Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats

In a few recent studies, the presence of arrhythmias based on reentry and circus movement of the slow wave have been shown to occur in normal and diseased stomachs. To date, however, reentry has not been demonstrated before in any other part of the gastrointestinal system. No animals had to be killed for this study. Use was made of materials obtained during the course of another study in which 11 rats were treated with streptozotocin and housed with age-matched controls. After 3 and 7 mo, segments of duodenum, jejunum, and ileum were isolated and positioned in a tissue bath. Slow wave propagation was recorded with 121 extracellular electrodes. After the experiment, the propagation of the slow waves was reconstructed. In 10 of a total of 66 intestinal segments (15%), a circus movement of the slow wave was detected. These reentries were seen in control (n = 2) as well as in 3-mo (n = 2) and 7-mo (n = 6) diabetic rats. Local conduction velocities and beat-to-beat intervals during the reentries were measured (0.42 ± 0.15 and 3.03 ± 0.67 cm/s, respectively) leading to a wavelength of 1.3 ± 0.5 cm and a circuit diameter of 4.1 ± 1.5 mm. This is the first demonstration of a reentrant arrhythmia in the small intestine of control and diabetic rats. Calculations of the size of the circuits indicate that they are small enough to fit inside the intestinal wall. Extrapolation based on measured velocities and rates indicate that reentrant arrhythmias are also possible in the distal small intestine of larger animals including humans.

[Effect of moxibustion on motility, absorption and content of ATP in small intestine of spleen-deficiency rats]

OBJECTIVE

To explore the mechanism of reinforcing function of moxibustion to spleen-stomach.

METHODS

Forty healthy Sprague Dawley rats were randomly divided into 4 groups: group A (blank group), group B (model group), group C (moxibustion group) and group D (herbs group). The rat model of spleen-deficiency was established by intragastric administration with 200% Dahuang (Rhubarb) infusion. The rats in group A and B, and D served as the blank control, model, and Sijunzi decoction group respectively, while those in group C received moxibustion at "Zusanli" (ST 36), "Zhongwan" (CV 12), "Guanyuan" (CV 4), "Pishu" (BL 20) and "Weishu" (BL 21), etc. The common symptoms and intestinal propulsive rate were observed. The content of I-xylose in serum was detected by phloroglucinol method. Colorimetry method was used to detected content of ATP in jejunum tissues.

RESULTS

Compared with group A, the symptom score in group B was increased significantly (both P < 0.01), while the intestinal propulsive rates, the content of D-xylose in serum and ATP in jejunum tissues were decreased significantly (P < 0.05, P < 0.01). Compared with group B, the symptom score in group C and D was decreased significantly (both P < 0.01), while the intestinal propulsive rates, the content of D-xylose in serum and ATP in jejunum tissues were increased significantly (P < 0.05, P < 0.01). There were no significant difference between group C and D (P > 0.05).

CONCLUSION

Moxibustion at "Zusanli" (ST 36) etc. could relieve symptoms of spleen-deficiency, enhance motility and absorption functions of small intestine and improve metabolism of small intestine. The efficacy is equal to administration of Sijunzi decoction.

Gastric and small intestinal dysfunction in spinal cord injury patients

BACKGROUND

Many patients with spinal cord injury (SCI) suffer from constipation, abdominal pain, nausea, or bloating, and colonic transit times are prolonged in most. Gastric and small intestinal dysfunction could contribute to symptoms but remain to be described in detail. Also, it is obscure whether the level of SCI affects gastric and small intestinal function.

AIM

To study orocecal transit time and gastric emptying (GE) in patients with SCI.

METHODS

Nineteen patients with SCI (7 ♀, median age 54 years) and 15 healthy volunteers (9 ♀, median age 32 years) were included. All were referred because of neurogenic bowel problems. Eleven patients had low SCI (located at conus medullaris or cauda equina) affecting only the parasympathetic nerves to the left colon and eight had high SCI (above Th6) affecting parasympathetic and sympathetic innervation. Subjects ingested a small magnetic pill that subsequently was tracked by the Motility Tracking System - MTS-1 (Motilis, Lausanne, Switzerland).

RESULTS

Orocecal transit time was longer than normal both in individuals with high lesions (P < 0.01) and in individuals with low lesions (P < 0.01). Individuals with high lesions had slower GE than those with conal/cauda equina lesions (P < 0.05). Basic contractile frequencies of the stomach and small intestine were unaffected by SCI.

CONCLUSION

Surprisingly, upper gastrointestinal transit is prolonged in subjects with SCI suffering from bowel problems, not only in subjects with cervical or high thoracic lesions but also in subjects with conal/cauda equina lesions. We speculate that this is secondary to colonic dysfunction and constipation.

[Balloon-assisted enteroscopy in surgical practice]

The authors analyze their experience with video-capsular enteroscopy and balloon-assisted enteroscopy in 184 patients. High diagnostic significance of enteroscopy and the possibility to perform minimally invasive operations are shown.

[The role of the small intestine in the development of metabolic syndrome]

AIM

To comprehensively investigate the function of the small intestine (SI) in metabolic syndrome (MS).

SUBJECTS AND METHODS

Seventy-eight patients with MS were examined using, in addition to clinical studies, comprehensive ones of the function of SI: evaluation of its motor, digestive, and absorptive functions. The specific features of the hormonal and autonomic status were studied in the patients with MS.

RESULTS

Clinical local and common signs of SI lesion were seen in 82.9% of the patients. Examination of SI function revealed its impairments at all stages of hydrolysis and resorption in the presence of hypomotor dyskinesia in the postprandial period and hypersympaticotonia in the patients with MS. New pathogenic patterns were found in relation to the role of hormones in intestinal digestive and absorptive dysfunctions in MS.

CONCLUSION

The findings may suggest that SI functional changes found in MS are an important component of its complex pathogenetic circle.

