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At least 397 records · Page 22Linked to original sources
PubMed2000

Endoscopic placement of Sengstaken-Blakemore tube.

A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of acute variceal bleeding. Due to a number of reported complications from the misplacement of this tube, an x-ray localization before full inflation of the gastric balloon is recommended as the standard of care. Here, we report a new technique of SB tube placement with endoscopic confirmation in three patients. This technique is easy, accurate, and can be performed in any unit where a patient with variceal bleeding can be managed. Because it cuts down on the need for an x-ray or ultrasound confirmation, this technique may well become the "standard of care" among the practicing gastroenterologists.

Aged↗
PubMed1999

Effect of a liquid meal given as a bolus into the jejunum on human pancreatic secretion.

Major features of pancreatic secretion stimulated by a meal depend on intestinal phase mechanisms. However, an intrajejunal (i.j.) meal infusion is widely used for the treatment of inflammatory pancreatic diseases when the resting of the gland is desired. This study was undertaken to compare the effects of an intragastric (i.g.) and an i.j. complete fluid (Lundh) test meal on pancreatic enzyme secretion. Eight men (mean age, 43 years; range, 31-48) free from pancreatic disease were studied. Pancreatic secretion was measured via a multiple-lumen tube by aspiration of the duodenal juice. After a fasting period, the Lundh test meal was placed in the stomach or the upper jejunum. After the i.g. administration of the test meal, the aspirated duodenal juice was reinfused into the jejunum. The effect of atropine infusion (0.5 microg/kg/h) on the pancreatic enzyme secretion was studied. The pancreatic amylase, trypsin, and lipase outputs were determined. The plasma levels of cholecystokinin (CCK) and of gastrin were measured by bioassay and radioimmunoassay, respectively. The trypsin, amylase, and lipase secretions increased significantly after either an i.g. or an i.j. test meal intake. The trypsin, amylase, and lipase outputs were significantly decreased during the i.j. perfusion as compared with i.g. administration. The gastrin levels increased significantly after i.g., but remained unchanged after i.j. administration. The CCK release attained its maximum 40 and 60 min after the i.g. and i.j. test meal, respectively. However, the CCK release was significantly lower during the i.j. administration as compared with i.g. perfusion. An atropine infusion significantly reduced the i.g. and i.j. test meal-stimulated enzyme outputs. An i.j.-administered meal stimulates the pancreatic enzyme secretion, but this effect is significantly lower than that which occurs on i.g. administration. The i.j. meal-stimulated secretion of pancreatic enzymes is subject to both cholinergic and peptidergic regulation. The deficiency of gastrin and the delayed and decreased CCK release are believed to account for the reduced enzyme output.

Adult↗
PubMed2007

Feed intolerance in critical illness is associated with increased basal and nutrient-stimulated plasma cholecystokinin concentrations.

OBJECTIVE: Delayed gastric emptying and intolerance to gastric feeding occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Cholecystokinin (CCK) slows gastric emptying. The aim of this study was to determine plasma CCK concentrations during fasting and in response to small-intestine nutrient infusion in critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Level 3, mixed medical and surgical intensive care unit. SUBJECTS: A total of 31 mechanically ventilated, critically ill patients (23 men, 51 +/- 3 yrs) and 28 healthy subjects (21 men, 43 +/- 2 yrs). INTERVENTIONS: Subjects received two 60-min duodenal infusions of Ensure (complete balanced nutrition), at 1 and 2 kcal/min, in a randomized, single-blind fashion. The nutrient infusions were separated by a 2-hr "washout" period. Blood samples for measurement of plasma CCK concentrations were obtained immediately before and every 20 mins during nutrient infusion. MEASUREMENTS AND MAIN RESULTS: Baseline and nutrient-stimulated plasma CCK concentrations were higher in critically ill patients compared with healthy subjects (p < .001). The magnitude of the rise in plasma CCK in response to nutrients was also greater in the critically ill (p < .01). Of the 23 patients who received enteral nutrition before the study, nine were intolerant of gastric feeding. In these patients, both the baseline plasma CCK concentration and the magnitude of CCK increase during nutrient infusions were greater than in patients with feed tolerance (p < .002). Impaired renal function was associated with an increased baseline CCK concentration but had no effect on the CCK response to nutrients. CONCLUSIONS: Both fasting and nutrient-stimulated plasma CCK concentrations are increased in critically ill patients, particularly in those with feed intolerance. This may provide a humoral mechanism for delayed gastric emptying seen in critical illness.

APACHE↗
PubMed2006

Early oral nutrition after major upper gastrointestinal surgery: why not?

PURPOSE OF REVIEW: To examine the available documentation addressing the introduction of early food after major upper gastrointestinal surgery. RECENT FINDINGS: No high-quality trials, recent or old, have addressed this topic. A few attempts have been identified. Information is extracted from papers discussing other topics of postoperative care in this field. Generally, nasogastric tubes and nil-by-mouth prevail in the early postoperative period. SUMMARY: The reluctance to allow early food at will is not evidence based, but neither is the safety of an alternative regimen. Early food at will should probably be allowed after hepatic resections, gastric resections, and total gastrectomies and maybe also after pancreaticoduodenectomies. Resections of the esophagus remain the most challenging issue. The need is urgent for high-powered and high-quality randomized controlled clinical trials.

