The effect of renal transplantation on basal serum gastrin concentration

Basal serum gastrin concentration was measured before and every week during the initial 5 weeks after renal transplantation in 9 of 20 patients with chronic renal failure who obtained a well functioning renal transplant. Furthermore, calcium and phosphorus metabolism in relation to serum gastrin was investigated in all 20 patients 5 weeks after transplantation. Before renal transplantation, serum gastrin was markedly elevated as compared with the levels in normal controls. During the first 3-5 weeks after renal transplantation, serum gastrin decreased towards normal values. A slight but significant increase in serum gastrin persisted 5 weeks after transplantation. No significant relation between changes in serum gastrin concentration and in calcium and phosphorus metabolism was observed.

Low-dose oral iron absorption test in anaemic patients with and without iron deficiency determined by bone marrow iron content

The low-dose oral iron absorption test (OIAT) was performed in 85 consecutive anaemic patients referred for bone marrow examination in order to investigate the ability of the test to predict bone marrow iron stores and to differentiate between different categories of anaemia. Eight patients were excluded for technical reasons. Test results from 77 patients are presented as Cmax (micromol/l): the maximum increase in S-iron measured during a 3 h period after administration of 10 mg oral iron sulfate. Iron deficiency was defined as the absence of stainable iron in bone marrow aspirates. Cmax was higher in 46 iron deficient patients [3 (median); 0 and 13 (1st and 3rd quartiles); 0-40 (range)] than in 31 non-iron-deficient patients (0; 0 and 2; 0-4) (P<0.01). 27 patients had primary bone marrow disease, 25 patients had absent bone marrow iron stores accompanied by inflammation, 17 patients had anaemia of chronic disease (ACD) and 8 patients had uncomplicated iron deficiency anaemia (IDA). Patients with IDA had higher Cmax (15; 13 and 28; 6-40) than patients with ACD (1; 0 and 2; 0-3), and than the 69 non-IDA patients (1; 0 and 3; 0-19) (P<0.001). Cmax values above 5 micromol/l always indicated absent bone marrow iron stores.

Low-dose oral iron absorption test: establishment of a reference interval

The low-dose oral iron absorption test (OIAT), a possible test for iron deficiency, is based on the fact that intestinal iron absorption is higher in iron-deficient subjects than in those with normal or increased iron stores. The aims of this study were to establish a reference interval for the OIAT, to evaluate five different ways of presenting the results, and to advocate for the use of one of these methods. OIAT was performed in 122 healthy volunteers, 3 of whom were excluded as a result of technical difficulties. The volunteers were given 10 mg of oral iron sulphate at 0900 h on an empty stomach. S-iron was measured just before iron consumption, and after 1, 2 and 3 h. The maximum increase in S-iron during the test, presented as Cmax (micromol l(-1)), was higher in females (5 [median]; 3 and 7 [1st and 3rd quartiles]; 0-34 [range]) than in males (3; 1 and 5; 0-13) (p<0.001 Mann Whitney U-test). Furthermore, Cmax was significantly higher in females aged 22 44 years than in all other age groups (males and females), but did not fluctuate significantly with age in males. Cmax was higher in premenopausal than in postmenopausal females (6; 5 and 10; 0-34 and 4; 2 and 5; 0-12, respectively) (p <0.01 Mann Whitney U-test). In conclusion, iron absorption assessed by the OIAT was higher in premenopausal females than in postmenopausal females and males. We suggest reference intervals of 0-34 micromol l(-1) in premenopausal females, and 0-11 micromol l(-1) in all other persons, i.e. males and postmenopausal females.

Trisomy 10 survival: a literature review and presentation of seven new cases

Trisomy 10 as the only chromosome aberration is a rare phenomenon in malignant and premalignant hemopoietic disorders. We describe 7 new cases and have found another 12 in the literature. It appears that, whereas adult patients have myeloid disorders (acute myeloid leukemia, myeloproliferative, or myelodysplastic syndromes), in children the diagnosis is lymphocytic leukemia or lymphoma. The median survival was 122 months in the total material. Age above 60 years proved to be a significant adverse factor (median survival only 5 months; p = 0.003). None of the other clinical, cytogenetic, or hematological variables were of demonstrable prognostic importance. In contrast with the larger trisomy 10 clones, those of limited size were associated with nonleukemic diagnoses, normal or slightly elevated leukocyte counts, and few or no circulating blasts. This may suggest that expansion of the trisomy 10 clone is associated with clinical and hematological progression.

