Breath methane in functional constipation: response to treatment with Ispaghula husk.

BACKGROUND: Colonic fermentation produces hydrogen (H2 ), and also produces methane (CH4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation (CC) and with changes in gut motility. To determine CH4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH4 -producers and non-producers. METHODS: Forty-eight patients with functional constipation or irritable bowel syndrome-constipation and 19 healthy age-and-sex-matched volunteers (HV) filled in a 1-week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test (LBT) to measure H2 and CH4 production (peak and area under the time-concentration curve, AUC-) and a colonic transit time (CTT) assessment. In patients, measurements were repeated after a 4-week treatment with Ispaghula husk. KEY RESULTS: Prevalence of M+ in patients was 60.5% vs 52.6% in HV (p = 0.37). Patients had significantly longer CTT and greater production of both H2 and CH4 during LBT. There was a significant correlation between CH4 production and CTT (r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M- patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (-10 ± 35 h; p = 0.029 vs baseline) and CH4 levels: peak CH4 (-13 ± 24 ppm; p = 0.014) and CH4 -AUC (-817 ± 3100 ppm/min; p = 0.04). CONCLUSIONS & INFERENCES: Although CH4 production has been associated with CC pathophysiology, we found that CH4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH4 levels as a biomarker tool for CC requires further appraisal.

High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates.

BACKGROUND: Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates. AIMS: To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance. METHODS: Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT. RESULTS: A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects. CONCLUSIONS: Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.

Effects of MDMA (ecstasy) and two of its metabolites on rat embryos in vitro.

MDMA consumers are young people of childbearing age. Consequently, developmental exposure to this drug is a potential public health concern. Several studies have addressed MDMA neurotoxicity in adults; however, knowledge of the effects of MDMA on developing embryos is limited. After administration, MDMA is metabolized species specifically via two main pathways. One leads to the formation of MDA and the other to the formation of HHMA. Here we evaluated the embryotoxic effects of MDMA, and also those of MDA, a main metabolite of MDMA in rats, and HHMA, a main metabolite in humans. For this purpose, we used the whole embryo culture (WEC). Our results show a concentration-dependent embryotoxic effect of MDMA, MDA and HHMA at a concentration range of 25-50µg/ml. The embryotoxic potential of the parent compound and the two metabolites was comparable in vitro.

MDMA (ecstasy) delays pubertal development and alters sperm quality after developmental exposure in the rat.

3,4-Methylenedioxymethamphetamine, MDMA or "ecstasy" is consumed mainly by young population at childbearing age. Therefore, there may be a risk of exposure of some pregnant women. The effects of the developmental exposure to MDMA on the sexual development and long-term sexual behaviour/fertility were assessed in Sprague-Dawley rats. MDMA was administered subcutaneously at 0 (control), 0.5, 5 and 10 mg/kg to female rats once a day, three consecutive days a week during 10 weeks, including gestation and lactation. The male offspring was evaluated for sexual maturation and mated with untreated sexually receptive females to evaluate the mating and pregnancy rates. Hormonal, haematological, biochemical, histological, genotoxicological and testicular and sperm parameters were also evaluated. A significant higher incidence of DNA damage in sperm and interstitial oedema in testes was found. There was also a significant and dose-related decrease in sperm count and a significant decrease in sperm motility at all doses. A significant delay in preputial separation onset in all treated groups was observed. This study reports by the first time an alteration of spermatogenesis after in utero and lactation MDMA exposure in the rat.

La coordinación entre profesores de fisiología y toxicología: un caso práctico en la Facultad de Farmacia de la Universidad de Barcelona / Physiology and toxicology teachers’ coordination. A case study in the Faculty of Pharmacy, University of Barcelona

