gastrins and Postoperative-Complications

The problems encountered with ileal and colocystoplasty have led to the use of the stomach for bladder augmentation, termed gastrocystoplasty. The advantages of gastrocystoplasty over intestinal segment augmentation include reduced chloride reabsorption, decreased mucus production, decreased urinary infection in the presence of acid urine, extremely low incidence of stones, and avoidance of complications from short bowel syndrome. The gastric patch provides comparable improvements in bladder volume, pressure, and continence. The thick muscular wall of the stomach facilitates ureteric reimplantation as compared with the small intestine, but the rate of stenosis and reflux may not be superior. The disadvantages of the gastric patch include complications of severe systemic alkalosis, which is usually manifest in dehydrated, renal compromised patients, and the hematuria-dysuria syndrome (HDS), which is more prevalent in patients with renal insufficiency, normal pelvic sensation, and urinary incontinence. The postoperative complication rate of gastrocystoplasty is comparable with that of other augmentation procedures and similarly warrants proper selection and close follow-up of patients. In this report we review the literature and present the results, including a discussion of the technique and the pathophysiology of its complications.

Topics: Bacteriuria; Child; Gastrins; Hematuria; Humans; Neoplasms; Postoperative Complications; Stomach; Urinary Bladder; Urinary Diversion; Urinary Reservoirs, Continent; Urodynamics

Topics: Bile; Gastric Acid; Gastric Emptying; Gastrins; Humans; Pepsin A; Postoperative Complications; Vagotomy; Vagus Nerve

Exogenous infusion of acid into the canine duodenum inhibits acid secretion stimulated by endogenously released and exogenously administered gastrin. The importance of this mechanism in normal acid homeostasis and in the inhibition of chronic endogenous acid hypersecretion is not established. In this study the classic Dragstedt model antral colonic transplant (ACT) was used to produce endogenous hypergastrinemia and acid hypersecretion. The effects of the ACT when the duodenum was retained in continuity with the stomach (gastroduodenostomy) were compared with those obtained when the duodenum was no longer in continuity with the stomach (gastrojejunostomy). The duodenum markedly suppressed gastrin release (p = 0.003) and gastric acid secretion (p = 0.005) in each of the four dogs. The dogs remained free of ulcers for 8 months after gastroduodenostomy and ACT. However, after conversion to gastrojejunostomy, large, chronic peptic ulcers developed after a mean of 3.5 months. The inhibitory effect of the duodenum on gastric release and gastric acid secretion protected the dog against ulceration for an extended period. The duodenum may be the major site of inhibitory control of acid secretion and endogenous gastrin release in dogs.

Topics: Anastomosis, Surgical; Animals; Colon; Dogs; Duodenum; Gastric Acid; Gastric Acidity Determination; Gastrins; Jejunal Diseases; Jejunum; Models, Biological; Pentagastrin; Postoperative Complications; Pyloric Antrum; Stomach

Topics: Animals; Dogs; Gastrins; Gastrointestinal Hormones; Humans; Intestine, Small; Kidney Failure, Chronic; Liver Cirrhosis; Malabsorption Syndromes; Peptic Ulcer; Postoperative Complications; Short Bowel Syndrome

Topics: Adolescent; Adult; Duodenal Ulcer; Endoscopy; Female; Gastric Acid; Gastric Acidity Determination; Gastrins; Humans; Insulin; Intraoperative Period; Male; Middle Aged; Postoperative Complications; Pyloric Antrum; Recurrence; Stomach Ulcer; Time Factors; Vagotomy; Vagotomy, Proximal Gastric

Topics: Cimetidine; Gastrectomy; Gastric Juice; Gastrins; Humans; Hyperplasia; Neoplasm Metastasis; Postoperative Complications; Pyloric Antrum; Vagotomy; Zollinger-Ellison Syndrome

Topics: Adipose Tissue; Diet, Diabetic; Dietary Carbohydrates; Digestive System; Gastrins; Glucagon; Humans; Hypothalamus; Insulin; Liver; Pancreatectomy; Pancreatic Hormones; Postoperative Care; Postoperative Complications; Salivary Glands; Somatostatin

After reviewing the more recent acquisitions on the physiology and pathophysiology of gastrin, the authors concentrate on situations of hypergastrinemia, which they divide into a hyperhydrochloric and a hypohydrochloric variety. Among the former, which they subdivide into preoperative and postoperative, the authors discuss problems of differential diagnosis versus peptic ulcers in patients so afflicted. To that end they propose diagnostic policies comprising among other instrumental and laboratory tests the study of gastric secretion, blood gastrin levels in basal conditions and after stimulation by a protein meal, BBS, secretin, and calcium. From analysis of the results of such tests they were able to find a precise nosographic placement for postoperative hypergastrinemia, and from there they arrived at surgical programs aiming to correct postoperative peptic ulcers on the basis of their etiology and pathogenesis.

Topics: Gastrectomy; Gastrins; Humans; Hyperparathyroidism; Peptic Ulcer; Postoperative Complications; Pyloric Stenosis; Stomach Diseases; Vagotomy; Zollinger-Ellison Syndrome

Topics: Animals; Dumping Syndrome; Gastrectomy; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Humans; Hypoglycemia; Insulin; Insulin Secretion; Postoperative Complications; Vagotomy

In a short survey recent results of research on gastrin are presented. Special stress is laid upon the mechanism of liberating gastrin, the role of the vagus in this process and the consequences of gastric surgery on serumgastrin. In clinical practice the differential diagnosis of hypergastrinemia in ulcer disease is very important, for it will have a decisive influence on the therapeutic decisions and the specific kind of surgical treatment.

Topics: Duodenal Ulcer; Gastrins; Humans; Peptic Ulcer; Postoperative Complications; Vagotomy; Zollinger-Ellison Syndrome

Topics: Anemia, Hypochromic; Body Weight; Bone Diseases; Chronic Disease; Diarrhea; Dumping Syndrome; Duodenal Obstruction; Duodenal Ulcer; Female; Follow-Up Studies; Gastrectomy; Gastric Juice; Gastric Mucosa; Gastrins; Histamine; Humans; Insulin; Male; Methods; Pentagastrin; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Recurrence; Stomach Ulcer; Vomiting

Topics: Animals; Bacteria; Bacteriolysis; Bile Acids and Salts; Celiac Disease; Dogs; Duodenum; Food; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Intestinal Mucosa; Intestine, Small; Lithocholic Acid; Postoperative Complications; Secretory Rate; Vagotomy

Topics: Diarrhea; Drainage; Dumping Syndrome; Duodenal Ulcer; Female; Gallbladder; Gastric Juice; Gastrins; Gastrointestinal Hemorrhage; Gastrointestinal Motility; Humans; Intestine, Small; Male; Pancreas; Peptic Ulcer Perforation; Postoperative Complications; Pyloric Antrum; Pyloric Stenosis; Pylorus; Recurrence; Stomach; Stomach Ulcer; Vagotomy

Topics: Duodenal Ulcer; Gastrectomy; Gastric Mucosa; Gastrins; Humans; Pepsin A; Peptic Ulcer; Postgastrectomy Syndromes; Postoperative Complications; Stomach Ulcer; Vagotomy; Vagus Nerve

Topics: Drainage; Duodenum; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Peptic Ulcer; Postoperative Complications; Pyloric Antrum; Recurrence; Stomach; Vagotomy; Vagus Nerve

Topics: Afferent Loop Syndrome; Deglutition Disorders; Diet Therapy; Dumping Syndrome; Gastric Acidity Determination; Gastrins; Gastroenterostomy; Gastroscopy; Humans; Hyperparathyroidism; Malabsorption Syndromes; Pentagastrin; Peptic Ulcer; Postgastrectomy Syndromes; Postoperative Complications; Stomach; Stomach Ulcer; Sutures; Zollinger-Ellison Syndrome

Topics: Abdomen; Duodenal Diseases; Duodenal Neoplasms; Duodenal Ulcer; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagitis; Esophagoplasty; Esophagus; Female; Gastrins; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Male; Peptic Ulcer; Peptic Ulcer Perforation; Postoperative Complications; Rupture, Spontaneous; Stomach Diseases; Stomach Neoplasms; Stomach Ulcer; Stress, Psychological; Vagotomy

To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen.. A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications.. There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (. In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.

Topics: Abdomen; Abdomen, Acute; Adrenocorticotropic Hormone; Child; Gastrins; Humans; Hydrocortisone; Motilin; Postoperative Complications; Prospective Studies; Somatostatin

Prolonged intestinal paralysis can be a problem after gastrointestinal surgery. Several systematic reviews and meta-analyses have suggested the efficacy of gum chewing for the prevention of postoperative ileus.. The purpose of this study was to examine the efficacy of gum chewing for the recovery of bowel function after surgery for left-sided colorectal cancer and to determine the physiological mechanism underlying the effect of gum chewing on bowel function.. This was a single-center, placebo-controlled, parallel-group, prospective randomized trial.. The study was conducted at a general hospital in Japan.. Forty-eight patients with left-sided colorectal cancer were included.. The patients were randomly assigned to a gum group (N = 25) and a control group (N = 23). Four patients in the gum group and 1 in the control group were subsequently excluded because of difficulties in continuing the trial, resulting in the analysis of 21 and 22 patients in the respective groups. Patients in the gum group chewed commercial gum 3 times a day for ≥5 minutes each time from postoperative day 1 to the first day of food intake.. The time to first flatus and first bowel movement after the operation were recorded, and the colonic transit time was measured. Gut hormones (gastrin, des-acyl ghrelin, motilin, and serotonin) were measured preoperatively, perioperatively, and on postoperative days 1, 3, 5, 7, and 10.. Gum chewing did not significantly shorten the time to the first flatus (53 ± 2 vs. 49 ± 26 hours; p = 0.481; gum vs. control group), time to first bowel movement (94 ± 44 vs. 109 ± 34 hours; p = 0.234), or the colonic transit time (88 ± 28 vs. 88 ± 21 hours; p = 0.968). However, gum chewing significantly increased the serum levels of des-acyl ghrelin and gastrin.. The main limitation was a greater rate of complications than anticipated, which limited the significance of the findings.. Gum chewing changed the serum levels of des-acyl ghrelin and gastrin, but we were unable to demonstrate an effect on the recovery of bowel function.

Topics: Aged; Aged, 80 and over; Chewing Gum; Colectomy; Colon, Descending; Colonic Neoplasms; Defecation; Female; Flatulence; Gastrins; Gastrointestinal Motility; Ghrelin; Humans; Ileus; Japan; Length of Stay; Male; Middle Aged; Motilin; Postoperative Care; Postoperative Complications; Serotonin; Sigmoid Neoplasms; Treatment Outcome

The aim of this study was to evaluate differences in electrogastrographic activity and serum gastrin secretion in patients subjected to general anesthesia (GA) vs blended anesthesia (BA = GA plus epidural analgesia) for abdominal aortic surgery.. Thirty-four patients (all males: 28 with abdominal aorta aneurysm, 6 with obstructive aorto-iliac disease; mean age: 68+/-7 years) were randomly assigned either to GA (N.=17) or to BA (N.=17) for abdominal aortic surgery. Each patient was evaluated for serum gastrin secretion at the time of electrogastrography (EGG) 24 h before and after surgery, using ambulatory equipment. Gastrin levels were tested under fasting conditions and after a standard meal. EGG shows gastric electrical activity that parallels gastric motor activity.. Before surgery, no significant difference was found for any of the EGG parameters or the serum gastrin integrated value (area under the curve [AUC]) between the two groups of patients. After surgery, an increased frequency of electrical waves (tachygastria) was observed in 22% of those undergoing GA and in 5% of patients undergoing BA. The power ratio (postprandial/fasting total power) was exceedingly high (>4) in 53% of the GA patients and in 11% of the BA patients (P<0.05). The gastrin AUC was 263+/-58 pg/mL in the GA group and 179+/-92 pg/mL in the BA group (P<0.01).. An excess of EGG activity and serum gastrin secretion was observed in patients undergoing GA vs those submitted to BA. Thus, the latter procedure seems to affect gastric function less than GA alone.

