Gastric secretion and emptying after ordinary meals in duodenal ulcer.

We have studied the gastric response to an ordinary solid-liquid meal in 12 patients with active duodenal ulcer and 8 healthy volunteers. Our method employs gastric and duodenal markers to quantify acid, pepsin, and volume outputs in response to the meal, without manipulating intragastric pH. Intragastric volume, rate of gastric emptying, delivery of acid into the duodenum, and serum gastrin response were also measured simultaneously. On a separate day, peak acid output in response to betazole (1.5 mg per kg subcutaneously) was determined. Our results indicate an inappropriately prolonged gastric secretory response to meals in duodenal ulcer disease, without a concomitant increase in peak postprandial secretory rates or an increase in serum immunoreactive gastrin levels. Further, the stomach in duodenal ulcer disease did not "retain" the additional acid secreted in the later postprandial period, and abnormally high rates of acid delivery into the duodenum occurred. Our data are consistent with a dual defect in the duodenal mechanisms regulating both acid secretion and acid delivery into the duodenum.     

Gastric emptying of liquids in normal subjects and patients with healed duodenal ulcer disease

We have characterized the dose-response of inhibition of gastric emptying by acid, glucose, and fat in duodenal ulcer (DU) patients and normals (N) matched by age and sex. Gastric emptying was measured by the George technique while intragastric pH was maintained constant by intragastric titration. Acid, glucose, and fat inhibited gastric emptying in a dose-dependent fashion in both groups. DU patients emptied all three types of meals faster than normals, but differences were only seen at the lower doses of glucose or with the less potent doses of acid and fat. With low concentrations of glucose and at all concentrations of acid, DU patients emptied the meals faster than normals only in the first 5 min; but with fat the differences persisted throughout the 30-min test. Differences in gastric emptying of liquid meals in DU patients vs normals are small, and they occur with nutrient as well as acid meals. The variable responses obtained with the different concentrations may explain the inconsistencies found by other workers.     

Gastric emptying in active duodenal ulcer

Gastric emptying of a radiolabeled solid-phase meal was studied in 45 patients with an active duodenal ulcer, and in 32 healthy controls. Precise analysis of the course of gastric emptying was possible with the use of the function gamma approximation and power-exponential fitting. Unchanged lag phase followed by a small but significant acceleration of gastric emptying was found in duodenal ulcer patients as compared with healthy controls.     

Gastric emptying andHelicobacter pylori infection in duodenal ulcer disease

The pathogenetic link betweenHelicobacter pylori gastritis and duodenal ulcer is still unknown. Fast gastric emptying of liquids might be important in the pathogenesis of gastric metaplasia of the duodenum and duodenal ulcer through an increased exposure of the duodenum to gastric acid. InH. pylori-infected subjects, an abnormal gastric emptying could affect urea breath test results and correlate with the histological gastritis. This study was performed to evaluate the gastric emptying of liquids in duodenal ulcer patients withH. pylori infection and the possible relation between the bacterial load, gastric emptying, and urea breath test results. Seventeen duodenal ulcer patients withH. pylori gastritis and 15 healthy volunteers were studied by a combined [¹⁴C]octanoic acid and [¹³C]urea breath test to evaluate gastric emptying rate andH. pylori status simultaneously. Endoscopy with antral biopsies was performed in all duodenal ulcer patients. Duodenal ulcer patients withH. pylori infection have a normal liquid gastric emptying that is unrelated with the histological severity of gastritis. The urea breath test results and the gastric emptying parameters do not correlate with histology. A significant correlation between the gastric emptying and the urea hydrolysis rate is found. It is concluded thatH. pylori infection in duodenal ulcer patients is not associated with abnormally fast liquid gastric emptying, and this finding should be taken into account when a causal link betweenH. pylori infection and duodenal ulcer disease is searched for. The correlation between gastric emptying and urea hydrolysis rate explains why no conclusions on intragastric bacterial load can be drawn from the urea breath test results.This study was presented in part as an oral communication at the Annual Meeting of the American Gastroenterological Association, May 1994, New Orleans, and published in abstract form inGastroenterology 106:A160, 1994.     

