Comparison between herbs used for the treatment of gastroesophageal reflux diseases(GERD)

Background:An abnormality that causes reflux is termed as Gastroesophageal reflux disease (GERD), which is symptomatic by nature and adds to the long-term effects.Objective:The aim of this study is to observe and monitor the effects of a herbal ttratment of GERD with SiniZuojin Decoction (SNZID)and to assess its mediation impacts regarding the use of the medication in patients with Gastrointestinal EBB ailment.Materials and Methods:The cohort research methodology was used inthe study.The research included 2581 individual patients who were older than 18 years of age and were suffering from Gastrointestinal ebbailment. The patients were selected from various government herbal clinics in eastern China, including the states of Anhui, Fujian, Jiangsu, Jiangxi, Shandong, and Zhejiangover, from 2008 to 2018. Results:The study was conducted with a total of 2581 patients. The thorough assessment indicated that Sini Zuojin Decoction (SZD)notwithstanding standard stomach remedies pack was more effective than the traditionalist stomach suppositories bundle (RR=1.34, with CI=95% [1.47, 1.38], and P-value = 0.008); Test packs including SZD was essentially better contrasted with traditional stomach medicines(TSM)gearshifts in developing dyspepsia, substernal chest plague, decreasing regurgitation, and vomiting (P < 0.0002); SNZJD plus traditional stomach medicines(SPTSM)could by and large lessen full-scale sign scores with liberal ampleness (P < 0.00002). The replication degree and antagonistic effects regarding Sacroiliac Joint Dysfunction(SJD)treatment were basic. As confirmed through the TSA regarding thorough assessment, the results were significant, yet repeat security consequences were uncertain. As shown by the computation of the Grading of Recommendations Assessment, Development and Evaluation(GRADE)strategy, the idea regarding verification was minimal. Moreover, Schizoaffective disorder(SZD)may treat Gastrointestinal ebb ailment by presenting the onsetof the infection and controlling factors that may contribute to Gastrointestinal ebb ailments.Conclusion:The research evaluated the efficiency of Sini Zuojin Decoction in treating patients suffering from Gastrointestinal Ebb Ailments. [Ethiop. J. Health Dev.2022: 36(2) (00-00)]

Oclusión gastroduodenal crónica por síndrome de Wilkie: reporte de un caso / Chronic gastroduodenal occlusion by Wilkie syndrome: a case report

RESUMEN El síndrome de Pinza Aortomesentérica o "Síndrome de Wilkie" es una entidad muy rara, se caracteriza por una pérdida de peso impor-tante y vómitos de alimentos parcialmente digeridos. La sospecha diagnóstica se fundamenta por la presencia de factores predisponen-tes y/o de riesgo. Estudios imagenológicos como un esofagogastroduodeno seriado y ecografía Doppler permiten su confirmación. El tratamiento primario se apoya en una adecuada nutrición. Frente al fracaso del tratamiento médico, se indica el manejo quirúrgico con diferentes técnicas para resolver la oclusión. Se presenta el caso de una adolescente con oclusión gastroduodenal crónica, fallo en el tratamiento médico y resolución quirúrgica con buenos resultados.Palabras claves: Síndrome de la arteria mesentérica superior, obstrucción duodenal, reflujo duodenogástrico, laparotomía, anastomosis quirúrgica; gastroparesia.

ABSTRACT Superior mesenteric artery syndrome or "Wilkie syndrome" is a very rare entity, characterized by significant weight loss and vomiting of partially digested food. The diagnostic suspicion is based on the presence of predisposing and/or risk factors. Imaging studies such as serial esophagogastroduodenum and Doppler ultrasound allow its confirmation. The primary treatment is supported by adequate nutrition. Following the failure of medical treatment, surgical management is indicated with different techniques to resolve the occlusion. We present the case of a teenager with chronic gastroduodenal occlusion, failure in medical treatment and surgical resolution with good results.Keywords: Superior mesenteric artery syndrome; duodenal obstruction; duodenogastric reflux; laparotomy; anastomosis, surgical; gas-troparesis

Esôfago de Barrett: concordância diagnóstica entre os achados da endoscopia digestiva alta e a histologia / Barrett's Esophagus: diagnostic agreement between high digestive endoscopy findings and histology

Justificativa: A Doença do Refluxo Gastroesofágico (DRGE) apresenta alta prevalência na população mundial. Uma de suas complicações, é o esôfago de Barrett (EB), uma alteração histológica pré-maligna do epitélio esofágico. O seu diagnóstico se da através do exame endoscópico e posterior confirmação histopatológica. Objetivo: Estimar a concordância diagnóstica, nos casos suspeitos de EB, entre o exame endoscópico e a análise histológica. Métodos: Foram analisados 151 pacientes, retrospectivamente, com suspeita diagnóstica de EB na endoscopia. Os dados foram obtidos a partir de prontuários eletrônicos, entre Julho de 2013 e Julho de 2014. Os laudos anatomopatológicos foram obtidos através de registros do laboratório Byori. Resultados: Entre os 151 pacientes submetidos a biópsias com suspeita endoscópica de EB, 47 (31,1%) obtiveram confirmação diagnóstica através do exame anatomopatológico. Conclusão: A endoscopia digestiva alta é um bom exame para detecção de metaplasia colunar, entretanto, nos casos de esôfago de Barrett, essa eficácia não se reproduziu.

