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BACKGROUND: Proximal stomach by virtue of its property of accommodation acts as a reservoir for the ingested food, but its role in emptying and the factors modulating it remain unexplored. AIM: To assess the effects of distension and of feeding on proximal gastric tone. SUBJECTS: 14 healthy volunteers with no current or past history of any gastro-intestinal symptoms. METHODS: Isobaric changes in volume of the proximal stomach were recorded both during fasting and for the first 30 minutes after a meal. RESULTS: For a given degree of distension, the mean (SEM) intragastric pressure was consistently lower, immediately after meal ingestion (9.8 (1.1), mm Hg) than during fasting (12.9 (0.6) mm Hg; p < 0.01). Proximal gastric tone was continuously variable with a frequency of fluctuation of 0.9-1.3/minute and an amplitude of 16.8 (2.2) ml, superimposed upon slower higher amplitude fluctuations in baseline tone. These variations in tone were unaffected by the degree of gastric distension or by food. CONCLUSIONS: While proximal gastric tone decreases after meal ingestions consistent with accommodation, the fluctuations in tone are not an importance factor in the modulation of nutrient emptying from the proximal stomach in the immediate postprandial period. [ABSTRACT FROM PUBLISHER]

Postprandial bloating and fullness are commonly found both in dysmotility like functional dyspepsia, and after vagotomy but the relation between gastric accommodation and symptom production has not been investigated. Intragastric pressure levels and symptoms developed during controlled distension of the gastric fundus were recorded in nine patients with functional dyspepsia, in seven patients after truncal vagotomy, and in 11 healthy volunteers. The procedure was repeated after ingestion of a liquid nutrient meal (250 ml; 250 kcal). Gastric tone, expressed as the average value of pressure over the distension period was lower in controls (median: 11.3 mm Hg) than in either the dyspeptic patients (median: 16.48 mm Hg) or postvagotomy patients (median: 19.12 mm Hg) (p < 0.05). Meal ingestion reduced gastric tone in controls, but no significant change occurred in either the dyspepsia or the postvagotomy patients. Volumes at which discomfort was elicited by distension during fasting were lower both in dyspeptic patients (median: 210 ml) and in postvagotomy patients (median: 180 ml) than in healthy volunteers (median: 660 ml) (p < 0.05). Discomfort thresholds were unaffected by meal ingestion. These results suggest that a disturbance of gastric relaxation may be related to symptom development in dysmotility like functional dyspepsia, while similarities between dyspeptic patients and postvagotomy patients suggest that the impaired gastric accommodation in functional dyspepsia may be due to an underlying vagal defect. [ABSTRACT FROM PUBLISHER]

beta Adrenoceptor blockade is known to accelerate transit through the small intestine without changing either the number or pattern of intestinal contractions. This study therefore tested the hypothesis that an increase in intraluminal aboral propulsive force may contribute to this transit acceleration. Twenty paired studies were performed, in 10 healthy volunteers, after oral administration of either 100 mg atenolol (a selective beta 1 antagonist) or matched dummy tablets according to a double blind, randomised protocol. The frequency of occurrence of, and the propulsive force exerted by, traction events related to intestinal contractions were measured, using a combined traction force detector and manometry assembly. After atenolol, a consistent increase in the force generated per traction event was noted, both for propagating contractions mean (SEM) (12.0 (1.8) g v control 5.9 (0.07) g; p < 0.05) and for stationary (11.6 (1.4) g v control 7.0 (0.7) g; p < 0.05). In contrast no change in the number of traction events was noted (control v atenolol = 1.6 (0.3) v 1.64 (0.4) per min for propagating and 0.7 (0.1) v 0.85 (0.16) per min for stationary contraction; p > 0.05). beta Adrenoceptor blockade thus increases the propulsive force generated by intestinal contractions, possibly by removing a sympathetic neural inhibition of intestinal tone. [ABSTRACT FROM PUBLISHER]

Small intestinal intraluminal pressure activity and aboral traction forces were explored in 19 healthy volunteers using a combined manometry and traction force detecting assembly sited in the upper small intestine. Each aboral traction event was classified as being associated with either a propagating or a stationary contraction and its force measured. During phase I no contractions or traction events were seen. During phase II, traction events related to propagating contractions mean (SEM) (2.2 (0.2)/min) and to stationary contractions (0.3 (0.1)/min) generated similar force/event (7.5(0.9 g v 8.7 (1.4) g, p > 0.05). During phase III, all traction events were related to propagating contractions and generated 9.3 (2.4) g force/event (p > 0.05 v phase II). After feeding, traction events related to propagating contractions generated similar force/event to those related to stationary contractions (5.9 (1.0) g v 9.3 (2.7) g, p > 0.05 v each other and v fasting). No consistent pattern was seen in the temporal distribution of the traction events or in the pattern of the amplitude of the force of successive traction events. [ABSTRACT FROM PUBLISHER]

