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Mechanism of histamine-induced excitation of the cat pylorus.

Intravenous histamine causes high amplitude repetitive phasic contractions of the in vivo cat pylorus but has little effect on the antrum and duodenum. The genesis of this phasic response was studied using a pinned perfused catheter with openings at the pylorus, antrum, and duodenum. 2-Pyridylethylamine, an H1 agonist, produced phasic contractions similar to histamine whereas dimaprit, an H2 agonist, did not. Conversely, histamine-induced excitation is competitively antagonized by the H1 inhibitor diphenhydramine but not by the H2 inhibitor cimetidine. Thus histamine excitation is mediated through H1 receptor stimulation. Tetrodotoxin caused inhibition of the histamine response indicating that pyloric excitation is partly mediated through a neural pathway. To identify the nature of this pathway adrenergic and cholinergic blockers were used. Atropine, hexamethonium, and propranolol had no effect on the histamine response. Phentolamine and reserpine increased the magnitude of the histamine response. Conversely, phenylephrine blocked the histamine response. We conclude: histamine induces high phasic contractions in the pylorus; this effect is mediated through neural (nonadrenergic noncholinergic) and myogenic H1 receptors; alpha adrenergic stimulation inhibits the histamine response and alpha adrenergic blockade and catecholamine depletion increase it.

Animals↗

Role of lipid peroxidation in gastric mucosal lesions induced by ischemia-reperfusion in the pylorus-ligated rat.

The peroxidation of lipids and changes in the activities of related enzymes, such as xanthine-xanthine oxidase (XOD), superoxide dismutase (SOD), and glutathione peroxidase (GSH-px) in the gastric mucosa were studied in rat model of ischemia-reperfusion with pylorus ligation. Myeloperoxidase (MPO), a marker enzyme of leucocytes, was also studied. Thiobarbituric acid reactive substances (TBA RS) in gastric mucosa were significantly increased by clamping the celiac artery for 30 min and reperfusion for 60 min after 3 h of pylorus ligation. XOD activity in gastric mucosa increased with the development of gastric mucosal injury. Allopurinol significantly suppressed XOD activity but did not inhibit mucosal injury or the increase in TBA RS. MPO activity in the gastric mucosa was significantly increased by gastric mucosal injury. Famotidine significantly inhibited the increase in MPO activity in gastric mucosa, while allopurinol did not. SOD and GSH-px activities in the gastric mucosa were decreased significantly by gastric mucosal injury. SOD activity was normal following treatment with famotidine and allopurinol. Moreover, GSH-px activity recovered to the normal level with famotidine and allopurinol treatment. These findings suggest that oxygen radicals and lipid peroxidation can cause gastric mucosal injury by ischemia-reperfusion in the pylorus-ligated rat. The generation of oxygen free radicals may be derived mainly from activated polymorphonuclear leukocytes (PMN), and the decrease in SOD and GSH-px activity in gastric mucosa seems to aggravate mucosal injury by free radicals and lipid peroxidation.

Allopurinol↗

Comparative evaluation of the role of endogenous gastrin in basal acid secretion in conscious rats provided with chronic fistula and pylorus ligation.

