Brian E. Lacy

Impact of Anal Incontinence on Psychosocial Function and Health-Related Quality of Life

The relationship among the frequency of anal incontinence (AI), psychosocial factors, and health-related quality of life (HRQOL) was evaluated. Consecutive patients (n=280) completed a bowel symptom questionnaire, the Symptom Checklist 90—Revised (SCL 90-R), and an assessment of HRQOL. Group 1 had no incontinence, Group 2 had AI less than once per week, and Group 3 experienced AI more than once per week. Multivariate analyses were used to evaluate the relationship among symptoms, the SCL-90-R subscales, and HRQOL. Group 3 reported more frequent stools than the other groups. Significant psychological distress was present in both incontinent groups compared to Group 1 (P=0.002). A reduction in overall HRQOL was also seen in the incontinent groups. Depression was inversely correlated with QOL-Satisfaction and QOL-Ratings and positively correlated with QOL-Interference. AI was associated with impaired psychosocial function and decreased HRQOL. The frequency of AI was associated with increased HRQOL-Interference, but minimally with the degree of psychosocial impairment.

The effects of tegaserod, a 5-HT4 receptor agonist, on gastric emptying in a murine model of diabetes mellitus

Abstractu2002 The C57BLKS/J db/db transgenic mouse is a model of diabetes mellitus that has been shown to have delayed gastric emptying. We assessed gastric emptying rates in C57BLKS/J mice, and determined the effects of tegaserod, a new selective 5‐HT4 receptor partial agonist, on gastric emptying.

Novel nuclear shuttle peptide to increase transfection efficiency in esophageal mucosal cells

The major barrier to successful transfection appears to be passage of the DNA plasmid from the cytoplasm into the cell nucleus. The M9 nuclear localization peptide, a fragment of the naturally occurring heterogeneous nuclear ribonucleoprotein A1, which serves to shuttle messenger RNA across the nuclear membrane, has been proposed as a tool for enhancing transfection efficiency. We tested three different reporter plasmids to assess the ability of M9 to improve transfection efficiency in esophageal mucosal cells. The effect of M9 on the intracellular movement of plasmid was also assessed using fluorescent microscopy to trace rhodamine-labeled plasmid. The M9 nuclear shuttle peptide consistently increased the transfection efficiency. When transfection was carried out with specific plasmids, β-galactosidase enzyme activity, keratinocyte growth factor-1 growth factor levels, and the number of transfected cells expressing growth factor peptides were progressively increased with increasing M9 to plasmid ratios. Fluorescent microscopy demonstrated that the M9 shuttle allowed rhodamine-tagged plasmid to gain access to the nucleus, while it was located exclusively in the cytoplasm without the peptide. The M9 shuttle peptide increases transfection efficiency in esophageal mucosal cells, and therefore may have a useful role in gene therapy applications involving the esophagus.

Functional and Motility Disorders of the Gastrointestinal Tract

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Use and attitudes towards complementary and alternative medicine therapies among patients at a gastroenterology and hepatology clinic compared to a healthy population

Use and attitudes towards complementary and alternative medicine therapies among patients at a gastroenterology and hepatology clinic compared to a healthy population

Manometric analysis of patients with gastrointestinal manifestations of scleroderma

