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PubMed1990

The effect of terminal ileal triglyceride infusion on gastroduodenal motility and the intragastric distribution of a solid meal.

The infusion of triglyceride emulsions into the terminal ileum in concentrations that approximate those found in malabsorption results in the slowing of gastric emptying. The aim of this study was to characterize the changes in gastroduodenal motility responsible for this effect. Antropyloroduodenal pressures in 8 healthy volunteers were recorded with a manometric assembly incorporating a sleeve sensor across the pylorus and side holes in the antrum and duodenum. Each subject ingested a 100-g, 99m Tc-labeled solid meal; when approximately 25% of the meal had emptied from the stomach, a triglyceride emulsion (20% Intralipid) was infused into the terminal ileum at 1 ml/min for 45 min. Gastric emptying slowed markedly 15-30 min after the start of the lipid infusion (p = 0.01), and there was retrograde movement of the solid meal from the distal to the proximal portion of the stomach. During lipid infusion, there was a decrease in antral (p = 0.01), duodenal (p less than 0.05), and propagated antropyloroduodenal pressure waves (p less than 0.05) and an increase in isolated pyloric pressure waves (p less than 0.05). The rate of gastric emptying correlated with antral pressure waves (r = 0.92, p less than 0.001), duodenal pressure waves (r = 0.80, p less than 0.01), and propagated pressure waves (r = 0.88, p = 0.0025) and correlated inversely with the number of isolated pyloric pressure waves (r = -0.60, p = 0.05). The changes in antral, pyloric, and duodenal motility and the intragastric redistribution of a solid meal associated with ileal lipid infusion are likely to contribute to the delay in gastric emptying caused by this stimulus.

Adult↗
PubMed1987

Transduodenal feedings: a superior route of enteral nutrition.

Our recent study comparing gastric with jejunal feedings in neonatal piglets demonstrated better weight gain, less diarrhea, and less fat malabsorption in animals fed gastrically. These differences were postulated to be due either to loss of duodenal osmoregulation and absorption, and/or to loss of the combined effects of salivary enzymes, gastric emptying, and gastric secretions on jejunal feedings. The objective of this investigation was to determine the relative contributions of gastric and duodenal function to the differences between gastric and jejunal feedings. Seven piglets (3 to 5 days old, 1.5 to 2.0 kg) underwent operative transgastric insertion of a duodenostomy tube placed just distal to the pylorus. Intravenous fluids and antibiotics were administered for two days postoperatively, then Premature Enfamil Formula (24 kcal/oz; Mead Johnson, Evansville, IN) was administered continuously through the feeding tube. The animals were maintained on 115 kcal/kg/d as in the previous study. Weight, fecal fat analysis, and stool characteristics were determined throughout the 2-week period. The resulting data were compared with data from our previous study comparing gastric with jejunal feedings. These data suggest the vital importance of gastroduodenal contributions of absorption, osmoregulation, and regulation of nutrient concentrations in improving the nutritional status of experimental animals. Duodenal feedings may be preferred to either gastric or jejunal feedings because they provide equivalent nutritional support without the gastroesophageal reflux and aspiration reported with gastric feedings in the neonatal population.

Animals↗
PubMed1985

A simplified technique for gastric and duodenal decompression for duodenal injuries.

A simplified effective method of the decompression for use after repair of duodenal injuries is described. A Moss esophagogastric decompression tube is inserted as a gastrostomy to provide decompression of stomach and duodenum through a single tube. In addition, the complications associated with long-term nasogastric tube drainage are avoided.

Drainage↗
PubMed1993

Fate of oral enzymes in pancreatic insufficiency.

Oral pancreatic enzyme supplements, including those protected from gastric acidity by enteric coating, often achieve only partial correction of pancreatic steatorrhoea. To characterise the mechanisms involved in vivo, eight patients with steatorrhoea due to advanced pancreatic insufficiency and nine healthy controls were studied. Two sets of studies (small bowel intubation and five day faecal fat quantification) were randomly performed while patients were either on enteric coated pancreatin or equivalent placebo. A 260 cm long multilumen tube was used for double marker perfusion of two 20 cm segments located in the duodenum and in the ileum respectively. Luminal pH, flow, and trypsin and lipase activity outputs were measured at each segment for four hours postcibally. Placebo treated patients with pancreatic steatorrhoea had low enzyme outputs in the duodenal test segment and even lower outputs in the ileal segment. Pancreatin treatment significantly decreased steatorrhoea (p < 0.05) and increased luminal enzyme outputs (p < 0.05). The increase was much greater in the ileal than in the duodenal segment. Thus enteric coated pancreatin treatment abolished the normal gradient between postcibal duodenal and ileal lipase output. The results suggest that enteric coated pancreatin nearly corrects severe pancreatic steatorrhoea. The ingested lipase was utilised inefficiently, however, as luminal enzyme activity in the ileum was enhanced to a greater extent than in the duodenum, and consequently the absorptive potential of the small bowel was only partially utilised.

