Luminal gastric somatostatin-like immunoreactivity in response to various stimuli in man.

This study investigates release of somatostatin-like immunoreactivity (SLI) into the gastric lumen of five healthy human subjects in response to pharmacological stimuli (pentagastrin and secretin) and physiological stimuli (sham feeding and intrajejunal perfusion of elemental diet). Basal and poststimulation gastric juice aspirates were collected at 15-min intervals, extracted with acetone, and SLI determined by radioimmunoassay, with these results: A considerable amount of SLI was secreted during the basal period. Pentagastrin stimulated SLI release quickly and was associated with increased acid secretion. Both secretin and sham feeding increased SLI only slightly. During intrajejunal perfusion of the elemental diet, SLI increased significantly, was associated with decreased acid secretion, and rapidly returned to basal level when elemental diet was replaced by saline. Basal levels of gastric luminal SLI thus showed distinct changes in response to each stimulus. Although the physiological action of luminal SLI remains to be studied, its levels may reflect gastric D-cell activities.

Upper gastrointestinal endoscopy in normal asymptomatic volunteers.

In a prospective study, 355 healthy, asymptomatic, male volunteers, 18 to 45 years of age, were screened by esophagogastroduodenoscopy before admission to clinical trials. One hundred thirty-four volunteers (38%) showed abnormal endoscopic findings. Some volunteers had more than one site of involvement or more than one grade of lesion in each anatomic location. In 49 (14%) of these subjects the esophagus was a site of involvement, while in 86 (24%) the stomach was involved, and in 71 (20%) the duodenum was involved. The point prevalences in these asymptomatic subjects were 8.5% for erosive esophagitis, 12% for erosive gastritis, 10% for erosive duodenitis, 2% for gastric ulcer, and 2% for duodenal ulcer.

A new criterion in the assessment of bentiromide as a test of exocrine pancreatic function in alcoholics.

Bentiromide (N-benzoyl-L-tyrosyl-p-aminobenzoic acid; Bz-Tyr-PABA) is a useful agent in the assessment of exocrine pancreatic function. Bz-Tyr-PABA is hydrolyzed by chymotrypsin in the intestine with liberation of PABA and its metabolic products, arylamines. This study was undertaken to determine the normal values for absorption and excretion of arylamines in normal volunteers and in alcoholics without detectable disorders of the pancreas, liver, or small intestine. After an overnight fast, basal blood and urine samples for baseline arylamine levels were collected, followed by oral administration of 500 mg of bentiromide. A 6-h urine collection was instituted, and 90- and 120-min plasma samples were obtained. The results were analyzed comparing normals and alcoholics: The mean concentration of arylamines was significantly higher in alcoholics than nonalcoholic subjects in baseline urine and in plasma at 90 and 120 min; no significant difference was found between alcoholics and nonalcoholics when comparing mean arylamine levels in 6-h urines. In summary, cumulative 6-h urine arylamine levels are more reliable as a criterion than 90- and 120-min plasma levels in the assessment of exocrine pancreatic function in alcoholics.

Light and electron microscopic studies of diet-induced hepatic changes in mice.

Adult mice were fed a choline-deficient ethionine enriched (CDE) diet for 24, 48 or 72 h. They were then fasted for 24 or 48 h prior to sacrifice. All tissues were studied by light and electron microscopy. Animals fed the CDE diet for 24 h exhibited cells with vacuolated cytoplasm, and the accumulation of lipid in these cells was clearly abnormal. Animals fed the CDE diet for 24 h and subsequently a regular diet for 48 h displayed normal hepatocytes, suggesting that the alterations at 24 h were reversible. Following 48 or 72 h of feeding the CDE diet, abundant lipid-laden cells were observed in the hepatic lobules, and at the electron microscope level these cells were undergoing frank degeneration. Evidence indicated that changes after 48 or 72 h were irreversible.

Effects of somatostatin and a somatostatin agonist on diet-induced pancreatitis in mice.

We examined the effects of somatostatin-14 and the potent somatostatin agonist (N-acetyl-[Des(Ala1,Gly2),p-Cl-Phe6,D-Trp8]-somatostatin amide) on choline deficient, ethionine enriched diet (CDED)-induced acute pancreatitis in mice. Serum amylase determinations were performed, and specimens from the pancreas were examined by light and electron microscopy. No significant beneficial effects of somatostatin or its agonist were found in this model of acute pancreatitis.

Healing of benign gastric ulcer: comparison of cimetidine and placebo in the United States.

