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At least 541 records · Page 30Linked to original sources
PubMed1984

The incidence of duodenogastric reflux in peptic ulcer disease.

Using 99mTc diethyl HIDA, a gamma camera was used to assess duodenogastric reflux of bile in the supine position in control patients and patients with active duodenal ulceration. Cholecystokinin was injected intravenously during the test to contract the gall bladder. Patients with benign gastric ulcers, and a group of age matched controls, were investigated for duodenogastric bile reflux in the sitting position by a nasogastric aspiration technique after a 10% dextrose meal. Of 60 patients with duodenal ulceration 32 (53%) were reflux positive, and of 13 control patients 6 (46%) were positive. Of 30 patients with gastric ulceration 17 (53%) were reflux positive, and 8 out of 15 (53%) control subjects were positive. The incidence of duodenogastric reflux assessed supine in the fasting state, and seated after a liquid meal, was similar in patients with peptic ulceration and in normal controls.

Cholecystokinin↗
PubMedDate not supplied

[The prevention of the aorto-mesenteric compression syndrome in interventions for ileoanal anastomoses].

Restorative proctocolectomy with ileal-anal anastomosis can induce a duodenal stenosis due to the compression between superior mesenteric artery (SMA) and aorta when the ileum is pulled-down to the anus stretching the SMA. This situation may require prolonged nasogastric intubation or even surgery. In our experience this occurred in 10% of pts. Aiming to avoid this complication we have performed an intestinal derotation just before ileal-anal anastomosis abolishing any possibility of duodenal compression. Comparing this latter group of patients to those who didn't receive intestinal derotation, we observed a significant reduction of nasogastric tube drainage and of the nasogastric intubation time. We think that intestinal derotation could be effective in preventing SMA syndrome after restorative proctocolectomy and ileal-anal anastomosis.

Adolescent↗
PubMed1976

Influence of ether anaesthesia and oro-gastric intubation on gastric evacuation and small bowel propulsion after laparotomy. A methodological study in the rat.

A model for the simultaneous study of gastric evacuation and small bowel propulsion in the rat is presented. By means of a modification, with both indwelling duodenal and gastric tubes, studies on fully conscious animals were possible. Gastric evacuation and small bowel propulsion were analysed with respect to the effects of ether anesthesia and gastric intubation. The gastric intubation in ether anaesthesia greatly retarded gastric evacuation but left small bowel propulsion unaffected one day after laparotomy. The main factor retarding gastric evacuation appeared to be the oro-gastric intubation procedure. Ether anaesthesia neither affected gastric evacuation nor small bowel propulsion after laparotomy when the test meal was deposited into the stomach and into the duodenum, respectively, via the permanent tubes.

Anesthesia, Inhalation↗
PubMed1975

Acute gastric disease after cutaneous thermal injury.

Diffuse erosive "gastritis" was discovered as early as five hours postinjury in 45 of 54 burn patients (83.5%) evaluated by gastroduodenoscopy. Acute ulcers were identified in 14 patients (26%); concomitant duodenal disease was present in 34 patients (76%). Microvascular fibrin thrombi were not demonstrated even though five patients had disseminated intravascular coagulation. Seven patients were examined before nasogastric intubation; four, with a mean burn size of 59.6% total body surface, had diffuse "gastritis." Low total serum protein levels were measured in 81% of tested patients, but were not predictive of mucosal disease. Hemorrhage followed the clinical deterioration of six patients (11.1%); one ulcer perforated. Whereas coagulation abnormalities, nasogastric intubation, and hypoproteinemia may augment mucosal injury, the morphologic and histologic examinations of the lesions suggested a primary ischemic cause resulting from the opening of submucosal shunts or local vasoconstriction.

Blood Proteins↗
PubMed1993

Modulation of human periodic interdigestive gastrointestinal motor and pancreatic function by the ileum.

