Reduced food intake after jejunoileal bypass: a possible association with prolonged gastric emptying and altered gut hormone patterns

The object of this study was to examine whether eating behavior, food preference, gastric emptying, and gut hormone patterns are altered after jejunoileal bypass (JIB) in patients with severe obesity. Eight obese [mean (+/- SD) body mass index (BMI; in kg/m2) 42.9 +/- 4] subjects were studied prospectively before and 9 mo after JIB with eight age- and sex-matched normal-weight control subjects. Total energy intake, data from the universal eating monitor (VIKTOR), eating motivation measured by visual analog scales, a food-preference checklist, a forced-choice list, solid-phase gastric emptying, and postprandial concentrations of cholecystokinin, motilin, and neurotensin were studied. BMI was reduced by 29% after JIB. Compared with normal subjects, the JIB patients showed a reduced desire to eat, decreased hunger, and reduced prospective consumption before a test meal. After surgery, obese subjects selected fewer food items and showed a reduced preference for high-carbohydrate and high-fat items before a test meal. There was a trend from an accelerated toward a decelerated eating pattern in obese subjects after JIB. After JIB, gastric emptying of obese subjects was slowed and similar to that in control subjects. Obese subjects had lower postprandial cholecystokinin concentrations that were lower than those of control subjects both before and after JIB. Postprandial concentrations of neurotensin were higher after JIB. We conclude that after JIB, the desire to eat and preference for high-carbohydrate and high-fat items is reduced, resulting in decreased energy intake. That gastric emptying is prolonged and gut hormone patterns are altered with low postprandial plasma cholecystokinin and high neurotensin plasma concentrations may at least partly account for these observations.

Gastrointestinal hormones and gastric emptying 20 years after jejunoileal bypass for massive obesity

OBJECTIVE

Some studies have shown a more rapid gastric emptying in obese subjects. Six to twelve months after jejunoileal bypass (JIB) neurotensin (NT) and enteroglucagon have been shown to be elevated after food intake. These hormones, together with peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) have been implicated in the reduction of upper gastrointestinal motility seen after infusion of nutrients into the ileum.

AIM

To study if the postprandial gut hormone pattern and gastric emptying is altered 20 y after JIB.

SUBJECTS

Seven subjects operated with JIB a mean (s.d.) 20 +/- 3 y ago, with a BMI of 44 +/- 4 kg/m2 at the time of surgery and 31 +/- 4 at present. For comparison seven sex-matched non-operated obese controls (BMI 43 +/- 3) were studied.

METHODS

Serial blood samples were obtained every 10 min after intake of a 280 kcal meal. Radioimmunoassays for motilin, cholecystokinin (CCK), NT, PYY and GLP-1 were performed. Gastric emptying of a solid meal was studied using a radioactively labelled omelette (of 310 kcal) for 120 min).

RESULTS

After JIB postprandial motilin, CCK, NT, PYY and GLP-1 were elevated compared to non-operated obese subjects. Similarly, basal levels of CCK, motilin, GLP-1 and PYY were elevated in the operated group. No difference was observed in the rate of gastric emptying between the two groups.

CONCLUSION

Both fasting and postprandial gut hormone levels are elevated 20 y after JIB. The impact of long-term rapid stimulation of the ileum and subsequent raised gut hormone levels on gastric emptying is not clear.

Stimulation of beta-adrenoceptors with isoprenaline inhibits small intestinal activity fronts and induces a postprandial-like motility pattern in humans

AIMS

To investigate the effects of beta-adrenoceptor stimulation, using the agonist isoprenaline and the antagonist propranolol, on migrating motor complexes in the upper intestine of 16 healthy human volunteers.

METHODS

Fasting motility was monitored using a tube with water perfused side holes connected to a pneumohydraulic system. Continuous eight hour recordings were obtained from each volunteer after a 12 hour fasting period. In all experiments, saline was given as control for the first four hour period and beta-adrenergic agents for the next four hours. In separate control studies, saline was given for the whole eight hour period.

