E. Øster-Jørgensen

The Relationship between Gallbladder Dynamics and the Migrating Motor Complex in Fasting Healthy Subjects

The relationship between gallbladder dynamics and the interdigestive migrating motor complex (MMC) was investigated in 10 healthy male volunteers by a hepatobiliary scintigraphy and gastroduodenal pressure recordings. Filling of the gallbladder commenced in late phase II or in phase III of the MMC and continued in a linear fashion during the following phase I. Simultaneously, an abrupt decrease in delivery of activity into the duodenum was encountered. Emptying of the gallbladder always occurred in phase II and lasted 14-46 min (median, 30 min). The transformation from filling to emptying of the gallbladder was closely related to changes from phase I to II on the motility curve.

The Effects of Omeprazole on Intragastric pH, Intestinal Motility, and Gastric Emptying Rate

BACKGROUND The present study was designed to investigate whether omeprazole changes the characteristics and thereby the functions ascribed to fasting intestinal motility, postprandial motility, postprandial pH, and gastric emptying. METHODS Ten healthy subjects were investigated. The studies were performed after 10 days of treatment with 40 mg omeprazole daily/placebo. Duodenal pressures and intragastric pH were detected by strain-gauge transducers and a pH electrode attached to a miniature computer. The meal consisted of an omelette labelled with 99mTc-sulphur colloids followed by 150 ml water labelled with 111In-diethylenetriamine pentaacetic acid. RESULTS The difference in fasting intragastric pH between the two series was highly significant. The profile from the placebo series showed a relationship between phase activity and pH. The pH increased from phase I (median, 1.3; 95% confidence interval (CI), 0.9-1.6) to a maximum at 25% (1.8 (0.9-2.1)) and 50% (1.6 (1.1-3.8)) of cycle duration and decreased thereafter until the end of the cycle. The profile from the omeprazole series showed significantly higher values during the entire cycle but no relationship between phase activity and pH. Pretreatment with omeprazole was followed by a delay in gastric emptying of liquid at 30 min (64% (49%-66%) (omeprazole series) versus 78% (67%-83%); P < 0.01) and solid at 180 min (71% (48%-86%) (omeprazole series) versus 96% (87%-100%); P < 0.01). There was no significant difference in duration of postprandial motility (305 min (157-350 min) (omeprazole) versus 259 min (129-403 min)). CONCLUSIONS Omeprazole eliminates the temporal relationship between intragastric pH and characteristics of the migrating motor complex and induces a delay in gastric emptying of both liquid and solid. A non-significant increase in duration of postprandial motility may represent a type-II error.

Increases in plasma motilin follow each episode of gallbladder emptying during the interdigestive period, and changes in serum bile acid concentration correlate to plasma motilin

BACKGROUND The relationship between each single period of gallbladder emptying during the migrating motor complex (MMC) cycle and changes in concentration of plasma motilin and serum bile acids is unknown. METHODS The variations in the concentration of plasma motilin and serum bile acids in relation to interdigestive gallbladder motility and the MMCs was studied in nine healthy male volunteers. A method combining biliary scintigraphy (99mTc-labelled dimethyl-iminodiacetic acid) and continuous pressure recording from the antroduodenal region was used. RESULTS During 9 MMC cycles a total of 15 episodes of gallbladder emptying were observed with a median (range) duration of 25 min (15-45 min). Each episode of gallbladder emptying was followed by a steep increase in plasma motilin, reaching a median value of 30 pmol/l (13-43 pmol/l), corresponding to an increase of 18 pmol/l (4-33 pmol/l). The increase in plasma motilin started at the beginning of gallbladder emptying, but the peak value was not reached until a median of 20 min (10-45 min) later. Low plasma motilin concentrations were found between the emptying periods in cases with two or more emptying during the MMC cycle. The serum concentration of bile acids also showed a cyclic variation in relation to gallbladder motility. During periods of gallbladder emptying serum bile acid concentration had a median value of 1.78 mumol/l, as compared with a median value of 1.17 mumol/l during periods of gallbladder filling. This difference did not reach significance, however. In the pooled data from all subjects, a significant correlation (p < 0.01) between the serum concentration of bile acids and plasma concentration of motilin was found. CONCLUSION Gallbladder emptying was followed by a steep increase in plasma motilin concentration, and in cases of two or more emptying periods during the MMC cycle the concentration decreased in between. The shape of the serum bile acid profile is dependent on the intestinal transport and absorption of bile acids, and the significance of the cyclic variation in serum concentration of bile acids in relation to plasma motilin, gallbladder motility, and MMC needs further investigation.

