Gastric Motility in Duodenal Ulcer

Kay, Andrew W (1949) Gastric Motility in Duodenal Ulcer. PhD thesis, University of Glasgow.

Abstract

1. The pressing problem of peptic ulcer merits investigation from any hopeful viewpoint. The physiological upset which occurs in peptic ulceration is by no means fully understood and, in particular, our knowledge of the gastric motor activity is small. This thesis reports the results of a study of gastric motility in duodenal ulceration. 2. The technique of recording gastric motility is first described. with the patient fasting, a swallowed balloon is inflated to a standard pressure of 10cm. of water and connected to a tambour-kymograph unit for recording. The advantages of this method of gastro-graphy over other reported methods are discussed. The interpretation of the waves obtained is provided and certain difficulties and fallacies are defined. 3. The pattern of gastric motility in 30 normal subjects has been ascertained before investigating patients with duodenal ulcer. It was noted that the fasting stomach is never completely at rest and that, even in its most quiescent state, minor changes in tone are occurring constantly. 4. A detailed study has been made of the gastrograms obtained from 66 patients with active duodenal ulceration. Gastric contractions were found to be of greater amplitude and or shorter duration than in normal subjects and fusing of waves, not seen in controls, was common. Based on these criteria alone, the gastrographic diagnosis of duodenal ulcer would not be reliable. 5. The fact that inhibition of gastric motility follows the ingestion of cold water has been confirmed in 30 normal subjects. In audition, it is shown that the temperature of the water does not influence the type of gastric motor response but merely alters the duration of the response. In the presence of active duodenal ulceration, gastric activity was found to be either unaltered (Type II Reversal Response) or even stimulated (Type I Reversal Response) by the ingestion of water. This reversed response to water has been demonstrated consistently in 90 patients with active duodenal ulcer and it has been shown that a normal response returns with healing of the ulcer. Thus, the water test is of value in the diagnosis of active duodenal ulceration. This test has been used as an aid to the diagnosis of the "X-ray negative dyspepsias" and examples are provided which demonstrate its usefulness. 6. Evidence is presented which suggests that the receptor point for the gastric motor response to water is in the duodenum. This duodenal mechanism, which normally inhibits gastric motility, is damaged by active ulceration but functions normally when the lesion has healed. The water test can therefore be used to provide reliable evidence of healing. 7. The gastrographic diagnosis of pyloric stenosis depends on the demonstration of an increased latent period for the water test. This test also gives accurate information concerning the activity of the causal ulcer, provided it is duodenal. Save in extreme cases of stenosis accompanied by gastric atony, the gastrogram gives no accurate indication of the degree of pyloric obstruction. gastric arrhythmia may be present in patients with pyloric stenosis resulting from duodenal ulceration. It is especially common when the original ulcer is no longer in a state of activity. 8. It is a common practice to advise the patients suffering from peptic ulcer to smoke less tobacco. A study has been made of the effect of tobacco smoking on gastric motility in patients with duodenal ulcer. Smoking was not found to produce any constant change in gastric motor function. This result, taken in conjunction with similar reported observations on gastric acidity ana on symptomatology, indicates that moderate smoking is probably not harmful to the ulcer patient. 9. Opportunity has been taken to make observations on spontaneous ulcer pain. In two patients, pain was definitely related to the occurrence of true gastric contractions; in other cases, the level of gastric acidity appeared to play the predominant role. The literature on ulcer pain is reviewed and the merits of the various theories of its causation are discussed. It seems certain that a variety of stimuli can produce pain and the most usual one is probably hydrochloric acid. The view that these various stimuli all act by increasing the tissue tension around the ulcer has much to commend it. (Abstract shortened by ProQuest.).

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine, Surgery
• Date of Award: 1949
• Depositing User: Enlighten Team
• Unique ID: glathesis:1949-79720
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 Mar 2020 10:43
• Last Modified: 03 Mar 2020 10:43
• URI: https://theses.gla.ac.uk/id/eprint/79720