RESUMEN
The growing epidemic of obesity and the increase in weight loss surgery has led to a resurgence of interest in biliary reflux because anatomical alterations may be refluxogenic. HIDA scan is the least invasive scan with good patient tolerability, sensitivity and reproducibility for the diagnosis of biliary reflux. Patients with more advanced oesophageal lesions have a higher degree of duodenal reflux. It has been shown in animal models and in vitro that there is more Barrett's and dysplasia with duodenal reflux. There are two cases of post-OAGB malignancy reported in 20 years, both without correlation with a biliary aetiology, so the carcinogenic risk probably remains theoretical. Prospective trials on OAGB should include endoscopy preoperatively and at 5-year intervals, to have data on the real effects of bile exposure on the gastric reservoir and oesophagus.
Asunto(s)
Cirugía Bariátrica , Reflujo Biliar , Reflujo Duodenogástrico , Derivación Gástrica , Obesidad Mórbida , Animales , Humanos , Obesidad Mórbida/cirugía , Derivación Gástrica/efectos adversos , Reflujo Biliar/etiología , Reflujo Biliar/cirugía , Reflujo Duodenogástrico/complicaciones , Estudios Prospectivos , Reproducibilidad de los Resultados , Cirugía Bariátrica/efectos adversosRESUMEN
Bile reflux or duodenogastric reflux (DGR), refers to the retrograde flow of duodenal contents (mainly bile) into the stomach; capable of producing chemical damage to the mucosa, and triggering mutations towards the development of intestinal metaplasia, dysplasia and even gastric cancer. OBJECTIVE: This study aimed to estimate the prevalence of primary bile reflux in cholecystectomized patients and to identify whether cholecystectomy is a risk factor for development of DGR. MATERIALS AND METHODS: An analytical cross-sectional and observational study was conducted, in which all patients who underwent upper digestive endoscopy from February to June 2023 in a private endoscopic center in Lima, Peru, were included. According to the endoscopic report, patients were divided into two groups as those with DGR and those without DGR. Demographic characteristics, history of cholecystectomy, and endoscopic findings were statistically analyzed. 408 patients were included. RESULTS: The mean age of the population was 48.18 ± 16.82 years; 61.52% were female. The prevalence of DGR was 25.74% in the population, while in cholecystectomized patients it was 52.11%. The prevalence of DRG in patients with a history of cholecystectomy was 2.58 times compared to patients without cholecystectomy (p<0.001). Age ≥50 years also behaved as a risk factor for RDG (p=0.025). No significant difference in diabetes, Helicobacter pylori infection or smoking were found. CONCLUSION: In conclusion, a history of cholecystectomy as well as age were found to be risk factors for development of primary DGR.
Asunto(s)
Reflujo Biliar , Reflujo Duodenogástrico , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Masculino , Reflujo Duodenogástrico/complicaciones , Reflujo Duodenogástrico/epidemiología , Reflujo Biliar/complicaciones , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Estudios Transversales , Factores de Riesgo , Colecistectomía/efectos adversosRESUMEN
BACKGROUND: We previously reported the development of pancreatic acinar cell metaplasia (PACM) in the glandular stomach of a duodenal contents reflux model (reflux model). AIMS: We aimed to investigate the characteristics and histogenesis of PACM using a reflux model. METHODS: A reflux model was created using 8-week-old male Wistar rats, which were killed up to 30 weeks postoperatively. Histological examination was performed to analyze the glandular stomach-jejunal anastomosis. Furthermore, electron microscopic images of PACM samples were compared with pancreatic and gastric glands removed from rats that had not undergone surgery. Immunostaining for α-amylase, HIK1083, TFF2, and Ki-67 was performed, and double fluorescent staining was carried out using antibodies against α-amylase and HIK1083, or α-amylase and TFF2. RESULTS: In all reflux model rats, PACM was observed proximal to the glandular stomach-jejunal anastomosis, surrounded by pseudopyloric metaplasia. The number of chief cells was decreased in the deep part of the gland, where PACM occurred. Electron microscopy showed that PACM cells had greater numbers of rough endoplasmic reticulum tubules than chief cells, and exhibited pancreatic acinar cell morphology. Upon immunochemical staining, the regenerative foveolar epithelium and part of the pseudopyloric glands stained strongly positive for TFF2, whereas PACM cells were only weakly positive. Double fluorescent staining identified early lesions of PACM in the neck, which were double positive for α-amylase and TFF2, but negative for HIK1083. CONCLUSIONS: PACM could be induced by duodenal contents reflux. PACM originates from stem cells located in the neck of oxyntic glands during gastric mucosal regeneration.