The Relationship between Gut Hormone Secretion and Gastric Emptying in Different Phases of the Migrating Motor Complex

Background: No studies are available on the relationship between the response of gut hormones and gastric emptying in different phases of the migrating motor complex. This study examined whether basal gut hormone concentrations in plasma before food ingestion are predictors of emptying characteristics and whether different hormone secretion patterns are associated with specific alterations in emptying rate. Methods: Twelve healthy men were examined on two occasions: one with meal ingestion in phase I and the other with meal ingestion in phase II. The meal consisted of an omelette labelled with 99mTc followed by 150ml water labelled with 111In. Plasma concentrations of gastrin, cholecystokinin, motilin, and peptide YY were measured in the fasting state, immediately after food ingestion, and at 15-min intervals in the postprandial period. Results: New findings from the present study include a higher incremental integrated postprandial motilin response in phase I than in phase II (998 pmol/l*30 min (495 to 2...

Cholecystokinin, secretin, pancreatic polypeptide in relation to gallbladder dynamics and gastrointestinal interdigestive motility

Using a combined technique of hepatobiliary scintigraphy and gastrointestinal motility recordings, the changes in blood concentrations of cholecystokinin (CCK), secretin and pancreatic polypeptide (PP) were studied in relation to gastrointestinal motility and gallbladder dynamics in the interdigestive state in 7 healthy male volunteers. No changes in CCK concentration were found in relation to the migrating motor complex (MMC). In 3 subjects a slightly but insignificant elevated secretin level was seen during phase I of the MMC, otherwise no changes were observed. More pronounced fluctuations in PP appeared with significantly higher values during phase III compared to phase II. Values of concentrations of CCK, secretin and PP in periods with gallbladder filling were not significantly different from the values in periods of emptying.

The Effects of Omeprazole on Interdigestive Motility and Early Postprandial Levels of Gastrin and Secretin

Ten healthy men participated in a crossover study, and the experiments took place after 10 days of treatment (40 mg omeprazole every morning). Blood samples were drawn at fixed intervals during a complete migrating motor complex (MMC) cycle. The manometric pressure tube was removed after passage of the second duodenal phase III, and an omelet (1400 KJ) tagged with 99mTc was ingested, followed by 150 ml of water tagged with 111In-diethylenetriaminepentaacetic acid. Mean plasma gastrin (pmol/l) in phases I, II, and III in the omeprazole group was 18.8, 23.3, 19.9, respectively. The corresponding figures for the placebo group were 9.3, 9.6, 9.5, respectively. All mean values for the omeprazole group were significantly higher (p less than 0.01). Mean plasma gastrin in the omeprazole group was significantly higher in phase II than in phase I (p less than 0.05). Mean plasma secretin (pmol/l) in phases I, II, and III in the omeprazole group was 1.6, 1.4, 1.1, respectively. The corresponding figures for the placebo group were 2.0, 1.7, 2.2, respectively. Mean plasma secretin in the omeprazole group was significantly lower in phases I and III (p less than 0.05). The mean incremental integrated postprandial gastrin response (pmol.30 min/l) was significantly higher in the omeprazole group (475.0 versus 97.5) (p less than 0.05). The immediate postprandial mean value of secretin was significantly lower in the omeprazole group (p less than 0.05). We conclude that 40 mg omeprazole elicits i) a phase-related increase in fasting plasma gastrin, ii) a decrease in secretin in phases I and III, iii) an augmented meal-stimulated gastrin response, and iv) a secretin response characterized by a significantly lower mean in the immediate postprandial period.