Following ingestion of a meal, unabsorbed nutrients may reach the distal intestine partly after the termination of the prandial period, i.e., in the presence of interdigestive motor and secretory patterns. To determine if interdigestive motility and pancreatic enzyme secretion are modulated by the delivery of nutrient into the ileal lumen, six fasting volunteers were intubated with an oroileal multilumen tube system that permitted multiple small intestinal manometry, gastric and duodenal aspiration, and perfusions of marker and test solutions. Ileal perfusions of nutrient or saline solutions were started during phase I of the interdigestive motility cycle. Ileal perfusion with carbohydrate or lipids increased the duration of motor quiescence and decreased the length of the interdigestive cycle, mainly by decreasing the proportion of phase II activity compared with ileal saline (p < 0.01). Pancreatic outputs of amylase, trypsin, and chymotrypsin prior to ileal perfusions were low because, due to the protocol, perfusions were started during phase I. With ileal saline, enzyme outputs increased (p < 0.05) in association with the occurrence of phase II motility, as expected. By contrast, ileal carbohydrate and triglyceride perfusion prevented the phase II-associated increase in enzyme outputs (p < 0.05). The data suggest that the presence of nutrients within the ileal lumen may modulate interdigestive motor and pancreatic functions.

Adult↗
PubMed1981

Duodenogastric reflux in humans: its relationship to fasting antroduodenal motility and gastric, pancreatic, and biliary secretion.

Duodenogastric reflux may have pathophysiologic importance, but its mechanism is poorly understood. We propose that duodenogastric reflux and periodic changes in motor and secretory activity of the upper gut during fasting may be related. Therefore we determined the relationships between duodenogastric reflux and interdigestive motor-secretory cycles in a group of 6 healthy individuals, on each of whom we performed three 7-h studies in random order on separate days. In all studies gastric intubation and antral pressure recordings were performed. However, in design 1 we used a slow duodenal perfusion rate of [14C]PEG in saline (0.25 ml/min) while in design 3 we used a fast perfusion rate (3.0 ml/min). Duodenal pressures were also recorded during these designs. In design 2 no transpyloric tubes were present. Our study shows that, in humans, fasting duodenogastric reflux of bile and pancreatic juice is cyclic and closely related to the interdigestive migrating motor complex. Reflux is highest during late phase II (when secretory activity is also on the rise) and lowest after phase III. One of the important functions of the migrating motor complex in humans may be to clear the stomach of refluxed duodenal secretions.

Adult↗
PubMed1976

[Practical value of gastric intubation during peptic ulcer. Analysis of 410 cases, after Histalog stimulation].

This study was carried out in 410 subjects, collecting gastric fluid for one hour, after 15 minutes emptying and one hour, after 15 minutes emptying and one hour's study of basal secretion using, as stimulant, Histalog at a maximal dose of 2 mg/kg without exceeding 130 mg. The object of this statistical analysis was to determine the average figures and the standard deviations of the volumes of secretions, together with those of the output of hydrogen ions in 5 groups of subjects: controls (60), gastric ulcers (38), duodenal ulcers (200), patients suspected of duodenal ulcer (60) or affected by dyspeptic syndrome without radiological nor endoscopic lesions (52). In the normal subject, the hydrochloric acid output was situated between 5 and 27 mEq. The diagnosis of duodenal ulcer was very unlikely when secretion was less than 9 mEq in man and almost certain above 30 mEq.

Adult↗
PubMed1991

Sensitivity of the gastric mucosa to acid and duodenal contents in patients with nonulcer dyspepsia.

Nonulcer dyspepsia is a common clinical syndrome whose etiology is unknown. The sensitivity of the gastric mucosa to acid and duodenal contents in 18 patients with nonulcer dyspepsia was studied. The patients had a normal upper gastrointestinal endoscopy and biopsy specimens were obtained for determination of Helicobacter pylori status. Fifteen of the 18 patients were infected with H. pylori. All patients underwent intubation with double-lumen tube and collection of cholecystokinin-stimulated pancretico-biliary secretions. Subsequently, normal saline, 0.1N hydrochloric acid, and autologous duodenal secretions were infused into the stomach in a randomized blinded fashion. A positive response was defined as the production of epigastric pain by acid and/or bile but not by saline. By this definition, only 6 patients (33%) had a positive response and none had reproduction of their usual symptoms. In patients with a negative response, only 4 remained asymptomatic during all infusions. The remaining 8 had symptoms during infusion of saline, 7 of whom also had symptoms during infusion of acid and/or duodenal secretions. Two of these patients had reproduction of their usual symptoms. In conclusion, the gastric mucosa in patients with nonulcer dyspepsia is not abnormally sensitive to acid or duodenal contents.