We determined the relative contributions of endogenous gastrin, histamine and cholinergic tone to basal acid secretion in chronic fistula rats. Results were compared with those for acid secretion in pylorus-ligated rats. In chronic fistula rats, YM022 ¿(R)-1-[2,3-dihydro-1-(2'-methylphenacyl)-2-oxo-5-phenyl-1 H-1,4-benzodiazepin-3-yl]-3-(3-methylphenyl)urea¿ dose-dependently inhibited pentagastrin-stimulated acid secretion and abolished this secretion at 1 mumol/kg, s.c., but did not affect histamine- and carbachol-induced acid secretion even at 10 mumol/kg. In contrast, famotidine at 1 mumol/kg completely inhibited not only the acid secretion induced by histamine but also those by pentagastrin and carbachol. Furthermore, atropine abolished carbachol- and pentagastrin-stimulated acid secretion and significantly suppressed histamine-stimulated acid secretion at 0.1 mumol/kg. YM022 dose-dependently inhibited basal acid secretion. The YM022 dosage required to inhibit basal acid secretion is consistent with that required to suppress pentagastrin-induced acid secretion. Famotidine (1 mumol/kg) and atropine (0.1 mumol/kg) also abolished basal acid secretion. In pylorus-ligated rats, YM022 inhibited acid secretion in a dose-dependent manner; the inhibition at 1 mumol/kg, i.v. was 65%. No additional effect was observed when rats were dosed at 30 mumol/kg. Famotidine partially inhibited acid secretion in these rats, whereas atropine abolished this secretion. These results indicate that the major part of basal acid secretion in rats is attributable to endogenous gastrin via histamine- and cholinergic tone-dependent pathways. Moreover, pylorus ligation reduces the relative contribution of gastrin to acid secretion due to the activation of cholinergic tone.

Animals↗

Double channel pylorus.

Radiographic and clinical features in five patients with the double channel pylorus deformity are reviewed and compared with previously reported cases. The double channel pylorus is a form of gastroduodenal fistula with a characteristic radiographic appearance. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb. A peptic ulcer lies in or immediately adjacent to the accessory channel in almost all cases. The double channel pylorus appears to be an acquired form of peptic deformity in the great majority of cases and is probably more common than the number of reported cases would imply.

Aged↗

The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus.

OBJECTIVE: Gastroparesis is a disorder of delayed gastric emptying that is often chronic in nature. Up to 50% of type 1 diabetic subjects have symptoms of gastroparesis, which include nausea, vomiting, and early satiety. Elevated pyloric pressures may be responsible for delayed gastric emptying in diabetic subjects. Botulinum toxin inhibits the release of acetylcholine and produces transient paralysis when injected into smooth muscle. The aim of this study was to determine whether injection of the pylorus with botulinum toxin in patients with diabetic gastroparesis improves symptoms of gastroparesis, alters gastric emptying scan time, and/or changes weight and insulin use. RESEARCH DESIGN AND METHODS: This was an open-label trial with age- and sex-matched control subjects from a tertiary care referral center for patients with gastroparesis. Eight type 1 diabetic subjects (six women and two men; mean age 41 years; mean years with diabetes 25.3) who had failed standard therapy were enrolled. Intervention consisted of injection of the pylorus with 200 units of botulinum toxin during upper endoscopy. Symptoms, antropyloric manometry, gastric emptying scan times, weight, and insulin use were all recorded before intervention and during a 12-week follow-up period. RESULTS: Seven of the eight patients completed the full 12-week follow-up period. No complications were noted. Mean symptom scores declined from 27 to 12.1 (P < 0.01), whereas the SF-36 physical functioning domain also improved (P < 0.05). Four patients noted an increase in insulin use of >5 units/day. Six of the seven patients gained weight (P = 0.05). Gastric emptying scan time improved in four patients. CONCLUSIONS: Botulinum toxin injection of the pylorus is safe and improves symptoms in patients with diabetic gastroparesis. These results warrant further investigation with a large, double-blind, placebo-controlled trial.

Adult↗

Distribution of heme oxygenase-2 in nerves and interstitial cells of Cajal in the normal pylorus and in infantile hypertrophic pyloric stenosis.

CONTEXT: Interstitial cells of Cajal (ICCs) are pacemaker cells, which are of fundamental importance in regulating gastrointestinal motility. Recent evidence suggests that carbon monoxide is a neurotransmitter involved in neurotransmission between ICC and smooth muscle cells. Heme oxygenase-2 (HO-2) is the major physiological mechanism for the generation of carbon monoxide in the enteric nervous system. OBJECTIVE: To investigate the immunocolocalization of HO-2 and ICCs in the normal pylorus and in infantile hypertrophic pyloric stenosis (IHPS). DESIGN: Specimens from 18 infants with IHPS and 8 control specimens were examined using double-immunostaining with c-Kit and HO-2 antibodies. The immunolocalization was detected with the help of confocal laser scanning microscopy. RESULTS: Abundant HO-2 immunoreactivity was found in ICCs in the smooth muscle layer of normal pylorus. There was a decrease in the number of ICCs and lack of HO-2 immunoreactivity in ICCs in IHPS. CONCLUSIONS: The results of the present study provide the first evidence for the presence of HO-2 in ICCs in the normal human pylorus. The lack of ICCs and HO-2 in IHPS suggests impaired intracellular communication between ICCs and smooth muscle cells, contributing to motility dysfunction in IHPS.