The healing of NSAID-induced gastric lesion may be followed by small intestinal and cardiovascular side effects

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among some of the most commonly used medications. Serious adverse effects induced by NSAIDs may occur not only in the upper gastrointestinal tract, but in the small intestine and cardiovascular system. However, these side effects are studied and investigated separately. Here we tested the hypothesis that the healing of indomethacin-induced gastric erosion may be followed by small intestinal and cardiovascular adverse effects. First we examined the development of gastrointestinal lesions 4-24-48-72 h after a single indomethacin (35 mg/kg s.c.) injection given to fasted male rats (refeeding after 4 h). Then with a telemetric device heart rate, core body temperature and locomotion changes were recorded in the freely moving animals for 72 h after indomethacin or its vehicle injection (control). Indomethacin produced hemorrhagic erosion in the glandular stomach 4 h after its administration which was almost completely healed 48 h later. Parallel to the healing a gradual increase of injury to the small intestine became apparent. The control rats' heart rate, core body temperature and locomotion all agreed with a normal circadian rhythm. However, the circadian cycle of rats treated with indomethacin in 24 h after its administration was disrupted: their heart rate rose to it's maximal level and their locomotion and core temperature values fell to their minimal. These results suggest that the healing of gastric erosion induced by a single indomethacin injection may be followed by other pathological events outside of the stomach, among which there may be intestinal injury and a loss of a normal circadian cycle of heart rate as well as body temperature and locomotion.

Orocecal transit time and small intestinal bacterial overgrowth in type 2 diabetes patients from North India

BACKGROUND

Diarrhea, constipation, flatulence, and abdominal pain are common complaints in type 2 diabetes patients. Impaired intestinal motility is often followed by small intestinal bacterial overgrowth (SIBO). Therefore, this study was planned to determine the incidence of SIBO and its relation with orocecal transit time (OCTT) in type 2 diabetes patients.

SUBJECTS AND METHODS

SIBO and OCTT were measured by using noninvasive glucose and lactulose hydrogen breath tests, respectively. For this study, 84 patients with type 2 diabetes mellitus in the age range 30-65 years and 45 age-matched apparently healthy controls were enrolled.

RESULTS

The glucose hydrogen breath test was suggestive of SIBO in 15.5% of patients with type 2 diabetes mellitus but in one (2.2%) of controls. There was a significant increase (P<0.001) in OCTT in type 2 diabetes patients compared with controls. It was also observed that OCTT in type 2 diabetes patients with SIBO was significantly delayed (P<0.001) compared with type 2 diabetes patients without SIBO.

CONCLUSION

This study indicates that SIBO in diabetes patients may be due to delayed OCTT.

Slow wave propagation and plasticity of interstitial cells of Cajal in the small intestine of diabetic rats

The number of myenteric interstitial cells of Cajal (ICC-MY), responsible for the generation and propagation of the slow wave in the small intestine, has been shown to decrease in diabetes, suggesting impairment of slow-wave (SW) propagation and related motility. To date, however, this expected decrease in SW propagation has neither been recorded nor analysed. Eleven rats were treated with streptozotocin and housed in pairs with 11 age-matched control animals. After 3 or 7 months, segments of duodenum, jejunum and ileum were isolated and divided into two parts. One part was processed for immediate freezing, cryosectioning and immunoprobing using anti-c-Kit antibody to quantify ICC-MY. The second part was superfused in a tissue bath, and SW propagation was recorded with 121 extracellular electrodes. In addition, a cellular automaton was developed to study the effects of increasing the number of inactive cells on overall propagation. The number of ICC-MY was significantly reduced after 3 months of diabetes, but rebounded to control levels after 7 months of diabetes. Slow-wave frequencies, velocities and extracellular amplitudes were unchanged at any stage of diabetes. The cellular automaton showed that SW velocity was not linearly related to the number of inactive cells. The depletion of ICC-MY is not as severe as is often assumed and in fact may rebound after some time. In addition, at least in the streptozotocin model, the initial reduction in ICC-MY is not enough to affect SW propagation. Diabetic intestinal dysfunction may therefore be more affected by impairments of other systems, such as the enteric system or the muscle cells.

[Microbiota and irritable bowel syndrome]

Irritable bowel syndrome (IBS) is a multifactorial disease during which the pathophysiological role of the gut microbiota has been recently highlighted. In almost 20% of the patients, IBS is clearly a post-infectious IBS as a consequence of an acute bacterial gastroenteritis. Some papers have reported an abnormal colonic fermentation in IBS patients that could explain symptoms such as bloating and be one of the factors triggering visceral hypersensitivity. More recently, significant differences in the composition of both the luminal and mucosa-associated microbiota have been reported between both IBS patients and healthy controls and IBS subgroups while some arguments exist for a small intestinal overgrowth in a subset of IBS patients. All these arguments for a deleterious role of the gut microbiota lead to the actual discuss to consider new therapeutic options, including mainly pre- and probiotics and maybe antibiotics.

[Effect of Tongfu granules and its constituents on barrier function of small intestine in rats with sepsis]

OBJECTIVE

To investigate the effects of Tongfu granules and its constituents on barrier function of small intestine in rats with sepsis.

METHODS

The male rats were divided into model group, Tongfu granules group, Rhubarb group and Magnoliae cortex group by random digits table, normal rats as control group. Intraperitoneal injection of lipopolysaccharide (LPS, 6 mg/kg) was used to reproduce sepsis model. After establishment of model, rats in Tongfu granules group were given Tongfu granules 28 g×kg(-1)×d(-1) by gavage, and Rhubarb group and Magnoliae cortex group rats were given Rhubarb or Magnoliae cortex 5 g×kg(-1)×d(-1) by gavage, while the model group was given normal saline in same quantity, once a day. Blood samples of rats were collected at 24, 48, 72 hours for measuring tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) with enzyme linked immunosorbent assay (ELISA). The pathological changes in intestinal mucosa were observed, and the pathological scores was estimated at 72 hours.

RESULTS

The levels of TNF-α and IL-8 were significantly higher in model group than those in control group at different time points. The serum levels of TNF-α and IL-8 were significantly lower in treatment groups than those in model group, and the level of TNF-α (ng/L) in Tongfu granules group was significantly lower than that in Rhubarb and Magnoliae cortex groups at different time points (24 hours: 44.64±1.48 vs. 47.18±1.83 and 46.96±2.23, 48 hours: 51.38±1.36 vs. 57.17±2.23 and 59.41±2.01, 72 hours: 55.54±2.58 vs. 64.34±1.02 and 65.96±3.45, all P<0.05), and IL-8 (ng/L) level at 72 hours was significantly lower than that in Magnoliae cortex group (65.53±4.52 vs. 69.14±2.82,P<0.05). The scores of the lesions were significantly higher in model group than that in control group (3.90±0.17 vs. 0). The scores of Rhubarb group, Magnoliae cortex group and Tongfu granules group were 3.15±0.28, 3.18±0.08, and 2.95±0.15, respectively, which were lower than those of the model group (all P<0.01), and the Tongfu granules group descended obviously than other groups. In control group, the intercellular tight junctions were normal, and the morphology of microvilli and mitochondria was also normal. In model group, the microvilli of intestinal mucosa of the small intestine were absent or disintegrated. The intercellular tight junctions were seen to be blurred in Rhubarb and Magnoliae cortex groups, and they were close to normal state in Tongfu granules group. Their integrity was better preserved compared with that of the model group.

