An Outbreak Associated with Streptococcus equi Subsp. zooepidemicus in Layers: Evidence of Fecal Transmission

Major disease outbreaks caused by Streptococcus equi subsp. zooepidemicus seldom are reported in poultry. Besides acute septicemia, infection can result in a subacute or chronic form of disease with described mortality rates of 11% to 80%. Previously, the source of infection in poultry was linked to horses in which this bacterium can be present as an opportunistic pathogen on mucus membranes. The main route of spreading and being maintained within a poultry flock, after entering the stable, however, remains unclear. This case report describes an outbreak associated with S. zooepidemicus affecting a flock of 28 500 layer hens housed in an aviary system with free range. Besides sudden deaths, clinical signs of depression were noticed. Between 44 and 61 wk of age a total mortality of 23% was observed. Egg production dropped from 92% to 83%. Bacterial titration revealed substantial numbers of S. zooepidemicus present in the ceca of a healthy chicken. This novel finding hypothesizes that transmission of the infection within the flock might occur through the fecal route.

A case of clubbed down syndrome in broilers

This study presents a case of clubbed down syndrome in conventional broilers. During the first week of life, severe growth retardation was observed in approximately 25% of the flock. The growth-retarded chicks weighed only 45 g and showed a typical feather disorder which was most apparent on their abdomen and was defined in literature as typical for clubbed down syndrome. Necropsies, histology, biochemical analysis of blood and liver samples, serology and different PCR tests were performed in broilers to assess the aetiology of the clinical signs that were present in the affected broiler farm. Because of the suspicion of a possible link with the broiler-breeder farms, different investigations including serology, PCR and feed analysis were also performed on these farms. The results suggest that an accidentally excessive amount of calcium and iron in the feed of broiler-breeders, 3 weeks prior to first clinical signs in broilers, led to the development of clubbed down in the offspring, because of a relative Zn-deficiency in broiler-breeders and an absolute Zn-deficiency in the hatching eggs that were produced during this period. This appeared to be a reversible process as no clinical signs were observed in younger offspring of these broiler-breeders after they had consumed more of the new batch of feed. A potential involvement of Astrovirus could not be completely ruled out. This study demonstrates the importance of correct mineral concentrations in broiler-breeder feed and the impact it can have on the development of the offspring.

In ovo vaccination of broilers against Campylobacter jejuni using a bacterin and subunit vaccine

Campylobacter jejuni and Campylobacter coli originating from poultry meat have been the most important causes of foodborne bacterial gastroenteritis in the European Union since 2005. In-feed application of maternal antibodies from vaccinated hens was shown to confer protection of broilers against Campylobacter infection. Here, it was investigated if these vaccines can be used to protect broilers against Campylobacter infection after in ovo vaccination. Embryos were immunized in ovo at day 18 with a bacterin or a subunit vaccine and at 19 D post hatch, these birds were inoculated with C. jejuni according to a seeder model. Quantification of C. jejuni in the broilers cecal content showed that the in ovo vaccinated birds were not protected against C. jejuni infection. Quantification of blood anti-Campylobacter antibody titers did not show any induction of Campylobacter-specific serological response in the vaccinated birds, which may explain the lack of protection in the vaccinated chicks.

An atypical case of proventricular dilatation in a Red-and-green Macaw (Ara chloropterus)

A Red-and-green Macaw (Ara chloropterus) was presented with regurgitation and passage of undigested seeds in the feces. Radiographic examination revealed dilatation of the proventriculus. Contrast radiography was performed and revealed that the proventricular dilatation and associated clinical signs resulted from circumferential thickening of the proventricular wall leading to severe narrowing of the lumen of the proventriculus. Testing for parrot bornavirus (PaBV) was negative. After the initiation of antimicrobial treatment because of suspected bacterial overgrowth, all clinical signs resolved two weeks after the start of the treatment, and radiographs taken four months after initial presentation revealed a normal appearance and size of the proventriculus. In the present case, bacterial proventriculitis associated with hyperplasia of the proventricular wall was put forward as a final but presumptive diagnosis highlighting the need to differentiate bacterial proventriculitis from other causes of proventricular dilatation in macaws.

Adenoviral Gizzard Erosions in Two Belgian Broiler Farms

Fowl adenovirus infections are widely prevalent in poultry. Many of the viruses can infect chickens without resulting in overt disease. Nevertheless, some fowl adenoviruses can cause important disease complexes in chickens such as inclusion body hepatitis, hydropericardium syndrome, necrotic pancreatitis, and gizzard erosion. Adenoviral gizzard erosions have been regularly reported from Japan, but detailed reports from Europe are scarce and available only from Italy, Poland, Hungary, and Germany. This case report describes two concurrent outbreaks of gizzard erosions caused by fowl adenovirus A in two Belgian broiler farms. Clinical signs observed were signs of depression, reduced feed intake, reduced weight gain, and lack of uniformity of the flocks. At necropsy, typically multiple erosions within the koilin layer of the gizzard were observed. Histopathological examination showed a multifocal, erosive ventriculitis with basophilic intranuclear inclusions in the epithelium. PCR analysis confirmed the diagnosis of fowl adenovirus. These findings suggest that outbreaks of adenoviral gizzard erosion can also lead to significant economic losses in Belgium.

Cytologie bij zangvogels: een nuttige diagnostische tool

Ziekteproblemen bij in groep gehouden zangvogels zijn vaak van infectieuze aard. De waargenomen klinische klachten zijn echter dikwijls dezelfde en voornamelijk aspecifiek. Cytologisch onderzoek van de organen na post-mortemonderzoek zijn desgevallend van onschatbare diagnostische waarde. In dit artikel worden de basisprincipes van de cytologische staalnametechniek van organen en de beoordelingswijze van een cytologisch preparaat beschreven. Verder wordt een overzicht gegeven van belangrijke infectieuze aandoeningen bij zangvogels, waarvan met behulp van cytologisch onderzoek een definitieve of waarschijnlijke, etiologische diagnose gesteld kan worden. Bij deze kan dit overzicht een nuttige leidraad zijn voor elke dierenarts met zangvogels in zijn of haar patiëntenbestand.

