gastrins and Abdominal-Pain

Manual acupuncture (MA) manipulations are one of the key factors influencing acupuncture effects in traditional Chinese medicine theory. Different MA manipulations contain different stimulating parameters, thus generating different acupuncture responses or effects. Evidence has demonstrated that acupuncture is effective for functional dyspepsia (FD). However, the effects of different stimulating parameters of MA manipulations on FD remain unclear.. This study is a randomized controlled trial with a four-arm, parallel-group structure. Patients with FD with epigastric pain syndrome (EPS) will be included and randomly allocated into four groups: three MA manipulation groups (separately treated with a frequency of 1 Hz, 2 Hz, or 3 Hz) and a control group. All groups will receive omeprazole as a basic treatment and acupuncture: in the MA manipulation groups, the needles will be manipulated manually with three different frequencies on the basis when de qi is reached, while in the control group, the needles will be inserted without any manipulation. All patients will receive acupuncture treatment of five consecutive sessions per week for 2 weeks and be followed up at 4, 8, and 12 weeks. The primary outcomes of the study include patients' response to the treatment. The secondary outcomes include dyspeptic symptoms, quality of life, mental status, fasting serum gastrin, motilin, and ghrelin concentrations, and adverse events. The protocol was approved by the Ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (2016-K-057-01).. The aim of this study is to evaluate the efficacy and safety of MA manipulations with different stimulating parameters (different frequencies) on EPS in patients with FD.. Chinese Clinical Trial Registry, ChiCTR-IOR-16008189 . Registered on 30 March 2016.

Topics: Abdominal Pain; Adolescent; Adult; Biomarkers; China; Clinical Protocols; Double-Blind Method; Dyspepsia; Electroacupuncture; Female; Gastrins; Ghrelin; Humans; Male; Mental Health; Middle Aged; Motilin; Pain Measurement; Quality of Life; Research Design; Syndrome; Time Factors; Treatment Outcome; Young Adult

Nonsteroid anti-inflammatory drugs represent an important osteoarthritis (OA) therapy component, but also a leading cause of gastropathy: one of the most frequent and serious OA therapy complications. The aim of the present study was to study the influence of GI health in an OA population receiving either ginger or diclofenac.. Forty-three (43) patients with confirmed OA (knee and hip) were included in a randomized controlled study. A ginger group of 21 patients (17 women, 4 men) was given a specific ginger combination daily (340 mg EV.EXT 35 Zingiber officinalis extract) for 4 weeks. A diclofenac group (positive control) of 22 patients (18 women, 4 men) received 100 mg diclofenac daily for the same period. Both groups also received 1000 mg glucosamine daily. Gastrointestinal pain and dyspepsia were evaluated according to the severity of dyspepsia assessment (SODA) form. Patients also underwent esophagogastroduodenoscopy (EGDS) including biopsy before and after the treatment. Serum gastrin-17 levels, and stomach mucosa prostaglandins (PG) E1, E2, F2α, and 6-keto PGF1α (PGI2) levels were measured. Arthritic pain was evaluated using the visual analogue scale (VAS) on standing and moving.. The ginger group showed a slight but significantly lowered SODA pain and no change of SODA dyspepsia. EGDS showed significantly increased levels of PGE1, PGE2, and PGF2α in the stomach mucosa. This rise in gastric mucosa PG levels correlated with an increase in serum gastrin-17. On the other hand, the diclofenac group showed increased SODA pain and dyspepsia values with a corresponding significant decrease of stomach mucosa prostaglandins and general negative stomach mucosa degeneration. Both groups showed a relevant and significantly lowered VAS pain both on standing and moving.. The ginger combination is as effective as diclofenac but safer in treating OA, being without effect on the stomach mucosa. The increased mucosal PGs synthesis in the ginger group supports an increased mucosa-protective potential. VAS; visual analogue scale, 0-100 mm.

