[Biliary reflux-gastritis: etiology, pathogenesis and modern principles of treatment].

Objective. To study etiopathogenetic aspects of biliary reflux-gastritis (RG) and develop modern principles of its therapy depending on acidity of stomach contents, atrophy ofgastric mucosa, and Helicobacter pylori infection. Different pathogenetic mechanisms of RG are discussed with special reference to bile flow into the antrum as a result of duodenogastric reflux. It is shown that the use of de-nol and probiotic ProBiotic Complex for the treatment of biliary reflux-gastritis increases effectiveness of H. pylori eradicationby 18.2% and prevents the development of bowel dysbiosis.

[Gastroesophageal reflux disease associated with duodenogastroesophageal reflux in patients with biliary pathology: the specific features of the course and esophagogastroduodenal microbial biocenosis].

AIM: To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics. SUBJECTS AND METHODS: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL. RESULTS: Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities. CONCLUSION: The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.

[Gastroesophageal reflux disease and connective tissue dysplasia in aspect of premorbid and comorbid disorders].

AIM: To investigate the phenotypic and visceral signs of connective tissue dysplasia (CTD) and comorbid diseases of the digestive system in gastroesophageal reflux disease (GERD) patients with different types of esophageal reflux as the predictors of its variants. MATERIAL AND METHODS: In 124 patients with GERD the clinical features, phenotypic and visceral signs of undifferentiated CTD were studied in details. RESULTS: In 82.0% of patients with GERD associated with gastroesophageal type of reflux (GER) phenotypic and especially visceral signs of STD were detected, mainly in the form of cardiochalasia and hiatal hernia. In patients with duodenogastroesophageal reflux symptoms (DGER) the signs of STD were marked in 42.0% of cases, mostly in the form of biliary tract structure abnormalities. The risk of GERD associated with prevalence of GER, was 11.9 times higher in the presence of diagnostically meaningful combination of 6 or more signs of STD than in patients with DGER. Realization of predictor options in GER occurs in the preference of sharp, acidic foods, spices, taking medications that reduce lower esophageal sphincter tone. GERD, associated with DGER, is formed in patients with family history of diseases of the biliary tract and in the preference of food rich of calories. CONCLUSION: Study of STD symptoms as predictors of structural development of GERD and its variants is prospective to predict disease, choice of profession and eating behavior, primarily in young adults.

[The clinical and pathogenetic types of gastroesophageal reflux disease: risk factors and predictors].

AIM: To study the clinical and pathogenetic types of gastroesophageal reflux disease (GERD) in terms of different types of reflux into the esophagus, their risk factors and predictors. MATERIALS AND METHODS: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, the phenotypic and visceral signs of existing undifferentiated connective tissue dysplasias (UDCTD), and the suprasegmental and segmental autonomic apparatus were studied in detail in 124 patients with GERD. RESULTS: Two clinical and pathogenetic types of GERD associated with the predominance of gastroesophageal or duodenogastroesophageal refluxes (GER and DGER) are identified. The type of the disease running in the predominance of GER develops in subjects with the high rate of visceral stigmas of UDCTD--cardiac failure and hiatal hernias, sympathetic autonomic tone in the digestive system. The feeding preference of piquant and spicy dishes and spices serves to realize the predictors of this type. The DGER-associated type develops in subjects with a concurrence of sympathetic and parasympathetic total autonomic tones in the digestive system in the presence of preexisting biliary tract diseases, including abnormalities in the structure of the gallbladder as visceral signs of UDCTD and it is realized in the feeding preference of high-calorie dishes. CONCLUSION: It is promising to study the autonomic status and the signs of UDCTD as structural and functional predictors of GERD and its types for the prediction of the disease, professional orientation, and the acquisition of eating behavior primarily in young people.

[Disturbances of gastrointestinal motility of the stomach in patients with chronic gastric erosions and biliary tract disease].

Article dwells on comparison data about motor function of the stomach in the three groups of patients: with gastric erosions and biliary tract diseases, duodenal ulcer disease, chronic gastritis. It is shown, that patients with gastric erosions and biliary tract diseases are characterized by slower evacuation function of the stomach, hypotonus of the stomach. Frequency of duodenal reflux in this group of patients is very high (85,9 %).