Topics: Aged; Anesthesia, Epidural; Anesthesia, General; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Arterial Occlusive Diseases; Eating; Elective Surgical Procedures; Electrodiagnosis; Fasting; Gastrins; Humans; Ileus; Iliac Artery; Male; Middle Aged; Myoelectric Complex, Migrating; Postoperative Complications

After pylorus-preserving Whipple (PPW), delayed gastric emptying (DGE) is reported in up to 50% of these patients. We analyzed gastric emptying and hormonal adaptation of cholecystokinin (CCK), pancreatic polypeptide (PP), and gastrin following two surgical procedures for chronic pancreatitis (CP): the PPW and the duodenum-preserving pancreatic head resection (DPPHR).. Ten patients underwent DPPHR and 10 underwent PPW for CP. Preoperatively and 10 days and 6 months postoperatively, gastric emptying (paracetamol absorption test) and CCK, gastrin, and PP were measured using a test meal stimulation.. The area under the serum paracetamol time curve for 0 to 120 minutes (AUC) showed no preoperative difference. Ten days postoperatively, the AUC was significantly reduced (P <0.05) after PPW but not after DPPHR. Six months postoperatively, AUC was comparable with the preoperative findings in DPPHR and PPW. The integrated 180-minute PP release was significantly reduced 10 days and 6 months postoperatively in both groups. The integrated 180-minute CCK release was decreased 10 days after PPW, but failed to be significant (P = 0.053). Gastrin levels were postoperatively unchanged.. Following DPPHR we found no delay in gastric emptying. In contrast, DGE occurs early after PPW. Our data may help explain the slower recovery in PPW patients with regard to weight gain and relief from pain, which may be due to the functional alteration of gastric emptying and motility after this type of surgery.

Topics: Acetaminophen; Adult; Cholecystokinin; Chronic Disease; Female; Gastric Emptying; Gastrins; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreaticoduodenectomy; Pancreatitis; Postoperative Complications

To determine the results of a new surgical procedure for patients with Barrett's esophagus.. In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients.. Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length.. No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients.. This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.

Topics: Adult; Aged; Barrett Esophagus; Bile Reflux; Duodenum; Female; Follow-Up Studies; Fundoplication; Gastric Acid; Gastric Emptying; Gastrins; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Manometry; Middle Aged; Postoperative Complications; Prospective Studies; Vagotomy

Since 1980, 73 patients with Zollinger-Ellison syndrome (ZES) without radiographic evidence of liver metastases were studied on a prospective protocol including medical management of gastric acid hypersecretion, extensive radiographic tumor localization, and exploratory surgery to find and resect gastrinoma for potential cure. Each patient had gastric acid hypersecretion effectively controlled with either H2-blockers or omeprazole. Patients were divided prospectively into two groups, with all patients undergoing the same preoperative localization studies and extensive laparotomy. In contrast to group 1 (1980-1986) (36 patients), group 2 (1987-Oct. 1990) (37 patients) also underwent additional procedures (transillumination and duodenotomy) at surgery to find duodenal gastrinomas. Preoperative imaging studies localized tumor in 38 (52%) patients, and portal venous sampling for gastrin determinations was positive in 49 (67%) patients. Gastrinomas were found and resected in 57 (78%) patients. Significantly more gastrinomas (92% of patients) were found in group 2 than in group 1 patients (64%) (p less than 0.01). This increase was due to increased numbers of duodenal gastrinomas in group 2 than in group 1 patients (43% versus 11%; p less than 0.01). The increased ability to find duodenal gastrinomas did not significantly improve the immediate disease-free rate, which was 58% for all patients. Duodenal primary gastrinomas were found to have a significantly greater incidence of metastases (55%) and a significantly shorter disease-free interval (12 months) than pancreatic gastrinomas (22% and 84 months, respectively) suggesting that duodenal gastrinomas may be more malignant and not more frequently curable than pancreatic gastrinomas. Operations were performed with no deaths and 11% morbidity rate. Long-term follow-up showed that 50% of patients initially rendered disease free would develop recurrent disease by 5 years. Survival was excellent for all patients, and none died of malignant spread of the tumor or uncontrolled peptic ulcer disease, with a mean follow-up of 5 years. This finding is in contrast to patients who presented with metastatic disease on imaging studies and had a 20% 5-year survival rate. This study suggests that all patients with localized sporadic ZES can have the gastric acid hypersecretion managed medically, that overall survival of these patients is excellent, most (78%) can have all gastrinoma found and resected, and some (30%) will be cu

Topics: Adult; Aged; Anti-Ulcer Agents; Combined Modality Therapy; Duodenal Neoplasms; Female; Follow-Up Studies; Gastric Acid; Gastric Acidity Determination; Gastrins; Humans; Laparoscopy; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Pancreatic Neoplasms; Postoperative Complications; Prospective Studies; Survival Rate; Time Factors; Treatment Outcome; Zollinger-Ellison Syndrome

The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

Topics: Adult; Antacids; Cimetidine; Female; Gastrectomy; Gastrins; Guanidines; Humans; Jejunal Diseases; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Recurrence

The influence of Domperidone and Metoclopramide on the Serum Gastrin Level and Gastric Acid Secretion was investigated in a crossed, randomized double blind study in 12 male subjects aged 29 years on the average and presenting a healthy stomach. Neither after Domperidone nor after Metoclopramide could a significant change in Gastrin Level and Acid Secretion be observed. Since both Domperidone and Metoclopramide exert a motility promoting but not secretagogue effect on the upper gastrointestinal tract, both drugs are suitable for the treatment of disordered motility and evacuation related to ulcer disease, as well as for the treatment of postoperative gastroatonia.

Topics: Adult; Antiemetics; Benzimidazoles; Domperidone; Gastric Acid; Gastrins; Gastrointestinal Motility; Humans; Male; Metoclopramide; Piperidines; Postoperative Complications; Stomach Ulcer

Parietal cell vagotomy has been in clinical use for 7 years in elective treatment of nonobstructive duodenal ulcer, and for even a shorter period for complicated cases and for gastric ulcer The evolution of the surgical technique has not yet come to an end and the ability to perform the procedure is still improving. It can therefore be questioned, if this operation is yet ripe for a realistic clinical trial, and the great variation in recurrence rate reported in pilot series as well as in prospective randomized clinical trials points to the possibility that we will have to wait several years before the anticipated mean recurrence rate is known. At present it can be stated that even if gastric emptying is not quite undisturbed, the addition of a drainage procedure in nonobstructive cases is unnecessary. The same may be true in some patients with pyloric obstruction. Furthermore, the mortality rate is very low and the incidence of moderate-to-severe dumping and diarrhea is virtually nil.

Topics: Animals; Clinical Trials as Topic; Denmark; Diarrhea; Drainage; Dumping Syndrome; Duodenal Ulcer; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Peptic Ulcer; Pilot Projects; Postoperative Complications; Pyloric Stenosis; Recurrence; Stomach; Stomach Ulcer; Vagotomy

The results of highly selective vagotomy without drainage and selective vagotomy with pyloroplasty for duodenal ulcer were compared in a randomized, controlled trial of a series of 100 patients. The frequency of dumping, diarrhoea, and epigastric fullness was significantly lower after highly selective (6, 6, and 8 percent) than after selective vagotomy (30, 20, and 28 percent) one year after the operations. Recurrent and persisting duodenal ulcers appearing from one to four years after the operations were significantly more frequent after highly selective (22 percent) than after selective vagotomy (8 percent). No significant relationships were found between recurrent ulceration and gastric acid secretion measurements after the two operations. The Hollander response was early positive in 28 percent and late positive in 30 percent of the patients subjected to highly selective vagotomy, while the corresponding figures after selective vagotomy were 26 and 32 percent. The overall clinical results of the two operations were not different according to the classification of Visick. Excluding the patients with recurrence resulted in significantly better clinical results after highly selective vagotomy.

Topics: Adult; Clinical Trials as Topic; Diarrhea; Duodenal Ulcer; Female; Follow-Up Studies; Gastric Juice; Gastrins; Histamine; Humans; Insulin; Male; Middle Aged; Postoperative Complications; Pylorus; Recurrence; Vagotomy

Small intestinal bacterial overgrowth (SIBO) might be associated with a history of abdominal surgery. We aimed to evaluate the prevalence of SIBO and to investigate serum gastrin and pepsinogen as predictors of SIBO in patients with a history of hysterectomy, gastrectomy, or cholecystectomy.. This prospective study surveyed 146 patients with a history of hysterectomy, gastrectomy, or cholecystectomy, and 30 healthy controls, who underwent a hydrogen (H2)-methane (CH4) glucose breath test (GBT) for SIBO. Serum pepsinogen I and II and gastrin levels were reviewed.. GBT positivity (+) was significantly higher in patients with histories of abdominal surgery than that in in controls (37.6% vs 13.3%, P < 0.01). Among GBT+ patients, 36.0% (18/50), 96.2% (25/26), and 17.1% (12/70) were in the hysterectomy, gastrectomy, and cholecystectomy groups, respectively. Among the GBT subtypes, 43.6% (24/55), 10.9% (6/55), and 45.5% (25/55) of patients were in the GBT(H2)+, GBT(CH4)+, and GBT(mixed)+ groups, respectively. The gastrectomy group had significantly more GBT+ or GBT(H2)+ patients than the other surgical groups. Gastrin levels were higher in GBT(H2)+ patients and lower in GBT(CH4)+ patients than those in GBT- patients. Previous gastrectomy and elevated gastrin levels were independent predictive factors of GBT(H2)+.. SIBO is not uncommon in patients with histories of abdominal surgeries, but it is more common in patients who have undergone gastrectomy. Serum gastrin level could be a serologic predictor of H2-producing SIBO. The relationship between serum gastrin and SIBO requires further research.

Topics: Abdominal Wall; Aged; Breath Tests; Case-Control Studies; Cholecystectomy; Dysbiosis; Feasibility Studies; Female; Gastrectomy; Gastrins; Gastrointestinal Microbiome; Humans; Hydrogen; Hysterectomy; Intestinal Mucosa; Intestine, Small; Male; Middle Aged; Pepsinogen A; Pepsinogen C; Postoperative Complications; Predictive Value of Tests; Prevalence; Prognosis; Prospective Studies

Upper gastrointestinal (GI) bleeding is a feared consequence of open heart surgery in children. Increased gastric acid secretion is a known key factor in the pathogenesis of gastritis and upper intestinal ulcerations. The aim of this study is to evaluate the serum kinetics of acid-stimulating factors and associated perioperative parameters after heart surgery in children.. Fifteen pediatric patients after open heart surgery and 15 children with cardiac catheterization were included in this study. Serum levels of gastrin, histidine, alanine, and tryptophan were analyzed before and up to 26 h after surgery.. In the postoperative period there was a significant elevation of gastrin with a peak at 4 h after surgery. Serum histidine was increased significantly immediately after surgery only in patients undergoing heart surgery with cardioplegia. No association of gastrin and histidine elevation with ischemia, perfusion time or lactate was observed.. Factors that are responsible for postoperative gastrin elevation still have to be determined. Circumstances of extracorporeal circulation (ECC) in low-risk patients most likely do not lead to relevant elevation of amino acids with acid-stimulatory effect in our study population.

