Motonobu Sugimoto

Comparison between gastric scintigraphy and the [13C]-acetate breath test with Wagner-Nelson analysis in humans.

1 The [13C]‐acetate breath test (ABT) quantifies gastric emptying as the half [13CO2]‐excretion time (T1/2b), but T1/2b differs from the scintigraphic half‐emptying time (T1/2s). The aims of the present study were to accurately determine the half‐emptying time by ABT with Wagner–Nelson analysis (T1/2WN), to compare T1/2WN with T1/2s and to validate the Wagner–Nelson strategy in ABT. 2 For a comparative study, eight volunteers simultaneously underwent ABT and scintigraphy. Anterior images were acquired and breath samples were collected every 15 min for 4.0 h after ingestion of a 200 kcal liquid meal labelled with 37 MBq [99mTc]‐colloidal sulphur and 100 mg [13C]‐acetate. For the validation experiment, another six volunteers underwent ABT, on two randomized occasions, using the 200 kcal liquid meal with 100 mg [13C]‐acetate. On either of the two occasions, a gel‐forming agent was stirred into the meal to intentionally delay gastric emptying by increasing meal viscosity. Breath samples were collected at regular 15 min intervals for 4 h post ingestion. 3 The Wagner–Nelson equation for ABT is F(t) = (Abreath(t) + C(t)/0.65)/Abreath(∞), where F(t) is a fractional dose of the [13C] label emptied, C(t) is the [13CO2] excretion (% dose/h), Abreath(t) is the area under the C(t) curve (% dose) and Abreath(∞) is the ultimate [13CO2] recovery in breath (% dose). The percentage gastric retention was estimated as 100 × (1 − F(t)). The time plots of scintigraphic activity and 100 × (1 − F(t)) were fitted to y(t) = 100 × e−K×t, K values were estimated mathematically for each plot by regression analysis and T1/2s and T1/2WN were calculated as (ln2)/K. The time versus pulmonary [13CO2] excretion plots were fitted to z(t) = m × k × β × e−kt(1 − e−k×t)β−1, where m, k and β are constants; T1/2b was calculated as –(ln(1 − 2−1/β)]/k. 4 Values of T1/2WN were closer to T1/2s than T1/2b, although T1/2WN and T1/2b yielded significant under‐ and overestimation of T1/2s, respectively. The high viscosity meal significantly prolonged T1/2WN and T1/2b; T1/2WN could detect the delayed transit of the viscous meal more sensitively than T1/2b. 5 The Wagner–Nelson method improves the accuracy of the ABT.

Role of infected grandmothers in transmission of Helicobacter pylori to children in a Japanese rural town.

Although the prevalence of Helicobacter pylori (H. pylori) increases with age and the main period of acquisition is childhood, the route of transmission of H. pylori infection remains unclear. This study aims to evaluate the relationship between prevalence of children and grandparents.

Retroperitoneal lymphangioleiomyomatosis associated with endosalpingiosis.

A case of retroperitoneal lymphangioleiomyomatosis (LAM) arising from endosalpingiosis is described. A 25‐year‐old woman with no history of tuberous sclerosis or hormonal therapy presented with a painless, palpable abdominal mass. Computed tomographic and magnetic resonance imaging studies of the abdomen demonstrated a 4 cm cystic mass in the retroperitoneum. Macroscopically, the excised retroperitoneal cyst was multilocular and measured 4.0×3.5×3.5 cm. Histologically, the lesion demonstrated three components. The first comprised multiple cysts or glands lined by columnar epithelial cells with cilia. The second component was a condensation of small stromal cells immediately subjacent to the cystic epithelium or glands. The third component was a thick exterior wall composed of plump spindle cells with clear to palely eosinophilic cytoplasm in a fascicular pattern, and slit‐like vascular spaces, resembling LAM. Immunohistochemically, the epithelium and glands were positive for cytokeratin 7. The stromal cells were positive for vimentin and CD10. The cells of the LMA‐like component showed positive staining for HMB45, alpha‐smooth muscle actin, muscle actin and h‐caldesmon. The lesion, LAM arising from endosalpingiosis, represents a distinctive pathologic entity that should be recognized and studied further. This type of lesion should be included in the differential diagnosis of retroperitoneal cystic lesions.

