Duodenogastric reflux in patients with gastric ulcer disease

We studied reflux of duodenal contents into the stomach in patients with gastric ulcers, patients with duodenal ulcers, and normal subjects. Duodenogastric reflux was assessed in the fasting state and after cholecystokinin octapeptide administration (0.02 micrograms/kg intravenously). Slight reflux was observed in the fasting state in all three groups. However, after cholecystokinin octapeptide administration, reflux was significantly greater in gastric ulcer patients than in control patients for pancreatic phospholipase A2 (p less than 0.01) and lysophosphatidylcholine (p less than 0.001). Also in gastric ulcer patients, the gastric contents were significantly more alkaline (pH 5.26 +/- 0.58, p less than 0.001) during duodenogastric reflux than in normal subjects (pH 3.65 +/- 0.50) or duodenal ulcer patients (pH 2.67 +/- 0.63). Our results suggest that reflux of both pancreatic and biliary secretions might contribute to the gastric mucosal injury in gastric ulcer patients and we postulate that pancreatic phospholipase A2 might have a greater role in this process than has been previously acknowledged.     

Sucralfate: the agent of choice in the treatment of peptic ulcer?

As many as 72 patients with erosive and ulcerous injuries to the stomach and duodenum were examined for the clinical efficacy of antepsin (sucralfate). Of these patients, 42 were with duodenal ulcer, 10 with gastric ulcer and 20 with erosive gastroduodenitis). Antepsin exerted a beneficial effect on the painful syndrome and on ulcer and erosion healing. The coefficient of the therapeutic efficacy of antepsin in duodenal ulcer patients turned out to be equal to 2.67 that of gastric ulcer to 2.1 and that in patients with gastroduodenitis was 2.6. The drug did not produce any well-defined side effects. In some cases (8.3%), it caused the appearance or enhancement of constipation. Antepsin is indicated not only in ulcer disease but also in duodenogastric reflux, reflux gastritis and reflux esophagitis.     

Evaluation of the intensity of the duodenogastric reflux based on the alkaline phosphatase and trypsin activities in the stomach contents]

Alkaline phosphatase and trypsin activities were measured in the gastric contents of patients with chronic gastritis with visually fixed duodenogastric reflux and without reflux. The authors discuss the advantages of a comparative approach to the enzymatic assessment of duodenogastric reflux presence, intensity, and length.     

Therapeutic complex in therapy of patients with complicated course of pylorobulbar ulcers

Combined treatment of pylorobulbar ulcers associated with duodenogastric reflux incorporated surgery, antiinflammatory and antisecretory therapy. The treatment provides preventing ulcer recurrence, gastric mucosa affection caused by duodenogastric reflux and infection Helicobacter pylori. Finally, this led to improved quality of life.     

A comparative assessment of gastric secretory function using a probe method and intragastric Ph-metry

To compare informative value of probing and intragastric pH-metry, relevant examination was performed in 130 patients with chronic gastritis, 132 patients with noncomplicated peptic ulcer and 50 healthy subjects. pH values obtained with probing and intragastric pH-metry did not differ significantly in defects of gastric mucosa, superficial gastritis, peptic ulcer. In apparent atrophic gastritis intragastric pH-metry detected minimal secretion of H ions in all the patients, whereas probing failed to show it. Intragastric pH-metry is useful in recognizing duodenogastric reflux and decompensated acid stomach as shown by antral basal pH (below 2.0).     

Motor and secretion function of stomach and duodenum, duodenogastric reflux in patients with duodenal ulcer

Gastric secretion, motor function and tonicity of the stomach and duodenum, duodenogastric reflux were studied in inpatients with two clinicopathogenetic types of duodenal ulcer: observed at young age (type 1) and in later life (type 2). The examination included pH-metry with simultaneous balloon cimography, chromogastroduodenoscopy with Kongo-red, tests for Helicobacter pylori conducted on the biopsy samples. All the patients were found to have continuous acid production. High acid production was more frequently registered in males with the disease type 1, the lowest production was in females with the disease type 2. Duration of the acid inflow into the duodenum in patients with the disease type 2 was greater than that in young subjects. Mild ulcer was associated with moderate acidity in the duodenum, in severe ulcer the acidity was very high. Males with the disease 1 and 2 and females with type 2 had hyperkinetic, hypertonic gastric motor function. In duodenal ulcer prevalent is hypertonic, hyperkinetic type of duodenal motor function being most frequent among males with the disease type 2. Duodenogastric reflux occurs more often in patients with intensive acid production associated with hypotonic, hypokinetic motor type and duodenal tone.     

