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1.
Rev. medica electron ; 43(2): 3231-3238, mar.-abr. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251940

ABSTRACT

RESUMEN El páncreas ectópico es una entidad poco común. Como tumor submucoso de origen congénito, frecuentemente presenta un curso asintomático, aunque con posibles complicaciones. Su diagnóstico de certeza se basa en la endoscopia, el ultrasonido endoscópico y la histología, que permiten adoptar una conducta expectante o quirúrgica. El paciente estudiado presentó un páncreas ectópico localizado en antro gástrico asociado a síntomas de reflujo gastroesofágico rebeldes a tratamiento, los cuales motivaron el estudio endoscópico, con el consecuente hallazgo de dicha entidad (AU).


ABSTRACT Ectopic pancreas is a little common entity. As congenital-originated sub mucous tumor, it frequently presents an asymptomatic course, though with possible complications. Its definitive diagnosis is based in the endoscopy, endoscopic ultrasound and histology, allowing to adopt an expectant or surgical behavior. The current patient presented an unresponsive-to-treatment ectopic pancreas located in the gastric antrum associated to gastro-esophageal reflux symptoms. This motivated the endoscopic study consequently leading to finding this entity (AU).


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Pyloric Antrum/pathology , Gastroesophageal Reflux/complications , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/drug therapy , Signs and Symptoms , Therapeutics/methods , Endoscopy/methods
2.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1725-1730, Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143678

ABSTRACT

SUMMARY OBJECTIVE: Bronchoaspiration of gastric content is associated with high morbidity and mortality, but evaluating this complication is a difficult task. However, gastric ultrasonography can safely assess gastric content and prevent bronchoaspiration. Therefore, a systematic review was performed in order to verify the efficacy of ultrasonography in the qualitative and quantitative analyses of gastric content. METHODS: A literature review of articles published between 2009 and 2019 in the PubMed and LILACS databases was conducted using combinations of the keywords "gastric ultrasound," "gastric emptying," and "gastric content." RESULTS: Of the 20 articles found, 19 chose the antral region as the best site for qualitative analysis of the gastric content. Regarding quantitative measurement, the most commonly used method to calculate the gastric volume in eight articles was the formula "Gastric Volume = 27 + (14.6 × ATAG) − (1.28 × Age)," in which the area of the transverse section of the gastric antrum (ATAG) could also be calculated by the largest antral diameters or by free tracing. CONCLUSION: An efficient evaluation of the gastric content can be performed by ultrasonography of the antral region, contributing to greater safety in the clinical management of patients with increased risk for bronchoaspiration during airway management.


RESUMO OBJETIVO: A broncoaspiração do conteúdo gástrico associa-se à alta morbimortalidade, porem a avaliação desta complicação é tarefa dificil. Por outro lado, a ultrassonografia gástrica avalia o conteúdo gástrico com segurança, podendo evitar a broncoaspiração. Portanto, foi realizada revisão sistemática com objetivo de verificar a aplicabilidade da ultrassonografia na análise qualitativa e quantitativa do conteúdo gástrico. MÉTODOS: Revisão de literatura de artigos publicados entre 2009 e 2019 nas bases de dados PubMed e LILACS usando combinações das palavras chave: "Gastric ultrasound", "gastric emptying" e "gastric content". RESULTADOS: Foram encontrados 20 artigos. A região antral foi escolhida em 19 artigos como melhor local do ponto de vista qualitativo para analisar o conteúdo gástrico. A respeito da mensuração quantitativa, o método mais utilizado para cálculo do volume gástrico, escolhido em 8 artigos, foi através da fórmula Volume gástrico = 27 + (14,6 x ATAG) - (1,28 x Idade), em que a Área da Secção Transversa do Antro Gástrico (ATAG) pode ser igualmente calculada pelos maiores diâmetros antrais ou pelo seu traçado livre. CONCLUSÃO: A ultrassonografia da região antral permite boa avaliação do conteúdo gástrico, trazendo maior segurança ao manejo clínico de pacientess com risco aumentado para broncoaspiração no manejo da via aerea.


