ABSTRACT
Objective:To evaluate the clinical efficacy of Zhiwei pill for bile reflux gastritis （BRG） with symptoms of disharmony of liver and stomach， evaluate the safety after treatment by three-arm study， and investigate the regulatory action to gastrointestinal hormones. Method:One hundred and eighty patients were randomly divided into placebo group （60 cases）， control group （60 cases） and observe group （60 cases） by random number table. Patients in three groups got lifestyle intervention of non-drug therapy. Patients in control group got hydrotalcite tablets 1-2 hours after meal or untimely bedtime or in case of stomach pain， 2 tablets/time， 3 times/day. Patients in placebo group got simulated medicine of Zhiwei pill 1 hour after meal， 6 g/time， 3 times/day. Patients in observe group got Zhiwei pill 1 hour after meal， 6 g/time， 3 times/day. The treatment continued for 4 weeks in all 3 groups. Before and after treatment， scores were graded for symptoms of disharmony of liver and stomach and patient reported outcome （PRO） scale for patients with chronic gastrointestinal diseases. Gastroscopy was taken to grade the scores of bile reflux and mucosa under gastroscope. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， substance P （SP） and gastrointestinal hormones were detected. Efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope were compared， and safety after treatment was evaluated. Result:After treatment， the total scores of the main symptoms and 7 secondary symptoms of disharmony of liver and stomach in observe group were all lower than those in placebo group and control group （<italic>P</italic><0.01）， and scores of symptoms of disharmony of liver and stomach and PRO were all lower than those in control group and placebo group （<italic>P</italic><0.01）. After treatment， scores of degree of bile reflux and mucosa under gastroscope in observe group were all lower than those in placebo group and control group （<italic>P</italic><0.01）. Level of CCK was lower than that in placebo group and control group （<italic>P</italic><0.01）， while levels of MTL， GAS and SP were higher than those in placebo group and control group （<italic>P</italic><0.01）. Total effective rate of TCM syndrome was 91.38%（53/58）， higher than 71.93%（41/57） in control group and 34.62%（18/52） in placebo group. The total effective rate in gastroscopy was 93.10%（54/58）， higher than 78.95%（45/57） in control group and 28.85%（15/52） in placebo group （<italic>P</italic><0.05 or <italic>P</italic><0.01）. No adverse reactions related to Zhiwei pill were found. Conclusion:Zhiwei pill can improve bile reflux， promote the healing of mucosa under gastroscope， regulate gastrointestinal hormones， improve gastrointestinal motor function， significantly alleviate clinical symptoms， and improve quality of life， with better efficacy for TCM syndrome and efficacy in gastroscopy， and it is safe for clinical use.
ABSTRACT
Objective:To evaluate the efficacy of addition and subtraction therapy of Huaganjian combined with Jinlingzisan for bile reflux gastritis （BRG） with stagnancy heat of liver and stomach syndrome， and to investigate its effect on inflammatory factors and gastrointestinal hormones. Method:One hundred and fifty patients were divided into control group and observation group evenly according to random number table. The 68 patients in control group finished the treatment （5 cases of dropout， loss of follow-up and 2 cases of withdrawal）， and 69 patients in observation group completed the treatment （3 cases of dropout， loss of follow-up and 3 cases of withdrawal）. Patients in control group got oral Dalitong granules before the meal， 1 bag/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Huaganjian combined with Jinlingzisan， 1 dose/day. The treatment continued for 4 weeks in both groups. Before the treatment， gastroscope was used to evaluate the degree of bile reflux and the condition of mucosa under gastroscope. Before and after treatment， scores of stagnancy heat of liver and stomach syndrome， patient reported outcome （PRO） scale of chronic gastrointestinal diseases， self rating anxiety scale （SAS）， and self rating depression scale （SDS） were recorded. A follow-up of 6 months was conducted to record the clinical recurrence. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， prostaglandin E2 （PGE2）， tumor necrosis factor-α （TNF-α）， and interleukin-8 （IL-8） were detected both before and after treatment. In addition， the safety was discussed. Result:Scores of degree of bile reflux， mucosa under gastroscope and stagnancy heat of liver and stomach syndrome in the observation group were lower than those in control group （<italic>P</italic><0.01）. Scores of 6 dimensions in PRO scale （dyspepsia， reflux， defecation， social， psychological， and general state） and scores of SAS and SDS in the observation group were lower than those in control group （<italic>P</italic><0.01）. Levels of CCK， TNF-α and IL-8 in the observation group were all lower than those detected in control group （P<0.01）， while levels of GAS and MTL were higher than those in control group （<italic>P</italic><0.01）. Observation group was superior to the control group in terms of efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope （<italic>Z</italic>=2.083， <italic>P</italic><0.05； <italic>Z</italic>=2.104， <italic>P</italic><0.05）. Clinical recurrence rate in observation group was 20.37% （11/54）， lower than 40.82% （20/49） in control group （<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn mathvariant="normal">2</mml:mn></mml:mrow></mml:msup></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002c.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic></alternatives></inline-formula>=5.105， <italic>P</italic><0.05）. No adverse reaction was found after oral administrationh of TCM. Conclusion:Addition and subtraction therapy of Huaganjian combined with Jinlingzisan can ameliorate the clinical symptoms， relieve anxiety and depression， improve the quality of life in patients with BRG and stagnancy heat of liver and stomach syndrome， improve the degree of bile reflux， promote the healing of gastric mucosa， reduce inflammatory reaction and regulate gastrointestinal hormones. It has good efficacy for TCM syndrome and under gastroscopy in a short term， and can reduce the recurrence rate with high safety in a long term.
ABSTRACT
Objective To investigate the application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy (LDG).Methods The retrospective cohort study was conducted.The clinicopathological data of 164 with early gastric cancer (GC) who were admitted to the First Affiliated Hospital of Fujian Medical University between June 2010 and April 2015 were collected.Of 164 patients undergoing LDG,45 receiving Billroth Ⅰ (B Ⅰ) anastomosis,39 receiving Billroth Ⅱ (B Ⅱ) anastomosis,44 receiving Roux-en-Y anastomosis and 36 receiving uncut Roux-en-Y anastomosis were allocated into the B Ⅰ group,B Ⅱ group,RY group and uncut RY group,respectively.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative short-term complications situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative nutriology and long-term complications up to May 2017.Measurement data with normal distribution were represented as x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparisons were done by the Tukey hsd test.Count data were described as the frequency and percentage,and comparisons among groups were analyzed the chi-square test or Fisher exact probability.Ordinal data were analyzed by the Kruskal Wallis test.Results (1) Surgical and postoperative recovery situations:patients in 4 groups underwent successfully LDG.Cases undergoing total LDG and assisted LDG and digestive tract reconstruction time in the B Ⅰ,B Ⅱ,RY and uncut RRY groups were respectively 0,29,13,15 and 45,10,31,21 and (42±7)minutes,(55±8)minutes,(64±8)minutes,(51±6) minutes,with statistically significant differences among 4 groups (x2 =21.628,F=74.441,P＜0.05).(2)Postoperative short-term complications situations:2,2,3 and 1 patients in the B Ⅰ,B Ⅱ,Roux-en-Y and uncut Roux-en-Y groups had respectively postoperative short-term complications,showing no statistically significant difference among 4 groups (x2 =0.840,P＞0.05).