Gerard P. van Berge-Henegouwen

University Medical Center Utrecht

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Karel J. van Erpecum

University Medical Center Utrecht

L. M. A. Akkermans

University Medical Center Utrecht

Alan F. Hofmann

University of California, San Diego

Piero Portincasa

University of Bari Aldo Moro

Willem Renooij

University Medical Center Utrecht

Antonio Moschetta

University of Bari Aldo Moro

Melvin Samsom

Jersey Shore University Medical Center

A. J. P. M. Smout

Amsterdam University Medical Centers

Nancy Am Ooteghem

Ziekenhuis Amstelland

Solko W. Schalm

Erasmus MC

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Utrecht University

University Medical Center Utrecht

Radboud University Nijmegen

University Medical Center

Academic Medical Center

Erasmus MC

Heidelberg University

University of Amsterdam

University Hospital Heidelberg

University of Groningen

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Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation

Scandinavian Journal of Gastroenterology (2005)

Anneke M. De Schryver Yolande C.A. Keulemans Harry P. F. Peters L. M. A. Akkermans A. J. P. M. Smout

It is not well known whether physical activity (PA) is useful in the management of patients complaining of constipation. The aim of this study was to test the influence of regular PA on colonic transit time and defecation in middle-aged inactive patients suffering from chronic idiopathic constipation.Forty-three subjects (> 45 years) were randomly divided into group A (n = 18, 16 F, 2 M) and group B (n = 25, 20 F, 5 M). Group A subjects maintained their normal lifestyle during 12 weeks, followed by a 12-week PA programme. Group B performed a 12-week PA programme after randomization. PA comprised 30 min of brisk walking and a daily 11-min home-based programme. Both groups received dietary advice. Colonic transit time was measured using a radiographic multiple marker single film technique.Despite dietary advice, mean fibre and fluid intake did not change. In group B a significant reduction in 3 out of 4 of the Rome I criteria for constipation was observed, i.e. percentage of incomplete defecations, percentage of defecations requiring straining and percentage of hard stools (p < 0.05). As a consequence, the number of fulfilled Rome criteria for constipation decreased (2.7 to 1.7; p < 0.05). Furthermore, the rectosigmoid and total colonic transit time decreased (17.5 to 9.6 h and 79.2 to 58.4 h, respectively; p < 0.05). After PA the number of fulfilled Rome criteria also decreased in group A (2.6 to 1.7; p < 0.05).In middle-aged inactive subjects with symptoms of chronic constipation, it is advisable to promote regular physical activity since it improves both the defecation pattern and rectosigmoid or total colonic transit time.

Group B

Transit time

Group A

10.1080/00365520510011641

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Citations (193)

Small Gallstones Are Associated with Increased Risk of Acute Pancreatitis: Potential Benefits of Prophylactic Cholecystectomy?

The American Journal of Gastroenterology (2005)

Niels G. Venneman Erik Buskens Marc G. Besselink Susanne Stads P. M. N. Y. H. Go

Pancreatitis is a severe complication of gallstone disease with considerable mortality. Small gallstones may increase the risk of pancreatitis. Our aims were to evaluate potential association of small stones with pancreatitis and potential beneficial effects of prophylactic cholecystectomy.Stone characteristics were determined in patients with biliary pancreatitis (115), obstructive jaundice due to gallstones (103), acute cholecystitis (79), or uncomplicated gallstone disease (231). Sizes and numbers of gallbladder and bile duct stones were determined by ultrasonography and endoscopic retrograde cholangiopancreatography, respectively. Effects of prophylactic cholecystectomy were assessed by decision analyses with a Markov model and Monte Carlo simulations.Patients with pancreatitis or obstructive jaundice had more and smaller gallbladder stones than those with acute cholecystitis or uncomplicated disease (diameters of smallest stones: 3 +/- 1, 4 +/- 1, 8 +/- 1, and 9 +/- 1 mm, respectively, p < 0.01). Bile duct stones were smaller in case of pancreatitis than in obstructive jaundice (diameters of smallest stones: 4 +/- 1 vs 8 +/- 1, p < 0.01). Multivariate analysis identified old age and small stones as independent risk factors for pancreatitis. Decision analysis in a representative group of patients with small (

Gallbladder Stone

10.1111/j.1572-0241.2005.00317.x

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Citations (140)

Behavior of various cholesterol crystals in bile from patients with gallstones

Hepatology (1996)

Piero Portincasa Karel J. van Erpecum A.J. Gerard Jansen Willem Renooij Mireille M. Gadellaa

Besides classical plate-like cholesterol monohydrate crystals, a variety of crystal shapes have recently been described in model biles but their relevance for human gallstone formation is unknown. We therefore studied crystallization behavior in gallbladder bile from cholesterol stone patients (54 untreated, 13 ursodeoxycholate-treated) and 6 pigment stone patients. Bile preparation by ultrafiltration or ultracentrifugation left biliary lipid composition unchanged but plates and their aggregates, and arcs and needles crystallized more extensively while spirals and tubules crystallized less extensively in ultra-centrifuged bile than in ultrafiltered bile. Plates, aggregates, and arcs/needles were seen in 90%, 36%, and 18% of the cases respectively of fresh unfiltered biles of untreated cholesterol stone patients, while spirals and tubules were always absent. In ultrafiltered biles arcs/needles, plates and aggregates progressively developed as persistent forms. Spirals and tubules occurred transiently and were associated with increased deoxycholic acid (+41%, P = .039) and with more extensive cholesterol crystallization. Rate/extent of crystallization of all crystal forms was higher ( P < .0001) for multiple than solitary cholesterol stone patients. Ursodeoxycholate-treated patients had atypical platelike cholesterol crystals in fresh unfiltered biles that decreased in size at prolonged observation and in 2 cases even dissolved after 15 and 20 days. No crystals ever developed in ultra-filtered bile of ursodeoxycholic acid (UDCA)-treated patients during 21 days. Pigment stone patients seldom developed crystals. Thus, plates, aggregates and arcs/needles are persistent forms with high crystallization rate in multiple cholesterol stone patients. Tubules and spirals are transient forms that are associated with more extensive crystallization. Patients treated with ursodeoxycholate often have atypical crystals in their fresh bile.

Ursodeoxycholic acid

Crystal (programming language)

Deoxycholic acid

10.1002/hep.510230414

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Citations (45)

Effects of ileal bile salts on fasting small bowel and gallbladder motility

Gastroenterology (2001)

Nancy Am Ooteghem Melvin Samsom Karel J. van Erpecum L. M. A. Akkermans Gerard P. van Berge-Henegouwen

Migrating motor complex

Intestinal motility

10.1016/s0016-5085(08)81125-0

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Effects of cholestyramine on gallbladder and gastric emptying in obese and lean subjects

European Journal of Clinical Investigation (1995)

Piero Portincasa Agostino Di Ciaula Vincenzo Ostilio Palmieri Gerard P. van Berge-Henegouwen Giuseppe Palasciano

Gallbladder stasis is frequent in obese subjects and may contribute to their increased risk for gallstone formation. The bile salt sequestrant cholestyramine acutely enhances postprandial gallbladder emptying in lean subjects, through disinhibition of a negative feedback between intraluminal bile salts and CCK release. In this study the effect of cholestyramine on both gallbladder and gastric antrum dynamics were studied by real-time ultrasonography in 12 obese and 15 lean subjects. For the acute study, on different days, subjects ingested a liquid meal (two egg yolks plus water 200 mL, 50 kJ) or a meal with 4 g cholestyramine. Gallbladder emptying was impaired in obese patients who had significantly larger fasting gallbladder volume (39.4 +/- 6.9 vs. 21.6 +/- 1.7 mL, P < 0.02), larger residual volume (12.3 +/- 1.8 vs. 4.0 +/- 0.5 ml, P < 0.0006) and slower emptying time (T/2: 33 +/- 2 vs. 21 +/- 2 min, P < 0.05) than lean subjects. Integrated antral emptying was also less in obese than lean subjects (5521 +/- 578 vs. 7908 +/- 491 %120 min-1, P < 0.02). Cholestyramine enhanced postprandial gallbladder emptying in both obese and lean subjects. Gastric emptying was delayed with cholestyramine in lean but not obese subjects. For the chronic study, after 1 month therapy with cholestyramine (4 g every 2 days), the motility tests were repeated in nine obese subjects. Gallbladder and gastric responses to a test meal, with or without cholestyramine, were preserved. We conclude that both gallbladder and antral emptying of a liquid test meal are impaired in obese subjects. Gallbladder emptying improves after acute administration of a low dose cholestyramine with test meal. This effect is sustained after 1 month treatment with a low dose of cholestyramine and does not interfere with gastric emptying of obese patients. Cholestyramine may improve gallbladder hypomotility in obese people.

