Current Opinion in Gastroenterology

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Schubert, Mitchell L.

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Schubert, Mitchell L.

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This review of the past year's literature focuses on progress in the elucidation of the pathways and mechanisms controlling gastric exocrine (ie, acid and pepsin) and endocrine (ie, gastrin, somatostatin, and histamine) secretion at central, peripheral, and intracellular levels by neural, hormonal, and paracrine agents. Molecular biologic and immunocytochemical techniques coupled with physiologic studies using selective agonists and antagonists have furthered our understanding of the pathways and mechanisms regulating gastric secretion.

Bell, Cameron J.

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The term mucosal defense refers to the ability of the gastroduodenal mucosa to resist injury induced by luminal irritants. Although it is becoming clear that most, if not all, peptic ulcers can be attributed to either Helicobacter pylori or nonsteroidal anti-inflammatory drugs (NSAID

Sarna, Sushil K.

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This review focuses on recent developments regarding the potential role of nitric oxide (NO) in the regulation of gastric motility and emptying. The nonadrenergic noncholinergic inhibitory motor neurons in the stomach containing NO synthase were found to project in the aboral direction and the cholinergic excitatory motor neurons in the oral direction up to a mean distance of about 1 mm. The implications of this polarization in the spatial organization of gastric contractions and gastric emptying are discussed. It seems that NO synthesis in the brain may also modulate gastric motor activity through the vagus nerves. In addition, some of the central peptides may modulate gastric motor activity by the release of NO from the enteric neurons. This modulation also occurs through the vagal efferents. It is ironic that the systemic administration of both NO donors and NO synthase inhibitors delay gastric emptying. The delay in gastric emptying by the two opposing classes of agents may, however, be due to the stimulation or inhibition of different parameters of gastropyloroduodenal contractions.

Marks, I N Solly

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The literature during the period under review has been dominated by the evolution of Helicobacter pylori eradication strategies focusing on the goal of eradication rates of about 90% with a 1 -week treatment regimen. Different proton pump inhibitors have been shown to be equally effective in proton pump inhibitor-based triple therapy regimens, and the potential of clarithromycin in these regimens has been confirmed. The effect of H. pylori eradication and its possible therapeutic implications are also considered. The efficacy of proton pump inhibitors in ulcer healing and medical maintenance are reported, and the current status of prophylactic therapy for nonsteroidal anti-inflammatory drug-associated gastropathy is examined.

Sugerman, Harvey J.

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Surgical treatment of stomach and duodenal disorders continues to evolve at a rapid pace. This process continues to be driven by technologic improvements and a better understanding of the disorders themselves. Laparoscopic surgery remains the most prominent and visible of the changes taking place in this area of abdominal surgery; however, changes also continue apace in areas ranging from surgery for morbid obesity to gastric cancer. This article highlights some of the changes taking place in this rapidly evolving area of general surgery.