Duodenogastric reflux (DGR) is a poorly defined condition which is difficult to accurately diagnose. There is a definite need for a simple test which can be used to define both the existence and severity of the disease. The long term monitoring of gastric intraluminal pH holds promise in this respect.
The first aim i s to measure the gastric luminal pH at different levels between the cardia and the pylorus in normal human volunteers and dogs to determine how the pH varies in different parts of the stomach under normal physiological conditions. The pH environment is probably influenced by eating, changes in posture, DGR, gastric emptying and acid secretion, therefore the intraluminal pH environment will be mapped at different sites in the stomach over prolonged periods of different physiologic activity including eating, posture change, induced DGR and altered gastric motility and acid secretion. With this background information, computer assisted analysis of gastric pH data in symptomatic patients will help define whether the disease of pathologic DGR indeed exists and a comparison with existing tests will indicate whether prolonged intragastric pH measurements on their own can be used in diagnosing the condition. Surgical therapy of DGR has included the use of the Roux-en-Y operation which results in profound alterations in gastrointestinal function. We have recently developed an alternative operation (the """"""""duodenal switch"""""""") which appears to be more physiologic in that no vagotomy is required and the antro-pyloric mechanism is left intact. These two surgical procedures will be analyzed and compared in both animals and humans. A key feature of the """"""""duodenal switch"""""""" involves suppression of acid secretion by a duodenal feedback mechanism. This will be studied using Pavlov pouches in dogs. The results of this project will provide a better understanding of the phenomenon of DGR, more definitive diagnosis of pathologic DGR, and will explore the physiological advantages of a new surgical therapy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK040381-01A1
Application #
3240598
Study Section
Surgery and Bioengineering Study Section (SB)
Project Start
1989-08-15
Project End
1992-07-31
Budget Start
1989-08-15
Budget End
1990-07-31
Support Year
1
Fiscal Year
1989
Total Cost
Indirect Cost
Name
Creighton University
Department
Type
Schools of Medicine
DUNS #
City
Omaha
State
NE
Country
United States
Zip Code
68178
Gasslander, T; Mukaida, H; Herrington, M K et al. (1995) Profound duodenogastric reflux causes pancreatic growth in rats. Gut 36:137-41
Barlow, A P; Hinder, R A; DeMeester, T R et al. (1994) Twenty-four-hour gastric luminal pH in normal subjects: influence of probe position, food, posture, and duodenogastric reflux. Am J Gastroenterol 89:2006-10
Singh, S; Hinder, R A; Naspetti, R et al. (1993) Cervical dysphagia is associated with gastric hyperacidity. J Clin Gastroenterol 16:98-102
Wilson, P; Welch, N T; Hinder, R A et al. (1993) Abnormal plasma gut hormones in pathologic duodenogastric reflux and their response to surgery. Am J Surg 165:169-76;discussion 176-7
Mirvish, S S; Huang, Q; Chen, S C et al. (1993) Metabolism of carcinogenic nitrosamines in the rat and human esophagus and induction of esophageal adenocarcinoma in rats. Endoscopy 25:627-31
Singh, S; Stein, H J; DeMeester, T R et al. (1992) Nonobstructive dysphagia in gastroesophageal reflux disease: a study with combined ambulatory pH and motility monitoring. Am J Gastroenterol 87:562-7
Hinder, R A (1992) Duodenal switch: a new form of pancreaticobiliary diversion. Surg Clin North Am 72:487-99
Attwood, S E; Smyrk, T C; DeMeester, T R et al. (1992) Duodenoesophageal reflux and the development of esophageal adenocarcinoma in rats. Surgery 111:503-10
Welch, N T; Yasui, A; Kim, C B et al. (1992) Effect of duodenal switch procedure on gastric acid production, intragastric pH, gastric emptying, and gastrointestinal hormones. Am J Surg 163:37-44;discussion 44-5
Stein, H J; Barlow, A P; DeMeester, T R et al. (1992) Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 216:35-43

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