Digestion, excretion, and energy value of fructooligosaccharides in healthy humans.

The fate of fructooligosaccharides (FOS) in the human gastrointestinal tract was evaluated in six healthy volunteers over an 11-d period. After an equilibration phase, 20.1 g FOS/d was given in three identical postprandial doses. Distal ileal output of FOS and their constituent components were determined by intestinal aspiration after a single meal, and the amounts of FOS excreted in stools and urine were also measured. Most of ingested FOS, 89 +/- 8.3% (mean +/- SEM), was not absorbed in the small intestine, and none was excreted in stools, indicating that the portion reaching the colon was completely fermented by colonic flora. A small fraction of ingested FOS was recovered in urine. The mean estimated energy value of FOS was 9.5 kJ/g. We conclude that in healthy humans, FOS are only slightly digested in the small intestine and then fermented in the colon, resulting in reduced energy production.

[Cystic dystrophy of the duodenal wall on aberrant pancreas. Apropos of 2 cases]. / Dystrophie kystique de la paroi duodénale sur pancréas aberrant (DKPA). A propos de deux observations.

Cystic dystrophy in heterotopic pancreas is characterized by the presence in the duodenal thickened muscularis of cysts corresponding to dilated ducts lined with exocrine epithelium. The pancreas proper is normal. Cystic dystrophy in heterotopic pancreas occurs mostly in men, in the periampullary region. Two cases, revealed by duodenal stenosis, are reported here. Symptoms and morphologic investigations favoured a diagnosis of malignancy: in one case, partial portal thrombosis was observed; this complication has not been previously described in association with cystic dystrophy in heterotopic pancreas. Endosonography was non-contributory in these 2 cases because of duodenal stenosis. A pancreaticoduodenectomy was performed associated in one case with portal thrombectomy. Pathologic findings allowed diagnosis of cystic dystrophy in heterotopic pancreas.

Digestion of raw banana starch in the small intestine of healthy humans: structural features of resistant starch.

The digestion of freeze-dried green banana flour in the upper gut was studied by an intubation technique in six healthy subjects over a 14 h period. Of alpha-glucans ingested, 83.7% reached the terminal ileum but were almost totally fermented in the colon. Structural study of the resistant fraction showed that a small part of the alpha-glucans which escaped digestion in the small intestine was composed of oligosaccharides from starch hydrolysis, whereas the rest was insoluble starch in granule form with physical characteristics similar to those of raw banana starch. Passage through the small intestine altered granule structure by increasing susceptibility to further alpha-amylase hydrolysis. Compared with resistant starch values in vivo, those obtained with the in vitro methods tested were inadequate to estimate the whole fraction of starch reaching the terminal ileum.

Comparison of lansoprazole with omeprazole on 24-hour intragastric pH, acid secretion and serum gastrin in healthy volunteers.

BACKGROUND: Lansoprazole and omeprazole are proton pump inhibitors which both strongly inhibit acid secretion, resulting in a significant increase in serum gastrin levels. However, no direct comparison of recommended doses (20 mg for omeprazole and 30 mg for lansoprazole) has been reported so far. Our aims were to compare the effects of omeprazole 20 mg/day and lansoprazole 30 mg/day on intragastric acidity and serum gastrin concentration in 12 healthy volunteers. METHODS: The study was double-blind, randomized and placebo-controlled with a cross-over design. On the seventh day of each period, 24-hour intragastric pH was measured using a combined glass electrode placed in the proximal stomach. The last morning dose of each regimen was taken at the end of 24-hour pH monitoring; acid output and serum gastrin concentrations were then studied in the fasting state and after stimulation with pentagastrin (maximal acid output) and a meal (post-prandial gastrin response). RESULTS: Compared to placebo, both drug regimens induced a sustained increase of 24-hour intragastric pH and significantly decreased basal and pentagastrin-stimulated acid secretion. Lansoprazole 30 mg was slightly more effective than omeprazole 20 mg in terms of time spent above pH 3 (P < 0.05). Accordingly postprandial gastrin concentrations rose slightly more after lansoprazole than after omeprazole. All other differences were insignificant. CONCLUSIONS: Both lansoprazole 30 mg and omeprazole 20 mg induce potent and long-lasting acid inhibition, with few minor differences when the two proton pump inhibitors are used at standard doses.

[Effect of enprostil on the healing and the recurrence of duodenal ulcer. Comparison with ranitidine]. / Effect de l'enprostil sur la cicatrisation et la récidive des ulcéres duodénaux. Comparaison à la ranitidine.

Enprostil, a synthetic prostaglandin E2, has been shown to exert both antisecretory and mucoprotective activity. It is effective in duodenal ulcer healing. OBJECTIVE--This study was performed to compare the frequency and the delay of spontaneous duodenal ulcer relapse during a two-year follow up period after initial healing by enprostil (35 micrograms, twice a day) or ranitidine (300 mg per day). METHODS--This multicentric, double-blind, randomized study included 642 patients (324 in the enprostil group and 318 in the ranitidine group). Patients included in the follow up period were evaluated by an endoscopy at 6 months, one and two years after healing. RESULTS--After a 6 weeks treatment period, healing rate was 85% for ranitidine and 70% for enprostil, respectively (P < 0.001). Adverse effects, especially digestive ones, occurred more often with enprostil than with ranitidine (P < 0.001). After initial healing, there was no significant difference between the 2 groups concerning the cumulative rate of relapse, despite a non significant trend for a milder rate of relapse in the enprostil group (P = 0.08). Twenty-seven % of the patients randomized to treatment (intend-to-treat analysis) in the enprostil group and 29% in the ranitidine group had no ulcer recurrence 6 months after ulcer healing, and respectively 12% and 13% at 2 years (difference not statistically significant). CONCLUSIONS--It is concluded that a) ranitidine is more effective and has less adverse effects than enprostil for duodenal ulcer healing, b) after duodenal ulcer healing by enprostil, there is a non significant trend for a lower rate of relapse than after healing with ranitidine, c) there is the same proportion of patients without ulcer in the 2 groups after 6 months and 2 years.

