Gastric mucosa after partial gastrectomy

Induction of intestinal metaplasia in the rat gastric mucosa by local X-irradiation

Attempts were made to learn about an optimal condition for the induction of intestinal metaplasia in the gastric mucosa. The gastric region of 5-week-old female Wistar rats was irradiated with 500 rad of X-ray daily for 6 times (Group I) or with 1,000 rad of X-ray every two days for 3 times (Group III). In addition, the effect of immunization by allogeneic stomach antigen on the intestinalization was studied in rats irradiated with 500 rad of X-ray daily for 6 times (Group II). In a group of rats (Group II) injected with allogeneic stomach antigen and X-irradiated the process of intestinalization was more accelerated as compared to that in rats treated with X-ray (Group I). The similar results were obtained in rats irradiated with 1,000 rad of X-ray 3 times (Group II). Intestinal metaplasia developed more later in the fundic gland mucosa which became usually atrophic due to the loss of parietal cell mass. There was an intimate association among the parietal cell loss in the fundic gland, a rise in pH value and the development of intestinal metaplasia. In all groups, no case of gastric adenocarcinoma was detected during observation period up to 52nd week.

Bile reflux and the gastric mucosa: an experimental ferret model

To study the effects of chronic bile reflux on the mammalian gastric mucosa, the ferret model was chosen for its practical aptitude and for its similarity to human gastric anatomy and physiology. A technique was first perfected for endoscopically directed gastric mucosal biopsy in the ferret. Subsequently, a surgical model of maximal enterogastric reflux (MR) and a control model of minimal reflux or "nonreflux" (NR) were developed. A stable population of 9 MR and 9 NR ferrets surviving 1-3 years has been established. All 18 animals, plus 6 nonoperative control animals, have undergone multiple repeat endoscopy and gastric biopsy without complication. The surgical and endoscopic techniques, with preliminary findings, are described.

Gastric juice factors after Roux-Y reconstruction compared with Billroth II partial gastrectomy

Gastric juice was studied in five patients after Billroth II partial gastrectomy, in six patients after Roux-Y reconstruction, and in eight healthy control subjects. Juice was obtained over a 24 hour period by hourly nasogastric aspiration prior to measurement of pH, total and stable N nitrosocompounds, nitrites, bile acids (total and free), and bacterial count. Large variations in almost all compounds were seen during the 24 hour period in individual patients, and in addition, there were large variations between patients within the clinical groups. The gastric juice pH concentration was higher in the Billroth II group, as was the bacterial flora count (median 3 X 10(6) organisms/ml). Although Roux-Y bile diversion reduced the exposure to bile acids, it did not prevent it, and bacterial proliferation was increased (1 X 10(7) organisms/ml). No significant differences or sizeable trends were seen in N nitrosocompounds or nitrite concentrations.

Role of carcinoembryonic antigen assay in the management of cancer

CEA is a molecule produced by a large number of malignant and benign tissues. Measuring levels of CEA circulating in the blood by radioimmunoassay can be used in the management of cancer patients. Because of high false positive and false negative percentages in normal populations, it has not been useful in screening for malignancy. However, in several types of cancer patients the test has been shown to be of considerable clinical value. Elevated CEA levels indicate a poor prognosis in patients with primary colorectal cancer, primary pancreatic cancer, primary breast cancer, and primary lung cancer. Serial CEA titers obtained following cancer treatments can be used to monitor the therapy. CEA can assess the adequacy of surgical removal of a primary colon or rectal cancer, monitor responses to chemotherapy, and assess response to radiation therapy. The greatest clinical impact of CEA has been in the detection of recurrent colon or rectal cancer following surgical resection of the primary malignancy. Early detection of recurrence, when combined with reoperative second-look surgery, may result in 30% long-term survivors.

