Search

Aim: To assess the epidemiology and course of GORD, treatment demand, and factors predictive of GORD course in a 1-year study in patients with heartburn consulting general practitioners., Methods: A total of 984 patients with pyrosis were included by general practitioners. After the initial visit, they had follow up at 3, 6 and 12 months by phone contact., Results: Most patients (87%) had been suffering from heartburn for 4+/-1.5 years; upper GI endoscopy had been performed in 63% of patients. Patients evaluated the symptoms of the current episode as mild (6%), moderate (60%), or severe/incapacitating (34%). During the year of follow up, 12% of the patients were free of heartburn; the mean number of consultations with general practitioners and gastroenterologists was 5.1 and 0.5 respectively. At day 90, discomfort due to heartburn was absent in 4% of patients, slight in 51%, moderate in 32%, and severe in 6%. At day 360, predictive factors for discomfort were: discomfort related to heartburn on D90, the length of time the patients had been suffering from GORD, and the main reason for consultation on D1; patients for whom heartburn was not the main reason for consultation on D1 experienced a higher level of discomfort. The predictive factors for the extent of treatment demand over 12 months were: age, discomfort related to heartburn on D90, severity on D1, the frequency of episodes prior to the episode on D1 and the levels of stress and anxiety measured on D1., Conclusions: Epidemiologic characteristics of patients with heartburn consulting a general practitioner were different from these of the general population. Treatment demand depends both on severity of heartburn and level of stress and anxiety.

Transient lower esophageal sphincter (LES) relaxations (TLESRs) are the main underlying mechanism of gastroesophageal reflux. Although CCK acts through CCK-A receptors to increase the TLESRs induced by gastric distension, the respective roles of endogenous CCK and fundic tone in triggering postprandial TLESRs remain unknown. The aim of this study was to determine the effect of the CCK-A receptor antagonist, loxiglumide, on postprandial LES function and fundic tone in humans. LES motor events and fundic tone were simultaneously monitored in two groups of healthy volunteers. Recordings were performed during fasting and for 3 h after a liquid meal (200 ml/200 kcal) administered either orally or intraduodenally at a rate mimicking gastric emptying. Each subject received loxiglumide (10 mg. kg-1. h-1) or saline (control) in randomized order, which was started 40 min before the meal and maintained for 3 h thereafter. After the oral meal, loxiglumide significantly reduced TLESRs (P = 0.002) without significantly affecting LES pressure and fundic tone. After duodenal infusion of the meal, loxiglumide totally abolished the increase in TLESRs, reduced LES pressure fall (P < 0.02), and strongly inhibited fundic relaxation (P = 0.0001). We concluded that endogenous CCK is involved in the postprandial control of both LES function and fundic tone through activation of CCK-A receptors.

Background: Because of their tolerance and safety, low doses of H2-receptor antagonists are now increasingly used in some countries for self-care medication of gastro-oesophageal reflux symptoms., Aim: The purpose of this randomized, double-blind, placebo-controlled, five-way crossover study was to determine and to compare the effects of low doses of ranitidine and cimetidine both on gastric pH and on oesophageal acid exposure., Methods: Gastric and oesophageal pH were simultaneously monitored in 20 healthy subjects using two glass pH electrodes, after placebo and single doses of ranitidine 75 mg and cimetidine 200 mg (effervescent and tablet forms), for 4 h before and after a meal., Results: During the fasting period, median gastric pH rose significantly with both drugs, but more rapidly with the effervescent forms; the oesophageal acid exposure was significantly decreased by all drug regimens. After the meal, although there was no significant difference in gastric pH values, oesophageal acid exposure was significantly decreased in comparison with placebo with both forms of ranitidine (P < 0.05), and also for ranitidine tablets in comparison with cimetidine tablets (P < 0.05)., Conclusions: Low doses of ranitidine and cimetidine increase gastric pH, with a more pronounced effect for ranitidine. Effervescent formulations of both drugs induce a slightly more rapid initial increase in pH than tablets. Ranitidine demonstrates a more prolonged effect than cimetidine and decreases oesophageal acid exposure monitored after a meal ingested 4 h after the drug intake.

Background & Aims: Igmesine, a final sigma ligand, has been shown to inhibit intestinal secretion and diarrhea in animal models. The purpose of this study was to measure the inhibitory effect of igmesine on basal and prostaglandin E2 (PGE2)-induced jejunal secretion in normal volunteers., Methods: Jejunal absorption of water and electrolytes was measured with a three-lumen open-segment perfusion method in 16 volunteers. A double-blind crossover study was performed involving intraluminal infusion of PGE2 after oral administration of placebo or igmesine at two doses., Results: PGE2 induced net secretion of water and electrolytes (P < 0.01 vs. basal conditions). The effect of PGE2 on water and electrolytes was not changed by 25 mg of igmesine but was suppressed by 200 mg of igmesine. This effect lasted at least 3 hours after a single oral dose. Igmesine at a dose of 200 mg also produced a significant decrease in basal rates of water and electrolyte absorption., Conclusions: Igmesine, a final sigma ligand, inhibits PGE2-induced intestinal secretion in normal humans. Evaluating the drug in chronic diarrheas may be of interest.

