The act of vomiting in man.

Lumsden, K.; Holden, W. S.

doi:10.1136/gut.10.3.173

Cited by 49 publications

(13 citation statements)

References 6 publications

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“…The proximal part of the stomach also relaxes during the early stages of vomiting (20). This phenomenon was observed when vomiting occurred spontaneously (33), or when it was induced by stimulation of autonomic afferent nerves (19) or by apomorphine (20). In 1931, McSwiney (34) proposed the existence of inhibitory fibers in the vagus nerve and that vagal stimulation causes gastric inhibition when the prevailing gastric tone is high.…”

Section: Discussionmentioning

confidence: 99%

Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig.

Desai

Zembowicz

Sessa

et al. 1991

Proc. Natl. Acad. Sci. U.S.A.

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Here we show that the relaxation induced by stimulation of the vagus nerve in the presence of cholinergic (muscarinic) and adrenergic blockade in the isolated stomach of the guinea pig is mediated by nitric oxide (NO). This is substantiated by inhibition of vagal relaxation by NGmonomethyl-L-arginine, an inhibitor of NO synthesis. The effect of NG-monomethyl-L-arginine was partially reversed by coincubation with L-anine but not with D-arginne. NO activates soluble guanylate cyclase, and relaxation of the stomach induced by vagal stimulation was prevented by an inhibitor of soluble guanylate cyclase, methylene blue, further supporting our conclusions. The relaxant effect of vagal stimulation was also ablated by hexamethonium, an inhibitor of ganglionic nicotinic receptors, thereby showing that gangionic transmission did not rely on NO, through its release from pr onic neurons. However, hexamethonium did not inhibit the gastric relaxation brought about by increasing the inragastric pressure, which is also mediated by NO as previously described by us. The selective inhibition by hexamethonum of only the vagafly mediated relaxation but not of the pressure-induced relaxation of the stomach indicates the existence of at least two separate neuronal pathways able to generate NO and bring about gastric accommodation of food or fluid.Endothelium-derived relaxing factor, or nitric oxide (NO; ref. 1), plays important roles in the cardiovascular and immune systems (2, 3). Demonstration of the biosynthesis of NO by neuronal cells in the central nervous system (4) suggested a role for NO in intercellular communication in the brain. NO synthase, an NADPH-dependent dioxygenase that catalyzes formation of NO from one of the guanidino nitrogens of L-arginine, has been purified from the rat brain (5), sequenced, and expressed from its cDNA (6). The enzyme has been immunolocalized in nerve fibers and cell bodies of neurons in the brain and in the myenteric plexus in the gastrointestinal tract (7). Moreover, the myenteric plexus is an abundant source of neurons showing NADPH diaphorase activity (8), and NADPH diaphorase is a NO synthase (9). All these findings suggest the existence of nerves that release NO as a transmitter ("nitroxergic" nerves) in the central and peripheral nervous system. Inhibitory nerves were described in the stomach (10) and nonadrenergic, noncholinergic (NANC) inhibitory nerves have now been recognized in many parts of the gastrointestinal tract (11). Recent evidence demonstrates that these nerves are nitroxergic at some sites. Thus, the generation and release of NO has been demonstrated on electrical stimulation of NANC nerves in the canine ileocolonic junction (12) and rat stomach fundus (13). Also, the inhibition of NO formation prevents the relaxation of gastrointestinal smooth muscle, induced by electrical field stimulation of NANC nerves (13-15) or by other putative NANC neurotransmitters such as vasoactive intestinal peptide (VIP) (15), adenosine 5'-triphosphate (ATP), or -t-aminobutyric acid (1...

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Section: Discussionmentioning

confidence: 99%

Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig.

Desai

Zembowicz

Sessa

et al. 1991

Proc. Natl. Acad. Sci. U.S.A.

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“…The emetic process involves a coordinated sequence of events involving both respiratory and gastrointestinal structures (19)(20)(21)(22). Initiation and coordination of this process is the responsibility of the vomiting center, a structure located in the lateral reticular formation of the medulla.…”

Section: Psychophysiology Of Nausea and Vomitingmentioning

confidence: 99%

The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: a review and synthesis.

