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Abdallah H, Khalil M, Farella I, JohnBritto JS, Lanza E, Santoro S, Garruti G, Portincasa P, Di Ciaula A, Bonfrate L. Ramadan intermittent fasting reduces visceral fat and improves gastrointestinal motility. Eur J Clin Invest 2023; 53:e14029. [PMID: 37203871 DOI: 10.1111/eci.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ramadan is a model of intermittent fasting linked with possible beneficial effects. Scarce information, however, is available about the combined effects of Ramadan intermittent fasting (RIF) on anthropometric and metabolic indices, gastrointestinal symptoms, and motility. METHODS In 21 healthy Muslims, we assessed the impact of RIF on caloric intake, physical activity, gastrointestinal symptoms and motility (gastric/gallbladder emptying by ultrasonography, orocaecal transit time by lactulose breath test), anthropometric indices, subcutaneous and visceral fat thickness (ultrasonography), glucose and lipid homeostasis. RESULTS Mean caloric intake decreased from a median of 2069 kcal (range 1677-2641) before Ramadan to 1798 kcal (1289-3126) during Ramadan and increased again to 2000 kcal (1309-3485) after Ramadan. Although physical activity remained stable before, during, and after RIF, body weight, body mass index and waist circumference decreased in all subjects and in both genders, together with a significant decrease in subcutaneous and visceral fat thickness and insulin resistance. The postprandial gastric emptying speed was significantly faster after than before RIF. Fasting gallbladder volume was about 6% smaller after, than before Ramadan, with a stronger and faster postprandial gallbladder contraction. After RIF, lactulose breath test documented increased microbiota carbohydrate fermentation (postprandial H2 peak), and faster orocaecal transit time. RIF also significantly improved gastric fullness, epigastric pain and heartburn. CONCLUSIONS RIF generates, in healthy subjects, multiple systemic beneficial effects in terms of fat burden, metabolic profile, gastrointestinal motility and symptoms. Further comprehensive studies should assess the potential beneficial effects of RIF in diseased people.
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Affiliation(s)
- Hala Abdallah
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mohamad Khalil
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Ilaria Farella
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Jerlin Stephy JohnBritto
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Elisa Lanza
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Sergio Santoro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Gabriella Garruti
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Leonilde Bonfrate
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
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Portincasa P, Bonfrate L, Wang DQH, Frühbeck G, Garruti G, Di Ciaula A. Novel insights into the pathogenic impact of diabetes on the gastrointestinal tract. Eur J Clin Invest 2022; 52:e13846. [PMID: 35904418 DOI: 10.1111/eci.13846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Type 2 and type 1 diabetes are common endocrine disorders with a progressively increasing incidence worldwide. These chronic, systemic diseases have multiorgan implications, and the whole gastrointestinal (GI) tract represents a frequent target in terms of symptom appearance and interdependent pathophysiological mechanisms. Metabolic alterations linked with diabetic complications, neuropathy and disrupted hormone homeostasis can lead to upper and/or lower GI symptoms in up to 75% of diabetic patients, with multifactorial involvement of the oesophagus, stomach, upper and lower intestine, and of the gallbladder. On the other hand, altered gastrointestinal motility and/or secretions are able to affect glucose and lipid homeostasis in the short and long term. Finally, diabetes has been linked with increased cancer risk at different levels of the GI tract. The presence of GI symptoms and a comprehensive assessment of GI function should be carefully considered in the management of diabetic patients to avoid further complications and to ameliorate the quality of life. Additionally, the presence of gastrointestinal dysfunction should be adequately managed to improve metabolic homeostasis, the efficacy of antidiabetic treatments and secondary prevention strategies.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - David Q-H Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gema Frühbeck
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gabriella Garruti
- Department of Emergency and Organ Transplants, Unit of Endocrinology, University of Bari Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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Di Ciaula A, Molina-Molina E, Bonfrate L, Wang DQH, Dumitrascu DL, Portincasa P. Gastrointestinal defects in gallstone and cholecystectomized patients. Eur J Clin Invest 2019; 49:e13066. [PMID: 30592298 PMCID: PMC8118136 DOI: 10.1111/eci.13066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy. Systematic studies on dyspepsia and dynamic gastrointestinal motor function are missing in gallstone patients with preserved gallbladder or after a cholecystectomy. MATERIALS AND METHODS Forty-six gallstone patients (age 55 ± 2 years; 15M, 31F) and 24 cholecystectomized patients (age 57 ± 2 years; 6M, 18F) (no difference in type and volume of gallstones between the two groups) were compared against a group of 65 healthy controls (age 51 ± 2 years; 30M, 35F). Dyspepsia occurring in the prior months was assessed by a questionnaire, gastric and gallbladder emptying by functional ultrasonography and orocecal transit time by a hydrogen breath test using a lactulose-enriched standard liquid meal. RESULTS Gallstone patients had significantly greater dyspepsia, fasting and residual gallbladder volumes, and slower gallbladder emptying, gastric emptying and small intestinal transit time than controls. In cholecystectomized patients, gastric emptying further delayed, compared to gallstone patients and controls. CONCLUSION Gallstone patients with the gallbladder "in situ" or after a cholecystectomy display dyspeptic symptoms. Symptoms are associated with multiple gastrointestinal motility defects involving the gallbladder, stomach and small intestine. After cholecystectomy, gastric emptying worsens.
