Gastric compliance and motility in the portal hypertensive rat

Mind/Body psychological treatments for irritable bowel syndrome

Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.

Contribution of ascites to impaired gastric function and nutritional intake in patients with cirrhosis and ascites

BACKGROUND & AIMS

Protein calorie malnutrition and weight loss are common among patients with cirrhosis and ascites. The cause of these symptoms is unclear, with several putative mechanisms proposed. The primary aims of this study were to compare gastric volumes and accommodation between patients with cirrhosis complicated by ascites and healthy controls, and to evaluate the effect of large-volume paracentesis in the patient group.

METHODS

Patients with cirrhosis and ascites underwent assessment of gastric volumes as measured by single-photon emission computed tomography, gastric sensation assessed by a validated nutrient drink test, and a 3-day assessment of caloric intake before and after large-volume paracentesis. Age- and sex-adjusted linear regression models were used to compare gastric volumes and accommodation ratios between patients and healthy volunteers. Paired Wilcoxon rank-sum tests were used to compare gastric measures before and after paracentesis among the patient group.

RESULTS

Fifteen patients (median age, 54 y) were compared with 112 healthy (age- and sex-matched) controls. Median postprandial gastric volumes (627 mL patients vs 721 healthy controls) and gastric accommodation were reduced significantly in patients compared with healthy controls (P = .02 and .006, respectively). After paracentesis: (1) fasting gastric volumes were increased (median 312 mL post- vs 241 mL pre-, P = .04), (2) patients tolerated ingestion of larger maximum volumes (median 964 mL post- vs 738 mL pre-, P = .04), and (3) caloric intake was increased (median 34% kcal post- vs 3110 kcal pre-, P = .005).

CONCLUSIONS

Postprandial gastric volumes and accommodation ratios are reduced in patients with cirrhosis and ascites compared with healthy controls. In addition, large-volume paracentesis increases fasting gastric volumes, volumes ingested until maximal satiation, and caloric intake.

Gastric motility in patients with presinusoidal portal hypertension

OBJECTIVE

The aim of this study was to evaluate the consequences of portal hypertension (PH) for the motor functions of the human stomach.

METHODS

The PH model used was the hepatosplenic form of mansonic schistosomiasis, as this is a condition characterized by PH but with considerably preserved hepatocellular function. The study included 15 patients with PH and 25 healthy volunteers who served as controls. The adaptive relaxation of the stomach was studied in 12 patients with PH and in 10 controls by a manometric method during rapid insufflation (25-30 s) of 700 ml of air into the gastric fundus. The gastric emptying of a liquid solution (15 patients with PH and 20 controls) and of a solid-liquid meal (nine patients with PH and 12 controls) was determined by gamma scintigraphy. The thickness of the gastric antrum wall was measured by ultrasonography in 12 patients with PH and in 10 controls.

RESULTS

Patients with PH showed the following: 1) reduction of the adaptive relaxation of the stomach (p < 0.0001); 2) acceleration of gastric emptying of the test solution (T 1/2, p = 0.0316), which became particularly expressive 25, 30, 40, and 50 min after ingestion (p = 0.0181, 0.0215, 0.0181, and 0.0215, respectively); 3) no alteration in gastric emptying of the solid-liquid meal as judged by T 1/2 values (p = 0.9170) or lag-phase values (p = 0.7544); and 4) a conspicuous increase in gastric wall thickness as determined by antrum wall measurements (p = 0.0008).

CONCLUSIONS

The reduced gastric adaptive relaxation demonstrated in patients with PH and normal hepatocellular function leads us to consider this condition as a cause of diastolic dysfunction of the stomach. In this disease, the motor alteration may be explained as a consequence of the reduction of gastric wall compliance, probably resulting from edema and vascular ectasia, which were indirectly detected by the increase thickness of the gastric antrum wall. The discrete acceleration of liquid gastric may be also related to the reduced gastric wall compliance.

Bacterial translocation in the portal-hypertensive rat: studies in basal conditions and on exposure to hemorrhagic shock

BACKGROUND

Portal hypertension is associated with altered intestinal motor and mucosal function. The aim of this study was to determine whether portal hypertension, per se, or in association with acute hemorrhagic shock, predisposes to the translocation of bacteria across the intestine.

METHODS

Translocation to both mesenteric lymph nodes and blood was compared in three groups of rats: portal-hypertensive (single-stage calibrated stenosis of portal vein), sham-operated, and unoperated controls. Half of the animals in each group were exposed to hemorrhagic shock.

RESULTS

In the basal state, translocation to both mesenteric lymph nodes (portal hypertension vs. sham vs. controls, 411.5 +/- 119 vs. 151.1 +/- 42.6 vs. 18.1 +/- 12.6 colony-forming units [CFU]/g; P < 0.05) and blood (portal hypertension vs. sham vs. controls, 100% vs. 30% vs. 0% positive blood cultures; P < 0.05) was significantly increased in the portal-hypertensive animals. Furthermore, translocation was strikingly increased in these animals after hemorrhagic shock (mesenteric lymph node cultures, portal hypertension vs. portal hypertension with shock, 411 +/- 119 vs. 1018.2 +/- 372.2 CFU/g; P < 0.05).

CONCLUSIONS

Portal hypertension promotes bacterial translocation, especially in relationship to acute hemorrhage. These findings may, in part, explain the susceptibility of patients with liver disease to sepsis of enteric origin.