Colecistectomía como factor de riesgo para reflujo duodenogástrico

El reflujo biliar o reflujo duodenogástrico (RDG) es el flujo retrógrado del contenido duodenal (principalmente bilis) hacia el estómago, capaz de producir daño químico a la mucosa y desencadenar mutaciones hacia el desarrollo de metaplasia intestinal, displasia e incluso, cáncer gástrico. El objetivo de este estudio fue estimar la prevalencia del reflujo biliar primario en pacientes colecistectomizados e identificar si la colecistectomía es un factor de riesgo para el RDG. Se realizó un estudio observacional transversal analítico, en el que fueron incluidos todos los pacientes que se realizaron endoscopía digestiva alta entre febrero y junio del 2023, en un centro endoscópico privado en la ciudad de Lima, Perú. De acuerdo al reporte endoscópico, los pacientes fueron divididos en dos grupos: con RDG y sin RDG. Se analizaron estadísticamente las características demográficas, el antecedente de colecistectomía y los hallazgos endoscópicos. Fueron incluidos 408 pacientes. La edad media de la población fue 48,18 ± 16,82años; el 61,52% fueron mujeres. La prevalencia de RDG fue de 25,74% en la población y de 52,11% en pacientes colecistectomizados. La prevalencia de RDG en pacientes colecistectomizados fue 2,58 veces en comparación a los pacientes sin colecistectomía (p< 0,001). La edad ≥50 años también se comportó como factor de riesgo para RDG (p=0,025). No hubo diferencias significativas respecto a diabetes, infección por Helicobacter pylori ni consumo de tabaco. En conclusión, el antecedente de colecistectomía y la edad demostraron ser factores de riesgo para el desarrollo de RDG primario.

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. 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. 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. In conclusion, a history of cholecystectomy as well as age were found to be risk factors for development of primary DGR.

Effects of primary duodenogastric reflux on Helicobacter pylori infection and drug resistance in children in Wuxi area / 中国小儿急救医学

Objective:To investigate the effect of primary duodenal bile reflux(DGR)on Helicobacter pylori(HP)infection and drug resistance in children in Wuxi area, and to provide the basis for the selection of anti-HP drugs in children with subsequent DGR.Methods:The clinical data of children who had received upper gastrointestinal endoscopy and HP examination because of abdominal pain, nausea, vomiting, gastrointestinal bleeding, dyspepsia and other upper gastrointestinal symptoms were collected from January 2020 to February 2022 in the Gastroenterology Department of Wuxi Children′s Hospital.According to the results of endoscopy, children were divided into DGR group (217 cases) and control group without DGR (1 252 cases), and their age, gender, HP infection rate and abdominal pain were analyzed.Results:A total of 1 469 children were included in this study, with a median age of 11(9, 14) years, 808(55.0%) males and 661(45.0%) females.HP infection was detected in 322(21.9%) cases.The median age of DGR group was higher than that in control group[13(11, 15) years vs. 11(8, 14) years, P<0.001], and the incidence of DGR was increased in the elder group( χ2=45.963, P<0.001). There was no significant difference between DGR group and control group in sex and whether abdominal pain was the first symptom ( P>0.05). There were 47(22.0%) cases positive for HP in DGR group and 275(22.0%)cases in control group, with no significant difference( P>0.05). A total of 256 cases were isolated and cultured positive of HP.And in vitro susceptibility tests of strains, there was no significant difference between DGR group and control group in the single and combined resistance rates of HP to metronidazole, clarithromycin, levofloxacin, amoxicillin, furazolidone and tetracycline hydrochloride( P>0.05). Conclusion:Elder children are more likely to have primary DGR.The occurrence of primary DGR has no significant effect on HP infection and drug resistance.

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

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

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

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

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

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

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

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

Gastritis crónica antral por Helicobacter pylori en pacientes con y sin reflujo duodenogástrico / Chronic Antral Gastritis for Helicobacter pylori in Patients with and without Duodenogastric Reflux