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Affiliation(s)
- Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie, ASL BAT, Bisceglie, Italy
| | - Emilio Molina-Molina
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, Italy
| | - Leonilde Bonfrate
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, Italy
- Division of Geriatrics and Gerontology, Hospital “Miulli”, Acquaviva delle Fonti, Italy
| | - David Q.-H. Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York
| | - Dan L. Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Bari, Italy
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Di Ciaula A, Wang DQH, Portincasa P. Gallbladder and gastric motility in obese newborns, pre-adolescents and adults. J Gastroenterol Hepatol 2012; 27:1298-305. [PMID: 22497555 DOI: 10.1111/j.1440-1746.2012.07149.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Impaired gallbladder and gastric motility have been associated with obesity in adults. The timing of appearance of this dysfunction, however, is unclear. METHODS Lean and obese subjects from three different age groups were studied noninvasively: 50 newborns (1-12 months old, six obese), 18 pre-adolescents (7-8 years old, seven obese), and 99 adults (22-80 years old, 32 obese) classified according to standard normal tables and body mass index. Changes of fasting/postprandial gallbladder and gastric motility were assessed simultaneously by functional ultrasonography in response to milk (newborns and pre-adolescents) and to a liquid test meal (adults). RESULTS In newborns, fasting and postprandial gallbladder volumes and gastric emptying were similar between obese and lean subjects. In pre-adolescents, obese subjects had a larger fasting gallbladder volume, with slower postprandial gastric emptying than lean subjects. In obese adults, the most evident dysfunction emerged, with larger fasting and postprandial residual gallbladder volume, and slower postprandial gastric emptying than lean subjects. CONCLUSIONS Obese subjects display abnormal gallbladder and gastric motility patterns, which first appear in pre-adolescents and deteriorate in adults. Such abnormalities are absent in obese newborns. Functional ultrasonography can detect altered cholecysto-gastric motility at the earliest stage. Our findings suggest an age-related decline of motility, probably secondary to excessive fat and insulin-resistance.
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Affiliation(s)
- Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie, Bisceglie (BAT), Italy
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5
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Abstract
Gastrointestinal motility disorders in their most severe forms may directly lead to intestinal failure. Abnormal motor function may also contribute to the overall gut dysfunction of children who have other underlying gastrointestinal diseases, such as Hirschsprung disease or gastroschisis. Understanding the extent and the severity of the dysmotile segments has direct therapeutic and prognostic implications. Our ability to study gastrointestinal motility has greatly improved in the past few years, with the development of less-invasive diagnostic tests. Optimal treatment of children with intestinal motility disorders relies on a multidisciplinary approach, which focuses on optimizing nutrition, improving gastrointestinal motility, and reducing psychosocial disability. Patient education is important to avoid aggravations of symptoms caused by dietary indiscretions.
