gastrins and Biliary-Tract-Diseases

Topics: Biliary Tract Diseases; Ceruletide; Cholangiography; Cholelithiasis; Duodenal Ulcer; Endoscopy; Gastrins; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastrointestinal Hormones; Humans; Intestinal Absorption; Lactose Intolerance; Pancreatic Diseases; Peptic Ulcer; Radionuclide Imaging; Secretin; Stomach Neoplasms

In order to delineate the role of enterogastric reflux in changes of postoperative gastric secretory functions, 22 patients with peptic ulcers, who were randomly assigned to partial gastrectomy without vagotomy with either Billroth II or Roux-en-Y anastomosis, were prospectively studied before and 6 months after surgery. Preoperatively, there were no significant differences in gastric secretory functions between the two groups of 11 patients. Postoperatively, median fasting bile acids in the stomach increased in the Billroth II patients from 0.35 to 16.10 mumol/hr (p less than 0.01), but significantly decreased in the Roux-en-Y patients from 0.30 to 0.10 mumol/hr (p less than 0.05), which indicated adequate prevention of enterogastric reflux after the Roux-en-Y procedure. Gastrectomy resulted in significant reductions of median values of basal acid output (4.6 vs 0.6 mmol/hr, p less than 0.01, and 4.2 vs 0.4 mmol/hr, p = 0.02), peak acid output (31.6 vs 4.2 mmol/hr, p less than 0.01, and 38.7 vs 4.5 mmol/hr, p less than 0.01), serum pepsinogen A (121 vs 86 micrograms/L, p less than 0.01, and 92 vs 45 micrograms/L, p less than 0.01), meal-stimulated serum gastrin secretion (1472 vs 199 pM.60 min, p less than 0.0001, and 1017 vs 199 pM.60 min, p less than 0.0001) in the patients with Billroth II and Roux-en-Y anastomosis, respectively. There were, however, no significant differences in gastric secretory parameters between the two groups when studied 6 months after surgery. Therefore it is concluded that after gastrectomy, enterogastric reflux does not affect the secretory function of the gastric remnant within the first 6 months after surgery.

Topics: Anastomosis, Roux-en-Y; Anastomosis, Surgical; Bile Acids and Salts; Bile Reflux; Biliary Tract Diseases; Eating; Fasting; Female; Gastrectomy; Gastric Acid; Gastrins; Humans; Male; Middle Aged; Pepsinogens; Peptic Ulcer; Prospective Studies

To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides.. Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed.. Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t=5.254, 3.438 and 3.527, P<0.001). SOD of the reflux group was shorter than the control group (t=2.049, P<0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t= -2.230 and -2.235, P<0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP.. About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.

Topics: Bile; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Case-Control Studies; Cholecystectomy; Drainage; Duodenogastric Reflux; Female; Gastrins; Humans; Male; Manometry; Middle Aged; Motilin; Muscle Contraction; Pressure; Radioimmunoassay; Radiopharmaceuticals; Sphincter of Oddi; Sphincter of Oddi Dysfunction; Technetium Tc 99m Pentetate

The authors studied the changes of gastric acid secretion and determined the levels of somatostatin (SS) and gastrin (Gn) in blood, gastric juice and pyloric antrum in 28 patients Roux-en-Y with cholangiojejunostomy (CJR-Y). Gastric acid hypersecretion was identified, and the level of SS was found dropped while the content of Gn increased in these specimens. It was considered that the reduction of SS synthesis and secretion might have a key effect on the mechanism of secondary gastric acid hypersecretion in patients after CJR-Y.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Bile Ducts; Biliary Tract Diseases; Female; Gastric Acid; Gastrins; Humans; Jejunum; Male; Middle Aged; Postoperative Period; Somatostatin

In order to explore the mechanism of secondary gastric acid hypersecretion after Roux-en-Y Cholangio-jejunostomy (CJR-Y), we studied the changes of gastric acid secretion and determined the levels of somatostatin (SS), gastrin (Gn), neurotensin (NT), beta-endorphin (beta-EP) in serum, gastric juice and pyloric antrum in patients with CJR-Y. The results showed that gastric hypersecretion developed, levels of SS in those specimens decreased significantly and the content of Gn increased obviously after CJR-Y; whereas the content of NT and beta-EP did not change significantly. We concluded that the decreased level of SS plays a role in the mechanism.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Bile Ducts; Biliary Tract Diseases; Gastric Acid; Gastrins; Humans; Jejunum; Middle Aged; Neurotensin; Postoperative Complications; Somatostatin

