G. P. Van Berge Henegouwen

What Is the Optimal Time Window in Symptom Analysis of 24-Hour Esophageal Pressure and pH Data?

Since noncardiac chest pain is the only well-established indication for 24-hr esophageal pH and pressure recording, the analysis of the association between chest pain episodes and esophageal motility abnormalities or reflux is the most important part of data analysis in 24-hr monitoring. Until now, different time windows have arbitrarily been used by various research groups. The aim of this study was to determine the optimal time window for symptom analysis in 24-hr esophageal pH and pressure monitoring. For this purpose repetitive symptom association analysis was carried out, using time windows of various onsets and durations. For each time window, the symptom indices for reflux and dysmotility were calculated. The symptom index for both reflux and dysmotility showed a gradual increase for windows with increasingly early onset, following a pattern that would be predicted on the basis of Poissons theory. However, both indices had a relatively sharp cutoff point at 2 min before the onset of pain. Both indices only showed a predictable gradual increase when the time window starting at −2 min was extended beyond the moment of pain onset. It is concluded that the optimal time window for symptom analysis in 24-hr esophageal pH and pressure recording begins at 2 min before the onset of pain and ends at the onset of pain.

Proximal gastric motor activity in response to a liquid meal in type I diabetes mellitus with autonomic neuropathy.

Disordered gastric emptying occurs in 30-50% ofpatients with diabetes mellitus. Although the rate ofgastric emptying is dependent on the integration ofmotor activity in different regions of the stomach, there is limited information about the functionof the proximal stomach in diabetes mellitus. In thepresent study the response of the proximal stomach to aliquid meal was examined in eight diabetic patients with autonomic neuropathy and gastrointestinalsymptoms and in 10 healthy volunteers, using anintragastric bag connected to an electronic barostat.Postprandial relaxation of the proximal stomach wasmeasured as an increase of intragastric bag volume at aconstant pressure level of 1 mm Hg above theintraabdominal pressure. During the experiment the bloodglucose levels were maintained within the euglycemic range. Before ingestion of the meal theintragastric bag volume was larger in the diabeticpatients than in the healthy volunteers, 234.4 ±29.1 ml vs 155.3 ± 15.3 ml (P = 0.06). Themaximum volume was not different in diabetics compared to the healthy controls(386.3 ± 45.2 ml versus 399.0 ± 35.2 ml).However, the maximum volume increase was significantlyless in diabetics (143.7 ± 38.6 ml) compared tothe controls (231.4 ± 30.5 ml, P < 0.04). Bloatingwas inversely correlated with the volume changes, whichsuggests that impaired relaxation of the proximalstomach may play a role in the genesis of thissensation. In conclusion, this study shows a lower fastingfundal tone and a decrease in volume change of thegastric fundus after a nutrient drink in patients withautonomic neuropathy due to type I diabetes mellitus. These abnormalities may play a role in theabnormal distribution of food, disordered liquid gastricemptying, and in the genesis of the sensation ofbloating observed in these patients.

Iron and inflammatory bowel disease

Both anaemia of iron deficiency and anaemia of chronic disease are frequently encountered in inflammatory bowel disease. Anaemia of iron deficiency is mostly due to inadequate intake or loss of iron. Anaemia of chronic disease probably results from decreased erythropoiesis, secondary to increased levels of proinflammatory cytokines, reactive oxygen metabolites and nitric oxide.

Colorectal visceral perception in diverticular disease

Background and aims: The pathogenesis of asymptomatic diverticular disease (ADD) and symptomatic uncomplicated diverticular disease (SUDD) has not been elucidated. The aim of our study was to assess whether altered visceral perception or abnormal compliance of the colorectal wall play a role in these clinical entities. Methods: Ten ADD patients, 11 SUDD patients, and nine healthy controls were studied. Using a dual barostat device, sensations were scored and compliance curves obtained using stepwise intermittent isobaric distensions of the rectum and sigmoid, before and after a liquid meal. In addition, the colonic response to eating was assessed by monitoring the volumes of both barostat bags at operating pressure before and after the meal. Results: In the rectum, perception was increased in the SUDD group compared with controls (pu200a=u200a0.010) and the ADD group (pu200a=u200a0.030). Rectal compliance curves were not different between the groups. In the sigmoid colon, perception in the pre- and postprandial periods was increased in SUDD compared with controls (pu200a=u200a0.018) but not when compared with ADD. Sigmoid volume-pressure curves had comparable slopes (compliance) in all groups but were shifted downwards in SUDD compared with ADD in the preprandial period (pu200a=u200a0.026). The colonic response to eating (decrease in intrabag volume) was similar in all three groups, both in the rectum and sigmoid. Conclusion: Symptomatic but not asymptomatic uncomplicated diverticular disease is associated with heightened perception of distension, not only in the diverticula bearing sigmoid, but also in the unaffected rectum. This hyperperception is not due to altered wall compliance.