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Affiliation(s)
- Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Portincasa P, Mearin F, Robert M, Plazas MJ, Mas M, Heras J. Eficacia y tolerabilidad de cinitaprida en el tratamiento de los pacientes con dispepsia funcional y vaciamiento gástrico enlentecido. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:669-76. [PMID: 19819042 DOI: 10.1016/j.gastrohep.2009.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 06/30/2009] [Indexed: 12/24/2022]
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Portincasa P, Di Ciaula A, Wang HH, Palasciano G, van Erpecum KJ, Moschetta A, Wang DQH. Coordinate regulation of gallbladder motor function in the gut-liver axis. Hepatology 2008; 47:2112-26. [PMID: 18506897 DOI: 10.1002/hep.22204] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gallstones are one of the most common digestive diseases with an estimated prevalence of 10%-15% in adults living in the western world, where cholesterol-enriched gallstones represent 75%-80% of all gallstones. In cholesterol gallstone disease, the gallbladder becomes the target organ of a complex metabolic disease. Indeed, a fine coordinated hepatobiliary and gastrointestinal function, including gallbladder motility in the fasting and postprandial state, is of crucial importance to prevent crystallization and precipitation of excess cholesterol in gallbladder bile. Also, gallbladder itself plays a physiopathological role in biliary lipid absorption. Here, we present a comprehensive view on the regulation of gallbladder motor function by focusing on recent discoveries in animal and human studies, and we discuss the role of the gallbladder in the pathogenesis of gallstone formation.
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Affiliation(s)
- Piero Portincasa
- Department of Internal Medicine and Public Medicine, Clinica Medica A. Murri, University of Bari Medical School, Bari, Italy.
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Di Ciaula A, Covelli M, Berardino M, Wang DQH, Lapadula G, Palasciano G, Portincasa P. Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma. BMC Gastroenterol 2008; 8:7. [PMID: 18304354 PMCID: PMC2276219 DOI: 10.1186/1471-230x-8-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 02/27/2008] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies on gastrointestinal symptoms, dysfunctions, and neurological disorders in systemic scleroderma are lacking so far. METHODS Thirty-eight scleroderma patients (34 limited, 4 diffuse), 60 healthy controls and 68 dyspeptic controls were scored for upper and lower gastrointestinal symptoms (dyspepsia, bowel habits), gastric and gallbladder emptying to liquid meal (functional ultrasonography) and small bowel transit (H2-breath test). Autonomic nerve function was assessed by cardiovascular tests. RESULTS The score for dyspepsia (mainly gastric fullness) was greater in scleroderma patients than healthy controls, but lower than dyspeptic controls who had multiple symptoms, instead. Scleroderma patients with dyspepsia had a longer disease duration. Fasting antral area and postprandial antral dilatation were smaller in scleroderma patients than dyspeptic and healthy controls. Gastric emptying was delayed in both scleroderma patients (particularly in those with abnormal dyspeptic score) and dyspeptic controls, who also showed a larger residual area. Despite gallbladder fasting and postprandial volumes were comparable across the three groups, gallbladder refilling appeared delayed in dyspeptic controls and mainly dependent on delayed gastric emptying in scleroderma. Small intestinal transit was also delayed in 74% of scleroderma and 66% of dyspeptic controls. Bowel habits were similar among the three groups. Autonomic neuropathy was not associated with dyspepsia, gastric and gallbladder motility and small intestinal transit. CONCLUSION In scleroderma patients dyspepsia (mainly gastric fullness), restricted distension of the gastric antrum and diffuse gastrointestinal dysmotility are frequent features. These defects are independent from the occurrence of autonomic neuropathy.
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Affiliation(s)
| | - Michele Covelli
- Department of Internal and Public Medicine (DIMIMP) University Medical School of Bari, Section of Rheumatology, Bari, Italy
| | - Massimo Berardino
- Department of Internal and Public Medicine (DIMIMP) University Medical School of Bari, Section of Internal Medicine, Bari, Italy
| | - David QH Wang
- Department of Medicine, Liver Center and Gastroenterology Division, Beth Israel Deaconess Medical Center, Harvard Medical School and Harvard Digestive Diseases Center, Boston, Massachusetts, USA
| | - Giovanni Lapadula
- Department of Internal and Public Medicine (DIMIMP) University Medical School of Bari, Section of Rheumatology, Bari, Italy
| | - Giuseppe Palasciano
