Abstract
To determine the acute gastrotoxicity of refluxed duodenal contents, anex vivo rat gastric chamber was used to study mucosal damage produced by conjugated and unconjugated human bile acids and lysolecithin at neutral and acidic pH; the effects of trypsin, human duodenal aspirate, and combinations of chenodeoxycholic acid, lecithin, and lysolecithin were also studied. At neutral pH, all bile acids except tauroursodeoxycholic acid, caused dose-dependent falls in mucosal potential difference and losses of mucosal nucleic acid into the chamber fluid, indicating mucosal damage. The di-α-hydroxy bile acids, deoxycholic and chenodeoxycholic acids, were more gastrotoxic than cholic and ursodeoxycholic acids, and all unconjugated bile acids were more toxic than their conjugated species, none of which produced damage at concentrations below 2.0 mM. For all but the taurine conjugates, bile acid-induced changes in potential difference were lower at acidic then at neutral pH. Lysolecithin gastrotoxicity, comparable at neutral pH to that of chenodeoxycholic acid, was also reduced at acidic pH. Lecithin decreased the gastrotoxicity of chenodeoxycholic acid and lysolecithin. Trypsin produced no damage, and the gastrotoxicity of human duodenal aspirate was unaffected by prior heat inactivation of pancreatic enzymes.
Similar content being viewed by others
References
Capper WM, Airth GR, Kilby JO: A test for pyloric regurgitation. Lancet 2:621–623, 1966
Delaney JP, Cheng JWB, Butler BA, Ritchie WP Jr: Gastric ulcer and regurgitation gastritis. Gut 11:715–719, 1970
DuPlessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974–978, 1965
Watt PCW, Sloan JM, Spencer A, Kennedy TL: Histology of the postoperative stomach before and after diversion of bile. Br Med J 287:1410–1412, 1983
Rhodes J, Barnardo DE, Phillips SF, Rovelstad RA, Hofmann AF: Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology 57:241–252, 1969
Caygill CPJ, Hill MJ, Kirkham JS, Northfield TC: Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet 1:929–931, 1986
Davenport HW: Destruction of the gastric mucosal barrier by detergents and urea. Gastroenterology 54:175–181, 1968
Silen W, Forte JG: Effects of bile salts on amphibian gastric mucosa. Am J Physiol 228:637–644, 1975
Davenport HW: Effect of lysolecithin, digitonin and phospholipase A upon the dog's gastric mucosal barrier. Gastroenterology 59:505–509, 1970
Carter KJ, Farley PC, Ritchie WP: Effect of topical bile acids on gastric superficial cells. Surgery 96:196–202, 1984
Ritchie WP, Cherry KJ: Influence of hydrogen ion concentration on bile acid induced acute gastric mucosal ulcerogenesis. Ann Surg 189:637–641, 1979
Dowling RH, Small DM: The effect of pH on the solubility of varying mixtures of free and conjugated bile salts in solution. Gastroenterology 54:1291, 1968 (abstract)
Orchard R, Reynolds K, Fox B, Andrews R, Parkins RA, Johnson AG: Effect of lysolecithin on gastric mucosal structure and potential difference. Gut 18:457–461, 1977
Armstrong D, Farrell M, Hanby A, Murphy GM, Dowling RH: Is theex vivo rat gastric chamber model suitable for studying the gastrotoxicity of refluxed duodenal contents? Initial results using deoxycholic acid. Clin Chim Acta 178:313–326, 1988
Wallace JL, Morris GP, Krausse EJ, Greaves SE: Reduction by cytoprotective agents of ethanol-induced damage to the rat gastric mucosa: A correlated morphological and physiological study. Can J Physiol Pharmacol 60:1686–1699, 1982
Prasad AS, DuMouchelle E, Koniuch D, Oberleas D: A simple fluorimetric method for the determination of RNA and DNA in tissues. J Lab Clin Med 80:598–602, 1972
Duncan DB: Multiple range and multiple F tests. Biometrics 11:1–42, 1955
Dowling RH, Hofmann AF, Barbara L (eds): Workshop on Ursodeoxycholic Acid. Lancaster, MTP Press, 1978, pp 1–88
Tint GS, Salen G, Colalillo A, Graber D, Verga D, Speck J, Shefer S: Ursodeoxycholic acid: A safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 97:351–356, 1983
Meredith TJ, Hilson A, Murphy GM, Dowling RH: An explanation for bile acid-mediated gastritis and the relief of dyspepsia with chenodeoxycholic (CDCA) and ursodeoxycholic (UDCA) acid therapy. Clin Sci 60:22P, 1981 (abstract)
Frigerio G: Ursodeoxycholic acid in the treatment of dyspepsia: Report of a multicenter controlled trial. Curr Ther Res 26:214–224, 1979
Del Vecchio Blanco C, Caporaso N, Gentile S, Rinaldi M, Pucci R: Safe use of ursodeoxycholic acid in the treatment of dyspeptic symptoms in patients with chronic active hepatitis: A double-blind controlled trial. J Intern Med Res 10:278–282, 1982
