Scandinavian journal of gastroenterology. Supplement
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In 62 patients the late results of isoperistaltic jejunal interposition in reconstructive ulcer surgery are analyzed 1.5 to 9.5 years postoperatively (mean 3.1 years); a follow up was possible in 58 patients. 38 (65.5%) had a Visick I or II result; 16 (28%) a fair result (Visick III) and 4 a poor result (Visick IV). 12 of the 58 followed up patients developed a jejunal stomal ulceration in the mean time. These ulcerations were mostly (60%) asymptomatic, superficial and nonbleeding. The histology of the gastric remnant remained unchanged in the most patients and didn't show any benefit of bile diverting operation. ⋯ Similar reports are found in the literature. Even an additional vagotomy doesn't prevent the ulcer formation sufficiently in every case. In conclusion reflux-preventive jejunal interposition is shown to be heavily ulcer-prone, it should be used in reconstructive ulcer surgery very carefully only with short (15 cm) segments and additional vagotomy.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
The role of bile salts in cysteamine-induced duodenal ulcer in the rat and the ulceroprotective property of lysolecithin.
Cysteamine induces duodenal ulcers in rats, but bile diversion inhibits ulcer formation. Since lysolecithin inhibits stress ulceration in rats, it is assessed now whether lysolecithin inhibits cysteamine-induced ulcers, too. Male rats were operated: division of the duodenum distally to the pylorus, duodenojejunostomy. Roux-en-Y duodenojejunostomy. 4 groups comprising 10 animals. Drinking solution for group 1, 3 and 4: Na taurocholate and glycocholic acid (5 mmol/l). For group 2 addition of 0.2 mmol/l lysolecithin. Cysteamine-HCl (10%) twice subcutaneously on the 19th day in group 1, 3 and 4, isotonic NaCl in group 2. In group four 1 ml lysolecithin per gastric tube 1 h before cysteamine. ⋯ Lysolecithin, a substance produced during fat digestion, exerted an ulceroprotective property (lyso-protection) under experimental conditions, as shown here for the first time, to the author's knowledge. The enhancement of cysteamine-induced duodenal ulcer development by bile salts is again documented.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
Enhancement of duodenal and jejunal ulceration by histamine-induced gastric hypersecretion in dogs with diversion of duodenal contents.
In a previous investigation deviation of duodenal contents protected rats significantly from the development of peptic ulceration under maximal acid secretion. We have now assessed the effect of diversion of duodenal contents in dogs submitted to the same operative procedure under histamine-induced hypersecretion. Six mongrel dogs underwent the following procedure: A two cm duodenal segment was left adjacent to the intact pylorus, proximal jejunum anastomosed to this segment and a Roux-en-Y duodeno-jejunostomy performed. ⋯ It was concluded that the diversion of duodenal contents enhanced ulcer formation in dogs and that the model mimicked a Zollinger-Ellison Syndrome. Ulceration occurred in transitional or jejunal type of duodenal mucosa. No gastric lesions were found and this suggests that the diversionary procedure was an effective means of preventing bile from reaching the gastric mucosa.
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Gut peptide secreting tumours originate most commonly from the pancreatic Islets of Langerhans. Tumours at a variety of other sites have also been shown to synthesize and release these peptides, reflecting the wide distribution of the peptide secreting cells of the diffuse neuroendocrine system. ⋯ This may explain the lack of clinical sequelae in association with tumours such as the somatostatinomas. The clinical features, methods of diagnosis, localisation and treatment of these tumours will be discussed.