Celiac Disease↗
PubMedDate not supplied

[Lazarus phenomenon: spontaneous resuscitation].

A 94-year-old woman undergoing surgery for simple repair of a duodenal perforation experienced a sudden massive hemorrhage (1500 mL) when the duodenum was separated from adjacent structures. Hemodynamic stability was re-established when fluids were replaced. After the abdominal wall was closed, increased amplitude of the QRS wave was observed and heart rate slowed until there was no pulse. Electromechanical dissociation (EMD) was diagnosed and cardiopulmonary resuscitation was started. When EMD persisted after 40 minutes, resuscitative measures were stopped and the ventilator was disconnected, though orotracheal intubation and arterial and electrocardiographic monitoring were maintained. After 2 or 3 minutes, heart rhythm restarted spontaneously and arterial pressure waves reappeared on the monitor. The patient progressed well for 72 hours, after which she developed septic shock and multiorgan failure, dying 18 days later. The Lazarus phenomenon may be more common than the medical literature would indicate, possibly because a large gap in our understanding of the pathophysiology of the phenomenon underlies anecdotes about "miracles". As we wait for adequate international consensus on a protocol for monitoring the withdrawal of resuscitative measures, we should act prudently before definitively certifying death. The case we report occurred during a surgical intervention in which the patient had received general anesthesia. We believe that the causes that might explain the Lazarus phenomenon are quite different in that context than they would be in a nonsurgical setting, such that it would be useful to create a national database to keep a record of such intraoperative events.

Aged↗
PubMed1987

Effect of dietary and infused lactose on rat intestinal lymph lipids.

Twenty-four male, 6- to 8-week-old Sprague-Dawley rats were fed one of two skim-milk-based diets or stock laboratory diet for 100-120 days to assess the effect of dietary and infused lactose on intestinal lymph lipids. One skim-milk-based diet had its lactose enzymatically hydrolyzed by commercial beta-galactosidase to its constituent monosaccharides galactose and glucose, while the second skim milk diet was unaltered. Serum triglycerides, but not serum cholesterol, were higher in the lactose- versus the glucose-/galactose-adapted rats at 90 days. There was no diet-associated qualitative difference in serum lipoproteins as analyzed by agarose gel electrophoresis. After the rats had consumed the diets for 100-120 days, 0.9% saline and 20% solutions of lactose, and equimolar mixtures of glucose/galactose, glucose and maltose were infused sequentially via a duodenal cannula, then intestinal lymph was collected via a mesenteric lymph duct cannula, the only significant difference was a 134% increase in lymph cholesterol, but not lymph triglyceride output, when lactose was infused into lactose-adapted rats.

Adaptation, Physiological↗
PubMed2002

Endoscopic sphincterotomy with needle-shaped knife: report of 476 cases.

OBJECTIVES: To evaluate endoscopic duodenal sphincterotomy and improve its success rate. METHODS: Needle-shaped knife was used for endoscopic sphincterotomy (EST) in 476 patients with biliary or pancreatic diseases from March 1995 to October 2000. RESULTS: Direct incision was made in 243 patients, papillary fenestration in 89, and opposite incision in 144. The papilla located beside and in the diverticulum in 56 and 12 patients, respectively. EST emergency was made in 147 patients. ERCP after EST because of the difficulty in intubation was made successfully in 62 patients. Mild complications occurred in 14 patients (2.94%), all of whom were cured after symptomatic treatment. CONCLUSIONS: EST with needle-shaped knife has such advantages as safety in operation and convenience in incision. It is suitable for the papilla with different shape, with a higher success rate.

Adolescent↗
PubMed2006

Rapid initial gastric emptying and hypersensitivity to gastric filling in functional dyspepsia: effects of duodenal lipids.