Introducción: la gastritis crónica antral por Helicobacter pylori y la afección por reflujo duodenogástrico (RDG) son enfermedades frecuentes que pueden coexistir. La posible influencia del reflujo duodenogástrico sobre la infección por Helicobacter pylori es un tema controvertido. Objetivo: estimar el comportamiento histopatológico de la gastritis crónica antral por Helicobacter pylori según la presencia o no de reflujo duodenogástrico e identificar si existen diferencias entre ellos. Métodos: estudio tipo caso-control. Universo: total de pacientes atendidos entre agosto 2011-agosto 2012 en el Servicio de Gastroenterología del Hospital Universitario Vladimir Ilich Lenin de Holguín, con endoscopia y biopsia gástrica antral diagnóstica de gastritis crónica antral e infección por H. pylori, diagnosticadas en el Departamento de Anatomía Patológica del Hospital Pediátrico Provincial Octavio de la Concepción y de la Pedraja según estado de actividad, severidad lesional y densidad de colonización por Helicobacter pylori. Se seleccionaron dos grupos: de estudio o casos con RDG (n = 25) y de control sin RDG (n = 47). Resultados: las formas activas (80%), mayores grados de severidad lesional (68%) y de densidad de colonización de Helicobacter pylori (56%) predominaron en el grupo estudio sin diferencias significativas con el grupo control (P> 0,05). Conclusiones: no existió una relación sinérgica, ni antagónica, entre la infección por Helicobacter pylori y el material refluido respecto a la acción lesiva sobre la mucosa gástrica y la magnitud de la colonización por la bacteria.

Introduction: the chronic antral gastritis for Helicobacter pylori (H pylori) and duodenogastric reflux disorders are frequent affections that can coexist. The possible influence of the duodenogastric reflux disorders on chronic antral gastritis for Helicobacter pylori is a controversial theme. Objective: to estimate the histopathological behavior of the chronic antral gastritis for H. pylori according to the presence or not of duodenogastric reflux. Methods: a control case study was carried out. The universe comprised the total of patients attended during August 2011- August 2012 in Gastroenterology Service of the Teaching Hospital of Holguín, with endoscopy and gastric antral diagnostic biopsy of chronic antral gastritis and infection by H. pylori. Two samples were selected: a study group with duodenogastric reflux (25 patients, 34.7%) and a control group without duodenogastric reflux (47 patients). Results: the active forms (80%), bigger degrees of severity lesion (68%) and of Helicobacter pylori's density of colonization (56%) predominated in the study group without significant differences comparing to the control group (P< 0.05). Conclusions: there were no synergetic and antagonistic relations between the infection for Helicobacter pylori and the flowed back material in relation to the harmful action on the gastric mucosa and the magnitude of the colonization for the bacterium.

Advances in Study on Bile Reflux Gastritis / 胃肠病学

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.

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

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

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

The study on gastric electrical activity and gastric emptying in patients with primary pathological duodenogastric reflux / 中华消化杂志

Objective To explore the etiological factors of primary pathological duodenogastric reflux (DGR) through investigating the relationship between severity of bile refulx,the changes of surface gastric electric rhythm and gastric emptying movement in primary pathological DGR patients.Methods From January 2007 to April 2008 in Qingdao Municipal Hospital,58 cases of outpatients diagnosed as primary pathological DGR and 21 healthy individuals (control group) were collected and underwent 24-hour gastric bilirubin monitoring,gastric endoscopy,gastric electric rhythm,and gastric emptying test.The relationship between gastric electric parameters and gastric emptying,bilirubin reflux,Hp infection was analyzed.Results 1.The main frequency in fasting and postprandial of primary pathological DGR patients [(1.94±0.04) cpm vs (2.93±0.07) cpm; (2.12±0.03) cpm vs (3.35 ±0.05) cpm],the percentage of normal gastric slow wave in fasting and postprandial (74.46± 0.56 vs 85.55 ± 1.06 ; 63.97 ± 0.64 vs 86.13 ± 1.49),and fasting/postprandial power ratio (PR) (1.68±0.02 vs 2.75±0.09) were all lower than those of control group (P＜0.05).The percentage of bradygastria in fasting and postprandial of DGR patients (18.04±0.36 vs 7.76±0.78;23.73±0.91 vs 8.47±0.55),the percentage of tachygastria in fasting and postprandial (8.93±0.26 vs 5.75±0.66;13.02±0.40 vs 7.66±0.27) were higher than that of control group (P＜0.05).2.The main frequency of severe reflux patients in fasting and postprandial [( 1.68 ± 0.07) cpm vs (2.13 ± 0.07)cpm; (2.18±0.09) cpm vs (2.76±0.06) cpm],the percentage of normal gastric slow wave in fasting and postprandial (69.71±0.43 vs 80.35±0.68; 56.36 ±0.85 vs 72.34±0.80),fasting /postprandial PR (1.47±0.04 vs 2.02±0.04) were lower than those of mild-reflux group (P＜0.05).The percentage of bradygastria in fasting and postprandial of severe reflux patients (22.94 ± 0.68 vs 13.47 ± 0.61; 29.61 ± 1.14 vs 17.55 ± 0.51) and the percentage of tachygastria in fasting and postprandial (9.94 ± 0.54 vs 7.02 ± 0.42 ; 17.04 ± 0.70 vs 10.71 ± 0.20) were higher than that of mild-reflux group (P＜0.05).3.There was no significant difference of gastric electrical parameters in fasting and postprandial between Hp-positive and Hp-negative groups (P＞0.05).4.The ratio of gastric emptying in DGR group was significantly lower than that of control group (37.9％ vs 90.5 ％,P＜0.05).The gastric emptying delay in DGR group significantly increased compared with control group (60.3％ vs 9.5％,P＜0.05).There was no significant difference in gastric emptying delay between severe-reflux group and light-reflux group (69.0％ vs 51.7％,P ＞ 0.05).Conclusions There is dysfuntion of gastric myoelectrical activity and gastric motility in primary pathological DGR patients,which may be an important mechanism in pathological DGR.

