Low frequency of upper gastrointestinal complications in a cohort of high-risk patients taking low-dose aspirin or NSAIDS and omeprazole.

BACKGROUND: There is very little information available on the incidence of complications and on the best prevention therapy in high-risk patients taking non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin. Randomized-controlled trials in such patients are rare for ethical reasons. We studied the incidence of gastrointestinal complications in high-risk patients taking long-term low-dose aspirin or non-aspirin-NSAIDs combined with omeprazole in a real-life clinical setting. METHODS: This was a multicentre, prospective and observational study including 247 consecutive high-risk patients who had a clinical indication for long-term treatment with either low-dose aspirin or non-aspirin NSAIDs and omeprazole therapy. The occurrence of gastrointestinal complications was measured. RESULTS: In addition to a recent history of peptic ulcer bleeding, all patients had at least 1 other risk factor and 112 (45.3%) had 3 or more risk factors; 78.9% were taking low-dose aspirin and the remainder non-aspirin NSAIDs. Mean follow-up was 14.6 +/- 10.38 months. Three patients taking low-dose aspirin developed upper gastrointestinal bleeding (1.2%; 95% CI 0.3-3.5; 1.0 event/100 patients/year). This was similar to the rate observed in studies involving non-high-risk patients taking low-dose aspirin and higher than that observed in patients not taking low-dose aspirin. Two additional patients developed a lower gastrointestinal bleeding event (0.81% (0.04%-3.12%); 0.67 events/100 patients/year), which was within the range expected in NSAID users. CONCLUSIONS: The use of omeprazole in the high-risk patient taking low-dose aspirin or NSAIDs seems to be a safe therapeutic approach in this population and is associated with a low frequency of upper gastrointestinal complications.

Evaluation of duodenogastric reflux in gallstone disease before and after simple cholecystectomy.

Duodenogastric reflux (DGR) has been suggested as an etiopathogenic factor in gastric disease in patients with gallstones. We evaluated the DGR levels in 15 patients before and after simple cholecystectomy for gallstones and compared the results with those of 15 healthy subjects. Gastric juice was obtained by continuous nasogastric suction for 24 hours. The bile acids (BA) present in the samples were quantified by thin-layer chromatography and in situ spectrofluorometry. The mean BA concentration for the control subjects was 2.25 mumol reflux/hour, whereas the mean value for the 15 patients with cholelithiasis was 8.86 mumol reflux/hour before cholecystectomy and 24.55 mumol reflux/hour after cholecystectomy. Five patients did not have detectable BA in the gastric juice in both analyses; the remaining 10 patients showed a significant increase in the BA after surgery. From these data, we conclude that gallstone disease is not always accompanied by an increased DGR. However, in patients in whom DGR is present, its level is higher than in control subjects and increases significantly after cholecystectomy. This is probably due to the greater amount of bile in the duodenum that may reflux through an incompetent pyloric channel.

Bile reflux in postoperative alkaline reflux gastritis.

This study evaluates enterogastric reflux (EGR) levels in patients with and without symptoms of postoperative alkaline reflux gastritis (PARG) after gastric surgery. The bile acids (BA) present in the gastric juice were quantified by thin-layer chromatography and spectrofluorometry. The mean BA concentration for controls was 2.25 mumol reflux/hour, for 15 asymptomatic patients 47.94 and for 15 patients with symptoms of PARG 125.79. After biliary diversion by a Roux-en-Y anastomosis in the latter, their BA in 13 of these patients after surgery, and relapsed in only one during a 4-year follow-up. The remaining two patients had the lowest preoperative BA levels in this group. These results indicate that EGR is increased after gastric surgery more markedly indicated that EGR is increased after gastric surgery more markedly in patients with symptoms of PARG, and that patients who have high levels of EGR (more than 80 mumol BA reflux/hour) clearly benefit from biliary diversion.

[Determination of duodenogastric reflux by quantification of bile acids in the gastric juice]. / Determinación del reflujo duodenogástrico mediante la cuantificación de los ácidos biliares del jugo gástrico.

The existence of duodeno-gastric reflux was evaluated in a group of 15 healthy subjects, in fasting and for 24 hours. The assessment of duodeno-gastric reflux was made by quantitation of the bile acids (BA) present in the gastric juice. The individual free and conjugated BA were separated and quantified by means of thin-layer chromatography and in situ spectrofluorometry. In 7 of the subjects studied no BA were detected, and in the other 8 subjects the BA levels were below 6 mumol reflux/hour. There were no free BA detected in any of the subjects. The levels of BA in gastric juice increased progressively with age, but there were no differences between sex. The chromatographic technique used is highly sensitive for the analysis of BA in biological samples. The study of BA in the gastric juice provides a quantitative and reliable assessment of the degree of duodeno-gastric reflux.

A randomized trial of gastric decompression after truncal vagotomy and anterior pylorectomy.

To test the assumption that gastric decompression is beneficial after TV, 66 patients who underwent elective TV plus anterior pylorectomy were randomly allocated into three groups immediately after completing pyloric reconstruction. Patients in group G had a tube gastrostomy, patients in group ND did not have gastric decompression and patients in group NGS were treated with nasogastric suction for 48 to 72 hours. Roentgenographically, greater gastric distension could be noted in patients in the ND group but this was not clinically significant. Patients in the NGS group had a high incidence of mechanical complications, especially when tubes were in place for more than 48 hours. Infections of the chest were not related to gastric decompression techniques. Patients in groups NGS and ND had significantly shorter hospital stays than patients in group G. During the immediate post-operative period after TV, we would recommend no gastric decompression or short term (less than 48 hours) nasogastric suction. Routine gastrostomy is unwarranted.