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PubMed1986

Gastrointestinal complications after cardiac surgery.

From 1975 to 1985, a total of 1596 coronary artery bypasses or valve replacements resulted in 18 gastrointestinal tract complications in 16 patients at Good Samaritan Hospital in Cincinnati. Twelve patients were treated surgically (hemorrhagic duodenal ulcer, one patient; perforated duodenal ulcer, one patient; cholecystitis: acalculous, gangrenous, two patients, and calculus, one patient; perforated cecum, one patient; ischemic colitis, one patient; and perforated diverticulitis of the colon, five patients). Six patients were treated conservatively by either nasogastric intubation or nothing by mouth and intravenous therapy (ileus, three patients; acute sigmoid diverticulitis, one patient; and active peptic ulcer disease, two patients). Multisystem failure caused two deaths. The etiology of hollow viscus complications seems to be related to a low-flow state, impairing normal tissue perfusion that can initiate an ischemic change. This change can lead to acute inflammation, perforation, or both or late stricture. When evidence of an acute abdominal disorder is observed or when conservative treatment falls to alleviate symptoms, prompt surgical intervention should be performed.

Aged↗
PubMed1976

Amine metabolism and the small bowel in uraemia.

Intestinal intubation was carried out in 21 subjects: 9 with end-stage renal failure, 2 with early renal insufficiency, 7 untreated patients with blind-loop syndrome, and 3 normal volunteers. All 9 patients with uraemia had significantly raised duodenal dimethylamine (D.M.A.) concentrations compared with the other groups tested. Alteration of the intestinal bacterial flora with antibiotics markedly reduced serum D.M.A. and trimethylamine concentrations and modified the symptoms. Potentially toxic metabolites in the small bowel might have significant nutritional and toxic sequelae in uraemia and these findings suggest that current therapeutic approaches to the treatment of end-stage kidney disease should be re-examined in relation to bowel flora.

Anti-Bacterial Agents↗
PubMed2000

[CT enteroclysis for detection of small bowel tumors].

PURPOSE: To assess the feasibility and the usefulness of CT enteroclysis (helical CT with enteroclysis) in detecting small bowel tumors. MATERIALS AND METHODS: Fifty patients were referred for suspicion of small bowel tumor. CT enteroclysis is performed by injecting a large volume of water using a pomp through a nasojejunal tube followed by a thin section helical acquisition. RESULTS: Forty-eight helical CT enteroclysis were performed in order to detect 25 small bowel tumors. Among them 22 were confirmed by histological study. The mean size of tumors was 23 mm. In 12 of 17 cases, diagnosis was missed or incomplete at conventional barium study. Enteroscopy was performed in 12 of 22 cases, with discordant result in one case and incomplete result in 3 cases. In 8 cases, including 5 carcinoid tumors, patients had surgery after CT enteroclysis only, enteroscopy would probably have not made the diagnosis because the lesions were far from the duodenojejunal junction and ileocaecal valve. CONCLUSION: Helical CT enteroclysis is a new method for detecting small bowel tumors, easy to perform, well tolerated. It seems to be more sensitive than conventional barium studies and less invasive than enteroscopy. Tumor characterization and staging can be performed using a single examination. It seems to be justified to perform CT enteroclysis to detect small bowel tumors or in the evaluation of patients with polyposis.

Adult↗
PubMedDate not supplied

[Highly selective vagotomy in the elective treatment of duodenal ulcer].

Highly selective vagotomy (HSV) is the elective treatment of duodenal ulceration, however, it is little used in our hospitals. A retrospective study was carried out comparing 20 patients operated on HSV with 31 patients that underwent truncal vagotomy+drainage (TV+D) in the last ten years at Surgery Unit N. 7 (3. "C") of the "Edgardo Rebagliati Martins" Hospital. Nasogastric intubation was discontinued and solid food was tolerated earlier after HSV. Hospital stay was 6.37 +/- 2.69 days in HSV and 8.23 +/- 1.93 days in TV+D (p = 0.006638). Diarrhea was the commonest post-operative problem continued by wound infection, dehiscent wound, pneumonia and dysphagia. No difference was found in the Visick graduation between both groups. There was recurrent ulceration in two patients in the TV+D group. The mean time of follow-up in HSV group was 3.03 years and VT+D was 5.37 years (p = 0.005868). The authors conclude that HSV is a better surgical technique than VT+D, with earlier recuperation and less hospital stay.