CONCLUSION

Injury of barrier function of the small intestine was found in septic rat. It was found that traditional Chinese medicine Tongfu granules, Rhubarb and Magnoliae cortex could protect the barrier function of the small intestine by decreasing the TNF-α and IL-8 levels in septic rats. Above-mentioned effects of Tongfu granules were better than Rhubarb and Magnoliae cortex.

Bleeding from the small intestine and aortic regurgitation in Noonan syndrome

A 62-year-old man was admitted to our hospital because of melena. On admission physical examination revealed that he had typical features of Noonan syndrome (NS). Investigation via upper endoscopy with the single balloon demonstrated oozing from the small intestine. Bleeding sometimes occurs in patients with NS. We speculated that coagulation defects or vascular malformations might have been present at the first visit in this case. However, coagulation function was normal. By upper endoscopy with the single balloon we clearly revealed the angioectasia in the small intestine. This case documents the first association among NS, aortic regurgitation and angioectasia in the small intestine.

Acidic polysaccharide of Panax ginseng as a defense against small intestinal damage by whole-body gamma irradiation of mice

An acidic polysaccharide of Panax ginseng (APG), ginsan, has been reported to protect the hematopoietic system by increasing the number of bone marrow cells and spleen cells. Therefore, we evaluated the ability of APG to protect mice from radiation-induced damage of the small intestine. APG treatment caused the lengthening of villi and a numerical increase of crypt cells in the small intestine at 3.5 days after 7Gy irradiation compared to irradiated, non-treated controls. In addition, APG significantly inhibited irradiation-induced apoptosis by decreasing the amount of pro-apoptotic p53 and Bax as well as augmenting that of anti-apoptotic Bcl-2 at 24h after irradiation. These results indicate that APG might be a useful adjunct to therapeutic irradiation as a protective agent for the gastrointestinal tract of cancer patients.

[Clinical and functional characteristics of small intestine in the metabolic syndrome]

THE AIM

Complex investigation of the small intestine functional condition in metabolic syndrome.

MATERIALS AND METHODS

The 65 patients with metabolic syndrome were examined. We used clinical data and complex examination of the small intestine function by tests with mono-, di- and polycarboanhydrates.

RESULTS

In mojoriti of patients (82.9%) the clinical local and common signs of small intestine lesion were reviled. In study intestine function the disturbances in all stages of hydrolysis and resorbtion were found.

CONCLUSION

Exchangings of the small intestine functional condition in metabolic syndrome are not only secondary, but lead to its progressing.

[Duodenogastral reflux burden gastroesophageal reflux disease]

The article presents research data of duodenogastral reflux (DGR) role in patients with gastroesophageal reflux disease. It is shown that in the presence DGR, the reflux esophagitis is detected at a higher frequency and outside of esophageal manifestations of the disease. The comorbidities of hepatobiliary zone and pancreas contributes to the DGR development, as well as the syndrome of bacterial overgrowth in the small intestine.

Pathophysiology of acute small bowel disease with CT correlation

The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

[The clinical and functional status of the stomach and small intestine in patients with chronic inflammatory bowel diseases concurrent with chronic opisthorchiasis]

To study the impact of Opisthorchis infestation on the upper digestive tract and small bowel in chronic inflammatory bowel diseases, the authors examined 164 patients with inflammatory bowel diseases, including 71 patients with ulcerative colitis and 45 with Crohn's disease without parasitosis and 48 with chronic opisthorchiasis (31 with ulcerative colitis and 17 with Crohn's disease). A control group consisted of 20 healthy individuals and 20 patients with chronic opisthorchiasis. A diagnosis was established by colonofibroscopy and a morphological study of colonic biopsy specimens. Gastric mucosal atrophic changes and motor evacuatory disorders as duodenogastric reflux were significantly more frequently encountered in inflammatory bowel diseases concurrent with chronic opisthorchiasis. The presence of Opisthorchis infestation significantly worsened fat and carbohydrate malabsorption in the small bowel in inflammatory bowel diseases.

Determinants of accelerated small intestinal transit in alcohol-related chronic pancreatitis

Patients with chronic pancreatitis may have abnormal gastrointestinal transit, but the factors underlying these abnormalities are poorly understood. Gastrointestinal transit was assessed, in 40 male outpatients with alcohol-related chronic pancreatitis and 18 controls, by scintigraphy after a liquid meal labeled with (99m)technetium-phytate. Blood and urinary glucose, fecal fat excretion, nutritional status, and cardiovascular autonomic function were determined in all patients. The influence of diabetes mellitus, malabsorption, malnutrition, and autonomic neuropathy on abnormal gastrointestinal transit was assessed by univariate analysis and Bayesian multiple regression analysis. Accelerated gastrointestinal transit was found in 11 patients who showed abnormally rapid arrival of the meal marker to the cecum. Univariate and Bayesian analysis showed that diabetes mellitus and autonomic neuropathy had significant influences on rapid transit, which was not associated with either malabsorption or malnutrition. In conclusion, rapid gastrointestinal transit in patients with alcohol-related chronic pancreatitis is related to diabetes mellitus and autonomic neuropathy.

Enteric circular muscle dysfunction in the cystic fibrosis mouse small intestine

BACKGROUND Cystic fibrosis (CF) has multiple effects on the gastrointestinal system, including altered motility. The Cftr knockout mouse model of CF has impaired small intestinal transit but the mechanism is unknown. METHODS Behaviour of circular smooth muscle was studied in an organ bath. Expression levels of prostaglandin (PG) degradative genes were measured by quantitative RT-PCR, and PGE(2) levels were measured by enzyme immunoassay. KEY RESULTS Cystic fibrosis circular muscle activity was erratic and had variable frequency of contractions, as compared to WT. The CF tissue was non-responsive to cholinergic stimulation or direct KCl depolarization. PGE(2) and PGF(2alpha) are significantly elevated in the CF mouse small intestine, and we hypothesized these contribute to impaired smooth muscle activity. After inhibition of PG synthesis, the CF circular muscle exhibited greater cholinergic responsiveness, which was reversed by exogenous PGE(2). PGF(2alpha) enhanced activity of CF tissue only after inhibition of PG synthesis. The enteric microbiota was implicated in PGE(2)-mediated dysmotility because broad spectrum antibiotic treated WT mice, which have slowed transit, exhibit impaired circular muscle activity. This was accompanied by decreased expression of PG degradative genes and increased intestinal PGE(2) levels. Furthermore, administration of oral laxative, which eradicates bacterial overgrowth and improves transit in CF mice, increased expression of PG degradative genes, decreased PGE(2) levels, and improved CF muscle activity. CONCLUSIONS & INFERENCES These results suggest that the enteric microbiota modulates PGE(2) levels in a complex manner, which affects enteric smooth muscle activity and contributes to slower small intestinal transit in CF.