Gastroduodenal reflex in duodenal ulcer and chronic hyperacidic gastritis

AIM: To study motor and secretory function of the stomach and duodenum in duodenal ulcer (DU) and chronic hyperacidic gastritis (CHG). MATERIAL AND METHODS: Autonomic nervous system was studied and esophagogastroduodenoscopy, 24-h intragastric pH-metry were made in 42 DU and 20 CHG patients. RESULTS: In comparable secretion, the patients of the above groups differed by severity and frequency of duodenogastric reflux (DGR). Grave and moderate DGR was typical for CHG and DU in the absence of complications. Minimal DGR occurred in DU with complications. CONCLUSION: DGR severity may be of prognostic significance for DU course.     

Quantitative-qualitative assessment of duodenogastric reflux at 24-h pH-metry

AIM: To study characteristics (other than duration) of duodenogastric reflux (DGR), correlations of secretory function and DGR characteristics with gastroduodenal disorders (ulcer, chronic hyperacid gastritis). MATERIAL AND METHODS: A total of 110 patients were examined with 24-h pH-metry: 68 patients with duodenal ulcer (DU), 15 patients with gastric ulcer (GU), 27 patients with chronic hyperacid gastritis (CHG). Mean levels of pH and duration of hyperacidity in the body and an antral part of the stomach, duration of DGR, pH in the body and antral part of the stomach depending on DGR severity were studied. RESULTS: DGR was registered almost in all the patients with DU, GU and CHG. Groups of the patients differed by duration and height" of the DGR. CONCLUSION: Patients with DU are characterized by low refluxes which do not reach gastric body.     

Ultrasonic diagnosis of duodenogastric reflux

A method of ultrasound diagnosis of duodenogastric reflux was developed. It enables the reflux identification with a high accuracy. It is suggested that 3 grades of the intensity of echographically recordable duodenogastric reflux may be distinguished. The method enables an individual estimation of the action efficacy and the choice of an adequate dose of pharmacological agents, particularly metoclopramide, for the treatment of duodenogastric reflux.     

Chronotherapy approaches in the treatment of gastroduodenal ulcer

Each patient with ulcer has his/her own 24-h biorhythm of acid production, features of food alkalization, duration of duodenogastric and gastroesophageal reflux. Pharmacological test conducted in prolonged 24-h pH-metry helps to select the most effective antisecretory drug, while analysis of 24-h biorhythm of acid production--optimal time for drug intake and number of its daily doses.     

Painful syndrome in patients with ulcer disease in relation to intragastric pH

Painful abdominal syndrome and diurnal fluctuations of pH values were investigated in 125 patients with different clinical variants of duodenal ulcer disease (DUD) in the phase of exacerbation. Fifty patients had uncomplicated DUD; it was complicated in the remaining 75 patients. The clinical course of the uncomplicated disease was characterized by moderate to severe painful hyperacidity syndrome coincident with the period of exacerbation, marked daily variations of pH, and manifest duodenogastric reflux (DGR). These made the patients opportunely apply for medical aid while acidification and alkalinization processes in the stomach prevented the development of complications. The complicated disease was associated with short-term pain or its absence, monotonic diurnal variations of acid production and alkalinization, weak DGR. Taken together, these clinical features explain why such patients less frequently apply for medical aid and eventually develop destructive complications.     

Specific features of ulcer disease in sailors of the North Sea basin]

The course of ulcer disease (UD) in sailors of the North seas was analysed and compared to that in non-sailors. UD in sailors runs with less pronounced subjective symptoms, manifests at younger age, is frequently accompanied by duodenal mucosa erosions and duodenogastric reflux. The greatest number of UD exacerbations was observed in the first month in sea and two months after getting home. Because of the fear to lose the job the sailors often do not seek medical assistance in spite of ulcer symptoms and this results in many cases of late diagnosis.     

Mucosal protective effects of ecabet sodium: pepsin inhibition and interaction with mucus

Pepsin, acid and Helicobacter pylori are major factors in the pathophysiology of peptic ulcer disease and reflux oesophagitis. Ecabet sodium reduces the survival of H. pylori in the stomach and inhibits pepsin activity in the gastric juice of experimental animals. Here we have investigated the effects of ecabet sodium on some of the factors involved in the dynamics of the mucosal barrier, i.e. pepsins and mucins. This study used gastric juice obtained from 12 non-symptomatic volunteers and nine patients with reflux oesophagitis. Ecabet sodium significantly inhibited pepsin activity in human gastric juice, with a maximum inhibition of 78%. Pepsin 1, the ulcer-associated pepsin, was inhibited to the greatest extent. The ability of gastric juice to digest mucin was significantly inhibited by ecabet. As with gastric juice proteolytic activity, the inhibitory effect of ecabet on mucolysis was greater in gastric juice from patients with reflux oesophagitis than in that from controls. Ecabet sodium showed a positive interaction with gastric mucin, as assessed by an increase in viscosity. Thus ecabet sodium may reduce the aggressive potential of gastric juice towards the mucosa, which may be relevant in the treatment of reflux oesophagitis and peptic ulcer disease. In addition, it may strengthen the mucus barrier in peptic ulcer disease and gastritis.     