Topics: Cardiac Surgical Procedures; Child; Child, Preschool; Gastric Acid; Gastric Acidity Determination; Gastrins; Gastritis; Gastrointestinal Hemorrhage; Humans; Infant; Postoperative Complications

Topics: Gastric Antral Vascular Ectasia; Gastric Mucosa; Gastrins; Gastroscopy; Humans; Hyperplasia; Laser Coagulation; Polyps; Postoperative Complications; Stomach Neoplasms; Stomach Ulcer

Accurate diagnosis of gastrointestinal graft-versus-host disease (GvHD) is important, as it contributes significantly to postallogeneic stem cell transplant (SCT) morbidity and mortality. To test the hypothesis that proton pump inhibitor (PPI) therapy may interfere with histologic evaluation of gastric GvHD by inducing apoptosis, we evaluated epithelial apoptotic body counts in antral and fundic biopsies from SCT recipients and control patients, both taking and not taking PPIs at the time of endoscopic biopsy. Hematoxylin and eosin-stained slides of gastric biopsies from 130 patients (75 allogeneic SCT with GvHD on clinical and histologic grounds, and a comparison group of 55 age- and sex-matched nontransplant patients with histologically normal gastric biopsies) were reviewed. The groups were further stratified into patients taking (PPI+) and not taking PPIs (PPI-) at the time of biopsy. Apoptotic bodies (AB)/10 (400 x) high power fields (HPF) were quantified for each case. Mean apoptotic body counts were then calculated for each case group. Seventy antral cases (31 control and 39 transplant) were also evaluated via gastrin immunohistochemistry, and the mean number of gastrin positive cells/400 x HPF calculated. In the PPI- groups, apoptosis was increased in biopsies from transplant patients, compared with controls, both in antral and fundic mucosa. In PPI+ patients, there was significantly more apoptosis in the gastric body in transplant patients than in controls. However, comparing antral biopsies from control and transplant PPI+ patients, there was no significant difference in AB quantitation. More apoptosis was seen in antral biopsies from PPI+ control patients when compared with PPI- control patients (P = 0.009). Mean numbers of gastrin positive cells/400 x HPF were increased in both control and transplant patients taking PPIs (85 and 58, respectively) compared with samples from those patients not taking PPIs (48 and 51, respectively). PPI therapy is associated with increased apoptosis in antral biopsies and may interfere with the evaluation of GvHD in biopsies from this site. A similar increase in apoptosis was not seen in fundic biopsies; biopsy of the gastric fundus rather than antrum may be preferable for the diagnosis of upper gastrointestinal GvHD.

Topics: Adolescent; Adult; Apoptosis; Biomarkers; Biopsy; Child; Child, Preschool; Enzyme Inhibitors; Female; Gastric Fundus; Gastrins; Graft vs Host Disease; Humans; Immunohistochemistry; Infant; Male; Middle Aged; Postoperative Complications; Proton Pump Inhibitors; Pyloric Antrum; Stem Cell Transplantation; Stomach Diseases

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is highly effective for morbid obesity. However, the long-term effects in the bypassed segments are unknown. The aim of this study is to evaluate gastrin and histologic changes in bypassed segments after LRYGBP.. 10 50-kg pigs were subjected to LRYGBP. Preoperative weight and serum gastrin were compared with similar measures at 6 months postoperatively, when the pigs were euthanized. At necropsy, full-thickness gastric, duodenal, and jejunal biopsies were performed. Normal biopsies were obtained from a control group of 10 pigs.. 1 pig died at 3 months postoperatively because of an intestinal intussusception. In the remaining 9 pigs, weight increased after surgery from 52+/-2.2 kg to 55+/-1.9 kg. Serum gastrin was unchanged after surgery (mean 68.2 vs 68.3 pg/mL at 3 months and 61.7 pg/mL at 6 months). Histology showed no abnormalities from sections in all control pigs, and in 7 of the LRYGBP pigs as well. 1 LRYGBP pig was found to have hyperplastic duodenal glands, jejunal mucosa with mild chronic inflammation, and gastric mucosa with focal erosive gastritis. 1 LRYGBP pig had jejunal sections showing Peyer's patches.. LRYGBP is not associated with gastrin changes and major histologic changes in the bypassed segments, at 6 months postoperatively in the porcine model.

Topics: Anastomosis, Roux-en-Y; Animals; Disease Models, Animal; Gastric Bypass; Gastrins; Postoperative Complications; Stomach; Swine

For treatment of giant perforated peptic ulcers, we hypothesized that partitioning of the gastric body instead of the antrum would prevent hypergastrinemia and minimize ulcerogenic risk. By maintaining part of the acid-secreting gastric body in continuity with the excluded distal stomach, gastrin-secreting cells in the antrum would still be inhibited by gastric acid secretion from the gastric body.. We studied (1) gastric body partition with gastrojejunostomy in 8 critically ill patients with giant perforated peptic ulcers and (2) the influence of gastric partition on serum gastrin in 18 dogs with gastric antral partition + gastrojejunostomy, or gastric body partition + gastrojejunostomy, or gastrotomy.. No patient developed major postoperative complications. Serum gastrin levels were normal in 6 patients but showed an abnormal increase in 2 patients 1 month after gastric body partition. Serum gastrin levels had returned to the normal range at postoperative follow-up after 2 years. In the animal study, serum gastrin levels and the number of G-cells in the excluded antrum and acid-secreting parietal cells in the gastric body were increased when evaluated on day 60 postoperatively or after antral partition, compared with preoperative data in the same group. These changes did not occur in the group undergoing partition of the gastric body and the group undergoing gastrostomy. Postoperative serum gastrin levels, and the number of G-cells and parietal cells also was significantly greater in the antral partition group than in the other 2 groups. No ulcer was found in any dog in the gastric body partition and gastrostomy groups, but ulcers occurred in 4 dogs in the antral partition group, all of whom died of ulcer perforation.. Gastric body partition + gastrojejunostomy is a simple, dependable procedure for patients with perforated giant peptic ulcers. This procedure does not require extreme expertise and can be performed in a very short time, even by a trainee general surgeon in emergency.

Topics: Adult; Aged; Animals; Digestive System Surgical Procedures; Dogs; Gastrins; Humans; Models, Animal; Peptic Ulcer; Peptic Ulcer Perforation; Postoperative Complications; Radiography; Recurrence; Risk Factors

Gastrectomy (GX) was carried out in the male rat according to the Longmire and the Roux-en-Y procedure. The focus of the postoperative investigations was to evaluate the influence of post-GX morphological changes occurring at the site of two types of end-to-end esophagojejunal anastomosis (with and without invagination), in particular food intake, body weight gain, food efficiency, hematocrit and bone density. GX failed to alter food intake, fasting blood glucose, alpha-amino nitrogen, or free fatty acids, but led to uniformly decreased body weight, food efficiency and serum gastrin, and increased serum osteocalcin, indicating high turnover osteopenia. However, irrespective of the type of (digestive tract) reconstruction (Longmire or Roux-en-Y), the invagination anastomosis was associated with lower mortality, fewer complications, less early postoperative weight loss, less intensive tissue changes at the anastomotic site, and improvement of bone density and hematocrit. Bivariate and multivariate regression analysis revealed that bone density was negatively influenced by epithelial hyperplasia of the anastomotic tissue, while hematocrit was positively influenced by bone density. In contrast, food intake appeared to have no influence. It was concluded that (1) the histological status of the esophagointestinal anastomosis varies depending on the surgical technique applied and (2) the type of anatomical reconstruction of the digestive tract (Longmire vs. Roux-en-Y) and food intake may be of minor importance for the bone and hematological status of GX rats. Future investigations are justified to clarify whether esophagojejunal proinflammatory tissue factors may contribute to the GX-mediated damage of bone mineral and bone marrow, thereby leading to low body weight.

Topics: Anastomosis, Roux-en-Y; Animals; Bone Density; Bone Remodeling; Esophagus; Gastrectomy; Gastrins; Jejunum; Male; Nutritional Status; Postoperative Complications; Rats; Rats, Sprague-Dawley; Survival Analysis

During a period of 13.5 years 17 patients with a gastrinoma and an associated Zollinger-Ellison syndrome were treated. In three patients (18%) the gastrinoma was part of a multiple endocrine neoplasia type I (MEN I). The median interval from the initial symptoms to the definite diagnosis was 5.0 years. During this interval seven patients (41%) underwent gastric surgery up to four times. The preoperative imaging studies localized the primary tumor in only seven patients (41%). In five of six diagnostic laparotomies the primary site of the tumor was identified and proved by pathologic work-up. The surgical procedures (n = 13) included five resections of the pancreas (3 x pancreatic head, 2 x left pancreatic resection), two duodenal resections, three enucleations of the tumor and three palliative operations (hospital mortality: 0%). Following laparotomy the gastrinoma could be histologically proved in eleven of 17 patients (6 x pancreas, 4 x duodenum, 1 x in the hepatoduodenal ligament). The rate of metastatic spread as characteristic feature of malignancy was 59%. After complete resection of the primary tumor (n = 8) none of these patients died because of the gastrinoma during the follow-up (median: 7.3 years). In the remaining patients three deaths were caused by the metastatic spread of the gastrinoma. Considering the high rate of preceding operations, the high malignancy rate and the excellent prognosis after RO-resection the diagnostic interval in patients with ZES is too long. Despite the modern radiographic imaging the exploratory laparotomy is of high value in patients with ZES.

Topics: Adult; Aged; Duodenal Neoplasms; Duodenum; Female; Follow-Up Studies; Gastrectomy; Gastrinoma; Gastrins; Humans; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Pancreas; Pancreatic Neoplasms; Postoperative Complications; Reoperation; Zollinger-Ellison Syndrome

To help determine the etiology and most appropriate treatment regimen for hypergastrinemia, dysuria-hematuria and metabolic alkalosis following augmentation gastrocystoplasty.. Two patients who presented with refractory metabolic alkalosis (1 with dysuria-hematuria) underwent extensive laboratory evaluation, complete upper gastrointestinal evaluation and intravesical pH probe placement.. Both patients eventually required high dose oral potassium chloride supplementation. Bladder mucosal pH was not reflected by buffered urinary pH. Both patients demonstrated significant gastroesophageal reflux and diminished overall gastric acid output.. Outpatient maintenance on potassium chloride supplementation may be warranted in select patients and appears to be preferable to histamine blockade or omeprazole. Postoperative screening esophagogastroscopy and an additional surgical maneuver might be indicated to prevent possible adverse sequelae of reflux esophagitis. Gastrocystoplasty may be an inappropriate operation in children with renal insufficiency who have not had metabolic acidosis.