OBJECTIVE: Impaired distension-induced gastric accommodation and hypersensitivity to distension have been demonstrated by gastric barostat in patients with functional dyspepsia (FD). In this study we investigated distension-induced responses to gastric filling with water in healthy volunteers and FD patients, using non-invasive ultrasonography. MATERIAL AND METHODS: Eighteen healthy volunteers and 18 FD patients were given infusions of 10 ml saline or lipid (3 kcal/ml) through a nasoduodenal tube. After tube retraction, the stomach was filled with 1000 ml water during 10 min. Intragastric volume was monitored by 3D ultrasonography, and fullness, pain and nausea were assessed. RESULTS: Compared with healthy volunteers, patients with FD had faster gastric emptying at 5 min (p = 0.0008) and reported more fullness (p = 0.006) during gastric filling with water. Prior duodenal lipid exposure reduced initial gastric emptying rate in FD patients to the level seen in healthy volunteers. However, despite similar gastric volumes, the patients still reported greater fullness (p = 0.002) and nausea (p = 0.01). CONCLUSIONS: Patients with FD had abnormally rapid initial gastric emptying of water and hypersensitivity to gastric filling. Though normalizing gastric emptying rate and volumes, duodenal lipid exposure did not improve hypersensitivity. Rapid initial gastric emptying of water might be a sign of impaired distension-induced gastric accommodation.

Adult↗
PubMed1986

Duodenal delivery of levodopa for on-off fluctuations in parkinsonism: preliminary observations.

The pathogenesis of on-off motor fluctuations in parkinsonism remains incompletely understood, but slowed or erratic gastric emptying of orally administered levodopa may be involved. In 3 patients with resistant on-off fluctuations, direct duodenal continuous infusion of levodopa via a nasoduodenal tube resulted in a heightened therapeutic effect, including a reduction in motor fluctuations. In 1 of these patients, continuous duodenal levodopa infusion produced greater benefit than did intermittent duodenal levodopa administration. Direct duodenal delivery of levodopa lessens the problems with gastric emptying and may be suitable for long-term therapy in selected patients with resistant on-off motor fluctuations.

Adult↗
PubMed2002

High-fat diet effects on gut motility, hormone, and appetite responses to duodenal lipid in healthy men.

There is evidence that gastrointestinal function adapts in response to a high-fat (HF) diet. This study investigated the hypothesis that an HF diet modifies the acute effects of duodenal lipid on appetite, antropyloroduodenal pressures, plasma CCK and plasma glucagon-like peptide-1 (GLP-1) levels in humans. Twelve healthy men were studied twice in randomized, crossover fashion. The effects of a 90-min duodenal lipid infusion (6.3 kJ/min) on the above parameters were assessed immediately following 14-day periods on either an HF or a low-fat (LF) diet. After the HF diet, pyloric tonic and phasic pressures were attenuated, and the number of antropyloroduodenal pressure-wave sequences was increased when compared with the LF diet. Plasma CCK and GLP-1 levels did not differ between the two diets. Hunger was greater during the lipid infusion following the HF diet, but there was no difference in food intake. Therefore, exposure to an HF diet for 14 days attenuates the effects of duodenal lipid on antropyloroduodenal pressures and hunger without affecting food intake or plasma hormone levels.

Adult↗
PubMed1999

ERCP in post-Billroth II gastrectomy patients: emphasis on technique.

OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) in post-Billroth II (BII) gastrectomy is more difficult due to anatomical changes. The difficulties include entrance to the afferent loop and selective cannulation. Our aim here is to report the success rate and special manipulations and techniques of this procedure. METHODS: A retrospective review of 56 ERCP procedures in post-BII gastrectomy patients was performed. There were 43 male and 13 female patients with a mean age of 63 yr (range, 32-78 yr). All cases were tried with forward-viewing endoscope first. Of the failed cases, 10 were retried by side-view duodenoscope. The entrance to the afferent loop was attempted by starting from the upper opening at the anastomosis site and, if this failed, then using the lower opening; presence of bile; and air-contrasted afferent loop under fluoroscopy. If failure of afferent loop entrance resulted, hand compression over the mid-abdomen, or polypectomy snare in the working channel of the endoscope, was tried. For failure of common bile duct cannulation with straight catheters, techniques of pushing the catheter against the duodenal wall and bending the tip of the endoscope or guidewire were used. RESULTS: The success rate of afferent loop entrance was 76.7% (43 of 56 cases). The afferent loop was identified in the upper orifice of the anastomosis in 93% (40 of 43) of the cases. Eight cases of afferent loop entrance could be facilitated by hand compression, and three by polypectomy snare in the working channel of the endoscope. The success rate of ERCP cannulation in those successful afferent loop intubation cases was 81.3% (35/43 cases). Most of the selective common bile duct (CBD) cannulation was achieved by straight (new) catheter and an additional six cases were successful using the techniques mentioned. No serious complications were encountered, except three cases of submucosal hemorrhage. CONCLUSION: The overall success rate of BII ERCP was 62.5% (35 of 56 cases). The special manipulations mentioned in BII ERCP can be helpful in certain cases.

