Gabriella Bonora

Interdigestive gastroduodenal motility and serum motilin levels in patients with idiopathic delay in gastric emptying

The interdigestive gastroduodenal motor activity and serum motilin levels were studied in 22 dyspeptic patients with markedly delayed gastric emptying not due to diseases known to impair gastroduodenal motility and in 7 control subjects with normal gastric emptying. Motor activity was recorded using a manometric probe positioned in the gastric antrum and in the proximal duodenum, and blood samples for radioimmunoassay of motilin were taken every 15 min during the recording period. The control subjects showed gastroduodenal activity fronts of the migrating motor complex associated with motilin peaks. Almost all patients with delayed gastric emptying showed no activity fronts in the stomach, and only half of them showed activity fronts starting in the duodenum. In these patients a significant reduction in the number of motilin peaks and in the integrated motilin output during the identified peaks was also observed. The results of this study indicate that most dyspeptic patients with idiopathic delay in gastric emptying may also have an alteration in interdigestive gastroduodenal motility, mainly characterized by a lack of gastric activity fronts, associated with an impaired motilin release.

Composite Gastric Carcinoma and Precursor Lesions with Amphicrine Features in Chronic Atrophic Gastritis

A composite carcinoma of the gastric body consisting of endocrine and mucous epithelial cells with interspersed amphicrine cells is reported together with ultrastructural and immunocytochemical documentation of endocrine and nonendocrine differentiation. The tumor was associated with hypergastrinemia related to chronic atrophic gastritis (achlorhydria) and with multiple proliferative lesions, such as intramucosal microcarcinoid (IMC) and endocrine cell proliferations of the micronodular and linear type, which are currently regarded as carcinoid precursor changes. Ultrastructurally, a composite architecture with amphicrine features was demonstrated in the primary tumor, IMC, and liver metastases. On the other hand, the endocrine cell proliferations exclusively contained gastrin and enterochromaffinlike cells. Immunostaining with antibodies to calcitonin documented a number of positive cells both in the primary and in the metastatic sites. This is the first report of mixed exocrine-endocrine-amphicrine components both in a metastasizing carcinoma and in its precursor lesions in a chronic hypergastrinemic state. Unlike previously reported lesions, the endocrine component was unexpectedly composed of calcitonin cells, which are not usually present in the gastric mucosa.

Influence of Gastric Acid Secretion on Interdigestive Gastric Motor Activity and Serum Motilin in the Elderly

The purpose of this study is to investigate the influence of gastric secretion on the interdigestive gastric motor activity and related serum motilin variations in elderly subjects. The study was carried out on two groups of elderly subjects: one with achlorhydria or marked hypochlorhydria due to chronic atrophic gastritis and the other with normal acid secretion. A group of nonelderly subjects with normal acid secretion was also examined as control. Gastric motility was studied manometrically and serum motilin was measured by radioimmunoassay on blood samples taken every 15 min during the entire motor recording period of 200-300 min. Both groups of elderly subjects showed (1) alterations in interdigestive gastric motility and (2) serum motilin which was steadily high without the normal cyclic fluctuations. These studies suggest that the alterations in gastric motor activity and serum motilin in aged subjects are not related to the acid secretory capacity of the stomach. Other factors, such as alterations in the neurohormonal control system of gut motility, should be considered in the genesis of these age-related disorders.

Secretin-stimulated trypsin-like immunoreactivity in alcoholics.

Serum trypsin-like immunoreactivity (TLI) was studied in alcoholics without evidence of pancreatic disease and in controls. Basal values were 29 +/- 4.6 microgram/l (mean +/- S.E.M) in alcoholics and 23 +/- 4.4 microgram/l in controls (p not significant). The injection of secretin was followed by a significant increase of serum TLI in both groups; the integrated trypsin output (ITO) in the first hour after secretin administration was 947 +/- 403 (mean +/- S.E.M.) in alcoholics and 76 +/- 15 in controls (p less than 0.05). In 9 (75%) of the alcoholics tested, ITO was higher than the highest ITO of controls. The increase of serum TLI after injection of secretin is probably due to secretion and/or regurgitation of trypsinogen into the bloodstream when the pancreas is stimulated with intravenous secretin. In the light of experimental studies on chronic ethanol intoxication in animals, the increased ITO observed in alcoholics may suggest obstruction to pancreatic secretory flow in spite of the absence of any clinical sign of pancreatic disease.

Effect of Secretin on Serum Trypsin-Like Immunoreactivity in Alcoholics

Serum trypsin-like immunoreactivity (TLI) was studied with a newly developed radioimmunoassay in human subjects. The intravenous administration of secretin was followed by an evident increase of serum TLI significantly greater in alcoholics as compared to controls.

Gastric argyrophil carcinoid and parathyroid adenoma: an unusual endocrine neoplasm association

Objective: Description of a patient who developed a gastric argyrophil carcinoid tumour, against a background of marked achlorhydria-related hypergastrinaemia, and who went on to develop a parathyroid adenoma 2 years later. Design: A single patient case report and review of the literature. Setting: Department of Medicine and Pathology at a University Hospital. Intervention: Surgical therapy. Conclusion: Parathyroid glands should be examined in all patients with gastric argyrophil carcinoid and, conversely, gastric status should be established in patients with hyperparathyroidism.

Antral gastrin cell hyperfunction in children

Objective: A description of the clinical history, diagnosis and management of a child with antral gastrin cell hyperfunction. Design: Detailed studies of hormonal, endoscopic and morphologic patterns. Setting: Gastrointestinal endocrinology section of a university hospital. Patient: A 14-year-old boy who complained of two episodes of acute upper gastrointestinal bleeding due to duodenal ulcer. Interventions and outcome measures: H2-antagonist therapy. Conclusions: Antral gastrin cell hyperfunction can be an underlying cause of peptic ulcer in children. The diagnosis is made by basal and protein meal-stimulated serum gastrin levels. Long-term H2-antagonist treatment is suggested.

Radioimmunoassay of secretin in human serum

A sensitive radioimmunoassay for secretin has been developed. Antisera were raised against synthetic porcine secretin coupled to bovine serum albumin. N-alpha- desaminotyrosyl -beta-alanyl secretin was radioiodinated by a slight modification of the chloramine-T method. Pure synthetic porcine secretin was used as a standard. Free and bound hormone were separated by dextran-coated charcoal. No cross-reactivity was found with structurally and physiologically related peptides. The sensitivity of the assay was high enough to measure fasting secretin levels in human serum. Patients with acute or chronic pancreatitis had mean serum secretin concentration not significantly different from healthy subjects. In patients with pancreatic carcinoma the mean serum secretin concentration was significantly lower than in healthy subjects, although a wide overlap of the two groups was evident.