Lack of correlation between methotrexate concentrations in serum, saliva and sweat after 24 h methotrexate infusions

1 Methotrexate (MTX) concentrations were studied in serum, mixed saliva and sweat during and after 24 h continuous MTX infusions (0.5-6 g m-2) in 14 patients with various malignant diseases. 2 The serum-MTX concentrations declined in a biphasic manner, but the MTX elimination in saliva and sweat varied to a much greater extent. 3 Saliva/serum and sweat/serum ratios during the MTX infusion were 2.3% and 0.55% respectively. The ratios had increased significantly 20 and 44 h postinfusion. 4 No correlations were demonstrated between salivary- and serum-MTX concentrations during the MTX infusion or 20 and 44 h later. 5 Markedly delayed renal MTX excretions were demonstrated in two patients. In one of them the salivary MTX elimination was also retarded, whereas this was not seen in the other one. 6 We conclude that measurements of MTX concentrations in mixed saliva cannot substitute for serum-MTX determinations in the monitoring of patients after 24 h MTX infusions.

Association of pernicious anemia and intrinsic factor antibody with HLA-D

One-hundred-and-six patients with pernicious anemia were HLA-A, B, C typed by serological technique and HLA-D typed by mixed lymphocyte culture technique for the specificities HLA-Dw1 - 8 and the locally defined D "H". In 13 cases, the D-typing was unsuccessful due to technical difficulties. HLA-A, B, C antigen frequencies did not show any significant deviation from expected values, while D typing showed increased frequencies of Dw2 and Dw5 and a possibly decreased frequency of Dw3. The typing was compared with clinical data such as the presence of organ specific autoimmune disease in first degree relatives, presence of anemia or myelopathy at time of diagnosis and presence of antibodies towards parietal cells or intrinsic factor. The presence of intrinsic factor antibody was associated with the presence of Dw2 and a decrease of Dw5 and possibly also with a decrease of Dw4. No associations were found for the other investigated parameters. If intrinsic factor antibodies have a pathogenetic role, our findings might reflect a heterogeneity of pernicious anemia. These findings and the recently reported association between HLA-DR5 and Hashimoto's disease link these two thyrogastric diseases together to form a special subgroup within the group of organspecific autoimmune diseases; the other diseases in the group have as a common denominator the frequent presence of D/DR3.

Abnormal duodenal loop demonstrated by X-ray. Relation to gastric emptying time

Gastric emptying time of a solid meal was estimated on X-ray in 7 patients with a normal duodenal loop, 7 patients with a proximal duodenal anomaly, and 12 patients with a distal duodenal anomaly. A determination coefficient between gastric emptying time and duration of serum gastrin increase was calculated. The food-stimulated serum gastrin secretory pattern was studied in 9 patients with a normal duodenal loop, 6 with a proximal duodenal anomaly, and 13 with a distal duodenal anomaly. The various groups presented significantly different gastric emptying times; thus patients with normal duodenal loop had a mean gastric emptying time of 6 h, patients with proximal duodenal anomalies ahd a mean gastric emptying time of 4.5 h, and patients with distal duodenal anomalies had a mean gastric emptying time of 9 h. Gastric emptying time and duration of increased serum gastrin secretion was positively correlated (R2 = 0.89). The food-stimulated serum gastric secretory pattern was equal in patients with proximal duodenal anomalies and those with distal duodenal anomalies and furthermore, reached significantly higher serum gastrin concentrations than in patients with a normal duodenal loop.

The role of serum gastrin in the secretion of calcitonin: studies in patients with pernicious anaemia and in healthy subjects

Basal concentrations of serum gastrin and serum calcitonin were measured in 38 patients with pernicious anaemia and in 32 healthy control subjects. The fasting level of serum gastrin was greatly elevated in 32 patients and was within normal range in 6 patients, the difference between pernicious anaemia patients and controls being highly significant (P less than 0.001). No significant difference between fasting serum calcitonin concentrations in patients and healthy subjects was found. Furthermore, these hormones were studied before and after a beef meal in eight of the patients with hypergastrinaemia and in six healthy control subjects. After the meal serum gastrin concentrations increased significantly from basal values in both patients and controls, the peak values being reached 60 and 30 min after the meal, respectively. No significant changes in serum calcitonin concentrations were observed after the meal in either group. In five patients a transient rise in serum calcitonin occurred 5-10 min after ingestion, beginning, however, before any rise in serum gastrin was observed. Our results indicate that serum gastrin is without influence on calcitonin release, either in hypergastrinaemic patients with pernicious anaemia or in healthy subjects.