Implantation of an artificial sphincter is an alternative treatment for patients with severe faecal incontinence. This prospective study from one institution has evaluated the results from 13. Preoperative and postoperative incontinence scores, anal manometry, and quality of life were evaluated in 13 patients who had undergone implantation of an artificial sphincter over a 7-year period. Two patients were definitive failures. One developed acute total colitis after 5 years of satisfactory function, and a second had discomfort and demanded removal of an otherwise functioning device. After a median follow-up of 30 (range 5-76) months, 11 patients had an activated and functional device. These included 6 with a urinary AMS 800 and 5 with the newly designed anal ABS. The mean incontinence score decreased from 17 to 4, and quality of life improved markedly. Two of the 11 patients had undergone successful reimplantation, one following rupture of the cuff and the second following ulceration of the control pump through the labia. In no case was infection or erosion of the anal canal a cause of failure. While the cause of incontinence and age did not affect outcome, psychological reaction had a significant impact. The artificial anal sphincter may have a role to play in severe faecal incontinence.

Background: Recent studies indicate that gastric emptying may be influenced by patterns of previous nutrient intake. Endogenous cholecystokinin (CCK), whose synthesis and release can be affected by dietary intake, has a major role in the regulation of gastric emptying., Aims: To evaluate the influence of diets with differing protein content on gastric emptying of differing liquid test meals and plasma CCK levels in the rat and to check whether the inhibitory effect of exogenous CCK on gastric emptying is modified after long term intake of diets with differing protein content., Methods: Rats were fed for three weeks with high protein, medium protein (regular), or low protein diet. On day 22 gastric emptying of a peptone meal was studied. In addition, basal and postprandial CCK levels after the different dietary regimens were measured by bioassay. The time course of dietary adaptation was studied and its specificity assessed through the use of different (peptone, glucose, and methylcellulose) test meals. The effect of exogenous CCK-8 on gastric emptying was studied at the end of the adaptation period (three weeks)., Results: Feeding the animals with a high protein diet for three weeks resulted in a significant (p < 0.05) acceleration (by 21.2 (8.2)%) of gastric emptying while feeding with a low protein diet was followed by a significant (p < 0.05) delay (by 24.0 (6.2)%) in the emptying rate. When the time course of the effect of dietary adaptation on gastric emptying was studied, it appeared that at least two weeks are required for dietary protein to be effective. The regulatory effect of dietary protein on gastric emptying proved to be dependent on meal composition. Only the emptying rate of a protein containing meal (40% peptone) was significantly modified by previous dietary intake. No significant (p > 0.05) changes were observed with glucose and methylcellulose meals whose emptying rates were similar in rats receiving a high protein or low protein diet. A peptone meal strongly and significantly (p < 0.05) increased plasma CCK levels in rats fed a medium protein (regular) diet. Results were similar in rats receiving a low protein diet (p < 0.05) but not in rats on a high protein diet (p > 0.05). As a consequence, postprandial plasma levels of CCK in rats fed with a medium or low protein diet were significantly (p < 0.05) higher than those in rats receiving a high protein diet. In rats on high and low protein diets, dose response curves to CCK-8 were virtually identical, suggesting that dietary protein intake has no influence on the effect of exogenous CCK., Conclusions: These results clearly show that gastric emptying of a protein containing meal can be modified by previous dietary protein intake. This effect, which is time dependent and meal specific, may be related to changes in endogenous CCK release which will affect emptying rate. While the exact mechanisms underlying this adaptive response need to be studied and clarified further, these results emphasise the importance of dietary history in the evaluation and interpretation of gastric emptying data.

Background: To evaluate the safety and clinical efficacy of botulinum toxin (BT) in patients with achalasia followed up for six months., Methods: Fifty five symptomatic patients with manometrically proven achalasia were included in a multicentre prospective trial. Before and two weeks and two months after intrasphincteric injection of BT, symptoms of dysphagia, regurgitation, and chest pain were scored on a 0-3 scale, and lower oesophageal sphincter pressure (LOSP) was assessed. The symptom score was determined again at six months, clinical improvement being defined by < or = 3, relapse by > 3, and failure as a relapse after two injections or loss to follow up., Results: Except for transient chest or epigastric pain (22%), no side effects were observed. There was a significant decrease in LOSP after treatment. Symptom scores were significantly improved at two weeks (2.0 (SD 1.6)), two months (1.7 (1.8)), and six months (1.9 (2.0)) compared with pretreatment values (5.1 (1.8), p < 0.001). At six months, 33 patients had clinical improvement (27 after one injection), 17 were considered failures, and five had just relapsed. Although there was a trend for age (older patients being more responsive), age, sex, prior duration of symptoms, initial symptom score, weight loss, LOSP, magnitude of oesophageal contractions, vigorous or non-vigorous achalasia, previous dilatations, and radiological features were not predictive of results., Conclusions: This multicentre series confirms that intrasphincteric injection of BT is a safe procedure, resulting in clinical improvement in 60% of patients with achalasia at six months. The therapeutic role of BT in achalasia needs further evaluation with regard to other alternatives.

