The Motility of the Small Intestine in Sprue 1

Abstract

An abnormal small-intestinal pattern has been demonstrated by roentgenologic studies in both the tropical and non-tropical variety of sprue (1 to 3). Generalized hypomotility is observed, and the barium moves along the gut in thick, sausageshaped masses which are separated by intestinal areas, apparently in a state of spasm. Many of the bowel loops are widely dilated and often contain considerable gas. At the same time, the mucosal relief is strikingly altered in that the usual markings of the valvulae conniventes are thickened, widely separated, and, in advanced cases, completely obliterated. In an admirable review of this subject, Golden (4) has, however, reiterated the original contention of Snell and Camp (1) that the observed changes are not characteristic of sprue, but may occur in other chronic deficiency states and, at times, may appear as the result of emotional stresses.In 2 patients with sprue, whom we repeatedly intubated over a period of 8 and 13 months, respectively, the small-intestinal motor activity was studied by means of the balloon-kymograph method, described by Ingelfinger and Abbott (5). Of the 2 patients, the first would be considered to have the tropical, the second, the non-tropical vanety of sprue.CASE REPORTS Case 1. W. C., a 36-year-old man, first noticed loose stools at the age of 21, shortly after he had been purser for 6 months on a boat sailing between New York and South America. Since that time, he had suffered from intermittent bouts of weight loss, distension, cramps, and frequent bowel movements, consisting of light stools never containing blood or pus. In the year before entry to this hospital, he had been subjected to 3 ileostomies in an effort to relieve his distension and cramps.Physical examination on July 18, 1941, revealed an emaciated individual with extreme hypotonia of the entire musculature. A brown pigmentation covered the forehead, cheilosis was present, and the tongue appeared dark red and smooth. The abdomen was markedly distended and tympanitic. Both a proximal and a distal ileostomy

Absorption of l-methionine from the human small intestine

“…In normal subjects, the proximal Km values ranged from 12 to 28 and the distal from 2.0 to 5.7, depending on concentration range used for calculation. In accord with the high proximal and low distal methionine absorption rates, the proximal Vmax (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) mmoles/hr per segment) was much higher than the distal (5-6 mmoles/hr per segment).…”

“…We found the mean Km for methionine in the proximal small intestine to be about 19 mmoles/liter (Table II). The K. for L-methionine in the entire rat small intestine in vivo was 9.6 mmoles/liter (calculation based on initial concentration) (21 (22). If this decreased motility caused pooling of perfusate and retrograde flow, the perfused segment would be longer than in normal subjects.…”

The Effect of Atropine Upon the Absorption of Vitamin A

“…Records of the small intestinal motor activity in patients with sprue show that the tone is greatly reduced, that the large (L) waves are absent for long periods of time, and that the small (S) waves tend to be of diminished amplitude (1). A very similar record is obtained from the gut of a normal person who has been given atropine (2), a similarity which is apparent in Figure 1.…”

Electrogenic glucose absorption in untreated and treated coeliac disease.

“…Thus conditions in which there is increased pooling alter the shape of the absorption curve and lead to higher experimental values for Km and PD max. All the available evidence indicates that there is greater possibility of pooling in coeliac disease compared with normal subjects, in that there is less absorption of solute and water (Schedl and Clifton, 1961;Holdsworth and Dawson, 1965), and more secretion (Fordtran et al, 1967;Schmid et al, 1969;Russell et al, 1972) while the jejunal tone and motility are reduced (Ingelfinger and Moss, 1943;Ritchie and Salem, 1965). The fact that the 'Apparent Km' and PD max are actually lower in untreated coeliac disease strongly suggests that pooling does not account for the observed differences between this group and the controls.…”