Effect of ethanol ingestion on postprandial gastric emptying and secretion, biliopancreatic secretions, and duodenal absorption in man

Association of Alcohol Drinking and Helicobacter pylori Infection : A Meta-analysis

BACKGROUND

The association between drinking and Helicobacter pylori infection was not clear in the literature. Owing to mixed and inconclusive results, a meta-analysis was conducted to summarize and clarify this association systematically.

METHODS

Based on a comprehensive search of PubMed, Embase, and Web of Science databases, studies investigating the association between drinking and H. pylori infection were retrieved. We evaluated the strength of this relationship using odds ratios (ORs) with 95% confidence intervals. Sensitivity analysis was also conducted.

RESULTS

A total of 24 individual studies were included in this meta-analysis. The risk of H. pylori infection was significantly lower in alcohol drinkers than nondrinkers (OR=0.83). People who drink wine (OR=0.90) or mixed types of alcoholic beverages (OR=0.78) had a lower risk of infection compared with those who drink beer. Among people aged 40 years or older, alcohol drinkers had a lower risk of H. pylori infection than nondrinkers (OR=0.68). Among people less than 40 years of age, alcohol drinking was not associated with H. pylori infection risk. Data showed that women were at a lower risk of H. pylori infection than men (OR=0.86).

CONCLUSIONS

This meta-analysis suggests that the risk of H. pylori infection among alcohol drinkers is lower than that of nondrinkers. Drinking wine and mixed types of alcohol are better at reducing H. pylori infection than drinking beer. Nonetheless, we discourage reducing H. pylori infection through drinking, which increases the risk of other diseases.

Smoking, alcohol consumption, diabetes, body mass index, and peptic ulcer risk: A two-sample Mendelian randomization study

Background: Observational evidence has shown that smoking, alcohol consumption, type 2 diabetes, and body mass index (BMI) are risk factors for peptic ulcer disease (PUD), including gastric ulcer (GU) and duodenal ulcer (DU). However, the observed associations may be confounding factors. Herein, we use Mendelian randomization (MR) to examine causal associations such as smoking, alcohol, type 2 diabetes, BMI, and risks of PUD. Methods: We used 8,17,41,325,82, 231, and 616 identified genetic variants as proxies for age of smoking initiation (AgeSmk), smoking cessation (SmkCes, current/former), number of cigarettes smoked per day (CigDay), smoking status (SmkIni, ever/never), alcohol consumption, type 2 diabetes, and BMI to obtain unconfounded effect estimates on the GU and DU levels among 452,264 participants from the Gene ATLAS. The causal relationship was estimated by using inverse-variance weighted (IVW) as the main method. Sensitivity analysis includes Cochran's Q test, the MR-Egger test, MR pleiotropy residual sum and outlier (MR-PRESSO), and MR-robust adjusted profile score (MR-RAPS). In addition, secondary MR analysis was conducted within summary data using genetic risk scores (GRSs) as instrumental variables (IVs). Results: In our two-sample MR analyses, genetic predisposition to smoking (SmkInit) and BMI were associated with an increased risk of GU. The beta values were 0.0035 (95% CI, 0.0021, 0.0049, p = 1.56E-06) for smoking (SmkInit) and 0.0021 (95% CI, 0.0009, 0.0033, p = 0.0008) for BMI. Genetic predisposition to smoking (SmkInit) and higher genetically predicted BMI were associated with an increased risk of DU. The beta values of DU were 0.0029 (95% CI, 0.0017, 0.0041, p = 2.43E-06) for smoking (SmkInit) and 0.0018 (95% CI, 0.0007, 0.0029, p = 0.001) for BMI. No other causal association between smoking (AgeSmk, CigDay, and SmkCes), alcohol consumption, type 2 diabetes, and GU or DU was observed. Consistent results were obtained in sensitivity analyses. Furthermore, the GRS approach showed similar results in the several MR methods. Conclusion: These findings do not support a causal role of AgeSmk, CigDay, SmkCes, alcohol consumption, and type 2 diabetes in the development of GU and DU. However, it is confirmed that SmkInit and BMI have a causal part in the development of GU and DU.

Slow Drinking of Beer Attenuates Subjective Sedative Feeling in Healthy Volunteers: A Randomized Crossover Pilot Study

The change in physiological parameters and subjective feelings according to the speed of drinking alcohol has not been reported to date. The aim of this randomized crossover pilot study was to investigate the objective and subjective effects of different speeds of alcohol ingestion in healthy volunteers. Accordingly, 11 male and 7 female healthy Japanese adults were asked to consume 480 mL of beer at three different drinking speeds (80, 40, and 20 mL/5 min). According to the objective measurement, the transient increase in blood alcohol and serum uric acid concentrations was most inhibited at a drinking speed of 20 mL/5 min. Acetate, lactate, pyruvate, and lactate/pyruvate ratios did not differ between the three drinking speeds. Stimulant feelings measured by the subjective scores of the Brief Biphasic Alcohol Effects Scale did not differ between the three speeds. However, the sedative feeling score obtained at a drinking speed of 20 mL/5 min (the slowest speed of alcohol consumption) was significantly weakened in comparison with those obtained at drinking speeds of 40 and 80 mL/5 min. Therefore, a slower consumption of alcohol mitigated the subjective sedative feeling. The effects of slower alcohol consumption may be caused by the slower slope of the increasing trend of blood alcohol concentration.

Comparative effects of low-carbohydrate, full-strength and low-alcohol beer on gastric emptying, alcohol absorption, glycaemia and insulinaemia in health

AIMS

The aim of this study was to evaluate the comparative effects of low-carbohydrate (LC), full-strength (FS), and low-alcohol (LA) beer on gastric emptying (GE), ethanol absorption, glycaemia and insulinaemia in health.

METHODS

Eight subjects (four male, four female; age: 20.4 ± 0.4 years; BMI 22.7 ± 0.4 kg/m2 ) had concurrent measurements of GE, plasma ethanol, blood glucose and plasma insulin for 180 min on three separate occasions after ingesting 600 mL of (i) FS beer (5.0% w/v, 246 kcal, 19.2 g carbohydrate), (ii) LC beer (4.6% w/v, 180 kcal, 5.4 g carbohydrate) and (iii) LA beer (2.6% w/v, 162 kcal, 17.4 g carbohydrate) labelled with 20 MBq 99mTc-calcium phytate, in random order.

RESULTS

There was no difference in the gastric 50% emptying time (T50) (FS: 89.0 ± 13.5 min vs LC: 79.5 ± 12.9 min vs LA: 74.6 ± 12.4 min; P = .39). Plasma ethanol was less after LA than LC (P < .001) and FS (P < .001), with no difference between LC and FS (P = 1.0). There was an inverse relationship between plasma ethanol at 15 min and GE after LA (r = -0.87, P < .01) and a trend for inverse relationships after LC (r = -0.67, P = .07) and FS (r = -0.69, P = .06). The AUC 0-180 min for blood glucose was greater for LA than LC (P < .001), with no difference between LA and FS (P = .40) or LC and FS (P = 1.0).

