between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in func... more between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in functional dyspeptic patients
AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship w... more AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy. METHODS: Ninety consecutive hemiplegic patients and 81 consecutive orthopedic patients were investigated during physical motor rehabil itation in the same period, in the same center and on the same diet. All subjects were interviewed ≥ 3 mo after injury using a questionnaire inquiring about bowel habits before injury and at the time of the interview. Patients ’ mobility was evaluated by the Adapted Patient Evaluation Conference System. Drugs considered for the analysis were nitrates, angiogenic converting enzyme (ACE) inhibitors,
Mediators and Drugs in Gastrointestinal Motility II, 1982
The esophagus controls transit of ingesta from the hypopharynx to the stomach. It allows eructati... more The esophagus controls transit of ingesta from the hypopharynx to the stomach. It allows eructation and vomiting and opposes reflux and regurgitation into the pharynx. Esophageal function is therefore dependent on motor activity and is regulated by the anatomic and functional characteristics of the muscle walls at the level of the upper esophageal sphincter, the esophageal body, and the lower esophageal sphincter, respectively.
The term "dysfunction" defines the motor disorders of the gall bladder and the sphincter of Oddi ... more The term "dysfunction" defines the motor disorders of the gall bladder and the sphincter of Oddi (SO) without note of the potential etiologic factors for the diYculty to diVerentiate purely functional alterations from subtle structural changes. Dysfunction of the gall bladder and/or SO produces similar patterns of biliopancreatic pain and SO dysfunction may occur in the presence of the gall bladder. The symptom-based diagnostic criteria of gall bladder and SO dysfunction are episodes of severe steady pain located in the epigastrium and right upper abdominal quadrant which last at least 30 minutes. Gall bladder and SO dysfunctions can cause significant clinical symptoms but do not explain many instances of biliopancreatic type of pain. The syndrome of functional abdominal pain should be diVerentiated from gall bladder and SO dysfunction. In the diagnostic workup, invasive investigations should be performed only in the presence of compelling clinical evidence and after non-invasive testing has yielded negative findings. Gall bladder dysfunction is suspected when laboratory, ultrasonographic, and microscopic bile examination have excluded the presence of gallstones and other structural abnormalities. The finding of decreased gall bladder emptying at cholecystokinin-cholescintigraphy is the only objective characteristic of gall bladder dysfunction. Symptomatic manifestation of SO dysfunction may be accompanied by features of biliary obstruction (biliary-type SO dysfunction) or significant elevation of pancreatic enzymes and pancreatitis (pancreatic-type SO dysfunction). Biliary-type SO dysfunction occurs more frequently in postcholecystectomy patients who are categorized into three types. Types I and II, but not type III, have biochemical and cholangiographic features of biliary obstruction. Pancreatic-type SO dysfunction is less well classified into types. When noninvasive investigations and endoscopic retrograde cholangiopanreatography show no structural abnormality, manometry of both biliary and pancreatic sphincter may be considered.
Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during end... more Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during endoscopic manometry and reported to range, in control subjects, from (M±SE) 3-0±0-6 to 7*5±0*7 c/min. Recently, high frequency (>8 c/min) phasic contractions or absence of phasic activity were recorded in patients with postcholecystectomy or pancreatic complaints, possibly suggesting a sphincter of Oddi dysfunction. In the present study, sphincter of Oddi (biliary tract) phasic contractility was measured by perendoscopic manometry in 13 subjects without specific clinical symptoms of biliopancreatic disease and with a normal common bile and pancreatic duct at ERCP. Four T-tube patients with no evidence of common bile duct stones or papillary stenosis were studied for comparison (transductal sphincter of Oddi manometry). Basal frequency was found to range from 0 to 7 c/min (M±SE: 2-99±0.46) in perendoscopic manometry (85 min of recording time) and from 0 to 12 c/min (2.0±0.3) in transductal manometry (2546 min of recording time). Long lasting transductal recordings also showed that frequency of activity derived from the sphincter area varied cyclically in close relation with the duodenal migrating motor complex. It is concluded that the sphincter of Oddi in man is likely to participate in the interdigestive gastrointestinal motor activity and that short perendoscopic recordings may not be representative of the overall sphincter of Oddi activity.