Adult↗
PubMed2001

Impact of early high caloric duodenal feeding on the oxygen balance of the splanchnic region after severe burn injury.

Early enteral nutrition is recommended in burned patients. Depending on the amount administered, enteral feeding causes an increase of intestinal oxygen-demand. Although early moderate enteral nutrition has been shown to be beneficial, early high calorie enteral nutrition might lead to an imbalance of the O(2)-balance of the gut since intestinal perfusion is decreased after major burns. In 20 severely burned patients during the first 48 h of early high caloric duodenal feeding an assessment of the CO(2)-gap between the arterial and the gastric CO(2), as parameter for the intestinal O(2)-balance, was performed. Time points were prior to starting the enteral nutrition (BASE) subsequently every 30 min after increasing the amount of nutrition administered and from the 11th to the 48th h after beginning of nutrition in intervals of 6 h. In none of the patients was the CO(2)-gap increased during the rapid increase of enteral nutrition. On the contrary the CO(2)-gap decreased significantly. We conclude that high caloric duodenal feeding in the early hypodynamic postburn phase does not have adverse effects on the oxygen balance of the intestine.

Adult↗
PubMed1996

Ultrastructural changes in the duodenal mucosa induced by ingested histamine in patients with chronic urticaria.

Histamine in food may be responsible for some cases of food intolerance. We previously demonstrated disturbances in the metabolism of ingested histamine in patients with chronic urticaria (CU) and proposed that this could be related to increased intestinal permeability to histamine. The present study was undertaken to look for ultrastructural changes in the intestinal tract that might explain this abnormality. We examined duodenal biopsies from seven patients with CU before and after intraduodenal administration of histamine (120 mg). Five subjects had clinical symptoms (diarrhea, urticaria, headache, accelerated heart rate, and drop in blood pressure) within 1 h of duodenal histamine challenge (DHC). Ultrastructural changes, including edema of the interstitial tissue, enlargement of the basal intercellular spaces, slight congestion of the endothelial cells, and pericapillary edema, were observed in six subjects 45 min after DHC. In all the biopsies, the epithelium was normal, and the tight junctions were not modified by DHC. This morphologic study demonstrates that histamine can induce edema in the basal intercellular spaces of the duodenal mucosa and in the submucosa without evident change in the integrity of intercellular junctions. The most plausible route for histamine to have taken would appear to be an intracellular one.

Administration, Oral↗
PubMed1979

The effect of gastroduodenal xylocaine on the basal pancreatic secretion in rats.

The effect of intragastric and intraduodenal xylocaine on the pancreatic secretion was investigated in conscious rats. A 1% xylocaine infusion strongly decreased pancreatic protein output and flow during recirculation of pancreatic juice into the duodenum, but it diminished only moderately the increase in the secretion seen after its diversion and after duodenal infusion of soybean trypsin inhibitor. Moderate inhibition appeared during prolonged diversion of pancreatic juice. The response to exogenous CCK + secretin was not modified. The results indicate that during recirculation of pancreatic juice, which is more physiologic than its diversion from the duodenum, the neural control may play a significant role.

Animals↗
PubMed2005

Duodenogastric reflux after esophagectomy and gastric pull-up: the effect of the route of reconstruction.