Topics: Alkalosis; Child; Child, Preschool; Female; Gastric Mucosa; Gastrins; Hematuria; Humans; Male; Postoperative Complications; Stomach; Urinary Bladder

The aim of this study was to determine whether increased duodenogastric reflux contributes to postcholecystectomy symptoms.. Gastric pH monitoring, hepatobiliary scintigraphy, gastric emptying scans, and gastric acid analysis were performed in asymptomatic (n = 10) and in symptomatic (n = 27) patients after cholecystectomy. Normal subjects (n = 20), patients with dyspepsia related to gastric acid hypersecretion (n = 20), patients with reflux gastritis after gastric surgery (n = 10), and patients with confirmed primary pathologic duodenogastric reflux (n = 10) were studied as controls. Symptomatic patients also underwent upper gastrointestinal endoscopy.. Symptomatic patients had significantly increased interprandial gastric exposure to pH < 3 compared with asymptomatic subjects, which correlated well with a high incidence of hepatobiliary scans positive for abnormal duodenogastric reflux and chronic gastritis on endoscopy. Gastric alkaline exposure in symptomatic patients was similar to that seen in patients with primary pathologic duodenogastric reflux and patients with duodenogastric reflux related to gastric surgery. Gastric acid secretion and gastric emptying were not altered. Five patients tested before and after laparoscopic cholecystectomy showed that nocturnal gastric alkalization was enhanced after operation.. This study suggests that excessive duodenogastric reflux may be responsible for persistence of symptoms after cholecystectomy.

Topics: Adult; Aged; Cholecystectomy; Duodenogastric Reflux; Dyspepsia; Female; Gastric Acidity Determination; Gastric Emptying; Gastrins; Gastrointestinal Contents; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Posture; Reference Values; Technetium Tc 99m Disofenin

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

The secretion of hormones stimulating and inhibiting gastric secretory activity was studied in 85 patients with postvagotomy syndromes. The somatropin level was found to increase significantly in gastrostasis. The lower values of the blood insulin and C-peptide content in patients with recurrent ulcers was evidently associated either with insufficiency of the pancreatic insular apparatus or with partial vagal denervation, increased STH level, and plausible inhibiting effect of glucagon. Increased somatostatin secretion in the dumping syndrome, gastrostasis, and peptic ulcers may be due to the encountered hypergastrinemia.

Topics: C-Peptide; Constriction, Pathologic; Diarrhea; Dumping Syndrome; Gastric Acid; Gastrins; Glucagon; Growth Hormone; Humans; Insulin; Insulin Secretion; Neurotransmitter Agents; Peptic Ulcer; Postoperative Complications; Recurrence; Somatostatin; Stomach Diseases; Syndrome; Vagotomy, Proximal Gastric

Although widely reported on, the clinical diversity and eventual varied outcome of patients with extrapancreatic gastrinomas remain a medical mystery. In an attempt to help clarify conflicting management of extrapancreatic gastrinomas, we reviewed our experience with these unique tumors.. Retrospective analysis with long-term follow-up (mean, 8 years).. Tertiary care referral center.. From January 1958 through January 1993, we identified and operated on 23 patients with extrapancreatic gastrinomas (duodenum, n = 18; stomach, n = 3; nodal, n = 2). The 12 men and 11 women (none with multiple endocrine neoplasia type I syndrome) ranged in age from 12 to 68 years (mean, 47 years). Preoperatively, all patients were symptomatic with peptic ulcer disease (duodenal [n = 18, 78%], jejunal [n = 4, 17%]) and/or diarrhea (n = 17, 74%).. Preoperatively, tumor localization was successful in only three patients (13%). Surgical management included tumor excision only in 14 patients (61%), partial gastroduodenectomy in six (27%), total gastrectomy in one (4%), limited enterectomy in one (4%), and tumor biopsy alone in one (4%). Seven patients had evidence of lymphatic metastases at the time of operation, including a single patient with hepatic metastases (malignancy rate, 30%). Postoperatively, complications developed in seven patients (30%): wound infection in two, ileus in two, pulmonary sepsis in one, intra-abdominal abscess in one, and diabetic ketoacidosis in one. The postoperative mortality rate was 4%.. Emphasis was placed on rendering patients eugastrinemic.. Long-term follow-up (mean, 8 years) of all patients revealed that 11 patients (48%) were eugastrinemic, asymptomatic, and not receiving gastric acid-reducing medication. Sixteen patients remain alive and well. Of the six now decreased patients who had been participating in long-term follow-up (mean survival, 14 years), death was due to atherosclerotic coronary artery disease in four and tumor progression in two.. Following surgical excision, patients with extrapancreatic gastrinomas have a favorable outcome, with nearly half being cured.

Topics: Adolescent; Adult; Aged; Child; Duodenal Neoplasms; Female; Follow-Up Studies; Gastrinoma; Gastrins; Humans; Lymphatic Metastasis; Male; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Stomach Neoplasms; Surgical Procedures, Operative; Survival Rate; Time Factors; Treatment Outcome

A total of 34 children with normal renal function underwent either gastrocystoplasty or continent urinary reservoirs with stomach at our institutions. Severe hypochloremic hypokalemic metabolic alkalosis developed in 2 patients, manifested by intractable seizure disorder in 1 and altered mental status with respiratory depression in 1. Symptoms developed at 4 and 6 months, respectively. Despite severe alkalosis, urinary pH was less than 5.0 and fractional excretion of chloride remained high in both patients. Resuscitation with sodium chloride, arginine hydrochloride and potassium chloride restored electrolyte balance in less than 48 hours in both patients. Serum gastrin was slightly elevated in 1 patient (137 pg./ml., normal 0 to 125) who responded to long-term histamine-blocker therapy. The other patient had significant hypergastrinemia (624 pg./ml.) with secondary hyperaldosteronism. Maximum doses of histamine blockers, oral replacement of sodium chloride and potassium chloride, and the proton pump inhibitor omeprazole failed to control recurrent bouts of severe hypochloremic metabolic alkalosis. This patient ultimately underwent removal of three-quarters of the gastric augmentation and replacement with ileum. Postoperatively, serum gastrin levels and electrolytes reverted to normal. The pathophysiology of this potentially lethal complication is further discussed.

Topics: Acid-Base Imbalance; Child; Child, Preschool; Female; Gastrins; Humans; Postoperative Complications; Reoperation; Stomach; Urinary Bladder; Urinary Reservoirs, Continent; Water-Electrolyte Imbalance

Recurrent peptic ulcer after gastric surgery differs from duodenal ulcer in that they usually occur with low acid output, which is sufficient to cause ulceration in predisposed stomach or anastomosis. The proton pump inhibitor (PPI), significantly more potent and long-acting than H2-blocker, is expected to be more effective for postoperative recurrent ulcers. We evaluated the efficacy of omeprazole (OPZ) on recurrent ulcers in 12 patients following either gastrectomy or vagotomy. The healing rate after 4 week treatment with OPZ was 58% and increased to 100% after 8 week. Evaluation of quick symptom relief also supported the efficacy of OPZ treatment. These findings showed that OPZ treatment resulted in a more rapid healing of recurrent ulcers compared with H2-blocker. It remains to be clarified whether quit of treatment with PPI would induce high ulcer relapse rates, and whether maintenance therapy with PPI would be the only alternative therapy for surgical intervention.

Topics: Adenosine Triphosphatases; Adult; Aged; Female; Gastrectomy; Gastric Acid; Gastrins; H(+)-K(+)-Exchanging ATPase; Humans; Male; Middle Aged; Omeprazole; Peptic Ulcer; Postoperative Complications; Recurrence; Vagotomy

Surgery for peptic ulcer disease may increase the risk of pancreatic cancer. The effect of duodenogastric reflux on pancreatic carcinogenesis was tested, and changes in the circulating levels of cholecystokinin (CCK) and gastrin were measured. Male Wistar rats (n = 40) weighing 250-300 g were randomized to undergo gastrotomy (control) or split gastrojejunostomy (to produce complete duodenogastric reflux) and then to receive azaserine (30 mg/kg/week intraperitoneally) or saline injections for 3 weeks. At 6 months, blood CCK was assayed and the pancreas was excised for quantitative estimation of atypical acinar cell foci (AACF), the precursor lesions of carcinoma. Rats that had undergone split gastrojejunostomy weighed 15-19 per cent less than controls (P < 0.05), but their relative pancreatic weight (mg pancreas per 100 g body-weight) was 52-60 per cent greater (P < 0.001). Acidophilic AACF occurred only in azaserine-treated rats with duodenogastric reflux. Although plasma CCK concentrations were unchanged, split gastrojejunostomy increased basal and postprandial gastrin levels by 98-175 per cent (P < 0.05). Duodenogastric reflux produces sustained hypergastrinaemia and promotes experimental pancreatic carcinogenesis.

Topics: Anastomosis, Surgical; Animals; Cholecystokinin; Duodenogastric Reflux; Gastrins; Jejunum; Male; Pancreatic Neoplasms; Postoperative Complications; Rats; Rats, Inbred Strains; Stomach

During the last years interest has focused on the trophic effect of gastrin in colorectal carcinomas. Some reports indicated an increased serum level of gastrin in patients with colorectal adenomas or carcinomas. In a prospective study in 261 patients submitted to colonoscopy fasting serum gastrin concentrations were determined. 91 patients served as control, 89 patients had one or more adenomas, 55 patients suffered from a colorectal carcinoma, 17 had a benign, postoperative stenosis of the colon, and 9 had a chronic inflammatory bowel disease. All patients fulfilled the following criteria: No regular drug intake, no previous gastric or small bowel operation, no known ulcer disease, no abnormalities in serum calcium, creatinine, triglycerides, cholesterol and blood urea. Mean gastrin level was 86.63 +/- 23.8 pg/ml in the control, 84.57 +/- 25.1 pg/ml in the adenoma group and 84.6 +/- 24.4 pg/ml in the carcinoma group. No difference of serum gastrin levels were observed regarding sex, age, tumor stage and localisation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Colonic Diseases; Colonic Polyps; Colorectal Neoplasms; Female; Gastrins; Humans; Inflammatory Bowel Diseases; Intestinal Obstruction; Male; Middle Aged; Postoperative Complications

The character of "Spleen Deficiency" (SD) Syndrome was evaluated by determination of the blood levels of various gastroenteropancreatic hormones and thyroid hormone. Patients of SD group were diagnosed clinically by Syndrome Differentiation, and those of the normal group were volunteer blood donors. RIA was used to determine all the hormones except T3RUR.. TT3, FT3 of the SD group were very significantly lower than that of normal group (P less than 0.001). The levels of rT3 in SD group were significantly higher than normal control (P less than 0.05). For TT4, T3RUR and FT4, there were no significant differences between the two groups. Among the gastroenteropancreatic hormones, gastrin in the SD group was significantly lower than that of the normal group (P less than 0.01), motilin was very significantly higher (P less than 0.002). The value of pp was similar in the two groups, under physiological conditions, however, in adults the hormone tended to increase with age. Since the average age of patients in the SD group was 54.9, and that of the normal group was 38.5, remarkably lower values were seen in the SD group. Other hormones such as VIP, SST, glucagon and insulin were of no significant difference between the two groups. The result showed that thyroid hormone and some of gastroenteric hormones in the blood of patients with SD after major operations were quite different from normal, and was common to patients with general SD Syndrome, with low T3 syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Cholecystectomy; Female; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Motilin; Postoperative Complications; Splenic Diseases; Thyroxine; Triiodothyronine; Yang Deficiency

In a follow-up study operative risk, postoperative functional disorders and incidence of anastomotic (recurrent) ulcer after partial gastrectomy with Roux-en-Y gastrojejunostomy for gastroduodenal ulcer were evaluated in 52 patients. Lethality for elective treatment was 0 and for emergency surgery (ulcer bleeding) 16.7%. 29.5% of the patients reported postoperative functional disorders. Because Roux-en-Y reconstruction prevented duodenogastric reflux, intragastric pH was low (median 2.2) and in the absence of ulcer protective, neutralizing reflux anastomotic ulcer occurred in 15.9% of the patients. With regard to the high rate of recurrent ulcer Roux-en-Y reconstruction after partial gastrectomy for primary ulcer surgery should be avoided and reconstruction procedures preferred, which guarantee duodenogastric reflux.

