Search

Background: Inflammatory bowel disease (IBD) is associated with delay in gastric emptying, increase in ghrelin, and decrease in leptin. The aim was to investigate the correlation between gastroduodenal (GD) symptoms, gastric emptying, and serum levels of active ghrelin and leptin in IBD. Twenty-seven IBD patients and 26 healthy volunteers were asked to complete the Porto Alegre Dyspeptic Symptoms Questionnaire. A gastric emptying test for solids was performed using a C13 octanoic acid breath test. During this test, serum samples were collected for measuring active ghrelin and leptin concentrations by radioimmunoassay. Summary: Patients with IBD demonstrated delayed gastric emptying compared with healthy volunteers. In patients with GD symptoms, the delay in gastric emptying was more pronounced, and there were significant correlations of satiety and vomiting with gastric emptying. Basal leptin, but not active ghrelin, increased in patients with GD symptoms compared with patients without these symptoms. There were negative correlations between basal active ghrelin with total Porto Alegre score and epigastric pain in IBD patients with GD symptoms. Key Messages: In IBD, satiety and vomiting were associated with delay in gastric emptying. Conversely, epigastric pain had a negative correlation with active ghrelin. Our results suggest that different pathophysiological mechanisms contribute to GD symptoms in IBD.

Object The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Methods Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22–79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. Results The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm3) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm3 and 89.09 ± 14.72 mm3, respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm2) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm2 and 5.64 ± 0.85 mm2, respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05. Conclusions Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.

Surgical outcome after microvascular decompression (MVD) for primary trigeminal neuralgia (TN) has been demonstrated as being related to the characteristics of the neurovascular compression (NVC), especially to the degree of compression exerted on the root. Therefore, preoperative determination of the NVC features could be of great value to the neurosurgeon, for evaluation of conflicting nature, exact localization, direction and degree of compression. This study deals with the predictive value of MRI in detecting and assessing features of vascular compression in 100 consecutive patients who underwent MVD for TN.The study included 100 consecutive patients with primary TN who were submitted to a preoperative 3D MRI 1.5 T with T2 high-resolution, TOF-MRA, and T1-Gadolinium. Image analysis was performed by an independent observer blinded to the operative findings and compared with surgical data.In 88 cases, image analysis showed NVC features that coincided with surgical findings. There were no false-positive results. Among 12 patients that did not show NVC at image analysis, nine did not have NVC at intraoperative observation, resulting in three false-negative cases. MRI sensitivity was 96.7% (88/91) and specificity 100% (9/9). Image analysis correctly identified compressible vessel in 80 of the 91 cases and degree of compression in 77 of the 91 cases. Kappa-coefficient predicting degree of root compression was 0.746, 0.767, and 0.86, respectively, for Grades I (simple contact), II (distortion), and III (marked indentation; p0.01).3D T2 high-resolution in combination with 3D TOF-MRA and 3D T1-Gadolinium proved to be reliable in detecting NVC and in predicting the degree of the root compression.

We have observed that acute blood volume expansion increases the gastroduodenal resistance to the flow of liquid in anesthetized dogs, while retraction decreases it (Santos et al. (1991) Acta Physiologica Scandinavica, 143: 261-269). This study evaluates the effect of blood volume expansion and retraction on the gastric emptying of liquid in awake rats using a modification of the technique of Scarpignato (1980) (Archives Internationales de Pharmacodynamie et de Therapie, 246: 286-294). Male Wistar rats (180-200 g) were fasted for 16 h with water ad libitum and 1.5 ml of the test meal (0.5 mg/ml phenol red solution in 5% glucose) was delivered to the stomach immediately after random submission to one of the following protocols: 1) normovolemic control (N = 22), 2) expansion (N = 72) by intravenous infusion (1 ml/min) of Ringer-bicarbonate solution, volumes of 1, 2, 3 or 5% body weight, or 3) retraction (N = 22) by controlled bleeding (1.5 ml/100 g). Gastric emptying of liquid was inhibited by 19-51.2% (P

Because diffusion tensor imaging (DTI) is able to assess tissue integrity, we used diffusion to detect abnormalities in trigeminal nerves (TGN) in patients with trigeminal neuralgia (TN) caused by neurovascular compression (NVC). We also studied anatomical TGN parameters (cross-sectional area [CSA] and volume [V]). Using DTI sequencing in a 3-T magnetic resonance imaging (MRI) scanner, we measured the fraction of anisotropy (FA) and the apparent diffusion coefficient (ADC) of TGN in 10 patients selected as candidates to have microvascular decompression (MVD) for TN, and 6 normal control subjects. We compared data between the affected nerves of TN (ipsilateral TN), unaffected nerves of TN (contralateral TN), and both nerves in normal subjects (controls), and correlated these data with CSA and V. The FA of the ipsilateral TN (0.37±0.08) was significantly lower (P.05) compared with the contralateral TN (0.48±0.08) and control values (0.52±0.04). The ADC of ipsilateral TN (5.6±0.89 mm(2)/s) was significantly higher (P.05) compared with the contralateral TN (4.26±0.59 mm(2)/s) and control values (3.84±0.43 mm(2)/s). Ipsilateral TN had less V and CSA compared with contralateral TN and control values (P.05). The Spearman correlation coefficient showed a strong positive correlation between loss of FA and loss of V (r=0.7576) and loss of CSA (r=0.9273) of affected nerves. The Spearman correlation coefficient showed a strong negative correlation between increase in ADC and loss of V (r=-0.7173) and loss of CSA (r=-0.7416) in affected nerves. DTI revealed alteration in the FA and ADC values of the affected TGN. These alterations were correlated with atrophic changes in patients with TN caused by NVC.

