Ryuichi Sakita

Lesions of the upper gastrointestinal tract in patients with chronic renal failure

SummaryEndoscopy of the upper gastrointestinal tract was performed on 84 patients with end-stage chronic renal failure undergoing hemodialysis. Gastric acid secretion and fasting plasma gastrin levels were also examined in these patients.Hemorrhagic gastritis was most frequently observed (23 cases) followed by erosive gastritis (18 cases). No patients had gastric ulcers. Duodenal ulcers were observed in only two patients. Gastrointestinal bleeding was observed in 15 cases (17.9%). Thirteen of these 15 cases had hemorrhagic gastritis, one of which had a duodenal ulcer as a complication.Fasting plasma gastrin levels (359.6 ± 336.5 pg/ml) were significantly higher than those of normal subjects (35.2 ± 37.1 pg/ml), but no acceleration in gastric acid secretion was observed either in the basal condition (BAO 0.8± 0.7 mEq/h) or following tetragastrin stimulation (MAO 9.0 ± 6.9 mEq/h).Our results were inconsistent with the previous reports that high frequencies of peptic ulcers and increased gastric acid secretion were observed in patients with chronic renal failure.Our data suggest that the defensive factors rather than the aggressive factors of the gastroduodenal mucosa may be involved in chronic renal failure.

GASTRIC EMPTYING IN PATIENTS WITH GASTRODUODENAL DISEASE FIRST REPORT

試験食として自然食を主とした流動食を用いたacetaminophen(以下APAPと略す)法で胃排出機能検査をおこない,服用後45分の血中APAP濃度(mcg/ml)をもつて胃排出能とした.消化性潰瘍の胃排出能,酸分泌能と胃排出能に検討を加え胃潰瘍と十二指腸潰瘍の相違を胃排出能の面から考察した.又消化性潰瘍の再発とそれぞれの潰瘍の胃排出能との関係についても検討した.活動期の胃潰瘍,十二指腸潰瘍の胃排出能はそれぞれ, 7.7±3.3mcg/ml, 11.3±3.4mcg/mlであり,健康正常者のそれは9.4±2.6mcg/mlであつた.胃潰瘍では明らかに胃排出能の遅延(p<0.05)が認められ,十二指腸潰瘍では明らかに胃排出能の亢進が認められた(p<0.05).酸分泌能との関係では胃潰瘍では低酸,正酸,過酸をとわず胃排出能の遅延が認められたのに反し,十二指腸潰瘍では過酸ほど胃排出能の亢進が認められた(p<0.025).再発のあきらかな胃潰瘍患者の胃排出能は6.8±3.0mcg/mlであり,再発未確認例(10.4±4.3mcg/ml)に比し有意に胃排出能の遅延が認められた(p<0.005),一方,十二指腸潰瘍においては再発のあきらかな例の胃排出能は11.9±4.0mcg/mlと,再発未確認例の9.3±3.5mcg/mlに比し明らかに胃排出能の亢進が認められた(p<0.025).