Abdominal Pain↗
PubMed1985

Carcinoma of the extrahepatic bile ducts: results of an aggressive surgical approach.

Ninety patients with adenocarcinoma of the extrahepatic bile ducts were treated between 1969 and 1984. Fifty-four tumors involved the upper third, 15 the middle third, and 21 the lower third of the common duct. Twenty-two patients had gallstones and five had inflammatory bowel disease. Forty-three patients had operations before definitive treatment; the diagnosis was made in only 18. Resection was accomplished in 30 patients (33%): 12 of 54 in the proximal third, six of 15 in the middle third, and 12 of 21 in the distal third. The mean survival in patients who underwent resection was 32 months (proximal third, 28 months; middle third, 32 months; lower third, 37 months). Surgical bypass was performed in 28 patients (mean survival 10 months) and intubation alone was performed in 24 patients (mean survival 8 months). Recurrent cholangitis occurred in 56% of intubated patients compared with 26% of patients treated without tubes. Radiation was used with resection and for palliation. Responses were observed, but the complication of radiation duodenitis has limited the dose. An aggressive approach to resection of bile duct tumors is possible with a low operative mortality rate and offers the best opportunity for cure as well as good palliation. Internal bypass is preferable to chronic intubation. The role of radiation therapy in this disease is still not clear.

Adenocarcinoma↗
PubMed1988

Inactivation of human lipase by proteases.

To determine if human lipase is inactivated by trypsin and chymotrypsin, we intubated 22 human subjects with an oroduodenal tube and stimulated pancreatic secretion with cholecystokinin octapeptide. The duodenal aspirate from each subject was divided into a control and a test sample and incubated in a 37 degrees C water bath for 2 h. An inhibitor of trypsin or chymotrypsin or more of one of these enzymes was added to the test sample. We found that the loss of lipase activity was partly prevented by inhibiting trypsin with aprotinin (910 KU/ml; P = 0.03) and was accelerated by adding bovine trypsin (2.5 mg/ml; P = 0.01). Inhibiting chymotrypsin with turkey egg white (2.5 mg/ml) totally abolished the loss of lipase activity (P = 0.01), and addition of bovine chymotrypsin (5 mg/ml) accelerated the loss of lipase activity more than adding trypsin (P = 0.01). After inhibiting chymotrypsin (to maintain lipase activity), increasing trypsin activity by adding a single or repeated doses of trypsin did not decrease lipase activity. Conversely, the addition of a single dose of chymotrypsin after inhibiting trypsin activity markedly decreased lipase activity (P less than 0.004). In conclusion, chymotrypsin is a more potent inactivator of human lipase than trypsin; chymotrypsin inactivates lipase in the absence of trypsin, but trypsin inactivation of lipase requires chymotrypsin.

Adult↗
PubMed1998

Recognition of intussusception around gastrojejunostomy tubes in children.

OBJECTIVE: We describe antegrade intussusceptions of duodenum and jejunum around gastrojejunostomy tubes seen on sonography and fluoroscopic contrast tube studies. Reduction of the intussusception was achieved by bolus injection of air or contrast medium through the tube or exchange over a wire. CONCLUSION: Sonography and fluoroscopic contrast tube studies permit diagnosis of intussusception around gastrojejunostomy tubes.

Child, Preschool↗
PubMed2000

Duodenal obstruction due to a swallowed nasogastric tube.

Nasogastric tubes are commonly used, not only in surgical practice but in all disciplines. Their use, however, is not without complications. We present the first reported case of duodenal obstruction due to a swallowed nasogastric tube, and recommend that nasogastric tubes be used in their entirety (uncut) with the splayed distal end intact. This simple procedure will prevent a rare but distressing complication that might be amenable only to laparotomy.

Duodenal Obstruction↗