Bleeding duodenal ulcer after Roux-en-Y gastric bypass surgery: the value of laparoscopic gastroduodenoscopy

Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. One of the rare, but potentially fatal complications of gastric bypass is upper gastrointestinal bleeding, which can pose diagnostic and therapeutic dilemmas. This report describes a 39-year-old male with morbid obesity who underwent a Roux-en-Y gastric bypass. Three months postoperatively, he sustained repeated and severe upper attacks of upper gastrointestinal bleeding. He received multiple blood transfusions, and had repeated upper and lower endoscopies with no diagnostic yield. Finally, he underwent laparoscopic endoscopy which revealed a bleeding duodenal ulcer. About 5 ml of saline with adrenaline was injected, followed by electrocoagulation to seal the overlying cleft and blood vessel. He was also treated with a course of a proton pump inhibitor and given treatment for H pylori eradication with no further attacks of bleeding. Taking in consideration the difficulties in accessing the bypassed stomach endoscopically, laparoscopic endoscopy is a feasible and valuable diagnostic and therapeutic procedure in patients who had gastric bypass

Incidence of helicobacter pylori in dental plaque of Saudi gastritis patients

Helicobacter pylori [H. pylori] was identified in denial plaque, raising the possibility of future gastritis and peptic ulceration. This trial was to study the association between presence of H. pylori in dental plaque and in the stomachs of patients with gastritis; the effect of oral hygiene and periodontal condition on the stomach. Patients and Seventy-five Saudi adult dyspeptic patients, together with 60 healthy persons as control. Two samples of dental plaque were taken from gingival crevice of deepest pocket. One sample was kept in Christensen's urea agar and incubated for H. pylori detection by rapid urease test. The second sample was kept in 5% sheep blood agar, chocolate agar and a selective medium to culture the H. pylori. Gastric urease test was done for the same patients. [1] Plaque urease test results showed 89% positive patients. [2] Dental plaque Index: Mild dental plaque accumulation in 24%, moderate in 41%, while severe accumulation was in 35% of the patients. [3.] Gingival Index: Showed mild, moderate and severe gingivitis in 17%, 48% and 35% of patients, respectively. [4] Community periodontal index of treatment needs [CPITN]: Showed gingivitis, mild periodontitis and moderate periodontitis in 50%, 23% and 27% of patients, respectively. [5] Gastric urease 87% of patients were positive. [6] All cultured samples results were negative. The ability to detect H. pylori in dental plaque samples offers a potential for a noninvasive test for gastric infection and would lend support for oral spread of H. pylori as the principal mode of transmission. However, the presence of H. pylori in dental plaque and in the stomach [in gastritis patients] could permit not only a target for therapeutic procedures but also a monitoring tool for the efficacy of therapy