- Department of Internal and Public Medicine (DIMIMP) University Medical School of Bari, Section of Internal Medicine, Bari, Italy
| | - Piero Portincasa
- Department of Internal and Public Medicine (DIMIMP) University Medical School of Bari, Section of Internal Medicine, Bari, Italy
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Altomare DF, Rinaldi M, Rubini D, Rubini G, Portincasa P, Vacca M, Artor NA, Romano G, Memeo V. Long-term functional assessment of antegrade colonic enema for combined incontinence and constipation using a modified Marsh and Kiff technique. Dis Colon Rectum 2007; 50:1023-31. [PMID: 17309003 DOI: 10.1007/s10350-006-0863-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Constipation and fecal incontinence can severely affect quality of life for patients, particularly when simultaneously present. Malone antegrade colonic enema enables periodic colonic emptying, thus preventing uncontrolled passage of feces and constipation. METHODS Eleven patients with fecal incontinence and severe constipation or perineal colostomy after Miles' operation underwent a modified Marsh and Kiff ileostomy for antegrade colonic enema. Before and after surgery, the patients were fully evaluated for gastrointestinal functions, including gallbladder and stomach emptying time, H(2)-breath test, colonic transit time, dynamic defecography, and anorectal manometry. The severity of incontinence and constipation was scored preoperatively and postoperatively by using the American Medical System score and Cleveland Clinic Constipation scale, respectively, whereas the quality of life was measured by the Gastrointestinal Quality of Life Index. The surgical technique involved division of the terminal ileum 10 to 15 cm from the ileocecal valve, anastomosis and intussusception of the ileum with the cecum, narrowing of the ileal conduit with a linear stapler, and a small, introflexed ileostomy with an advanced skin flap. RESULTS During the postoperative period, the mean American Medical System score decreased significantly from 77 to 11 (P<0.01) and the mean Cleveland Clinic Constipation score from 23 to 8.5 (P<0.01) with a significant improvement of quality of life. Antegrade colonic enema did not affect gallbladder, gastric, or orocecal transit time, which remained comparable with baseline. Colonic scintigraphy showed that antegrade colonic enema was efficient to clean the whole colon and rectum, leaving only 24 (range, 6-40) percent of the initial radioactivity after 30 minutes. Ileal manometry confirmed the presence of a high-pressure zone, preventing accidental reflux. CONCLUSIONS Modified Marsh and Kiff technique is a safe and effective surgical option to treat patients with combined fecal incontinence and severe constipation and those with perineal colostomy after Miles. It should be recommended as a last option before colostomy.
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Affiliation(s)
- Donato F Altomare
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Unit, University of Bari, piazza G Cesare, 11-70124, Bari, and Department of Surgical Unit, Ospedale Moscati, Avellino, Italy.
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Colecchia A, Mazzella G, Sandri L, Azzaroli F, Magliuolo M, Simoni P, Bacchi-Reggiani ML, Roda E, Festi D. Ursodeoxycholic acid improves gastrointestinal motility defects in gallstone patients. World J Gastroenterol 2006; 12:5336-43. [PMID: 16981264 PMCID: PMC4088201 DOI: 10.3748/wjg.v12.i33.5336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To simultaneously evaluate the presence of defects in gallbladder and gastric emptying, as well as in intestinal transit in gallstone patients (GS) and the effect of chronic ursodeoxycholic acid (UDCA) administration on these parameters and on serum bile acids and clinical outcome in GS and controls (CTR).
METHODS: After a standard liquid test meal, gallbla-dder and gastric emptying (by ultrasound), oroileal transit time (OITT) (by an immunoenzymatic technique) and serum bile acids (by HPLC) were evaluated before and after 3 mo of UDCA (12 mg/kg bw/d) or placebo administration in 10 symptomatic GS and 10 matched healthy CTR.
RESULTS: OITT was longer in GS than in CTR (P < 0.0001); UDCA significantly reduced OITT in GS (P < 0.0001), but not in CTR. GS had longer gastric half-emptying time (t1/2) than CTR (P < 0.0044) at baseline; after UDCA, t1/2 significantly decreased (P < 0.006) in GS but not in CTR. Placebo administration had no effect on gastric emptying and intestinal transit in both GS and CTR.
CONCLUSION: The gallstone patient has simultaneous multiple impairments of gallbladder and gastric emptying, as well as of intestinal transit. UDCA administration restores these defects in GS, without any effect in CTR. These results confirm the pathogenetic role of gastrointestinal motility in gallstone disease and suggest an additional mechanism of action for UDCA in reducing bile cholesterol supersaturation.
