Elevated serum dopamine increases while coffee consumption decreases the occurrence of reddish streaks in the intact stomach.

BACKGROUND AND AIM: Reddish streaks in an intact stomach are an endoscopic feature of duodenogastric reflux. This study aimed to identify which factors are associated with gastric reddish streaks and thus help prevent mucosal damage from duodenogastric reflux. METHODS: Demographic data, personal habits, stressful life events, and psychological distress were compared between subjects with only gastric reddish streaks and those with normal mucosa who underwent upper gastrointestinal endoscopy as part of a self-paid physical checkup. Stress hormones dopamine and cortisol were also checked by high-performance liquid chromatography and radioimmunoassay methods respectively. RESULTS: There were 95 subjects with gastric reddish streaks and 52 subjects with normal mucosa. No significant differences in age, gender, blood groups, education levels, marital status, religion, aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, smoking habit, alcohol consumption, and intake of tea was found between the two groups, but intake of coffee was borderline more common in subjects with normal mucosa (38.5% vs 22.1%, P = 0.055). Subjects with gastric reddish streaks had lower Helicobacter pylori infection rate (37.8% vs 19.3%, P < 0.05). There were no significant differences in psychological distress and stressful life events between the two groups. Multivariate analysis shows that serum dopamine concentrations (odds ratio = 11.31, 95% confidence interval = 2.11-60.48, P = 0.005) and being without the consumption of coffee (odds ratio = 2.97, 95% confidence interval = 1.27-6.94, P = 0.012) were associated with gastric reddish streaks. CONCLUSIONS: Elevated serum dopamine and less coffee consumption are associated with gastric reddish streaks. These findings implicate that increased dopamine level plays a role for abnormal duodenogastric reflux.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy.

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy / Quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo em ratos Wistar submetidos à gastrojejunostomia

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info®, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

OBJETIVO: Avaliar a quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo, em ratos Wistar, submetidos a gastrojejunostomia. MÉTODOS: Sessenta ratos machos Wistar, com média de idade de três meses foram operados e distribuídos em 03 grupos: Grupo 1 - Os animais foram submetidos a laparotomia exploradora. Grupo 2 - Os animais foram submetidos a gastrojejunostomia. Grupo 3 - Os animais foram submetidos a gastrojejunostomia e tomaram celecoxib, diariamente. Após um período de 53 semanas, os animais foram sacrificados. As alterações da mucosa do corpo gástrico dos animais do grupo 1 e da anastomose gastrojejunal dos animais dos grupos 2 e 3 foram analisadas no exame histopatológico e imuno-histoquímica e foram comparadas. Todas as análises estatísticas foram realizadas pelo programa Epi Info®, versão 3.4.3. RESULTADOS: No cotejo entre os animais dos grupos 2 e 3 com relação à presença de adenocarcinoma observou-se uma diferença estatística significante (p=0,0023). A análise de associação entre os grupos 2 e 3 com relação à expressão da COX-2, também evidenciou uma diferença estatística significante (p=0,0018). CONCLUSÃO: O celecoxib teve efeito inibidor da carcinogênese gástrica, induzida pelo refluxo em ratos.

Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease--Bilitec, intraluminal impedance and Bravo capsule pH monitoring.

Ambulatory pH monitoring detects abnormal levels of acid reflux in the oesophagus and can be used to correlate patients' symptoms with oesophageal acid exposure. Catheter-based pH testing has several limitations, including issues of sensitivity, specificity, tolerability and the inability to record non-acid reflux events. In an effort to improve upon these drawbacks, several devices have been introduced, including the Bilitec system for measuring duodenogastro-oesophageal reflux; intraluminal impedance monitoring, which detects the distribution, composition and clearing of both acid and non-acid oesophageal reflux; and a wireless pH monitoring device, the Bravo capsule. Initial investigations using the Bilitec system demonstrated that duodenogastro-oesophageal reflux tracked very closely with acid reflux and decreased with proton-pump inhibitor (PPI) therapy, casting doubt on the clinical utility of Bilitec monitoring. Recent evidence revealed a possible role for duodenogastro-oesophageal reflux in a subset of patients who continue to report reflux symptoms in the setting of normalized oesophageal acid exposure on high-dose PPI therapy. When combined with pH monitoring, impedance monitoring enhances the detection and characterization of gastro-oesophageal reflux and may have a role in the evaluation of certain specific gastro-oesophageal reflux disease (GERD) symptoms that persist despite acid suppression therapy. The utility of the Bravo wireless technology for GERD diagnosis has been validated in several studies, with improvements over catheter-based pH monitoring in tolerability, accuracy and sensitivity, as well as the ability to record periods both off and on PPI therapy in a single study. All three diagnostic modalities have advanced the understanding of GERD pathogenesis, but their impact on the clinical management of GERD is still the focus of active investigation.