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

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

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

Comparative study on rabeprazole and hydrotalcite in treatment of patients with bile-reflux gastritis after cholecystectomy / 中华消化杂志

Objective To compare the efficacy of rabeprazole and hydrotalcite in treatment of patients with bile-reflux gastritis after cholecystectomy.MethodsPatients,who underwent cholecystectomy and were confirmed with bile reflux gastritis by 24 h gastric bilirubin monitoring,were enrolled in the study.Patients were randomly assigned into control group (n=30),rabeprazole group (n= 30,20 mg daily),hydrotalcite group (n= 29,1.0 g three times daily) and rabeprazole combined with hydrotalcite group (combination group,n= 31) and treated for 8 weeks.Dyspeptic symptoms of abdominal pain,bloating,heartburn and bitter taste were observed.The endoscopic and histological examination were performed 2 weeks after treatment to evaluate the improvement of inflammation and histological activity.The 24 h bilirubin monitoring was used to assess the total per cent of bilirubin absorption (value of 0.14 units or greater) time,the number of reflux episodes and the number of reflux episodes lasting longer than 5 min.Results The dyspeptic symptoms were relieved in three groups after treatment.However,the endoscopic oedema (2.11 ±0.77 vs 1.50 ±0.67,P<0.05) and the histological activity (2.87±0.72 vs 1.97±0.78,P<0.05) as well as the number of reflux episodes> 5 min (18.26+ 1.80 vs 9.70± 1.20) were improved most significantly in combination group after treatment.There was no statistical difference in rabeprazole and hydrotalcite groups before and after treatment.Whereas the total percent time of bilirubin absorption value >0.14 decreased in three treatment groups after treatment (P<0.05).Conclusion Rabeprazole combined with hydrotalcite is effective in the treatment of patients with bile reflux gastritis after cholecystectomy.

Diagnostic value of porphobilin staining of gastric mucus for primary pathological duodenogastric reflux / 中华消化内镜杂志

Objective To study the diagnostic value of porphobilin staining of gastric mucus for primary pathologic duodenogastric reflux (DGR). Methods A total of 58 DGR patients diagnosed from January, 2007 to April, 2008 were recruited to the study as DGR group, and 21 healthy volunteers as control.All subjects underwent 24-hour intragastric bilirubin monitor and gastroscopy. Bilirubin absorption value of 0. 25 and median reflux time of 23.60% were taken as thresholds to differentiate low reflux group ( reflux time ＜ 23.60% ) and high reflux group (reflux time ≥23.60% ). Porphobilin staining of gastric mucosa was quantitatively analyzed. Results Deposition of porphobilin in mucosa of gastric antrum, gastric angle and gastric body in primary pathologi DGR group was significantly higher than those in healthy group (P ＜0. 05 ). The occurrence of atrophic and intestinal metaplasia of gastric antrum in high reflux group was significantly higher than that of low reflux group (P ＜ 0. 05). Deposition of porphobilin in mucosa of gastric antrum, gastric angle and gastric body in high reflux group was significantly higher than that of low reflux group (P ＜ 0. 05 ). The New Sydney system pathological scores of gastric antrum and angle of high reflux group was higher than that of low reflux group ( P ＜ 0. 05 ). The deposition of porphobilin in mucosa of gastric antrum and gastric angle was positively correlated with New Sydney system pathological scores in primary pathological DGR group (r=0.59, P=0.041 andr=0.73, P=0.038). Conclusion Porphobilin staining of mucosa in gastric antrum can reflect the severity of bile reflux, and is positively correlated with the extent of gastric mucosal lesion, which may be helpful in diagnosis of primary pathological DGR.

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

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

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

Os nitritos são importantes na gênese do adenocarcinoma associado ao esôfago de Barrett? / Are the nitrites important in a genesis of the adenocarcinoma associated to the Barrett esophagus?

