Diabetic gastroparesis is a common gastrointestinal complication which develops in about 20-30% of patients with longstanding diabetes mellitus. Recent studies have shown that erythromycin stimulates gastrointestinal motor activity by binding on motilin receptors of gastrointestinal smooth muscles and that it improves gastric emptying in patients with diabetic gastroparesis. In this respect, we present a 35-year-old patient with diabetic gastroparesis, complicated with a gastric bezoar, who was successfully treated with endoscopic bezoar fragmentation and oral erythromycin for 3 weeks.
Adult ; Bezoars* ; Diabetes Mellitus ; Erythromycin ; Gastric Emptying ; Gastroparesis* ; Humans ; Motilin ; Motor Activity ; Muscle, Smooth

No abstract available.
*Gastric Bypass ; Humans ; Hunger/*physiology ; Motilin/*blood ; Obesity/*blood/physiopathology/*surgery

Adult ; Diagnosis, Differential ; Dyspepsia ; blood ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Motilin ; blood

OBJECTIVETo explore the effect of modified Baizhu (Rhizoma Atractylodis Macrocephalae) powder on the gastrointestinal function in mouse models with stomach-cold functional dyspepsia. Meanwhile,the mouse models were administered with Shihu (dendrobium), a traditional Chinese drug with cold nature and flavour, to explore the way via which it exert its effect on specific symptoms. Methods: Mouse models with stomach-cold functional dyspepsia were established by ice water and ice NaOH. The effects of modified Baizhu powder and dendrobium on mice were observed in terms of water intake, weight change,small intestine propulsion rate, intestinal absorption function, and effects on ghrelin and motilin.

RESULTSThe modified Baizhu powder effectively increased food intake, water intake, body weight (P<0.05) and swimming time (P<0.01), increased the small intestine propulsion rate and serum D-xylose content (P<0.05), and up-regulated ghrelin (P<0.05). Also, it showed a trend to down-regulate the motilin, although the change was not statistically significant (P>0.05). In contrast,the use of Shihu aggravated symptoms in the mouse models. Conclusion: The changes in ghrelin and motilin levels may be the neuro-endocrine mechanisms via which the modified Baizhu powder and Shihu exert their effects on mouse models.

Animals ; Disease Models, Animal ; Dyspepsia ; Ghrelin ; Intestine, Small ; Medicine, Chinese Traditional ; Mice ; Motilin ; Powders ; Stomach

OBJECTIVETo observe the clinical efficacy difference in treatment of functional dyspepsia (FD) between syndrome differentiation based acupuncture and ordinary acupuncture.

METHODSSeventy FD patients were assigned to a syndrome differentiation based acupuncture group (Group A) and an ordinary acupuncture group (Group B) by Excel Software randomization. Zhongwan (RN12 ), Tianshu (ST25), and Zusanli (ST36) were needled as main points for patients in Group A. Meanwhile, different combined acupoints were needled according to syndrome differentiation. Only the same main points were needled for patients in Group B. All patients were needled once per day, 30 min each time, 6 days as one treatment cycle, 2 treatment cycles in total. Fasting serum levels of gastrin (GAS) and motilin (MTL) were determined before treatment and after 2 treatment cycles. 36-item Short-form Heath Survey (SF-36) and Nepean Dyspepsia Index [NDI, including Nepean Dyspepsia Symptom Index (NDSI) and Nepean Dyspepsia Life Quality Index (NDLQI)] were assessed before treatment, after 2 treatment cycles, and one month after treatment.

RESULTSCompared with before treatment in the same group, serum levels of GAS and MLT increased in the two groups after 2 treatment cycles (P <0. 05), but changes were more obvious in Group A (P <0. 05). Compared with before treatment in the same group, SF-36 and NDLQI score increased, and NDSI score decreased in the two groups after 2 treatment cycles and 1 month after treatment (all P <0. 05). Compared with Group B, SF-36 and NDLQI score increased in Group A after 2 treatment cycles and 1 month after treatment (P <0. 05, P <0. 01). But NDSI score at 1 month after treatment was lower in Group A than in Group B (P <0.01).

CONCLUSIONSyndrome differentiation based acupuncture could evidently improve dyspeptic symptoms of FD patients, and significantly improve their quality of life with remarkable curative effect.

Acupuncture Points ; Acupuncture Therapy ; Dyspepsia ; therapy ; Humans ; Motilin ; Needles ; Quality of Life ; Surveys and Questionnaires ; Syndrome

OBJECTIVETo determine the effect of the area postrema (AP) of the medulla oblongata on gastrointestinal interdigestive migrating motor complex (MMC) and the plasma motilin level.

