Giuseppe Chiarioni - Academia.edu (original) (raw)
Papers by Giuseppe Chiarioni
International journal of pancreatology, 1991
Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, ... more Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, 65 patients with acute or chronic pancreatic diseases, nine with acute abdomen, four with macroamylasemia, and four with duodenal duplication. In controls, up to four fractions (2 salivary, 2 pancreatic) were found; the pancreatic fractions were as a mean 44.707o (SD 8.6) of total. In chronic pancreatitis, only patients with steatorrhea showed a significant reduction of pancreatic isoamylase (p<0.001). In all patients with acute pancreatitis or pseudocysts, an additional fraction (similar to the so-called P3 fraction) was resolved. Moreover, additional isoenzymes were found in all patients with severe acute pancreatitis or pseudocysts, and not in controls or patients with mild forms, acute abdomen or duodenal duplication. A similar pattern was shown in a stored control serum after 10 mo at-20 ~ These fractions disappeared after successful surgical drainage. No specific alteration was found in pancreatic cancer. Amylase fractionation by isoelectric focusing can be used to confirm an acute pancreatitis, and to monitor patients with pancreatic pseudocysts and collections after surgical drainage.
Digestive Diseases and Sciences, 2021
Digestive Diseases and Sciences, 2019
Case Reports in Obstetrics and Gynecology, 2017
Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forc... more Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses. Intramural hematoma of the esophagus is generally benign and most patients recover fully with conservative treatment. Bleeding can be managed medically unless in hemodynamically unstable patients, for whom surgical or angiographic treatment may be attempted; only rarely esophageal obstruction requires endoscopic decompression. We report an unusual case of esophageal hematoma, presenting in a young pr...
World Journal of Gastroenterology, 2005
AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant o... more AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant occurrence of megarectum is not uncommon. However, the definition of megarectum is variable, and a few data exist for Italy. We studied anorectal manometric variables and sensation in a group of constipated children with megarectum defined by radiologic criteria. Data from this group were compared with those obtained in a similar group of children with recurrent abdominal pain. METHODS: Anorectal testing was carried out in both groups by standard manometric technique and rectal balloon expulsion test. RESULTS: Megarectum patients displayed discrete abnormalities of anorectal variables and sensation with respect to controls. In particular, the pelvic floor function appeared to be impaired in most patients. CONCLUSION: Constipated children with megarectum have abnormal anorectal function and sensation. These findings may be helpful for a better understanding of the pathophysiological basis of this condition.
Techniques in Coloproctology, 2015
Alimentary pharmacology & therapeutics, 2015
indicate patients without evidence of partial villous atrophy. 4 Finally, we acknowledge that the... more indicate patients without evidence of partial villous atrophy. 4 Finally, we acknowledge that there are no universally accepted guidelines to monitor adherence to dietary advice in CD. 4 We assume that all the patients were compliant with GFD at follow-up. However, we feel that limiting the follow-up to the measurement of anti-tissue transglutaminase antibodies and dietetic consultation makes it hard to allow for full response of the disease to GFD. 5 In conclusion, one may wonder whether metabolic syndrome was associated with the prescription of a GFD in patients where it was not mandatory, or simply the tale of an immune condition poorly responding to mandatory dietetic treatment, as an alternative. Eventually, this paper might raise concerns on the potential harm of a GFD when the prescription is not mandatory.
World journal of gastrointestinal surgery, Jan 30, 2009
... Italy Shivendra Shukla, Professor, Department of Medical Pharmacology and Physiology, Univers... more ... Italy Shivendra Shukla, Professor, Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, 1 Hospital Drive, M530 Medical Sciences Bldg., Columbia MO 65212, United States Bin Wang ...
Zeitschrift für Gastroenterologie, 1998
Erythromycin has been proposed as a therapeutic agent for the treatment of functional motor disor... more Erythromycin has been proposed as a therapeutic agent for the treatment of functional motor disorders of the upper gastrointestinal tract. Moreover, some data exist showing a potential effect on colonic motility. Since no data are available concerning erythromycin effects in chronically constipated patients, we investigated the effects of three different doses of the drug (50, 200, and 500 mg i. v.) on colonic intraluminal pressures in such patients. 18 severely constipated women were studied by a colonoscopically-positioned manometric probe, and were randomized to receive one of three doses of erythromycin. Proximal and distal colonic motility was recorded basally, then during placebo infusion for 60 min and for a further 60 min after the drug had been infused. Analysis of the tracings showed that, except for the lowest dose in the distal colon, erythromycin failed to stimulate colonic motility in constipated patients. It is concluded that erythromycin cannot be considered a coloki...
