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At least 1,171 records · Page 65Linked to original sources
PubMed2000

Mallory-Weiss tear following cardiac surgery: transoesophageal echoprobe or nasogastric tube?

A case of fatal upper gastrointestinal bleeding from a Mallory-Weiss tear after transoesophageal echocardiography during cardiac surgery is reported. After the echo-cardiographic examination, which is considered a safe procedure, a nasogastric tube was inserted which immediately revealed bright red blood. Eventually the patient lost 9 litres of blood. The role of the echo-probe and the nasogastric tube in causing the Mallory-Weiss tear is discussed. Although this case is not conclusive about the mechanism of oesophageal damage, it is suggested that the safety recommendations for transoesophageal echocardiography also apply for instrumentation of the oesophagus with a nasogastric tube after the transoesophageal echocardiographic examination.

Aged↗
PubMed1987

The contribution of the stomach to ethanol oxidation in the rat.

To estimate the amount of ethanol that can be oxidized in the stomach, steady-state conditions were created in a group of fed rats by giving a loading dose of ethanol (2 g/kg body wt I.V.) followed by continuous infusion either intravenously or intragastrically. The rate of ethanol oxidation was calculated from the rate of infusion required to maintain steady blood levels of approximately 30 mM for at least 3 hours. Gastrointestinal ethanol concentrations and total contents also remained steady. The rate of ethanol oxidation was 19.3% faster during intragastric than during intravenous infusion (p less than 0.01). When measured at the prevailing luminal ethanol concentration (145 mM) and expressed per body weight, the gastric ADH activity represented 14% of the hepatic activity at 30 mM ethanol, suggesting that gastric ADH activity could account for most of the increased rate of oxidation when ethanol is given intragastrically. Thus, gastric ethanol oxidation by a high Km ADH in the rat represents a significant fraction of the total rate of ethanol oxidation and it is therefore one of the factors which determines the bioavailability of orally administered ethanol.

Alcohol Dehydrogenase↗
PubMed2006

Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study.

OBJECTIVE: To compare the efficacy and safety of early, nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with predicted severe acute pancreatitis (SAP). SUMMARY BACKGROUND DATA: In SAP, the magnitude of the inflammatory response as well as increased intestinal permeability correlates with outcome. Enteral feeding has been suggested superior to parenteral feeding due to a proposed beneficial effect on the gut barrier. METHODS: Fifty patients who met the inclusion criteria were randomized to TPN or EN groups. The nutritional regimen was started within 24 hours from admission and EN was provided through a nasogastric tube. The observation period was 10 days. Intestinal permeability was measured by excretion of polyethylene glycol (PEG) and concentrations of antiendotoxin core antibodies (Endocab). Interleukins (IL)-6 IL-8, and C-reactive protein (CRP) were used as markers of the systemic inflammatory response. Morbidity and feasibility of the nutritional route were evaluated by the frequency of complications, gastrointestinal symptoms, and abdominal pain. RESULTS: PEG, Endocab, CRP, IL-6, APACHE II score, severity according to the Atlanta classification (22 patients), and gastrointestinal symptoms or abdominal pain did not significantly differ between the groups. The incidence of hyperglycemia was significantly higher in TPN patients (21 of 26 vs. 7 of 23; P < 0.001). Total complications (25 vs. 52; P = 0.04) and pulmonary complications (10 vs. 21; P = 0.04) were significantly more frequent in EN patients, although complications were diagnosed dominantly within the first 3 days. CONCLUSION: In predicted SAP, nasogastric early EN was feasible and resulted in better control of blood glucose levels, although the overall early complication rate was higher in the EN group. No beneficial effects on intestinal permeability or the inflammatory response were seen by EN treatment.

Aged↗
PubMed1976

Inhibition of food intake in the rat following complete absorption of glucose delivered into the stomach, intestine or liver.

