Effects of lipid adminstration in the duodenum and jejunum on visceral sensitivity and gastric tone in healthy subjects

GASTROENTEROLOGY Vol. 118, No.4

A1162 AGA ABSTRACTS

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5349

CATEGORIES OF SEXUAL ABUSE IN ITALIAN FEMALE PATIENTS WITH SEVERE FUNCTIONAL DISORDERS. Gabriele Bazzocchi, Daniela Ravaglia, Silvia Varani, Rabih Chattat, Dept Internal Medicine and Gastroenterology, Bologna, Italy; Dept of Psychology, Bologna, Italy. This study had two aims: alto investigate the prevalence of sexual abuse among female patients seen in a tertiary-care gastroenterologic clinic having refractory and multiorgan functional complaints; b) to investigate whether any difference in the sexual abuse type resulted in a case control comparison. Method: thirty consecutive women (37 ± 14 years, range 20-60 years)complaining of functional g.i. symptoms fullfilling the Rome criteria for bowel disorders associated to symptoms referable to functional conditions of at least two further systems, in particular at reumathologic, neurologic and gynaecologic level, were asked to complete the italian version of the Drossman's questionnaire for sexual abuse (Ann Intern Med 1990; 113: 828-833). During the third visit, after having signed consent, they filled in anonymous self-administered questionnaire: this had to be put into an envelope and then into a sealed box which was transparent so that patient could verify it was full of identical envelopes. Since they were alone in a private room, they could decide to not answer without the Authors knowing that. A case control design with individual matching was used: 38 healthy women (39± 11 years, range 20-60 years) were recruited between the university campus visitors: all accepted the procedure according to the same previously described setting. Results: 29 patients and all the controls completed the questionnaire. Some type of sexual abuse were reported by 17/29 and 21/38 respectively patients and controls (58% vs 55%; n.s.); 12/17 and 14/21 respectively gave positive score during childhood, i.e.< I3 years, (70% vs 66%, n.s.). On the contrary, 7/17 patients (41%) replied yes to the question E (has anyone ever tried forcefully or succeeded to have sex when you didn't want this?)vs only 1/21 of control subjects (4.7%): p<.009, Fisher's 2 by 2 Exact Test. Whether we consider the positive scores for contact sexual abuse (item C and D), excluding question E, patients were 6/17 vs 6/21 controls (35% and 28%, n.s.). Finally, 4/17 patients and 14/21 controls experienced only not contact sexual abuse, having answered yes only to item A and B (23% vs 66%, p<.OOI, Fisher's 2 by 2 Exact test). Conclusion: 1) prevalence of sexual abuse histories is high in the Italian population; 2) patients with multiple functional disorders differ from healthy for higher prevalence of "rape" sexual abuse, more than if the sexual exposure occurred during childhood or adulthood; 3)sexual harassment characterize more the abuse categories in general population.

A MULTICENTER, GENERAL PRACTICE COMPARISON OF ISPAGHULA HUSK WITH MACROGOL 4000 IN THE TREATMENT OF CHRONIC IDIOPATHIC CONSTIPATION. Marc A. Bigard, Hosp Brabois, Vandoeuvre, France. AIMS: To evaluate the clinical efficacy and tolerability of Ispaghula husk in comparison to Macrogol 4000, in adults suffering from chronic idiopathic constipation. METHODS: A multicentric clinical trial was set up in general practice according to an open-label comparative design. 120 patients, were enrolled by randomization into 2 parallel treatment groups : Ispaghula (n = 61) or Macrogol (n = 59). During a I-week baseline period, the patients were assessed for their symptomatology of constipation without any treatment: number of stools and colonic transit time. All patients were then treated up to 21 consecutive days during which they kept daily records of their stools. In patients showing a reduced colonic transit time at baseline, a second measure was performed at the end of the 3-week treatment. RESULTS: The primary criteria of efficacy was the evolution of the mean number of stools per week during the treatment period. Both treatments showed significant efficacy for this criteria: evolution from 4.0 stools per week at baseline to 5.9 at endpoint for Ispaghula group (p = 0.001) and evolution from 4.0 to 7.7 for Macrogol group (p = 0.001). The significant higher mean number of stools noted with Macrogol (intergroup analysis p = 0.006) corresponded to an important frequency of patients with a high number of stools (35.6% had more than 8 stools a week compared to 14.8% with Ispaghula husk). These efficacy results were associated with a good tolerability of the two treatments. There were no serious adverse events and no significant change in laboratory tests. Nevertheless, 3 patients (all treated with Macrogol) prematurely discontinued the treatment because of diarrhea. CONCLUSIONS: Ispaghula husk and Macrogol 4000 demonstrated similar efficacy for chronic constipation treatment and showed similar lag-time for onset of action.