Inter- and intrasubject variability of solid and liquid gastric emptying parameters. A scintigraphic study in healthy subjects and diabetic patients.

This study was performed to assess: (1) the inter- and intrasubject variability of gastric emptying measurements by a scintigraphic method in 12 healthy subjects and 14 diabetic patients, and (2) the reproducibility of diagnosis of either the presence or absence of gastroparesis. To address this issue, radiolabeled solid-liquid meals were ingested by all subjects on two separate days. High intersubject variability of gastric emptying measurements was shown in both populations. Intrasubject variability was higher in diabetic patients than in healthy subjects. However, there was no significant difference between the means of any parameters obtained on two separate days. The reproducibility of the diagnosis of gastroparesis was excellent for all parameters; the solid half emptying time was the most reproducible parameter (92% in healthy subjects and 93% in diabetic patients). The means +/- SD of the difference between the two separate days' half emptying time results were -10.6 +/- 41.3 min for solids and -4.8 +/- 36.6 min for liquids and were not statistically different from zero. Only one difference between the half emptying time results on two separate days was not in the 95% confidence interval for both solids and liquids; however, this result came from a diabetic patient with obvious gastroparesis on both days. Thus: (1) in spite of high inter- and intrasubject variability, the scintigraphic method of measuring gastric emptying is highly reproducible for the diagnosis of gastroparesis; (2) reproducibility is better in healthy subjects than in diabetic patients; and (3) the knowledge of intrasubject variability allows assessment of the required sample sizes for pharmacological studies using prokinetic medications.

[Electrogastrography: responses to food and sham feeding and relationships with gastric emptying of solids in men]. / Electrogastrographie: réponses à l'alimentation et au repas fictif et relations avec la vidange gastrique des solides chez l'homme.

Cutaneous electrogastrography is a non invasive method to study gastric electromechanical activity. The aim of this work was to determine the amplitude of electrogastrographic (EGG) activity a) during fasting, b) after a meal, c) following vagal stimulation by sham feeding, and to determine the relationship between gastric emptying of solids and EGG activity. EGG activity was recorded in eight healthy subjects in various experimental conditions, twice after sham feeding, twice after a meal, and once during the simultaneous scintigraphic assessment of gastric emptying of the solid component of a meal. During one of the sham feeding tests, subjects were intubated and acid secretion was measured. The EGG signal amplitude was continuously monitored and an intercorrelation function (IF) was calculated using the Fast Fourier Transforms of electrical activity recorded by 2 cutaneous electrodes placed on the epigastric area. During fasting, IF was usually of low amplitude with occasional short increases of amplitude. Sham feeding without intubation rarely induced an early and brief increase in IF amplitude (2 of 8 subjects). Sham feeding-induced acid secretion was negatively correlated with IF amplitude (r = 0.78, P = 0.02) suggesting a motor inhibition associated with vagally stimulated acid secretion. When given orally, meals induced an increase in IF amplitude, but there was major intra- and interindividual variations. There was no significant correlation between the IF increase and the half emptying time for solids (r = 0.62, P = 0.10). This study shows that the high variability of EGG activity during fasting considerably hampers the analysis of changes induced by any stimulus.(ABSTRACT TRUNCATED AT 250 WORDS)

[Measurement of gastric emptying, intestinal transit time and colonic filling by scintiscan in healthy subjects]. / Mesure de la vidange gastrique, du temps de transit intestinal et du remplissage colique par scintigraphie chez le sujet sain.

A scintigraphic technique allowing combined measurements of gastric emptying, small intestinal transit time and colonic filling was developed and its reproducibility assessed in 8 healthy volunteers. Each subject underwent four tests: a) two were performed in the fasting state (99mTc labelled water, added to lactulose), b) two in the postprandial state (balanced meal, 1,750 kJ, included pellets labelled with 111In, the gut transit of which being nearly the same as dietary fibers). Intestinal transit was modeled using linear operators (expressed as a convolution product). In fasting state (lactulose), orocecal transit time of water was 109 +/- 60 min and 89 +/- 36 min (m +/- DS) for the first and second tests, respectively. In the postprandial state, values were 297 +/- 37 min and 293 +/- 43 min respectively for the pellets. Small bowel transit times were 135 +/- 70 and 103 +/- 40 min respectively in fasting state for water, and 209 +/- 47 and 209 +/- 29 min respectively in postprandial state for the pellets. Determination of residual variance showed that reproducibility of the test was better in the postprandial state than in the fasting state. Water orocecal transit times measured using this technique and lactulose orocecal transit time measured using hydrogen breath test were strongly correlated (r = 0.98, n = 12, P less than 0.01). This isotopic method provides a reproducible assessment of gastric emptying, small bowel transit, and colonic filling and could represent a reliable and non invasive tool for further physiological and pharmacological studies.