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Gastric Acid Secretion in Patients Undergoing Chronic Dialysis

Gastric Acid Secretion in Patients Undergoing Chronic Dialysis Abstract THE treatment of uremia by chronic hemodialysis has raised a number of serious economic, moral, emotional, and medical problems.1-3 As experience with this form of treatment is still limited, medical complications, especially if unanticipated, may seriously disrupt treatment and limit long-term, successful management. We have been confronted with the development of peptic ulcer in four of seven patients undergoing hemodialysis. The gastric secretion of acid was measured in patients undergoing chronic hemodialysis to quantitate one factor possibly responsible for this complication. Methods Dialysis Techniques. —The chronic hemodialysis unit at this institution has been operative since December 1963. Although patients were selected primarily because of medical indications, an attempt was made to assess such factors as stability of personality and potential of cooperation with a precise medical regimen. All patients were severely ill at the time of entrance into the program.Initially, the dialysis technique used was a recirculating 17-hour References 1. Retan, J.W., and Lewis, H.Y.: Repeated Dialysis of Indigent Patients for Chronic Renal Failure , Ann Intern Med 64:284-292 ( (Feb) ) 1966.Crossref 2. Brown, H.W., et al: Clinical Problems Related to Prolonged Artificial Maintenance of Life by Hemodialysis in Chronic Renal Failure , Trans Amer Soc Artif Intern Organs 8:281-291, 1962.Crossref 3. Pendras, J.P., and Erickson, R.V.: Hemodialysis: A Successful Therapy for Chronic Uremia , Ann Intern Med 64:293-311 ( (Feb) ) 1966.Crossref 4. Ward, S., et al: Comparison of Histalog and Histamine as Stimulants for Maximal Gastric Secretion in Human Subjects and in Dogs , Gastroenterology 44:620-626 ( (May) ) 1963. 5. Baron, J.H.: Studies of Basal and Peak Acid Output With an Augmented Histamine Test , Gut 4: 136-144 ( (June) ) 1963.Crossref 6. Grossman, M.I.; Kirsner, J.B.; and Gillespie, I.E.: Basal and Histalog Stimulated Gastric Secretion in Control Subjects and in Patients with Peptic Ulcer or Gastric Cancer , Gastroenterology 45:14-26, 1963. 7. Wormsley, K.G., and Grossman, M.I.: Maximal Histalog Test in Control Subjects and Patients With Peptic Ulcer , Gut 6:427-435, 1965.Crossref 8. Thompson, J.C.; Lerner, H.J.; and Musicant, M.E.: Heparin Inhibition of Gastric Secretion in Duodenal Ulcer and Control Patients , Surg Gynec Obstet 122:751-753 ( (April) ) 1966. 