SUMMARY To investigate the relationships between gastric change accompanying patients with acute stroke and the function of the autonomic nervous system and pituitary-adrenal system, studies on the gastroendoscopic technique and biochemical observations were done in 122 patients.The mean urinary noradrenalin and adrenalin excretions were elevated in patients with acute gastric changes, especially in patients with multiple erosions and acute ulcers.An elevation of the mean fasting serum gastrin concentration was found in patients with acute ulcers and no acute gastric changes.The mean urinary 17-OHCS excretion was increased in patients with multiple erosions, petechiae and acute ulcers.In conclusion, the sympathetic and parasympathetic nervous system and the pituitary-adrenal system have respectively different roles in the production of various types of acute gastric changes in patients.ACUTE CHANGES of the gastrointestinal tract in association with cerebral disease have been recognized since the first half of the nineteenth century. This subject has received much attention more recently, and a number of clinical and experimental studies on patients with various cerebral diseases and concomitant gastrointestinal changes have been reported.'"* These studies suggested that such gastrointestinal changes were induced by the accelerated function of the autonomic system and/or pituitary-adrenal system due to a lesion of the hypothalamus or its centrifugal tracts. But, in spite of considerable clinical and experimental work, the role of the autonomic nervous system and hypothalamicpituitary-adrenal system in the production of acute gastrointestinal changes still remains unclear.In the present study, in order to investigate the relationship between acute gastric change accompanying cases of acute stroke and the function of the autonomic nervous system and pituitary-adrenal system, studies using the gastroendoscopic technique, and analyses of urinary noradrenalin excretion, urinary adrenalin excretion, serum gastrin concentration and urinary 17-OHCS excretion were done on 122 patients with acute stroke.
MethodsOne hundred twenty-two patients who were admitted to the Research Institute of Brain and Blood Vessels, Akita, Japan, from May 1973 to October 1974 were studied, including 50 with cerebral hemorrhage, 40 with cerebral infarction, and 32 with subarachnoid hemorrhage. In all patients positive results of these cerebral lesions were found by carotid and/or vertebral angiography, and stroke patients with a normal angiogram were excluded. There were 89 men and 33 women, age 29 to 80 years (mean age, 56.7 ± 10.9 years). Most patients were admitted within three days after the onset of stroke (85%), and all within 18 days after stroke.The first gastroendoscopic examination (Olympus GTF S-2) was done on the majority of patients within one week after the onset and on all within two to three weeks. On 44 patients the gastroendoscopic examination was done only once, and on the rest of the patients the examination was done severa...