Gastric emptying after different surgical procedures for duodenal ulcer

Gastric emptying has been studied in patients operated upon for duodenal ulcer by either 1) parietal cell vagotomy without or 2) with pyloroplasty, 3) truncal vagotomy combined with pyloroplasty or 4) antral resection, 5) gastric resection a.m. Billroth I or 6) Billroth II. Isotonic saline and 10% glucose solution have been used as test meals. Volumes of meal remaining 10 and 30 minutes after the instillations of the saline and the glucose meal respectively have been estimated. After parietal cell vagotomy without pylorplasty (PCV) the gastric emptying rate of 10% glucose solution was significantly faster than in unoperated duodenal ulcer patients. After all the other surgical procedures the gastric emptying rate of saline as well as of glucose solution was in turns significantly faster than after PCV. These results indicate the importance of the antrum-pyloric region for the control of gastric emptying rate of isotonic saline and hyperosmolar glucose solution.     

Gastric pepsin and acid secretion in patients with acute and healed duodenal ulcer

The relationship between gastric pepsin, acid secretion, and duodenal ulcer activity was studied in 33 patients with an endoscopically proven carter, in 17 patients who were studied within 3 mo of an acute crater but who no longer had a crater endoscopically, and in 10 patients who had no duodenal ulcer symptoms for longer than 3 mo after a crater and who had negative endoscopy. There were an additional 11 patients who had paired studies in the early-healed and late-healed stages of their disease. There were no significant differences between the values obtained in the paired and nonpaired group. Basal and pentagastrin-stimulated outputs of both pepsin and acid were significantly higher (p less than 0.001) when an acute crater was present than in 23 control subjects. At 3 mo or more after healing there was a significant (p less than 0.001) fall in both basal and stimulated pepsin and acid output which became insignificantly different from that of controls. In 104 basal studies the ratio of pepsin to acid secretion was 33,000 +/- 2500 (mean +/- SE) pepsin units/mmol H+ with no difference between any groups including controls. In 102 stimulated studies the ratio was 13,600 +/- 400 PU/mmol H+, also with no differences between any groups. Although data in the literature are conflicting, these results support a direct relationship between the activity of duodenal ulcer disease and acid-pepsin secretion.     

Gastric emptying of liquids after highly selective vagotomy for duodenal ulcer

In a group of clinical patients with duodenal ulcer submitted to highly selective vagotomy, gastric emptying studies were performed pre-operatively and 2 weeks and 6 months after surgery. A standard liquid meal labeled with radioactive technetium was used for scanning. In this group of duodenal ulcer patients, no abnormal emptying was noted prior to surgery as compared with controls. After highly selective vagotomy, the gastric emptying time for liquids was statistically shorter as compared with preoperative values. It is concluded that highly selective vagotomy may be the operative treatment of choice for duodenal ulcer patients with respect to acid secretion, but that it alters gastric motility and emptying significantly.     

Effect of age on gastric emptying of liquid-solid meals in man

A dual radioisotopic method was employed to study the rate of gastric emptying of meals in ten males with an average age of 31 years and 10 elderly males with an average age of 76.4 years. All study subjects were fed a standardized 900-g meal labeled with a liquid (111indium-DTPA) and solid (99mtechnetium-tagged liver) phase isotopic marker. There were no significant differences in solid food emptying rates between the young and aged men. A delay in liquid emptying, however, was observed in the aged men. The clinical significance of this observation is unknown.     

Gastric emptying of solids, acid secretion and tobacco in duodenal ulcer]

We study in a group of patients with endoscopically diagnosed duodenal ulcer (19; 17 males) and controls (11; 7 males) the gastric emptying of solids through scintigraphy and gastric acid secretion by standard tests. In the same way we investigated prospectively some clinical data, specially smoking habits. As a whole, patients with duodenal ulcer showed an emptying of solids slightly faster than controls (T 1/2-minutes-: 85.4 +/- 28.6 in patients with duodenal ulcer versus 116.9 +/- 46.5 in controls, p less than 0.03). However, most of our patients (15 of 19 or 79%) were found to have a normal emptying rate. No correlation was found between secretory outputs and gastric emptying. Smokers with duodenal ulcer had a faster emptying that non-smokers with duodenal ulcer (T 1/2 74.8 +/- 30.05 vs. 99.91 +/- 19.86; p = 0.05).     