Cholestyramine

Crossover study

10.1111/j.1365-2362.1995.tb01953.x

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Citations (46)

Intraduodenal bile salts exert negative feedback control on gallbladder (GB) emptying in the fasting state without affecting cholecystokinin (CCK) release

Gastroenterology (2000)

Nancy Am Ooteghem Antonio Moschetta Jens F. Rehfeld Melvin Samsom L. M. A. Akkermans

10.1016/s0016-5085(00)82876-0

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Citations (0)

Effects of a standardized wheat bran preparation on biliary lipid composition and bile acid metabolism in young healthy males

European Journal of Clinical Investigation (1980)

A.W.M. Huijbregts Gerard P. van Berge-Henegouwen M.P.C. Hectors André van Schaik S. D. J. Van Der Werf

Abstract. The effects of adding bran to the normal diet on biliary lipid composition and bile acid metabolism in a group of young healthy males was studied. A chemically standardized coarse wheat bran product, with serum lipid lowering properties, in a dose of 0–5 kg ‐1 body weight per day was used. Bran feeding for 4 or 8 weeks did not change biliary lipid and biliary bile acid composition. Faecal bile acid and neutral sterol composition was similar before and after 8 weeks of bran. Bile acid kinetics, measured by double isotope dilution after simultaneous injection of [ 3 H]cholic acid and [ 14 C]deoxychoIic acid, showed only minor differences before and during bran ingestion. The most surprising finding was an increase in 7α‐dehydroxyl‐ation fraction (input of deoxycholic acid divided by synthesis of cholic acid) in six out of seven subjects after 4 weeks of bran and in all four subjects after 8 weeks of bran. In conclusion, the bran product we used is not effective in lowering the biliary cholesterol saturation in healthy young males. Nor does it reduce deoxycholate input in our subjects even after 8 weeks of bran.

Deoxycholic acid

10.1111/j.1365-2362.1980.tb02084.x

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Citations (26)

Triple therapy with ursodeoxycholic acid, prednisone and azathioprine inprimary biliary cirrhosis

European Journal of Gastroenterology & Hepatology (1999)

Frank H. J. Wolghagen Hubert J. F. van Hoogstraten Henk R. van Buuren Gerard P. van Berge-Henegouwen Fiebo J.W. ten Kate

Wolghagen, Frank H. J.; van Hoogstraten, Hubert J. F.; van Buuren, Henk R.; van Berge-Henegouwen, Gerard P.; ten Kate, Fiebo J. W.; Hop, Wim C. J.; van der Hoek, Egbert W.; Kerbert, Marjo J.; van Lijf, Hans H.; den Ouden, Janny W.; Smit, Adelbert M.; de Vries, Richard A.; van Zanten, Rene A. A.; Scalm, Solko W.

Ursodeoxycholic acid

Primary Biliary Cirrhosis

Biliary cirrhosis

10.1097/00042737-199901000-00012

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Physical activity as an additional treatment for constipation in the elderly

Gastroenterology (2001)

A. M. P. De Schryver Yolande C.A. Keulemans Harry P. F. Peters L. M. A. Akkermans A. J. P. M. Smout

10.1016/s0016-5085(08)81985-3

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Citations (1)