Stefaniwsky AB, Tint GS, Speck J, Shefer S, Salen G: Ursodeoxycholic acid treatment of bile reflux gastritis. Gastroenterology 89:1000–1004, 1985
Morris GP, Wallace JL, Harding PL: A functional model for extracellular gastric mucus in the rat. Virchows Arch (Cell Pathol) 46:239–251, 1984
Wallace JL, Whittle BJR: Role of mucus in the repair of gastric epithelial damage in the rat. Inhibition of epithelial recovery by mucolytic agents. Gastroenterology 91:603–611, 1986
Dawson AM, Isselbacher KJ: Studies on lipid metabolism in the small intestine with observation on the role of bile salts. J Clin Invest 39:730–736, 1960
Ritchie WP, Felger TS: Differing ulcerogenic potential of dihydroxy and trihydroxy bile acids in canine gastric mucosa. Surgery 89:342–347, 1981
Lillimoe KD, Kidder GW, Harmon JW, Gadacz TR, Johnson LF, Bunte RM, Hofmann AF: Tauroursodeoxycholic acid is less damaging than taurochenodeoxycholic acid to the gastric and esophageal mucosa. Dig Dis Sci 28:359–364, 1983
Harmon JW, Doong T, Gadacz TR: Bile acids are not equally damaging to gastric mucosa. Surgery 84:79–86, 1978
Harmon JW, Lewis CD, Gadacz T: Bile salt composition and concentration as determinants of canine gastric mucosal injury. Surgery 89:348–354, 1981
Chadwick VS, Gaginella TS, Carlson CL, Debongnie JC, Phillips SF, Hofmann AF: Effect of molecular structure on bile acid-induced alteration in absorption function, permeability and morphology in the perfused rabbit colon. J Lab Clin Med 74:661–665, 1978
Kaliszan R: Chromatography in studies of quantitative structure-activity relationships. J Chromatogr 270:71–83, 1981
Armstrong MJ, Carey MC: The hydrophilic-hydrophobic balance of bile salts. Inverse correlation between reverse-phase high performance liquid chromatographic mobilities and micellar cholesterol-solubilizing capacities. J Lipid Res 23:70–80, 1982
Hofmann AF, Roda A: Physicochemical properties of bile acids and their relationship to biological properties: An overview of the problem. J Lipid Res 25:1477–1489, 1984
Black RB, Hole D, Rhodes J: Bile damage to the gastric mucosal barrier: The influence of pH and bile acid concentration. Gastroenterology 61:178–184, 1971
Eastwood GL: Effect of pH on bile salt injury to mouse gastric mucosa. Gastroenterology 68:1456–1465, 1975
Duane WC, Wiegand DM, Sievert CE: Bile acid and bile salt disrupt gastric mucosal barrier in the dog by different mechanisms. Am J Physiol 242:G95-G99, 1982
Johnson AG, McDermott SJ: Lysolecithin: A factor in the pathogenesis of gastric ulceration? Gut 15:710–713, 1974
Duane WC, McHale AP, Sievert CE: Lysolecithin-lipid interactions in disruption of the canine gastric mucosal barrier. Am J Physiol 250:G275-G279, 1986
Dewar EP, King RFG, Johnston D: Bile acid and lysolecithin concentrations in the stomach of patients with gastric ulcer: Before operation and after treatment by highly selective vagotomy, Billroth I partial gastrectomy and truncal vagotomy and pyloroplasty. Br J Surg 70:401–405, 1983
Duane WC, Wiegand DM, Gilberstadt ML: Intragastric duodenal lipids in the absence of a pyloric sphincter: Quantitation, physical state, and injurious potential in the fasting and postprandial states. Gastroenterology 78:1480–1487, 1980
Wingate DL, Phillps SF, Hofmann AF: The effect of glycine conjugated bile acids, with or without lecithin, on water and glucose absorption in the perfused human jejunum. J Clin Invest 52:1230–1236, 1973
Fimmel CJ, Etienne A, Cilluffo T, Ritter C von, Gasser T, Rey J-P, Caradonna-Moscatelli P, Sabbatini F, Pace F, Bühler HW, Bauerfeind P, Blum AL: Long-term ambulatory gastric pH monitoring: Validation of a new method and effect of H2-antagonists. Gastroenterology 88:1842–1851, 1985
Ota S, Tsukahara H, Terano A, Hata Y, Hiraishi H, Mutoh H, Sugimoto T: Protective effect of tauroursodeoxycholate against chenodeoxycholate-induced damage to cultured rabbit gastric cells. Dig Dis Sci 36:409–416, 1991
Author information
Authors and Affiliations
Additional information
This manuscript is dedicated to Prof. Gustav Paumgartner of Munich, on the occasion of his 60th birthday.
The study was supported in part by grants from Gipharmex SpA, Milan, Italy, and from the Special Trustees of Guy's Hospital, London, UK.
Rights and permissions
About this article
Cite this article
Armstrong, D., Rytina, E.R.C., Murphy, G.M. et al. Gastric mucosal toxicity of duodenal juice constituents in the rat. Digest Dis Sci 39, 327–339 (1994). https://doi.org/10.1007/BF02090205
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02090205