pituitrin and Peptic-Ulcer

Peptic ulcer is a common disorder of gastrointestinal system and its pathogenesis is multifactorial, where smoking and nicotine have significant adverse effects. Smoking and chronic nicotine treatment stimulate basal acid output which is more pronounced in the smokers having duodenal ulcer. This increased gastric acid secretion is mediated through the stimulation of H2-receptor by histamine released after mast cell degranulation and due to the increase of the functional parietal cell volume or secretory capacity in smokers. Smoking and nicotine stimulate pepsinogen secretion also by increasing chief cell number or with an enhancement of their secretory capacity. Long-term nicotine treatment in rats also significantly decreases total mucus neck cell population and neck-cell mucus volume. Smoking also increases bile salt reflux rate and gastric bile salt concentration thereby increasing duodenogastric reflux that raises the risk of gastric ulcer in smokers. Smoking and nicotine not only induce ulceration, but they also potentiate ulceration caused by H. pylori, alcohol, nonsteroidal anti-inflammatory drugs or cold restrain stress. Polymorphonuclear neutrophils (PMN) play an important role in ulcerogenesis through oxidative damage of the mucosa by increasing the generation of reactive oxygen intermediates (ROI), which is potentiated by nicotine and smoking. Nicotine by a cAMP-protein kinase A signaling system elevates the endogenous vasopressin level, which plays an aggressive role in the development of gastroduodenal lesions. Smoking increases production of platelet activating factor (PAF) and endothelin, which are potent gastric ulcerogens. Cigarette smoking and nicotine reduce the level of circulating epidermal growth factor (EGF) and decrease the secretion of EGF from the salivary gland, which are necessary for gastric mucosal cell renewal. Nicotine also decreases prostaglandin generation in the gastric mucosa of smokers, thereby making the mucosa susceptible to ulceration. ROI generation and ROI-mediated gastric mucosal cell apoptosis are also considered to be important mechanism for aggravation of ulcer by cigarette smoke or nicotine. Both smoking and nicotine reduce angiogenesis in the gastric mucosa through inhibition of nitric oxide synthesis thereby arresting cell renewal process. Smoking or smoke extract impairs both spontaneous and drug-induced healing of ulcer. Smoke extract also inhibits gastric mucosal cell proliferation by reducing ornithine

Topics: Animals; Epidermal Growth Factor; Gastric Mucosa; Histamine; Humans; Mast Cells; Neutrophils; Nicotine; Nitric Oxide; Peptic Ulcer; Rats; Reactive Oxygen Species; Smoking; Vasopressins

Vasopressin, released from the posterior pituitary and from the vascular endothelium, can cause vasoconstriction and provoke platelet aggregation, leading to an impaired tissue blood supply. In humans with pituitary diabetes insipidus the central release of vasopressin is diminished, and in the Brattleboro homozygous rat there is congenitally no synthesis of this hormone. The gastroduodenal intramucosal vasopressin level is elevated in normal rats following various acute ulcerogenic challenges (after ethanol, reserpine, indomethacin, cold-restraint stress, endotoxin shock and hemorrhagic shock), and vasopressin-deficient rats are less sensitive to these stimuli. In a hospital- and population-based case-control, age-matched retrospective study, the incidence of human gastroduodenal ulceration is significantly higher in the normal population (in whom the release of vasopressin is presumed to be intact) than in the vasopressin-deficient one (central diabetes insipidus patients). In conclusion, endogenous vasopressin plays an aggressive role in development of gastroduodenal ulceration, especially that related to stress.

Topics: Adult; Aged; Animals; Case-Control Studies; Diabetes Insipidus; Humans; Incidence; Middle Aged; Peptic Ulcer; Rats; Rats, Brattleboro; Stress, Physiological; Vasoconstrictor Agents; Vasopressins

Interventional radiology is defined as a radiologic subspecialty and the services provided are tabulated in this article; those services relevant to internists are described in greater detail. This article is intended as a survey, and the authors encourage the reader to consult the references provided for a more in-depth review.

Topics: Abscess; Angiography; Angioplasty, Balloon; Arterial Occlusive Diseases; Arteriovenous Malformations; Biopsy, Needle; Cholestasis; Drainage; Embolization, Therapeutic; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemoptysis; Humans; Neoplasms; Peptic Ulcer; Radiography; Vasopressins

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: Anti-Bacterial Agents; Blood Transfusion; Cryotherapy; Drainage; Esophageal and Gastric Varices; Esophageal Perforation; Gastrointestinal Hemorrhage; Hemostasis; Hepatic Encephalopathy; Humans; Hypertension, Portal; Intubation, Gastrointestinal; Liver Cirrhosis; Myocardial Infarction; Peptic Ulcer; Pneumonia, Aspiration; Portacaval Shunt, Surgical; Sclerosing Solutions; Therapeutic Irrigation; Ulcer; Vasopressins; Vitamin K

