ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00109.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractPsychological factors are widely held to be important for the orderly function of the gastrointestinal tract as well as for the development and course of disorders affecting the gut. Evidence supporting these assumptions is scarce, although it has become clear that intestinal functions are influenced by the state of central nervous activation, i.e. by satiation, relaxation and sleep as well as hunger, tension and rage. Freud assumed that the accumulation of an unabreacted quota of affect induced defence or repression and a conversion of emotion into bodily symptoms. Subsequently, disorders such as globus sensation, diffuse oesophageal spasm and ‘cardiospasm’ were viewed as conversion symptoms. Other concepts claimed an aetiological role of specific conflicts, certain affective states and ‘inappropriate perpetuations of organ reactions adaptive to, or protective against, some stress in human life’. However, these and other psychosomatic concepts could not be verified. Conversely, an illness exacerbation may precipitate a disruption in a patient's adjustment to his/her environment and interfere with his/her ability to fight the disease. Psychotherapeutic interventions may help patients to cope with their illness and its consequences and possibly alter the course of disease. Psychosocial factors may determine a patient's reactions to, and handling of, a disease and thus should not escape the physician's at

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00110.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractIn recent years, new neurophysiological techniques have been developed which allow access to the gut‐brain axis in humans. Among these tools, recording of cerebral evoked potentials following stimulation of a viscera (rectosigmoid, oesophagus) as well as the striated anal sphincter muscle have gained importance for evaluation of afferent pathways in functional bowel disorders. Oesophageal and anal motor evoked potentials after transcranial magnetoelectrical stimulation of the motor cortex and the spine have demonstrated the feasibility to access the efferent motor pathways to these muscles as well, but studies are still needed to demonstrate their clinical importance. Finally, recording of electromechanical coupling at the level of a single muscle (external anal sphincter) will give further insight into the continence mechanism in health and diseas

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00111.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractWe performed electrophysiological studies in 12 normal, healthy subjects to determine the relative locations of the lower oesophageal sphincter, crural diaphragm and squamocolumnar junction. Oesophagogastric junction pressure, crural diaphragm electromyogram and mucosal potential difference were measured using a specially designed catheter. This catheter had a side hole to measure pressure and electrodes placed around the side hole for crural diaphragm electromyogram recordings. Mucosal potential difference was measured at the side hole that measured pressure. Recordings were obtained using a motorized rapid pullthrough at a constant speed of 0.85 cm/sec. Rapid pullthroughs were performed under the following conditions: (a) end expiration (diaphragm relaxed), (b) during a sustained maximal contraction of the diaphragm, and (c) during 50% of maximal diaphragmatic contraction. Our results show that the lower oesophageal sphincter is 4.4 cm in length, 2 cm of which is located in the abdomen. The crural diaphragm is 1.7 cm in length and surrounds the proximal half of the lower oesophageal sphincter. The squamocolumnar junction is located in the upper half of the lower oesophageal sphincter in the majority of subjects. The relative location of the lower oesophageal sphincter to the crural diaphragm does not change during diaphragmatic contraction. We conclude that a part of the lower oesophageal sphincter is located in the abdomen. The intra‐abdominal location of the lower oesophageal sphincter may be important for its anti‐reflux barrier funct

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00112.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractMechanisms for contractile effects of tachykinins on muscle strips of rat duodenum were studied using substance P (SP), neurokinin A (NKA), neurokinin B (NKB) and neuropeptide K (NPK), and the tachykinin analogues SP methyl ester (SPME), Nle10‐NKA(4–10) (NleNKA) and senktide (SENK) selective for neurokinin (NK)‐1, NK‐2 and NK‐3 receptors, respectively. NK receptors responsible for smooth muscle contraction were identified using selective ligands to protect NK receptors combined with inactivation of residual receptors with N‐ethylmaleimide. Tachykinins (10−9to 10−5M) caused dose‐related contractions of the muscle strips. The order of potency of native tachykinins was NKA>NKB>SP>NPK in circular, and NKB>NKA>NPK>SP in longitudinal muscle, whereas that of selective tachykinin analogues was SENK>NleNKA>SPME. NKA, NleNKA and SENK were equieffective as acetylcholine, whereas SP, SPME, NKB and NPK were less effective. Spantide decreased the sensitivity to all tachykinin analogues. Atropine reduced the sensitivity to SENK only, whereas hexamethonium reduced the sensitivity to SENK and SPME, but not to NleNKA. Selective receptor protection with SPME, NleNKA or SENK protected contractions induced by SPME, NleNKA and SENK, respectively. Responses to tachykinin analogues were reduced in Ca2+‐free medium. Thus, NKA is suggested to be the dominating tachykinin to stimulate contraction of the rat duodenum via NK receptors coupled to Ca2+‐dependent signal transduction pathways. Of the receptors available, the NK‐1 subtype involves a nicotinic transmission step, and the NK‐3 subtype also a muscarinic step, whereas the NK‐2 receptor subtype is not dependen

