Number Of Activity Fronts Research Articles

Effects of octreotide on manometric variables in patients with neuropathic abnormalities of the small bowel.

At present, there are few therapeutic options in patients with chronic intestinal dysmotilities. Octreotide, a long-acting somatostatin analog, has recently been shown to be a potentially useful drug in this setting, being able to start activity fronts (AF) in the small bowel in both healthy subjects and patients with intestinal motor disorders. We studied the effects of octreotide on manometric variables in 10 patients with chronic upper gastrointestinal symptoms and an intrinsic neuropathic disorder of the small intestine. Gastrointestinal manometry was carried out for 6 hr during fasting and 2 hr after a standard 605-kcal mixed meal. Thereafter octreotide, 50 micrograms subcutaneously was administered and the recording session continued for a further hour. Analysis of the tracings during fasting showed that 44% of the AF were abnormal; octreotide significantly increased the hourly number of AF (2 +/- 0.26 vs 0.67 +/- 0.14, P < 0.0001) and their duration (8.33 +/- 1.3 vs 6.12 +/- 0.34 min, P < 0.05) with respect to the baseline (fasting) period, and the propagation velocity also significantly slowed (3.4 +/- 0.4 vs 11 +/- 0.6 cm/min, P < 0.05). After the drug, 80% of patients displayed two AF and 10% more than two AF; the first AF after octreotide was always abnormally propagated. An almost complete inhibition of small bowel postprandial contractile activity was observed in 80% of patients, and the remaining 20% showed decreases. In three subjects, octreotide injection evoked the appearance of pylorospasm. From these results we conclude that octreotide could be of some benefit in patients with neuropathic disorders of the small bowel, although it remains to be established whether it is most useful in patients with more severe conditions, characterized by the complete absence of AF. The appearance of pylorospasm may contribute to the delayed gastric emptying observed after the drug is administered.

Different interdigestive antroduodenal motility patterns in chronic antral gastritis with and without Helicobacter pylori infection.

Fasting antroduodenal motor activity was studied in 15 dyspeptic patients with chronic superficial antral gastritis and Helicobacter pylori infection (group A), 10 dyspeptic patients with chronic superficial antral gastritis without Helicobacter pylori infection (group B), and eight healthy control subjects (group C) by manometric recording of phases of the interdigestive migrating motor complex (MMC) prolonged over 240 min. A significantly lower incidence of activity fronts (phase III of MMC) starting from the antrum was observed in patients with gastritis and Helicobacter pylori infection vs patients without bacterial colonization (P = 0.013) and in these latter vs control subjects (P = 0.013). Likewise, the overall number of activity fronts was smaller in patients with gastritis than in healthy subjects (P = 0.034). Symptomatic evaluation was performed in the two groups of dyspeptic patients, without detecting any differences in frequency and severity of complaints. Our results show a significant reduction in the occurrence of interdigestive antral phase III of MMC in chronic gastritis associated with Helicobacter pylori infection, suggesting a possible relationship between fasting motility and bacterial colonization.

Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia.

This study aimed to compare fasting and postprandial gastrointestinal motor patterns in patients with ulcer and non-ulcer dyspepsia. Forty five subjects were studied: 10 with uncomplicated gastric ulcer, eight with uncomplicated duodenal ulcer, 18 with chronic idiopathic dyspepsia, and nine healthy asymptomatic controls. Gastrointestinal fasting and postprandial motor patterns were recorded using a low compliance perfusion technique. The interdigestive antral cumulative motility index, computed for 30 minutes before the appearance of duodenal activity fronts, and the number of activity fronts with an antral component were significantly less in patients with ulcers and those with non-ulcer dyspepsia compared with asymptomatic controls. The patient groups also had a reduced antral motor response to a solid-liquid test meal compared with healthy controls. Intestinal motor abnormalities (bursts of non-propagated phasic pressure activity and discrete clustered contractions) were recorded in a minority of patients, all with associated irritable bowel symptoms. In conclusion, antral hypomotility is a frequent but nonspecific motor abnormality in dyspepsia; abnormal motor patterns of the small bowel are less frequent and seem to be confined to patients with concomitant irritable bowel syndrome.