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American Journal of Physiology.... May 2019Esophageal acid sensory signals are transmitted by both vagal and spinal pathways to the cerebral cortex. The influence and interplay of these pathways on esophageal...
Esophageal acid sensory signals are transmitted by both vagal and spinal pathways to the cerebral cortex. The influence and interplay of these pathways on esophageal acid-related functional connectivity has been elusive. Our aim was to evaluate the esophageal acid exposure-related effect on the anterior cingulate cortex (ACC) functional connectivity networks using functional MRI-guided functional connectivity MRI (fcMRI) analysis. We studied six Sprague-Dawley rats for fcMRI experiments under dexmedetomidine hydrochloride anesthesia. Each rat was scanned for 6 min before and after esophageal hydrochloric acid infusion (0.1 N, 0.2 ml/min). The protocol was repeated before and after bilateral cervical vagotomy on the same rat. Seed-based fcMRI analysis was used to examine ACC networks and acid-induced network alterations. Three-factor repeated-measures ANOVA analysis among all four subgroups revealed that the interaction of acid infusion and bilateral vagotomy was mainly detected in the hypothalamus, insula, left secondary somatosensory cortex, left parietal cortex, and right thalamus in the left ACC network. In the right ACC network, this interaction effect was detected in the caudate putamen, insula, motor, primary somatosensory cortex, secondary somatosensory cortex, and thalamic regions. These regions in the ACC networks showed decreased intranetwork connectivity due to acid infusion. However, after bilateral vagotomy, intranetwork connectivity strength inversed and became stronger following postvagotomy acid infusion. Signals transmitted through both the vagal nerve and spinal nerves play a role in esophageal acid-related functional connectivity of the ACC. The vagal signals appear to dampen the acid sensation-related functional connectivity of the ACC networks. These studies show that esophageal acid-induced brain functional connectivity changes are vagally mediated and suggest that signals transmitted through both the vagal nerve and spinal nerves play a role in esophageal acid-related functional connectivity of the anterior cingulate cortex. This paper focuses on the development of a novel rat functional MRI model fostering improved understanding of acid-related esophageal disorders.
Topics: Animals; Brain Mapping; Esophagus; Gyrus Cinguli; Hydrochloric Acid; Magnetic Resonance Imaging; Neural Pathways; Rats; Rats, Sprague-Dawley; Spinal Nerves; Vagotomy; Vagus Nerve
PubMed: 30817181
DOI: 10.1152/ajpgi.00228.2018 -
Annals of Surgery Jan 1979A survey was undertaken of 558 men with duodenal ulcer who had been treated ten to 16 years previously by truncal vagotomy and drainage, truncal vagotomy and antrectomy...
A survey was undertaken of 558 men with duodenal ulcer who had been treated ten to 16 years previously by truncal vagotomy and drainage, truncal vagotomy and antrectomy and subtotal gastrectomy. Of the 558, 65 had died and 111, presumed living, could not be traced, leaving 382 available for assessment. Between 75 and 85% of the traced patients were considered to have an excellent or very good result, which is a slight improvement on the previously published results in this same group of patients at five to eight years follow-up. Some of the side effects of operation had diminished slightly in frequency and there had been no significant increase in the incidence of recurrent ulceration since the previous survey. Anemia was an uncommon finding. As between the various forms of operation, truncal vagotomy and antrectomy and subtotal gastrectomy demonstrated significantly better protection against proven recurrent ulcer than did truncal vagotomy and pyloroplasty (p less than 0.05). Compared with truncal vagotomy and gastroenterostomy, however, the results of both resection operations, though better, did not achieve statistical significance at p - 0.5 level (p less than 0.1). In regard to Visick gradings the resection procedures had better scores, but the differences were not significant at the p - 0.05 level, except for vagotomy and antractomy as compared with vagotomy and pyloroplasty. But it is stressed that in formulating a policy of surgical therapy for duodenal ulcer the greater inherent immediate risks of resection operations need to be borne in mind.
Topics: Drainage; Duodenal Ulcer; Evaluation Studies as Topic; Follow-Up Studies; Gastrectomy; Gastroenterostomy; Humans; Male; Pyloric Antrum; Recurrence; Risk; Vagotomy
PubMed: 758858
DOI: 10.1097/00000658-197901000-00004 -
World Journal of Surgical Oncology Jul 2023The interplay between the nervous system and cancer plays an important role in the initiation and progression of gastric cancer. Few studies have presented evidence that...