Sphincter of Oddi manometry by choledochoscope in patients with duodenobiliary reflux.

BACKGROUND AND AIM: Previous research has confirmed that duodenobiliary reflux exists in patients with choledocholithiasis. The objective of this study was to investigate whether the motor activity of the sphincter of Oddi (SO) has an effect on duodenobiliary reflux. METHODS: A total of 51 patients orally ingested 1mL water containing technetium-99m diethylenetriaminepentaacetatic acid, and a 2-h bile collection was obtained from the T tube. Technetium counts in the collected bile were performed using an RM905 radioactivity meter. The patients were divided into two groups: reflux group (duodenobiliary reflux positive) and control group (duodenobiliary reflux negative). Next, 33 cases were randomly selected and double blinded to receive SO manometry by choledochoscope. RESULTS: Of the 51 total cases, 16 bile samples exhibited radioactivity. The average SO basal pressure and contraction pressure values were 7.2±3.9mmHg and 53.5±24.5mmHg, respectively, in the reflux group, and 14.7±11.0mmHg and 117.2±65.6mmHg, respectively, in the control group. The choledochus pressure values were 5.1±1.6mmHg and 11.5±7.4mmHg in the reflux group and the control group, respectively. The differences between the groups were statistically significant; however, the SO contraction frequency, SO contraction duration, and duodenum pressure values were not significantly different between the groups. CONCLUSION: The decreases in the SO basal pressure and SO contraction pressure, and the decrease in choledochus pressure, might play a role in duodenobiliary reflux.

What influences the acidity in the gastric conduit in patients who underwent cervical esophagogastrostomy for cancer?

The aim of this study was to determine the factors influencing acidity in the gastric conduit after esophagectomy for cancer. Acidity and bile reflux in the stomach and in the gastric conduit were examined by 24-h pH monitoring and bilimetry in 40 patients who underwent transthoracic subtotal esophagectomy followed by esophageal reconstruction using a gastric conduit, which was pulled up to the neck through a posterior mediastinal route in 17 patients, through a retrosternal route in 10 patients, and through a subcutaneous route in 13 patients. They were examined at 1 week before surgery, at 1 month after surgery, and at 1 year after surgery. Helicobacter pylori infection was examined pathologically and using the (13) C-urea breath test. The factors influencing acidity of the gastric conduit were analyzed using the stepwise regression model. Gastric acidity assessed by percentage (%) time of pH < 4 was reduced after surgery and was significantly less in patients with H. pylori infection compared with those without H. pylori infection throughout the period from 1 week before surgery to 1 year after surgery. Duodenogastric reflux (DGR) assessed by % time absorbance > 0.14 into the lower portion of the gastric conduit was significantly increased after surgery throughout the period from 1 month after surgery to 1 year after surgery. Multivariate analysis showed that the acidity in the gastric conduit was influenced by H. pylori infection and DGR at 1 month after surgery, and by H. pylori infection and the route for esophageal reconstruction at 1 year after surgery. Acidity in the gastric conduit was significantly decreased after surgery. Acidity in the gastric conduit for esophageal substitutes is influenced by H. pylori infection and surgery. DGR influences the gastric acidity in the short-term after surgery, but not in the long-term after surgery.

[Dysmotility-type dyspepsia and eructation. Introduction of a new gas-analytical method]. / Dysmotilitas típusú dyspepsia és bélgázok. Új gázanalitikai módszer bemutatása.

This paper describes a new gas-analytical method used in a 55-year-old female patient with dyspepsia. Symptoms included epigastric fullness and inflation. Evaluation indicated an increased gas production in the proximal end of the small intestine that entered into the stomach via duodenogastric reflux. High CO2 content of eructed gas was confirmed in eructed gas samples using a tube in situ. Authors propose that this new analytical method of eructed gas may be applied in clinical practice in patients with dyspepsia.

[Clinico-endoscopic peculiarities of gastric ulcer of type I and II].