RESULTS

Isoprenaline (2.5 micrograms/kg/min) reduced the number of activity fronts (phase III) of migrating motor complexes from 3 (2-4) in controls to 1 (0-2) during isoprenaline infusion (p < 0.01). Also, phase II-like activity replaced the regular motility pattern (p < 0.01). By contrast, propranolol (25 micrograms/kg/min) did not induce any significant changes in phase III compared with controls. Saline alone had no effect on motor activity.

CONCLUSIONS

Isoprenaline inhibited activity fronts in the human proximal small intestine and induced a postprandial-like motility pattern, whereas propranolol did not affect motor patterns. Stimulation of beta-adrenoceptors is of importance in the control of motor activity of the human small intestine, especially under stressful conditions with high adrenergic activity.

Gastric emptying of solids in humans: improved evaluation by Kaplan-Meier plots, with special reference to obesity and gender

It has been suggested that obesity is associated with an altered rate of gastric emptying, and that there are also sex differences in gastric emptying. The results of earlier studies examining gastric emptying rates in obesity and in males and females have proved inconsistent. The aim of this study was to investigate the influence of obesity and gender on gastric emptying, by extending conventional evaluation methods with Kaplan-Meier plots, in order to assess whether these factors have to be accounted for when interpreting results of scintigraphic gastric emptying tests. Twenty-one normal-weight volunteers and nine obese subjects were fed a standardised technetium-99m labelled albumin omelette. Imaging data were acquired at 5- and 10-min intervals in both posterior and anterior projections with the subjects in the sitting position. The half-emptying time, analysed by Kaplan-Meier plot (log-rank test), were shorter in obese subjects compared to normal-weight subjects and later in females compared to males. Also, the lag-phase and half-emptying time were shorter in obese females than in normal females. This study shows an association between different gastric emptying rates and obesity and gender. Therefore, body mass index and gender have to be accounted for when interpreting results of scintigraphic gastric emptying studies.

Nitrergic inhibition of migrating myoelectric complex in the rat is mediated by vasoactive intestinal peptide

The role of vasoactive intestinal peptide (VIP) for the action of nitric oxide (NO) as a nonadrenergic noncholinergic inhibitory mediator was investigated regarding effects on migrating myoelectric complex (MMC) in rat. Animals were supplied with implanted bipolar electrodes at 5, 15 and 25 cm distal to pylorus for electromyography of small intestine. First, basal recordings with saline were followed by intravenous infusions of glyceryl trinitrate or VIP at different infusion rates to achieve dose-response relationships. Second, effects of different doses of the nitric oxide synthase inhibitor, N omega-nitro-L-arginine (L-NNA) were studied. Third, the action of L-NNA (1 mg kg-1) on the effect of VIP (500 pmol kg-1 min-1), and of the VIP receptor antagonist (4-Cl-D-Phe6, Leu17), VIP (45 nmol 20 min-1), on the action of glyceryl trinitrate (44 nmol kg-1 min-1) was investigated. Glyceryl trinitrate prolonged the MMC cycle length from 16.3 +/- 1.3 to 44.9 +/- 8.0 min (P < 0.001), while VIP completely disrupted the MMC for the whole infusion period (P < 0.05). Higher doses of either compound induced quiescence. L-NNA shortened MMC cycle length from 14.7 +/- 1.2 to 8.6 +/- 1.4 min (P < 0.05), increased its propagation velocity from 2.0 +/- 0.4 to 18.3 +/- 8.4 cm min-1 (P < 0.01) and increased calculated length from 6.3 +/- 1.0 to 55.4 +/- 18.4 cm (P < 0.01). Pretreatment with (4-Cl-D-Phe6, Leu17) VIP blocked the inhibitory action of glyceryl trinitrate and preserved MMC pattern (P < 0.05). In contrast, L-NNA had no effect on the inhibition of MMC caused by VIP. Our results indicate that inhibition of MMC is related to production of NO, which may mediate its actions through VIP.