Serum gastrin and serum calcitonin in patients with chronic renal failure

The interrelationship between serum gastrin and serum calcitonin concentrations was studied in 73 patients with chronic renal failure. In both haemodialyzed and non-dialyzed patients increased serum concentrations of these hormones were found compared with normal controls. In non-dialyzed patients with creatinine clearance above 10 ml/min a highly significant correlation between serum gastrin and creatinine clearance was found, whereas no correlation was found in patients with creatinine clearance below 10 ml/min. Between serum gastrin and serum calcitonin, a significant positive correlation was found in non-dialyzed patients. These findings may be explained by a relationship between the two hormones or be secondary to a decreased elimination due to the reduced renal function.

The effect of vagotomy on human gastroesophageal sphincter pressure in the resting state and following increases in intra-abdominal pressure

The effect of surgical isolation and extrinsic denervation of the distal 5 to 7 cm of the human esophagus on resting gastroesophageal sphincter pressure and its response to graded increases of external abdominal compression was determined in 89 patients with duodenal ulcer. Fasting serum gastrin concentration also was measured. No significant changes in resting sphincter pressure were obtained before and after vagotomy of various types: parietal cell vagotomy, selective gastric vagotomy plus drainage, and selective gastric vagotomy plus precise antrectomy. No correlation between resting sphincter pressure and fasting serum gastrin concentration was found in any of the groups studied. The increase in gastroesophageal sphincter pressure was similar to the increase in intragastric pressure after 10, 20, and 30 mm Hg of external abdominal compression and was unchanged after all types of vagotomies. These results suggest that (1) extrinsic innervation of the lower esophageal sphincter in humans does not regulate the resting tone of the sphincter; (2) extrinsic "mechanical" influence does not play any role in the maintenance of resting pressure; (3) the effect of increased abdominal pressure is a pure mechanical effect, is unchanged after vagotomy, and therefore is not regulated by external neural reflex.

Inhibition of gastrin secretion by hypertonic solutions in patients with pernicious anaemia and duodenal ulcer

Serum gastrin increased in patients with pernicious anaemia after a beef-meal, but decreased after an oral load of glucose, xylose or sodium chloride. 50 g of glucose and 25 or 75 g of xylose suppressed serum gastrin to approximately 40% of basal values at 60 min and were slightly more effective than 10 g of sodium chloride. There was no rise in beef-meal stimulated serum gastrin concentration in vagotomized patients and only a slight rise in two patients with duodenal ulcer when an oral dose of 10 g of sodium chloride was given together with the beef-meal. 25 g of xylose suppressed basal serum gastrin concentration significantly in six vagotomized patients. Nasal administration of small amounts of vasopressin decreased basal serum gastrin significantly in six vagotomized patients. Nasal administration of small amounts of vasopressin decreased basal serum gastrin significantly in all subjects examined. Further studies indicated, however, that vasopressin was only effective when pharmacological plasma concenten orally and intraduodenally were compared in six patients with pernicious anaemia. Serum gastrin concentration decreased approximately to the same extent in both experiments. It is concluded that the inhibitory effect of glucose on gastrin secretion most likely is mediated hormonally via osmo-receptors located in the small intestine.

The influence of cimetidine on basal gastro-oesophageal sphincter pressure, intargastric pH, and serum gastrin concentration in normal subjects