(3) Follow-up situations:all patients were followed up,and follow-up time in the B Ⅰ,B Ⅱ,RY and uncut RY groups were respectively (10.8 ± 3.5) months,(10.9 ±3.4)months,(11.3±3.2) months and (11.2±2.2) months,with no statistically significant difference among 4 groups (F=0.200,P＞0.05).① Comparisons of postoperative 1-year nutritional indexes:rates of changes in body mass index (BMI),hemoglobin (Hb),total protein (TP) and albumin were respectively 93％±7％,91％±7％,90％±7％,90％±9％ and 94％±9％,97％±11％,95％±9％,97％±9％ and 101％±9％,99％±7％,98％±7％,99％±7％ and 101％±10％,103％±7％,100％±10％,103％±9％ in the B Ⅰ,B Ⅱ1,RY and uncut RY groups,showing no statistically significant difference among 4 groups (F=1.182,0.724,1.050,0.971,P＞0.05).②)Of 164 patients within 1 year postoperatively,47 were complicated with gastric retention (27,12,6 and 2 with severity in grade 1,2,3 and 4),87 with residual gastritis (53,24,10 and 0 with severity in grade 1,2,3 and 4),and 38 with bile reflux (severity in grade 1).Of 38 patients with bile reflux,33 were combined with residual gastritis,showing a correlation between residual gastritis and bile reflux (r=0.396,P＜0.05).Cases with gastric retention,residual gastritis and bile reflux within 1 year postoperatively were respectively 16,9,21,1and 35,30,13,9 and 16,18,3,1 in the B Ⅰ,B Ⅱ],RY and uncut RY groups,showing statistically significant differences among 4 groups (x2 =21.261,41.103,30.469,P＜ 0.05).There were statistically significant differences in gastric retention occurrence between uncut RY group and B Ⅰ group or B Ⅱ group or RY group (x2 =12.958,6.675,20.065,P＜0.05),and in residual gastritis occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =20.831,18.587,P＜0.05) and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =22.452,20.220,P＜0.05).There were statistically significant differences in bile reflux occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =10.942,16.926,P＜0.05),and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =12.958,18.620,P＜0.05).Conclusion Roux-en-Y and uncut Roux-en-Y anastomoses are superior to B Ⅰ and B Ⅱ anastomoses in improving residual gastritis and bile reflux in the postoperative digestive tract reconstruction of LDG,and uncut Roux-en-Y anastomosis can effectively reduce occurrence of postoperative gastric retention.
ABSTRACT
Objective To investigate the therapeutic effect and mechanism of Chaizhixiaji Decoction on experimental bile reflux gastritis (BRG) rats.Methods Wistar rats were randomly divided into five groups by random according to weight and sex:control group,model group,Chaizhixiaji Decoction low and high dose groups,and Hydrotalcite Tablets group.Rats were given self-made reflux liquid orally to induce experimental bile reflux gastritis.The diet,stool and urine,hair color and body weight of rats in control group and model group were observed.The histopathological changes of gastric antrum mucosa were observed by naked eyeand light microscope after HE staining.ELISA method was used for detection of serum GAS,PGE2 content in gastric antrum mucosa.Result Compared with control group,rats in model group show thin boicing stool containing red yellow mucus,slow reaction,and body weight decreased significantly (P ＜ 0.05).There were patchy erosions of the gastric antrum with yellow green bile and more yellow mucus of model group in the naked eye.Model control group had a significant rise of inflammatory cells infiltration and intestinal metaplasia,and scores of inflammation and intestinal metaplasia increased significantly (P ＜ 0.01).GAS and PGE2 contents obviously decreased compared with that in control group (P ＜ 0.01).Compare with model group,Chaizhixiaji Decoction of high dosesignificantly improved gastric mucosal tissue damage morphology;reduced the infiltration of inflammatory cells and intestinal metaplasia,which score decreased significantly (P ＜ 0.05,0.01);and increasedlevels of GAS and PGE2 significantly (P ＜ 0.01).Conclusion Chaizhixiaji Decoction has obvious protective effect on gastric mucosa,and its mechanism may be related with the regulation of GAS,PGE2 contents.