Topics: Abdominal Pain; Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Dinoprost; Dinoprostone; Dyspepsia; Endoscopy, Digestive System; Female; Gastric Mucosa; Gastrins; Hip; Hip Joint; Humans; Knee; Knee Joint; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Measurement; Phytotherapy; Plant Extracts; Severity of Illness Index; Zingiber officinale

Lansoprazole is a new proton pump inhibitor for the treatment of peptic ulcer disease.. A double-blind, multicentre study was undertaken in 296 patients with endoscopically proven duodenal ulcer to compare the efficacy and safety of lansoprazole 15, 30 or 60 mg with placebo. Ulcer healing was documented by endoscopy at 2 and 4 weeks; patients whose ulcers healed after 4 weeks were followed for up to 6 months post-treatment.. Four-week healing rates of 89.4%, 91.7% and 89.9% were obtained with lansoprazole 15, 30 and 60 mg, respectively, compared with 46.1% on placebo (P < 0.001). All three doses of lansoprazole produced rapid symptom relief, although patients taking 60 mg lansoprazole required fewer antacids than did those taking 15 mg. At 6 months, the percentages of patients healed were 45.3%, 40.0% and 38.4% in the lansoprazole 15, 30 and 60 mg dosage groups, respectively, and 25.3% for the placebo group. No significant adverse events were documented during the period of this trial.. Lansoprazole is an effective and safe treatment for duodenal ulcer and the 15 mg dose is as effective as 30 or 60 mg.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Abdominal Pain; Adult; Aged; Anti-Ulcer Agents; Double-Blind Method; Duodenal Ulcer; Duodenoscopy; Female; Gastrins; Humans; Lansoprazole; Male; Middle Aged; Omeprazole; Treatment Outcome; Wound Healing

The efficacy and safety of omeprazole, in 241 patients with active recurrent duodenal ulcer from 21 Italian centres, was studied in a multicentre double-blind randomized trial comparing 20 mg omeprazole o.m. or 40 mg famotidine nocte with endoscopic examination, symptom recording, laboratory screening and gastrin assay. In a per protocol analysis, the duodenal ulcer healing rates for omeprazole and famotidine, documented by endoscopy, were 62% (68/109) and 33% (39/117) after 2 weeks of treatment (P less than 0.001), 92% (96/104) and 80% (86/108) cumulative after 4 weeks (P less than 0.05), and 99% (102/103) and 92% (96/104) after 6 weeks (P less than 0.05), respectively. The results of this trial demonstrate that 20 mg omeprazole o.m. is superior to 40 mg famotidine nocte in duodenal ulcer healing.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Dose-Response Relationship, Drug; Double-Blind Method; Duodenal Ulcer; Evaluation Studies as Topic; Famotidine; Female; Gastrins; Humans; Male; Middle Aged; Omeprazole

A 26-year-old man was admitted to hospital with a 6-month history of diarrhea and abdominal pain. Before admission, upper and lower gastrointestinal endoscopy had shown a mild erosive duodenitis and the patient was started on a proton pump inhibitor. Physical examination and laboratory tests on admission were not constructive. In addition, repeated gastrointestinal endoscopy, cross-sectional imaging and neuroendocrine markers did not point to a specific etiology. Therefore, as a provocation test, the proton pump inhibitor therapy was discontinued. Discontinuation resulted in a progression of the patient's symptoms and an endoscopic detection of duodenal ulcers. Except for the normal serum gastrin levels, this constellation was suggestive of a gastrinoma, so that further investigations were initiated. Subsequently, the diagnosis could be confirmed and the gastrinoma located. After successful pancreaticoduodenectomy, the patient was symptom-free.. As part of a systematic investigation on chronic diarrhea, the work-up for neuroendocrine causes can play an important role. In this context, it should be kept in mind that some gastrinoma patients present without an elevation of serum gastrin levels. Regardless of a negative gastrin test, a typical symptom constellation should therefore prompt further investigations.

Topics: Abdominal Pain; Adult; Chronic Disease; Diagnosis, Differential; Diarrhea; Duodenal Ulcer; Duodenitis; Follow-Up Studies; Gastrinoma; Gastrins; Gastroscopy; Humans; Lymphatic Metastasis; Male; Pancreatic Neoplasms; Pancreaticoduodenectomy

The Zollinger-Ellison syndrome consists of severe peptic ulceration, acid hypersecretion, and islet tumors known as gastrinomas. The discovery of gastrinomas in unusual locations such as lymph nodes, bones, ovaries, and the liver poses a diagnostic dilemma as to whether the tumor is primary or metastatic. Here we present a case of a primary gastrinoma within a lymph node.