Constipation: Current & Emerging Treatments, 2013
Digestive Diseases and Sciences, 1997
The mechanisms responsible for boweldisturbances in celiac disease are still relativelyunknown. R... more The mechanisms responsible for boweldisturbances in celiac disease are still relativelyunknown. Recent reports suggested that small bowel motorabnormalities may be involved in this pathologicalcondition; however, there are no studies addressing smallbowel transit in celiac disease before and after agluten-free diet. We studied the mouth-to-cecum transittime of a caloric liquid meal in a homogeneous group of celiac patients presenting with clinical
Recenti progressi in medicina, 2013
Colorectal cancer is a leading contributing cause of death for malignancy in the general populati... more Colorectal cancer is a leading contributing cause of death for malignancy in the general population. An efficient screening policy would result in a remarkable decrease in cancer-related mortality since a benign, fully removable adenoma is the biologic precursor in the vast majority of cases. Endoscopy of the lower bowel and fecal occult blood test are considered relevant means of providing effective cancer screening and early diagnosis of benign cancer precursors. Compliance to screening programs is key to effective cancer screening. This review deals with colorectal cancer screening programs with a particular focus on the most recent national and international guidelines on cancer screening and follow-up policies.
Gut, 1993
The motor and sensory function of the anorectum is well characterised in patients with solid stoo... more The motor and sensory function of the anorectum is well characterised in patients with solid stool incontinence. Fewer data are available in the case of liquid stool incontinence. Anorectal sensorimotor function was studied in 16 patients with liquid stool incontinence and severe urgency (10 with diarrhoea) unresponsive to conventional medical treatment, and in 16 healthy volunteers. The only significant difference found between incontinent patients and controls was a reduction in squeeze duration (p<00001). Fourteen patients were selected to receive biofeedback treatment. Treatment was associated with a substantial improvement in continence in 12 patients and with a significant decrease in urgency (p<005). Bowel frequency was not significantly influenced. Most patients showed a persistent improvement in anal motor function. Functional parameters were not predictive of outcome of treatment; the poor responders showed major psychological problems. In conclusion, an anal motor deficit is often present in disabling liquid stool incontinence. Biofeedback may improve anal continence in 75% of patients.
Gastroenterology, 2001
Purpose: We hypothesize that intraislet somatostatin inhibits insulin secretion via a delta to be... more Purpose: We hypothesize that intraislet somatostatin inhibits insulin secretion via a delta to beta cell axis in mice. To test this hypothesis and to better elucidate somatostatin receptor's (1-5) role in insulin homeostasis we studied the effect of somatostatin's immunoneutralization and the addition of additional somatostatin agonist on insulin secretion in the isolated perfused pancreata of wild type (WT) and SSTR5 knock out mice (KO). Methods: Groups of 12 mo KO and wr mice were screened by Southern Blot. Single pass perfusion of isolated pancreata were performed with either a monoclonal somatostatin antibody (SSAb), a control antibody (KLHAb), or Octreotide in the presence of low (70mg%) and high (30Omg%) glucose. Insulin (pg/ml) was measured using ELISA. Basal, l't, and 2 ~ phase insulin secretion were compared via ANOVA (mean _ SEM). Results: Neither SSAb nor Octreotide had an effect on basal, 1 =, or 2 "d phase insulin secretion in SSTR5 KO mice. SSAb did augment and Octreotide did inhibit basal, 1 ~t, and 2 "d phase insulin secretion in WT mice. And there was no difference in 1 = or 2 "~ phase insulin secretion in any SSTR5 KO mice (perfused with SSAb, KLHAb, or Octreotide)compared to WT mice pertused with SSAb.(See figure) Conclusion: SSAb auugmonied insulin secretion and Octreotide suppresed insulin secretion in WT mice, while neither had an effect on SSTR5 KO mice. The data supports that a delta-to-beta cell axis exists in the mouse and that this axis is mediated by SSTR5.