Unlabelled: Various options have been suggested to improve the functional results of abdominal rectopexy for rectal prolapse and to limit the risk of post-operative constipation., Objectives: In this prospective study, we evaluated the results of posterior abdominal rectopexy-sigmoidectomy to treat rectal prolapse syndrome in terms of morbidity, anatomic correction and bowel function. Patient benefits after surgery were assessed according to their pre-operative functional status., Patients and Methods: Twenty patients (14 females, mean age: 42 years) were treated for rectal prolapse with sutured abdominal rectopexy and sigmoidectomy., Results: (a) Thirteen patients had normal post-operative course. No anastomotic leak occurred. Mean hospital stay was 9.7 days. (b) Anatomical control was obtained in all cases for a mean follow-up of 31.2 months without recurrence. (c) Functional results: bowel movements per week remained unchanged pre- and post-operatively (18.6 +/- 33 vs 18.1 +/- 17). Constipation appeared or worsened in 2 patients (10%). Anal incontinence (n = 6-30%) never worsened post-operatively and improved in 3., Conclusions: This prospective clinical study confirmed the important functional disorders occurring in rectal prolapse syndrome. Rectopexy-sigmoidectomy is a valid option with stable mid-term results. Constipation was observed in 10% with no worsening of anal incontinence.

Objectives: The aim of this study was to determine the feasibility and tolerance of simultaneous assessment of the proximal gastric and lower esophageal sphincter tones in healthy humans, in fasting and fed conditions., Methods: Esophageal motility and lower esophageal sphincter tone were measured on two separate days in 7 healthy subjects. During one of these sessions, proximal gastric tone was simultaneously assessed with a balloon placed in the proximal stomach and connected to an electronic barostat. Motility was monitored 1 hour before and 4 hours after a liquid fat meal (400 mL/600 kcal). In four other healthy subjects, simultaneous assessment of proximal gastric and lower esophageal sphincter tones was performed after, suggestion of a 200 mL/200 kcal liquid meal., Results: Simultaneous use of gastric barostat and esophageal motility device was well tolerated in 10/11 healthy subjects. The presence of the barostat balloon did not significantly affect basal lower esophageal sphincter tone and the rate of transient lower esophageal sphincter relaxations. The important fall of lower esophageal sphincter basal tone after ingestion of the 400 mL/600 kcal meal did not allow to detect a post-prandial increase of transient lower esophageal sphincter; relaxations. After ingestion of the 200 mL/200 kcal meal, the incidence of transient lower esophageal sphincter relaxations increased (p < 0.02 vs. fasting). Maximal gastric relaxation was reached 15 min after meal, and appeared shorter (112 +/- 17 min vs. 167 +/- 24 min) and more pronounced (292 +/- 26 mL vs. 190 +/- 51 mL) than after the 400 mL meal, but differences were not statistically significant., Conclusions: Simultaneous assessment of proximal gastric and lower esophageal sphincter tone is feasible, after oval ingestion of a meal. Since the 400 mL meal induces in important inhibition of lower esophageal sphincter basal tone, the 200 mL meal seems more adequate for assessment of the transient lower esophageal sphincter relaxations.

Cholecystokinin (CCK) is a peptide released after feeding. Until now, CCK gene expression has been studied only on sacrified animals on mucosa scrapped off the duodenum. OBJECTIVE--The aim of this study was to assess CCK-mRNA detection on duodenal biopsy specimens in subjects undergoing gastrointestinal endoscopy. METHODS--Six biopsy specimens were taken from 6 healthy subjects, a) after a 12-h overnight fast and b) 6 or 12 h after a fat meal, and inducing a CCK release. CCK-mRNA was analyzed by Northern blot. RESULTS--Plasma CCK levels increased from basal levels of 0.5 +/- 0.1 pmole/L to 8.2 +/- 1.5 pmole/L 10 min after the meal. The fasting CCK-mRNA levels were 44.0 +/- 0.6% and the post-prandial levels increased to 74.0 +/- 6.0% at 6 h and decreased to 47.5 +/- 0.5% at 12 h. CONCLUSIONS--Detection of CCK gene expression in human duodenal biopsy specimens is feasible. Stimulation of CCK release after a meal is followed by an increase in CCK-mRNA in the duodenal mucosa.

Background & Aims: Low doses of erythromycin induce antral contractions and accelerate gastric emptying. However, the effect of erythromycin on the proximal stomach remains unknown. The aim of this study was to assess the effect and mechanism(s) of action of erythromycin on proximal gastric tone in humans., Methods: Gastric tone was measured using an electronic barostat in two groups of 6 subjects both in the fasting state and after a 200-kcal meal. On different occasions, subjects received saline, atropine alone (6 micrograms.kg-1.h-1 for 30 minutes), erythromycin alone (1.5 mg/kg in the fasting state and 1.5 and 3.0 mg/kg in the postprandial state), and erythromycin plus atropine., Results: Low-dose (1.5 mg/kg) erythromycin enhanced fasting gastric tone, but only the 3.0-mg/kg dose reduced the duration of meal-induced relaxation (37 +/- 14 vs. 105 +/- 20 minutes; P < 0.01). Atropine did not change the fasting or postprandial gastric tone as well as the erythromycin-induced responses. Plasma motilin levels were unaffected by erythromycin infusion. No correlation was observed between gastric tone and plasma motilin or erythromycin levels., Conclusions: Erythromycin enhances fasting and postprandial proximal gastric tone in humans by a mechanism that does not seem to involve endogenous motilin release or a cholinergic pathway.