CONCLUSION

In healthy young subjects, GE of FS, LC and LA beer is comparable and a determinant of the plasma ethanol response.

Alcohol and gastric motility: pathophysiological and therapeutic implications

Alcohol has been associated with alterations in gastric motility. The literature identifies that various factors play a role in alcohol's effect on gastric emptying including differences in alcohol concentration, osmolarity, caloric content, amino acids as well as different processing techniques (fermentation vs distillation). Additionally, chronic alcohol consumption has been shown to alter the myenteric nitrergic system resulting in impaired gastrointestinal motor function, and it also has an inhibitory effect on the release of several neurotransmitters that play a key role in gastrointestinal motility, including acetylcholine. Whether social or limited intake of alcohol could have a therapeutic role has not been apparent. Serendipitously, we have identified a therapeutic role for alcohol with a meal in the entity of dumping syndrome (DS) where there is postprandial rapid emptying of voluminous and hyperosmolar gastric contents into the small bowel. In the clinical setting of DS attributed to impaired vagal nerve function, there was normalization of gastric emptying and resolution of accompanying symptoms when drinking a glass of wine before and during meals. We propose that alcohol's anticholinergic effect was augmented in the setting of vagal nerve denervation resulting in slowing of gastric emptying and in alleviation of symptoms of early DS. This review article provides an in-depth analysis of the published literature on alcohol and gastric motility focusing on the accumulated knowledge that may have clinical application and relevance.

Basal and Spasmolytic Effects of a Hydroethanolic Leaf Extract of Melissa officinalis L. on Intestinal Motility: An Ex Vivo Study

Melissa officinalis L. (lemon balm) has been used for decades with symptomatic benefits in patients with digestive disorders. However, very little is known on the effects of M. officinalis on the gastrointestinal (GI) tract. In this study, the basal and spasmolytic properties of a hydroethanolic leaf extract (HLE) of M. officinalis were assessed ex vivo on different segments of the GI tract of mice after phytochemical characterization of the extract. M. officinalis HLE had site- and dose-dependent effects on the contractile activity of the GI tract, the motility response being impacted in the jejunum and ileum but not in the antrum and colon. The observed effects could be caused by the phenolic compounds (mainly rosmarinic acid) detected in the extract.

Alcohol intake and Helicobacter pylori infection: a dose-response meta-analysis of observational studies

Background Alcohol intake has been suggested to have an impact on the development of many chronic diseases. How alcohol intake may modulate risk of Helicobacter pylori (H. pylori) infection, however, remains a subject open for investigation. A dose-response meta-analysis was performed of epidemiological studies to better quantify this relationship. Materials and methods Twelve observational articles were identified. The summary odds ratio (OR) and confidence intervals (CI) were calculated for alcohol drinkers vs non-drinkers. The summary OR estimates were obtained using the random-effects model and dose-response meta-analysis. Sub-group and sensitivity analysis were also conducted. Results The summary OR was 0.78 (95% CI = 0.69-0.89). The dose-response analysis demonstrated that for drinkers of 10, 15, 30, 60 and 96 g/day alcohol intake, the estimated ORs were 0.80 (95% CI = 0.76-0.85), 0.79 (95% CI = 0.75-0.84), 0.83 (95% CI = 0.78-0.87), 0.85 (95% CI = 0.78-0.93) and 0.87 (95% CI = 0.70-1.06), respectively, compared to non-drinkers. The inverse relationship between alcohol intake and H. pylori infection was consistent, regardless of sex, age, geographic areas, detection methods or beverage types.

CONCLUSION

Evidence from these observational studies suggests that moderate alcohol intake is associated with a reduction in H. pylori infection of ∼ 22% and may facilitate elimination of H. pylori.

A comparison of the different animal models of fetal alcohol spectrum disorders and their use in studying complex behaviors

Prenatal ethanol exposure (PNEE) has been linked to widespread impairments in brain structure and function. There are a number of animal models that are used to study the structural and functional deficits caused by PNEE, including, but not limited to invertebrates, fish, rodents, and non-human primates. Animal models enable a researcher to control important variables such as the route of ethanol administration, as well as the timing, frequency and amount of ethanol exposure. Each animal model and system of exposure has its place, depending on the research question being undertaken. In this review, we will examine the different routes of ethanol administration and the various animal models of fetal alcohol spectrum disorders (FASD) that are commonly used in research, emphasizing their strengths and limitations. We will also present an up-to-date summary on the effects of prenatal/neonatal ethanol exposure on behavior across the lifespan, focusing on learning and memory, olfaction, social, executive, and motor functions. Special emphasis will be placed where the various animal models best represent deficits observed in the human condition and offer a viable test bed to examine potential therapeutics for human beings with FASD.

Alcohol and smoking

The WHO ranks smoking and alcohol consumption as the first and third leading causes of the global burden of disease in industrialized countries, using disability-adjusted life years (DALYs) as a combined measure of premature death and disability. Smoking is responsible for 12.2% of all DALYs and alcohol consumption for 9.2%. For example in Germany, annually 110,000-140,000 humans die prematurely because of cigarette smoking and 40,000 because of alcohol drinking. In Europe and the USA, more than 20% of all hospitalized men and more than 9% of all hospitalized women suffer from alcohol-associated diseases. In Germany, about 2.0 million people in the age group 18-64 years (3.8% of all Germans) are alcohol abusers and 1.3 million people (2.4%) are alcohol-dependent. Alcohol can cause acute as well as chronic damage in nearly all body organs. Smoking damages also nearly every human body organ and is worldwide the most important single preventable health risk factor as well as the main cause for premature mortality in industrial countries. One third of the adult Germans as well as of the world population are active smokers; men smoke more frequently than women (34.0 vs. 25.1%). In this review a short overview will be given on the most important deleterious effects of alcohol and smoking. The most recent data about the pathophysiological relevance of non-alcoholic compounds of alcoholic beverages will also be discussed.

Chronic alcohol consumption induces an overproduction of NO by nNOS- and iNOS-expressing myenteric neurons in the murine small intestine

BACKGROUND

There are indications that alterations in the nitric oxide (NO) system of relaxation mediate gastrointestinal motor disturbances induced by chronic alcohol consumption (CAC). As CAC is known to inhibit the motility of the mouse small intestine, we investigated in this model if CAC affects basal NO synthesis by myenteric neurons and which NOS isoforms are involved.

METHODS

The instantaneous NO synthesis of individual neurons was optically measured in whole-mount preparations loaded with the NO synthesis indicator DAF-FM, and the expression of nNOS, iNOS and eNOS was determined by immunohistochemistry.