Background: Gastroesophageal Reflux Disease (GERD) has a high prevalence in the world population. One of its complications is Barrett's esophagus (EB), a premalignant histological alteration of the esophageal epithelium. Its diagnosis is given through endoscopic examination and subsequent histopathological confirmation. Objective: Estimate at diagnostic agreement, we have suspense cases of EB, between endoscopic examination and histological analysis. Method: A total of 151 patients were retrospectively with suspected diagnosis of EB at endoscopy. Data were obtained from electronic medical records between July 2013 and July 2014. Anatomopathological reports were obtained from Byori laboratory records. Results: Among the 151 patients who underwent biopsy with endoscopic suspicion of EB, 47 (31.1%) obtained diagnostic confirmation through pathological examination. Conclusion: Upper digestive endoscopy is a good exam to detect columnar metaplasia, however, in Barrett's esophagus cases, this efficacy has not been reproduced.

Omeprazole and adenocarcinoma in the stomach of rats submitted to duodenogastric reflux. Is there a protective effect?

Abstract Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.

False-negative Hepatobiliary Scintigraphy for Biliary Atresia / 대한핵의학회잡지

We present the case of a patient with biliary and duodenal atresia who showed false-negative hepatobiliary scintigraphy results. The patient was born at 37 weeks and 2 days of gestation. Her mother had undergone amnioreduction after detection of a double-bubble ultrasound sign in the fetal abdomen. At 2 days of age, total serum bilirubin level was elevated. On hepatobiliary scintigraphy 4 days later, the gallbladder was visualized from 30 min and it showed duodeno-gastric reflux at 240 min. After 24 h, the radiotracer was almost washed out in the hepatic parenchyma, but there was retention in the gastroduodenal junction. Because the biliary to duodenal transit was visible, biliary atresia seemed unlikely. Abdominal ultrasonography at 7 days of age showed a small dysmorphic gallbladder, but triangular cord sign was not definite. Magnetic resonance cholangiography revealed atretic gallbladder. Although cystic and common bile ducts were visible, the proximal common hepatic bile duct was not visible. The next day, serum total bilirubin levels remained elevated (17.1 mg/dl) with direct bilirubin level of 1.2 mg/dl. Kasai portoenterostomy with duodeno-duodenostomy was performed at 10 days of age. Histopathological evaluation showed a fibrous obliteration of the common bile duct, consistent with that of biliary atresia.

Value of endoscopy application in the management of complications after radical gastrectomy for gastric cancer / 中华胃肠外科杂志

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.

Influence of duodenogastric reflux in the gastric mucosa histological changes of rats infected with Helicobacter pylori / Influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica de ratos infectados com Helicobacter pylori

ABSTRACT Objective: to evaluate the influence of Duodenal reflux in histological changes of the gastric mucosa of rats infected with Helicobacter pylori submitted to pyloroplasty. Methods: after two weeks of acclimation, we infected 30 male Wistar rats with Helicobacter pylori. We randomly divided them into three groups: one submitted to pyloroplasty, another to partial gastrectomy and the third, only infected, was not operated. After six months of surgery, euthanasia was carried out. Gastric fragments were studied by light microscopy to count the number of H. pylori, and to observe the histological changes (gastritis, metaplasia, dysplasia and neoplasia). We confirmed these changes by immunohistochemistry using the molecular markers PCNA and TGF-beta. Results: the animals submitted to pyloroplasty had higher percentage of colonization by H. pylori (median=58.5; gastrectomy=16.5; control=14.5). There was a positive correlation between the amount of H. pylori and the occurrence of chronic gastritis present in the antral fragments. Neoplasia occurred in 40% of rats from the group submitted to pyloroplasty. The staining with PCNA and TGF-ß confirmed the histopathological changes visualized by optical microscopy. Conclusions: the antral region was the one with the highest concentration of H. pylori, regardless of the group. There was a positive correlation between the appearance of benign disorders (chronic gastritis, metaplasia, dysplasia) and cancer in mice infected with H. pylori submitted to pyloroplasty.