Gastroenterology, 2001
OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75... more OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment. METHODS: Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6-12 months after training. RESULTS: Seventeen (71%) were classified responders: 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome. CONCLUSIONS: In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback.
Gastroenterology, 2006
Background & Aims: Uncontrolled trials suggest biofeedback is an effective treatment for pelvic f... more Background & Aims: Uncontrolled trials suggest biofeedback is an effective treatment for pelvic floor dyssynergia (PFD), a type of constipation defined by paradoxical contraction, or inability to relax, pelvic floor muscles during defecation. The aim was to compare biofeedback to laxatives plus education. Methods: Patients with chronic, severe PFD were first treated with 20 g/day fiber plus enemas or suppositories up to twice weekly. Nonresponders were randomized to either 5 weekly biofeedback sessions (n ؍ 54) or polyethylene glycol 14.6-29.2 g/day plus 5 weekly counseling sessions in preventing constipation (n ؍ 55). Satisfaction with treatment, symptoms of constipation, and pelvic floor physiology were assessed 6 and 12 months later. The biofeedback group was also assessed at 24 months. Laxative-treated patients were instructed to increase the dose of polyethylene glycol from 14.6 to 29.2 g/day after 6 months. Results: At 6 months, major improvement was reported by 43 of 54 (80%) biofeedback patients vs 12 of 55 (22%) laxative-treated patients (P < .001). Biofeedback's benefits were sustained at 12 and 24 months. Biofeedback also produced greater reductions in straining, sensations of incomplete evacuation and anorectal blockage, use of enemas and suppositories, and abdominal pain (all P < .01). Stool frequency increased in both groups. All biofeedback-treated patients reporting major improvement were able to relax the pelvic floor and defecate a 50-mL balloon at 6 and 12 months. Conclusions: Five biofeedback sessions are more effective than continuous polyethylene glycol for treating PFD, and benefits last at least 2 years. Biofeedback should become the treatment of choice for this common and easily diagnosed type of constipation.
Diseases of the Colon & Rectum, 2004
Constipation is a commonly reported symptom, and pelvic floor dyssynergia is frequently documente... more Constipation is a commonly reported symptom, and pelvic floor dyssynergia is frequently documented in constipated patients. The standard therapeutic approach for pelvic floor dyssynergia is biofeedback training, but long-term studies show that a significant percentage of patients remain symptomatic. Alternative or adjunctive therapeutic options are needed. The purpose of this study was to evaluate the long-term effects of electrogalvanic stimulation in patients with pelvic floor dyssynergia and severe constipation, to see whether this treatment may be of some benefit. Thirty consecutive constipated patients with clinical and instrumental evidence of pelvic floor dyssynergia entered the study and were treated with a standard high-frequency galvanic electrostimulation protocol. Clinical and instrumental (colon transit time, anorectal manometry, defecography, rectal balloon expulsion) assessment evaluations were performed basally and one year after the treatment. Overall, approximately 50 percent of patients showed significant improvement after electrogalvanic treatment, from both a clinical and an instrumental point of view, as shown by the objective measurements obtained through manometry, defecography, and the balloon expulsion test. The benefit was limited to normal transit constipation patients. Because of the relatively simple, painless and effective nature of electrogalvanic stimulation, we concluded that it may represent a useful adjunct to the therapeutic armamentarium for pelvic floor dyssynergia in normal transit constipation.
Digestive Diseases and Sciences, 1995
Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipat... more Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipation. However, outlet obstruction itself may be due to several mechanisms. Among these, the presence of a megarectum is a leading one. Pathophysiological studies in adult patients with idiopathic megarectum are scarce. We studied by manometric and defecographic means 15 adult subjects with idiopathic megarectum and severe chronic constipation. Twenty-five healthy volunteers of both sexes acted as controls. Manometric variables showed significant differences between patients and controls with respect to internal anal sphincter pressure (P = 0.02), minimum relaxation volume (P < 0.001), defecatory sensory threshold (P < 0.001), mean rectal tolerable volume (P < 0.001), and rectal compliance (P < 0.001). An altered response to straining was observed in 46.6% of patients and in 12% of controls (P = 0.04); the ability to expel a 50-ml balloon per anum was 13.3% in patients and 100% in controls (P < 0.001). Although all patients opened the anorectal angle and had descent of the pelvic floor, thereby confirming an adequate expulsion effort, evacuation of contrast material appeared extremely difficult. In fact, no subject was able to expel more than 30% of the rectal contents during fluoroscopic screening. These results confirm previous hypotheses that idiopathic megarectum displays features of a neuropathic process as an underlying mechanism. Further studies are needed that also take into consideration the muscle tone component of the rectum in these patients.
