Cisapride improves gallbladder kinetics in patients affected with myotonic muscular dystrophy.

Smooth muscle involvement is relatively common in myotonic muscular dystrophy (MMD). The effects of cisapride on gallbladder motor function in myotonic patients have been investigated in 10 alithiasic patients and in 10 healthy volunteers. Gallbladder volumes were measured by ultrasonography in fasting state and 15, 30, 45 and 60 min after milk intake. The patients were treated with cisapride for two months, after which they underwent a second ultrasonographic examination. Gallbladder emptying was slower and less effective in dystrophic patients than in healthy volunteers. Cisapride was found to improve gallbladder kinetics (efficacy of contraction and rate of emptying) in patients affected with myotonic muscular dystrophy.

[Evaluation of the efficacy of bicarbonate-alkaline water action on gallbladder motility]. / Valutazione dell'efficacia di un'acqua bicarbonato-alcalina sulla motilità colecistica.

Physiological gallbladder contraction, delivering bile salts during meals, plays a key role in digestive mechanisms. A bicarbonate-alkaline water (Uliveto) shows a positive effect on gallbladder kinetics: so it may be useful in order to improve dyspepsia due to delayed gallbladder emptying.

Double pylorus: report of two cases and review of the literature.

Double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb; in most cases it is a complication of penetrating ulcer, sometimes it is a congenital abnormality. The prevalence of this rare anomaly ranges from 0.02% to 0.13%; the male:female ratio is about 2:1. Two cases of acquired double pylorus are reported with a review of the literature. The first case represented an occasional report; in the other one the development of double pylorus from confluent prepiloric and bulbar ulcers was documented through serial endoscopies. Both patients were affected with chronic renal failure and referred previous treatment with diclofenac; however, their relationship with double pylorus onset remains unproven.

Liver triglyceride accumulation after chronic ethanol administration: a possible protective role of metadoxina and ubiquinone.

Hepatoprotective actions of metadoxina and ubiquinone have been studied in alcoholic rats by evaluating hepatic triglyceride accumulation and serum biochemical parameters of liver function. The two drug-treated groups displayed significantly lower triglyceride concentrations as compared to the ethanol-treated group. No significant differences were found among the two drug-treated and the control groups. Electron-microscopic abnormalities were found only in ethanol-treated rats. Serum biochemical parameters of liver function did not show any significant difference among all four groups. These results suggest a possible protective role of metadoxina and ubiquinone in ethanol-induced liver triglyceride accumulation.

[Hepato-cholescintigraphy using technetium Tc 99m diethyl IDA in the follow-up of biliodigestive anastomoses]. / L'epato-colescintigrafia con 99m Tc-dietil-IDA nel follow-up delle anastomosi bilio-digestive.

The results of a study conducted on 24 patients given biliodigestive shunts are reported. Follow-up involved cholescintigraphy using 99m-IDA technetium. This examination provided valuable information about the morphodynamics of biliary flow and when the biliary peak and intestinal appearance times were lengthened, it was also able to identify significant obstructions. The technique is considered highly significant.

Platelet activation in outpatients undergoing esophagogastroduodenoscopy.

To evaluate the influence of emotional stress on platelet function, we have measured by radio-immunoassay in plasma two platelet-secreted proteins, beta-thromboglobulin and platelet factor 4, in a series of outpatients undergoing esophagogastroduodenoscopy for upper digestive complaints. The plasma levels of beta-thromboglobulin and platelet factor 4, determined just before the instrumental examination, were significantly more elevated as compared to basal values, checked a week later. These results provide evidence of enhanced in vivo platelet release reaction during emotional stress.

Famotidine in the short-term treatment of duodenal ulcer and of concomitant peptic lesions: comparison with cimetidine.

Twenty patients affected with endoscopically demonstrated duodenal ulcer were studied. They were randomly divided into two groups of ten individuals each. The first group was treated with famotidine 40 mg/die/os, the second one with cimetidine 800 mg/die/os; both drugs were administered in one medication at bedtime. In each group, eight patients completed the treatment: six out of eight famotidine treated and five out of eight cimetidine treated patients showed ulcer healing on upper digestive endoscopy after four weeks of treatment; after eight weeks of therapy, all patients of both groups displayed ulcer healing. Nevertheless, an overall quantitative evaluation of all peptic lesions (performed according to an endoscopic arbitrary score) indicated a higher effectiveness of famotidine. Famotidine did not affect humoral parameters of renal, hepatic and myelopoietic function and did not significantly change fasting serum gastrin levels.

The effects of the antimuscarinic drugs pirenzepine and atropine on plasma portal levels of somatostatin and gastrin in the dog.

