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EFFECT OF BENADRYL ON GASTRIC ACIDITY
490 EFFECT OF BENADRYL ON GASTRIC ACIDITY SiB,—It is generally agreed that the acid gastric juice
plays an important part in the production of simple peptic ulcers. The most reliable methods of producing " peptic ulcers " experimentally-e.g., the diversion of
the alkaline duodenal contents into the ileum or the implantation of histamine in beeswax-are all based on the assumption that the acid gastric juice is the main factor concerned in ulcer formation, and this assumption underlies both the experimental quest for the best type of surgical procedure, and the work of Schiffrin and Ivy1 on enterogastrone, the latest of the inhibitors of gastric secretion. Secretion of gastric juice is initiated by three waves of stimuli: (1) those of psychic origin acting through the vagi ; (2) those of gastric origin, which are of two main types, including the direct action of the products ot
digestion,
and the mechanical and chemicalI stimulation of the pyloric mucosa with its hormonal link to the
parietal cells ; and (3) those of intestinal origin , caused by the production of secretagogues in the duodenum and jejunum from food
substances, the details of whose action Fig. I-Graph showing free acid secreted by eight patients in each 1/4 hour of a fractional gastric are unknown. All these analysis, with and without benadryl. stimuli annarently act ultimately through the which is the strongest pharmacological stimulant to acid secretion that is known, and which has a selective and direct action on the parietal cells. ’ Benadryl ’being an antagonist of histamine, I decided to test its power to diminish the acidity of the gastric secretion. It was therefore given by mouth to a few patients with diseases in no way connected with the stomach and duodenum. To rluuko
agency of histamine,
eight
women
with surgical lesions of the benabreast
dryl was given by mouth, evenly spaced the 45 over min. before the beginning of the gastric In analysis. the first two cases 150 mg. was
given;
but, since this
produced
Fig. 2-Free acid active
secreted by a duodenal ulcer, with
benadryl (300
mg.
a
definite increase in both patient with anthe free and and
by mouth).
without
total acidity in
both patients, the amount given was increased to 300 mg. in the later trials, but with exactly the same results (fig. 1). Two other patients were tested also ; in one of them, who had a duodenal ulcer, there was a huge increase in the acidity of the fasting contents, in spite of the fact that 300 mg. of benadryl had been given (fig. 2). The investigation was stopped because the findings confirm 1.
Schifirin, M. J., Ivy, A. C.
Arch.
Surg., Chicago, 1942, 44, 399.
McElin and Horton2 and Moersch and and because Crane et a1.4 have shown Rivers,3 experimentally that benadryl does not protect guineapigs against the development of ulcers after the implantation of histamine in beeswax. My experiments seem to show that benadryl is unlikely . to prove effective in the treatment of gastric and duodenal ulcers, and they throw some doubt on the hypothesis that the ultimate stimulus to the parietal cells is normally histamine. The sharp rise in gastric acidity which follows administration of benadryl should be remembered when this drug is given to relieve bronchial spasm or anaphylactic shock in patients with peptic ulcer. I wish to thank Mr. R. L. Newell for his help in the presentation of this work. F. S. A. DORAN. Manchester Royal Infirmary.