België ontsnapt niet aan het “rabbit hemorrhagic disease virus-2” (RHDV2) bij konijnen

Sinds 2016 is in België een duidelijke spreiding aan de gang van een nieuwe variant van het “rabbit hemorrhagic disease virus” (RHDV), aangeduid als RHDV2. Acute sterfte van konijnen is bij beide varianten van het virus het vaakst geziene verschijnsel. Vaccinatie tegen beide virusvarianten is mogelijk. Het vaccin dat momenteel in België geregistreerd is tegen RHD, beschermt niet tegen de variantstam. Via het cascadesysteem kan de dierenarts op eigen verantwoordelijkheid een vaccin invoeren dat in een andere EU-lidstaat daarvoor geregistreerd is. De actuele epidemiologische situatie verantwoordt dat konijnen preventief gevaccineerd worden tegen RHD. Ook myxomatose maakt echter nog steeds zeer veel slachtoffers, zowel onder wilde als onder tamme konijnen. Omwille van de actualiteit van het RHDV2 krijgt myxomatose momenteel te weinig aandacht. Er is een belangrijke taak weggelegd voor de dierenarts om konijneneigenaars correct te informeren over de belangrijke virale ziekten bij konijnen en de mogelijkheden tot preventie.

Variation in hemolytic activity of Brachyspira hyodysenteriae strains from pigs

Brachyspira hyodysenteriae is the primary cause of swine dysentery, which is responsible for major economic losses to the pig industry worldwide. The hemolytic activity of 10 B. hyodysenteriae strains isolated from stools of pigs with mild to mucohemorrhagic diarrhea was compared and seven hemolysis associated genes were sequenced. Hemolysis induced by these strains varied from strong to near absent. One weakly hemolytic B. hyodysenteriae strain showed sequence changes in five hemolysis associated genes (tlyA, tlyB, hemolysin III, hemolysin activation protein and hemolysin III channel protein) resulting in amino acid substitutions. The occurrence of weakly hemolytic strains identifiable as B. hyodysenteriae should be taken into account in swine dysentery diagnostics. The presence of these strains may affect herd dysentery status, with great impact on a farms trading opportunities.

Mycotoxins Deoxynivalenol and Fumonisins Alter the Extrinsic Component of Intestinal Barrier in Broiler Chickens

Deoxynivalenol (DON) and fumonisins (FBs) are secondary metabolites produced by Fusarium fungi that frequently contaminate broiler feed. The aim of this study was to investigate the impact of DON and/or FBs on the intestinal barrier in broiler chickens, more specifically on the mucus layer and antioxidative response to oxidative stress. One-day-old broiler chicks were divided into four groups, each consisting of eight pens of seven birds each, and were fed for 15 days either a control diet, a DON-contaminated diet (4.6 mg DON/kg feed), a FBs-contaminated diet (25.4 mg FB1 + FB2/kg feed), or a DON+FBs-contaminated diet (4.3 mg DON and 22.9 mg FB1 + FB2/kg feed). DON and FBs affected the duodenal mucus layer by suppressing intestinal mucin (MUC) 2 gene expression and altering the mucin monosaccharide composition. Both mycotoxins decreased gene expression of the intestinal zinc transporter (ZnT)-1 and regulated intracellular methionine homeostasis, which are both important for preserving the cell's critical antioxidant activity. Feeding a DON- and/or FBs-contaminated diet, at concentrations close to the European Union maximum guidance levels (5 mg DON and 20 mg FB1 + FB2/kg feed) changes the intestinal mucus layer and several intestinal epithelial antioxidative mechanisms.

Vraag & Antwoord

Vaccinatie van hobby- en sierhoenders Behandeling luchtweginfecties bij legkippen Bestrijding van vogelmijt bij gezelschapsvogels

Fumonisins affect the intestinal microbial homeostasis in broiler chickens, predisposing to necrotic enteritis

Fumonisins (FBs) are mycotoxins produced by Fusarium fungi. This study aimed to investigate the effect of these feed contaminants on the intestinal morphology and microbiota composition, and to evaluate whether FBs predispose broilers to necrotic enteritis. One-day-old broiler chicks were divided into a group fed a control diet, and a group fed a FBs contaminated diet (18.6 mg FB1+FB2/kg feed). A significant increase in the plasma sphinganine/sphingosine ratio in the FBs-treated group (0.21 ± 0.016) compared to the control (0.14 ± 0.014) indicated disturbance of the sphingolipid biosynthesis. Furthermore, villus height and crypt depth of the ileum was significantly reduced by FBs. Denaturing gradient gel electrophoresis showed a shift in the microbiota composition in the ileum in the FBs group compared to the control. A reduced presence of low-GC containing operational taxonomic units in ileal digesta of birds exposed to FBs was demonstrated, and identified as a reduced abundance of Candidatus Savagella and Lactobaccilus spp. Quantification of total Clostridium perfringens in these ileal samples, previous to experimental infection, using cpa gene (alpha toxin) quantification by qPCR showed an increase in C. perfringens in chickens fed a FBs contaminated diet compared to control (7.5 ± 0.30 versus 6.3 ± 0.24 log10 copies/g intestinal content). After C. perfringens challenge, a higher percentage of birds developed subclinical necrotic enteritis in the group fed a FBs contaminated diet as compared to the control (44.9 ± 2.22% versus 29.8 ± 5.46%).

In vitro susceptibility of Brachyspira hyodysenteriae to organic acids and essential oil components

The antibacterial potential of organic acids and essential oil components against Brachyspira hyodysenteriae, the causative pathogen of swine dysentery, was evaluated. Minimum inhibitory concentrations (MIC) of 15 compounds were determined at pH 7.2 and pH 6.0, using a broth microdilution assay. In addition, possible synergism was determined. MIC values for the three tested strains were similar. For organic acids, MIC values at pH 6.0 were lower than at pH 7.2. B. hyodysenteriae was most sensitive to cinnamaldehyde and lauric acid, with MIC values <1.5 mM. Most antibacterial effects of binary combinations were additive, however, for thymol and carvacrol, synergism could be observed. In vitro results demonstrate the antibacterial action of certain essential oil components and organic acids against B. hyodysenteriae.