Recently the Food and Drug Administration approved cimetidine for the treatment of benign gastric ulcer. Approval was based in part on the results of our large multicenter trial involving 172 patients with benign gastric ulcer between 0.5 and 2.5 cm in diameter: 87 were randomly assigned to receive cimetidine (300 mg four times daily) and 85 to receive placebo. Cimetidine treatment resulted in significantly more rapid healing than placebo; after 2 and 6 weeks of therapy, 10.0% and 44.8% of patients receiving placebo were healed, as compared to 22.6% and 65.1% receiving cimetidine. The results of our study were compared with the time-response curve previously published (0, 4, and 8 weeks of therapy). The combined data yielded linear healing rates for the first 8 weeks of therapy (r greater than 0.99 for both cimetidine and placebo). These studies can be used to define expectations for healing of benign gastric ulcer, and we recommend follow-up intervals of 8 and, if unhealed, 16 weeks.

Management of constipation in the elderly.

In the elderly, the history--including dietary habits, onset, duration, and change in bowel pattern--is very important. Recent changes could suggest bowel disease such as carcinoma or a disordered metabolism. If the defecation stimulus is repeatedly denied by voluntary contraction of the external anal sphincter, the normal defecation reflex may be blunted and, in time, completely lost.

Postoperative adhesions causing colon obstruction.

Intermittent abdominal distention and chronic abdominal pain with constipation are common complaints among middle-aged women who have previously undergone pelvic surgery. These patients are frequently diagnosed as having problems that are psychosomatic in origin. This article reports four female patients seen between 1979 and 1980 who had undergone previous pelvic surgery and had such complaints. All were diagnosed preoperatively by colonoscopic examination as having partial left colon obstruction caused by postoperative adhesions, a previously unreported disease. Successful treatment consisted of lysis of adhesions, reperitonealization of the pelvis, and restoration of the colon to its normal anatomic position.

Pancreatic immunoreactive somatostatin and diabetes mellitus.

Pancreatic secretions were collected during endoscopic retrograde cholangiopancreatography from 15 subjects without pancreatic, biliary, or hepatic diseases, 11 patients with non-insulin-dependent diabetes, and 11 patients with insulin-dependent diabetes. Pancreatic secretion was stimulated by the intravenous administration of one unit of secretin per kilogram of body weight. Immunoreactive somatostatin (IRS) in the pancreatic juice of the nondiabetic subjects ranged from 43 to 97 pg/ml, in non-insulin-dependent diabetics from 5 to 3872, and in the insulin-dependent diabetics from 0 to 2093. IRS in insulin-dependent diabetics under good plasma glucose control ranged from 0 to 281 pg/ml, compared to those under poor control who ranged from 518 to 2093 pg/ml. These results indicate that IRS in pancreatic juice is higher in poorly controlled insulin-dependent diabetics than in well controlled insulin-dependent diabetics and nondiabetics. Whether these changes in IRS are purely secondary phenomena or play some pathogenetic role in the disturbed metabolism of diabetes remains to be proven. The chromatographic profile of IRS in pancreatic juice on both gel filtration and high-performance liquid chromatography has indicated that these IRS moieties represent somatostatin 14 and somatostatin 28.

Effect of potassium chloride supplements on upper gastrointestinal mucosa.

Eight controlled 1- or 2-wk experiments involving 225 healthy male subjects and one study of 18 patients with hypertension, nine of whom were long-term users of a wax-matrix potassium chloride preparation, were conducted to evaluate the upper gastrointestinal safety of oral KCl supplements. All subjects in the short-term studies had normal upper gastrointestinal tracts. Subjects were examined again after at least 7 days of treatment with one of three commonly prescribed wax-matrix KCl tablets, KCl liquid, microencapsulated KCl, a potassium- sparer , or placebo. Some received an anticholinergic drug with treatment to induce delayed gastric motility. Diet and compliance to treatment regimens were controlled. Results indicate that upper mucosal injury, particularly erosions (43%) and ulcerations (11%), were more frequent after wax-matrix tablets. These changes occurred much less frequently after liquid KCl (0%), microencapsulated KCl (10.5% erosions, 1.2% ulcers), and the potassium-sparing drug (0%). More serious and more frequent lesions were associated with slowed motility. No occult bleeding was noted. Symptomatic complaints did not correlate with endoscopic findings. In the long-term study, patients with hypertension were examined endoscopically after 19 to 23 mo on KCl and again after 1 wk. Six of nine of the patients with hypertension treated for nearly 2 yr with a wax-matrix KCl supplement had significant lesions. One had developed ulceration after 7 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Mucosal irritant potential of a potassium-sparing diuretic and of wax-matrix potassium chloride.