Andrykowski

1990

Psychosomatic Medicine

101

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The role of state anxiety in the development of anticipatory nausea and vomiting (ANV) in cancer chemotherapy has been the focus of considerable empirical investigation and theoretical speculation. However, while some relationship between state anxiety and ANV is presumed to exist, determination of its precise nature has proven elusive. Specific hypotheses linking state anxiety to ANV are described and evaluated in light of the empirical evidence. These hypotheses include (a) ANV is a symptomatic concomitant of state anxiety; (b) state anxiety directly facilitates the classical conditioning of ANV; (c) state anxiety exacerbates the magnitude of post-treatment nausea and vomiting experienced, thus increasing the risk of ANV; (d) ANV causes infusion-related state anxiety; and (e) the observed relationship between ANV and state anxiety is a result of methodological artifact. It is concluded that state anxiety can play a causal role in the development of ANV in some patients. In particular, the hypothesis that state anxiety exacerbates post-treatment nausea and vomiting and thus increases the risk for ANV appears best supported by the data. Finally, the clinical implications of the relationship between ANV and state anxiety for the treatment and prevention of ANV are discussed.

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“…In an initial response to nausea, the stomach relaxes and the greater curvature descends (Abbot et al 1952;Barclay 1936;Lumsden & Holden 1969). This gastric relaxation may provide a reservoir for intestinal contents.…”

Section: Pharmacology and Physiologymentioning

confidence: 99%

“…During active retching, the gastric antrum contracts and the contents are forced toward the proximal gastric areas in preparation for the expulsive phase. Vomiting then ensues as a result of spasmodic contractions of the abdominal muscles and descent of the diaphragm (Lumsden & Holden 1969).…”

Section: Pharmacology and Physiologymentioning

confidence: 99%

Gastric Emptying

1986

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This review examines the various clinical options used to elicit gastric emptying, viz. drug-induced emesis, mechanical pharyngeal stimulation, gastric lavage, and catharsis. Apomorphine and syrup of ipecac are the 2 drugs most frequently used for induction of emesis. Both agents act centrally and, in addition, syrup of ipecac has a peripheral action. Toxins ingested or foods previously eaten may inhibit or enhance emetic action by interfering with mediating and conducting mechanisms. Studies indicate that both syrup of ipecac and apomorphine are similarly effective in inducing emesis; however, apomorphine has a shorter reaction time compared with syrup of ipecac. There are more risks involved with the use of apomorphine, since it causes central nervous system and respiratory depression. Syrup of ipecac has been shown to be relatively safe when used in its recommended dosage for emesis. However, several toxicities have been reported with the use of the fluid extract of ipecac. Emesis is contraindicated in patients who are obtunded or comatose, and in patients who have ingested stimulants, some hydrocarbons, or corrosives. Mechanical pharyngeal stimulation is a simple method of inducing emesis; however, it is often unsuccessful and rarely recovers a significant portion of the gastric contents. Gastric lavage is a procedure which has been relied upon for over a century. Its effectiveness is dependent on the nature, form, and dosage of the poison, latency between time of ingestion and lavage, and technique. In clinical experiments studying gastric lavage, it has been noted that the procedure is most beneficial 1 to 2 hours postingestion for the majority of poison ingestions. Lavage also provides an excellent route for activated charcoal and selected antidotes. Gastric lavage may pose several risks to the patient, including obstruction and contamination of the airways and oesophageal damage. Contraindications for gastric lavage are similar to those for emesis except that it may be safer to use in obtunded, comatose, or uncooperative patients. Cathartics used during initial poisoning therapy are usually the saline cathartics. They elicit an osmotic reaction in the small intestine which results in increased intraluminal fluid bulk, hyperperistalsis, and subsequent propulsion of contents. Cathartics have also been shown to stimulate the secretion of cholecystokinin, which is thought to have similar effects on the intestine. Cathartics have not been shown to significantly enhance drug elimination from the gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)

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The act of vomiting in man.

Cited by 49 publications

References 6 publications

Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig.

Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig.

The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: a review and synthesis.

Gastric Emptying

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