RESUMO Objetivo: avaliar a influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica de ratos, infectados por Helicobacter pylori, submetidos à piloroplastia. Método: após duas semanas de aclimatação, 30 ratos machos da raça Wistar, foram infectados com o microorganismo patogênico H. pylori. De forma aleatória, foram divididos em três grupos: um submetido à piloroplastia, outro à gastrectomia parcial e o terceiro, apenas infectados, não foi operado. Após seis meses de operados, procedeu-se a eutanásia. Os fragmentos gástricos foram estudados por microscopia óptica, para a contagem da quantidade de H. pylori, e para a observação das alterações histológicas (gastrite, metaplasia, displasia e neoplasia). A confirmação dessas alterações foi feita por imuno-histoquímica, utilizando os marcadores moleculares PCNA e TGFbeta. Resultados: os animais submetidos à piloroplastia tiveram maior percentual de colonização por H. pylori (mediana=58,5; gastrectomia=16,5; controle=14,5). Houve correlação positiva entre quantidade de H. pylori e ocorrência de gastrite crônica presente nos fragmentos do antro. Ocorreu 40% de neoplasia no grupo submetido à piloroplastia. A marcação de PCNA e TGF-beta confirmou as alterações histopatológicas visibilizadas à microscopia óptica. Conclusões: a região do antro foi a que apresentou a maior concentração de H. pylori, independente do grupo. Houve correlação positiva entre e o aparecimento de alterações benignas (gastrite crônica, metaplasia, displasia), e de neoplasia nos ratos infectados com H. pylori submetidos à piloroplastia.

Detection of Apical Inflammatory Root Resorption Associated with Periapical Lesion Using Different Methods

The aim of this study was to detect apical inflammatory root resorption (AIRR) associated with periapical lesion using cone beam computed tomography (CBCT) and scanning electronic microscopy (SEM). This clinical study evaluated AIRR in 88 root apexes, from 52 permanent teeth of 14 patients, extracted for different reasons. The patients were submitted to a clinical interview, review of dental/medical histories and clinical/imaging examinations for treatment planning. All selected teeth showed unrestorable condition because of the extensive coronal breakdown due to carious lesions, and root canal infection associated with periapical lesions. CBCT images were obtained from the patients with the aim of diagnosing the periapical diseases which showed complex or doubtful conditions. Two examiners assessed the presence or absence of AIRR. Apices were also analyzed under SEM. Chi-square test was used to compare the imaging methods for detection of AIRR. The level of statistical significance was set at 5%. AIRR associated with root canal infection and apical periodontitis was found in 61.4% of the cases studied by using SEM, and at least half of the cases by CBCT. The microscopic analysis remains as a reference standard against the imaging method to identify AIRR.

O objetivo deste estudo foi detectar reabsorção radicular inflamatória apical (RRIA) associada à lesão periapical utilizando tomografia computadorizada de feixe cônico (TCFC) e microscopia eletrônica de varredura (MEV). Este estudo clínico avaliou RRIA em 88 ápices radiculares de 52 dentes permanentes de 14 pacientes, extraídos por diferentes motivos. Os pacientes foram submetidos a uma entrevista clínica, revisão da história médica/dental, exames clínicos e de imagem para o plano de tratamento. Todos os dentes selecionados apresentaram condição não restaurável devido à extensa perda de estrutura dental associada a lesões cariosas, e infecção do canal radicular associada a lesões periapicais. TCFC foram obtidas dos pacientes com o objetivo de diagnosticar as alterações periapicais que se mostraram complexas ou duvidosas. Dois examinadores avaliaram a presença ou ausência de RRIA. Os ápices foram também analisados por MEV. O teste do qui-quadrado foi usado para comparar os métodos de detecção de RRIA. O nível de significância foi estabelecido em 5%. RRIA associada à infecção do canal radicular e periodontite apical foi encontrada em 61,4% dos casos estudados usando MEV, e pelo menos metade dos casos utilizando TCFC. A análise microscópica continua a ser o padrão frente a métodos de imagens para a identificação de RRIA.

Late administration of a specific COX-2 inhibitor does not treat and/or prevent progression of gastric tumors in rats submitted to duodenogastric reflux procedure

PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.

Influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica em ratos infectados por Helicobacter pylori: Modelo experimental / Influence of duodenogastric reflux in histological changes in mice infected by Helicobacter pylori: experimental model

O Helicobacter pylori, é tido como o principal fator de risco para o carcinoma gástrico. Diferentes estudos experimentais em animais procuram relacionar essa carcinogênese a outros fatores carcinógenos sem sucesso. Neste estudo, procurou-se avaliar-se em ratos, se há correlação entre o refluxo duodenogástrico, o Helicobacter pylori e o desenvolvimento do câncer gástrico ou de seus precursores. Para tal, realizou-se nos três grupos de ratos (n de dez por grupo) as técnicas de: piloroplastia precedida de infecção, gastrectomia subtotal precedida de infecção e um grupo no qual foi praticada apenas a infecção. Apois seis meses, analisou-se as alterações da mucosa, comparando-se os três grupos. As alterações da mucosa pesquisadas foram as seguintes: gastrites, metaplasias, displasias e neoplasias epiteliais. Ao término do estudo, foi encontrado, no grupo submetido a piloroplastia precedida de infecção um alto percentual de alterações epiteliais. Conclui-se que, no rato, a operação de piloroplastia, levou ao maior desenvolvimento da população do Helicobacter pylori, que se relaciona com as lesões pré- malignas e o adenocarcinoma gástrico