RACIONAL: O esôfago de Barrett é complicação do refluxo gastroesofágico e predispõe ao surgimento do adenocarcinoma, sendo que vários fatores têm sido relacionados à sua etiopatogenia. OBJETIVO: Analisar o modelo experimental de refluxo duodenogastroesofágico e a ingestão de solução de nitrito de sódio na gênese do adenocarcinoma associado ao esôfago de Barrett. MÉTODOS: Sessenta ratos machos Wistar foram divididos em quatro grupos, com 20 animais controles não operados (10 animais ingeriram somente água e 10 água mais solução de nitrito de sódio) e 40 animais submetidos à anastomose duodenogastroesofágica látero-lateral (20 animais ingeriram somente água e 20 animais ingeriram água mais solução de nitrito de sódio). A ocorrência de esofagite, metaplasia, displasia, esôfago de Barrett e adenocarcinoma associado foram analisados. A classificação de Viena para displasia e adenocarcinoma foi empregada na análise dos resultados. RESULTADOS: Após 42 semanas de observação, nos animais operados sem ingestão de nitritos o esôfago de Barrett foi registrado em 26,3 por cento (5/19), enquanto no grupo operado associado à ingestão de nitritos, foi encontrado em 72,3 por cento (13/18) dos animais, sendo que neste grupo também foi encontrado seis adenocarcinomas (33,3 por cento). Nenhum animal não operado apresentou o esôfago de Barrett. As categorias 2, 3 e 5 da classificação de Viena somente foram encontradas nos animais operados que ingeriram nitrito de sódio (66,7 por cento). CONCLUSÃO: A ingestão de nitrito de sódio associado ao refluxo duodenogastroesofágico têm importante participação na gênese do adenocarcinoma associado ao esôfago de Barrett.

BACKGROUND: Barrett's esophagus is a complication of gastroesophageal reflux and predisposes to adenocarcinoma of the esophagogastric transition and several factors have been related to its pathogenesis. AIM: To evaluated the genesis of adenocarcinoma associated with Barrett's esophagus in an experimental model of duodenogastroesophageal reflux with the additional ingestion of sodium nitrite METHODS: Sixty male Wistar rats were divided into four groups. Twenty of these animals served as controls (10 animals ingesting only water and 10 ingesting water plus a solution of sodium nitrite), while the remaining 40 animals were submitted to side-to-side duodenogastroesophageal anastomosis (20 animals ingesting only water and 20 ingesting water plus the sodium nitrite solution). The occurrence of esophagitis, metaplasia, dysplasia, Barrett's esophagus associated with adenocarcinoma were analyzed. The Vienna classification for dysplasia and adenocarcinoma was used in the analysis of results. RESULTS: After 42 weeks of observation, Barrett's esophagus was found in 26.3 percent (5/19) of the animals only submitted to surgery compared to 72.3 percent (13/18) of the animals in the group submitted to surgery and given nitrites. Six cases of adenocarcinoma (33.3 percent) were also found in this latter group. Categories 2, 3 and 5 of the Vienna classification were only found in animals submitted to surgery plus sodium nitrite (66.7 percent). CONCLUSION: The ingestion of sodium nitrite associated with duodenogastroesophageal reflux plays an important role in the genesis of adenocarcinoma associated with Barrett's esophagus.

Comparative Study of Duodenogastric Reflux according to Reconstructive Procedure after Distal Subtotal Gastrectomy

PURPOSE: Billroth I and II reconstructions are commonly performed after a distal subtotal gastrectomy. However, both may cause duodenogastric and duodenogastroesophageal reflux, which are conditions reported to have carcinogenic potential. This study investigated which reconstructive procedure would be most effective in prevent bile reflux into the gastric remnant after a distal gastrectomy. METHODS: A group of 43 patients who underwent a curative distal gastrectomy for gastric cancer were assigned to three groups prospectively according to the reconstructive procedure undertaken: 14, Billroth I (B-I); 14, Billroth II with Braun anastomosis (B-II with Braun); and 15 Billroth II (B-II). The bile reflux period (percent time) for the gastric remnant was measured using a Bilitec 2000 under standardized conditions. The endoscopic findings for reflux gastritis were classified into four grades. RESULTS: The mean standard error time of bile reflux in B-I, B-II with Braun and the B-II groups was 30.9+/-3.9%, 32.8+/-5.1% , and 60.9+/-7.0%, respectively. The B-II group showed significantly higher levels of the % time of bile reflux than the B-I or B-II with Braun groups (P<0.001). Regarding the endoscopic classification for reflux gastritis, the remnant stomach after B-II showed significantly more severe and extensive gastritis than that after the B-I and B-II with Braun procedures (P=0.003). There was also a positive correlation between the degree of % time of bile reflux and the extent of gastritis in the gastric remnant (P<0.001). CONCLUSION: After a distal subtotal gastrectomy, a B-II reconstruction is associated with a high reflux of duodenal content, whereas a Braun enteroenterostomy after a B-II reconstruction minimized the reflux at the levels of a B-I reconstruction.