Subject(s)
Humans , Pyloric Antrum/diagnostic imaging , Gastrointestinal Contents/diagnostic imaging , Prospective Studies , Ultrasonography , Gastric Emptying
3.
Rev. méd. panacea ; 9(2): 141-144, mayo-ago. 2020. ilus
Article in Spanish | LILACS, LIPECS | ID: biblio-1121363

ABSTRACT

El síndrome pilórico es un conjunto de síntomas y signos que se producen por una obstrucción total o parcial de la región pilórica que trae como consecuencia la dificultad para el vaciamiento gástrico y la consiguiente retención de su contenido. Se trata de un paciente que presentó vómitos postpandrial tardíos y dolor abdominal difuso después de ingerir alimentos sólidos. Pasado un mes de estos síntomas, los vómitos procedían ante la ingesta de líquidos, acompañado de astenia, anorexia y pérdida de peso. Se atiende en el servicio de cirugía del Hospital "Dr. Ernesto Guevara de la Serna". Se realizó endoscopia que observó obstrucción pilórica completa sin etiología precisada. La laparotomía exploratoria encontró dilatación gástrica con edema y endurecimiento del antro pilórico, múltiples tumoraciones y endurecimientos de un segmento de la unión yeyuno e íleon. Se efectuó antrectomía con gastroyeyunostomía y Brown, con resección de 60 cm de intestino delgado, que incluyó las tumoraciones encontradas. El diagnóstico histológico fue de Linfoma no Hodgkin Linfocitico bien diferenciado. (AU)


Pyloric syndrome is a set of symptoms and signs that are produced by a total or partial obstruction of the pyloric region that results in difficulty in gastric emptying and the consequent retention of its contents. This patient presented with late postpandrial vomiting and diffuse abdominal pain after ingesting solid food. After one month of these symptoms, vomiting was even caused by the intake of liquids, accompanied by asthenia, anorexia and weight loss. He is treated in the surgery service of Dr. "Ernesto Guevara de la Serna" Hospital. An endoscopy was performed which observed complete pyloric obstruction without precise aetiology. Exploratory laparotomy found gastric dilatation with edema and hardening of the pyloric antrum, multiple tumors and hardening of a segment of the jejunum-ion junction. Antrectomy was performed with gastrojejunostomy and Brown, with resection of 60 cm of small intestine, which included the tumors found. The histological diagnosis was well-differentiated Lymphocytic Non-Hodgkin's Lymphoma. (AU)


Subject(s)
Humans , Male , Adult , Pyloric Antrum , Lymphoma, Non-Hodgkin , Pyloric Stenosis, Hypertrophic , Laparotomy
4.
Biomédica (Bogotá) ; 39(supl.2): 157-171, ago. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1038836

ABSTRACT

Resumen Introducción. La inflamación del antro gástrico por Helicobacter pylori aumenta el riesgo de úlcera duodenal, y la del cuerpo gástrico puede producir gastritis atrófica e incrementar la probabilidad de cáncer gástrico. Estas reacciones inflamatorias diferenciadas según su localización, podrían explicarse por la composición de la microbiota gástrica asociada con H. pylori. Objetivo. Identificar y comparar la microbiota del antro y del cuerpo del estómago en individuos de dos poblaciones: una con alto riesgo y otra con bajo riesgo de cáncer gástrico en Nariño, Colombia. Materiales y métodos. Se incluyeron biopsias del cuerpo y el antro gástrico de pacientes con gastritis no atrófica o con gastritis atrófica y metaplasia. La microbiota se definió por secuenciación de la región V3-V4 del gen 16S del ARNr de H. pylori (illumina-MiSeq™). Las unidades taxonómicas operativas se clasificaron utilizando las bases de datos BLASTn y RDPII. Las diferencias entre las poblaciones microbianas del antro y del cuerpo gástrico se evaluaron mediante el análisis de varianza multivariado con base en permutaciones (Permutational Multivariate Analysis of Variance, PERMANOVA) y análisis multivariados. Resultados. La clase Epsilonproteobacteria representada por H. pylori fue más abundante en las biopsias del antro y del cuerpo de los individuos con gastritis no atrófica (>50 %), en tanto que, en los individuos con gastritis no atrófica, esta clase correspondió al 20 % con una mayor diversidad metagenómica. La infección por H. pylori disminuyó significativamente la diversidad metagenómica del antro (p=0,005), en comparación con la del cuerpo gástrico. Conclusiones. Los grupos bacterianos involucrados en la disbacteriosis pueden colonizar ambas regiones topográficas del estómago, independientemente de las reacciones sectorizadas de inflamación. La infección por H. pylori asociada con la microbiota gástrica está relacionada con su localización en el estómago, el tipo de lesión y el mayor o menor riesgo de cáncer gástrico, lo que sugiere su importancia en la disbacteriosis y la de esta en la enfermedad gástrica.


