West Haven criteria. All patients underwent glucose hydrogen breath test (GHBT) for SIBO and lactulose hydrogen breath test (LHBT) for OCTT.

Results

A total of 29 patients (38.67 %) had MHE and 15 (20 %) had early HE. Prevalence of MHE in Child–Turcotte–Pugh (CTP) class A, B, and C was 33.3, 38.71, and 45 %, respectively, while SIBO was detected in 26 (34.67 %). Prevalence of SIBO was 12.5 % in CTP class A, 41.94 % in CTP class B, and 50 % in CTP class C. Five (16.13 %) patients in no HE group had SIBO as compared to 14 (48.28 %) in MHE group and 7 (46.67 %) in early HE group (p = 0.018). OCTT was 111.13 ± 13.95 min in patients with no HE as compared to 137.59 ± 14.80 min in patients with MHE and 150 ± 15.12 min in patients with early HE (p < 0.001). OCTT was significantly prolonged in patients with SIBO (145 ± 17.49 min) than in those without SIBO (120.71 ± 18.3 min) (p < 0.001).

Conclusion

SIBO and delayed OCTT are more common with MHE and early HE in patients with cirrhosis.