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Ryouichi Tomita - One of the best experts on this subject based on the ideXlab platform.
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regulation of vasoactive intestinal peptide and substance p in the human Pyloric Sphincter
Hepato-gastroenterology, 2009Co-Authors: Ryouichi TomitaAbstract:BACKGROUND/AIMS: Brain-gut hormones (i.e., neuropeptides) such as vasoactive intestinal peptide (VIP) and substance P (SP) have been shown to exist in the enteric nervous system (ENS) of the Pyloric Sphincter (PS) in studies of immunohistochemistry. To clarify the role of neuropeptides in the ENS of the normal human PS, we investigated the enteric nerve responses to VIP and SP in normal human PS specimens in vitro. METHODOLOGY: Normal human PS specimens derived from 45 patients with early gastric cancer (35 men and 10 women aged from 44 to 65 years, average 57.4 years) were used. A total of 120 PS muscle strips were made from 45 PS. A mechanographic technique was used to evaluate in vitro muscle strip responses to VIP and SP before and after treatment with various autonomic nerve blockers. RESULTS: Responses to VIP and SP after blockade of the adrenergic and cholinergic nerves: Relaxation was elicited by VIP in 41.7% at 1 x 10(-8), 62.5% at 1 x 10(-7), and 83.3% at 1 x 10(-6) g/ml. Differences were noted in the percentages showing relaxation between 1 x 10(-8) and 1 x 10(-7) g/ml, between 1 x 10(-8) and 1 x 10(-6) g/ml, and between 1 x 10(-7) and 1 x 10(-6) g/ml (p = 0.0012, p < 0.0001, p = 0.0002, respectively). Contraction was elicited by administration of by SP in 31.7% at 1 x 10(-8), 58.3% at 1 x 10(-7), and 79.2% at 1 x 10(-6) g/ml, respectively. Differences were noted in the percentages showing contraction between 1 x 10(-8) and 1 x 10(-7) g/ml, between 1 x 10(-8) and 1 x 10(-6) g/ml, and between 1 x 10(-7) and 1 x 10(-6) g/ml (p = 0.0001, p < 0.0001, p = 0.0004, respectively). VIP caused relaxation and substance P caused contraction of the PS in a concentration-dependent manner. Response to VIP and SP at 1 x 10(-6) g/ml after blockade of the ENS by tetrodotoxin (TTX): The relaxation to VIP and contraction to SP following administration of TTX were weaker than after blockade of the adrenergic and cholinergic nerves. In the normal human PS, VIP and SP may act both via NANC nerves and directly on the muscle strips. CONCLUSIONS: Relaxation reaction via VIP nerves and contraction via SP nerves might be involved in regulation of ENS in the normal human PS.
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regulation of enteric nervous system in the proximal and distal parts of the normal human Pyloric Sphincter in vitro study
Hepato-gastroenterology, 2007Co-Authors: Ryouichi Tomita, Seigo Igarashi, Shigeru Fijisaki, Tugumichi Koshinaga, Katsuhisa TanjohAbstract:BACKGROUND/AIMS The structure of the Pyloric Sphincter (PS) muscle has recently been shown to divide into two parts (proximal and distal parts). To clarify the functional differences in the human PS between proximal and distal parts, we investigated the enteric nerve responses in normal proximal and distal PS specimens. METHODOLOGY Normal PS specimens derived from 20 patients with early gastric cancer (13 men and 7 women aged from 50 to 64 years, average 58.2 years) were used. These PS muscles were divided into 2 parts [1/2 oral site of PS; proximal part (PPS; n=26), 1/2 anal site of PS; distal part (DPS; n=24)]. A mechanographic technique was used to evaluate in vitro muscle strip responses to electrical field stimulation (EFS) before and after treatment with various autonomic nerve blockers. RESULTS Findings were: (1) Response to EFS before blockade of the adrenergic and cholinergic nerves: Excitatory responses (contraction reaction) via cholinergic nerves in the PPS were regulated more predominantly than in the DPS. Inhibitory responses (relaxation reaction) via adrenergic nerves in the DPS were regulated more predominantly than in the PPS. (2) Response to EFS after blockade of the adrenergic and cholinergic nerves: Excitatory responses (contraction reaction) via non-adrenergic non-cholinergic (NANC) excitatory nerves in the PPS were regulated significantly more than in the DPS (P = 0.0439). Inhibitory responses (relaxation reaction) via NANC inhibitory nerves in the DPS were also regulated significantly more than in the PPS (P = 0.0439). (3) EFS response in the pylorus was blocked by tetrodotoxin. CONCLUSIONS There are differences between the PPS and DPS in the regulation of the enteric nervous system. Contraction reaction via excitatory nerves, especially cholinergic nerves, was mainly involved in the regulation of enteric nerve responses to EFS in the PPS. Relaxation reaction via inhibitory nerves, especially NANC inhibitory nerves, was mainly involved in the regulation of enteric nerve responses to EFS in the DPS.