KEY RESULTS

The DAF-FM recordings showed that CAC induced an increase in neuronal NO synthesis (absolute fluorescence: control 34±12; CAC 140±56; mean±SD; P<0.0004). Neurons of control mice expressed the nNOS (29±3% of total) and iNOS (28±1%) isoforms. eNOS expression was observed in <0.5% of the neurons. Chronic alcohol consumption caused an increase in the proportion of iNOS-expressing neurons (to 33±5%; P<0.01) and a decrease in nNOS-expressing neurons (to 22±3%; P<0.0001), without altering the proportion of NO-producing neurons (control 55±13%; CAC 56± 11%; P=0.82).

CONCLUSIONS & INFERENCES

Chronic alcohol consumption induces a marked increase in NO synthesis by jejunal myenteric neurons, accompanied by an up-regulation of iNOS-expressing neurons and a downregulation of nNOS neurons. We conclude that the overproduction of NO may be a direct cause of gastrointestinal motility disturbances.

Reduced ¹³C-D-xylose absorption in alcoholics is more likely caused by alterations in small intestinal mucosa than delayed gastric emptying

OBJECTIVE

Alterations of the small intestinal absorptive surface are a probable cause of D-xylose malabsorption in chronic alcoholism. Delayed gastric emptying, however, may influence the (13)C-D-xylose breath test, which is used to study intestinal function in alcoholics. The aim of this study was to measure gastric emptying in alcoholics to elucidate whether retention of the test meal could explain the malabsorptive pattern of the (13)C-D-xylose breath test observed in alcoholics.

MATERIAL AND METHODS

Fifteen alcoholics performed the (13)C-octanoic acid and the (13)C-D-xylose breath tests on consecutive days in a random order. The (13)CO(2) expired was measured every 30 or 15 min for 4 h in the (13)C-D-xylose and the (13)C-octanoic acid breath tests, respectively, using a mass spectrometer equipped with a gas chromatograph. Test meals consisted of 100 mg of (13)C-D-xylose and 5 g of unmarked D-xylose dissolved in 250 ml water and 91 mg (13)C-octanoic acid embedded in a one-egg omelette served with white bread with margarine, respectively.

RESULTS

The alcoholic patients had a lower (13)C-D-xylose breath index compared with healthy controls (p < 0.0001). None of the (13)C-octanoic acid breath test variables, T(50%), T(max), T(lag), or GEC revealed any significant differences between the groups.

CONCLUSION

The pathological (13)C-D-xylose breath test in this group of alcoholics is unlikely to be caused by delayed gastric emptying. Malabsorption is the probable cause of the pathological (13)C-D-xylose breath test results in alcoholics.

Chronic alcohol consumption affects gastrointestinal motility and reduces the proportion of neuronal NOS-immunoreactive myenteric neurons in the murine jejunum

Alcohol consumption interferes with gastrointestinal transit causing symptoms in alcoholic patients. Nitric oxide (NO), synthesized by neuronal nitric oxide synthase (nNOS) plays an important role in the control of gastrointestinal motility. Our aim was to investigate whether chronic alcohol intake in a murine model induces gastrointestinal motility disturbances and affects the nitrergic myenteric neurons in the stomach and jejunum. Gastric emptying, small intestinal transit and geometric centre were measured in vivo after intragastric gavage of Evans blue. Nitrergic relaxations to electrical field stimulation (EFS) and exogenous NO were recorded in jejunal muscle strips in vitro. The proportion of nNOS-immunopositive myenteric neurons was assessed using PGP9.5 and nNOS immunostaining. After chronic alcohol consumption, gastric emptying and small intestinal transit were delayed compared with control mice, and the nitrergic nerve-mediated relaxations to EFS in the jejunum were decreased, whereas relaxations to exogenous NO did not differ. The proportion of nNOS-immunoreactive neurons did not change in the stomach, whereas in the jejunum the percentage decreased from 33% to 27% (P < 0.001) after chronic alcohol intake. The total number of myenteric neurons remained unchanged. These results suggest that chronic alcohol consumption disturbs gastric and small intestinal motility in vivo and in vitro and is associated with a decrease in the proportion of nNOS-immunoreactive myenteric neurons in the murine jejunum.

Smoking and drinking habits are important predictors of Helicobacter pylori eradication

PURPOSE

The aim of the study was to evaluate the effect of smoking and drinking habits, in separate and joint analyses, on the efficacy of H. pylori eradication.

MATERIALS AND METHODS

A total of 250 patients were recruited. They were treated with a 7-day course of omeprazole, amoxicillin, tinidazole (OAT), omeprazole amoxicillin, clarithromycin (OAC) or omeprazole, clarithromycin, tinidazole (OCT). The efficacy of H. pylori eradication was tested with a CLO-test and histology 4 weeks after the completion of antibacterial therapy.

RESULTS

Drinking was found not to affect the efficacy of H. pylori eradication in any therapeutic group, while smoking decreased it in the OAC group (smokers 69.6%, non-smokers 94.3%, p=0.006). In the OAT treated group H. pylori eradication rate was lower in smokers-non-drinkers than in smokers-drinkers and non-smokers-non-drinkers (38.9% vs 83.2% and 70.0%, p=0.002 and p=0.034, respectively), while in the OAC treated group, smokers-non-drinkers had lower eradication efficacy than non-smokers-drinkers and non-smokers-non-drinkers (59.1% vs 100% and 91.3%, p=0.01 and p=0.012, respectively). In the OCT treated group, differences between subgroups were not significant.

CONCLUSIONS

Smoking and drinking habits when analyzed jointly are more useful to predict the outcome of H. pylori eradication than when analyzed separately.

Physical and biological considerations for the use of nonaqueous solvents in oral bioavailability enhancement

This review addresses the use of nonaqueous solvents as components of oral formulations in discovery and preclinical studies. Pharmacology, pharmacokinetic, and safety studies are frequently conducted with solution formulations that use a solvent to solubilize poorly aqueous soluble drugs. The physical chemical basis for solubilization and the precipitation of solubilized drug following administration both contribute to the utility of nonaqueous solvent solutions as oral vehicles. While many of these solvents are considered nontoxic, they are not completely inert biologically. The effects of common nonaqueous solvents on the structural integrity of the epithelia, the inherent permeability of and flux across the GI membrane, the activity of efflux and metabolic enzymes, and the effects on GI motility and GI transit times will be described through an examination of available literature. The practical relevance of these factors to the development of early formulations will be examined critically and suggestions made for the suitability of nonaqueous solvents for a variety of purposes.

Chronic ethanol exposure impairs neuronal nitric oxide synthase in the rat intestine

BACKGROUND

Nitric oxide (NO), synthesized by neuronal (nNOS), endothelial (eNOS), and inducible (iNOS) nitric oxide synthases, plays an essential role in the physiological functions of the gastrointestinal (GI) tract. Chronic ethanol intake has been shown to interfere with several of these physiological functions, leading to the pathological alterations observed in alcoholic individuals. Our aim therefore was to investigate the effects of chronic ethanol consumption on NOS isoforms in different GI segments.

