To assess the importance of triglyceride digestion products in producing satiety, we determined the effects of duodenal infusions of triolein, oleic acid, and oleic acid plus monoolein on meal patterns in ad libitum-feeding rats. Oleic acid and oleic acid plus monoolein inhibited feeding similarly; triolein's effect was delayed and fourfold less potent. We then used the type A cholecystokinin (CCK-A)-receptor antagonist devazepide to assess the importance of CCK in mediating the anorexia produced by oleic acid. Oleic acid (at 320, 440, and 640 mumol/h) inhibited 3-h intake dose dependently by 32, 56, and 75%, respectively. Devazepide (1 or 2 mg/kg) blocked the responses to the 320 mumol/h dose, but had little if any effect on responses to the larger doses. Devazepide (1 mg/kg) did block anorexic responses to 3-h cholecystokinin octapeptide infusions (3 and 10 nmol.kg-1.h-1 iv) that inhibited 3-h intake by 25 and 65%, respectively. Our results suggest that the satiety response to triolein is produced by the products of triolein digestion and that CCK plays a significant, indispensable role in mediating the satiety response to duodenal delivery of small but not large loads of oleic acid.

FNA is a sensitive and specific test for the diagnosis of thyroid cancer, allowing definitive initial surgery and avoiding unnecessary procedures. Therefore, we recommend routine use of preoperative thyroid FNA, even in those patients in whom a resection is already planned.

Surgical therapy (Heller myotomy) is the most effective treatment to relieve dysphagia associated with achalasia. The advent of minimally invasive techniques, specifically the laparoscopic approach, significantly reduced the morbidity of surgical therapy, making it the procedure of choice for most patients who have achalasia. Pneumatic dilatation is a viable alternative, though is associated with inferior results and a higher risk of esophageal perforation than surgical therapy. Pharmacotherapy and Botox provide inferior results and should be reserved for temporizing therapy, or for patients who are deemed too frail for surgical intervention. For best results, a laparoscopic myotomy should be carried at least 3 cm onto the stomach, and a partial fundoplication should be performed to reduce the incidence of postoperative GE reflux.

The mechanisms mediating the anorexic effects of nutrients in the proximal and distal small intestine are not clearly understood. We determined the dose-dependent effects of duodenal and distal ileal infusions of glucose and oleic acid on meal patterns in ad libitum feeding rats. Rats with cannulas in both the duodenum and ileum received a 2-h infusion of glucose (0, 800, 1,600, 3,200, 6,400, or 12,800 mumol/h) or oleic acid (0, 48, 240, 640, or 1,280 mumol/h) into the duodenum or ileum at the start of the dark period, and meal patterns were monitored for 4 h. Cumulative food intake was inhibited dose dependently by ileal as well as duodenal infusion of both glucose and oleic acid. Ileal glucose was more inhibitory than duodenal glucose, whereas duodenal oleic acid was more inhibitory than ileal oleic acid. Duodenal glucose and oleic acid inhibited feeding by decreasing meal frequency; ileal oleic acid decreased only meal size, whereas ileal glucose reduced both meal size and frequency. We interpret these results to suggest that ileal oleic acid and glucose suppress feeding by different mechanisms and that these mechanisms differ from those mediating the anorexic responses to oleic acid and glucose in the duodenum.

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