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a novel surgical procedure of vagal nerve lower esophageal Sphincter and Pyloric Sphincter preserving nearly total gastrectomy reconstructed by single jejunal interposition and postoperative quality of life
Hepato-gastroenterology, 2005Co-Authors: Ryouichi TomitaAbstract:Background/aims For early gastric cancer total gastrectomy (TG) has so far been essentially unavoidable. We performed the nearly TG reconstructed by single jejunal interposition preservation of the vagal nerve, lower esophageal Sphincter (LES) and Pyloric Sphincter (D1 or D2 lymph node dissection, curability A) as a function-preserving surgical technique (i.e. NTG) to improve postoperative quality of life (QOL). In this report, the application criteria and points of the technique are outlined. QOL in patients after NTG was also compared with those after TG. Methodology Sixteen subjects who underwent NTG (12 men and 4 women subjects at age 30 to 70 years, mean 55.6 years) were interviewed to inquire about abdominal symptoms and compared with 20 patients after conventional TG (excision with D2 lymph node, radical curability A) reconstructed by single jejunal interposition without preserving the vagal nerve, LES, and Pyloric Sphincter (i.e. TGI; 14 men and 6 women at age 26 to 70 years, mean 54.8 years). The former was named group A and the latter group B. Included were cases with early cancer localizing at the upper third and middle stomach, 2cm or further in distance from oral-side margin of the cancer to esophagogastric mucosal junction; and 3.5cm or further in distance from anal-side margin of the cancer to the Pyloric Sphincter. In excision with the lymph node, hepatic and celiac branches were preserved. To preserve LES, the abdominal esophagus was completely preserved. The Pyloric antrum was also preserved at 1.5cm from the Pyloric Sphincter. The substitute stomach was created as a 30-cm-long single jejunal segment having orthodromic peristaltic movement. Results The operative procedure in group A significantly improved postoperative gastrointestinal symptoms such as appetite loss (p=0.0004), weight loss (p=0.0369), reflux esophagitis (RE) (p=0.0163), early dumping syndrome (p=0.0163), endoscopic RE (p=0.0311), and postgastrectomy cholecystolithiasis (p=0.0163) compared with group B. Oral intake per one meal 5 years after operation compared with that before operation was better in group A than in group B (p=0.0703). Postoperative epigastric fullness was significantly detected in group A compared with group B (p=0.0072). Conclusions The proposed surgical technique of NTG is a function-preserving surgery appropriate to improve QOL of subjects with early gastric cancer. There was a defect in this technique of postprandial feeling of epigastric fullness. We think that a gut motility improvement agent is necessary to improve postprandial epigastric fullness after NTG.
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Novel Operative Technique for Vagal Nerve- and Pyloric Sphincter-preserving Distal Gastrectomy Reconstructed by Interposition of a 5 cm Jejunal J Pouch with a 3 cm Jejunal Conduit for Early Gastric Cancer and Postoperative Quality of Life 5 Years after Operation
World Journal of Surgery, 2004Co-Authors: Ryouichi Tomita, Katsuhisa Tanjoh, Shigeru FujisakiAbstract:The importance of the vagal nerve and Pyloric Sphincter, the need for pouch reconstruction, and the ideal pouch volume are all matters of controversy. A novel operative technique for vagal nerve- and Pyloric Sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit was developed as a function-preserving surgical technique to prevent postgastrectomy disorders. The application criteria and technique are outlined in this article. Postoperative quality of life was also investigated clinically. Twenty subjects who underwent this surgical operation (group A: 16 men and 4 women aged 41 to 70 years, mean age 59.5 years) were interviewed to inquire about postoperative gastrointestinal symptoms. These patients were compared with 44 others who underwent conventional distal gastrectomy with D2 lymphadenectomy (group B: 30 men and 14 women aged 43 to 73 years, mean age 62.6 years). Included were patients with early cancer [mucosal or submucosal 1 (SM1) cancer and no lymph node metastasis (N0)] in the middle or lower third of stomach (or both) who were either not eligible for endoscopic excision of gastric mucosa or for partial gastric excision in the mucosa = 3.5 cm or SM1 5.5 cm, or further in distance from the anal margin of the cancer to the Pyloric Sphincter. Cases in which the remnant stomach would become one-third or less of the original size were also applied. During excision with lymph nodes, the hepatic and celiac branches bifurcating from the anterior and posterior trunks of the vagal nerve were preserved. The antrum was severed 1.5 cm from the Pyloric Sphincter, preserving the arteria supraduodenalis. The substitute stomach was created as a 5 cm jejunal pouch with a 3 cm jejunal conduit for orthodromic peristaltic movement using an automatic suture instrument to complete a side-to-side anastomosis of the folded jejunum. The anal side of the gastric remnant was manually anastomosed with the jejunal J pouch, and anastomosis of the Pyloric antrum with the jejunal conduit was manually completed by stratum anastomosis. Postoperatively, the procedure in group A alleviated gastrointestinal symptoms such as appetite loss, epigastric fullness, reflux esophagitis, early dumping syndrome, body weight loss, endoscopic reflux esophagitis, and endoscopic gastritis in the remnant stomach, postprandial stasis of the substitute stomach, and postgastrectomy cholecystolithiasis better than in group B. The results suggest that the proposed technique is a function-preserving gastric operation appropriate for preventing postgastrectomy disorder.