METHODS

Rats received either 20% aqueous ethanol solution or water for 8 weeks. Tissue samples of the duodenum, jejunum, ileum, and colon of the rats were used for measurement of the NOS activity, protein content, and nNOS immunohistochemistry. Anti-HuC/D immunohistochemistry was used to determine the total number of neurons.

RESULTS

Measurement of the physiological constitutive NOS (cNOS) activity revealed a 20 times higher activity in the colon than in the small intestine and after chronic ethanol treatment demonstrated a significant decrease in the jejunum, ileum, and colon, while in the duodenum it remained unchanged compared with the control group. The physiological iNOS activity was higher in the ileum and colon than in the duodenum and jejunum, and these levels were not significantly affected by ethanol. Neuronal nitric oxide synthase immunohistochemistry revealed a significant decrease in the numbers of immunostained cells in all investigated intestinal segments, while the total number of myenteric neurons remained constant. The nNOS protein content measured by Western blotting indicated a significant decrease in the colon after ethanol consumption, while in other intestinal segments change was not detectable.

CONCLUSIONS

This study has demonstrated for the first time that chronic ethanol consumption has a differential effect on NOS activity, NOS protein content, and the number of nitrergic neurons in different intestinal segments, suggesting that chronic ethanol administration affects the NO pathways in the enteric nervous system.

Isolation of stimulants of gastrointestinal motility in beer

BACKGROUND

Among various alcoholic beverages, it has reported that beer has a potent activity to stimulate gastric emptying. Our previous studies showed that beer congener stimulated gastrointestinal motility by directly stimulating muscarinic M3 receptor, present in smooth muscles of the gastrointestinal tract. However, active components that account for the action have yet to be identified. We attempted to isolate the stimulant(s) of gastrointestinal motility in beer.

METHODS

Beer congener was prepared from beer and used to separate and purify active components by a series of liquid chromatography using affinity to muscarinic M3 receptor as an index. Gastrointestinal motility-stimulating activity was evaluated using a test for activity that causes contraction of longitudinal muscles in guinea pig ileum and a test for gastric emptying activity in mice.

RESULTS

The active components (compounds A and B) were purified and isolated from beer by four liquid chromatography steps. The IC50 values of two active isolates to muscarinic M3 receptor were 0.65 x 10 g/ml and 2.30 x 10 g/ml, respectively. The concentrations of compounds A and B contained in beer were sufficient to explain most of the muscarinic M3 receptor binding activity of beer. The active fraction that contained both compounds A and B (which was 10 times as active as beer congener in muscarinic M3 receptor binding activity) dose-dependently contracted the longitudinal muscles of guinea pig ileum with an activity that was 20 times as potent as that of beer congener. The same active fraction significantly stimulated gastric emptying in mice with an activity 20 times as potent as that of beer congener.

CONCLUSIONS

Two active components (compounds A and B) were isolated as gastrointestinal motility stimulants (muscarinic M3 agonists) in beer. These results suggest that the two isolated active components are the active entities of the gastrointestinal motility-stimulating effect of beer.

THE EFFECT OF ETHANOL AND ALCOHOLIC BEVERAGES ON GASTRIC EMPTYING OF SOLID MEALS IN HUMANS

AIMS

The systematic study of the effect of pure ethanol, alcoholic beverages, and their non-alcoholic components on gastric emptying of solid meals in humans.

METHODS

16 fasting healthy male subjects received once weekly 300 ml of the following solutions in random order: 4 and 10% (v/v) ethanol, beer, red wine, 5.5 and 11.4% (w/v) glucose, and water. The test solutions were given either together with a low caloric (270 kcal, n = 8) or a high caloric (740 kcal, n = 8) solid meal. Ultrasonography of the antrum was used to determine gastric emptying.

RESULTS

Gastric half emptying time (t(1/2) ) of the high caloric solid meal with water was 131.3 +/- 7 min. The ingestion of 4 and 10% (v/v) ethanol (158.8 +/- 9.3 and 165.6 +/- 6.2 min, respectively), beer (163.1 +/- 11 min), and red wine (186.3 +/- 8.4 min) resulted in a significantly longer t(1/2) than water. The lag phases after 4 and 10% (v/v) ethanol, beer, and red wine were not significantly different from that of water (48.1 +/- 6.5 min). Compared with water, the ingestion of 5.5 and 11.4% (w/v) glucose resulted in a significantly longer t(1/2) (153.8 +/- 5 and 168.1 +/- 14.4 min, respectively) by increasing the duration of the lag phase. The high caloric meals resulted in a 2-fold prolongation of t(1/2) when compared with the low caloric meals. The effect of the solutions on the gastric emptying times, however, was similar for both test meals.

CONCLUSIONS

(i) Ethanol in low concentrations of 4 and 10% (v/v) prolongs gastric emptying of solid meals; this inhibitory effect is not dose-dependent. (ii) Alcoholic beverages (beer and red wine) also result in a prolongation of gastric emptying. The inhibitory effect of red wine, but not of beer, is more pronounced than that of the corresponding ethanol concentration and amount. (iii) The inhibitory effect of ethanol and alcoholic beverages is mainly induced by a prolongation of the gastric emptying phase (without affecting the lag phase), whereas 5.5 and 11.4% (w/v) glucose prolong the lag phase in a dose-dependent manner. (iv) The inhibitory effect of ethanol, beer, and red wine on gastric emptying does not depend on the caloric content of the meal.

Reliability of the [13C]-acetate breath test in the measurement of gastric emptying of ethanol solutions: a methodological study

BACKGROUND

The [13C]-acetate breath test is a clinically well-established test for measuring gastric emptying of liquids and correlates significantly with scintigraphy. However, no studies have been undertaken to examine the relationship between gastric emptying measured by the [13C]-acetate breath test and ultrasonography. Furthermore, it is not known how ethanol may affect gastric emptying as measured by the [13C]-acetate breath test. This is particularly important because of the additional steps of absorption, metabolism and exhalation of the tracer involved in the [13C]-acetate breath test compared to the simple measurement of gastric emptying by ultrasonography. The aim of the present study was to examine the relationship between the gastric half emptying times measured by the [13C]-acetate breath test and by ultrasonography and to determine the effect of ethanol on the comparability between both methods.

METHODS

On separate days, 10 healthy, fasted randomly selected subjects received the following solutions by gastric tube: 500 mL water, 4% and 10% (v/v) ethanol, 5.5% and 11.4 % (w/v) glucose. Gastric half emptying times of the test solutions were simultaneously determined using the [13C]-acetate breath test and ultrasonography of the fundus and the antrum.

RESULTS

The gastric emptying rates determined by ultrasonography of the fundus correlated significantly with the results obtained using the [13C]-acetate breath test for all test solutions (r = 0.64-0.92, P < 0.05 for all), whereas ultrasonography of the antrum correlated significantly with the breath test only when water (r = 0.94, P = 0.001) was used. The difference between the mean half-emptying times obtained using the [13C]-acetate breath test and ultrasonography of the fundus was 55 +/- 1.8 min. This difference was significantly longer when 4% and 10% (v/v) ethanol solutions were given (61.2 +/- 3.3 and 71.2 +/- 2.9 min) compared to water (P < 0.05).

