Kemal Akdamar

Upper gastrointestinal endoscopy in normal asymptomatic volunteers

In a prospective study, 355 healthy, asymptomatic, male volunteers, 18 to 45 years of age, were screened by esophagogastroduodenoscopy before admission to clinical trials. One hundred thirty-four volunteers (38%) showed abnormal endoscopic findings. Some volunteers had more than one site of involvement or more than one grade of lesion in each anatomic location. In 49 (14%) of these subjects the esophagus was a site of involvement, while in 86 (24%) the stomach was involved, and in 71 (20%) the duodenum was involved. The point prevalences in these asymptomatic subjects were 8.5% for erosive esophagitis, 12% for erosive gastritis, 10% for erosive duodenitis, 2% for gastric ulcer, and 2% for duodenal ulcer.

UPPER GASTROINTESTINAL LESIONS AFTER POTASSIUM CHLORIDE SUPPLEMENTS: A CONTROLLED CLINICAL TRIAL

The effects of a new microencapsulated potassium chloride formulation on upper gastrointestinal tract mucosa was compared with that of a popular wax-matrix formulation in 48 healthy volunteers. After a week of KCl, subjects were gastroscoped, the endoscopist being blind to the type of preparation taken. Wax-matrix formulations were associated with a higher incidence of upper gastrointestinal lesions. The lesions were not accompanied by epigastric symptoms. Glycopyrrolate, given to some volunteers to decrease gastric emptying, aggravated the effects of potassium chloride.

Congenital dilation of the intrahepatic bile ducts

Abstract Five additional patients with congenital dilation of the intrahepatic bile ducts are described. This disorder is still generally unrecognized but may be the explanation for certain unusual cases, associated with intrahepatic stones.

Healing of Benign Gastric Ulcer: Comparison of Cimetidine and Placebo in the United States

Recently the Food and Drug Administration approved cimetidine for the treatment of benign gastric ulcer. Approval was based in part on the results of our large multicenter trial involving 172 patients with benign gastric ulcer between 0.5 and 2.5 cm in diameter: 87 were randomly assigned to receive cimetidine (300 mg four times daily) and 85 to receive placebo. Cimetidine treatment resulted in significantly more rapid healing than placebo; after 2 and 6 weeks of therapy, 10.0% and 44.8% of patients receiving placebo were healed, as compared to 22.6% and 65.1% receiving cimetidine. The results of our study were compared with the time-response curve previously published (0, 4, and 8 weeks of therapy). The combined data yielded linear healing rates for the first 8 weeks of therapy (r greater than 0.99 for both cimetidine and placebo). These studies can be used to define expectations for healing of benign gastric ulcer, and we recommend follow-up intervals of 8 and, if unhealed, 16 weeks.

The liver in secondary syphilis.

Liver involvement is uncommon in secondary syphilis and may resemble liver disease from alcoholism or acute viral hepatitis. Liver biopsy usually indicates nonspecific reactive hepatitis with or without cholestasis. Jaundice may sometimes be absent although liver damage is present. The liver abnormalities can be resolved with antibiotic therapy, but penicillin therapy may cause Jarisch-Herxheimer reaction. Syphilitic hepatitis should be considered in the differential diagnosis of obscure liver disease.

Effect of potassium chloride supplements on upper gastrointestinal mucosa

Eight controlled 1‐ or 2‐wk experiments involving 225 healthy male subjects and one study of 18 patients with hypertension, nine of whom were long‐term users of a wax‐matrix potassium chloride preparation, were conducted to evaluate the upper gastrointestinal safety of oral KCl supplements. All subjects in the short‐term studies had normal upper gastrointestinal tracts. Subjects were examined again after at least 7 days of treatment with one of three commonly prescribed wax‐matrix KCl tablets, KCl liquid, microencapsulated KCl, a potassium‐sparer, or placebo. Some received an anticholinergic drug with treatment to induce delayed gastric motility. Diet and compliance to treatment regimens were controlled. Results indicate that upper mucosal injury, particularly erosions (43%) and ulcerations (11%), were more frequent after wax‐matrix tablets. These changes occurred much less frequently after liquid KCl (0%), microencapsulated KCl (10.5% erosions, 1.2% ulcers), and the potassium‐sparing drug (0%). More serious and more frequent lesions were associated with slowed motility. No occult bleeding was noted. Symptomatic complaints did not correlate with endoscopic findings. In the long‐term study, patients with hypertension were examined endoscopically after 19 to 23 mo on KCl and again after 1 wk. Six of nine of the patients with hypertension treated for nearly 2 yr with a wax‐matrix KCl supplement had significant lesions. One had developed ulceration after 7 days. The incidence of lesions was lower in a carefully matched group of controls who received only placebo (erosions in three of nine; none had or developed ulcers). Incidence of upper mucosal injury with wax‐matrix tablets is higher than with other liquid or microencapsulated forms of KCl or with a potassium‐sparing drug.