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operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal j pouch with preservation of vagal nerve lower esophageal Sphincter and Pyloric Sphincter for early gastric cancer
World Journal of Surgery, 2001Co-Authors: Ryouichi Tomita, Shigeru Fujisaki, Katsuhisa Tanjoh, Masahiro FukuzawaAbstract:Nearly total gastrectomy preserving the vagal nerve, the lower esophageal Sphincter (LES), and the Pyloric Sphincter was developed as a function-preserving surgical technique to improve postgastrectomy disorders. In this paper, application criteria and technique are outlined, and postoperative quality of life was clinically investigated. Ten subjects who underwent this surgical operation (group A: 7 male and 3 female subjects at age 48 to 68 years with a mean age of 58.3 years) were interviewed to inquire about reflux esophagitis, dumping syndrome, and microgastria. Group A was compared with 20 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of the lower esophageal Sphincter (LES), total vagotomy, and single jejunal interposition (group B: 16 male and 4 female subjects at age 48 to 72 years with a mean age of 63.9 years). Included were cases with early cancer (M or SM1 of N0) localizing at the middle third and lower stomach, which was not applicable to endoscopic excision of gastric mucosa or partial gastric excision in M cancer, 2 cm or farther from the margin of the cancer to the esophagogastric mucosa cephalad junction and 3.5 cm or farther from the margin of the cancer to the Pyloric caudad Sphincter; in SM1 cancer, 4 cm or farther from the oral-side margin of the cancer to esophagogastric mucosa junction and 5.5 cm or farther from the anal-side margin of the cancer to the Pyloric Sphincter. In excision with lymph nodes, hepatic and celiac branches bifurcating from anterior and posterior trunks of the vagal nerve were preserved. To preserve LES, the esophagus was severed at the His angle at right angle to the longitudinal axis of the esophagus. The antrum was severed at 1.5 cm from the Pyloric Sphincter, preserving the arteria supraduodenalis. An alternative gaster was created as a 15-cm jejunal pouch with a 5-cm jejunal conduit for orthodromic peristaltic movement, using an automatic suture instrument to complete side-to-side anastomosis of folded jejunum with 1- to 1.5-cm long upper end of the pouch not anastomosed. The abdominal esophagus was mechanically anastomosed with a jejunal J pouch, and anastomosis of the Pyloric antrum with a jejunal conduit was manually completed by stratum anastomosis. In group A, food ingestion per time could be taken the same as that of a healthy person, with no reflux esophagitis and dumping syndrome being noticed. Reflux esophagitis developed more significantly in group B than in group A (p < 0.05). In food ingestion per time, group B was significantly delayed compared with group A (p < 0.05). The present results suggested that the surgical technique proposed is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorder of subjects.
Henry P Parkman - One of the best experts on this subject based on the ideXlab platform.
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Pyloric Sphincter characteristics using endoflip in gastroparesis
Revista Portuguesa De Pneumologia, 2018Co-Authors: Mohammed Saadi, Zubair Malik, Henry P Parkman, Ron ScheyAbstract:Abstract Introduction and aims Pyloric Sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether Pyloric Sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to Pyloric Sphincter BoNT/A injection. Methods EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller Pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and Pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater Pyloric compliance at baseline correlated with greater improvement in early satiety and nausea at 8 weeks and greater Pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus.