CONCLUSIONS

A good correlation was found between gastric emptying as measured by the [13C]-acetate breath test and ultrasonography of the fundus. Measurements that were obtained using the [13C]-acetate breath test demonstrate a longer gastric half emptying time compared with those obtained using ultrasonography. This difference is even more marked when ethanol solutions are used. Presumably, this is because ethanol affects the absorption and/or the hepatic metabolism of the tracer. The [13C]-acetate breath test is therefore not a reliable gastric emptying test for comparison of different solutions, especially when ethanol-containing liquids are used.

Effect of ethanol and some alcoholic beverages on gastric emptying in humans

BACKGROUND

There is a paucity of detailed and controlled studies on the action of ethanol and alcoholic beverages on gastric emptying in humans. This study was designed to compare the effect of beer, red wine, whisky and their comparable pure ethanol solutions on gastric emptying in a controlled and randomized investigation.

METHODS

On separate days, 10 healthy, fasted subjects received the following solutions, in random order, through a gastric tube: 500 mL beer, red wine, comparable pure ethanol solutions (4% and 10% v/v), glucose (5.5% and 11.4% w/v) and water, 125 mL whisky and 40% (v/v) ethanol (both followed by 125 mL water) and 250 mL water. Gastric emptying of the test solutions was assessed using ultrasonography of the antrum.

RESULTS

As measured by ultrasonography of the antrum, half emptying times of the ethanol solutions (4%, 10% and 40% v/v) were significantly (P < 0.05) longer (22.6 +/- 4.8, 22.7 +/- 4.3 and 27.8 +/- 3.3 min, respectively, n=10) than those of water (14.6 +/- 1.9 min (500 mL) and 13.2 +/- 1.7 min (250 mL), respectively). The half emptying times of beer (39.3 +/- 4.3 min) and red wine (72.6 +/- 7.6 min) were significantly longer than those of the corresponding ethanol concentrations, whereas whisky was emptied at nearly the same rate (26.4 +/- 5.9 min) as 40% (v/v) ethanol. Emptying of glucose 5.5% and 11.4% (w/v) was significantly and dose dependently slower (29.7 +/- 4.5 and 64.8 +/- 8.9 min) than water.

CONCLUSIONS

1) Pure ethanol in concentrations of 4%, 10% and 40% (v/v) inhibits gastric emptying. 2) The inhibitory effect of beer and red wine, but not of whisky, is stronger than that of their comparable ethanol concentrations. 3) Caloric content and non-alcoholic ingredients in alcoholic beverages produced by fermentation (beer and wine), but not in those produced by distillation (whisky), are most likely responsible for this effect.

Interest of Chromogranin A for diagnosis and follow-up of endocrine tumours

OBJECTIVE

To determine the interest of Chromogranin A (CgA) determination for diagnosis and follow-up in patients with gastroenteropancreatic endocrine tumours (GEP-ET) and multiple endocrine neoplasia type 1 (MEN-1).

PATIENTS AND METHODS

CgA levels were measured with an immunoradiometric assay in 124 sporadic GEP-ET, 34 MEN-1 and 127 controls. Serial determinations were performed in 56 patients (212 visits). Changes in CgA levels over 25% were considered as significant.

RESULTS

Using a cut-off value of 130 micro g/l, established from a receiver-operating characteristic curve, the specificity of CgA was 98.4%, with a sensitivity of 62.9%, higher in secreting than in nonsecreting tumours (73%vs. 45%; P < 0.003) and related to the extent of metastatic spreading (P < 0.001). In nonsecreting tumours, the positive predictive value (PPV) of CgA for the presence of metastases was 100% but the negative predictive value (NPV) was only 50%. In MEN-1, high CgA levels indicated a pancreatic tumour with a 100% specificity but the sensitivity was 59%. During the follow-up, the concordance between CgA and tumour evolution was 80%, whatever the secretory status. In patients with carcinoid tumours, the concordance was higher for CgA than for serotonin (81%vs. 54%; P < 0.001).

CONCLUSION

Due to its high specificity, CgA determination may help to discriminate the endocrine character of a GEP tumour and to indicate a pancreatic tumour in MEN-1. However, its low NPV in nonsecreting tumours limits its interest for diagnosis and staging. By contrast, serial evaluation of CgA seems of particular interest for the follow-up of GEP-ET tumours.

The mechanisms of the inhibitory effect of ethanol on gastric emptying involve type A CCK receptors

The mechanisms involved in the mediation of the inhibitory effects of ethanol on gastric emptying were studied in adult male rats. The gastric emptying was determined by measuring the amount of phenol red recovered from the stomach after intragastric administration. Intragastric administration of a 2.5 g kg(-1) body weight dose of ethanol resulted in inhibition of the gastric emptying. Prior intraperitoneal treatment with lorglumide (CR-1409), a selective CCK-A receptor antagonist, abolished the inhibitory effect of ethanol on the gastric emptying. This observation furnishes evidence indicative of the involvement of type A CCK receptors in the mediation of the inhibitory effect of large doses of ethanol on the gastric emptying.

Alcohol-related diseases of the oesophagus and stomach

This chapter deals with the most clinically relevant alcohol-related diseases of the oesophagus and stomach. Despite the early findings of W. Beaumont 170 years ago that excessive drinking is associated with gastric bleeding, systematic studies on the action of alcohol and alcoholic beverages on the function of the stomach have only been performed in the last 15 years. The aim of this review is to summarize the data on the effect of acute and chronic alcohol consumption/abuse on the oesophagus and stomach.

Effect of acute cigarette smoking, alone or with alcohol, on gastric barrier function in healthy volunteers

BACKGROUND

Smoking is a risk factor for gastroduodenal ulcer and gastric adenocarcinoma. However, the pathophysiological mechanisms induced by acute cigarette smoking in the human gastric mucosa are poorly understood.

AIM

To evaluate the effect of acute cigarette smoking, alone or with alcohol, on the gastric permeability to sucrose, a specific marker of mucosal damage in the stomach.

SUBJECTS AND METHODS

Twenty healthy volunteers (8 smokers/12 non-smokers) were studied. Each fasted subject ingested 500 ml of a 20% sucrose solution and the amount of sucrose excreted in a 5-hour urine collection was measured by gas chromatography Four sucrose permeability tests were carried out: 1. basal, 2. while smoking 5 cigarettes, 3. after drinking 50 ml of a 40 degrees alcoholic beverage, 4. a combination of 2+3.