Topics: Anastomosis, Roux-en-Y; Bile Reflux; Female; Follow-Up Studies; Gastrectomy; Gastric Acidity Determination; Gastrins; Humans; Jejunum; Male; Peptic Ulcer; Postgastrectomy Syndromes; Postoperative Complications; Radiography; Recurrence

The use of segments of stomach for bladder augmentation is gaining popularity in pediatric urology due to favorable muscular and secretory properties. However, in a renal failure patient who underwent gastrocystoplasty a high level of acid production within the bladder associated with persistent hypergastrinemia was noted leading to severe systemic metabolic alkalosis. This condition was unresponsive to standard acid-inhibiting or neutralizing therapies but it was treated successfully with omeprazole, a proton-pump inhibitor recently introduced for treatment of peptic ulcer disease.

Topics: Alkalosis; Child, Preschool; Gastric Acid; Gastrins; Humans; Hydrogen-Ion Concentration; Male; Omeprazole; Postoperative Complications; Stomach; Urinary Bladder; Urine; Vesico-Ureteral Reflux

Topics: Acute Kidney Injury; Gastrins; Gastrointestinal Hemorrhage; Hemofiltration; Humans; Male; Middle Aged; Postoperative Complications; Shock, Septic; Stress, Physiological

Basal serum gastrin, integrated gastrin response to a meal, and integrated gastrin response to insulin induced hypoglycaemia were measured in 60 patients with duodenal ulcer before and after elective highly selective vagotomy to determine whether antral gastrin has a role in resistance to H2 receptor antagonist treatment which the patients had received before surgery or in the development of recurrent ulceration after vagotomy. The basal gastrin, integrated gastrin response to a meal, and the integrated gastrin response to insulin were similar in patients whose ulcers healed after H2 receptor agonist treatment or were refractory to at least three months of this treatment. The same parameters measured before or after highly selective vagotomy were similar in patients who eventually developed recurrent ulceration compared with those who did not. As expected the basal and meal stimulated (but not insulin stimulated) serum gastrin values increased after highly selective vagotomy. Ulcer patients with particularly high gastrin values (whether basal or stimulated) were not more resistant to H2 receptor antagonist treatment or prone to develop ulcer recurrence after highly selective vagotomy. This study suggests that antral gastrin is not important in 'resistance' of duodenal ulceration either to H2 receptor antagonist treatment or to highly selective vagotomy.

Topics: Adolescent; Adult; Aged; Cimetidine; Drug Resistance; Duodenal Ulcer; Female; Gastrins; Histamine H2 Antagonists; Humans; Male; Middle Aged; Postoperative Complications; Pyloric Antrum; Ranitidine; Recurrence; Vagotomy, Proximal Gastric

During the past 9 years, we have treated 23 patients with gastrointestinal hemorrhage following corrective surgery for biliary atresia. Ulcers or erosions of the stomach, duodenum or intestinal wall were observed endoscopically in 20 cases. In other 3 cases, bleeding point was not determined endoscopically, but massive bleeding was recognized frequently. Ten patients bled within 6 months of surgery, and the incidence of bleeding was also seen even after the age of 10 years. A history of cholangitis, the presence of jaundice and the use of cholagogues were related to the postoperative gastrointestinal bleeding. Serum concentrations of gastrin and gastric inhibitory polypeptide showed high values after surgery in almost half the biliary atresia patients examined, however, no clear relationship between the concentration of these factors and gastrointestinal hemorrhage was established.

Topics: Biliary Atresia; Child; Child, Preschool; Female; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hemorrhage; Humans; Infant; Jaundice; Male; Peptic Ulcer Hemorrhage; Postoperative Complications

The insulinoma is the most common pancreas tumour with endocrine activity, with more than 2,000 cases being described in the literature worldwide. The first successful extirpation was performed by Graham in 1928. Clinical appearance is characterized by severe paroxysmal hypoglycaemia together with inadequately increased serum insulin levels. Surgery is indicated in such situations because of limited effectiveness of medicamentous therapy. Surgical approach and long-time results are discussed in this paper, with reference being made to 13 cases of the authors.

Topics: Adenoma, Islet Cell; Adult; C-Peptide; Female; Follow-Up Studies; Gastrins; Glucose Tolerance Test; Humans; Hypoglycemia; Insulin; Insulinoma; Male; Neoplasm Recurrence, Local; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Reoperation

Cholecystokinin (CCK) is a polypeptid released postprandially by the upper intestinal mucosa. There are several biological active forms of CCK. Radioimmunological measurements of CCK may not detect all biological active forms or may have the disadvantage of crossreacting with gastrin. In the following we describe a modification of a bioassay for CCK which was first developed by Liddle et al. (J Clin Invest 1985). By means of this bioassay pre- and postprandial plasma CCK-levels of healthy male volunteers are compared with CCK-levels of patients with partial gastric resections and excluded duodenum. Both groups showed similar basal CCK-values (about 1 pM) and a food induced increase of this hormone by reaching maximal values after 15 to 30 min (control: 4.30 +/- 0.65 vs. operated: 13.37 +/- 2.83 pM). Patients with gastric resections, however, had about three times more CCK released over the 60 min time period studied as compared to controls. Thus exclusion of the duodenum, the supposed main place of CCK production, does not cause a lower but rather higher increase of postprandial CCK release.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Cholecystokinin; Duodenal Ulcer; Gastrectomy; Gastric Emptying; Gastrins; Humans; Intestinal Absorption; Middle Aged; Peptic Ulcer Hemorrhage; Postoperative Complications; Radioimmunoassay; Stomach Ulcer

Pathophysiological effects following biliary tract reconstruction for benign biliary diseases were investigated from the standpoint of gastric acid secretion, metabolism of nutrients and gastrointestinal hormone release. Patients undergoing Roux-Y hepaticojejunostomy showed a significant increase in maximum acid output at follow-up, although only one case of peptic ulcer was observed. In addition, the frequency of cases showing gastric acid hypersecretion was higher than for jejunal interposition hepaticoduodenostomy. Two kinds of test meals (carbohydrate-rich or fat-rich) were given, on different days, to each patient before and about four weeks after surgery. Plasma concentrations of gastrointestinal hormones and glucose or triglyceride were determined. Fasting concentrations of gut hormones (gastrin, GIP, insulin and GLI) were similar to those before surgery, and increased after the ingestion of the test meals. Gastrin and total GLI levels tended to be higher in the Roux-Y than in the interposition group, and vice versa for both insulin and GIP. The changes in plasma glucose and triglyceride, following the Roux-Y procedure, suggest disturbances in carbohydrate tolerance, fat digestion, and in the anabolic phase of absorbed fat. Patients undergoing the Roux-Y procedure should be carefully followed up, since gastric acid hypersecretion induced by a postprandial augmented release of gastrin was observed.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Biliary Tract Surgical Procedures; Blood Glucose; Carbohydrate Metabolism; Fats; Female; Gastric Acid; Gastrins; Gastrointestinal Hormones; Humans; Jejunum; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Triglycerides

The aim of this study was to determine whether mucosal antrectomy, which preserves antropyloric motility, would enhance the antiulcer properties of proximal gastric vagotomy (PGV). Hydrochloric acid and gastrin secretion were studied in five dogs before and after PGV and mucosal antrectomy, while the response to the Mann-Williamson operation (an ulcer-producing operation) was evaluated in four control dogs with intact stomachs, five dogs with PGV alone, and six dogs with PGV plus mucosal antrectomy. Proximal gastric vagotomy and mucosal antrectomy decreased mean +/- SEM basal and pentagastrin-stimulated acid secretion from 4.3 +/- 1.3 to 0.4 +/- 0.3 mEq/hr and from 21 +/- 0.7 to 7.4 +/- 1.8 mEq/hr, respectively (p less than 0.05). Basal plasma gastrin was altered little by the operation (68 +/- 9.7 pg/ml before, 58 +/- 11 pg/ml after; p greater than 0.05) but the 4-hour integrated plasma gastrin response to a 200 gm meat meal decreased from 13 +/- 1.8 to 3.3 +/- 0.7 ng X min/ml (p less than 0.05). Only one of six dogs with mucosal antrectomy and PGV developed peptic ulcer after the Mann-Williamson operation, whereas four of five with PGV alone and three of four controls developed ulcers (p less than 0.05, PGV alone versus PGV and mucosal antrectomy). In conclusion, PGV and mucosal antrectomy decreased acid secretion and postcibal gastrin response and provided greater protection against peptic ulcer than PGV alone.

Topics: Animals; Dogs; Evaluation Studies as Topic; Female; Gastric Acid; Gastric Mucosa; Gastrins; Jejunal Diseases; Male; Peptic Ulcer; Postoperative Complications; Pyloric Antrum; Vagotomy, Proximal Gastric

In the rat, both partial resection of the pancreas and occlusion of the side branches of the biliodigestive duct were investigated with respect to their influence on gastric secretion (acid, pepsin, sodium), gastric mucosal blood flow (MBF), development of gastric ulcers, and gastrin and somatostatin in the blood. On the 14th postoperative day the exocrine pancreatic function is reduced and ulcer index and severity are significantly enhanced. There are no simultaneous changes in gastric secretion or MBF. Aortal gastrin was decreased and somatostatin was unchanged. We conclude that: in the rat, reduction of exocrine pancreatic function should be considered an ulcerogenic factor; factors others than gastric hypersecretion or reduced MBF are responsible for ulcer formation, and an etiological role of either circulating gastrin or somatostatin is doubtful.

Topics: Animals; Aorta; Duodenogastric Reflux; Gastric Acid; Gastric Juice; Gastric Mucosa; Gastrins; Male; Pancreatectomy; Pancreatic Ducts; Pepsin A; Portal Vein; Postoperative Complications; Rats; Rats, Inbred Strains; Regional Blood Flow; Sodium; Somatostatin; Stomach Ulcer

Topics: Diagnosis, Differential; Duodenal Ulcer; Gastrectomy; Gastrins; Humans; Male; Microscopy, Electron; Middle Aged; Pancreas; Pancreatic Neoplasms; Postoperative Complications; Zollinger-Ellison Syndrome

Topics: Duodenal Ulcer; Duodenoscopy; Gastrectomy; Gastrins; Humans; Postoperative Complications; Recurrence; Reoperation; Vagotomy, Proximal Gastric

A middle-aged woman developed a postgastric bypass megaloblastic anemia which responded to treatment. She eventually had the bypass reversed 6 1/2 yr after it had been performed. Gastric parietal cell function has remained abnormal almost 3 yr after reversal of the bypass, as demonstrated by abnormal Schilling tests and high serum gastrin levels. Parietal cell antibodies in high titer, but no intrinsic factor antibodies, were demonstrated in her blood. These observations are interpreted as indicating the development of irreversible chronic atrophic gastritis probably related to reflux of bile into the bypassed stomach.

