Gastrointestinal function and structure in HIV-positive patients.

We examined 19 patients (17 men) with human immunodeficiency virus (HIV) infection and gastrointestinal symptoms to determine whether those symptoms were due to either a gastrointestinal tract infection or a defect in mucosal absorption because of an enteropathy. The erythrocyte folate and serum vitamin B12 levels were within normal limits in all of the patients. The serum ferritin level was elevated in 12. The xylose absorption test results were abnormal in 8 of the 13 patients able to complete the study. None of the duodenal aspirates yielded a pathogen. Light microscopy revealed nonspecific lymphocytic inflammation without infection in the stomach (in seven patients), the esophagus (in five), the duodenum (in two) and the rectum (in two). However, biopsy specimens were positive for Candida albicans in the esophagus (four patients), cytomegalovirus in the esophagus (one) and the rectum (two), Helicobacter pylori in the antrum (two), Treponema infection in the rectum (two) and Mycobacterium avium-intracellulare in the small intestine (one). Only three patients had a normal series of biopsy specimens. All of the patients had similar ultrastructural changes at the epithelial-stromal junction of the antral glands and in the intestinal crypts. We conclude that abnormal biochemical and endoscopic findings are common in HIV-positive patients with gastrointestinal symptoms. Defects in carbohydrate absorption and ultrastructural changes may be responsible for some aspects of HIV enteropathy.     

Diagnostic value of a peroral sucrose permeability test in children with recurrent upper abdominal pain

The access of ingested sucrose into blood and urine indicates the presence of mucosal lesions in the upper gastrointestinal tract. The study involved 42 children, aged 5-15, having recurrent upper abdominal pain and 43 peers with minor extra-abdominal complaints. Sucrose in urine was determined by thin layer chromatography. The test was positive in 27 out of 42 children having recurrent abdominal pain (64.3%) and in none of the control children (chi2 = 37.6, p < 0.0001). When correlated with endoscopic findings it was falsely negative in 12 out of 38 patients with endoscopically verified lesions of the stomach or duodenum and falsely positive in 1 out of 4 without lesions. Sensitivity of the test was 68.4%, specificity 97.9%, positive predictive value 96.3%. The test cannot be used as an alternative to endoscopy, but may serve for screening of candidates for it.     

Role of alcoholism in the development of upper gastrointestinal tumors

A preliminary report on the results of studies on the relationship between alcohol abuse and upper gastrointestinal tumours is presented. Alcohol abuse was measured with the aid of a questionnaire. GGTP and mean MCV were determined. Within the 1st September, 1986--30th September, 1987, 75 patients with the cancer of the upper gastrointestinal tract and 107 patients with benign lesions to this area were examined. Alcohol abuse was found in 33% of patients with the cancer and 19% of patients with benign lesions to the upper gastrointestinal tract. This difference is statistically significant (p greater than 0.05). The results of GGTP and MCV values were statistically insignificant in both groups. The authors have found more marked correlation of alcohol abuse with the cancer of the upper gastrointestinal tract in relation to the oral cavity and pharynx than the stomach. Further studies including larger groups of patients are recommended.     

A microsphere study on the effects of somatostatin and secretin on regional blood flow in anesthetized dogs

The endogenous peptides somatostatin and secretin are effective in the therapy of upper gastrointestinal tract bleeding and acute pancreatitis. The clinical effects may be partly brought about by changes in the regional blood flow. To evaluate the effects of somatostatin (50 and 100 μg/min over 6–8 min) and secretin (0.1 and 0.5 U · kg^?1 · min^?1 over 3–5 min) on tissue blood flow, particularly of the gastrointestinal tract, the tracer microsphere reference sample method was used in anesthetized dogs.Infusion of somatostatin significantly diminished gastric and pancreatic blood flow whereas no changes of duodenal and ileal blood flow could be obtained. Blood flow through spleen, kidneys and adrenal glands was increased but no changes were observed in the blood flow of other tissues. Cardiac hemodynamics remained unchanged.Secretin increased the blood flow of the duodenum, the kidneys and the adrenal glands and diminished gastric blood flow without changing pancreatic, ileal, hepatic, pulmonary and muscle blood flow. Cerebral, pituitary and myocardial blood flow was increased by a higher dose of secretin. It also evoked a slight but significant positive ino- and chronotropic effect. Since secretin and somatostatin differ in their respective effects on gastrointestinal blood flow it is suggested that the previously reported beneficial effects of both peptides on upper gastrointestinal bleeding cannot solely be attributed to changes in regional blood flow.     

