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PubMed1977

Is there an oxyntopyloric reflex for release of gastrin in man?

Plasma gastrin concentrations and gastric acid output were measured during graded balloon distention of the gastric fundus and body in 20 patients with duodenal ulcer. Acid output rose stepwise with increasing distention volumes but plasma gastrin remained unchanged. During intragastric neutralization in 5 of these subjects, fundic distention did not elicit a significant rise in plasma gastrin, whereas the acid response was similar to that observed in the control study when the gastric contents were acid. In 8 of the 20 patients, proximal gastric vagotomy profoundly suppressed the acid response to fundic distention. Basal plasma gastrin concentrations were elevated after vagotomy but were unchanged during graded fundic distention. The results suggest that neural reflex activation of the oxyntic glands is the main mechanism by which fundic distention stimulates acid secretion in man. The failure of fundic distention to release gastrin does not, however, completely rule out the existence of an oxyntopyloric distention reflex for gastrin release in man. Fundic distention in man seems to both stimulate acid secretion and induce an inhibitory mechanism acting on acid secretion. This inhibitory mechanism may, purely speculatively, also mask the effect of an oxyntopyloric reflex for gastrin release. The present study and earlier work suggest that in man distention of the stomach is a poor stimulus for release of gastrin, regardless of whether the pyloric or the oxyntic gland area, or both, are distended.

Adult↗
PubMed1986

An experimental study into the cause of acute haemorrhagic gastritis in cirrhosis.

To clarify the role of endotoxaemia and congestion of the stomach in the development of acute haemorrhagic gastritis in cirrhotic patients and to investigate the mechanisms of gastric mucosal haemorrhage, the present study was undertaken using rats. Congestion of the stomach was produced by the ligation of gastric veins. Congestion of the stomach or endotoxaemia could not produce gastric mucosal haemorrhage by itself. However, petechial haemorrhage was induced when endotoxin was given to the rats with congestion of the stomach, and the gastric mucosal haemorrhage was largely prevented by administration of gabexate mesilate, an anti-kallikrein drug. Administration of bromelain, which releases prekallikrein and high molecular weight kininogen, instead of endotoxin, also induced gastric mucosal haemorrhage. These findings suggest that the cause of acute haemorrhagic gastritis may be the coexistence of endotoxaemia and congestion of the stomach due to liver cirrhosis and portal hypertension. The mechanisms of the haemorrhage may be as follows: Endotoxin-induced bradykinin acts on the dilated capillaries and small veins in the mucosa and markedly increases their permeability.

Animals↗
PubMed1992

[Special problems in the surgical treatment of megaesophageal cardial achalasia. A clinical case].

The paper report the case of a patient brought to the Authors' attention suffering from megaesophageal cardial achalasia who had already undergone gastroduodenal resection according to BII. It was considered worthwhile to report this case due to the problems which arose concerning the choice of a thoracic rather than abdominal route owing to the impossibility of associating cardiomyotomy with anti-reflux plastica surgery because of the reduced dimensions of the stomach.

Aged↗
PubMed2003

[Surgery for morbid obesity: 2. Complications. Results of a Technologic Evaluation by the ANAES].

The frequency of bariatric surgery has increased markedly in France in recent years, partly due to a better appreciation of the problem of morbid obesity but also due to the commercial introduction of adjustable gastric banding devices which can be placed by laparoscopic approach. Numerous complications of this surgery are known and require recognition to be appropriately treated. Studies of complications suffer from selection bias, methodologic flaws, and lack of follow-up. The incidence and type of complication are affected by the learning curve and surgical techniques. Postoperative mortality varies from 0.14% for laparoscopic gastric banding (LGB), to 0.31% for vertical banded gastroplasty (VBGP) and 0.35% for Roux-en-Y gastric bypass (GBP); pulmonary embolus accounts for 60-70% of deaths in all groups combined. Early post-operative complications vary with specific procedures. Abdominal wall complications, already frequent in an obese population, are decreased from 10% for open procedures to 6% for laparoscopic gastric banding. Both VBGP and GBP are now being done laparoscopically with increasing frequency. Complications specific to LGB include gastric perforation (0.3%), or port problems (5%). Complications with VBGP and GBP include fistula (1-3%), deep abscess, and pulmonary embolus (2%). Global early morbidity is 4.2% for LGB, and varies from 6.4%-22% for VBGP and 6.2%-11.3% for GBP depending on laparoscopic versus open approach. Late mechanical complications are also specific to type of surgery. Pouch dilatation is the most common late complication of LGB (6.3%) and seems related both to operative experience and to site of placement of the band; it has decreased with higher positioning of the band to leave a minimal gastric pouch and with dissection through the pars flaccida of the lesser omentum instead of directly along the muscular wall of the stomach. It usually requires reintervention. Erosion of the gastric band into the stomach (1.6%) is often asymptomatic and is suggested by late weight gain. With VBGP, disruption of a gastric staple line occurs in 12.1% and stenosis of the outlet with proximal dilatation in 6.5%; erosion of the calibrating band of Marlex or silastic occurs in 2.7%. With GBP, the disruption of a staple line across an intact stomach (23%) has become less of a problem with division of the gastric pouch from the distal stomach (2%). Stenosis of the gastrojejunostomy (3.7%) and marginal ulcer (3.5%) are not uncommon. The incidence of wound hernia, obstructive adhesions, and late cholecystectomy vary with the length and thoroughness of follow-up. Late functional complications such as vomiting, dysphagia, heartburn and esophagitis vary with the quality and length of follow-up study. GBP may cause diarrhea and dumping syndrome. Nutritional complications are more common with GPB than with purely restrictive procedures; iron, folate, and Vitamin B12 deficiency are the rule with GBP and require routine replacement therapy; iron deficiency has been noted even with LGB. ate death seems more related to co-morbidities than to the intervention itself. Thorough long-term follow-up study of complications is indispensable for assessment of outcomes and improvement of laparoscopic techniques. Even the less traumatic surgical approach of laparoscopic band placement should not be considered free of risk; strict adherence to pre-operative surgical indications should be maintained.