Purpose: The aim of this study was to analyze esophageal, anorectal and small bowel manometry studies in patients with scleroderma to determine whether GI symptoms correlate with manometric findings, and to determine if the findings of one GI manometric study predict the findings of another. Methods: Esophageal, duodenal and anorectal manometry studies from 32 scleroderma patients with GI symptoms were evaluated. Symptoms were recorded at the time of initial evaluation. Esophageal manometry (EMS) parameters included: LES pressure, percent LES relaxation, and amplitude of esophageal body contractions. Anorectal manometry (ARM) parameters analyzed included: Anal canal pressures, presence of rectoanal inhibitory reflex, external anal sphincter tone, and rectosigmoid compliance. Antroduodenal manometry was reviewed to assess neuromuscular function of the stomach and small intestine in response to drug challenges. Upper endoscopy and gastric emptying scans were reviewed, if available. Results: Mean age was 52.8 years (range 30 –77 years) with 27F:3M. Symptoms included: GERD in 31/32, dysphagia in 25/32, severe nausea/vomiting in 25/32, abdominal pain in 29/32 patients, abdominal bloating and distention in 25/32 patients, constipation in 16/32, and fecal incontinence in 14/32 patients. Mean LES pressure was 14.7 mm Hg; LES relaxation with water was complete in 10 patients and incomplete in 10. At 5 cm above LES, mean amplitude of contraction was 24.9 mm Hg. Anorectal manometry in 12 patients showed mean anal canal pressure of 31.4 mm Hg, relative EAS squeeze pressure of 40.4 mm Hg, average compliance of 3.62 ml/mm Hg and RAIR present in 6/12 patients. Small bowel motility in 5 patients demonstrated a reduced amplitude of contraction in the small intestine in 3 patients (normal in 2 patients). In 10 patients who underwent both EMS and ARM, low esophageal body contractile amplitudes were associated with low anal canal pressures. Conclusions: Symptoms of dysphagia and GERD were associated with low amplitude of contractions in the esophageal body, and fecal incontinence was associated with low anal canal pressures. Patients who had reduced esophageal body amplitudes were also likely to have reduced anal canal pressures. EMS findings did not correlate with small bowel manometric findings. Thus in scleroderma patients with complaints of both dysphagia and incontinence, the finding of low smooth muscle tone in the esophagus is likely to predict low anal canal pressures.

Do patient's complaints of dysphagia predict esophageal manometry findings?

Purpose: Complaints of dysphagia can be measured by location, frequency, duration, and severity. It is not known whether the intensity of symptoms correlate with manometric findings. The aim of this study was to investigate the relationships between a patients rating of dysphagia symptoms and characteristics of esophageal manometry.

Does the combination of solid and liquid swallows improve esophageal manometry in patients with dysphagia

Does the combination of solid and liquid swallows improve esophageal manometry in patients with dysphagia

Physiology and Pathophysiology of Colorectal Sensory Processes

Pain referred to the abdomen is the symptom most commonly reported by patients evaluated in gastroenterology clinics. In many instances, abdominal pain is acute and short-lived, and symptoms resolve without a clear diagnosis being made. In other cases, the underlying cause is identified, treatment is initiated, and the pain is relieved. In some patients, however, abdominal pain becomes a chronic problem and may exist as an episodic or recurrent problem with multiple exacerbations over time, or as an intractable, persistent symptom that can be debilitating. Extensive diagnostic testing often fails to reveal an organic cause for the pain. These patients are often diagnosed with one of the functional gastrointestinal (GI) disorders, which include disorders of colonic afferent processes (e.g., colonic hypersensitivity), characteristic of disorders such as the irritable bowel syndrome (IBS). This chapter will focus on the physiology and pathophysiology of colorectal sensory processes and their relationship to chronic abdominal pain and functional GI pain.

CASE REPORT: Inflammatory Causes of Gastroparesis: Report of Five Cases

Gastroparesis is a disorder of delayed gastric emptying. It can be defined as the impaired transit of intraluminal contents from the stomach to the duodenum in the absence of mechanical obstruction. The etiologies of gastroparesis are multiple and diverse. Common known causes include long-standing diabetes mellitus, prior gastric surgery with or without vagotomy, collagen vascular disorders, pseudoobstruction, medications, and viral infections. Idiopathic gastroparesis still accounts for one third of all cases (1), although some of these patients may have had a preceding, albeit unrecognized, viral illness. Symptoms of gastroparesis are nonspecific and include early satiety, nausea, anorexia, abdominal pain, bloating, and weight loss. Two additional symptoms that correlate well with the presence of gastroparesis are vomiting and postprandial fullness (2). In this report we describe a series of five cases of gastroparesis, three of which developed after vaccination and two of which occurred after the development of Lyme disease. We believe these are the first such reported cases in the medical literature. These cases raise the possibility that inflammatory conditions may produce gastroparesis.