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PubMed1997

Charcoal deposits in the esophageal and gastric mucosa.

We report the case of a 75-yr-old woman referred for gastrointestinal endoscopy to investigate severe iron deficiency anemia. Black linear lesions were observed in the distal esophagus and stomach. Biopsies revealed aggregates of coarse black foreign material, which was later identified as charcoal. The patient's previous medical history included an antidepressant overdose 5 yr before the current admission. The patient had a gastric lavage, using a large bore orogastric tube, followed by the administration of activated charcoal. The patient had no other history of charcoal ingestion. We propose that the charcoal became entrapped in mucosal tears caused by the traumatic intubation 5 yr previously, causing the incidental mucosal tattooing seen at endoscopy.

Aged↗
PubMed1977

Postgastrostomy deformity of the stomach.

Temporary postoperative tube gastrostomy may produce permanent deformity of the stomach as visualized on an upper gastrointestinal series. Six cases were studied illustrating two configurations of the gastric deformity. These appear to be related to the location of the gastrostomy opening in the stomach. The findings were either anterior displacement of the gastric antrumwith adherence to the anterior abdominal wall or acute angulation of the gastric body in a medial and anterior direction.

Gastrostomy↗
PubMed1997

Duodenal obstruction in thyroid storm.

A 35-year-old, previously healthy woman, known to be thyrotoxic, was transferred from a community hospital for "acute abdomen." Abdominal pain, distention, and hyperemesis resolved with placement of nasogastric tube (NGT) and return of 2,600 mL of bilious fluid. Continued high NGT output made oral or NGT administration of antithyroid drugs impossible. We gave propylthiouracil (PTU) by retention enemas with therapeutic serum levels and sublingual saturated solution of potassium iodide (SSKI) with 70% absorption based on 24-hour free iodine urinary excretion. The patient's thyroxine (T4) and triiodothyronine (T3) radioimmunoassays were normal on hospital days 10 and 12, respectively. However, free T4 and T3 resin uptake did not normalize until hospital day 31. On hospital day 32, she tolerated removal of NGT without nausea and 4 days later was taking a regular diet. We conclude that our patient's gastrointestinal symptoms were a prominent feature of her thyrotoxicosis and that rectal PTU and sublingual SSKI are effective in administration of antithyroid drugs.

Abdomen, Acute↗
PubMed1987

Intact biliary excretion of gastrically administered prostaglandin F2 alpha in rats: developmental differences.

Tritium-labeled prostaglandin F2 alpha was administered via orogastric tube to bile duct-cannulated suckling and weanling rats to determine if maturational differences were present in the biliary excretion of prostaglandin F2 alpha and metabolites. Animals were killed 2 h after radioactivity administration. Characterization of radioactivity present in bile revealed age-related differences in biliary prostaglandin F2 alpha excretion. Suckling rats had a greater proportion of radioactivity migrating in chromatographic regions of greater polarity than prostaglandin F2 alpha. Compared with the weanling, a significantly greater amount of radioactivity cochromatographed with intact, unmetabolized prostaglandin F2 alpha (33.08 +/- 1.99 vs. 21.38 +/- 1.46). These results indicate that orogastrically administered prostaglandin F2 alpha can be absorbed from the gastrointestinal tract, transported to the liver, and subsequently excreted into bile and detected in an unmetabolized form in suckling and weanling rats. The enterohepatic circulation of milk-derived prostaglandin present in bile may contribute to the overall content of intestinal prostaglandins.

Age Factors↗
PubMed2006

Dose-independent pharmacokinetics of metformin in rats: Hepatic and gastrointestinal first-pass effects.

