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Vu, M. K., J. Vecht, E. H. Eddes, I. Biemond, C. B. H. W. Lamers, and A. A. M. Masclee. Antroduodenal motility in chronic pancreatitis: are abnormalities related to exocrine insufficiency? Am. J. Physiol. Gastrointest. Liver Physiol. 278: G458-G466, 2000.--In patients with chronic pancreatitis (CP) the relation among exocrine pancreatic secretion, gastrointestinal hormone release, and motility is disturbed. We studied digestive and interdigestive antroduodenal motility and postprandial gut hormone release in 26 patients with CP. Fifteen of these patients had pancreatic insufficiency (PI) established by urinary para-aminobenzoic acid test and fecal fat excretion. Antroduodenal motility was recorded after ingestion of a mixed liquid meal. The effect of pancreatic enzyme supplementation was studied in 8 of the 15 CP patients with PI. The duration of the postprandial antroduodenal motor pattern was significantly (P [is less than] 0.01) prolonged in CP patients (324 [+ or -] 20 min) compared with controls (215 [+ or -] 19 min). Antral motility indexes in the first hour after meal ingestion were significantly reduced in CP patients. The interdigestive migrating motor complex cycle length was significantly (P [is less than] 0.01) shorter in CP patients (90 [+ or -] 8 min) compared with controls (129 [+ or -] 8 min). These abnormalities were more pronounced in CP patients with exocrine PI. After supplementation of pancreatic enzymes, these alterations in motility reverted toward normal. Digestive and interdigestive antroduodenal motility are abnormal in patients with CP but significantly different from controls only in those with exocrine PI. These abnormalities in antroduodenal motility in CP are related to maldigestion. pancreatic enzyme supplementation; cholecystokinin; peptide YY

Background: Slow transit constipation may be part of a more generalized gastrointestinal motility disorder. Methods: Gastric motor and sensory function were evaluated using a barostat in 17 patients with slow transit constipation and in 16 healthy controls. A step-wise isobaric distension procedure was performed, followed by a barostat procedure including a liquid meal. Symptoms were scored using visual analog scales. Plasma levels of gastrointestinal hormones were determined postprandially. Results: Proximal gastric compliance was significantly reduced in the patients. Basal gastric volume did not differ between patients and controls. Postprandial fundus relaxation was significantly reduced in the patients and correlated significantly with daily upper gastrointestinal symptoms. Postprandial secretion of cholecystokinin and gastrin was reduced in the patients. Conclusions: In patients with slow transit constipation, proximal gastric compliance is reduced and postprandial fundus relaxation is impaired. These findings support the hypothesis that slow transit constipation may be part of a pan-enteric disorder. [ABSTRACT FROM AUTHOR]

Background: Patients with Crohn disease (CD) have an increased risk of developing gallstones. Among other factors, gallbladder motility may have a role in the pathogenesis of gallstone formation. We have evaluated whether gallbladder motor function is affected in Crohn disease with special emphasis on the influence of disease localization and previous bowel resection. Methods: Thirty-seven patients (20 females and 17 males, age 36 ± 2 years) with inactive Crohn disease (CDAI < 150) were studied: 15 patients after ileocecal resection and 22 non-operated patients; 12 had small bowel disease and 10 had large bowel disease. Nineteen healthy subjects (10 female; 9 male, age 30 ± 2 years) served as controls. Gallbladder volumes were measured in the fasting state and at regular intervals for 2 h after ingestion of a solid meal (780 kcal). Blood samples were drawn at regular intervals for determination of cholecystokinin (CCK) and peptide YY (PYY). Results: Fasting gallbladder volumes were significantly (P < 0.05) reduced in patients with large bowel disease (20.8 ± 2.1 ml) or after ileocecal resection (18.3 ± 2.4 ml) compared to patients with small bowel disease (28.0 ± 2.1 ml) and controls (27.2 ± 1.8 ml). Fasting plasma CCK levels were significantly (P < 0.05) higher in patients with large bowel disease or after ileocecal resection compared to patients with small bowel disease and controls. Postprandial gallbladder emptying and endogenous plasma CCK and PYY secretion in patients with Crohn disease were not different from controls. Conclusions: Fasting gallbladder volume is decreased and fasting plasma CCK levels are increased in patients with Crohn disease of the large bowel and patients after ileocecal resection. Postprandial gallbladder motility, CCK and PYY release were not affected in patients with Crohn disease. [ABSTRACT FROM AUTHOR]

In patients with Crohn's disease, the prevalence of gallstones is increased, especially in patients with ileal disease or after ileal resection. Recent studies point to alterations in enterohepatic bilirubin cycling, resulting in increased biliary bilirubin levels leading to pigment rather than cholesterol gallstones. Gallbladder (hypo)motility is another important factor in the pathogenesis of gallstones leading to bile stasis, crystallisation and stone formation. Postprandial gallbladder emptying is not markedly reduced in patients with Crohn's disease but lower fasting gallbladder volumes have been observed in patients with colonic disease or after ileocaecal resection. Prolonged and repeated bowel rest before and after intestinal surgery has been recognised as a significant risk factor for gallstone formation in patients with Crohn's disease.