Adult↗
PubMed1989

Intestinal pseudo-obstruction due to dialysis amyloidosis.

Marked gastric dilatation and the carpal tunnel syndrome developed concurrently in a 58-year-old man treated with hemodialysis for 14 years. Despite extensive examinations, no attributable organic lesion was demonstrated in the gastrointestinal tract. However, amyloid deposition, which was immunohistochemically identified as beta-2 microglobulin, was demonstrated in the stomach and the synovia excised from the right carpal tunnel. Intestinal pseudo-obstruction due to dialysis amyloidosis was considered to be the cause of the gastric dilatation. There have been a few recently reported cases with dialysis amyloidosis in which extra-articular amyloid deposition resulted in overt clinical problems. The present case provides additional evidence that dialysis amyloidosis can develop serious extra-articular complications; intestinal pseudo-obstruction is a very rare gastrointestinal manifestation.

Amyloidosis↗
PubMed2006

Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope.

BACKGROUND: Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature. OBJECTIVE: A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Consecutive subjects from December 1, 2002, to January 10, 2005, with symptomatic pseudocysts in whom EUS-guided drainage was attempted. INTERVENTIONS: By using a therapeutic linear echoendoscope, a 19-gauge aspiration needle was inserted into the pseudocyst. A guidewire was placed through the needle, and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa. The needle knife was then advanced by using electrocautery into the pseudocyst. The cystenterostomy was dilated by using a balloon over the guidewire. One to 4 stents were placed through the tract. MAIN OUTCOME MEASUREMENTS: Successful pseudocyst drainage. RESULTS: A total of 21 of 23 patients underwent technically successful pseudocyst drainage. One patient had self-limited hypotension during the procedure. Another patient had free intraperitoneal air after the procedure but correct stent placement. LIMITATIONS: Retrospective analysis, small sample size. CONCLUSIONS: In this preliminary experience, wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.

Adult↗
PubMedDate not supplied

Bradypneic, a new mutation in mice causing slow breathing, runting, and early death.

A new recessive mutation, bradypneic (bd), causes variable weight retardation beginning as early as 3 to 5 days. Severely affected mice die within the first 2 weeks; less severely affected mice may survive to weaning or to adulthood and may be fertile. Bradypneic mice tested at 3 weeks or older breathed at half the normal rate, but breathing was deeper and O2 consumption per unit of body surface was normal. No obstruction was found in the nasal passages, pharynx, trachea, or bronchi. The lungs were somewhat emphysematous and, probably in consequence, the right atrium was enlarged. The only other pathological conditions found were dilation of some of the distal tubules of the kidney and large amounts of gas in the stomach and intestines. The investigation did not reveal the cause of the breathing defect, but it is possible that the breathing defect is responsible for the emphysema, intestinal gas, small size, and early death. Extensive linkage tests have not yet revealed the chromosomal location of bd.

Animals↗
PubMed2004

Lower oesophageal meat bolus clearance using a radiologically guided balloon catheter: case in a 94-year-old patient.

Lower oesophageal foreign body meat bolus obstruction is potentially life-threatening. We report a case in a 94-year-old woman in which conservative measures and flexible oesophagoscopy were unsuccessful. Rigid oesophagoscopy was considered technically difficult and so clearance by interventional radiology was attempted. Through the mouth a radiologically guided balloon catheter was introduced. It was passed beyond the bolus to dilate the site of obstruction, before being withdrawn and inflated above the bolus, pushing it into the stomach. Although successful in this case, the technique is previously unreported and so its complication rate is unknown. It is therefore presented only to be considered when other treatments are neither effective nor possible.