A detailed analysis of clinico-endoscopic peculiarities of gastric ulcer type I and II was presented. The peculiarities of a clinical course and the complications character of differently localized gastric ulcers were determined. There was shown the connection between concomitant disorders of esophagogastroduodenal motor-evacuation function and gastric ulcer localization and type. While tactics of treatment and operative procedure choosing it is mandatory to take into account the clinical course peculiarities and the results of endoscopic investigation.

[Diagnostic aspects of chronic cholangitis after cholecystectomy].

AIM: To determine the chronic cholangitis risk factors and to provide a practically significant diagnostic criteria of chronic cholangitis in patients after cholecystectomy. MATERIALS AND METHODS: Were examined the clinical, anamnestic data, clinical laboratory and instrumental studies of the condition of the hepatobiliary system in 127 patients with chronic cholangitis after cholecystectomy. The determination of microbial contamination of bile was performed during the duodenal intubation. RESULTS: In the bile microbial landscape study were noted the violation of biliary system microbiota in 92.1% of cases. Herewith identified a combination of bacterial factors with parasitic invasion (mixed infection) in 28 (22.0%) patients. Cholangitis develops in the presence of duodeno biliary reflux, duodenal motility disorders and hypotonia of Oddi's sphincter in the early postoperative period. In the late periods after cholecystectomy, cholangitis chronization defines outflow obstruction and cholestasis due to functional or organic causes in most patients. CONCLUSIONS: Risk factors for chronic cholangitis should be referred to long history of gallstone disease, performance of cholecystectomy in the emergency order against the inflammatory process of thehepatobiliary system, absence of adequate correction of postoperative hypertension of bile duct, destruction of sphincter apparatus major duodenal papilla during surgery.

[Duodenogastral reflux burden gastroesophageal reflux disease].

The article presents research data of duodenogastral reflux (DGR) role in patients with gastroesophageal reflux disease. It is shown that in the presence DGR, the reflux esophagitis is detected at a higher frequency and outside of esophageal manifestations of the disease. The comorbidities of hepatobiliary zone and pancreas contributes to the DGR development, as well as the syndrome of bacterial overgrowth in the small intestine.

[Morphological features and esophago-gastroduodenal zone microbiocenose in patients with syndrome postcholecystectomic syndrome].

Endoscopical and histological features of oesophagogastroduodenal zone, parameters of pH-metry and electrogastroenterography, qualitative and quantitative characteristics of microbiocenosis were studied in 80 female persons with postcholecystectomy syndrome more then a year after cholecystectomy. In the presence of duodenogastral reflux the most natural is the combination of distal oesophagitis, antral atrophic gastritis and duodenitis, accompanied with low level of gastric acidity, gastric hypokinesis and duodenal dyskinesis, dysbacteriosis of mucosal microflora with its quantitative increase and appearance of bacteria with expressed pathogenicity non-typical for this biotope. These data should be taken into consideration for determination of pre- and postoperative treatment tactics for patients with gallstones.

Laparotomy attenuates lipopolysaccharide-induced gastric bleeding in the rat.

Lipopolysaccharide (LPS) increases systemic inflammation and causes duodenogastric reflux of bile and gastric bleeding. Laparotomy prevents gastric injury from the luminal irritant bile, but its effects on LPS-induced gastric injury are unknown. We hypothesized that laparotomy would diminish inflammation and attenuate gastric bleeding caused by LPS. In the rat, laparotomy, done either before or after administration of LPS, attenuated LPS-induced bile reflux, gastric bleeding, and cyclooxygenase-2, but not inducible nitric oxide synthase, expression when compared to controls given LPS. Laparotomy also blunted LPS-induced changes in serum cytokine production. These data suggest that laparotomy has gastroprotective effects by preventing LPS-induced bile reflux and gastric bleeding and by a mechanism mediated, at least in part by cyclooxygenase-2.

Ketamine suppresses LPS-induced bile reflux and gastric bleeding in the rat.