Our objective was to obtain national data of the estimated prevalence, sociodemographic relations... more Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S. householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income, and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globas, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work~school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
The microbial ecosystem of the gastrointestinal tract is characterized by a great number of micro... more The microbial ecosystem of the gastrointestinal tract is characterized by a great number of microbial species living in balance by adopting mutualistic strategies. The eubiosis/dysbiosis condition of the gut microbiota strongly influences our healthy and disease status. This review briefly describes microbiota composition and functions, to then focus on eubiosis and dysbiosis status: the two sides of the microbiota.
1. Adv Neurol. 1999;80:347-51. Urinary and anorectal function evaluation in Parkinson's ... more 1. Adv Neurol. 1999;80:347-51. Urinary and anorectal function evaluation in Parkinson's disease. Stocchi F, Corazziari E, Carbone A, Vacca L, De Pandis MF, Berardelli A, Ruggieri SA. Department of Neurological Sciences, University La Sapienza, Rome, Italy. ...
Gallbladder (GB) and Sphincter of Oddi (SO) dysfunctions represent the dysfunctional disorders of... more Gallbladder (GB) and Sphincter of Oddi (SO) dysfunctions represent the dysfunctional disorders of the biliary tract (BTDD) that manifest clinically as a variable combination of chronic or recurrent biliopancreatic symptoms and/or pancreatitis not explained by structural abnormalities. GB and SO dysfunctions are motor disorders of muscle contractility that, irrespective of the potential etiologic factors, cause abnormal GB emptying and, respectively, obstruction to the flow of bile and/or pancreatic juice into the duodenum. GB dysfunction is usually diagnosed on clinical grounds in patients with biliary type pain not accompanied by increase of temperature not by laboratory examinations and in whom ultrasonography (US) and/or cholescintigraphy can possibly detect an altered GB emptying. Although cholecystectomy is the most appropriate treatment of GB dysfunction and 50% to 70% of the patients benefit of cholecystectomy, no single test can predict the long-term outcome of surgery. SO d...
Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otil... more Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otilonium bromide (OB) (40 mg tid or placebo). In our patients we performed, before and after the treatment, a clinical evaluation (symptom variations) and functional studies (sigmoid manometry during bowel distension). As regards clinical parameters, otilonium bromide significantly reduced abdominal pain and bloating and significantly increased (p less than 0.02) the pain threshold. However the comparison with the placebo group did not show any difference between the two groups. Sigmoid motility during distension was significantly reduced (p less than 0.05) in OB group, whereas it did not change in the placebo group. We can conclude that, in irritable bowel syndrome (IBS) patients, OB is able to improve symptoms and to reduce stimulated motor activity of the sigmoid.
LETTERS If you have a burning desire to respond to a paper published in Gut, why not make use of ... more LETTERS If you have a burning desire to respond to a paper published in Gut, why not make use of our "rapid response" option? Log onto our website (www.gutjnl.com), find the paper that interests you, and send your response via email by clicking on the "eLetters" option in the box at the top right hand corner. Providing it isn't libellous or obscene, it will be posted within seven days. You can retrieve it by clicking on "read eLetters" on our homepage. The editors will decide as before whether to also publish it in a futrue paper issue. As diagnosis of sphincter of Oddi (SO) dysfunction may require perendoscopic manometric assessment of the sphincter, which is an invasive technique carrying a significant risk of pancreatitis, non-invasive scintigraphy has been proposed as an alternative diagnostic method. Craig et al (Gut 2003;52:352–7) reported their experience in assessing SO dysfunction in post-cholecys-tectomy patients with scintigraphy using th...