Contractile responses of rat duodenum caused by transmural nerve stimulation: interaction between tachykininergic and cholinergic mechanisms

We have studied the importance of tachykinins and acetylcholine for motor stimulation of the rat duodenum in vitro. Contractions induced by transmural nerve stimulation and tachykinin receptor agonists selective for NK1, NK2 and NK3 receptors were used in combination with a neurokinin (NK)2 receptor antagonist, MEN 10,627, and atropine as a muscarinic receptor antagonist. Transmural nerve stimulation in the range 0.5-32 Hz caused frequency-dependent contractions. MEN 10,627 (10(-8), 10(-7) and 10(-6) M) dose-dependently reduced the contractile frequency-response curve (P < 0.01-0.001). Addition of atropine (10(-8) M) completely inhibited the response to transmural nerve stimulation (P < 0.001). As control, atropine alone reduced this response only by about 65%. Of the tachykinin analogues, [beta-AlaB]-neurokinin A(4-10) selective for NK2 receptors caused concentration-dependent contractions with high potency (pD2 8.01) and high efficacy, while substance P methyl ester acting on NK1 receptors had lower potency (pD2 7.94) and low efficacy, and senktide acting on NK3 receptors had a low potency (pD2 7.52) but high efficacy. With increasing concentrations of MEN 10,627 the response to [beta-AlaB]-neurokinin A(4-10) was markedly reduced (P < 0.01), while responses to substance P methyl ester and senktide were only slightly affected. Our results indicate that the physiological contractile responses of the rat duodenum are co-mediated by acetylcholine and tachykinins, for which NK2 receptors seem to be most important.

Characteristics of fasting and fed myoelectric activity in rat small intestine: evaluation by computer analysis

Evaluation of gastrointestinal myoelectric activity has been limited by the assessment techniques and the complexity of the recorded myoelectric signal. Commonly, myoelectric activity is evaluated as motor patterns, which only gives a semiquantitative measure of myoelectric events within the bowel wall. Using myoelectric recordings from the proximal small intestine in rats, a computerized system for acquisition, storage, display and calculation of characteristics for the myoelectric activity was developed. The software was tested in myoelectric recordings from nine rats in fasting and fed states. All migrating myoelectric complexes (MMCs) during fasting and fed myoelectric patterns were recognized in both digital and analog recordings. Reproduction of myoelectric recordings by the computerized system was indistinguishable from that of the analog system. Employing an appropriate cut-off trigger level and a high sampling frequency, spike potentials were recorded in the proximal jejunum with 0.4 (0.3-0.5) spikes 10 s-1 during phase 1 of MMC, 19.5 (15.1-23.9) (P < 0.001) during phase 2, and 103.8 (97.2-110.5) (P < 0.001) during phase 3. In fasted state, MMCs were most frequent in the proximal jejunum whereas fewer were found in the duodenum and distal jejunum. To achieve stable values for MMC cycle length at least four MMCs had to be calculated. After feeding in phase 1, the myoelectric activity increased to 23.8 (13.6-33.9) spikes 10 s-1 (P < 0.001), whereafter the spiking activity decreased over a period of 2 h until a fasting motor pattern was resumed. It is concluded that computerized technology enables evaluation not only of myoelectric patterns, but also of spiking activity per time unit, i.e. the intensity of myoelectric activity in the gut.

Haemodynamic changes in the small intestine correlate to migrating motor complex in humans

OBJECTIVE

To evaluate local intestinal blood flow and its relationship to fasting gut motility in humans.

DESIGN AND METHODS

Regional laser Doppler flowmetry (LDF) was carried out for 8 h in 14 tasted volunteers. LDF measured as perfusion units (PU) was performed using two single-fibre microprobes attached to a small intestinal manometry tube, which monitored migrating motor complexes (MMCs). Luminal pressures of small intestine were registered in analogue and digital recordings.

RESULTS

During phase 1 of MMC, PU values of 65 (33-95) and 37 (20-100) in proximal and distal duodenum were measured. During phase 2, PU values increased by 17% and 38%, respectively (each P < 0.001). At phase 3 of MMC, corresponding PU values increased by 363% and 443% (each P < 0.001) and remained at high levels until termination of phase 3. During phase 3 there was aboral propagation of LDF activity. Computerized recordings allowed detailed analysis of relationships between LDF pattern and luminal pressures. At pressures below 48 (42-54) mmHg, individual LDF cycles and contraction cycles were phase displaced at 180 degrees, indicating low perfusion during contractions. When pressures exceeded 48 (42-54) mmHg, a decrease in PU was registered and the cycling pattern of LDF was abolished. Then, as luminal pressure decreased below 33 (25-41) mmHg, PU increased by 246%.