Helicobacter pylori is considered the main risk factor for gastric carcinoma. Different experimental studies in animals seek to relate this carcinogenesis to other carcinogenic factors without success. This study sought to evaluate in rats, if there was a correlation between duodenogastric reflux, Helicobacter pylori and the development of gastric cancer or its precursors. To this end, it was carried out in three groups of rats the techniques: pyloroplasty, subtotal gastrectomy and only infection. After six months, the changes in mucosa were analyzed comparing the three groups. The mucosal changes reseached were: gastritis, metaplasia, dysplasia and epithelial neoplasms. At the end of the study, was found in the group that underwent pyloroplasty a high percentage of epithelial alterations and these correlated with the population of Helicobacter pylori. It is concluded that in the rat, the operation of pyloroplasty led to increased colonization of the population of Helicobacter pylori and is related with the development of benign lesions and gastric cancer

Sensibilidade da seriografia do esôfago, estômago e duodeno para o diagnóstico de doença do refluxo gastroesofágico em recém-nascidos prematuros / Sensitivity of upper gastrointestinal series in the diagnosis of gastroesophageal reflux in premature infants

OBJETIVO: Determinar a sensibilidade da seriografia do esôfago, estômago e duodeno (SEED) para o diagnóstico da doença do refluxo gastroesofágico (DRGE) em recém-nascidos prematuros, tendo como padrão ouro a monitoração prolongada do pH esofágico distal, e descrever a presença de anormalidades anatômicas do tubo digestivo. MATERIAIS E MÉTODOS: Foram incluídos no estudo 41 recém-nascidos, com média de 1.243,9 g, apresentando sinais/sintomas de DRGE e resultados alterados na monitoração do pH (índice de refluxo > 10 por cento). A SEED foi realizada logo que as condições clínicas dos recém-nascidos foram estáveis para a realização dos exames radiológicos. RESULTADOS: A monitoração prolongada do pH e a SEED foram realizadas com 49,8 e 66,8 dias de vida, respectivamente. A sensibilidade da seriografia foi de 56,1 por cento (IC 95 por cento: 39,9-71,2 por cento). Refluxo significativo foi observado em 41,4 por cento dos casos, refluxo médio em 44,8 por cento e refluxo pequeno em 13,8 por cento. A SEED identificou apenas um caso de hérnia de hiato. CONCLUSÃO: A SEED apresentou baixa sensibilidade para a DRGE em prematuros e não se associou com a gravidade do refluxo, na comparação com a monitoração do pH, sendo, entretanto, útil no diagnóstico de alteração anatômica.

OBJECTIVE: To determine the sensitivity of upper gastrointestinal (UGI) series, adopting the 24-h esophageal pH monitoring as the gold standard in the diagnosis of gastroesophageal reflux disease (GERD) in preterm newborns, besides describing the presence of anatomical abnormalities in the digestive tube. MATERIALS AND METHODS: The present study included 41 neonates with average birth weight of 1,243.9 g, presenting signs/symptoms of GERD and abnormal 24-h esophageal pH monitoring (reflux index > 10 percent). The UGI series was performed as soon as the infants' clinical conditions were considered sufficiently stable. RESULTS: The 24-h pH monitoring and UGI series were performed respectively at 49.8 and 66.8 days of life. The UGI series sensitivity was of 56.1 percent (CI 95 percent: 39.9-71.2 percent). The reflux index was significant in 41.4 percent, moderate in 44.8 percent, and mild in 13.8 percent of the cases. Only one case of hiatus hernia was identified by UGI series. CONCLUSION: Upper gastrointestinal series has demonstrated low sensitivity in the diagnosis of GERD in preterm newborns and was not associated with the reflux severity as compared with pH monitoring. However, it is useful in the detection of anatomical abnormalities in the upper gastrointestinal tract.

