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Biomedical subjects

S J Rune

Publications and source records attributed to S J Rune.

At least 37 records · Page 2Linked to original sources

Duodenal bulb acidity in patients with duodenal ulcer.

Intraluminal pH was measured simultaneously in the human stomach and proximal duodenum with six small glass electrodes tied together at 1.5-cm intervals. Twenty-four healthy control subjects and 44 patients with duodenal ulcer disease were studied under fasting conditions and for 3 h after a standard liquid meal. Mean and median hydrogen ion activity, percentage of time with pH below 2 and 3, and the frequency of pH fluctuations were calculated from digital pH data sampled at a frequency of once per second from each electrode. None of these measurements of acidity differed significantly between the two groups or between subgroups of normosecretor controls and hypersecretor ulcer patients. At the time of pH study 15 of the patients had endoscopically verified active ulcer disease and 13 patients were without disease activity. Gastric as well as duodenal bulb acidity was the same in these two subgroups. We conclude that even though duodenal ulcer patients deliver more acid into the duodenum, this does not cause increased luminal acid aggression.

Adult↗

Intraluminal pH in the stomach, duodenum, and proximal jejunum in normal subjects and patients with exocrine pancreatic insufficiency.

In situ pH was measured simultaneously with microelectrodes in the stomach, duodenal bulb, midduodenum, duodenojejunal junction, and proximal jejunum. Fourteen healthy subjects and 8 patients with exocrine pancreatic insufficiency were studied under fasting conditions and for 3 h after a standard liquid meal. The luminal pH gradient was steepest in the proximal 10 cm of the duodenum, where acidity was reduced from pH 2 to pH 5 in the fasting state and from pH 1.7 to pH 4.3 in the second and third postprandial hour. Acidity was further reduced in the distal duodenum to a pH between 5 and 6 at the duodenojejunal junction. The frequent wide and rapid pH fluctuations seen in the duodenal bulb were gradually reduced along the duodenum and became rare in the jejunum. In patients with pancreatic insufficiency, duodenal or jejunal acidity did not differ significantly from the controls, with the exception of the single 10-min period occurring 70-80 min after the meal when duodenal bulb pH was 2.1 as compared with 3.1 in the normal subjects (p less than 0.05). All patients, including 2 patients with a very high duodenal acidity, demonstrated a duodenal pH gradient as steep as that found in the normal subjects, indicating sources of bicarbonate other than the pancreas.

Adult↗

Effect of omeprazole and cimetidine on duodenal ulcer. A double-blind comparative trial.

We conducted a double-blind randomized study of 132 patients to determine whether the new, investigational proton-pump inhibitor, omeprazole (30 mg per day), would accelerate healing and pain relief, as compared with cimetidine (1 g per day), in patients with duodenal ulcer. After two weeks of treatment, which was completed by all patients, the healing rates were 73 per cent in the omeprazole group and 46 per cent in the cimetidine group (P less than 0.01). After four weeks of treatment, which was completed by 118 patients, the corresponding figures were 92 and 74 per cent (P less than 0.05). In the omeprazole group 55 per cent of the patients were free of pain after the first week, as compared with 40 per cent of those treated with cimetidine (P greater than 0.05). No major clinical or biochemical side effects of omeprazole or cimetidine were noted. A six-month follow-up study revealed no significant difference between the recurrence rates after omeprazole and after cimetidine treatment. In May 1984 clinical trials with omeprazole were temporarily suspended, since a study of long-term toxicity in rats had shown the development of gastric carcinoid tumors.

Adult↗

Development of cimetidine resistance in the Zollinger-Ellison syndrome.

A patient with the Zollinger-Ellison syndrome was followed with multiple gastric secretion tests and serum gastrin analyses for six years. During this period cimetidine requirement increased to a daily dose of 8 g, but it reversed spontaneously after two years. The altered cimetidine effectiveness was not associated with reduced oral bioavailability and serum calcium was unchanged. Total serum gastrin was very high at all times, and fractionation of gastrins in serum by gel filtration showed varying proportion of big to small gastrins, but not in a mode which explained the parietal cell resistance to cimetidine.

