Michinaga Takahashi

Intragastric capsaicin stimulates colonic motility via a neural reflex in conscious dogs

BACKGROUND & AIMS Capsaicin is known to contract smooth muscles and to have an excitatory action on thin, primary afferent neurons. The aim of this study was to test the hypothesis that intragastric capsaicin may have an excitatory effect on colonic motility. METHODS Mongrel dogs equipped with five strain-gauge force transducers on the colon (C1-C5) were used. In 5 dogs, the effect of intragastric capsaicin (0.05, 0.1, 0.3, and 0.5 mg/kg) on colonic motility in the presence or absence of the cholinergic blockers atropine and hexamethonium was studied. In 4 dogs, the effect of capsaicin (0.5 mg/kg) administration into a vagally innervated or denervated gastric pouch on colonic motility was investigated. RESULTS Motility at C2-C3, C1-C3, and C1-C5 was significantly increased by 0.1, 0.3, and 0.5 mg/kg of capsaicin, respectively. The excitatory effect of capsaicin on colonic motility was inhibited by atropine and hexamethonium. Colonic motility at C1-C4 was significantly increased by capsaicin administration into a vagally innervated pouch but was not affected by capsaicin administration into a vagally denervated pouch. CONCLUSIONS These results indicate that intragastric capsaicin predominantly stimulates motility in the proximal half of the colon through neural pathways, probably through a vagovagal reflex, but sympathetic involvement cannot be excluded.

E-PASS comprehensive risk score is a good predictor of postsurgical mortality from comorbid disease in elderly gastric cancer patients

The long‐term prognosis of elderly gastric cancer patients is poor because of the cancer and unrelated comorbidities. We investigated the risk factors for mortality after gastrectomy to aid surgeons in deciding the correct operative procedure for elderly gastric cancer patients.

Taurocholate-Induced Gastric Damage in Rats with Obstructive Jaundice

We examined the severity of taurocholate-induced gastric mucosal damage in rats with obstructive jaundice. Oral administration of 100 mM taurocholate induced severer gastric mucosal damage in rats with jaundice than in intact rats. Pretreatment with 5 mM taurocholate significantly protected the gastric mucosa against 100 mM taurocholate-induced damage, suggesting adaptive cytoprotection in rats with jaundice. The reductions in the gastric mucosal potential difference and hexosamine contents in the gastric mucosa in response to 100 mM taurocholate were significantly attenuated by prior administration of 5 mM taurocholate in both intact rats and rats with jaundice.

An experimental study on the gastric acid and gut hormone secretion after pylorus preserving duodenectomy in dogs.

SummaryTo clarify changes in gastric acid and gut hormone secretion after pylorus-preserving pancreaticoduodenectomy (PPPD), an experimental study was performed using a model of pylorus-preserving duodenectomy in dogs previously provided with Heidenhain pouch (HP). The duodenectomy involves resection of the duodenum and 10 cm of the proximal jejunum preserving 2 cm of juxtapyloric duodenum and round-shaped duodenal wall around pancreatic papilla. Reconstruction was done by anastomosing the θ-shaped jejunal loop to gallbladder, juxtapyloric duodenum and peripapillar round-shaped duodenal wall with ligation of the common bile duct. For these dogs, intravenous glucose tolerance test (IVGTT), oral glucose tolerance test (OGTT), meal ingestion test (TM) and histological studies of pancreatic specimen obtained at autopsy were performed investigating pancreatic, gastric acid and gut hormone secretion. Preservation of endocrine and exocrine pancreatic secretion after operation demonstrated our experimental model to be adequate for evaluation of the factor of duodenectomy in PPPD on gastric acid and gut hormone secretion avoiding the influences of changes in pancreatic secretion. Postprandial gastric acid secretion from HP did not change significantly after operation. Postprandial secretion of gastrin, glucagon, GIP and enteroglucagon did not alter significantly after operation. These results indicated that in the clinical PPPD procedure, preservation of more than 2 cm of duodenum from the pylorus produced neither postprandial gastric acid hypersecretion, which might be cause of postoperative stomal ulcer, nor any change of related gut hormone secretion.

Extreme dilatation of the interposed jejunal pouch after proximal gastrectomy associated with portal venous gas: A case report

Highlights • Dilatation of the interposed jejunal pouch developed after proximal gastrectomy.• Shock state with portal venous gas was restored after conservative therapy.• The pouch dilatation recurred soon after resuming oral ingestion.• Resection of the pouch with R-Y esophagojejunostomy relieved the patient.• Surgical intervention should be considered for refractory pouch dilatation.