Digestive Diseases and Sciences, 1996
Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may... more Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may have motor abnormalities not limited to the colon. We studied by manometric means gastric and small bowel motility in a homogeneous group of patients with chronic idiopathic constipation, ie, the slow transit type. Twenty-one patients were recruited for the study and compared to 33 healthy subjects. Manometric examination was carried out for about 5 hr fasting and 1 hr after a standard meal. Analysis of the manometric tracings revealed during fasting no abnormalities in number and configuration of migrating motor complex with respect to controls. However, in 70% of patients motor abnormalities were detected, represented by bursts of nonpropagated contractions and discrete clustered contractions. After feeding, the patient group displayed a significantly shorter antral motor response to the meal with respect to controls; moreover, intestinal bursts of nonpropagated contractions were found in 19% of patients, and 14% of them had an early return of the activity fronts. We conclude that patients with slow transit constipation frequently display motor abnormalities of the upper gut. These findings further strengthen the concept that this condition may represent a panenteric disorder.
International journal of pancreatology, 1991
Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, ... more Isoamylase analysis by isoelectric focusing was performed in the serum of 30 healthy volunteers, 65 patients with acute or chronic pancreatic diseases, nine with acute abdomen, four with macroamylasemia, and four with duodenal duplication. In controls, up to four fractions (2 salivary, 2 pancreatic) were found; the pancreatic fractions were as a mean 44.707o (SD 8.6) of total. In chronic pancreatitis, only patients with steatorrhea showed a significant reduction of pancreatic isoamylase (p<0.001). In all patients with acute pancreatitis or pseudocysts, an additional fraction (similar to the so-called P3 fraction) was resolved. Moreover, additional isoenzymes were found in all patients with severe acute pancreatitis or pseudocysts, and not in controls or patients with mild forms, acute abdomen or duodenal duplication. A similar pattern was shown in a stored control serum after 10 mo at-20 ~ These fractions disappeared after successful surgical drainage. No specific alteration was found in pancreatic cancer. Amylase fractionation by isoelectric focusing can be used to confirm an acute pancreatitis, and to monitor patients with pancreatic pseudocysts and collections after surgical drainage.
Digestive Diseases and Sciences, 2021
Digestive Diseases and Sciences, 2019
Case Reports in Obstetrics and Gynecology, 2017
Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forc... more Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses. Intramural hematoma of the esophagus is generally benign and most patients recover fully with conservative treatment. Bleeding can be managed medically unless in hemodynamically unstable patients, for whom surgical or angiographic treatment may be attempted; only rarely esophageal obstruction requires endoscopic decompression. We report an unusual case of esophageal hematoma, presenting in a young pr...
World Journal of Gastroenterology, 2005
AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant o... more AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant occurrence of megarectum is not uncommon. However, the definition of megarectum is variable, and a few data exist for Italy. We studied anorectal manometric variables and sensation in a group of constipated children with megarectum defined by radiologic criteria. Data from this group were compared with those obtained in a similar group of children with recurrent abdominal pain. METHODS: Anorectal testing was carried out in both groups by standard manometric technique and rectal balloon expulsion test. RESULTS: Megarectum patients displayed discrete abnormalities of anorectal variables and sensation with respect to controls. In particular, the pelvic floor function appeared to be impaired in most patients. CONCLUSION: Constipated children with megarectum have abnormal anorectal function and sensation. These findings may be helpful for a better understanding of the pathophysiological basis of this condition.
Techniques in Coloproctology, 2015
Alimentary pharmacology & therapeutics, 2015
indicate patients without evidence of partial villous atrophy. 4 Finally, we acknowledge that the... more indicate patients without evidence of partial villous atrophy. 4 Finally, we acknowledge that there are no universally accepted guidelines to monitor adherence to dietary advice in CD. 4 We assume that all the patients were compliant with GFD at follow-up. However, we feel that limiting the follow-up to the measurement of anti-tissue transglutaminase antibodies and dietetic consultation makes it hard to allow for full response of the disease to GFD. 5 In conclusion, one may wonder whether metabolic syndrome was associated with the prescription of a GFD in patients where it was not mandatory, or simply the tale of an immune condition poorly responding to mandatory dietetic treatment, as an alternative. Eventually, this paper might raise concerns on the potential harm of a GFD when the prescription is not mandatory.
