Gastric emptying and postprandial duodenogastric reflux in pylorectomized dogs

A two-marker technique was used to determine gastric emptying rate and postprandial duodenogastric reflux rate without transpyloric intubation. The fractional gastric emptying rate in five dogs with normal pylorus was 3.0 +/- 0.3 (SE) X 10(-2)/min. In three dogs with circular pylorectomy, it was 5.8 +/- 0.8 X 10(-2)/min (P less than 0.01). The duodenogastric reflux rates were 0.72 +/- 0.23 (SE) ml/min and 3.21 +/- 0.97 ml/min. (P less than 0.05). The percentage of the test meal that by to-and-fro movements across the pylorus was emptied more than once was 2.3 +/- 1.0 (SE) in normal dogs and 15.5 +/- 2.4 after pylorectomy (P less than 0.005). Because the higher emptying rate was accompanied by more to-and-fro movements, the amount of the meal remaining in the stomach, and thus net gastric emptying, was similar in both groups. It is concluded that pylorectomy increases both reflux rate and emptying rate. This effect on emptying can only be detected by a method that includes the measurement of to-and-fro movements across the pylorus. The pylorus thus appears to prevent postprandial duodenogastric reflux and to slow gastric emptying.

Does gastric aminopyrine clearance reflect gastric mucosal blood flow or parietal cell function?

Gastric aminopyrine clearance was measured in human volunteers and dogs with untreated basal secretion, in human volunteers and dogs treated with secretory inhibitors, in dogs treated with histamine, and in patients with pernicious anaemia. When aminopyrine was given as a bolus to man or dog, aminopyrine clearance and the ratio aminopyrine concentration in gastric juice/aminopyrine concentration in plasma showed an initial peak two to three times over steady state levels. When aminopyrine was given with histamine, the peaks were even higher. No peaks occurred when an aminopyrine bolus was given to patients with pernicious anaemia or to healthy volunteers treated with secretory inhibitors. The height of the peaks paralleled the acid secretory rate. The peaks may best be explained by aminopyrine accumulation in the parietal cells and washing out of aminopyrine by volume flow. The steady state levels might reflect both parietal cell function and gastric mucosal blood flow.

Predictors of duodenal ulcer healing and relapse

Predictors of duodenal ulcer healing and relapse were examined in a population known to have a high healing incidence. Two double-blind prospective studies were performed in 134 patients over 4 wk and in 66 patients over 1 yr, respectively. Short-term treatment consisted either of cimetidine 1 g/day, pirenzepine 75 mg/day, or placebo. In a multiple stepwise linear regression analysis the following factors proved to increase healing incidence in decreasing order of importance: female sex, moderate alcohol consumption, abstinence from smoking, young age, and cimetidine treatment. The following factors had no influence on duodenal ulcer healing: number and total area of peptic lesions, concomitant disease, relatives with duodenal ulcer, duration of duodenal ulcer disease, and status as a migrant worker. In the long-term study, treatment consisted either of cimetidine 400 mg at bedtime, pirenzepine 30 mg at bedtime, or placebo. Cimetidine prevented ulcer relapse. Smoking favored duodenal ulcer relapse in the placebo group, but not in the cimetidine and pirenzepine group. For all the other factors no statistically significant effect was found. It is concluded that in a population with high spontaneous healing incidence (a) factors other than drug treatment such as sex, alcohol intake, smoking, and age are at least as important predictors of the outcome of short-term treatment as the drug treatment itself; (b) moderate alcohol intake might favor ulcer healing; (c) the unfavorable effect of smoking on ulcer relapse is overcome by low-dose, long-term, antisecretory treatment.

