Arthur B. French

Esophageal motor abnormalities in scleroderma and related diseases

SummaryEsophageal motor activity was measured by intra-esophageal pressure recordings in 53 patients with scleroderma and 29 patients with other collagen diseases. The purpose of the study was to determine the relationship of motor abnormalities to esophageal symptoms, to compare the abnormalities in scleroderma with those in other collagen diseases, and to try to increase understanding of the responsible mechanism. Methacholine was given to 36 of the 53 patients with scleroderma to confirm that the Mecholyl test is negative in scleroderma and to see whether intraluminal pressure changes accompany the resulting improvement in esophageal emptying.Abnormalities in the intraluminal pressure response of the esophagus to deglutition were seen in 79% of the patients with scleroderma. Of those with an abnormal swallowing pattern, 62% showed diminution or absence of the lower esophageal sphincter pressure zone. Although changes in swallowing pattern did not correlate with esophageal symptoms, absence of lower esophageal sphincter pressure did. The 29 patients with other collagen diseases had similar but less severe abnormalities in the motor response to deglutition. Usually there was better preservation of the lower esophageal sphincter. Neither abnormality correlated with esophageal symptoms in this group.The Mecholyl test was negative in patients with scleroderma. No significant change was found in the pressure studies after methacholine.Of the 66 patients who had both X-ray and manometric studies of the esophagus, intraluminal pressure studies showed aperistalsis in all patients without peristalsis on X-ray studies as well as in 18 patients who appeared to show normal esophageal peristalsis on X-ray studies.

Comparison of phenol red and polyethyleneglycol as nonabsorbable markers for the study of intestinal absorption in humans

SummaryWhen phenol red and polyethyleneglycol were used simultaneously as nonabsorbable markers in perfusion studies of the absorptive capacity of high jejunum in humans, apparent absorption was the same when calculated from either marker. This similar indication of dilution and of absorption by the two markers was found in normal subjects and in patients with nontropical sprue, whether aqueous or saline solutions of dextrose were infused. The similarity strengthens the evidence that either phenol red or polyethyleneglycol is a satisfactory “nonabsorbable” marker compound to indicate dilution in perfusion studies of dextrose and electrolyte absorption in limited segments of human intestine.

Predicted absorption rates with simultaneous bulk fluid flow in the intestinal tract

Abstract A general physical model for simultaneous peristaltic bulk fluid flow and absorption along the intestinal tract is described. Within the framework of this physical model, various physicochemical properties and transport mechanisms are considered including passive transport, and passive transport coupled with facilitated diffusion or membrane metabolism. Important parameters obtained from previous in situ rat intestinal absorption studies serve as useful preliminaries to show the interplay of bulk fluid flow rate along the intestinal tract, pH, intestinal length, and the permeabilities of the aqueous boundary layer and membrane on the predicted fraction of drug absorbed. A means of estimating the anatomical reserve length, which would be based upon experimentally determined parameters in situ , and its usefulness in making predictions of value to the clinician are considered as well.

Protein-losing gastroenteropathy: Concepts derived from lymphangiography

SummaryLymphangiograms in 2 patients with protein-losing gastroenteropathy showed abnormalities of both abdominal and lower-extremity lymphatics.With the application of lymphangiography, the generalized nature of the lymphatic dysplasia in primary protein-losing gastroenteropathy has become evident.Striking lymphangiographic similarities between primary protein-losing gastroenteropathy and primary lymphedema suggest that both entities are part of a continuous spectrum of lymphatic dysplasias.

Physiologic Responses to Gastric Acid Hypersecretion in Zollinger-Ellison Syndrome

SummaryTwo patients with gastric acid hypersecretion and intact stomachs had diarrhea with steatorrhea. In 1 patient continuous outpouring of large volumes of alkaline juice into the duodenum, combined with the buffering capacity of food, resulted in normal or near normal pH levels in the upper small intestine for at least 90 min. after a meal. The tryptic activities in intestinal aspirates after the meal were essentially normal. Watery diarrhea was controlled when an anticholinergic drug was given both night and day, but steatorrhea was not reduced. In the other patient the alkaline secretions of the upper intestine were inadequate to neutralize the gastric acid output. The mechanisms by which acid secreted by the stomach is neutralized in the upper small bowel and the mechanisms of diarrhea are discussed.

Cellular and humoral sensitivity to gluten fractions in patients with treated nontropical sprue

The presence of circulating antibodies and lymphocyte response to gliadin and fraction III were measured in three groups of 12 patients each. Group I consisted of patients with nontropical sprue maintained on a gluten-free diet; Group II contained patients with other gastrointestinal diseases manifesting malabsorption and Group III was composed of normal controls. Rabbits immunized to both antigens provided positive controls for each method of antibody determination. Results agree with those previously reported in that negligible antibody titers were present to either antigen in normals, patients with other forms of malabsorption or patients with nontropical sprue maintained, for some time, on a gluten-free diet. Lymphocyte stimulation failed to occur with either gluten fraction although the hyporesponsiveness to phytohemagglutinin, previously reported by others, was not observed. Further studies are needed in patients with nontropical sprue following controlled antigenic challenge. Antibody levels in jejunal fluid should also be studied. Until such studies are carried out, evaluation of immunologic factors in the pathogenesis of nontropical sprue will be incomplete.

Tropical sprue--specific disease or extreme of a spectrum?

Excerpt Tropical sprue is a form of malabsorption that occurs in residents of the tropics. Symptoms are those of malabsorption: diarrhea, abdominal distention, and weight loss with general malnutri...

Electrolyte and Nutrient Losses from the Gastrointestinal Tract After Bowel Resection or Bypass.

Excerpt Fecal electrolyte and nutrient losses vary greatly with the length of the gastrointestinal tract in continuity and with composition of food ingested. To understand the effect of altering th...