Metaplasia intestinal en pacientes con reflujo duodenogástrico y ácidos biliares totales elevados / Intestinal metaplasia en patients with duodenogastric reflux and high total bile acids

Existen evidencias que tanto los ácidos biliares como el Helicobacter pylori en la mucosa gástrica son capaces de desencadenar un proceso inflamatorio que según su intensidad y persistencia favorecen la aparición de fallas y mutaciones en la replicación celular que se expresan desde una metaplasia, displasia hasta un cáncer. Se realizó un estudio epidemiológico observacional, descriptivo, prospectivo de corte transversal en el Instituto de Gastroenterología, en pacientes con reflujo duodenogástrico y ácidos biliares totales elevados, con el objetivo de conocer la asociación entre la metaplasia intestinal y la presencia o no de Helicobacter pylori. Al concluir la investigación se observó que la metaplasia estuvo presente en 48,7 por ciento de los 39 pacientes estudiados, que existió una asociación estadísticamente significativa (p<0,05) en la distribución de la bacteria en los pacientes con y sin metaplasia intestinal, que los pacientes con reflujo duodenogástrico, a pesar de tener una lesión histológica, presentaron resultados negativos en cuanto a la presencia de Helicobacter pylori. En las muestras con diagnóstico histológico de gastritis crónica severa y atrófica, el 75 por ciento presentaban Helicobacter pylori. La localización de la metaplasia intestinal fue mayor en la región antral (84,3 por ciento). En los pacientes con reflujo duodenogástrico la presencia de Helicobacter pylori no parece estar asociada a grados intensos de metaplasia, aunque el microorganismo se encuentre en todas las categorías, mientras que cuando no hay, la metaplasia tiende a ser menos severa. En el 100 por ciento de los casos la densidad de la bacteria fue ligera

The cytotoxic and cancerous action of bile acids on gastric mucosa is a very interesting subject within the gastroduodenal diseases due to they are able to alter the membrane, the cellular metabolism, to give rise to a inflammatory process, to increase the proliferation, the cell apoptosis and the DNA damage, that according to its intensity and persistence, favor the appearance of failures and mutations in cell replication. With the discovery and characterization of Helicobacter pylori it is considered that according to its intensity and the time of persistence in gastric mucosa provokes damages with failures and cellular mutations. In this sense, a prospective and descriptive study was conducted in the Institute of Gastroenterology in patients presenting with duodenogastric and high total bile acids to know the association between the intestinal metaplasia and the presence or not of Helicobacter pylori. Metaplasia was present in the 48.7 percent of the 39 study patients, that there was a statistically significant association (p< 0.05) in Helicobacter pylori distribution in patients with and without intestinal metaplasia; that patients with duodenogastric reflux, despite of a histological lesion also had a greater frequency of negative results as regards the presence of Helicobacter pylori. In samples with histological diagnosis of severe and atrophic chronic gastritis, 75 percent, respectively, had Helicobacter pylori and in consequence, there was a significant association between presence or not of microorganism and the chronic gastritis intensity. Intestinal metaplasia location was higher in antral region (84.3 percent) and also with a higher ratio of microorganism positivity. In patients with duodenogastric reflux, presence of Helicobacter pylori don't seems to be associated with intense degrees of intestinal metaplasia, although the microorganism is present in all categories, but when there is not Helicobacter pylori, intestinal metaplasia to tend to ...

Thyrotoxic Vomiting: A Case Report and Possible Mechanisms

The symptoms related to gastrointestinal (GI) tract are sometimes chief complaints in patients with endocrine disease. Thyrotoxicosis is a rare, but notable cause for unexplained and repeated vomiting. Here, we report an adolescent patient with thyrotoxicosis who was initially presented with repeated vomiting and epigastric pain. A 13-year-old female was referred to a GI outpatient department for evaluation of vomiting and abdominal pain from a pediatric clinic. Esophagogastroduodenoscopy revealed acute gastritis with duodenogastric reflux and suspicious reflux esophagitis of minimal change, but there was no significant improvement after treatment and as a result she was admitted to the emergency room. She was subsequently diagnosed as Graves' disease because an initial laboratory test at the GI outpatient department revealed thyroid stimulating hormone < 0.01 microIU/mL and additional blood tests showed elevated thyroid hormones and positive thyroid stimulating hormone receptor antibody. The vomiting and epigastric pain improved remarkably after treatment with antithyroid drugs. Clinicians should consider the possibility of thyrotoxicosis in patient with unexplained and repeated vomiting.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy / Quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo em ratos Wistar submetidos à gastrojejunostomia

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info®, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

OBJETIVO: Avaliar a quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo, em ratos Wistar, submetidos a gastrojejunostomia. MÉTODOS: Sessenta ratos machos Wistar, com média de idade de três meses foram operados e distribuídos em 03 grupos: Grupo 1 - Os animais foram submetidos a laparotomia exploradora. Grupo 2 - Os animais foram submetidos a gastrojejunostomia. Grupo 3 - Os animais foram submetidos a gastrojejunostomia e tomaram celecoxib, diariamente. Após um período de 53 semanas, os animais foram sacrificados. As alterações da mucosa do corpo gástrico dos animais do grupo 1 e da anastomose gastrojejunal dos animais dos grupos 2 e 3 foram analisadas no exame histopatológico e imuno-histoquímica e foram comparadas. Todas as análises estatísticas foram realizadas pelo programa Epi Info®, versão 3.4.3. RESULTADOS: No cotejo entre os animais dos grupos 2 e 3 com relação à presença de adenocarcinoma observou-se uma diferença estatística significante (p=0,0023). A análise de associação entre os grupos 2 e 3 com relação à expressão da COX-2, também evidenciou uma diferença estatística significante (p=0,0018). CONCLUSÃO: O celecoxib teve efeito inibidor da carcinogênese gástrica, induzida pelo refluxo em ratos.

