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PubMed1972

Intrajejunal volatile fatty acids in the stagnant loop syndrome.

In the stagnant loop syndrome an abnormal anaerobic flora colonizes the small bowel. Anaerobic organisms are characterized by fermentation reactions leading to the production of volatile fatty acids. This paper describes the measurement of intrajejunal volatile fatty acid concentrations in 11 patients with the stagnant loop syndrome. Nine normal persons and 18 patients with gastrointestinal disease without intestinal stasis acted as controls. Acetate and propionate concentrations were greatly increased in the patients with the stagnant loop syndrome and returned to normal in those patients treated with antibiotics. The measurement of intrajejunal volatile fatty acid concentrations as an index of overgrowth of anaerobic organisms is discussed.

Acetates↗
PubMed1970

Studies on the 57Co vitamin B12 plasma level absorption test.

Results of the (57)Co vitamin B(12) plasma level absorption test are described in 163 patients. The use of intramuscular carbachol with the test and the presence or absence of current vitamin B(12) therapy did not affect the test results. Injection of 1,000 mug of unlabelled vitamin B(12) during the test augmented plasma levels in patients with normal absorption but tests without this injection gave satisfactory differentiation between the normal and malabsorption ranges. Results from patients having had a gastrectomy, ileal resection, or a past history of adult coeliac disease are also described. Amongst patients with presumed Addisonian pernicious anaemia, two with unresolved equivocal results and three with falsely normal results were found. The significance of these is discussed.

Anemia, Pernicious↗
PubMed1985

Effect of Billroth II operation on the intestinal interdigestive motor activity.

The interdigestive motor activity of the gastric remnant and the efferent jejunal loop was studied manometrically in 10 patients who underwent Billroth II operation for duodenal ulcer. Two groups, one of 9 normal subjects and the other of 7 duodenal ulcer patients, were used as controls. In the Billroth II group the interdigestive migrating motor complex (IMMC) showed a higher relative duration of phase II activity than the controls and a shorter mean time-interval than the controls between subsequent activity fronts, with abnormal jejunal propagation. These findings indicate that the distal two-thirds of the stomach are necessary for the inhibitory mechanism, which in normal conditions slow down the idiointestinal interdigestive motor activity to the level of that of the stomach, and suggest that some postgastrectomy syndromes, such as diarrhoea, may have their pathological basis in this hyperactive intestinal IMMC.

Duodenal Ulcer↗
PubMed2005

[Late follow-up of gastrectomized patients for peptic ulcer: clinical, endoscopic and histopathological aspects].

BACKGROUND: The gastrectomy is an uncommon procedure because the proton bomb inhibitors associated to the antibiotic outlines used to eradicate the Helicobacter pylori changed the focus of the peptic ulcer treatment. AIMS: Later evaluation on those patients who underwent partial gastrectomy as a treatment for peptic ulcer, at that time when any drug to eradicate the Helicobacter pylori was not used. The clinical evaluation included the late postoperative symptoms and postgastrectomy syndromes like dumping, diarrhea, alkaline gastritis and nutritional aspects. The upper digestive endoscopy analysed the surgery reconstruction and the gastric stump, the duodenum and the jejunum mucosa aspects. The histopathological evaluation included looking for Helicobacter pylori by using two different methods: histology and urease test. CASUISTIC AND METHODS: Fifty-nine patients, 44 (74.6%) male, median age 55.5 years old (range from 31 to 77 years old), who underwent a clinical interview and an upper digestive endoscopy. Paraffin blocks from the surgical specimen were reviewed in order to find out if the patients did have or did not have Helicobacter pylori before surgery. RESULTS: The final results show that most of the patients had very good and good clinical evolution (Visick I e II) in 96%. The most common symptoms on late postoperative are mild dyspepsia with or without Helicobacter pylori, and diarrhea, anemia and dumping occurred in, respectively, 11 (18.6%), 2 (3.4%) and 2 (3.4%) cases. The Billroth I reconstruction had the best clinical results on statistical rate. The endoscopic finding showed normal results in the most number of cases, and reflux alkaline gastritis or erosive gastritis in a few cases. Ulcer recurrences were diagnosed in two patients (3.4%), and both had positive Helicobacter pylori. Most of the patients had Helicobacter pylori (86%) before surgery and also in the postoperative time (89.9%). CONCLUSIONS: The patients had a very good clinical evolution after the gastrectomy. The Billroth I reconstruction had the best clinical results. The Helicobacter pylori is still present on gastric stump in late postoperative time, and we believe that it does not bring any negative influence to surgical results.

Adult↗
PubMed2005

[Surgical treatment of diseases of operated stomach].

Experience with treatment of 262 patients with late complications after operations for duodenal ulcer was analyzed. Eighty-four (32.1%) patients underwent earlier suturing of perforated duodenal ulcer, 97 (37.0%) -- resection of the stomach and 81 (30.9%) -- various types of vagotomy. In recurrent ulcers after sutured perforation organ-saving operations (62, or 73.8%) have important advantages over resection of the stomach. Combined postgastrectomy syndromes (18, or 18.6%) were most difficult for surgical treatment. Resection of the stomach (70, or 86.4%) patients is the best reconstructive operation for postvagotomy syndromes.

