Hydrochloric acid is known to adversely affect many stages in the coagulation system. The authors produced superficial bleeding lesions in the canine esophagus, stomach and duodenum by a flexible biopsy forceps introduced via fiberoptic endoscope and determined the mean bleeding time after the topical application of normal saline and again after the topical application of hydrochloric acid. Mean bleeding time in the gastric lesions 277 ± 14 (mean ± S.D.) seconds was significantly (P < 0.05) longer than that from the esophageal (209 ± 12 sec) or duodenal lesions (211 ± 10 sec). After topical application of 0.5 N HCl bleeding time was significantly (P < 0.005) prolonged to 279 ± 12, 345 ± 17 and 283 ± 13 sec in the esophageal, gastric and duodenal lesions, respectively. The clinical implications are discussed. The bleeding from the upper gastrointestinal tract differs from the bleeding that is observed in skin wounds. Gastroduodenal hemorrhage can be quite prolonged and rebleeding is not uncommon. Bleeding time from various sites of external puncture wounds in the dog is variable and may range from 60-240 sec. When Ivy bleeding time test is performed by puncturing the human skin, bleeding normally stops in 3-8 min and blood loss is not greater than 0.5 ml. It seems that adverse local factors are responsible for the poor hemostatic response in the esophagus, stomach and duodenum. The possible reasons for such poor response may be gastrointestinal motility, absence of local autoregulation of blood flow and local antihemostatic chemical factors. Although coagulation system seems to be important in gastrointestinal hemostasis, the vascular component has received more attention and therapy to stop upper gastrointestinal bleeding has included iced saline lavage, pitressin infusion and topical application of levarterenol. A recent, in vitro, study has demonstrated the deleterious effect of acid on both the soluble (plasmatic) and the cellular (platelet-mediated) aspects of blood coagulation; this effect of hydrochloric acid may contribute to prolonged gastroduodenal hemorrhage. The control of acute mucosal gastrointestinal bleeding by use of antacids or H2-receptor blockers may be explained on this basis. In the present study the authors produced superficial bleeding lesions in the canine esophagus, stomach and duodenum by means of a flexible biopsy forceps introduced via a fiberoptic esophago-gastroduodenoscope. The authors determined the mean bleeding time from esophageal, gastric and duodenal lesions while they were being bathed with normal saline and again after the topical application of hydrochloric acid.
|Original language||English (US)|
|Title of host publication||American Journal of Proctology Gastroenterology and Colon and Rectal Surgery|
|Number of pages||3|
|State||Published - 1979|
ASJC Scopus subject areas