Duodenogastric reflux (DGR) is a common sequel of subtotal esophagectomy and gastric pull-up, and it may contribute to mucosal changes of both the gastric conduit and the esophageal remnant. This study investigated the effect of the route of reconstruction on the DGR. 24-hour ambulatory bilirubin monitoring was performed on patients who underwent transhiatal subtotal esophagectomy and a gastric tube interposition either in the posterior mediastinum (PM group, n = 11), or in the retrosternal space (RS group, n = 8): A Control group of 8 healthy volunteers was also studied. The median percentage of reflux time, the median number of reflux episodes, and the median number of reflux episodes longer than 5 minutes, in PM versus RS groups, were 29.1% versus 0.15% (p < 0.001), 185 versus 8 (p = 0.002) and 10 versus 0 (p = 0.001), respectively. The values of the above variables in PM versus control groups were 29.1% versus 3.95% (p = 0.007), 185 versus 21 (p = 0.02), and 10 versus 2 (p = 0.009), respectively, whereas in RS versus control groups they were 0.15% versus 3.95% (p = 0.01), 8 versus 21 (p = 0.04), and 0 versus 2 (p = 0.05), respectively. Posterior mediastinal gastric interposition is associated with high reflux of duodenal contents, whereas retrosternal interposition minimizes the reflux at levels even lower than those of the healthy individuals. The latter type of reconstruction may be a good alternative from that perspective, especially in patients with long life expectancy.

Adult↗
PubMed1988

The effects of carbidopa dose and time and route of administration on systemic L-dopa levels in rats.

The effects of carbidopa dose and time and route of administration on systemic plasma levels of parenterally and nonparenterally administered L-dopa were examined in rats. Intravenous coadministration of L-dopa + carbidopa resulted in significant (P less than 0.05) carbidopa-dependent increases in both the area under the plasma L-dopa concentration versus time profile (AUC; +27%) and the plasma L-dopa half-life (t1/2; +35%). Simultaneous duodenal or rectal carbidopa administration did not alter the L-dopa i.v. pharmacokinetic profile. Carbidopa pretreatment significantly increased the i.v. L-dopa AUC (+38 and +82% for i.v. and duodenal pretreatments, respectively) compared to simultaneous administration. Both i.v. and duodenal carbidopa increased duodenal L-dopa AUC to a similar extent (+282 and +239% for i.v. and duodenal administration, respectively). Rectal studies indicated poor absorption of both L-dopa and carbidopa, with no demonstrable effect on plasma L-dopa. The results indicate that the timing and route of carbidopa and L-dopa administration are important in determining the extent of i.v. or duodenal L-dopa systemic availability. The rat model affords results similar to those reported in human studies and may be useful for more extensive evaluation of L-dopa and carbidopa interactions.

Animals↗
PubMed2001

A randomized, pharmacokinetic and pharmacodynamic, cross-over study of duodenal or jejunal administration compared to nasogastric administration of omeprazole suspension in patients at risk for stress ulcers.

OBJECTIVES: The aim of this study was to characterize absorption and pH control of simplified omeprazole suspension (SOS), 2 mg/ml in 8.4% sodium bicarbonate, administered via the nasogastric versus jejunal or duodenal route. METHODS: Nine critically ill surgical patients, NPO and mechanically ventilated, were enrolled in this randomized cross-over study. Patients received a single 40 mg dose of SOS by the nasogastric and either the jejunal or duodenal route. Twenty-four-hour continuous intragastric pH monitoring was performed during the study period. Sequential blood samples were collected over 24 h to characterize SOS absorption and pharmacokinetic parameters. RESULTS: Nasogastric administration of SOS resulted in lower maximum mean +/- SD serum concentrations compared to jejunal/duodenal dosing (0.970 +/- 0.436 vs 1.833 +/- 0.416 microg/ml, p = 0.006). SOS absorption was significantly slower when administered via nasogastric tube (108.3 +/- 42.0 vs 12.1 +/- 7.9 min, p < 0.001). However, all routes of administration resulted in similar SOS area under the serum concentration-time curves (AUC(0-infinity)) (415.1 +/- 291.8 vs 396.7 +/- 388.1 microg x min/ml, p = 0.91) [corrected]. Mean intragastric pH values remained >4 at 1 h after SOS administration and remained >4 for the entire 24-h study (6.32 +/- 1.04, 5.57 +/- 1.15, nasogastric vs jejunal/duodenal, p = 0.015), regardless of administration route. CONCLUSIONS: In critically ill surgical patients, pharmacokinetic parameters and subsequent pH control after the administration of SOS are similar by the jejunal, nasogastric, or duodenal route. SOS suspension offers an alternative acid control measure when patients are unable to take oral medications, yet have an enteral tube in place.

Adult↗