Duodenogastric reflux in the fasting dog: role of pylorus and duodenal motility

A two-marker technique was used to determine duodenogastric reflux in fasting dogs with normal or surgically modified gastroduodenal junctions. All nine dogs had an esophagostomy for gastric marker perfusion. The duodenal marker was given via a duodenal fistula. In two dogs a Heineke-Mikulicz pyloroplasty was performed, and in four dogs extramucosal circular pylorectomy was performed in addition. The mean fasting duodenogastric reflux rate in dogs with a normal pylorus was 1.1 +/- 0.5 (SE) ml/10 min; after pyloroplasty it was 1.6 +/- 0.3 ml/10 min (P greater than 0.1), and after pylorectomy it was 1.5 +/- 0.4 ml/10 min (P greater than 0.1). Simultaneous intraduodenal manometry revealed no relation between the interdigestive myoelectric complex and reflux. The marker technique for the measurement of reflux was validated by pharmacologically induced reflux. Subcutaneous injection of 0.1 mg of apomorphine increased the reflux rate tenfold. A transpyloric tube increased reflux rate fivefold. It is concluded that, in the fasting dog, phenomena such as retropulsive peristalsis are determinants of duodenogastric reflux and not the presence or absence of the pylorus and normal interdigestive motility.

[Is the sonographic diagnosis of hepatic cirrhosis and hepatic metastases reliable (author's transl)]

In a prospective study the reliability of the sonographic diagnosis of hepatic cirrhosis and metastases was investigated in 101 patients. Sonographic diagnoses were checked by laparoscopy. Hepatic cirrhosis was accurately diagnosed in 78% of the cases and hepatic metastases were correctly diagnosed in 92% of cases. The absence of cirrhosis or metastases was correctly recognised in 93% and 98%, respectively. The sonographic diagnosis of liver cirrhosis is based on five criteria: convexity of the ventral surface, caudal margin greater than 45%, rigid contours on palpation diffuse density of the internal structure, and splenomegaly. The most important criterium for the diagnosis of metastases is the presence of circumscribed contour changes. In 32 patients with cirrhosis and in 12 patients with metastases one diagnosis was incorrect. Thus sonography has a high accuracy in the diagnosis of hepatic cirrhosis and metastases.

Effect of ranitidine on gastric acid and pepsin secretion following sham feeding

The effect of oral ranitidine 150 mg on the acid and pepsin response to sham feeding or pentagastrin was examined in healthy volunteers in a double-blind randomized trial. Gastric juice was collected up to 255 min after ingestion of the drug. In placebo treated subjects, basal acid secretion rate and the secretion rate following sham feeding and injection of 6 micrograms kg-1 of pentagastrin were 5.3 +/- 2.0 S.E.M., 12.3 +/- 3.2, and 24.4 +/- 5.4 mmol h-1, respectively. The corresponding values in ranitidine treated subjects were 0.1 +/- 0.1, 0.5 +/- 0.2, and 3.4 +/- 1.2, respectively. The reduction of acid secretion in all three instances is statistically significant (p less than 0.025, p less than 0.05, and p less than 0.05, respectively). Basal, sham feeding stimulated, and pentagastrin stimulated pepsin secretion rates in the placebo treated group were 38.4 +/- 7.0 S.E.M., 68.6 +/- 13.2, and 39.2 +/- 8.0 mg h-1, respectively. In the ranitidine treated group, the values were 5.0 +/- 3.4, 13.2 +/- 5.6, and 19.6 +/- 6.0, respectively. The reduction of pepsin secretion during basal state and following sham feeding is statistically significant (p less than 0.005 and p less than 0.01). Thus, oral ranitidine inhibits the acid and pepsin response to sham feeding in man. Its inhibitory effect on the acid response to pentagastrin lasts for at least 4 h.

Antigenic modulation of mammary tumour virus envelope antigen or GR thymic lymphoma cells in relation to expressions of H-2, TL cell-surface antigens and THY1

The MLr antigen, a mammary tumour virus-induced antigen on the surface of GR thymic lymphoma cells (GRSL) can be modulated from the cell surface upon incubation with specific antiserum for 1-2 h at 37 degrees C, followed by washing the cells. In contrast, a number of other cell-surface antigens on these GRSL cells cannot be modulated under similar conditions. These antigens include histocompatibility antigens of the H-2 complex (H-2.8 of the K-end and H-2dx(D) of the H-2dx haplotype) and two thymic markers, TL1.2 and Thy1.2. Antigenic modulation of MLr as tested by trypan-blue exclusion and by chromium51 release does not lead to a measurable change in the expression of H-2K, H-2D, TL and Thy1.2 antigens. These results could be confirmed by absorption analysis. The latter analysis showed that the number of antigenic sites per cell are about the same for MLr and the two H-2 antigens, while TL antigens are scarcer and Thy1.2 antigens are more abundant. The procedure of antigenic modulation showed that the MLr antigen resides on MTVgp52, the major protein of the envelope. There was no evidence of internal proteins, such as MTVp27, on the surface of GRSL cells.