5348 THE INFLUENCE OF MOTILIDES ON THE FUNCTION OF THE GASTROINTESTINAL TRACT AND EXPERIMENTAL ULCEROGENESIS, T. Beregova, O. Tsyruk, Kiev Shevchenko Univ, Kiev, Ukraine. The aim of the study: the investigation of effects of erythromycin and oleandomycin on the gastointestinal motility, gastric emptying gastric acid secretion and experimental uIcerogenesis. The methods: in chronical experiments on dogs with gastric and small intestine fistula, we investigated the effect of motilides erithromycin and oleandomycin on gastric acid secretion, stimulated by pentagastrin, histamine and carbacholin, and on periodical and food gastric and small intestine and colon motility by balloongraphyc method and also on gastric emptying of chyme by the method of drainage of small intestine fistula. Futhermore, we investigated the influences of erithromycin on the damage of gastric mucosa in rats induced by immobilization stress. The results: It was established that erithromycin and oleandomycin evoked periodical motor activity of stomach, small intestine and colon. Erithromycin also enhanced the food motility of the gastrointestinal tract and speeded up gastric emptying from chyme. Contrary oleandomycin didn't influence on food motility of the stomach and small intestine. Erithromycin diminished gastric acid secretion stimulated by carbacholin and pentagastrin on 84-85%, stimulated by histamine - on 70%. The same results were received for secretion of pepsin. Erithromycin diminished gastric acid secretion stimulated by histamine on 70%, debit of pepsin of histamine gastric secretion on 35%. Compared to control rats, erithromycin decreased of gastric mucosal damages (hemorrhages, lesions, ulcers) evoked by immobilization stress. Summary: our data will probably lead to new clinically useful motilides.

5350 ACTIVATION OF MULTIPLE CORTICAL AREAS FOLLOWING ANORECTAL STIMULATION AT DIFFERENT SITES - A FMRI STUDY. Ferdinand Binkofski, Alfons Schnitzler, Kirsten Stottrop, Paul Enck, Dept of Neurology, Duesseldorf, Germany; Dept of Gen Surg, Tuebingen, Germany. We assessed brain activation by means of BOLD fMRI in 8 healthy volunteers following electrical stimulation of the anal canal, and the distal (+ 10 ern) and mid rectum (+ 20 em) by applying I Hz and 2 Hz stimuli in successive runs per location, and with intensities above perception, but below pain/discomfort. A block design was chosen for each recording, with 5 epochs recorded during baseline/no stimulation and 5 epochs during which stimulation was performed. During each epoch, 16 axial slices with 0.1 mm intersclice gap in the anterior-posterior commissure plane covering the brain volume above the temporal pole were generated by a 1.5 Tesla Siemens Vision MRI system (Siemens Magnetom, Erlangen, Germany) using standard echoplanar imaging and radiofrequency head coil. Voxel size was 3.12 x 3.12 x 5.5 mm. Data analysis used a fixed effects model representing a case study of 8 cases on SPM96 software. After realignement, spatial normalization and smoothing with 8 mm Gaussian kernel, group activation maps were calculated by pooling the data for each condition across all subjects, and only voxels passing a threshold of z=O.OI and a cluster of IO voxels were considered significant. Results: Besides SII activation, the insular cortex, the medial cingulate cortex, and the inferior posterior parietal cortex (ipp) are activated under all conditions. With higher stimulation frequencies, the anterior cingulate cortex becomes activated in addition, and with increasing intensity, the activated areas of the cingulate cortex shift cranially. Area 6 and Broca were activated only with distal rectum stimulation. Conclusion: Vissceral afferent information processing involves - besides the SII cortex - deeper brain structures as well. It seems that specifically the cingulate cortex plays a major role in both topographic and intensity-coded information processing from different compartments of the pelvic floor. This is of major relevance in our understanding of normal and abnormal perception generated in the lower gastrointestinal tract, such as in irritable bowel syndrome. (Supported by grants from Deutsche Forschungsgemeinschaft, En 50/18-1 and SFB 194 AI6). 5351 EFFECTS OF LIPID ADMINSTRATION IN THE DUODENUM AND JEJUNUM ON VISCERAL SENSITIVITY AND GASTRIC TONE IN HEALTHY SUBJECTS. Einar S. Bjornsson, Malte Norstrom, Magnus Simron, Hasse Abrahamsson, Sahlgrenska Univ Hosp, Gothenburg, Sweden. Duodenal lipid adminstration exaggerates the sensory response to gastric distention. Enteral feeding with a tube placed distal to the Treitz' ligament has been proposed as an alternative to intraduodenal feeding. Our aim was to compare the effects of duodenal and jejunal lipid infusions on gastric perception and tone in healthy subjects. Methods: I3 healthy volunteers (ageI8-61; 4 females) participated on two different study days. A feeding tube was placed fluoroscopically in the descending duodenum and in the proximal jejunum, in random order, on the two occasions. A gastric balloon-catheter, connected to a barostat was placed in the proximal stomach. Sensory thresholds for first sensation, gas or fullness, bloating