Abstract Introduction: Inflammation in the gastric antrum caused by Helicobacter pylori increases the risk of duodenal ulcer while inflammation in the body generates atrophic gastritis and increased risk of gastric cancer. These inflammatory responses according to gastric topography could be explained by the composition of the gastric microbiota associated with H. pylori. Objective: To identify and compare the microbiota of the gastric antrum and body of individuals from two populations, one with high risk and one with low risk of gastric cancer from Nariño, Colombia. Materials and methods: Biopsies of the gastric antrum and body of patients with non-atrophic gastritis or metaplastic atrophic gastritis were included. The microbiota was defined by sequencing the 16S rRNA gene, V3-V4 region, (illumina-MiSeq™). The operational taxonomic units were classified using the BLASTn and RDPII databases. The differences among microbial populations were evaluated with the PERMANOVA and multivariate analyses. Results: The Epsilonproteobacteria class represented by H. pylori was more abundant in the antrum and body biopsies of individuals with metaplastic atrophic gastritis (>50%) while in individuals with non-atrophic gastritis it was 20 % and had greater metagenomic diversity. Helicobacter pylori infection significantly decreases the metagenomic diversity of the gastric antrum (p=0.005) compared to that of the body. Conclusions: The bacterial groups involved in the dysbiosis can colonize both topographic regions of the stomach, regardless of the sectorized inflammation responses. Helicobacter pylori infection associated with the gastric microbiota is related to its localization in the stomach, the type of lesion, and the population at risk of gastric cancer, which suggests its importance in microbial dysbiosis and gastric disease.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Stomach/microbiology , Stomach Neoplasms/epidemiology , Gastrointestinal Microbiome , Gastritis/microbiology , Pyloric Antrum/microbiology , Risk , Helicobacter pylori/isolation & purification , Helicobacter pylori/genetics , Helicobacter Infections/microbiology , Helicobacter Infections/epidemiology , Colombia/epidemiology , Ribotyping , Gastric Mucosa/microbiology , Gastric Mucosa/pathology , Gastritis/epidemiology , Gastritis, Atrophic/microbiology , Gastritis, Atrophic/epidemiology , Metaplasia
5.
Rev. bras. anestesiol ; 69(3): 266-271, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013416

ABSTRACT

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.


Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pyloric Antrum/diagnostic imaging , Cohort Studies , Ultrasonography/methods , Respiratory Aspiration/prevention & control , Preoperative Care/methods , Body Mass Index , Cesarean Section/methods , Prospective Studies , Gastrointestinal Contents/diagnostic imaging , Obesity/complications
7.
Article in Chinese | WPRIM | ID: wpr-774413