Although delayed gastric emptying is found in some patients with functional dyspepsia, there seems to be little relation between rate of emptying and symptoms. This study examined the hypothesis that food maldistribution rather than gastric stasis may equate to symptoms in such patients and used scintigraphic techniques to quantify the partition of gastric contents between proximal and distal stomach during gastric emptying. Eleven patients with functional dyspepsia characterised by chronic severe postprandial bloating without organic abnormality, and 12 healthy volunteers, ingested a standard meal labelled with technetium-99M (99mTc). Serial images of the gastric area in anterior and posterior projections were taken for 90 minutes, regions of interest for proximal, distal, and total stomach were defined, and activity time curves were derived from the geometric means of anterior and posterior counts. Total emptying in patients (median: 46 minutes; range: 30-76) was not significantly different from controls (45 minutes; 28-58) and only three showed delayed gastric emptying. In controls, food remained predominantly in the proximal half of the stomach after ingestion and then redistributed to the distal half. In the patients, however, initial activity in the proximal half after ingestion (48%; 40-65) was significantly lower (p < 0.05) than in controls (60%; 39-73) and distributed more fully to the distal half of the stomach with a peak distal activity (56%; 34-58), which was consistently higher than in controls (36%; 33-42) (p < 0.05). It is concluded that this subgroup of functional dyspepsia patients show abnormal intragastric distribution of food, independent of gastric emptying rate. [ABSTRACT FROM PUBLISHER]

A quiz concerning the diagnosis of a 46-year-old woman who experiences intermenstrual bleeding is presented.

This article presents a question related to the diagnosis in case of a 79 year old Caucasian male who presented with a two week history of melena. The answer of this question is also given. The patient's past medical history included hypertension, atrial fibrillation, and malignant melanoma. He was on warfarin. Examination demonstrated a palpable irregular liver edge and the presence of melena was confirmed on per-rectal examination. Gastroscopy identified three ulcers with craters in the gastric fundus, the largest being approximately 2.5 cm in size.

The article presents a quiz related to a case study of a 40 year old previously healthy man with a ten day history of profuse watery diarrhea up to 10 times per day but no blood in the stools. He also complained of mild headache, myalgia, and fever. He had vomiting and crampy abdominal pain two days prior to admission. An urgent colonoscopy was performed on the patient. The quiz was related to the diagnosis of the patient.

This article focuses on a study related to optimal sites to biopsy for an accurate diagnosis of H pylori infection based on its topographical distribution using CLO test. Accurate diagnosis of H pylori is critical for the optimal management of patients undergoing gastroscopy. Generally only one antral biopsy is taken fore CLO well. The study concludes that Using CLO well technique to diagnose H pylori, taking 2 biopsies from the body appears to be superior to taking 2 biopsies from the antrum of the stomach.

Competing Interests: Competing interests: None declared.

Background: Screen time (ST) behaviours, for example, television (TV) watching and computer use, among youth are associated with unhealthy eating, and these patterns track over time. A positive association between ST and TV watching with consumption of caffeinated foods and beverages has been described in national samples of children in a few European countries. The association of ST behaviours with caffeine intake has not been previously reported. We examined whether ST behaviours were associated with caffeine intake on a given day (% consumers and amount consumed) in a nationally representative sample of US children., Methods: Data on 3421 children (ages 6-11 years) from the cross-sectional National Health and Nutrition Examination Survey 2007-2012 were used. Time spent on TV watching and computer use was determined using questionnaires. Dietary intake was assessed using a 24-hour recall by trained interviewers. Caffeine intake (mg) was estimated by using updated food and nutrient databases. Caffeine consumption was examined in relation to time spent (≥2 vs<2 hours/day) on ST behaviours., Results: Children who watched TV ≥2 hours/day had significantly higher (~45% more) caffeine intake. Total ST or computer use was not associated with caffeine consumption in school-aged children., Conclusion: TV watching was positively associated with caffeine intake in school-aged children, suggesting the need for continued monitoring of ST and caffeine intake behaviours in children and adolescents as well as examining the correlates of these behaviours to inform nutrition and health policies., Competing Interests: Competing interests: None declared.