Fifteen healthy subjects, fasted at least 8 hr, were studied by means of an infused manometric method. Twenty minutes after termination of the natural phase III activity in the duodenum, erythromycin or normal saline was administered intravenously for 15 min. When normal saline (N=5) was infused, the next migrating motor complex (MMC) was initiated 151.2±42.1 min after the infusion. On the other hand, when erythromycin was infused at a rate of 1.0 mg/kg/hr (N=5) or 3.0 mg/kg/hr (N=5), MMC-like contractions were initiated at shorter intervals, ie, 47.8±40.9 min (P<0.005) or 23.0±13.0 min (P <0.001), respectively. The duration, frequency, amplitude, and migrating velocity of the naturally occurring MMC (N-MMC) were not significantly different from those of the erythromycin-induced contractions except for the duration of the phase III contractions in the stomach; the duration (5.3±2.2 min) of the erythromycin-induced contractions being significantly (P<0.05) longer than that (3.2±0.9 min) of the naturally occurring MMC. The immunoreactive motilin (IRM) concentration did not increase significantly after the infusion of erythromycin, when compared to that after infusion of normal saline. It is concluded that erythromycin at a dose of 1–3 mg/kg/hr for 15 min during the interdigestive state, similar to motilin, has a significant influence upon the initiation of MMC in the human gastrointestinal tract, but further investigations are required to confirm whether endogenous motilin is involved or not.

Erythromycin induces migrating motor complex in human gastrointestinal tract

The effects of erythromycin (EM) on gastrointestinal contractile activity during the interdigestive period were investigated in seven healthy subjects using an infused catheter system, and the changes in the plasma motilin concentration were also determined. Graded EM doses (0.1–1.5 mg/kg) were administered intravenously over 5 min, usually during gastric phase I. EM induced interdigestive migrating contractions (IMCs). Their induction rate was low after low doses of EM, but gradually increased as the dose increased to reach, 71.4% at an EM dose of 0.375 mg/kg. Strong contractions, which were quite similar to phase III activity of the stomach but did not migrate or migrated incompletely to the duodenum, were observed at EM doses above 0.375 mg/kg. Therefore, the optimum dose of EM for inducing an IMC was established to be 0.375 mg/kg. In comparison with spontaneous IMCs, EM-induced IMCs had a significantly longer duration in the stomach and a significantly lower amplitude in the duodenum. These observations indicate that EM induced phase III activity more intensively in the stomach than in the duodenum. The plasma motilin concentration increased significantly during EM-induced IMCs, and this suggested a close relationship between this hormone and induction of the IMC. The increase in motilin levels was also observed of the strong gastric contractions which did not migrate or migrated incompletely to the duodenum. Therefore, it seems reasonable to suggest that motilin is involved in phase III activity of the stomach rather than in that of the duodenum.

Effect of erythromycin on interdigestive gastrointestinal contractile activity and plasma motilin concentration in humans.

Three experimental diets were prepared from a standard formula plus pure oleic, linoleic, or eicosapentaenoic acid (2% by weight). Mucosal resistance to acid was tested in anaesthetised rats fed the experimental diets for at least four weeks (60 rats per diet) by duodenal infusion of HCl (200 to 700 mumol) 30 minutes after pretreatment with either saline or 100 mumol HCl (used as a mild irritant). Rats were killed one hour after the test and the duodenal damage was assessed 'blindly' using a combined macroscopic and histological score. Differences were tested by analysis of covariance of the dose-response curves. Mucosal resistance was similar in the three groups when the acid challenge was given after saline pretreatment. Resistance to acid in all three groups was significantly increased by previous exposure to 100 mumol HCl (p < 0.01). Interestingly, rats fed a linoleic or eicosapentaenoic supplemented diet after pretreatment with HCl developed significantly higher resistance to acid than those fed the diet with oleic acid (p < 0.05). Pretreatment with indomethacin suppressed the difference between diets. In conclusion, dietary polyunsaturated fatty acids enhance duodenal resistance to acid by potentiation of adaptive cytoprotection.

https://gut.bmj.com/content/gutjnl/34/10/1303.full.pdf

Influence of dietary fat on duodenal resistance to acid.

Duodenal mucosal resistance to intraluminal acid in the rat: Role of adaptive cytoprotection

A technique of combined hepatobiliary scintigraphy and gastrointestinal motility recordings was used to study the relationship between gallbladder dynamics and gastrointestinal motility recordings in the postprandial state in eight healthy male volunteers. In all, a fed-like motility pattern was observed after ingestion of a standard meal, and all activity from the HIDA-scintigraphy was diverted to the duodenum. Gallbladder radioactivity on the scintigram was not seen until 145-249 (median, 180) min after ingestion, except for two cases in which an early and transient activity was seen. Together with increasing gallbladder radioactivity characteristic changes in duodenal motility occurred. In five subjects a decrease in motility index was encountered with a motility curve resembling phase I of the interdigestive migrating motor complex. In one subject it was associated with the appearance of a phase-Ill complex, and in two subjects it occurred without any changes in motility index.

Postprandial gallbladder filling: relation to gastrointestinal motility

[A study on continuous simultaneous recordings of gastrointestinal motility and intraduodenal pH in human healthy subjects (author's transl)].

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[A study on continuous simultaneous recordings of gastrointestinal motility and intraduodenal pH in human healthy subjects (author's transl)].