Ranitidine inhibits gastric acid and pepsin secretion following sham feeding

The effect of an oral therapeutic dose of 150 mg of ranitidine on the acid and pepsin response to sham feeding and pentagastrin was examined in healthy volunteers, using a double-blind random-isation method. Gastric juice was collected up to 255 minutes after ingestion of the drug. In placebo-treated subjects, basal acid secretion rate and the secretion rate following sham feeding and injection of 6 micrograms/kg of pentagastrin were 5.3 meq/h +/- 2.0 SEM, 12.3 +/- 3.2, and 24.4 +/- 5.4, respectively. The corresponding values in ranitidine-treated subjects were 0.1 +/- 0.1, 0.5 +/- 0.2, and 3.4 +/- 1.2, respectively. The reduction of acid secretion in all three instances is statistically significant (p less than 0.025, p less than 0.05, and p less than 0.05, respectively). Basal, sham feeding-stimulated, and pentagastrin-stimulated pepsin secretion rates in the placebo-treated group were 38.4 mg/h +/- 7.0 SEM, 68.6 +/- 13.2, and 39.2 +/- 8.0, respectively. In the ranitidine-treated group, the values were 5.0 +/- 3.4, 13.2 +/- 5.6, and 19.6 +/- 5.0, respectively. The reduction of pepsin secretion during basal state and following sham feeding is statistically significant (p less than 0.005 and p less than 0.01). Thus, oral ranitidine inhibits the acid and pepsin response to sham feeding in man. Its inhibitory effect on the acid response to pentagastrin lasts for at least 4 hours.

Limited usefulness of the breath test in evaluation of drug metabolism: a study in human oral contraceptive users treated with dimethylaminoantipyrine and diazepam

Demethylation of 14C-dimethyl-N-aminoantipyrine (aminopyrine) and 14C-diazepam was measured by means of a breath test in women taking oral contraceptive steroids (OCS) and in controls not receiving OCS. Short-term half-life of 14CO2 in the breath after intake of 2 muCi of aminopyrine was significantly prolonged in women taking OCS when compared with controls. After intake of 2 muCi diazepam there were no statistically significant differences between the two groups. With 2 muCi diazepam or 10 muCi aminopyrine a biexponential decline of 14CO2 content in the breath was superimposed on a circadian, rhythm. 14CO2 in the aminopyrine breath test in the morning increased after the patients had risen from bed, whereas in the diazepam breath test the 14CO2 content decreased. It is concluded that the effect of OCS on drug metabolism is very specific. Furthermore, the appearance of 14CO2 in the breath does not depend only on hepatic microsomal demethylation.

How often does peptic ulcer produce "typical" ulcer symptoms?

Subjective symptoms of 876 hospitalized patients who underwent upper fiber-panendoscopy were evaluated in a prospective study. Ulcer-like symptoms were defined as pain-like discomfort with a regular food-related rhythm. These symptoms indicate ulcer disease with high specificity (96%) but low sensitivity (28%). In particular old patients with second disease rarely have ulcer-like symptoms. In spite of their high specificity, however, ulcer-like symptoms are not proof of active ulceration. Patients with scars but no ulcers may also have ulcer-like symptoms.

[Hypochlorhydria in acute gastritis (author's transl)]

After swallowing a non-sterilised pH electrode a 25-year-old medical student developed an influenza-like illness followed by hypo- and achlorhydria for several weeks, acute leukocyte-gastrititis, and epithelial defects of the antrum. This possibly represents an infectious disease which can be transmitted by contaminated electrodes or probes.

How reliable is determination of ulcer size by endoscopy?

