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Role of New Anatomy, Biliopancreatic Reflux, and Helicobacter Pylori Status in Postgastrectomy Stump Cancer. J Clin Med 2022; 11:jcm11061498. [PMID: 35329824 PMCID: PMC8952228 DOI: 10.3390/jcm11061498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/14/2023] Open
Abstract
Distal gastrectomy for benign gastroduodenal peptic disease has become rare, but it still represents a widely adopted procedure for advanced and, in some countries, even for early distal gastric cancer. Survival rates following surgery for gastric malignancy are constantly improving, hence the residual mucosa of the gastric stump is exposed for a prolonged period to biliopancreatic reflux and, possibly, to Helicobacter pylori (HP) infection. Biliopancreatic reflux and HP infection are considered responsible for gastritis and metachronous carcinoma in the gastric stump after oncologic surgery. For gastrectomy patients, in addition to eradication treatment for cases that are already HP positive, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the residual mucosa of any metaplastic-atrophic-dysplastic features following surgery.
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Kolli S, Mori A, Weissman S, Mehta TI, Dang-Ho KP, Shah J, Singh M, Reddy M, Suryanarayan A. Etiological Analysis of Reactive Gastropathy in an Urban Population. Gastrointest Tumors 2021; 8:115-120. [PMID: 34307309 DOI: 10.1159/000513610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background Reactive gastropathy (RG) is an adaptive response to assaults of the gastric mucosa. Demographic information regarding RG as well as the coincidence of RG and gastrointestinal cancer are poorly characterized entities. Objective Herein, we aim to investigate relationships of RG to both modifiable and nonmodifiable risk factors, as well as conduct a stratified analysis by race in an ethnically diverse, urban population. Methods In this retrospective study, we queried an urban hospital inpatient pathology database searching for patients with surgical gastric biopsies positive for RG between March 25, 2015, and March 25, 2016. Of the 728 patients with a final diagnosis of RG, 292 were selected based on strict inclusion and exclusion criteria. We explored risk factors and conducted a stratified analysis for associations based on patient demographics. Results In this urban minority population, nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication associated with RG (Fig. 1), as well as the most common cause of RG, followed by chronic bile reflux. In addition, significant differences in demographics and gastropathic characteristics associated with RG, stratified by ethnicity, were found (Fig. 2). Notably, Hispanics, African Americans, and Caucasians had the highest rate of concomitant RG and diabetes, hypertension, and tobacco/alcohol use, respectively. Conclusion Our study indicated that NSAID usage is the most common cause of RG, followed by bile reflux-mediated mucosal injury, in an ethnically diverse urban US-based population. Of note, few patients had intestinal metaplasia, suggesting it to be a slow or negligent sequela of RG.
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Affiliation(s)
- Sindhura Kolli
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Amit Mori
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, New Jersey, USA
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Khoi Paul Dang-Ho
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Jamil Shah
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Manpreet Singh
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Madhavi Reddy
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Anand Suryanarayan
- Department of Gastroenterology, NYU Brooklyn Hospital, Brooklyn, New York, USA
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Chen Q, Zhong Q, Zhou J, Qiu X, Dang X, Cai L, Su G, Xu D, Lin G, Guo K, Liu Z, Chen Q, Li P, Li T, Xie J, Lin S, Wang J, Lin J, Lu J, Cao L, Lin M, Zheng C, Lin W, He Q, Huang C. Conditional survival and recurrence of remnant gastric cancer after surgical resection: A multi-institutional study. Cancer Sci 2020; 111:502-512. [PMID: 31710406 PMCID: PMC7004538 DOI: 10.1111/cas.14231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022] Open
Abstract
The present study was designed to evaluate the dynamic survival and recurrence of remnant gastric cancer (RGC) after radical resection and to provide a reference for the development of personalized follow-up strategies. A total of 298 patients were analyzed for their 3-year conditional overall survival (COS3), 3-year conditional disease-specific survival (CDSS3), corresponding recurrence and pattern changes, and associated risk factors. The 5-year overall survival (OS) and the 5-year disease-specific survival (DSS) of the entire cohort were 41.2% and 45.8%, respectively. The COS3 and CDDS3 of RGC patients who survived for 5 years were 84.0% and 89.8%, respectively. The conditional survival in patients with unfavorable prognostic characteristics showed greater growth over time than in those with favorable prognostic characteristics (eg, COS3, ≥T3: 46.4%-83.0%, Δ36.6% vs ≤T2: 82.4%-85.7%, Δ3.3%; P < 0.001). Most recurrences (93.5%) occurred in the first 3 years after surgery. The American Joint Committee on Cancer (AJCC) stage was the only factor that affected recurrence. Time-dependent Cox regression showed that for both OS and DSS, after 4 years of survival, the common prognostic factors that were initially judged lost their ability to predict survival (P > 0.05). Time-dependent logistic regression analysis showed that the AJCC stage independently affected recurrence within 2 years after surgery (P < 0.05). A postoperative follow-up model was developed for RGC patients. In conclusion, patients with RGC usually have a high likelihood of death or recurrence within 3 years after radical surgery. We developed a postoperative follow-up model for RGC patients of different stages, which may affect the design of future clinical trials.
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Yoon K, Kim N, Kim J, Lee JW, Lee HS, Lee JC, Yoon H, Shin CM, Park YS, Ahn SH, Park DJ, Kim HH, Lee YJ, Lee KH, Kim YH, Lee DH. Dynamic Changes in Helicobacter pylori Status Following Gastric Cancer Surgery. Gut Liver 2017; 11:209-215. [PMID: 27840366 PMCID: PMC5347644 DOI: 10.5009/gnl16224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Helicobacter pylori eradication is recommended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for "retesting" postoperative H. pylori status. Methods Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were assessed pre- and postoperatively. Results One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for H. pylori, and 60 (42.9%) showed spontaneous negative conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group. Conclusions A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individuals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori.
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Affiliation(s)
- Kichul Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul Adventist Hospital, Seoul, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyeon Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Won Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Ueo T, Yonemasu H, Yao K, Ishida T, Togo K, Yanai Y, Fukuda M, Motomura M, Narita R, Murakami K. Histologic differentiation and mucin phenotype in white opaque substance-positive gastric neoplasias. Endosc Int Open 2015; 3:E597-604. [PMID: 26716119 PMCID: PMC4683146 DOI: 10.1055/s-0034-1393177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The authors previously reported that the white opaque substance (WOS) in gastric epithelial neoplasia was caused by accumulation of lipid droplets by immunohistochemical and immunoelectron microscopic studies of adipophilin, which was recently identified and validated as a marker of lipid droplets. The aim of the current study was to investigate the characteristics of the histologic differentiation and mucin phenotype in WOS-positive gastric epithelial neoplasias. PATIENTS AND METHODS A total of 130 gastric epithelial neoplasias (45 adenomas and 85 early adenocarcinomas) from 120 patients were retrospectively evaluated. The presence or absence of WOS was evaluated by M-NBI. Lipids were examined by immunohistochemical staining for adipophilin. Tissue phenotypes were immunohistochemically classified as intestinal (I), gastrointestinal (GI), and gastric (G) using antibodies against CD10, MUC2, MUC5AC and MUC6. The histologic differentiation and mucin phenotype of WOS-positive neoplasias were characterized and examined according to adipophilin expression. RESULTS The presence of WOS by M-NBI was correlated with histologic differences between adenoma or differentiated type adenocarcinoma and mixed type or undifferentiated type adenocarcinoma (P = 0.0153). Adipophilin was only expressed in primary adenoma and well to moderately differentiated adenocarcinoma components but not in undifferentiated components. WOS and adipophilin expression were only observed in neoplasias with I or GI phenotypes, but not in those with the G phenotype (P < 0.0001). CONCLUSIONS WOS in gastric epithelial neoplasias might indicate differentiation into a mature histological subtype with GI or I mucin phenotype.
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Affiliation(s)
- Tetsuya Ueo
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | | | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Japan
| | - Tetsuya Ishida
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | - Kazumi Togo
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | - Yuka Yanai
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | - Masahide Fukuda
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | | | - Ryoich Narita
- Department of Gastroenterology, Oita Red Cross Hospital, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
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Response to: oesophageal adenocarcinoma and atrophic gastritis - different viewpoints on the junction. Eur J Gastroenterol Hepatol 2015; 27:985-6. [PMID: 26114912 DOI: 10.1097/meg.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Weledji EP, Enow Orock G, Ngowe MN. Intestinal metaplasia and anastomotic recurrence of gastric carcinoma. J Gastrointest Oncol 2014; 5:474-80. [PMID: 25436128 DOI: 10.3978/j.issn.2078-6891.2014.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 06/29/2014] [Indexed: 12/16/2022] Open
Abstract
Intestinal metaplasia (IM) of the stomach has been shown to increase the relative risk of gastric cancer. Endoscopic surveillance has been proposed and advocated for populations at risk. Those patients who had undergone surgery for gastric malignancy exhibited precancerous lesions such as atrophic gastritis and IM, and the possibility of anastomotic recurrence is higher than for the patients who had undergone benign gastric surgery. At present, there are no other recognized good markers of gastric dysplasia or cancer. We reviewed the literature on IM of the stomach to ascertain whether residual premalignant (type III) IM may predispose to anastomotic recurrence of gastric cancer.
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Affiliation(s)
- Elroy Patrick Weledji
- 1 Department of Surgery, 2 Department of Pathology, Faculty of Health Sciences, University of Buea, Buea, S.W. Region, Cameroon
| | - George Enow Orock
- 1 Department of Surgery, 2 Department of Pathology, Faculty of Health Sciences, University of Buea, Buea, S.W. Region, Cameroon
| | - Marcelin Ngowe Ngowe
- 1 Department of Surgery, 2 Department of Pathology, Faculty of Health Sciences, University of Buea, Buea, S.W. Region, Cameroon
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8
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Miyashita T, Miwa K, Inokuchi M, Nakagawara H, Tajima H, Takamura H, Ninomiya I, Kitagawa H, Fushida S, Fujimura T, Hattori T, Ohta T. Spontaneous clearance of Helicobacter pylori after pylorus-preserving gastrectomy for gastric cancer. Oncol Rep 2013; 30:299-303. [PMID: 23673508 DOI: 10.3892/or.2013.2472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/08/2013] [Indexed: 12/24/2022] Open
Abstract
Residual mucosa in the gastric stump after pylorus-preserving gastrectomy (PPG) is considered a risk factor for the development of gastric stump carcinoma (GSC). Duodenogastric reflux (DGR) and Helicobacter pylori (H. pylori) infection are suspected to contribute to the development of GSC. The aim of this study was to investigate the prevalence of H. pylori in the residual stomach after PPG for gastric cancer and to assess factors associated with the presence of H. pylori. We investigated 72 patients who had undergone PPG at least 1 year prior to the study and were confirmed to be positive for H. pylori infection on presurgical endoscopic biopsy. The extent of DGR, the prevalence of H. pylori infection based on H. pylori stool antigen (HpSA) tests and the severity of gastritis were analyzed in these post-PPG patients. None of the patients had DGR, as shown by (99m)Tc-PMT. Of the 72 post-PPG patients, 33 (46%) were positive for HpSA. The prevalence of H. pylori infection was significantly lower after surgery than before surgery. The endoscopic severity of remnant gastritis, as well as histological inflammation and activity, were higher in H. pylori-positive patients than in H. pylori-negative patients. In conclusion, some patients who undergo PPG and are negative for DGR experience spontaneous clearance of H. pylori infection.
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Affiliation(s)
- Tomoharu Miyashita
- Department of Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan.
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9
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Zhang Y, Yang X, Gu W, Shu X, Zhang T, Jiang M. Histological features of the gastric mucosa in children with primary bile reflux gastritis. World J Surg Oncol 2012; 10:27. [PMID: 22289498 PMCID: PMC3278363 DOI: 10.1186/1477-7819-10-27] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/31/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Bile reflux is one of the primary factors involved in the pathogenesis of gastric mucosal lesions in patients with chronic gastritis; however, little is known about the exact histological features of bile reflux and its contributions to gastric mucosal lesions in this disease, especially in children with primary bile reflux gastritis (BRG). The aim of this study was to investigate the classic histological changes of the gastric mucosa in children with primary BRG. METHODS The Bilitec 2000 was used for 24 h monitoring of gastric bile in 59 children with upper gastrointestinal symptoms. The histological characteristics of the gastric mucosa were examined and scored. RESULTS Thirteen of the 59 patients had a helicobacter pylori infection and were excluded; therefore, 46 cases were included in this study. The positive rate of pathological duodenogastric reflux was significantly higher in patients with foveolar hyperplasia than those without foveolar hyperplasia; however, the rate was significantly lower in patients with vascular congestion than those without vascular congestion. The longest reflux time and the total percentage time of bile reflux were significantly lower in patients with vascular congestion than those without vascular congestion. A total of 9 types of histological changes were analyzed using a binary logistic regression. Foveolar hyperplasia and vascular congestion in the superficial layer became significant variables in the last step of the stepwise regression. CONCLUSIONS Foveolar hyperplasia was associated with the severity of bile reflux, suggesting that it is a histological feature of primary BRG in children, while vascular congestion may be a protective factor.
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Affiliation(s)
- Yanyi Zhang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou 310003, P.R. China
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Choi BW, Zeon SK, Kim SH, Jo I, Kim HW, Won KS. Significance of SUV on Follow-up F-18 FDG PET at the Anastomotic Site of Gastroduodenostomy after Distal Subtotal Gastrectomy in Patients with Gastric Cancer. Nucl Med Mol Imaging 2011; 45:285-90. [PMID: 24900019 DOI: 10.1007/s13139-011-0105-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 08/16/2011] [Accepted: 08/22/2011] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aim of this study was to characterize the patterns of fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography/computed tomography (FDG PET/CT) at the anastomotic site of gastroduodenostomy after distal subtotal gastrectomy in patients with gastric cancer. METHODS From May 2007 to May 2010, two or more follow-up measurements using FDG PET/CT scans were done for 19 patients (11 men, 8 women; mean age, 62.0 ± 10.3 years) who underwent distal subtotal gastrectomy with gastroduodenostomy between February 2006 and March 2008 for detecting gastric cancer recurrence at our medical center. The FDG PET/CT images were retrospectively reviewed. Patients with local recurrence, regional nodal metastasis or distant metastasis on follow-up studies were excluded. CT and endoscopy were done within 1 month before or after the FDG PET/CT scan. Eight patients had two follow-ups of FDG PET/CT, and 11 patients had three follow-ups. The mean interval between surgery and the first follow-up FDG PET/CT was 12.9 ± 0.8 months (n = 19); between the first and second it was 12.3 ± 1.0 months (n = 19); between the second and third it was 11.6 ± 0.7 months (n = 11). The F-18 FDG uptakes at the anastomotic site and fundus in the remnant stomach were measured by maximum standardized uptake value (SUVmax) using a region of interest technique. RESULTS The SUVmax at the anastomotic site was significantly higher than that of the fundus on all series of first, second and third follow-up studies (3.3 ± 1.1 vs. 2.1 ± 0.7, p < 0.001: 3.1 ± 0.9 vs. 2.2 ± 0.7, p = 0.001: 3.0 ± 0.6 vs. 2.1 ± 0.7, p = 0.006, respectively). The SUVmax for the anastomotic site and fundus, and SUVmax ratio for the anastomotic site over the fundus were not significantly different throughout the series. CONCLUSION The SUVmax at the anastomotic site is significantly higher than that of the fundus and does not decrease significantly over time. Therefore, the local recurrence of gastric cancer after surgery could not be definitely differentiated from physiologic uptake or postoperative inflammatory change.
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Affiliation(s)
- Byung Wook Choi
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
| | - Seok Kil Zeon
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
| | - Sung Hun Kim
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
| | - Il Jo
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
| | - Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea
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Ahsberg K, Olsson H, Staël von Holstein C. Increased mortality in prostate carcinoma and smoking-related disease after parietal cell vagotomy: a long-term follow-up study. Scand J Gastroenterol 2010; 44:947-51. [PMID: 19530033 DOI: 10.1080/00365520903039945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE There is an increased risk of gastrointestinal carcinoma and smoking-related diseases after partial gastrectomy for peptic ulcer disease. The purpose of this study was to evaluate long-term cancer incidence and mortality after parietal cell vagotomy (PCV), a surgical method with a low rate of side effects, but creating hypochlorhydria in the stomach mimicking long-term treatment with antisecretory drugs. MATERIAL AND METHODS Data on 383 ulcer patients operated on with PCV during 1971-80 at Lund University Hospital were compared with the national registers for cause of death and cancer incidence for selected diagnoses. Median follow-up was 28 years and 31 years, respectively. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated. RESULTS An increased incidence of cancer in the respiratory organs (SIR 1.97, 95% CI: 1.08-3.31) and prostate carcinoma (SIR 1.85, 95% CI: 1.22-2.69) was found, and among men also an increased mortality in prostate carcinoma (SMR 3.85, 95% CI: 1.41-8.38) and chronic respiratory disease (SMR 2.76, 95% CI: 1.01-6.02). Overall mortality was similar to that of the background population and no increased risk of gastrointestinal malignancies was observed. CONCLUSIONS Patients with peptic ulcer operated on with PCV have a long-term increased risk of smoking-related diseases, but PCV does not seem to increase the risk of gastrointestinal carcinoma. An increased risk of, and mortality in prostate carcinoma was found, a cancer previously not found to be related to smoking. This might be the result of surgery-induced hypochlorhydria, which warrants further investigation in patients on long-term proton-pump inhibitors.
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Bair MJ, Wu MS, Chang WH, Shih SC, Wang TE, Chen CJ, Lin CC, Liu CY, Chen MJ. Spontaneous Clearance of Helicobacter pylori Colonization in Patients with Partial Gastrectomy: Correlates with Operative Procedures and Duration After Operation. J Formos Med Assoc 2009; 108:13-9. [DOI: 10.1016/s0929-6646(09)60027-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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13
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Li XB, Lu H, Chen HM, Chen XY, Ge ZZ. Role of bile reflux and Helicobacter pylori infection on inflammation of gastric remnant after distal gastrectomy. J Dig Dis 2008; 9:208-12. [PMID: 18959592 DOI: 10.1111/j.1751-2980.2008.00348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The influence of the main pathogenic factors on remnant gastritis is still to be evaluated. The aim of this study was to investigate the role of bile reflux and Helicobacter pylori infection on endoscopic inflammation and histological changes of gastric remnant after distal gastrectomy. METHODS A total of 281 patients with a more than 1-year history of distal gastrectomy were retrospectively involved after excluding those with tumors and ulcers on endoscopy. The severity of endoscopic remnant gastritis and bile reflux were recorded during the endoscopy. The histological changes including chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori were evaluated independently. RESULTS An endoscopic inflammation of remnant gastric mucosae was found in 81.1% (228/281) of the patients. The prevalence of H. pylori infection and bile reflux in patients with endoscopic remnant gastritis was more common than in those without gastritis (21.5%vs 0%, 88.6%vs 24.5%, P < 0.0001). The score of histological chronic inflammation was significantly higher in patients with bile reflux than in those without obvious bile reflux (1.65 vs 1.45, P = 0.02). Chronic inflammation (1.82 vs 1.57), activity (0.78 vs 0.34), atrophy (0.67 vs 0.41) and intestinal metaplasia (0.67 vs 0.27) in H. pylori-positive patients were all significantly more severe than in H. pylori-negative patients. CONCLUSION Bile reflux and H. pylori infection exacerbates the severity of endoscopic remnant gastritis and chronic histological inflammation.
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Affiliation(s)
- Xiao Bo Li
- Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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14
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Laiyemo AO, Smoot DT. Metastatic gastric stump cancer occurring six years after a partial gastrectomy for gastric ulcer. J Natl Med Assoc 2008; 100:737-9. [PMID: 18595579 DOI: 10.1016/s0027-9684(15)31352-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastric stump cancer (GSC) is known to occur following partial gastrectomy for benign diseases. The risk is believed to increase four-to-five-fold 20 years after gastrectomy. We report a 41-year-old man with metastatic adenocarcinoma of the gastric stump six years after he underwent a partial gastrectomy for a gastric ulcer, following a major rebleeding episode. We highlight the need for identification of patients at risk of developing gastric stump cancer-especially as it has now been described in patients who underwent gastric bypass surgery for obesity-a population that continues to increase.
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Affiliation(s)
- Adeyinka O Laiyemo
- Cancer Prevention Fellowship Program, Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA.
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Park JH, Lee JH, Rhee PL, Kim JJ, Rhee JC, Kim S, Park CK. Endoscopic Screening for Remnant Gastric Cancer: Points to be Considered. Gut Liver 2007; 1:22-6. [PMID: 20485654 DOI: 10.5009/gnl.2007.1.1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 04/28/2007] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS It is difficult to detect early gastric cancer (EGC) during endoscopic surveillance because the remnant stomach is usually deformed after surgical resection and the mucosa at the gastric stump are changed due to bile reflux. In this study, we aimed to determine the characteristic endoscopic findings of cancer in the remnant stomach. METHODS Fifty-five remnant gastric cancer (RGC) patients were classified into three groups according to location and elapsed time after surgery. Among 32 RGCs that developed less than 10 years after surgery, 21 lesions were located close to the anastomosis site (recurrent cancers), whereas 11 lesions were not (residual cancers). Twenty-three cancers developed at least 10 years after surgery (newly developed cancers). The endoscopic features were compared among these groups. RESULTS Most patients (29/32, 91%) with residual or recurrent cancer developed their tumors within five years after surgery, and the proportion of EGC was 43.8% (14/32). However, 91.3% (21/23) of newly developed cancers were advanced gastric cancers. When classified according to the Japanese classification system for EGC, 71% (5/7) of the residual cancers were of the elevated type, whereas 86% (6/7) of the recurrent cancers were of the depressed type (p=0.00). CONCLUSIONS During the first 5 years after subtotal gastrectomy, endoscopists should mainly try to find depressed lesions on the anastomosis site as well as elevated lesions on the non-anastomosis site.
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Affiliation(s)
- Jung Ho Park
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Sinning C, Schaefer N, Standop J, Hirner A, Wolff M. Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol 2006; 33:133-9. [PMID: 17071041 DOI: 10.1016/j.ejso.2006.09.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 09/06/2006] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come. METHODS The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search. RESULTS Patients subjected to distal gastric resection have a 4-7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori. CONCLUSION The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.
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Affiliation(s)
- C Sinning
- Department of Surgery, University of Bonn, Sigmund-Freud-Strasse 25, Bonn D-53105, Germany
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KATO S, MATSUKURA N, MATSUDA N, TSUKADA K, NAITO Z, TAJIRI T. Helicobacter pylori eradication therapy modulates acidity and interleukin-1beta mRNA levels in un-operated stomach and in remnant stomach after gastrectomy in gastric cancer patients. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1746-6342.2006.00057.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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18
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Xing C, Kato S, Matsukura N, Matsuda N, Xu H, Takashi E, Yamada N, Naito Z, Tajiri T. Interleukin-8, cyclo-oxygenase-2, and trefoil factor family 1 gene expression and their association with Helicobacter pylori infection in the remnant stomach. Surg Today 2006; 35:1026-32. [PMID: 16341482 DOI: 10.1007/s00595-005-3075-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 03/15/2005] [Indexed: 12/13/2022]
Abstract
PURPOSE The risk factors for secondary stomach carcinogenesis after distal gastrectomy have not been evaluated in detail. METHODS Using gastrointestinal endoscopy, we examined 112 patients who had undergone gastrectomy. Biopsy specimens were taken from the stoma and the upper corpus mucosa in the remnant stomach to examine the associations among Helicobacter pylori (H.pylori) infection, bile reflux, and the expressions of interleukin-8 (IL-8), cyclo-oxygenase-2 (COX-2), and trefoil factor family 1 (TFF1) genes in the stomach mucosa. RESULTS The IL-8 levels in the corpus mucosa were significantly higher in the H.pylori-positive patients than in the H.pylori-negative patients (P = 0.015). The IL-8 levels were significantly higher in the stomal mucosa than in the corpus mucosa in the H.pylori-positive patients (P = 0.047). The COX-2 levels in the corpus mucosa tended to be higher in the H.pylori-positive patients, but these levels were not significantly different in the stoma mucosa. The COX-2 levels in the corpus were significantly higher after Billroth II (BII) anastomosis than after Billroth I (BI) anastomosis (P = 0.041). TFF1 expression in the stoma was higher in the H.pylori-positive patients than in the H.pylori-negative patients, but the difference was not significant. CONCLUSIONS Both H.pylori infection and bile reflux increased IL-8 levels after BI anastomosis. Furthermore, COX-2 levels were higher after BII than after BI anastomosis. These indicators will become useful not only as biomarkers to predict the degree of inflammation in the stomach mucosa, but also as surrogate biomarkers to predict the risk of secondary stomach carcinogenesis in the remnant stomach mucosa.
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Affiliation(s)
- Chengzhong Xing
- Department of Surgery for Organ Function and Biological Regulation, Nippon Medical School, 1-1-5 Sendagi, Tokyo, 113-8603, Japan
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Abstract
In this article, key concepts in gastric anatomy and physiology are reviewed. Attention is given to historical development of concepts of acid secretion, to the role of stomach in digestion, and to the mechanisms that protect gastric mucosa from acid and hostile luminal conditions. Evolving ideas that may influence understand-ing of the physiologic consequences of emerging therapeutics, and procedures that target anatomy or function of the stomach are also reviewed.
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Affiliation(s)
- David I Soybel
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA.
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N/A, 吕 宾, 汪 晓, 徐 毅, 范 一, 孙 翠. N/A. Shijie Huaren Xiaohua Zazhi 2005; 13:1353-1355. [DOI: 10.11569/wcjd.v13.i11.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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21
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Chen SL, Mo JZ, Cao ZJ, Chen XY, Xiao SD. Effects of bile reflux on gastric mucosal lesions in patients with dyspepsia or chronic gastritis. World J Gastroenterol 2005; 11:2834-7. [PMID: 15884134 PMCID: PMC4305928 DOI: 10.3748/wjg.v11.i18.2834] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis.
METHODS: A total of 49 patients diagnosed with dyspepsia and chronic gastritis underwent 24-h ambulatory and simultaneous monitoring of intragastric bilirubin absorbance and pH values, and then they were divided into bile reflux positive group and bile reflux negative group. Severity of pathological changes in gastric mucosa including active inflammation, chronic inflammation, intestinal metaplasia, atrophy and dysplasia as well as Helicobacter pylori (H pylori) infection at the corpus, incisura and antrum were determined respectively according to update Sydney system criteria. The profiles of gastric mucosal lesions in the two groups were compared, and correlations between time-percentage of gastric bilirubin absorbance >0.14 and severity of gastric mucosal lesions as well as time-percentage of gastric pH >4 were analyzed respectively.
RESULTS: Thirty-eight patients (21 men and 17 women, mean age 44.2 years, range 25-61 years) were found existing with bile reflux (gastric bilirubin absorbance >0.14) and 11 patients (7 men and 4 women, mean age 46.2 years, range 29-54 years) were bile reflux negative. In dyspepsia patients with bile reflux, the mucosal lesions such as active inflammation, chronic inflammation, intestinal metaplasia, atrophy or H pylori infection in the whole stomach, especially in the corpus and incisura, were significantly more severe than those in dyspepsia patients without bile reflux. Moreover, the bile reflux time was well correlated with the severity of pathological changes of gastric mucosa as well as H pylori colonization in the near-end stomach, especially in the corpus region. No relevance was found between the time of bile reflux and pH >4 in gastric cavity.
CONCLUSION: Bile reflux contributes a lot to mucosal lesions in the whole stomach, may facilitate H pylori colonization in the corpus region, and has no influence on acid-exposing status of gastric mucosa in patients with dyspepsia or chronic gastritis.
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Affiliation(s)
- Sheng-Liang Chen
- Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.
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22
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Nakase Y, Sakakura C, Miyagawa K, Kin S, Fukuda K, Yanagisawa A, Koide K, Morofuji N, Hosokawa Y, Shimomura K, Katsura K, Hagiwara A, Yamagishi H, Ito K, Ito Y. Frequent loss of RUNX3 gene expression in remnant stomach cancer and adjacent mucosa with special reference to topography. Br J Cancer 2005; 92:562-9. [PMID: 15685235 PMCID: PMC2362072 DOI: 10.1038/sj.bjc.6602372] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 12/02/2004] [Accepted: 12/09/2004] [Indexed: 02/08/2023] Open
Abstract
Our previous studies suggest that a lack of RUNX3 function is causally related to the genesis and progression of human gastric cancer. This study was conducted to determine whether alteration of RUNX3 gene expression could be detected in the normal-looking gastric remnant mucosa, and to ascertain any difference in the potential of gastric carcinogenesis between the anastomotic site and other areas in the remnant stomach after distal gastrectomy for peptic ulcer (RB group) or gastric cancer (RM group), by analysing RUNX3 expression with special reference to topography. A total of 89 patients underwent distal gastrectomy for gastric cancer from the intact stomach (GCI group) and 58 patients underwent resection of the remnant stomach for gastric cancer (RB group: 34 cases, RM group: 24 cases). We detected RUNX3 and gene promoter methylation by in situ hybridisation, quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), and methylation-specific PCR. The interval between the initial surgery and surgery for remnant gastric cancer (interval time) was 10.4 years in the RM group, and 27.5 years in the RB group. Cancers in the RB group were significantly more predominant in the anastomosis area (P<0.05). Within the tumour, downregulation of RUNX3 expression ranged from 74.7 to 85.7% in the three groups. The rate of downregulation of RUNX3 of adjacent mucosa was 39.2% (11 in 28 cases) in RB and 47.6% (10 in 21 cases) in RM, which are significantly higher than that of the GCI group (19.5%, 17 in 87 cases). In noncancerous mucosa of the remnant stomach in the RB group, RUNX3 expression decreased more near the anastomosis area. In the RM group, however, there were no significant differences in RUNX3 expression by sampling location. Based on RUNX3 downregulation and clinical features, residual stomach mucosa of the RM group would have a higher potential of gastric carcinogenesis compared to the RB or GCI group. Gastric stump mucosa of the RB group has higher potential especially than other areas of residual stomach mucosa. Measurement of RUNX3 expression and detection of RUNX3 methylation in remnant gastric mucosa may estimate the forward risk of carcinogenesis in the remnant stomach.
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Affiliation(s)
- Y Nakase
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - C Sakakura
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - K Miyagawa
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - S Kin
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - K Fukuda
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - A Yanagisawa
- Department of Pathology, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Koide
- Department of Surgery , Kyoto First Red Cross Hospital, Kyoto, Japan
| | - N Morofuji
- Department of Surgery , Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Y Hosokawa
- Department of Pathology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - K Shimomura
- Department of Surgery, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - K Katsura
- Department of Pathology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - A Hagiwara
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - H Yamagishi
- Department of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Surgery and Regenerative Medicine, Kyoto, Japan
| | - K Ito
- Institute of Molecular and Cell Biology and Oncology Research Institute, National University of Singapore, 30 Medical Drive, Singapore 117609, Singapore
| | - Y Ito
- Institute of Molecular and Cell Biology and Oncology Research Institute, National University of Singapore, 30 Medical Drive, Singapore 117609, Singapore
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23
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Zhang C, Liu ZK, Yu PW. Effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation. World J Gastroenterol 2004; 10:1537-9. [PMID: 15133869 PMCID: PMC4656300 DOI: 10.3748/wjg.v10.i10.1537] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate the effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation.
METHODS: Concenration of bile acid and total bacterial counts (TBC) in gastric juice were measured in 49 patients with peptic ulcer before and after gastrectomy. One year after the operation, sample of gastric mucosa taken from all the patients were used for histological examination.
RESULTS: The concentration of gastric bile acid was significantly increased in group B-I, or B-II and SV + A than that in group HSV (P < 0.05-0.01). The abnormal histological changes in the remnant gastric mucosa were more common in the first 2 groups than in the last group.
CONCLUSION: The type of gastrtectomy can affect bile reflux. The abnormal histological changes in the remnant gastric mucosa are closely related to the elevation of bile acid concentration and increase of TBC in gastric juice. HSV can effectively prevent bile reflux and keep the gastric physiological functions stable.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Southwest Hospital, Third Military Medical University, Gaotan Yan, Chongqing 400038, China.
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