ABSTRACT
Objective To investigate the therapeutic effect and mechanism of Chaizhixiaji Decoction on experimental bile reflux gastritis (BRG) rats.Methods Wistar rats were randomly divided into five groups by random according to weight and sex:control group,model group,Chaizhixiaji Decoction low and high dose groups,and Hydrotalcite Tablets group.Rats were given self-made reflux liquid orally to induce experimental bile reflux gastritis.The diet,stool and urine,hair color and body weight of rats in control group and model group were observed.The histopathological changes of gastric antrum mucosa were observed by naked eyeand light microscope after HE staining.ELISA method was used for detection of serum GAS,PGE2 content in gastric antrum mucosa.Result Compared with control group,rats in model group show thin boicing stool containing red yellow mucus,slow reaction,and body weight decreased significantly (P ＜ 0.05).There were patchy erosions of the gastric antrum with yellow green bile and more yellow mucus of model group in the naked eye.Model control group had a significant rise of inflammatory cells infiltration and intestinal metaplasia,and scores of inflammation and intestinal metaplasia increased significantly (P ＜ 0.01).GAS and PGE2 contents obviously decreased compared with that in control group (P ＜ 0.01).Compare with model group,Chaizhixiaji Decoction of high dosesignificantly improved gastric mucosal tissue damage morphology;reduced the infiltration of inflammatory cells and intestinal metaplasia,which score decreased significantly (P ＜ 0.05,0.01);and increasedlevels of GAS and PGE2 significantly (P ＜ 0.01).Conclusion Chaizhixiaji Decoction has obvious protective effect on gastric mucosa,and its mechanism may be related with the regulation of GAS,PGE2 contents.
ABSTRACT
[Objective] To investigate professor SHAN Zhaowei's experience of diagnosing and treating bile reflux gastritis(BRG). [Method] The experience of Professor SHAN Zhaowei on recognition of etiology and pathogenesis, treatment principle, characteristics of prescription selection and administration of BRG is summarized and studied. Besides his academic ideas and clinical medication experience are shown with typical cases. [Result] In his view, emotional disorder is the most common etiology, and liver-stomach disharmony is the basic pathogenesis. He puts forward that we should pay attention to dispersing the stagnated liver Qi, regulating the stomach to lower the adverse flow of Qi when we treat it, and emphasizes the combination of disease differentiation and syndrome differentiation. Meanwhile, herbs of protecting gastric mucosa are compatibly used to improve the curative effect. And the case in this article has obtained good treatment results. [Conclusion] Pro. SHAN Zhaowei thinks that emotional regulation to patency for patients is very important. The dispersing the stagnated liver Qi, regulating the stomach and protecting gastric mucosa treatment proposed by SHAN Zhaowei is smart, simple and effective, which embodies the characteristic of his healing and MengHe Medicine.
ABSTRACT
Based on the records of ancient medical books, this article analyzed the etiology and pathogenesis of primary bile reflux gastritis. Combined with the clinical diagnosis and treatment experience and thinking, this article explained from various aspects of the principle, method, formula, and medicine, and divided the treatment into three steps, with a purpose to provide references for clinical treatment.