Carcinogenesis of the upper gastrointestinal tract induced by N-methyl-N'-nitro-nitrosoguanidine and reflux of duodenal contents in the rat / Carcinogênese do trato gastrointestinal alto induzida pelo N-methyl-N'-nitro-nitrosoguanidina e pelo refluxo duodenogástrico no rato

PURPOSE: To investigate the combined effects of reflux of duodenal contents through the pylorus and treatment with N-methyl-N'-nitro-nitrosoguanidine (MNNG) on the development of lesions in the glandular stomach, at the gastrojejunal anastomosis and in the forestomach of rats. METHODS: Eighty Male Wistar rats were divided into 4 groups: G1: MNNG + Reflux, G2: Reflux, G3: MNNG and G4: Gastrostomy. MNNG was given in the drinking water (100 mg/ml) for 12 weeks and then two groups (G1 and G2) were submitted to a gastrojejunal anastomosis followed by section of the afferent loop and suture of both stumps to allow reflux of duodenal contents through the pylorus. The animals were sacrificed 18 and 36 weeks after surgery. The lesions obtained in the antral mucosa, at the gastrojejunal anastomosis and in the forestomach were analysed histologically. RESULTS: Duodenal reflux induced proliferative lesions at both glandular and squamous mucosa of the stomach. In the antrum, adenomatous hyperplasia (AH) was observed in 20% and 50% of the animals at the 18th and 36th weeks respectively. Aditionally 85% of the animals presented AH at the gastrojejunal anastomosis and 60% developed squamous hyperplasia at the squamous portion of the stomach. MNNG treatment plus duodenal reflux enhanced the development of malignant tumors at both glandular and squamous mucosa, since there were 30% of antral adenocarcinomas and 45% of squamous carcinomas at the 18th week and the frequency of these malignant tumors rose to 50% in the antrum and 65% in the squamous mucosa at the 36th week. CONCLUSION: The reflux of duodenal contents through the pylorus enhanced the development of proliferative lesions, benign and malignant, in the glandular stomach and in the forestomach of rats.

OBJETIVO: Investigar os efeitos do refluxo duodenogástrico e sua interação com o cancerígeno químico N-methil-N'-nitro-nitrosoguanidina (MNNG) no desenvolvimento de lesões no estômago glandular, anastomose gastrojejunal e no estômago escamoso do rato. MÉTODOS: Foram utilizados 80 ratos Wistar divididos em 4 grupos: G1: MNNG + Refluxo, G2: Refluxo, G3: MNNG e G 4: Gastrostomia. O MNNG foi oferecido na água de beber (100mg/ml) por 12 semanas. A seguir foi feita anastomose gastrojejunal na porção glandular do estômago nos grupos G1 e G2, com secção da alça aferente junto ao estômago e sutura de ambos os cotos para permitir o refluxo do conteúdo duodenal para o estômago pelo piloro. Os animais foram sacrificados 18 e 36 semanas após a cirurgia. As lesões identificadas foram submetidas à exame histopatológico. RESULTADOS: O refluxo duodenogástrico levou ao desenvolvimento de lesões proliferativas no estômago glandular e na porção escamosa. No antro, hiperplasia adenomatosa (HA) foi diagnosticada em 20 e 50% dos animais (G2) na 18ª e 36ª semanas, respectivamente. Na anastomose gastrojejunal 85 por cento dos animais (G2) apresentaram HA e 60% apresentaram hiperplasia escamosa no estômago escamoso, na 36ª semana. No grupo MNNG+Refluxo foram identificados na 18ª semana, 30% adenocarcinomas no antro e 45%carcinomas escamosos. A freqüência destas lesões malignas aumentou, respectivamente, para 50% e 65% na 36ª semana. CONCLUSÃO: O refluxo duodenogástrico potencializou o desenvolvimento de lesões proliferativas benignas e malignas no estômago glandular e em sua porção escamosa, no rato.