ABSTRACT

OBJECTIVE@#To compare the clinicopathological features and the prognosis between patients with adenocarcinoma of esophagogastric junction (AEG) and with adenocarcinoma of gastric antrum (AGA), and to investigate the prognostic factors of AEG and AGA.@*METHODS@#A retrospective cohort study was performed on clinicopathological data of 239 AEG patients (AEG group) and 313 AGA patients selected simultaneously (AGA group) undergoing operation at Harbin Medical University Cancer Hospital from January 2001 to December 2012.@*INCLUSION CRITERIA@#(1) receiving radical surgery (R0 resection); (2) AEG or AGA confirmed by pathological examination of postoperative tissue specimens; (3) without preoperative neoadjuvant radiotherapy or chemotherapy; (4) complete clinicopathological and follow-up data; (5) patients who died of non-tumor-related causes were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. The overall survival (OS) of patients was compared by Kaplan-Meier method and Log-rank test. Multivariate prognosis analysis was performed using Cox proportional hazards regression model.@*RESULTS@#As compared to AGA group, AEG group had higher proportion of male [82.0%(196/239) vs. 65.2%(204/313),χ²=19.243,P0.05). The 5-year OS rate was 33.5% and 56.9% in AEG group and AGA group respectively and the median OS was 60.0(3.0-60.0) months and 33.6(3.0-60.0) months respectively; the difference was statistically significant (P<0.001). In AEG group, univariate analysis showed that differences of hemoglobin level (5-year OS rate: 24.0% for <130 g/L, 39.9% for ≥130 g/L, P=0.006), tumor diameter (5-year OS rate: 41.9% for <5 cm,28.8% for ≥5 cm, P=0.014), N stage (5-year OS rate: 42.2% for N0, 40.9% for N1, 31.7% for N2, 15.8% for N3a, 9.0% for N3b, P<0.001) and TNM stage (5-year OS rate: 56.2% for stage I, 38.5% for stage II, 28.3% for stage III,P=0.017) were statistically significant (all P<0.05); multivariate analysis revealed that the worse N stage was an independent risk factor of prognosis survival for AEG patients(HR=1.404,95%CI:1.164-1.693, P<0.001), and serum hemoglobin level ≥130 g/L was an independent protective factor of prognosis survival for AEG patients (HR=0.689,95%CI:0.501-0.946,P=0.021). In AGA group, univariate analysis showed that differences of serum albumin (5-year OS rate: 49.1% for <40 g/L, 61.1% for ≥ 40 g/L, P=0.021), tumor diameter (5-year OS rate: 74.2% for <5 cm, 39.9% for ≥ 5 cm, P<0.001), T stage (5-year OS rate: 98.3% for T1,83.3% for T2,50.0% for T3,36.8% for T4, P<0.001), N stage (5-year OS rate: 89.0% for N0, 62.3% for N1, 50.0% for N2, 33.9% for N3a, 10.3% for N3b, P<0.001) and TNM stage (5-year OS rate: 97.3% for stage I, 75.8% for stage II, 32.8% for stage III, P<0.001) were statistically significant (all P<0.05); multivariate analysis revealed that the worse T stage (HR=1.516,95%CI:1.060-2.167,P=0.023) and the worse N stage (HR=1.453,95%CI:1.209-1.747,P<0.001) were independent risk factors for prognosis of AGA patients.@*CONCLUSIONS@#As compared to AGA, AEG presents have poorer prognosis,and is easier to present with later pathological stage and larger tumor diameter. N stage and hemoglobin level are independent factors associated with the OS of AEG patients. T stage and N stage are independent factors associated with the OS of AGA patients.


Subject(s)
Adenocarcinoma , Mortality , Pathology , General Surgery , Adult , Aged , Esophagogastric Junction , Pathology , General Surgery , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Staging , Prognosis , Pyloric Antrum , Pathology , General Surgery , Retrospective Studies , Stomach Neoplasms , Mortality , Pathology , General Surgery
8.
Clinical Endoscopy ; : 616-619, 2019.
Article in English | WPRIM | ID: wpr-785661

ABSTRACT

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.