between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in func... more between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in functional dyspeptic patients
AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship w... more AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy. METHODS: Ninety consecutive hemiplegic patients and 81 consecutive orthopedic patients were investigated during physical motor rehabil itation in the same period, in the same center and on the same diet. All subjects were interviewed ≥ 3 mo after injury using a questionnaire inquiring about bowel habits before injury and at the time of the interview. Patients ’ mobility was evaluated by the Adapted Patient Evaluation Conference System. Drugs considered for the analysis were nitrates, angiogenic converting enzyme (ACE) inhibitors,
Mediators and Drugs in Gastrointestinal Motility II, 1982
The esophagus controls transit of ingesta from the hypopharynx to the stomach. It allows eructati... more The esophagus controls transit of ingesta from the hypopharynx to the stomach. It allows eructation and vomiting and opposes reflux and regurgitation into the pharynx. Esophageal function is therefore dependent on motor activity and is regulated by the anatomic and functional characteristics of the muscle walls at the level of the upper esophageal sphincter, the esophageal body, and the lower esophageal sphincter, respectively.
The term "dysfunction" defines the motor disorders of the gall bladder and the sphincter of Oddi ... more The term "dysfunction" defines the motor disorders of the gall bladder and the sphincter of Oddi (SO) without note of the potential etiologic factors for the diYculty to diVerentiate purely functional alterations from subtle structural changes. Dysfunction of the gall bladder and/or SO produces similar patterns of biliopancreatic pain and SO dysfunction may occur in the presence of the gall bladder. The symptom-based diagnostic criteria of gall bladder and SO dysfunction are episodes of severe steady pain located in the epigastrium and right upper abdominal quadrant which last at least 30 minutes. Gall bladder and SO dysfunctions can cause significant clinical symptoms but do not explain many instances of biliopancreatic type of pain. The syndrome of functional abdominal pain should be diVerentiated from gall bladder and SO dysfunction. In the diagnostic workup, invasive investigations should be performed only in the presence of compelling clinical evidence and after non-invasive testing has yielded negative findings. Gall bladder dysfunction is suspected when laboratory, ultrasonographic, and microscopic bile examination have excluded the presence of gallstones and other structural abnormalities. The finding of decreased gall bladder emptying at cholecystokinin-cholescintigraphy is the only objective characteristic of gall bladder dysfunction. Symptomatic manifestation of SO dysfunction may be accompanied by features of biliary obstruction (biliary-type SO dysfunction) or significant elevation of pancreatic enzymes and pancreatitis (pancreatic-type SO dysfunction). Biliary-type SO dysfunction occurs more frequently in postcholecystectomy patients who are categorized into three types. Types I and II, but not type III, have biochemical and cholangiographic features of biliary obstruction. Pancreatic-type SO dysfunction is less well classified into types. When noninvasive investigations and endoscopic retrograde cholangiopanreatography show no structural abnormality, manometry of both biliary and pancreatic sphincter may be considered.
Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during end... more Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during endoscopic manometry and reported to range, in control subjects, from (M±SE) 3-0±0-6 to 7*5±0*7 c/min. Recently, high frequency (>8 c/min) phasic contractions or absence of phasic activity were recorded in patients with postcholecystectomy or pancreatic complaints, possibly suggesting a sphincter of Oddi dysfunction. In the present study, sphincter of Oddi (biliary tract) phasic contractility was measured by perendoscopic manometry in 13 subjects without specific clinical symptoms of biliopancreatic disease and with a normal common bile and pancreatic duct at ERCP. Four T-tube patients with no evidence of common bile duct stones or papillary stenosis were studied for comparison (transductal sphincter of Oddi manometry). Basal frequency was found to range from 0 to 7 c/min (M±SE: 2-99±0.46) in perendoscopic manometry (85 min of recording time) and from 0 to 12 c/min (2.0±0.3) in transductal manometry (2546 min of recording time). Long lasting transductal recordings also showed that frequency of activity derived from the sphincter area varied cyclically in close relation with the duodenal migrating motor complex. It is concluded that the sphincter of Oddi in man is likely to participate in the interdigestive gastrointestinal motor activity and that short perendoscopic recordings may not be representative of the overall sphincter of Oddi activity.