Topics: Abdominal Pain; Aged; Biopsy; Gastrinoma; Gastrins; Humans; Jejunum; Lymph Nodes; Male; Peptic Ulcer Perforation; Treatment Outcome; Zollinger-Ellison Syndrome

Examination and long-term follow-up covered 95 patients with duodenal ulcer (DU). Mean age of the patients was 32 +/- 1.67 years. The patients were divided into two groups: with rare DU recurrences (n = 36) and with frequent recurrences (n = 59). Diagnostic criteria for development of rarely recurrent DU were the following: blood group A(II), exacerbations in winter, weak symptoms at DU onset, weak abdominal pains, solitary surface ulcers. For development of frequently recurrent DU, diagnostic criteria include O(I) blood group, spring exacerbations, marked symptoms of the exacerbation, severe abdominal pains, multiple deep ulcers.

Topics: Abdominal Pain; ABO Blood-Group System; Adult; Duodenal Ulcer; Female; Gastric Acid; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Male; Pepsinogen A; Predictive Value of Tests; Prognosis; Recurrence; Risk Factors; Seasons; Severity of Illness Index; Somatostatin; Wound Healing

Topics: Abdominal Pain; Adrenal Gland Neoplasms; Diabetes Mellitus, Type 1; Esophageal Stenosis; Gastrins; Humans; Hypercalcemia; Male; Middle Aged; Zollinger-Ellison Syndrome

Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups. The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group, aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50 children in the control group, 32 were seropositive (64%) for Hp IgG (P > 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels in 62 Hp-seropositive children (60.4 ng/l) were not different from those in 30 Hp-seronegative children (57.3 ng/l) and those in 42 children with RAP (58.2 ng/l) were also not significantly different from those in 50 healthy children (62.9 ng/l). Thus, no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population.

Topics: Abdominal Pain; Antibodies, Bacterial; Case-Control Studies; Child; Enzyme-Linked Immunosorbent Assay; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Recurrence; Turkey

Topics: Abdominal Pain; Adult; Anemia, Pernicious; Carcinoid Tumor; Diagnosis, Differential; Female; Gastrins; Gastritis, Atrophic; Gastroscopy; Humans; Hyperplasia; Precancerous Conditions; Pyloric Antrum; Stomach Neoplasms

The association between Helicobacter pylori and recurrent abdominal pain (RAP) is controversial. In this cross-sectional study, the authors aim to determine whether hypergastrinaemia causes RAP in children with H pylori gastritis. In 439 children age 4 to 13 years (mean 7.3 years) attending for nongastrointestinal day-case surgery, anti-Helicobacter immunoglobulin G (IgG) was identified in serum by an enzyme-linked immunosorbent assay (ELISA) method validated in children and fasting plasma gastrin was measured. A history of RAP was sought. One hundred twenty-seven children (29%) tested seropositive for H pylori. Fifty-one seronegative children (16.3%) and 22 seropositive children (17.3%) gave a history of RAP. The mean fasting gastrin in seronegative children was 52 ng/L compared with 117 ng/L in seropositive children (P < .001). The mean fasting gastrin in seropositive children with RAP (124 ng/L) was not significantly different from that of seropositive children without RAP (115 ng/L). The high prevalence of H pylori seropositivity in this study is at variance with other reported paediatric data from the developed world. No association between childhood H pylori gastritis, hypergastrinaemia, and RAP was found. In children with H pylori gastritis, the increase in circulating gastrin (mean 140% increase) is greater than that seen in adults (50% increase).

Topics: Abdominal Pain; Case-Control Studies; Child; Cross-Sectional Studies; Enzyme-Linked Immunosorbent Assay; Female; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Prevalence; Recurrence; Seroepidemiologic Studies

The objective of the present study was to measure plasma concentrations of the gastrointestinal hormones gastrin, somatostatin and cholecystokinin in plasma of children with recurrent abdominal pain, since these hormones affect gastrointestinal function. Forty-four children (7-16 years old) with recurrent abdominal pain and 36 control children (matched for age and sex) participated in the study. In a blood sample collected after an overnight fast, gastrin, somatostatin and cholecystokinin concentrations were measured by radioimmunoassay. The children with recurrent abdominal pain had higher plasma cholecystokinin levels (p < 0.001) than the controls. Whether or not this aberration is related to the clinical symptoms of children with recurrent abdominal pain remains to be established.