Gastric acid secretion and gastric emptying of liquids in 99 male duodenal ulcer patients

Gastric acid hypersecretion and accelerated gastric emptying are commonly considered as possible determinants of duodenal ulcer, but the relative frequencies of these gastric dysfunctions have never been evaluated in a homogeneous group of patients. We studied basal and pentagastrin-stimulated gastric acid secretion and gastric emptying of a radiolabeled caloric liquid meal in 99 consecutive male patients with endoscopically proven, active, uncomplicated duodenal ulcers. Compared to matched healthy subjects, ulcer patients presented increased basal and stimulated acid secretion (P<0.001).Sixty-nine patients had peak acid output values above the 95% confidence limits of the control population (14.2–30.6 meq/hr).Cigarette smoking was correlated with gastric acid hypersecretion. No significant difference was found between duodenal ulcer patients and controls in mean gastric emptying times. Ulcer patients showed a greater variance of gastric acid secretion and emptying values than healthy subjects. This reflects varied gastrointestinal function among ulcer patients. No significant correlation was found between gastric acid output and gastric emptying times. These findings suggest that gastric acid hypersecretion, but not accelerated gastric emptying of liquids, play a relevant role in the pathogenesis of duodenal ulcer.     

Gastric and duodenal ulcer

Die Wirkungen von Benzedrin und Pervitin auf die physische und psychische Leistungsfähigkeit sind in Versuchen an etwa 1400 jungen, gesunden, hochgradig ermüdeten Versuchspersonen, die in bis zu 3-tägigen Übungen ohne Schlaf ermüdet worden waren, studiert worden. Die Ergebnisse sind in den Zusammenfassungen der einzelnen Kapitel vorgelegt: I. Die Einwirkung von Benzedrin und Pervitin auf die körperliche Leistungsfähigkeit. II. Die Einwirkung von Benzedrin und Pervitin auf die psychische Leistungsfähigkeit (Bourdontests, Rechenaufgaben). Ein Beitrag zur Frage der Bedeutung des Ermüdungsgrades (und des Tagesrhytmus) für die Wirkung (Dosierung) des Benzedrins. III. Die Einwirkung von Benzedrin auf die Treffsicherheit ermüdeter Schützen beim Scheibenschiessen.     

Rapid gastric emptying in duodenal ulcer patients

Isosmotic liquid peptone meals adjusted to pH 7, 3, and 1.5 were instilled on separate days into the stomachs of 8 duodenal ulcer patients and 7 healthy controls. Using a marker-dilution method, duodenal acid load (DAL) was measured as the amount of unbuffered hydrogen ions delivered to the duodenum per unit time. Gastric emptying was measured as the total volume of gastric contents, including meal plus gastric secretion, passing through the pylorus per unit time (VPP). Mean pentagastrin-stimulated acid output was not significantly different between the two groups. However, after all three test meals, mean DAL was significantly greater in duodenal ulcer than in normal subjects in both hours of the test, and VPP was significantly greater in ulcer than in normal subjects in the first 40 min. In both groups, following peptone meals of pH 7 and 3, the volume of gastric contents delivered through the pylorus decreased as the amount of free hydrogen ions entering the duodenum increased, but a given load of acid was less effective in slowing emptying in duodenal ulcer patients than in controls. These studies indicate that duodenal ulcer patients empty liquid meals more rapidly than do normal subjects, independent of the initial pH of the meals, and that, in addition, acid inhibition of gastric emptying is defective in duodenal ulcer.Dr. Grossman died May 26, 1981.S. K. Lam was a visiting scientist from the Department of Medicine, University of Hong Kong. Queen Mary Hospital, Hong Kong. M.I. Grossman holds a Veterans Administration Senior Medical Investigatorship.These studies were supported by National Institutes of Arthritis, Metabolism and Digestive Diseases grant AM 17328 to the Center for Ulcer Research and Education and by Veterans Administration Research Funds.This work was presented in part in abstract form at the 80th Annual Meeting of the American Gastroenterological Association, New Orleans, Louisiana, May 19–25, 1979.     

Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [su99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H₂ antagonists or antacids during 1–18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T 1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.     

Gastric emptying in control subjects and patients with duodenal ulcer before and after vagotomy.

The emptying of a solid meal labelled with Indium 113mDTPA from the stomach was studied with a gamma camera in 26 normal subjects, 27 patients with duodenal ulcer, on 41 occasions after truncal vagotomy and pyloroplasty and 38 times after highly selective vagotomy. Applying the method of principal component analysis to the results, differences were detected between control and duodenal ulcer subjects and two probable subgroups of duodenal ulcer were observed. Half emptying times did not reveal these patterns. After vagotomy, delayed emptying was general at one week. At one month, patients after highly selective vagotomy had a more normal result than those with truncal vagotomy and pyloroplasty (TV), but by six months no significant difference in overall emptying rate was found, although changes in the pattern of gastric emptying persisted in some patients after TV.     

Is gastric emptying abnormal in duodenal ulcer?

To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.