Abnormalities of left colonic motility in ambulant nonconstipated patients with irritable bowel syndrome

Our objective was to evaluate left colonic motility patterns recorded under physiological conditions during 24 hr in fully ambulant nonconstipated IBS patients compared to healthy controls. A 42-hr manometry of the left colon was performed in 11 nonconstipated IBS patients and 10 age- and sex-matched healthy volunteers. On day 1, a 6-channel, 10-cm interval, solid-state catheter was positioned. Frequency, amplitude, and motility index (MI) of segmenting pressure waves in the descending and sigmoid colon were calculated during the 24-hr study period on day 2. High-amplitude propagated contractions (HAPCs) were identified visually and their characteristics were calculated. In IBS patients a higher frequency of segmenting pressure waves was observed in the sigmoid colon compared to the descending colon (P = 0.006). In contrast, no regional differences were observed in controls. Awakening (P = 0.048) as well as having a meal (P = 0.024) was associated with a smaller increase of contraction frequency in the descending colon of IBS patients compared to controls. HAPCs occurred more frequently in IBS patients than in controls (P = 0.035

Association between pain episodes and high amplitude propagated pressure waves in patients with irritable bowel syndrome.

). HAPCs in IBS patients reached a more distal colonic level and occurred more frequently in clusters. Defecation in IBS patients, but not in controls was always preceded by a cluster of HAPCs. In conclusion, left colonic segmenting pressure waves and HAPC characteristics are altered in nonconstipated IBS patients.

Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia

OBJECTIVES:In the pathogenesis of irritable bowel syndrome (IBS), both increased visceral sensitivity and altered colonic motility seem to play a role. The aim of this study was to quantify the temporal relationship between pain episodes and the occurrence of high amplitude propagated pressure waves (HAPPWs).METHODS:A total of 11 IBS patients with the nonconstipation predominant pattern of IBS and 10 sex- and age-matched healthy volunteers were studied. On day 1, a solid state manometric catheter was positioned in the left colon and connected to a data logger. The subjects then went home. Thereafter they pressed a button on the data logger at the beginning and end of each pain episode. The 24-h manometric signal recorded on day 2 was divided into consecutive 5-min periods. These periods were evaluated for the occurrence of pain and HAPPWs. Fishers exact test was applied to calculate the probability that HAPPWs and pain episodes were unrelated. The symptom association probability (SAP) was calculated as (1.0 − P) × 100%. A SAP of >95% was considered to indicate that the observed association did not occur by chance.RESULTS:In four of seven patients with pain on day 2, the SAP was >95%. HAPPWs that were related to pain originated at a more proximal level (p = 0.026) and occurred earlier (p = 0.007) than HAPPWs that were not related to pain. The duration of a pain period was correlated with the number of pain-related HAPPWs in that period (r = 0.906, p = 0.013). Two of the 10 healthy subjects experienced pain, and these pain episodes were not associated with HAPPWs.CONCLUSION:Using objective analysis techniques, an association between pain episodes and HAPPWs was found in nonconstipated IBS patients with pain. HAPPWs that are associated with pain are only slightly different from HAPPWs not associated with pain.

A randomized trial in primary biliary cirrhosis comparing ursodeoxycholic acid in daily doses of either 10 mg/kg or 20 mg/kg

Heightened visceroperception and a decreased duodenal motor response to intraduodenal acid infusion have been reported in functional dyspepsia.

Effect of alosetron on left colonic motility in non‐constipated patients with irritable bowel syndrome and healthy volunteers

Ursodeoxycholic acid (UDCA) prolongs transplantation‐free survival in primary biliary cirrhosis (PBC). However, the optimal therapeutic dose has not been established.

Biliary lipid and bile acid composition in insulin-dependent diabetes mellitus arguments for increased intestinal bacterial bile acid degradation

Alosetron is a 5‐hydroxytryptamine‐3 receptor antagonist reducing symptoms in female patients with diarrhoea‐predominant irritable bowel syndrome, and is known to increase the colonic transit time.