BACKGROUND
The interplay between the nervous system and cancer plays an important role in the initiation and progression of gastric cancer. Few studies have presented evidence that the sympathetic nervous system inhibits the occurrence and development of gastric cancer while the parasympathetic nervous system promotes the growth of gastric cancer. To investigate the effect of vagotomy, which is the resection of a parasympathetic nerve innervating the stomach, on the progression of gastric cancer, a retrospective study was conducted comparing the prognosis of simple palliative gastrojejunostomy (PGJ) and palliative gastrojejunostomy with vagotomy (PGJV).
METHODS
From January 01, 2000, to December 31, 2021, the medical records of patients who underwent PGJ or PGJV because of gastric outlet obstruction due to incurable advanced gastric cancer at the Yeungnam University Medical Center were retrospectively reviewed. Patients were divided into two groups: locally unresectable gastric cancer (LUGC) or gastric cancer with distant metastasis (GCDM), according to the reason for gastrojejunostomy, and factors affecting overall survival (OS) were analyzed.
RESULTS
There was no significant difference in surgical outcomes and postoperative complications between the patients with PGJV and patients with PGJ. In univariate analysis, vagotomy was not a significant factor for OS in the GCDM group (HR 1.14, CI 0.67-1.94, p value 0.642), while vagotomy was a significant factor for OS in the LUGC group (HR 0.38, CI 0.15-0.98, p value 0.045). In multivariate analysis, when vagotomy is performed together with PGJ for LUGC, the OS can be significantly extended (HR 0.25, CI 0.09-0.068, p value 0.007).
CONCLUSIONS
When PGJ for LUGC was performed with vagotomy, additional survival benefits could be achieved with low complication risk. However, to confirm the effect of vagotomy on the growth of gastric cancer, further prospective studies using large sample sizes are essential.
Topics: Humans; Retrospective Studies; Stomach Neoplasms; Case-Control Studies; Palliative Care; Prospective Studies; Vagotomy; Gastric Outlet Obstruction
PubMed: 37480111
DOI: 10.1186/s12957-023-03111-9 -
Annals of Surgery Oct 1986A retrospective study of 1068 patients who had operations for peptic ulcer disease in the 12-year period from January 1, 1974, to January 1, 1986, permits these...
A retrospective study of 1068 patients who had operations for peptic ulcer disease in the 12-year period from January 1, 1974, to January 1, 1986, permits these conclusions: The number of patients admitted to the Massachusetts General Hospital (MGH) has declined steadily in the years of this study--1974-1986. The average number of patients admitted with a diagnosis of peptic ulcer disease in precimetidine years--1974, 1975, and 1976--and in recent years--1982, 1983, and 1984--shows a decline of 39.3% in admissions. In the same periods, the average number of operations per year has declined from 92 in precimetidine years to an average of 71 (16.5%) recently. The decline has been greatest in patients operated on electively for duodenal ulcer. Operations for massive hemorrhage and acute perforations and the number of deaths have remained nearly constant. The overall mortality rate was 10.3%. The mortality following elective operations for pain was 0.5%; for urgent operations, including those for obstruction, 4.5%, and for bleeding other than massive, 7.5%; and for emergency operations, including those for acute perforation, 20.9%, and for massive hemorrhage, 22.1%. The main causes of death were organ failure (most commonly of the lungs) and sepsis. Early complications were documented 345 times and were followed by reoperation in 84 cases, or 7.4% of the total. Delayed stomal function was noted in 63 cases and required reoperation in 14. It was most common after Roux anastomoses and required operative intervention most commonly after gastric resection, Billroth I (GRBI). Delay was three times as common when vagotomy (V) was added to GR. Early postoperative hemorrhage was a serious complication when it occurred after operations for acute perforations or massive hemorrhage. The incidence was 3.7% after suture of a perforation; after operations for acute massive hemorrhage, it was 4.3% after pyloroplasty and vagotomy, with or without arterial ligation [PV(L)], and 0.3% after GR, with or without arterial ligation [GR(L)]. Late complications led to reoperation in 66 cases (6.2%). The most important were recurrent ulceration and alkaline gastritis. Recurrence rates after a minimum follow-up of 5 years (based on survivors of initial procedures and a second operation, both in the MGH) were 20.5% after suture of a perforation, 6.2% after PV, 2.3% after GRBII, and 0.4% after GRVBII. These figures are lower than expected; incomplete follow-up and improved medical care are factors.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Attitude of Health Personnel; Cimetidine; Duodenal Ulcer; Emergencies; Gastrectomy; Humans; Retrospective Studies; Stomach Ulcer; Vagotomy
PubMed: 3767481
DOI: 10.1097/00000658-198610000-00014 -
Neural Plasticity 2017The aim of this study was to investigate the effect of subdiaphragmatic vagotomy on insulin sensitivity, secretion, and degradation in metabolic programmed mice, induced...