El aprendizaje es un proceso continuo que no debería finalizar una vez aprobada una determinada asignatura. En cualquier estudio universitario hay muchas materias que, para su comprensión, requieren de conocimientos adquiridos previamente en otras. En los estudios de Farmacia del plan 2002, los profesores de toxicología habían constatado que los estudiantes de dicha asignatura no recordaban conceptos básicos cursados en asignaturas de semestres anteriores. La asignatura de toxicología necesita para su comprensión conocimientos de, entre otras materias, fisiología y fisiopatología. Por esta razón se planteó la necesidad de hacer una actuación conjunta entre los profesores de Fisiología y Toxicología.Los objetivos de este proyecto fueron: a) Identificación de los contenidos fisiológicos y fisiopatológicos que los alumnos deben conocer para el seguimiento de la asignatura de toxicología. b) Unificación terminológica. c) Realización de un conjunto de preguntas básicas sobre estos contenidos. d) Detección, a través de estas preguntas, de los temas o grupos de temas con porcentajes más altos de respuestas incorrectas. e) Detectar los temas de fisiología y fisiopatología en los que hay que hacer más hincapié para favorecer el seguimiento de toxicología. En esta comunicación se describe la experiencia y los resultados obtenidos(AU)

Learning is a continuous process that should be still performed once a particular subject has been passed. In the university, many subjects require prior knowledge of others subjects for better understanding. During the Pharmacy curriculum of 2002, toxicology teachers observed that students did not seem to remember the basic concepts presumably acquired in previous semesters. For example, for the toxicology subject, students should have basic knowledge of physiology and pathophysiology. For this reason, a joint action among physiology and toxicology teachers was considered.The objectives of this project were: a) Identifying the physiological and pathophysiological aspects that students should know to follow the toxicology course. b) Reaching agreement over the common terminology. c) Executing a set of basic questions about these physiological and pathophysiological aspects. d) Detecting through these questions, the topics with a highest percentage of incorrect answers. e) Identifying which physiology and pathophysiology topics should be emphasized to encourage students to follow the toxicology subject. This communication describes the experience and outcomes of this project(AU)

Scoring system has better discriminative value than Helicobacter pylori testing in patients with dyspepsia in a setting with high prevalence of infection.

OBJECTIVE: To prospectively assess the accuracy of a scoring system to predict organic diseases in dyspeptic patients in an area of South Europe, and to compare it with that of Helicobacter pylori testing in patients with dyspepsia in an environment with high prevalence of H. pylori infection. METHODS: Symptoms and demographic data were recorded in 501 consecutive dyspeptic patients referred to an outpatient gastroenterology clinic. A simple scoring system was constructed from the predictive factors obtained in a multi-variate logistic regression analysis. Overall predictive accuracy was assessed with the c statistic. The model was validated using bootstrap techniques. The accuracy of clinical judgement and H. pylori testing to predict endoscopic diagnosis was also assessed. RESULTS: Organic dyspepsia (peptic ulcer, oesophagitis or malignancies) was diagnosed in 45% of the patients. The test for H. pylori was positive in 68%, and 29% of infected patients had an ulcer. The organic dyspepsia predictive model had an accuracy of 0.79, which decreased to 0.77 after validation adjustment. The predictive accuracies for clinical judgement and H. pylori testing were 0.69 and 0.61, respectively. The addition of H. pylori testing to the scoring system resulted in a minor improvement of the predictive accuracy. CONCLUSION: In an environment with a high rate of H. pylori infection and a low prevalence of peptic ulcer among infected patients, a scoring system has higher predictive accuracy for the diagnosis of organic disease than H. pylori testing. Moreover, in this setting, H. pylori testing adds a minimum value to the predictive capability of the scoring system.

[The attitude of primary health care physicians in the metropolitan area of Barcelona about the diagnosis and treatment of Helicobacter pylori infection in gastroduodenal diseases]. / Actitud de los médicos de atención primaria del área metropolitana de Barcelona frente al diagnóstico y tratamiento de la infección por Helicobacter pylori en enfermedades gastroduodenales.