We report the association of primary sclerosing cholangitis and systemic lupus erythematosus in a 39 year-old man. Six months after a diagnosis of primary sclerosing cholangitis was established, the patient was hospitalized for a pleural effusion and acute pericarditis. Emergency pericardiocentesis, was required due to sudden cardiac tamponnade. Plasmatic anti-DNA and anti-nuclear antibodies were present. Treatment by steroids greatly improved symptoms. This clinical association suggests that some immune disorders may be common to the two diseases.

Optimal surgical treatment for neuropathic severe anal incontinence is still controversial: the combination of pre-anal levator plication and post-anal repair (Parks) has been recently described. This non-randomized prospective study evaluated the results of pre- and post-anal repair for medically non-corrected neuropathic and traumatic anal incontinence. Ten female patients (mean age: 59) were operated by pre- and post-anal levatorplasty (total pelvic floor repair). Incontinence was scored clinically according to the Jorge and Wexner score (normal: 0, max.: 20) and with no rectal manometry, before and after surgery. Fourteen months after surgery (range: 9-18 months), anal continence for stools was achieved in 7 out of 10 patients: the patients clinical scores decreased from 15 (12-19) pre-operatively to 6 (1-18) post-operatively (p < 0.01) (4 for good results, 17 for the 3 failures). No manometric parameter was able to predict or explain postoperative functional results. Only anal canal length and maximal amplitude of anal contractions were significantly improved from 3.0 cm (2.0-4.0) to 3.5 cm (2.2-4.5), p < 0.05) for the former and from 54 to 69 cm H2O for the latter (p < 0.05). In this small series, pre- and post-anal levatorplasty effectively corrected severe neuropathic anal incontinence in the short-term, in 70% of cases. In our experience, this technique appears to be superior to post-anal repair, without increasing technical problems or morbidity.

Background: The effect of alosetron, a new specific 5-HT3 receptor antagonist, on the visceral perception in response to gastric distension was assessed in 12 healthy male subjects in a randomized, double-blind, placebo controlled crossover trial., Methods: Each subject was given orally either alosetron 1 mg b.d. or placebo b.d. for 6 days (wash-out period 7-28 days). At the end of each dosing period, both isobarometric and isovolumetric gastric distensions were performed using an electronic barostat., Results: Alosetron did not modify the gastric wall compliance (pressure-volume relationship). Alosetron had an effect similar to placebo on the visceral perception scores in both isobarometric and isovolumetric distensions. The mean (+/- SEM) thresholds for abdominal discomfort were, respectively, 16.8 +/- 0.7 mmHg and 825 +/- 61 mL with alosetron, 16.7 +/- 0.6 mmHg and 883 +/- 45 mL with Placebo (P = NS)., Conclusions: 5-HT3 receptors do not appear to be involved in the visceral perception of gastric distension in healthy subjects.

Background: Lansoprazole and omeprazole are proton pump inhibitors which both strongly inhibit acid secretion, resulting in a significant increase in serum gastrin levels. However, no direct comparison of recommended doses (20 mg for omeprazole and 30 mg for lansoprazole) has been reported so far. Our aims were to compare the effects of omeprazole 20 mg/day and lansoprazole 30 mg/day on intragastric acidity and serum gastrin concentration in 12 healthy volunteers., Methods: The study was double-blind, randomized and placebo-controlled with a cross-over design. On the seventh day of each period, 24-hour intragastric pH was measured using a combined glass electrode placed in the proximal stomach. The last morning dose of each regimen was taken at the end of 24-hour pH monitoring; acid output and serum gastrin concentrations were then studied in the fasting state and after stimulation with pentagastrin (maximal acid output) and a meal (post-prandial gastrin response)., Results: Compared to placebo, both drug regimens induced a sustained increase of 24-hour intragastric pH and significantly decreased basal and pentagastrin-stimulated acid secretion. Lansoprazole 30 mg was slightly more effective than omeprazole 20 mg in terms of time spent above pH 3 (P < 0.05). Accordingly postprandial gastrin concentrations rose slightly more after lansoprazole than after omeprazole. All other differences were insignificant., Conclusions: Both lansoprazole 30 mg and omeprazole 20 mg induce potent and long-lasting acid inhibition, with few minor differences when the two proton pump inhibitors are used at standard doses.