BACKGROUND: Although ketamine has many beneficial effects in a rat model of noninfectious inflammation with lipopolysaccharide (LPS), its effects on gut ileus are unknown. We hypothesized that ketamine would improve LPS-induced ileus and therefore examined its effects on gastric emptying and intestinal transit as well as duodenogastric bile reflux and associated gastric bleeding. METHODS: Male rats received saline or ketamine (7 mg/kg ip) 1 hour before saline or LPS (20 mg/kg ip) for 5 hours. Thirty minutes before killing, rats received orogastric rhodamine B isothiocyanate-labeled dextran and 5 minutes later fluorescein isothiocyanate-labeled dextran via a duodenal catheter. GI contents were collected for dye, bile acid, and hemoglobin (index of bleeding) determinations. RESULTS: LPS significantly impaired intestinal transit and increased duodenogastric bile reflux and gastric luminal hemoglobin content. Ketamine improved intestinal transit, prevented LPS-induced bile reflux, and diminished gastric bleeding. In mechanistic studies, ketamine also attenuated LPS-induced upregulation of the proinflammatory genes inducible nitric oxide synthase and cyclo-oxygenase-2 in the stomach but preserved expression of the anti-inflammatory gene heme-oxygenase-1 (Western blot). CONCLUSIONS: These data suggest that ketamine may prevent LPS-induced gastric bleeding by decreasing bile reflux through improved intestinal transit or by local changes in nitric oxide, prostaglandin, and carbon monoxide metabolism.

[Duodenogastric reflux and gastric pathology in the elderly patients].

OBJECTIVE: To determine the frequency of duodenogastric reflux (DGR), and to assess the changes in the gastric mucosa in the presence of bile reflux. MATERIALS AND METHODS: Our study includes the results of 1371 gastroduodenoscopies carried out in 2008, for patients between 65 and 92 years old, the study includes both kind of patients who were admitted to hospital and those who were investigated on an outpatient basis. The main group includes 695 patients with various level of DGR severity, and the control group consists of 676 patients without DGR. RESULTS: DGR was diagnosed in 14.8% more in women. In case of the presence of DGR we have found changes in the antrum mucosa as congestion, and minor erosion, hyperplasia, metaplasia of gastric and esophageal mucosa, and stomach polyps. And we have not noticed such changes when DGR was absent. We have found that the high frequency of antral hyperplasia is correlated to the DGR severity. CONCLUSION: DGR is diagnosed in more than 10% of patients who undergo gastroduodenoscopy. DGR is an indicator of conditions often associated with various morphological changes in gastric mucosa; therefore this finding has to be taken in consideration in the further investigations and management of such patients.

[The clinical and functional status of the stomach and small intestine in patients with chronic inflammatory bowel diseases concurrent with chronic opisthorchiasis].

To study the impact of Opisthorchis infestation on the upper digestive tract and small bowel in chronic inflammatory bowel diseases, the authors examined 164 patients with inflammatory bowel diseases, including 71 patients with ulcerative colitis and 45 with Crohn's disease without parasitosis and 48 with chronic opisthorchiasis (31 with ulcerative colitis and 17 with Crohn's disease). A control group consisted of 20 healthy individuals and 20 patients with chronic opisthorchiasis. A diagnosis was established by colonofibroscopy and a morphological study of colonic biopsy specimens. Gastric mucosal atrophic changes and motor evacuatory disorders as duodenogastric reflux were significantly more frequently encountered in inflammatory bowel diseases concurrent with chronic opisthorchiasis. The presence of Opisthorchis infestation significantly worsened fat and carbohydrate malabsorption in the small bowel in inflammatory bowel diseases.

Pyloric sphincter dysfunction in nNOS-/- and W/Wv mutant mice: animal models of gastroparesis and duodenogastric reflux.