A pressure and pH-sensitive probe has been constructed for simultaneous measurement of gastro-oesophageal sphincter pressure and intragastric pH. The coefficient of variation for measurements of the gastro-oesophageal sphincter was 0.24, and for the intragastric pH, 0.09. After peroral ingestion of 400 mg of cimetidine or placebo, simultaneous measurements of gastro-oesophageal sphincter pressure and intragastric pH were made at fixed time intervals, and at the same time blood samples were taken for determination of serum gastrin and serum cimetidine concentrations. No demonstrable difference was found in the time-course of the gastro-oesophageal sphincter pressure after ingestion of cimetidine or placebo. After ingestion of cimetidine a significant rise in intragastric pH (p less than 0.05) occurred after 40 min, and this increased pH was maintained for the remainder of the experimental period, corresponding to a serum cimetidine concentration of over 1.00 mg/l. Similarly, there was a significant rise (p less than 0.05) in serum gastrin concentration after 150 min. There was a significant direct correlation between corresponding measurements of intragastric pH and serum gastrin (p less than 0.001), between intragastric pH and serum cimetidine (p less than 0.001), and between serum gastrin and serum cimetidine (p less than 0.05). Ingestion of cimetidine results in an increase in the serum gastrin concentration in healthy subjects, presumably as a result of reduced secretion of acid in the stomach. Neither the endogenous increase in serum gastrin concentration nor the increase in intragastric pH causes alteration in the gastro-oesophageal sphincter pressure.

Increased sensitivity of gastrin release to adrenaline in duodenal ulcer

Serum gastrin concentrations were measured in patients with duodenal ulcer and controls before, during, and after one-hour intravenous infusion of various doses of adrenaline (0.12 microgram to 6 microgram/min). Gastrin concentrations in the basal state were significantly increased in duodenal ulcer patients compared to controls. The maximal rise in serum gastrin concentrations was obtained at a dose of 4 microgram/min adrenaline in both groups of subjects, and the increase was significantly higher in duodenal ulcer patients than in controls. Adrenaline increased predominantly the gastrin III component (gastrin-17 like) in both duodenal ulcer patients and controls. The threshold level of adrenaline-induced gastrin release was significantly lower in duodenal ulcer patients: intravenous infusion of adrenaline in a dose of 0.12 microgram and 0.25 microgram/min increased serum gastrin concentrations 23 and 43%, respectively, but had no effect in controls. Rises in plasma adrenaline concentrations were similar in both groups of subjects in response to the various doses of adrenaline employed. Only the smallest dose of adrenaline (0.12 microgram/min) resulted in clearly physiological variations in plasma adrenaline concentrations. The results indicate that endogenous adrenaline may stimulate the secretion of gastrin during physiological conditions in patients with duodenal ulcer.

Increased plasma noradrenaline and serum gastrin in patients with duodenal ulcer

Serum gastrin, serum insulin, plasma noradrenaline, plasma adrenaline, pulse rate and blood pressure were measured repeatedly during 24h in six patients with duodenal ulcer and in six control subjects. Mean serum gastrin concentration was 3-4 times higher in duodenal ulcer patients than in controls during both the day and at night. Serum insulin was the same in both groups of subjects. Overnight fasting and mean supine plasma noradrenaline as well as mean supine pulse rate were significantly higher in duodenal ulcer patients than in controls. Plasma adrenaline and arterial blood pressure were the same in patients and controls. These results suggest that sympathetic nervous activity is increased in patients with duodenal ulcer. The increased sympathetic nervous activity may mean that duodenal ulcer patients are subject to more stress than normal subjects or may be compensatory to increased vagal nervous activity presumed by some authors to be present in such patients.

Gastroesophageal sphincter pressure and serum gastrin: reaction to food stimulation in normal subjects and in patients with gastric or duodenal ulcer

Gastroesophageal sphincter pressure and serum gastrin concentration were determined in the fasting state and after the intake of a protein food in 6 normal subjects, 6 patients with gastric ulcer, and in 6 patients with duodenal ulcer. No significant differences in the fasting state were found. After the food intake, gastroesophageal sphincter pressure increased significantly over basal values in normals and in patients with duodenal ulcer, but in patients with gastric ulcer a decrease in pressure was noted. Serum gastrin rose in all subjects studied after the food stimulation, but it was significant only in the gastric and duodenal ulcer group. In two normals and two patients with duodenal ulcer the ingestion of a potato meal of similar weight to that of the protein meal showed no change either in serum gastrin or in sphincter pressure. In one additional normal subject and one duodenal ulcer patient the constant intravenous infusion of Aminosol for 2 h produced no change in serum gastrin or sphincter pressure. These results indicate that the effect of protein food on sphincter pressure is different for gastric or duodenal ulcers, and, furthermore, that this effect is mediated by proteins in the gastrointestinal tract.