RESULTS

Sucrose excretion increased after alcohol ingestion (40.5 +/- 6.0 mg vs 143.1 +/- 28.9 mg, p = 0.002), but was not modified by acute cigarette smoking (34.4 +/- 5.9 mg). When alcohol and cigarettes were simultaneously consumed, the increase in alcohol-induced sucrose excretion was significantly reduced (73.1 +/- 16.6 mg, p = 0.03). Basal sucrose excretion was similar in smokers and non-smokers. However, in acute cigarette smoking, a decrease in sucrose excretion was observed in smokers (p = 0.02) but not in non-smokers.

CONCLUSIONS

These results indicate that acute cigarette smoking may tighten the gastric mucosa in habitual smokers and this is associated with a smaller increase of gastric permeability induced by alcohol.

Activated charcoal alone or after gastric lavage: a simulated large paracetamol intoxication

AIMS

Activated charcoal is now being recommended for patients who have ingested potentially toxic amounts of a poison, where the ingested substance adsorbs to charcoal. Combination therapy with gastric lavage and activated charcoal is widely used, although clinical studies to date have not provided evidence of additional efficacy compared with the use of activated charcoal alone. There are also doubts regarding the efficacy of activated charcoal, when administered more than 1 h after the overdose. The aim of this study was to examine if there was a difference in the effect of the two interventions 1 h post ingestion, and to determine if activated charcoal was effective in reducing the systemic absorption of a drug, when administered 2 h post ingestion.

METHODS

We performed a four-limbed randomized cross-over study in 12 volunteers, who 1 h after a standard meal ingested paracetamol 50 mg kg(-1) in 125 mg tablets to mimic real-life, where several factors, such as food, interfere with gastric emptying and thus treatment. The interventions were activated charcoal after 1 h, combination therapy of gastric lavage followed by activated charcoal after 1 h, or activated charcoal after 2 h. Serum paracetamol concentrations were determined by h.p.l.c. Percentage reductions in the area under the curve (AUC) were used to estimate the efficacy of each intervention (paired observations).

RESULTS

There was a significant (P<0.005) reduction in the paracetamol AUC with activated charcoal at 1 h (median reduction 66%, 95% confidence intervals 49, 76) compared with controls, and a significant (P<0.01) reduction for gastric lavage followed by activated charcoal at 1 h (median reduction 48.2%, 95% confidence interval 32.4, 63.7) compared with controls. There was no significant difference between the two interventions (95% confidence interval for the difference -3.8, 34.0). Furthermore, we found a significant (P<0.01) reduction in the paracetamol AUC when activated charcoal was administered 2 h after tablet ingestion when compared with controls (median 22.7%, 95% confidence intervals 13.6--34.4).

CONCLUSIONS

These results suggest that combination treatment may be no better than activated charcoal alone in patients presenting early after large overdoses. The effect of activated charcoal given 2 h post ingestion is substantially less than at 1 h, emphasizing the importance of early intervention.

Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using omeprazole, clarithromycin and amoxicillin for 1 week

OBJECTIVE

To study the relationship between daily alcohol consumption and the result of eradication therapy for Helicobacter pylori using omeprazole, clarithromycin and amoxicillin for 1 week.

DESIGN

Clinical trial.

SETTING

Urban health centre, general medicine section.

PARTICIPANTS

One hundred and fifty-six patients with a diagnosis of peptic ulcus or chronic gastritis. Helicobacter pylori infection was confirmed by the urease test, the 14C-urea breath test, IgG serology or biopsy.

INTERVENTIONS

A combination of omeprazole, 20 mg twice daily, clarithromycin, 500 mg twice daily, and amoxicillin, 1000 mg twice daily was administered for 1 week. No other drugs were given. Four to 8 weeks later a 14C-urea breath test was carried out to confirm eradication.

MAIN OUTCOME MEASURES

Logistic regression was used to assess the relationship between eradication and daily alcohol consumption (main covariable), age, sex, smoking, length of illness, pathology studied (ulcus or gastritis) and therapeutic compliance.

RESULTS

Eradication (intention to treat analysis) was successful in 118 patients (75.6%; 95% CI, 68.9-82.4). The only variable significantly associated with the result of the therapy was daily alcohol consumption, with a higher probability of failure in non-consumers (29.9%) than in consumers (12.2%), adjusted OR 3.24 (95% CI, 1.12-9.20; P = 0.03). Eradication was dose dependent: 70.1% in abstemious patients (n = 107), rising to 79.3% in users of 4-16 g of pure ethanol a day (n = 29) and to 100% in users of 18-60 g daily (n = 20) with a P value of 0.005 for the trend.

CONCLUSIONS

Daily alcohol consumption appears to have an additive effect in this eradication therapy.

Nutritional problems in end-stage liver disease: contribution of impaired gastric emptying and ascites

GOALS

To evaluate gastric emptying before and after paracentesis in patients with cirrhosis.

BACKGROUND

Patients with ascites often report early satiety. The effect of paracentesis on gastric emptying has not been studied previously.

STUDY

Twelve patients who required therapeutic paracentesis were studied (mean age, 57 years; range, 47-69 years). Gastric emptying was performed with radionuclide scintigraphy. Satiety was evaluated with a visual analogue scale. Wilcoxon signed-rank tests were used for comparison between pre-and poststudies.

RESULTS

The causes of cirrhosis included alcohol (seven patients), a combination of alcohol and hepatitis C (two), chronic hepatitis C only (one), primary biliary cirrhosis (one), and cryptogenic (one). The median volume of ascitic fluid removed at paracentesis was 5,450 mL (range, 2,500-7,200 mL). Median 2-hour gastric emptying was 65.5% before paracentesis and 61.5% after ( p > 0.05). Median 4-hour gastric emptying was 92.5% before paracentesis and 96.5% after ( p > 0.05). Both satiety score and caloric intake were significantly improved after paracentesis ( p < 0.05).

CONCLUSIONS

Although satiety and calorie intake improve after large-volume paracentesis in patients with cirrhosis, these changes do not seem to correspond with improved gastric emptying. Therefore, other mechanisms most likely contribute to satiety.

[Alcohol and pancreas]

The mechanism of the pancreatic toxicity of alcohol is not completely elucidated. Many cofactors may contribute to the pancreatic toxicity of alcohol: diet, genetic factors. Chronic pancreatitis occurs after a long lasting and heavy alcoholism. During the first years, acute manifestations occur and, then endocrine and exocrine pancreatic insufficiency.

Alcohol as a gastric disinfectant? The complex relationship between alcohol consumption and current Helicobacter pylori infection

Alcoholic beverages have antimicrobial effects against Helicobacter pylori in vitro. To elucidate the relation between alcohol consumption and current infection with H. pylori in vivo, we carried out a pooled analysis of three recent studies from Southern Germany, comprising 1410 adults age 15 to 69. Detailed information on consumption of various alcoholic beverages was collected through standardized questionnaires. Helicobacter pylori infection was measured by 15C-urea breath test. Overall, prevalence of current H. pylori infection was lower among subjects who consumed alcohol (34.9%) than among nondrinkers (38.0%). The adjusted odds ratio was 0.79, with a 95% confidence interval of 0.58-1.08. Furthermore, alcohol consumption showed a strong inverse relation to the result of the 13C-urea breath test, a semiquantitative measure of the bacterial load, among infected subjects. The inverse association between alcohol consumption and H. pylori infection was not monotonic, however. Odds of infection were lowest at moderate levels of alcohol consumption and increased at higher levels of alcohol consumption, regardless of the type of alcoholic beverages consumed. These results support the hypothesis that moderate alcohol consumption may favor suppression and eventual elimination of H. pylori infection. At higher levels of alcohol consumption, the antimicrobial effects of alcoholic beverages may be opposed by adverse systemic effects of drinking, such as adverse effects on the immune defense.

Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study

Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

Alcohol-related diarrhea

Abstract Alcohol generates a large caloric yield without supplying any essential nutrients; alcoholics may thus maintain body weight while suffering from malnutrition. In addition, diarrhea is a common complaint of both acute and chronic alcoholics. Here, we review the effects of alcohol on gastrointestinal morphology, function, its nervous system and motility. Acute morphological changes such as erosions, inflammatory cell infiltrations and microvascular changes are seen in the stomach and small intestine in acute alcoholics. In addition, atrophic gastritis, reduced villous height and decreased mucosal surface area of the small intestine have been described in chronic alcoholics. Acute administration of alcohol inhibits absorption of nutrients and fluids, and can stimulate secretion of water and electrolytes. Bacterial overgrowth in the proximal small intestine and decreased pancreatic secretions have been also described in chronic alcoholics. The well-known deleterious effects of alcohol on the central nervous system raise the possibility of similar acute and chronic effects of the enteric nervous system. Such effects could alter motility and transit. Indeed, esophageal dysmotility and delayed gastric emptying have been observed with high concentrations of alcohol in experimental studies and in chronic alcoholics. Small bowel motility and transit may be abnormal in both acute and chronic alcoholics, and colonic propulsive motility is increased after acute administration of alcohol. Any, or all, of these changes in gastrointestinal functions may contribute to diarrhea in acute binge drinkers and chronic alcoholics. Unfortunately, there is a lack of systematic studies of the pathophysiology of alcohol abuse, and an integrating concept of the diarrhea of alcoholics is still not possible.

A review: acute and chronic effects of ethanol and alcoholic beverages on the pancreatic exocrine secretion in vivo and in vitro

Whereas oral or intraduodenal ethanol causes a moderate stimulation of pancreatic bicarbonate and enzyme output, intravenous ethanol inhibits basal and hormonally stimulated pancreatic exocrine secretion in humans, dogs, cats, pigs, rabbits, and rats. This inhibition could be mediated by inhibitory cholinergic mechanisms or be the result of a direct cellular effect of ethanol. In vitro investigations have specified several signaling molecules that may be involved in the action of ethanol on stimulus-secretion coupling in the exocrine pancreas, including cyclic adenosine monophosphate, intracellular calcium, and cholecystokinin and somatostatin receptors. In difference to pure ethanol solutions and distilled spirits, beer strongly stimulates pancreatic enzyme output, probably by nonalcoholic fermentation products. During chronic alcoholism, the ethanol-induced inhibition is replaced by an enhanced enzyme output that causes intraductal protein precipitation. In vitro investigations suggest that this increase is reversible after alcohol withdrawal. The occurrence of protein precipitates is considered to be a crucial step in the development of chronic alcoholic pancreatitis in humans. Other ethanol-induced secretory alterations that may contribute to the development of alcoholic pancreatitis are a decreased secretion of trypsin inhibitor, an increased cholinergic tone, and changes in the concentration of lithostathine.

Gastric emptying of beer in Mexican-Americans compared with non-Hispanic whites

Gastric emptying studies were performed on 11 nondiabetic Mexican-Americans and 11 nondiabetic non-Hispanic whites following ingestion of 450 mL beer. Plasma glucose, serum insulin, and serum alcohol levels were measured in the fasting state and at 7, 15, 30, 45, and 60 minutes following ingestion of the beer. The area under the gastric emptying curve was significantly larger for non-Hispanic whites compared with Mexican-Americans (P = .0492), indicating that Mexican-Americans had faster stomach emptying. Partial correlation coefficients (adjusted for ethnicity, gender, age, and body mass index [BMI]) showed the gastric half-emptying time was inversely related to the incremental levels of glucose (r = -.709, P = .0010) and alcohol (r = -.650, P = .0035). The faster the rate of gastric emptying of beer, the higher the glucose and alcohol levels. There were no significant correlations between insulin and the rate of gastric emptying. The caloric emptying rate for the beer was much more rapid than previously reported for other liquid meals.

Effect of beer, yeast-fermented glucose, and ethanol on pancreatic enzyme secretion in healthy human subjects

The effect of beer, ethanol (4% v/v), and corresponding volumetric (water), caloric (glucose 5.76% w/v), and osmotic (glucose 11.5% w/v) control solutions on pancreatic enzyme output and release of gastrin and cholecystokinin (CCK) were studied in six healthy human subjects. As a simpler model of beer, yeast-fermented glucose solution (11.5% w/v) was also studied and compared with unfermented glucose (11.5% w/v). Among the control solutions, the two glucose solutions, but not water, significantly (P < 0.05) increased the 150-min integrated trypsin and amylase output over basal levels. Beer and fermented glucose caused a significantly higher increase in trypsin and amylase output compared to water or glucose. Ethanol (4% v/v) failed to stimulate pancreatic enzyme output. Fermented glucose and beer, but not the control solutions, significantly increased plasma gastrin levels above basal values. Isotonic and hypertonic glucose, beer, and fermented glucose significantly increased plasma levels of cholecystokinin (CCK), but the effect was significantly higher after hypertonic glucose than after isotonic glucose, beer, or fermented glucose. Ethanol and water had no effect on plasma levels of gastrin and CCK. We conclude that: (1) in the doses studied intragastric beer and fermented glucose but not ethanol (4% v/v) stimulate pancreatic enzyme output and release of gastrin and CCK; (2) the lack of effect of ethanol indicates that nonalcoholic ingredients of beer and fermented glucose are responsible for this stimulatory effect; and (3) CCK could be one of the major mediators of the stimulation of pancreatic enzyme output after ingestion of beer and fermented glucose.

Prolonged consumption of moderate doses of alcohol and in vitro gastro-duodenal and ileal contractility in the rat

The effects of chronic feeding with moderate doses of ethanol (3% vol/vol in drinking water for 8 weeks), which do not induce tolerance, dependence and withdrawal, on the contractility of gastric, duodenal and ileal strips from rats were investigated. Only 50% of ethanol-treated specimens (as compared to 100% of saccharose-fed controls) exhibited antral phasic contractions (frequency decreased by 31% and 27% in the antrum and duodenum, respectively; P < 0.03 vs. controls). The depolarizing agent potassium chloride (KCl, 80 mM) produced less peak active tension in the fundus of ethanol-fed rats (P < 0.01). In alcoholic rats the sensitivity of the antrum to acetylcholine was fourfold less than that of control specimens. It is concluded that, in the rat, moderate doses of ethanol given chronically impair both spontaneous and tonic contractility of the stomach and duodenal muscle without affecting ileal contraction. It is possible that motility defects in the gut exposed to ethanol concentrations which do not cause tolerance, dependence or withdrawal in the rat may be due to a local rather than a systemic effect on the smooth muscle.