ABSTRACT
Objective To investigate the clinical effect of regulating Spleen Yangwei Decoction combined with rabeprazole in the treatment of rheumatoid gastritis with hot and humid obstruction.MethodsFrom April 2013 to February 2015, 88 patients with reflux gastritis caused by cholecystectomy in our hospital were selected as the subjects.TCM syndrome differentiation was hot and humid type, and random number table was divided into observation Group and control group of 44 cases, the control group given rabeprazole, citrate xylapril tablets and other Western medicine treatment, observation group on the basis of this plus self-adjusting spleen and stomach soup, are treated for 3 months, (TNF-α) and interleukin-8 (IL-8) levels were measured by enzyme-linked immunosorbent assay (ELISA) in the two groups before and after treatment, and the quality of life scale was used to evaluate the levels of tumor necrosis factor-α (TNF-α) (QOL) and digital pain score (NRS) were compared between the two groups to improve the quality of life and pain, and to observe the recurrence of bile reflux and adverse reactions.ResultsThe effective rate was 93.18% in the observation group and 77.27% higher than that in the control group (P<0.05).The QOL score (121.29±1.88) in the observation group was higher than that in the control group(P<0.05).The results of bile test showed that the levels of pg/mL, IL-8 (8.58±1.64) pg/mL and NRS (2.10±0.71) were lower than those in the control group (P<0.05).There was no significant difference between the observation group (11.36%) and the control group (4.54%).The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P< 0.05).ConclusionModified Spleen Yangwei Decoction combined with rabeprazole can effectively treat rheumatoid reflux gastritis, reduce bile reflux, improve the level of inflammatory factors, quality of life and pain, and mild adverse reactions, it is worth in the clinical promotion application.
ABSTRACT
Objective To evaluate the clinical effect of hydrotalcite in treatment of bile reflux gastritis.Methods66 patients with bile reflux gastritis were chosen in our hospital from May 2013 to May 2014 as the research object, according to the order of admission they were divided into two groups, 33 cases of control group were treated with sucralfate treatment, observation group patients were treated with hydrotalcite comparative analysis, clinical curative effect in the observation group and the control group of patients were compared.ResultsAfter treatment for a period of time after the 33 patients in the control group,the total effective treatment for 28 cases, the total effective rate was 84.85%, the observation group of 33 cases of patients treated with total effective number of 32 cases, the total effective rate was 96.97%.The effective rate of the observation group was significantly higher than that of the control group(P<0.05).After the corresponding treatment, the incidence of complication in the control group was 15.15%, the observation group was 9.09%.There was no significant difference in the incidence of complications between the two groups.ConclusionThe use of hydrotalcite in treatment of bile reflux gastritis clinical curative effect significantly, can improve the treatment efficiency to a certain extent, high safety.
ABSTRACT
Introduction@#Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increasedenterogastric reflux may provide the basis for increased mucosal injury. In clinical practice the symptoms of bile reflux gastritis are nonspecific than the other gastritis. Only endoscopy and biopsy can confirm the diagnosis. Observation demonstrates that, in practice there is tendency to increase the bile reflux gastritis. However, in Mongolia there are much less research and studies in this area. @*Goal@#Evaluate the endoscopical and histological changes caused by duodenal reflux on the gastricmucosa@*Materials and Methods@#We included in our study 70 patients with bile reflux gastritis admitted in Second General Hospital in Ulaanbaatar. In all cases we performed an upper gastrointestinal endoscopy and at least 4 biopsyspecimens were done from antral mucosa and the histological features were scored in accordance with the Sydney system. @*Results@#The average age of the patients with bile reflux gastritis was 61.64±9, 69 years. Reflux gastritis was noted to 15 males and 55 females. Gastroduodenal reflux after chlocystoectomic surgery was noted in 46 cases (65.71%), and biliarytract disease was noted in 16 cases (22.85%). The average time interval from original operation tothe discovery of the bile reflux gastritis was 9.22 years after chlocystoectomic surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 41 cases (58.57%),gastric antral atrophy in 20 cases (28.57%), gastric diffuse atrophy in 27 cases (38.57%), thepresence of bile into the stomach in 70 cases (100%), erosions in 3 cases (4.28%), gastric ulcer in2 cases (2.85%), intestinal metaplasia in 10 cases (14.28%).The histologic alterations observed from tissues collected during endoscopic examination were chronic super facial gastritis in 19 cases (27.14%), chronic atrophic gastritis in 51 cases (72.85%),an intestinal metaplasia in 32 cases (14.28%), gastric erosions and ulcer in 4 cases (5.71%),dysplasia in 1case (1.42%), Helicobacter pylori infection in 14 cases (20%).@*Conclusions@#The most frequent risk factors for bile reflux gastritis were chlocystoectomic surgery and biliary tract disease. Histological findings of patients with bile reflux gastritis revealed gastric cancer precursor lesions, therefore follow-up endoscopic examinations and early treatment of bile reflux are essential.