Intragastric N-nitrosation is unlikely to be responsible for gastric carcinoma developing after operations for duodenal ulcer

Three groups of patients studied after operations which had cured their duodenal ulcer were compared with a control group (no operation, n = 8). The surgical procedures included: proximal gastric vagotomy (n = 7), truncal vagotomy and pyloroplasty (n = 7), truncal vagotomy and antrectomy (n = 8). Samples of gastric juice were aspirated half hourly or hourly over 24 hours for measurement of pH, counts of all identified bacteria, nitrite and total N-nitrosocompounds. Although the pH over 24 hours was significantly higher after proximal gastric vagotomy (p less than 0.05) and truncal vagotomy and antrectomy (p less than 0.001) than controls, there was no difference between truncal vagotomy and pyloroplasty and controls. Counts of nitrate reducing bacteria over 24 hours were also significantly higher after truncal vagotomy and antrectomy than controls (p less than 0.1) but no differences were observed between the other groups. Only after truncal vagotomy and antrectomy was nitrite over 24 hours significantly increased compared with controls (p less than 0.01). Despite these higher values after truncal vagotomy and antrectomy, there was no significant difference in total N-nitrosocompounds between any of the four groups. Whereas bacterial counts and nitrite increased with pH, no correlation was found between total N-nitrosocompounds and pH. These results provide no evidence that exposure to total N-nitrosocompounds is increased after operations for duodenal ulcer.

Causes and clinical significance of gastritis following Billroth II resection for duodenal ulcer

Billroth II resection was carried out in 1000 duodenal ulcer patients in the period 1948-1956. Twenty-two to thirty years later, gastroscopy and biopsy was performed in 196 of 423 survivors. Chronic atrophic gastritis appeared in 93 per cent of the cases, 47 per cent showed slight and 46 per cent severe changes. Seven per cent had normal mucosa. The microscopic grade of gastritis proved to be independent of age, alcohol and tobacco consumption and serum gastrin. No correlation between clinical status, such as dumping, diarrhoea, vomiting and pain, haematological parameters and the microscopic grade of gastritis, could be found. It is suggested that gastritis might be caused by reflux of bile, pancreatic and intestinal juices, and that postgastrectomy symptoms and anaemia do not depend on the microscopic grade of gastritis.

Comparison of the combination of cholestyramine/alginates with placebo in the treatment of postgastrectomy biliary reflux gastritis

Postgastrectomy biliary reflux gastritis is quite common. Several drugs have been used in its treatment, including the bile acid-binding resin cholestyramine, which seemed ineffective, possibly because of its rapid disappearance from the gastric remnant. It was suggested that by using alginates, which form a raft floating on the gastric contents, cholestyramine would be retained in the stomach for a longer period. 32 patients received either placebo or cholestyramine/alginates/bicarbonate (CAB). Gastroscopy with biopsies, laboratory studies and physical examination were performed before and after the trial. A two week intervals patients were interviewed about the effect on symptoms. A detailed Y-ray study was made of 5 patients, in which a series of pictures was taken after ingestion either of placebo or CAB together with a novel contrast medium. There was no statistical difference between treatment groups with respect to symptoms, gastroscopy or histological findings, nor did the X-ray study show any difference in retention time between placebo and CAB.

A study of the aetiology of gastritis following gastric surgery. I. Immunofluorescent studies of the gastric mucosa

The gastritis which follows surgical trauma is probably not of autoimmune origin. Although identical with the gastritis of pernicious anaemia (PA) upon routine histological examination, immunofluorescent examination of post-operative gastritis differs in that IgA-containing plasma cells alone are found, in contrast to the predominantly IgG-containing plasma cells in PA.

Changes in gastric mucosal cell proliferation after antrectomy or vagotomy in man

The rate of gastric epithelial cell proliferation was studied in peptic ulcer patients treated by partial gastrectomy or proximal gastric vagotomy (PGV). Endoscopic biopsies were incubated in vitro with 3H-thymidine and autoradiographs were prepared. The percentage of DNA-synthesizing cells (labeling index) in the progenitor cell region was estimated. Five patients were studied before and 3 months after antrectomy, whereas six other subjects were studied before and 2 weeks and 2 months after PGV. The results indicate that epithelial cell proliferation in fundic mucosa is accelerated after antrectomy in man and that PGV is followed by an increased rate of cell renewal in fundic and antral mucosa, whereas the kinetic parameters in duodenal mucosa remain unaffected by this operation. It is concluded that the proliferative changes after these operations are most likely caused by the development of gastritis. The study did not support the hypothesis that gastrin exerts a physiological trophic action on human gastric mucosa.