Gastric Ulceration in the Pig Subjected to Haemorrhagic Shock

Role of bile acid reflux in acute hemorrhagic gastritis

“…Reprint requests: Wallace P. Ritchie, M.D., Ph.D., Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia 22908, U.S.A. ed, however, if the pylorus was occluded during the period of shock, thus preventing upper intestinal chyme from coming in contact with ischemic gastric mucosa. Kivilaakso et al [2] performed a similar study in immature Yorkshire piglets subjected to shock with similar results; there was a 90% incidence of stress ulcers in control animals compared to no ulcers in animals with permanent bile diversion. The primacy of bile acids in this process was suggested by Hamza and DenBesten [3] who noted that the addition of a high concentration (15 raM) of taurocholic acid to the contents of the intact stomach of the dog subjected to shock during pylorus occlusion produced mucosal damage that was as severe as that observed in control (no pylorus occlusion) animals.…”

“…The final hypothetical factor involved is reflux of upper intestinal content. Although no direct assessment of this factor has been made in humans, Kivilaakso et al [2] have shown experimentally that reflux precedes acute lesion formation in the intact stomach of animals subjected to hemorrhagic shock. As indicated, we have also demonstrated that acute mucosal damage can occur in the presence of bile acid concentrations that are routinely found in the gastric content of postoperative patients.…”