gastrins and Peritonitis

As beta-adrenergic blockers grow increasingly popular for the therapy of a wide variety of disorders, it becomes increasingly important to appreciate the spectrum of physiologic effects on the gastrointestinal system and the potential hazards associated with use of these agents. This review details the effects of the beta-adrenergic blocking agents on the gastrointestinal tract.

Topics: Adrenergic beta-Antagonists; Animals; Bile Ducts; Digestive System; Drug Interactions; Gastrectomy; Gastric Acid; Gastrins; Gastrointestinal Motility; Humans; Hypoglycemia; Intestinal Absorption; Intestinal Mucosa; Pancreas; Peritonitis; Receptors, Adrenergic

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida tropicalis; Candidiasis; Child, Preschool; Digestive System Surgical Procedures; Female; Fluconazole; Gastrins; Humans; Peritonitis; Reoperation; Rupture, Spontaneous; Stomach Rupture; Treatment Outcome

Two personal cases of Zollinger-Ellison syndrome (ZES) are described. Total gastrectomy (TG) was performed in the first case as an emergency measure, following acute peritonitis caused by a recurrence of ulcer, with perforation 27 days after the first gastric resection. The patients is in good health, though with persistently high blood gastrin levels. The second case was marked by a long history of recurrent ulcer, with two earlier gastric resections. Here, success was obtained by simply enucleating a small gastrinoma from the head of the pancreas in view of the arteriographic evidence. The patient is in excellent health 2 1/2 yr after surgery with stable, normal blood gastrin. The recent literature and these cases suggest that surgery is the method of choice for ZES, its primary aim being the removal of gastrinomas, since these prove malignant in 60-100% of cases, and TG does not in any way inhibit their growth, as was once supposed. Blood gastrin values permit early diagnosis and postoperative monitoring, while arteriography and transhepatic portal catheterisation constitute a useful guide to the location of the tumour. Hyperchlorhydria can be effectively controlled with H2 receptor inhibitors, both in the preoperative diagnostic stage, and after surgery in the event of failure. TG offers the best results in over 60% of cases, when the tumours is multifocal, widely metastasised, or undiscoverable.

Topics: Adult; Angiography; Female; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Peritonitis; Postoperative Complications; Zollinger-Ellison Syndrome

Topics: Animals; Carbachol; Drug Synergism; Duodenal Ulcer; Female; Gastric Juice; Gastrins; Histamine; Injections, Subcutaneous; Mesentery; Peritonitis; Pylorus; Rats; Succinates