Gastroesophageal sphincter pressure and serum gastrin: reaction to food stimulation in normal subjects and in patients with gastric or duodenal ulcer

Gastroesophageal sphincter pressure and serum gastrin concentration were determined in the fasting state and the intake of a protein food in 6 normal subjects, 6 patients with gastric ulcer, and in 6 patients with duodenal ulcer. No significant differences in the fasting state were found. After the food intake, gastroesophageal sphincter pressure increased significantly over basal values in normals and in patients with duodenal ulcer, but in patients with gastric ulcer a decrease in pressure was noted. Serum gastrin rose in all subjects studied after the food stimulation, but it was significant only in the gastric and duodenal ulcer group. In two normals and two patients with duodenal ulcer the ingestion of a potato meal similar in weight to the protein meal showed no change either in serum gastrin or in sphincter pressure. In one additional nromal and one duodenal ulcer, the constant intravenous infusion of Aminosol during 2 hours produced no change in serum gastrin or sphincter pressure. These results indicate that the effect of protein food on sphincter pressure is different for gastric or duodenal ulcers; furthermore, that this effect is mediated by proteins in the gastrointestinal tract.

Gastroesophageal sphincter pressure and serum gastrin studies following food intake before and after vagotomy for duodenal ulcer

Gastroesophageal sphincter pressure (GESP) and serum gastrin concentration (SGC) were determined in the basal state and after a protein meal in 6 patients with duodenal ulcer (DU) 6 patients after parietal cell vagotomy (PCV) 6 patients after selective gastric vagotomy plus drainage (SGV + D), and 6 patients after selective gastric vagotomy plus precise antrectomy (SGV + A). No correlation in the resting state between GESP and SGC was observed. After food ingestion, DU patients showed a sustained rise in GESP which lasted up to the end of the experiment. The vagotomized patients, however, showed no rise in sphincter pressure after food intake--rather a tendency to decrease in pressure occurred. On the contrary, SGC rose significantly after food ingestion in patients with SGV + D or PCV, while in DU patient this rise was less significant. Patients with vagotomy and antrectomy showed no rise in SGC. These results do not suggest that SGC and extrinsic vagal innervation in the resting state play a significant role in the maintenance of the tone of GES. After food ingestion an interaction may occur between intact vagal innervation and rise in SGC in order to obtain an adequate rise in GESP.

Gastroesophageal sphincter pressure and serum gastrin studies following food intake before and after vagotomy for duodenal ulcer

Gastroesophageal sphincter pressure (GESP) and serum gastrin concentration (SGC) were determined in the basal state and after a protein meal in six patients with duodenal ulcer (DU), six patients after parietal cell vagotomy (PCV), six patients after selective gastric vagotomy plus drainage (SGV + D), and six patients after selective gastric vagotomy plus precise antrectomy (SGV + A). No correlation in the resting state between GESP and SGC was observed. After food ingestion, DU patients showed a sustained rise in GESP which lasted up to the end of the experiment. The vagotomized patients, however, showed no rise in sphincter pressure after food intake--rather a tendency to a decrease in pressure occurred. On the contrary, SGC rose significantly after food ingestion in patients with SGV + D or PCV, while in DU patients this rise was less significant. Patients with vagotomy and antrectomy showed no rise in SGC. These results do not suggest that SGC and extrinsic vagal innervation in the resting state play a significant role in the maintenance of the tone of GES. After food ingestion an interaction may occur between intact vagal innervation and rise in SGC in order to obtain an adequate rise in GESP.

Antral vagotomy in parietal cell vagotomized dogs with a Heineke-Mikulicz pyloroplasty. Effect upon gastric emptying and motility, serum gastrin concentration, and Heidenhain pouch acid secretion

In 6 Heidenhain pouch (HP) dogs who previously had undergone parietal cell vagotomy (PCV) with a Heineke-Mikulicz pyloroplasty (Ppl), the antral nerves were cut. No significant changes in HP acid secretion or serum gastrin concentration occurred. In a similar previous study using HP dogs with a PCV and a gastroduodenostomy (GD), a significant rise in HP acid secretion without concomitant changes in serum gastrin concentration were observed after antral denervation. These findings indicate that the antral vagal nerves have no direct influence on HP acid secretion, but the rised HP acid secretion in the GD dogs after antral denervation may be related to the changed gastroduodenal emptying pattern which partly excludes the food acid stream from the acid inhibitory mechanism in the duodenal bulb.