Aged↗
PubMed1977

Duodenal bacterial flora in early stages of transient monosaccharide intolerance in infants.

The aerobic and anaerobic bacterial flora of the duodenum were studied in 10 infants with transient monosaccharide intolerance. 5 infants had protracted diarrhoea after an episode of acute gastroenteritis and 5 had acute gastroenteritis. The duration of monosaccharide intolerance ranged from 1 to 20 days. Serial intubations were performed on 8 infants. In 5 of 8 cases the bacterial flora were of a normal type at the first intubation at 0--4 days after the onset of monosaccharide intolerance. In 4 of those 5 patients there was an increase in bacterial count a few days later and anaerobes appeared. These findings are not consistent with the suggestion that monosaccharide intolerance is caused by abnormal bacteria in the upper small bowel.

Bacteria↗
PubMed1978

Effect of topical acid on duodenal pepsinogen secretion in the rat.

The effect of topical acid on duodenal pepsinogen secretion was studied in the anesthetized rat. Perfusion of a 5-cm segment of the proximal duodenum with normal saline or buffered saline (pH 7.2 or 6.0) elicited no detectable pepsinogen response. Perfusion with 10, 25, and 100 mN HCl resulted in a graded increase in pepsinogen output. Acetylcholine bromide, 500 microgram/ml, in buffered saline, pH 7.2, also stimulated pepsinogen secretion. The pepsinogen response to 100 mN HCl and to acetylcholine was completely abolished by atropine. Secretin, 2 units/kg, did not alter pepsinogen output during perfusion with buffered saline or acid, while secretin, 75 units/kg, increased pepsinogen output. These observations suggest that topical acid stimulates duodenal pepsinogen secretion through a cholinergic reflex and that secretin is not a significant stimulant of duodenal pepsinogen secretion in the rat within the dose range employed (1--2 units/kg).

Acetylcholine↗
PubMed1997

Altered postprandial motility in chronic pancreatitis: role of malabsorption.

BACKGROUND & AIMS: Intraileal nutrients modulate gastrointestinal motility, but effects of maldigestion on postprandial motility are unknown. The aim of this study was to compare motor responses with ileal nutrient exposure in health and pancreatic insufficiency after a meal or intraluminal perfusion. METHODS: After oroileal multilumen intubation for duodeno-jejuno-ileal sampling, marker perfusion, and motility recording, 14 normal subjects and 12 patients with severe pancreatic insufficiency received a labeled liquid meal twice, either with placebo or pancreatin. Effects of intraileal nutrient perfusion on fed motility induced by duodenal amino acid perfusion were also investigated. RESULTS: Compared with normals, untreated patients had greater cumulative ileal nutrient delivery (69 +/- 21 vs. 487 +/- 232 kJ), shorter fed pattern (196 +/- 22 vs. 131 +/- 14 minutes), greater 90% gastric emptying (163 +/- 12 vs. 128 +/- 10 minutes), and faster small intestinal transit (86 +/- 9 vs. 44 +/- 6 minutes). Pancreatin reversed these changes. Ileal nutrient perfusion converted fed into interdigestive-like motility in normals (7 of 8) and patients (4 of 5). CONCLUSIONS: In subjects with pancreatic insufficiency, a low-energy liquid meal induces shorter fed motor pattern associated with accelerated gastric emptying and intestinal transit compared with healthy subjects. Because changes responded to enzyme treatment and could be reproduced by ileal nutrient perfusion, ileal delivery of malabsorbed chyme may be involved as a mechanism.

Adult↗
PubMedDate not supplied

Does the use of an enteral feeding tube with a pH-sensitive tip facilitate enteral nutrition?