Aged↗
PubMed1993

New experimental model of proximal and distal colon transposition in rats.

The proximal and distal portions of the colon have different morphologic and histochemical features. To ascertain whether these features are genetically or environmentally determined, we attempted to develop a transposition model of the proximal and distal portions of the colon in rats. Four-month-old male Fisher 344 rats were used. Four centimeters of the proximal colon segment circulated by the right colonic artery and 4 cm of the distal colon segment circulated by the middle colic artery were interchanged isoperistaltically. In the control group, the colon was transected and reanastomosed. All rats tolerated the surgery and maintained good condition for 4 weeks, when they were euthanized. No differences in body weight and food intake were observed between the transposition and control groups. Macroscopic appearance of the stomach and small intestine was normal in both the transposition and control groups, but the cecum was dilated and the new proximal portion of the colon was slightly dilated in the transposition group. This new experimental model will be helpful in examining the mechanism by which different features of the proximal and distal portions of the colon are derived. It will also assist in the research of carcinogenesis in the colon, in determining why the distal portion of the colon is more susceptible to carcinogens, compared with the proximal portion of the colon.

Animals↗
PubMed2003

Axonal dopamine receptors activate peripheral spike initiation in a stomatogastric motor neuron.

We studied the effects of dopamine on the stomatogastric ganglion (STG) of the lobster, Homarus americanus. The two pyloric dilator (PD) neurons are active in the pyloric rhythm, have somata in the STG, and send axons many centimeters to innervate muscles of the stomach. Dopamine application to the stomatogastric nervous system when the PD neurons were rhythmically active evoked additional action potentials during the PD neuron interburst intervals. These action potentials were peripherally generated at a region between the STG and the first bilateral branch, approximately 1 cm away from the STG, and traveled antidromically to the neuropil and orthodromically to the pyloric dilator muscles. Focal applications of dopamine to the nerves showed that spikes could be initiated in almost the entire peripheral axon of the PD neurons. Dopamine also evoked spikes in isolated peripheral axons. The concentration threshold for peripheral spike initiation was at or below 10-9 m dopamine. Thus, the peripheral axon can play an important role in shaping the output signaling to the muscles by the motor neuron.

Action Potentials↗
PubMed1983

Impaired acid secretion and pancreatic polypeptide release in some patients with achalasia.

Achalasia is characterized by an intrinsic denervation of the esophagus. It is not known whether this process extends to other parts of the gastrointestinal tract. By means of the modified sham feeding test, we studied the innervation of the stomach and the pancreas in 13 patients with achalasia. We compared the results with those from a group of 15 healthy controls and a group of 10 vagotomized patients. We saw two patterns of response in the achalasia group: 6 patients secreted acid and released pancreatic polypeptide, as did the controls. The other 7 patients neither secreted acid nor released pancreatic polypeptide after modified sham feeding, as did the vagotomized patients. We conclude that some patients with achalasia have denervation of the stomach and pancreas, as assessed by the modified sham feeding test. These differences are unrelated to age, sex, and duration and severity of the disease or treatment. Interestingly, all patients who responded normally developed reflux esophagitis after dilatation. Besides being an interesting pathophysiologic observation, the response to modified sham feeding can help identify those patients at greater risk of developing reflux esophagitis after esophageal dilatation.

Adolescent↗
PubMed1990

[Three-month subacute oral toxicity study of mofezolac (N-22) in dogs].