AGAAl163

April 2000

and discomfort were assessed before and after adminstration of lipid infusion (2 kcallmin, 60 min) in the duodenum and the jejunum, respectively. Gastric balloon volume changes were measured during the lipd infusion as measure of gastric tone. Viscerosomatic referral pattern was evaluated during the distentions and ratings for satiety and nausea were obtained. Results: Before lipid infusion in the jejunum, perception thresholds (PTs) for bloating were 17.1± I mm Hg (mean, SEM) and 13.5±0.5 (p=0.OO5) after the infusion. Comparable values for bloating, before and after duodenal lipids were 16.2±0.8 and 14.7± I, respectively (n.s). PTs for discomfort were 19.1±0.8 vs. 15.2±0.7 before and after lipids infused in the jejunum (p=0.OOO3) and 18±0.9 vs. 16.6±0.7 before and after duodenal lipids (p=O.04). The percentual reductions of the discomfort threshols were higher after jejunal lipid adminstration compared to the PTs reductions after duodenal lipids (l9.6±3% vs. 9.9±4%, p=0.09). In all subjects, gastric balloon volumes increased within 5 minutes from the start of the lipid infusions, with 47±4 min 46±6 min passing until maximal volumes were reached in the stomach after jejunal and duodenal perfusions, respectively (n.s). Maximal gastric relaxation after jeunal lipid perfusion was 416±45 ml vs. 419±40 ml after duodenal lipids. Scores for satiety and nausea were similar on both study days, as well as viscerosomatic referral pattern. Conclusion: Administration of lipids in duodenum and jejunum affects gastric tone similarly. Jejunal perfusion oflipids seems to induce more pronounced effects on perception in the stomach. The jejunal route of enteral nutrition does not seem to have advantage over intraduodenal feeding with respect to symptoms.

5352 PHYSICIAN GENDER MAY INFLUENCE REFERRAL OF PATIENTS WITH IRRITABLE BOWEL SYNDROME TO GASTROENTEROLOGISTS. Marie L. Borum, George Washington Univ, Washington, DC. INTRODUCTION: Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder. Primary care physicians (PCPs) frequently manage patients with IBS. However, referrals to a gastroenterologist are often for IBS evaluation and/or management. This study evaluated PCPs reported prevalence of IBS patients in their practice and referral patterns. METHODS: An anonymous questionnaire, delivered to and completed by 49 (23 men, 26 women) PCPs, evaluated reported prevalence of IBS patients in their practices and their rate of referrals to gastroenterologists. Database development and statistical analysis was completed using Epi Info (version 6) program. Statistical significance was determined with contingency tables which generated Chi-square and p-values. RESULTS: Greater than 46% of PCPs reported that 25-49% of their patients had IBS (Table 1). Approximately 40% of PCPs reported that 1-24% of their IBS patients were referred to a gastroenterologist (Table 2). Subgroup analysis revealed that female PCPs had a statistically greater percentage of IBS patients (Table I) and referred their IBS patients to a gastroenterologist significantly less (Table 2). CONCLUSION: PCPs report that a signficant percentage of their patients have IBS. Patients with IBS can often be referred to a gastroenterologist. Female PCPs report a higher percentage of IBS patients and refer less frequently. Further study is necessary to evaluate the impact of PCP gender upon IBS management. TABLE 1 % IBS pts 75-100 50-74 25-49 1-24 0

All PCPs 0(0%) 2 (4.08%) 23 (46.94%) 18 (36.73%) 10 (20.41%)

Male PCPs 0(0)%) 0(0%) 7 (30.43%) 9 (39.13%) 7 (30.43%)

All PCPs

Male PCPs

p-value

Female PCPs

2 (4.08%) 7 (14.29%) 15 (30.61%) 20 (40.82%) 5 (10.20%)

0(0%) 3 (13.03%) 11 (47.83%) 6 (26.09%) 3 (1304%)

P=0.492 P=1.000 P=0.028 P=0.017 P=0.655

2 (7.69%) 4 (15.38%) 4 (15.38%) 14 (58.85%) 2 (7.69%)

p-value

P=0.045 P=0.205 P=0.157

Female PCPs 0(0%) 2 (7.69%) 16 (61.54%) 5 (19.23%) 3(11.54%)

