In a prospective randomised study, the effect of acupuncture on sham feeding stimulated gastric acid secretion was investigated. In eight healthy volunteers (five men, three women, mean (SEM) age 26-3 (4.7) years) various methods of acupuncture were performed. Apart from the sham procedure, the acupuncture was performed at the classic acupuncture points. Electroacupuncture reduced gastric acid secretion expressed as median (range) significantly during the first 30 minute period to 1-6 (0-5.2) mmol compared with 3-8 (2.3-14-5) mmol (p<0.05) during control period (sham feeding without acupuncture). Inhibition of gastric acid secretion by electroacupuncture was also significant during the second 30 minute period (0-2 (0-5.6) v 3-6 (0.3-9.1) mmol; p<0.05) and for peak acid output (0.8 (0.2-5.1) v 7'6 (3.4.12-1) mmol; p<0.05). Transcutaneous electrical nerve stimulation also resulted in significant reduction of gastric acid secretion during the first 30 minute period (1-0 (0-3.6) mmol v 3-8 (2.3-14.5) mmol; p<005), and peak acid output (3-6 (1*2-12*0) v 7*6 (3.4-12-1) mmol; p<0.05). The classic needle acupuncture, laser acupuncture, and sham acupuncture had no significant effect on gastric acid secretion. This study shows firstly that in healthy volunteers, only the versio;is of acupuncture using more pronounced stimulation (electroacupuncture, transcutaneous electrical nerve stimulation), but not those with only mild stimulation of the nerves (classic needle acupuncture, laser acupuncture), and secondly only acupuncture performed at defined points lead to significant reduction in gastric acid secretion. (Gut 1994; 35: 1026-
MethodsEight healthy subjects (five men, three women, mean (SEM) age 26-3 (4.7) years) took part in the study. As one participant failed to complete the study, the data of seven volunteers were considered for evaluation. Different methods of acupuncture used included needle acupuncture, electroacupuncture, laser acupuncture, and transcutaneous electric nerve stimulation. Apart from sham acupuncture the acupuncture was performed at the classic acupuncture points. For the control period sham feeding without acupuncture was given in all subjects in the study.The subjects gave their written informed consent, and the study protocol was accepted by the ethics commission
SUMMARY
The synthetic opioid, loperamide, reduces stool weight, frequency of bowel movements, urgency and faecal incontinence in acute and chronic diarrhoea. In man, the mechanism of action of loperamide is primarily the retardation of small‐intestinal transit, and the stimulation of anal sphincter pressure and of faecal continence. This mechanism increases mucosal contact time, allowing more complete absorption of electrolytes and water. Studies in animals have demonstrated inhibitory effects of opiates and opioids, including loperamide, on fluid and electrolyte secretion induced by various secretagogues. By comparison, opiates have smaller if any antisecretory or pro‐absorptive actions in man. The discrepancies between the results obtained in animal and human experiments are most certainly due to the large differences between drug doses used. Besides its opiate‐receptor binding and stimulating activity, loperamide also behaves as a calcium–calmodulin antagonist and as a calcium channel blocker. These two other mechanisms might contribute to loperamide's antidiarrhoeal activity. Loperamide is more effective and safer than other opiates or opioid drugs in the treatment of both infantile and adult diarrhoea of various causes, although adequate fluid and electrolyte replacement remain the prime need.
A new gastrointestinal phantom is described that is suitable for the basic training in endoscopy of the upper gastrointestinal tract and the cannulation of the papilla of Vater. Its important dmracteristics are the true-to-life, plastic imitation of the inside of the hollow organs and the excellent smooth-sliding property, so that the use of all flexible oesophagoscopes, gastroscopes and duodenoscopes presently available can be practised. The incorporation of the training on the phantom into the endoscopic training programme as a whole is discussed.
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