Topics: Adult; Anemia, Megaloblastic; Female; Gastric Acid; Gastrins; Humans; Intrinsic Factor; Parietal Cells, Gastric; Postoperative Complications; Stomach; Vitamin B 12 Deficiency

Topics: Adult; Common Bile Duct; Duodenal Ulcer; Duodenoscopy; Esophagogastric Junction; Female; Gastric Acid; Gastrins; Humans; Jejunum; Male; Manometry; Middle Aged; Postoperative Complications

To evaluate the effect of renal transplantation on the frequent gastric hypoacidity encountered among uraemic patients, 84 patients (19 with chronic renal failure receiving dietary treatment, 29 receiving regular dialysis treatment, and 36 with a well-functioning renal transplant) were studied for their gastric acid secretory capacity. The mean duration of preoperative dialysis treatment of the dialysed patients was 13.7 months, and the mean length of postoperative follow-up study of the transplant patients was 10.1 months. The mean gastric acid secretory capacity of all three subgroups of renal patients was similar, and all these means fell within the reported reference interval of healthy controls. Gastric hypoacidity was observed in 26% of the non-dialysed and in 17% of the dialysed patients but also in 28% of the patients with a well-functioning renal graft. Thus uraemia seems to result in gastric hypoacidity, which tends to persist for over 10 months after normalization of renal function through transplantation.

Topics: Adult; Female; Gastric Acid; Gastrins; Humans; Kidney Transplantation; Male; Middle Aged; Pentagastrin; Postoperative Complications; Renal Dialysis; Uremia

Surgical approach to short bowel syndrome has been dealing with two major problems: lack in absorptive surface and dysfunction of the peristalsis of the widely distended loop above the anastomosis. In those children having a very short intestine, one is reluctant to either resect or reduce the diameter of this loop. Bianchi, followed by Boeckman and Traylor, described a procedure of loop lengthening by dividing it longitudinally. Their procedure has the advantage of restoring normal peristalsis without losing any absorptive surface. A modification of the original procedure of Bianchi is described. We report on its application in a child born with laparoschisis and intestinal atresia; she had in fact 25 centimetres of duodenum and proximal jejunum anastomosed with left colonic angle. This child was referred to us with functional occlusion related to distension above an intact and unobstructed anastomosis. She was operated on at six weeks of age. Postoperatively oral feeding could be started after one month. Broviak's catheter for parenteral nutrition was removed at six months. In conclusion we believe that this technique offers a chance of better and faster adaptation to children born with short bowel syndrome.

Topics: Dietary Fats; Enteral Nutrition; Feces; Female; Gastrins; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Nitrogen; Parenteral Nutrition; Pneumoperitoneum; Postoperative Complications; Short Bowel Syndrome

The article describes 44 observations of peptic ulcers, the appearance of them being explained by the retained antral mucosa in the stump of the duodenum and stomach.

Topics: Calcium; Gastrectomy; Gastric Mucosa; Gastrins; Humans; Peptic Ulcer; Postoperative Complications; Secretin; Zollinger-Ellison Syndrome

Topics: Adolescent; Adult; Aged; Diarrhea; Esophageal Neoplasms; Esophagus; Female; Gastrectomy; Gastric Juice; Gastrins; Humans; Male; Middle Aged; Postoperative Complications; Proglumide

37 patients suffering from apudomas of the pancreas are reported (18 insulinomas, 6 isletcell-hyperplasias, 9 Zollinger-Ellison syndroms, 1 glucagonoma, 3 without hormone production). In preoperative localization computerized tomography and angiography were the best with 65% positive findings. Insulinomas were enucleated, all free of recidives. 50% of operated isletcell hyperplasias had a postoperative resisting hyperinsulinism. Either gastrectomy or tumour enucleation was performed in the Zollinger-Ellison syndrome. The five-years survival rate was 43%.

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Child; Female; Follow-Up Studies; Gastrectomy; Gastrins; Glucagon; Humans; Hyperplasia; Insulin; Insulinoma; Islets of Langerhans; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Stomach Neoplasms; Zollinger-Ellison Syndrome

Serum gastrin levels in 16 patients with congenital hypertrophic pyloric stenosis (CHPS) were measured and oesophageal manometric studies were performed in 14 of these 16 patients before and after pyloromyotomy. Hypergastrinaemia was found in the patients with CHPS, and the 7th postoperative serum gastrin level was much higher than the preoperative pressure. However, there was no significant correlation between the LES pressure change and the serum gastrin change. These results indicate that competence of LES after pyloromyotomy in patients with CHPS is maintained not only by endogenous gastrin rise but also by other factors.

Topics: Esophagogastric Junction; Female; Gastrins; Humans; Hypertrophy; Infant; Male; Manometry; Postoperative Complications; Pyloric Stenosis

Exploratory laparotomy and a search for gastrinomas was performed in 52 patients with the Zollinger-Ellison syndrome (ZES). Gastrinoma tissue was resected in 11 patients (21%), 6 (12%) of whom appear to have been cured. After surgery, serum gastrin levels in these six patients have remained normal from 10 months to 10 years. In the 46 other patients, tumor was unresectable because of metastases or multiple primary tumors (21 patients; 40%) or inability to find the tumor at laparotomy (21 patients; 40%). Multiple pancreatic islet cell adenomata were found in six of seven patients with multiple endocrine neoplasia (MEN), indicating that patients with this condition usually have diffuse involvement of the pancreas. The results of CT scans correlated with findings at laparotomy in 13 of 16 patients. The smallest tumor detected by CT scans was 1 cm in diameter. CT technology is more accurate in finding gastrinomas now than in the past and has a useful role in preoperative evaluation. The possibility of resection should be seriously considered in every patient with Zollinger-Ellison syndrome. Abdominal CT scans, transhepatic portal venous sampling, and laparotomy should be used to find the tumor and to determine whether it is resectable. Using presently available methods, it should be possible to cure about 25% of patients with gastrinomas who do not have MEN and over 70% of those without MEN who appear to have a solitary tumor. Total pancreatectomy may be necessary to cure some patients with MEN, but that operation is rarely justified. The morbidity and mortality of surgical attempts at curing this disease have become minimal; we have had no deaths or serious complications following such operations in over 10 yrs. Total gastrectomy and indefinite use of H2-receptor blocking agents are the therapeutic options for patients with unresectable gastrinomas. Because H2-receptor blocking agents fail to control acid secretion in many patients after several yrs of therapy, total gastrectomy is indicated in a large proportion of patients whose tumors cannot be resected. Total gastrectomy in patients with ZES is also safe using current techniques; our last death following this operation for ZES occurred 15 yrs ago.

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Female; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Neoplasms; Postoperative Complications; Tomography, X-Ray Computed; Zollinger-Ellison Syndrome

During a 3-year period proximal gastric vagotomy without drainage and selective gastric vagotomy with drainage were performed in 61 patients with duodenal ulcer. Of these, 57 patients were followed for 3-6 years. 77% were symptom-free (Visick I); 8,3% were improved but still have periods of dyspepsia (Visick II) and 14% were failures because of recurrent ulcer (Visick III). There were seven duodenal recurrences in the bulb, and one prepyloric recurrence. There were no operative deaths or major complications. The side effects, like diarrhoea and dumping, after proximal gastric vagotomy and selective vagotomy were mild and rare. The majority of our patients gained their ideal body weight within the first six months from surgery. Blood chemistry did not show any deficiency in haemoglobin secondary to vagotomy, but plasma basal level of gastrin was constantly higher after surgery. It is concluded that 3-6 years after proximal gastric vagotomy and selective gastric vagotomy for duodenal ulcer there was a 14% recurrence rate, but the absence of mortality, severe complications or significant side effects seems to be at least as important as the high recurrence rate.

Topics: Adolescent; Adult; Aged; Body Weight; Diarrhea; Drainage; Duodenal Ulcer; Follow-Up Studies; Gastrins; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Vagotomy; Vagotomy, Proximal Gastric

Seven of nine patients with ulcers recurring after a variety of gastric operations enjoyed loss of dyspeptic symptoms within 2 days of taking cimetidine, 1,200 mg/day for 6 weeks, and endoscopic confirmation of healing of the recurrent ulcer was established within 6 weeks of therapy. Once ulcer healing had been achieved in these seven patients, symptomatic remission persisted for over 19 months without maintenance therapy with cimetidine, and no complications suggestive of recurrent ulcerations occurred during this period in these seven patients. The eighth patient with a recurrent ulcer after vagotomy and pyloroplasty had symptoms suggestive of a gastric outlet obstruction in association with a bezoar and an elevated fasting serum gastrin concentration; cimetidine failed to heal the ulcer and a partial gastrectomy with Billroth I anastomosis was undertaken. The ninth patient lost his dyspeptic symptoms while on cimetidine, but 1 month after stopping therapy he succumbed to a massive hemorrhage; autopsy revealed a large pyloric channel ulcer. We suggest that cimetidine is helpful for the control of symptoms and the healing of recurrent ulcers after gastric surgery, but that endoscopy be repeated after an appropriate interval while such patients remain on cimetidine to assure that the disappearance of symptoms is truly associated with a lack of peptic ulceration. If the ulceration persists, we believe that cimetidine should be continued for a longer period.

Topics: Adult; Aged; Cimetidine; Dyspepsia; Female; Follow-Up Studies; Gastrectomy; Gastrins; Gastroscopy; Guanidines; Humans; Male; Middle Aged; Postoperative Complications; Recurrence; Reoperation; Stomach Ulcer; Vagotomy

Gastric emptying was delayed preoperatively in 9 of 19 patients with duodenal ulcer disease, but all 9 patients with evidence of retention by scan were asymptomatic; gastric emptying was normal in the remaining 10 patients. A significant delay in gastric emptying was documented by scan in 17 of 19 patients immediately after parietal cell vagotomy (despite the absence of symptoms of gastric retention). Delayed emptying was demonstrated in three patients who were restudied more than 1 year after parietal cell vagotomy; again these patients had no symptoms of gastric retention at any time. A sustained reduction in basal and stimulated acid secretion in both the early and late postoperative period was documented in all 19 patients, and serum gastrin levels also remained low. This absence of acid or gastrin stimulation is corroborated by the fact that there was no recurrence of ulcers in these patients during a follow-up period of up to 37 months.

Topics: Adult; Aged; Duodenal Ulcer; Female; Gastric Emptying; Gastric Juice; Gastrins; Humans; Male; Middle Aged; Postoperative Complications; Vagotomy; Vagotomy, Proximal Gastric

Clinical and laboratory results are presented of 229 patients treated by highly selective vagotomy for duodenal ulcer in a non-university teaching hospital. Sixty-two per cent of the operations were performed by residents as part of their training. After 1-8 years follow-up (97 per cent complete) there were 22 recurrences (9.6 per cent). The residents had fewer recurrences than the consultants, but their patients follow-up was shorter. The usual Visick grading is presented (1, 2: 83.5 per cent; 3, 4: 16.5 per cent) as well as an additional way of grading described by Visick in 1948 which suggests that 4 per cent appear to be permanent failures. Mortality rate was 0.4 per cent, complications rate was low and side effects were in general of minor importance. Laboratory results are presented showing that the basal acid output (BAO) was reduced permanently by 65 per cent, and the PAO by 50 per cent. In patients with recurrences BAO was not reduced and the PAO was less reduced than in the non-recurrence group. Metabolic parameters did not deteriorate. Basal serum gastrin rose after operation while serum vitamin B12 remained constant with a minimal tendency to decrease.

Topics: Adolescent; Adult; Aged; Consultants; Duodenal Ulcer; Female; Gastric Acid; Gastrins; Humans; Internship and Residency; Male; Middle Aged; Postoperative Complications; Recurrence; Reoperation; Time Factors; Vagotomy; Vagotomy, Proximal Gastric

Topics: Animals; Biliary Tract Surgical Procedures; Dogs; Duodenum; Female; Gastric Acid; Gastrins; Jejunum; Liver; Male; Postoperative Complications; Stomach

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

The Authors review recent advances in understanding of the chemical composition and site of elaboration of gastrin; then they describe the physiological actions of the hormone and its connections with gastrointestinal pathology. They also discuss recently developed diagnostic procedures aiming at a more accurate clinical definition of hypergastrinism and hypogastrinism.