To remark about incidence of Helicobacter pylori infections and chronic gastritis in patients with duodenogastric reflux

Study on 82 gastritis patients (19-63 years old), in which 40 patients had endoscopic features of duodenogastric reflux and 42 had no endoscopic of duodenogastric reflux, were treated at 19.8 Hospital from December 2000 to October 2001. All subjects were assessed of gastric mucosa's damages in endoscopy and histology as well as Helicobacter pylori infection rate. The results: the rate of patients were infected with H.pylori significantly fewer than in group without duodenogastric reflux. The rate of H.pylori infection in mild duodenogastric reflux patients was significantly higher than the rate in moderate and severe duodenogastric reflux patients. In patients with both factors (duodenogastric reflux and H.pylori infection), chronic atrophic gastritis' rate was significantly higher compared with the rate of patients who had only one factor or non of both. In patients with duodenogastric reflux but without H.pylori infection: simply chronic gastritis' rate was significantly lower and chronic atrophic gastritis' rate was higher than group without duodenogastric reflux

Helicobacter pylori Infection and Pathologic Findings in Bile Reflux Gastritis / 대한소화기내시경학회지

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.

Relationship between duodenogastric reflux and chronic inflammation of gastric mucosa / 中华消化杂志

0.05) for penetrating blood vessel, 46% and 18%( P

Gastric Stump Cancer

PURPOSE: Gastric stump cancer is defined as a cancer that develops in the stomach after a resection in cases of non-malignant or malignant gastric disease. The interval between the gastrectomy and the detection of gastric stump cancer must be over 5 years. Since duodenogastric reflux gastritis is a precancerous condition and one of the most important factors inducing gastric stump cancer, we compared the bile-acid content of gastric juice between gastric stump cancer patients and controls. MATENRIALS AND METHODS: To evaluate retrospectively the surgical treatment of patients with gastric stump cancer, we reviewed the cases histories of 1016 stomach cancer patients who had been operated on at the Department of General Surgery, Kosin University Gospel Hospital, between 1995 and 1998. The gastric juice was collected during the operations on the gastric stump cancer patients by using a needle puncture of the fundus of the stomach and during the endoscopic examinations of the control subjects. The samples were analyzed for various bile acids (gas chromatography/mass spectrometry). RESULTS: The 6 gastric stump cancer cases accounted for 0.6% of all gastric cancer patients; 5 patients were first operated on for a peptic ulcer and the remaining one for an adenocarcinoma of the stomach. All of the cases were men. The reconstruction method after the initial gastrectomy was a Billroth II in all cases. The sites of the gastric stump cancer were the anastomotic sitein 2 patients, the upper body in 2, the fundus in 1 and the cardia in 1. The operative methods were 3 total gastrectomies, 2 subtotal gastrectomies with Roux en Y anastomosis, and 1 partial gastrectomy with lymph node dissection and had a curative intention in all patients. All of the patients were still surviving at the time of this report. The gastric juices of 4 gastric stump patients showed significantly higher contents of cholic acid (36.42microgram/ ml) compared to the gastric juices of 35 control subjects (12.82microgram/ml)(p< or =0.0001). Chenodeoxycholic acid and lithocholic acid were not significantly different. CONCLUSION: The gastric juice of gastric stump cancer patients contained a significantly higher cholic acid content. At the time of the initial gastrectomy, an operative method that prevents duodenogastric reflux may prevent or minimize the development of gastric stump cancer, and more aggressive surgical treatment may improve survival.

A preliminary study on the relationship between duodenogastric reflux and Helicobacter pylori infection / 中华消化杂志

Objective To study the relationship between contents of duodenogastric reflux and Helicobacter pylori (H.pylori) infection in patients with peptic ulcer. Methods Seventy patients with peptic ulcer diagnosed by endoscopy entered the study. Contents of duodenogastric reflux was detected by 99M TC- EHIDA and H.pylori status was determined by both histology with Giemsa staining and serum anti-H.pylori-IgG level using ELISA method. Results In patients without contents of duodenogastric reflux, H.pylori infection rate was 83.3%(35/42), significant higher than 39.3%(11/28) in those with contents of duodenogastric reflux (P