Asunto(s)
Reflujo Duodenogástrico , Yeyuno/cirugía , Metaplasia , Páncreas , Jugo Pancreático/metabolismo , Estómago , Células Acinares/patología , Anastomosis Quirúrgica/métodos , Animales , Ácidos y Sales Biliares/metabolismo , Reflujo Duodenogástrico/complicaciones , Reflujo Duodenogástrico/metabolismo , Mucosa Gástrica/patología , Metaplasia/etiología , Metaplasia/patología , Modelos Teóricos , Páncreas/metabolismo , Páncreas/patología , Ratas , Ratas Wistar , Estómago/patología , Estómago/cirugíaRESUMEN
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.
Asunto(s)
Adenocarcinoma , Reflujo Duodenogástrico , Omeprazol , Inhibidores de la Bomba de Protones , Adenocarcinoma/etiología , Adenocarcinoma/prevención & control , Animales , Reflujo Duodenogástrico/complicaciones , Mucosa Gástrica , Humanos , Omeprazol/farmacología , Inhibidores de la Bomba de Protones/farmacología , Ratas , Ratas WistarRESUMEN
BACKGROUND: The presence of Barrett's mucosa in the esophageal remnant is a result of post-esophagectomy anastomotic site exposure to gastric acid and is regarded as a human model of Barrett's esophagus onset. Here, we attempted to clarify the relationship between duodenogastric reflux and formation of columnar epithelium by following the changes over time after esophagectomy. METHODS: A total of 96 patients underwent esophagectomy due to superficial cancer from April 2000 to March 2018 were included in this study. Cases were divided into two groups according to the reconstruction technique after esophagectomy as either the gastric pull-up (Ga) group and ileocolonic interposition (Ic) group. Previously obtained endoscopic pictures of the cases were reviewed retrospectively and chronologically. RESULTS: There were 24 cases of columnar epithelium in the Ga group (42%) and 1 in the Ic group (2.6%) (P < 0.01) with 32 reflux cases (56%) in the Ga group and 1 (2.6%) in the Ic group (P < 0.01). Reflux precedes the development of columnar epithelium in both the Ga- and Ic groups. Multivariate analysis revealed surgical technique (odds ratio 10.6, 95% CI 1.2-97.5, P = 0.037) and reflux (odds ratio 4.5, 95% CI 1.3-15.6, P = 0.0017) as risk factors. CONCLUSIONS: The development of columnar epithelium was preceded by reflux comprising principally gastric acid and was strongly associated with a strong inflammatory state.
Asunto(s)
Esófago de Barrett/fisiopatología , Reflujo Duodenogástrico/complicaciones , Epitelio/patología , Esofagectomía/efectos adversos , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/efectos adversos , Estudios de Casos y Controles , Reflujo Duodenogástrico/prevención & control , Endoscopía del Sistema Digestivo/métodos , Esofagitis Péptica/complicaciones , Esofagitis Péptica/prevención & control , Femenino , Ácido Gástrico/química , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Procedimientos de Cirugía Plástica/métodos , Estudios RetrospectivosAsunto(s)
Reflujo Duodenogástrico/complicaciones , Gastrectomía/efectos adversos , Muñón Gástrico/patología , Gastroenterostomía/efectos adversos , Neoplasias Gástricas/diagnóstico , Anciano , Biopsia , Endoscopía del Sistema Digestivo , Muñón Gástrico/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Gástricas/etiología , Neoplasias Gástricas/patología , Úlcera Gástrica/cirugíaRESUMEN
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.