those
of
GASTRO-ENTERITIS AND MASTOIDITIS SiB,—I would like to endorse the observations (Sept. 13) of my friend Mr. McGibbon. His point is that the middle-ear infection is caused by the passage of infected vomitus from the nasopharynx up the eustachian tube, and not by a blood-borne infection. This assertion is supported and amplified by a case of my own in which a well-developed infant of 14 days developed otitis media which proved to be tuberculous. The organism was considered to be of the bovine type ; and this led to the discovery that the milk supplied to the child was tuberculous. Furthermore it had been the mother’s custom to feed the infant lying flat on its back ; and, if the flow through the teat was free, milk was often noticed in the child’s nose. In other words, there was recurring regurgitation of tuberculous milk into the nasopharynx, with ultimate infection of the middle ear. Another suggestive point is the frequency of otitis media or its residua in children with cleft palate, in which condition nasopharyngeal regurgitation can readily take place. The following prophylactic measures therefore commend themselves : 1. Babies should be fed in the sitting position. 2. Weakly infants with gastro-enteritis should be nursed in the lateral position, so that there is less risk of vomitus reaching the nose and nasopharynx. This, of course, demands unremitting nursing attention. JOHN ROBERTS. --
SALMONELLA IN THE BACK-YARD SIR,-Your annotation of Aug. 23, does not emphasise the recognised importance of different animal species as possible reservoirs of human salmonella infections in this country. Reference is made to the danger of S. typhi-murium food-poisoning from the consumption of inadequately cooked duck eggs, and to that section of the Medical Research Council reportdealing with the isolation of salmonellas from the mesenteric lymphglands of healthy pigs at slaughter. The annotation then continues : " Other domestic animals may also have been invaded but there is no information on this point."In a survey of avian salmonellosis in Great Britain, Gordon and Buxton6 have recorded the isolation from poultry of S. pullorum, S. gallinar2czn, S. typhi-murium, S. thompson, S. enteritidis, S. eal-i,fornia, S. bareilly, S. montevideo, S. anatum, and S. london. Later, the same workers reported S. oranienburg and S. bovis morbificans as causing serious disease in chicks ; and during May of this year S. cubana and S. brancaster were isolated from two separate hatches of turkey poults. During the first eight months of this year over ninety outbreaks of avian salmonellosis, excluding S. pullorum and S. gallinarum, have been recorded at this laboratory ; and the organism most frequently encountered has been S. thompson. The importance of poultry as a possible reservoir of salmonella infections from both the agricultural and public-health points of view is fully realised by the veterinary profession. Investigations into the methods 2. McElin, T. W., Horton, T. B. Proc. Mayo Clin. 1945, 20, 417. 3. Moersch, R. U., Rivers, A. B. Gastroenterology, 1946, 7, 91. 4. Crane, J. T., Lindsay, S., Dailey, M. E. Amer. J. digest. Dis. 1947. 14, 56. 5. Spec. Rep. Ser. med. Res. Coun., Lond. no. 260, 1947. 6. Vet. J. 1946, 102, 187. 7. Brit. med. J. 1947, i, 898.
plays an important part in the production of simple peptic ulcers. The most reliable methods of producing " peptic ulcers " experimentally-e.g., the diversion of
the alkaline duodenal contents into the ileum or the implantation of histamine in beeswax-are all based on the assumption that the acid gastric juice is the main factor concerned in ulcer formation, and this assumption underlies both the experimental quest for the best type of surgical procedure, and the work of Schiffrin and Ivy1 on enterogastrone, the latest of the inhibitors of gastric secretion. Secretion of gastric juice is initiated by three waves of stimuli: (1) those of psychic origin acting through the vagi ; (2) those of gastric origin, which are of two main types, including the direct action of the products ot
digestion,
and the mechanical and chemicalI stimulation of the pyloric mucosa with its hormonal link to the
parietal cells ; and (3) those of intestinal origin , caused by the production of secretagogues in the duodenum and jejunum from food
substances, the details of whose action Fig. I-Graph showing free acid secreted by eight patients in each 1/4 hour of a fractional gastric are unknown. All these analysis, with and without benadryl. stimuli annarently act ultimately through the which is the strongest pharmacological stimulant to acid secretion that is known, and which has a selective and direct action on the parietal cells. ’ Benadryl ’being an antagonist of histamine, I decided to test its power to diminish the acidity of the gastric secretion. It was therefore given by mouth to a few patients with diseases in no way connected with the stomach and duodenum. To rluuko
agency of histamine,
eight
women
with surgical lesions of the benabreast
dryl was given by mouth, evenly spaced the 45 over min. before the beginning of the gastric In analysis. the first two cases 150 mg. was
given;
but, since this
produced
Fig. 2-Free acid active
secreted by a duodenal ulcer, with
benadryl (300
mg.
a
definite increase in both patient with anthe free and and
by mouth).
without
total acidity in
both patients, the amount given was increased to 300 mg. in the later trials, but with exactly the same results (fig. 1). Two other patients were tested also ; in one of them, who had a duodenal ulcer, there was a huge increase in the acidity of the fasting contents, in spite of the fact that 300 mg. of benadryl had been given (fig. 2). The investigation was stopped because the findings confirm 1.