Enteral Nutrition↗
PubMed1999

Effect of omeprazole paste on gastric acid secretion in horses.

In a multicentre trial, 13 cannulated horses were treated orally once daily with a paste that delivered omeprazole at a dose of 4 and 5 mg/kg bwt in a 2-period crossover design to evaluate steady state gastric acid suppression. In each period, basal (unstimulated) and pentagastrin-stimulated gastric output were evaluated at 5-8 h after 5 doses, at 13-16 h after 10 doses, and at 21-24 h after 15 doses. Baseline data for gastric acid secretion were collected once for each horse in the month prior to initiation of omeprazole treatment. The inhibition of gastric acid secretion relative to baseline values, following treatment with omeprazole, were calculated and expressed as per cent. Pharmacokinetic data were also collected in this trial. At 4 mg/kg bwt, the oral paste formulation of omeprazole inhibited both basal and pentagastrin-stimulated gastric acid secretion by 99% at 5-8 h after treatment and by 83% (basal) and 90% (pentagastrin-stimulated) at 21-24 h. Inhibition following the administration of omeprazole at a dose of 5 mg/kg bwt was not significantly greater than when given at 4 mg/kg bwt. The results from this study could possibly lead to the development of an effective and practical antisecretory treatment of ulcer disease in horses.

Administration, Oral↗
PubMed1978

Measurement of flow and sampling of digesta in the preruminant calf.

1. Methods of measuring and sampling the flow of digesta passing through intestinal cannulas in preruminant calves were studied and compared. 2. The effect of collecting digesta from a duodenal cannula on abomasal emptying in a calf given whole milk was determined. When digesta were collected and returned to the duodenum manually in large amounts (about 200 g) the outflow of abomasal contents was intermittent. When digesta were returned to the animal either manually or automatically in amounts of less than about 50 g abomasal emptying was smooth. 3. An automatic apparatus for measuring and sampling the flow of digesta continuously was developed. The device allowed effluent to be returned smoothly to an ingoing cannula at the same rate that digesta left the outgoing cannula. After a feed of whole milk abomasal contents were observed to enter the duodenum in an orderly series of gushes. Each gush consisted of about 5--30 g of digesta. 4. The apparatus was rearranged to measure the effects of composition of duodenal digesta on abomasal emptying. Replacement of duodenal digesta with a suspension containing heated soyabean flour slowed the abomasal outflow of a feed containing casein. 5. Automatic apparatus was used to collect digesta arriving at the distal ileum. Withholding effluent from the large intestine did not affect the movement of digesta from the ileum.

Abomasum↗
PubMed1972

Comparative evaluation of water recovery test and fluoroscopic screening in positioning a nasogastric tube during gastric secretory studies.

Acid secretion studies were carried out in 50 patients. Fluoroscopy or a modified water recovery test was used to position the nasogastric tube. For every patient each positioning procedure was used on one of two consecutive days, and acid output studies were performed. The tests were assessed by two observers and accepted or rejected. Analysis revealed no significant differences between the acid studies irrespective of the method used for positioning the nasogastric tube. Rejection rates by either procedure showed no significant difference. Practical considerations favour the continued use of water recovery as a means of positioning the nasogastric tube for gastric secretion studies.

Analysis of Variance↗
PubMed1973

Pyloric reflux and the healing of gastric ulcers.

Pyloric reflux is rare in healthy subjects but is common in those with benign gastric ulcer. Healing of a gastric ulcer is associated with a diminution of reflux, and occasionally the pylorus becomes fully competent.

Adult↗
PubMed1975

The gastric response to a transpyloric duodenal tube.

The quantification of gastric, pancreatic, biliary, and small bowel functions in man often requires the use of intestinal tubes. In this study, the presence of a transpyloric tube did not alter gastric emptying, acid secretion, or serum gastrin levels in response to an ordinary solid meal.

Adult↗
PubMed2002

Evaluation of patients with jejunostomy tubes: imaging findings.

PURPOSE: To determine the frequency and nature of abnormalities observed on radiographs after placement of jejunostomy (J) tubes for enteral nutrition. MATERIALS AND METHODS: Radiology database review revealed that 280 studies of the J tube or of the small bowel with water-soluble contrast material and/or barium sulfate were performed in patients during 10 years. Review of the radiologic reports revealed abnormalities related to the placement of tubes in 105 (38%) cases. Images were reviewed to determine abnormalities in these 105 cases. Radiologic, medical, and surgical records were also reviewed to determine the clinical course and any subsequent interventions. RESULTS: One or more complications were detected in 40 (14%) of 280 cases: small-bowel obstruction in 17 (6%) cases, nonobstructive small-bowel narrowing in six (2%), extraluminal tracks or collections in seven (2%), extravasation of contrast material to the skin in 11 (4%), jejunal hematomas in five (2%), and intussusceptions in four (1%). Mechanical problems related to the tube were detected in 52 (19%) cases, including coiling, kinking, or knotting of the tube in 38 (14%), malpositioning in five (2%), retrograde flow in four (1%), occlusion in four (1%), and a hole in one (<1%). Focal thickening of small-bowel folds was detected in 24 (9%) cases. CONCLUSION: Radiographs in 280 patients with J tubes revealed one or more complications that resulted from tube placement (40 [14%] cases), mechanical problems related to location or function of the tube (52 [19%] cases), and development of focally thickened small-bowel folds (24 [9%] cases).

Adult↗