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Pyloric Sphincter characteristics using EndoFLIP® in gastroparesis
'Elsevier BV', 2018Co-Authors: Mohammed Saadi, Zubair Malik, Henry P Parkman, Ron ScheyAbstract:Introduction and aims: Pyloric Sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether Pyloric Sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to Pyloric Sphincter BoNT/A injection. Methods: EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. Results: Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller Pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and Pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater Pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater Pyloric distensibility correlated with improvement in upper abdominal pain. Conclusions: EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus. Resumen: Introducción y objetivos: Existen anormalidades en el esfínter pilórico que pueden ser detectadas en la gastroparesia. La inyección de toxina botulínica tipo A (BoNT/A) en el píloro ha sido utilizada en el tratamiento de gastroparesia con diversos resultados. El objetivo del presente artículo fue evaluar si existía correlación entre las características del esfínter pilórico observadas con el catéter luminal de imagen funcional (EndoFLIP®) con planimetría por impedancia en pacientes con gastroparesia, y síntomas, vaciamiento gástrico y respuesta terapéutica tras inyección de BoNT/A en esfínter pilórico. Métodos: El estudio con EndoFLIP® se llevó a cabo en pacientes en tratamiento para gastroparesia con BoNT/A. Se utilizó el índice de síntoma cardinal de gastroparesia (GSCI por sus siglas en inglés) antes del tratamiento y a las 2, 4, 8 y 12 semanas después del tratamiento. Resultados: Se reclutó a 44 pacientes (30 con gastroparesia idiopática, 14 con gastroparesia diabética). Se encontró correlación entre menor diámetro pilórico, área de sección transversal (AST) y distensibilidad, y vómito y arcadas más intensos en la evaluación basal. También se observó una tendencia a correlacionar de mayor retención gástrica con el AST y una distensibilidad pilórica disminuidas. El tratamiento con BoNT/A dio como resultado una disminución significativa en el GSCI a las 2 y 4 semanas después del tratamiento, pero no a las 8 o 12 semanas después. La náusea, la saciedad temprana, la plenitud posprandial y el dolor abdominal superior mejoraron hasta 12 semanas, mientras que la pérdida de apetito, la plenitud gástrica y el estómago visiblemente más grande mejoraron solo hasta 4 semanas. Las arcadas y el vómito no mejoraron. La elasticidad pilórica basal correlacionó con un mayor grado de mejora de saciedad temprana y náuseas a las 8 semanas, y la mayor distensibilidad pilórica correlacionó con una mejora en el dolor abdominal. Conclusiones: Las características del píloro observadas con EndoFLIP® proporcionaron información fisiopatológica importante relacionada a síntomas, vaciamiento gástrico y predicción de respuesta a tratamiento dirigido al píloro en pacientes con gastroparesia. Keywords: Gastroparesis, EndoFLIP®, Botulinum toxin A, Pylorus, Diabetes, Palabras clave: Gastroparesia, EndoFLIP®, Toxina botulínica tipo A, Píloro, Diabete
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assessing Pyloric Sphincter pathophysiology using endoflip in patients with gastroparesis
Neurogastroenterology and Motility, 2015Co-Authors: Zubair Malik, Abhinav Sankineni, Henry P ParkmanAbstract:Background Pyloric dysfunction has been associated with gastroparesis, particularly diabetic gastroparesis. Endoscopic functional luminal imaging probe (EndoFLIP) uses 16 sensors inside a balloon that is inflated inside a Sphincter to assess physiologic characteristics. The aim of this study was to measure the pressure, diameter, cross-sectional area (CSA), and distensibility of the pylorus using EndoFLIP in patients with gastroparesis. In addition, the relationship between Pyloric pathophysiology with gastroparesis etiology, symptoms, and gastric emptying was assessed. Methods EndoFLIP was performed in 54 patients (39 idiopathic gastroparesis, 15 diabetic gastroparesis). The EndoFLIP catheter was passed endoscopically so that the balloon straddled the pylorus. Pressure, diameter, CSA, and distensibility of the pylorus were measured at 20, 30, 40, and 50 cc balloon volume. Key Results Pyloric Sphincter contour was seen best at 40 cc balloon distension (diameter 12.2 ± 0.44 mm, CSA 125.2 ± 9.15 mm2, pressure 18.0 ± 1.23 mmHg, length 1.59 ± 0.34 cm, distensibility 10.7 ± 2.57 mm2/mmHg). There was a wide range seen in diameter (5.6–22.1 mm) and distensibility (1–55 mm2/mmHg) of the pylorus. Symptoms of early satiety and postprandial fullness were inversely correlated with Pyloric Sphincter diameter and CSA. No significant difference was seen between diabetic and idiopathic gastroparetics. Conclusions & Inferences EndoFLIP is a novel technique that can be used to assess Pyloric physiologic characteristics. Early satiety and postprandial fullness were inversely correlated with diameter and CSA of the Pyloric Sphincter. No significant differences were seen comparing diabetic and idiopathic gastroparetics. This technology may be of benefit to help select patients with Pyloric Sphincter abnormalities.
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treatment of idiopathic gastroparesis with injection of botulinum toxin into the Pyloric Sphincter muscle
The American Journal of Gastroenterology, 2002Co-Authors: Larry S Miller, Robert S Fisher, Gregory A Szych, Steven Kantor, Matthew Q Bromer, Linda C Knight, Alan H Maurer, Henry P ParkmanAbstract:Treatment of idiopathic gastroparesis with injection of botulinum toxin into the Pyloric Sphincter muscle
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treatment of idiopathic gastroparesis with injection of botulinum toxin into the Pyloric Sphincter muscle
2001 Digestive Disease Week, 2002Co-Authors: Larry S Miller, Robert S Fisher, Gregory A Szych, Steven Kantor, Matthew Q Bromer, Linda C Knight, Alan H Maurer, Henry P ParkmanAbstract:OBJECTIVES: We aimed to determine if botulinum toxin injection into the Pyloric Sphincter improves gastric emptying and reduces symptoms in patients with idiopathic gastroparesis. METHODS: Patients with idiopathic gastroparesis not responding to prokinetic therapy underwent botulinum toxin (80-100 U, 20 U/ml) injection into the Pyloric Sphincter. Gastric emptying scintigraphy was performed before and 4 wk after treatment. Total symptom scores were obtained from the sum of eight upper Gl symptoms graded on a scale from 0 (none) to 4 (extreme). RESULTS: Ten patients were entered into the study. The mean percentage of solid gastric retention at 4 h improved from 27 ± 6% (normal < 10%) before botulinum toxin injection into the pylorus to 14 ± 4% (p = 0.038) 4 wk after treatment. The symptom score decreased from 15.3 ± 1.7 at baseline to 9.0 ± 1.9 (p = 0.006) at 4 wk, a 38 ± 9% decrease. Improvement in symptoms tended to correlate with improved gastric emptying of solids (r = 0.565, p = 0.086). CONCLUSIONS: This initial pilot study suggests that botulinum toxin injection into the pylorus in patients with idiopathic gastroparesis improves both gastric emptying and symptoms.
