Wednesday, July 12, 2023

Gastric Freeze-A Cold Hearted Idea

A stomach freezing machine. That eggplant size balloon
in the MDs hand was inserted transesophageally and zero
Degree F. ethyl alcohol circulated via a double lumen catheter.

 Whoever came up with that old medical adage stating if there are 3 or more treatments available for a single ailment, none are effective, was likely talking about duodenal ulcer treatments of the 1960s.Whacky dietary regimens featuring half and half or whole cream as the main ingredient, antacids, and of course tranquilizers because nervous folks suffered from ulcers were medical interventions of the day.

About 15% of ulcer patients had a dismal response to medical treatments and required surgery. The operation of choice was a gastrectomy with or without vagotomy (cutting the nerves that stimulate acid secretion.) This was big time surgery of the day and carried about a 5% mortality rate along with patient dissatisfaction from digestive problems. Every old nurse was acutely aware of the dreaded dumping syndrome where high carbohydrate foods entered the duodenum like greased lightening causing dizziness and occasional fainting.

Intractable medical problems like gastric ulcers often produce nonsense like this textbook edict, "The disease is easy to treat but difficult to cure."  (That classic was from our Brunner's Nursing textbook.) About one in ten Americans harbored an ulcer and the disease favored men. The combination of lots of suffering folks and the medical mind set to do something... anything... for a cure frequently produced disastrous results. Medical breakthroughs touted on newspaper front pages sometimes proceeded to the obituaries as time passed. Certainly, this was readily evident with frozen stomachs and their hemorrhagic complications.

In 1960, a group of surgeons headed by the famous Dr. Wangensteen, inventor of the lifesaving intermittent suction named after him came up with the notion that gastric ulcers could be cured by freezing the stomach.  General hypothermia (lowering the body temperature to 86 degrees F. (or 30 degrees C.) was occasionally used to help patients survive brain or cardiac surgery.  Under general hypothermia, gastric acid secretion was noted to decrease.

Dr. Wangensteen questioned, instead of cooling the whole body, what would transpire if only the stomach was chilled? He took the notion one step further and wondered about not merely cooling the stomach, but actually freezing it. I guess he never thought about what happens to a frostbitten ear; it falls off.

Desperate for an ulcer cure, freezing the stomach seemed worth a try. A balloon shaped like the stomach and a double lumen catheter to circulate freezing cold ethyl alcohol (zero degrees F.) through the balloon was devised. Experimental trials in animal trials commenced. I could never, ever work in an animal lab with dogs whose internal organs were rearranged and fooled around with in the dubious name of science.

One of the bizarre demonstrations of the frozen stomach efficacy was to oxygenate a frog and lower it into the stomach of a live dog. From an untreated stomach the completely digested frog was pulled up 6 hours later. From the frozen dog's stomach the frog would emerge hopping away at a lively pace. Yikes.. and I thought watching my cat vomit mouse parts was disgusting!

The May, 1962 Readers Digest ran an article, (They're Freezing Ulcers to Death,) and thousands of patients began demanding the treatment. Maybe they should have renamed the magazine The Digesters Reader! Sorry, blame that one on my foolishness.

The medical industrial complex quickly responded and stomach freezing machines were manufactured for eager hospitals and physicians despite the reservations of more conservative practitioners. This was not another innocuous pill that could be discontinued in the event of complications, but an anatomical alteration with the potential of real morbidity and mortality.

The gastric freeze did eliminate symptoms for some folks, but the ulcers always returned with virulent ferocity. A few unlucky souls experienced immediate separation of the lining of their stomachs and uncontrolled bleeding which required emergency surgery with sometimes catastrophic loss of life. The gastric freeze treatment lasted about 5 years (1963-1968) before practitioners gave it up. Too many complications with loss of life.

A bona fide cure for most gastric ulcers came about when a 1985 article published by Warren and Marshall in The Journal of Gastroenterology described a bacterial infection by H. Pylori as the cause of ulcers. The good doctors proved their point by infecting themselves with the bacteria. an antibiotic regimen proved to be the bonafide cure for gastric ulcers.