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Affiliation(s)
- A Colecchia
- Dipartmento di Medicina Interna e Gastroenterologia Policlinico S.Orsola-Malpighi Via Massarenti 9, Bologna 40138, Italy
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11
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Di Ciaula A, Portincasa P, Di Terlizzi L, Paternostro D, Palasciano G. Ultrasonographic study of postcibal gastro-esophageal reflux and gastric emptying in infants with recurrent respiratory disease. World J Gastroenterol 2006; 11:7296-301. [PMID: 16437631 PMCID: PMC4725147 DOI: 10.3748/wjg.v11.i46.7296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To check the utility of postcibal ultrasonography for the evaluation of reflux in relation to gastric emptying in infants with recurrent respiratory symptoms and to link imaging with clinical data. METHODS Esophageal reflux (hyperechoic retrograde filling) and gastric emptying (antral areas) were quantified before and after ingestion of a standard formula in 35 untreated infants (13 with chronic cough, 22 with recurrent bronchitis) and in 31 controls. RESULTS The prevalence of abnormal (> or =8 episodes) postcibal refluxes was 74% in patients and 3% in controls. Number, duration of the longest episode and extent of refluxes were significantly higher in patients compared to controls. Number of refluxes was higher in patients with symptomatic refluxes than in those without. Infants with recurrent bronchitis had more refluxes than those with chronic cough and controls. Extent and timing of gastric emptying were similar in patients and controls. CONCLUSION Esophageal ultrasonography is a useful and physiological test in infants with recurrent respiratory diseases, which have a high prevalence of abnormal postcibal esophageal reflux and a gastric emptying similar to that of normal controls. Esophageal reflux is more severe in subjects with recurrent bronchitis than in those with chronic cough.
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Affiliation(s)
- Agostino Di Ciaula
- Division of Internal Medicine, P.O. Bisceglie, 70052 Bisceglie (BA), Italy.
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12
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Portincasa P, Moschetta A, Petruzzelli M, Palasciano G, Di Ciaula A, Pezzolla A. Gallstone disease: Symptoms and diagnosis of gallbladder stones. Best Pract Res Clin Gastroenterol 2006; 20:1017-29. [PMID: 17127185 DOI: 10.1016/j.bpg.2006.05.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical aspects and the diagnostic features of gallstone disease are described. The natural history of silent gallstones is overviewed, and the risk of developing symptoms and complications is also discussed. The importance of colicky pain as a specific gallstone symptom is highlighted, and the role of both laboratory tests and diagnostic investigations for differential diagnosis is discussed. Finally, we describe the diagnostic features of gallbladder stone disease, including indications, sensitivity, specificity, and limitations of different test investigations under special circumstances.
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Affiliation(s)
- P Portincasa
- Clinica Medica A. Murri, Department of Internal and Public Medicine, University of Bari Medical School, Piazza Giulio Cesare 11-Policlinico-70124 Bari, Italy.
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Di Francesco V, Zamboni M, Dioli A, Zoico E, Mazzali G, Omizzolo F, Bissoli L, Solerte SB, Benini L, Bosello O. Delayed Postprandial Gastric Emptying and Impaired Gallbladder Contraction Together With Elevated Cholecystokinin and Peptide YY Serum Levels Sustain Satiety and Inhibit Hunger in Healthy Elderly Persons. J Gerontol A Biol Sci Med Sci 2005; 60:1581-5. [PMID: 16424292 DOI: 10.1093/gerona/60.12.1581] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Altered gastric and cholecystic motility are risk factors for malnutrition in elderly persons, mainly through impaired satiety-appetite rhythm. Contrasting data have been published about this topic. The aim of this study was to evaluate, in healthy elderly participant, postprandial gastric and cholecystic emptying in relation to serum CCK (cholecystokinin) and PYY (peptide YY), as well as satiety and hunger sensations. METHODS We studied 10 community-dwelling elderly persons, (77 +/- 3 years old) and 9 younger adult persons (32 +/- 8 years old). Using ultrasonography, we measured gastric antrum area and cholecystic volume in fasting condition and after an 800-kcal mixed meal. Time for gastric and cholecystic emptying, and percentage of cholecystic emptying were calculated. Satiety and hunger were evaluated every 30 minutes using visual analogue scales. CCK and PYY serum levels were assayed 30 minutes before and at times 0, 30, 60, 120, and 240 minutes after the meal. RESULTS Elderly participants showed a longer gastric emptying time compared to younger participants (448 +/- 104 vs 306 +/- 57 minutes, p <.002). Postprandial cholecystic emptying was significantly reduced in the older group (maximum contraction, 69% vs 84%; p <.05). After the meal, CCK and PYY levels showed higher, persistent elevation in elderly participants. In this group, postprandial satiety lasted significantly longer than in younger participants, and hunger was suppressed throughout the postprandial period. Antral area directly correlated with satiety and inversely with hunger. Gallbladder volume inversely correlated to satiety. CONCLUSIONS This study showed, in a group of healthy elderly people, delayed gastric emptying associated to reduced cholecystic contractility together with higher CCK and PYY serum levels. These modifications facilitated long-lasting satiety and hunger suppression after a meal. This condition may lead to caloric restriction and finally to malnutrition at older ages.
