Gastric secretory response to pressure on vagal nuclei

Acute intracranial hypertension increases gastric tonus in anesthetized rats

We studied the acute effect of intracranial hypertension (ICH) on gastric tonus of anesthetized rats. Brain ventricles were cannulated bilaterally for intracerebro-ventricular pressure (ICP) monitoring and ICH induction. Next, a balloon catheter was inserted at the proximal stomach and coupled to a barostat for gastric volume (GV) monitoring by plethysmography. Arterial pressure (AP) and heart rate (HR) were monitored continuously during 80-min. After a 20-min basal period, they were submitted to control or ICH protocols. In controls, the ICP varied spontaneously up to the end. Other rats were subjected to ICP rising to 10, 20, 40 or 60 mmHg and kept at these levels for 30-min. Another group was subjected after basal period to stepwise ICH (ICP rising to 20, 40 and 60 mmHg at every 10-min interval). Next, the ICH rats were monitored for further 30-min. Other rats, previously submitted to a subdiaphragmatic vagotomy, splanchnicectomy plus ganglionectomy or their respective sham surgery, were also studied under ICH. Each subset consisted of 5-6 rats. Data were compared to respective basal values after ANOVA and Bonferroni's test. In controls, the GV, AP, HR values remained within stable levels. Besides inducing bradycardia and arterial hypertension, ICH10 mmHg decreased GV by 14.8% at the 50-min interval. In ICH20, 40 and 60 mmHg subsets, GV decreased 14.0, 24.5 and 30.6% at the 40-min interval, respectively. In stepwise ICH rats, GV decreased 10.2% and 12.7%, respectively under ICP of 40 and 60 mmHg. The GV values remained significantly lower than basal levels during the last 30-min of monitoring. Thus, ICH decreases the GV in an ICP-dependent pattern besides inducing Cushing's reflex.

Cushing's ulcer in traumatic brain injury

Traumatic brain injury (TBI) remains a complicated and urgent disease in our modernized cities. It becomes now a public health disease. We have got more and more patients in Neurosurgery Intensive Care Unit following motor vehicle accidents and others causes. TBI brings multiple disorders, from the primary injury to secondary injury. The body received the disturbances in the brain, in the hypothalamo-pituitary-adrenocortical (HPA) axis, in the gastric mucosa, in the immune and neuroendocrine systems. The mortality of TBI is more than 50 000 deaths / year, the third of the mortality of all injuries. Cushing ulcer is one of the severe complications of TBI and its mortality rate is more than 50%. Many studies have improved the management of TBI and the associated complications to give patients a better outcome. Furthers studies need to be done based on the similar methodology to clarify the different steps of the HPA axis and the neuroendocrine change associated. The aim of the present review is to assess the clinical and endocrinal features of hypopituitarism and stress ulcer following TBI.

A review of stress ulcer prophylaxis in the neurosurgical intensive care unit

STRESS ULCERS OCCUR frequently in intensive care unit patients who have intracranial disease. After major physiological stress, endoscopic evidence of mucosal lesions of the gastrointestinal tract appears within 24 hours of injury; 17% of these erosions progress to clinically significant bleeding. Gastrointestinal hemorrhage has been associated with mortality rates of up to 50%. The pathogenesis of stress ulcers may not be completely understood, but gastric acid and pepsin appear to play significant roles. Antacids, H2 antagonists, and sucralfate are effective prophylactic agents in the medical/surgical intensive care unit. Appropriate therapy for neurosurgical patients remains unclear, however. This review summarizes the current literature regarding the pathogenesis and therapy of stress ulcers in neurosurgical patients.

Intracerebroventricular pressure inhibits gastric antral and duodenal contractility but not acid secretion in conscious rabbits

Acute nausea characteristically accompanies head injury or increased intracranial pressure, or both. The etiology of this symptom is unclear. We studied the effect of increased intracranial pressure on gastric antral and duodenal contractility and gastric acid secretion in conscious rabbits. Intracerebroventricular pressure was maintained at 3, 8, or 13 cmH2O using normal saline perfused into the lateral cerebral ventricle and gastric antral and duodenal contractility was monitored using chronically implanted strain gauge force transducers. Gastric acid secretion was measured in a separate group of rabbits with chronically implanted gastric cannulas. Increased intracerebroventricular pressure (13 cmH2O) resulted in an immediate suppression of the amplitude of gastric and duodenal contractions by greater than 80% and greater than 60%, respectively. After normalization of intracerebroventricular pressure, the contractile pattern returned to basal levels. Intravenous bolus injection of bethanechol reversed the suppression of gastric antral contractility induced by increased intracranial pressure. Increased pressure for 2 h did not modify gastric acid output as compared with normal pressure controls, whereas atropine significantly inhibited and histamine stimulated gastric acid secretion in the same animals maintained at normal pressure. These results demonstrate that acutely increased intracranial pressure rapidly and reversibly inhibits gastric and duodenal motor function in conscious rabbits.

Effect of increased intracranial pressure on gastric acid secretion

The effects of intracranial pressure on gastric acid secretion were studied in 30 rabbits. Intracranial pressure was increased in a graded and controlled fashion using a barostat connected to a cannula in the lateral cerebral ventricle. Eighteen rabbits were studied under urethane anesthesia with a background subthreshold intravenous infusion of bethanechol. Twelve rabbits were studied in the conscious state. Increases in intracranial pressure led to immediate and significant increases in gastric acid output in a dose-related manner in both conscious and anesthetized animals. Serum gastrin levels did not increase in either group of animals. Vagotomy only partially abolished the increase in acid outputs seen with increased intracranial pressure, whereas atropine completely blocked the response. We conclude that increased intracranial pressure causes stimulation of acid secretion by a gastrin-independent cholinergic mechanism that is only partially mediated by the vagus.

The organization of the gastric efferent projections in the brainstem of monkey: an HRP study

Topographic localization of neurons in the dorsal motor nucleus (DMN) of the vagus innervating the stomach and the extent of central decussation of its fibers were investigated in the monkeys after chronic unilateral cervical vagotomy. This study presents findings in regard to the non-topographic representation of the stomach in both DMN and lack of a well-defined decussation of its fibers in the brainstem of monkeys. Reported findings in the rat and cat vis-a-vis our own results in the monkey indicate species difference in the organization of efferent vagal gastric fibers. The evidence of a very small number of HRP-labeled cells in DMN on the vagotomized side after intervals of 2-36 weeks is being reported here, for what we believe to be the first time, and its significance has been discussed.

Massive gastroduodenal hemorrhage and perforation in acute spinal cord injury

Fatal gastrointestinal hemorrhage or perforation are important problems in the management of patients in the acute phase of spinal cord injury. This paper describes 3 patients with these conditions, and shows some of the associated hazards, especially the danger of painless penetration, perforation, and peritonitis, plus the increased morbidity of these serious problems in the presence of the neurological sequelae of spinal cord injury. Our experience shows that life-threatening hemorrhage from the gastrointestinal tract occurs in about 2.5% of patients with cord injury, and often occurs during the first few days after the accident. We believe that a high index of suspicion and an aggressive therapeutic approach are necessary to save these patients from the traditionally high mortality associated with massive upper gastrointestinal hemorrhage, especially during this critical period of acute spinal cord injury.