ABSTRACT
Objective To evaluate the accuracy of confocal laser endomicroscopy (CLE)in primary bile reflux gastritis (BRG).Methods From November 10th to December 15th,2015 ,55 patients underwent CLE examination and preliminarily diagnosed as BRG with traditional white-light endoscopy were enrolled.CLE score standard was designed.Dixon pathologic score was considered as gold standard. Receiver operating characteristic (ROC)curve was drawn to evaluate the accuracy of CLE score in BRG diagnosis.Sensitivity,specificity and 95 % confidence interval (CI )were calculated.Kappa analysis was performed to assess the inter-observer agreement of CLE score.Results According to Dixon pathologic score standard,29 patients (52.7%)were diagnosed as primary BRG among the 55 enrolled patients. Among the 42 Helicobacter pylori (H .pylori )negative patients,the area under receiver operating characteristic curve (AUC)of CLE in BRG diagnosis was 0.90 (95 %CI 0.81 —1 .00).Taking CLE score over six as the cut-off value for diagnosis,the sensitivity and specificity was 84.00% (95 %CI 65 .35 %—93.60%)and 82.35 % (95 %CI 58.97%—93.81 %),respectively.The Kappa value for inter-observer agreement in BRG diagnosis was 0.60 (95 %CI 0.24—0.95).Conclusion Primary BRG can be accurately diagnosed by CLE in H .pylori negative patients with high sensitivity and specificity.
ABSTRACT
Bile reflux gastritis (BRG)has been recognized as a chemical gastropathy due to excessive duodenogastric reflux (DGR).Abnormalities in pyloric anatomic structure,as well as antropyloric and duodenal dysmotility are considered to be implicated in the occurrence of pathologic DGR.Bile acid may induce apoptosis of gastric mucosal cells,and high concentration of bile acid plays a crucial role in the induction of intestinal metaplasia in stomach.In this review article, advances in study on BRG,including the mechanisms of DGR,the pathogenic effect of bile acid on gastric mucosa,and the diagnosis and treatment of BRG were summarized.
ABSTRACT
Objective:To observe the curative effects of the combined application of domperidone, pantoprazole and hydrotalcite tablets in the treatment of bile reflux gastritis ( BRG) and explore the underlying mechanism. Methods:Totally 80 patients with BRG were randomly divided into the treatment group and the control group with 40 cases in each. The treatment group was received panto-prazole, hydrotalcite tablets and domperidone, and the control group was treated by hydrotalcite tablets and domperidone. The efficacy was observed in both groups after 4 weeks. Results:The effective rate of symptom relief in the treatment group and the control group was respectively 92. 5% and 62. 5% (P<0. 05). After the 4 week treatment, the gastritis healing rate in the treatment group was higher than that in the control group (P<0. 05). The improvement of gastric mucosal hyperemia, edema and erosion in the treatment group was better than that in the control group with significant difference (P<0. 05). Cholic acid in gastric juice and gastric acid se-cretion were significantly reduced in both groups after the treatment, while the reduction of gastric acid secretion in the treatment group was more notable than that in the control (P<0. 05). Conclusion:Pantoprazole can be used to control BRG, and the combination of the three drugs shows better efficacy in the treatment of BRG.
ABSTRACT
Objective To explore the effect of combining omepnazole and ursodeoxyeholic acid to treat bile reflux gastritis.Methods Retrospectively analyzed the effect of combining omepnazole and ursodeoxycholic acid on reflux gastritis in 45 cases.Results The whole effective rate is 75% in control group and 93% in treatment group in which 10 patients'symptoms lessened significantly after have taken such medicine for 2 days.Conclusion The marked effect of combining omepnazole and ursodeoxyeholic acid on bile reflux gastritis was found.