High seroprevalence of respiratory pathogens in hobby poultry

Seroprevalence studies on respiratory pathogens have been done extensively in commercial laying hens, broilers, and, to a lesser extent, backyard poultry. In Europe, seroprevalence studies in backyard and fancy breed poultry flocks are scarce and limited to a few pathogens, such as Mycoplasma gallisepticum (MG); others, such as Ornithobacterium rhinotracheale (ORT), are missing. A commercial ELISA for detection of antibodies against six selected pathogens was performed on 460 serum samples from chickens across Flanders. Anti-ORT antibodies were, by far, the most prevalent, with a prevalence of 95.4%. Infectious bronchitis virus, Mycoplasma synoviae, and avian metapneumovirus antibodies were found in 75.6%, 76.3%, and 63.5% of the animals, respectively. Antibodies against MG and infectious laryngotracheitis virus were found in 36.7% and 30% of the animals, respectively. These data demonstrate the high seroprevalence of respiratory pathogens among hobby poultry; therefore, it is possible that this group could act as a reservoir for commercially kept poultry.

The mycotoxin deoxynivalenol predisposes for the development of Clostridium perfringens-induced necrotic enteritis in broiler chickens

Both mycotoxin contamination of feed and Clostridium perfringens-induced necrotic enteritis have an increasing global economic impact on poultry production. Especially the Fusarium mycotoxin deoxynivalenol (DON) is a common feed contaminant. This study aimed at examining the predisposing effect of DON on the development of necrotic enteritis in broiler chickens. An experimental Clostridium perfringens infection study revealed that DON, at a contamination level of 3,000 to 4,000 µg/kg feed, increased the percentage of birds with subclinical necrotic enteritis from 20±2.6% to 47±3.0% (P<0.001). DON significantly reduced the transepithelial electrical resistance in duodenal segments (P<0.001) and decreased duodenal villus height (P = 0.014) indicating intestinal barrier disruption and intestinal epithelial damage, respectively. This may lead to an increased permeability of the intestinal epithelium and decreased absorption of dietary proteins. Protein analysis of duodenal content indeed showed that DON contamination resulted in a significant increase in total protein concentration (P = 0.023). Furthermore, DON had no effect on in vitro growth, alpha toxin production and netB toxin transcription of Clostridium perfringens. In conclusion, feed contamination with DON at concentrations below the European maximum guidance level of 5,000 µg/kg feed, is a predisposing factor for the development of necrotic enteritis in broilers. These results are associated with a negative effect of DON on the intestinal barrier function and increased intestinal protein availability, which may stimulate growth and toxin production of Clostridium perfringens.

Passive immunization to reduce Campylobacter jejuni colonization and transmission in broiler chickens

Campylobacter jejuni is the most common cause of bacterium-mediated diarrheal disease in humans worldwide. Poultry products are considered the most important source of C. jejuni infections in humans but to date no effective strategy exists to eradicate this zoonotic pathogen from poultry production. Here, the potential use of passive immunization to reduce Campylobacter colonization in broiler chicks was examined. For this purpose, laying hens were immunized with either a whole-cell lysate or the hydrophobic protein fraction of C. jejuni and their eggs were collected. In vitro tests validated the induction of specific ImmunoglobulinY (IgY) against C. jejuni in the immunized hens' egg yolks, in particular. In seeder experiments, preventive administration of hyperimmune egg yolk significantly (P < 0.01) reduced bacterial counts of seeder animals three days after oral inoculation with approximately 104 cfu C. jejuni, compared with control birds. Moreover, transmission to non-seeder birds was dramatically reduced (hydrophobic protein fraction) or even completely prevented (whole-cell lysate). Purified IgY promoted bacterial binding to chicken intestinal mucus, suggesting enhanced mucosal clearance in vivo. Western blot analysis in combination with mass spectrometry after two-dimensional gel-electrophoresis revealed immunodominant antigens of C. jejuni that are involved in a variety of cell functions, including chemotaxis and adhesion. Some of these (AtpA, EF-Tu, GroEL and CtpA) are highly conserved proteins and could be promising targets for the development of subunit vaccines.

Occurrence and pathology of mycotoxins in commercial parrot feeds

Mycotoxins are toxic secondary metabolites of fungi. Animal feeds can be easily infected by fungi during production and storage, resulting in mycotoxin contamination. This study was performed to evaluate the possible health risks of mycotoxin-contaminated feed for cockatiels. The occurrence of mycotoxins in commercial parrot feeds (5 seed mixes and 5 pelleted feeds) was investigated by liquid chromatography tandem mass spectrometry. The following 12 mycotoxins were detected: zearalenone, deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, fusarenon X, aflatoxin B1, sterigmatocystin, alternariol, alternariol methylether, fumonisin B1, fumonisin B3, and ochratoxin A. Zearalenone was the most prevalent. Pathological effects after 21 days feeding mycotoxin-contaminated diets were examined in an in vivo trial with 3 groups of 5 cockatiels: group 1 (control) was fed a non-contaminated pelleted feed; group 2 was fed a pelleted feed containing zearalenone, deoxynivalenol, 15-acetyldeoxynivalenol, and fumonisins; and group 3 was fed a pelleted feed containing fumonisins. Average body weight gain and relative organ weight were not significantly different between the treatment groups and the control group. Apoptosis of renal tubular cells, diarrhoea, reduced appetite, enlargement of liver, kidney and proventriculus were occasionally observed in the birds from groups 2 and 3. In summary, contamination with mycotoxins is common in parrot feeds. The mycotoxin levels did not reach toxic levels, but might pose a potential threat to some sensitive cockatiels.

Occurrence of viable Brachyspira spp. on carcasses of spent laying hens from supermarkets

Brachyspira spp. are frequent inhabitants of the chicken's intestine and some have been associated with enteric disease in humans. We studied contamination with Brachyspira spp. of carcasses of spent laying hens as a possible source of infections for humans and animals that may eat this meat. Eleven batches of hen carcasses, for a total of 110 carcasses, were bought in Belgian supermarkets during 2009-2010. Carcass rinse samples were examined for the presence of Brachyspira. Brachyspira spp. were cultured from some carcass in all batches. Besides presumably non-pathogenic species such as Brachyspira murdochii and Brachyspira innocens, the poultry pathogen Brachyspira intermedia and the poultry and suspected human pathogen Brachyspira pilosicoli were identified in 7/11 and 1/11 carcass batches, respectively, at high numbers, as shown using quantitative polymerase chain reactions. Multilocus sequence typing (MLST) demonstrated the presence of 2 and 13 MLST types of B. pilosicoli and B. intermedia, respectively, with all strains belonging to novel MLST types. The findings show that carcasses of spent laying hens are commonly contaminated with high numbers of Brachyspira spp., including the suspected zoonotic agent B. pilosicoli.