Topics: Bombesin; Calcium; Dietary Proteins; Endocrine System Diseases; Gastrectomy; Gastrins; Gastrointestinal Diseases; Humans; Postoperative Complications; Secretin; Vagotomy

Reports on increased duodenal ulceration after bile diversion prompted the present investigation of gastric acid secretion and gastrin in 16 patients with a Roux-en-Y hepaticojejunostomy and 11 patients with a choledochoduodenostomy. Basal and pentagastrin stimulated acid output, gastrin in serum and gastrin in the antral mucosa were all significantly elevated in patients with a Roux-en-Y compared with those patients having a choledochoduodenostomy. In patients with a Roux-en-Y, bile bypassed the duodenum and the most proximal part of the jejunum; it is hypothesized that the bypass of bile may induce gastric acid hypersecretion secondary to an altered biosynthesis and release of gastrin.

Topics: Adult; Aged; Cholestasis, Extrahepatic; Common Bile Duct; Duodenal Ulcer; Duodenum; Female; Follow-Up Studies; Gastric Juice; Gastrins; Hepatic Duct, Common; Humans; Jejunum; Male; Methods; Middle Aged; Postoperative Complications

Topics: Brunner Glands; Duodenal Ulcer; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Intestinal Mucosa; Kidney Transplantation; Postoperative Complications; Transplantation, Homologous

Topics: Cimetidine; Gastric Emptying; Gastric Juice; Gastrins; Guanidines; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Postoperative Complications; Syndrome

Retained gastric antrum was evaluated in six dogs, and diagnostic methods correlated with histopathology. Secretin and calcium infusion did not significantly alter circulating gastrin levels. 99 mTc scanning was uniformly positive and did not depend on the presence of parietal cells. The failure to consistently develop hypergastrinemia and the absence of gastrin cell hyperplasia suggest that factors other than gastrin may be implicated in the recurrent ulceration seen with retained antrum.

Topics: Animals; Calcium; Dogs; Gastrectomy; Gastrins; Peptic Ulcer Perforation; Postoperative Complications; Pyloric Antrum; Radionuclide Imaging; Secretin; Technetium

The influence of selective proximal vagotomy (SPV) and of an additional pyloroplasty (Heineke-Mikulicz) on gastric emptying, acid and gastrin secretion, and duodenogastric reflux was examined experimentally. After SPV, gastric emptying of fluids and a solid meal was significantly faster than before surgery. An additional pyloroplasty did not influence gastric emptying time significantly. Gastrin secretion after stimulation with a protein-rich meal increased significantly after SPV and did not change much after pyloroplasty was added. It can be concluded that increased gastrin secretion after SPV is not a result of delayed emptying. Pentagastrin-stimulated acid secretion was reduced by 70% after SPV and after additional pyloroplasty as well. The results show that reduced acid secretion after SPV causes the rise in serum gastrin levels. After SPV no duodenogastric reflux occurred. An additional pyloroplasty led to a significant rise of bromsulphaleine used as a marker for bile in gastric aspirate. Obviously destruction of the pylorus leads to a loss of its antireflux function. This leads to an antral gastritis which after 3 months is of chronic-atrophic type. A stimulation of gastrin output by bile could not be demonstrated. It can be concluded that after SPV gastric emptying is not delayed. A pyloroplasty does not affect gastrin release and acid secretion. Drainage procedures together with SPV should be avoided to prevent duodenogastric reflux and antral gastritis.

Topics: Duodenal Diseases; Gastric Emptying; Gastrins; Humans; Postoperative Complications; Pylorus; Vagotomy

Of 97 patients, who had a PGV since July 1971, 86 were checked intraoperatively on completeness of vagotomy with various methods, including Kongo-red-staining, pH-electrode and Burge-test. On theoretical grounds, the Burge-test combined with pH-measurement seems the most reliable procedure. In 14 cases an incomplete Vagotomy could such be avoided. 72 patients, who met the critiria of more than 6 months follow-up, were graded according to VISICK with 89% good results (I, II) and 11% VISICK III, IV. Two Patients needed reoperation, one with recurrent ulcer. Our results confirm the good impression we had initially, regarding the low postoperative morbidity, effective reduction of acidity and recurrence rate, but longterm follow-up studies are still required to form a final judgement.

Topics: Drainage; Duodenal Ulcer; Gastrins; Humans; Hydrogen-Ion Concentration; Manometry; Postoperative Complications; Time Factors; Vagotomy

Topics: Calcium; Gastrectomy; Gastrins; Humans; Methods; Postgastrectomy Syndromes; Postoperative Complications; Preoperative Care; Recurrence; Secretin; Stomach Ulcer; Vagotomy

Topics: Adult; Analgesics; Antacids; Female; Gastrectomy; Gastrins; Humans; Hypnotics and Sedatives; Male; Parasympatholytics; Peptic Ulcer; Postoperative Complications; Recurrence; Tranquilizing Agents

Fasting and postprandial gastric acid secretion and gastrin were determined in Heidenhain pouch dogs before (C) and after (R) massive enterectomy (five dogs) and after additional proximal gastric vagotomy (PGV) in three dogs. Basal acid output was unchanged (C = 7 +/- 2 microneq/hour; R = 11 +/- 4 microneq/hour), but postprandially the hourly (third through eighth hour) and cumulative acid outputs (C = 3.6 +/- 0.3 mEq/8 hour; R = 7.2 +/- 0.4 MEq/8 hour) were significantly increased by resection (P less than 0.001). Similarly, fasting gastrin was unaltered by resection (C = 41 +/- 2 pg/ml; R = 46 +/- 8 pg/ml), whereas hourly gastrin concentrations significantly (P less than 0.05) exceeded control values. Increased gastrin correlated linearly (P less than 0.02) with increased acid output. After PGV, basal acid levels remained unchanged (R = 4 +/- 2 micronEq/hour; PGV = 9 +/- 4 micronEq/hour), but postprandial acid output significantly exceeded prevagotomy values at all time periods (P less than 0.05). Cumulative acid output also was increased (R = 6.8 +/- 0.6 MEq/8 hour; PGV = 11.2 +/- 0.6 mEq/8 hour; P less than 0.001). Serum gastrin, however, remained unchanged. Hypersecretion of acid from Heidenhain pouches after massive enterectomy is increased further by PGV without a concomitant increase in serum gastrin.

Topics: Animals; Dogs; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Intestine, Small; Postoperative Complications; Secretory Rate; Vagotomy

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

Serum gastrin behaviour after stimulation with a protein meal was examined in 20 patients of both sexes suffering from x-graphically and endoscopically accertained recurring peptic ulcer, and a marked increase was found in the hormone in the majority of patients when observations were made 15 and 45 minutes after the meal. The genesis of this increase is therefore discussed, with consideration of the importance that extra-gastric sites of production of the hormone may have in such penomenon.

Topics: Adult; Female; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Recurrence

Twenty-four patients with postoperative recurrent peptic ulcer, presenting to a teaching hospital over a six-year period, are reviewed. The diagnosis was confirmed by endoscopy or surgery in all cases. Four patients (16-7%) were shown to have the Zollinger-Ellison syndrome and were treated successfully by total gastrectomy. This is a significantly higher incidence of Zollinger-Ellison syndrome than in previous reports. Six patients were treated medically, with one death. In the remainder, an inadequate initial operation was considered to be the cause of recurrence. Reoperation, usually involving complete vagotomy and antrectomy, was performed. There was no mortality in this group, and no patients have had further recurrence. The importance of serum gastrin studies in all patients with recurrent peptic ulcer is emphasized.

Topics: Female; Gastrins; Humans; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Recurrence; Zollinger-Ellison Syndrome

Topics: Diagnosis, Differential; Diarrhea; Gastrectomy; Gastrins; Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Radiography; Stomach Neoplasms; Zollinger-Ellison Syndrome

Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.

Topics: Adolescent; Adult; Aged; Duodenal Ulcer; Esophagitis, Peptic; Esophagogastric Junction; Female; Gastrins; Gastroesophageal Reflux; Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Male; Manometry; Middle Aged; Muscle Tonus; Postoperative Complications; Suture Techniques; Vagotomy

In 50 patients (10 anephric, 10 with chronic renal failure, and 30 with acute renal failure) the correlation was studied between basal PG levels and basal and stimulated gastric acid secretion. a) The mean PG level in all 3 groups was significantly higher than in the control group, with the highest values in the anephric, which decreased to normal after kidney transplantation. b) In the patients with ARF and after transplantation there was a very positive correlation between PG levels and kidney function. c) Hemodialysis decreased PG levels moderately but significantly. d) Gastric acid studies showed in all groups a very low BAO and basal intragastric pH, with a significant release of gastric acid after pentagastrin stimulation, especially in the anephric.

Topics: Acute Kidney Injury; Gastric Juice; Gastrins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Nephrectomy; Postoperative Complications; Transplantation, Homologous

Seven babies with 100 cm or less remaining small bowel have been evaluated for evidence of gastric hyperacidity and/or hypergastrinemia. Two babies were also studied after feeding. No patient demonstrated hyperacidity or hypergastrinemia. This infant data is discussed in regards to reported contradictory data in adult studies.

Topics: Age Factors; Gastric Acidity Determination; Gastric Juice; Gastrins; Humans; Infant; Infant, Newborn; Intestine, Small; Postoperative Complications

In 10 healthy controls, in 3 patients with subtotal resection of the small intestine and in 7 patients with jejuno-ileal bypass gastric ackd secretion and serum gastrin were determined in the basal state and after stimulation. The patients with short bowel revealed basal and pentagastrin stimulated gastric acid secretion in the lower normal range. Hypergastrinaemia, however, was present in these patients in the basal state and after food stimulation of gastrin release, while in patients with jejuno-ileal bypass basal and postprandial serum gastrin concentrations were within the normal range. These data suggest, that hypergastrinaemia in patients with short bowel is due to dimished gastrin catabolism and that the small intestine plays a significant role in gastrin inactivation.

Topics: Gastrins; Humans; Ileum; Intestine, Small; Jejunum; Pentagastrin; Postoperative Complications; Secretory Rate; Stimulation, Chemical; Stomach

Pathophysiological and nutritional conditions were compared after esophageal reconstruction in 15 patients with a gastric tube and in 12 patients with a pedicled colon segment for the treatment of esophageal cancer. There was no significant difference in the postoperative nutritional index, iron and vitamin B12 metabolisms. On the other hand, the long gastric tube from the greater curvature of the stomach used as an esophageal substitute retained some secretory functions of both exocrine and endocrine although the effect of truncal vagotomy may have to be taken into consideration.

Topics: Aged; Colon; Esophageal Neoplasms; Esophagoplasty; Female; Gastric Juice; Gastric Mucosa; Gastrins; Glucose Tolerance Test; Humans; Iron; Male; Middle Aged; Nutritional Physiological Phenomena; Postoperative Complications; Stomach; Transplantation, Autologous; Vitamin B 12

The working effect of Gastrin, neostigmine and prostaglandin in regard to the emptying of the stomach was tested on 31 dogs that had undergone a truncular vagotomy. Gastrin and neostigmine were proved to increase the motility at the stomach pylorus but was not able to bring about a coordinated emptying pattern. Prostaglandin shows different effects on the emptying reflex of the stomach. PGF 2 alpha increases the motility on the measuring marks, but at different time intervals. Because of this a coordinated motility is made possible.

