Zollinger-Ellison Syndrome With Diarrhœa and Malabsorption

Rawson, AnnetteB.; England, M. L.; Gillam, G.G.; French, J. M.; Stammers, F. A. R.

doi:10.1016/s0140-6736(60)91271-x

Cited by 90 publications

(14 citation statements)

References 14 publications

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“…Figs. [16][17][18][19]. Rat infused with lactic acid 3.0 g % demonstrating more extensive changes than those seen in the group infused with 2.5 gm % acid.…”

Section: Necropy Findingsmentioning

confidence: 99%

Prolonged Infusion of the Small Intestine of the Rat — Effect of Dilute Solutions of Lactic Acid on Fat Absorption and Mucosal Morphology

Hamilton

1967

Pediatr Res

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ExtractA satisfactory technique for the continual infusion of solutions into the intestinal tract of the small animal was developed. Using this technique, dilute solutions of lactic acid were infused into the rat and their effect on fat absorption and mucosal structure assessed. Thirty-five rats were studied in five groups, infused with either ion-free water or lactic acid (2.0 g/100 ml, 2.5 g/100 ml, 3.0 g/100 ml, 3.5 g/100 ml) for 10 days. Fecal fat excretion measured as a percentage of ingested fat was increased significantly in rats infused with acid in a concentration of 3.0 g/100 ml (7.2 1-2.1) and 2.5 g/100 ml (6.5 f2.1) compared to the water-infused group (2.9 f 1.9) or those infused with lactic acid 2.0 g/100 ml (2.2 f0.9). Six rats infused with lactic acid 3.5 g/100 ml died within 72 hours of a perforated intestine and the two remaining ones were killed prematurely for histological study.Histological abnormalities were confined to the small intestine. Mucosal structure was normal in both the water-infused group and those receiving lactic acid 2.0 g/100 ml. Shortening of villi occurred a t the site of infusion in both the groups infused with lactic acid 2.5 g/100 ml and 3.0 g/100 ml. Fusiform processes of epithelial cells were observed extending on narrow pedicles from the tips of some of the shortened villi. Gross derangement of villous structure was observed in two rats killed after 48 hours on the most concentrated acid (3.5 g/100 ml) .I t is probable that the abnormalities in fat absorption and mucosal structure were a direct effect of the infusion with lactic acid. The mechanism behind the development of steatorrhea can only be the subject of speculation. The histological observations suggest that the lesions produced in the mucosa were associated with disordered turnover of the surface epithelial cells. SpeculationA new technique for the continual long-term infusion of the small intestine of small animals may have considerable application to the study of normal and abnormal intestinal function and structure in the future. The observations of disordered fat absorption and mucosal lesions in response to the infusion of an organic acid into the intestinal lumen may be relevant to the study of the pathogenesis of certain malabsorptive states.

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“…Figs. [16][17][18][19]. Rat infused with lactic acid 3.0 g % demonstrating more extensive changes than those seen in the group infused with 2.5 gm % acid.…”

Section: Necropy Findingsmentioning

confidence: 99%

Prolonged Infusion of the Small Intestine of the Rat — Effect of Dilute Solutions of Lactic Acid on Fat Absorption and Mucosal Morphology

Hamilton

1967

Pediatr Res

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“…Maynard and Point (1958) described one such patient in whom there was a gross excess of fat in the stools. They postulated that the steatorrhoea was the result of the inactivation of pancreatic enzymes at the low pH caused by the excessive gastric secretion and this hypothesis has received support from the work of Summerskill (1959) and Rawson, England, Gillam, French, and Stammers (1960). There seems little doubt that the gastric hypersecretion is due to the formation of a gastrin-like substance by the adenoma (Gregory, Tracy, French, and Sircus, 1962).…”