METHODSInterdigestive MMC activities of the antrum and duodenum were recorded by strain gauge implanted on the serosa of 8 conscious dogs. A cannula was intubated in femoral vein for motilin injection. The plasma motilin concentration was measured by RIA. We observed: (1) normal interdigestive MMC activity and fluctuations in plasma motilin concentration; (2) the effects of electrically damaging the AP on MMC activity and plasma motilin level; (3) whether intravenous injection of motilin could induce phase III contractions after the AP was destroyed.

RESULTS(1) Typical interdigestive MMC with phase I, II, III, and IV was recorded in normal dogs. Phase III was concurrent with the peak of plasma motilin level. (2) In damaged AP dogs, antroduodenal interdigestive MMC contractions were suppressed; cyclic, phasic and migratory pattern of MMC was disrupted. Plasma motilin concentration was decreased. Intravenous injection of motilin could not induce phase III contractions.

CONCLUSIONSThe area postrema might play an important role, which is mediated by motilin, on the regulation of interdigestive MMC.

Animals ; Dogs ; Fourth Ventricle ; physiology ; Medulla Oblongata ; physiology ; Motilin ; blood ; Myoelectric Complex, Migrating ; physiology ; Stomach ; physiology

OBJECTIVE: To explore the clinical therapeutic effect of herb-partitioned moxibustion at point in patients of diabetic gastroparesis differentiated as spleen and stomach deficiency and retention of turbid dampness as well as its effect mechanism. METHODS: A total of 134 patients with diabetic gastroparesis were randomized into an observation group and a control group, 67 cases in each one. In the observation group, herb-partitioned moxibustion at point was adopted, 40 min each time, once a day for 5 times a week. In the control group, itopride hydrochloride tablets were prescribed for oral administration, 50 mg each time, three times a day. A total of 6 weeks of treatment was required in the two groups. Before and after treatment, the gastroparesis cardinal symptom index (GCSI) scores, 4-hour gastric emptying rate, TCM symptom score, as well as the levels of plasma motilin and serum gastrin were observed in the patients of the two groups. Additionally, the clinical therapeutic effect was evaluated in the two groups. RESULTS: After treatment, the score of every item of GCSI, TCM symptom scores and the levels of plasma motilin and serum gastrin were all reduced as compared with those before treatment in the patients of the two groups (<0.05), and those in the observation group were lower than the control group (<0.05). Regarding 4-hour gastric emptying rates, which were increased as compared with those before treatment in the two group (<0.05), and the rate in the observation group was higher remarkably than that in the control group (<0.05). The total effective rate was 92.5% (62/67) in the observation group, higher than 74.6% (50/67) in the control group (<0.05). CONCLUSION Herb-partitioned moxibustion at point relieves the clinical symptoms in the patients with diabetic gastroparesis and increases the gastric emptying rate, which is probably related to the regulation of the levels of plasma motilin and serum gastrin.
Acupuncture Points ; Diabetes Mellitus ; Gastric Emptying ; Gastrins ; blood ; Gastroparesis ; therapy ; Humans ; Motilin ; blood ; Moxibustion

PURPOSE: We studied smooth muscle strips from rabbit gastric antrum and low esophageal sphincter (LES) to explore the difference between newborn and adult rabbit on erythromycin (EM)- induced contractions. Another aim of this study was to determine the mechanism of LES contractile activities induced by erythromycin (EM). METHODS: Muscle strips prepared from newborn and adult rabbits were stimulated with agonists such as KCl, motilin and EM, and the isometric tensions were measured. To study the underlying mechanism of EM-stimulated contraction of LES, the receptor antagonsts, including tetrodotoxin, hexamethonium, atropine, propranolol and phentholamine, were used. A high concentration of motilin (1 micrometer) was employed to provoke tachyphylaxis. RESULTS: Antral smooth muscle and LES from newborn rabbits developed less active force than those from adult rabbits when stimulated with KCl, motilin and erythromycin, however, the effective concentrations (EC50s) were similar in both age groups. Antral smooth muscle strips showed both tonic and phasic contractions but LES muscle strips showed only tonic contractions. These findings were observed in both newborn and adult rabbits. The contraction force of antral smooth muscle strips in response to agonists was greater than that of LES. The contractile response of LES to repeated motilin or EM administration was markedly decreased. EM- induced contractions of LES were markedly decreased by motilin tachyphylaxis but were unaffected by tetrodotoxin, hexamethonium, atropine or propranolol plus phentolamine. CONCLUSOIN: The data suggest that the contractilities of antrum and LES smooth muscle from newborn rabbit are less than those from adult ones, however, the effective concentratons of EM (EC50) are not different between the two age groups. The results also suggest that erythromycin induces the contraction of rabbit LES via motilin receptor in vitro.
Adult ; Atropine ; Erythromycin* ; Gastrointestinal Motility ; Hexamethonium ; Humans ; Infant, Newborn* ; Motilin ; Muscle, Smooth ; Phentolamine ; Propranolol ; Pyloric Antrum* ; Rabbits ; Tachyphylaxis ; Tetrodotoxin

OBJECTIVETo observe the effect of gastric dynamics by transcutaneous electrical acupoint stimulation (TEAS) combined general anesthesia when controlled hypotension dropped to 60% of the mean arterial prenssure (MAP) baseline, and to provide experimental evidence for organ protection in clinical controlled hypotension.