1. Solutions of glucose or other carbohydrates were administered during the dark or light period of the circadian cycle to rats which had been only briefly deprived of food. 2. food was restored to the animals at various times after administration of a glucose load by stomach tube. With delays between loading and access to food of up to 3 hr by night and 2 hr by day, subsequent food intake was less than intake after non-nutritive loads. 3. measurement of the glucose content of the gastrointestinal tract at various times after glucose loading showed that this depression of intake was still apparent even when the rat was offered food some time after complete absorption of the stomach load. 4. infusion of a glucose solution into the duodenum or the hepatic protal vein also inhibited subsequent food intake. 5. in all cases, the inhibition of food intake was expressed as a decrease in the size of the first meal after restoring access to food. 6. these results provide the first demonstration that the entry of normal amounts of carbohydrate into the body by the physiological route is followed by depression of food intake which lasts until after absorption is complete.

Animals↗
PubMedDate not supplied

Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel.

Percutaneous endoscopic gastrostomies are used most commonly for enteral feeding. We report the use of such gastrostomies for decompression of the obstructed gastrointestinal tract. Percutaneous endoscopic gastrostomies were performed on 53 patients over a 2-year period for gastrointestinal decompression because of gastric or small bowel obstruction. Forty-six patients had malignant obstruction from a primary abdominal or metastatic carcinoma and 7 patients had non-malignant obstruction or stasis. Gastrostomy for decompression was successful in 41 of 46 (89%) cases of malignant obstruction and in all 7 of the non-malignant cases. Tube utilization for decompression averaged 60 +/- 91 days. A 28 F tube with a 4-inch perforated intragastric portion was fashioned to maximize drainage. This efficient decompression tube allowed oral intake of liquids and soft foods in 88% of patients. Complications, which occurred in 4%, included one case of fatal peritonitis and one case of cellulitis.

Digestive System Neoplasms↗
PubMedDate not supplied

Intraoperative placement of the nasoenteric feeding tube: a practical alternative?

BACKGROUND: The provision of early postoperative enteral feeding may be enhanced by the placement of enteral feeding access during celiotomy, but surgeons are often reluctant to pursue this option because of the extra effort required. METHODS: We conducted a retrospective review of our 2-year experience with 60 sequential intraoperative nasoenteric feeding-tube placements and included data on demographics, diagnosis, surgery, type of feeding tube, formula, tolerance, and complications. Our surgeons placed intraoperative nasoenteric feeding tubes at their discretion in a variety of subjects who were undergoing elective or urgent celiotomies. RESULTS: The surgeries largely involved the upper gastrointestinal tract, and feeding-tube placements were readily accomplished. The majority of patients received enteral feedings within 3 postoperative days and achieved feeding rates of 50 mL/h or greater. The average duration of feeding-tube use was 1 week, accounting for 399 feeding days overall. There were no serious complications attributable to feeding-tube placement or use, but inadvertent tube removal by patients or staff was a limitation. CONCLUSIONS: Intraoperative placement of the nasoenteric feeding tube may be a reasonable option for treating the surgical patient at nutritional risk who faces a limited course of impaired oral intake postoperatively.

Adolescent↗
PubMed2001

Oral tolerance revisited: prior oral tolerization abrogates cholera toxin-induced mucosal IgA responses.

Oral delivery of a large dose or prolonged feeding of protein Ags induce systemic unresponsiveness most often characterized as reduced IgG and IgE Ab- and Ag-specific CD4(+) T cell responses. It remains controversial whether oral tolerance extends to diminished mucosal IgA responses in the gastrointestinal tract. To address this issue, mice were given a high oral dose of OVA or PBS and then orally immunized with OVA and cholera toxin as mucosal adjuvant, and both systemic and mucosal immune responses were assessed. OVA-specific serum IgG and IgA and mucosal IgA Ab levels were markedly reduced in mice given OVA orally compared with mice fed PBS. Furthermore, when OVA-specific Ab-forming cells (AFCs) in both systemic and mucosa-associated tissues were examined, IgG AFCs in the spleen and IgA AFCs in the gastrointestinal tract lamina propria of mice given OVA orally were dramatically decreased. Furthermore, marked reductions in OVA-specific CD4(+) T cell proliferative and cytokine responses in spleen and Peyer's patches were seen in mice given oral OVA but were unaffected in PBS-fed mice. We conclude that high oral doses of protein induce both mucosal and systemic unresponsiveness and that use of mucosal adjuvants that induce both parenteral and mucosal immunity may be a better way to assess oral tolerance.