Schifirin, M. J., Ivy, A. C.
Arch.
Surg., Chicago, 1942, 44, 399.
McElin and Horton2 and Moersch and and because Crane et a1.4 have shown Rivers,3 experimentally that benadryl does not protect guineapigs against the development of ulcers after the implantation of histamine in beeswax. My experiments seem to show that benadryl is unlikely . to prove effective in the treatment of gastric and duodenal ulcers, and they throw some doubt on the hypothesis that the ultimate stimulus to the parietal cells is normally histamine. The sharp rise in gastric acidity which follows administration of benadryl should be remembered when this drug is given to relieve bronchial spasm or anaphylactic shock in patients with peptic ulcer. I wish to thank Mr. R. L. Newell for his help in the presentation of this work. F. S. A. DORAN. Manchester Royal Infirmary.
those
of
GASTRO-ENTERITIS AND MASTOIDITIS SiB,—I would like to endorse the observations (Sept. 13) of my friend Mr. McGibbon. His point is that the middle-ear infection is caused by the passage of infected vomitus from the nasopharynx up the eustachian tube, and not by a blood-borne infection. This assertion is supported and amplified by a case of my own in which a well-developed infant of 14 days developed otitis media which proved to be tuberculous. The organism was considered to be of the bovine type ; and this led to the discovery that the milk supplied to the child was tuberculous. Furthermore it had been the mother’s custom to feed the infant lying flat on its back ; and, if the flow through the teat was free, milk was often noticed in the child’s nose. In other words, there was recurring regurgitation of tuberculous milk into the nasopharynx, with ultimate infection of the middle ear. Another suggestive point is the frequency of otitis media or its residua in children with cleft palate, in which condition nasopharyngeal regurgitation can readily take place. The following prophylactic measures therefore commend themselves : 1. Babies should be fed in the sitting position. 2. Weakly infants with gastro-enteritis should be nursed in the lateral position, so that there is less risk of vomitus reaching the nose and nasopharynx. This, of course, demands unremitting nursing attention. JOHN ROBERTS. --
SALMONELLA IN THE BACK-YARD SIR,-Your annotation of Aug. 23, does not emphasise the recognised importance of different animal species as possible reservoirs of human salmonella infections in this country. Reference is made to the danger of S. typhi-murium food-poisoning from the consumption of inadequately cooked duck eggs, and to that section of the Medical Research Council reportdealing with the isolation of salmonellas from the mesenteric lymphglands of healthy pigs at slaughter. The annotation then continues : " Other domestic animals may also have been invaded but there is no information on this point."In a survey of avian salmonellosis in Great Britain, Gordon and Buxton6 have recorded the isolation from poultry of S. pullorum, S. gallinar2czn, S. typhi-murium, S. thompson, S. enteritidis, S. eal-i,fornia, S. bareilly, S. montevideo, S. anatum, and S. london. Later, the same workers reported S. oranienburg and S. bovis morbificans as causing serious disease in chicks ; and during May of this year S. cubana and S. brancaster were isolated from two separate hatches of turkey poults. During the first eight months of this year over ninety outbreaks of avian salmonellosis, excluding S. pullorum and S. gallinarum, have been recorded at this laboratory ; and the organism most frequently encountered has been S. thompson. The importance of poultry as a possible reservoir of salmonella infections from both the agricultural and public-health points of view is fully realised by the veterinary profession. Investigations into the methods 2. McElin, T. W., Horton, T. B. Proc. Mayo Clin. 1945, 20, 417. 3. Moersch, R. U., Rivers, A. B. Gastroenterology, 1946, 7, 91. 4. Crane, J. T., Lindsay, S., Dailey, M. E. Amer. J. digest. Dis. 1947. 14, 56. 5. Spec. Rep. Ser. med. Res. Coun., Lond. no. 260, 1947. 6. Vet. J. 1946, 102, 187. 7. Brit. med. J. 1947, i, 898.