gastrins and Burns

This clinical study compares effects between enteral nutrition and parenteral nutrition in the early stage of severe burns. Nineteen cases of severe burn patients were divided randomly into total enteral nutrition group (TEN) and total parenteral nutrition group (TPN). Plasma motilin, malondialdehyde (MDA), superoxide dismutase (SOD), endotoxin, tumor necrosis factor (TNF), serum gastrin, diamine oxidase (DAO), and urine lactulose/mannitol ratio (L/M) was determined on post burn day (PBD) 1, 4, 8, 14, respectively. The results showed that serum gastrin, plasma motilin, and SOD were significantly higher in TEN than in TPN on PBD4, 8 (p<0.05-0.01). Plasma MDA was obviously lower in TEN than in TPN on PBD4, 8 (p<0.01). Plasma endotoxin was significantly lower in TEN than in TPN on PBD4, 8 (p<0.01). Plasma TNF were significantly lower in TEN than in TPN on PBD4, 8, 14 (p<0.01). The level of serum DAO and urine L/M ratio in TEN was obviously lower than in TPN on PBD4 and 8, respectively (p<0.05-0.01). A positive correlation between L/M and DAO, MDA, TNF (r=0.5822-0.7598, p<0.05-0.01), and a negative correlation between L/M and SOD (r=-0.7771, p<0.01), and a positive correlation between plasma endotoxin and TNF, MDA (r=0.9038 and 0.6705, p<0.05-0.01) were found. These results indicate that enteral nutrition was a more effective route to preserve gastrin secretion and motility of gastrointestinal tract, lower intestinal ischemia and reperfusion injury, reduce intestinal permeability, decrease plasma endotoxin and inflammatory mediators, and maintain mucosa barrier function. Whenever gastrointestinal function permits, enteral nutrition was superior to parenteral nutrition early after burn.

Topics: Adult; Biomarkers; Burns; Endotoxins; Enteral Nutrition; Enzyme-Linked Immunosorbent Assay; Female; Gastrins; Humans; Lactulose; Male; Malondialdehyde; Mannitol; Motilin; Parenteral Nutrition; Skin; Superoxide Dismutase; Treatment Outcome; Tumor Necrosis Factor-alpha

To investigate the changes and significance of serum gastrin (GAS), beta-endorphin (beta-EP) and plasma motilin (MTL) in patients with severe burns.. Blood samples were gotten according to different timepoints from 32 admitted burned patients, and then serum GAS, beta-EP and plasma MTL were determined by radio-immuno assay (RIA).. In patients with severe burns, serum GAS decreased significantly in early period. And at the timepoint of 8 h, it reached the lowest level. But during 9-24 h it elevated for a while, and then it reached a relatively stable level. MTL reached the highest level at the timepoint of 2 h after burning. Then at the shock stage, it was comparatively lower. And at the timepoint of 8 h after burning, it reached the lowest level, then raised persistently after reabsorption, but still lower than the normal level. At the early stage after burning, beta-EP raised, then reached the highest level at 8 h after burning. GAS and MTL decreased and beta-EP increased significantly with the increase of the burned area. However, when the burned area was over 70% of the total body surface area, there was no relationship between them.. Blood GAS, MTL and beta-EP have represented regular changes in patients with severe burns at the early stage after burning. And the pain-stimulus and shock are effective factors.

Topics: Adolescent; Adult; beta-Endorphin; Burns; Female; Gastrins; Humans; Male; Middle Aged; Motilin; Radioimmunoassay; Time Factors

Heterogeneity is the most important consideration in the pathophysiology of peptic ulcer disease. Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation. If they heal there is no predictable recurrence. Factors concerned with mucosal defense are relatively more important than aggressive factors such as acid and pepsin. Local ischemia is the earliest recognizable gross lesion. The gastric mucosa is at least as vulnerable as the duodenal mucosa and probably more so. Most drug-induced ulcers occur in the stomach. Chronic or recurrent true peptic ulcers (penetrating the muscularis mucosae) usually present with abdominal pain. Many duodenal ulcer patients report that the pain occurs when the stomach is empty or is relieved by food, and follows a pattern of relatively long periods of freedom from symptoms between recurrences. Approximately 50% of patients experience a recurrence within a year if anti-ulcer medication is stopped. In most western countries recurrent duodenal ulcer is more common than gastric ulcer. Peptic ulcer disease is also more common in men. Recent evidence indicates genetic and familial factors in duodenal ulcer and increased acid-pepsin secretion in response to a variety of stimuli. However, it is also becoming clear that of all the abnormal functions noted, few are present in all subjects and many are clustered in subgroups. In chronic gastric ulcer of the corpus, defective defense mechanisms, such as duodenogastric reflux and atrophic gastritis, seem to be more important than aggressive factors. Nevertheless, antisecretory medications accelerate the healing of such ulcers. It remains to be seen whether prostaglandins, mucus secretion, or gastric mucosal blood flow are impaired in chronic ulcer disease.

Topics: Acute Disease; Animals; Burns; Chronic Disease; Duodenal Ulcer; Gastric Acid; Gastric Emptying; Gastrins; Humans; Intestinal Mucosa; Peptic Ulcer; Recurrence; Spinal Cord Injuries; Stomach Ulcer; Stress, Physiological

To better define the pathogenetic relationship between gastric acid secretion, serum gastrin levels and acute gastroduodenal disease in burned patients, fasting serum gastrin levels were correlated with the results of a nonaugmented gastric analysis performed in 31 hemodynamically stable burned patients. Gastroduodenoscopy documented the status of the gastric and duodenal mucosa at the time of acid analysis and serum gastrin collection. Twenty-two patients had acute gastroduodenal disease. Dffuse, superficial, gastroduodenal erosions were present in 17 patients; five additional patients had ulcerative lesions. Nine patients had normal endoscopic examinations. Gastrin levels were not predictive of the incidence, severity or location of disease. Gastric acidity, however, did correlate with disease severity-correlation coefficient, r=+0.41,p less than 0.05-being lowest in normal persons, intermediate in superficial disease and highest in ulceration. There was no correlation between the levels of serum gastrin and gastric acid secretion. The relative hyperacidity in patients with acute gastroduodenal disease suggests that acid may be one of the factors potentiating mucosal injury in these patients and may be particularly important in the evolution of life-threatening ulceration.

Topics: Acute Disease; Adolescent; Adult; Burns; Gastric Juice; Gastrins; Humans; Middle Aged; Peptic Ulcer

Hyperglucagonaemia and hypergastrinaemia were observed in some severely burnt patients during their illness. Hyperglucagonaemia seemed to be related to the severity of illness rather than to the burn itself, and the close correlation of glucagon concentrations with glucose and urea and its inverse correlation with bicarbonate concentrations suggest that glucagon might contribute to the hypercatabolic state. One patient developed high levels of gastrin and massive bleeding from a stress ulcer of the duodenum. Possibly gastrin hypersecretion may have a role in the pathogenesis of Curling's ulcer.

Topics: Acid-Base Equilibrium; Adult; Aged; Blood Glucose; Burns; Duodenal Ulcer; Female; Gastrins; Glucagon; Humans; Male; Peptic Ulcer Hemorrhage; Stress, Physiological; Syndrome; Urea

Topics: Adolescent; Adult; Aged; Burns; Child; Child, Preschool; Female; Gastric Juice; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer