Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 7 Articles
Abstract\nBackground: Gastric epithelial hyper-proliferation was reported in patients with Helicobacter pylori (H. pylori)ââ?¬â??\ninfected gastric mucosa with intestinal metaplasia (IM) changes. In patients with gastric ulcer (GU) and IM, the GU\nmay have a different healing rate in comparison to patients without IM. This study aimed to compare the\ndifference in GU healing between H. pyloriââ?¬â??infected patients with IM and those without IM.\nMethods: We retrospectively analyzed patients at the Keelung Chung Gung Memorial Hospital during the period\nfrom March 2005 to January 2011. The inclusion criteria were: 1) endoscopic findings of GU and biopsy histological\nexamination plus rapid urease test indicating H. pylori infection; 2) gastric IM adjacent to a GU but with no atrophic\ngastritis changes; 3) patients receiving H. pylori eradication triple therapy and 8 weeks of maintenance therapy with\na proton pump inhibitor; and 4) patients receiving follow-up endoscopy within the 3rd and the 4th months after\ntreatment.\nResults: In total, 327 patients with GU and H. pylori infection (136 with IM and 191 without IM) were included.\nPatients with IM had a higher GU healing rate than those without IM (91.9% vs. 84.3%, P = 0.040). Multivariate\nlogistical regression analysis revealed that failure of H. pylori eradication (Odds = 4.013, 95% CI: 1.840ââ?¬â??8.951, P < 0.\n001) and gastric IM (Odds = 0.369, 95% CI: 0.168ââ?¬â??0.812, P = 0.013) were the predictors of non-healing GU following\ntreatment.\nConclusions: Patient with gastric IM change may have a higher GU healing rate than those without gastric IM.\nHowever, successful H. pylori eradication is a more important factor for GU healing than gastric IM....
Background. Although Billroth II (BII) reconstruction is simpler and faster than Billroth I or Roux-en-Y (RY) reconstruction in\npatients undergoing totally laparoscopic distal gastrectomy (TLDG), BII reconstruction is associated with several complications,\nincluding more severe bile reflux. BII Braun anastomosis may be a better alternative to RY reconstruction. Methods. This\nretrospective study included 56 consecutive patients who underwent TLDG for gastric cancer, followed by BII Braun or RY\nreconstruction, between January 2013 and December 2015. Surgical outcomes, including length of operation, quantity of blood\nlost, and postoperative complications, were compared in the two groups. Results. Clinicopathological characteristics did not differ\nbetween the BII Braun and RY groups. Mean length of operation was significantly longer in the RY than the BII Braun group\n(157.3 min versus 134.6 min, p < 0.010), but length of hospital stay, blood loss, and complication rate did not differ between the two\ngroups. Ileus occurred in three patients (10.0%) in the RY group. Endoscopic findings 6 months after surgery showed bile reflux\nin seven (28%) patients in the BII Braun group and five (17.2%) in the RY group (p = 0.343), but no significant differences in rate\nof gastric residue or degree of gastritis in the remnant stomach in the two groups. Conclusions. B-II Braun anastomosis is a good\nalternative to RY reconstruction, reducing length of operation and ileus after TLDG....
Background. There are several diagnostic methods for Helicobacter pylori (H. pylori) infection. A cost-effective analysis is needed to\ndecide on the optimal diagnostic method. The aim of this study was to determine a cost-effective diagnostic method in patients with\natrophic gastritis (AG). Methods. A decision-analysis model including seven diagnostic methods was constructed for patients with\nAG diagnosed by esophagogastroduodenoscopy. Expected values of cost and effectiveness were calculated for each test. Results. If\nthe prevalence of H. pylori in the patients with AG is 85% and CAM-resistant H. pylori is 30%, histology, stool H. pylori antigen\n(SHPAg), bacterial culture (BC), and urine H. pylori antibody (UHPAb) were dominated by serum H. pylori IgG antibody\n(SHPAb), rapid urease test (RUT), and urea breath test (UBT). Among three undominated methods, the incremental costeffective\nratios (ICER) of RUT versus SHPAb and UBT versus RUT were $214 and $1914, respectively. If the prevalence of\nCAM-sensitive H. pylori was less than 55%, BC was not dominated, but its H. pylori eradication success rate was 0.86.\nConclusions. RUT was the most cost-effective at the current prevalence of CAM-resistant H. pylori. BC could not be selected due\nto its poor effectiveness even if CAM-resistant H. pylori was more than 45%....
Background: Gastric cancer and gastric precancerous lesions are highly prevalent\nin China. However, prevalence of the different precancerous lesions has not\nbeen reported from the north-east region of China. Detection of precancerous\ngastric lesions at an early stage complemented with a follow-up strategy for high\nrisk groups would probably aid in declining the mortality rate in patients with\ngastric cancer. Helicobacter pylori infection, salt intake, smoking, alcohol, family\nhistory of gastric cancer, atrophic gastritis and intestinal metaplasia are established\nrisk factors of gastric cancer. The aim of this study was to evaluate the\nfrequency of various histopathological phenotypes among atrophic gastritis patients\nin this region and to report if gender and increasing age carry risk in the\ndevelopment of these lesions. Methods: This retrospective study was conducted\non 518 patients with endoscopic diagnosis of atrophic gastritis. Using the patient\nnumber in database, histopathological diagnosis of the biopsy specimen of\nall patients was recorded. All biopsy specimens were assessed for the presence of\ninflammation, atrophic gastritis, metaplasia and/or dysplasia. Results: Intestinal\nmetaplasia was observed in 67.38% of patients. Dysplasia and atrophy were\npresent in 9.46% and 3.67% patients, respectively. Gender and increasing age\nwere not found to be risk factors for intestinal metaplasia, dysplasia and atrophic\ngastritis (p-values 0.08, 0.43, 0.297 and 0.98, 0.20, 0.54; respectively). 19.49%\nsubjects showed inflammatory activity which was significantly associated with\nfemale gender (P = 0.0008). Conclusion: Intestinal metaplasia was the most\nhistopathological phenotype among endoscopically diagnosed atrophic gastritis\npatients. Large-population based on prospective studies should be designed to\ndetermine prevalence of precancerous lesions and the risk factors involved in the progression of these lesions in our region....
HIV infection is reportedly associated with an increased permeability of the intestinal epithelium and can cause HIV enteropathy,\nwhich occurs independently of opportunistic infections. However, the characteristics of small bowel abnormalities attributable\nto HIV infection are rarely investigated. In the present study, we assessed the intestinal mucosal changes found in HIVinfected\npatients and compared them with the mucosa of healthy control subjects using capsule endoscopy (CE). Three of\nthe 27 HIV-infected patients harbored gastrointestinal opportunistic infections and were thus excluded from subsequent\nanalyses. The endoscopic findings of CE in HIV-infected patients were significantly higher than those in control subjects\n(55% versus 10%, P = 0 002); however, most lesions, such as red spots or tiny erosions, were unlikely to cause abdominal\nsymptoms. After validating the efficacy of CE for the diagnosis of villous atrophy, we found that the prevalence of villous\natrophy was 54% (13/24) among HIV-infected patients. Interestingly, villous atrophy persisted in patients receiving long-term\nantiretroviral therapy, though most of them exhibited reconstituted peripheral blood CD4+ T cells. Although we could not draw\nany conclusions regarding the development of small bowel abnormalities in HIV-infected patients, our results may provide\nsome insight regarding the pathogenesis of HIV enteropathy....
Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE). Lately, several hemostatic\npowders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage\ntherapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488\nexaminations in 344 patientswere upperGI endoscopies).Hemospray was applied during 35 examinations in 27 patients (19 males),\n33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60%) and in 14 (40%) as\nsalvage therapy. Short-termsuccess was reached in 34 of 35 applications (97.1%),while long-termsuccess occurred in 23 applications\n(65.7%). Similar long-term results were found after primary application (64,3%) or salvage therapy (66,7%). Rebleeding was found\nin malignant and extended ulcers. One major adverse event (2.8%) occurred with gastric perforation after Hemospray application.\nDiscussion. Hemospray achieved short-termhemostasis in virtually all cases. The long-termeffect is mainly determined by the type\nof bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from\nhemodynamic stabilization and consecutive interventions in optimized conditions....
Backgroud: The detectable rate of minimal gastric GISTs has continuously increased. While the surveillance and\nmanagement of GIST <2 cm have been deemed controversial or lack evidence-based approaches. The aim of the\ncurrent study is to propose a cut-off value of tumor size for treatment policy and the appropriate timing for\nendoscopic ultrasonography (EUS) follow-up in the minimal EUS-suspected gastric GIST patients.\nMethods: A single-institution retrospective study was performed. 69 patients with EUS-suspected gastric GISTs were\nstudied from November 2008 to March 2015. 69 patients with minimal gastric GISTs ââ?°Â¤2 cm diagnosed by EUS were\nfollowed for a mean period of 29 months (range, 12 to 70). An at least 20% increase of the maximal diameter of\nthe tumors was set as a significant change.\nResults: During follow-up, Of the 69 minimal EUS-suspected GISTs, 16 (23.2%) showed significant changes in size.\n11 out of 69 GISTs (15.9%), 6 out of 43 GISTs (14.0%), 7 out of 30 GISTs (23.3%) showed significant changes in size,\nat 1 year, 2 years, and more than 3 years respectively. The receiver operating characteristic curve analysis showed\nthat the tumor size cut-off was 9.5 mm. Only 4.7 and 3.7% of gastric EUS-suspected GISTs of <9.5 mm in size\nshowed significant changes at 1 year and 2 years, while 9.5% at more than 3 years. 34.6, 31.3 and 55.6% of gastric\nEUS-suspected GISTs of ââ?°Â¥ 9.5 mm in size showed significant changes at 1 year, 2 years and more than 3 years.\nConclusions: Minimal EUS-suspected GISTs, larger than 9.5 mm may be associated with significant progression.\nThe patients with a ââ?°Â¥ 9.5 mm GIST should have a EUS 6ââ?¬â??12months, while <9.5 mm GIST may have a EUS\nextended to every 2ââ?¬â??3 years....
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