The influence of an abnormal duodenal loop on basal and food-stimulated serum gastrin concentrations

Postprandial serum gastrin secretion was studied in 26 patients with X-ray-negative dyspepsia. Seven patients had a normal duodenum while 19 had duodenal anomalies. In patients with an abnormal duodenal loop, the mean postprandial serum gastrin secretion was significantly higher after 45, 60 and 120 min than that of the control group. No significant difference was demonstrated in the basal state. A delay in gastric emptying rate might be the cause of increased postprandial serum gastrin secretion in patients with an abnormal duodenal loop.

The role of adrenaline and of the vagus in gastrin release and acid secretion in dogs

Serum gastrin, gastric acid secretion and plasma adrenaline in response to intravenous injection of 2-deoxy-D-glucose and to insulin were measured in six dogs with gastric fistulae before and after denervation of the antrum and the intestine (antral-intestinal vagotomy). Serum gastrin and gastric acid secretion were also measured in the same dogs during intravenous infusion of adrenaline in doses which produced an elevation of plasma adrenaline to levels occurring during hypoglycaemia and after the injection of 2-deoxy-D-glucose. Antral-intestinal vagotomy reduced basal gastrin concentration slightly and basal gastric acid secretion considerably. The rise in serum gastrin in response to 2-deoxy-D-glucose and hypoglycaemia was abolished while the increase in gastric acid secretion was reduced after antral-intestinal vagotomy. Beef meal-stimulated gastrin secretion was the same before and after vagotomy. Intravenous infusion of adrenaline had no effect on either serum gastrin or gastric acid secretion. It is concluded that in the dog, in contradistinction to man, gastrin release after insulin is dependent on an intact vagus. Release of gastrin by adrenaline in the dog does not appear to be physiological since it is not achieved by the amount of adrenaline released in response to hypoglycaemia.

On the cause of the increased Heidenhain pouch secretion and serum gastrin concentration after gastrojejunostomy in dogs. With a statistical appendix

In 10 dogs with Heidenhain pouches (HP) a gastrojejunostomy (GEA) was constructed and later converted into a Roux en-Y anastomosis in order to abolish or reduce transstomal reflux. Next, duodenal inhibition was abolished by duodenal transection, and finally the duodenal bulb was excised. Twenty-four hour HP acid output increased after GEA, some 70% of the increase being attributable to transstomal reflux, the rest to decreased duodenal inhibition. Abolished duodenal inhibition caused a new rise, not significantly different from that caused by the combined effect of reflux and decreased duodenal inhibition after GEA. Twenty-four hour fasting HP acid output and 5 hr food-stimulated HP acid output rose after GEA by the same amount as that caused by abolished duodenal inhibition. A significant correlation was found between integrated gastrin and total HP acid output after food stimulation. Both fasting and food-stimulated gastrin concentration rose after GEA, the latter caused by reflux alone. Elimination of duodenal inhibition caused an unexpected rise in both fasting and food-stimulated gastrin concentration.

Duodenal denervation in dogs. Effect upon gastroduodenal emptying and motility, Heidenhain pouch acid secretion and serum gastrin concentration

In dogs with the continuity of the stomach and duodenum intact the peristaltic and antiperistaltic waves in the duodenum disappeared completely and gastric emptying became faster after selective duodenal denervation. No significant changes occurred in fasting and food-stimulated Heidenhain pouch acid secretion or in serum concentration. It is concluded that the duodenal vagal nerves have importance for duodenal motility, but do not influence the gastrin release from the antrum and the small bowel or the acid secretion from a Heidenhain pouch.

Influence of parietal cell vagotomy and selective gastric vagotomy on gastric emptying rate and serum gastrin concentration

Gastric emptying of a solid meal and serum gastrin concentration were studied in 26 patients with duodenal ulcer disease before and after parietal cell vagotomy (PCV), selective gastric vagotomy with drainage (SGV + D), or parietal cell vagotomy with drainage. PCV had no significant effect on gastric emptying rate, whereas emptying was significantly delayed after SGV + D. The integrated gastrin output 60 to 300 min after the test meal was insignificantly altered after PCV, but significantly increased after SGV + D. It is concluded that the drainage procedure did not normalize the disturbed gastric emptying after SGV. The prolonged hypergastrinemia period after food stimulation may reflect stasis.