9. Schreiner, G.E., and Maher, J.F.: Uremia: Biochemistry, Pathogenesis and Treatment , Springfield, Ill: Charles C Thomas, Publishers, 1961, pp 331-347. 10. Jaffe, R.H., and Laing, D.R.: Changes of the Digestive Tract in Uremia: A Pathologic Anatomic Study , Arch Intern Med 53:851-864, 1934.Crossref 11. Lieber, C.S., and Lefevre, A.: Ammonia as a Source of Gastric Hypoacidity in Patients with Uremia , J Clin Invest 38:1271-1277, 1959.Crossref 12. Mossberg, S.M.; Thayer, W.R.; and Spiro, H.J.: Azotemia and Gastric Acidity; the Effect of Intravenous Urea on Gastric Acid and Gastric Ammonium Production in Man , J Lab Clin Med 61: 469-475 ( (March) ) 1963. 13. Fleshier, B., and Gabuzda, G.J.: Effect of Ammonium Chloride and Urea Infusion on Ammonium Levels and Acidity of Gastric Juice , Gut 6:349-356, 1965.Crossref 14. Moynihan, B.G.A.: "Uremic Ulcer of the Duodenum," in Peptic Ulcer , ed 2, Philadelphia: W. B. Saunders Co., 1912, pp 44-67. 15. Donegan, W.L., and Spiro, H.M.: Parathyroids and Gastric Secretion , Gastroenterology 38:750-759 ( (May) ) 1960. 16. Fillastre, J.P., et al: Effet de l'injection intraveineuse de gluconate de calcium sur la secretion gastrique , Presse Med 71:1738-1740 ( (Aug 31) ) 1963. 17. Murphy, D.L., et al: Hypercalcemia and Gastric Secretion in Man , J Appl Physiol 21: 1607-1610, 1966. 18. Cowgill, G.R., and Rakieten, T.L.: The effect of Intravenous Injection of Calcium Lactate on Gastric Secretion , Amer J Physiol 94:165-169 ( (July) ) 1930. 19. Grant, R.: The Inhibition of Gastric Secretion by Intravenous Injections of Calcium Salts , Amer J Physiol 132:460-466, 1941. 20. Kramer, P.: The Adverse Effects of Belladonna Alkaloids in Benign Pyloric Obstruction: An Experimental Study , New Eng J Med 251:600,1954.Crossref 21. Brettschneider, L.; Monafo, W.; and Osborne, D.P.: Intestinal Obstruction Due to Antacid Gels , Gastroenterology 49:291-294, 1965. 22. Bleifer, K.H.; Belsky, J.L.; and Bleifer, D.J.: Sodium Content of Four Antacids , New Eng J Med 261:604-605, 1959.Crossref 23. Rimer, D.G., and Frankland, M.: Sodium Content of Antacids , JAMA 173:995-998 ( (July) ) 1960.Crossref 24. Randall, R.E., Jr., et al: Hypermagnesemia in Renal Failure , Ann Intern Med 61:73-88 ( (July) ) 1964.Crossref 25. Dufault, F.X., Jr., and Tobias, G.J.: Potentially Reversible Renal Failure Following Excessive Calcium and Alkali Intake in Peptic Ulcer Therapy , Amer J Med 16:231-236 ( (Feb) ) 1954.Crossref 26. McMillan, D.E., and Freeman, R.B.: The Milk Alkali Syndrome , Medicine 44:485-501 ( (Nov) ) 1965.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Gastric Acid Secretion in Patients Undergoing Chronic Dialysis

