Role of Pyloric Reflux in Experimental Stress Ulceration during Haemorrhagic Shock

Abstract

The significance of pyloric reflux of bile and duodenal juice in experimental gastric stress ulceration was studied using a swine shock ulcer model. Following a haemorrhagic shock of 3 h duration, nine of the ten control piglets (90%) with normal bile flow have gastric mucosal lesions. None of the five piglets with permanent bile diversion (ligation of common bile duct; cholecystojejunostomy) has gastric lesions. Intragastric instillation of pure bile prior to the shock in piglets with permanent bile diversion induced gastric lesions in only one of the five test animals (20%). If duodenal juice was used instead, four of the six test animals (67%) have lesions. The results indicate that, in the pig, an uninterrupted flow of bile into the duodenum is a prerequisite for the development of gastric mucosal lesions following haemorrhagic shock. They also suggest that duodenal juice containing both bile and pancreatic juice has a stronger ulcerogenic influence on shocked porcine gastric mucosa than bile alone.

Bile Acids in Gastric Fluids from Llamas and Alpacas with and without Ulcers

“…The causal relationship is more difficult to establish; only half of the camelids with ulcers had concurrent reflux and reports on the pathogenicity of bile acids in other species are not definitive. [7][8][9][10][11][12][13][14][15][16][17] In some camelids, ulceration might have been initiated during a previous bout of reflux, which diminished premortem. Similarly, the lack of ulceration in the 3 camelids with intestinal distention could relate to their relatively acute clinical courses; ulcers might have developed if the camelids' clinical conditions had not deteriorated so quickly.…”

“…Constant bile flow and lack of a gall bladder in camelids might also promote entry of bile into the intestines during periods of ileus. Periodic reflux is common in healthy people 7,8 and horses 9 and has been linked to gastric ulcers in rats, 10 pigs, 11 mice, [12][13] and horses. 9 Its role in ulcer production in people is still controversial.…”

A Novel Endoscopic Transgastric Fundoplication Procedure for Gastroesophageal Reflux: An Initial Animal Evaluation

“…I4~16 Although technically different, current operations for GER have in common a number of features which are thought to be important in creating a competent GEJ. These include: (1) creating an increased length of intraabdominal esophagus, (2) creating an increased angle of His, (3) creating a valve mechanism at the distal esophagus, (4) tightening the esophageal hiatus, and (5) forming a complete or partial gastric wrap around the esophagus to augment extraesophageal pressure. This technique achieves all of these effects except tightening of the esophageal hiatus.…”

Experimental Microsurgical Model in Rats Preventing Duodenogastric Reflux

“…Results from a wide variety of experimental models and clinical conditions support such conclusions. Such experiments were done in dogs (10,12), pigs (7,8,15,16) or rats (5,14) and on isolated gastric mucosa (9). In comparison with the animal models used hitherto our operative model differs in two main re spects.…”