[Use of reamberin for correction of enterocyte functional activity in experimental disseminated purulent peritonitis]

Violation of the structural integrity and functional activity of mitochondria in the muscular coat of small intestine is among the main factors responsible for enteroparesis under conditions of widespread purulent peritonitis. This morphofunctional disorder leads to a sharp decrease in ATP synthesis, which is directly related to a low electric activity of parts of the small intestine. The drug reamberin that contains succinic acid favors elimination of the dysfunction of enterocyte mitochondria and restoration of the intestinal motility under conditions of widespread purulent peritonitis.

[Influence of enteral administration of hypertonic electrolyte glucose solution on the intestinal barrier and organ functions in dogs with severe burn]

OBJECTIVE

To study the change in intestinal barrier and organ functions of burned dog after enteral administration of hypertonic electrolyte glucose solution (HEGS) in shock stage.

METHODS

Twenty-four Beagle dogs inflicted with 35% TBSA full-thickness burn were divided into no-fluid group (NF), intravenous infusion with isotonic electrolyte glucose solution (IEGS) group (II group), enteral infusion with IEGS group (EI), and enteral infusion with HEGS group (EH) according to the random number table, with 6 dogs in each group. Saline, containing 50 g/L glucose, was intravenously or enterally infused into dogs in II group and EI group respectively 0.5 hour post injury (PIH) for resuscitation. Total infusion volume within PIH 24 was 4 mL x kg(-1) x %TBSA(-1) (half of the total volume was infused in the first 8 hours in a constant speed, the other half volume was infused in the rest 16 hours in a constant speed). HEGS, containing 18 g/L NaCl and 50 g/L glucose, was enterally infused into dogs in EH group. Total infusion volume within PIH 24 was 2 mL x kg(-1) x %TBSA(-1), with the same infusion speed as that in II and EI groups. Liver and kidney function indexes [activity of ALT and CK-MB, expression levels of creatinine and blood urea nitrogen (BUN) in serum], activity of diamine oxidase (DAO), and activity of Na(+)-K(+)-ATPase in intestinal mucosa at PIH 24 were determined.

RESULTS

ALT activity in each group was close to one another. Serum levels of creatinine and BUN in II, EI, and EH groups were significantly lower than those in NF group. CK-MB activity obviously increased at PIH 2 in every group. CK-MB activity in EH group at PIH 2 to 8 was respectively lower than that in NF and II groups. DAO activity in serum in II, EI, and EH groups decreased since PIH 4 or PIH 6, respectively from (3.9 + or - 0.6) U/L to (3.6 + or - 0.5) U/L, (4.8 + or - 0.4) U/L to (2.8 + or - 0.8) U/L, (6.4 + or - 1.8) U/L to (3.5 + or - 0.8) U/L, all were significantly lower than those in NF group [from (12.5 + or - 0.4) U/L to (9.7 + or - 1.1) U/L, comparison between EH group and NF group, t value at PIH 4, 6, 8, 24 was respectively 10.25, 12.44, 17.99, 16.21, P values all below 0.05]. The order of Na(+)-k(+)-ATPase activity in intestinal mucosa at PIH 24 in each group from high to low was II group, EH group, EI group, and NF group (comparison between former 3 groups and NF group, t value was respectively 10.09, 4.96, 8.32, F value was 26.79, P values all below 0.05).

CONCLUSIONS

HEGS does not cause significant harm to the barrier function of intestinal mucosa of shock dog after burn. Compared with NF, HEGS can significantly improve functions of heart, liver, and kidney, and it can achieve the same resuscitation effect as enteral or intravenous infusion of IEGS with only half of the solution volume.

[Pathomorphological alterations in the liver and small intestine in experimental modelling of abdominal compartment syndrome]

Review of experimental study of pathomorphological alterations of hepar and small intestine of rats under modeling of intra-abdominal hypertension of up to 20 mm. Hg within 6, 12, and 24 hours. Dissection of liver pulp shows the signs of venous stasis, dystrophic alterations of liver pulp, focal bleedings; visceral edema is observed on the intestine wall, plethora and bleedings. At that pathomorphological alterations augmented towards the end of experiment.

Gastric emptying, small intestinal transit and fecal output in dystrophic (mdx) mice

Duchenne muscular dystrophy (DMD), which results from deficiency in dystrophin, a sarcolemma protein of skeletal, cardiac and smooth muscle, is characterized by progressive striated muscle degeneration, but various gastrointestinal clinical manifestations have been observed. The aim was to evaluate the possible impact of the dystrophin loss on the gastrointestinal propulsion in mdx mice (animal model for DMD). The gastric emptying of a carboxymethyl cellulose/phenol red dye non-nutrient meal was not significantly different at 20 min from gavaging between wild-type and mdx mice. The intestinal transit and the fecal output were significantly decreased in mdx versus normal animals, although the length of the intestine was similar in both animals. The present results provide evidence for motor intestinal alterations in mdx mice in in vivo conditions.

[Clinical and functional changes in small intestine in the treatment of osteoarthritis with nonsteroidal antiinflammatory drugs]

Comparative evaluation of changing in functional conditions of the small intestine in using non-selective and selective non-steroidal anti-inflammatory drugs (NSAID) was estimated. The treatment of osteoarthrosis with NSAID lasted up to 3 years and longer then 3 years. As a result of integrated investigations of 92 patients it was revealed that NSAID damage the absorption primarily in proximal area of the small intestine, however the more prolonged period of using the drugs the more severe damage to intestinal digestion both of cavitary and membranous stages of hydrolysis occur. Enteropathy develops in a less extend of expression in comparison with non-selective NSAID in using selective NSAID. New pathogenic appropriateness concerning the role of hormones in functional disturbances of the small intestine in using NSAID was proved.