CONCLUSION

Our findings show a relationship between fasting motility and blood flow in the human gut, in which the blood flow exhibited a pattern similar to phase 1, 2 and 3 of the MMC.

Glucagon-like peptide I enhances the insulinotropic effect of glibenclamide in NIDDM patients and in the perfused rat pancreas

OBJECTIVE

To investigate the acute effects of glibenclamide and glucagon-like peptide I (GLP-I) and their combination in perfused isolated rat pancreas and in patients with secondary failure to sulfonylureas.

RESEARCH DESIGN AND METHODS

Rat islets were perfused with 10 nmol/l GLP-I in combination with 2 mumol/l glibenclamide. In human experiments, GLP-I (0.75 pmol. kg-1.min-1) was given as a continuous infusion during 240 min, while glibenclamide (3.5 mg) was administered orally. Eight patients participated in the study (age 57.6 +/- 2.7 years, BMI 28.7 +/- 1.5 kg/m2, mean +/- SE). In all subjects, blood glucose was first normalized by insulin infusion administered by an artificial pancreas (Biostator).

RESULTS

GLP-I increased the insulinotropic effect of glibenclamide fourfold in the perfused rat pancreas. In human experiments, treatment with GLP-I alone and in combination with glibenclamide significantly decreased basal glucose levels (5.1 +/- 0.4 and 4.5 +/- 0.1 vs. 6.0 +/- 0.3 mmol/l, P < 0.01), while with only glibenclamide, glucose concentrations remained unchanged. GLP-I markedly decreased total integrated glucose response to the meal (353 +/- 60 vs. 724 +/- 91 mmol.l-1. min-1, area under the curve [AUC] [-30-180 min], P < 0.02), whereas glibenclamide had no effect (598 +/- 101 mmol.l-1. min-1, AUC [-30-180 min], NS). The combined treatment further enhanced the glucose lowering effect of GLP-I (138 +/- 24 mmol. l-1.min, AUC [-30-180 min], P < 0.001). GLP-I, glibenclamide, and combined treat-stimulated meal-induced insulin release as reflected by insulinogenic indexes (control 1.44 +/- 0.4; GLP-I 6.3 +/- 1.6, P < 0.01; glibenclamide 6.8 +/- 2.1, P < 0.01; combination 20.7 +/- 5.0, P < 0.001). GLP-I inhibited basal but not postprandial glucagon responses. Using paracetamol as a marker for gastric emptying rate of the test meal, treatment with GLP-I decreased gastric emptying at 180 min by approximately 50% compared with the control subjects (P < 0.01).

CONCLUSIONS

In acute experiments on overweight patients with NIDDM, GLP-I exerted a marked antidiabetogenic action on the basal and postprandial state. The peptide stimulated insulin, suppressed basal glucagon release, and prolonged gastric emptying. The glucose-lowering effect of GLP-I was further enhanced by glibenclamide. This action may be at least partially accounted for by a synergistic effect of these two compounds on insulin release. Glibenclamide per se enhanced postprandial but not basal insulin release and exerted a less pronounced antidiabetogenic effect compared with GLP-I.

Beta-adrenoceptors regulate myoelectric activity in the small intestine of rats: stimulation by beta 2 and inhibition by beta 3 subtypes