Lesions of the Gastrointestinal Tract Resembling Regional Enteritis—A Granulomatous Disease: A Report of Three Cases

Although regional enteritis classically involves the terminal ileum, lesions showing similar histology may involve other segments of the gastrointestinal tract, either independently or concomitantly with terminal ileum involvement. Histologically the basic reaction is non-specific chronic inflammation with a granulomatous component and a variable degree of fibrosis. Such lesions in the upper gastrointestinal tract resulted in nonspecific intestinal complaints and roentgenographically showed mucosal alterations and loss of normal motility. Those with colonic involvement were difficult to differentiate from ulcerative colitis, clinically and, in the early stages, roentgenographically. With more advanced involvement, roentgenographical diagnosis was possible.Three patients with lesions illustrating the aforementioned features were diagnosed and treated. One had lesions in the colon and terminal ileum. In the others the terminal ileum was not involved; in the second the stomach, duodenum and upper jejunum were involved, and in the third the colon was involved.     

Motilin--an update

Motilin isolated in 1971 from the porcine gastrointestinal tract and localized there to endocrine cells, now appears to have a CNS neural origin by RIA and immunohistochemistry. In most species motilin releases neurotransmitters in the CNS to both increase and decrease neural transmission and in the gastrointestinal tract to increase motor activity. In the fasting animal, motilin initiates premature activity fronts of the migrating motor complex (MMC) in the upper gastrointestinal tract by an atropine or tetrodotoxin-sensitive mechanism. Immunoreactive motilin-release from the gut can be correlated with the passage of these fronts through the upper gut. In the dog, the associated events of this MMC, i.e. motor activity of the duodenum extrinsic and intrinsic neural activity and emptying of biliary and pancreatic secretions into the duodenum, all appear to contribute to the peaks in peripheral plasma immunoreactive motilin concentrations. In man, there appears to be a close association of motilin secretion with biliary and pancreatic secretions being emptied into the duodenum and less evidence for motor activity releasing motilin. Only in the dog is there strong evidence for an absolute requirement of motilin for the consolidation of the motor activity of the upper gut into the MMC. In man, the evidence is less convincing although motilin may facilitate the process and in the pig, motilin appears to have little or no role in MMC generation. No pathological consequences of hypermotilemia have been described although elevated motilin levels have been found to be associated with some diarrheal states, renal failure, and in the first week following abdominal surgery. Motilin thus remains a hormone seeking a physiological function in some species and a pathological role in all species.     

Endoscopic removal of a foreign body perforating the duodenum.

Perforation of the intestine by an ingested foreign body usually results in peritonitis or abscess formation and the treatment is surgical. In one case the duodenum was perforated by a toothpick, and hemorrhage from the upper gastrointestinal tract occurred 3 months later. Diagnosis and management were accomplished by operative endoscopy.     

Resolution of gastrointestinal protein loss after Helicobacter pylori eradication in a patient with hypertrophic lymphocytic gastritis

BACKGROUND: Lymphocytic gastritis is a rare condition found in approximately 1% of dyspeptic patients. An association with Helicobacter pylori infection has been described. Hypertrophic lymphocytic gastritis is a rare cause of gastrointestinal protein loss. Here, we describe a patient with hypertrophic lymphocytic gastritis, in whom gastrointestinal protein loss resolved completely following H. pylori eradication. CASE REPORT: A 38-year old obese man without gastrointestinal symptoms showed a markedly decreased serum protein (53 g/l, normal 66-85 g/l), a decreased serum albumin (33 g/l, normal 35-52 g/l) and decreased serum immunoglobulin G and immunoglobulin M levels. A renal cause for protein loss was excluded, liver function was normal. Endoscopy of the upper gastrointestinal tract revealed enlarged rigid gastric folds, and an H. pylori-associated lymphocytic gastritis. 99mTc-labelled albumin scintigraphy showed an increased activity in the upper left abdomen compatible with protein secretion in the stomach, and tracer pooling in the upper small bowel. Push enteroscopy with histology demonstrated a normal upper small bowel. Two months after eradication therapy, cure of H. pylori infection was documented and serum protein (71 g/l) and albumin (41 g/l) had returned to normal, while lymphocytic gastritis was still present. One year after eradication therapy endoscopy of the upper gastrointestinal tract and histology and laboratory values were normal. CONCLUSION: Protein-losing gastropathy caused by H. pylori-associated hypertrophic lymphocytic gastritis can be cured solely by H. pylori eradication therapy.     