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confidence: 99%

Watery diarrhoea and an islet cell tumour

Hindle¹,

McBrien²,

Creamer³

1964

Gut

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“…Decreased enzymatic activity in unstimulated duodenal aspirates has been found by some authors (Maynard and Point, 1958;Summerskill, 1959) and normal by others (Rawson, England, Gillam, French, and Stammers, 1960;Donaldson, Vom Eigen, and Dwight, 1957). After stimulation with secretin and pancreozymin both normal (Shay, Chey, Koide, and Burnett, 1962) and decreased responses (Summerskill, 1959) have been reported.…”

mentioning

confidence: 82%

Secretory response to secretin in a patient with diarrhoea and the Zollinger-Ellison pattern of gastric secretion

Petersen¹,

Myren²,

Liavåg³

1969

Gut

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SUMMARY In a woman with diarrhoea and the Zollinger-Ellison pattern of gastric secretion, the secretion of fluid and bicarbonate into the duodenum in response to secretin was found to be significantly greater than in controls. No pancreatic tumour was found at operation. The pancreas was, however, larger than normal.The patient did not show symptoms of peptic ulcer disease until vagotomy and pyloroplasty had been performed. A capacity to secrete large amounts of bicarbonate was believed to be the explanation of why she was able to tolerate great amounts of acid.Little attention has been paid to the exocrine pancreatic function in the Zollinger-Ellison syndrome. Decreased enzymatic activity in unstimulated duodenal aspirates has been found by some authors (Maynard and Point, 1958;Summerskill, 1959) and normal by others (Rawson, England, Gillam, French, and Stammers, 1960;Donaldson, Vom Eigen, and Dwight, 1957). After stimulation with secretin and pancreozymin both normal (Shay, Chey, Koide, and Burnett, 1962) and decreased responses (Summerskill, 1959) have been reported. A recent report dealing with the response to a test meal in two patients with the Zollinger-Ellison syndrome (Cook and French, 1968) demonstrates that the amount of alkalinity and activity of trypsin in the upper small intestine may show great variations. CASE REPORTA 37-year-old married woman had diarrhoea for the first time in 1964. She had never had dyspepsia before or other complaints indicating any disorder, including endocrine disease. The diarrhoea progressed and in 1966 when we saw her for the first time, she was passing five to 10 loose stools daily which often were bulky and greyish in colour, suspicious of steatorrhoea. She had no dyspepsia or weight loss and her appetite was good. During the next two years the diarrhoea progressed moderately but the patient had no other complaints. A temporary improvement was achieved during treatment with an anticholinergic drug, oxyphencyclimine HCl.1 'Daricon, Pfizer. 796LABORATORY FINDINGS The physical examination of the patient was unremarkable. Her body weight was 65 kg and her height 167 cm. Blood examination showed normal values for concentrations of haemoglobin, protein, iron, cholesterol, urea, and creatinine. The sedimentation rate was 1 mm/hr and the red and white blood cell counts were within normal limits. Glucose tolerance tests performed in 1967 and 1968 were normal and normal values were obtained for the blood concentrations of alkaline phosphatase, glutamic oxalic transaminase, total bilirubin and prothrombin, and for bromsulphalein by the retention test. The serum concentrations of electrolytes, including potassium, were normal.Absorption studies Stool fat excretion was raised on a standard ward diet containing approximately 100 g fat daily. The absorption of vitamin A was decreased, being 582 IU/100 ml in 1968, a slight improvement over the values for earlier reports. Two ofthree D-xylose tests were abnormal. In 1967 the result for D-xylose tests was 3.7 g in five-hour urine and i...

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Zollinger-Ellison Syndrome With Diarrhœa and Malabsorption

Cited by 90 publications

References 14 publications

Prolonged Infusion of the Small Intestine of the Rat — Effect of Dilute Solutions of Lactic Acid on Fat Absorption and Mucosal Morphology

Prolonged Infusion of the Small Intestine of the Rat — Effect of Dilute Solutions of Lactic Acid on Fat Absorption and Mucosal Morphology

Watery diarrhoea and an islet cell tumour

Secretory response to secretin in a patient with diarrhoea and the Zollinger-Ellison pattern of gastric secretion

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