AIM: To evaluate the attitude of primary health care physicians versus the diagnosis and treatment of infection by Helicobacter pylori in patients with dyspepsia and gastroduodenal ulcer. DESIGN: An observational, transversal study was performed by a self administered questionnaire from June to October, 1997. PARTICIPANTS: Primary health care physicians from 38 reformed Medical Centers in the metropolitan area of Barcelona were included in the study. RESULTS: Of the 359 doctors to whom the questionnaire was sent, 283 responded (78.8%). In a patient with dyspepsia 95.4% would first request endoscopy. If they knew of the presence of infection by Helicobacter pylori 96.1% would administer eradication treatment in patients with gastric and duodenal ulcer and 15% would also do so if the endoscopy were normal. If the presence of infection by Helicobacter pylori were unknown in a patient with gastroduodenal ulcer, 65.3% would treat with anti-H2 or proton pump inhibitors associated with a diagnostic test of infection by Helicobacter pylori. If the physician decided to carry out eradication treatment of Helicobacter pylori infection, 98.6% would use one of the regimes recommended by different scientific societies. If confirmation of eradication of Helicobacter pylori infection were requested, 89% would do so one and three months after completion of treatment. In patients with gastric ulcer, 69.3% would request endoscopy on completion of treatment. The percentage of physicians specialized in Family and Community Medicine who would carry out eradication treatment in patients with duodenal ulcer and Helicobacter pylori infection and who would request endoscopies in patients with dyspepsia was found to be statistically significant in comparison with physicians without this specialty. CONCLUSIONS: The attitude of primary care physicians in the metropolitan area of Barcelona with regard to the diagnosis and treatment of infection by Helicobacter pylori in gastroduodenal diseases largely reflects the recommendations recently made by several scientific societies. In general there are no significant differences with respect to this attitude in regard to the age and sex of the physician, although their training was found to influence in some of the responses analyzed.

[Infectious gastroenteritis in relapses of inflammatory bowel disease. Therapeutic implications]. / Gastroenteritis infecciosa en los brotes de enfermedad inflamatoria intestinal. Implicaciones terapéuticas.

The incidence and clinical importance of infectious gastroenteritis was studied in 67 consecutive relapses of inflammatory bowel disease (IBD). A stool culture was done in every case before starting treatment. Stool culture was positive in 6 relapses (8.9%): Four were exacerbations of ulcerative colitis and two of Crohn's disease (8.8% in ulcerative colitis vs 9% in Crohn's disease; NS). The microorganisms isolated were Campylobacter jejuni in three cases, Salmonella enteritidis in two and Staphylococcus aureus in one case. There were not clinical differences between patients with positive and negative stool culture. Treated with antibiotics, stool cultures became negative in all of them but only in three the disease was controlled. The other three had to be treated with corticosteroids to achieve remission. We conclude that stool culture should be practised in all relapses of IBD and in case of positivity, antibiotic therapy should be started. With this approach the use of corticosteroids can be avoided in some patients.

Effect of dexfenfluramine on energy expenditure in obese patients on a very-low-calorie-diet.

AIM: To investigate the effect of dexfenfluramine (dF) on Energy Expenditure (EE). DESIGN: 20 obese females were studied in a double-blind design. Pre-diet and at 14 and 28 days of VLCD and dF treatment (30 mg/d) or placebo, Resting Metabolic Rate (RMR), 3 h-Thermic Effect of Food (3 h-TEF) and body composition were determined. EE and body composition were measured by indirect calorimetry and bioelectrical impedance, respectively. RESULTS: No differences between groups were observed in relation to weight loss, body composition changes or RMR. At 3 h postprandial, the EE was still elevated in both groups. No changes on TEF were observed in the placebo group during VLCD. In contrast, TEF decreased in dF group during VLCD (P < 0.05). No significant differences in TEF at the end of the study were observed between groups. CONCLUSION: These results suggest that dF modifies 3 h-TEF but not RMR in obese patients during VLCD administration.

Changes in body composition and resting energy expenditure after rapid weight loss: is there an energy-metabolism adaptation in obese patients?

The aim of this study was to assess changes in resting energy expenditure (REE) related to changes in fat free mass (FFM) in nine morbid obese (BMI 43 +/- 5.1 kg/m2) hospitalised females on VLCD. REE was measured by 30 min indirect calorimetry before and after 28 days of hospitalisation. Changes in FFM were assessed by bioelectrical impedance analysis (BIA), hydrostatic weighing (HW) and nitrogen balance (N). REE decreased 11.5% from 7.8 +/- 1.0 to 6.9 +/- 0.8 MJ/d. Total weight loss was 8.4 +/- 1.9 kg or 7.4% with an estimated FFM loss of 3.4 +/- 1.8 (BIA), 2.9 +/- 1.9 (HW) and 1.8 +/- 1.0 (N). As the fall in REE was larger than the loss of FFM, it is concluded that morbid obese patients develop an energy saving adaptation during rapid weight loss.