Adjuvants, Immunologic↗
PubMed2001

Device for the removal of button batteries.

OBJECTIVE: There is an increasing number of accidents by erroneous ingestion of button batteries in recent years; the batteries arouse the interest of infants because of their attractive shape and luster. The batteries remaining in the gastrointestinal tract and discharging electric current over a long period of time may induce ulceration or perforation, thus must be carefully considered the selection of appropriate treatment. METHODS: We remove erroneously ingested button batteries with two tubes with ferrite magnets nearly the same size as the button batteries themselves. PATIENTS: Four cases of erroneous ingestion of button batteries. RESULTS: We easily removed button batteries from the stomach within 5 minutes in all cases with two magnet-attached tubes. CONCLUSION: We present this battery removal device together with a literature review, because it seems convenient and useful.

Equipment Design↗
PubMed2003

Pharmacokinetics and feeding responses to muramyl dipeptide in rats.

N-acetyl-muramyl-L-alanine-D-isoglutamine or muramyl dipeptide (MDP) is the minimally active subunit of bacterial peptidoglycan. During a systemic infection, the involvement of MDP has been demonstrated in food intake depression by the macrophage hydrolysis of Gram-positive bacteria. Under normal conditions, mammals are constantly exposed to the release of endogenous MDP from degraded gut flora and that of exogenous MDP from the diet. However, MDP digestion and absorption in the gastrointestinal tract are not fully understood, and their physiological significance needs to be clarified. After gavage (1.5 mg/kg), very low levels of MDP were found in the systemic circulation of rats and feeding patterns were not altered. In contrast, after the intraperitoneal injection of a similar dose, a depression in food intake was observed. The rats reduced their meal frequency and constant feeding rate, showing signs of satiety. The behavioral satiety sequence (BSS) was modified by behavioral changes, similar to those which appear during sickness, such as an increase in resting and a reduction in grooming. Our data suggest that the hypophagic effect of MDP may result from satiety and sickness behavior.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1987

A comparison of Levin and sump nasogastric tubes for postoperative gastrointestinal decompression.

Prospective analysis of the relative postoperative efficacy of Levin and sump nasogastric tubes was performed. One hundred cases using each tube were randomly selected. Operations in the two groups were similar. Mean output per hour from the tubes was close: 25.29 cc from Levin, and 26.56 cc from sump tubes. Analysis of variance showed no significant difference. There was a difference (P = .05 level) in hourly drainage from women patients, 20.49 cc from Levin, and 25.14 cc from sump tubes. There were no major complications attributable to the tubes. Output from tubes was usually low in early postoperative hours, rising steadily for the first 3 days. Drainage per nursing shift decreased throughout the day. Fever is associated with nasogastric tube use. In the absence of other etiology, a diagnosis of "tube fever" can be made. There is no difference in the clinical efficacy of Levin and sump tubes. There is no scientific basis for the prevalent use of sump tubes.

Abdomen↗
PubMed1985

The delivery of nutritional support. A potpourri of new devices and methods.

With continued interest and increasing awareness of nutritional support to patients, both hospitalized and at home, many new developments in the field of devices and methods of delivering nutritional support have occurred. The indications, methods of use, and the associated complications related to feeding via nasogastric tube, tube esophagostomy, gastrostomy, and jejunostomy in the light of new devices and methods are outlined. The authors' experience shows that postoperative enteral feeding is a reliable and efficient method of providing supportive nutrition, provided the appropriate patients are selected. Home enteral nutritional support via gastrostomy allows stable cancer patients to maintain their nutritional status and enjoy life independent of the hospital setting for an extended period of time. When feeding via the gastrointestinal tract is neither feasible nor desirable, for both short-term and long-term nutritional support, access to the central venous system becomes necessary because peripheral vein feeding has limited cost-effectiveness. Delivery of nutrients into the superior vena cava by long antecubital catheters has been advocated, and the use of Hickman/Broviac catheters, instead of conventional subclavian catheters, is becoming an increasingly common practice. Experience with the use of arteriovenous fistulae and the Infuse-A-Port (Infusaid Corp.) are reviewed; the method used for declotting infected and thrombosed catheters is outlined. Current trends in the use of three-liter bags containing a fat emulsion with glucose and amino acids are mentioned.

