Abstract
In this study, we investigated the relationship between gastric emptying and duodenal events in patients with the Zollinger-Ellison syndrome due to a gastrinoma. Like the inhibitory effect of a meal on gastric secretion (described in a companion paper), postprandial inhibition of gastric emptying reduces fractional gastric emptying rates to normal during the first two hours after a meal. Gastric discharges of content into the duodenum fluctuate considerably, and, in some patients, duodenal acid load and neutralising duodenal secretions appear to be incoordinated. These mechanisms interact in part as a protective system that maintains reasonably normal duodenal homeostasis in most Zollinger-Ellison patients during the early postprandial period. Our data may explain why clinical evidence of overt-malabsorption is less prevalent and severe in these patients than would be expected from their enormously increased fasting gastric secretory outputs.
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- Ammon H. V., Thomas P. J., Phillips S. F. Effects of oleic and ricinoleic acids on net jejunal water and electrolyte movement. Perfusion studies in man. J Clin Invest. 1974 Feb;53(2):374–379. doi: 10.1172/JCI107569. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Clain J. E., Go V. L., Malagelada J. R. Inhibitory role of the distal small intestine on the gastric secretory response to meals in man. Gastroenterology. 1978 Apr;74(4):704–707. [PubMed] [Google Scholar]
- DELEU J., TYTGAT H., VANGOIDSENHOVEN G. E. DIARRHEA ASSOCIATED WITH PANCREATIC ISLET-CELL TUMORS. Am J Dig Dis. 1964 Feb;9:97–108. doi: 10.1007/BF02243513. [DOI] [PubMed] [Google Scholar]
- DONALDSON R. M., Jr, VOM EIGEN P. R., DWIGHT R. W. Gastric hypersecretion, peptic ulceration and islet-cell tumor of the pancreas (the Zollinger-Ellison syndrome); report of a case and review of the literature. N Engl J Med. 1957 Nov 14;257(20):965–970. doi: 10.1056/NEJM195711142572003. [DOI] [PubMed] [Google Scholar]
- DiMagno E. P., Go V. L., Summerskill W. H. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973 Apr 19;288(16):813–815. doi: 10.1056/NEJM197304192881603. [DOI] [PubMed] [Google Scholar]
- Dubois A., Eerdewegh P. V., Gardner J. D. Gastric emptying and secretion in Zollinger-Ellison syndrome. J Clin Invest. 1977 Feb;59(2):255–263. doi: 10.1172/JCI108636. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Go V. L., Poley J. R., Hofmann A. F., Summerskill W. H. Disturbances in fat digestion induced by acidic jejunal pH due to gastric hypersecretion in man. Gastroenterology. 1970 May;58(5):638–646. [PubMed] [Google Scholar]
- Levy A. G., Benson J. W., Hewlett E. L., Herdt J. R., Doppman J. L., Gordon R. S., Jr Saline lavage: a rapid, effective, and acceptable method for cleansing the gastrointestinal tract. Gastroenterology. 1976 Feb;70(2):157–161. [PubMed] [Google Scholar]
- Longstreth G. F., Malagelada J. R., Go V. L. The gastric response to a transpyloric duodenal tube. Gut. 1975 Oct;16(10):777–780. doi: 10.1136/gut.16.10.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Love A. H., Mitchell T. G., Phillips R. A. Water and sodium absorption in the human intestine. J Physiol. 1968 Mar;195(1):133–140. doi: 10.1113/jphysiol.1968.sp008451. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Malagelada J. R., Go V. L., DiMagno E. P., Summerskill W. H. Interactions between intraluminal bile acids and digestive products on pancreatic and gallbladder function. J Clin Invest. 1973 Sep;52(9):2160–2165. doi: 10.1172/JCI107400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Malagelada J. R., Longstreth G. F., Deering T. B., Summerskill W. H., Go V. L. Gastric secretion and emptying after ordinary meals in duodenal ulcer. Gastroenterology. 1977 Nov;73(5):989–994. [PubMed] [Google Scholar]
- Malagelada J. R., Longstreth G. F., Summerskill W. H., Go V. L. Measurement of gastric functions during digestion of ordinary solid meals in man. Gastroenterology. 1976 Feb;70(2):203–210. [PubMed] [Google Scholar]
- Malagelada J. R. Pathophysiological responses to meals in the Zollinger-Ellison syndrome: I. Paradoxical postprandial inhibition of gastric secretion. Gut. 1978 Apr;19(4):284–289. doi: 10.1136/gut.19.4.284. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McCarthy D. M., Olinger E. J., May R. J., Long B. W., Gardner J. D. H2-Histamine receptor blocking agents in the Zollinger-Ellison syndrome. Experience in seven cases and implications for long-term therapy. Ann Intern Med. 1977 Dec;87(6):668–675. doi: 10.7326/0003-4819-87-6-668. [DOI] [PubMed] [Google Scholar]
- SINGLETON J. W., KERN F., Jr, WADDELL W. R. DIARRHEA AND PANCREATIC ISLET CELL TUMOR: REPORT OF A CASE WITH A SEVERE JEJUNAL MUCOSAL LESION. Gastroenterology. 1965 Aug;49:197–208. [PubMed] [Google Scholar]
- SUMMERSKILL W. H. Malabsorption and jejunal ulceration due to gastric hypersecretion with pancreatic islet-cell hyperplasia. Lancet. 1959 Jan 17;1(7064):120–123. doi: 10.1016/s0140-6736(59)90003-0. [DOI] [PubMed] [Google Scholar]
- Shimoda S. S., Saunders D. R., Rubin C. E. The Zollinger-Ellison syndrome with steatorrhea. II. The mechanism of fat and vitamin B 12 malabsorption. Gastroenterology. 1968 Dec;55(6):705–723. [PubMed] [Google Scholar]
- Vogel R. M., Weinstein L. D., Herskovic T., Spiro H. M. Mechanisms of steatorrhea in the Zollinger-Ellison syndrome. Ann Intern Med. 1967 Oct;67(4):816–822. doi: 10.7326/0003-4819-67-4-816. [DOI] [PubMed] [Google Scholar]