Quantification of gastric emptying and duodenogastric reflux stroke volumes using three-dimensional guided digital color Doppler imaging.

OBJECTIVE: To develop a non-invasive method for evaluating gastric emptying and duodenogastric reflux stroke volumes using three-dimensional (3D) guided digital color Doppler imaging. METHODS: The technique involved color Doppler digital images of transpyloric flow in which the 3D position and orientation of the images were known by using a magnetic location system. RESULTS: In vitro, the system was found to slightly underestimate the reference flow (by average 8.8%). In vivo (five volunteers), stroke volume of gastric emptying episodes lasted on average only 0.69 s with a volume on average of 4.3 ml (range 1.1-7.4 ml), and duodenogastric reflux episodes on average 1.4 s with a volume of 8.3 ml (range 1.3-14.1 ml). CONCLUSION: With the appropriate instrument settings, orientation determined color Doppler can be used for stroke volume quantification of gastric emptying and duodenogastric reflux episodes.     

Quality of life and vegetative status of patients with ulcer disease

AIM: To analyse features of vegetative status of patients with ulcer disease (UD) with reference to quality of life (QL), course of UD, clinical and secretory-motor characteristics. MATERIAL AND METHODS: A total of 200 UD patients were examined. UD was at the stage of exacerbation, new-onset, with a favourable or unfavourable course. The vegetative status was studied by parameters of Kerdo index, variation pulsometry, vegetative crises, insomnia. Quality of life (QL) was assessed by a medicosocial questionnaire. The patients were divided into two groups: with satisfactory and unsatisfactory QL. 120 patients had 24-h pH-metry. RESULTS: Among patients with normal QL normotonics and vagotonics prevailed. Low QL was seen in sympathicotonics. Sleep disorders and vegetative crises were in patients with vegetative imbalance, especially in combination with unsatisfactory QL. The worst QL was associated with sympathicotony. Vegetative balance was observed in a favourable UD course, moderate in time duodenogastric reflux (DGR). Sympathicotony runs with marked DGR, vasotony--minimal DGR, scare symptoms. CONCLUSION: Vegetative dysfunction in UD is due to permanent or paroxysmal vegetative disorders. Sympathicotony is accompanied with dyskinetic pain syndrome and longer duodenogastric reflux which is tolerated bad. Vegetative dystonia is more often in unfavorable course of UD.     

胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用

目的探讨胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用。方法采用病理组织学检查和快速尿素酶试验对76例胆汁反流性胃炎及22例兼有胆汁反流性胃炎和消化性溃疡的患者行幽门螺杆菌检测,并与29例消化性溃疡患者作对照。结果胆汁反流性胃炎组幽门螺杆菌阳性率为31.6%(24/76例),兼有胆汁反流性胃炎和消化性溃疡组幽门螺杆菌阳性率为59.0%(13/22例),消化性溃疡组幽门螺杆菌阳性率为72.4%(21/29例),前二组比较,差异有显著意义(P<0.05),后二组比较,差异无显著意义(P>0.05)。结论胆汁反流在胆汁反流性胃炎的发病中起主要作用,幽门螺杆菌感染在消化性溃疡的发病中起主要作用。胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡的共同发病中互不明显影响,幽门螺杆菌感染所起的作用可能更大一些。     

Gastric acidity and duodenogastric reflux during nasojejunal tube feeding in mechanically ventilated patients

Objective: In order to prevent gastric microbial overgrowth, which may complicate nasogastric feeding, administration of nutrients more distally into the gut has been advocated in intensive care patients, as it offers the advantage of keeping the stomach empty and acid. In this study, we assessed the impact of jejunal feeding upon gastic pH in a group of mechanically ventilated, critically ill patients, with special focus on duodenogastric reflux as a possible cause of gastric alkalinization during jejunal nutrition. Design: Prospective experimental study. Setting: Multidisciplinary intensive care unit of a university hospital. Patients and methods: Gastric pH was recorded by continuous pHmetry over a 4-h period of fasting followed by a 4-h period of nasojejunal feeding at 100 kcal/h in 21 mechanically ventilated, critically ill patients. To determine the contribution of duodenogastric reflux to modifications of gastric acidity, the diet was traced with [¹¹¹In] DTPA (pentetic acid) in 11 of these 21 patients; gastric contents were aspirated every 30 min, then analysed for measurement of radioactivity, glucose, and bile acid concentration. Measurements and results: Median intragastric pH increased slightly from 1.59 (1.20–2.73; interquartile range) (fasting) to 2.33 (1.65–4.64) (feeding) (p = 0.013), and the length of time that the pH was 4 or above increased from 1 (0–24) to 9 (0–142) min (p = 0.026). The variability of pH values and the number of acute alkalinization episodes did not change between the two phases. In 10 of 11 patients in which the diet was labeled with [¹¹¹In] DTPA, reflux was documented at a given time of the feeding period. Bile acid concentrations in the stomach increased from 392 (61–1076) (fasting) to 1446 (320–2770) μmol/l (feeding) (p = 0.010) and mean glucose concentration increased from 59 (28–95) to 164 (104–449) mg/dl (p = 0.006). Conclusion: Duodenogastric reflux is common in mechanically ventilated critically ill patients with nasojejunal feeding tubes. It occurs both during fasting and during nasojejunal feeding. During nasojejunal feeding, moderate alkalinization of the gastric contents occurs as a result of bile and nutrient reflux. Received: 24 August 1998 Accepted: 18 February 1999     