World journal of gastrointestinal surgery, Jan 30, 2009
... Italy Shivendra Shukla, Professor, Department of Medical Pharmacology and Physiology, Univers... more ... Italy Shivendra Shukla, Professor, Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, 1 Hospital Drive, M530 Medical Sciences Bldg., Columbia MO 65212, United States Bin Wang ...
Zeitschrift für Gastroenterologie, 1998
Erythromycin has been proposed as a therapeutic agent for the treatment of functional motor disor... more Erythromycin has been proposed as a therapeutic agent for the treatment of functional motor disorders of the upper gastrointestinal tract. Moreover, some data exist showing a potential effect on colonic motility. Since no data are available concerning erythromycin effects in chronically constipated patients, we investigated the effects of three different doses of the drug (50, 200, and 500 mg i. v.) on colonic intraluminal pressures in such patients. 18 severely constipated women were studied by a colonoscopically-positioned manometric probe, and were randomized to receive one of three doses of erythromycin. Proximal and distal colonic motility was recorded basally, then during placebo infusion for 60 min and for a further 60 min after the drug had been infused. Analysis of the tracings showed that, except for the lowest dose in the distal colon, erythromycin failed to stimulate colonic motility in constipated patients. It is concluded that erythromycin cannot be considered a coloki...
Constipation: Current & Emerging Treatments, 2013
Digestive Diseases and Sciences, 1997
The mechanisms responsible for boweldisturbances in celiac disease are still relativelyunknown. R... more The mechanisms responsible for boweldisturbances in celiac disease are still relativelyunknown. Recent reports suggested that small bowel motorabnormalities may be involved in this pathologicalcondition; however, there are no studies addressing smallbowel transit in celiac disease before and after agluten-free diet. We studied the mouth-to-cecum transittime of a caloric liquid meal in a homogeneous group of celiac patients presenting with clinical
Recenti progressi in medicina, 2013
Colorectal cancer is a leading contributing cause of death for malignancy in the general populati... more Colorectal cancer is a leading contributing cause of death for malignancy in the general population. An efficient screening policy would result in a remarkable decrease in cancer-related mortality since a benign, fully removable adenoma is the biologic precursor in the vast majority of cases. Endoscopy of the lower bowel and fecal occult blood test are considered relevant means of providing effective cancer screening and early diagnosis of benign cancer precursors. Compliance to screening programs is key to effective cancer screening. This review deals with colorectal cancer screening programs with a particular focus on the most recent national and international guidelines on cancer screening and follow-up policies.
Gut, 1993
The motor and sensory function of the anorectum is well characterised in patients with solid stoo... more The motor and sensory function of the anorectum is well characterised in patients with solid stool incontinence. Fewer data are available in the case of liquid stool incontinence. Anorectal sensorimotor function was studied in 16 patients with liquid stool incontinence and severe urgency (10 with diarrhoea) unresponsive to conventional medical treatment, and in 16 healthy volunteers. The only significant difference found between incontinent patients and controls was a reduction in squeeze duration (p<00001). Fourteen patients were selected to receive biofeedback treatment. Treatment was associated with a substantial improvement in continence in 12 patients and with a significant decrease in urgency (p<005). Bowel frequency was not significantly influenced. Most patients showed a persistent improvement in anal motor function. Functional parameters were not predictive of outcome of treatment; the poor responders showed major psychological problems. In conclusion, an anal motor deficit is often present in disabling liquid stool incontinence. Biofeedback may improve anal continence in 75% of patients.