Michal Zalecki - One of the best experts on this subject based on the ideXlab platform.
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RESEARCH ARTICLE The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)—Neuronal Tracing Studies
2016Co-Authors: Michal ZaleckiAbstract:Background Gastric ulcerations in the region of antrum pylori represent a serious medical problem in hu-mans and animals. Such localization of ulcers can influence the intrinsic descending nerve supply to the Pyloric Sphincter. The Pyloric function is precisely regulated by intrinsic and ex-trinsic nerves. Impaired neural regulation could result in Pyloric Sphincter dysfunction and gastric emptying malfunction. The aim of the study was to determine the effect of gastric an-tral ulcerations on the density and distribution of intramural gastric descending neurons sup-plying the Pyloric Sphincter in pigs. Methodology/Principal Findings The experiment was performed on 2 groups of pigs: healthy gilts (n=6) and gilts with experi-mentally induced peptic ulcers in the region of antrum pylori (n=6). Gastric neurons supply-ing Pyloric Sphincter were labeled using the retrograde neuronal tracing technique (20μl of Fast Blue tracer injected into the Pyloric Sphincter muscle). After a week survival period the animals were sacrificed and the stomachs were collected. Then, the stomach wall wa
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the influence of gastric antral ulcerations on the expression of galanin and galr1 galr2 galr3 receptors in the pylorus with regard to gastric intrinsic innervation of the Pyloric Sphincter
PLOS ONE, 2016Co-Authors: Michal Zalecki, W Sienkiewicz, Amelia Frankeradowiecka, M Klimczuk, J KaleczycAbstract:Gastric antrum ulcerations are common disorders occurring in humans and animals. Such localization of ulcers disturbs the gastric emptying process, which is precisely controlled by the pylorus. Galanin (Gal) and its receptors are commonly accepted to participate in the regulation of inflammatory processes and neuronal plasticity. Their role in the regulation of gastrointestinal motility is also widely described. However, there is lack of data considering antral ulcerations in relation to changes in the expression of Gal and GalR1, GalR2, GalR3 receptors in the Pyloric wall tissue and galaninergic intramural innervation of the pylorus. Two groups of pigs were used in the study: healthy gilts and gilts with experimentally induced antral ulcers. By double immunocytochemistry percentages of myenteric and submucosal neurons expressing Gal-immunoreactivity were determined in the Pyloric wall tissue and in the population of gastric descending neurons supplying the Pyloric Sphincter (labelled by retrograde Fast Blue neuronal tracer). The percentage of Gal-immunoreactive neurons increased only in the myenteric plexus of the Pyloric wall (from 16.14±2.06% in control to 25.5±2.07% in experimental animals), while no significant differences in other neuronal populations were observed between animals of both groups. Real-Time PCR revealed the increased expression of mRNA encoding Gal and GalR1 receptor in the Pyloric wall tissue of the experimental animals, while the expression(s) of GalR2 and GalR3 were not significantly changed. The results obtained suggest the involvement of Gal, GalR1 and galaninergic Pyloric myenteric neurons in the response of Pyloric wall structures to antral ulcerations.
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Percentages of FB+/PGP+/Gal+ perikarya in the myenteric plexus of the stomach antrum.
2016Co-Authors: Michal Zalecki, Waldemar Sienkiewicz, Amelia Franke-radowiecka, Magdalena Klimczuk, Jerzy KaleczycAbstract:Graph presenting percentages of FB-positive neurons supplying the Pyloric Sphincter in the control and experimental animals of the subgroup T which simultaneously co-expressed immunoreactivity to PGP 9.5 and Gal. The differences between the control and experimental animals were statistically insignificant.
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The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)-Neuronal Tracing Studies.