Topics: Animals; Dogs; Gastrins; Gastrointestinal Motility; Neostigmine; Postoperative Complications; Prostaglandins; Stomach; Vagotomy

Studies on gastric emptying after antrectomy and vagotomy with gastroduodenostomy show that the gastric remnant empties in the same way as the intact stomach by hormonal control. If gastrointestinal passage after gastric resection is restored by gastrojejunostomy no endocrine regulation can be found.

Topics: Animals; Dogs; Duodenal Ulcer; Duodenum; Esophagus; Gastrectomy; Gastric Mucosa; Gastrins; Glucagon; Humans; Pentagastrin; Postoperative Complications; Pressure; Pyloric Antrum; Vagotomy

Topics: Animals; Biological Transport; Duodenal Ulcer; Enterochromaffin Cells; Gastric Mucosa; Gastrins; Gastrointestinal Diseases; Gastrointestinal Motility; History, 20th Century; Humans; Nerve Regeneration; Neurosecretion; Nucleic Acids; Postoperative Complications; Recurrence; Stomach; Vagotomy; Vagus Nerve

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

50 cases of interposition of jejunal loop (32 for gastric cancer and 18 for ulcerous pathology) carried out over the last 3 years are reported. From a technical point of view and as an alternative to degastroenteroanastomosis, interposition of the loop is preferred in partial oral end-to-end on the stomach. In neoplastic lesions, Mouchet-Camey type reconstruction was adopted as a routine measure. After describing the complications of the operation and analyzing the causes, the long-term results are evaluated using absorption curves with 131-I labelled oleic acid. The excellent weight increase in the inflammatory forms, and the lack of reflow and dumping in patients subjected to total gastrectomy for cancer, confirm the value of the technique.

Topics: Adult; Aged; Dumping Syndrome; Duodenal Ulcer; Gastrectomy; Gastrins; Humans; Iodine Radioisotopes; Jejunum; Middle Aged; Neoplasm Metastasis; Oleic Acids; Peptic Ulcer; Postoperative Complications; Radioimmunoassay; Stomach Neoplasms; Stomach Ulcer; Zollinger-Ellison Syndrome

Topics: Duodenal Ulcer; Gastrectomy; Gastric Juice; Gastrins; Humans; Postoperative Complications; Pylorus; Recurrence; Vagotomy

From the experience of treating 91 patients with a proven recurrent ulcer we consider that if a proven ulcer is shown to be present and a gastrin-secreting tumour is excluded an appropriate reoperation will almost always produce a successful result (94 per cent). Before subjecting patients to reoperation all attempts must be made to secure a precise diagnosis. The following investigations should be performed: barium meal, panendoscopy of the upper gastrointestinal tract, determination of maximum acid output (with insulin test and gastrin analysis if appropriate), and cholecystography. Before accepting a diagnosis of recurrent ulcer at least 2 of the first 3 tests should be postive. If the primary operation was a resection we advocate vagotomy alone as the second operation, provided there are no local complications such as stenosis, bleeding, or fistula. If the primary operation was a vagotomy and the recurrence is associated with a positive response to the insulin test we advocate revagotomy and antrectomy. If the insulin test is negative we normally repeat the test; if it is still negative then we use antrectomy alone.

Topics: Barium Sulfate; Cholecystography; Endoscopy; Follow-Up Studies; Gastrectomy; Gastric Acidity Determination; Gastrins; Gastroenterostomy; Humans; Peptic Ulcer; Postoperative Complications; Recurrence; Vagotomy

With better methods of diagnosis, patients will be identified earlier in the course of their disease and will often have atypical and borderline manifestations of the syndrome. Serum gastrin measurements with calcium and especially with secretin challenge will be the most important method of diagnosis. Any patient with acid hypersecretion who has a high serum gastrin level that does higher on secretin infusion should be considered to have the Zollinger-Ellison syndrome. A firm diagnosis of the Zollinger-Ellison syndrome should be made, if at all possible, prior to operation. At operation, a thorough search of the pancreas, duodenum, stomach, greater and lesser omentum and liver should be made for primary and secondary gastrinomas. If the preoperative data firmly establish the diagnosis of the Zollinger-Ellison syndrome, a total gastrectomy should be carried out even if no primary tumor is found. Similarly, a total gastrectomy should be done even if there are massive hepatic metastases. If total gastrectomy is not performed, the patient is apt to die of complications of acid hypersecretion. The only possible exceptions to the rule of always performing a total gastrectomy are in asymptomatic patients with easily excisable tumors or patients with tumors of the duodenum that are easily excisable, providing that in both instances after the excision of the tumor the output of gastric acid as measured at operation is immediately halted. All possible metastatic tumor tissue should be removed. The more tumor tissue removed, the longer the patient will survive. Metastases should be treated aggressively. They do not disappear after total gastrectomy in our experience, and they may kill patients. Patients should be followed after operation with serial measurements of serum gastrin concentrations and by hepatic scintillation scans and hepatic angiography. If hepatic metastases develop, intrahepatic artery infusions of 5-fluorouracil may slow tumor growth.

Topics: Adenocarcinoma; Adult; Aged; Angiography; Calcium; Endoscopy; Female; Gastrectomy; Gastrins; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Pancreatic Neoplasms; Peptic Ulcer; Postoperative Complications; Preoperative Care; Radioimmunoassay; Secretin; Zollinger-Ellison Syndrome

Plasma gastrin response to the intravenously administered secretin was investigated in various clinical entities. The marked increase of plasma gastrin was found in response to secretin in a case of suspected Zollinger-Ellison syndrome in contrast to various degrees of plasma gastrin decrease seen in patients with ordinary or postoperative recurrent peptic ulcer. The diagnostic value of secretin provocation test was stressed especially in relation to differentiation between Zollinger-Ellison syndrome and recurrent ulcer due to retained pyloric antrum kept away from the food-passing route, both of which are characterized by hypergastrinemia and acid hypersecretion.

Topics: Adult; Diagnosis, Differential; Gastrins; Humans; Injections, Intravenous; Male; Peptic Ulcer; Postoperative Complications; Recurrence; Secretin; Zollinger-Ellison Syndrome

A survey of pathogenesis, pathobiochemistry, pathological anatomy, clinic, diagnostics and therapy of the Zollinger-Ellison-syndrome is given. The Zollinger-Ellison-syndrome is, it is true, relatively rare, but its limitation from the usual peptic ulcer has great practical consequences. The suspicion of a Zollinger-Ellison-syndrome is aroused by therapy-resistent ulcers, which in every third person are associated with a diarrhoea, by recidivations of ulcer after gastric operations and by a large basal secretion of acid. The decisive diagnostic means is the serum gastrin determination. The only promising therapy is, as a rule, the gastrectomy.

Topics: Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Postoperative Complications; Prognosis; Stomach; Zollinger-Ellison Syndrome

Topics: Gastrins; Humans; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Postoperative Complications; Radioimmunoassay; Transplantation, Homologous

Topics: Biopsy; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Hyperplasia; Meat; Peptic Ulcer; Postoperative Complications; Pyloric Antrum; Radioimmunoassay; Recurrence; Tissue Extracts; Zollinger-Ellison Syndrome

Topics: Alkaline Phosphatase; Amylases; Bilirubin; Duodenal Neoplasms; Duodenum; gamma-Glutamyltransferase; Gastrins; Humans; Intestinal Absorption; Iron; Leucyl Aminopeptidase; Lipase; Pancreas; Pancreatic Neoplasms; Pancreatitis; Postoperative Complications

Topics: Animals; Diarrhea; Dogs; Dumping Syndrome; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Insulin; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Pylorus; Rabbits; Recurrence; Secretory Rate; Stomach; Vagotomy

Topics: Duodenal Ulcer; Duodenum; Evaluation Studies as Topic; Follow-Up Studies; Gallbladder; Gastrectomy; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Intestine, Small; Pancreas; Pancreatic Juice; Pentagastrin; Postoperative Complications; Pylorus; Secretory Rate; Stimulation, Chemical; Stomach; Vagotomy

Topics: Duodenal Ulcer; Evaluation Studies as Topic; Gastrins; Humans; Insulin; Postoperative Complications; Time Factors; Vagotomy

Topics: Adult; Age Factors; Aged; Blood Group Antigens; British Columbia; Female; Gastrectomy; Gastric Acidity Determination; Gastrins; Gastroenterostomy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Recurrence; Sex Factors; Substance-Related Disorders; Time Factors; Vagotomy

Topics: Atropine; Bile Acids and Salts; Biopsy; Duodenum; Ethylamines; Fats; Feces; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Immunoassay; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Intubation, Gastrointestinal; Middle Aged; Postoperative Complications; Pyrazoles; Secretin; Stomach Diseases

Topics: Adult; Aged; Anemia, Pernicious; Duodenal Ulcer; Ethylamines; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Insulin; Male; Middle Aged; Postoperative Complications; Pyrazoles; Recurrence; Stomach Neoplasms; Stomach Ulcer; Vagotomy; Zollinger-Ellison Syndrome

Topics: Adrenal Cortex Hormones; Gastrins; Humans; Hydrogen-Ion Concentration; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Peptic Ulcer; Postoperative Complications; Transplantation, Homologous; Uremia

Topics: Gastric Juice; Gastric Mucosa; Gastrins; Humans; Insulin; Pentagastrin; Pepsin A; Postoperative Complications; Secretory Rate; Stimulation, Chemical; Vagotomy

Topics: Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Insulin; Male; Postoperative Complications; Vagotomy

Topics: Amylases; Animals; Cholecystokinin; Chymotrypsin; Digestion; Digestive System; Dogs; Gastrins; Humans; Intestinal Absorption; Lipase; Lipid Metabolism; Pancreas; Peptic Ulcer; Postoperative Complications; Proteins; Secretin; Trypsin; Vagotomy

Topics: Blood Protein Electrophoresis; Gastric Juice; Gastrins; Gastroenterostomy; Humans; Postoperative Complications; Pyloric Stenosis; Radioimmunoassay; Serum Albumin; Serum Globulins; Zollinger-Ellison Syndrome

Topics: Gastrectomy; Gastrins; Gastroenterostomy; Humans; Methods; Postoperative Complications; Prognosis; Pylorus; Retrospective Studies; Stomach Ulcer; Vagotomy

Topics: Animals; Dogs; Gastric Juice; Gastric Mucosa; Gastrins; Histamine; Humans; Intestine, Small; Liver Cirrhosis; Peptic Ulcer; Portacaval Shunt, Surgical; Postoperative Complications

Topics: Adenoma, Islet Cell; Adult; Carcinoid Tumor; Diagnosis, Differential; Duodenal Neoplasms; Gastric Mucosa; Gastrins; Histamine; Humans; Male; Neoplasms; Peptic Ulcer; Postoperative Complications; Radiography; Serotonin; Tissue Extracts; Zollinger-Ellison Syndrome

Topics: Adolescent; Adult; Child; Female; Gastrins; Hemangioma; Humans; Hypersplenism; Liver Cirrhosis; Liver Diseases, Parasitic; Male; Middle Aged; Portacaval Shunt, Surgical; Portal Vein; Postoperative Complications; Schistosomiasis; Zollinger-Ellison Syndrome

Topics: Diarrhea; Duodenal Ulcer; Gastrins; Gastritis; Humans; Postoperative Complications; Secretory Rate; Vagotomy

Topics: Drainage; Duodenal Ulcer; Electric Stimulation; Electrodiagnosis; Gastric Acidity Determination; Gastrins; Humans; Postoperative Complications; Statistics as Topic; Vagotomy