https://www.gastrojournal.org/article/0016-5085(85)90225-2/pdf

Prostaglandins and the gastrointestinal mucosa: Are they important in its function, disease, or treatment?

https://www.gastrojournal.org/article/0016-5085(88)90482-9/pdf

Double-blind, placebo-controlled endoscopic comparison of the mucosal protective effects of misoprostol versus cimetidine on tolmetin-induced mucosal injury to the stomach and duodenum

Objectives: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects.

Method: A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10-year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro-omental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy.

Results: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P = .046) and flap-related morbidity (P = .037), hypocalcemia (P < .001), late complications (P = .003), and stricture (P = .009). Gastric transposition had increased total (P = .007), flap-related (P = .035), late complications (P = .034), and hypocalcemia (P = .001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P = .048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P = .014) and fistula (P = .012). Circumferential defects predicted for flap-related morbidity (P = .030), hypocalcemia (P = .017), and late complications (P = .042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition.

Conclusion: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.

Morbidity after flap reconstruction of hypopharyngeal defects.

The time taken for gastric emptying of a liquid (milk) or a semi-liquid (pudding) meal was evaluated in 477 infants and children. These patients were referred for suspected gastro-oesophageal reflux and underwent gastro-oesophageal scintigraphy, prolonged oesophageal pH study, manometric evaluation of the lower oesophageal sphincter pressure, and fibreoptic endoscopy. No difference in gastric emptying was observed in children aged under 3 years, regardless of the presence or absence of the gastro-oesophageal reflux, the pressure of the lower oesophageal sphincter, or the presence of oesophagitis. In children over 6 years, however, gastric emptying was significantly delayed in those presenting with reflux compared with those without reflux; in children over 3 years there was slower gastric emptying in those with a decreased lower oesophageal sphincter pressure compared with those with higher pressure and in those with overt oesophagitis compared with those without oesophagitis. This study suggests that gastro-oesophageal reflux is more severe in childhood than in infancy, probably due to more complex motor disorders affecting the gastric fundus as well as lower oesophageal sphincter function.

https://adc.bmj.com/content/archdischild/62/5/449.full.pdf

Gastric emptying with gastro-oesophageal reflux.

Introduction
Roux-en-Y gastric bypass (RYGB) restricts food intake. Consequently, patients consume less calcium. In addition, food no longer passes through the duodenum, the main site of calcium absorption. Therefore, calcium absorption is significantly impaired. The goal of this study is to compare two common calcium supplements in gastric bypass patients.

Comparison of the absorption of calcium carbonate and calcium citrate after Roux-en-Y gastric bypass.

The effect of prostaglandin E2 on gastric mucosal bleeding caused by aspirin was studied. Blood in serial gastric washings was measured chemically for 30 min. Normal blood loss was equivalent to 0.05 ml/day. Aspirin, 600 mg four times daily, increased gastric bleeding on day 1; bleeding was further increased on day 2. On day 2, ingestion of 0.5 mg of prostaglandin E2 15 min before 600 mg of aspirin reduced the gastric microbleeding caused by aspirin. Prostaglandin E2, 0.5 mg four times daily, did not change the normal blood loss. No consistent changes in gastric emptying or in secretion of chloride were detected.

Effect of prostaglandin E2 on gastric mucosal bleeding caused by aspirin

The object of this study was to determine in 12 healthy subjects the relation between gastric secretion of acid and absorption of calcium from two different preparations of calcium, as judged from increased outputs of calcium in the urine. The increase in urinary output of calcium after solid calcium carbonate was greater in the subjects with the most gastric secretion of acid. The absorption of calcium after a solution of monocalcium citrate was independent of gastric secretion of acid. In the four subjects with the least gastric secretion of acid, there was no absorption of calcium after calcium carbonate, but the absorption after monocalcium citrate was as great as that for those who secreted greater amounts of acid.

Relation between gastric secretion of acid and urinary excretion of calcium after oral supplements of calcium

Seven subjects were given one day's treatment with full doses of either aspirin, ibuprofen, or placebo, and then their stomachs were washed out three times at intervals of 10 min, for five successive days. The blood in the recoveries was estimated chemically. After compensating for gastric emptying, the rate of bleeding was expressed as ml blood per day. Relative to placebo, one day's treatment with aspirin increased the rate of blood loss significantly at day 1, median 2.7 ml/day, and not thereafter. A corresponding dose of ibuprofen did not produce any significant bleeding. The procedure gives specific information about gastric bleeding. It can measure rates of bleeding down to 0.01 ml/day.

J. N. Hunt

Papers

Effect of prostaglandin E2 on gastric mucosal bleeding caused by aspirin

Relation between gastric secretion of acid and urinary excretion of calcium after oral supplements of calcium

A procedure for measuring gastric bleeding caused by drugs