Pharmacokinetic parameters of metformin were evaluated after intravenous and oral administration (50, 100, and 200 mg/kg) in rats. The hepatic, gastric, and intestinal first-pass effects were also measured after intravenous, intraportal, intragastric, and intraduodenal administration (100 mg/kg) in rats. The total area under the plasma concentration-time curve from time zero to time infinity (AUC) values were dose-proportional after both intravenous and oral dose ranges studied. After oral administration (100 mg/kg), approximately 4.39% of oral dose was not absorbed and extent of absolute oral bioavailability (F) value was approximately 29.9%. The gastrointestinal first-pass effect of metformin was approximately 53.8% of oral dose in rats (the gastric and intestinal first-pass effects were approximately 23.1 and 30.7%, respectively), and the hepatic first-pass effect was approximately 27.1% after absorption into the portal vein. Since approximately 41.8% of oral metformin was absorbed into the portal vein, the value of 27.1% is equivalent to 11.3% of oral dose. The first-pass effects of metformin in the lung and heart were almost negligible in rats. The low F value of metformin in rats was mainly due to considerable gastrointestinal first-pass effects. The stability of metformin, distribution of metformin between plasma and blood cells, and factors affecting protein binding of metformin to 4% human serum albumin were also discussed.

Administration, Oral↗
PubMed1993

Oral ranitidine as prophylaxis for gastric stress ulcers in intensive care unit patients: serum concentrations and cost comparisons.

OBJECTIVES: a) To determine whether enteral ranitidine in intensive care unit (ICU) patients would produce serum levels that would reduce stimulated gastric acid by > or = 50%, and b) to evaluate the differences in cost between enteral and parenteral administration of ranitidine. DESIGN: Prospective, nonrandomized clinical trial. SETTING: A surgical ICU in a public primary teaching hospital for a medical school. PATIENTS: Postoperative or posttraumatic surgical patients who met one or more main criteria for stress. INTERVENTIONS: Two groups of patients were given ranitidine through a nasogastric tube. Group 1 (n = 10) received 150 mg every 12 hrs, and group 2 (n = 8) received 300 mg every 12 hrs. MEASUREMENTS AND MAIN RESULTS: Serum samples for measurement of ranitidine concentrations were collected at 2, 6, and 12 hrs after the fifth dose of oral ranitidine. Patients were monitored for upper gastrointestinal bleeding. All patients had therapeutic serum ranitidine concentrations at 2 and 6 hrs, while 88% of patients had therapeutic levels at 12 hrs. CONCLUSIONS: a) Enteral administration of ranitidine every 12 hrs leads to effective absorption of the drug from the upper gastrointestinal tract of ICU patients. b) Serum concentrations of ranitidine for both 150-mg and 300-mg enteral doses remained within, or exceeded, the therapeutic range in > 90% of ICU patients with clinically important criteria of stress.

Administration, Oral↗
PubMed1997

Necrotizing enterocolitis: diagnosis with CT examination of urine after enteral administration of iodinated water-soluble contrast material.

PURPOSE: To develop a new method for diagnosing necrotizing enterocolitis with use of computed tomography (CT). MATERIALS AND METHODS: Urine specimens from 22 neonates were obtained 8-12 hours after iohexol was administered enterally. Twelve neonates had suspected (n = 5) or definite (n = 7) necrotizing enterocolitis, and 10 neonates without necrotizing enterocolitis underwent routine upper gastrointestinal study. Urine from another 13 neonates without necrotizing enterocolitis who did not receive iohexol was collected. The attenuation coefficient of each urine specimen was determined with CT. RESULTS: The mean CT attenuation coefficient of urine from neonates who did not receive iohexol was 5.6 HU +/- 3.9, and that from neonates without necrotizing enterocolitis who underwent upper gastrointestinal study was 6.7 HU +/- 3.2. The mean CT attenuation coefficient of urine from patients with suspected necrotizing enterocolitis was 26.0 HU +/- 3.4, and that in patients with definite necrotizing enterocolitis was 71.0 HU +/- 18.8. The mean CT attenuation coefficients in neonates with necrotizing enterocolitis were significantly different from that in patients without necrotizing enterocolitis who underwent upper gastrointestinal study. CONCLUSION: Urine from neonates with necrotizing enterocolitis show significantly higher CT attenuation coefficients than those from patients without necrotizing enterocolitis. CT examination of urine may allow early detection of necrotizing enterocolitis.

Administration, Oral↗
PubMed2006

Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy.

