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PubMed1994

Intestinal obstruction.

Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Many of these patients are unfit for surgery due to extensive local disease or poor general condition. There are now many drug regimens available that will relieve obstructive symptoms in most patients, although a few, mainly with high obstruction, will require a venting procedure.

Abdominal Neoplasms↗
PubMed1996

Effect of epidural analgesia on postoperative ileus after ileal pouch-anal anastomosis.

Epidural analgesia has been reported to enhance gastrointestinal motility and shorten postoperative ileus. Postoperative ileus can be influenced by many factors, including the operative procedure. Our aim was to evaluate the effect of supplemental epidural anesthesia and postoperative analgesia on ileus after ileal pouch-anal anastomosis (IPAA). This was a retrospective review of 50 consecutive nonrandomized patients undergoing IPAA over a 10 year period by a single surgeon. 27 patients received general anesthesia and parenteral analgesia. 23 patients received supplemental epidural anesthesia and analgesia. The two groups were comparable with respect to age, sex, diagnosis, and American Society of Anaesthesiology status. Operative time, blood loss, and transfusion requirements were also similar, but massive (>1,000 mL) blood loss was more frequent in the general group (37% vs 13%, P < .05). Twelve (44%) patients in the general group and seven (30%) in the epidural group had complications (NS). Mean duration of nasogastric suction, tube reinsertion, and interval to taking liquid and regular diets was similar in the two groups. Mean pain scores for the first 24 hours were significantly lower in the epidural group (1.9 +/- 1.0 vs 2.5 +/- 0.6, P < 0.05). Supplemental epidural anesthesia and analgesia does not shorten clinical postoperative ileus after a complex colorectal procedure (IPAA).

Adolescent↗
PubMed1989

Almitrine bismesylate disposition in the human digestive tract.

The absorption of almitrine from the upper gastrointestinal tract has been evaluated in 6 healthy volunteers by an intubation technique. Almitrine bismesylate dissolved in malic acid was introduced into the stomach after homogenization with a meal containing the marker 14C-polyethylene glycol (PEG) 4000. Unlabeled PEG 4000 was infused into the second part of duodenum throughout the experiment. Samples of the luminal content were collected every 15 min for four hours from the stomach and at the ligament of Treitz. Blood was also collected. Almitrine was neither absorbed from nor metabolized in the stomach. About 37% of the quantity of drug emptied from the stomach was absorbed from the duodenum. Almitrine was detected in plasma 50 min after ingestion of the meal and its plasma concentration-time profile reflected the cumulative gastric emptying rate. The metabolite tetrahydroxy almitrine was found in intestinal samples as soon as unchanged drug was detected in plasma. The intraluminal rate of formation of the metabolite increased with time. The results suggest hepatic metabolism of almitrine followed by rapid excretion of the metabolite in the bile.

Adult↗
PubMed1976

The effect of posture on the emptying of the intrathoracic vagotomized stomach.

Ten patients were studied at periods ranging from 6 months to 25 years after oesophagogastrostomy and gastric drainage. Gastric emptying studies and overnight gastric aspirates in both the supine and erect positions were carried out. Evidence was found in these patients of increased duodenogastric reflux and poor gastric emptying in the supine posture. All of the patients had gastritis, and some had gastric mucosal ulceration. These findings have led to the conclusion that in the supine posture the combination of duodenogastric reflux and poor gastric emptying leads to gastric mucosal damage.

Bile↗
PubMed1978

Mannitol and glucose: effects on gastric acid secretion and endogenous gastric inhibitory polypeptide (GIP).

Serum gastric inhibitory polypeptide was measured in dogs prepared with Heidenhain pouches and Mann-Bollman fistulae following the intraduodenal (ID) infusion of isotonic saline, 20% glucose, or 20% mannitol. Following ID 20% glucose, serum GIP concentrations rose significantly (P less than 0.05) between 30 and 120 min and there was a significant inhibition (P less than 0.05) of acid secretion in the Heidenhain pouches between 15 and 75 min. A good correlation (r = 0.925) was found between the rise in serum GIP and the inhibition of acid secretion. Although neither ID isotonic saline nor 20% mannitol stimulated GIP release, the latter produced a significant (P less than 0.05) inhibition of acid secretion between 60 and 105 min. We conclude: (1) the inhibitory effect of acid secretion following ID glucose is mediated in part by the release of endogenous GIP; (2) glucose and mannitol probably inhibit gastric acid secretion by different mechanisms.

Animals↗
PubMed1988

Effect of composition of gastric contents on resistance to emptying of liquids from stomach in humans.

Experiments were conducted in normal healthy volunteers to investigate whether factors other than the intragastric pressure induced by tonic contraction of the gastric fundus could regulate the gastric emptying of liquids. The emptying of solutions of different osmolality and composition from the stomach was measured, while maintaining the intragastric pressure constant with a barostat system that employed an external reservoir. Preliminary experiments showed a linear relationship between intragastric pressure and emptying rate, but indicated that a normal intragastric pressure of 7 cm water would be insufficient by itself to maintain normal emptying. When intragastric pressure was maintained at 20 cm water, an isotonic solution of 30 mM glucose in saline (278 mosm/kg) emptied at a rate of 49.9 +/- 0.5 ml/min (mean +/- SEM, N = 11). Milk (284 mosm/kg) and a hyperosmolar solution of 30 mM glucose in saline (586 mosm/kg) significantly reduced the emptying rate. These results suggest that factors other than the intragastric pressure induced by fundic contraction regulate the rate at which liquids empty from the stomach and that the slower emptying of hyperosmotic solutions or solutions containing fat could be brought about in part either by an increased resistance of the pylorus and possibly the duodenum or a reduction in the effectiveness of an antroduodenal pump.