The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats

PURPOSE: To assess the effects of Roux-en-Y jejunal limb length on gastric emptying and enterogastric reflux. METHODS: Seventy male Wistar rats were submitted to antrectomy with Roux-en-Y reconstruction and then were divided into two groups of 35 animals. Group A, short limb (7.5 cm) and Group B, standard limb (15 cm). Group A and B were subdivided into five subgroups each in order to study enterogastric reflux at 30 and 60 minutes and to evaluate gastric emptying at 5, 10 and 15 minutes. In order to measure gastric emptying and enterogastric reflux, radiotracers 99m Tc-Phytate and 99m Tc-DISIDA were respectively used. RESULTS: For gastric emptying, the radiotracer concentration was lower in Group A than in Group B after five minutes. The enterogastric reflux was present, but there were no significant differences between enterogastric reflux indexes concerning both A and B Groups. CONCLUSION: A standard Roux limb, besides being unable to protect the stomach from the enterogastric reflux, may become a functional barrier for gastric emptying.

OBJETIVO: Determinar os efeitos do comprimento da alça jejunal em Y de Roux sobre o esvaziamento gástrico e o refluxo enterogástrico. MÉTODOS: Setenta e cinco ratos machos foram submetidos à antrectomia com reconstrução em Y de Roux e divididos em dois grupos de 35 animais. Grupo A, alça curta (7,5cm) e Grupo B (15cm), alça de comprimento padrão. Os grupos A e B foram subdivididos em cinco subgrupos cada para o estudo do refluxo enterogástrico aos 30 e 60 minutos e para o estudo do esvaziamento gástrico aos 5, 10 e 15 minutos. 99m Tc-Fitato and 99m Tc-DISIDA foram utilizados para os estudos do esvaziamento gástrico e do refluxo enterogástrico, respectivamente. RESULTADOS: No estudo do esvaziamento gástrico, a concentração do radiotraçador foi menor no grupo A do que no Grupo B aos cinco minutos. Foi encontrado o refluxo enterogástrico, nos grupos A e B, sem diferenças entre eles. CONCLUSÃO: A alça em Y de Roux de comprimento padrão foi ineficaz em proteger o estômago do refluxo enterogástrico, e pode tornar-se uma barreira funcional ao esvaziamento gástrico.

Tubo gástrico con conservación anatómica y funcional del píloro / Gastric tube with anatomical and functional conservation of the pylorus

INTRODUCCIÓN. No existe consenso en cuanto a la realización de un procedimiento de drenaje gástrico cuando se ha realizado una esofagectomía subtotal y se ha sustituido el esófago por el estómago tubulizado y desnervado. Es el objetivo de este estudio evaluar el resultado obtenido en pacientes a quienes se practicó esofagectomía subtotal y sustitución del órgano con estómago tubulizado sin aplicar drenaje gástrico (piloroplastia). MÉTODOS. Se analizaron 16 pacientes tratados con este procedimiento entre enero de 2002 y septiembre de 2005. Las variables estudiadas fueron la técnica quirúrgica empleada, las complicaciones posoperatorias y la presencia de síntomas de retención gástrica o de reflujo duodenogástrico, al alta y durante el seguimiento hasta los 6 meses. RESULTADOS. La resección por la técnica de McKeown se realizó en el 50 por ciento de los casos, mientras que el acceso transhiatal se practicó en el 43,8 por ciento y la técnica de Ivor Lewis en el 6,2 por ciento. Siete pacientes (43,8 por ciento) sufrieron complicaciones, principalmente por fístula esofagogástrica cervical (6 casos). El último de ellos presentó atelectasia y bronconeumonía bilateral que lo llevaron a la muerte. En el seguimiento a los 6 meses no se encontraron síntomas de reflujo alcalino ni de dificultad a la evacuación del estómago. CONCLUSIONES. No se demostró la presencia de retención gástrica o reflujo duodenogástrico en este estudio. No obstante, sería recomendable la realización de un estudio aleatorio que compare los resultados obtenidos en pacientes a quienes se practica un procedimiento de drenaje gástrico y en aquellos en quienes se mantienen intactas la fisiología y la anatomía del píloro desnervado(AU)

INTRODUCTION. There is no consensus as to the carrying out of a procedure of gastric drainage when a subtotal esophagectomy has been performed and the stomach has been replaced by the tubulised denervated esophagus. It is the aim of this study to evaluate the result obtained in patients who underwent subtotal esophagectomy and replacement of the organ by tubulised stomach without applying gastric drainage (pyroloplasty). METHODS. 16 patients treated with this procedure from January 2002 to September 2005 were analyzed. The studied variables were the surgical technique used, the postoperative complications and the presence of symptoms. RESULTS. The resection by McKeown's technique was performed in 50 percent of the cases, whereas the transhiatal access was carried out in 43.8 percent and Ivor Lewis' technique in 6.2 percent. Seven patients (43.8 percent) suffered complications, mainly due to esophagogastric cervical fistula (6 cases). The last of them presented atelactasia and bilateral bronchopneumonia that caused his death. At the six months of follow-up, there were neither symptoms of alkaline reflux nor of difficulty to evacuate the stomach. CONCLUSIONS. The presence of gastric retention or duodenogastric reflux was not proved in this study. However, it is recommendable to conduct a randomized study to compare the results obtained in patients that underwent a procedure of gastric drainage with those whose physiology and anatomy of the denervated pylorus are intact(AU)