Our objective was to obtain national data of the estimated prevalence, sociodemographic relations... more Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S. householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income, and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globas, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work~school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
The microbial ecosystem of the gastrointestinal tract is characterized by a great number of micro... more The microbial ecosystem of the gastrointestinal tract is characterized by a great number of microbial species living in balance by adopting mutualistic strategies. The eubiosis/dysbiosis condition of the gut microbiota strongly influences our healthy and disease status. This review briefly describes microbiota composition and functions, to then focus on eubiosis and dysbiosis status: the two sides of the microbiota.
1. Adv Neurol. 1999;80:347-51. Urinary and anorectal function evaluation in Parkinson's ... more 1. Adv Neurol. 1999;80:347-51. Urinary and anorectal function evaluation in Parkinson's disease. Stocchi F, Corazziari E, Carbone A, Vacca L, De Pandis MF, Berardelli A, Ruggieri SA. Department of Neurological Sciences, University La Sapienza, Rome, Italy. ...
Gallbladder (GB) and Sphincter of Oddi (SO) dysfunctions represent the dysfunctional disorders of... more Gallbladder (GB) and Sphincter of Oddi (SO) dysfunctions represent the dysfunctional disorders of the biliary tract (BTDD) that manifest clinically as a variable combination of chronic or recurrent biliopancreatic symptoms and/or pancreatitis not explained by structural abnormalities. GB and SO dysfunctions are motor disorders of muscle contractility that, irrespective of the potential etiologic factors, cause abnormal GB emptying and, respectively, obstruction to the flow of bile and/or pancreatic juice into the duodenum. GB dysfunction is usually diagnosed on clinical grounds in patients with biliary type pain not accompanied by increase of temperature not by laboratory examinations and in whom ultrasonography (US) and/or cholescintigraphy can possibly detect an altered GB emptying. Although cholecystectomy is the most appropriate treatment of GB dysfunction and 50% to 70% of the patients benefit of cholecystectomy, no single test can predict the long-term outcome of surgery. SO d...
Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otil... more Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otilonium bromide (OB) (40 mg tid or placebo). In our patients we performed, before and after the treatment, a clinical evaluation (symptom variations) and functional studies (sigmoid manometry during bowel distension). As regards clinical parameters, otilonium bromide significantly reduced abdominal pain and bloating and significantly increased (p less than 0.02) the pain threshold. However the comparison with the placebo group did not show any difference between the two groups. Sigmoid motility during distension was significantly reduced (p less than 0.05) in OB group, whereas it did not change in the placebo group. We can conclude that, in irritable bowel syndrome (IBS) patients, OB is able to improve symptoms and to reduce stimulated motor activity of the sigmoid.
LETTERS If you have a burning desire to respond to a paper published in Gut, why not make use of ... more LETTERS If you have a burning desire to respond to a paper published in Gut, why not make use of our "rapid response" option? Log onto our website (www.gutjnl.com), find the paper that interests you, and send your response via email by clicking on the "eLetters" option in the box at the top right hand corner. Providing it isn't libellous or obscene, it will be posted within seven days. You can retrieve it by clicking on "read eLetters" on our homepage. The editors will decide as before whether to also publish it in a futrue paper issue. As diagnosis of sphincter of Oddi (SO) dysfunction may require perendoscopic manometric assessment of the sphincter, which is an invasive technique carrying a significant risk of pancreatitis, non-invasive scintigraphy has been proposed as an alternative diagnostic method. Craig et al (Gut 2003;52:352–7) reported their experience in assessing SO dysfunction in post-cholecys-tectomy patients with scintigraphy using th...
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