Daytime ingestion of alcohol alters nighttime jejunal motility in man

We studied the effects of acute ingestion of intoxicating doses of alcohol on jejunal motility in six male volunteers ages 24-45 who had two 24-hr ambulatory manometries, one week apart, that each included three standardized meals with either red wine (0.6 g of alcohol/kg) or dealcoholized wine. Breath alcohol was measured at regular intervals for 3 hr following alcohol. The results show that the MMC cycle was significantly (P < 0.01) shorter during the night than during the day in the "nonalcohol" group but not in the "alcohol" group and that the amplitude of contractions was higher during the night than the day in the alcohol group (P < 0.01). All meals interrupted the MMC and induced a fed pattern. After the 300-kcal liquid meal, the duration of the fed pattern was shorter (P < 0.01), with a lower motility index (P < 0.01) and fewer contractions (P < 0.01), than following the two 600-kcal meals. The number of clustered contractions occurring in the postprandial period was lower in the alcohol group than in the nonalcohol group. After the three alcohol doses, a breath alcohol peak was reached in 20-60 min, and in all subjects, breath alcohol fell below 22 micrograms/100 ml after the third hour. This study showed that alcohol had only minor effects on postprandial contractile activity but abolished the circadian variation of the MMC normally seen in healthy subjects. The fact that breath alcohol was low by the time of onset of sleep, suggests that the effects on the MMC may be mediated through central rather than local mechanisms.

Effect of ethanol on absorption of a nutrient solution in the upper human intestine

The study compares the duodenal and jejunal absorption of an ethanol-containing nutrient solution (4% wt/vol, 4.06 kcal/min = 17.2 kJ/min, 1190 mosmol/kg) with the corresponding ethanol-free solution (2.64 kcal/min = 11.2 kJ/min, 160 mosmol/kg) and with another ethanol-free solution adapted in caloric load and osmolality (4.06 kcal/min = 17.2 kJ/min, 1160 mosmol/kg) by the addition of NaCl and glucose in eight healthy volunteers, using the intestinal perfusion technique. Ethanol added to a nutrient solution did not exert a significant effect on the net absorption of nutrients in the upper intestine. However, duodenal but not jejunal net water (p < 0.05) and sodium (p < 0.02) movements were significantly modified. Compared with the hyperosmolar ethanol-free solution, perfusion of ethanol induced in the duodenum a significantly lower (p < 0.001) net water and sodium secretion and higher absorption rates of total nitrogen and fatty acids (p < 0.001). The importance of the composition of control solutions in studies investigating the effects of ethanol in the gastrointestinal tract is emphasized.

Gastric emptying in non-responders to H2-receptor antagonists

H2-receptor antagonists are known to fail to increase the intragastric pH in some patients (so-called non-responders), and we have recently found a higher frequency of non-responders among cirrhotics. Since intragastric pH is also affected by gastric emptying, in the present study we determined the gastric emptying of 300 ml orange juice labelled with [99mTc]-Solco Nanocoll using a gamma camera. Measurements were made over a period of 60 min in cirrhotic patients and controls without liver disease who either responded to 300 mg ranitidine or showed no response. The mean (+/- SD) liquid half-emptying time (T1/2) was 26.3 +/- 17.5 min (range, 9-75 min) in responders (n = 10), 20.9 +/- 8.6 min (range, 7-34 min) in non-responders (n = 10), 19.4 +/- 19.2 min (range, 7-75 min) in cirrhotics (n = 11), and 27 +/- 4.6 min (range, 17-33 min) in controls (n = 9). In 19 of the 20 subjects gastric emptying was normal (T1/2, less than 40 min). Since gastric emptying was not delayed in any of the non-responders, it would appear very unlikely that gastric motility plays a major role in the non-response to H2-receptor antagonists.

The effect of acute and chronic ethanol administration on gastric emptying in cats

There continues to be disagreement regarding the effects of ethanol on gastric emptying. This study was designed to assess different degrees of ethanol exposure on gastric emptying. Scintigraphic gastric emptying studies were performed in healthy adult cats and the half time (t1/2) of gastric emptying was obtained from each study. Repeat measures of gastric emptying were again obtained in these cats under the conditions of both acute and chronic ethanol exposure and 24 hr following ethanol withdrawal. Gastric emptying half times were prolonged significantly during acute and chronic exposure to ethanol. The mean value for t1/2 under control conditions was 46.46 min, while for acute and chronic exposure to ethanol the mean t1/2 values were 69.34 and 91.33 min, respectively. In addition, we demonstrated a similar delay in gastric emptying during active withdrawal from alcohol (t1/2 = 70). We conclude that both acute and chronic alcohol exposure significantly delay gastric emptying.

Mechanism of ethanol induced hepatic injury

Ethanol is hepatotoxic through redox changes produced by the NADH generated in its oxidation via the alcohol dehydrogenase pathway, which in turn affects the metabolism of lipids, carbohydrates, proteins and purines. Ethanol is also oxidized in liver microsomes by an ethanol-inducible cytochrome P-450 (P-450IIE1) which contributes to ethanol metabolism and tolerance, and activates xenobiotics to toxic radicals thereby explaining increased vulnerability of the heavy drinker to industrial solvents, anesthetic agents, commonly prescribed drugs, over-the-counter analgesics, chemical carcinogens and even nutritional factors such as vitamin A. Induction also results in energy wastage and increased production of acetaldehyde. Acetaldehyde, in turn, causes injury through the formation of protein adducts, resulting in antibody production, enzyme inactivation, decreased DNA repair, and alterations in microtubules, plasma membranes and mitochondria with a striking impairment of oxygen utilization. Acetaldehyde also causes glutathione depletion and lipid peroxidation, and stimulates hepatic collagen synthesis, thereby promoting fibrosis.

Where do we stand on gastric motility?

This review deals with several aspects of gastrointestinal motility. It attempts to relate basic knowledge to clinically relevant issues. The review is organized around specific contractile patterns and tasks in the gastrointestinal region that are grouped into three broad categories: tonic contractility of the stomach, antral phasic contractility, and resistance of the gastric outlet. There is also a section dealing with the evaluation of gastric motor function for diagnostic purposes describing the technologic means for investigating motility disorders in patients presenting with different clinical syndromes. In this section there is also reference to the criteria to be used in interpretation of the results and practical advice on the use of each test. Finally, the review deals with the issue of treatment of gastric motor disorders, comprising both dietary and pharmacologic approaches.