Antral denervation of parietal cell vagotomized dogs. Effect upon gastric emptying and motility, Heidenhain pouch acid secretion and serum gastrin concentration

In ten Heidenhain pouch (HP) dogs who previously had undergone parietal cell vagotomy (PCV) with gastroduodenostomy, the antral nerves were cut, and the PCV thus converted to a selective gastric vagotomy (SGV). Mean gastric emptying rate was unaffected but antral motility changed considerably, the stomach became big and slack, and the emptying of a food-barium meal became purely passive. While the duodenal bulb was often filled with gastric content before antral denervation, this happened very seldom afterwards. Fasting, food-stimulated and 24-hour HP acid secretion increased significantly after denervation, but this was not accompanied by any significant changes in serum gastrin concentration. This indicates that other factors than gastrin must be responsible for the increased HP acid response to a meal after antral denervation.

The effect of insulin on food-stimulated secretion of gastrin after parietal cell vagotomy and selective gastric vagotomy

Serum gastrin concentration was measured in 11 patients with Parietal Cell Vagotomy and Drainage (PCV + D) and in 11 patients with Selective Gastric Vagotomy and Drainage (SGV + D) in the basal state, after a meal, and after a meal in combination with insulin-hypoglycaemia. Insulin had an early and transitory, but significant, inhibitory effect on the food-induced rise in serum gastrin concentrations. This inhibition was the same whether the patients had a PCV + D or SGV + D, indicating that it has no relation to the vagal innervation of the antrum. In the second hour after the meal the integrated gastrin output was significantly higher when insulin was added to a meal in patients with PCV + D but not in patients with SGV + D. This may indicate a certain, possibility sensitizing, effect of the vagal antral nerves.

Increased serum gastrin concentration in hemodialysis patients treated with 1-alpha-hydroxy vitamin D

Serum gastrin and serum calcium concentrations were measured in 9 hemodialysis patients treated with 1-alpha-hydroxy vitamin D3 and in 15 control patients. Serum calcium and serum gastrin concentrations were significantly increased after 1 and after 5 months of treatment with 1-alpha-hydroxy vitamin D3. It is concluded that serum gastrin concentration is sensitive to a rise in calcium concentration within physiological range in patients with chronic renal failure.

Gastroduodenostomy in dogs with and without parietal cell vagotomy. Effect upon gastric emptying and motility, Heidenhain pouch acid secretion and serum gastrin concentration

Heidenhain pouch (HP) dogs were studied. After gastroduodenostomy (GD) gastric emptying time was unaffected, but cineradiography showed that the strength of the antral contractions diminished considerably, while the number of peristaltic waves increased. "Circus movements" of the barium meal through the GD to the duodenum and back to the stomach through the pylorus occurred. No significant changes in food-stimulated HP acid secretion or serum gastrin response were observed. After parietal cell vagotomy (PCV) gastric emptying and motility was unaffected, but food-stimulated HP acid secretion and serum gastrin response increased significantly. After addition of a GD to PCV gastric emptying time decreased significantly but similar changes in antral motility occurred as after GD alone. The food-stimulated HP acid secretion and serum gastrin response became significantly reduced. Fasting HP acid secretion and serum gastrin concentration were not significantly altered by any of the surgical procedures.

Gastrin concentrations in serum and gastric mucosa in patients with pernicious anaemia

Sessile polyps in the antrum were found in 12 of 51 patients with pernicious anaemia. During gastroscopy, mucosal biopsies for gastrin determination were taken from the antrum and fundus and from the polyps. Patients with high gastrin concentration in the antral mucosa showed high serum gastrin concentrations, while most patients with low antral gastrin concentrations also had low serum gastrin values. On an average, the gastrin concentrations in the antrum were approximately 10 times, and those in the fundus approximately 100 times, higher than the corresponding values obtained in a reference group. The gastrin content in the polyps was not different from that in the surrounding antral mucosa. This study suggests that the polyps are not due to a functional hypertrophy of the antral mucosa caused by locally increased production of gastrin.

