pituitrin and Gastritis

Topics: Acute Disease; Animals; Duodenal Ulcer; Gastrectomy; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Intestinal Mucosa; Peptic Ulcer; Peptic Ulcer Hemorrhage; Permeability; Stomach Ulcer; Stress, Psychological; Vagotomy; Vasopressins

Topics: Abdomen; Aged; Crohn Disease; Duodenal Diseases; Duodenal Ulcer; Esophageal Achalasia; Esophagitis; Follow-Up Studies; Gastrectomy; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Hernia, Diaphragmatic; Humans; Intestine, Small; Methods; Obesity; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach Neoplasms; Stomach Ulcer; Vagotomy; Vasopressins; Zollinger-Ellison Syndrome

In a prospective randomized study, 38 patients with massive upper gastrointestinal tract hemorrhage, mostly due to esophageal varices or erosive gastritis, were treated with either standard medical therapy or standard therapy plus selective intra-arterial vasopressin infusion. Cessation of hemorrhage occurred more frequently in the vasopressin-treated group. The study design did not permit meaningful comparisons of mortality of transfusion requirements. We conclude that in patients bleeding from esophageal varices or gastritis, selective intra-arterial vasopressin is more effective in controlling hemorrhage than standard therapy.

Topics: Adult; Aged; Clinical Trials as Topic; Esophageal and Gastric Varices; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Middle Aged; Prospective Studies; Vasopressins

Severe upper gastrointestinal bleeding is unusual in newborns, and is usually seen in sick premature infants. We report on three healthy full-term neonates who, after uneventful deliveries, presented with profuse bleeding in the first 48 h of life. Two infants had duodenal ulcers and one had diffuse hemorrhagic gastritis. All three patients responded to conservative medical therapy and have shown no recurrence of symptoms during a follow-up period of 1-4 yr.

Topics: Duodenal Ulcer; Female; Follow-Up Studies; Gastritis; Gastrointestinal Hemorrhage; Humans; Infant, Newborn; Male; Peptic Ulcer Hemorrhage; Ranitidine; Time Factors; Vasopressins

Since bleeding from acute lesions of the gastric mucosa can cease spontaneously and the mortality rate of emergency surgery is high, conservative treatment is always preferable. Satisfactory results were obtained with continuous infusions of vasopressin in low doses (0.2 U/kg/hr for 8 hours) so that this treatment appears a valid alternative to more recent techniques (somatostatin).

Topics: Acute Disease; Adult; Aged; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach Ulcer; Vasopressins

Topics: Anti-Ulcer Agents; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer Hemorrhage; Prostaglandins; Somatostatin; Stomach Ulcer; Stress, Physiological; Vasopressins

Over a 3-year period continuous intravenous infusion of moderate doses of vasopressin in 13 patients bleeding profusely from hemorrhagic gastritis, was associated with rapid control of the bleeding in 11 patients, while in 2 patients prolonged infusion was required to stop the hemorrhage. In 2 patients there was a relapse of the hemorrhage 3 and 7 days after the initial treatment, which was successfully controlled by renewed vasopressin infusion. There was no mortality and no complications of the vasopressin treatment were encountered. The results compared favourably with the experience from the preceding 3-year period where a comparable group of patients undergoing conventional medical and surgical treatment suffered a mortality of 38%. This study therefore suggests that vasopressin infusion performed continuously with moderate doses over extended periods, improves survival of patients with severe hemorrhagic gastritis through control of bleeding.

Topics: Adult; Aged; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Injections, Intravenous; Male; Middle Aged; Vasopressins

Topics: Animals; Antacids; Blood Pressure; Cimetidine; Dogs; Gastric Juice; Gastritis; Gastrointestinal Hemorrhage; Humans; Vasopressins

Topics: Acute Disease; Adult; Aged; Diverticulum, Colon; Duodenal Ulcer; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach; Stomach Ulcer; Varicose Veins; Vasopressins

A four year experience in the management of 585 patients with massive upper gastrointestinal tract bleeding (U. G. I. B.)has been reviewed. The effect of routine fiberoptic gastroscopy, selective angiography, and selective pitressin arterial infusion has been analyzed as it effects the more accurate diagnosis and better non-operative therapy of these dangerously ill patients. Duodenal and gastric ulcer, which comprise one-half of such patients, are best treated by early operation. Mallory-Weiss-syndrome is more frequent than previously appreciated. Pitressin infusion is worthy of trial in diffuse gastritis, varicose- and stress ulcer bleeding. Stress bleeding is usually one manifestation of multiple organ failure due to bacterial sepsis.