TABLE 2 % of IBS pts referred to GI 75-100 50-74 25-49 1-24 0

5353 IMPROVED RESIDENCY EDUCATION MAY ENHANCE KNOWLEDGE OF THE IRRITABLE BOWEL SYNDROME. Marie L. Borum, George Washington Univ, Washington, DC. INTRODUCTION: Irritable bowel syndrome (IBS) is frequently diagnosed and managed by primary care physicians (PCPs). Physician practice patterns are influenced by residency training. There are no data on resident physicians' comfort with IBS diagnosis and management. This study evaluated resident physicians' reported ease of IBS diagnosis and treatment. METHODS: An anonymous questionnaire was completed by 31 internal medicine resident physicians (6 PGYI; 10 PGY2; 15 PGY3). The questionnaire evaluated residents' reported ease of IBS diagnosis, ease of IBS management and knowledge of the Rome criteria. A comparison of responses between residents in different postgraduate years of training (PGY) was conducted. Database development and statistical analysis was

completed using Epi Info 6.0 program. Statistical significance was determined with contingency tables which generated Chi-square and p-values. RESULTS: The majority of residents reported that IBS diagnosis was somewhat easy (58%) or not easy (39%) and that IBS management was not easy (71%). PGY3 residents reported significantly more comfort with the diagnosis of IBS compared to residents in PGYI (p=0.031) and PGY2 (p=0.OO9). There was no significant difference in the ease of IBS management or knowledge of the Rome criteria between residents of different postgraduate years. Most of the residents (74%) never heard of the Rome criteria. (Table) Table 1 CONCLUSION: The majority of internal medicine residents report that IBS diagnosis is somewhat easy or not easy and that IBS management is not easy. PGY3 residents reported significantly more comfort with IBS diagnosis than PGYI and PGY2 residents. However, the majority of residents are not familiar with the Rome criteria. Improved education may enhance resident physicians' diagnosis and management of IBS. TABLE 1

PGYl Diagnosis Very easy Easy Somewhat easy Not easy Management Very easy Easy Somewhat easy Not easy Rome Criteria Very familiar Familiar Somewhat familiar Never heard ofit

p-value PGY 1v2

PGY2

p-value PGY 2v3

PGY3

p-value PGY 1v3

0 0 2(33%) 4(67%)

1000 1.000 1.000

0 1(10%) 3(30%) 6(60%)

1000 0.009 0028

0 0 13(87%) 2(13%}

0031 0175

0 0 2(33%) 4(67%)

1.000 0.559 1000

0 1(10%) 1(10%) 8(80%)

1.000 0.345 0653

0 0 5(33%) 10(67'10)

0.613 0613

0 0 2(33%) 4(67%)

1000 0.559 1000

0 1(10%) 1(10%) 8(80%)

1.000 0615 1.000

0 0 4(27%) 11 (73%)

1000 1.000

5354 MAGNETIC DETECTION OF CHRONIC MESENTERIC ISCHEMIA. Alan Bradshaw, Allison Redmond, John P. Wikswo, William O. Richards, Vanderbilt Univ, Nashville, TN; Vanderbilt Univ Med Ctr, Nashville, TN. INTRODUCTION: Chronic mesenteric ischemia (CMI) is characterized by decreased frequency of the intestinal electrical control activity (ECA). The magnetoenterogram (MENG) measures the magnetic fields associated with intestinal ECA, and recordings of the MENG correlate strongly with serosal electrode recordings (Dig. Dis. Sci. 41(12): 2293-2301, 1996; Am. J. Physiol. 272: G1l59-1167, 1997). Previous studies have demontrated that measured MENG parameters reflect underlying GI electrophysiology in humans (IEEE Trans. Biomed. Eng. 46(8): 959-970, 1999) and pathophysiology associated with acute ischemia in animal models (J. Vasco Surg. 30:309-319, 1999). METHODS: We studied the MENG of one human patient diagnosed with CMI. A Superconducting QUantum Interference Device (SQUID) magnetometer was positioned over the subject's umbilicus and fasting recordings were obtained for a period of 30 minutes. The subject suspended respiration for 45 seconds to I minute during the recordings to avoid contamination with motion artifact. The subject was fed a chicken soup meal, and the recording repeated. Data were subjected to AutoRegressive (AR) spectral analysis to identify the dominant ECA frequencies during the short data segment while respiration was suspended. RESULTS: The patient's ECA frequency dropped significantly from the preprandial (11.1 cycles per minute, cpm) to postprandial (7.3 cpm) recording, for a decrease in ECA frequency of 34%. This finding is in stark contrast to data from normal human subjects. A previous study demonstrated no significant change in intestinal ECA frequency before and after a standardized meal in normal subjects (10.0 ± 0.3 cpm preprandial; 9.88 ± 0.24 cpm postprandial; a net change of 0.12 ± 0.14 cpm, or a 1.2% decrease; N = II; p