Patients with SYDS following abdominal operation or with severe acute abdominal diseases were observed on changes of the thyroid, adrenal function and digestive hormones. The results showed that the serum concentration of T3 in patients with SYDS decreased by about 50% with the control (P less than 0.001). The concentration of T4 decreased too (P less than 0.001). The rT3 content increased and there were no obvious changes in the content of TSH and T3RUR. The manifestations conformed to "low T3 syndrome" in nonthyroid diseases. The amount of urine 17-KS and 17-OHCS per 24 hours decreased (P less than 0.001 and P less than 0.05 respectively). The serum gastrin level decreased by 60.4% with the control (P less than 0.002) and that of VIP increased (P less than 0.05). The results suggested that the patients had decreased thyroid and adrenal function and the secretion of hormones of digestive tract decreased.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Abdomen, Acute; Adult; Aged; Biliary Tract Diseases; Female; Gastrins; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Postoperative Period; Stomach Diseases; Thyroxine; Triiodothyronine; Vasoactive Intestinal Peptide

Thirty patients with bile reflux gastritis, proven by gastroscopy and Milk 99mTc-EHIDA Test, were studied and their clinical features were compared with those of patients with non-bile reflux gastritis. The symptoms were similar in both groups of patients, whereas histologically in bile reflux gastritis there were more hyperemia of mucosa, more obvious edema in lamina propria and more polymorphonuclear infiltration. Furthermore, in bile reflux gastritis the histological changes were more severe in the antrum and decreased in severity toward the cardia. Acid secretion was significantly lower in patients with bile reflux gastritis than in patients with non-bile reflux gastritis while the serum gastrin level was significantly higher in the former than in the latter group. The authors suggest that there may be a vicious cycle among duodenogastric reflux, low level of gastric acidity and high level of serum gastrin. When duodenogastric reflux occurs, not only the bile salts damage the gastric mucosa and subsequently cause the back diffusion of hydrogen ion but also the alkaline duodenal juice neutralizes the gastric acid, resulting in decrease of gastric acidity. The bile salts and low acidity can stimulate the release of serum gastrin which antagonizes the effects of cholecystokinin and secretin on pyloric tone and aggravates the duodenogastric reflux.

Topics: Adult; Aged; Bile Reflux; Biliary Tract Diseases; Female; Gastric Acidity Determination; Gastrins; Gastritis; Humans; Male; Middle Aged

I investigated the significance of bile reflux, when vagotomy was done to stress ulcer, by means of measuring gastric ulcer index, gastric pH and serum gastrin levels of rats. And in order to examine influence of alkali factor of bile, I measured gastric acid output and serum gastrin levels after alkali or acid solution was infused into the untreated rat's stomach. Results were summarized as follows: 1. When I infused alkali solution into the untreated stomach, there was no significant change in serum gastrin level but gastric acid output was significantly accelerated, as compared with infusing acid solution. On the other hand, when I infused alkali solution into the vagotomized stomach, serum gastrin level increased significantly and gastric acid output was significantly accelerated, as compared with infusing acid solution, so, acceleration of acid output observed when I infused alkali solution into the untreated stomach was not suppressed in spite of vagotomy operation. 2. In the vagotomized group, gastric acid output was significantly suppressed and serum gastrin level increased significantly as compared with the untreated group. But, when bile was led into the stomach in the vagotomized group, acid output was accelerated and serum gastrin level also showed a tendency to increase as compared with the group of vagotomy alone. 3. When mild stress was inflicted, stress ulcer formation was significantly prevented in the bile reflux group (vagotomy + pyloroplasty) as well as in the non-bile reflux group (vagotomy + pyloric ligation + gastroileostomy) if vagotomy was done. But, when severe stress was inflicted, stress ulcer formation was significantly prevented in the non-bile reflux group, but not prevented in the bile reflux group. As mentioned above, it was proved that stress ulcer formation was not prevented under a severe stress, if bile reflux existed, even though vagotomy was done. So, if we do vagotomy operation, we need to choose the operation method not to induce bile reflux as much as possible.

Topics: Animals; Bile Reflux; Biliary Tract Diseases; Gastric Acid; Gastrins; Male; Rats; Rats, Inbred Strains; Stomach Ulcer; Stress, Physiological; Vagotomy

The gastric mucosa of 19 mongrel dogs was submitted to a bilio-pancreatic, isolated biliary or isolated pancreatic reflux. With an isolated biliary reflux, there is a more rapid and more severe hyperaemia and foveolar hyperplasia of the mucosa of the fundus than with an isolated pancreatic reflux. There was no significant change in the basal serum level of gastrin with any of these different types of alkaline reflux, but we observed a statistically significant increase in the level of histamine in the gastric mucosa. Hyperaemia and foveolar hyperplasia of the fundic mucosa both disappeared when the alkaline reflux was suppressed, and there was a statistically significant decrease in the basal serum level of gastrin and in the level of histamine in the gastric mucosa.

Topics: Animals; Bile Reflux; Biliary Tract Diseases; Dogs; Duodenogastric Reflux; Gastric Mucosa; Gastrins; Gastritis; Gastrostomy; Histamine; Hyperemia; Jejunum; Time Factors

In 26 patients with Roux-Y choledochojejunostomy and 10 with jejunal interposition choledochoduodenostomy, gastrin-stimulated gastric acid secretion and serum levels of gastrin and secretin after feeding were examined before operation and at the time of follow-up. The follow-up levels of maximum acid output were higher than those before operation in each group, and they tended to be higher in patients with Roux-Y choledochojejunostomy (Group I) than in those with jejunal interposition choledochoduodenostomy (Group II), but the difference was not significant. There was no instance of postoperative peptic ulcer in either group. The levels of serum gastrin after feeding tended to be higher in Group II, whereas serum secretin levels were contrarily higher in Group I. The changes in these hormones could be considered not as the cause but rather as the outcome of the changes in postoperative gastric acid secretion.