Subject(s)
Abdominal Pain , Aged , Bezoars , Colon , Colon, Ascending , Colonoscopy , Diet , Endoscopy, Digestive System , Female , Gastric Bypass , Gastrostomy , Humans , Ileum , Intestine, Small , Pyloric Antrum , Surgical Instruments , Ulcer , Vomiting
9.
Article in English | WPRIM | ID: wpr-740758

ABSTRACT

BACKGROUND/AIMS: Although functional abdominal pain disorders (FAPDs) are common in children, the accurate pathogenesis of FAPDs is not known yet. Micro-inflammation, particularly tissue eosinophilia of gastrointestinal (GI) tract, has been suggested as the pathophysiology observed in several GI disorders. We aimed to evaluate eosinophilic infiltration throughout the entire GI tract in children with FAPDs, compared to those with inflammatory bowel diseases (IBD) and to normal reference values. METHODS: We included 56 children with FAPDs, 52 children with Crohn’s disease, and 23 children with ulcerative colitis. All subjects underwent esophagogastroduodenoscopic and colonoscopic examination with biopsies. Tissue eosinophil counts were assessed in 10 regions throughout the GI tract. RESULTS: Eosinophil counts of the gastric antrum, duodenum, terminal ileum, cecum, and ascending colon were significantly higher in children with FAPDs compared to normal reference values. Eosinophil counts of the stomach and the entire colon were observed to be significantly higher in children with IBD than in those with FAPDs. Even after selecting macroscopically uninvolved GI segments on endoscopy in children with IBD, eosinophil counts of the gastric body, cecum, descending colon, sigmoid colon, and the rectum were also significantly higher in children with IBD than those with FAPDs. CONCLUSIONS: Significantly high eosinophil counts of the stomach and colon were observed in the order of IBD, followed by FAPDs, and normal controls, regardless of endoscopically detected macroscopic IBD lesions in children. This suggests some contribution of GI tract eosinophils in the intrinsic pathogenesis of FAPDs in children.


Subject(s)
Abdominal Pain , Biopsy , Cecum , Child , Colitis, Ulcerative , Colon , Colon, Ascending , Colon, Descending , Colon, Sigmoid , Duodenum , Endoscopy , Eosinophilia , Eosinophils , Gastrointestinal Diseases , Gastrointestinal Tract , Humans , Ileum , Inflammatory Bowel Diseases , Pyloric Antrum , Rectum , Reference Values , Stomach
10.
Article in English | WPRIM | ID: wpr-718630

ABSTRACT

Gastric tuberculosis accounts for approximately 2% of all cases of gastrointestinal tuberculosis. Diagnosis of gastric tuberculosis is challenging because it can present with various clinical, endoscopic, and radiologic features. Tuberculosis manifesting as a gastric subepithelial tumor is exceedingly rare; only several dozen cases have been reported. A 30-year-old male visited emergency room of our hospital with hematemesis and melena. Abdominal CT revealed a 2.5 cm mass in the gastric antrum, and endoscopy revealed a subepithelial mass with a visible vessel at its center on gastric antrum. Primary gastric tuberculosis was diagnosed by surgical wedge resection. We report a rare case of gastric tuberculosis mimicking a subepithelial tumor with acute gastric ulcer bleeding.


Subject(s)
Adult , Diagnosis , Emergency Service, Hospital , Endoscopy , Gastrointestinal Hemorrhage , Hematemesis , Hemorrhage , Humans , Male , Melena , Pyloric Antrum , Stomach Ulcer , Tomography, X-Ray Computed , Tuberculosis , Tuberculosis, Gastrointestinal
11.
Clinical Endoscopy ; : 192-195, 2018.
Article in English | WPRIM | ID: wpr-713155

ABSTRACT

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.


Subject(s)
Adenocarcinoma , Biopsy , Endoscopy, Digestive System , Endosonography , Female , Gastrectomy , Humans , Middle Aged , Mucous Membrane , Pancreas , Pyloric Antrum , Stomach , Stomach Neoplasms
12.
Rev. Assoc. Med. Bras. (1992) ; 63(2): 134-141, Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-842533

ABSTRACT

Summary Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.