The effects of the antimuscarinic drugs pirenzepine and atropine on somatostatin and gastrin portal levels under basal conditions and during bethanechol infusion have been investigated in anesthetized dogs. Iv bolus administration of pirenzepine (1 mg/kg) or atropine (0.1 mg/kg), decreased gastrin concentrations, but did not affect basal somatostatin levels. During 120 min of bethanechol infusion (160 micrograms/kg/h) gastrin levels increased but somatostatin levels were unchanged. Pirenzepine (1 mg/kg iv bolus), administered at the 60th min of bethanechol infusion, decreased the gastrin concentrations, and markedly enhanced somatostatin levels. Under the same conditions atropine (0.1 mg/kg iv bolus) decreased gastrin levels, but had little or no effect on somatostatin levels. These results indicate that muscarinic receptors with similar affinity for pirenzepine and atropine mediate excitatory cholinergic influences on gastrin release. By contrast, muscarinic receptors with higher affinity for pirenzepine seem to be involved in the cholinergic inhibition of somatostatin release: by selectively blocking these receptors, pirenzepine may increase portal somatostatin levels.

Effects of white wine, Coke and water on basal and food-stimulated gastric acid secretion and gastrin release in the dog.

The effects of three types of white wine (10% ethanol; pH 2.84-3.26), Coke (pH 2.45) and water (pH 8.03) on basal and food-stimulated gastric acid secretion in dogs were investigated. Water and Coke did not significantly modify acid secretion and gastrin release under basal conditions. By contrast, white wine or water +10% ethanol significantly increased acid secretion, with a tendency to elevate plasma gastrin concentrations. Acid secretion and gastrin release induced by a standard meal were not significantly modified by previous administration of Coke and water. In contrast, white wine and water +10% ethanol significantly increased food-stimulated total acid output, without changing plasma gastrin levels. It is concluded that Coke and water have only trivial effects on basal and on food-stimulated gastric acid secretion and gastrin release in the dog. The gastric stimulant effect of white wine is mainly related to its percentage of alcohol regardless of the slight differences in pH of the solutions.

The effects of prolonged administration of cimetidine or pirenzepine on gastric mucosal cell kinetics, serum gastrin levels and acid secretory responses in rats.

60 days' treatment of rats with cimetidine 160 mg/kg/die per os produced a significant increase in total gastrin cell number, gastrin cell density of antral mucosa as well as parietal cell density of fundic mucosa as compared with controls. By contrast, the same parameters significantly decreased in rats treated for 60 days with pirenzepine 16 mg/kg/die per os. Under the same conditions, immunoreactive serum gastrin levels were found to be significantly enhanced in cimetidine-treated rats, but not significantly changed in rats treated with pirenzepine. 48 hours after drug withdrawal, gastric secretory responses to pentagastrin were found to be significantly increased in cimetidine-treated rats and decreased in pirenzepine-treated rats. These results suggest that a feed-back reaction to cimetidine-induced prolonged hypochlorhydria mediates hyperactivity of the gastrin cell system which, in turn, induces parietal-cell hyperplasia. The hyperplasia accounts for hypersecretive responses in cimetidine-treated rats. The inhibitory activity displayed by pirenzepine on the same parameters may be due to the blockade of vagal trophic influences on gastric mucosal cells and/or to the release of inhibitory factors such as somatostatin.

Staining methods for morphometric studies of parietal and gastrin cells in the rat stomach.

In order to select the most suitable procedures for quantitative microscopy of both parietal and gastrin cell populations in the rat stomach, various staining methods were compared. For parietal cell identification in particular, the following procedures were tested: i) the modification of the haematoxylin-eosin method proposed by Marks and Drysdale, ii) the haematoxylin-eosin-saffron fluorochrome stain on paraffin sections, iii) the haematoxylin-azophloxin-saffron fluorochrome stain on paraffin sections, and iv) the May-Grunwald-Giemsa stain on thin sections from plastic-embedded specimens. This last provided the best results in parietal cell individualization and seemed to be the most suitable method for an accurate image analysis. Immunohistochemistry was the only unequivocal way to identify gastrin cells. Two variant procedures were examined; a) the agar-paraffin embedding technique, and b) the combination of a mucin staining with the immunoperoxidase reaction. The first technique provided an easier procedure for handling seriate strips of gastric mucosa for proper enumeration of immunostained cells. The second was presented as a promising variant procedure for a combined investigation of both G-cell population and mucin secretion patterns under differnt experimental conditions in the same specimen.

Pirenzepine versus ranitidine in gastroprotection during antiblastic chemotherapy: a double-blind study.

Corticosteroids and cytostatic drugs possess a documented lesive action on upper digestive mucosa, making epigastric pain and/or pyrosis common complaints among patients on antitumor treatment. The selective antimuscarinic pirenzepine and the H2-receptor antagonist ranitidine were tested against the ulcerogenic action of antiblastic chemotherapy. Thirty-eight patients affected with malignant lymphoproliferative disorders were endoscopically examined and the endoscopic pictures were quantified by using an arbitrary score. According to a double-blind randomized sequence, 19 out of the 38 patients received pirenzepine 100 mg/die/p.o. and the other 19 received ranitidine 300 mg/die/p.o. along with antitumoral therapy for periods of 3-6 months. Seven patients died of hematologic complications before ending the treatment. In the 31 surviving patients (13 pirenzepine- and 18 ranitidine-treated) a second endoscopic examination was performed at the end of the treatment and the lesion score repeated. No significant difference was found between initial and final scores in both groups. The antisecretive action of the two drugs may account for their effectiveness, but other mechanisms such as cytoprotection cannot be ruled out.