The definition of criteria relevant to disease severity assessments should be considered in parallel with the long-term aims of treatment in gastro-oesophageal reflux disease (GORD). There is no doubt that the resolution of symptoms is the major management aim. Heartburn and regurgitation are specific for GORD when they are the predominant symptoms, but prove to be insensitive when the diagnosis of GORD is based on the measurement of oesophageal acid exposure. A relationship between the frequency of heartburn and the degree of acid exposure has been reported in GORD patients both with and without oesophagitis. GORD may also, however, cause a wide spectrum of atypical symptoms (e.g. non-cardiac chest pain or respiratory symptoms). To the extent that a causal relationship between these symptoms and reflux episodes has been established, evaluation of symptom severity should also encompass these atypical presentations. The role of symptoms in the prediction of relapse of oesophagitis is controversial, but in several studies the presence of residual symptoms of GORD at the time of healing has indicated a greater probability of relapse. Endoscopy is a useful technique for the evaluation of disease severity. Indeed, even typical symptoms may not predict the presence and severity of oesophagitis in an individual patient. Despite the fact that the interpretation of therapeutic trials is often impeded by differences in the grading systems used, healing rates of oesophageal lesions are inversely proportional to the initial severity of oesophagitis when drugs such as H2-receptor antagonists are used. Differences are less evident with highly effective drugs such as omeprazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous electrogastrography is a non invasive method to study gastric electromechanical activity. The aim of this work was to determine the amplitude of electrogastrographic (EGG) activity a) during fasting, b) after a meal, c) following vagal stimulation by sham feeding, and to determine the relationship between gastric emptying of solids and EGG activity. EGG activity was recorded in eight healthy subjects in various experimental conditions, twice after sham feeding, twice after a meal, and once during the simultaneous scintigraphic assessment of gastric emptying of the solid component of a meal. During one of the sham feeding tests, subjects were intubated and acid secretion was measured. The EGG signal amplitude was continuously monitored and an intercorrelation function (IF) was calculated using the Fast Fourier Transforms of electrical activity recorded by 2 cutaneous electrodes placed on the epigastric area. During fasting, IF was usually of low amplitude with occasional short increases of amplitude. Sham feeding without intubation rarely induced an early and brief increase in IF amplitude (2 of 8 subjects). Sham feeding-induced acid secretion was negatively correlated with IF amplitude (r = 0.78, P = 0.02) suggesting a motor inhibition associated with vagally stimulated acid secretion. When given orally, meals induced an increase in IF amplitude, but there was major intra- and interindividual variations. There was no significant correlation between the IF increase and the half emptying time for solids (r = 0.62, P = 0.10). This study shows that the high variability of EGG activity during fasting considerably hampers the analysis of changes induced by any stimulus.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic barostat allows to measure volume variations of an intragastric air-filled bag maintained at a low constant pressure level, reflecting gastric tone variations. The aims of the present study were to record physiologic variations of gastric tone in humans a) in the fasting state, with and without different stimuli, and b) in the fed state. The bag was placed into the proximal stomach of healthy subjects and connected to the barostat. Volume variations were recorded in the basal state and in response to a) a balanced liquid meal (200 mL, 200 kcal, n = 8), b) sham feeding and sham feeding after cholinergic blockade (atropine 10 micrograms.kg-1 IV, n = 8), and c) graded antroduodenal distensions performed with a tandem balloon (n = 6). During fasting, the proximal stomach presented both a tonic and an intermittent phasic motor pattern (volume waves of 1.2 min maximal period). Meal ingestion was rapidly followed by a dramatic fall in proximal gastric tone (> 200% of preprandial volume within 11 +/- 5 min). After a meal, the intragastric bag returned to preprandial volume after 92 +/- 12 min (ranges: 75-110). Proximal gastric tone was not significantly modified by atropine or by sham feeding alone or after atropine. Antroduodenal distensions reproducibly induced volume dependent relaxations (r = 0.98, P < 0.001) with inhibition of the phasic activity. These results confirm the value of electronic barostat for the measurement of proximal gastric tone, and show that postprandial relaxation is not masked by a low volume liquid meal. Sham feeding does not appear to be an adequate stimulus to induce gastric relaxation. This suggests that vagal fibers involved in gastric relaxation are not the same (or have a higher stimulation threshold) than fibers involved in cephalic phase of gastric secretion.

Short-chain fatty acids (SCFAs) alter ileal and colonic motility, but their effects on duodenojejunal motility are unknown. Simultaneous jejunal manometric recordings and hydrogen breath tests after lactulose were performed in eight healthy subjects during continuous duodenal infusion of either saline or SCFAs. These experiments were conducted in the fasting state and postprandially. The effects of various boluses of SCFAs on duodenojejunal motility were also determined in six subjects. During the fasting period, the number and characteristics of migrating motor complex, prolonged propagated contractions, discrete clustered contractions, motility index, and orocecal transit time were similar during saline and SCFAs. Similarly, the motility index and the duration of the postprandial period were not different between SCFAs and saline after the meal. The motility index was significantly increased after each of the 100-ml boluses (saline or SCFAs), but was not altered after the 12.5-ml boluses, suggesting a volume-related effect. Thus, SCFAs do not seem to affect proximal small bowel motility in healthy humans.

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)