Resumo Objetivo: A aspiração pulmonar do conteúdo gástrico é uma das complicações mais temidas em anestesia. A sua prevenção depende do jejum pré-operatório e da identificação dos pacientes de risco. Não há um método diagnóstico que possa acessar o conteúdo gástrico a qualquer momento. O objetivo deste estudo realizado em voluntários foi fazer uma avaliação qualitativa e quantitativa do conteúdo gástrico utilizando a ultrassonografia. Método: O estudo foi realizado em 67 voluntários utilizando uma técnica já descrita de avaliação do antro gástrico, em quatro diferentes situações: jejum, após a ingestão de líquido claro, leite ou refeição sólida. Foi feita uma avaliação qualitativa e quantitativa do conteúdo gástrico por um radiologista que desconhecia o estado gástrico do voluntário. O antro foi considerado vazio, contendo líquido claro ou espesso, ou sólido. O volume total do estômago foi calculado com base na área seccional do antro. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Para cada tipo de conteúdo gástrico, as características ultrassonográficas do antro e de seu conteúdo foram descritas e ilustradas. A avaliação qualitativa pode distinguir um estômago vazio de outros com diferentes conteúdos. O volume gástrico calculado foi significativamente maior após a ingestão de qualquer alimento em comparação com o jejum. Conclusão: A ultrassonografia à beira do leito pode determinar a natureza do conteúdo gástrico. Também foi possível diferenciar um antro vazio daquele com algum volume. Essas informações podem ser úteis na determinação do risco de aspiração gástrica, principalmente se a condição gástrica é desconhecida ou incerta.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Pyloric Antrum/diagnostic imaging , Gastrointestinal Contents/diagnostic imaging , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/prevention & control , Preoperative Care/methods , Feasibility Studies , Cross-Sectional Studies , Prospective Studies , Ultrasonography , Fasting , Anesthesia/adverse effects , Middle Aged
13.
Article in English | WPRIM | ID: wpr-173848

ABSTRACT

BACKGROUND: Gastric microbiota along with Helicobacter pylori (HP) plays a key role in gastric disease. The aim of our study is to investigate the difference of human gastric microbiota between antrum and body according to disease (control vs. gastric cancer) and HP status. METHODS: Each antrum and body biopsy was collected from 12 subjects at Seoul National University Bundang Hospital. Gastric microbiota was analyzed by bar-coded 454 pyrosequencing of the 16S rRNA gene. Twelve subjects consisted of HP-negative control (n = 2), HP-negative cancer (n = 2), HP-positive control (n = 3), and HP-positive cancer (n = 5). The analysis was focused on non-HP urease-producing bacteria (UB) and non-HP nitrosating or nitroreducing bacteria (NB) between antrum and body. RESULTS: Gastric body samples showed higher diversity compared to gastric antrum mucosa samples but there was no significant difference. The mean of operational taxonomic units was higher in HP(−) cancer than HP(+) cancer (antrum, 273.5 vs. 228.2, P = 0.439; body, 585.5 vs. 183.2, P = 0.053). The number of non-HP UB and non-HP NB was higher in HP(−) cancer groups than the others. These differences were more pronounced in the body (P = 0.051 and P = 0.081, respectively). Analysis of overlap of non-HP UB and non-HP NB revealed the higher composition of Streptococcus pseudopneumoniae, S. parasanguinis, and S. oralis in HP(−) cancer groups than the others, only in the body (P = 0.030) but not in the antrum (P = 0.123). CONCLUSIONS: Higher diversity and higher composition of S. pseudopneumoniae, S. parasanguinis, and S. oralis in HP(−) cancer group than the other groups in the body suggest that analysis of microbiota from body mucosa could be beneficial to identify a role of non-HP bacteria in the gastric carcinogenesis.