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Publisher
American Medical Association
Copyright
Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1967.00300050001001
Publisher site
See Article on Publisher Site

Abstract

Abstract THE treatment of uremia by chronic hemodialysis has raised a number of serious economic, moral, emotional, and medical problems.1-3 As experience with this form of treatment is still limited, medical complications, especially if unanticipated, may seriously disrupt treatment and limit long-term, successful management. We have been confronted with the development of peptic ulcer in four of seven patients undergoing hemodialysis. The gastric secretion of acid was measured in patients undergoing chronic hemodialysis to quantitate one factor possibly responsible for this complication. Methods Dialysis Techniques. —The chronic hemodialysis unit at this institution has been operative since December 1963. Although patients were selected primarily because of medical indications, an attempt was made to assess such factors as stability of personality and potential of cooperation with a precise medical regimen. All patients were severely ill at the time of entrance into the program.Initially, the dialysis technique used was a recirculating 17-hour References 1. Retan, J.W., and Lewis, H.Y.: Repeated Dialysis of Indigent Patients for Chronic Renal Failure , Ann Intern Med 64:284-292 ( (Feb) ) 1966.Crossref 2. Brown, H.W., et al: Clinical Problems Related to Prolonged Artificial Maintenance of Life by Hemodialysis in Chronic Renal Failure , Trans Amer Soc Artif Intern Organs 8:281-291, 1962.Crossref 3. Pendras, J.P., and Erickson, R.V.: Hemodialysis: A Successful Therapy for Chronic Uremia , Ann Intern Med 64:293-311 ( (Feb) ) 1966.Crossref 4. Ward, S., et al: Comparison of Histalog and Histamine as Stimulants for Maximal Gastric Secretion in Human Subjects and in Dogs , Gastroenterology 44:620-626 ( (May) ) 1963. 5. Baron, J.H.: Studies of Basal and Peak Acid Output With an Augmented Histamine Test , Gut 4: 136-144 ( (June) ) 1963.Crossref 6. Grossman, M.I.; Kirsner, J.B.; and Gillespie, I.E.: Basal and Histalog Stimulated Gastric Secretion in Control Subjects and in Patients with Peptic Ulcer or Gastric Cancer , Gastroenterology 45:14-26, 1963. 7. Wormsley, K.G., and Grossman, M.I.: Maximal Histalog Test in Control Subjects and Patients With Peptic Ulcer , Gut 6:427-435, 1965.Crossref 8. Thompson, J.C.; Lerner, H.J.; and Musicant, M.E.: Heparin Inhibition of Gastric Secretion in Duodenal Ulcer and Control Patients , Surg Gynec Obstet 122:751-753 ( (April) ) 1966. 9. Schreiner, G.E., and Maher, J.F.: Uremia: Biochemistry, Pathogenesis and Treatment , Springfield, Ill: Charles C Thomas, Publishers, 1961, pp 331-347. 10. Jaffe, R.H., and Laing, D.R.: Changes of the Digestive Tract in Uremia: A Pathologic Anatomic Study , Arch Intern Med 53:851-864, 1934.Crossref 11. Lieber, C.S., and Lefevre, A.: Ammonia as a Source of Gastric Hypoacidity in Patients with Uremia , J Clin Invest 38:1271-1277, 1959.Crossref 12. Mossberg, S.M.; Thayer, W.R.; and Spiro, H.J.: Azotemia and Gastric Acidity; the Effect of Intravenous Urea on Gastric Acid and Gastric Ammonium Production in Man , J Lab Clin Med 61: 469-475 ( (March) ) 1963. 13. Fleshier, B., and Gabuzda, G.J.: Effect of Ammonium Chloride and Urea Infusion on Ammonium Levels and Acidity of Gastric Juice , Gut 6:349-356, 1965.Crossref 14. Moynihan, B.G.A.: "Uremic Ulcer of the Duodenum," in Peptic Ulcer , ed 2, Philadelphia: W. B. Saunders Co., 1912, pp 44-67. 15. Donegan, W.L., and Spiro, H.M.: Parathyroids and Gastric Secretion , Gastroenterology 38:750-759 ( (May) ) 1960. 16. Fillastre, J.P., et al: Effet de l'injection intraveineuse de gluconate de calcium sur la secretion gastrique , Presse Med 71:1738-1740 ( (Aug 31) ) 1963. 17. Murphy, D.L., et al: Hypercalcemia and Gastric Secretion in Man , J Appl Physiol 21: 1607-1610, 1966. 18. Cowgill, G.R., and Rakieten, T.L.: The effect of Intravenous Injection of Calcium Lactate on Gastric Secretion , Amer J Physiol 94:165-169 ( (July) ) 1930. 19. Grant, R.: The Inhibition of Gastric Secretion by Intravenous Injections of Calcium Salts , Amer J Physiol 132:460-466, 1941. 20. Kramer, P.: The Adverse Effects of Belladonna Alkaloids in Benign Pyloric Obstruction: An Experimental Study , New Eng J Med 251:600,1954.Crossref 21. Brettschneider, L.; Monafo, W.; and Osborne, D.P.: Intestinal Obstruction Due to Antacid Gels , Gastroenterology 49:291-294, 1965. 22. Bleifer, K.H.; Belsky, J.L.; and Bleifer, D.J.: Sodium Content of Four Antacids , New Eng J Med 261:604-605, 1959.Crossref 23. Rimer, D.G., and Frankland, M.: Sodium Content of Antacids , JAMA 173:995-998 ( (July) ) 1960.Crossref 24. Randall, R.E., Jr., et al: Hypermagnesemia in Renal Failure , Ann Intern Med 61:73-88 ( (July) ) 1964.Crossref 25. Dufault, F.X., Jr., and Tobias, G.J.: Potentially Reversible Renal Failure Following Excessive Calcium and Alkali Intake in Peptic Ulcer Therapy , Amer J Med 16:231-236 ( (Feb) ) 1954.Crossref 26. McMillan, D.E., and Freeman, R.B.: The Milk Alkali Syndrome , Medicine 44:485-501 ( (Nov) ) 1965.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1967

References