cholecystokinin and Intestinal-Obstruction

Cholecystokinin (CCK) was used in a randomized double-blind trial to evaluate its effect on post-operative paralytic ileus. Sixty patients were admitted to the study. The return of postoperative intestinal motility was registered with subjective and/or objective methods. No differences were found between the CCK group and the placebo group.

Topics: Adult; Aged; Cholecystectomy; Cholecystokinin; Cholelithiasis; Clinical Trials as Topic; Double-Blind Method; Female; Gastrointestinal Motility; Humans; Intestinal Obstruction; Male; Middle Aged; Postoperative Complications; Random Allocation

Independent secretion of vasoactive substances by glomus tumors of the skull base is widely recognized. Surgical removal of these tumors often results in an unexplained prolonged postoperative ileus, even in cases in which the vagus nerve is preserved. There is evidence that these tumors may secrete neuropeptides, such as cholecystokinin, in addition to catecholamines. A retrospective analysis of cases of glomus tumors of the skull base operated on at The Otology Group was carried out to correlate preoperative neuropeptide levels, vagus nerve status at surgery, and duration of postoperative ileus. High circulating levels of cholecystokinin associated with these tumors may be responsible for the unexplained phenomenon of prolonged postoperative ileus. The relevance of neuropeptides to the postoperative management of these patients is discussed. Preventive measures that may avert the potentially lethal complications of aspiration and negative nitrogen balance are described.

Topics: Catecholamines; Cholecystokinin; Glomus Jugulare Tumor; Humans; Intestinal Obstruction; Paraganglioma, Extra-Adrenal; Paraneoplastic Syndromes; Postoperative Care; Postoperative Complications; Retrospective Studies; Skull Neoplasms

Topics: Adult; Aged; Cholecystokinin; Female; Gastrointestinal Motility; Humans; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Male; Middle Aged

Topics: Abdomen; Cholecystokinin; Humans; Intestinal Obstruction

Sincalide, a synthetic analog of cholecystokinin capable of stimulating bowel motility, has been administered to 12 patients with symptoms and signs of vincristine-induced ileus. Patients were given intravenous infusions of sincalide 0.01 microgram/kg/h over 2-24 h (mean, 8 h) for 1-12 days (mean, 5 days), usually until all evidence of ileus had resolved. Improvement was noted within 48 h of initiation of therapy in eight patients (75%), whereas marginal or no responses were observed in four patients. The mean duration of ileus was 3.6 days in responders and 7.7 days in nonresponders. Toxicity was minimal and consisted of diarrhea in two patients, in whom symptoms promptly resolved with discontinuation of the drug. Further explorations of this promising agent in the treatment of vincristine-induced ileus appears warranted.

Topics: Cholecystokinin; Gastrointestinal Motility; Humans; Intestinal Obstruction; Peptide Fragments; Sincalide; Vincristine

Myoelectrical activity of the gut has been studied in the postoperative period on 54 patients who underwent cholecystectomy. They have been divided into one control group and four other groups which were treated with pentagastrin, cholecystokinin, prostigmine or coherin (a posterior pituitary extract). In all patients, bursts of spikes were recorded during the early postoperative period. However, the slow waves were strongly disturbed at this time. Pentagastrin, CCK-PZ and prostigmine had no effect on the slow waves, while they increased the frequency of the spikes. These substances did not reduce the duration of the 'physiological' ileus. On the contrary, coherin was found to improve the regularity of the slow waves and to reduce the duration of the 'physiological' ileus.

Topics: Cholecystectomy; Cholecystokinin; Gastrointestinal Motility; Humans; Intestinal Obstruction; Jejunum; Neostigmine; Pentagastrin; Peptides; Pituitary Hormones, Posterior; Postoperative Complications

Intra-intestinal pressure was recorded with open-tip catheters in experimental low small-bowel obstruction in the cat. At zero time the pressure was 2-4 mmHg. After 72 hours sustained intraluminal pressure ranged mainly between 5 and 10 mmHg. Long periods of inactivity alternated with short bouts of spontaneous bowel activity. During activity the pressure rose to about 20 mmHg. In motility responses elicited by cholecystokinin, momentary pressure waves amounting to 40-50 mmHg were recorded. The result of simple mechanical obstruction is predominantly a bowel distension, whereas the magnitude of sustained intraluminal pressure is rather modest. Possible effects of distension on intestinal microcirculation are discussed.

Topics: Animals; Cats; Cholecystokinin; Disease Models, Animal; Gastrointestinal Motility; Intestinal Obstruction; Intestine, Small; Pressure; Stimulation, Chemical

Topics: Animals; Cholecystokinin; Dogs; Gastrointestinal Motility; Ileum; Intestinal Obstruction; Neostigmine; Rabbits; Telemetry