Gastroenterology, 2001
Purpose: We hypothesize that intraislet somatostatin inhibits insulin secretion via a delta to be... more Purpose: We hypothesize that intraislet somatostatin inhibits insulin secretion via a delta to beta cell axis in mice. To test this hypothesis and to better elucidate somatostatin receptor's (1-5) role in insulin homeostasis we studied the effect of somatostatin's immunoneutralization and the addition of additional somatostatin agonist on insulin secretion in the isolated perfused pancreata of wild type (WT) and SSTR5 knock out mice (KO). Methods: Groups of 12 mo KO and wr mice were screened by Southern Blot. Single pass perfusion of isolated pancreata were performed with either a monoclonal somatostatin antibody (SSAb), a control antibody (KLHAb), or Octreotide in the presence of low (70mg%) and high (30Omg%) glucose. Insulin (pg/ml) was measured using ELISA. Basal, l't, and 2 ~ phase insulin secretion were compared via ANOVA (mean _ SEM). Results: Neither SSAb nor Octreotide had an effect on basal, 1 =, or 2 "d phase insulin secretion in SSTR5 KO mice. SSAb did augment and Octreotide did inhibit basal, 1 ~t, and 2 "d phase insulin secretion in WT mice. And there was no difference in 1 = or 2 "~ phase insulin secretion in any SSTR5 KO mice (perfused with SSAb, KLHAb, or Octreotide)compared to WT mice pertused with SSAb.(See figure) Conclusion: SSAb auugmonied insulin secretion and Octreotide suppresed insulin secretion in WT mice, while neither had an effect on SSTR5 KO mice. The data supports that a delta-to-beta cell axis exists in the mouse and that this axis is mediated by SSTR5.
Gastroenterology, 2001
OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75... more OBJECTIVES: Biofeedback is a nonsurgical treatment that reportedly produces good results in 65-75% of fecally incontinent patients. However, previous studies have not ruled out nonspecific treatment effects. It is also unknown whether biofeedback works primarily by improving the strength of the striated pelvic floor muscles or by improving the rectal perception. We aimed to 1) evaluate the efficacy of biofeedback in formed-stool fecal incontinence, 2) assess the relative contribution of sensory and strength retraining to biofeedback outcomes, and 3) identify patient characteristics that predict a good response to treatment. METHODS: Twenty-four patients with frequent (at least once a week) solid-stool incontinence were provided with three to four biofeedback sessions. They were taught to squeeze in response to progressively weaker rectal distentions. Patients were re-evaluated by anorectal manometry and symptom diary 3 months after completing training and by diary and interview 6-12 months after training. RESULTS: Seventeen (71%) were classified responders: 13 became continent and four reduced incontinence frequency by at least 75%. Clinical improvements were maintained at 12-month follow-up. At 3-month follow-up, responders had significantly lower thresholds for perception of rectal distention and for sphincter contraction, but squeeze pressures did not significantly differ from those of nonresponders. Baseline measures that predicted a favorable response were sensory threshold (50 ml or less), urge threshold (100 ml or less), lower threshold for sphincter contraction, and lower threshold for the rectoanal inhibitory reflex; neither anal squeeze pressure nor severity of incontinence predicted treatment outcome. CONCLUSIONS: In solid-stool fecal incontinence biofeedback training effects are robust and seem not to be explained by expectancy or nonspecific treatment effect. Sensory retraining appears to be more relevant than strength training to the success of biofeedback.
Gastroenterology, 2006
Background & Aims: Uncontrolled trials suggest biofeedback is an effective treatment for pelvic f... more Background & Aims: Uncontrolled trials suggest biofeedback is an effective treatment for pelvic floor dyssynergia (PFD), a type of constipation defined by paradoxical contraction, or inability to relax, pelvic floor muscles during defecation. The aim was to compare biofeedback to laxatives plus education. Methods: Patients with chronic, severe PFD were first treated with 20 g/day fiber plus enemas or suppositories up to twice weekly. Nonresponders were randomized to either 5 weekly biofeedback sessions (n ؍ 54) or polyethylene glycol 14.6-29.2 g/day plus 5 weekly counseling sessions in preventing constipation (n ؍ 55). Satisfaction with treatment, symptoms of constipation, and pelvic floor physiology were assessed 6 and 12 months later. The biofeedback group was also assessed at 24 months. Laxative-treated patients were instructed to increase the dose of polyethylene glycol from 14.6 to 29.2 g/day after 6 months. Results: At 6 months, major improvement was reported by 43 of 54 (80%) biofeedback patients vs 12 of 55 (22%) laxative-treated patients (P < .001). Biofeedback's benefits were sustained at 12 and 24 months. Biofeedback also produced greater reductions in straining, sensations of incomplete evacuation and anorectal blockage, use of enemas and suppositories, and abdominal pain (all P < .01). Stool frequency increased in both groups. All biofeedback-treated patients reporting major improvement were able to relax the pelvic floor and defecate a 50-mL balloon at 6 and 12 months. Conclusions: Five biofeedback sessions are more effective than continuous polyethylene glycol for treating PFD, and benefits last at least 2 years. Biofeedback should become the treatment of choice for this common and easily diagnosed type of constipation.