Effects of somatostatin and a somatostatin agonist on diet-induced pancreatitis in mice

We examined the effects of somatostatin-14 and the potent somatostatin agonist (N-acetyl-[Des(Ala1,Gly2),p-Cl-Phe6,D-Trp8]-somatostatin amide) on choline deficient, ethionine enriched diet (CDED)-induced acute pancreatitis in mice. Serum amylase determinations were performed, and specimens from the pancreas were examined by light and electron microscopy. No significant beneficial effects of somatostatin or its agonist were found in this model of acute pancreatitis.

Luminal gastric somatostatin-like immunoreactivity in response to various stimuli in man

This study investigates release of somatostatin-like immunoreactivity (SLI) into the gastric lumen of five healthy human subjects in response to pharmacological stimuli (pentagastrin and secretin) and physiological stimuli (sham feeding and intrajejunal perfusion of elemental diet). Basal and poststimulation gastric juice aspirates were collected at 15-min intervals, extracted with acetone, and SLI determined by radioimmunoassay, with these results: (1) A considerable amount of SLI was secreted during the basal period. (2) Pentagastrin stimulated SLI release quickly and was associated with increased acid secretion. (3) Both secretin and sham feeding increased SLI only slightly. (4) During intrajejunal perfusion of the elemental diet, SLI increased significantly, was associated with decreased acid secretion, and rapidly returned to basal level when elemental diet was replaced by saline. Basal levels of gastric luminal SLI thus showed distinct changes in response to each stimulus. Although the physiological action of luminal SLI remains to be studied, its levels may reflect gastric D-cell activities.

Somatostatin in human pancreatic and gastric juice.

Considerable amounts of IRS are secreted after secretin injection in human pancreatic juice collected during endoscopic retrograde cholangiopancreatography. The mean IRS levels in the pancreatic juice of non-diabetic patients were 79 +/- 10 (SE) pg/ml. The IRS levels in NIDDM were considerably higher, the mean value being 1635 +/- 313 (SE) pg/ml. The mean IRS level in IDDM were 312 +/- 151 (SE) pg/ml. In IDDM, those patients whose blood glucose levels were well controlled by insulin showed low pancreatic juice IRS ranging from non-detectable to 46 pg/ml. On the other hand, those with uncontrolled hyperglycemia showed IRS levels ranging form 452 to 1047 pg/ml. Gel-filtration profiles of IRS in pancreatic juice extracts were not consistent in all cases. Some showed IRS peaks eluting with SS14 and SS28, while others contained IRS species that were eluted in more retarded fractions. The retarded IRS fraction exhibited biological activity indistinguishable from that of SS14 as indexed using a quantitative cytochemical method.

Pancreatic immunoreactive somatostatin and diabetes mellitus

Pancreatic secretions were collected during endoscopic retrograde cholangiopancreatography from 15 subjects without pancreatic, biliary, or hepatic diseases, 11 patients with non-insulin-dependent diabetes, and 11 patients with insulin-dependent diabetes. Pancreatic secretion was stimulated by the intravenous administration of one unit of secretin per kilogram of body weight. Immunoreactive somatostatin (IRS) in the pancreatic juice of the nondiabetic subjects ranged from 43 to 97 pg/ml, in non-insulin-dependent diabetics from 5 to 3872, and in the insulin-dependent diabetics from 0 to 2093. IRS in insulin-dependent diabetics under good plasma glucose control ranged from 0 to 281 pg/ml, compared to those under poor control who ranged from 518 to 2093 pg/ml. These results indicate that IRS in pancreatic juice is higher in poorly controlled insulin-dependent diabetics than in well controlled insulin-dependent diabetics and nondiabetics. Whether these changes in IRS are purely secondary phenomena or play some pathogenetic role in the disturbed metabolism of diabetes remains to be proven. The chromatographic profile of IRS in pancreatic juice on both gel filtration and high-performance liquid chromatography has indicated that these IRS moieties represent somatostatin 14 and somatostatin 28.