Abnormalities in proximal small bowel motility in patients with cirrhosis

Chesta, J; Defilíppí, C

doi:10.1002/hep.1840170513

Cited by 79 publications

(76 citation statements)

References 20 publications

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“…34 Altered small intestinal motility was described in patients with cirrhosis. 18,35,36 Chang et al 25 have recently found that the frequency of motor migrating complex activity fronts and the motor migrating complex velocity were significantly higher in cirrhotic patients without SBP than in those with SBP. All these alterations in small intestinal motility could result, as we have found in the present study, in a prolonged intestinal transit time in cirrhotic patients when compared to normal controls, which in turn might facilitate the appearance of IBO.…”

Section: Discussionmentioning

confidence: 99%

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

et al. 2000

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Deranged intestinal motility, which occurs in cirrhosis, may facilitate the development of intestinal bacterial overgrowth (IBO), which can lead to bacterial translocation (BT). To assess the effect of cisapride on IBO and BT in cirrhosis, cirrhotic rats received cisapride or a placebo for 7 days, and measurements of jejunal bacterial content and BT studies were performed. In addition, jejunal fluid from 46 cirrhotic patients was obtained for quantitative bacterial culture. Those patients in whom gram-negative IBO was detected were randomized to receive or not to receive cisapride (20 mg twice per day) for 1 week. Cisapride significantly reduced IBO in cirrhotic rats. In addition, no BT was documented in treated animals, whereas it occurred in 40% in nontreated cirrhotic rats. Total IBO was documented in 23 of 46 cirrhotic patients, which was caused by gram-negative organisms in 10 cases. Orocecal transit time (OCT) significantly decreased after cisapride therapy, and was associated with the abolishment of bacterial overgrowth caused by gram-negative organisms in 4 out of 5 treated patients, whereas it persisted in nontreated cases. Cisapride administration to cirrhotic rats resulted in a reduction of the IBO, which is associated with a marked decrease in BT. On the other hand, cisapride facilitates the abolition of IBO caused by gram-negative organisms in cirrhotic patients. (HEPATOLOGY 2000;31:858-863.)

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Section: Discussionmentioning

confidence: 99%

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

et al. 2000

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“…Evidence from various studies has shown that altered intestinal motility may be involved in the pathogenesis of IBO in patients with liver disease (23,51), and could be associated with a higher incidence of SBP (24). A number of studies where the administration of prokinetic drugs caused a decrease in both IBO and BT point at the contribution of altered intestinal motility to these phenomena.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, selective intestinal decontamination with suppression of aerobic intestinal bacteria prevents BT in cirrhotic rats, and is the current prophylaxis for SBP in humans (17)(18)(19)(20). On the other hand, several studies have shown that impaired intestinal motility is one of the fac-tors contributing to enteric bacterial overgrowth, and also that intestinal transit is delayed in the setting of cirrhosis mainly related to the severity of disease (21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Role of intestinal bacterial overgrowth and intestinal motility in bacterial translocation in experimental cirrhosis

Sánchez

Casafont

Guerra

et al. 2005

Rev. esp. enferm. dig.

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Background: intestinal bacterial overgrowth (IBO) is related to small bowel motility and has been involved in the pathogenesis of bacterial translocation (BT) in experimental models, and both overgrowing gut flora and translocating bacteria to mesenteric lymph nodes are common features in cirrhosis.Objectives: the aims of this study were to analyze cecal aerobic bacteria and intestinal transit in cirrhotic rats, and their relationship with BT, evaluating the role of intestinal bacterial overgrowth and small bowel dismotility in the development of BT in experimental cirrhosis.Material and methods: we included twenty-seven male Sprague-Dawley rats with carbon tetrachloride-induced cirrhosis without ascites and ten controls. Cultures of mesenteric lymph nodes (MLN), peripheral and portal blood, liver, spleen and cecal samples were carried out. Small intestinal transit was determined in ten cirrhotic rats and in ten control rats.Results: the prevalence of bacterial translocation was 56%. Total cecal aerobic bacteria count was significantly higher in cirrhotic rats than in control rats (p < 0.001). Cirrhotic rats with translocated bacteria had higher total aerobic intestinal counts than culture-negative MLN bacteria (p < 0.05). The prevalence of total intestinal bacterial overgrowth in cirrhotic animals was 67%, and 0% in control animals (p < 0.001). According to BT, total IBO was more frequent in cirrhotic rats with BT versus those without BT (93 vs. 33%) (p < 0.001). Of the translocating bacteria, 95.6% were found to be overgrown in the cecum. The smallintestinal transit was slower in cirrhotic rats (60.5 ± 12.7 cm vs. 81.2 ± 5.7 cm) than in control animals (p < 0.001).Conclusions: these results suggest that the increase of intestinal aerobic bacteria in experimental cirrhosis is associated with translocation. In addition, IBO is frequent in cirrhotic rats, and is supposed to play an important role in the development of BT. Impaired motility of the small intestine is a common feature in cirrhosis and may be implicated in the pathogenesis of IBO.

