Subject(s)
Colitis, Ulcerative/diagnosis , Crohn Disease/diagnosis , Adult , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Female , Humans , Male , Middle Aged , PrognosisABSTRACT
The effect induced on the gastroduodenal motility by the extramucosal section of the circular layer of the first two parts of the duodenum, excluding the pylorus, was studied in a series of 5 dogs. The myoelectric and manometric activities of the antrum, pylorus, and duodenum were recorded by using special devices surgically implanted in the gut wall. The recordings were made 3 mo after operation, both during basal conditions and after stimulation with neostigmine. The results were statistically compared with those obtained in a control group of 4 dogs in which the electromanometric devices had been implanted 3 mo before. The gastric emptying time of a food-barium meal was determined radiologically before the operations, and 3 and 9 mo after. The results demonstrate that extramucosal duodenal myotomy: (a) significantly decreases the basal and stimulated motor activity of the duodenum, without noteworthy alterations of the gastroduodenal myoelectrical activity and coordination of motor waves; and (b) significantly shortens the gastric emptying time.
Subject(s)
Duodenum/physiology , Gastrointestinal Motility , Action Potentials , Animals , Dogs , Gastric Emptying , Muscle Contraction , Muscle, Smooth/physiology , Pressure , Pyloric Antrum/physiologyABSTRACT
Numerous experimental and clinical observations have established the role of hypertonic duodenal dyskinesia in the etiology of duodenogastric reflux and delayed emptying of the stomach. The original procedure proposed, section of the duodenal muscle fibres, demonstrated a relative hypotonia of the viscera and maintenance of antropyloroduodenal coordination. The present study confirms the effects of extramucosal duodenal myotomy after short- and long-term follow-up in dogs: reduction in gastric emptying time, absence of duodenal stagnation, and lack of morphological changes in the viscera. Unfavorable in duodenogastric reflux, it has favorable effects, on the contrary, on gastric emptying and antral function.
Subject(s)
Duodenum/surgery , Muscle, Smooth/surgery , Animals , Dogs , Follow-Up Studies , Gastric Emptying , MaleABSTRACT
A manometric study of duodenal motor activity was performed in 8 duodeno-gastric (D.G.) reflux patients and in 5 healthy volunteers. The examination was done by an open-tip probe containing three catheters which was positioned in the descending portion of the duodenum. The evaluation of manometric data evidenced in D.G. reflux patients a Motility Index (M.I.) significantly higher than that of control subjects in all the three duodenal recording points both in basal conditions and after prostigmine stimulation. Evaluation of the percentage of coordinated waves showed that in D.G. reflex patients the waves had a frequency lower than that in normals. On the basis of these results we can conclude that the duodenum of patients with D.G. reflux exhibits hyperkinetic-dyskinetic disturbances suggesting an important role of the duodenum in determing D.G. reflux.
Subject(s)
Duodenum/physiopathology , Gastroesophageal Reflux/physiopathology , Pylorus/physiopathology , Adult , Female , Gastrointestinal Motility , Humans , Male , Manometry/instrumentation , Middle AgedABSTRACT
Functional aspects of the antral-pyloric segment were evaluated in 30 patients without gastroduodenal disorders by means of prolonged endoscopic observations. Patients were examined in standardized conditions. Pressure measurements of the antrum, pylorus and duodenal bulb were assessed by means of water-perfused polyvinyl tubes in 7 patients of the same group a few days after the endoscopy. The pylorus appeared open in above 80% of the total endoscopic observation time. Pyloric closure was observed only for few seconds at the end of 30-40% of antral peristaltic waves. The antrum and pylorus appeared to contract in sequence. Antral peristaltic waves moved at a mean rate of 2.4 per minute and duodenal reflux was observed at a mean rate of 0.96 per minute usually in the form of bubbles. The manometric measurements by means of pull through in 7 patients and immediately after by means of prolonged registration carried out in a fixed position in 4 patients failed to show a high pressure zone in the gastroduodenal junction. In some cases it was possible to observe a peculiar phasic activity in the pyloric tract. The endoscopic and manometric observations suggest that human pylorus does not act as a true physiological sphincter. These findings confirm the functional aspects described by radiology and manometry in other studies. In this way, endoscopy appears to be a useful procedure to evaluate some functional aspect of the gastroduodenal tract.
Subject(s)
Pylorus/physiology , Adult , Aged , Duodenum/physiology , Female , Fiber Optic Technology , Gastrointestinal Motility , Gastroscopy , Humans , Male , Manometry , Middle Aged , Pressure , Pyloric Antrum/physiologyABSTRACT
A study of the motor activity of the gastroduodenal (GD) junction has been carried out on 8 subjects by using an original probe provided with a suction cup, that allows not only a duodenogastric (DG) pull-though, but also a prolonged recording of the pyloric, antral and duodenal motor activity, in basal condition and after intraduodenal instillation of HCl 0.1 N and intravenous infusion of cerulein. The position of the probe was controlled with fluoroscopy and transmural potential difference. The DG pull-through did not show a zone of high pressure at the GD junction, but the prolonged study showed, during HC1 and cerulein administrations, a significant increase of the pyloric tonus.