Role of bile in rat gastric mucosal injury due to duodenogastric reflux / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effect of bile in inducing gastric mucosal injury in rats.</p><p><b>METHODS</b>SD rats were divided into 4 groups, namely bile duct ligation group, duodenogastric reflux (DGR) group, DGR plus bile duct ligation group and normal control group. The pathological changes in the gastric mucosa and tight junction 3 months after gastrojejunostomy were observed and compared with the findings in the normal control rats.</p><p><b>RESULTS</b>Compared with the rats in DGR plus bile duct ligation group, the rats in DGR group showed obvious gastric mucosal hyperemia, foveolar hyperplasia and severely impaired tight junction between the gastric mucosal cells.</p><p><b>CONCLUSION</b>Bile plays an important role in gastric mucosal injury due to DGR.</p>

Pathogenic effects of primary duodenogastric reflux on gastric mucosa of children / 中华儿科杂志

<p><b>OBJECTIVE</b>Duodenogastric reflux (DGR) is a reverse flow of duodenal juice into stomach through pylorus composed of bile acid, pancreatic secretion, and intestinal secretion. The increased entero-gastric reflux results in mucosal injury that may relate not only to reflux gastritis but also esophagitis, gastric ulcers, carcinoma of stomach and esophagus. However, the exact mechanisms of gastric mucosal damage caused by DGR are still unknown. The objective of the present study is to investigate the pathogenic effect of primary DGR on gastric mucosa in children, and to explore the correlation of DGR with clinical symptoms, Hp infection and intragastric acidity.</p><p><b>METHOD</b>Totally 81 patients with upper gastrointestinal manifestations were enrolled and they were graded according to the symptom scores and underwent endoscopic, histological examinations and 24-hour intra-gastric bilirubin was monitored with Bilitec 2000. Of the 81 cases, 51 underwent the 24-hour intra-gastric pH monitoring by ambulatory pH recorder simultaneously. The total fraction time of bile reflux was considered as a marker to evaluate the severity of DGR. The total fraction time of bile reflux was compared between the patients with positive and negative results under endoscopy and histologically, respectively. The correlations of the total fraction time of bile reflux with clinical symptom score, Hp infection, intragastric acidity were analyzed respectively.</p><p><b>RESULT</b>The total fraction time of bile reflux in the patients with hyperemia and yellow stain gastric antral mucosa under endoscopy was significantly higher than that without those changes [17.1% (0.5% approximately 53.2%) vs. 6.5% (0 approximately 58.6%), Z = -1.980, P < 0.05; 19.8% (0.5% approximately 58.6%) vs. 8.8% (0 approximately 38.0%), Z = -2.956, P < 0.01 respectively]. Histologically, the cases with intestinal metaplasia had significantly higher total fraction time of bile reflux than in the cases without intestinal metaplasia [29.0% (1.9% approximately 58.6%) vs. 14.3% (0 approximately 53.7%), Z = -2.026, P < 0.05], but no significant difference was found either between the cases with and without chronic inflammation (P > 0.05) or between the cases with and without active inflammation (P > 0.05). The severity of bile reflux was positively correlated with the score of abdominal distention (r = 0.258, P < 0.05), but no correlation with either the severity of intragastric acid (r = -0.124, P > 0.05), or Hp infection (r = 0.016, P > 0.05) was found.</p><p><b>CONCLUSION</b>Primary DGR could cause gastric mucosal lesions manifested mainly as hyperemia and bile-stained gastric antral mucosa under endoscopy and the gastric antral intestinal metaplasia histologically in children. There was no significant correlation between DGR and gastric mucosal inflammatory infiltration. DGR had no relevance to Hp infection and intragastric acidity. We conclude that DGR is probably an independent etiological factor and might play a synergistic role in the pathogenesis of gastric mucosal lesions along with gastric acid and Hp infection.</p>

Development of Barrett's Esophagus Soon after Total Gastrectomy

The role of duodenal reflux and the time required for the development of Barrett's esophagus has remained controversial. We report a case of Barrett's esophagus that developed 6 months after total gastrectomy. A 76-year-old man diagnosed with gastric adenocarcinoma underwent a total gastrectomy and a Rouxen-Y esophagojejunostomy. The gastroesophageal junction in the resected specimen was both grossly and microscopically normal at the time of the operation. A routine follow-up endoscopic examination performed 6 months later revealed a tongue-like projection of redcolored columnar tissue. No reflux symptoms (heartburn or acid regurgitation) had been present during the intervening 6 months. A biopsy specimen from the esophagus showed intestinal-type metaplasia of the columnar epithelium. This case supports the development of Barrett's esophagus solely from duodenal reflux and after a relatively short time in this clinical setting.