Antimicrobial susceptibility pattern of Brachyspira intermedia isolates from European layers

A broth microdilution method was used to determine the antimicrobial susceptibility of 20 Brachyspira intermedia isolates obtained from different layer flocks in Belgium and The Netherlands between 2008 and 2010. The antimicrobial agents used were tylosin, tilmicosin, tiamulin, valnemulin, doxycycline, and lincomycin. The minimal inhibitory concentration (MIC) distribution patterns of tylosin, tilmicosin, lincomycin, and doxycycline were bimodal, demonstrating acquired resistance against doxycycline in three strains, against the macrolides in two strains, and against lincomycin in one strain. The MICs of tiamulin and valnemulin showed a monomodal distribution, but with tailing toward the higher MIC values, possibly suggesting low-level acquired resistance in six isolates. Sequencing revealed a G1058C mutation in the 16S rRNA gene in all doxycycline-resistant strains. The strain resistant to tylosin, tilmicosin, and lincomycin had an A2058T mutation in the 23S rRNA gene.

Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial

INTRODUCTION

Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying.

METHODS

Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit.

RESULTS

The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms.

CONCLUSIONS

The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.

Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?

OBJECTIVE

Different subgroups can be identified in functional dyspepsia based on symptom type or severity, and may correlate with pathophysiological disturbances. In particular, female sex and severe fullness and vomiting have been reported to be strong independent predictors of slow solid gastric emptying. We aimed to determine if symptom patterns or severity could identify those with abnormal gastric emptying among patients with dysmotility-like functional dyspepsia and, for comparison, type I diabetes mellitus.

METHODS

Patients with postprandial symptoms and documented functional dyspepsia by endoscopy (n = 551) and patients with type I diabetes who had postprandial dyspepsia (n = 247) enrolling in two separate randomized controlled trials were evaluated at baseline. Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated C13 octanoic acid breath test with sampling over 4 h. A self-report questionnaire measured the presence and severity of eight symptoms on visual analog scales. The validated Nepean Dyspepsia Index measured the frequency, severity, and bothersomeness of 15 upper GI symptoms on Likert scales.

RESULTS

Gastric emptying was definitely delayed (t1/2 > 192 min) in 24% of patients with functional dyspepsia and 28% with diabetes. Delayed gastric emptying was associated with female gender but not age or Helicobacter pylori status. The age- and sex-adjusted risk (odds ratio) of delayed gastric emptying for the upper GI symptoms ranged from 0.99 to 1.0 (all p values > or =0.2). The results were very similar in functional dyspepsia and diabetes. There was also no correlation between t1/2 and number of symptoms or symptom severity scores.

CONCLUSIONS

Symptom prevalence and severity were similar in dyspeptic patients with and without delayed gastric emptying. Specific symptoms do not seem to be of predictive value in dysmotility-like dyspepsia for identifying alterations of gastric emptying.

Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis

BACKGROUND

The efficacy of prokinetic agents in functional (nonulcer) dyspepsia has been questioned based on recent trial results. We performed a meta-analysis to determine the efficacy of cisapride and domperidone in functional dyspepsia.

METHODS

Computer and manual searching was used to identify placebo-controlled studies that included >20 patients. The statistical analysis focused on: global assessment by the investigator, epigastric pain, early satiety, abdominal distension and nausea (all rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis was performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated.

RESULTS

For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For all outcome measures, there was a statiscally significant benefit in favor of cisapride: global assessment of improvement by the investigator or patient (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), early satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% CI 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of publication, and country where study was performed had only small modifying effects. There were insufficient data to determine whether there is a relationship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of global assessment of improvement by the investigator. This showed an OR of 7.0 (95% CI 3.6-16) in favor of domperidone.

CONCLUSIONS

Both cisapride and domperidone seem to be efficacious in functional dyspepsia, although this conclusion is largely based on global assessment by the investigator, which may not be an optimal outcome measure.

Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis

BACKGROUND

The efficacy of prokinetic agents in functional (nonulcer) dyspepsia has been questioned based on recent trial results. We performed a meta-analysis to determine the efficacy of cisapride and domperidone in functional dyspepsia.

METHODS

Computer and manual searching was used to identify placebo-controlled studies that included >20 patients. The statistical analysis focused on: global assessment by the investigator, epigastric pain, early satiety, abdominal distension and nausea (all rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis was performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated.

RESULTS

For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For all outcome measures, there was a statiscally significant benefit in favor of cisapride: global assessment of improvement by the investigator or patient (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), early satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% CI 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of publication, and country where study was performed had only small modifying effects. There were insufficient data to determine whether there is a relationship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of global assessment of improvement by the investigator. This showed an OR of 7.0 (95% CI 3.6-16) in favor of domperidone.

CONCLUSIONS

Both cisapride and domperidone seem to be efficacious in functional dyspepsia, although this conclusion is largely based on global assessment by the investigator, which may not be an optimal outcome measure.

Quality of life in functional dyspepsia: responsiveness of the Nepean Dyspepsia Index and development of a new 10-item short form

BACKGROUND

The Nepean Dyspepsia Index is a reliable and valid measure of quality of life in functional dyspepsia, but responsiveness has been little studied. The Nepean Dyspepsia Index originally contained 42 items designed to measure impairment of a subject's ability to engage in relevant aspects of their life because of dyspepsia, and their enjoyment of these aspects; in addition, the individual importance of areas was assessed. It was subsequently shortened to 25 items, yielding five sub-scales.

AIM

To test the Nepean Dyspepsia Index's responsiveness and develop a responsive, very short form.

