gastrins and Crohn-Disease

Many gastric acid hypersecretory states (basal acid output of greater than 15.0 mEq/h) exist for which the etiology is known, such as Zollinger-Ellison syndrome, systemic mastocytosis, antral exclusion, antral predominant Helicobacter pylori gastritis (antral G cell hyperplasia), chronic gastric outlet obstruction, short gut syndrome and basophilic leukemias. However, many hypersecretory patients have no identified etiology for their acid hypersecretion and are designated as idiopathic gastric acid hypersecretors with a basal acid output of greater than 10 mEq/h and a normal serum gastrin level. Because of the gastric acid hypersecretion these patients also commonly have an increased frequency of stools. Idiopathic gastric acid hypersecretion represents a known cause of gastric acid hypersecretion that is far more common than Zollinger-Ellison syndrome and it has a markedly different treatment regimen and natural history. We report a case of a patient with idiopathic gastric acid hypersecretion previously misdiagnosed as having Crohn's disease because of a presenting complaint of diarrhea and mimicking Zollinger-Ellison syndrome because her fasting serum gastrin level was elevated when incorrectly measured in the presence of antisecretory treatment.

Topics: Adult; Anti-Ulcer Agents; Crohn Disease; Diagnosis, Differential; Diarrhea; Female; Gastric Acid; Gastrins; Humans; Omeprazole; Zollinger-Ellison Syndrome

A patient with long-standing Crohn's disease of the large and small intestine was found to have extensive gastric metaplasia of the ileum. Most metaplastic glands were of the pyloric type, but numerous oxyntic glands with parietal and chief cells were also seen. By immunofluorescence the chief cells contained both the group I and group II pepsinogens, while the pyloric gland cells contained only the group II pepsinogens. Gastric-containing or other endocrine cells were not detected in the metaplastic pyloric and oxyntic glands. The latter findings are consistent with the concept expressed by Pearse that the endocrine and exocrine cells of the gastrointestinal mucosa may originate from different precursor elements during embryogenesis.

Topics: Choristoma; Crohn Disease; Female; Fluorescent Antibody Technique; Gastric Mucosa; Gastrins; Humans; Ileum; Intestinal Neoplasms; Metaplasia; Middle Aged; Pepsinogens; Pylorus; Stomach

Topics: Crohn Disease; Gastrins; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans

Gastrin plays an important role in the regulation of gastric acid secretion in humans. Tumour necrosis factor alpha (TNF-alpha) stimulates gastrin release from antral G cells in vitro. The aim was to determine whether gastrin release decreases in patients with Crohn disease treated with monoclonal antibody to TNF-alpha.. Twenty-five consecutive patients with Crohn disease (10 M, 15 F; 18 with fistulas) were treated with a single intravenous infusion of the monoclonal antibody to TNF-alpha, infliximab, at a dose of 5 mg/kg. Basal and bombesin stimulated gastrin was measured after an overnight fast immediately before and 2 weeks after infliximab. Helicobacter pylori status was determined by serology.. Twenty-two patients were H. pylori-negative. Basal plasma gastrin was 21 (16-26) pmol/L before and 19 (15-25) pmol/L after infliximab (NS). Bombesin stimulated gastrin decreased from 49 (40-62) pmol/L before to 36 (33-59) pmol/L (P < 0.005) 2 weeks after infliximab.. Gastrin release in response to bombesin decreases in patients with Crohn disease treated with infliximab.

Topics: Adult; Aged; Antibodies, Monoclonal; Bombesin; Crohn Disease; Female; Gastrin-Secreting Cells; Gastrins; Gastrointestinal Agents; Humans; Infliximab; Male; Middle Aged; Tumor Necrosis Factor-alpha

The presence of gastrin producing cells in the regenerating mucosa of the small intestine in 9 out of 19 patients with Crohn's disease, nonspecific ulcer or tuberculosis was histochemically examined, employing the method of peroxydase-antiperoxydase complex. Gastrin producing cells were found in 19 out of a total of 23 specimens with pyloric gland metaplasia, whereas they were found to be present in only 1 out of a total of 15 specimens without pyloric gland metaplasia. They were usually seen in the glands adjacent to the metaplastic pyloric glands. No gastrin producing cells were seen in the control specimens. It is suggested that gastric gland metaplasia of the small intestine is a true metaplastic change, into mucosa which has the functional property of the stomach.