PloS one, 2015Co-Authors: Michal ZaleckiAbstract:Background Gastric ulcerations in the region of antrum pylori represent a serious medical problem in humans and animals. Such localization of ulcers can influence the intrinsic descending nerve supply to the Pyloric Sphincter. The Pyloric function is precisely regulated by intrinsic and extrinsic nerves. Impaired neural regulation could result in Pyloric Sphincter dysfunction and gastric emptying malfunction. The aim of the study was to determine the effect of gastric antral ulcerations on the density and distribution of intramural gastric descending neurons supplying the Pyloric Sphincter in pigs. Methodology/Principal Findings The experiment was performed on 2 groups of pigs: healthy gilts (n=6) and gilts with experimentally induced peptic ulcers in the region of antrum pylori (n=6). Gastric neurons supplying Pyloric Sphincter were labeled using the retrograde neuronal tracing technique (20μl of Fast Blue tracer injected into the Pyloric Sphincter muscle). After a week survival period the animals were sacrificed and the stomachs were collected. Then, the stomach wall was cross-cut into 0.5cm thick sections taken in specified intervals (section I - 1.5cm; section II - 3.5cm; section III - 5.5cm; section IV – 7.5cm) starting from the Sphincter. Consecutive microscopic slices prepared from each section were analyzed under fluorescent microscope to count traced neurons. Obtained data were statistically analyzed. The total number of FB-positive perikarya observed within all studied sections significantly decreased from 903.3 ± 130.7 in control to 243.8 ± 67.3 in experimental animals. In healthy pigs 76.1 ± 6.7% of labeled neurons were observed within the section I, 23.53 ± 6.5% in section II and only occasional cells in section III. In experimental animals, as many as 93.8 ± 2.1% of labeled cells were observed within the section I and only 6.2 ± 2.2% in section II, while section III was devoid of such neurons. There were no traced perikarya in section IV observed in both groups of pigs. Conclusions/Significance Obtained results revealed for the first time significant impact of antral ulcerations on intramural descending nerve pathways supplying the Pyloric Sphincter in pigs, animals of increasing value in biomedical research and great economic importance.
Shigeru Fujisaki - One of the best experts on this subject based on the ideXlab platform.
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Novel Operative Technique for Vagal Nerve- and Pyloric Sphincter-preserving Distal Gastrectomy Reconstructed by Interposition of a 5 cm Jejunal J Pouch with a 3 cm Jejunal Conduit for Early Gastric Cancer and Postoperative Quality of Life 5 Years after Operation
World Journal of Surgery, 2004Co-Authors: Ryouichi Tomita, Katsuhisa Tanjoh, Shigeru FujisakiAbstract:The importance of the vagal nerve and Pyloric Sphincter, the need for pouch reconstruction, and the ideal pouch volume are all matters of controversy. A novel operative technique for vagal nerve- and Pyloric Sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit was developed as a function-preserving surgical technique to prevent postgastrectomy disorders. The application criteria and technique are outlined in this article. Postoperative quality of life was also investigated clinically. Twenty subjects who underwent this surgical operation (group A: 16 men and 4 women aged 41 to 70 years, mean age 59.5 years) were interviewed to inquire about postoperative gastrointestinal symptoms. These patients were compared with 44 others who underwent conventional distal gastrectomy with D2 lymphadenectomy (group B: 30 men and 14 women aged 43 to 73 years, mean age 62.6 years). Included were patients with early cancer [mucosal or submucosal 1 (SM1) cancer and no lymph node metastasis (N0)] in the middle or lower third of stomach (or both) who were either not eligible for endoscopic excision of gastric mucosa or for partial gastric excision in the mucosa = 3.5 cm or SM1 5.5 cm, or further in distance from the anal margin of the cancer to the Pyloric Sphincter. Cases in which the remnant stomach would become one-third or less of the original size were also applied. During excision with lymph nodes, the hepatic and celiac branches bifurcating from the anterior and posterior trunks of the vagal nerve were preserved. The antrum was severed 1.5 cm from the Pyloric Sphincter, preserving the arteria supraduodenalis. The substitute stomach was created as a 5 cm jejunal pouch with a 3 cm jejunal conduit for orthodromic peristaltic movement using an automatic suture instrument to complete a side-to-side anastomosis of the folded jejunum. The anal side of the gastric remnant was manually anastomosed with the jejunal J pouch, and anastomosis of the Pyloric antrum with the jejunal conduit was manually completed by stratum anastomosis. Postoperatively, the procedure in group A alleviated gastrointestinal symptoms such as appetite loss, epigastric fullness, reflux esophagitis, early dumping syndrome, body weight loss, endoscopic reflux esophagitis, and endoscopic gastritis in the remnant stomach, postprandial stasis of the substitute stomach, and postgastrectomy cholecystolithiasis better than in group B. The results suggest that the proposed technique is a function-preserving gastric operation appropriate for preventing postgastrectomy disorder.
