Aspects of basal gastric secretion in man.
In patients with duodenal ulcer, basal secretion may be significantly inhibited by venepuncture or by overnight aspiration of gastric contents. The implications of these findings are discussed.
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In patients with duodenal ulcer, basal secretion may be significantly inhibited by venepuncture or by overnight aspiration of gastric contents. The implications of these findings are discussed.
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A secretin-cholecystokinin test was performed in 103 patients, representing both normal and reduced exocrine pancreatic function. The duodenum was intubated with a triple-lumen tube. The gastric and duodenal contents were aspirated separately and sampled in 10-min periods. An inert, water-soluble marker (58Co-vitamin B12 dissolved in isotonic saline) was infused at a constant rate into the duodenum. Exocrine pancreatic secretion was stimulated by continuous intravenous infusion of secretin for 60 min and a combination of secretin and cholecystokinin for another 60 min. The total recovery of the infused marker was 80%. The concentration of marker in the aspirate did not vary significantly between consecutive 10-min periods during the last 20 min of the secretin stimulation period or during the last 50 min of the combined secretin-cholecystokinin stimulation period, indicating a steady secretion rate into the duodenum. By means of the marker concentrations in the aspirate, the duodenal volumes were calculated and found to vary significantly less than the aspirated volumes. This finding demonstrates that the duodenal volume calculated from the recovery of an inert marker is a closer estimate of the true volume than that obtained by the usual aspiration technique without a volume indicator.
A 50-year-old man was admitted to our hospital because of a single episode of hematemesis followed by melena for about 14 hours. On gastroendoscopy a 1.2 x 1.4 cm2 deep ulcer was visualized in the back wall of the first part of the duodenum with active bleeding. Digital subtracted angiography showed an obvious leakage of contrast agents from the gallbladder artery. So hemobilia and cholecystoduodenal fistula with upper gastric tract bleeding were diagnosed. Cholecystectomy was performed after the duodenal fistula was resected and repaired. Common bile duct was intubated with a T-tube after no bleeding and stones were verified inside. A pathologic examination confirmed the presence of chronic cholecystitis with the formation of suppurate granulomatosis. The postoperative course was uneventful. He has been doing well without any recurrence of bleeding for the last 7 months.
Endoscopic drainage of the common bile duct by endoprosthesis has been advocated as an effective alternative to palliative surgery in the management of malignant occlusion icterus. Apart from other complications duodenal perforation may occur at the time of endoscopic insertion of the prosthesis. Perforation as a late sequel of endoscopic retrograde placement of such an endoprosthesis is rare. This paper presents the case of duodenal perforation eight days after implantation of a biliary endoprosthesis necessitating immediate surgical intervention.
Relief of duodenal ulcer pain by aluminum hydroxide gel (AG) was compared with that obtained by a dummy gel (DG) in randomized trials. In 44 individual pain episodes, complete relief was obtained by 15-ml doses of AG in 79% and by DG in 45% (P less than 0.05). In 48 identical blind trials replicated at another hospital the difference was not significant. The gels were also tested against ulcer pain induced by intragastric acid instillation (Palmer test) in 35 patients; pain was relieved by AG in 63% and by DG in 62%. Presumed effectiveness in terminating ulcer episodes was studied in 65 patients admitted for pain; 37 received milk and cream hourly and 28 did not. All were treated with 15 ml of AG or DG during waking hours. Median time for complete disappearance of spontaneous pain was 3 days for AG and 7 days for DG, the same in both groups. In all patients the acid instillation test was repeated every few days. For the milk and cream group it became negative after 4 days with AG and after 6 days with DG. In 18 patients with gastric ulcer treated for 4 weeks AG led to greater reductions in size than did DG. A number of these trials indicate AG to be more effective than DG, but sampling and other methodological problems limit the certainty of any conclusions.
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To test the assumption that gastric decompression is beneficial after TV, 66 patients who underwent elective TV plus anterior pylorectomy were randomly allocated into three groups immediately after completing pyloric reconstruction. Patients in group G had a tube gastrostomy, patients in group ND did not have gastric decompression and patients in group NGS were treated with nasogastric suction for 48 to 72 hours. Roentgenographically, greater gastric distension could be noted in patients in the ND group but this was not clinically significant. Patients in the NGS group had a high incidence of mechanical complications, especially when tubes were in place for more than 48 hours. Infections of the chest were not related to gastric decompression techniques. Patients in groups NGS and ND had significantly shorter hospital stays than patients in group G. During the immediate post-operative period after TV, we would recommend no gastric decompression or short term (less than 48 hours) nasogastric suction. Routine gastrostomy is unwarranted.