To measure their relative upper gastrointestinal irritant potential, either 5 mg amiloride and 50 mg hydrochlorothiazide (twice daily) or 24 mEq wax-matrix potassium chloride (three times a day) were given to 30 normal subjects with no prior endoscopic abnormalities in the esophagus, stomach, or duodenum. All subjects received glycopyrrolate, 2 mg (3 times a day) to slow gastric emptying. Repeat endoscopy after 7 days of treatment with wax-matrix potassium chloride revealed that 10 of 15 (67%) of the subjects developed one or more gradable upper gastrointestinal lesions (esophageal ulcer, gastric ulcer, eight cases of one or more mucosal erosions, and four cases of hyperemia or edema of the esophagus, stomach, or duodenum). Four subjects (27%) taking amiloride/hydrochlorothiazide developed either mild hyperemia or edema, but there were no erosions or ulcers in this group.

Campylobacter enterocolitis in New Orleans.

Campylobacter is being increasingly recognized as a common pathogen producing acute diarrheal illness. During 1981, all stool cultures at Charity Hospital were routinely screened for Campylobacter. Twenty-nine of 2,233 total cultures were positive. We performed a retrospective study to evaluate the disease's clinical picture and epidemiologic features. Campylobacter-positive cultures comprised 1.3% of all stool specimens and 21.6% of all positive cultures. Age, sex, and race in the Campylobacter group did not differ significantly from a comparison group. The distribution of the rates of Campylobacter-positive cultures did not show temporal trends. The clinical symptoms were nonspecific and the disease was usually self-limited, with diarrhea lasting from seven to ten days in untreated patients. The disease may occasionally be confused with a nonspecific inflammatory bowel disease. Thus, it is important that stool cultures be routinely screened for Campylobacter so that appropriate therapy can be administered.

Inhibition of nocturnal gastric secretion in normal human volunteers by misoprostol: a synthetic prostaglandin E1 methyl ester analog.

Misoprostol (SC-29333) is a synthetic prostaglandin E1 analog that has been found to be a potent inhibitor of gastric secretion in animals. Nocturnal gastric antisecretory activity of misoprostol, in tablet form, was studied in 16 adult volunteers, under basal condition. The study was a randomized, double-blind, cross-over, comparison of placebo, and three graded doses of misoprostol (50, 100, and 200 micrograms). Misoprostol exhibited a statistically significant inhibition of total acid output only at the 200 micrograms dose and this inhibition was maintained for 3 h postadministration of the drug. The antisecretory effects of misoprostol were characterized by suppression of H+ ion but not of the volume of gastric secretion. No untoward effects were noted in the volunteers. As a consequence of the gastric antisecretory effects, the present studies indicate that misoprostol is a promising therapeutic agent for the treatment of peptic ulcer.

Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial.

The effects of a new microencapsulated potassium chloride formulation on upper gastrointestinal tract mucosa was compared with that of a popular wax-matrix formulation in 48 healthy volunteers. After a week of KCl, subjects were gastroscoped, the endoscopist being blind to the type of preparation taken. Wax-matrix formulations were associated with a higher incidence of upper gastrointestinal lesions. The lesions were not accompanied by epigastric symptoms. Glycopyrrolate, given to some volunteers to decrease gastric emptying, aggravated the effects of potassium chloride.

The liver in secondary syphilis.

Liver involvement is uncommon in secondary syphilis and may resemble liver disease from alcoholism or acute viral hepatitis. Liver biopsy usually indicates nonspecific reactive hepatitis with or without cholestasis. Jaundice may sometimes be absent although liver damage is present. The liver abnormalities can be resolved with antibiotic therapy, but penicillin therapy may cause Jarisch-Herxheimer reaction. Syphilitic hepatitis should be considered in the differential diagnosis of obscure liver disease.

Immunoreactive somatostatin in human pancreatic secretion.

Somatostatin in human pancreatic juice collected during endoscopic retrograde cholangiopancreatography following secretin injection was determined by RIA. The mean immunoreactive somatostatin (IRS) levels in the pancreatic juice of 13 non-diabetics was 78 +/- 11 (SE) pg/ml. The IRS levels in 4 non-insulin-dependent diabetics ranged from 843 to 2286 pg/ml with a mean of 1559 +/- 392 (SE) pg/ml. This was significantly greater than non-diabetic values. The IRS in the pancreatic juice was immunologically indistinguishable from somatostatin14 but consisted of 2 major components, one corresponding to somatostatin14 and the other being of a molecular size of approximately 3000 daltons.