Topics: Duodenal Neoplasms; Esophageal and Gastric Varices; Gastrectomy; Gastritis; Gastrointestinal Hemorrhage; Humans; Mallory-Weiss Syndrome; Methods; Peptic Ulcer Hemorrhage; Stomach Neoplasms; Vagotomy; Vasopressins

Alterations in gastric physiology caused by selective embolization and vasopressin infusion of the left gastric artery were evaluated in 29 dogs. Gastric acidity was not significantly altered following Gelfoam embolization but decreased sharply with vasopressin infusion. These results suggest that the segmental occlusion caused by Gelfoam embolization permits significant collateral blood flow to the gastric mucosa, while the arteriolar and capillary constriction caused by vasopressin effectively decreases mucosal blood flow. These findings are consistent with the clincal observation that embolization is more effective in controlling bleeding ulcers, while vasopressin infusion is more effective for controlling hemorrhagic gastritis.

Topics: Angiography; Animals; Dogs; Embolization, Therapeutic; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Gastrointestinal Hemorrhage; Histamine; Models, Biological; Peptic Ulcer Hemorrhage; Stomach; Vasopressins

Topics: Aspirin; Blood Transfusion; Child; Child, Preschool; Esophageal and Gastric Varices; Esophagitis, Peptic; Esophagoplasty; Gastritis; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Parasympatholytics; Peptic Ulcer; Stress, Psychological; Vasopressins; Vitamin K Deficiency Bleeding

Topics: Animals; Bile; Bile Acids and Salts; Disease Models, Animal; Dogs; Gastric Juice; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Ischemia; Peptic Ulcer Hemorrhage; Secretory Rate; Stomach Ulcer; Vasopressins

Over a four-year period, 585 patients were hospitalized for massive upper gastrointestinal bleeding. Endoscopy diagnosed the cause of bleeding in 80% of 200 patients so studied. Selective angiography localized the bleeding site in 12 of 20 patients, and infusion of vasopressor stopped hemorrhage in six. Barium studies was 90% accurate in diagnosing ulcer disease but failed to detect gastritis. One hundred thirty (22%) patients were operated upon for medically uncontrolled bleeding. The proportion of patients requiring surgery fell from 33% in year one to 13% in year four. Benign ulcer disease caused bleeding in 51% of surgical patients, while gastritis was found in 20%, esophageal varices in 15% and stress ulcer in 8%. Overall operative mortality was 29%. Among 38 duodenal ulcer patients, mortality was 18%. Vagotomy and pyloroplasty were more effective than resection in this group. Resection for distal gastric ulcers in 22 patients resulted in a mortality of 14% and no rebleeding. While V&P controlled bleeding in 12 alcoholics with gastritis, five (42%) died postoperatively. Mortality among 20 patients with esophageal varices was 35%, although all five survived who had porto-caval shunts. Eight of 10 patients operated upon for stress ulcer bleeding died. Postoperative rebleeding occurred in 14 patients, eight of whom were again operated upon. In all but one a new lesion was found to be responsible for hemorrhage. Increasing use of gastroscopy and selective angiography can be expected to improve diagnostic capabilities in patients with upper gastrointestinal bleeding. Infusing vasopressor into selected arteries should reduce the need for surgical control of gastritis, variceal and stress ulcer bleeding, conditions poorly managed by current operative techniques.