Subject(s)
Bacteria , Biopsy , Carcinogenesis , Genes, rRNA , Helicobacter pylori , Helicobacter , Humans , Microbiota , Mucous Membrane , Pyloric Antrum , Seoul , Stomach Diseases , Streptococcus
14.
Gut and Liver ; : 798-806, 2017.
Article in English | WPRIM | ID: wpr-82308

ABSTRACT

BACKGROUND/AIMS: Botulinum toxin type A (BTX), a long-acting inhibitor of muscular contraction in both striated and smooth muscles, is responsible for gastric motility. The aim of this study was to investigate the effects of an endoscopic intragastric BTX injection on weight loss, body fat accumulation, and gastric emptying time. METHODS: The BTX group consisted of 15 obese rats in which 20 U of BTX were injected into the gastric antrum. The saline group consisted of 15 obese rats injected with 20 U of saline, and the control group included 10 obese rats that did not receive a surgical intervention. The gastric emptying time, biochemical parameters, and body fat volume were evaluated using micro-computed tomography (micro-CT) and histologic evaluations. RESULTS: The postoperative body weight of the BTX group was significantly lower than those of the other groups (p < 0.001) at 6 weeks after the operation. The gastric emptying time (156±54 minutes) was significantly delayed in the BTX group. The BTX group showed significantly lower lipid levels than the other groups. A reduction in body fat volume was observed in the BTX group using micro-CT and histological evaluations. CONCLUSIONS: BTX application to the gastric antrum represents a potentially effective treatment for obesity and may help improve the lipid profile by increasing the gastric emptying time.


Subject(s)
Adipose Tissue , Adiposity , Animals , Body Weight , Botulinum Toxins , Botulinum Toxins, Type A , Endoscopes , Gastric Emptying , Models, Animal , Muscle Contraction , Muscle, Smooth , Obesity , Pyloric Antrum , Rats , Weight Loss
15.
Article in English | WPRIM | ID: wpr-70264

ABSTRACT

BACKGROUND/AIMS: Portal hypertension (PH) is a syndrome characterized by chronic increase in the pressure gradient between the portal vein and inferior vena cava. Previous studies have suggested an increased frequency of antral elevated erosive gastritis in patients with PH, as well as an etiologic association; however, there has not been any histological evidence of this hypothesis to date. Our aim was to evaluate the histological features found in elevated antral erosions in patients with portal hypertension. METHODS: Sixty-nine patients were included; 28 with and 41 without PH. All patients underwent endoscopy, and areas with elevated antral erosion were biopsied. RESULTS: In the PH group, 24 patients had inflammatory infiltration with or without edema and vascular congestion, and 4 patients had no inflammation. In the group without PH, all patients showed inflammatory infiltration of variable intensity. There was no statistical significance between the two groups in the presence of Helicobacter pylori. There as a histological similarity between the two groups, if PH patients without inflammation were excluded; however, more edema and vascular congestion were observed in the PH group (p=0.002). CONCLUSIONS: The findings show that elevated antral erosions in patients with PH have more evident edema and vascular congestion in addition to lymphocytic infiltration.


Subject(s)
Edema , Endoscopy , Estrogens, Conjugated (USP) , Gastric Antral Vascular Ectasia , Gastritis , Helicobacter pylori , Humans , Hydrogen-Ion Concentration , Hypertension, Portal , Inflammation , Lymphocytes , Portal Vein , Pyloric Antrum , Vena Cava, Inferior
18.
Article in Korean | WPRIM | ID: wpr-222507

ABSTRACT

Since the first case of gastric serrated adenoma found in 2001, 35 additional cases have been reported. Among these cases, 26 cases were associated with invasive adenocarcinoma within the serrated adenoma. Gastric serrated adenoma when compared with traditional adenoma has close correlation with invasive carcinoma. Serrated colorectal polyps are classified as hyperplastic polyps, sessile serrated adenoma/polyps, and tranditional serrated adenoma (TSA) depending on histological features. Two distinct phenotypes of TSA in the colon and rectum are reported. Those are unlocked serrated crypts (US-TSA) and ectopic crypt formations (ECFs). All gastric serrated adenoma are TSA in historical aspect and ECFs on phenotype. Whereas gastric adenomas are reported with high frequency in the antrum, gastric serrated adenomas are founded in the body and cardia. We report a case of a 60-year-old woman receiving endoscopic submucosal dissection for gastric serrated adenoma with adenocarcinoma discovered during routine screening.