The role of the beta-adrnergic receptor in the secretion of gastrin: studies in normal subjects and in patients with duodenal ulcers

Intravenous infusion of isoproterenol, a beta-adrenergic receptor stimulatory agent, increased serum gastrin concentration significantly more in patients with a duodenal ulcer than in healthy subjects. The rise in pulse rate, blood glucose concentration and in serum insulin was the same in both groups of subjects. Gastrin secretion was also increased significantly more in the patients than in the control subjects after a beef-meal. Basal serum gastrin concentrations were higher in the patients than in the control subjects and correlated to the rise in serum gastrin during both tests in the patients with a duodenal ulcer. Isoproterenol and meal stimulated gastrin secretion, expressed as percent of the basal value, were twice as higher in the patients as in the control subjects. The combined administration of isoproterenol and the meal had an additive effect on the rise in serum gastrin. Isoproterenol stimulated gastrin secretion was completely suppressed by propranolol, a beta-adrenergic receptor blocking agent, which had no effect on meal stimulated gastrin secretion. It is concluded that the mechanism of the hypersecretion of gastrin in patients with a duodenal ulcer did not involve a specific abnormality of the beta-adrenergic receptor or the receptor which recognized proteins and their digested products. There is no established role of beta-adrenergic receptor activity in the hypersecretion of gastrin in patients with duodenal ulcers. It is suggested that the beta-adrenergic receptor may have some yet unknown function unrelated to the acute secretory response of gastrin.

Inhibition of meal-stimulated gastrin secretion after oral glucose

Serum gastrin concentration was measured in six male subjects before and after a beef meal, with and without 100 g of oral glucose being given 30 min previously. There was a pronounced inhibition of beef-stimulated gastrin secretion after the oral glucose load.

The effect of carbachol on resting gastro-oesophageal sphincter pressure and serum gastrin in normal human subjects

With the purpose of investigating the mechanism of action behind the rise in gastro-oesophageal sphincter pressure induced by cholinergic activity, serum gastrin and sphincter pressure were recorded in 8 normal human subjects before and in relation to administration of carbachol. Carbachol was given subcutaneously in a dose of 4.5 mug per kg body weight. Mean sphincter pressure recorded 15, 30, and 45 minutes after administration of carbachol was significantly higher than the basal mean. The administration of carbachol did not lead to significant changes in serum gastrin and a relationship between serum gastrin and sphincter pressure was not demonstrable. It is concluded, that the carbachol-induced rise in the basal sphincter pressure is not dependent on an increase in serum gastrin, but probably attributable to either direct cholinergic stimulation of the receptors or a cholinergically enhanced sensitivity of the receptors for gastrin. Moreover, it is concluded that carbachol in individual dosages may be a suitable adjuvant in the medical treatment of patients with gastro-oesophageal reflux.

Plasma adrenaline and serum gastrin: studies in insulin-induced hypoglycemia and after adrenaline infusions

Serum gastrin, plasma adrenaline, and blood glucose concentration were measured in 12 patients during insulin-induced hypoglycemia. Six patients had a duodenal ulcer, and 6 patients, 2 to 3 months earlier, had undergone a selective gastric vagotomy due to a duodenal ulcer. The lowest blood glucose concentration was obtained 30 min after the injection of insulin. The rise in plasma adrenaline showed a significant correlation with the degree of hypoglycemia attained. Serum gastrin was approximately doubled in both groups of subjects during the test. There was a strong correlation between rise in serum gastrin expressed in percentage of the basal value and the plasma adrenaline during hypoglycemia. In other experiments, adrenaline was infused intravenously in normal subjects in amounts (6 mug per min for 20 min) resulting in plasma concentrations comparable to those seen during the infusion. It is concluded that adrenaline is a hitherto little recognized factor influencing the gastrin response to hypoglycemia.

Parietal cell vagotomy in dogs. Influence on heidenhain pouch acid secretion, serum gastrin concentration, gastric emptying and motility

No change was observed in fasting Heidenhain pouch (HP) acid secretion and fasting serum gastrin concentration following parietal cell vagotomy (PCV) in six dogs whereas significant increase in food-stimulated pouch secretion and serum gastrin concentration was observed. The increase in pouch secretion after PCV took place mainly in the first 2 h after meal. The maximum serum gastrin concentration was reached at 15 min after feeding before as well as after PCV. Maximum in HP secretion was reached later, at 120 min before and at 90 min after surgery. Gastric emptying studies, using a food-barium meal, showed a slight decrease in the emptying rate after PCV in two dogs, while it was unchanged in the others. Cineradiography showed an unaffected antral motility in all dogs after PCV.