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

Certain types of bariatric surgical procedures have proved not only to be effective with regard to treating obesity, but they also seem to be associated with endocrine changes which independently of weight loss give rise to remission of type 2 diabetes. Currently, it is speculated that surgical re-routing of nutrients triggers changes in the release of gastrointestine-derived hormones, which in turn cause amelioration of the diabetic state. The 'hindgut hypothesis' states that surgical re-routing of nutrients to the distal part of the small intestine results in increased secretion and concomitant glucose-lowering effects of glucagon-like peptide-1, whereas the 'foregut hypothesis' emphasises that surgical bypass of the foregut prevents the release of a hitherto unidentified nutrient-induced diabetogenic signal in susceptible individuals. Recent studies have shown that in patients with type 2 diabetes, glucagon is differentially secreted in response to oral and i.v. glucose, respectively, with lack of suppression (and initial net secretion) during oral glucose administration and a perfectly normal suppression during isoglycaemic i.v. glucose administration. These findings could point towards a role for glucagon or gut-derived glucagonotropic signalling as putative diabetogenic signals of the foregut hypothesis. In the present paper the hypotheses describing the glucose-lowering mechanisms of bariatric surgical procedures sharing the common feature of a bypass of the duodenum and the proximal jejunum are outlined and a possible role for glucagon in these is proposed.

Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography

OBJECTIVE

To determine the natural history and treatment of high-grade small bowel obstruction (HGSBO). Small bowel obstruction is a frequent complication of abdominal surgery. Complete and strangulating obstructions are managed operatively while partial obstructions receive a trial of nonoperative therapy. The management and outcome of patients with HGSBO diagnosed by computed tomography (CT) has not been examined.

DESIGN

Retrospective medical record review. Outcomes for nonoperative vs operative management were analyzed using Fisher exact and log-rank tests.

SETTING

Tertiary care referral center.

PATIENTS

One thousand five hundred sixty-eight consecutive patients admitted from the emergency department with a diagnosis of small bowel obstruction between 2000 and 2005 by CT criteria.

MAIN OUTCOME MEASURES

Recurrence of symptoms and complications.

RESULTS

One hundred forty-five patients (9%) with HGSBO were identified, with 88% follow-up (median, 332 days; range, 4-2067 days). Sixty-six (46%) were successfully managed nonoperatively while 79 (54%) required an operation. Length of stay and complications were significantly increased in the operative group (4.7 days vs 10.8 days and 3% vs 23%; P < .001). Nonoperative management was associated with a higher recurrence rate (24% vs 9%; P < .005) and shorter time to recurrence (39 days vs 105 days; P < .005) compared with operative intervention. Computed tomography signs of ischemia, admission laboratory results, and presence of cancer or inflammatory bowel disease were not predictive of an operation.

CONCLUSIONS

Patients with HGSBO by CT can be managed safely with nonoperative therapy; however, they have a significantly higher rate of recurrence requiring readmission or operation within 5 years.

[Clinical value of wireless capsule endoscopy in diagnosis of small bowel disease in children]

OBJECTIVE

The pathological change of small bowel is difficult to examine because it is anatomically unique. The development of wireless capsule endoscopy provides an unique opportunity to visualize the entire small bowel in a minimally invasive manner. The aim of this study was to assess the safety and clinical value of wireless capsule endoscopy in children.

METHODS

During the last 4 years (June, 2004-June, 2008), 46 times of wireless capsule endoscopy were performed in 43 patients with suspected small bowel disease, including obscure gastrointestinal bleeding (n = 11), recurrent abdominal pain (n = 20), chronic diarrhea (n = 9), protein losing enteropathy (n = 2), recurrent vomiting (n = 1). Of the 43 cases, 28 were male and 15 were female, the age ranged from 6 to 18 years, 8 of these cases were < 10 years old. The weight of the patients ranged between 15 kg and 60 kg. The average time of capsule passing through the stomach and the small intestine, the tolerance to and complication of wireless capsule endoscopy in patients, the image quality of capsule endoscopy, and the cleanliness of small intestine after fasting for 8 hours were observed and recorded.

RESULT

All the patients could easily swallow the capsule and had good tolerance. The overall success rate was 94% (43/46). The median time of capsule passing through the stomach and small intestine was 73 min (range, 3 - 600 min) and 246 min (range, 73 - 413 min), respectively. The diagnostic yield of pathological change in small intestine was 90% (37/41), and the diagnostic accordance rate was 84% (31/37). Based on the wireless capsule endoscopy, diagnostic findings included Crohn's diseases (15), lymph follicular hyperplasia (4), nonspecific enteritis (4), vascular malformations (3), small bowel tumour (2), primary intestinal lymphangiectasia (2), gastrointestinal motility disorders (2), Meckel's diverticulum (1), angioma (1), small intestinal worm disease (1), duodenal ulcer (1), and polyposis syndromes (1). The capsule of 1 patient remained in the stomach. The cleanliness of small intestine after 8 hours fasting was good. And the capsule endoscopy can show high quality small intestine image.

CONCLUSION

Wireless capsule endoscopy is a noninvasive, safe and useful tool for the investigation of the small intestine in children, especially for obscure gastrointestinal bleeding and Crohn's disease.

Melatonin ameliorates hemorrhagic shock-induced organ damage in rats

BACKGROUND

Hemorrhagic shock (HS) followed by resuscitation can result in production of several inflammatory mediators, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), leading to multiple organ dysfunction. Melatonin can attenuate organ damage with its anti-inflammation effects. The present study was designed to investigate the effects of melatonin on the physiopathology and cytokine levels after HS in rats.

METHODS

HS was induced in rats by withdrawing 40% of the total blood volume (6 mL/100 gm body weight) from a femoral artery catheter, immediately followed by intravenous injection of 10mg/kg melatonin. Mean arterial pressure and heart rate were monitored continuously for 48 h after the start of blood withdrawal. Biochemical parameters, including levels of hemoglobulin, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine (Cre), lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and lactate, were determined 30 min before and 0, 1, 3, 6, 12, 24, and 48 h after induction of HS while an equal volume of normal saline was replaced as fluid resuscitation. Cytokine levels including TNF-α and IL-6 in the serum were measured at 1, 24, and 48 h after HS. The kidney, liver, lung, and small intestine were removed for pathology assessment at 48 h after HS.

RESULTS

HS significantly increased the heart rate, blood GOT, GPT, BUN, Cre, LDH, CPK, lactate, TNF-α, and IL-6 levels, and decreased hemoglobulin and mean arterial pressure in rats. Treatment with melatonin preserved the mean arterial pressure, decreased tachycardia, and markers of organ injury, and suppressed the release of TNF-α and IL-6, with no change in hemoglobulin after HS in rats.