Using beta-adrenergic agonists and antagonists this study investigated the importance of three different adrenoceptor subtypes for the regulation of migrating myoelectric complexes (MMCs) of the upper small intestine in conscious, naive rats. After a control period of 60 min with four activity fronts, agonists were given as an intravenous infusion for another 60 min. The non-selective beta-adrenoceptor agonist isoprenaline (1 microgram kg-1 min-1) inhibited MMCs and induced irregular spiking during the infusion period. This effect was blocked by intravenous administration of a bolus dose of either the non-selective beta-adrenoceptor antagonist propranolol (1 mg kg-1), or the beta 2-antagonist ICI 118 551 (1 mg kg-1), both given prior to isoprenaline. However, acebutolol (1 mg kg-1), a selective beta 1-antagonist, failed to antagonize the effect of isoprenaline. Furthermore, prenalterol, a selective beta 1-agonist (12.5-800.0 micrograms kg-1 min-1), had no effect on the MMC pattern, whereas the beta 2-selective agonist ritodrine (25-100 micrograms kg-1 min-1) induced a myoelectric pattern similar to one induced by isoprenaline. The partial beta 3-adrenoceptor agonist D7114 (50-100 micrograms kg-1 min-1), disrupted the MMCs and induced quiescence. Neither of the antagonists, i.e. propranolol (1 mg kg-1), acebutolol (1 mg kg-1) nor ICI 118 551 (1 mg kg-1), given alone induced changes in the MMC pattern. In conclusion, beta 2-adrenoceptors in particular but also beta 3-adrenoceptors seem to be of importance in the regulation of small intestinal motility by disrupting the regular MMC pattern in rats.

Tachykinins increase vascular permeability in the gastrointestinal tract of the rat

The occurrence of inflammation as indicated by extravasation of Evans blue bound to plasma proteins was examined in various parts of the gastrointestinal tract in the rat, following administration of tachykinins, capsaicin and hydrochloric acid. Intravenous neurokinin A dose-dependently induced extravasation in stomach, duodenum, jejunum, caecum and colon, but had no effect in ileum. Neurokinin B equipotently induced extravasation in the stomach but had no effect in other parts of the gut and substance P had no effects on extravasation of Evans blue in any of the examined parts of the gastrointestinal tract. Capsaicin given intraperitoneally increased vascular permeability in stomach and duodenum only, while extravasation of Evans blue after capsaicin given intraluminally did not differ from the effect of the vehicle alone. As a comparison, HCl given intraluminally in the duodenum was found to induce a prominent extravasation of Evans blue of a greater magnitude than than of tachykinins. We suggest that tachykinins, and in particular neurokinin A, may be of importance for extravasation of plasma proteins as part of inflammatory reactions in the upper and lower gastrointestinal tract.

Release of somatostatin, neurotensin and vasoactive intestinal peptide upon inhibition of gastric acid secretion by duodenal acid and hyperosmolal solutions in the conscious rat

The inhibitory effect of duodenal exposure to acid and hyperosmolal solutions on pentagastrin-stimulated gastric acid secretion was studied in conscious rats equipped with chronic gastric fistula and duodenal Thiry-Vella loop. The loop was challenged with saline, HCl or hyperosmolal polyethylene glycol. Gastric acid secretion was measured in samples from the gastric fistula. Gut peptide concentrations were measured in duodenal perfusates collected each 30 min, and in plasma samples collected both during stimulated acid secretion alone, and at the end of experiments in combination with luminal challenges of the loops. During pentagastrin-stimulated gastric acid secretion, luminal perfusion of the duodenal loop with acid caused inhibition of acid secretion (P < 0.001) and a prominent release of somatostatin both to the lumen (P < 0.001) and to the circulation (P < 0.05). Also, neurotensin (P < 0.01) and vasoactive intestinal peptide (P < 0.01) were released to the lumen, but not to the circulation. Upon perfusion of the duodenal loop with hyperosmolal polyethylene glycol, acid secretion was inhibited (P < 0.05) and somatostatin alone was released to the luminal side (P < 0.01). In conclusion, duodenal exposure to acid inhibits pentagastrin-stimulated gastric acid secretion and releases SOM to the circulation that may directly inhibit acid secretion. Concomitantly, somatostatin (SOM), neurotensin and vasoactive intestinal peptide are released to the lumen. Duodenal exposure to hyperosmolal polyethylene glycol inhibits acid secretion with a luminal release of SOM only. Thus, luminal acid and hyperosmolal solutions inhibit gastric acid secretion by separate mechanisms. After acid or hyperosmolal challenge, the release of SOM to the circulation indicates gastric acid inhibition in an endocrine manner, while a luminal release of gut peptides indicates a local peptide overflow that might be of importance via paracrine regulatory mechanisms in the intact animal.