Topics: Abdominal Pain; Adolescent; Child; Cholecystokinin; Female; Gastrins; Humans; Male; Recurrence; Somatostatin

Nine patients with Zollinger-Ellison syndrome were treated with octreotide acetate (100 micrograms delivered subcutaneously three times daily) and followed up for 1 to 48 months. Serum gastrin levels were obtained at predetermined intervals. All patients had elevated baseline fasting gastrin levels (greater than 150 ng/L [greater than 150 pg/mL]). One month after administration of octreotide, gastrin levels were in the reference range for five (62%) of eight patients, and a mean gastrin suppression rate of 76% was achieved (ie, values were a mean of 76% less than baseline values). One year after administration of octreotide, five (71%) of seven evaluable patients had gastrin levels of less than 200 ng/L (200 pg/mL), and the mean gastrin suppression rate was more than 80% for these seven patients. During the second year, control at these levels was maintained in four patients; one patient continued to have controlled levels for 42 months. Complete symptomatic response occurred in seven patients (78%), and partial response in two patients (22%). All six patients with diarrhea before treatment were cured of it. Octreotide acetate provides efficacious long-term suppression of elevated gastrin levels and excellent symptomatic relief in patients with Zollinger-Ellison syndrome.

Topics: Abdominal Pain; Adolescent; Aged; Diarrhea; Fasting; Female; Follow-Up Studies; Gastrinoma; Gastrins; Humans; Injections, Subcutaneous; Male; Middle Aged; Octreotide; Pancreatic Neoplasms; Prospective Studies; Zollinger-Ellison Syndrome

All 95 portal venous sampling (PVS) procedures performed in patients with Zollinger-Ellison syndrome in the past 10 years at the authors' institution were reviewed. It was possible to catheterize at least one branch of the pancreaticoduodenal venous arcade in all but two procedures (98%). The highest concentration of gastrin was found in a selective sample from the pancreaticoduodenal venous arcade or the transverse pancreatic vein in 56 of 91 procedures (62%). Selective sampling of pancreatic head veins yielded a gastrin gradient sufficient for localization in 60 patients (63%). Among 55 solitary sporadic gastrinomas identified at surgery, PVS allowed correct localization of the tumor in 32 (58%); if selective samples had not been obtained, only eight (15%) would have been localized (P less than .0005). Sensitivity was the same for tumors in the gastrinoma triangle (64%) and the body or tail of the pancreas (60%). There were no false-positive results. The overall complication rate was 20%, but most complications were abdominal pain lasting 3 days or less. Six patients (6%) had serious complications.

Topics: Abdominal Pain; Blood Specimen Collection; Catheterization, Peripheral; Duodenum; Female; Gastrins; Humans; Male; Middle Aged; Pancreas; Phlebography; Sensitivity and Specificity; Veins; Zollinger-Ellison Syndrome

Antral gastrin cell hyperfunction is a rare condition, often associated with severe duodenal ulcer disease. In children, clinical and functional characteristics of this syndrome are poorly known. Two cases are described here: one child had melena and the other had moderate abdominal pain, both without peptic ulceration. Basal and postprandial increase of gastrin levels showed a response over the upper normal range, indicating gastrin cell hyperfunction. Acid hypersecretion, both basal and after pentagastrin stimulation, was also found in the two children, confirming the biological effect of their sustained hypergastrinemia. Gastrin cell counts were within the normal range, while the number of somatostatin D cells was significantly reduced. This report stresses the importance of diagnosing antral gastrin cell hyperfunction in children because this unrecognized condition may manifest with serious complications (bleeding) or nonspecific abdominal symptoms.

Topics: Abdominal Pain; Biopsy; Cell Count; Child; Enterochromaffin Cells; Female; Gastric Acid; Gastrins; Humans; Immunohistochemistry; Male; Melena; Pyloric Antrum; Somatostatin; Stomach Diseases

We have investigated the relationship between cholecystokinin levels and abdominal pain in patients with chronic pancreatitis. The baseline and postprandial cholecystokinin levels were measured in 15 patients with chronic pancreatitis (8 with and 7 without abdominal pain) and in a reference group of 8 healthy subjects. The baseline, 30 and 60 min postprandial plasma cholecystokinin levels were significantly (p less than 0.05) higher in the patients with pain as compared with the other two groups. No correlation was observed between increased cholecystokinin levels and impairment of the exocrine pancreatic function as assessed by the NBT-PABA test. The increased cholecystokinin levels might be an important factor in the genesis of pain in chronic pancreatitis.

Topics: Abdominal Pain; Adult; Cholecystokinin; Chronic Disease; Female; Food; Gastrins; Humans; Male; Pancreatitis; Radioimmunoassay