Adult↗

Evaluation of the marker technique for measurement of exocrine pancreatic secretion rate.

A secretin-cholecystokinin test was performed in 103 patients, representing both normal and reduced exocrine pancreatic function. The duodenum was intubated with a triple-lumen tube. The gastric and duodenal contents were aspirated separately and sampled in 10-min periods. An inert, water-soluble marker (58Co-vitamin B12 dissolved in isotonic saline) was infused at a constant rate into the duodenum. Exocrine pancreatic secretion was stimulated by continuous intravenous infusion of secretin for 60 min and a combination of secretin and cholecystokinin for another 60 min. The total recovery of the infused marker was 80%. The concentration of marker in the aspirate did not vary significantly between consecutive 10-min periods during the last 20 min of the secretin stimulation period or during the last 50 min of the combined secretin-cholecystokinin stimulation period, indicating a steady secretion rate into the duodenum. By means of the marker concentrations in the aspirate, the duodenal volumes were calculated and found to vary significantly less than the aspirated volumes. This finding demonstrates that the duodenal volume calculated from the recovery of an inert marker is a closer estimate of the true volume than that obtained by the usual aspiration technique without a volume indicator.

Cholecystokinin↗

IgA antibodies to herpes simplex virus type 1 in duodenal juice and saliva from patients with peptic ulcer and non-ulcer controls.

Fasting duodenal juice and saliva were obtained from 26 peptic ulcer patients and 28 controls. IgA antibodies to herpes simplex virus type 1 (HSV-1) were measured by the indirect enzyme-linked immunosorbent assay (ELISA). Total IgA in the samples was measured by the double-sandwich ELISA. The median and interquartile range of anti HSV-1 IgA titres in saliva were 8 (4-12) and 4 (1-8) in ulcer patients and controls, respectively (p less than 0.02). Comparative values in duodenal juice were 12 (2-16) and 4 (0-6) (p less than 0.002). The concentration of total IgA was not higher in ulcer patients than in controls, and no correlation existed between total IgA and anti HSV-1 titres. The results add further evidence that HSV type 1 is involved in the pathogenesis of peptic ulceration.

Adult↗

Additional antacid does not increase the effect of cimetidine in gastric ulcer disease.

Eighty-one adult outpatients with endoscopically confirmed gastric ulceration were treated with cimetidine (1 g/day). In addition, the patients were allocated at random to either intensive antacid treatment or placebo treatment. This part of the study was double-blind. It was found that additional antacid treatment had no effect on ulcer healing and symptoms in cimetidine-treated gastric ulcer patients. The results were similar in patients with corpus ulcers and patients with prepyloric ulcers.

Adult↗

Duodenal bulb pH in normal subjects.

Four pH electrodes strapped together at 1 X 5 cm intervals were positioned in the pyloric region. Electrodes situated in the stomach record steady acid pH while electrodes distal to the pylorus show fluctuating pH, thereby enabling the electrodes to be localized from the pH pattern. Digital pH values were sampled and stored at a rate of 2/s from each electrode. For each 10-min period, the mean hydrogen ion activity, the percentage of time that the pH was at less than 3.0 and number of pH spikes were computed. Fourteen healthy subjects were studied in the fasting state and for 3 h after 300 ml chocolate milk. Log mean hydrogen ion activity in the proximal part of the duodenal bulb was (median and interquartile range): fasting pH 2.40 (2.23-3.00); 0-60 min after meal: pH 5.7 (4.92-5.95); 60-120 min: pH 2.31 (1.95-3.20) 120-180 min: pH 2.20 (1.99-2.44). Repeated studies in twelve subjects showed a linear correlation between 1st and 2nd study, r = 0.87. A significant linear correlation was found between peak acid output to pentagastrin and postprandial bulb acidity.