ABSTRACT
PURPOSE: The five-year survival rate is over 95% for radically resected early gastric cancer. The development of diagnostic techniques enables early detection of gastric cancer, so the life expectancy of patients with early gastric cancer is prolonged. Therefore, a limited number of surgeries are performed these days for the purpose of increasing the quality of life. The purpose of this study is to assess the postoperative quality of life after a pylorus-preserving gastrectomy (PPG) compared with that after a subtotal gastrectomy with gastroduodenal anastomosis (B-I). MATERIALS AND METHODS: One hundred seven (107) patients who underwent gastric surgery for early gastric cancer from January 1999 to December 2003 at the Department of Surgery of Chonnam National University Hospital were selected. We compared patients who underwent a PPG with those who underwent a B-I. The clinical results were compared by using the chi-square test and the Student's T-test. The data were considered to be significant when the P value was less than 0.05. RESULTS: Twenty-nine patients (29) underwent a PPG, and the other seventy-eight (78) patients underwent a B-I. There was no significant difference between the two groups on sex, age, and postoperative abdominal symptoms. The patients who underwent a PPG showed shorter operation times and less reflux gastritis and esophagitis on endoscopic evaluation than the patients who underwent a B-I. CONCLUSION: The pylorus-preserving gastrectomy (PPG) is a more physiologic operation than the subtotal gastrectomy with gastroduodenal anastomosis (B-I) and improves the postoperative quality of life.
Subject(s)
Humans , Esophagitis , Gastrectomy , Gastritis , Life Expectancy , Quality of Life , Stomach Neoplasms , Survival RateABSTRACT
Objective To explore the clinical character istics of bile reflux gastritis. Methods We observed 1328 patients with bile reflux gastritis(excluding gastritis of the remnant stomach),and selected 425 superficial gastritis as control group.All the patients took helicobacter pylori(Hp) rapid urease examination. 664 cases in observed group and all in patients of control group were examined for bile disease by UB. Results In 1328 patients,there were 797 male and 531 female,and the ratio of male and female was 1.5/1.The detecting rate of bile reflux gastritis was decreased along with aging. Among all the patients,there were 651 simple superficial gastritis(49%),86 gastric ulcer(6.5%),412 duodenal ulcer (31%),122 combined ulcer(9.2%) and 57 other disease(4.7%).In observed group,1030 HP(77.56%) were regative; 298 Hp(22.44%) were positive,and in control group,282 Hp(66.35%) were regative,147 Hp(33.65%) were positive.The amount of gallbladder disease resection was 221(33.3%),which was more than that of control group(16.9%). Conclusion The detecting rate of bile reflux gastritis was decreased along with aging.Bile reflux gastritis is more often combined with ulcer disease or gallbladder disease. The Hp infection rate of bile reflux gastritis is significant lower than that of non-bile reflux gastritis.