Role of bile in regulation of gut motility

Bile empties into the duodenum not only after a meal but also in the interdigestive state. In man, interdigestive biliary emptying is related to fasting motor activity, the migrating motor complex (MMC), in the stomach and small bowel and generally occurs during phase 2 preceding a gastroduodenal phase 3 activity (activity front). It seems that the main regulatory peptide to initiate phase 3 is motilin. During a period with 13 phase 3 activities of MMC, 18 episodes of gall-bladder emptying and 19 motilin peaks were observed. Such a peak of plasma motilin usually took place 25 +/- 11 min after onset of biliary emptying. In conclusion, data indicate that motilin is released to the circulation by the biliary output and induces phase 3 of MMC. The induced phase 3 propels bile acids along the gut to promote their absorption in the distal intestine. The choleretic action of recycling of bile acids may cause subsequent episodes of biliary emptying with motilin release by the action of the enterohepatic circulation of bile acids. In such a manner the MMC may be withheld as a recycling motility pattern.

Gastrointestinal motility in obesity

Gastrointestinal motility is closely linked to the rate at which nutrients become systemically available. Regulation of gastric emptying represents the most important brake against delivery of nutrients to the intestine in excess of digestive and absorptive capacity. In man, gastric emptying is slowed in proportion to the energy density of the meal, which will level out the rate of energy delivery to the duodenum. Studies suggest a more rapid gastric emptying in obesity, although the opposite has been reported in some experimental settings. Moreover, gastric volume is larger in obese individuals and appropriate satiety signals are not triggered in response to gastric distension. Postprandial intestinal transit time in obesity is similar to that in normal-weight subjects, however, despite this fact, intestinal absorption of nutrients is more efficient in obesity. Several regulatory mechanisms for gastrointestinal motility, such as the autonomous and enteric nervous systems and gastrointestinal regulatory peptides, are also of importance for feeding behaviour and metabolism. Dysfunction of the autonomous nervous system has been observed, the sensitivity to cholecystokinin is decreased in obesity, and plasma concentrations of somatostatin and neurotensin are lower than in normal-weight subjects. These changes in regulatory mechanisms favour rapid gastrointestinal transit of ingested nutrients and promote rapid intestinal absorption in obesity and decreased satiety in response to ingested food. It is presently not known whether the observed changes in gastrointestinal motility in obesity represent a primary feature linked to the pathogenesis of such disease.

Inhibition of the migrating motor complex by duodenal drainage in man

The effect of varying bile acid output on fasting small intestinal motility was investigated in healthy male volunteers. Biliary output was manipulated by jejunal infusion of isotonic mannitol, which resulted in increased output, and by prolonged drainage of duodenal contents, which resulted in decreased output. Intestinal motility was measured by manometric recordings performed at four levels in the proximal small intestine. A marker dilution technique was used to measure pancreatico-biliary output. There were three experimental groups: duodenal drainage, non-drainage and control. Both duodenal drainage and non-drainage groups underwent jejunal saline infusion, followed by mannitol infusion. The control group did not receive drainage or infusions. In the drainage group, 0.41 (0.13-0.68) activity fronts of the migrating motor complex (MMC) per hour were recorded during saline infusion, but only 0.06 (0-0.19) activity fronts per hour were observed during mannitol infusion. In the non-drainage group, 0.71 (0.61-0.81) activity fronts per hour were observed during saline infusion and 0.50 (0.18-0.82) activity fronts per hour were recorded during mannitol infusion. In the control group, 0.58 (0.33-0.84) activity fronts per hour were recorded during the first 4-h session and 0.58 (0.45-0.71) activity fronts per hour during the second session. There was no difference between the number of activity fronts per hour observed in the control group and those observed in the saline infusion of the drainage group.(ABSTRACT TRUNCATED AT 250 WORDS)

Greatly increased luminal nitric oxide in ulcerative colitis

A role for nitric oxide (NO) in ulcerative colitis has been suggested because mucosal NO synthase activity, measured by indirect assays, is increased in this disorder. We directly measured luminal NO in the colons of twelve controls and six patients with active ulcerative colitis. During colonoscopy, gas was aspirated from different parts of the colon and immediately analysed by a chemiluminescence technique. NO concentrations were more than 100 times higher in the patients than in the controls. Luminal NO is rapidly and easily measurable and may be used to monitor inflammatory bowel disease.