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Quaglietta L, Mastroianni R, Miele E, Esposito C, Terracciano LM, Vallone G, Staiano A. Cystic lymphangioma associated with enteric duplication as a cause of recurrent vomiting. Dig Liver Dis 2005; 37:533-6. [PMID: 15975542 DOI: 10.1016/j.dld.2004.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 07/14/2004] [Indexed: 12/11/2022]
Abstract
We describe a case report of a 6-year-old boy with a 4-year history of recurrent vomiting with a cyclical vomiting pattern. Although initially labelled with and treated for Cyclical Vomiting Syndrome the cause was subsequently found to be an enteric duplication associated with cystic lymphangioma, an association not previously described.
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Affiliation(s)
- L Quaglietta
- Department of Paediatrics, University Federico II, Naples, Italy
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15
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Portincasa P, Moschetta A, Berardino M, Di-Ciaula A, Vacca M, Baldassarre G, Pietrapertosa A, Cammarota R, Tannoia N, Palasciano G. Impaired gallbladder motility and delayed orocecal transit contribute to pigment gallstone and biliary sludge formation in β -thalassemia major adults. World J Gastroenterol 2004; 10:2383-90. [PMID: 15285024 PMCID: PMC4576293 DOI: 10.3748/wjg.v10.i16.2383] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Gallbladder and gastrointestinal motility defects exist in gallstones patients and to a lesser extent in pigment gallstone patients. To investigated the role of gallbladder and gastrointestinal motility disorders in pigment gallstone formation in β -thalassemia major.
METHODS: Twenty-three patients with β -thalassemia major (16 females; age range 18-37 years) and 70 controls (47 females, age range 18-40 years) were studied for gallbladder and gastric emptying (functional ultrasonography), orocecal transit (OCTT, H2-breath test), autonomic dysfunction (sweat-spot, cardiorespiratory reflex tests), bowel habits, gastrointestinal symptoms and quality of life (all with questionnaires). Gallbladder content (ultrasonography) was examined before and during 8-12 mo follow-up.
RESULTS: Gallstones and/or biliary sludge were found in 13 (56%) patients. β -thalassemia major patients had increased fasting (38.0 ± 4.8 mL vs 20.3 ± 0.7 mL, P = 0.0001) and residual (7.9 ± 1.3 mL vs 5.1 ± 0.3 mL, P = 0.002) volume and slightly slower emptying (24.9 ± 1.7 min vs 20.1 ± 0.7 min, P = 0.04) of the gallbladder, together with longer OCTT (132.2 ± 7.8 min vs 99.7 ± 2.3 min, P = 0.00003) than controls. No differences in gastric emptying and bowel habits were found. Also, patients had higher dyspepsia (score: 6.7 ± 1.2 vs 4.9 ± 0.2, P = 0.027), greater appetite (P = 0.000004) and lower health perception (P = 0.00002) than controls. Autonomic dysfunction was diagnosed in 52% of patients (positive tests: 76.2% and 66.7% for parasympathetic and sympathetic involvement, respectively). Patients developing sludge during follow-up (38%, 2 with prior stones) had increased fasting and residual gallbladder volume.
CONCLUSION: Adult β -thalassemia major patients have gallbladder dysmotility associated with delayed small intestinal transit and autonomic dysfunction. These abnormalities apparently contribute together with haemolytic hyperbilirubinemia to the pathogenesis of pigment gallstones/ sludge in β -thalassemia major.
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Affiliation(s)
- Piero Portincasa
- Section of Internal Medicine, Department of Internal and Public Medicine, University Medical School of Bari, P.zza G. Cesare 11, 70124 Bari, Italy.