Although the pathogenic role of gastroesophageal reflux in Barrett's esophagus (BE) is now widely accepted, the pattern of pH profile in the esophagus of patients with BE is not well documented. The aim of this study was to assess the severity and "extent" of acid exposure in patients with BE using an automated single or two-channel 24-hour pH monitoring system. Eighteen patients with histologically proven BE were compared with 3 other groups: a) 100 patients with clinical symptoms and pHmetrically proven acid reflux divided in 2 sub-groups: 38 patients without esophagitis at endoscopy, and 62 patients with esophagitis (Savary-Miller classification; grade I: n = 24, grade II: n = 27, grade III: n = 8, grade IV: n = 3) and b) 9 healthy volunteers. In 17 patients with BE, and in 14 patients with reflux and healthy volunteers, 2 electrodes were placed 5 (electrode E1) and 10 cm (electrode E2) above the lower esophageal sphincter. In the other patients, pH was monitored using a single pH electrode (E1) only. The mucosal acid exposure at E1 (percentage of time below pH 4 on total period, day and night), the number of reflux episodes longer than 5 min were significantly higher in the BE group when compared with the other groups. The number of patients with abnormal acid exposure at E2 was significantly higher (P less than 0.01) in the BE group (15/17 cases) than in the reflux group (5/14 cases). The mean duration of acid reflux was significantly longer in BE than in other groups at both recording sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Rectocele is a frequent rectal static disorder. Its usual clinical manifestation is a distressing outlet obstruction. Surgical treatments actually proposed are based on a trans-anal approach. Perineal approach has specific interests as shown on a consecutive series of 20 patients operated on between January 90 and January 92. The surgical modalities were, after mobilization of the recto-vaginal wall, careful concentric folding of the rectocele followed by suturing the rectal fascia and pre-anal levatorplasty without associated colpectomy. Results (mean follow-up: 15 months) showed: 1) anatomic correction obtained in 18 cases, without local complications, but one dyspareunia, 2) restoration of normal rectal evacuation in 16 cases. The 4 functional failures were observed in patients with associated anorectal disorders (anismus, colon inertia).

A scintigraphic technique allowing combined measurements of gastric emptying, small intestinal transit time and colonic filling was developed and its reproducibility assessed in 8 healthy volunteers. Each subject underwent four tests: a) two were performed in the fasting state (99mTc labelled water, added to lactulose), b) two in the postprandial state (balanced meal, 1,750 kJ, included pellets labelled with 111In, the gut transit of which being nearly the same as dietary fibers). Intestinal transit was modeled using linear operators (expressed as a convolution product). In fasting state (lactulose), orocecal transit time of water was 109 +/- 60 min and 89 +/- 36 min (m +/- DS) for the first and second tests, respectively. In the postprandial state, values were 297 +/- 37 min and 293 +/- 43 min respectively for the pellets. Small bowel transit times were 135 +/- 70 and 103 +/- 40 min respectively in fasting state for water, and 209 +/- 47 and 209 +/- 29 min respectively in postprandial state for the pellets. Determination of residual variance showed that reproducibility of the test was better in the postprandial state than in the fasting state. Water orocecal transit times measured using this technique and lactulose orocecal transit time measured using hydrogen breath test were strongly correlated (r = 0.98, n = 12, P less than 0.01). This isotopic method provides a reproducible assessment of gastric emptying, small bowel transit, and colonic filling and could represent a reliable and non invasive tool for further physiological and pharmacological studies.

The prevalence of lactase deficiency (LD) and lactose intolerance is not well known in France. Using breath hydrogen and methane analysis after 50 g oral lactose load, we investigated the prevalences of LD, lactose intolerance, and methane producer status in 102 healthy adults born in western France, and we examined the relationships between these parameters and the daily milk consumption. In 10 subjects with LD and lactose intolerance, we studied the reproducibility of the lactose hydrogen breath test results for the diagnosis of LD and lactose intolerance and estimated the quantity of lactose malabsorbed in comparison with the lactulose hydrogen breath test. The prevalence of LD was 23.4 percent and symptoms of lactose intolerance were observed in 50 percent of the 24 subjects with LD. The daily milk consumption was not significantly different in the 24 subjects with LD and in the 78 subjects without LD (281 +/- 197 vs 303 +/- 217 ml/24 h). The prevalence of methane producer status was 42.1 percent. The symptomatic group of lactose malabsorbers (n = 12) was characterized by a shorter lactose mouth to caecum transit time (39 +/- 20 vs 88 +/- 48 min; P less than 0.05), and more marked hydrogen production (6.1 +/- 2.3 vs 3.4 +/- 2.4 10(3) ppm.min; P less than 0.04). In the 10 subjects with LD and lactose intolerance, the hydrogen breath test was reproducible for diagnosis of LD and lactose intolerance, and for hydrogen production. The quantity of lactose malabsorbed was 60 percent. In France, symptoms of lactose intolerance are not severe and do not affect the daily consumption of milk and dairy products.

The relationship between starch alpha-amylase (EC 3.2.1.1) susceptibility, plasma responses and gastric emptying rates has been investigated in humans. Nine randomly chosen healthy subjects were given three carbohydrate test meals (25 g starch or equivalent glucose units): two maize starch pastes with (a) 240 (S24) or (b) 500 (S50) g amylose/kg, and a glucose solution (GS). At 30 min, in vitro starch alpha-amylolysis was 48 (SD 4)% for S24 and 35 (SD 4)% for S50. Test meals differed in viscosity (mPa x s: S24, 54,000; S50, 190; GS, 4). Carbohydrates were labelled with 99mTechnetium and isotope gastric emptying was measured by external gamma counting. Carbohydrate isotopic gastric emptying patterns were exponential. Half gastric emptying time (min) was significantly (P less than 0.05) shorter for S50 (19(SD 2] than for GS (26(SD 2] or S24 (29(SD 2]. No correlation was found between half gastric emptying time and plasma response values. Values for peak insulin (pmol/l) above fasting were significantly (P less than 0.05) different: GS, 306 (SD 11); S24, 227 (SD 11); S50, 187 (SD 11). It is concluded that alpha-amylase susceptibility of the test carbohydrates is a determining factor in the insulin response of healthy subjects, while viscosity of the test meals and gastric emptying rate have no effect.