Therapeutic effect of DA-9601 on chronic reflux gastritis induced by sodium taurocholate in rats.

AIM: To investigate the therapeutic effects of DA-9601 on sodium taurocholate (TCA)-induced chronic reflux gastritis in SD rats. METHODS: In this study, we have investigated the therapeutic effects of DA-9601 on chronic erosive and atrophic gastritis induced by 6 mo of TCA administration (5 mmol/L in drinking water) in SD rats. RESULTS: Four weeks of DA-9601 administration (0.065%, 0.216% in rat chow), following the withdrawal of TCA treatment, resulted in a significant decrease in total length of erosions in rats in a dose-dependent manner. Furthermore, the indicators of atrophic gastritis, such as reduced mucosal thickness and reduction in the number of parietal cells, were improved by the administration of DA-9601 in a dose-related manner. DA-9601 also attenuated inflammatory cell infiltration and the proliferation of collagenous fiber in the gastric mucosa. The improvement in the reduction of the gastric mucus was observed in the rats receiving a high dose of DA-9601 (0.216%). The therapeutic effect of DA-9601 on experimental chronic erosive gastritis was superior to that of rebamipide (1.08% in rat chow). Biochemical analyses showed increased mucosal prostaglandin E2 and reduced glutathione levels by DA-9601 treatment. CONCLUSION: We suggest that DA-9601 is a promising agent for the treatment of chronic erosive and atrophic gastritis with an etiological factor of bile reflux. Increased mucosal prostaglandin E2 and reduced glutathione by DA-9601 treatment may be therapeutic mechanisms for chronic erosive and atrophic gastritis.

MR imaging of the stomach: potential use for mangafodipir trisodium--a study in swine.

PURPOSE: To evaluate mangafodipir trisodium as a potential contrast agent at magnetic resonance (MR) imaging of the stomach. MATERIALS AND METHODS: Mangafodipir trisodium was injected intravenously into three swine at a dose of 5 micromol per kilogram of body weight. For comparison, gadopentetate dimeglumine was injected into three other swine at a dose of 0.1 mmol per kilogram of body weight. T1-weighted three-dimensional MR images were acquired in all six swine at 1.5 T before and approximately 10, 15, 20, 25, 30, and 40 minutes after contrast material administration. Extracted stomach specimens were imaged at 3.0 T. In vivo and ex vivo images were evaluated visually and quantitatively for contrast enhancement of the stomach, and in vivo images were evaluated for the presence of reflux from the duodenum. RESULTS: Mangafodipir trisodium produced prolonged and selective enhancement of the inner surface of the stomach, in contrast to the more general enhancement seen with gadopentetate dimeglumine, and reflux from the duodenum could not account for this selective enhancement. Ex vivo images confirmed that T1 enhancement in the stomach wall with mangafodipir trisodium was limited to the inner surface. Gadopentetate dimeglumine did not produce selective enhancement of the inner surface of the stomach. CONCLUSION: Mangafodipir trisodium preferentially enhances the inner surface of the stomach on MR images acquired in swine and, therefore, may have potential for use as a contrast agent at MR imaging of the human stomach.

[Combined use of electric sleep and hofitol in the treatment of primary chronic gastroduodenitis]. / Kompleksnoe primenenie élektrosna i khofitola v lechenii pervichnogo khronicheskogo gastroduodenita.

Primary chronic gastroduodenitis (PCGD) accounts for 60-85% of the diseases of the gastroduodenal zone. In our study 90 patients with PCGD were divided into three groups getting one of the following therapies: electric sleep, hofitol, electric sleep plus hofitol. The effects of the treatments were assessed with updated techniques including computed pH-metry. Hofitol showed a good effect on dyspepsia, enhanced the alkalizing ability of the duodenal bulb. Electric sleep relieved pain and asthenoneurotic syndromes, decreased high acidity of the gastric juice in the body of the stomach. Electric sleep in combination with hofitol normalized macroscopic picture of the upper gastrointestinal tract and corrected imbalanced immunity.

Effect of duodenal distension on the pyloric sphincter and antrum and the gastric corpus: duodenopyloric reflex.