Objectives: After antireflux surgery, more than 30% of patients develop dyspeptic symptoms such as fullness and early satiety. We have previously shown that these symptoms are related to fundoplication-induced changes in proximal gastric motor and sensory function, especially impaired postprandial relaxation. We hypothesize that impaired fundus relaxation may be more pronounced after complete versus partial fundoplication., Methods: Fasting and postprandial proximal gastric motor and sensory function were measured with an electronic barostat in patients after laparoscopic partial (n = 14) and complete (n = 14) fundoplication, in gastroesophageal reflux disease (GERD) patients (n = 12), and in healthy control subjects (n = 15). Gastric emptying and vagus nerve function tests were performed in all patients., Results: Minimal distending pressure (MDP) and proximal gastric compliance were not significantly different among patients after antireflux surgery, GERD patients, and healthy controls. Maximal postprandial fundus relaxation was significantly (p < 0.01) reduced in patients after partial (267 +/- 32 ml) and complete (294 +/- 34 ml) fundoplication compared with GERD patients (448 +/- 30 ml) and healthy controls (409 +/- 25 ml). Sensations of fullness were not significantly different between patients with partial and complete fundoplication. There was a significant positive correlation between the postoperative duration and the degree of postprandial fundus relaxation (r = 0.67; p < 0.001)., Conclusions: Both after complete and after partial fundoplication, proximal gastric motor function is affected, with impaired postprandial relaxation and increased sensation of fullness. These alterations are not related to the type of fundoplication but correlate significantly with the duration of the postoperative period.

Fat stimulates superior mesenteric artery (SMA) blood flow. Little is known, however, about the influence of fatty acid chain length on SMA flow. The present study was performed to compare the effect of long chain triglycerides (LCT, corn oil), very long chain triglycerides (VLCT, fish oil) and medium chain triglycerides (MCT) on SMA flow. A total of seven healthy volunteers (four men, three women; aged 26 +/- 4 years) participated in three experiments, performed in random order during 60 min continuous intra-duodenal infusion of either LCT (30 mL h(-1); 240 kcal h-1), equicaloric VLCT (30 mL h(-1); 240 kcal h(-1)) or MCT in equimolar (15 mL h(-1); 113 kcal h(-1)) and equicaloric amount (30 mL h(-1); 225 kcal h(-1)). Basal and stimulated SMA blood flow were measured by Doppler ultrasonography. At regular intervals blood samples were taken for measurement of plasma cholecystokinin (CCK) and plasma peptide YY (PYY). Basal SMA blood flow volumes were not significantly different among the LCT, VLCT and MCT experiments (426 +/- 135, 460 +/- 114 and 503 +/- 177 mL min(-1), respectively). The SMA flow increased significantly (P < 0.05) during fat infusion but was significantly higher during LCT (1460 +/- 692 mL min-1) compared with VLCT (1061 +/- 384 mL min-1), MCT 15 mL h(-1) (870 +/- 286 mL min(-1)) and MCT 30 mL h-1 (904 +/- 223 mL min(-1)). Plasma CCK levels increased significantly (P < 0.05) during LCT and VLCT but not during MCT infusion. No correlation was found between SMA flow and plasma CCK levels (r = 0.27; P = 0.2) The SMA blood flow in response to triglycerides is dependent on fatty acid chain length. This chain length-dependent blood flow response is, however, not linear and is not related to plasma CCK levels.

Background and Aims: Compared to long chain triglycerides (LCT), medium chain triglycerides (MCT) are considered an attractive caloric source in malabsorptive diseases because of their favorable physico-chemical characteristics. The use of MCTis, however, limited by the occurrence of gastrointestinal symptoms such as diarrhoea. We have, therefore, investigated the effects of MCT and LCT on proximal (cholecystokinin; CCK) and distal (peptide YY; PYY) gut hormone secretion., Methods: Eight healthy volunteers participated in four experiments performed in random order during continuous intraduodenal administration for 360 min of a) saline (control); b) LCT15 mmol/h; c) MCT15mmol/h (equimolar); d) MCT 30 mmol/h (equicaloric). Plasma CCK and PYY were determined at regular intervals (radioimmunoassay). Duodenocecal transit (DCTT) was measured by lactulose H(2)breath test., Results: DCTT during LCT (105 +/- 11 min) was not significantly different from saline (111 +/- 10 min). Both low dose MCT (54 +/- 5 min) and high dose MCT (61 +/- 6 min) significantly accelerated DCTT (P< 0.05). Plasma CCK increased significantly (P< 0.05) during LCT but not during MCT or saline. PYY increased significantly (P< 0.05) not only during LCT, but also during low and high dose MCT but not during saline., Conclusions: Intraduodenal MCTs a) accelerate intestinal transit; b) do not stimulate CCK release; c) but stimulate release of the distal gut hormone PYY. These results suggest that MCTs are not rapidly absorbed in the proximal gut but probably reach the ileocolonic region and stimulate PYY release., (Copyright 1999 Harcourt Publishers Ltd.)