BACKGROUND & AIMS: Nitrergic nerves and interstitial cells of Cajal (ICC) have been implicated in the regulation of pyloric motility. The purpose of these studies was to define their roles in pyloric function in vivo. METHODS: Pyloric sphincter manometry was performed in wild-type controls, neuronal nitric oxide synthase-deficient (nNOS(-/-)) mice, and ICC-deficient W/W(v) mice, and the effect of deafferented cervical vagal stimulation was examined. RESULTS: Mice showed a distinct approximately 0.6-mm-wide zone of high pressure at the antroduodenal junction, representing the pyloric sphincter. In wild-type controls, the pylorus exhibited tonic active pressure of 12.4 +/- 1.6 mm Hg with superimposed phasic contractions. The motility indices, minute motility index, and total myogenic activity were reduced by vagal stimulation, and the reduction was antagonized by the nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). In nNOS(-/-) mice, pyloric basal tone, minute motility index, and total myogenic activity were not significantly different from those in controls, but vagal stimulation paradoxically increased pyloric motility. In contrast, the W/W(v) mice had significantly reduced resting pyloric pressure that was suppressed by vagal stimulation in an L-NAME-sensitive manner. The stomachs of fasted nNOS(-/-) mice showed solid food residue and bezoar formation, while W/W(v) mice showed bile reflux. CONCLUSIONS: In nNOS(-/-) mice, loss of nitrergic pyloric inhibition leads to gastric stasis and bezoars. In contrast, basal pyloric hypotension with normal nitrergic inhibition predisposes W/W(v) mice to duodenogastric bile reflux.

Comparison of the degree of duodenogastroesophageal reflux and acid reflux between patients who failed to respond and those who were successfully treated with a proton pump inhibitor once daily.

OBJECTIVES: The objective of this study was to compare the degree of esophageal acid exposure and duodenogastroesophageal reflux (DGER) during treatment between gastroesophageal reflux disease (GERD) patients who responded fully to proton pump inhibitor (PPI) once a day and those who failed to respond. METHODS: Gastroesophageal reflux disease patients who continued to report symptoms 3 times a week for 3 months while on PPI once a day were assigned to the PPI failure group. GERD patients who were asymptomatic on PPI once a day for 3 months were assigned to the PPI success group. All patients underwent upper endoscopy to assess esophageal mucosal injury. Subsequently, all patients underwent simultaneous 24-h esophageal Bilitec 2000 and pH testing while on treatment. Patients recorded GERD-related symptoms during the test. RESULTS: Twenty-four patients were enrolled in the PPI failure group and 23 patients were enrolled in the PPI success group. Endoscopy was normal in 63% of PPI failure patients and 76% of PPI success patients. Abnormal DGER was documented in 82% of PPI success patients vs. 67% of PPI failure patients (P=NS). All pH testing and Bilitec parameters in the PPI failure group were similar to those in the PPI success group (P=NS). Of the 34 GERD symptoms recorded by the PPI failure group, 64% were associated with acid reflux and 41% were associated with DGER (P<0.05). CONCLUSIONS: There is no difference in the degree of DGER and acid exposure during treatment between patients who failed to respond and those who achieved complete symptom resolution on PPI once daily. GERD symptoms in the PPI failure group are more commonly associated with acid reflux than with DGER.

[Psychoemotional and humoral changes in patients with combined reflux disorders].

AIM: To investigate disorders of psychoemotional functions, humoral regulation (substance P) and duodenal motility (DM) in patients with combined refluxes for their differential correction. MATERIAL AND METHODS: A total of 60 patients with gastroesophageal and duodenogastric refluxes were examined. RESULTS: Patients with reflux disorders had more frequent and severe neurotic reactions. Humoral changes are associated with characteristics of psychoemotional regulation. The risk of subnormal levels of the substance P rises substantially in changes in the scales of anxiety, neurotic depression, hysterical reaction and autonomic disorders. Segmental duodenal motility regresses with lowering of plasmic levels of substance P. CONCLUSION: Patients with combined reflux disorders have psychoemotional disorders, abnormal humoral regulation and duodenal motility necessitating a differential approach to treatment of such patients.

[Duodenogastric reflux in patients with recurrent postoperative complicated duodenal ulcers].

Duodenogastric reflux (DGR) was revealed in 52.6% patients, suffering recurrent postoperative complicated duodenal ulcers (RPOCDU). Pylorodestructive operations performance, pyloric involvement into ulcerative infiltrate and absence of chronic duodenal impassability (CHDI) correction during the first operation done had constituted the DGR occurrence causes. While establishing the indications for elective operation performance as well as choosing the surgical method of the RPOCDU treatment it is necessary to take into account the presence and severity degree of DGR. Surgical treatment of DGR must obligatory include not only the pyloric preservation and strenghtening, but the CHDI correction as well. Selective periarterial sympathectomy of duodenum constitutes an effective method, improving her tone without pyloric innervations disturbing.