Topics: Adult; Aged; Crohn Disease; Female; Gastrins; Humans; Ileal Diseases; Ileum; Intestinal Mucosa; Male; Metaplasia; Middle Aged; Regeneration; Ulcer

Topics: Adolescent; Adult; Colitis, Ulcerative; Colonic Diseases, Functional; Crohn Disease; Gastrins; Humans; Middle Aged; Radioimmunoassay

The number of peptide hormones which have been localized in the gut and in neurons of the central and peripheral nervous system has increased considerably. As there is almost no information about their importance in children with gastrointestinal diseases, we developed highly sensitive radioimmunoassays and measured postprandial serum/plasma levels of gastrin, secretin, vasoactive intestinal polypeptide (VIP) and motilin in 112 healthy children (N), 28 patients with cystic fibrosis (CF) and 17 children with Crohn's disease (CD). Gastrin values were not pathologic in children with CF nor those with Crohn's disease (N = 56.2 +/- 29.6 pg/ml; CF = 57.0 +/- 34.2 pg/ml; CD = 43.6 +/- 26.6 pg/ml). A significant age dependency was established for secretin and VIP. These peptides were elevated in CF-patients. In children with Crohn's disease only Secretin was increased. Motilin was elevated in all patients: N = 78.0 (49.1-124.0) pg/ml; CF = 148.0 (70.8-309) pg/ml; CD = 153.0 (87.6-266).

Topics: Adolescent; Adult; Child; Child, Preschool; Crohn Disease; Cystic Fibrosis; Gastrins; Humans; Infant; Motilin; Radioimmunoassay; Secretin; Vasoactive Intestinal Peptide

We have studied fasting levels and the response to a standard test breakfast of blood glucose and several gut hormones in 24 patients with ulcerative colitis, in 14 patients with Crohn's disease, and in 14 healthy control subjects. Patients with ulcerative colitis had significantly elevated fasting human pancreatic polypeptide (HPP) concentrations, and both basal and postprandial levels of gastrin, gastric inhibitory polypeptide (GIP), and motilin were greater than normal. In contrast, patients with Crohn's disease had normal gastrin levels but had increased fasting and postprandial levels of GIP and motilin and, in addition, of enteroglucagon, compared with controls. These patients also had greater than normal HPP concentrations 30 min after the breakfast. Normal levels of insulin, pancreatic glucagon, neurotensin, and vasoactive intestinal polypeptide were found in both groups of patients. Much remains to be known about the pathophysiology of these two debilitating diseases, and the abnormal release of gut hormones may be of importance.

Topics: Adolescent; Adult; Aged; Blood Glucose; Colitis, Ulcerative; Crohn Disease; Female; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Glucagon-Like Peptides; Humans; Insulin; Male; Middle Aged; Motilin; Neurotensin; Pancreatic Polypeptide; Vasoactive Intestinal Peptide

Topics: Colitis, Ulcerative; Crohn Disease; Gastrins; Humans

Topics: Adolescent; Adult; Crohn Disease; Gastric Mucosa; Gastrins; Humans; Ileum; Middle Aged; Postoperative Complications

Topics: Adult; Arginine; Child; Crohn Disease; Female; Gastrins; Humans; Ileum; Pylorus; Secretory Rate; Stimulation, Chemical

Gastric acid secretion before and after stimulation with pentagastrin and serum gastrin response to a test meal were recorded in 9 male controls and in 7 male patients from whom more than 50 cm of the terminal ileum had been resected because of Crohn's disease. The mean gastric acid secretion before and after stimulation was not found to be significantly different in the two groups. The mean fasting serum gastrin concentration and the serum gastrin response in absolute values were not different in the two groups. The MAO-BAO/'integrated gastrin response' was higher (p less than 0.05), and the gastrin response in relation to fasting level was lower in the patients than in the controls (p less than 0.05). The results indicate that an increased parietal cell sensitivity to gastrin is present after ileal resection. The negative acid feed back mechanism, however, seems to be at work. Under physiological conditions, therefore, the increased sensitivity may not result in acid hypersecretion.

Topics: Crohn Disease; Digestion; Eating; Fasting; Food; Gastric Juice; Gastrins; Humans; Ileostomy; Male; Pentagastrin; Secretory Rate; Stimulation, Chemical

Topics: Adolescent; Adult; Aged; Chromatography, Gel; Crohn Disease; Eating; Fasting; Female; Gastrins; Humans; Ileum; Iodine Radioisotopes; Jejunum; Male; Middle Aged; Obesity; Syndrome