Upper gastrointestinal Kaposi's sarcoma in patients positive for HIV antibody without cutaneous disease

Six patients with antibodies to the human immunodeficiency virus (HIV) and with persistent gastrointestinal symptoms of HIV infection but without cutaneous lesions of Kaposi''s sarcoma underwent endoscopy. Four also underwent barium meal examination. In all six cases small lesions were seen in the stomach at endoscopy, and histological examination of biopsy specimens taken from the lesions confirmed the diagnosis of Kaposi''s sarcoma. The barium meal examinations were reported as normal in three patients and showed oesophageal candidiasis in the fourth.These findings suggest that Kaposi''s sarcoma of the upper gastrointestinal tract is common in patients positive for HIV antibody, even those without cutaneous lesions. Endoscopy, with biopsy of suspicious lesions, is necessary to make the diagnosis and is recommended in all HIV antibody positive patients with persistent upper gastrointestinal symptoms.     

Duodenal atresia in an infant with triple-X syndrome: a new associated malformation in 47,XXX

BACKGROUND: An association between the triple-X syndrome (47,XXX) and gastrointestinal malformations is extremely rare. Most 47,XXX patients present with a normal phenotype, but genitourinary malformations have been described. CASE: We report a case of a child with 47,XXX and duodenal atresia. Antenatal ultrasound scan showed a dilated fetal stomach and upper part of the duodenum (double bubble phenomenon) at 31 weeks of gestation in a 31-year-old woman with polyhydramnion. The amniotic fluid karyotype showed 47,XXX. After a scheduled delivery, duodenal atresia was confirmed and treated with duodeno-duodenostomy. CONCLUSIONS: The possible association of gastrointestinal and genitourinary tract anomalies requires a detailed postnatal clinical investigation and ultrasonographic examination of the abdomen, retroperitoneum, and pelvis on all triple-X syndrome patients.     

Transmural potential difference of the gastrointestinal tract: its diagnostic value in placing small intestine catheters without roentgen exposure

Functional disorders of the upper gastrointestinal tract frequently require the placement of biopsy tubes into the duodenum. At present, monitoring of correct placement of these tubes usually entails the use of x-rays involving a single or repeated exposures. For accurate placement of duodenal tubes, the difference in TPD between the stomach and the duodenum has been employed as a criterion. Measurement of the TPD is technically simple, can be done at the bedside and obviates the need for using x-rays. Suitable hardware and the procedure are described in detail.     

Morphofunctional state of the digestive tract in the early stages of atherosclerosis]

Cholesterol, alpha- and beta-lipoproteids, serotonin were determined in the blood serum of dogs which were on atherogenic diet for 2 months. The serotonin content was examined in various parts of the gastrointestinal tract (GIT). Parallel studies of the structural changes were carried out in the vascular system (VS) and various parts of the GIT. There was found a direct correlation between a rise in the cholesterol and serotonin level in the blood and serotonin in the GIT tissues. The initial stages of atherosclerotic changes were revealed in the vascular system. Along with compensatory-adaptive changes detected in the duodenum and the upper protions of the small intestine, initial stages of dystrophic-atrophic processes were observed in the lower portions. Comparative analysis of biochemical and morphological data indicated that disturbances of the morphofunctional state in the GIT played an important role in the genesis of the early stages of atherosclerosis.     

16S rRNA gene-based analysis of mucosa-associated bacterial community and phylogeny in the chicken gastrointestinal tracts: from crops to ceca

Mucosa-associated microbiota from different regions of the gastrointestinal (GI) tract of adult broilers was studied by analysis of 16S rRNA gene sequences. The microbiota mainly comprised Gram-positive bacteria along the GI tract. Fifty-one operational taxonomic units (OTUs) (from 98 clones) were detected in the ceca, as compared with 13 OTUs (from 49 clones) in the crops, 11 OTUs (from 51 clones) in the gizzard, 14 OTUs (from 52 clones) in the duodenum, 12 OTUs (from 50 clones) in the jejunum and nine OTUs (from 50 clones) in the ileum. Ceca were dominantly occupied by clostridia-related sequences (40%) with other abundant sequences being related to Faecalibacterium prausnitzii (14%), Escherichia coli (11%), lactobacilli (7%) and Ruminococcus (6%). Lactobacilli were predominant in the upper GI tract and had the highest diversity in the crop. Both Lactobacillus aviarius and Lactobacillus salivarius were the predominant species among lactobacilli. Candidatus division Arthromitus was also abundant in the jejunum and ileum.     

Clinical findings,early endoscopy,and multivariate analysis in patients bleeding from the upper gastrointestinal tract.

A simple system has been developed to identify patients with upper gastrointestinal tract haemorrhage who run a high risk of continued bleeding or rebleeding. The system is based on six items of patient data available at or soon after arrival in hospital. It was evaluated in a prospective study of 66 patients with upper gastrointestinal tract haemorrhage. Over half of the patients classified by the system into a high-risk category either continued bleeding or rebled after apparent cessation (as against one out of 33 patients in the low-risk category). The high-rish group also had a higher mortality (21%) than those in the low-risk group (nil). The addition or subtraction of early endoscopic findings made little difference to the accuracy of prognosis.     

Distribution of nitrogen-13 from labeled nitrate and nitrite in germfree and conventional-flora rats.

The in vivo distribution of physiological concentrations of NO3- and NO2- labeled with 13N was studied in germfree and conventional-flora Sprague-Dawley rats after gastric intubation (gavage), intravenous (cardiac or tail vein), or intraluminal (intestinal) injection. Some in vitro studies were performed to determine the influence of the bacterial flora on ion distribution. After gavage with 13NO3-, essentially all of the label passed into the upper small intestine, where most was absorbed; however, up to 24% of the 13N could reach the ileum within 1 h. Gavage with 13NO2- resulted in some gastric absorption of the label, but most seemed to exit the stomach via passage into the duodenum. The exit of 13NO2- from the stomach was slower, and less 13N appeared to be absorbed from the small intestine than with 13NO3-. Movement of label through the gastrointestinal tract could be enhanced by inducing diarrhea. Absorbed 13N was either excreted in the urine, reentered the gastrointestinal tract at various points, or was temporarily stored in the eviscerated carcass. The bacterial flora, either by incorporation or chemical alteration, appeared to have some influence on the distribution of 13N from 13NO3- or 13NO2-.     

超声胃镜小探头对上消化道黏膜下病变的诊断价值探讨

目的:探讨超声胃镜小探头对上消化道黏膜下病变的诊断价值.方法:使用超声胃镜小探头对我院2010年6月-2011年12月62例经电子胃镜检查的上消化道黏膜下病变患者进行检查,对病变的浸润范围与性质进行分析,结果与术后病理进行对比.结果:良性间质瘤43例,占69.35％,恶性间质瘤6例,占9.68％,异位胰腺5例,占8.06％,囊肿6例,占9.68％,脂肪瘤与静脉曲张各1例,占1.61％.所有结果均经病理检查证实,符合率100％,结果具有代表性(P＜0.05).结论:使用超声胃镜小探头能清楚显示上消化道各层管壁结构,确定上消化道黏膜下病变的性质,提高诊断率,具有极高的临床价值,可作为上消化道黏膜下病变的诊断方法在临床推广应用.     

Distribution of nitrogen-13 from labeled nitrate and nitrite in germfree and conventional-flora rats

The in vivo distribution of physiological concentrations of NO3- and NO2- labeled with 13N was studied in germfree and conventional-flora Sprague-Dawley rats after gastric intubation (gavage), intravenous (cardiac or tail vein), or intraluminal (intestinal) injection. Some in vitro studies were performed to determine the influence of the bacterial flora on ion distribution. After gavage with 13NO3-, essentially all of the label passed into the upper small intestine, where most was absorbed; however, up to 24% of the 13N could reach the ileum within 1 h. Gavage with 13NO2- resulted in some gastric absorption of the label, but most seemed to exit the stomach via passage into the duodenum. The exit of 13NO2- from the stomach was slower, and less 13N appeared to be absorbed from the small intestine than with 13NO3-. Movement of label through the gastrointestinal tract could be enhanced by inducing diarrhea. Absorbed 13N was either excreted in the urine, reentered the gastrointestinal tract at various points, or was temporarily stored in the eviscerated carcass. The bacterial flora, either by incorporation or chemical alteration, appeared to have some influence on the distribution of 13N from 13NO3- or 13NO2-.     

Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage.

OBJECTIVE--To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage. DESIGN--Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect. SETTING--Inpatient care in hospitals in the United Kingdom, Sweden, and Australia. PATIENTS--1267 Patients admitted to hospital with primary diagnosis of acute upper gastrointestinal haemorrhage. Five of the six trials included a high proportion of elderly patients. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43-88%) or gastric erosions (4-23%). A variable proportion had a degree of clinical shock at entry. INTERVENTIONS--Tranexamic acid 3-6 g/day given intravenously for two or three days followed by 3-6 g/day by mouth for a further three to five days (four trials) or 4.5-12 g/day by mouth for two to seven days (two trials). END POINTS--Frequency of recurrent haemorrhage, need for surgery, and death. MAIN RESULTS--Treatment with tranexamic acid was associated with a 20-30% reduction in the rate of rebleeding, a 30-40% reduction (95% confidence interval 10% to 60%) in mortality. CONCLUSIONS--Treatment with tranexamic acid may be of value to patients considered to be at risk of dying after an upper gastrointestinal haemorrhage.