Topics: Alcoholism; Angiography; Barium Sulfate; Esophageal and Gastric Varices; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Injections, Intra-Arterial; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Risk; Vasopressins

Dissatisfaction with the high morbidity and mortality of traditional methods of handling massive gastrointestinal hemorrhage has led to the exploration of means other than surgical to attain hemostasis. Some, such as selective arterial infusion of surgical Pituitrin, have quickly won general acceptance in hospitals where facilities and interested personnel are available. Others, such as alkalinization, have become popular because of their inherent simplicity. Systemic hypothermia, requiring intensive patient care, has not been without considerable risk of significant complications. Iced saline lavage has never been subjected to critical evaluation. It is possible that the emptying of the stomach through mechanical destruction of the intragastric clot by repeated irrigations, reducing the antral stimulation by relief of distension, may be as important as the temperature of the solution in the stomach. Gastric irrigations with norepinephrine solutions have awaited the results of physiologic studies showing that the cardiovascular and renal effects of injected levarterenol are avoided, and that permanent damage to the gastrointestinal mucosa does not result. Trials have been confined largely to very poor-risk patients, and the hemostasis that has resulted has not been explainable, in all cases, on the basis of the physiologic activity of the agent (e.g., control of bleeding from tumor vessels). Evacuation of gastric content prior to introduction of the norepinephrine solution seems important. Lower gastrointestinal bleeding from benign disease has also responded to advances in applied pharmacology, with intra-arterial infusion of surgical Pituitrin again coming into progressively wider use. Intraperitoneal instillation of norepinephrine has also proved useful, even in patients who have adhesions from prior surgery or inflammatory disease, but closer monitoring of blood pressure and urine output are necessary because some of this solution is absorbed by the parietal peritoneum and not deactivated by the liver before entering the systemic circulation. Taken together, selective arterial infusion of vasopressin and topical application of norepinephrine can be considered complementary rather than competitive therapies. Because of the more extensive experience with selective angiographic infusion, it should be the first choice in institutions where it is readily available. For patients in whom arterial puncture is inadvisable, and where angiography is not readily

Topics: Antacids; Gastrectomy; Gastric Lavage; Gastritis; Gastrointestinal Hemorrhage; Humans; Hypothermia, Induced; Injections, Intra-Arterial; Norepinephrine; Peptic Ulcer Hemorrhage; Postoperative Care; Stomach; Stress, Psychological; Vagotomy; Vasopressins

Topics: Adult; Aged; Angiography; Animals; Celiac Artery; Dogs; Epinephrine; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Parenteral; Injections, Intra-Arterial; Male; Middle Aged; Vasopressins

Topics: Adult; Angiography; Arteries; Blood Transfusion; Catheterization; Esophageal and Gastric Varices; Gastritis; Gastrointestinal Hemorrhage; Gelatin Sponge, Absorbable; Hemostasis; Humans; Ileum; Jejunum; Male; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach; Vasopressins

Topics: Adult; Angiography; Celiac Artery; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Male; Mesenteric Arteries; Middle Aged; Peptic Ulcer; Stress, Physiological; Vasopressins

Topics: Adolescent; Adult; Aged; Angiography; Child; Child, Preschool; Epinephrine; Esophageal and Gastric Varices; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Injections, Intra-Arterial; Male; Middle Aged; Peptic Ulcer Hemorrhage; Ulcer; Vasopressins

Topics: Adult; Aged; Arteries; Capillaries; Celiac Artery; Colonic Diseases; Diverticulum, Colon; Duodenal Ulcer; Epinephrine; Gastritis; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Infusions, Parenteral; Male; Mallory-Weiss Syndrome; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach Ulcer; Vasopressins

Topics: Aminocaproates; Blood Coagulation Disorders; Blood Transfusion; Duodenal Ulcer; Esophageal and Gastric Varices; Esophagitis; Fibrinogen; Fibrinolysis; Gastritis; Gastrointestinal Hemorrhage; Heparin; Humans; Liver Diseases; Phosphorus Isotopes; Portacaval Shunt, Surgical; Stomach Ulcer; Therapeutic Irrigation; Vasopressins; Vitamin K

Topics: Acute Disease; Animals; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Rats; Vasopressins

Topics: Animals; Gastritis; Neostigmine; Rats; Vasopressins