Arm↗
PubMed1998

Food intake responses to upper gastrointestinal lipid infusions in humans.

Previous studies in humans and animals have shown that the presence of lipid in the small intestine can reduce food intake. Studies that have combined intraduodenal lipid infusions with gastric distension produced a greater reduction in food intake than when these two stimuli were separated. In this study, subjects received duodenal lipid (Intralipid 20%) infusions for varying periods before and during the consumption of a liquid test meal. The aim of this procedure was to maximise the interaction between intestinal nutrient stimulation and gastric distension. A dose-dependent decrease in food intake was observed that corresponded to the duration of infusion; 90- (180 kcal) and 45-min (90 kcal) infusions but not 15-min (30 kcal) infusions significantly reduced intake compared to saline. These results show that concomitant intestinal nutrient stimulation and gastric distension is an effective test for the measurement of suppression of food intake by intestinal nutrients.

Adult↗
PubMed1987

Mechanism of hypocalcemia induced by intraperitoneal, intragastric, and intravenous administration of ethanol to the rat.

Acute hypocalcemic effects of intraperitoneal administration of 3 and 5 g ethanol/kg body weight; intragastric administration of 3, 5, and 7 g ethanol/kg body weight; and intravenous administration of 2.5 a ethanol/kg body weight were investigated in 20 h fasted female Wistar rats. Dose-dependent hypocalcemia was similarly induced by intraperitoneal and intragastric routes of administration. Net calcium efflux from plasma, as indicated by the plasma 45Ca activity, was unaffected by 3 g ethanol/kg body weight but was delayed at higher doses of ethanol. Intragastric, but not intraperitoneal, administration of ethanol increased the gastrointestinal luminal calcium content partly by enhancing calcium secretion. Significantly increased tissue 45Ca content 30 min after ethanol administration was evident in the duodenum (31%), jejunum (27%), and colon (33%) in the intragastric ethanol-treated group and in the duodenum (40%), jejunum (38%), ileum (45%), colon (39%), and liver (25%) in the intraperitoneal ethanol-treated group. Thus, the hypocalcemia induced by both intraperitoneal and intragastric administration of ethanol could be partly accounted for by the suppression of calcium efflux from some soft tissues. In contrast, intravenous administration of ethanol was found to enhance the calcium efflux from plasma without affecting the net 45Ca content in the soft tissues. The mechanism(s) by which ethanol affects calcium transport has yet to be elucidated.

Animals↗
PubMed2006

Enteral granulocyte colony-stimulating factor for the treatment of mild (stage I) necrotizing enterocolitis: a placebo-controlled pilot study.

BACKGROUND/PURPOSE: The presence of granulocyte colony-stimulating factor (G-CSF) in human milk and the expression of G-CSF receptors on intestinal villous enterocytes of neonates suggest that G-CSF has a role in the development and integrity of the gastrointestinal tract. We hypothesized that enteral recombinant human G-CSF (rhG-CSF) given to preterm infants with necrotizing enterocolitis (NEC) in the earlier stages could protect against disease progression and complications. METHODS: Preterm infants with mild (stage I) NEC (n = 18) were assigned to receive enteral rhG-CSF (n = 8) or placebo (n = 10) for 5 days from the first day of the diagnosis. Clinical and gastrointestinal parameters were followed during the whole period of hospitalization. RESULTS: In the study group, none of the infants with stage I NEC had a clinical progression to stage II or III, whereas in the control group, 5 (50%) infants with stage I NEC had a disease progression to stage II or III (P < .05). In the study group, the time required for the resolution of clinical and radiological findings of NEC and the total duration of systemic therapy and hospitalization were significantly shorter than the control group (P < .001). CONCLUSION: Enteral rhG-CSF treatment could prevent the progression of mild (stage I) NEC to further stages and decrease the time required for the resolution of clinical and radiological signs of the disease.