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operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal j pouch with preservation of vagal nerve lower esophageal Sphincter and Pyloric Sphincter for early gastric cancer
World Journal of Surgery, 2001Co-Authors: Ryouichi Tomita, Shigeru Fujisaki, Katsuhisa Tanjoh, Masahiro FukuzawaAbstract:Nearly total gastrectomy preserving the vagal nerve, the lower esophageal Sphincter (LES), and the Pyloric Sphincter was developed as a function-preserving surgical technique to improve postgastrectomy disorders. In this paper, application criteria and technique are outlined, and postoperative quality of life was clinically investigated. Ten subjects who underwent this surgical operation (group A: 7 male and 3 female subjects at age 48 to 68 years with a mean age of 58.3 years) were interviewed to inquire about reflux esophagitis, dumping syndrome, and microgastria. Group A was compared with 20 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of the lower esophageal Sphincter (LES), total vagotomy, and single jejunal interposition (group B: 16 male and 4 female subjects at age 48 to 72 years with a mean age of 63.9 years). Included were cases with early cancer (M or SM1 of N0) localizing at the middle third and lower stomach, which was not applicable to endoscopic excision of gastric mucosa or partial gastric excision in M cancer, 2 cm or farther from the margin of the cancer to the esophagogastric mucosa cephalad junction and 3.5 cm or farther from the margin of the cancer to the Pyloric caudad Sphincter; in SM1 cancer, 4 cm or farther from the oral-side margin of the cancer to esophagogastric mucosa junction and 5.5 cm or farther from the anal-side margin of the cancer to the Pyloric Sphincter. In excision with lymph nodes, hepatic and celiac branches bifurcating from anterior and posterior trunks of the vagal nerve were preserved. To preserve LES, the esophagus was severed at the His angle at right angle to the longitudinal axis of the esophagus. The antrum was severed at 1.5 cm from the Pyloric Sphincter, preserving the arteria supraduodenalis. An alternative gaster was created as a 15-cm jejunal pouch with a 5-cm jejunal conduit for orthodromic peristaltic movement, using an automatic suture instrument to complete side-to-side anastomosis of folded jejunum with 1- to 1.5-cm long upper end of the pouch not anastomosed. The abdominal esophagus was mechanically anastomosed with a jejunal J pouch, and anastomosis of the Pyloric antrum with a jejunal conduit was manually completed by stratum anastomosis. In group A, food ingestion per time could be taken the same as that of a healthy person, with no reflux esophagitis and dumping syndrome being noticed. Reflux esophagitis developed more significantly in group B than in group A (p < 0.05). In food ingestion per time, group B was significantly delayed compared with group A (p < 0.05). The present results suggested that the surgical technique proposed is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorder of subjects.
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the role of nitric oxide no in the human Pyloric Sphincter
Hepato-gastroenterology, 1999Co-Authors: R Tomita, K Tanjoh, Shigeru Fujisaki, Masahiro FukuzawaAbstract:BACKGROUND/AIMS: Nitric oxide (NO) has recently been shown to be a neurotransmitter in non-adrenergic non-cholinergic (NANC) inhibitory nerves in the gastrointestinal tract. To clarify the role of NO in the human Pyloric Sphincter, enteric nerve responses in Pyloric tissue specimens obtained from patients with gastric cancer were investigated. METHODOLOGY: Fresh specimens of normal pylorus obtained from 18 patients with gastric cancer were used. The subjects consisted of 12 men and 6 women, aged from 45-74 years (average: 60.1 years). A mechanograph was used to evaluate in vitro Pyloric Sphincter muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, and N G -nitro-L-arginine (L-NNA) and L-arginine. RESULTS: Cholinergic nerves were mainly involved in the regulation of enteric nerve responses to EFS in the basal condition of the study, and NANC inhibitory nerves acted on human pylorus. L-NNA concentration dependently inhibited the relaxation in response to EFS in the human pylorus, and this inhibitory effect in the pylorus was reversed by L-arginine. CONCLUSIONS: These findings suggest that the cholinergic/adrenergic and NANC inhibitory nerves play important roles in regulating contraction and relaxation of the human pylorus, and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of the human pylorus.
Kenton M. Sanders - One of the best experts on this subject based on the ideXlab platform.
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role of nitric oxide as an inhibitory neurotransmitter in the canine Pyloric Sphincter
American Journal of Physiology-gastrointestinal and Liver Physiology, 1993Co-Authors: Orline Bayguinov, Kenton M. SandersAbstract:Experiments were performed to test the hypothesis that enteric inhibitory neurotransmission in Pyloric muscles is mediated by NO. Junction potentials were recorded with intracellular microelectrodes from cells near the myenteric and submucosal surfaces of the circular muscle layer. Inhibitory junction potentials (IJPs) were apamin sensitive and were reduced by arginine analogues [NG-nitro-L-arginine-methyl ester (L-NAME) and NG-monomethyl-L-arginine (L-NMMA)]. The effects of arginine analogues were reversed by L-arginine. Inhibition of IJPs unmasked excitatory JPs (EJPs) in the myenteric region and increased excitability of cells in the submucosal region. IJPs were also reduced by oxyhemoglobin. As with arginine analogues, reduction in IJPs increased EJP amplitude. Combination of L-NAME and oxyhemoglobin completely blocked IJPs, suggesting that NO, or an NO-containing compound, mediated the enteric inhibitory nerve responses. Exogenous NO hyperpolarized membrane potential, and these responses were also reduced by apamin. The magnitude of the responses to a given dose of NO was similar in cells of the myenteric and submucosal regions, suggesting that relatively smaller IJPs in submucosal cells may be due to a lower density of enteric inhibitory innervation in the submucosal region. The effects of NO were mimicked by 8-bromoguanosine 3',5'-cyclic monophosphate (cGMP) and M & B 22948, a specific cGMP phosphodiesterase inhibitor, suggesting that the hyperpolarization response to NO may be mediated by enhanced production of cGMP. IJPs were also prolonged by M & B 22948. IJPs and NO disrupted normal electrical rhythmicity in cells in the myenteric region. This may provide a basis for inhibitory effects of enteric inhibitory nerve stimulation on Sphincter pressure in Pyloric canal in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regulation of neural responses in the canine Pyloric Sphincter by opioids.
