Theodore Hersh

The Effects of Metoclopramide on Postoperative Ileus A Randomized Double-blind Study

Metoclopramide or placebo was administered postoperativcly in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A—those with laparotomy without a gastrointestinal anastomosis or ostomy procedure, and group B—those with laparotomy undergoing an anastomosis or ostomy procedure. Metoclopramide reduced nausea and emesis postoperatively. However, the only significant effect on postoperative adynamic ileus was an earlier return to tolerance of solid foods in the patients in Group A.

The Surgical Treatment of Bile Reflux Gastritis: A Study of 59 Patients

Fifty-nine patients underwent duodenogastric diversion for bile reflux gastritis. Sixty per cent of 37 patients who underwent measurement of solid food gastric emptying had delayed gastric emptying. Patients were also assessed in terms of the degree of gastritis present endoscopically. Fifty-six patients were available for follow-up of from six months up to six years. The results demonstrated the following: Patients with delayed gastric emptying and reflux gastritis fared poorly after duodenogastric diversion; the greater the severity of gastritis visible by endoscopy, the better the results of diversion. Only 47% of patients achieved a satisfactory result of duodenogastric diversion.

Impaired intestinal absorption in the Zollinger-Ellison syndrome independent of gastric hypersecretion

Abstract The watery diarrhea observed in the Zollinger-Ellison syndrome has been attributed largely to the effects of acidification of the small bowel contents caused by gastric hypersecretion. However, the present study demonstrates that patients with the Zollinger-Ellison syndrome continue to have significant reductions in jejunal absorption of water, sodium, and glucose when the gastric hypersecretion is controlled without removing the secreting pancreatic tumor. These findings suggest that the gastrin-like hormone released in this syndrome directly inhibits small bowel absorption as well as causing gastric hypersecretion. Both mechanisms may be important in producing diarrhea.

Intestinal bacterial flora after total and partial colon resection

Quantitative and qualitative stool and ileostomy effluent culture specimens were taken from 8 subjects with ileostomies, 8 with ileoproctostomies, 8 with transverse or descending colostomies, and 10 normal subjects. The specimens were cultured for total aerobes, anaerobes, coliforms,Streptococci, Lactobacilli andBacteroides. The predominant organisms cultured were from theBacteroides species in patients who had part of, or an intact colon. In subjects without any colon—ie, in those with an ileostomy—Bacteroides were recovered in significantly smaller numbers. The mean recovery ofBacteroides from the stools of normal subjects was 8.7±0.31 to log10 viable organisms/g of feces; from colostomy patients, 8.3±0.34; from ileoproctostomy patients, 6.8±0.39; and from ileostomy patients, 2.7±1.2.Bacteroides growth appears to be related to the amount of colonic tissue present, since recoveries are poor in patients with ileoproctostomies and still poorer in patients with ileostomies. The anal sphincter does not appear to be related to the predominance of anaerobic organisms, which predominate in patients with colostomies who do not have an anal sphincter.

Effects of Brocresine on Zollinger-Ellison Syndrome Report of 2 Cases

SummaryBrocresine, an inhibitor of histidine decarboxylase activity, was given to 2 patients with Zollinger-Ellison syndrome. In Patient 1, during a short period of study, there appeared to be a reduction in gastric acid secretion, manifested primarily by a decrease in the volume of secretion. In Patient 2, during a longer period of brocresine treatment, there was significant reduction in both concentration and output of acid but no significant change in the acid secretory response to administered histamine. These findings, though inconclusive, are consistent with the hypothesis that histamine may serve as the chemical mediator of the effect of gastrin on gastric acid secretion in man. In each patient there was marked relief of diarrhea which antedated any detectable effect of brocresine on gastric acid secretion. This finding was not anticipated and its mechanism is unexplained. It suggests that in patients with Zollinger-Ellison syndrome, diarrhea may occur as a result of factors other than gastric acid hypersecretion.

Effects of anticholinergic drugs on Zollinger-Ellison syndrome

SummaryAnticholinergic drugs in a patient with Z-E syndrome were only temporarily successful in suppressing gastric hypersecretion and producing symptomatic relief. After escape from control with propantheline bromide, glycopyrrolate was only partially successful in suppressing basal acid secretion. Eventually, complete escape from anticholinergic control occurred with a recurrence of significant gastric hypersecretion and the development of severe peptic esophagitis, necessitating total gastrectomy.