Disease Progression↗
PubMed1987

Small bowel radiography: how, when, and why?

Since the advent of endoscopy for evaluating the upper and lower gastrointestinal (GI) tracts, it has become clear that only in the small bowel does barium radiography remain unchallenged. Regrettably, barium examination of the small bowel has traditionally been regarded by many radiologists as a study of minor importance. Small bowel follow-through techniques and enteroclysis methods differ in their diagnostic purpose, potential, and methods of performance. This review examines in detail the spectrum of barium examination techniques currently available for evaluating the small bowel. The benefits of enteroclysis in the majority of clinical situations requiring contrast examination of the small bowel are stressed. Radiologists play the crucial role in the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of small bowel radiography.

Administration, Oral↗
PubMed1994

[Use of a gastrointestinal tube in the treatment of gastric and duodenal ulcer].

The trial of a gastrointestinal tube in gastroduodenal ulcer indicates its high efficiency for enteral tube feeding in serious ulcer cases and as a therapeutic modality in noncomplicated cases. The tube introduction in 55 patients out of 89 promoted the defect healing within 2-3 weeks, in 30 out of 36 cicatrization occurred on week 3-5. The presence of the tube produced no effect on acid production in the stomach, cicatrization of the ulcer took place without basic therapy in remaining hypo-achlorhydria and hyperchlorhydria. Clinico-endoscopic evidence and data on gastroduodenal motility and evacuation suggest the conclusion on the neuro-reflex mechanism of the tube action which eliminates painful syndrome and motor-evacuatory abnormalities which are believed essential in pathogenesis of peptic ulcer.

Adult↗
PubMed2007

Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial.

BACKGROUND: Nasogastric decompression has been routinely used in most major abdominal operations to prevent the consequences of postoperative ileus. The aim of the present study was to assess the necessity for routine prophylactic nasogastric or nasojejunal decompression after gastrectomy. METHODS: A prospective randomized trial included 84 patients undergoing elective partial or total gastrectomy. The patients were randomized to a group with a postoperative nasogastric or nasojejunal tube (Tube Group, n = 43) or to a group without a tube (No-tube Group, n = 41). Gastrointestinal function, postoperative course, and complications were assessed. RESULTS: No significant differences in postoperative mortality or morbidity, especially fistula or intra-abdominal sepsis, were observed between the groups. Passage of flatus (P < 0.01) and start of oral intake (P < 0.01) were significantly delayed in the Tube Group. Duration of postoperative perfusion (P = 0.02) and length of hospital stay (P = 0.03) were also significantly longer in the Tube Group. Rates of nausea and vomiting were similar in the two groups. Moderate to severe discomfort caused by the tube was observed in 72% of patients in the Tube Group. Insertion of a nasogastric or nasojejunal tube was necessary in 5 patients in the No-tube Group (12%). CONCLUSIONS: Routine prophylactic postoperative nasogastric decompression is unnecessary after elective gastrectomy.

Aged↗
PubMed1999

A novel approach to ring-type foreign body removal: the "U-wire".

BACKGROUND: Foreign body ingestions are common, especially in pediatric, edentulous, psychiatric, and incarcerated populations. For the 20% of foreign bodies that do not pass spontaneously through the gastrointestinal tract, removal using modern, flexible endoscopes has become routine. METHODS: We describe the successful endoscopic removal of a ring-type or "closed loop" foreign body by means of a novel technique. Utilizing a nasogastric tube inserted alongside the endoscope, a guidewire inserted through the tube is directed through the ring with a "rat-tooth" grasping forceps passed through the accessory channel of the endoscope. The wire is snared and pulled up through the endoscope creating a "U," with both ends of the wire outside of the patient. The nasogastric tube, endoscope, and foreign body may then be removed safely. RESULTS: The technique was easy to perform and the foreign body was removed without complication. CONCLUSIONS: Using the U-wire technique, ring-type foreign bodies may be readily and safely removed.

Adult↗