British Journal of Pharmacology, 1993Co-Authors: Orline Bayguinov, Kenton M. SandersAbstract:1. Regulation of excitatory and inhibitory junction potentials (e.j.ps and i.j.ps) by opioid peptides was studied in isolated muscle strips from the Pyloric Sphincter of the dog. 2. Methionine enkephalin (MetEnk; 10(-10) to 10(-6) M) and [D-Ala2, D-Leu5] enkephalin (DADLE; 10(-11) to 10(-7) M), a delta-specific opioid agonist, inhibited i.j.ps and e.j.ps recorded from cells in the myenteric and submucosal regions of the circular muscle layer. These compounds had no effect on resting potential or slow wave activity suggesting that the effects on junction potentials were not due to direct effects on smooth muscle cells. 3. MetEnk and DADLE caused similar effects on junction potentials in preparations in which the myenteric plexus was removed, suggesting that opioids inhibit pre-junctional effects on nerve fibres within the muscularis externa. 4. Inhibition of junction potentials by MetEnk and DADLE was blocked by approximately the same extent by naloxone (10(-6) M) and ICI 174,864 (10(-6) M), a delta-specific antagonist. 5. MetEnk and DADLE blocked a portion of the i.j.p. that was sensitive to arginine analogues; after treatment with N omega-nitro-L-arginine methyl ester (L-NAME, 10(-4) M), MetEnk and DADLE had no further effect on i.j.ps. These data suggest that opioids regulate nitric oxide-dependent neurotransmission. 6. Naloxone (10(-6) M) alone had no effect on i.j.ps elicited by short trains of electrical field stimuli. 7. I.j.p. amplitude was reduced after a period of conditioning stimulation (2 min, 30 Hz, 30 V). Naloxone blocked the post-stimulation inhibition. Repetitive stimulation at high frequencies (30 Hz) resulted in sustained hyperpolarization. Naloxone increased the amplitude of the hyperpolarization responses elicited by high frequency stimulation.8. These results show that e.j.ps and i.j.ps in the canine pylorus are inhibited by opioids. A portion of the inhibitory effects appears to be mediated via delta receptors.9. Although Pyloric muscles are richly innervated by nerves containing opioid peptides, brief trains of stimuli do not appear to release concentrations of opioids that are effective in regulating junction potentials. Higher frequency stimulation (or longer durations of stimulation) appear to be necessary to release concentrations of opioids that are effective in modulating the amplitude of junction potentials.
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characterization of ionic currents of circular smooth muscle cells of the canine Pyloric Sphincter
The Journal of Physiology, 1991Co-Authors: F Vogalis, Kenton M. SandersAbstract:1. The ionic currents of circular muscle cells from canine Pyloric Sphincter were characterized using the whole-cell patch clamp technique. 2. Subpopulations of circular muscle cells from the myenteric and submucosal halves of the circular layer were isolated and studied separately to determine whether differences in the currents expressed by these cells could explain differences in electrical behaviour observed in situ. 3. Resting potentials of isolated cells were about 20 mV positive to cells in intact muscles. Polarization under current clamp to the level of tissue resting potentials caused spontaneous discharge of action potentials in many cells. 4. Outward current measured under voltage clamp could be divided into a voltage-dependent component and a voltage- and Ca(2+)-dependent component. The latter was affected by manipulations of external [Ca2+], nifedipine and dialysis of cells with EGTA. 5. A few cells exhibited a channel that was activated with hyperpolarization. These channels produced inward current at potentials positive to the potassium reversal potential, EK, and reversed at -13 mV. 6. Inward currents, recorded from Cs(+)-loaded cells, were characterized by a transient phase and a sustained phase that persisted throughout the test depolarization. The inward current was reduced by nifedipine but in some cells a nifedipine-resistant component was observed. 7. There were no fundamental differences in the ionic currents recorded from circular muscle cells from the myenteric and submucosal regions, suggesting that the electrical activity of the tissue must be dependent upon structural characteristics (i.e. electrical coupling, fibre bundle dimensions, etc.) of the tissue. 8. The ionic conductance characterized can be related to many of the excitable events recorded from Pyloric muscles.