Topics: Adult; Aged; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Duodenum; Gastric Acid; Gastrins; Humans; Jejunum; Middle Aged; Peptic Ulcer; Postoperative Period

The chronic antral ulcer developed spontaneously in (WB X C57BL/6)F1-W/WV mice. Natural history of the ulcer was investigated to make clear the mechanisms involved in the development of ulcer in this mutant mouse. Although no histopathologic abnormalities of the stomach were detected at the fifth day after birth, erosions developed at the tenth day and the severity of the ulcerative lesions advanced with age. Antral pH of the W/WV mice was higher than that of the congenic +/+ mice, and the content of gastrin in the glandular stomach of the former was lower than that of the latter. Therefore, hyperacidity cannot be the cause of the ulcer in the W/WV mice. Bilirubin was demonstrable in the stomach contents of the suckling W/WV mice. After subcutaneous injection of [35S]sulfobromophthalein, the 35S radio-activity in the stomach contents of the 10-day-old W/WV mice was about 40 times as great as that observed in the +/+ littermates. As the peak of the bile reflux occurred shortly before the development of obvious ulcer that penetrated beyond the muscularis mucosae, the bile reflux could be a cause rather than a result of the ulcer.

Topics: Animals; Bile Reflux; Biliary Tract Diseases; Bilirubin; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Hydrogen-Ion Concentration; Male; Mice; Mice, Mutant Strains; Pyloric Antrum; Rats; Stomach Ulcer

A case of adrenocortical hyperfunction due to ectopic production of ACTH by a gastrin-producing tumor of the pancreas is described. Cushing's syndrome preceded the appearance of the overt Zollinger-Ellison syndrome by 2 years and was treated by bilateral adrenalectomy. The Zollinger-Ellison syndrome was initially treated with cimetidine, which successfully reduced the secretion of gastric acid. Because the pancreatic gastrinoma continued to grow, causing obstruction of the common bile duct, biliary diversion and total gastrectomy were performed. There is evidence that the pancreatic gastrinoma was the source of the ectopic production of ACTH and possibly secretion. The role of Histamine-2 blocking agents as therapy in the Zollinger-Ellison syndrome is discussed.

Topics: Adrenocorticotropic Hormone; Adult; Biliary Tract Diseases; Cholestasis; Common Bile Duct; Constriction, Pathologic; Gastrins; Hormones, Ectopic; Humans; Male; Pancreatic Neoplasms

Topics: Animals; Biliary Tract Diseases; Chemistry; Cyclic AMP; Gastric Juice; Gastric Mucosa; Gastrins; History, 20th Century; Humans; Peptic Ulcer; Prostaglandins; Prostaglandins E; Prostaglandins E, Synthetic

Topics: Animals; Biliary Tract Diseases; Dogs; Gastrins; Humans; Kidney Diseases; Liver Diseases

Topics: Animals; Biliary Tract Diseases; Contraceptives, Oral; Duodenal Ulcer; Gastric Mucosa; Gastrins; Gastroesophageal Reflux; Gastrointestinal Diseases; Humans; Intestine, Small; Liver; Liver Neoplasms; Liver Regeneration; Pancreas Transplantation; Postoperative Complications; Rats; Stomach; Transplantation, Homologous; Vagotomy

Topics: Animals; Biliary Tract Diseases; Brain Diseases; Calcium; Cholecystectomy; Cholelithiasis; Cholesterol; Dihydroxyphenylalanine; Dogs; Duodenal Ulcer; Gastrectomy; Gastric Juice; Gastrins; Gastrointestinal Diseases; Humans; Hyperparathyroidism; Liver Diseases; Norepinephrine; Pancreas; Secretin; Serotonin; Stimulation, Chemical; Vagotomy

Topics: Animals; Ascites; Bile; Biliary Tract Diseases; Digestive System Physiological Phenomena; Esophageal and Gastric Varices; Gastric Juice; Gastrins; Gastrointestinal Diseases; Hepatic Encephalopathy; Humans; Hypercholesterolemia; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Regeneration; Liver Transplantation; Pancreas; Preservation, Biological; Radioimmunoassay; Rats

Topics: Biliary Tract Diseases; Cholangiography; Cholecystokinin; Gastrins; Humans; Intestine, Small; Pancreatic Diseases; Secretin; Stomach Diseases

Topics: Biliary Tract Diseases; Biopsy; Diagnosis, Differential; Gastric Acidity Determination; Gastric Juice; Gastrins; Gastrointestinal Diseases; Gastroscopes; Humans; Liver Diseases; Male; Methods; Pancreatic Diseases; Pancreatic Juice