Intestinal motility responses to neuropeptide gamma in vitro and in vivo in the rat: comparison with neurokinin 1 and neurokinin 2 receptor agonists

We have studied the effect of a novel tachykinin, neuropeptide gamma (NP gamma) on small intestinal motility in the rat. Experiments were done in vitro on longitudinal muscle strips of duodenum, and in vivo on the migrating myoelectric complex (MMC) of the small intestine. In vitro, contractile effects of NP gamma were compared with those of a selective neurokinin 1 (NK1) receptor agonist, substance P methyl ester (SPME), and a selective neurokinin 2 (NK2) receptor agonist, Nle10-NKA(4-10)(NleNKA). NP gamma, SPME and NleNKA caused concentration-dependent contractions (P < 0.001). NP gamma was eight-fold more potent than NleNKA, and 118-fold more potent than SPME. Contractile responses to NP gamma were reduced by hexamethonium (P < 0.01) and atropine (P < 0.05). The non-selective NK receptor antagonist spantide I only slightly reduced the contractile response to NP gamma, as did the selective NK1 antagonist GR 82,334, and the selective NK2 antagonist L-659,877 and MEN 10,376. In vivo, effects of NP gamma on the MMC were compared with those of the natural tachykinins substance P (SP) and neurokinin A (NKA). NP gamma disrupted the MMC and induced irregular spiking in a dose-dependent manner from 25 to 100 pmol kg-1 min-1 i.v. (P < 0.05). The effect of NP gamma was more prominent than that of NKA at equal doses, while SP had no effect. Our findings show that NP gamma exerts potent stimulatory effects on small intestinal motility, most likely mediated directly via distinct NK receptors on smooth muscle cells, but also indirectly via a cholinergic link.

Transforming growth factor-alpha and epidermal growth factor inhibit gastric acid secretion and stimulate release of somatostatin and neurotensin in the conscious rat

The study compared inhibitory actions of transforming growth factor-alpha (TGF alpha) and epidermal growth factor (EGF) on gastric acid secretion and effects of these peptides on release of gut peptides considered important for acid inhibitory and gastrointestinal protective mechanisms. TGF alpha and EGF did not affect basal acid secretion, but inhibited pentagastrin-stimulated acid secretion in a dose-dependent manner from 0.10 to 1.7 nmol kg-1 h-1 i.v. by maximally 72% for TGF alpha (P < 0.001) and 76% for EGF (P < 0.001). At the highest doses, TGF alpha and EGF caused 194% and 698% increase of somatostatin-like immunoreactivity (SOM-LI) in plasma, respectively (each P < 0.05). Neurotensin-like immunoreactivity (NT-LI) increased 438% by EGF (P < 0.05), but the increase of 700% with TGF alpha did not reach statistical significance. The levels of vasoactive intestinal peptide-like immunoreactivity (VIP-LI) did not change. In gastric juice, SOM-LI increased 80% by TGF alpha i.v. (P < 0.05), but NT- and VIP-LI did not change. EGF i.v. had no effects on levels of SOM-, NT- or VIP-LI in luminal juice. Thus, TGF alpha and EGF inhibit acid secretion, but also promote the release of SOM and NT into the circulation and may be involved in the acid inhibitory effects of these growth factors.