The acrolein cytotoxicity and cytoprotective action of α-tocopherol

SummaryThe influence of acrolein on hepatocytes and the effect of a-tocopherol on acrolein cytotoxicity were investigated using primary cultured rat hepatocytes. Hepatocellular injury was dependent on both acrolein concentration in medium and on duration of exposure. Treatment of hepatocytes with 100 μM acrolein resulted in a marked loss of cellular glutathione (GSH) within 15 min, gradual accumulation of cellular lipid peroxide (LPO) and subsequent lactate dehydrogenase (LDH) leakage in the medium from 3 hr after exposure to acrolein. Cellular GSH peroxidase (GSH-Px) activity at 2 hr was significantly decreased. Electron microscopic examination on hepatocytes at 8 hr revealed a marked swelling of mitochondria and ruptures of the plasma membrane. Simultaneous treatment with 100 μM acrolein and 20 μM α-tocopherol did not prevent the loss of cellular GSH, though it prevented the LPO accumulation and the LDH leakage. The decrease of cellular GSH-Px activity with acrolein treatment was not mitigated by cotreatment with a-tocopherol. Ultrastructural alterations of hepatocytes induced by acrolein were minimized by co-treatment with α-tocopherol. In conclusion, acute loss of GSH and GSH-Px may increase cellular LPO and lead to hepatocellular injury, though suppression of cellular LPO accumulation by α-tocopherol can prevent the hepatocellular injury, even under condition of lack of GSH and GSH-Px.

Extensive atrophic gastritis increases intraduodenal hydrogen gas

Objective. Gastric acid plays an important part in the prevention of bacterial colonization of the gastrointestinal tract. If these bacteria have an ability of hydrogen (H2) fermentation, intraluminal H2 gas might be detected. We attempted to measure the intraluminal H2 concentrations to determine the bacterial overgrowth in the gastrointestinal tract. Patients and methods. Studies were performed in 647 consecutive patients undergoing upper endoscopy. At the time of endoscopic examination, we intubated the stomach and the descending part of the duodenum without inflation by air, and 20 mL of intraluminal gas samples of both sites was collected through the biopsy channel. Intraluminal H2 concentrations were measured by gas chromatography. Results. Intragastric and intraduodenal H2 gas was detected in 566 (87.5%) and 524 (81.0%) patients, respectively. The mean values of intragastric and intraduodenal H2 gas were 8.5 ± 15.9 and 13.2 ± 58.0 ppm, respectively. The intraduodenal H2 level was increased with the progression of atrophic gastritis, whereas the intragastric H2 level was the highest in patients without atrophic gastritis. Conclusions. The intraduodenal hydrogen levels were increased with the progression of atrophic gastritis. It is likely that the influence of hypochlorhydria on bacterial overgrowth in the proximal small intestine is more pronounced, compared to that in the stomach.

Salivary gland scintigraphy in gastro-esophageal reflux disease

Abstract.Gastro-esophageal reflux disease (GERD) is associated with a decreased salivary flow as well as gastric acid production. This study therefore aimed to investigate functional disorders of salivary glands in patients with GERD.Methods:Thirty-one consecutive patients with GERD underwent salivary gland scintigraphy.Results:If the results defined the optimal cutoff point for determining the decreased salivary secretion as 51 % in parotid glands and 36 % in submandibular glands, a decreased salivary secretion of right parotid gland, left parotid gland, right submandibular gland, and left submandibular gland was found in 39 %, 32 %, 36 %, and 58 %, respectively. Overall, salivary function disorder of at least one major salivary gland was found in 24 patients (78 %) with GERD. There was no difference in the incidence of impaired salivary function between GERD patients with and without erosive esophagitis. Salivary gland function was more frequently diminished than expected in GERD. We concluded that the presence of impaired salivary gland function was considered to be one of risk factors for developing GERD symptoms.

Distribution of 3α-hydroxysteroid dehydrogenase (bile acid binder) in rat small intestine: Comparison with glutathione S-transferase subunits

We identified and quantitated theY′ bile acid binder, i.e., 3α-hydroxysteroid dehydrogenase (3α-HSD), in rat small intestinal mucosa, and compared its longitudinal distribution with that of glutathione S-transferases (GST). The enzyme activity of 3α-HSD in intestinal mucosa was approximately one-third of that in liver, and it had similar activity in the proximal, middle, and distal portions of the intestine. Immunoreactive protein corresponding to hepatic bile acid binder was detected in all segments of rat small intestine mucosal cytosol by Western blot analysis. There was no significant difference in the concentration of bile acid binder, assayed by enzyme-linked immunosorbent assay (ELISA), between the proximal and the distal intestine, this being 2.93±0.03 and 3.29±0.95 nmol/g tissue, respectively (mean±SD of four animals). On the other hand, the concentration of GST 1-1 showed sharp longitudinal decline and that of GST 3–4 was negligible in the small intestine, as we previously reported, indicating that bile acid binder was a prominent cytosol binding protein in the distal intestine. These results suggested the possible role of bile acid binder in the intracellular transport of bile acids in the ileum.