Adolescent↗
PubMed2006

Simultaneous dynamic study of gastric emptying and changes of serum levels of gut hormones in patients after peptic ulcer surgery.

BACKGROUND: The aim was to examine the influence of different modalities of peptic ulcer surgery on the gastric emptying (GE) pattern and related serum level changes of selected gut hormones. MATERIAL AND METHODS: Fifty eight subjects were examined. In 48 of them peptic ulcer surgery was performed at least six months before the examination: Billroth I (B1) in 11, Billroth II (B2) in 16, B1 with the selective vagotomy--Harkins 1 (H1) in 9 and B2 with the selective vagotomy--Harkins 2 (H2) in 12. Ten healthy volunteers (C) were also examined. RESULTS: The results of gastric emptying showed that the lag phase duration was inversely related to the GE rates, and the GE pattern was linear in both controls (C) and in operated patients, except in B2 group, in which the GE pattern was exponential. In comparison with C group, GE was slower in B1, H1 and H2 groups, and faster in B2 group. The plasma gastrin values in C group, showing two peaks, were higher in relation to other groups. In relation to C group, higher values of motilin were obtained in patients after the selective vagotomy. The plasma somatostatin values recorded in B1 and H1 groups, showing the marked peaks, were higher in relation to C group. In relation to C group the highest plasma neurotensin values were obtained in B2 group. CONCLUSIONS: In order to understand entirely the influence of peptic ulcer surgery on the GI function, further research of the role of specific hormones and neuropeptides is needed, which would enable more precise selection of the therapy in order to prevent postvagotomy and postgastrectomy syndromes.

Gastric Emptying↗
PubMed1990

[Secondary postresection enteral insufficiency].

The literature on the problem of enteral insufficiency is reviewed. Secondary enteral insufficiency is of interest both to clinicians and to physiologists and pathophysiologists, who might join their efforts for studying the fine mechanisms of the intestinal functions and refine the methods of treatment of enteral insufficiency.

Afferent Loop Syndrome↗
PubMed1990

From Prout to the proton pump--a history of the science of gastric acid secretion and the surgery of peptic ulcer.

Prior to the 17th century, there was considerable confusion regarding the process of digestion. Although some physicians were certain that it was initiated by acid in the stomach, both the source and the nature of the acid were unclear. In the early 19th century, Prout confirmed the active secretion of hydrochloric acid by the stomach and related it to the symptoms of dyspepsia. Jacob Helm and, subsequently, Beaumont studied digestion in humans with gastric fistulas and each commented extensively on the physiologic manifestation of digestion. The role of the vagus nerves in the control of gastric acid secretion was identified in the early and mid-19th century by Brodie, and subsequently elaborated upon by Pavlov. By the early 20th century, Latarjet and Jaboulay in France, performing operations for abdominal pain and tabes, reported the effects of vagotomy on acid secretion and gastric motility. In 1943, Dragstedt, in the United States, reported the cure of duodenal peptic ulcer disease by supradiaphragmatic vagotomy. He later observed the substantial delays in emptying of the stomach, which necessitated the introduction of concomitant gastric drainage procedures, such as gastrojejunostomy and pyloroplasty. In 1902, Bayliss and Starling had described the existence of a chemical regulator of function--secretin--which they termed a hormone. Shortly thereafter, Edkins reported results of studies that supported the presence of an acid regulatory hormone, gastrin, in the antrum of the stomach. Unfortunately, controversy marred this observation, and the action of gastrin was for more than 30 years ascribed to histamine. Komarov, in 1938, confirmed the existence of gastrin and its stimulatory effects on acid secretion. Physiologic recognition of the roles of vagal stimulation and antral gastrin in the secretion of acid from the stomach resulted in the development of the operation of vagotomy and antrectomy for peptic ulcer disease. Studies of the pylorus and the motility of the stomach resulted in an appreciation of the genesis of the postgastrectomy syndromes. By the middle of the 20th century, a clear appreciation of the morphologic characteristics of the parietal cell and its ability to secrete hydrochloric acid was under way. The complex metabolic process of the cell was correlated with the major morphologic transformation necessary to generate secretion of hydrochloric acid. The development of sophisticated research technology allowed the appreciation of the complex intracellular processes necessary to allow the generation of a 2.5 million-fold gradient of hydrogen ion secretion.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenosine Triphosphatases↗
PubMed1985

[Rational diagnosis of the malassimilation syndrome].

Malassimilation is that pathological condition, in which one or several foodstuff factors are insufficiently absorbed. The sequels of this disturbance may then be observed as malabsorption symptoms. In the survey of the possibilities of a malassimilation syndrome the pathophysiological fundaments were chosen as starting-point of the discussions, at suspicion for a malassimilation syndrome one should at first decide between maldigestion and malabsorption. The in most cases appearing causes of a maldigestion and malabsorption are cited. As a transitional form between the two the ciliated border disease is mentioned. The methods of the diagnostics of the malassimilation syndrome which are at our disposal as well as specific diagnostic methods are briefly treated. At the end a simple scheme of the clinical strategy at suspicion for a malassimilation syndrome is recommended.

Celiac Disease↗