Intestinal microflora stimulates myoelectric activity of rat small intestine by promoting cyclic initiation and aboral propagation of migrating myoelectric complex

Microbial modulation of myoelectric activity in small intestine was studied. Germ-free male Sprague-Dawley rats were equipped with bipolar electrodes from the duodenojejunal junction to the midpoint of small intestine. Prior to and one week after introduction of conventional intestinal microflora, 32 +/- 5% and 61 +/- 5% (mean +/- SE), respectively, of activity fronts of the migrating myoelectric complex reached the midpoint (P < 0.05), and the interval between activity fronts in proximal jejunum was reduced from 31.2 +/- 2.0 min to 17.5 +/- 0.8 min, respectively (P < 0.01). The pattern of propagation was more regular after conventionalization. Slow-wave frequency in proximal jejunum was 38.5 +/- 1.2/min in germ-free rats and 43.0 +/- 0.8/min in conventional rats (P < 0.01), but introduction of microflora failed to increase the frequency in germ-free rats. The frequency of spike potentials succeeding jejunal infusion of 5 ml of 12.5% glucose remained unchanged after conventionalization. Statistical analyses showed that the interval between activity fronts varied mainly within rats, whereas the propagation velocity showed statistically significant variability between rats (P < 0.01), regardless of intestinal microflora. Luminal control by the resident microflora is important for physiological cycling and aboral propagation of the migrating myoelectric complex, but seems to be of no major consequence for postprandial myoelectric response.

Meal energy density as a determinant of postprandial gastrointestinal adaptation in man

The relationships between the meal energy density and postprandial gastric emptying, intestinal propulsion and absorption, and pancreaticobiliary secretions were investigated. Nine different 300-ml liquid test meals with energy densities ranging from 2.5 to 7.2 MJ l-1 were studied by means of a multiple-indicator dilution technique. The higher the energy density of the meal, the slower the gastric emptying of the test meal marker (P < 0.01). Despite slowing of gastric emptying of the meal marker the higher the energy density of the meal, the more energy was emptied to the duodenum during the 1st h after meal intake (P < 0.01). The small-intestinal transit time for the mid-portion of the meal correlated positively with energy density of the test meal (P < 0.05). Despite the prolonged time for transit through the jejunal test segment after meals with high energy density, the fractional absorption of energy varied only 50-70%, with no correlation to the energy density of the meal. As a consequence, more energy passed unabsorbed from the test segment to lower parts of the intestine after meals with high energy density (P < 0.05). We conclude that the energy density of a liquid meal is a strong determinant for the subsequent gastrointestinal adaptation. This relates not only to gastric emptying but also to intestinal transit and absorption of nutrients. The early onset of regulation suggests a role for the gastrointestinal tract in modulating the availability of systemic energy, which might be of importance for short-term regulation of food intake.

Dihydropyridine calcium channel antagonists disrupt migrating myoelectric complexes and counteract intestinal disorders associated with morphine withdrawal diarrhea

The effects of two dihydropyridine (DHP) calcium channel antagonists, nifedipine and nimodipine, on migrating myoelectric complexes (MMCs) of the small intestine were studied in naive and morphine-dependent rats. In addition, the effects of two other calcium channel antagonists, verapamil and diltiazem, on the MMCs were investigated. Nifedipine (1.0-4.0 mg kg-1 intravenously) or nimodipine (1.0-4.0 mg kg-1 intravenously) had an inhibitory effect on the spontaneously occurring MMCs, whereas verapamil (2.5-5.0 mg kg-1 intravenously) or diltiazem (2.5-5.0 mg kg-1 intravenously) had no effect. Bay K 8644 (0.25 mg kg-1 intravenously), a DHP calcium channel agonist, instantly reversed the inhibition induced by nifedipine or nimodipine. When given alone, Bay K 8644 induced irregular spiking activity. In morphine-dependent rats with regular MMCs naloxone (1.0 mg kg-1 intravenously) induced intense spiking activity and profuse diarrhea. Nifedipine (2.0 and 4.0 mg kg-1 intravenously) and nimodipine (2.0 and 4.0 mg kg-1 intravenously) given before naloxone prevented the intense, abstinence-evoked spiking and associated diarrhea. In healthy volunteers nimodipine at an infusion rate of 2 mg h-1 for 4 h did not inhibit the fasting motility pattern. Our findings indicate that DHP-binding sites are involved in the regulation of MMC in the rat and that drugs acting as antagonists at these sites can be used to suppress morphine withdrawal diarrhea and, tentatively, other functional disorders of the intestine.