| Bile exposure of the denervated stomach as an esophageal substitute. | |
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MedLine Citation:
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PMID: 11426748 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Both the supine position and the existence of a gastric drainage procedure are suspected to promote reflux of duodenal juice into the denervated intrathoracic stomach. Erythromycin has been shown to weaken pyloric resistance to gastric outflow and to enhance antral motility, gastric emptying, and gallbladder contractility. METHODS: The presence of bile in the gastric transplant of 79 patients was monitored over a 24-hour period with use of the Bilitec 2000 optoelectronic device 3 to 195 months after subtotal esophagectomy. Ten patients were reinvestigated after a 3-year period. Five groups were studied: group I: n = 12, no gastric drainage, never given erythromycin, group 2: n = 40, gastric drainage, never given erythromycin, group 3: n = 7, no gastric drainage, given erythromycin, group 4: n = 13, gastric drainage, given erythromycin, and group 5: n = 7, no longer given erythromycin (with or without gastric drainage). The percentage of time gastric bile absorbance was more than 0.25 was calculated for the total, supine, and upright periods of recording in reference to data from 25 healthy volunteers. RESULTS: The Bilitec test was pathologic in 9 of the 12 patients of group 1 whereas it was normal in three. Gastric exposure to bile was longer in group I patients than in controls for the total (p = 0.012) and supine (0.036) periods, but the difference did not reach statistical significance for the upright period (p = 0.080). Bile exposure in group 4 did not significantly differ from controls (total: p = 0.701; supine: p = 0.124; upright: p = 0.712). Bile exposure for the total period did not significantly differ whether patients were taking erythromycin or the drug had been discontinued at the time of the study (p = 0.234); and it tended to decrease with time in patients investigated twice (p = 0.046). CONCLUSIONS: Gastric exposure to bile after truncal vagotomy and transposition of the stomach up to the neck is pathologic in three quarters of patients. It is more marked in the supine than in the upright position and tends to decrease with time. The addition of a gastric drainage procedure in combination with erythromycin therapy tends to normalize gastric exposure to bile. The effects of erythromycin may persist after discontinuation of the drug. |
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Authors:
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C A Gutschow; J M Collard; R Romagnoli; J M Michel; M Salizzoni; A H Hölscher |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 71 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2001 Jun |
Date Detail:
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Created Date: 2001-06-27 Completed Date: 2001-07-12 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1786-91 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Louvain, Brussels, Belgium. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Bile Reflux / diagnosis*, drug therapy Erythromycin / administration & dosage Esophagectomy* Female Follow-Up Studies Humans Male Middle Aged Muscle Denervation* Postoperative Complications / diagnosis*, drug therapy Stomach / innervation, transplantation* Vagotomy, Truncal |
| Chemical | |
Reg. No./Substance:
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114-07-8/Erythromycin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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