The etiology of irritable bowel syndrome (IBS) is complex and multifaceted. Psychosocial factors play a role in such a process. Several reports suggest that IBS patients have increased psychopathology scores as compared with population controls. The influence of depressive symptoms on rectal sensitivity thresholds vary across different studies. The influence of predominant bowel habits on rectal sensitivity thresholds as determined by barostat-based investigations is not well established. The present report aimed to investigate the influence of depressive symptoms on rectal sensitivity in different subtypes of IBS patients (diarrhea/constipation-predominant vs. alternating subtypes). Depressive symptoms correlated well with first pain sensitivity threshold in alternating patients (n = 8; [rho] = -0.77; p = 0.02) but not in diarrhea/constipation predominant symptoms (n = 11; [rho] = -0.44; p = 0.27). These data suggest that depressive symptoms might impact pain thresholds differently according to the subtype of IBS.

Background: Symptoms compatible with GI functional disorders are higher in patients with IBD compared with controls. We demonstrated that delayed gastric emptying was associated with dyspeptic symptoms in inactive Crohn's disease. Serum ghrelin and leptin levels were elevated in IBD patients and it was described that these hormones couldmodify the gastrintestinal motility. High ghrelin or leptin serum concentrations are associated with symptoms in functional dyspepsia. The relationship between ghrelin and leptin with GI symptoms and gastric motility in IBD patients has not been studied. Aim: To investigate the relationship between dyspeptic symptoms, gastric emptying, serum levels of ghrelin and leptin in IBD. Methods: Twenty seven patients with IBD (14 with Crohn's disease and 13 with ulcerative colitis) underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (PADYQ, The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms; fasting blood samples were also collected to measure active ghrelin or leptin by a RIA. Then, IBD patients were allocated in two groups according to their total PADYQ score: non-dyspeptic (score=0), dyspeptic (score > 0). Control group was composed by 26 sex-matched healthy volunteers. The study was approved by the local Ethical Committee (049.07.08). Results: IBD patients had a significantly (p

society for the study of obesity (JASSO) (waist circumference ≥85 cm in men, ≥90 cm in women plus at least two of following, TGs ≥150 mg/dl and/or HDL cholesterol

The effect of acute and sequential volaemic changes on the gastroduodenal flow of saline was assessed in 23 anaesthetized dogs following two different experimental protocols. Hypervolaemia, by i.v. infusion of saline, induced a gradual decrease on gastroduodenal flow which amounted to 76% below control values (P less than 0.001) when volaemic expansion attained 5% of body weight. This effect was volume dependent (17% increase on gastroduodenal flow per volume of infused saline equivalent to 0.5% of body weight, P less than 0.001), lasted for at least 90 minutes after infusion was completed and was also obtained by expanding previously bled animals. Hypovolaemia due to bleeding was followed by an increase on gastroduodenal flow of about 88% above control values (P less than 0.05) when haemorrhage was equal to 3% of body weight. This effect was also volume dependent (23% increase on gastroduodenal flow per volume of blood shed equivalent to a 0.5% of body weight, P less than 0.01) and was reversed after blood volume was restored. These modifications in the resistance of the gastroduodenal segment to the flow of liquid due to acute volaemic changes suggest that the extracellular fluid volume modulates the contractile activity of the gastroduodenal portion of the gut possibly to set a gastroduodenal handling of liquid adequate to cope with volaemic imbalances.

with age, gender and calendar period. Results: Among 1568 potential cases of gastroparesis, 83 met diagnostic criteria for definite, 126 probable, and 221 possible. The age-adjusted (to 2000 U.S.whites) incidence per 100,000 person-years of definite gastroparesis for the years 1996-2006 was 2.5 (95% CI, 1.2-3.8) for men, and 9.8 (95% CI, 7.5-12.1) for women. The age-adjusted prevalence of definite gastroparesis per 100,000 person on January 1, 2007 was 9.6 (95% CI, 1.8-17.4) for men and 37.8 (95% CI, 23.2-52.4) for women. Poisson regression indicated significantly increasing rates with age and for females (both p