Michael Jones

Enhanced perception of physiological intestinal motility in the irritable bowel syndrome

An increased awareness of intestinal distention or contraction is implicated in the pathogenesis of the irritable bowel syndrome. This study aimed to test this hypothesis in 20 patients with the irritable bowel syndrome and 10 controls by relating the reporting of abdominal sensations to the occurrence of the duodenal phase 3 activity front of the migrating motor complex. During prolonged recordings of interdigestive small bowel motility, subjects were asked to report any episodes of abdominal sensation they experienced. Diurnally, the rate of occurrence of abdominal sensation was significantly greater in patients with the irritable bowel syndrome than in controls (P less than 0.001); such episodes were coincident with a duodenal activity front in 9 patients with the irritable bowel syndrome and in 1 control (P less than .05). Moreover, the rate of occurrence of episodes of sensation was greater (P less than 0.01) during diurnal phase 3 activity than during diurnal phase 2 activity. When episodes were coincident with duodenal phase 3 activity, these activity fronts were of significantly greater amplitude (irritable bowel syndrome: median, 23 mm Hg) than noncoincident activity fronts (median, 17 mm Hg; P less than 0.05) in both patients and controls. These data strongly suggest that certain physiological small bowel motor events, if of sufficient contraction amplitude, are able to be perceived by a greater proportion of irritable bowel syndrome patients and with greater frequency than by healthy subjects. The authors conclude that the threshold for perception of intestinal contraction is lower than normal in at least some patients with the irritable bowel syndrome.

Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia

The relative contributions of altered gastric motor function andHelicobacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated scintigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; patients were subdivided on the basis of both specific symptom clusters and the presence or absence ofH. pylori gastritis. Twenty-one (28%) patients displayed abnormal solid and/or liquid gastric emptying, with prolonged solid lag time the most prominent alteration detected. The number of patients with abnormal scintigraphic patterns increased to 36 (48%) when intragastric distribution parameters (fundal half-emptying time and antral maximal fraction) were examined. Although patients with reflux-like dyspepsia (N=36) demonstrated significantly slower rates of liquid emptying at 45 and 70 min and a higher prevalence of abnormal liquid intragastric distribution when compared to patients with motility-like dyspepsia (N=39) or to controls (N-34), the absolute differences were small and unlikely to be of clinical significance. Patients withoutH. pylori gastritis (N=50) demonstrated a significantly more prolonged solid lag time when compared to those withH. pylori gastritis (N=25), but the difference was small and there were no other differences between these two subgroups. We conclude that in patients with functional dyspepsia: (1) abnormal solid gastric emptying is present in less than one third; (2) assessment of parameters of intragastric distribution enables more subtle gastric motor dysfunction to be identified; and (3) neither dividing patients into symptom subgroups nor accounting for the presence or absence ofH. pylori gastritis has a major influence on the prevalence or type of gastric motor dysfunction.

Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology (IVF/ET).

The association between mood state and treatment outcome after In Vitro Fertilization/Embryo Transfer (IVF/ET) was assessed in a prospective sample of 330 women, of whom 113 were first time participants (inductees) and 217 were repeat cycle women (veterans). Initial evaluation of mood state indicated a significantly higher level of depression amongst veterans than inductees and a significantly greater proportion of veterans (25%) with clinically elevated depression scores compared with inductees (15%) and community norms (approx. 12%). Up to 12 months after initial assessment and after controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women. The results and their implications are discussed.

Psychosocial adjustment to infertility and its treatment: Male and female responses at different stages of IVF/ET treatment ☆

Gender differences in psychosocial adjustment to infertility and its treatment were evaluated amongst a cross-sectional sample of 330 couples, of whom 113 were first time participants and 217 were repeat cycle couples. Whilst 30% of both husbands and wives experienced clinically elevated anxiety regardless of stage of treatment; repeat cycle women (25%) faced the further risk of developing clinically severe depressive symptoms. Significant differences in the amount of care and control received from their spouse and in the degree they suppressed their emotions were reported amongst repeat cycle couples. Any clinical implications of differences in male-female caring styles are discussed within the IVF context. Our results suggest that interventions intended not only to reduce anxiety and depressive symptoms, but also to facilitate ongoing psychosocial functioning, should be implemented for couples at different stages of IVF/ET treatment.

Effects of cigarette smoking on solid and liquid intragastric distribution and gastric emptying

BACKGROUNDnThe acute effects of cigarette smoking on gastric emptying are controversial, whereas its effects on the intragastric distribution of solids and liquids are not established.nnnMETHODSnDual isotope gastric scintigraphy was performed in 15 habitual smokers (studied twice, either sham smoking or actively smoking) and in 15 age- and sex-matched nonsmokers.nnnRESULTSnAcute smoking was associated with an increased prevalence of episodes of retrograde intragastric movement of solids (3 of 15 sham subjects vs. 12 of 15 actively smoking subjects; P < 0.01) and of liquids (0 of 15 vs. 7 of 15; P < 0.01) from distal to proximal stomach. Fundal half-emptying time (T1/2) for liquids was also prolonged by smoking (43 +/- 19 minutes sham vs. 125 +/- 216 minutes active; P < 0.05). Acute smoking delayed solid lag time (13 +/- 6 minutes sham vs. 32 +/- 18 active; P < 0.05) and liquid T1/2 (46 +/- 21 vs. 90 +/- 50 minutes; P < 0.05). In the nonsmokers, such episodes of proximal intragastric redistribution did not occur, and intragastric and overall emptying parameters did not differ significantly from those of habitual sham smokers.nnnCONCLUSIONSnAcute cigarette smoking produces excessive antrofundal redistribution of both solid and liquid contents and delays solid and liquid gastric emptying.

