The Effect of Secretin on Pepsin Secretion in Heidenhain Pouch

PURPOSE: This research was done to confirm the effect of secretin on pepsin secretion and to study whether or not feeding can depress the secretin-stimulated pepsin secretion (SSPS) with its related factors. METHODS: Heidenhain (HP) and Pavlov pouches (PP) were made in 6 dogs and cannulae were then inserted into the pouches. The fluids were collected through the cannula every 10 minutes for 3 hours in various conditions, including resting, feeding, secretin perfusion, acidification of the stom-ach and, gastric distension. A modified Anson's hemoglobin method was used to check the amount of pepsin. RESULTS: When secretin was perfused in the HP, there was no increase of pepsin secretion at 0.1 and 0.2 CU/kg/hr, but the pepsin secretion increased at 0.4 and 1.0 CU/kg/hr. Compared to the control, ANOVA showed significant differences for secretin 0.4 CU/kg/hr (P<0.01) and for secretin 1.0 CU/kg/hr (P<0.001). When milk was administered through the gastric cannula after secretin stimulation, pepsin production increased in the PP, but pepsin secretion in the HP dropped close to the basal level after administering milk. This depression was not related to acidity of the milk. ANOVA showed significant differences for secretin with milk vs milk alone (P<0.0005) and vs secretin alone (P<0.0025). The inhibition of SSPS was not observed with any gastric distension or acid perfusion. CONCLUSION: In the HP, secretin increased the pepsin secretion and the vagus nerve has an inhibitory effect on pepsin secretion under secretin stimulation. Milk feeding depressed the SSPS, and that depression was not related to pH of the food and gastric distension. Further study is needed in order to clarify the mechanism of depression.

Esophagus, Stomach & Intestine; Adenocarcinoma Arising from Barrett's Esophagus: A case report / 대한소화기내시경학회지

Barrett's esophagus is a metaplastic process in which the squamous epithelium of the lowet esophagus is replaced by columnar epithelium. Most cases are believed to be related to prolonged gastroesophageal reflux. Detection of Barretts esophagus is important in that it results in adenocarcinoma in about 10% of patients. We report a case of adenocarcinoma arising from Barrett's esophagus in a 56 year-old man, diagnosed incidentally at a physical check-up. Grossly, the esophagogastric junction was irregular and there were two small ulcers in the lower esophagus. Microscopically, ihe squamous epithelium of the lower hagus was replaced by specialized intesinal mucosa with a small focus of adenocarcinona confined to the submucosa in one area. Many separate dysplastic foci were also present in the nearby esophageal mucosa.

The Role of Endoscopic Ultrasonography in Staging of Esophageal Cancer : Preliminary Report / 대한소화기내시경학회지

The prognosis of esophageal cancer is poor and strategies for treatment depend on the tumor stage at the time of diagnosis. Surgery is the main therapeutic modality in esophageal cancer and known as the only treatment for cure. Preoperatively it is most important to assess whether the primary tumor is completely resectable or not. Previous staging modality such as CT can not clearly define the depth of invasion and lymph node metastasis of esophageal cancer which is the most important factor in assessing the possibility of curative resection. Endoscopic ultrasonography is now considered as an useful method in evaluating staging and resectability of esophageal cancer. We compared the findings of endoscopic ultrasonography with pathology result to evaluate the accuracy of this new technique in staging of esophageal cancer in 4 esophageal cancer patients who received surgery among the 23 patients assessed by endoscopic ultrasonography due to esophageal cancer, The depth of invasion, lymph node metastasis, and staging was correct in 3 among 4 patients. We consider endoscopic ultrasonography is an useful technique in staging of esophageal cancer.

Common bile duct and Gall Bladder Varices: Findings of ERCP and Doppler ultrasonography / 대한소화기내시경학회지

After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.