Department of Pediatric Surgery,Children's Hospital,Chongqing University of Medical Sciences,Chongqing 630014,China
Xian-Qing Jin,male,born 1945-08-09,Yancheng,Jiangsu Province,Graduate d from Chongqing Medical College in 1969.Professor of,pediatric surgery,having 4 3 Papers and 4 books published.
Telephone:+86·811·3876500-3023
*Project supported by the National Natural Science Foundation of China.
Correspondence to Dr JIN Xiao-Qing
Received 8th August,1996.
Abstract
AIM To study the relationship between hypergastrinemia and the pathogenesis of acute intussusception,which is one of the most common forms of intestinal obstruction in infants.
METHODS Double antibody radioimmunoassay was used in the measu rement of serum gastrin levels.The blood specimens of patients with acute intussusception and normal infants were taken for measuring their serum cAMP levels by 125l cAMP radioimmunoassay.The pressures of ileum cavity and ileocecal valve determined before and after injection of gastrin(20μg/kg)in to the veins of 8 young dogs.
RESULTS The values of serum gastrin and cAMP were significantl y higher in patients than in the controls(P<0.01,P<0.05).Animal experiments showed strong peristalsis of ileum cavity and marked relax of ileocecal valve after injection of gastrin into the veins of young dogs.
CONCLUSION Hypergastrinemia might be the chief factor of the p athogenesis of intussusception in infants.
Subject headings lntussusception/etiology lntestinal obstruction; Gastrins; Cyclic AMP
Jin XQ, Wu F, Lei PY, Xu JL, Chen ZY. The role of hypergastrinemia in the pa thogenesis of intussusception in infants.
Chin J New Gastroenterol,1997;5(4)：207-208
INTRODUCTION
Intussusception is one of the most common forms of intestinal obstruction in infants,but its pathogenesis is still uncertain.The purpose of our clinical and laboratory studies is to enunciate the relationship between hypergastrinemia and the pathogenesis of acute intussusception.From 1986 to 1990 the serum gastrin levels of 124 blood specimens of 88 patients with intussusception under 3 years of age were measured,and 20 normal infants and 15 patients with ileum obstruction with the same measurement served as controls.In addition,serum cAMP levels of 10 normal infants and 10 patients with intussusception were determined.In the animal experimental study,the pressures of ileum cavity and ileocecal valve were determined before and after injection of gastrin into the veins of 8 young dogs.Results of both clinical and laboratory studies showed that the effect of gastrin and the etiology of intussusception are identical,so we hypothesize that hypergastrinemia might be the chief factor of the pathogenesis of intussuscrption in infants.
MATERIALS AND METHODSThe measurment of serum gastrin levelPatient groups,58 males and 30 females with intussusception aged from 3 months to 3 years,were diagnosed by typical clinical features and natural air enema or operation.The 124 blood specimens were obtained at the first day(before treatment)and the first week in hospital and the first and third month out of hospital after 4 hours fasting and without taking any medicine.The blood specimens of 20 normal infants (normal control group) and 20 patients with ileum obstruction (ileum obstruction group) with same age and condition were collected for measuring the serum gastrin levels by the double antibody radioimmunoassy.Serum cAMP levels were determined by 125 I cAMP radioimmunoassay in 10 normal infants and 10 patients with acute intussusception.The pressures of ileum cavity and ileocecal valve were determined before and after the injection of gastrin (20μg/kg) into the veins of 8 young dogs.
RESULTSThe valuers of serum gastrin in the 2 control groups and 4 patient groups are shown in Table 1.Levels of serum gastrin was significantly higher in patient groups (patient groups 1,2 and 3)than in the two control groups(P<0.01 or P<0.05),which decreased slowly (P approach to 0.05),but there was no significant difference between the normal control group and ileum obstruction group(P>0.05).
Table 1 The values of serum gastrin in all groups (ng/L) | Normalcontrol | Ileum obstruction | Groups of intussusception | | Before treatment | 1 week after treatment | 1 month after treatment | 3 months after treatment | | N | 20 | 15 | 71 | 23 | 14 | 16 | | x±s | 89±32 | 106±71 | 219±98a | 207±130a | 183±152b | 148±45c |
aP<0.01,bP<0.05,cP<0.05
The values of serum gastrin in recurrent cases (n=5)were higher (320 ng/L ± 61 ng/L)than in other patient groups.The values of serum cAMP in patient (10)and contorl groups(10) were 22.2±9.5 and 32.4±7.6 respectively.The measurements of the pressures of ileum cavity and ileocecal valve showed a strong peristalsis of ileum of 8 kPa and at a frequency of every 8 minutes after injection,(3.5 kPa and a frequency of every 12 minutes before injection);and marked relax of ileocecal valve after injection of gastrin into the veins of young dogs.
DISCUSSIONThe physiological functions of gastrin.In recent years it has become apparent th at the gut is the most complex endocrine organ and the list of peptides secreted from gut continue to increase.Gastrin,an important gut hormone,was discovered in 1905 and its main physiological functions are:①to increase the peristalsis of small intestin and relax the sphincter of ileocecal valve;②to promote the secretion of digestive glands and ③to increase the synthesis of DNA and RNA of intestinal mucosa[1].The relationship between hypergastrinemia and the pathogenesis of intussusception.The clinical study showed the significant difference of gastrin levels between the patient and control groups(P<0.05 or P<0.01).The highes values of serum cAMP in patient group indirectly demonstrated that there is a active metabolism of hormone in the patients with intussusception.In the animal experiment,a strong peristalsis of ileum and marked relaxation of ileocecal valve were seen after injection of gastrin into the veins of young dogs.All these results showed that the effect of gastrin and the pathogenesis of intussusception are identical.Main clinical features of intussusception can be explained for this new hypothesis.In the group under 14 years of age,there is the highest physiological serum gastrin level in infant group,which easily affects hypergasreinemia in infants[2].A physiological high serum gastrin level,before becoming hypergastrinemia,improves digestive function and maintains a good nutritive condition in infants,so that the patients with intussusception usually are well fed infants.Recent studies demonstrate that estrogen can depress the secretion of gastrin thus female infants with higher estrogen show a lower incidence of intussusception than male infants[3].Clinical and laboratory studies have demonstrated that serum gastrin levels were not higher in intestinal obstruction reported by some authors[4,5].Reasonably,hypergastrinemia might be the main factor of the pathogenesis of intussusception in infants.
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(Jin XQ Wu F Lei PY Xu
JL Chen ZY)
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