Enteric Nervous System↗

Pathophysiology after pylorus-preserving pancreatoduodenectomy: a comparative study of pancreatogastrostomy and pancreatojejunostomy.

BACKGROUND/AIMS: Pylorus-preserving pancreatoduodenectomy using the pancreatogastrostomy technique may result in pancreatic exocrine insufficiency and obstruction of the pancreatic duct. A prospective randomized comparison of pancreatogastrostomy and pancreatojejunostomy was therefore performed to assess pathophysiologic changes after pylorus-preserving pancreatoduodenectomy. METHODOLOGY: The study population consisted of 23 patients (pancreatogastrostomy: 10, pancreatojejunostomy: 13) who were observed for 2 years. RESULTS: Neither physical condition (dietary intake, body weight, performance status, and frequency of bowel movements) nor nutritional parameters (serum levels of total protein, albumin, total cholesterol, and cholinesterase) differed significantly between the two groups; these parameters recovered to pre-operative levels within 1 year in both groups. Changes in pancreatic function diagnosis (PFD) test results were similar between the two groups. The glucose tolerance test results revealed deterioration of glucose tolerance in 2 patients (20%) in the pancreatogastrostomy group and 3 patients (23%) in the pancreatojejunostomy group. In 2 of 3 patients in each group with non-dilated pancreatic ducts before surgery, the pancreatic ducts dilated after surgery. Diabetes developed after surgery in one such patient in each group. No significant differences were observed between the two groups with respect to changes in glucose tolerance test results and the diameter of the pancreatic duct. CONCLUSIONS: This prospective randomized study demonstrates no difference in pathophysiologic changes between patients undergoing pancreatogastrostomy or pancreatojejunostomy after pylorus-preserving pancreatoduodenectomy, at least in the first 2 years.

Adult↗

Temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia.

OBJECTIVE: To investigate the temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia (FD). METHODS: Eleven healthy subjects (HS) and 14 patients with FD were studied. Antral-pyloro-duodenal manometry was performed for 3 hours fasting and 2 hours after 80 Kcal of solid test meal. RESULTS: (1) The incidence of phase III was 7/11 in HS and 3/14 in FD in antrum (P < 0.05), 8/11 and 4/14 in pylorus (P < 0.05), 10/11 and 6/14 in duodenum (P < 0.05), respectively. (2) The percentage of antropyloroduodenal coordinations during phase II of MMC was 58.5% in HS and 18.5% in FD (P < 0.001). (3) The pyloroduodenal coordination was 78.2% and 38.9% (P < 0.01) at 60 minutes after meal and 77.1% and 54.0% (P < 0.01) at 120 minutes postprandially in HS and in FD. (4) The percentage of isolated pyloric pressure waves (IPPWs) was 4.8%, 29.7% (P < 0.001) at 60 minutes, and 9.3%, 25.1% (P < 0.01) at 120 minutes in HS and FD. CONCLUSIONS: There were abnormalities of gastro-pyloro-duodenal motility in both interdigestive and digestive stages; the higher incidence of IPPWs and disordered temporal and spatial relationship of pylorus to antroduodenal motility may result in a delayed gastric emptying in FD. The possible mechanism may be involved in abnormal neural control.

Adolescent↗

[Pylorus-preserving pancreatoduodenectomy--a report of 15 cases].