AIM: To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS: Three hundred and sixteen patients submitted to operations associated with colorectostomy from January 2004 to September 2005 were randomized to two groups: In experimental group (n=161), the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding; In control group (n=155), the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastomotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS: The median and average days to the first passage of flatus (3.0+/-0.9 vs 3.6+/-1.2, P<0.001), the first passage of stool (4.1+/-1.1 vs 4.8+/-1.4, P<0.001) and the length of postoperative stay (8.4+/-3.4 vs 9.6+/-5.0, P<0.05) were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage (1.24% vs 2.58%), acute dilation of stomach (1.86% vs 0.06%) and wound complications (2.48% vs 1.94%) were similar in the groups, but fever (3.73% vs 9.68%, P<0.05), pulmonary infection (0.62% vs 4.52%, P<0.05) and pharyngolaryngitis (3.11% vs 23.23%, P<0.001) were much more in the control group than in the experimental group. CONCLUSION: The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.

Adult↗
PubMedDate not supplied

Acid-suppression profile of two continuously infused intravenous doses of cimetidine.

The effect of two doses (37.5 mg/hr and 50 mg/hr) of continuously infused cimetidine on gastric acid secretion and pH control over 24 hours was compared with that of placebo in 21 adult males with active duodenal ulcer or scarring from healed duodenal ulcer. This single-center, double-blind, three-way crossover trial consisted of three treatment periods separated by 5- to 7-day washout periods. Gastric contents were continuously aspirated through a nasogastric tube during the second half of each study hour. Volume, pH, and titratable acidity were measured from the aspirates collected during the last 20 minutes of each aspiration period. The median pH, volume (ml), and titratable acidity (mEq/hr) values for the 37.5-mg/hr infusion were 5, 16.0, and 0.24, respectively (P < 0.05 versus placebo). For the 50-mg/hr infusion, the respective values were 5.3, 15.8, and 0.14 (P < 0.05 versus placebo); and for placebo, the values were 1.4, 30.5, and 6.83. The median percent of time that the pH was > or = 4 was 65%, 65%, and 0% for the 37.5-mg/hr, 50-mg/hr, and placebo infusions, respectively (P < 0.05 versus placebo). The 37.5-mg/hr and 50-mg/hr intravenous doses of continuously infused cimetidine are commonly used in the hospital setting to treat intractable ulcers or prevent upper gastrointestinal bleeding in critically ill patients. The results of this study demonstrate that both doses are similarly effective in maintaining intragastric pH and acid secretion at levels generally recognized as being effective.

Adolescent↗
PubMed2002

Metoclopramide for migration of naso-enteral tube.

BACKGROUND: Enteral alimentation by feeding tube is a common problem and an efficient method of providing nutritional support to hospitalized patients with insufficient oral intake, but adequate gastrointestinal function. The use of metoclopramide, a prokinetic agent, has been recommended to achieve transpyloric placement, but its efficacy is controversial. OBJECTIVES: To determine the effect of intravenous metoclopramide on transpyloric passage of the naso-enteral tube. SEARCH STRATEGY: Relevant RCTs were identified by electronic search through MEDLINE, EMBASE, LILACS and the Cochrane Controlled Trials Register databases. SELECTION CRITERIA TYPES OF PARTICIPANTS: Adults needing enteral nutrition. Types of intervention: Intravenous or intramuscular metoclopramide compared to placebo or no intervention. Types of studies: Randomised controlled trials. Types of outcome measures: The success of migration of transpyloric intubation. DATA COLLECTION AND ANALYSIS: The reviewers evaluated the allocation concealment, which was classified as adequate, uncertain or inadequate. Two reviewers extracted the data independently. All analyses were performed according to the intention-to-treat method. MAIN RESULTS: Four studies were included and analysed. There was no statistically significant difference between intravenous or intramuscular metoclopramide administered to promote the tube migration (OR 0.65, 95% CI 0.33 to 1.28). Intravenous metoclopramide 10 mg (OR 0.68, 95% CI 0.37 to 1.23) and 20 mg (OR 0.27, 95% CI 0.01 to 10.84) were equally ineffective in facilitating transpyloric intubation. REVIEWER'S CONCLUSIONS: Four studies were included and analysed. There was no statistically significant difference between intravenous or intramuscular metoclopramide administered to promote the tube migration (OR 0.65, 95% CI 0.33 to 1.28). Intravenous metoclopramide 10 mg (OR 0.68, 95% CI 0.37 to 1.23) and 20 mg (OR 0.27, 95% CI 0.01 to 10.84) were equally ineffective in facilitating transpyloric intubation.