Diseases of the Colon & Rectum, 2004
Constipation is a commonly reported symptom, and pelvic floor dyssynergia is frequently documente... more Constipation is a commonly reported symptom, and pelvic floor dyssynergia is frequently documented in constipated patients. The standard therapeutic approach for pelvic floor dyssynergia is biofeedback training, but long-term studies show that a significant percentage of patients remain symptomatic. Alternative or adjunctive therapeutic options are needed. The purpose of this study was to evaluate the long-term effects of electrogalvanic stimulation in patients with pelvic floor dyssynergia and severe constipation, to see whether this treatment may be of some benefit. Thirty consecutive constipated patients with clinical and instrumental evidence of pelvic floor dyssynergia entered the study and were treated with a standard high-frequency galvanic electrostimulation protocol. Clinical and instrumental (colon transit time, anorectal manometry, defecography, rectal balloon expulsion) assessment evaluations were performed basally and one year after the treatment. Overall, approximately 50 percent of patients showed significant improvement after electrogalvanic treatment, from both a clinical and an instrumental point of view, as shown by the objective measurements obtained through manometry, defecography, and the balloon expulsion test. The benefit was limited to normal transit constipation patients. Because of the relatively simple, painless and effective nature of electrogalvanic stimulation, we concluded that it may represent a useful adjunct to the therapeutic armamentarium for pelvic floor dyssynergia in normal transit constipation.
Digestive Diseases and Sciences, 1995
Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipat... more Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipation. However, outlet obstruction itself may be due to several mechanisms. Among these, the presence of a megarectum is a leading one. Pathophysiological studies in adult patients with idiopathic megarectum are scarce. We studied by manometric and defecographic means 15 adult subjects with idiopathic megarectum and severe chronic constipation. Twenty-five healthy volunteers of both sexes acted as controls. Manometric variables showed significant differences between patients and controls with respect to internal anal sphincter pressure (P = 0.02), minimum relaxation volume (P < 0.001), defecatory sensory threshold (P < 0.001), mean rectal tolerable volume (P < 0.001), and rectal compliance (P < 0.001). An altered response to straining was observed in 46.6% of patients and in 12% of controls (P = 0.04); the ability to expel a 50-ml balloon per anum was 13.3% in patients and 100% in controls (P < 0.001). Although all patients opened the anorectal angle and had descent of the pelvic floor, thereby confirming an adequate expulsion effort, evacuation of contrast material appeared extremely difficult. In fact, no subject was able to expel more than 30% of the rectal contents during fluoroscopic screening. These results confirm previous hypotheses that idiopathic megarectum displays features of a neuropathic process as an underlying mechanism. Further studies are needed that also take into consideration the muscle tone component of the rectum in these patients.
Digestive Diseases and Sciences, 1996
Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may... more Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may have motor abnormalities not limited to the colon. We studied by manometric means gastric and small bowel motility in a homogeneous group of patients with chronic idiopathic constipation, ie, the slow transit type. Twenty-one patients were recruited for the study and compared to 33 healthy subjects. Manometric examination was carried out for about 5 hr fasting and 1 hr after a standard meal. Analysis of the manometric tracings revealed during fasting no abnormalities in number and configuration of migrating motor complex with respect to controls. However, in 70% of patients motor abnormalities were detected, represented by bursts of nonpropagated contractions and discrete clustered contractions. After feeding, the patient group displayed a significantly shorter antral motor response to the meal with respect to controls; moreover, intestinal bursts of nonpropagated contractions were found in 19% of patients, and 14% of them had an early return of the activity fronts. We conclude that patients with slow transit constipation frequently display motor abnormalities of the upper gut. These findings further strengthen the concept that this condition may represent a panenteric disorder.