Gastric pharmacological activities of tripotassium dicitrato bismuthate in rats and dogs.

The effects of tripotassium dicitrato bismuthate (TDB) on gastric acid, pepsin and mucoprotein secretion in rats and on hydrochloric-peptic secretion and plasma gastrin levels in dogs were investigated. In Shay rats, TDB did not affect acid secretion but significantly lowered pepsin concentration and increased the amount of bound mucoproteins. In addition, gastric mucosal lesions were significantly prevented by the drug. In dogs, chronically fitted with both gastric fistulae and Heidenhain pouches, acid secretion and plasma gastrin levels stimulated by a meat meal were unaffected by TDB, while pepsin concentration and pepsin output were significantly decreased. On the basis of these results, the antiulcer activity of TDB appears to be ascribed to the protection of the gastric mucosa through an increase in mucoprotein synthesis and a decrease of pepsin activity.

Use of antisecretory drugs for gastroprotection during antiblastic chemotherapy.

Both prednisone and cytostatic drugs have an ulcerogenic effect on digestive mucosa. The protective action of the antisecretory drugs pirenzepine and ranitidine are compared against gastroduodenal lesions induced by antiblastic therapy. Twenty patients affected with lymphoproliferative disorders were endoscopically examined: none of them suffered from gastric or duodenal peptic ulcers or erosions. Ten out of the 20 patients received pirenzepine 100 mg/die/p.o. and the other 10 received ranitidine 300 mg/die/p.o. The study was performed according to a double-blind, randomized sequence. The antisecretory medication was administered together with antitumoral therapy for periods of 3-6 months. Four patients died of haematological complications before the course of treatment was completed. A further endoscopic examination was performed at the end of treatment: no patient showed evidence of gastric or duodenal peptic ulcers or erosions. Among the pirenzepine-treated cases, 1 out of the 7 evaluable patients showed a histological worsening of a pre-existing gastritis, while a slight duodenitis was observed in 1 out of the 9 ranitidine-treated patients. The comparable effectiveness of the two drugs is probably related to their antisecretory action, but cytoprotective mechanisms cannot be excluded.

Comparative study with oxmetidine and ranitidine on acid secretion and gastrin release in the dog.

The antisecretory potency of oxmetidine was compared with that of ranitidine for its action against gastric acid secretion induced by histamine and by 2-deoxy-D-glucose (2DG) in the conscious gastric-fistula dog. Oxmetidine, administered i.v. during histamine stimulation, was nearly as effective as ranitidine, with a similar duration of action, but it was about twice as potent as ranitidine against 2DG-stimulated acid secretion. In experiments with bombesin, both oxmetidine and ranitidine significantly decreased gastric acid secretion to a similar extent, without affecting plasma gastrin levels.

Pirenzepine in long-term therapy for duodenal ulcer.

A total of 60 patients with endoscopically diagnosed duodenal ulcer were treated with pirenzepine or cimetidine for 8-10 weeks until endoscopic healing of the ulcer. After ulcer healing 20 random patients received 50 mg pirenzepine per os daily for 6 months, 20 received 400 mg cimetidine per os daily for 6 months, and the remaining 20 received topic antacids for 6 months whenever they complained of pyrosis and/or epigastric pain. Endoscopic checks were repeated after 6 months (or earlier, if clinical picture was consistent with relapsing ulcer). Relapsing duodenal ulcer or erosive duodenitis was observed in 5 patients treated with pirenzepine (25%), in 4 patients treated with cimetidine (20%), and in 13 patients treated with occasional antacids (65%). Differences were significant between the antacid-treated patients and each of the other two groups, but not significant between pirenzepine-treated and cimetidine-treated groups.

Effects of gonadotropin-releasing hormone (GnRH) on gastric secretion and gastrin release in the dog.

The effects of GnRH on gastric secretion and gastrin release from dogs provided with gastric fistulae and Heidenhain pouches have been investigated. A transient yet significant inhibition of pentagastrin-stimulated secretion from gastric fistulae was observed, while secretion from Heidenhain pouches was unchanged. The maximal inhibitory effect of GnRH on both acid and pepsin secretion stimulated by 2-deoxy-D-glucose was obtained from gastric fistulae. On the contrary, GnRH failed to affect either acid secretion stimulated by bethanechol or acid secretion and gastrin release induced by bombesin. The present results indicate that GnRH possesses an inhibitory action on gastric secretion from the vagally innervated stomach of the dog. The most likely inhibitory mechanism seems to be represented by a decrease of the vagal activity.

The effect of pirenzepine on gastric acid secretion and gastrin release induced by bombesin and meal in the dog.

Pirenzepine exerted a powerful inhibitory effect on gastric acid secretion from both the gastric fistula and the Heidenhain pouch of the dog, following intravenous infusion of bombesin. Similar results were obtained from the Heidenhain pouch when hypersecretion was stimulated by the meal test. The rise in plasma levels of radioimmunological gastrin, obtained by either bombesin or food administration, was not significantly affected by pirenzepine. The overall results indicate that the inhibitory effect of pirenzepine on gastric acid secretion in the dog was independent from the release of endogenous gastrin.