Antiemetics↗
PubMed1995

[Study of the length of the installed gastric tube for children].

The purpose of this study was to find the proper measurement of the length of gastric tube for children preoperatively. The author found that the tube can only reach the cardia of stomach by routine measurement and can not achieve the purpose of gastrointestinal decompression. This study was done to 34 patients. The length of the inserted gastric tube was measured by the distance from the hair border of the middle forehead to the umbilicus. The tube was confirmed to reach the body of stomach during surgery and can reduce gastro-intestinal pressure effectively after operation.

Child↗
PubMed1993

Small bowel obstruction after abdominal aortic surgery.

Early postoperative small bowel obstruction (SBO) is a known complication of intestinal surgery, but its frequency, etiology, and morbidity after abdominal aortic procedures have not been reported. To study this complication, the records of 1475 patients who had an abdominal aortic operation for aneurysmal (n = 818) or occlusive (n = 657) disease on a private surgical service from 1963 to 1990 were reviewed. Forty-four patients (2.9%) developed a postoperative SBO. Small bowel obstruction occurred from 4 to 28 (mean 6) days postoperatively. All patients were treated with nasogastric suction. Eighteen of the 44 (41%) required reoperation from 6 to 30 (mean 14.2) days after the initial aortic procedure. All 18 had lysis of adhesions, and two required small bowel resections. There were no bowel infarctions and no late graft infections. Overall mortality was 5 per cent, and morbidity was 16 per cent. Incidence of pancreatitis in the entire series was 0.5 per cent, and incidence of colonic ischemia in the aneurysm group was 0.9 per cent. We conclude that 1) Early postoperative small bowel obstruction is an unusual complication of aortic surgery but is more frequent than other gastrointestinal complications such as intestinal ischemia and pancreatitis; 2) Management principles are similar to those for early postoperative bowel obstruction following other procedures; 3) Reoperation is required in nearly half of patients, particularly when SBO does not resolve within 2 weeks.

Adult↗
PubMed1997

Gastric tubes, meals, acid, and analysis: rise and decline.

The stomach tube was first used to administer food and medication or to remove poisonous substances. Later, it served to aspirate the stomachs of patients with gastric retention. Chemical analysis of stomach contents after a meal was first suggested in 1871 and quickly became an important laboratory procedure as various test-meal stimuli and more flexible tubes were developed. Quantitative estimations of free and total acidity were made by titration with 0.01 mol/L sodium hydroxide and specific indicators. Pentagastrin has supplanted secretagogues such as histamine and betazole; meal stimulation, tubeless tests, and other tests of gastric secretion are no longer used clinically. Tests of gastric acid secretion have been used in the diagnosis of upper gastrointestinal lesions and to help select the type of surgical procedure for gastric and duodenal ulcers, but the tests have decreased in importance because of their limited diagnostic sensitivity and specificity. Today, fiberoptic endoscopy is replacing gastric analysis as well as radiologic examination.

Food↗
PubMed1999

Effect of doxapram on episodes of apnoea, bradycardia and hypoxaemia in preterm infants.

