Gastric ulcer and regurgitation gastritis.
TL;DR: The evidence favouring the hypothesis that regurgitation of duodenal contents into the stomach causes gastritis and an attendant decrease in mucosal resistance to ulceration is summarized.
Abstract: Experimental and clinical data have incriminated excess gastric acid secretion as an important factor in the development of duodenal ulcer. On the other hand, gastric ulcer is characteristically associated with normal to low levels of acid secretion, and mucosal resistance factors have been invoked to explain the pathogenesis. The purpose of this report is to summarize the evidence favouring the hypothesis that regurgitation of duodenal contents into the stomach causes gastritis and an attendant decrease in mucosal resistance to ulceration. Recent experimental results from our laboratory support this proposition1' 2 , 4 The concept of regurgitation gastritis is not original with us but has received inadequate attention. Four lines of evidence favour the proposed hypothesis. (1) Gastric ulcer is invariably accompanied by gastritis. (2) Individuals with gastric ulcer have greater than normal regurgitation of duodenal contents into the stomach. (3) Exposure of normal gastric mucosa to intestinal contents leads to gastritis. (4) Gastritis increases the susceptibility of the mucosa to ulcer formation.
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TL;DR: Clinically, bile diversion by suprapapillary Roux-en-Yduodenojejunostomy alleviates symptoms of duodenogastric reflux disease without being ulcerogenic (in the presence of normal gastric secretion) or prolonging gastric emptying.
Abstract: Existing Roux-en-Y bile diversion procedures for duodenogastric reflux coupled with distal gastric resection or antrectomy and vagotomy have varied success due to interruption of the physiologic relationships between stomach and duodenum, the reduction of the gastric reservoir, the side effects of vagotomy, and the effect of the Roux limb on gastric emptying. A new bile diversion procedure, suprapapillary Roux-en-Y duodenojejunostomy, was studied, which eliminates the need for gastric resection to prevent jejunal ulcers by preserving duodenal inhibition of gastric acid secretion and the protective effects of duodenal secretion on the surrounding mucosa. Experimentally, the incidence of jejunal ulceration was significantly decreased by the preservation of the proximal duodenum. Clinically, bile diversion by suprapapillary Roux-en-Y duodenojejunostomy alleviates symptoms of duodenogastric reflux disease without being ulcerogenic (in the presence of normal gastric secretion) or prolonging gastric emptying.
201 citations
TL;DR: It is shown that, in humans, fasting duodenogastric reflux of bile and pancreatic juice is cyclic and closely related to the interdigestive migrating motor complex.
150 citations
TL;DR: There was, in general, an inverse relation between fasting serum gastrin concentrations and rates of gastric hydrochloric acid secretion.
Abstract: Fasting venous serum gastrin concentrations and both unstimulated and maximum-stimulated gastric hydrochloric acid secretory rates were determined in 168 subjects. The patients included 55 with duodenal peptic-ulcer disease, nine with gastric ulcers and 69 with assorted gastrointestinal abnormalities, and 35 control subjects without recognized gastrointestinal diseases. Fasting serum gastrin concentrations were measured by radioimmunoassay and compared for groups of patients with differing rates of basal and stimulated gastric acid secretion. There was, in general, an inverse relation between fasting serum gastrin concentrations and rates of gastric hydrochloric acid secretion. Fasting serum gastrin concentrations in patients with duodenal-ulcer disease were not found to be significantly greater than those of the control subjects. However, mean serum gastrin concentrations in the patients with gastric-ulcer disease were found to be significantly greater than those of both the control subjects and...
121 citations
TL;DR: A new, tubeless technique for the measurement of enterogastric reflux was developed and in patients with vagotomy, hemigastrectomy, and Bilroth II gastrojejunostomy, it was found that asymptomatic postsurgical patients with the syndrome of alkaline gastritis had higher reflux indices than normal subjects.
116 citations
TL;DR: The objective was to determine whether alterations of pyloric-sphincter pressure are involved in the increased duodenogastric reflux in patients with gastric ulcer.
Abstract: To determine whether alterations of pyloric-sphincter pressure are involved in the increased duodenogastric reflux in patients with gastric ulcer, pyloric-sphincter pressure was measured in 10 patients, both while their ulcer was active and after healing. Basal pressures in the patients with gastric ulcers did not differ from those in normal persons. Although pyloric pressure increased in normal subjects during either endogenous release or exogenous administration of secretin and cholecystokinin, patients with gastric ulcer showed no response. In normal subjects, during duodenal acidification, duodenogastric reflux significantly diminished as pyloric pressure increased, but not in patients with gastric ulcer. After healing of the ulcer, the pyloric sphincter still showed no response to hormonal stimulation. These studies suggest that in patients with gastric ulcer, pyloric-sphincter dysfunction is responsible for increased duodenogastric reflux.
114 citations
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Book•
01 Jan 1959TL;DR: The subject upon which the experiments of the latter were performed was a young man, of a good constitution, robust and healthy, who was accidentally wounded by the discharge of a musket loaded with buck-shot on the Gth of June, 1822.
Abstract: This item was featured in the Rare Book exhibition "From Hippocrates to Harrison". The exhibition commemorated 150 years of the Faculty of Medicine.
433 citations
TL;DR: It is suggested that reflux of bile into the stomach may be a causative factor in gastric ulcer or, if secondary to the presence of an ulcer, may delay healing.
346 citations
Journal Article•
225 citations
208 citations