The mechanical effect of balloon distension of the duodenum on the stomach was studied in 10 mongrel dogs with a mean weight of 14.8 +/- 3.2 kg. The response of the pyloric sphincter and antrum as well as of the corpus of the stomach to duodenal distension by a balloon filled with water in increments of 2 ml, up to 6 ml, was determined. The test was repeated after anesthetizing the pyloric sphincter and antrum and the duodenum, each at a separate time. In 5 of 10 dogs the effect of duodenal distension on the vagotomized stomach was studied. Duodenal distension with 2 ml of water produced an increase in the pyloric sphincter pressure (p < 0.05) and a decrease in the antral pressure (p < 0.05); it had no effect on corporeal pressure (p > 0.05). Distension with 4 ml and 6 ml produced the same effect as 2 ml (p > 0.05). The anesthetized pyloric sphincter and antrum did not respond to duodenal distension. Likewise, the pyloric sphincter and antrum showed no response to distension of the anesthetized duodenum or of the duodenum after vagotomy. Pyloric sphincter contraction and antral dilatation upon duodenal distension suggest a reflex relation we call the duodenopyloric reflex. This reflex appears to prevent duodenopyloric reflux. Moreover, the antrum dilates probably to accommodate more gastric contents.

[Diagnosis, prevention and treatment of postoperative reflux gastritis]. / Diagnostika, profilaktika i lechenie posleoperatsionnogo refliuks-gastrita.

Postoperative reflux gastritis in persons who were operated on for peptic ulcer occurs much more frequently after resection of the stomach (68.6%) than after organ-preserving operations on the stomach (39.4%). The incidence of reflux gastritis after gastric resection depends on the type of gastroenteroanastomosis. It is encountered much less frequently after Roux' operation (9.2%). The pronounced character and frequency of reflux gastritis after organ-preserving operations on the stomach are determined by the type of stomach-draining operations, the localization of the ulcer before the operation, whether in the stomach or the duodenum, the existence of duodenogastric reflux (DGR) before the operation. Measures for the prevention of postoperative reflux gastritis in the management of peptic ulcer are as follows: (a) wide introduction of organ-preserving operations, preferably SPV by itself or in combination with duodenoplasty; (b) formation of Roux' gastroenteroanastomosis when resection of the stomach is indicated. Reflux gastritis must be treated by nonoperative methods, including medicinal, dietetic, and spa therapy. Surgery is indicated in reflux gastritis combined with other diseases of a stomach which had been operated on, for which an operation is necessary, and in occasional cases of erosive reflux gastritis.

[The correction of motor-tonic disorders of the gastrointestinal tract and of duodenogastric reflux with laser radiation]. / Korrektsiia motorno-tonicheskikh narushenii zheludochno-kishechnogo trakta i duodenogastral'nogo refliuksa lazernym izlucheniem.

Forty-five patients with duodenogastric reflux and defective gastroduodenal motor tonicity (gastroduodenal hypotonia, duodenal hypertension, gastric hypotonia in combination with duodenal hypertension) were exposed to He--Ne laser radiation. The impact was focused on the biologically active points G14, TR5, VC15, E21. The treatment resulted in normalization of the gastrointestinal pressure gradient, in discontinuance or reduction of duodenogastric reflux.

[Functional state of the stomach after vagotomy and the correction of various post-vagotomy complications]. / Funktsional'noe sostoianie zheludka posle vagotomii i korrektsiia nekotorykh post-vagotomicheskikh oslozhnenii.

The author studied the secretory and motor-emptying function and the endoscopic picture of the stomach after various types of vagotomy conducted for peptic ulcer in 84 patients. The effect of the motor-evacuative function on the secretion values is shown. It is pointed out that secretion must be studied after restoration of adequate motor-emptying function, which is normalized 3-6 months after the operation. The endoscopic picture of the stomach depends on the type of the auxiliary operation on the stomach and the lapse of time after the operation, and the existence of reflux. The author suggests a differentiated complex of rehabilitation therapy including endogenous intracavitary pneumomassage of the stomach, its percutaneous electrostimulation, and the intake of mildly-mineralized water; early application of these measures raises the efficacy of the surgical treatment.

[Conservative treatment of postvagotomy disorders]. / Konservativnoe lechenie postvagotomicheskikh rasstroistv.