OBJECTIVE: To prevent post operative disturbauce of gastric emptying by pylorus-preserving pancreatoduodenectomy (PPPD). METHODS: 1. To preserve the vascular and nerve supply of gastric antrum, pylorus and duodenal bulb during operation. 2. To ensure long enough resection of duodenum from the pylorus. 3. To perform folding suture to shorten the hapatogastric ligament. RESULTS: In 15 cases of pancreatic and periampullar cancer so freated, neither residual cancer nor gastric emptying disorder was found after operation. The quality of life of the patients was improved. CONCLUSION: PPPD is a therapeutic choice for patients with pancreatic and peri-ampullar cancer.

Adult↗

[Pancreatoduodenal resection with preservation of the pylorus].

Experience with 106 pancreatoduodenal resections (PDR) with pylorus savage for tumors and benign diseases of pancreatic head and periampullar zone is analyzed. Features of mobilization of pancreatoduodenal complex in PDR are shown. They permit to reduce the rate of complications (gastrostasis). Necessity of differential approach to choice of creation of biliodigestive anastomosis is demonstrated. Risk of postoperative pancreatitis is highest in non-dilated pancreatic duct and small-changed pancreatic parenchyma. In these cases terminolateral pancreatojejunostomy with external drainage of pancreatic duct (12 patients) and pancreatogastrostomy (21) are preferable. PDR with pylorus savage permitted to use wider pancreato-, bilio- and duodenoenteroejunoanastomosis on one loop of the jejunum. Gastrostasis was seen in 50% patients after PDR with pylorus savage. Technical features of surgery and also postoperative complications leading to gastrostasis are demonstrated.

Humans↗

[Pyoroplasty with "cruciform" incision of the pylorus].

In cases when the pylorus area is significantly modified by the presence of the ulcerative lesions, frequently associated with hypertrophy of the pyloric sphincter, which does not allow to carry out in satisfactory conditions pyloroplasty of the Heinecke-Mikulicz type, the author introduces an improvement of the above mentioned technique by adding anterior sphincterectomy, obtained by a "cross like" incision of the pylorus. The final suture of the pyloroplasty is exclusively of the transversal type, in a single or in a double layer, when the lumina of the pylorus allows for such a suture.

Duodenal Ulcer↗

[Pylorus-preserving gastric resections in gastroduodenal ulcers].

The article analyses the results of pylorus-preserving resections of the stomach in 116 patients among whom 80 had gastric ulcer, 29 ad duodenal ulcer, and 7 had gastroduodenal ulcers. Changes of acidity and motor-evacuation function of the gastric stump were studied according to the method of pylorus-preserving resection. The late-term results of treatment in follow-up periods of 2 to 5 years are shown, they were found to be good in 96.6% of patients treated by operation and poor in 1.7%. It is noted that the function of the gastric stump is better when the vagus innervation of the pylorus is preserved. Mediogastric resection with selective proximal vagotomy in patients suffering from duodenal ulcer with a superacidic stomach led to stable normalization of acid production, which was a reliable measure for the prevention of a recurrent ulcer.

Adult↗

Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND AND PURPOSE: Pylorus-preserving pancreaticoduodenectomy is associated with a high incidence of delayed gastric emptying. The aim of this study was to determine the incidence and risk factors for delayed gastric emptying after this procedure. METHODS: This retrospective study included 63 consecutive patients who received pylorus-preserving pancreaticoduodenectomy from July 1993 to December 2002. The patients were divided into 2 groups based on the presence of delayed gastric emptying. Preoperative indices, postoperative morbidity, nasogastric intubation, and hospital stay were compared. The risk factors for delayed gastric emptying were analyzed. RESULTS: The postoperative incidence of delayed gastric emptying was 44% (28/63 patients). Multivariate analysis revealed that no preoperative biliary drainage, no cholestatic change in the liver and blood loss > 400 mL were significant risk factors for delayed gastric emptying. CONCLUSIONS: Pylorus-preserving pancreaticoduodenectomy is a safe procedure with a high incidence of delayed gastric emptying. Delicate surgical dissection to decrease blood loss and the extent of perigastric inflammation may be the key factor to prevent delayed gastric emptying.