The aim of this study was to investigate the effect of subdiaphragmatic vagotomy on insulin sensitivity, secretion, and degradation in metabolic programmed mice, induced by a low-protein diet early in life, followed by exposure to a high-fat diet in adulthood. Weaned 30-day-old C57Bl/6 mice were submitted to a low-protein diet (6% protein). After 4 weeks, the mice were distributed into three groups: LP group, which continued receiving a low-protein diet; LP + HF group, which started to receive a high-fat diet; and LP + HFvag group, which underwent vagotomy and also was kept at a high-fat diet. Glucose-stimulated insulin secretion (GSIS) in isolated islets, ipGTT, ipITT, in vivo insulin clearance, and liver expression of the insulin-degrading enzyme (IDE) was accessed. Vagotomy improved glucose tolerance and reduced insulin secretion but did not alter adiposity and insulin sensitivity in the LP + HFvag, compared with the LP + HF group. Improvement in glucose tolerance was accompanied by increased insulinemia, probably due to a diminished insulin clearance, as judged by the lower C-peptide : insulin ratio, during the ipGTT. Finally, vagotomy also reduced liver IDE expression in this group. In conclusion, when submitted to vagotomy, the metabolic programmed mice showed improved glucose tolerance, associated with an increase of plasma insulin concentration as a result of insulin clearance reduction, a phenomenon probably due to diminished liver IDE expression.
Topics: Animals; Diet, High-Fat; Diet, Protein-Restricted; Glucose; Insulin; Insulin Resistance; Insulysin; Liver; Mice; Obesity; Vagotomy
PubMed: 28951790
DOI: 10.1155/2017/9652978 -
Gut Jul 1978Twenty-four hour intragastric pH during normal daily activity has been studied by nasogastric intubation and aspiration of gastric samples in seven patients four years...
Twenty-four hour intragastric pH during normal daily activity has been studied by nasogastric intubation and aspiration of gastric samples in seven patients four years after vagotomy (four truncal, three selective). Two of these patients also had pre- and early postoperative studies. Mean pH was inversely correlated with basal, insulin- and pentagastrin-stimulated acid outputs. However, one of four patients after truncal vagotomy with drainage, and two of three after selective vagotomy and drainage had most of their hourly intragastric pH values more acidic than pH 3.5 despite more than 70% reductions in preoperative stimulated-acid outputs.
Topics: Gastric Acidity Determination; Gastric Juice; Humans; Male; Secretory Rate; Time Factors; Vagotomy
PubMed: 680598
DOI: 10.1136/gut.19.7.664 -
Gut Aug 1982The effects of fundic vagotomy on acid and pepsin secretion in 12 patients (10 males, two females; nine duodenal ulcer, three gastric ulcer) were studied using a...
The effects of fundic vagotomy on acid and pepsin secretion in 12 patients (10 males, two females; nine duodenal ulcer, three gastric ulcer) were studied using a pentagastrin dose response before and after Vagotomy. In the intact stage H, Cl, and pepsin output all had the same ED50, 120-127 pmol/kg/h. Vagotomy reduced basal output of acid by 78%, Cl- by 50%, and pepsin by 62%. Postvagotomy basal outputs were not related to preoperative levels, while maximum acid output was reduced by an average of 35%, proportionally to the preoperative output (r = 0.94). Vagotomy uncompetitively (ED50 increase, Vmax decrease) inhibited the pentagastrin dose response of acid, chloride, and pepsin output. Postoperatively, a six-fold greater dose of pentagastrin (450 vs 76 pmol/kg/h) was required to stimulate acid to 50% of its preoperative maximum output. For pepsin secretion the increase was 12-fold (185 vs 15 pmol/kg/h). In five of the nine duodenal ulcer patients pentagastrin dose responses were repeated with a background infusion of urecholine, 20 micrograms/kg/h. Urecholine increased basal and peak acid, pepsin, and chloride outputs, and the ratio of basal: maximal almost to prevagotomy levels; it also restored the sensitivity to pentagastrin. Serum gastrin was not significantly changed by urecholine or by vagotomy. We conclude that the level of basal acid and pepsin secretion in ulcer patients, which is largely eliminated by vagotomy, is dependent on the vagus and not on serum gastrin. The effects of vagotomy are functional, are due to cholinergic withdrawal, and usually can be restored by cholinergic replacement.
