technetium-tc-99m-lidofenin and Stomach-Ulcer

It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric surgery, by milk-technetium 99m (99mTc)-dimethyl iminodiacetic acid (HIDA) scintigraphy. After excluding the cases with spontaneous gallbladder evacuation before milk ingestion, there were 26 controls, 41 duodenal ulcer (DU) patients, 22 after HSV (15 prospective cases), 50 after TVP (23 prospective cases), 8 after TV with gastrojejunostomy (TV-GJ), 10 after Billroth I gastrectomy, and 29 after Billroth II gastrectomy. None of the patients with gastrectomy had additional vagotomy. TVP significantly delayed the onset and decreased the rate of gallbladder emptying as compared with the control, DU, HSV, and Billroth I groups. TVP also changed the pattern of emptying in 20% of the cases (sequential emptying and refilling events). Antiulcer operations excluding the duodenum (TV-GJ and Billroth II) further reduced the rate of gallbladder emptying as compared with (1) control, DU, HSV, and Billroth I groups (P < 0.0001) and (2) TVP (P < 0.001). Onset of gallbladder emptying was not affected by Billroth II gastrectomy, but was significantly delayed by TV-GJ (P < 0.001). The latter two operations also significantly changed the pattern of gallbladder emptying, exhibiting sequential emptying and refilling events, in most cases (P < 0.01 versus TVP). In conclusion, all antiulcer procedures, except HSV, greatly disturb the pattern, the onset, and the rate of gallbladder emptying. Truncal vagotomy seems to disrupt vagally mediated preduodenal mechanism, resulting in delayed onset and reduced rate, whereas duodenal exclusion by gastrojejunostomy results in severely decreased rate of gallbladder emptying.

Topics: Duodenal Ulcer; Female; Gallbladder; Gallbladder Emptying; Gastrectomy; Gastrostomy; Humans; Imino Acids; Injections, Intravenous; Jejunostomy; Male; Organotechnetium Compounds; Postoperative Care; Postoperative Period; Prospective Studies; Pylorus; Radionuclide Imaging; Stomach Ulcer; Technetium Tc 99m Lidofenin; Time Factors; Vagotomy, Proximal Gastric; Vagotomy, Truncal

We intended to estimate D.G.R. in patients suffering from GU, and CG, comparing them with healthy controls. 70 patients, divided in 3 groups, were studied; Group A (Control): 14 cases, Group B (GU) type I Johnson: 11 cases, type III Johnson: 20 cases; Group C (CG): 25 cases (11 antral and 14 antral and fundic). The following studies were performed in all of them upper digestive tract X-ray and fibro-endoscopy with multiple antral and fundic biopsies. Tc 99 HIDA 2 ml. Cu. I.V. was used as radioactive compound, and in the first hour 0.3 ml Cu. in 100 cc of water was administered orally, so as to confirm gastric topography. All patients were studied for 2 hour. Quantitative assessment of D.G.R. was expressed in % related to the hepatobiliary area. D.G.R. was detected in 7.1% of patients in Group A: 54.5% of GU type I and 70% in GU type III. In antral CG a 72.7% of D.G.R. was observed and in antral and fundic CG a 87.6% was found. The differences were significant in all the cases. D.G.R. MAGNITUDE, expressed as geometric mean, was: for Group A: 0.73%; for Group B: Ulcer type I: 6.26% and type III: 6.26%, for Group C: 6.78% in antral gastritis and 11.41% in antral and fundic gastritis.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Duodenogastric Reflux; Female; Gastritis; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Stomach Ulcer; Technetium Tc 99m Lidofenin

Topics: Duodenal Ulcer; Duodenogastric Reflux; Humans; Imino Acids; Organometallic Compounds; Radionuclide Imaging; Stomach Ulcer; Technetium Tc 99m Lidofenin

In this work the duodenogastric reflux was quantified as the amount of radioactivity entering the stomach after an i.v. administration of 99mTc-HIDA in ulcer patients and in patients who had undergone BI gastrectomy. The results were compared with visual evidence of gastric activity in the gamma camera images and biochemical determination of gastric bile reflux. The method is useful in quantifying the reflux if the activity is above the background activity. It allows the determination of an upper limit for the reflux when the reflux is evident visually. Only two or three images are needed for the quantitation. No correlation was found between biochemical measurement of fasting bile reflux in the stomach and radioisotopic quantification.

Topics: Adult; Aged; Duodenogastric Reflux; Female; Humans; Imino Acids; Male; Middle Aged; Postgastrectomy Syndromes; Radionuclide Imaging; Stomach Ulcer; Technetium; Technetium Tc 99m Lidofenin

A new method is described which allows simultaneous measurement of gastric emptying and duodenogastric reflux and avoids transpyloric intubation. After intragastric instillation of a liquid lipid meal in six healthy volunteers the fractional gastric emptying rate was 2.9 +/- 0.3 in the upright and 2.5 +/- 0.6 SEM X 10(-2)/min in the supine position, respectively (p greater than 0.5). The duodenogastric reflux rate (expressed as fraction of the intraduodenal amount of duodenal marker) was 0.30 (range 0.03-0.81) and 0.22 (0.01-0.55) X 10(-2)/min, respectively (p greater than 0.2). Atropine (40 micrograms/kg) decreased the supine gastric emptying rate to 1.1 +/- 0.2 (p less than 0.05) and increased the supine duodenogastric reflux rate to 2.74 (0.04-9.80) X 10(-2)/min (p less than 0.05). Fasting duodenogastric reflux rate was similar in the supine and upright position, 0.49 (0.04-0.89) and 0.42 (0.06-0.97) X 10(-2)/min, respectively (p greater than 0.5). Fractional gastric emptying rate was similar in 10 volunteers and 17 patients with type I gastric ulcer (2.1 +/- 0.4 vs 1.7 +/- 0.2 SEM X 10(-2)/min, p greater than 0.2). Their duodenogastric reflux rates were also similar, 0.65 (0.01-5.24) vs 1.10 (0.01-10.83) X 10(-2)/min (p greater than 0.5). We conclude therefore that (1) gastric emptying and both fasting and postprandial duodenogastric reflux are independent of the posture; (2) fasting and postprandial reflux are of similar magnitude; (3) atropine shows gastric emptying and increases duodenogastric reflux; and (4) patients with type I gastric ulcer have neither slowed gastric emptying nor increased duodenogastric reflux.

Topics: Adult; Aged; Atropine; Bile Reflux; Duodenal Diseases; Fasting; Female; Food; Gastric Acid; Gastric Emptying; Humans; Imino Acids; Male; Methods; Middle Aged; Posture; Stomach Diseases; Stomach Ulcer; Technetium; Technetium Tc 99m Lidofenin