Female↗

Pylorotomy in pylorus-preserving pancreaticoduodenectomy.

BACKGROUND/AIMS: The incidence of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy has been reported to be 30% to 70%. METHODOLOGY: Between January 1996 and December 2002, 43 patients underwent pylorus-preserving pancreaticoduodenectomy, involving pylorotomy, in the First Department of Surgery, Kinki University School of Medicine. The first step in pylorotomy is to cut the duodenal stump obliquely. The next is incision of the pyloric sphincter along its inferior aspect. The incidences of postoperative complications and changes in body weight were collated retrospectively. RESULTS: Delayed gastric emptying was observed in 4 patients (9.3%). However, this complication did not last more than 1 month in any patients. Two patients (4.7%) developed reflux esophagitis 1 month after surgery, but this complication had resolved by 6 months. Weight gain was noted beginning 3 months after surgery. CONCLUSIONS: Pylorus-preserving pancreaticoduodenectomy involving pylorotomy may reduce the incidence of delayed gastric emptying and preserve the long-term quality of life more than similar procedures.

Female↗

[Duodenopancreatectomy with conservation of the pylorus].

The authors report on their initial experience with pylorus-preserving pancreatoduodenectomy. In the last three years 11 patients with neoplastic disease of the pancreatic head and ampullary region underwent the above mentioned procedure. The surgical technique carefully preserved the blood supply and innervation to the antro-pyloric region and duodenum was transected 2 cm distal to the pylorus. Postoperative mortality was 9%. Postoperative nasogastric suction was required for eight days (median). Long term results are quite good with a satisfactory restoration of intestinal function and a weight gain of 95% of pre-illness weight. At the present time preserving the pylorus appears an usefull modification of Whipple procedure.

Adenocarcinoma↗

Gastrin, ACTH and STH after pylorus ligation and vagotomy in rats.

Plasma levels of gastrin, adrenocorticotropin (ACTH) and somatotropin (STH) were determined 24 hours after pylorus ligation and after pylorus ligation and vagotomy by radioimmunoassay. Pylorus ligation increases the serum levels of these hormones, while vagotomy inhibits the production of these ones. We conclude that the antiulcerogenetic effect of surgical vagotomy is closely related with the changes in the level of these hormones.

Adrenocorticotropic Hormone↗

A case of double pylorus accompanied by adrenal adenoma.

We report here a case of double pylorus diagnosed endoscopically in a patient with adrenal adenoma. A 44-yr-old man was found to have double pylorus during examinations for recurrent epigastric pain and obesity. We think that the formation of double pylorus in this case resulted from recurrent peptic ulcer which, in turn, probably was induced by the hypersecretion of endogenous corticosteroids accompanying adrenal adenoma.

Adenoma↗

Studies on the gastroulcerogenic effects of pylorus ligation, hypothermic restraint stress, aspirin, indomethacin and reserpine in morphine dependent rats.

The gastric mucosal damage induced by pylorus ligation for 6 h, hypothermic restraint stress, aspirin, indomethacin and reserpine was studied in morphine dependent rats. Morphine tolerance and dependence were produced by administering the gradually increasing concentrations of morphine sulphate in drinking water for 21-24 days. The tolerance and dependence produced by morphine were confirmed by a decreased analgesic response to morphine in the hot plate test and by producing a naloxone precipitated withdrawal syndrome respectively. The intensity of gastric mucosal damage induced by pylorus ligation, aspirin and indomethacin was significantly higher in morphine dependent rats than that observed in the naive animals. Studies on the gastric secretion did not reveal any significant change in the volume of gastric secretion, titrable acidity and gastric output of 6 h pylorus ligated rats. The average lesion scores in the reserpine treated and hypothermic restraint stressed rats were not significantly different from those obtained in the naive animals. Further studies are required to establish the exact mechanisms underlying these observations.

Animals↗