Subject(s)
Adenocarcinoma , Adenoma , Cardia , Colon , Female , Humans , Mass Screening , Middle Aged , Phenotype , Polyps , Pyloric Antrum , Rectum , Stomach
19.
Article in English | WPRIM | ID: wpr-149376

ABSTRACT

BACKGROUND/AIMS: To evaluate a new monoclonal antibody for Helicobacter pylori urease in gastric tissue. METHODS: A total of 107 volunteers were enrolled. All subjects underwent a 13C-urea breath test and esophagogastroduodenoscopy. Gastric aspirates were analyzed for pH and ammonia. Six biopsy specimens in the gastric antrum and body were obtained for a rapid urease test and histology. The new monoclonal antibody-based H. pylori urease test (HPU) was performed to rapidly and qualitatively detect urease in two biopsy specimens. RESULTS: H. pylori infection was diagnosed in 73 subjects. The sensitivity and specificity of the HPU was 89% and 74%, respectively. The subjects were divided into two groups: one with true-positive and true-negative HPU results (n = 90) and the other with false-positive and false-negative HPU results (n = 17). Across all subjects, ammonia levels were 900.5 +/- 646.7 and 604.3 +/- 594.3 mumol/L (p > 0.05), and pH was 3.37 +/- 1.64 and 2.82 +/- 1.51 (p > 0.05). Sensitivity was higher in the presence of atrophic gastritis or intestinal metaplasia. CONCLUSIONS: HPU detected H. pylori in approximately 10 min. Gastric aspirate ammonia and pH levels did not affect the test results. Sensitivity was good in the presence of atrophic gastritis or intestinal metaplasia.


Subject(s)
Adult , Antibodies, Monoclonal/immunology , Bacterial Proteins/analysis , Biomarkers/analysis , Biopsy , False Negative Reactions , False Positive Reactions , Female , Gastritis, Atrophic/diagnosis , Helicobacter Infections/diagnosis , Helicobacter pylori/enzymology , Humans , Immunologic Tests , Male , Metaplasia , Middle Aged , Predictive Value of Tests , Pyloric Antrum/microbiology , Reproducibility of Results , Time Factors , Urease/analysis , Workflow
20.
Article in English | WPRIM | ID: wpr-84967

ABSTRACT

BACKGROUND/AIMS: DA-9701 is a novel prokinetic agent. In the present study, we investigated the effect of DA-9701 on the motility of the gastric antrum in the normal and clonidine-induced hypomotility in an in vivo animal model. METHODS: A strain gauge force transducer was sutured on the gastric antrum to measure the contractile activity in rats. A total of 28 rats were subclassified into the 4 groups: (1) the placebo group, (2) the DA-9701 group, (3) the placebo group in the clonidine-pretreated rats, and (4) the DA-9701 group in the clonidine-pretreated rats. After the basal recording, either placebo (3% [w/v] hydroxypropylmethyl cellulose) or DA-9701 was administered. Contractile signals were measured after the administration and after a meal. In the clonidine-pretreated rats, either placebo or DA-9701 was administered. Contractile signals were measured after the administration and after a meal. RESULTS: Oral administration of DA-9701 did not significantly alter the motility index of the gastric antrum in the preprandial and postprandial periods, compared with the placebo group. The administration of clonidine decreased the motility index of the gastric antrum in the preprandial and postprandial periods, compared with the administration of placebo. This reduction of the antral motility by the administration of clonidine was not observed in the clonidine-pretreated DA-9701 group. The percentage of the motility index in the postprandial period was significantly greater in the clonidine-pretreated DA-9701 group, compared with the clonidine-pretreated placebo group. CONCLUSIONS: DA-9701 improves the hypomotility of the gastric antrum induced by clonidine, suggesting its gastroprokinetic effect in the pathologic condition.


Subject(s)
Administration, Oral , Animals , Clonidine , Meals , Models, Animal , Postprandial Period , Pyloric Antrum , Rats , Transducers
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