Topics: Adult; Bethanechol Compounds; Dose-Response Relationship, Drug; Duodenal Ulcer; Female; Gastric Acid; Humans; Male; Middle Aged; Pentagastrin; Pepsin A; Peptic Ulcer; Stomach Ulcer; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6807759
DOI: 10.1136/gut.23.8.675 -
Annals of Surgery Jun 1974The antral-duodenal contractile relationship was studied in control, after parietal cell vagotomy and truncal vagotomy conditions using extraluminal strain gage... (Comparative Study)
Comparative Study
The antral-duodenal contractile relationship was studied in control, after parietal cell vagotomy and truncal vagotomy conditions using extraluminal strain gage transducers. All conditions were investigated under interdigestive and digestive states and after insulin, bethanechol and histamine. After parietal cell vagotomy, there was minimal alteration of the antral-duodenal relationship in both the interdigestive and digestive states. The number and amplitude of contractions on both the antrum and duodenum (as reflected by a motility index) were not changed from control by the various stimulants. The one exception was that histamine markedly stimulated the duodenal contractile activity. In the truncal vagotomy condition, there was a total disruption of the antral-duodenal relationship in the interdigestive and digestive states. There was a significant decrease in the number and amplitude of contractions occurring on the antrum during the interdigestive and after insulin stimulation. Food was ineffective in stimulating the antrum in 2 of 3 dogs. In contrast, motor activity of the duodenum was minimally influenced by truncal vagotomy. In conclusion, parietal cell vagotomy has minimal disruptive effects on the antralduodenal relationship while truncal vagotomy reduces antral contractile activity.
Topics: Animals; Bethanechol Compounds; Digestion; Duodenum; Fasting; Gastrointestinal Motility; Histamine; Insulin; Male; Methods; Muscle Contraction; Pyloric Antrum; Stimulation, Chemical; Transducers; Vagotomy
PubMed: 4835504
DOI: 10.1097/00000658-197406000-00006 -
Acta Cirurgica Brasileira 2021To evaluate the influence of autonomic vagal and splenic activities on renal histomorphometric aspects in obese rats.
PURPOSE
To evaluate the influence of autonomic vagal and splenic activities on renal histomorphometric aspects in obese rats.
METHODS
Thirty male Wistar rats were used, of which, 24 received subcutaneous injections of monosodium glutamate (MSG) during the first 5 days of life (4 g/kg body weight) and six control animals received injections of saline solution (CON). Five experimental groups were organized (n = 6/group): falsely-operated control (CON-FO); falsely-operated obese (MSG-FO); vagotomized obese (MSG-VAG); splenectomized obese (MSG-SPL); vagotomized and splenectomized obese (MSG-VAG-SPL).
RESULTS
The MSG-FO group animals showed a significant reduction in body weight and nasal-anal length when compared to CON-FO group animals (p < 0.05). The MSG-VAG-SPL group showed significant reduced in most biometric parameters associated with obesity. Falsely-operated obese animals showed a significant reduction in renal weight, glomerular diameters, glomerular tuff and capsule areas and Bowman's space compared to CON-FO group animals (p < 0.05). There was a significant reduction in diameter, glomerular tuft and capsule areas, and Bowman's space in MSG-VAG, MSG-SPL, MSG-VAG-SPL groups when compared to the MSG-FO group.
CONCLUSIONS
Vagotomy associated with splenectomy induces a reduction in the adiposity and causes histological changes in the kidney of obese rats.
Topics: Animals; Kidney; Lipids; Male; Obesity; Rats; Rats, Wistar; Splenectomy; Vagotomy
PubMed: 33624722
DOI: 10.1590/ACB360205 -
The Yale Journal of Biology and Medicine 1994Peptic ulcer surgery has been revitalized by the introduction of minimal access techniques for surgery of chronic and perforated peptic ulcer. A wide range of... (Review)
Review
Peptic ulcer surgery has been revitalized by the introduction of minimal access techniques for surgery of chronic and perforated peptic ulcer. A wide range of vagotomies, including truncal vagotomy, anterior lesser curve seromyotomy with posterior truncal vagotomy and proximal gastric vagotomy, have been performed laparoscopically. Short-term (two-24 month) follow-up of laparoscopic anterior seromyotomy with posterior truncal vagotomy cases has been promising, but long-term follow-up is required to confirm these early good results. Laparoscopic repair of perforated peptic ulcers has also been described. Initial reports of laparoscopic gastrojejunostomy and Billroth II partial gastrectomy have also appeared. These procedures are technically very demanding and are currently being performed in only a few "centers of excellence" around the world. Cost-benefit analyses of medical treatment with proton-pump inhibitors versus laparoscopic vagotomy are necessary to determine which form of treatment is more economical in the long run. Criteria for patient selection need to be defined and substantiated by audit of outcome.
Topics: Humans; Laparoscopy; Peptic Ulcer; Stomach; Vagotomy
PubMed: 7502525
DOI: No ID Found