CONCLUSION

Treatment with melatonin suppresses the release of serum TNF-α and IL-6, and decreases the levels of markers of organ injury associated with HS, thus ameliorating HS-induced organ damage in rats.

Insulin secretion in healthy subjects and patients with Type 2 diabetes--role of the gastrointestinal tract

Postprandial glycaemia is now recognised as the major determinant of average glycaemic control in type 2 diabetes, as assessed by glycated haemoglobin. Therefore, an understanding of the factors influencing both the rise in blood glucose and insulin secretion after a meal is fundamental to the development of dietary and pharmacological approaches to optimise glycaemic control. The gastrointestinal tract regulates the rate at which carbohydrate and other nutrients are absorbed and is the source of regulatory peptides that stimulate pancreatic insulin secretion in the setting of elevated blood glucose levels. This article highlights the importance of the gastrointestinal tract in insulin secretion and glucose homeostasis and discusses potential strategies directed at modification of gastrointestinal function in order to improve glycaemic control in the management of diabetes.

Spiegelian hernia - - anatomy, diagnosing and imaging difficulties-report of 2 cases

Spiegelian hernias account for less than 1% of all hernias diagnosed in the adult population. The most important factors in the proper diagnostic process are detailed physical examination combined with imaging procedures. Two cases of Spiegelian hernias are presented. The anatomical background of the pathology, as well as diagnostic procedures and surgical treatment, is discussed.

Recent developments in gastrointestinal motility

In the past decade, the results of many studies on gastrointestinal motility and perception have been published that may be relevant to the clinician. A new classification of oesophageal motor disorders has been proposed in which "ineffective oesophageal motility" largely replaces the former "non-specific oesophageal motor disorders". Recent studies have shown that the incidence of transient lower oesophageal sphincter relaxations can be reduced pharmacologically, and this may open doors to a new therapeutic approach in gastro-oesophageal reflux disease. The mechanisms through which hiatus hernia promotes reflux have become clearer. The recently developed technique of intraluminal impedance monitoring has made it possible to study oesophageal transit, non-acid reflux and its role in the generation of reflux symptoms, as well as the characteristics of belching. Measurement of gastric emptying by means of a non-radioactive isotope and breath-testing has become widely available but, unfortunately, this development has not yet been accompanied by the advent of new therapeutic options for gastroparesis. The term "enteric dysmotility" has been coined for the condition in which upper abdominal symptoms are associated with distinct small intestinal bowel motility disorders in the absence of ileus-like episodes. The role of high-amplitude propagated contractions in the pathogenesis of constipation has been further defined. In cases of suspected sphincter of Oddi dysfunction, manometry of both sphincters (IBD and pancreatic) is now felt to be advisable.

Bowel resection induced intestinal adaptation: progress from bench to bedside

Intestinal adaptation after massive short bowel resection (SBR) is characterized structurally by an increase in intestinal wet weight, protein, DNA content, villus height, crypt depth, and absorptive surface area. These structural characteristics are driven by a proliferative stimulus that increases crypt cell division and augments cellular progression along the crypt-villus axis. Functional characteristics of adaptation include an upregulation of NA+/Glucose cotransporters, Na+/H+ exchangers, and other enzymes involved in digestion and absorption. The combination of structural and functional adaptation are physiologic live-saving events that compensate for the sudden loss of digestive and absorptive capacity in the remnant intestine. If intestinal adaptation does not occur or is inadequate, a lifelong dependence on parenteral nutrition will ensue, which ultimately results in devastating cholestatic liver dysfunction. Several mediators are thought to play an influential role in postresection small bowel adaptation, including intraluminal nutrients, gastrointestinal secretions, hormones, growth factors, and other genetic/biochemical factors. A thorough understanding of the mechanisms that drive intestinal adaptation will be essential in the development of novel and innovative therapies that result in saving lives.

Gastric and small bowel ileus after severe burn in rats: the effect of cyclooxygenase-2 inhibitors

Gastrointestinal (GI) ileus is a common complication after severe burns. Selective cyclooxygenase-2 inhibitors (COX-2i) improved post-operative ileus, but its effect on burn-induced GI dysmotility is unknown. Our aim was to test whether a COX-2i improves gastric emptying (GE) and small bowel transit (SBT) after burn. Experiment on GE: rats were anesthetized and randomized into sham/scald burn, treated/untreated with COX-2i. Six hours after burn, rats received a phenol red meal and were sacrificed 30 min later. Gastric emptying was determined based on the percentage of phenol red recovered in harvested stomachs. Experiment on SBT: rats received a duodenostomy and were scald/sham burned 5 days later. Six hours after burn, rats received a phenol red meal through the duodenostomy catheter and were sacrificed 100 min later. Geometric center (GC) was calculated for SBT. GE was decreased significantly in burned vs. sham animals (p<0.001). SBT was significantly impaired in burned vs. sham animals (p<0.001). The COX-2i improved GE in the burn rats but not GE in the control rats or SBT in the burn rats. COX-2i improves burn-induced delayed GE, suggesting the mediation of the latter via the prostaglandin pathway.

Coeliac disease

Coeliac disease is a chronic inflammatory disorder of the small bowel induced in genetically susceptible people by the irritant gluten and possibly other environmental cofactors. The disorder is characterised by a diverse clinical heterogeneity that ranges from asymptomatic to severely symptomatic, and it manifests with frank malabsorption, an increased morbidity attributable to the frequent association with autoimmune disorders and increased mortality resulting from the emergence of T-cell clonal proliferations that predispose the patient to enteropathy-type T-cell lymphoma. Our understanding of the molecular basis for this disorder has improved and enabled the identification of targets for new therapies, although a strict gluten-free diet remains the mainstay of safe and effective treatment. In this Seminar we critically reassess the clinical and diagnostic aspects of this disease and new perspectives in its pathogenesis and treatment.

