[A year's experience at a colitis clinic].
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Biomedical subjects
Publications and source records attributed to G Wickbom.
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Animal experiments and clinical studies suggest that duodenal secretions may be harmful to gastric mucosa after the antrum has been resected. Reflux of duodenal secretions into the gastric remnant after operation for ulcer disease may lead to the symptom complex of reflux gastritis. The injurious agent in the duodenal secretions has yet to be identified. Its relationship to altered gastric mucosa has not been fully elucidated. Diversion of the flow of duodenal secretions away from the stomach may relieve symptoms. Of several surgical procedures used, the Roux-en-Y limb has consistently afforded the best clinical result. Presented are 15 patients who had Roux-en-Y diversion for postoperative reflux gastritis. All patients showed marked improvement after this procedure. Twelve patients also had associated esophagitis. All original procedures were for benign ulcer disease. Three of the patients, who had Henley jejunal loop interpositions, continued to have symptoms which were relieved after conversion to a Roux-en-Y limb.
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Alkaline reflux gastritis is by far most common following gastric operations, but its true incidence remains to be determined. It is a distinct postgastrectomy disorder with unique features from other postgastrectomy syndromes. Eight patients with the diagnosis of postoperative alkaline reflux gastritis are presented. Five patients had Henley jejunal loop interposition procedures and two had takedown of their gastroenterostomy and pyloroplasty. One patient had a Roux-en-Y jejunojejunostomy after a vagotomy and pyloroplasty. A Henley jejunal loop failed to relieve the symptoms in one patient and a Roux-en-Y jejunojejunostomy brought complete relief of symptoms. Six of the eight patients had esophagitis. The frequent coexistence of alkaline esophagitis and alkaline gastritis must be considered in both treatment.
Canines with vagally innervated fundic pouches and chronic esophageal fistulas were subjected to sham feeding experiments during which pouch acid output and peripheral serum gastrin levels were measured. These dogs then underwent construction of vagally innervated antral pouches. The sham feeding experiments were repeated after recovery. Preoperatively sham feeding provoked a substantial increase in acid output accompanied by a small serum gastrin increase which did not achieve statistical significance. After creation of the innervated antral pouches, sham feeding evoked an acid secretory response similar to control values. Serum gastrins, however, increased nearly 500 percent in response to sham feeding. Our data support the concept that direct vagal stimulation of the parietal cell mass is the major mechanism by which sham feeding increased acid secretion.
Vagally denervated (Heidenhain) pouch acid outputs and serum gastrin concentrations, basal and in response to feeding, were measured in dogs before and after massive intestinal resection. Both 24-hr and postprandial Heidenhain pouch acid outputs increased (P less than 0.01) after intestinal resection. Increases in serum gastrin concentrations following feeding were greater after massive resection of the small intestine. There was an excellent correlation (r= 0.967; P less than 0.005) between increases in serum gastrin concentrations and Heidenhain pouch acid outputs after intestinal resection. These studies support and are consistent with the hypothesis that the polypeptide hormone gastrin plays a role in the production of the gastric acid hypersecretion which, in both dogs and man, frequently results from massive resection of the small intestine.
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