Adolescent↗
PubMed2005

Sonography as an alternative to radiography for nasogastric feeding tube location.

OBJECTIVE: To evaluate bedside sonographic confirmation of weighted-tip nasogastric feeding tube position, by comparison to radiography. DESIGN AND SETTING: Single-center, double-blind prospective study in a 14-bed medical intensive care unit (ICU) in a 780-bed teaching hospital. PATIENTS: Thirty-three ICU patients undergoing nasogastric tube insertion for enteral feeding. INTERVENTIONS: The tip of the nasogastric tube was located both by sonography and standard radiography. MEASUREMENTS AND RESULTS: The accuracy and procedure times of sonography and radiography for nasogastric tube tip location were compared during 35 procedures in 33 patients. The nasogastric tube tip was visualized by sonography in 34 of 35 procedures (sensitivity 97%) and by radiography in all procedures. The median length of the entire procedure was 24 min and 180 min with sonography and radiography, respectively. CONCLUSIONS: Bedside sonography performed by nonradiologists is a sensitive method for confirming the position of weighted-tip feeding nasogastric feeding tubes. It is more rapid than conventional radiography and can easily be taught to ICU physicians. Conventional radiography could be reserved for cases in which sonography is inconclusive.

Double-Blind Method↗
PubMed2000

Recent experience with percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) for enteral nutrition.

BACKGROUND: Enteral feeding is the preferred means of nutritional support in patients unable to eat orally. Jejunal-placed feeding tubes are often considered optimal for this purpose. Successful administration of such tube feedings depends on the method of placement and the size of the tube. Herein we review our experience with endoscopically placed jejunal feeding tubes. METHODS: Thirteen percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) tubes were placed in 13 patients at the Emory University hospital by one surgeon. Indications for jejunal placement included aspiration in five patients and suspicion of increased reflux susceptibility in eight patients. Insertion of an 8.5-Fr nasobiliary tube was attempted in nine patients using the technique described by Coates and MacFadyen. A 12-Fr tube was placed in four patients using a technique that took advantage of previously placed PEG tubes. RESULTS: Initial placement was successful in all but one patient. Nine tube-related complications occurred in seven patients. These included six tube occlusions, one tube site infection, one peristomal leak, and one tube perforation that required replacement. Five of six tube occlusions (83%) occurred in the smaller 8.5-Fr. tubes. There was one non-tube-related death. CONCLUSIONS: PEG/J insertion can be performed successfully and safely in most patients. Long-term tube patency is, however, dependent on the use of tubes with a large diameter; thus, modalities that enable placement of larger-sized tubes are preferable. Further technical developments are needed to facilitate the endoscopic insertion of larger jejunostomy tubes.

Adult↗
PubMed2004

A multicenter, randomized, double-blind, placebo-controlled trial of the prokinetic agent erythromycin in the postoperative recovery of infants with gastroschisis.

BACKGROUND/PURPOSE: The recovery of gut function after repair of gastroschisis is frequently prolonged, and these infants are prone to complications associated with parenteral nutrition. This trial was designed to investigate the effect of the prokinetic agent, erythromycin, on the attainment of full enteral feeding in infants after primary repair of uncomplicated gastroschisis. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was used to investigate the effect of enteral erythromycin (3 mg/kg/dose 4 times daily) compared with placebo on the attainment of full enteral feeding tolerance after primary repair of uncomplicated gastroschisis. Eleven neonatal surgical units in the United Kingdom participated in the study. The primary end-point was the time taken to achieve continuous enteral feeding at 150 mL/kg/24 hours sustained for 48 hours. RESULTS: Of 70 eligible infants, 62 were recruited and randomly divided. There were 30 patients in group I (placebo) and 32 in group II (erythromycin). The groups were comparable in terms of mean gestational age, mean birth weight, extent of evisceration, and degree of intestinal peel. There was no statistically significant difference between the 2 groups in the time taken to achieve full enteral feeding (27.2 v 28.7 days; P =.75). Similarly, no significant differences were found in the incidence of catheter-related sepsis, duration of parenteral nutrition, or time to discharge between the 2 groups. CONCLUSIONS: Enterally administered erythromycin at a dose of 3 mg/kg 4 times daily conferred no advantage in the time taken to achieve full enteral feeding after primary repair of uncomplicated gastroschisis.

Double-Blind Method↗
PubMed2006

Patients experience with long-term percutaneous endoscopic gastrostomy feeding following primary surgery for oral and oropharyngeal cancer.

Percutaneous endoscopic gastrostomy feeding (PEG) has an important role in providing nutritional support in selected patients undergoing treatment for oral and oropharyngeal cancer. Although morbidity data have been published there is very little from the patient perspective. The aim of this project was to devise, pilot and survey a PEG specific questionnaire and relate outcomes to health-related quality of life. A cross-sectional survey was conducted in April 2005 of patients who were alive and disease free and treated by primary surgery for oral and oropharyngeal squamous cell carcinoma between 1992 and June 2004. The survey comprised the University of Washington Quality of Life questionnaire and a 24 item PEG questionnaire. Of 344 alive and disease free patients, 243 (71%) responded. Clinical characteristics of responders and non responders were similar. Mean age of responders was 65 (SD 12) and 59% were male. There were 193 (79%) patients who never had a PEG as part of their treatment, 30 (12%) who had their PEG removed (median 7 months), and 20 (8%) who still had a PEG (median 34 months). Patients with PEGs reported significant deficits in all UW-QOL domains compared to non-PEG or PEG-removed patients and also reported a much poorer quality of life. The major PEG related problems were not those of discomfort, leakage or blockage, but interference with family life, intimate relationships, social activities, and hobbies. More can be done to counsel and support patients with long-term PEG placement.

Aged↗