Drug and spa conservative treatment of postvagotomy aftereffects has been reviewed. The analysis covers the use of enzymes, cholinergic blocking agents, cyproheptadine hydrochloride, amitriptyline hydrochloride, L-Dopa, diphenoxylic acids and opioids in dumping syndrome; benzohexonium and metoclopramide in gastrostasis; diphenoacids and opioids in postvagotomy diarrhea. Oral and external use of mineral water and mud applications proved most beneficial spa treatment modalities.

[State of the autonomic nervous system in children with disorders of the motor-evacuatory function of the upper part of the gastrointestinal tract]. / Sostoianie vegetativnoi nervnoi sistemy u detei s narusheniem motorno-évakuatornoi funktsii verkhnego otdela zheludochno-kishechnogo trakta.

The suprasegmental and segmental parts of the vegetative nervous system were examined in children with duodenogastric and gastroesophageal refluxes. The relationship between dysfunction of the vegetative nervous system and the occurrence of motor disorders in the upper part of the gastrointestinal tract is suggested.

Scintigraphic evaluation of enterogastric reflux using 75Se-HCAT: methodology and first clinical observations.

The aim of this study was to assess the possibility of detecting enterogastric reflux (EGR) by 75Se-HCAT cholescintigraphy. The lowest detectable activity in the gastric area at different concentrations of the radiotracer in the gallbladder was preliminary measured both in a plastic phantom and in an in vivo model. Ten patients were studied after a single oral administration of 1480 KBq 75Se-HCAT. Gamma camera imaging was carried out for five consecutive days during both fasting and after meal ingestion. In our in vivo model an EGR corresponding to 1% of gallbladder content on day one and 8% on day five was detected. In three out of five patients in whom bile was present in the stomach at endoscopy, 75Se-HCAT cholescintigraphy demonstrated an EGR, while in three out of five patients in whom endoscopy was negative, 75Se-HCAT cholescintigraphy detected EGR either during fasting or after meal ingestion. As EGR is not constant, 75Se-HCAT may be a useful tracer of bile to detect EGR over a prolonged period of time and in different physiological conditions.

Duodenogastric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux-associated gastritis.

The aim of this survey was to examine the incidence of duodenogastric reflux in patients with abdominal complaints and the relations between the nature and extent of reflux abdominal complaints, the use of drugs, smoking, the drinking of coffee and alcohol and histological changes in the gastric mucosa. A comparison was also made between gastric ulcer patients and patients with upper abdominal complaints with respect to the nature and extent of reflux. The patients examined included 107 with abdominal complaints and 33 with a gastric ulcer. Gastroscopy was performed, followed by determination of intragastric bile acids and lysolecithin and a duodenogastric isotope reflux examination using technetium-99m-diethyliminodiacetic acid (Tc-99m HIDA). Intragastric bile acid concentrations in the patients with upper abdominal complaints were in the range 7-21,458 mumol/l (mean 964 +/- 2342 mumol/l) and lysolecithin concentrations in the range 0-1992 mumol/l (mean 70 +/- 273 mumol/l). Isotope reflux was observed in 48% of the patients, the reflux index varying in the range 0-70% (mean 4 +/- 9%). The patients suffered more frequently from nausea, epigastric fullness and flatulence with increasing reflux, as assessed by the various methods used here, but only the increase in epigastric fullness symptoms with rising intragastric bile acid concentrations was statistically significant (p less than 0.05). Similarly the various measures of reflux were higher in those patients taking anticholinergic, psychotherapeutic or cardiovascular drugs, antacids or metoclopramide than in the patients not taking the respective drugs, although the only statistically significant increases were in intragastric bile acids among the users of antacids and metoclopramide (p less than 0.01 and p less than 0.05, respectively) and the increase in lysolecithin concentrations among those taking metoclopramide (p less than 0.05). Those abstaining from alcohol had an intragastric bile acid concentration over 1000 mumol/l significantly more often than those who drank alcohol (p less than 0.05), but smoking and the drinking of coffee showed no significant correlation with duodenogastric reflux. The body gastritis score increased significantly with the extent of isotope reflux and the concentrations of intragastric bile acids (p less than 0.05 and p less than 0.01, respectively), and the latter also showed a significant correlation with serum gastrin (p less than 0.05). No significant relationship could be detected between intragastric lysolecithin concentrations and the gastritis score.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparison of pumps used for enteroclysis.

An electric motor-driven pump for enteroclysis is more efficient than a hand-operated pump. It allows the radiologist to monitor infusion flow rates, protects the technologist from scattered radiation, reduces manpower, is associated with fewer mechanical problems, and improves uniformity of flow during performance of the procedure.