Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia

BACKGROUND: Heightened visceroperception and a decreased duodenal motor response to intraduodenal acid infusion have been reported in functional dyspepsia. AIM: To investigate the effect of treatment with a proton pump inhibitor on sensorimotor impairment in 19 patients with functional dyspepsia. METHODS: Patients were assigned double-blind to pantoprazole (n=10) or placebo (n=9) treatment for 2 weeks. Antropyloroduodenal manometry was performed before and after treatment, using a 21-channel catheter, and the responses to intraduodenal infusion of 5 mL of saline and acid were assessed. Nausea, fullness and epigastric pain were scored before and after each infusion. RESULTS: Acid induced a modest duodenal motor response and suppression of antral pressure waves, not altered by either treatment. However, acid evoked isolated pyloric pressure waves after pantoprazole treatment (P < 0.02), and not after placebo. Saline induced no motor response. Acid (not saline) induced nausea, both before and after treatment in both groups (all P < 0.05). Subgroup analysis of the seven acid-hypersensitive patients (37%) showed a tendency towards a decrease in nausea in all four pantoprazole-treated patients (P=0.07), in contrast to the three placebo-treated patients (P=1.0). CONCLUSIONS: In functional dyspepsia, pantoprazole influenced the acid-induced duodenogastric feedback mechanism, but not the impaired duodenal motor response. Duodenal acid hypersensitivity was decreased to some extent.     

Crohn''''s disease, fatigue, and infiiximab: Is there a role for cytokines in the pathogenesis of fatigue?

AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients. METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals. RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points±1.1, P≤0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points±1.4, P≤0.05). Quality of life was increased at the end of the study compared to baseline values (138.6±9.4 vs 179.4±6.7; P≤0.005), whereas depression scores were decreased (20.4±9.4 vs 11.3±2.2; P≤0.01). No correlation between the severity of fatigue and the level of cytokines was observed. CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.     

Partial gastric volumes and upper abdominal sensations in functional dyspeptic and GERD patients: a 3D ultrasonographic study

OBJECTIVES: The aim of the study was to evaluate the change in proximal and distal gastric volumes after ingestion of a nutrient drink and its relationship to upper abdominal sensations using three-dimensional ultrasonography. METHODS: Fifty FD patients, 20 GERD patients patients and 35 healthy controls participated. Partial gastric volumes and sensations were assessed while fasting and after ingestion of a nutrient drink (500 mL, 300 kcal). Division of partial gastric volumes by total gastric volume was used to calculate proximal and distal gastric volume ratios. RESULTS: The proximal gastric volume ratio was smaller in FD patients and larger in GERD patients compared to controls (p < 0.001 and p= 0.008, respectively). FD patients with impaired proximal relaxation (46%) had a larger increase in distal gastric volume (p= 0.008) and higher fullness sensations (p= 0.027) compared to FD patients with normal proximal relaxation. Fullness was related to distal gastric volume in both GERD patients and healthy controls (r= 0.761, p < 0.001 and r= 0.674, p= 0.001, respectively). In FD patients this relationship was not observed. CONCLUSIONS: Impaired proximal gastric volume change after ingestion of a nutrient drink is associated with a larger distal gastric volume and increased fullness. In health and in GERD patients, the distal stomach is important in the regulation of fullness. However, in FD patients with normal or altered gastric volume distribution, this relationship is disturbed, implying that other causes are involved in the excessive generation of fullness.     

Effect of meal temperature on the frequency of gastric myoelectrical activity

It was hypothesized that the transient postprandial decrease of the dominant frequency in the electrogastrogram (EGG) is related to the temperature of the meal. In a randomized three-period cross-over design, EGG recordings were made in 10 healthy volunteers. A liquid meal (36 kcal, 300 mL) was ingested at either 4, 37 or 55 °C. The changes in the dominant EGG frequency that occurred in the first 25 min postprandial were calculated using running spectrum analysis. After the meal a transient shift in frequency was seen, which was significantly greater after the cold meal than after the other meals (P<0.001), with a greater decrease in the dominant frequency (4 °C:−0.75 [−0.92 ∼ −0.68], 37 °C:−0.34 [−0.51 ∼ −0.18], 55 °C:−0.30 [−0.45 ∼ −0.12] cpm, P = 0.020) and a longer duration (4 °C: 16 [13 ∼ 19], 37 °C: 12 [6 ∼ 14], 55 °C: 5 [3 ∼ 8] min, P = 0.014). No differences were found between the 37 °C and 55 °C meals, the power ratios or the number of dysrhythmias. The magnitude of the postprandial shift in frequency of gastric myoelectrical activity depends on the temperature of the meal. Meal temperature should be taken into account in studies on postprandial gastric motility.     