AIM: To study the effect of doxapram on the frequency of apnoea, bradycardia and hypoxaemia. METHODS: Fifteen infants, median gestational age at birth 27 weeks (range 24-30), age at study 27 days (12-60), with >/=6 episodes of bradycardia or hypoxaemia/6 h despite serum caffeine levels in the therapeutic range, received doxapram either intravenously (0.5-2 mg/kg/h) or orally (2-8 mg/kg every 2 h). Six-hour recordings of pulse oximeter saturation (S(P)O(2)), pulse waveforms, ECG, breathing movements and nasal airflow were performed immediately before as well as 1, 3 and 6 days after onset of treatment. Recordings were analysed for apnoea (>/=4 s), bradycardia (heart rate < 2/3 of baseline) and hypoxaemia (S(P)O(2) </=80%). RESULTS: There was no difference between enteral and intravenous administration; results are therefore presented for the total group. Doxapram resulted in a significant decrease in the frequency of apnoea [22 (11-27) vs. 14 (7-23)/h, p < 0.01], bradycardia [3 (0-7) vs. 1 (0-3)/h, p < 0.01] and hypoxaemia [8 (0-18) vs. 2 (0- 17)/h, p < 0.01] already after 1 day of treatment, which was sustained throughout the 6-day study period. Side effects included an increase in the proportion of time spent awake [5 (0-24) vs. 12% (3-28), p < 0.01] and in gastric residuals [0% of feeding volume (0-5) vs. 4% (0-19), p < 0.05]. Enteral was switched to intravenous doxapram in 3 of 9 infants because of gastrointestinal side effects. CONCLUSION: Doxapram substantially reduced the frequency of apnoea, bradycardia and hypoxaemia in these patients with caffeine-resistant apnoea of prematurity. Enteral administration, however, was not tolerated in a significant proportion (33%) of infants.

Apnea↗
PubMedDate not supplied

Measures to test placement of nasogastric and nasointestinal feeding tubes: a review.

A literature review regarding commonly recommended bedside measures to test nasogastric and nasointestinal feeding tube placement is presented in this article. Among the methods discussed are: aspiration of recognizable gastrointestinal contents, auscultation of insufflated air, measurement of pH of gastrointestinal secretions, and observing for coughing and choking, inability to speak, and the appearance of bubbles from the end of the tube when it is held under water. Fallibilities in these methods as well as discrepancies in recommendations for their implementation and interpretation are discussed along with implications for current practice and needed areas for research.

Auscultation↗
PubMedDate not supplied

Primary infantile hypomagnesaemia: outcome after 21 years and treatment with continuous nocturnal nasogastric magnesium infusion.

UNLABELLED: Primary infantile hypomagnesaemia is an infrequent cause of neonatal hypocalcaemic seizures but one that responds well to magnesium supplementation. We describe a 22-year-old male, first reported at 4 months of age, who is currently free of neurological deficit but has suffered from intermittent hypomagnesaemic tetany and chronic diarrhoea due to large oral magnesium supplements. Hypothesizing that modest hypercalcaemia might prevent the tetany, we conducted a trial of 5 microg/day 1,25(OH)2D3 over 5 days. Despite the resultant increase in calcium, he developed tetany with the reduction of magnesium intake and decline of serum magnesium from 0.63 to 0.39 mmol/l (normal >0.65 mmol/l). After 1,25(OH)2D3 was stopped and the parenteral magnesium injections suspended, 33% of his usual oral supplement was given instead by continuous nasogastric infusion and serum magnesium rose to 0.60 mmol/l. This regimen was better tolerated because of decreased gastrointestinal side-effects and freedom from parenteral injections. We observed that 1,25(OH)2D3 supplements do not promote magnesium retention nor does the resultant hypercalcaemia prevent hypomagnesaemic tetany. CONCLUSION: Continuous nocturnal nasogastric infusion may be considered in lieu of parenteral therapy in primary infantile hypomagnesaemia.

Administration, Oral↗
PubMed1985

Enteral feeding--a practical approach.

Many patients in large hospitals require nutritional support to avoid the increased morbidity and mortality associated with malnutrition. Parenteral nutrition has been used for more than fifteen years but is expensive and can be hazardous. Most hospital patients requiring nutritional support can be fed through the gastrointestinal tract. Enteral nutrition can be delivered safely and cheaply orally or by tubes temporarily implanted. We outline a simple step approach from oral nutrition using a palatable, inexpensive, chemically defined, complete diet to jejunal nutrition using an implanted feeding tube and an 'elemental' dietary supplement: oral first, enteral next, parenteral when necessary.

Critical Care↗