[Estimation of energy expenditure in patients with morbid obesity]. / Estimación del gasto energético en pacientes con obesidad mórbida.

BACKGROUND: The equations available for the prediction of basal energy expenditure (BEE) may not be applicable in morbid obese individuals since the contribution of the fat free mass (FFM) over the BEE is not constant. The aim of this study was to obtain new equations for the prediction of BEE which are specific for patients with morbid obesity. METHODS: In 26 women with morbid obesity age, weight, body composition by bioelectric impedance and BEE by open circuit indirect calorimetry were determined. The BEE observed was compared with that estimated from the previously described equations. The multiple regression method was used to obtain the BEE prediction equations. RESULTS: Upon comparison of the BEE observed with the BEE estimated by the described equations a significant relation was found between both parameters. The differences were also significant except when the Harris-Benedict equation was used. Multiple regression analysis demonstrated that when the variables of body composition were included, the FFM explained 75% of the variation in BEE and on forcing the entrance of fatty mass, the explanation increased to 79%. When only the anthropometric variables were included, weight explained 69% of the variation. CONCLUSIONS: In morbid obesity, most of the equations described for estimating basal energy expenditure are not applicable. New equations are reported for the prediction of energy expenditure.

Effect of exercise and protein intake on energy expenditure in adolescents.

In order to evaluate the influence of physical exercise and protein intake on Resting Metabolic Rate (RMR) and Postprandial Energy Expenditure (PEE), 16 healthy, normal-weight, 15 year-old, adolescent males at the same stage of pubertal development were studied. They were assigned to two dietary groups receiving the same energy intake (1.3 x by measured RMR) and different proportions of macronutrients (13% protein, 39% fat, 48% CHO in Group A; 30% protein, 32% fat, 38% CHO in Group B). An increase in postprandial energy expenditure, relative to basal, was observed in all individuals. The postprandial energy expenditure was higher in group B than in group A. Postprandial Post-exercise Thermogenesis (expressed as Kcal/3 h) was significantly higher in group B than group A (p < 0.05). Although the RMR on the test day was not different between the groups, the RMR on day 2 was significantly higher than on day 1 in group B (p < 0.01). In group B, the post-exercise RQ was significantly lower than the preexercise RQ (p < 0.01). It is concluded that in normal-weight-adolescents, a hyperproteic diet followed by moderately-intensive exercise induces increases in EE and decreases in RQ in the postprandial post-exercise period and is accompanied by increase in the RMR the following day.

[Spanish scientific production in food and nutrition from 1987 to 1990]. / La producción científica española sobre alimentación y nutrición de 1987 a 1990.

BACKGROUND: The aims of this study were: to quantify the Spanish scientific production with international repercussion, to determine the degree of world diffusion and the participation of the different autonomic communities and the organisms implicated with reference to the area of sciences of alimentation and nutrition between 1987 to 1990. METHODS: Articles published during this period of time were selected by the Medline system, delimiting Spanish production. The articles selected were classified according to autonomic communities and institutions and in relation to the subsection of the area in question. The impact factor obtained from the Science Citation Index was used as an indicator of scientific diffusion. The autonomic communities of Catalonia and Madrid made up almost 50% of the scientific production between 1987 and 1989 with greater participation being observed from the other communities in 1990. The institutions of greatest scientific contribution were the medical and science schools. Thirty percent of the articles referred to experimental nutrition and toxicology of alimentation. CONCLUSIONS: a) Spanish participation in the diffusion of scientific studies on nutrition is similar to global participation in medical sciences, b) in 1990 an attenuation was detected in the differences existing in the degree of participation by the autonomic communities in the national scientific production; c) the schools of Medicine make up the institutions with greater relevance in scientific production while this activity is not reflected within the hospitals.