2004 Fiscal Year Final Research Report Summary
Effect of plasma cholecystokinin on the development of reflux esophagitis after B-1 gastrectomy.
| Project/Area Number |
15591378
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Digestive surgery
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| Research Institution | Chiba University |
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Principal Investigator |
MIYAZAKI Shinichi Chiba University Hospital, Assistant Professor, 医学部附属病院, 助手 (40334198)
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| Co-Investigator(Kenkyū-buntansha) |
GUNJI Yohio Chiba University, Dep.of Frontier Surgery, Associate Profeesor, 大学院・医学研究院, 助教授 (60241957)
AOKI Taito Chiba University Hospital, Assistant Professor, 医学部附属病院, 助手 (80372358)
OCHIAI Takenori Chiba University, Dep.of Frontier Surgery, Professor, 大学院・医学研究院, 教授 (80114255)
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| Project Period (FY) |
2003 – 2004
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| Keywords | Kholecystokinin / B-1 gastrectomy / remnant stomach motility / reflux esophagitis |
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| Research Abstract |
(1)Gastric emptying is a highly regulated process, and plasma CCK plays a major role in its feedback regulation. The gastroduodenal motility and gastric emptying of the two anastomosis-methods after B-I gastrectomy were characterized, while assessing the effect of CCK on the motility of the remnant stomach. Remnant stomachs with side-to-end anastomosis showed superior motility as compared to those with end-to-end anastomosis. Plasma CCK was higher in the end-to-end group, and might explain the difference in motility index between the two groups. (2)B-I gastrectomy causes accelerated gastric emptying. Upon duodenal distention, motility of gastric remnant was significantly inhibited, however, no reduction in duodenal MI was observed. The response was maintained for as long as duodenal distension continued. After evacuation of the balloon, MI returned to pre-distension levels. Increased plasma levels of CCK were observed upon distention of the duodenal balloon. Increased levels of plasma
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CCK during distention might play a role in this feedback mechanism. (3)We compared the clinical outcome after mechanical stapling with that after hand suturing in patients who underwent B-I gastrectomy. A prospective randomized trial showed that the stapling anastomosis method was quicker than the hand-suturing method. Anastomotic complications were similar for the two methods. (4)Endoscopic evaluation of the post operative status was done in the patients reconstructed by the jejunal interposition after total gastrectomy, while comparing those results with the patients reconstructed by the Roux-en-Y technique. Stenosis of anastomosis or reflux esophagitis were found in IP group.
Mechanosensory stimulation of the digestive tract influences postprandial release of CCK. Transient lower esophageal sphincter relaxations(TLESRs), which have been shown to be the main mechanism of gastro-esophageal reflux disease, are significantly increased by gastric distention in dogs and humans. Gastric distention is a potent trigger for TLESRs probably causes activation of mechanoreceptors in the subcardiac region of the stomach even after B-I gastrectomy and the release of CCK, which might partly play a role of the reflux esophagitis after B-1 gastrectomy. Less
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[Journal Article] Inhibitory remnant stomach motility by duodenal distention after B-1 gastrectomy.2005
Author(s)
Hirayama, N., Gunji, Y., Miyazaki, S., Kaiho, T., Shimada, H., Matsubara, H., Nabeya, Y., Aoki, T., Kobayashi, S., Ochiai, T.
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Journal Title
Hepato-Gastorenterology 52
Pages: 633-638
Description
「研究成果報告書概要(欧文)」より
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[Journal Article] Effect of the anastomosis-site after Billroth I gastrectomy on the motility of the remnant stomach.2004
Author(s)
Kaiho, T., Gunji, Y., Hirayama, N., Hayashi, H., Miyazaki, S., Shimada, H., Nabeya, Y., Matsubara, H., Kobayashi, S., Ochiai, T.
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Journal Title
Hepato-Gastorenterology 51
Pages: 906-911
Description
「研究成果報告書概要(欧文)」より
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[Journal Article] Evaluation of reconstruction method with interposition after total gastrectomy.2004
Author(s)
Gunji, Y., Nabeya, Y., Hayashi, H., Aoki, T., Akutsu, N., Shimada, H., Matsubara, H., Miyazaki, S., Kouda, K., Makino, H., Ochiai, T.
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Journal Title
J of Gastrointestinal Surgery 8
Pages: 213A
Description
「研究成果報告書概要(欧文)」より