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“…Manometry studies have described altered gut motility [88,193] in cirrhotics, whereas gastric emptying has been found to be delayed [74][75][76][77], normal [78][79][80] or accelerated [81]. Gastric accommodation has been reported to be impaired in patients with alcoholic cirrhosis [61] and cirrhotics with ascites [62] compared to healthy controls.…”

Section: Pathophysiology Of Gi Symptoms In Cirrhosis (Ii Iii)mentioning

confidence: 99%

Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

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Malnutrition is a common finding in patients with liver cirrhosis. Malnutrition has been shown to be associated with increased morbidity and mortality. Its pathogenesis remains unclear but both poor dietary intake and increased energy expenditure have been reported.Spontaneous bacterial peritonitis is an important clinical problem in cirrhotics. It may occur as a consequence of repeated access of bacteria from the intestinal lumen (translocation) to the mesenteric lymph nodes. One of the mechanisms proposed to explain bacterial translocation in cirrhosis includes increased intestinal permeability.The aims of the present study were to evaluate GI symptoms in cirrhotic patients and their possible relation to nutritional status, to assess whether gastric sensorimotor dysfunction or metabolic disturbances are associated with reduced food intake, and to investigate the role of ascites in intestinal permeability in patients with liver cirrhosis.Gastrointestinal symptoms and health-related quality of life (HRQOL) were assessed with the aid of two questionnaires. Gastric sensorimotor function was measured by means of an electronic barostat. Food intake, as assessed with a food diary, was related to fasting and postprandial glucose, insulin, leptin, and ghrelin concentrations. Intestinal permeability was evaluated by a 51 Cr-EDTA permeability test. Cirrhotics were found to have increased severity of GI symptoms compared with reference values from the general population. A relationship between GI symptoms and compromised HRQOL as well as weight loss was observed.Proximal stomach relaxation to a meal was increased in patients with liver cirrhosis as compared with healthy controls but the relation between gastric accommodation and energy intake was found to be disturbed in these patients. Gastric sensitivity to distension was shown to be related to GI symptom severity and to liver cirrhosis severity scores.Patients with liver cirrhosis exhibited higher postprandial insulin and glucose concentrations compared to controls. Cirrhotics had higher fasting leptin that fell significantly postmeal and they showed an attenuated increase of ghrelin before the next expected meal. Altered glucose and hormonal levels in patients with cirrhosis were associated with poor food intake.Only a few patients with cirrhosis had increased intestinal permeability, as assessed by a 51 Cr-EDTA test, which was not influenced to a major extent by ascites. Conclusions: In patients with liver cirrhosis GI symptom severity is high and it is associated with impaired HRQOL and weight loss. Gastric accommodation is not involved in the poor food intake observed in cirrhotics and gastric sensitivity seems to be a relevant factor for GI symptom generation in these patients. Altered postprandial glucose, leptin, and ghrelin levels are correlated to reduced energy intake in this patient group. Increased intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with liver cirrhosis and ascites.

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Abnormalities in proximal small bowel motility in patients with cirrhosis

Cited by 79 publications

References 20 publications

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

Role of intestinal bacterial overgrowth and intestinal motility in bacterial translocation in experimental cirrhosis

Intestinal permeability in cirrhotic patients with and without ascites

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