Gut ammonia production and its modulation

Systemic hyperammonemia has been largely found in patients with cirrhosis and hepatic encephalopathy, and ammonia plays a major role in the pathogenesis of hepatic encephalopathy. However, controversial points remain: a) the correlation between plasma ammonia levels and neurophysiological impairment. The lack of correlation between ammonia levels and grade of hepatic encephalopathy in some cases has been considered a weakness of the ammonia hypothesis, but new methods for ammonia measurements and the implication of systemic inflammation in the modulation of ammonia neurotoxicity could explain this gap; b) the source of ammonia production. Hyperammonemia has been considered as derived from urea breakdown by intestinal bacteria and the majority of treatments were targeted against bacteria-derived ammonia from the colon. However, some data suggest an important role for small intestine ammonia production: 1) the hyperammonemia after porto-caval shunted rats has been found similar in germ-free than in non-germ-free animals. 2) In cirrhotic patients the greatest hyperammonemia was found in portal drained viscera and derived mainly from glutamine deamination. 3) The amount of time required to increase of ammonia (less than one hour) after oral glutamine challenge supports a small intestine origin of the hyperammonemia. As the main source of ammonia in cirrhotics derives from portal drained viscera owing to glutamine deamidation, increased glutaminase activity in the intestine seems to be responsible for systemic hyperammonemia. Lastly, some genetic alterations in the glutaminase gene such as the haplotype TACC could modulate intestinal ammonia production and the risk of overt hepatic encephalopathy in cirrhotics.

Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease

BACKGROUND AND AIM

A recent study using lactulose hydrogen-breath testing suggests that small intestine bacterial overgrowth (SIBO) is a common cause of nonresponsive celiac disease (CD). The prevalence of SIBO in CD diagnosed by quantitative culture of intestinal aspirate is unknown. The aim of this study is to evaluate the prevalence and significance of SIBO in CD based on the results of quantitative culture of intestinal aspirate.

METHODS

We studied patients with CD in whom culture of intestinal aspirate was evaluated for the presence of anaerobes and aerobes. Bacterial overgrowth was diagnosed if culture demonstrated >10 colony forming units/mL. The causes of nonresponsive CD were investigated.

RESULTS

We included 149 biopsy-confirmed CD patients. The intestinal aspirate was collected in 79 (53%) patients with nonresponsive CD, 47 (32%) as initial work-up for malabsorption, and in 23 (15%) asymptomatic treated CD. SIBO was diagnosed in 14 (9.3%). Nine (11%) with nonresponsive CD, 5 (11%) at initial work-up for malabsorption, and 0 in asymptomatic treated CD. Patients with a positive culture had evidence of worse malabsorption. A coexistent disorder was found in 67% of patients with both nonresponsive CD and bacterial overgrowth.

CONCLUSIONS

The prevalence of SIBO diagnosed by quantitative culture of intestinal aspirate was 9.3% in patients with CD. Patients with symptomatic treated or untreated CD were affected. SIBO may coexist with other disorders associated with nonresponsive CD.

Glucagon-like peptide-2 reduces intestinal permeability but does not modify the onset of type 1 diabetes in the nonobese diabetic mouse

The development of type 1 diabetes (T1D) has been linked to environmental factors and dietary components. Increasing evidence indicates that the integrity of the gut mucosa plays a role in the development of autoimmune diseases, and evidence from both preclinical and clinical studies demonstrates that increased leakiness of the intestinal epithelium precedes the development of type 1 diabetes. However, there is limited information on modulation of gut barrier function and its relationship to diabetes development. Here we show that the nonobese diabetic (NOD) mouse, a model of T1D, exhibits enhanced intestinal transcellular permeability before the development of autoimmune diabetes. Treatment of NOD mice with a glucagon-like peptide 2 (GLP-2) analog, synthetic human [Gly(2)] glucagon-like peptide-2 (h[Gly(2)]GLP-2, increased the length and weight of the small bowel and significantly improved jejunal transepithelial resistance. However, chronic administration of once daily h[Gly(2)]GLP-2 failed to delay or reverse the onset of T1D when treatment was initiated in young, normoglycemic female NOD mice. Furthermore, h[Gly(2)]GLP-2 administration had no significant effect on lymphocyte subpopulations in NOD mice. These findings demonstrate that h[Gly(2)]GLP-2-mediated enhancement of gut barrier function in normoglycemic NOD mice disease is not sufficient to prevent or delay the development of experimental T1D.

[Intestinal mucosal barrier dysfunction after abdominal operation and its clinical significance]

OBJECTIVE

To investigate the plasma glutamine (Gln) level and relationships between the intestinal mucosal permeability and bacterial translocation and between bacterial translocation and systemic inflammatory response syndrome (SIRS) after abdominal operation.

METHODS

The peripheral blood was collected from 42 patients before and 2 and 7 days after elective abdominal operation. The plasma Gln concentration and lactulose/mannitol (L/M) ratio were measured and the whole blood bacterial DNA concentration was determined by polymerase chain reaction (PCR). The relationship between intestinal mucosal barrier dysfunction and the occurrence of postoperative SIRS was analyzed.

RESULTS

The plasma Gln level was significantly lowered (P<0.01) and L/M ratio increased (P<0.01) in these patients 2 and 7 days after the operation in comparison with the preoperative level. No bacterial DNA was detected before surgery, but PCR yielded positive results in 4 patients (9.5%, 4/42) at 2 days and in another patient at 7 days (2.4%, 1/42) after the operation. The 4 patients with positive PCR results 2 days after the operation showed significantly lower plasma Gln concentration (P<0.01) and higher L/M ratio (P<0.01) than those with negative results. SIRS occurred in 24 patients after surgery, whose plasma Gln level was significantly lower (P<0.01) and L/M ratio significantly higher (P<0.01) than that in the SIRS-free patients 2 days after the operation. Five of the 26 SIRS patients showed positive PCR results, while none of the 16 non-SIRS patients were positive, but this difference was not statistically significant (P>0.05).

CONCLUSION

Decreased plasma Gln and increased intestinal mucosal permeability are closely related to postoperative bacterial translocation and the intestinal mucosal barrier dysfunction, which may contribute to the occurrence of postoperative infection.

[A research of migrating motor complex in patients with irritable bowel syndrome]

OBJECTIVES

To compare the migrating motor complex (MMC) in irritable bowel syndrome (IBS) patients with that in healthy controls. To explore whether discrete clustered contractions (DCC) are connected with abdominal pain in IBS patients. To improve the method of measuring gastroenteric motility (esp. jejunum).

METHODS

By using 16-channel water-perfused catheter and manometry instruments, MMC in 16 cases of IBS with constipation (IBS-C), 18 cases of IBS with diarrhea (IBS-D) and 18 cases of healthy controls were monitored.