Infection-Induced Transient Remission of Idiopathic Thrombocytopenic Purpura

In 2 cases of idiopathic thrombocytopenic purpura a transient increase in platelet count was observed during and following infectious episodes. This association which is in contrast to the previously reported aggravating effect of infection on immune thrombocytopenia may be of rather frequent occurrence, being overlooked, however, because of lack of relevant clinical manifestations.

Gastric emptying in normal subjects: reproducibility and relationship to characteristics of the migrating motor complex

This study was designed to clarify whether a part of the variability in gastric emptying could be ascribed to a relationship between meal ingestion and phase activity of the migrating motor complex and whether reproducibility is increased when meal ingestion takes place in relation to preselected characteristics of the migrating motor complex. We examined 12 healthy males, and the design included three examinations, twice with meal ingestion in a duodenal Phase I, and once in a Phase II. The meal consisted of an omelette labelled with 99mTc followed by 150 ml water labelled with 111In. The results showed that liquid lag phase (min) and was significantly shorter in Phase II than in Phase I (1 vs. 4, P = 0.007). The half emptying time of solid linear phase (min) was reproduced with nearly identical median and range values in the three series (I[1]: 67[51–87]; I[2]: 63[47–80]; 61[47–76]). With meal ingestion in Phase I a significant difference between inter‐ and intra‐individual variance could not be demonstrated. With meal ingestion in Phase I a second examination in Phase I did not increase reproducibility of any of the variables compared to a second examination in Phase II. In conclusion, scientific investigations on gastric emptying have to be performed with phase related meal ingestion and a double‐radionuclide technique.

Gastric antrectomy with selective gastric vagotomy does not influence gallbladder motility during interdigestive and postprandial periods

Fasting gastrointestinal motility and gallbladder motility during the interdigestive state and in the postprandial period was studied in eight patients who were operated for ulcer disease with an antrectomy and selective gastric vagotomy. Nocturnal motility recording revealed all three phases of the migrating motor complex (MMC) in all but one patient, where no phase III activity was recorded. In the rest of the patients 3–10 events with phase III activity were recorded. At scintigraphy ([75Se]HCAT) a cyclic gallbladder filling and emptying in relation to the MMC cycle was found. Episodes with emptying were confined to phase II and a total of 13 episodes with a median duration of 25 min (range 10–70 min) were observed. A median of 10.7% (6.1–17.7%) of the gallbladder contents was emptied. In a control group of eight healthy young men the values were 13.5 min (9–36 min) and 6.9% (3.7–31.1%), respectively. These differences were not significant. During the postprandial period, a lag period in gallbladder emptying of median 15 min (5–20 min) was observed when food ingestion took place during phase I of the MMC. Thereafter a gradual emptying occurred with a rate of 0.95%/min (0.71–1.15%/min). In a control group of healthy young males, the lag period was 13.5 min (9–22.5 min) and the emptying rate 0.61%/min (0.08–0.77%/min). When food ingestion occurred during phase II of the MMC, the lag period of gallbladder emptying in the patient group was median 0 min (0–5 min) and the emptying rate was 0.77%/min (0.33–0.86%/min). The values in the control group were 0 min (−9 to 13.5 min) and 0.76%/min (0.54–2.25%/min), respectively. These differences between the patients and controls were not significant. In conclusion, antrectomy and selective gastric vagotomy do not influence fasting gastrointestinal motility or gallbladder motility during the interdigestive state or in the postprandial period.

Postprandial Gallbladder Filling: Relation to Gastrointestinal Motility

A technique of combined hepatobiliary scintigraphy and gastrointestinal motility recordings was used to study the relationship between gallbladder dynamics and gastrointestinal motility recordings in the postprandial state in eight healthy male volunteers. In all, a fed-like motility pattern was observed after ingestion of a standard meal, and all activity from the HIDA-scintigraphy was diverted to the duodenum. Gallbladder radioactivity on the scintigram was not seen until 145-249 (median, 180) min after ingestion, except for two cases in which an early and transient activity was seen. Together with increasing gallbladder radioactivity characteristic changes in duodenal motility occurred. In five subjects a decrease in motility index was encountered with a motility curve resembling phase I of the interdigestive migrating motor complex. In one subject it was associated with the appearance of a phase-III complex, and in two subjects it occurred without any changes in motility index.