Breath Hydrogen Gas Concentration Linked to Intestinal Gas Distribution and Malabsorption in Patients with Small-bowel Pseudo-obstruction

Summary Background The patient with colonic obstruction may frequently have bacterial overgrowth and increased breath hydrogen (H2) levels because the bacterium can contact with food residues for longer time. We experienced two cases with intestinal obstruction whose breath H2 concentrations were measured continuously. Case 1 A 70-year-old woman with small bowel obstruction was treated with a gastric tube. When small bowel gas decreased and colonic gas was demonstrated on the plain abdominal radiograph, the breath H2 concentration increased to 6 ppm and reduced again shortly. Case 2 A 41-year-old man with functional small bowel obstruction after surgical treatment was treated with intravenous administration of erythromycin. Although the plain abdominal radiograph demonstrated a decrease of small-bowel gas, the breath H2 gas kept the low level. After a clear-liquid meal was supplied, fasting breath H2 concentration increased rapidly to 22 ppm and gradually decreased to 9 ppm despite the fact that the intestinal gas was unchanged on X-ray. A rapid increase of breath H2 concentration may reflect the movement of small bowel contents to the colon in patients with small-bowel pseudo-obstruction or malabsorption following diet progression. Conclusions Change in breath H2 concentration had a close association with distribution and movement of intestinal gas.

Breath hydrogen and methane levels in a patient with volvulus of the sigmoid colon

Volvulus of the large bowel is the third most common cause of colonic obstruction. A patient with colonic obstruction or delayed small intestinal transit may frequently have bacterial overgrowth and increased breath hydrogen (H(2)) and/or methane (CH(4)) excretion because the bacterium can contact with food residues for a longer time. A 39 year old woman attended our hospital with complaints of abdominal pain and distension. This patients abdominal radiograph showed an inverted U-shaped shadow. The fasting breath CH(4) level was 26 ppm. An endoscopic procedure was immediately carried out with suspected sigmoid colon volvulus, and detorsion was achieved. There was resolution of the sigmoid volvulus after colonoscopy, and breath CH(4) concentration in the next morning decreased to 10 ppm. A liquid meal was supplied at noon on the second hospital day. The breath CH(4) concentration increased markedly to 38 ppm at 18:00 although she had no abdominal symptoms. This value peaked at 42 ppm at 18:00 on the third hospital day and was gradually reduced to 20 ppm the next day. The breath H(2) concentration value kept a low level during fasting and increased markedly to 51 ppm the next day after a liquid meal was supplied. The next morning, fasting breath H(2) concentration rapidly decreased to 6 ppm. This suggests that changes in breath H(2) levels may reflect transient malabsorption after a liquid test meal is supplied. In conclusion, breath H(2) and CH(4) analysis may be another tool for evaluating the intestinal circumstances.

High prevalence of gastroesophageal reflux symptoms in patients with both acute and nonacute cough.

Although there have been many studies that showed a close association between gastroesophageal reflux disease (GERD) symptoms and chronic cough, it has been unknown whether acute cough is also associated with GERD. The aim of this study was to evaluate the relationship between GERD and respiratory symptoms in general practice. 1725 consecutive patients who first attended our hospital were enrolled in the present study. They were asked to respond the F-scale questionnaire regardless of their chief complaints. Over all, 656 (38%) patients were diagnosed as GERD and 226 (13%) had respiratory symptoms. Patients with respiratory symptoms had GERD symptoms more frequently than patients without respiratory symptoms (p < 0.05). Forty-three (37%) of 115 patients with acute cough and 48 (43%) of 111 with nonacute cough had GERD symptoms, suggesting that development of GERD is not associated with the period of respiratory symptoms. Patients with respiratory symptoms are at a significantly increased risk of developing GERD. Whether or not treatment for GERD or respiratory diseases is useful for the prevention of respiratory symptoms and GERD, respectively, should not be driving management decisions in primary care.