ABSTRACT
Objective: To observe the effect of Weiyanyin on Motilin (MOT) in blood plasma of experiment bile reflux gastritis rats. Methods: To make the model of experiment bile reflux gastritis by drinking reflux liquid, compared with Domperidone.The effect of Weiyanyin on Pathological histology and MOT in blood plasma of bile reflux gastritis rats was observed. Results: The mucosal of rats in model group was damaged, amotic, and a lot of inflammatory cell could be seen, glandular organ hyperplasy and intestinal metaplasia in most of rats; At the same time the content of the MOT was decreased; Compared with model group, Weiyanyin could improve pathological histology of experiment bile reflux gastritis rats, and increase the content of MOT(P
ABSTRACT
BACKGROUND/AIMS: The role of Helicobacter pylori in bile reflux gastritis (BRG) is uncertain. We show the role of H. pylori and pathology in BRG. METHODS: Thirty seven patients, including 5 patients who had undergone subtotal gastrectomy, were diagnosed with BRG by gastroscopic findings of bile-stained mucosa with hyperemia/ erosions. We measured total bile acid (TBA) concentration and compared the H. pylori positivity between BRG patients and 70 non-BRG patients. We showed how often we could see the pathologic findings of reactive gastritis in BRG and compared the grade of lymphoplasma cell and neutrophil infiltration between H. pylori positive and negative group in BRG. RESULTS: TBA concentration of 10 patients was 7,376.7+/-5,482.6micro mol/L. H. pylori positive rate of BRG was 45.9% and that of non-BRG was 70% (p=0.015). The gastric pit elongation and tortuosity were found only in 3 cases with gastric surgery. The grade of lymphoplasma cell and neutrophil infiltration was 2.41+/-0.51 and 1.88+/-0.86 in H. pylori positive BRG and 1.55+/-0.69 and 0.55+/-0.76 in H. pylori negative BRG, respectively (p<0.001). CONCLUSIONS: H. pylori infection in BRG was lower than that in non-BRG. The gastric pit elongation and tortuosity of BRG were not seen often. The lymphoplasma cell and neutrophil infiltration were relatively sparse in H. pylori negative BRG.
Subject(s)
Humans , Bile Reflux , Bile , Duodenogastric Reflux , Gastrectomy , Gastritis , Helicobacter pylori , Helicobacter , Mucous Membrane , Neutrophil Infiltration , PathologyABSTRACT
BACKGROUND/AIMS: Reflux gastritis after gastrectomy is believed to be due to reflux of bile into residual stomach. However the substances that cause gastritis have not yet been precisely defined. Helicobacter pylori (H. pylori) infection is considered one of the most important pathogenetic factors in gastritis. The prevalence of H. pylori infection and the role of its infection on reflux gastritis after gastrectomy were investigated. METHODS: Eighty-one patients who had undergone subtotal gastrectomy were enrolled. Rapid urease test and histologic examination for H. pylori infection were performed during gastrofiberscopy. An eradication of H. pylori was attempted in fifteen H. pylori-positive patients who suffered from gastritis symptoms after gastrectomy. Follow-up endoscopy was performed more than 4 weeks after the end of eradication treatment. RESULTS: Forty-nine patients (60.5%) demonstrated H. pylori infection in their residual stomach. The histological gastritis score in patients with H. pylori infection was significantly higher than that without infection. Ten of the 15 patients (66.7%) with H. pylori infection had their infection successfully eradicated. And also their symptoms and histological gastritis score were significantly improved. CONCLUSIONS: H. pylori infection does play an important role on reflux gastritis after subtotal gastrectomy.
Subject(s)
Humans , Bile , Endoscopy , Follow-Up Studies , Gastrectomy , Gastric Stump , Gastritis , Helicobacter pylori , Helicobacter , Prevalence , UreaseABSTRACT
BACKGROUND/AIMS: It is suggested that postsurgical gastritis is mainly caused by the enterogastric reflux, but the pathogenesis and association with symptoms are not clearly established. The aims of this study were to investigate the role of duodenogastric reflux in postsurgical gastritis and to evaluate the relationship between an intragastric pH study and an intragastric bile reflux study. METHODS: The 33 patients with Billroth-II gastrectomy and 10 healthy volunteers were enrolled. After the endoscopy, we performed a simultaneous intragastric pH and a bile reflux study. RESULTS: The symptomatic patients with Billroth-II gastrectomy showed a greater increase in bilirubin reflux than the asymptomatic patients and normal controls. There was a significant association of gastritis with the presence of symptoms, but not with duodenogastric reflux. Intragastric bile reflux(% time> bilirubin absorbance 0.14) was not closely related with intragastric pH(% time> pH 4). CONCLUSIONS: The duodenogastric reflux was associated with symptoms but not with postsurgical gastritis. There was no close relationship between the intragastric pH study and the intragastric bile reflux study.