In patients with angina-like chest pain, the diagnostic value of esophageal investigations has not been definitively established. The aim of this study was to assess the diagnostic value of different esophageal investigations in 45 patients (group I) with angina-like chest pain for which a cardiac origin had been previously excluded. These investigations included esophageal manometry, Bernstein test, edrophonium test, balloon distention test, and 24-hour pH monitoring (with event marker). These patients were compared to two control groups: a) 9 subjects with documented coronary disease (group IIa), and b) 9 healthy volunteers (group IIb). Abnormal results were observed in 37 patients in group I (82 percent), and in 4 patients in group IIa (44 percent). In group I, manometry was abnormal in 29 percent of patients and pH monitoring in 41 percent; provocative tests were positive in 10 percent, 15 percent, and 38 percent for the Bernstein test, edrophonium test, and balloon distention test respectively. Esophageal origin of the pain was shown to be likely in 36 percent of patients in group I. These results confirm the high incidence of functional abnormalities of esophagus in patients with angina-like chest pain. They also confirm the diagnostic value of the different provocative tests and especially the balloon distention test.

The aim of this work was to evaluate a new commercially available pressure recording system (PC Polygraf, Synectics) and to compare this system with a classical method using perfused catheters. The PC Polygraf uses microtransducers and allows direct digitized storage and semi-automatic analysis of data. In the first part of this study, manometric assessment was conducted using only perfused catheters. The transducers were connected to both an analog recorder and to a PC Polygraf. Using the two methods of analysis, contraction amplitudes were strongly correlated (r = 0.99; p less than 0.0001) whereas durations were significantly but loosely correlated (r = 0.51; p less than 0.001). Resting LES pressure was significantly correlated (r = 0.87; p less than 0.05). In the second part of this study, simultaneous recordings of esophageal pressure were conducted in 7 patients, by placing side by side the two tubes (microtransducers and perfused catheters) with the sideholes at the same level. The characteristics of the waves were determined both by visual analysis of analog tracing and by semi-automatic analysis of digitized recording with adequate program. Mean amplitude was lower with the microtransducers than with the perfused catheters (60 vs 68 cm H2O; p less than 0.05), but the duration of waves was not significantly different when using both systems. Values obtained for each of these parameters using both methods were significantly correlated (amplitude: r = 0.74; duration: r = 0.51). The localization and the measure of the basal tone of sphincter were found to be difficult when using microtransducers. These results show that PC Polygraf allows a satisfactory analysis of esophageal pressure signals. However, only perfused catheters offer an excellent reliability for complete studies of both sphincter and peristaltism.

The incidence of symptoms in relation to upper digestive tract disorders in the French population is unknown. An epidemiologic survey involving a group of 1,800 apparently healthy subjects, considered to be representative of the French population over age fifteen, was conducted in order to evaluate: a) the incidence of epigastric pain and regurgitation, b) the pattern of symptoms, and c) recourse to medical care. The annual incidence of epigastric pain and/or regurgitation was 35.2 p. 100 (epigastric pain: 19.9 p. 100, regurgitation: 27.1 p. 100). The incidence was not related to age and body weight. There were more women and unemployed subjects in the group with epigastric pain and regurgitation. There were more smokers among symptomatic subjects than among those who were symptom free. In 2/3 of subjects, symptoms evolved by attacks. Usually, the attack lasted less than one day. Compared with subjects with regurgitations alone, subjects with epigastric pain had symptoms of longer duration and had more frequent pain attacks (75 p. 100 of these subjects had at least one monthly pain attack). In this group, epigastric pain occurred after apparently stressful events in 39 p. 100, and chest pain in 26 p. 100 of cases. Subjects with epigastric pain sought medical advice more often (74 p. 100) than subjects with regurgitation alone (24 p. 100). An upper barium swallow was performed in half of the consultants, whereas endoscopy was performed in only 21 p. 100 of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple factors contribute to the production of esophagitis in gastroesophageal reflux (GER), but the respective roles of esophageal (i. e. lower esophageal sphincter (LES) tone, peristalsis) and gastric factors (i. e. acid secretion and gastric emptying) are not well known. The aim of this work was to study the frequency and the severity of esophageal and gastric abnormalities observed in the same patients and to correlate these findings with the degree of esophagitis. Thirty-three consecutive patients with GER proven by esophageal pH recording (3-hr postprandial pH-test) were classified according to the presence (group A, n = 18) or absence (group B, n = 15) of severe esophagitis (i. e. erosions, ulcerations, or stenosis) at endoscopy. LES basal tone and esophageal peristalsis were studied by manometry. Gastric acid secretion and emptying of liquids were measured by intragastric titration coupled with the dye dilution technique. Results obtained in GER patients were compared with those found in twenty-three normal subjects. Hypotonia of LES (i. e. LES tone less than 7 cm H2O) was more frequent in group A (72 p. 100) than in group B patients (30 p. 100, p less than 0.05). Magnitude of esophageal peristaltic waves was lower in group A than in group B (p less than 0.10). When compared to values found in normal subjects, gastric emptying and acid secretion were not significantly different both in presence and in absence of esophagitis. There was no linear correlation between esophageal pH parameters and acid secretion values or gastric emptying rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Commercially available pH-monitoring systems include one or more event markers which should allow correlation between reflux episodes and symptoms. However, the clinical relevance of this feature has not yet been thoroughly investigated. In this prospective study, we attempted to establish whether the use of an event marker could improve the accuracy of intraesophageal pH-monitoring and if a correlation between symptoms, as detected by event markers and esophageal exposure to acid could be shown. One hundred seven patients were studied. Only 47 p. 100 used the event marker during 24 h pH-metry. There was no statistical significance in the incidence of gastroesophageal reflux (GER i.e. time spent below pH 4 greater than 4.2 p. 100), age and socioeconomic status between patients who used the marker and those who did not. A concordance index was calculated by dividing the number of reflux episodes associated with a marked event by the total number of marked events. In 50 p. 100 of the 16 patients who used the marker and had GER, the concordance index was greater than 75 p. 100. On the contrary, only 4 out of 35 patients without GER had a concordance index greater than 75 p. 100 (p less than 0.003). Finally, the index was less than 25 p. 100 in 4 patients with GER and in 22 without GER (p less than 0.02). The lowest pH reached within the esophagus was virtually identical during all the reflux episodes, regardless of marker pressing.(ABSTRACT TRUNCATED AT 250 WORDS)