Mo1693 Percutaneous Transhepatic Gallbladder Drainage Without Cholecystectomy Is Optimum Procedure in High-Risk Patients

Background: Intrahepatic stones are very uncommon in Western societies. In comparison, hepatolithiasis occurs more frequently in Southeast Asia because of the high prevalence of congenital biliary cysts and hepatobiliary parasites. Many Asian patients present with advanced disease which is usually managed with left hepatectomy. In North America both the underlying biliary pathology and the timing of presentation differ, but management has not been standardized, in part, because of the rarity of the disease. This analysis documents the etiology, presentation and outcomes of a transhepatic team approach for management of hepatolithiasis at a Western referral center. Methods: The records of patients with hepatolithiasis managed by interventional radiologists (IR) and surgeons from 2002 through 2012 were reviewed. Surgery was undertaken when required to repair the biliary pathology and/ or when the stone burden was extensive. All but one patient were managed with 20F transhepatic stent(s) placed either percutaneously or during surgery. Choledochoscopy was performed in almost all patients either percutaneously or intraoperatively to assist with stone removal. Laser lithotripsy and balloon dilation were undertaken for difficult stones and strictures. Transhepatic stents were removed when patients were stone and stricture free. A successful outcome was defined as stent removal without symptoms requiring more procedures. Results: Seventy-four patients were managed by IR alone (66%) or by IR and surgery (34%). The mean age was 55.6 years, and 51.4% were women. The majority of patients were Caucasian (80%), and only five (7%) were Asian. Underlying biliary pathology included benign strictures (55%), choledocholithiasis (22%), sclerosing cholangitis (12%), choledochal cysts (10%), and biliary parasites (1%). Twenty patients (27%) had biliary cirrhosis, and 17 of these patients developed hepatolithiasis after undergoing orthotopic liver transplantation. Fifteen additional patients (20%) had a prior biliary-enteric anastomosis. Upper abdominal pain (65%), cholangitis (47%) and jaundice (34%) were the most common presenting symptoms. The median number of IR procedures was 11, and choledochoscopy (88%) laser lithotripsy (68%) and balloon dilation (47%) were performed frequently. Surgical management included cholangioor hepatico-jejunostomy in 22 patients (88%) and hepatectomy in one (4%). Recurrent stone and stricture rates were both 26% and were managed with further biliary stenting. None of the patients have developed a cholangiocarcinoma with a median follow-up of 29 months. Conclusions: A combined interventional radiologic and surgical approach employing large bore transhepatic stents is a safe, but labor intensive, method for managing hepatolithiasis. This approach preserves hepatic parenchyma and prevents malignant degeneration.

Gastric Acid Secretion and Gut Hormone Release in Patients with Crohn's Disease.

手術目的で入院したCrohn病症例30例に対しテトラガストリン刺激による胃液検査を行い, 病変部位の長さや切除腸管の長さと胃酸分泌の関係を検討した.また, 術後に食事負荷試験を行い血漿ガストリン値, GIP値, total-GLI値を測定した.その結果, 術前のMAOで高酸を示し小腸病変の長さおよび切除腸管の長さとMAO, PAOの間に相関を認め, おのおの100cmを超える症例では高酸を示した.血漿ガストリン値, GIP値, total-GLI値のいずれも対照群と比較し低値をとる傾向が認められたが, とくに小腸を100cm以上切除された症例ではtotal-GLIの分泌量は対照群の2分の1であった.以上より, Crohn病の中でも小腸病変の高度な症例や小腸を大量に切除された症例では, 術前後の胃酸分泌亢進に十分注意する必要があると思われた.また, この機序としてエンテログルカゴン, GIPなどの胃酸分泌抑制物質の減少が関与する可能性が示唆された.

An experimental study of the ileo-jejunal transposition on the influence of canine gastric acid secretion and gut hormones.

Enteroglucagon (EG) の胃酸分泌抑制作用およびEG分泌とGIP分泌との関連について実験的に検討した.遠位回腸を空腸上部に有茎移植するモデルileo-jejunal transposition (IJT) が高EG血症を来すモデルであることに着目し, イヌ16頭を用いて, IJTおよびsham operationを施行し, その術前後でHeidenhain pouch (H-P) よりの胃酸分泌および消化管ホルモンについて検討し, 以下の成績を得た.1.IJT術後は高EG血症が認められた.2.IJT術後はgastrinの著明な上昇およびH-Pよりの胃酸分泌亢進が認められた.このことはEGのenterogastrone作用を支持する結果ではなかった.3.IJT術後はGIPが60分から90分で有意の分泌抑制を認めたが, これのみでIJT後の胃酸分泌亢進を説明することは難しいと考えられた.またEG分泌とGIP分泌との間には関連が認められなかった.以上より, 本モデルにおいて生じる高EG血症の胃酸分泌に与える影響は少ないと考えられた.