Asunto(s)
Humanos , Animales , Ratas , Omeprazol/farmacología , Adenocarcinoma/etiología , Adenocarcinoma/prevención & control , Reflujo Duodenogástrico/complicaciones , Inhibidores de la Bomba de Protones/farmacología , Ratas Wistar , Mucosa GástricaRESUMEN
Background and Objectives: Although there are many studies that investigate the relationship between duodenogastric reflux (DGR) and Helicobacter pylori in adult patients, the reported data are contradictory. In addition, there are very few studies in the literature investigating the relationship between DGR and H.pylori in the pediatric age group. In the present study, we investigated the effect of primary DGR on H.pylori and gastritis. Materials and Methods: A total of 361 patients who were referred to the clinic of our hospital with dyspeptic complaints who had an upper gastrointestinal system endoscopy and a gastric biopsy were included in the study. Results: DGR was detected in 45 cases, and 316 cases that did not have DGR were considered as the control group. Comparisons were made between the DGR cases and the control group in terms of risk factors (age, gender), the presence and density of H.pylori, and the presence and severity of gastritis. The average age of the patients who were included in the study was 11.6 ± 4.6 years. A total of 128 (36%) of the cases were male and 233 (64%) were female. DGR was present in 45 (13%) of the cases. The average age of the patients with DGR was 13.9 ± 3.1 years, the average age of the control group was 11.3 ± 4.7, and there were statistically significant differences (p < 0.001). No significant differences were detected in terms of gender between DGR and the control group (p > 0.05). H.pylori (+) was detected in 29 (64%) of patients with DGR, and in 202 (64%) of the control group. No significant differences were detected between H.pylori prevalence (p = 0.947). Gastritis was detected in 37 (82%) of the patients with DGR, and in 245 (77%) of the control group (p = 0.476). No significant differences were detected between the presence and density of H.pylori, gastritis presence, severity and DGR (p > 0.05). Conclusions: The ages of patients with DGR were significantly higher than in the control group, and advanced age was shown to be a risk factor for primary DGR. It was found that the presence of DGR has no effect on the presence and severity of H.pylori. Given this situation, we consider it is important to eradicate H.pylori infection, especially in the case where H.pylori is present together with DGR.
Asunto(s)
Reflujo Biliar/complicaciones , Reflujo Duodenogástrico/complicaciones , Gastritis/etiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/crecimiento & desarrollo , Adolescente , Factores de Edad , Reflujo Biliar/epidemiología , Reflujo Biliar/patología , Biopsia , Niño , Reflujo Duodenogástrico/epidemiología , Reflujo Duodenogástrico/patología , Endoscopía del Sistema Digestivo/métodos , Femenino , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Gastritis/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Factores de Riesgo , Índice de Severidad de la Enfermedad , Turquía/epidemiologíaRESUMEN
Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC) and its pre-cancerous lesion, Barrett's Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain) MKR (muscle (M)-IGF1R-lysine (K)-arginine (R) mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT) and MKR mice underwent jejunum-esophageal anastomosis side-to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1) signal transduction analyses. Most of the WT mice (63.1%) developed dysplasia, whereas most of the MKR mice (74.3%) developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2). Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR) and IGF1 receptor (IGF1R) were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.
Asunto(s)
Reflujo Duodenogástrico/complicaciones , Neoplasias Esofágicas/etiología , Esófago/patología , Hiperinsulinismo/complicaciones , Animales , Modelos Animales de Enfermedad , Reflujo Duodenogástrico/metabolismo , Reflujo Duodenogástrico/patología , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/patología , Esófago/metabolismo , Femenino , Hiperinsulinismo/metabolismo , Hiperinsulinismo/patología , Insulina/análisis , Insulina/metabolismo , Masculino , Ratones , Receptor ErbB-2/análisis , Receptor ErbB-2/metabolismo , Transducción de SeñalRESUMEN
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. 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.
Asunto(s)
Reflujo Duodenogástrico/complicaciones , Mucosa Gástrica/patología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Animales , Reflujo Duodenogástrico/cirugía , Gastrectomía , Infecciones por Helicobacter/cirugía , Masculino , Píloro/cirugía , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
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.