The effect of baclofen on gastro-oesophageal reflux,lower oesophageal sphincter function and reflux symptoms in patients with reflux disease

BACKGROUND: Baclofen decreases gastro-oesophageal reflux episodes in healthy subjects by reducing the incidence of transient lower oesophageal sphincter relaxations. AIM: To investigate the effect of baclofen on reflux symptoms, oesophageal pH and lower oesophageal sphincter manometry in patients with gastro-oesophageal reflux disease. METHODS: A double-blind, placebo-controlled, two-way crossover design was used to study the effect of baclofen on heartburn and regurgitation 3 h after a provocation test meal in 37 patients with gastro-oesophageal reflux disease. Additionally, in 20 of these patients, the effect of baclofen on oesophageal pH, transient lower oesophageal sphincter relaxations and basal lower oesophageal sphincter pressure was studied. RESULTS: Baclofen significantly decreased the acid reflux time and the incidence of gastro-oesophageal reflux episodes (8.3 +/- 8.8% vs. 12.4 +/- 12.0%, P = 0.03 and 10.9 +/- 7.3 per 3 h vs. 18.7 +/- 12.4 per 3 h). The incidence of transient lower oesophageal sphincter relaxations was significantly lower with baclofen than with placebo (15.1 +/- 6.4 per 3 h vs. 22.8 +/- 5.4 per 3 h, P < 0.0001). Lower oesophageal sphincter pressure and the percentage of transient lower oesophageal sphincter relaxations associated with reflux were not affected by baclofen. No significant effect on symptom scores was observed. CONCLUSIONS: Baclofen decreases post-prandial acid reflux in patients with gastro-oesophageal reflux disease by reducing the incidence of transient lower oesophageal sphincter relaxations. No effect of a single dose of baclofen on reflux symptoms could be demonstrated in this 3-h post-prandial study.     

Prematurity, Posture and the Development of Looking Behaviour During Early Communication

Abstract— This study concerns the developing relationship between motor control and looking behaviour in full term ( N =15) and pre-term ( N =29) infants during face-to-face interaction with the mother at 6, 12 and 18 weeks of corrected age. Infants with inborn errors or major medical complications were excluded. In the pre-term infants the development of head and arm postures during interaction differed from the full term pattern, especially in infants born before 32 weeks and/or small-for-gestational age. The full term infants were more advanced than other infants in the ability to grasp an object. These findings were related to group differences in looking behaviour, suggesting that differences in the development of looking behaviour may be (partly) accounted for by differences in the development of motor control.     

Regulation of antigen-specific regulatory T-cell induction via nasal and oral mucosa

With the identification of regulatory T cells (Tr), the hunt for ways to specifically intervene in ongoing inflammatory responses has grown exponentially. Tr are attractive for therapy because they have the potential to control deleterious responses while preserving normal immune function. It has long been known that application of soluble antigen via the mucosa induces mucosal Tr that preserve systemic tolerance upon challenge with the same antigen. Mucosal Tr exhibit three major properties that allow selective control of immune responses. They are (1) adaptive-that is, they differentiate from naive T cells in the periphery; (2) antigen-specific-that is, specific for the (exogenous) antigen applied via the mucosa; and (3) versatile-that is, suppress, irrespective of ongoing Th1 or Th2 cytokine polarization. These powerful characteristics provide mucosal Tr with all requirements necessary to selectively interfere in an unbalanced immune system, as occurs in diseases ranging from autoimmunity to transplant rejection and allergy. Until now, however, translation into clinical applications has led to moderate success. This is primarily due to limited knowledge about the fundamental characteristics of these cells because of the lack of a differential marker. The initial stages of mucosal Tr induction, which may hold the key to discovering the identity of mucosal Tr and unraveling their function, are discussed in this review.