METHODS

A randomized, double-blind controlled trial was performed in 589 patients with documented functional dyspepsia. Symptoms and quality of life were measured at baseline, 2 and 4 weeks. Responsiveness of the Nepean Dyspepsia Index quality-of-life section was evaluated by correlation with symptom scores and calculation of standardized changes in scores. Two items from each sub-scale which best represented the area of life (by factor loadings) were selected to create the 10-item short form (SF; short form-Nepean Dyspepsia Index). Internal consistency was assessed by Cronbach's alpha and responsiveness was assessed as above.

RESULTS

The Nepean Dyspepsia Index quality-of-life scales demonstrated excellent responsiveness to change in both the active and placebo arms (standardized response means all > 1.0). The Nepean Dyspepsia Index accounted for only 8% of the variance in percentage change in symptoms (by visual analogue scales), indicating that it was evaluating areas of life not covered by symptoms. The 10-item short form had adequate internal consistency (all scales > or = 0.70) and all strongly (and significantly) correlated with the long form sub-scales; it was also highly responsive.

CONCLUSION

The Nepean Dyspepsia Index is a responsive disease-specific quality-of-life measure; the 10-item short form can be applied in clinical trials of functional dyspepsia.

Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebo-controlled trial

INTRODUCTION

Motilin-receptor agonists are prokinetics; whether they relieve the symptoms of functional dyspepsia is unknown. We aimed to test the efficacy of the motilin agonist ABT-229 in functional dyspepsia patients with and without delayed gastric emptying.

METHODS

Patients were randomized with postprandial symptoms and documented functional dyspepsia by endoscopy (n=589 in intention-to-treat analysis). Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated 13C octanoic acid breath test. Patients were then further randomized within each strata, to receive one of four doses of ABT-229 (1.25, 2. 5, 5 or 10 mg b.d. before breakfast and dinner) or placebo for 4 weeks, following a 2-week baseline. The primary outcome was the assessment of change in symptom severity over the 2 weeks from baseline to final visit, based on a self-report questionnaire measuring severity on visual analogue scales.

RESULTS

Baseline characteristics across the treatment arms were very similar. No significant differences in the upper abdominal discomfort severity score (maximum 800 mm) were observed for any active treatment arm vs. placebo (mean change from baseline -139, -141, -145, -160 and -134 mm for placebo, 1.25, 2.5, 5, and 10 mg, respectively, at 4 weeks by intention-to-treat). More patients on placebo reported a good or excellent global response than patients on 1.25 or 5 mg of active therapy (both P < 0.05). The results were very similar in those with and without delayed gastric emptying. Helicobacter pylori status did not predict response. Excluding patients with any baseline heartburn (total remaining n=240), ABT-229 10 mg was inferior to placebo in relief of upper abdominal discomfort.

CONCLUSIONS

ABT-229 was of no value for relief of symptoms in functional dyspepsia, compared with placebo.

Toward office-based measurement of gastric emptying in symptomatic diabetics using [13C]octanoic acid breath test

OBJECTIVE

Current methods for measuring gastric emptying by breath test require sampling over several hours and are too inaccurate for clinical use. The aim of this study was to develop an office-based method for measuring gastric emptying of solids in patients with diabetes using a [13C]octanoic acid breath test.

METHODS

In 22 symptomatic diabetic patients (17 insulin-dependent diabetes, 5 non-insulin-dependent diabetes) and 6 controls, we simultaneously measured gastric emptying of an egg meal (420 kcal) by scintigraphy and [13C]octanoic acid breath test. Conventional (nonlinear) methods for scintigraphic and [13C]octanoic acid breath test emptying and generalized linear regression method to predict scintigraphic half-life (t(1/2)) using four breath samples obtained during the first 3 h.

RESULTS

Despite 8 h of breath sampling, the t(1/2) estimate using the conventional method was markedly different from the scintigraphic value (delta t(1/2): median, 113 min; range, 19-282 min). The generalized linear model (using samples at baseline, 30, and 120 or 150 min) yielded predicted scintigraphic tLAG and t(1/2) that were more accurate than the conventional method; mean standard deviations of differences were 16 and 27 min, respectively. Breath test correctly assessed normal or prolonged emptying in 21 of 22 patients.

CONCLUSIONS

The [13C]octanoic acid breath test can be simplified to measure gastric tLAG and t(1/2) and can be expected to correctly identify normal t(1/2) in symptomatic diabetics. Further refinement of the model will need to include studies of patients with markedly delayed t(1/2).

Will the use of different prevalence rates influence the development of a primary prevention programme for low-back problems?

To determine relations to low-back problems (LBP), different prevalence rates are used. The disadvantage of using different selection criteria is that studies are not comparable, except where they provide the same results. The present aim was to establish whether different prevalence selection criteria lead to different answers on a newly formed set of questionnaires. Since this set is new, reliability tests were performed (test-retest and calculations of Cronbach's Alpha, Cohen's Kappa and the intraclass correlation). Results of the questionnaire should form the cornerstones of a primary prevention programme. Altogether 1783 nurses in four Flemish (Belgian) hospitals were questioned. Information was gathered on work circumstances, education, general health, psychosocial factors, leisure activities, family situation and musculoskeletal problems. Four different datasets with variables related to lifetime prevalence LBP, annual prevalence LBP, point prevalence LBP and a set with all related variables were constructed. The variables demonstrating a relation with LBP differed slightly depending on the kind of prevalence used (lifetime, annual, point). A factor analysis on each set of prevalence related data failed due to the lack of homogeneity of the variables. Fear avoidance, coping aspects and musculoskeletal problems in other regions then the lower back were, in all circumstances, the most discriminating variables. Their discriminating power, however, differed depending on the kind of prevalence used. The differences were too small to influence the construction of the prevention programme. It is concluded that in developing a primary prevention programme any of the prevalence rates can be used. The combination of the three types of prevalence rates studied provides the most complete and reliable image.

The effect of motilin agonist ABT-229 on gastro-oesophageal reflux, oesophageal motility and lower oesophageal sphincter characteristics in GERD patients

BACKGROUND

ABT-229, a motilin agonist without antibacterial activity, has been shown to enhance both lower oesophageal sphincter pressure in cats and gastric emptying in humans.