Asunto(s)
Animales , Masculino , Ratas , Helicobacter pylori , Infecciones por Helicobacter/complicaciones , Reflujo Duodenogástrico/complicaciones , Mucosa Gástrica/patología , Píloro/cirugía , Distribución Aleatoria , Infecciones por Helicobacter/cirugía , Ratas Wistar , Reflujo Duodenogástrico/cirugía , GastrectomíaRESUMEN
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.
Asunto(s)
Reflujo Duodenogástrico , Endoscopía del Sistema Digestivo/métodos , Gastritis , Infecciones por Helicobacter , Probióticos/administración & dosificación , Antiinfecciosos/administración & dosificación , Ácidos y Sales Biliares/metabolismo , Sistema Biliar/fisiopatología , Reflujo Duodenogástrico/complicaciones , Reflujo Duodenogástrico/fisiopatología , Femenino , Gastritis/diagnóstico , Gastritis/etiología , Gastritis/fisiopatología , Gastritis/terapia , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/fisiopatología , Infecciones por Helicobacter/terapia , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estómago/microbiología , Estómago/patologíaRESUMEN
Comparative analysis of dissemination by H. pylori of the bile portions in patients of a control group, suffering an acute calculous cholecystitis (ACCH), was performed. Dissemination of H. pylori in a control group was significantly less, than in a bile portions of patients, suffering ACCH. While analyzing the rate and degree of dissemination by H. pylori of the gastic and gallbladder mucosa biopsies of patients, suffering chronic non-calculous cholecystitis, associated with duodenogastric reflux and gastroduodenitis, bacteria were revealed trustworthy more often and in more number, than in a gallbladder mucosa in patients, suffering ACCH.
Asunto(s)
Colecistitis/microbiología , Duodenitis/microbiología , Reflujo Duodenogástrico/microbiología , Gastritis/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/crecimiento & desarrollo , Adolescente , Adulto , Anciano , Colecistitis/complicaciones , Colecistitis/patología , Duodenitis/complicaciones , Duodenitis/patología , Reflujo Duodenogástrico/complicaciones , Reflujo Duodenogástrico/patología , Femenino , Vesícula Biliar/microbiología , Vesícula Biliar/patología , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastritis/complicaciones , Gastritis/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Helicobacter pylori/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
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.
Asunto(s)
Reflujo Duodenogástrico , Reflujo Gastroesofágico , Hernia Hiatal , Adolescente , Adulto , Sistema Biliar/patología , Sistema Biliar/fisiopatología , Tejido Conectivo/patología , Tejido Conectivo/fisiopatología , Reflujo Duodenogástrico/complicaciones , Reflujo Duodenogástrico/patología , Reflujo Duodenogástrico/fisiopatología , Esfínter Esofágico Inferior/patología , Esfínter Esofágico Inferior/fisiopatología , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/patología , Reflujo Gastroesofágico/fisiopatología , Hernia Hiatal/complicaciones , Hernia Hiatal/patología , Hernia Hiatal/fisiopatología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
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.