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16
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Portincasa P, Moschetta A, Baldassarre G, Altomare DF, Palasciano G. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. World J Gastroenterol 2003; 9:2293-9. [PMID: 14562396 PMCID: PMC4656481 DOI: 10.3748/wjg.v9.i10.2293] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Psychological factors, altered motility and sensation disorders of the intestine can be variably associated with irritable bowel syndrome (IBS). Such aspects have not been investigated simultaneously. The aim of this paper was to evaluate gastrointestinal motility and symptoms, psychological spectrum and quality of life in a large group of IBS patients in southern Italy.
METHODS: One hundred IBS patients (F:M = 73:27, age 48 ± 2 years, mean ± SE) fulfilling ROME II criteria matched with 100 healthy subjects (F:M = 70:30, 45 ± 2 years). Dyspepsia, bowel habit, alexithymia, psycho-affective profile and quality of life were assessed using specific questionnaires. Basally and postprandially, changes in gallbladder volumes and antral areas after liquid meal and orocaecal transit time (OCTT) were measured respectively by ultrasonography and H2-breath test. Appetite, satiety, fullness, nausea, and epigastric pain/discomfort were monitored using visual-analogue scales.
RESULTS: Compared with controls, IBS patients had increased dyspepsia (score 12.6 ± 0.7 vs 5.1 ± 0.2, P < 0.0001), weekly bowel movements (12.3 ± 0.4 vs 5.5 ± 0.2, P < 0.00001, comparable stool shape), alexithymia (score 59.1 ± 1.1 vs 40.5 ± 1.0, P = 0.001), poor quality of life and psycho-affective profile. IBS patients had normal gallbladder emptying, but delayed gastric emptying (T50: 35.5 ± 1.0 vs 26.1 ± 0.6 min, P = 0.00001) and OCTT (163.0 ± 5.4 vs 96.6 ± 1.8 min, P = 0.00001). Fullness, nausea, and epigastric pain/discomfort were greater in IBS than in controls.
CONCLUSION: ROME II IBS patients have a pan-enteric dysmotility with frequent dyspepsia, associated with psychological morbidity and greatly impaired quality of life. The presence of alexithymia, a stable trait, is a novel finding of potential interest to detect subgroups of IBS patients with different patterns recoveed after therapy.
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Affiliation(s)
- Piero Portincasa
- Section of Internal Medicine, Department of Internal and Public Medicine (DIMIMP), University of Bari Medical School, Bari, Italy.
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17
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Portincasa P, Moschetta A, Colecchia A, Festi D, Palasciano G. Measurements of gallbladder motor function by ultrasonography: towards standardization. Dig Liver Dis 2003; 35 Suppl 3:S56-61. [PMID: 12974512 DOI: 10.1016/s1590-8658(03)00096-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As real-time ultrasonography is a cheap, noninvasive, relatively easy, validated and reproducible technique, it can be repeated over time to document time-related changes of gallbladder motor function. Ultimately, functional ultrasonography estimates gallbladder shape and volume in fasting state and in response to a test meal (liquid or mixed solid-liquid, provided there is sufficient fat content) or exogenous stimulus (e.g., i.v. cholecystokinin or ceruletide). Although functional ultrasonography of the gallbladder has been mainly used for research purposes in specific referral centres, its simplicity makes such a technique appealing in the clinical setting to assess gallbladder motor function in both health and disease. Indications include the study of healthy subjects and of patients during pathophysiologically relevant conditions; in particular when subjects are at risk for gallbladder stasis and gallstone disease or during gallstone disease when a decision concerning medical dissolution therapy is required.
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Affiliation(s)
- P Portincasa
- Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University Medical School of Bari, Piazza G. Cesare, 70124 Bari, Italy.
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18
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Abstract
PURPOSE Ultrasound scanning is replacing scintigraphy in studies of gastric emptying of liquid, but both have considerable day-to-day variability. This study describes a modified ultrasound technique for assessing gastric emptying of liquid, and evaluates the inter- and intraindividual variation in emptying time. MATERIAL AND METHODS On different days, each of 12 healthy volunteers had meals of 350 ml broth. The antral area was measured at sonography 5 times before the meal as a baseline, and every 1-4 min after the meal. The time until the antral area had decreased to 150% of baseline (T150) was determined and used as surrogate expression of gastric emptying time. RESULTS The mean T150 for a broth meal was 12.6 min (range 5-21) and 13.5 min (6-23) (first and second meal, respectively). The standard deviation of the differences between the 12 pairs of repeated measurements was 3.1 min and the coefficient of variation was 24%. CONCLUSION Ultrasound monitoring of antral size after a liquid meal is a well suited method for assessing gastric emptying of liquid.