AIM

To investigate the effect of oral treatment with ABT-229 10 mg b.d., ABT-229 5 mg b. d. and cisapride 10 mg q.d.s. on gastro-oesophageal reflux, lower oesophageal sphincter pressure, transient lower oesophageal sphincter relaxations and symptoms in GERD patients.

METHODS

Twenty-four GERD patients completed the study. A randomized, double-blind, placebo-controlled, three-period incomplete crossover design was used with three dosing periods of 7 days. All patients received ABT-229 10 mg b.d. and placebo during two of the three periods. In the remaining period 12 patients were given ABT-229 5 mg b.d. and 12 received cisapride 10 mg q.d.s. Ambulatory 24 h recordings of oesophageal pH and pharyngeal, oesophageal, lower oesophageal sphincter and gastric pressures were performed on day 7 using an assembly incorporating a Dent sleeve connected to a portable water-perfused manometric system.

RESULTS

Oesophageal acid exposure was not affected by ABT-229 or cisapride, but the incidence of reflux episodes was reduced by cisapride. None of the drugs affected oesophageal motility, lower oesophageal sphincter pressure or the incidence of transient lower oesophageal sphincter relaxations. Both ABT-229 10 mg b.d. and cisapride reduced the severity of daytime heartburn.

CONCLUSION

The value of ABT-229 in the treatment of GERD appears to be limited.

Validity of a new quality of life scale for functional dyspepsia: a United States multicenter trial of the Nepean Dyspepsia Index

OBJECTIVE

The lack of a suitable disease-specific, health-related quality of life instrument for dyspepsia prompted the development of the Nepean Dyspepsia Index (NDI). The utility of the NDI in functional dyspepsia is unknown. We aimed to assess the validity of this new quality of life instrument for the first time in United States patients with documented functional dyspepsia.

METHODS

The long form of the NDI contains a symptom index and 42 items designed to measure impairment of subjects' ability to engage in and to enjoy relevant aspects of their life because of dyspepsia, as well as a ranking of the individual importance of each aspect. Patients (n = 101, mean age 51 yr, 62% female) who had a history of functional dyspepsia for > or = 1 month and a negative endoscopy within the prior 1 yr were followed for 14 days. Patients completed the NDI and the validated Speilberger State-Trait Anxiety Inventory, Beck Depression Inventory, Short Form-36, and a global assessment of symptoms and quality of life at baseline and 14 days later; the NDI was also retested at 48 h and 2 wk.

RESULTS

Five clinically relevant factors (subscales), namely, tension/sleep, interference, eating/drinking, knowledge/control, and work/study were identified by factor analysis, after incorporating individual importance ratings (25 items total). All subscales had excellent face validity and internal consistency (Chronbach's alpha, all >0.85). Reliability was also excellent (intraclass correlations all >0.84). There were modest typically negative correlations between a number of the NDI subscales and the Short Form-36, anxiety, and depression, indicating that the NDI is disease-specific and supporting its validity. Changes in NDI scales correlated moderately with global assessment of change (total score r = -0.49), indicating initial responsiveness.

CONCLUSIONS

The Nepean Dyspepsia Index is a valid, disease-specific index for functional dyspepsia, measuring symptoms and health-related quality of life.

Erythromycin derivatives ABT 229 and GM 611 act on motilin receptors in the rabbit duodenum

1. The present study was undertaken to determine whether the macrolide antibiotic erythromycin, its stable motilide derivatives ABT 229 and GM 611 and motilin act at the same receptors on intestinal muscle 2. Each compound contracted the longitudinal muscle of the rabbit duodenum in a concentration-dependent manner that was unaffected by 1 mumol/L tetrodotoxin. The potency order (pEC50 values in brackets) was motilin (8.4), ABT 229 (7.6), GM 611 (7.5) and erythromycin (6.0). 3. The motilin receptor antagonists GM 109 and [phe3, leu13]-motilin, both shifted the concentration-response curves for each agonist to the right, but did not affect concentration-response relationships for the muscarinic agonist carbachol. Schild regression analysis yielded similar pA2 values for GM 109 (in the range 7.2-7.5) for all agonists. This analysis was not done for [phe3, leu13]motilin, which was a non-competitive antagonist and partial agonist. 4. It is concluded that erythromycin, the motilides and motilin act at the same (motilin) receptor on rabbit duodenal muscle and do not have any detectable actions at other receptors in this preparation.

Development of a new dyspepsia impact scale: the Nepean Dyspepsia Index

BACKGROUND

There is not at present a suitable disease-specific health-related quality of life instrument for uninvestigated dyspepsia and functional (non-ulcer) dyspepsia.

AIM

To develop a new multi-dimensional disease-specific instrument.

METHODS

The Nepean Dyspepsia Index (NDI) was designed to measure impairment of a subject's ability to engage in relevant aspects of their life and also their enjoyment of these aspects; in addition, the individual importance of each aspect is assessed. A 42-item quality of life measure was developed and tested, both in out-patients presenting to general practice with upper gastrointestinal complaints (n = 113) and in a randomly chosen population-based sample (n = 347).

RESULTS

Adequate face and content validity was documented by an expert panel. Factor analysis identified four clinically relevant subscales: interference with activities of daily living, work, enjoyment of life and emotional well-being; lack of knowledge and control over the illness; disturbance to eating or drinking; and disturbance to sleep because of dyspepsia. These scales had high internal consistency. Both symptoms and the quality of life scores discriminated dyspepsia from health.

CONCLUSION

The Nepean Dyspepsia Index is a reliable and valid disease-specific index for dyspepsia, measuring symptoms and health-related quality of life.