The suface areas of 23 artificial ulcers in a rubber manikin and of 35 ulcers in 35 consecutive patients admitted for endoscopy of the upper gastrointestinal tract were estimated by six endoscopists. Of the 138 estimations made in the manikin 80% underestimated the true size of the ulcer: the mean (+/- SD) was -29 +/- 40%. The largest and the smallest estimate of the same ulcer by different endoscopists varied on average by a factor of 4.5 +/- 3.8, and the estimates by the same endoscopists of ulcers with the same size varied by a factor of 2.3 +/- 0.6. In the patients the scatter of the estimates was even larger, the mean factor being 7.8 +/- 6.3. Changes in ulcer size are therefore an unsuitable criterion for assessing ulcer healing. Even if consecutive examinations are performed by the same endoscopist, changes in ulcer area smaller than by a factor of 3 are not discernible.

[Treatment of reflux oesophagitis with cimetidine (author's transl)]

The effect of cimetidine on reflux oesophagitis was studied in a double-blind trial. Sixteen patients were given cimetidine 1.6 g/d, 20 patients received a placebo. Within the first six weeks the oesophagitis improved both on cimetidine and the placebo, but the patients taking the former had fewer complaints during the day than those on a placebo. Continuing the regimen for another six weeks further improved the endoscopic findings in patients with cimetidine but not in those on placebos. Complaints lessened during the sixth to twelfth week during cimetidine treatment, but remained unchanged under placebo administration. Complete healing of the oesophagitis was achieved in only 33% of patients with uncomplicated oesophagitis (grade I-III) and in 6% of those with severe complicated oesophagitis (grade IV). If non-surgical treatment is indicated, it must be continued through at least 6-12 weeks.

[Premedication of esophago-gastro-duodenoscopy with a neuroleptanalgesic drug and a tranquillizer--a controlled clinical study (author's transl)]

In a controlled double-blind randomized study Thalamonal and Valium were compared in 498 esophago-gastro-duodenoscopies. Both drugs were injected intravenously immediately before the procedure. Satisfactory sedation which made additional injection of the drug during the endoscopy superfluous could be achieved in 66% of the patients with Thalamonal and in 52% with Valium respectively. The difference between the two preparations is statistically significant (p less than 0,005). In 95 patients catamnestic studies were performed in order to evaluate second episodes of fatigue after the endoscopy. A good effect of the preparation during endoscopy and a lack of second attacks of sedation following discharge was observed only in 23% of the patients after Thalamonal and in 21% of the patients after Valium injection, respectively. Therfore a good premedication was achieved in only one fifth of the patients receiving one of the two drugs.

[Prevention of duodenal ulcer recurrence with cimetidine (author's transl)]

The effect of long-term prophylaxis of duodenal ulceration with cimetidine was tested in a double blind trial. In 20 patients treated with cimetidine there was a four-fold reduction in the relapse rate when compared with 18 placebo-treated patients. However, treatment of the acute phase of ulceration with cimetidine increased the recurrence rate more than five-fold when compared with placebo treatment. Slow healing of ulceration was followed by a two-fold incidence of recurrence when compared with rapid healing. From the results it is concluded that recurrence occurs in patients after slow healing and (or) previous cimetidine treatment if long-term prophylaxis with cimetidine is not carried out.

Topical anesthesia in preendoscopic medication: spray versus lozenges

Patients' acceptance of upper fiberpanendoscopy was significantly (p less than 0.001) better when topical anesthesia with oxybuprocaine was performed with a spray than with a lozenge.

[Therapy of duodenal ulcer with cimetidine, pirenzipine and placebo: report on a double-blind randomized study]

A double-blind randomized controlled study with pirenzepine (75 mg/day), cimetidine (1 g/day) and placebo was performed in 50 consecutive out-patients with duodenal ulcer. The patients also received an antacid containing aluminium hydroxide. Pirenzepine, cimetidine and placebo had similar effects on the 4-week healing rate. Dryness of the mouth was more frequent with pirenzepine than with the other two types of treatment. The incidence of other side effects did not differ in the three groups. A tendency towards more rapid disappearance of subjective symptoms in the patients treated with pirenzepine was not statistically significant. In conclusion, pirenzepine and cimetidine were not superior to placebo in the treatment of duodenal ulcer.