Mofezolac (N-22) is a new developed analgesic and anti-inflammatory agent. A subacute oral toxicity test of N-22 was carried out at dose-levels of 0, 2, 6 and 20 mg/kg/day using male and female beagle dogs. Treatment for 3 months was followed by 1 month recovery period except in the case of both sexes receiving 20 mg/kg/day. The results obtained from the present study were as follows. 1. Observation of general conditions revealed vomiting, sporadic bloody feces, anemia, recumbency and hyposthenia in both sexes receiving 20 mg/kg/day. Anemia or erosion of tongue was observed in each female receiving 6 mg/kg/day. 2. Respectively 3 dogs of both sexes receiving 20 mg/kg/day died during dosing period. In these animals, perforating ulcers were observed in the pars pylorica ventriculi or duodenum, and loss of blood, peritonitis and aggravation of general exhaustion were considered as causes of death. 3. Body weight tended to decrease in both sexes receiving 20 mg/kg/day, and food and water consumption levels decreased in males receiving 2 mg/kg/day or above and females receiving 2 mg/kg/day. 4. Urinalysis demonstrated an increasing tendency for specific gravity of urine and a decreasing tendency for urine volume in males receiving 2 mg/kg/day or above. 5. Hematological examination showed decreases in red blood cell count and Hb concentration in males receiving 2 mg/kg/day or above, and in Ht values in males receiving 6 mg/kg/day or above. 6. Serum biochemical examination revealed decreases in total protein and albumin in both sexes receiving 20 mg/kg/day. 7. There were no remarkable changes in hepatic and renal function, ophthalmological findings or electrocardiogram. 8. In the organ weights, significant decrease in thymus weights was observed in the dead animals receiving 20 mg/kg/day. 9. Pathologically, the dead animals receiving 20 mg/kg/day were found to exhibit peritonitis with perforating ulcers in the pars pylorica ventriculi or duodenum. In the surviving animals of this group, scar ulcers in the pars pylorica ventriculi and small intestine were evident on necropsy, and histopathology revealed neutrophils infiltration and thrombosis in blood vessels in the thickened submucosal stomach tissues. Moreover, localized hepatocyte necrosis and intrasinusoidal cellular infiltration in liver, as well as interstitial cellular infiltration, degeneration and dilatation of the renal tubules in the kidney were observed. In females receiving 6 mg/kg/day, the changes in kidney were similar to those in surviving animals receiving 20 mg/kg/day, and male of the group showed atrophy of thymus.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMedDate not supplied

Recurrence of gastric dilatation-volvulus after incisional gastropexy in a rottweiler.

An adult, castrated male rottweiler with a history of gastric dilatation-volvulus (GDV), which was treated 4 months previously by surgical gastric resection and incisional gastropexy, had a recurrence of clinical signs. Abdominal exploratory surgery revealed a 180 degrees -clockwise GDV, with a stretched adhesion at the original gastropexy site. The stomach was repositioned, and additional gastropexies were performed adjacent to the original gastropexy site and at the gastric fundus. The recurrence of GDV in this dog with an intact gastropexy suggested that a risk for volvulus remains after therapeutic incisional gastropexy.

Animals↗
PubMed1986

Reflex excitation and inhibition of the lower oesophageal sphincter induced by gastric distension in the cat.

Reflex responses of the lower oesophageal sphincter (l.o.s.) to distension of the stomach were studied by electromyographic and manometric techniques. Distension of the fundus and gastric antrum by inflation of a balloon elicited two types of reflex response of the l.o.s. Thus, whereas excitatory responses were recorded following slight distensions, larger distensions resulted in inhibitory responses. Splanchnic fibres and sympathetic fibres originating from the stellate ganglion, as well as vagal fibres served as the efferent pathways for the excitatory reflex response. The efferent pathways for the inhibitory response involved only vagal fibres.

Action Potentials↗
PubMed1980

[Histological and enzyme histochemical studies of intestinal interposition after total gastrectomy].

The formation of a stomach substitute with various intestinal interpolations (jejunum, ileocecum, colon) and the esophagojejunostomy by a Roux-anastomosis are carried through after total gastrectomy in animal experiments. The structural rebuilding proceedings in the intestinal interpolations were histologically and enzyme-histochemically examined after an experimental time of 3 months. A dilatation of the intestinal wall in connection with muscular wall hypertrophy appears in all operating method. In that way the reservoir function is guaranteed in the various stomach substitutes. The mucosa of the jejunal interpolation shows a hyperregeneratoric atrophy. A small enlargement of the surface originates in the colon interpolation from a villiferous conversion of the proximal parts of the crypts. The advance of the activity of the brush border enzymes in the ileocecum and the colon interpolation refers to an attempt of the mucosa on a change of the conditions of resorption. The essential pathogenetic factor of all rebuilding events appears in the intralumic environmental alteration in the intestinal interpolations.

Animals↗
PubMed2000

Effect of esophageal and gastric distention on bronchial hyper-responsiveness in patients with bronchial asthma.

OBJECTIVE: Over-eating is said to aggravate asthma though the mechanism is still unclear. We tried to study the mechanism by causing distention in oesophagus and stomach. METHODS: Fifteen patients with nocturnal asthma were studied in a random cross-over design. The esophagus and stomach of the subjects were distended with a balloon. The effect of the distention on the airways was measured by taking forced expiratory volume one second (FEV1), forced vital capacity (FVC) and bronchial hyper-responsiveness (BHR). RESULTS: Distention of stomach caused significant reduction in FEV1 on FEV1/FVC ratio but similar distention of esophagus did not. Histamine PD20 was decreased by 0.43 (SEM 0.28) doubling dose with gastric distention. However, with oesophageal distention no significant change was observed in PD20. CONCLUSION: It can be concluded that gastric distention leads to broncho-constriction as measured by FEV1, FEV1/FVC ratio along with increase in BHR probably by inducing airway inflammation. Therefore asthmatic patients should be advised to avoid large meals.

Adolescent↗