An action of erythromycin in the intestine that is not mediated via motilin receptors

1. Erythromycin lactobionate caused a concentration-dependent inhibition of nerve-mediated contractions of the longitudinal muscle of the guinea-pig ileum, with a threshold for effect of 10-30 mumol/L. The non-antibiotic derivative of erythromycin ABT-229 had a similar effect, but was approximately 10-fold less potent. At a greater concentration (1 mmol/L), erythromycin also depressed the direct contractile effect of 10 mumol/L carbachol on the muscle. 2. Human/porcine motilin (up to 100 mumol/L) did not reduce the nerve-mediated contractions, although it did contract the muscle (threshold 30 mumol/L). Antagonists of motilin receptors (phe3leu13motilin, up to 1 mumol/L, and GM-109, up to 3 mumol/L) did not reduce responses to erythromycin. 3. Erythromycin contracted the longitudinal muscle of the rabbit duodenum, with a threshold concentration of 0.1 mumol/L and ABT-229 contracted this tissue at a threshold concentration of 0.01 mumol/L. Effects of both agonists were antagonized by the motilin receptor antagonists phe3leu13motilin (0.3 mumol/L) and GM-109 (1 mumol/L). 4. It is concluded that the site(s) at which erythromycin acts in the guinea-pig ileum is not a motilin receptor and that ABT-229 is selective for the motilin receptor in comparison with non-motilin erythromycin sites and is unlikely to act at the latter site in therapeutic doses.

Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence

BACKGROUND

Loperamide improves anorectal function in patients with chronic diarrhoea. We wished to investigate whether the prodrug loperamide oxide has similar effects.

METHODS

Eleven patients with chronic diarrhoea and faecal incontinence participated in a randomized, placebo-controlled, double-blind, crossover study of the effects of loperamide oxide (4 mg twice daily for 1 week).

RESULTS

Loperamide oxide reduced wet stool weight and improved the patients' ratings of symptoms. Mouth-to-caecum transit time was not altered, but whole-gut transit time was prolonged. There were limited effects on anorectal function, but the mean minimum basal pressure mainly contributed by the internal anal sphincter (IAS) was increased, as was the mean volume infused before leakage occurred in the saline continence test.

CONCLUSION

Loperamide oxide is effective in the treatment of diarrhoea with faecal incontinence; normalization of colon transit time and an increase in the tone of the IAS seem to be the main determinants of efficacy.

Drug treatment of functional dyspepsia: a systematic analysis of trial methodology with recommendations for design of future trials

OBJECTIVES

To evaluate drug treatment of functional dyspepsia (including Helicobacter pylori) and provide guidelines for future trials based on a critical systematic overview of published studies.

METHODS

Data sources were a Medline search for articles published in English going back to 1966 and a manual search of four GI journals going back to 1980. Original randomized, double-blind, placebo-controlled trials were selected that enrolled at least 20 patients. Using a standardized, pretested data extraction form, studies were evaluated independently by two observers for study design, outcome measures, and results.

RESULTS

Fifty two eligible studies were evaluated. Many studies suffered from important weaknesses in study design and execution. Only five studies used previously validated outcome measures.

CONCLUSIONS

Because of suboptimal design and/or unclear presentation of the data, none of the trials provided unequivocal evidence that there is efficacious therapy for the treatment of functional dyspepsia.

Detection of antibodies to Salmonella enteritidis in sera and yolks from experimentally and naturally infected chickens

An indirect enzyme-linked immunosorbent assay (ELISA) based on the lipopolysaccharide (LPS) of Salmonella enteritidis phage type 4, was developed for the detection of antibodies to salmonella. Sera and yolks from chickens infected experimentally with S enteritidis showed strong positive reactions. Cross-reactions occurred with sera from chickens inoculated with S typhimurium or S gallinarum. Cross-reactions were weak with sera from chickens infected with five strains of other Enterobacteriaceae. The ELISA was tested with sera and yolks from commercial poultry flocks which were bacteriologically negative for salmonella or infected with salmonella serotypes belonging to serogroup D or to other serogroups. The serological reactions were strong in most flocks infected with S enteritidis and were weaker in flocks infected with S typhimurium. In some flocks infected with these serotypes no antibodies were detected. The correct setting of the cut-off value of the optical density in the ELISA makes it possible to discriminate between chickens which are infected with S enteritidis and chickens which are not infected with S enteritidis.

Effect of short-term starvation on gastric emptying in humans: relationship to oral glucose tolerance

To evaluate the effects of short-term starvation on gastric emptying in normal and obese subjects, the relationship between gastric emptying and oral glucose tolerance, and the mechanisms responsible for the delay in the systemic appearance of oral glucose observed after short-term fasting, we determined the effects of a 4-day fast on 1) gastric emptying and oral glucose tolerance in normal subjects and 2) gastric emptying in obese patients. Gastric emptying of 75 g glucose (320 ml) labeled with 99mTc colloid was measured in 12 healthy volunteers and 11 obese subjects after 12-h and 4-day fasts. In seven other obese subjects, the effect of a 4-day fast on gastric emptying of 320 ml normal saline was quantified. Gastric emptying of glucose was slower after the 4-day than after the overnight fast in both normal (P = 0.02) and obese (P < 0.001) subjects, with no difference between the two groups. In normal subjects, the rate of gastric emptying was related directly to the rise in plasma glucose at 30 min (r = 0.60; P < 0.05) but inversely to the plasma glucose at 180 min (r = -0.64; P < 0.02). In the obese subjects, gastric emptying of saline was not affected by fasting. These observations indicate that 1) gastric emptying of glucose is retarded by a 4-day fast, 2) the changes in gastric emptying reported in obesity may reflect different patterns of prior nutrient intake, and 3) delay in gastric emptying accounts for the slower systemic appearance of glucose after fasting.

Prognostic factors for relapse and maintenance treatment with cisapride in gastro-oesophageal reflux disease

AIM

To perform a further Cox proportional hazards logistic regression analysis of data from two large-scale placebo-controlled trials with cisapride as maintenance treatment in reflux disease.

RESULTS

Analysis of each of the two databases, allowing the model to operate freely, led to the identification of a number of unexpected putative predictors of outcome in the 6 to 12 months following initial healing of oesophagitis with an H2-receptor antagonist or omeprazole. This allowed us to delineate more accurately the patient population that is likely to respond to long-term continuous treatment with low or standard dose cisapride. The analysis revealed that symptom severity may be more useful than endoscopic severity in predicting relapse or in guiding therapy. Reflux oesophagitis outcome is particularly poor in the presence of treatment-recalcitrant symptoms or severe mucosal damage. Analysis showed cisapride to be effective in the maintenance treatment of patients with non-refractory symptoms, irrespective of the initial severity of oesophagitis, the healing agent used, or a history of previous endoscopic relapses.