Adult↗

Association between duodenal bulb ulceration and reduced exocrine pancreatic function.

Seventy two patients admitted to a medical department with dyspepsia but without a previous diagnosis of peptic ulcer disease or chronic pancreatitis were studied consecutively. A pancreatic function test (Lundh meal test) and an upper endoscopy was made in all patients. There was no difference in age, sex ratio, occurrence of upper abdominal pain or chronic alcoholism between the groups of patients with reduced pancreatic function (20) and the group with normal function (52). Seven duodenal ulcers were found, two in patients with normal pancreatic function (2/52 = 3.8%; 95% conf lim: 0.5-13.2) and five in patients with reduced pancreatic function (5/20 = 25%; 95% conf lim: 8.7-49.1). This difference was statistically significant (p less than 0.01). Duodenitis occurred with equal frequency in the two groups.

Adult↗

Exocrine pancreatic function in patients with dyspepsia.

The exocrine pancreatic function was studied in 460 patients suffering from dyspepsia (defined as abdominal pain, chronic diarrhoea, and/or weight loss) by measuring the duodenal concentrations of amylase and lipase after a test meal (Lundh test). In 159 of the patients (35 per cent) a reduced pancreatic function was found. In 143 out of these a diagnosis of possible or verified chronic pancreatitis was made. In about half of these 143 patients, the diagnosis chronic pancreatitis was clinically unexpected. Consequently, chronic pancreatitis is to be suspected as a cause of dyspepsia when more usual causes have been excluded.

Adult↗

Type-specific herpes-simplex-virus antibodies in patients with recurrent duodenal ulcer.

The prevalences of herpes-simplex-virus (HSV) type-1-specific antibodies in 52 patients with recurrent duodenal ulcer, 60 controls, and 32 patients with recurrent cold sores were 94%, 80%, and 100% respectively. Seropositive ulcer patients had significantly higher antibody levels than seropositive controls. The cold-sore group had higher antibody levels than the controls, but this difference did not reach statistical significance. Since all three groups had similar HSV type-2-specific antibody levels, the results demonstrate an unusual activity of HSV type 1 in duodenal-ulcer patients, compatible with the hypothesis that herpesvirus is an aetiological agent in some cases of this disorder.

Adolescent↗

Recurrence of duodenal ulcer pain after treatment with cimetidine for four and eight weeks.

This double-blind controlled trial compares the relapse rate in 19 duodenal ulcer patients who received cimetidine for eight weeks with that in 19 patients who received cimetidine for four weeks and inactive tablets for four weeks. Only patients who became symptom-free during the initial four weeks' treatment with cimetidine were included. The median period of remission after withdrawal of cimetidine was 50 days in patients treated with cimetidine for eight weeks and 76 days in patients treated with cimetidine for four weeks (P greater than 0.10). Six months after withdrawal of cimetidine 15 relapses had occurred in both groups. It is concluded that patients who become symptom-free during four weeks' cimetidine treatment do not benefit by continuation of treatment for another four weeks.

Adult↗

The effect of antacid on gastric and duodenal bulb acidity.

A small glass pH electrode was positioned in the duodenal bulb and connected to a digital pH meter. The pH registered every half second was stored on a minidiskette with a capacity of 32.400 pH data on a single mini-disc. A microcomputer controlled electrode calibration, data collection, formating and storage. Four patients with duodenal ulcer were given a liquid test meal, and one hour later when gastric and duodenal acidity had reached high levels they were given 10 ml of antacid. From the stored pH data the mean pH and the mean hydrogen ion concentration was calculated. During the 10 min. period before antacid was given gastric pH was on average 1.5 and the duodenal pH on average 4 with a CH+ of 2.500 mumol/. Ingestion of antacid reduced gastric acidity to around pH 3, and the duodenal pH to 6 with a CH+ of 250 mumol/l. This effect of antacid was observed in all subjects, but the degree and the duration of the effect varied very much between the individuals.

Antacids↗