In humans except for the postoperative state, electromyographic activity of the small bowel can only be recorded with intraluminal electrodes. The aim of this study was to validate the use of intraluminal electrodes in pigs by comparing the signal recorded from such electrodes to those recorded with surgically implanted electrodes. A polyethylene probe equipped with bipolar ring-shaped electrodes was placed in the lumen of the proximal jejunum of 6 pigs, at the same level as intramuscular implanted electrodes. The signals were recorded in conscious pigs fed normally. By comparison to the myoelectric activity recorded from the intramuscular implanted electrodes, the intraluminal electrodes provided reliable spike burst detection (sensitivity 85 p. 100; positive predictive value 91 p. 100) in the fasted and fed state, and good identification of migrating myoelectric complexes. Spectral analysis showed the same frequency patterns for signals obtained with both types of electrodes. In conclusion, intraluminal ring-shaped electrodes allow reliable detection of small bowel myoelectric activity and may represent a useful tool for motility studies in man.

The aims of this study were to: a) evaluate the prevalence of Campylobacter pylori (CP) in patients referred to a gastroenterology unit for upper digestive tract endoscopy, b) compare the results of histologic (Warthin-Starry method) and bacteriologic (direct and culture) examinations, c) correlate the presence and abundance of CP with the "activity" of chronic gastritis as assessed by antral and fundic specimens, and d) report the preliminary results of an epidemiological survey in the area of Nantes, France. CP was observed in 30 of the 64 patients studied (46 p. 100 of cases), and was significantly associated with chronic gastritis of either the superficial or interstitial (87 vs. 12 p. 100 of patients positive and negative, respectively for CP studies, p less than 10(-9], and preatrophic and/or atrophic types (40 vs. 12 p. 100 of patients positive and negative, respectively, for CP studies, p less than 0.01). CP was also present in 7 of 10 patients with duodenal ulcers and in 4 to 6 with gastric ulcers. Histologic and bacteriologic studies gave concordant results in 94 p. 100 of cases, and had the same sensitivity for diagnosis. Patients positive for CP studies had a statistically significant increased incidence of epigastric burns, and, at endoscopic examination, their fundic area appeared congestive more frequently. CP were dictated in both the antrum and fundus, but lesions of chronic gastritis were more prominent in the former. There was a statistically significant correlation between the degree of inflammation observed in the lamina propria and the number of CP present in the same area (antrum and fundus).(ABSTRACT TRUNCATED AT 250 WORDS)

The pharmacological effects of low dose of omeprazole (Om) are not well known. This prompted us to investigate the effects of a 7-day treatment with a low dose of Om, 10 mg/d (Om10), on gastric acid secretion and serum gastrin levels and to compare the results with those obtained with an effective antisecretory dose of 20 mg/d (Om20). Twelve healthy volunteers received randomly and double-blind for three periods of 7 days, separated by at least 7 days, one capsule of placebo (P), Om10, Om20, given daily in the morning, in fasting condition. The last day of each period, 24 h pH was recorded using a glass electrode connected to a Digitrapper (Synectics). At the end of each pH-metry, acid secretion was measured in basal conditions (BAO), after sham-feeding (SAO) and after i.m. injection of 6 micrograms X kg-1 of pentagastrin (PAO). Whatever the threshold pH chosen, there was a statistically significant difference between P and Om10, P and Om20, and Om10 and Om20. Inhibition of acid concentrations was dose-dependent and prolonged, including nocturnal time. However, when considered on an individual basis, five subjects did not respond to Om10. More than 24 h after the last dose of Om has been administered, BAO, SAO and PAO were significantly reduced by either Om10 (respectively -52, -35 and -28 p. cent) and Om20 (respectively -60, -58 and -50 p. cent). Fasting serum gastrin concentration was significantly increased after Om20 treatment but not after Om10. We conclude that treatment with Om10 has a consistent and long lasting inhibitory action on gastric acidity without statistically significant effect on serum gastrin levels. These results suggest that 10 mg Om daily should be sufficient in some duodenal ulcer patients to effectively inhibit gastric acidity specially when long-term treatment seems to be indicated.