Sensitivity of avian Eimeria spp. to seven chemical and five ionophore anticoccidials in five Belgian integrated broiler operations

Coccidia were isolated from 122 Belgian broiler farms without clinical coccidiosis. Shuttle programs including robenidin or nicarbazine in the starter (7-14 days) followed by an ionophore or diclazuril in the grower ration were most commonly used. Out of 215 coccidiosis-positive groups, 146 Eimeria acervulina, 65 E. maxima, and 88 E. tenella isolates were tested without further laboratory propagation in 17 sensitivity profiles. For each profile, oocytes were pooled from 9 +/- 4 farms (mean +/- SD) that used the same anticoccidial program and that belonged to the same integrated broiler operation. Each suspension contained an equal number of isolates and oocyst numbers from each farm tested. Each profile included an unmedicated uninfected group, an unmedicated infected group, and 11 medicated infected groups, consisting each of three replicates of three Ross chicks. Medication started at 8 days of age, and each inoculated bird received 50,000 sporulated oocysts at 10 days. Results were related to the anticoccidial program that had been in use. Chemical drugs showed the highest activity against Eimeria, whereas ionophores were less efficacious. Of the latter, monensin (110 ppm) was least active; narasin (70 ppm), salinomycin (60 ppm), and maduramicin (5 ppm) took an intermediate position, and lasalocid (90 ppm) was most active. A 50% improvement in weight gain was obtained in 7 to 10 out of 17 profiles with 100 + 8.35 ppm clopidol/methylbenzoquate (10), 125 ppm nicarbazin (9), 3 ppm halofuginone (8), and 1 ppm diclazuril (7). A 50% improvement in feed conversion was obtained in 7 to 11 profiles with nicarbazin (11), halofuginone (10), diclazuril (9), 33 ppm robenidine (9), clopidol/methylbenzoquate (7), and lasalocid (7). Based on relative oocyst output, the highest activity against E. acervulina was obtained with clopidol/methylbenzoquate (8/16); the highest activity against E. maxima was obtained with lasalocid (6/6), diclazuril (5/6), and halofuginone (5/6); and the highest activity against E. tenella was obtained with diclazuril (8/8), amprolium/ethopabate (5/8), halofuginone (4/8), maduramicin (4/8), and nicarbazin (4/8).

Loperamide. Survey of studies on mechanism of its antidiarrheal activity

In castor oil challenged rats, low doses of loperamide inhibit diarrhea and normalize intestinal propulsion. Unlike other opioids, loperamide is devoid of central opiate-like effects, including blockade of intestinal propulsion, up to the highest subtoxic oral dose. Nevertheless, the antidiarrheal action of loperamide can be considered to be mu-opiate receptor mediated, only a few in vitro effects at rather high concentrations being not naloxone-reversible. There is little evidence that interactions with intestinal opiate receptors directly change epithelial cell function. When secretory stimuli increase mucosal tension, however, loperamide may reverse the elevated hydrostatic tissue pressure that opposes normal absorption. This antisecretory effect at the mucosal level is accompanied by motor effects when loperamide reaches the myenteric mu-opiate receptors. At therapeutic doses for the treatment of acute diarrhea, it is likely that the mucosal effect prevails.

A double-blind fluoroscopic study of cisapride on gastrointestinal motility in patients with functional dyspepsia

Twenty patients with functional dyspepsia were referred for radiologic examination and, upon confirmation of a hypomotile stomach, were given either 10 mg cisapride or placebo in a double-blind manner (10 patients per group). The movement of a 250-ml barium meal was assessed by means of television fluoroscopy performed at regular time intervals. Cisapride significantly improved antral contractility and enhanced gastric emptying compared with placebo. Deep peristaltic waves occurred over the entire small bowel, and motility and small-bowel transit time of the barium meal were significantly increased in the cisapride group compared with the placebo group. The study demonstrates that when a carefully defined protocol is observed, fluoroscopy following barium ingestion offers considerable potential in the assessment of gastrointestinal motility.

Study of the placental transfer of cisapride in sheep. Plasma levels in the pregnant ewe, the fetus, and the lamb

The placental transfer of cisapride, a new prokinetic agent, was studied in a sheep model. The pharmacokinetics of cisapride were studied in the lamb, the pregnant ewe, and the fetus by obtaining blood samples from chronically implanted arterial catheters. Comparable pharmacokinetic parameters were found in the lamb and the adult sheep: half-life, 1.39-1.83 hr; total plasma clearance, 1998-2160 ml/kg/hr; AUC, 92.6-100.1 ng.hr/ml. Cisapride plasma concentrations after continuous infusion were predicted correctly based on the parameters obtained after iv bolus. There was a materno-fetal transfer of cisapride following a single iv bolus administered to the mother. Cisapride crossed the placenta within 5 min and equilibrated with maternal plasma within 20 to 30 min after dosing. The average fetal-to-maternal plasma concentration ratio was 0.71. The amniotic fluid also contained measurable amounts of cisapride. The protein binding of cisapride in maternal and fetal plasma is 89.0% and 88.4%, respectively; the free fraction is 4 times larger than in humans. Cisapride crosses the ovine placental barrier. The sheep placenta is less permeable than the human placenta, but the higher free fraction of cisapride facilitates placental transfer.

Review article: a role for gastrointestinal prokinetic agents in the treatment of reflux oesophagitis?

Gastro-oesophageal reflux disease may result from a host of factors. Medical therapy has largely been aimed at neutralizing acid or decreasing acid production but improvement of upper-gastrointestinal motility may prove to be a valuable treatment modality as well. This paper reviews the current state of knowledge of the pathogenesis of reflux disease and concentrates upon promotility treatment with domperidone, metoclopramide and cisapride.

Perinatal mortality in Belgium

Perinatal mortality in Belgium remains high compared with other countries of Western Europe, although a marked decrease was observed during the period from 1956 to 1984. Analysis of the death causes indicates that further progress is feasible. Social inequalities and geographic variation are persisting in spite of the long-established policy of social welfare and free access to health services. Most of the studies on perinatal mortality in Belgium are descriptive and based on data recorded in birth and infant death certificates. In the future, alternative sources of information should be used to analyze more precisely and to understand more clearly the interactions between the different determinants of perinatal mortality and to evaluate the impact of social and health services.