Reverse diffusion of hydrogen ions and its correlation with acid secretion and proliferative activity of gastric mucosal epithelium in patients with variants of chronic gastritis and peptic ulcer

Eighty-one patients with chronic gastritis and 124 patients with peptic ulcer were examined. It was discovered that in chronic gastritis, the concomitant gastritis included, in patients with peptic ulcer, the degree of enhancement of reverse diffusion of hydrogen ions depended on the intensity of atrophy of the fundal and antral mucosa as well as on the extent of gastric lesions. The duodenogastral reflux promoted the increase of reverse diffusion of hydrogen ions. In mediogastral ulcer site, reverse diffusion of hydrogen ions was, at the height of exacerbation, enhanced to a greater degree than in the stage of ulcer healing. In atrophic variants of chronic gastritis and in peptic ulcer patients with an ulcer sited in the stomach, a close positive correlation was noted between reverse diffusion of hydrogen ions and proliferative activity of the gastric mucosa epithelium and a negative correlation between the diffusion and hydrochloric acid secretion. In patients with peptic ulcer of the duodenum without gastritis or the duodenogastral reflux, the characteristics of reverse diffusion of hydrogen ions did not differ from those seen in normal subjects.     

替普瑞酮对十二指肠胃反流致胃黏膜损伤的保护作用

目的：观察替普瑞酮对实验性十二指肠胃反流（duodenogastric reflux．DGR）致大鼠胃黏膜损伤的保护作用。方法：将SD大鼠分为空白对照组、DGR组和替普瑞酮干预组，手术建立大鼠DGR模型。其中DGR组每日给予生理盐水灌胃．替普瑞酮干预组每日予替普瑞酮（200mg/kg体重）灌胃。8周后对大鼠胃标本进行病理学检查，观察胃黏膜溃疡指数（ulcer index，UI）和胃黏液凝胶层厚度，测定胃黏膜氨基己糖、磷脂的含量。放射免疫法检测胃黏膜前列腺素E2（PGE2）水平。结果：替普瑞酮干预组胃黏膜病理改变和胃黏膜UI明显低于DGR组（P〈0．05），且胃黏液凝胶层厚度、胃黏膜氨基己糖、磷脂和PGE，含量均显著高于DGR组（P〈0．05或P〈0．0者）；但替普瑞酮干预组胃黏膜UI仍高于空白对照组，其余各指标仍低于空白对照组（P〈0．01）。结论：替普瑞酮对DGR所致胃黏膜损伤具有保护作用。     

长期使用质子泵抑制剂对肠道菌群的影响

目的观察胃食管反流病和消化性溃疡患者长期使用质子泵抑制剂治疗后肠道菌群变化。方法选取胃食管反流病及消化性溃疡患者60例（观察组）,口服奥美拉唑,20mg,每日2次,疗程8周;选取健康志愿者20例（对照组）;利用实时荧光定量聚合酶链反应（PCR）检测观察组患者服药前、服药后4周、8周及对照组健康者清晨粪便中大肠杆菌、肠球菌属、双歧杆菌属及乳酸杆菌属数量,并对各目标菌群数量进行比较分析。结果与对照组相比,观察组患者服药前及服药后4周粪便中4种目标菌群无明显变化（P〉0.05）,服药后8周,粪便中大肠杆菌（4.81±0.77）lonN/g及肠球菌属（5.24±0.63）lonN/g仍无显著变化（P〉0.05）,但双歧杆菌属（8.82±0.91）lonN/g及乳酸杆菌属（6.99±0.69）lonN/g明显减少（P〈0.05）。结论长期服用质子泵抑制剂后可致肠道双歧杆菌属及乳酸杆菌属数量明显下降,使肠道生物屏障受损,增加了肠源性感染风险。