John G. Banwell

Replacement of Water and Electrolyte Losses in Cholera by an Oral Glucose—Electrolyte Solution

Abstract The efficacy of an orally administered glucose-electrolyte solution in replacing stool losses of water and electrolytes in severe cholera was evaluated. After initial intravenous rehydrati...

Detection of Bacterial Deconjugation of Bile Salts by a Convenient Breath-Analysis Technic

Abstract When glycine-1–14C-cholate was given orally and 14CO2 specific activity of expired air measured by a breath-analysis technic, the results clearly separated patients with either ileal resection or bacterial-overgrowth syndromes from subjects without abnormalities of bile-salt metabolism. The normal subjects and the patients with steatorrhea unrelated to abnormalities of bile-salt metabolism had no appreciable rise in 14CO2 excretion (2.2 ± 0.60 [S.E.] and 1.3 ± 0.31 per cent administered dose, respectively) whereas subjects with ileal resection and bacterial-overgrowth syndromes had a rapid appearance of 14CO2 in expired breath (31.4 ± 4.62 and 23.4 ± 6.78 per cent of administered dose, respectively). Elimination of bacterial overgrowth with antibiotics or surgical fistula repair returned 14CO2 excretion (0.7 ± 0.23 per cent) to normal. Thus, the breath test will detect increased bacterial deconjugation of bile salts and assess effective antibiotic management of bacterial-overgrowth syndromes.

Intestinal fluid and electrolyte transport in human cholera.

The site, nature, magnitude, and duration of fluid and electrolyte loss into the small intestine during the acute and recovery phase of human cholera was defined in 27 Indian patients. 11 subjects without cholera served as controls. The marker perfusion technique employed was shown, in preliminary experiments, to measure accurately jejunal and ileal fluid and electrolyte transmucosal transport rates under conditions of cholera diarrhea. Fluid loss into the lumen occurred from jejunal and ileal mucosa. The fluid was isotonic in both regions. Bicarbonate concentration was significantly higher in ileal than jejunal fluid during all phases of the disease. Bicarbonate concentration in both regions was significantly higher in acute cholera than during convalescence. Fluid loss into the intestinal lumen ranged from 0.07 to 10.9 ml/hr per cm. Losses were significantly greater from jejunum than ileum. Net ileal absorption was recorded in five of 10 acute cholera studies. During the acute phase of the disease, net jejunal fluid transport showed a positive correlation with fasting intestinal flow rate and stool output. Stool output was also positively correlated with jejunal fasting intestinal flow rates. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by the sixth day after admission. These findings in human cholera validate the animal models of choleraic diarrhea and suggest that similar measurements of small intestinal secretory function in other nonspecific diarrheal diseases using the marker perfusion technique may be rewarding.

Acute undifferentiated human diarrhea in the tropics: II. Alterations in intestinal fluid and electrolyte movements

The nature and magnitude of fluid and electrolyte loss into the small intestine were defined by the marker perfusion technique in patients with acute undifferentiated diarrhea (AUD) in the tropics. The patients were divided into two groups according to their small bowel bacteriologic findings, namely those with a predominant Escherichia coli flora and those with a mixed flora. 11 normal subjects served as controls. Net jejunal fluid secretion occurred into the lumen in four of seven patients with E. coli flora and three of seven with a mixed flora. The magnitude of secretion in the jejunum was greater in the E. coli flora patients than in those with a mixed flora. Four E. coli patients and one mixed flora patient had net fluid secretion in the ileum, although the magnitude of secretion in this area was less than in the jejunum. Intestinal fluid had higher bicarbonate concentration in the ileum than in the jejunum but was isotonic in both regions. It resembled in composition fluid from the same region of intestine in normal individuals. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by 6-8 days after onset of the disease. Increase in unidirectional flux rates for H(3)O and (24)Na occurred in acute E. coli flora diarrhea and returned to normal levels in recovery: increase in J(beta) (plasma to lumen flux) primarily accounted for the increase in fluid loss. Intestinal biopsy revealed no alterations in villous architecture.A relationship between small bowel fluid production and the presence of toxigenic strains of E. coli within the small bowel has been found for E. coli flora patients. In many respects this disease resembles acute cholera. The mixed flora group represents a less defined entity which requires further study.

Products Containing Aspirin

ASPIRIN, widely employed in therapeutics, has well recognized side effects, which include hypersensitivity reactions, gastrointestinal blood loss and interaction with oral anticoagulants and uricos...

Colonic Dysfunction During Cholera Infection

To study the function of the colon in cholera, 12 patients with acute cholera diarrhea were subjected to measurements of ileocecal flow rates, fecal flow rates, and ionic compositions of stool and ileocecal fluid. Subtraction of fecal flow rates from ileocecal flow rates was taken as a measure of net fluid absorption by the colon. Additionally, these patients underwent colonoscopic perfusion of the colon that measured net colonic absorption rates of water and ions. The mean ileocecal flow rate was 7.9 ml/min compared with a mean fecal flow rate of 7.6 ml/min, indicating a small mean net fluid absorption by the colon of +0.30 ml/min. By colonoscopic perfusion, 6 patients showed net colonic absorption of water and 6 patients net secretion of water with a slight mean net fluid secretion of -0.03 ml/min. The handling of ions by the colon showed mean net absorption of sodium (100 mu Eq/min) and chloride (127 mu Eq/min), and net secretions of potassium (-42 mu Eq/min) and bicarbonate (-112 mu Eq/min). During convalescence, 5 patients who were studied again all showed net colonic absorption of water, and the handling of potassium changed significantly from net secretion in acute disease to net absorption (p less than 0.05). These results showed that the colon contributes to the clinical expression of cholera by failing to absorb water normally, and by secreting potassium at high rates.

COMPARISON OF SECRETORY AND HISTOLOGICAL EFFECTS OF SHIGELLA AND CHOLERA ENTEROTOXINS IN RABBIT JEJUNUM

The purpose of this study was to compare the actions of shigella toxin and cholera toxin to determine if mucosal damage is a prerequisite for shigella toxin-induced secretion. The secretory response to maximal doses of cholera toxin and shigella toxin were compared. The maximal rate of secretion and the electrolyte and protein concentration of the intestinal fluid were similar for both toxins. On the other hand, the time of onset after exposure to the toxin was 105 min for shigella toxin and 15 to 30 min for cholera toxin. In addition, cholera toxin-induced secretion was associated with depletion of goblet cell mucus, whereas no change was seen in association with the response to shigella toxin. Other than goblet cell depletion, there were no histological differences between loops secreting in response to cholera toxin and to shigella toxin. Finally, the secretory effect of the toxins are not additive. These studies suggest that, in spite of apparent differences in the patterns of secretory response to the two toxins, they may share a rate-limiting step in the secretory process.

Gastrointestinal intubation in ascariasis.

CROSBY1 recently compiled some of the ingenious devices designed for obtaining material from the gastrointestinal tract for diagnostic purposes. In particular, he described details of a gold trap, ...