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Affiliation(s)
- J F Pedersen
- Department of Radiology, Glostrup Hospital, University of Copenhagen, Denmark.
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Bellini M, Alduini P, Costa F, Tosetti C, Pasquali L, Pucciani F, Tornar A, Mammini C, Siciliano G, Maltinti G, Marchi S. Gastric emptying in myotonic dystrophic patients. Dig Liver Dis 2002; 34:484-8. [PMID: 12236481 DOI: 10.1016/s1590-8658(02)80106-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myotonic dystrophy is often associated with digestive symptoms that can precede the clinical appearance of skeletal muscle involvement. Although motility disorders may be observed in these patients at any level of the gastrointestinal tract, upper gastrointestinal symptoms have up to now usually been considered to be due to oesophageal rather than gastric dysmotility. AIMS To evaluate: a) gastric emptying in myotonic dystrophic patients without dyspeptic symptoms, and b) relationship between gastric emptying and severity and duration of the disease. PATIENTS AND METHODS Gastric emptying was evaluated in 11 non-dyspeptic dystrophic patients and in 22 healthy volunteers by means of computerised ultrasound scan, assessing the variation in the antral area over time after ingestion of a meal. RESULTS The final emptying time was higher in patients than in healthy volunteers (373' +/- 35' vs 270' +/- 47'; p < 0.001). Basal and maximal post-prandial antral areas were similar in the two groups. There was a significant correlation between gastric emptying and the duration of the disease (rs = 0.62; p = 0.04). No relationship was found between gastric emptying and severity of the disease. CONCLUSIONS Gastric emptying may be abnormally delayed in myotonic dystrophy patients, even in absence of dyspeptic symptoms. This delay is correlated with duration but not with severity of the disease. However there is no difference in either basal or maximal postprandial antral areas between myotonic dystrophy patients and healthy volunteers.
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Park DI, Rhee PL, Kim YH, Sung IK, Son HJ, Kim JJ, Paik SW, Rhee JC, Choi KW. Role of autonomic dysfunction in patients with functional dyspepsia. Dig Liver Dis 2001; 33:464-71. [PMID: 11572572 DOI: 10.1016/s1590-8658(01)80023-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. AIMS 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. PATIENTS A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. METHODS All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. RESULTS 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. CONCLUSIONS We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.
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Affiliation(s)
- D I Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Portincasa P, Moschetta A, Di Ciaula A, Palmieri VO, Milella M, Pastore G, Palasciano G. Changes of gallbladder and gastric dynamics in patients with acute hepatitis A. Eur J Clin Invest 2001; 31:617-22. [PMID: 11454017 DOI: 10.1046/j.1365-2362.2001.00834.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transient alterations of gallbladder morphology and dynamics have been reported in patients with during acute hepatitis A. The presence of dyspepsia also suggests involvement of gastric motility. During a 60-day follow-up, we investigated gallbladder and gastric motility in relation to dyspepsia in acute viral hepatitis A patients. Twenty patients were assessed at referral (day 0) and at days 7, 21, 42 and 60 and compared with 20 healthy volunteers. Gallbladder morphology and motility and gastric motility were assessed in the fasting and postprandial period by functional ultrasonography using a liquid test meal. Dyspeptic symptoms were scored. At day 0, fasting gallbladder volume was 5.9 +/- 1.3 mL, 32.6 +/- 4.6 mL, and 21.5 +/- 1.9 mL (mean +/- SE) in patients with gallbladder sludge (n = 7), without sludge (n = 13) and controls, respectively (P < 0.05 in sludge vs. no sludge and controls; P < 0.05 in no sludge vs. controls, ANOVA). Small fasting gallbladder volume in patients with sludge increased and sludge disappeared within 7 days. At day 0, patients with sludge also had increased thickness of fasting gallbladder wall and increased serum transaminase levels compared with patients without sludge and controls. Gallbladder contraction was similar in patients and controls. However, patients had delayed gastric emptying, which positively correlated with dyspepsia score. Gallbladder morphological changes observed in the acute phase of hepatitis A are transient and are associated with hepatocellular damage. Gastric emptying is delayed during the first week of disease and is associated with dyspeptic symptoms.
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Affiliation(s)
- P Portincasa
- University Medical School, Bari, Italy, Division of Internal Medicine, Bisceglie, Italy.
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