Asunto(s)
Adenocarcinoma/prevención & control , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Reflujo Duodenogástrico/complicaciones , Neoplasias Gástricas/prevención & control , Tiazinas/administración & dosificación , Tiazoles/administración & dosificación , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/etiología , Adenocarcinoma/patología , Animales , Progresión de la Enfermedad , Reflujo Duodenogástrico/cirugía , Masculino , Ilustración Médica , Meloxicam , Píloro/patología , Distribución Aleatoria , Ratas , Ratas Wistar , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/etiología , Neoplasias Gástricas/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Animales , Masculino , Ratas , Adenocarcinoma/prevención & control , /administración & dosificación , Reflujo Duodenogástrico/complicaciones , Neoplasias Gástricas/prevención & control , Tiazinas/administración & dosificación , Tiazoles/administración & dosificación , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/etiología , Adenocarcinoma/patología , Progresión de la Enfermedad , Reflujo Duodenogástrico/cirugía , Ilustración Médica , Píloro/patología , Distribución Aleatoria , Ratas Wistar , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/etiología , Neoplasias Gástricas/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Reflujo Duodenogástrico/fisiopatología , Esófago/patología , Reflujo Gastroesofágico/fisiopatología , Estómago/patología , Adolescente , Adulto , Reflujo Duodenogástrico/complicaciones , Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Estómago/fisiopatología , Adulto JovenRESUMEN
The mechanism through which each histological type of carcinoma arises from the esophageal mucosa remains unknown. This study was designed to investigate whether there is an association between the severity of duodeno-esophageal reflux and the histological type of esophageal cancer. A series of 120 male Fischer rats, weighing â¼180 g, were randomized to receive one of the following procedures: duodeno-forestomach reflux (DFR) with reduced exposure to duodenal contents, duodeno-esophageal reflux (DER) with increased exposure to duodenal contents and three control operations (DFR, DER control and sham). The reflux of bile was estimated with (99m)Tc-PMT scintigraphy. All animals were fed a standard diet without carcinogen. The esophageal mucosa was assessed 50 weeks after surgery for carcinoma. The median scanned fraction rate of duodeno-esophageal reflux was significantly lower for the rodents in the DFR group than those in the DER group. Five of 28 rodents in the DFR group and 17 of the 22 rodents in the DER group developed esophageal carcinoma. None of the controls developed carcinoma. The five rodents in the DFR group developed SCC. Of 22 esophageal carcinomas for the DER group, nine were SCC, 12 ADC and one was adenosquamous carcinoma. The fraction of esophageal SCC for the DFR group was significantly higher than that for the DER group, while the fraction of esophageal ADC for the DFR group was significantly lower than that for the DER group. These observations suggest that the severity of duodeno-esophageal reflux in rodents is related to the development of different histological types of esophageal carcinoma.
Asunto(s)
Adenocarcinoma/etiología , Carcinoma Adenoescamoso/etiología , Carcinoma de Células Escamosas/etiología , Reflujo Duodenogástrico/complicaciones , Neoplasias Esofágicas/etiología , Reflujo Gastroesofágico/complicaciones , Contenido Digestivo , Adenocarcinoma/patología , Animales , Carcinoma Adenoescamoso/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Masculino , Ratas , Ratas WistarRESUMEN
BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the 'gastrectomy' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett's, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett's mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.
Asunto(s)
Esófago de Barrett/etiología , Reflujo Duodenogástrico/complicaciones , Esófago/lesiones , Animales , Antiácidos/administración & dosificación , Esófago de Barrett/patología , Esófago de Barrett/fisiopatología , Modelos Animales de Enfermedad , Reflujo Duodenogástrico/fisiopatología , Duodenostomía , Receptores ErbB/metabolismo , Esofagostomía , Esófago/metabolismo , Esófago/patología , Gastrectomía , Ácido Gástrico/metabolismo , Antígeno Ki-67/metabolismo , Masculino , Metaplasia , Antígeno Nuclear de Célula en Proliferación/metabolismo , Inhibidores de la Bomba de Protones/administración & dosificación , Ratas , Ratas Sprague-DawleyRESUMEN
UNLABELLED: Studying role of duodenogastric reflux (DGR) in pathogenesis and sanogenesis of duodenal ulcer (DU). MATERIAL AND METHODS: 233 DU patients (92 patients with a mild, 45--with modern and 96--with the complicated current of disease) are surveyed. Control group were 100 healthy volunteers. Clinical research, endoscopy and 24-hours pH-metria was carried out. In a year after eradication Helicobacter pylori (Hp) 30 patients are repeatedly surveyed. RESULTS: at healthy acidity more low, and DGR above and more for a long time, than at DU patients. DU was especially supressed at complicated current DU. Eradication Hp was accompanied by acidity normalization only at mild DU, and at complicated DU--is not present. CONCLUSION: at healthy people DGR arises in reply to antrum's acidification and has compensative value, and at DU there is the considerable suppression leading to insufficiency of antrum's alkalization. After eradication Hp normalization DGR is marked only at mild current DU.