RESULTS

The MMC durations of IBS-C and IBS-D patients were (127.5 +/- 25.5) min and (74.5 +/- 18.7) min, respectively. Comparision with those in the control group [(87.5 +/- 24.2) min] showed significant differences (P < 0.001). The contraction amplitudes of stage III in different sites of IBS-C patients decreased significantly as compared with those in the controls [jejunum, (39.8 +/- 11.7) mm Hg vs. (61.1 +/- 14.1) mm Hg, P < 0.001, 1 mm Hg = 0.133 kPa]. The propagation velocities of stage III in different sites of IBS-C patients also decreased significantly as compared with those in the controls [jejunum, (1.8 +/- 0.9) cm/min vs. (2.6 +/- 0.8) cm/min, P < 0.01]. The contraction amplitudes of stage III in different sites of IBS-D patients increased significantly as compared with those in the controls [jejunum, (69.7 +/- 20.5) mm Hg vs. (61.1 +/- 14.1) mm Hg, P < 0.01]. The propagation velocities of stage III in different sites of IBS-D patients also increased significantly as compared with those in the controls [jejunum, (4.1 +/- 2.5) cm/min vs. (2.6 +/- 0.8) cm/min, P < 0.01]. DCC incidences of IBS-C and IBS-D were 87.5% and 88.8%, respectively. Comparision with those in the normal group (83.3%) did not show significant difference (P > 0.05). The prevalences of abnormal stage III contractions (include disturbances and interferences of stage III contractions) in IBS-C and IBS-D patients were 68.8% and 66.7%, respectively; there were no significant differences between the two groups (P > 0.05). However abnormal stage III contractions did not exist in healthy controls.

CONCLUSIONS

(1) The MMC of IBS-C and IBS-D patients are changed, as compared with that in healthy people; this implies that small intestinal motility dysfunction is one of the pathogenetic factors of IBS. The abnormal stage III contractions in jejunum may be a predominant change in IBS gastroenteric motility. (2) No apparent connection is found between DCC and pain in IBS. (3) By using 16-channel water-perfused catheter, we first carried out the method of monitoring jejunum contractions in China. Parameters of MMC in Chinese healthy people were investigated, esp. those of jejunum.

[Effect of non-steroidal anti-inflammatory drugs on small intestinal barrier function in rats]

OBJECTIVE

To approach the effect on mechanical barricade of the mucous membrane of small intestine caused by non-steroidal anti-inflammatory drugs (NSAIDs).

METHODS

Thirty-two male SD rats were randomly divided into control group and model group. The rats of the model group were given 7.5 mg/kg diclofenac by gavage, bid; the rats of the control group were given the same dose of saline. Then they were further randomly divided into two subgroups (n=8) at the first day and the fifth day after making the models to observe the scores of anatomical lesion on stomach and small intestine and the scores of tissue damage of mucous membrane and to quantitatively analyze the height of villi, as well as the thickness and the section area of mucous membrane with Carl Zeiss Imaging Systems. Observation of the change of ultrastructural organization of mucous membrane was carried out with transmission electron microscope.

RESULTS

The mucous membrane of stomach of the model groups was slightly edematous. There was no difference between the scores of the model groups and control groups. It was seen that the mucous membrane of small intestine of the first day model group presented with erythema, amaurosis and ulcer. The ulcer was distributed along mesentery. The mucous membrane of small intestine of the fifth day model group showed bleeding, perforation and sinus tract formation, and the scores of anatomical lesion was higher than that of the control group (P < 0.05). The scores of the lesions of the first and fifth day model groups were 3.5 and 5.0. The difference had statistical significance when compared with those of the control groups (the scores were 0) (P < 0.05). Cell degeneration and cellular necrosis of epithelial mucosa of small intestine was also seen in the first day model group. The top of villi was ablated. The height of the pile on jejunum was (126.9 +/- 32.0) microm and that on ileum was (118.6 +/- 22.9) microm. They were lower than those of the control group (P < 0.05). However there was no difference of the thickness and section area between them, but the thickness and section area showed a tendency of decrease. It was also seen that there were apomorphosis and sphacelism of epithelial cells in the fifth day model group. Some villi were ablated and laminae propria exposed. The height of villi on jejunum [(73.4 +/- 25.4) microm] and that on ileum [(109.3 +/- 17.6) microm] decreased significantly. The thickness of mucous membrane [(123.8 +/- 51.6) microm and (165.7 +/- 37.4) microm] decreased and the section area [(2.48 +/- 1.01) mm2 and (3.27 +/- 0.76) mm2] became smaller (P < 0.05 vs. control group). The mucous membrane of the villi on small intestine was continuous but arranged disorderly. Cytochondriome swelled, endocytoplasmic reticulin expanded with different degrees, intercellular junction widened partly. The microvilli in the fifth day model group were ablated more obviously and intercellular junctions were broken and destroyed gravely.

CONCLUSIONS

Diclofenac can cause damage to the function of mucous membrane barricade of small intestine. It could also lead to shortening of the villi, thinning of the mucous membrane, ablation of the microvilli, and widening of the tight intercellular junction as the characteristic morphological change.

[Syndrome of excessive bacterial growth in small intestine: etiology, pathogenesis, clinical manifestations]

In survey presented literature data about etiology, pathogenesis and clinical course of the syndrome of excess intestinal bacterial growth. Is produced information about intestinal microflora and its unfavorable changes in various environmental influences. Is showed that main clinical findings of the syndrome are formed by influence of disturbances of motility, intestinal digestion and absorption.

[Activity of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease in regard to small intestinal absorption function]

AIM

To study the effect of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease (COPD) in association with absorption of the small intestine.

MATERIAL AND METHODS

Small intestinal absorption was studied in 93 COPD patients (22, 36 and 35 patients at stage I, II and III, respectively) in a clinically stable stage of the disease and in 35 healthy controls. The absorption was investigated biochemically and with application of radionuclide methods, blood concentration of TNF alpha was measured with enzyme immunoassay.

RESULTS

The small intestine of patients with moderate and severe COPD showed subnormal absorption of fats, protein, carbohydrates. With the disease progression, this disorder aggravated. The same trend was seen in relation to TNF alpha concentration. A strong direct correlation was found between a high concentration of TNF alpha and a low absorption of 131I-albumin and fatty acids, this high concentration correlated negatively with low absorption of d-xilose.

CONCLUSION

Relationships between inflammation severity and small intestinal absorption of fats, protein, carbohydrates in patients with moderate and severe COPD means loss of essential nutrients, primarily protein and fats. This is important in understanding of pathobiological processes of development of extrapulmonary (intestinal) manifestations in COPD patients.