Enteral feedings are often used to achieve adequate, cost-effective nutritional support. Placement of feeding tubes is accomplished by either a trained nurse or physician form a nutritional support team. A radiographic examination is required to confirm proper placement. These examinations are expensive and delay initiation of feeding while radiographs are taken and evaluated. A new enteral feeding tube (pH-FT) that incorporates a permanent pH-sensitive tip into a small-bore feeding tube has been developed. A detachable meter is used to monitor pH. This study was undertaken to determine if the pH-FT was reliable in determining placement as compared with radiograph interpretation. Twenty inpatients (14 males and six females) with diagnoses including major burn, trauma, and gastrointestinal disease were intubated with the use of pH-FT. Measurement of pH was taken at the time the radiographic examination was done. Reference pHs used include the following: stomach, 1.1 to 2.0; stomach in the presence of antacids/H2 blockers, 3.5 to 5.0; and the duodenal, 6.0 to 7.3. Of the 20 patients studied, there were four in whom the pH assessment indicated stomach placement with 100% radiograph confirmation. Sixteen patients had duodenal placement indicated by pH assessment, with radiograph confirmation in 88% (14) of the patients. Two patients had a pH indicating duodenal placement, and radiographic examination showed placement to the pH-FT in the stomach. Two benefits of the pH-FT would be decreased cost and earlier initiation of enteral feeding when the radiographic examination and interpretation are eliminated.

Burns↗
PubMed2006

Prognostic value of mucins in the classification of ampullary carcinomas.

The ampulla of Vater is of high clinical relevance with regard to influx of chyme, ascending inflammation, intubation during diagnostic and therapeutic endoscopic investigation, therapeutic papillotomy, and especially to malignant transformation. Little is known about the distribution of mucins in the ampulla. In this study, we have investigated the mucin distribution in the normal ampulla of Vater and compared it to duodenal mucosa and Brunner glands. Expression of mucins in the ampulla of Vater and duodenum was monitored by reverse transcription-polymerase chain reaction and localization of the products by immunohistochemistry. The samples investigated originated from 30 autopsy cases. Mucins MUC1, MUC3, MUC4, MUC5AC, MUC5B, MUC6, MUC7, and MUC8 were expressed in the ampulla of Vater. Immunohistochemistry revealed production of MUC4, MUC5AC, MUC5B, and MUC6. The mucin composition varied in comparison with the duodenum referring to MUC2, MUC7, and MUC8. Detected mucins contribute to innate immunity, epithelial restitution, and protection against the aggressive secretions of the liver, gall bladder, and pancreas. By cross-linking, they influence the rheological properties of the secretions in the ampulla and facilitate unidirectional flow into the duodenum. Knowledge of their pattern of expression has prognostic value with regard to the detection of malignancy. The observed differences in the mucin distribution between the duodenum and the ampulla of Vater support the use of MUC2, MUC7, and MUC8 as useful tool in the classification of ampullary carcinomas.

Adult↗
PubMed1981

Pharmacological basis of dosage form of two antimalarials: chloroquine and mepacrine.

Chloroquine and mepacrine appear in the stomach wall and inhibit gastric emptying in the rat after oral or parenteral administration. Measuring their concentration in the stomach wall, it was found that it depended upon on the route of application. A smaller proportion of a given dose accumulated in the stomach wall when chloroquine and mepacrine were introduced by avoiding the stomach. The side effect of the two drugs, the inhibition of gastric motility, could be minimized by not only parenteral but also duodenal administration; the latter could be realized by enteric-coated tablets.

Administration, Oral↗
PubMed1975

The effect of phenformin upon the plasma pancreatic and gut glucagon-like immunoreactivity in diabetics.

Five patients with mild maturity-onset diabetes were given 250 ml of a 20% glucose solution by intraduodenal infusion and eight other patients similarly received an amino acid solution in a dose of 0.5 g amino acids per kg body weight. The pancreatic and gut glucagon-like immunoreactivity (pancreatic GLI and gut GLI) in plasma were measured before and after the application of the two stimuli. Each person was tested twice; the first (control) test was followed by a second test after three days of treatment with phenformin 150 mg daily, plus the same 150 mg dose taken 60 min before the intubation. The plasma pancreatic GLI increased slightly during both infusions, but was not affected by phenformin. Intraduodenal infusion of both glucose and the amino acid solution induced a greater rise in plasma gut GLI. After treatment with phenformin, the fasting plasma gut GLI was higher than the control value in eleven of thirteen patients. In most cases higher gut GLI plasma levels were also found after duodenal administration of glucose and amino acids. These data furnish further evidence of the local action of antidiabetic biguanides on the intestinal wall, including its hormonal activity. The hypothesis is advanced that the phenformin-induced increase in gut GLI secretion may bring about competition of the latter with pancreatic glucagon for receptors in liver cell membranes, reducing the effect of glucagon on the liver, and thus contributing to a decrease in glycaemia.

Adult↗