Symptom Provocation in Irritable Bowel Syndrome Effects of Differing Doses of Fructose-Sorbitol

The role of fructose and sorbitol, when ingested together, in the aetiology of irritable bowel syndrome (IBS) is controversial. The aims of this study in IBS patients, therefore, were to compare differences in symptom provocation with various doses of fructose-sorbitol and to relate differences in the extent of colonic hydrogen production after each dose to such symptom provocation. Two different mixtures of fructose and sorbitol--20 g fructose plus 3.5 g sorbitol (lower dose) and 25 g fructose plus 5 g sorbitol (higher dose)--were administered to 15 patients with IBS and to 24 healthy controls. Breath hydrogen concentrations were determined at 10-min intervals for 3 h after ingestion of each mixture, and the presence and severity of a range of gastrointestinal symptoms were recorded on a standard form before, during, and after the study. Total symptom score in IBS patients, but not controls, was greater (p < 0.05) after the higher than after the lower dose of fructose-sorbitol mixture, and, for the higher dose, symptoms were significantly greater in IBS patients than in controls (p < 0.05). Moreover, the increase in total symptom score between the higher and lower dose mixtures was of a greater magnitude (p = 0.01) in IBS patients than in controls. No significant correlation was observed between the increase in symptom score and the increase in peak hydrogen concentration or the increase in integrated hydrogen response between lower and higher dose mixtures, although these latter increases were at times substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

Enteric and central contributions to intestinal dysmotility in irritable bowel syndrome

The aim of the study was to further elucidate the pathophysiology of irritable bowel syndrome and its subgroups by examining and comparing alterations in small bowel motility, specifically phase II and phase III components of the migrating motor complex. Prolonged recordings of interdigestive small bowel motility were obtained during both diurnal and nocturnal periods in 20 patients with irritable bowel syndrome-10 with predominant constipation and 10 with predominant diarrhea-and in 10 healthy subjects. Diurnal amplitude (mean±sd) of phase III activity fronts was lower (P<0.05) in constipation-predominant patients (16.3±3.1 mm Hg) than in diarrhea-predominant patients (20.2±3.1) or controls (20.9±2.7). Similar findings were observed nocturnally. Phase III cycle length was also significantly prolonged diurnally in constipation-predominant patients when compared to the other groups. In the diarrhea-predominant group repetitive and rapidly propagated bursts of contractions were observed in eight patients, and this pattern occupied a significantly greater proportion of phase II motor activity than in controls. These alterations in phase II and in phase III components of the migrating motor complex suggest that both local (enteric) and more central mechanisms may operate to produce intestinal dysmotility in the irritable bowel syndrome and that these mechanisms differ according to the predominant alteration of bowel habit.

Longitudinal study of plasma ACTH and cortisol in very low birth weight infants in the first 8 weeks of life

There are few published data on plasma ACTH and cortisol in very low birth weight (VLBW) infants beyond the first week of life. We therefore measured plasma ACTH and cortisol longitudinally in 25 infants (mean birth weight 1025 g, mean gestational age 28 weeks) at 1, 2, 4 and 8 postnatal weeks to document normative values for infants not receiving dexamethasone. We also examined the influence of clinical state and dexamethasone treatment on plasma ACTH and cortisol levels. Median plasma ACTH increased significantly with advancing postnatal age from 1 week to 8 weeks (21.0 vs. 40.0 ng/l; P = 0.01) but did not correlate with postconceptional age. Median plasma cortisol decreased significantly with advancing postnatal age from 1 week to 8 weeks (216 vs. 50 nmol/l; P = 0.001) and correlated inversely with postconceptional age (P = 0.004). At 8 weeks infants who were clinically well (n = 6) had lower plasma ACTH values compared with sick (n = 6) infants (median: 37.0 vs. 63.5 ng/l; P = 0.033). Plasma ACTH did not correlate with clinical state at 1, 2 and 4 weeks. At none of the postnatal ages studied was plasma cortisol influenced by the degree of sickness. Five infants received dexamethasone to assist weaning from mechanical ventilation. Their median plasma ACTH level, at 8 weeks, was significantly lower than that of the 12 infants who did not receive dexamethasone (11.0 vs. 40.0 ng/l; P = 0.0006). Plasma cortisol was not significantly influenced by dexamethasone treatment (P = 0.27). These data provide further information on the evolution of adrenocortical function in VLBW infants in the first months of life.

Acute and chronic stress in duodenal ulcer disease

Acute and chronic life event stressors were objectively assessed in a sample of duodenal ulcer patients and community controls. Stress was assessed on two dimensions, personal threat and goal frustration. Chronic stressors (those of 6 months duration or more) involving high goal frustration were significantly and independently associated with the onset and relapse of duodenal ulcers, as were acute events of high immediate but transient personal threat.

Lunar Cycles and Violent Behaviour

Objective: It is commonly believed that the full moon exerts an influence on violence and aggression in psychiatric settings. The literature to date is contentious. This study used a robust methodology to examine the hypothesis that there was an increased frequency of violent and aggressive behaviour among hospitalised psychiatric clients at the time of the full moon. Method: Prospective data were collected in five inpatient psychiatric settings across the Northern Sydney Area Health Service. Morrisons hierarchy of violence and aggression was used to rate behaviour. Lunar phases were clearly defined and Poisson regression used to examine relationships between lunar phase and violence. Extraneous temporal variation was considered. Results: No significant relationship was found between total violence and aggression or level of violence and aggression and any phase of the moon. Conclusion: Future research could profitably examine the implications of a belief in the lunar effect among health workers in the face of evidence that no relationship exists between violence, aggression and the lunar cycle.