Topics: Bile; Biliary Tract Diseases; Cholelithiasis; Cholesterol; Gastric Juice; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Obesity; Peptic Ulcer; Phosphatidylcholines; Pylorus; Research; Stress, Physiological; Urinary Diversion; Vagotomy; Vasopressins; Vitamin A

Topics: Animals; Biliary Tract; Cats; Digestive System; Dogs; Esophagus; Gastric Juice; Gastrointestinal Motility; Guinea Pigs; Humans; Intestinal Absorption; Intestine, Large; Intestine, Small; Liver; Muscle, Smooth; Pancreas; Pancreatic Ducts; Peptic Ulcer; Rabbits; Rats; Regional Blood Flow; Salivary Glands; Stomach; Vasopressins

Topics: Animals; Cats; Dogs; Electric Stimulation; Gastric Acidity Determination; Gastric Juice; Gastrointestinal Motility; Haplorhini; Humans; Hypothalamo-Hypophyseal System; Hypothalamus; Methods; Parasympathetic Nervous System; Pepsin A; Peptic Ulcer; Rabbits; Stereotaxic Techniques; Stomach; Sympathectomy; Sympathetic Nervous System; Vagotomy; Vasopressins

Topics: Cimetidine; Clinical Trials as Topic; Emergencies; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Peptic Ulcer; Peptic Ulcer Hemorrhage; Stomach Ulcer; Stress, Physiological; Vasopressins

Topics: Acute Disease; Aminopyrine; Capillary Permeability; Gastric Mucosa; Humans; Peptic Ulcer; Regional Blood Flow; Spectrophotometry; Stomach; Vasoconstriction; Vasopressins

The mortality in patients with upper gastrointestinal bleeding has not changed in the past quarter century in spite of the introduction of new modes of therapy and treatment. In this review we address the possible reasons for a lack of change in mortality and the implications raised for the use of new techniques. We review the factors that affect the mortality of acute upper gastrointestinal hemorrhage and the diagnostic accuracy of upper gastrointestinal endoscopy. Based on this information, we present guidelines for the therapy of the major causes of upper gastrointestinal bleeding. These guidelines should be useful until new therapies have been assessed and become generally available.

Topics: Age Factors; Blood Transfusion; Cimetidine; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Mallory-Weiss Syndrome; Peptic Ulcer; Vasopressins

In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.

Topics: Aneurysm; Angiography; Duodenal Diseases; Embolization, Therapeutic; Enteritis; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Peptic Ulcer; Peutz-Jeghers Syndrome; Postoperative Complications; Salmonella Infections; Vasopressins

Topics: Animals; Antacids; Burns; Central Nervous System Diseases; Humans; Peptic Ulcer; Postoperative Complications; Stomach Ulcer; Stress, Physiological; Vasopressins; Wounds and Injuries

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

Superior mesenteric arteriography can often demonstrate actively bleeding marginal ulcers. Five cases diagnosed by angiography are reported. Pitressin infusions of the superior mesenteric artery stopped bleeding permanently in two cases, transiently in two cases, and was not attempted in one case. Pitressin infusions of the superior mesenteric artery should be attempted before surgery is performed for bleeding marginal ulcers.

Topics: Adult; Aged; Angiography; Catheterization; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Stomach Ulcer; 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: Celiac Artery; Cerebral Ventricle Neoplasms; Child; Female; Humans; Injections, Intra-Arterial; Peptic Ulcer; Peptic Ulcer Hemorrhage; Radiography; Stress, Physiological; Vasopressins

Topics: Animals; Cortisone; Drug Synergism; Edema; Gastric Juice; Gastric Mucins; Gastric Mucosa; Microscopy, Electron; Necrosis; Pepsin A; Peptic Ulcer; Peptic Ulcer Hemorrhage; Rabbits; Vasoconstrictor Agents; Vasopressins

Topics: Adrenocorticotropic Hormone; Animals; Dogs; Epinephrine; Hypophysectomy; Hypothalamus; Oxytocin; Pepsin A; Peptic Ulcer; Physiology; Quinolines; Research; Vasopressins

Topics: Arginine Vasopressin; Esophagus; Humans; Intercellular Signaling Peptides and Proteins; Nitrates; Peptic Ulcer; Peptides; Reserpine; Vasopressins

Topics: Animals; Dogs; Histamine; Histamine Agents; Peptic Ulcer; Stomach Ulcer; Vasopressins

Topics: Adrenocorticotropic Hormone; Animals; Cortisone; Peptic Ulcer; Rabbits; Vasopressins