METHODSEighteen male beagles were randomly divided into three groups, the general anesthesia group (blank), the general anesthesia induced controlled hypotension group (control), and the general anesthesia combined TEAS induced controlled hypotension group (experiment), 6 in each group. Controlled hypotension was performed in the latter two groups with isoflurane inhalation and intravenous injection of sodium nitroprusside (SNP). The mean arterial pressure (MAP) was lowered to 60% of the MAP baseline and kept for 60 min. Controlled hypotension was not performed in Beagles of the control group. For Beagles in the experiment group, TEAS [2/100 Hz, (4 ± 1) mA] was applied to bilateral Hegu (LI4), Quchi (LI11), Zusanli (ST36), and Sanyinjiao (SP6) from stable physiological conditions to the end of maintaining stages. Changes of EGG frequencies and EGG amplitudes were monitored. Serum levels of gastrin (GAS) and motilin (MTL) were also detected at corresponding time points during and after experiment.

RESULTSAs for the pressure control effect of TEAS combined general anesthesia in the controlled hypotension, during the process of controlled hypotension (T1-T4), MAP levels of two controlled pressure groups remained relatively stable, and were kept at 60% of the MAP baseline. When the blood pressure dropped to the target low MAP and maintained at 60 min (T1-T4), EGG amplitudes of Beagles in all the three groups showed decreasing tendency. But it was more obviously lower than its basic level in the control group (P <0.05), while it was not obviously decreased in the experiment group (P < 0.05). EGG frequencies of Beagles in all the three groups showed no obvious change during this stage. By the end of the MAP rising stage (T8), the EGG amplitude of the experimental group was significantly higher than that of the control group and the blank group (P < 0.05), while it didn' t show any obvious increase in the control group. During this period, EGG frequencies of the two controlled hypotension groups decreased more than those of the blank group. Two h after rising blood pressure (at T9), EGG amplitudes and frequencies in the two controlled hypotension groups basically restored to their respective baselines and levels of the blank group at T9. At 2 h (T9) after controlled hypotension, serum levels of GAS and MTL were lower than those of basic levels in the two controlled hypotension groups (P <0.05). However, serum levels of GAS and MTL had an increasing trend in the two controlled hypotension groups at 24-72 h (T10-T12). Besides, the increasing speed and amplitude was better in experiment group than in the control group at T10-T12. However, there was no statistical difference between the two groups (P > 0.05). At 72 h (T12) serum levels of GAS and MTL had basically restored to their basic levels in the two controlled hypotension groups and that of the blank control group.

CONCLUSIONEGG amplitudes could be effectively improved in TEAS combined general anesthesia for controlled hypotension at 60% of the MAP baseline, the recovery of the serum GAS level accelerated, gastric power improved and stomach protected.

Acupuncture Points ; Anesthesia ; methods ; Anesthesia, General ; Animals ; Arteries ; Dogs ; Gastrins ; Hypotension, Controlled ; Male ; Motilin ; Nitroprusside ; Transcutaneous Electric Nerve Stimulation

OBJECTIVETo investigate the changes and significance of serum gastrin (GAS), beta-endorphin (beta-EP) and plasma motilin (MTL) in patients with severe burns.

METHODSBlood samples were gotten according to different timepoints from 32 admitted burned patients, and then serum GAS, beta-EP and plasma MTL were determined by radio-immuno assay (RIA).

RESULTSIn patients with severe burns, serum GAS decreased significantly in early period. And at the timepoint of 8 h, it reached the lowest level. But during 9-24 h it elevated for a while, and then it reached a relatively stable level. MTL reached the highest level at the timepoint of 2 h after burning. Then at the shock stage, it was comparatively lower. And at the timepoint of 8 h after burning, it reached the lowest level, then raised persistently after reabsorption, but still lower than the normal level. At the early stage after burning, beta-EP raised, then reached the highest level at 8 h after burning. GAS and MTL decreased and beta-EP increased significantly with the increase of the burned area. However, when the burned area was over 70% of the total body surface area, there was no relationship between them.

CONCLUSIONBlood GAS, MTL and beta-EP have represented regular changes in patients with severe burns at the early stage after burning. And the pain-stimulus and shock are effective factors.

Adolescent ; Adult ; Burns ; blood ; Female ; Gastrins ; blood ; Humans ; Male ; Middle Aged ; Motilin ; blood ; Radioimmunoassay ; Time Factors ; beta-Endorphin ; blood