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00113.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA new intraluminal electrical impedance procedure for high‐resolution measurements and the quantitative assessment of gastrointestinal motility is examined in healthy volunteers by cineradiography and manometry. The peristalsis in the oesophagus, stomach and small bowel is recorded with a combined impedance‐pressure catheter. Additionally, investigations with a flexible 16‐channel impedance catheter with a closed surface and a diameter of 3 mm are carried out in the oesophagus and small intestine. The 16 measuring segments with a length of 2 cm each record the contractile patterns from a 32‐cm‐long organ section without a gap. The correctness of the physical approach is validated by concurrent impedance and cineradiography recordings of the oesophageal peristalsis. The comparative studies confirm a close relation between the pressure and the impedance changes in the oesophagus and small intestine. The time analysis of the impedance tracings offers information about the bolus transit and the change of the wall compliance along the organ. Regions of high or low compliance of the muscular wall can be recognized. From the impedance tracings the direction of the contraction waves as well as their velocities, lengths, beginnings and ends can be determined. Moreover, the beginning and end of the bolus, and from them the momentary bolus length, can be characterized for any instant during the bolu

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00114.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractTo determine whether myogenic factors are responsible for slowed colonic transit in senescent rats, maximum shortening velocity (V0), compliance of the series elastic component (SEC), measurements of passive force in calcium‐depleted tissue and peak isometric force (F0) were examined in proximal and distal colonic circular smooth muscle from 6‐ and 30‐monthold Fischer rats (n = 5). After mucosa was removed, measurements were made on strips stimulated with 80 m>mKCl in a 2.5 m>mCa2+Kreb's solution. Muscle strips were quick released at peak isometric force (F0) to afterloads of 60% of F0. The changes in muscle length from zero to 40 msec and 1 to 2 sec after release during isotonic contraction were used to calculate the SEC and V0as a fraction of total muscle length. Passive force (Fp) was measured in 2.5 m>mCa2+Kreb's solution and in a zero Ca2+, 0.1 m>mEGTA solution to determine the contribution of contractile and passive elements to passive force. The results of these studies indicate there is no difference in the V0(L0/sec) of adult (8.4 ± 1.5) and aged (7.5 ± 2.0) animals (P ± 0.05). Peak force (F0) in the distal colon of the aged rats was greater than adult rats (1.23 ± 0.1 vs 0.85 ± 0.01 kg/cm2, P = 0.05). The stiffness of the parallel elastic component and the length‐tension relationship were similar in adult and aged animals. Negligible decreases in Fpwere observed in zero calcium medium. However, basal contractile tone was elevated in aged animals (P = 0.05). These studies indicate basic differences in aged colonic circular muscle that may contribute to altered bowel transit and function d

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00115.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractSevere chronic constipation is a common health problem, particularly among elderly nursing‐home patients. Cholecystokinin (CCK) is involved in the regulation of colonic motility, and the blockade of CCKAreceptors with loxiglumide, a potent and highly specific CCKAantagonist, dramatically accelerates colonic transit time in healthy human volunteers. The effect of loxiglumide on the bowel habits and colonic transit time in 21 chronically constipated nursing‐home patients (mean age 83, range 71–89 years) was studied in a randomized, placebo‐controlled, double‐blind cross‐over study. Loxiglumide 800 mg t.i.d. or identical‐looking placebo tablets were given orally in sequence with a 7‐day washout period in between for 21 days each. The number of spontaneous bowel movements and that of administered enemas was recorded for each 3‐week phase. At the end of each treatment period colonic transit time was assessed using radio‐opaque markers. Treatment with loxiglumide significantly (P<0.005) accelerated colonic transit time from 113 ± 6 to 81 ± 10 h. The frequency of weekly bowel movements increased from 3.9 ± 0.5 (placebo) to 4.9 ± 0.5 (loxiglumide) (P<0.006), while the number of enemas over the 3 weeks decreased from 2.7 ± 0.6 to 1.3 ± 0.4 for placebo and loxiglumide, respectively (P<0.005). No serious side‐effects were observed and there were no signs of exocrine pancreatic insufficiency induced by loxiglumide. The blockade of CCKAreceptors with loxiglumide significantly improves chronic constipation in geriatric patients. Loxiglumide may therefore constitute the prototype of a new class of potent therapeutic agents effective in th

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00116.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:1350-1925    

DOI:10.1111/j.1365-2982.1993.tb00117.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY