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Baimakhanov B, Zhurayev S, Shokebaev A, Orynbassar N, Imammyrzayev N, Kazakhstan K, Kanatov K, Yenin Y, Ismailova G. Clinical Outcome and Recurrence of Open versus Laparoscopic Nissen Fundoplication in the Republic of Kazakhstan during 2010-2021. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:22-29. [PMID: 38322163 PMCID: PMC10839139 DOI: 10.30476/ijms.2023.96685.2839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/24/2022] [Accepted: 12/24/2022] [Indexed: 02/08/2024]
Abstract
Background Surgical treatment of recurrent gastroesophageal reflux disease (GERD) negatively affects patients' quality of life (QoL). Determination of risk factors is essential when considering a surgical approach. The present study aimed to evaluate short-term and long-term outcomes of primary laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF), as well as the risks of laparoscopic redo fundoplication. Methods A retrospective cohort observational study was conducted from 2010 to 2021 at the National Research Center of Surgery (Almaty, Kazakhstan). Depending on the type of primary GERD surgical correction, 475 patients were stratified into two groups, namely LNF (n=117) and ONF (n=358). The outcomes and associated complications of LNF and ONF surgeries were assessed. The odds ratio of recurrent GERD in terms of risk factors was analyzed as well as post-intervention QoL. Results Postoperative complications in ONF surgery were 2.7-fold higher than in LNF (P=0.0001). Moreover, intra-operative complications were higher with ONF surgery (7.7%) than with LNF (1.4%) (P=0.002). In cases with persistent clinical manifestations, the rate of redo fundoplication was the same after failed primary LNF and ONF. The risk factors associated with recurrent GERD, leading to redo fundoplication, were obesity (OR=2.16, P=0.473) and male sex (OR=3.0, P=0.272). One-year after LNF, 88.7% of the patients were satisfied with the outcome of the surgery. Conclusion Recurrent symptoms of GERD and the rate of redo fundoplication were associated with obesity and the male sex. Obesity was the main risk factor, necessitating stringent selection of patients for surgical management of the disease.
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Affiliation(s)
- Bolatbek Baimakhanov
- Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Shakir Zhurayev
- Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Adil Shokebaev
- Department Gastrointestinal Tract and Endocrine Surgery, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Nurbol Orynbassar
- Department of the Gastrointestinal Tract and Endocrine Surgery, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Nurmakhan Imammyrzayev
- Department of the Gastrointestinal Tract and Endocrine Surgery, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Khozybek Kazakhstan
- Department of the Gastrointestinal Tract and Endocrine Surgery, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Kuanysh Kanatov
- Department of the Gastrointestinal Tract and Endocrine Surgery, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Yevgene Yenin
- Department of Pathomorphology, Cytology, Syzganov National Scientific Center of Surgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Gulziya Ismailova
- Department of Clinical Specialties, Higher School of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
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Chiappetta S, de Falco N, Lainas P, Kassir R, Valizadeh R, Kermansaravi M. Safety and efficacy of Roux-en-Y gastric bypass as revisional bariatric surgery after failed anti-reflux surgery: a systematic review. Surg Obes Relat Dis 2023; 19:1317-1325. [PMID: 37507338 DOI: 10.1016/j.soard.2023.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 07/30/2023]
Abstract
This systematic review evaluates the safety and efficacy of Roux-en-Y gastric bypass (RYGB) on weight loss and anti-reflux outcomes when used as a revisional bariatric surgical procedure after failed anti-reflux surgery. A systematic literature search next to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed for articles published by 30 Mar 2022. After examining 416 papers, 23 studies were included (n = 874 patients). Primary anti-reflux surgery included mainly Nissen fundoplication (16 studies). Reasons for revisional surgery included predominantly gastroesophageal reflux disease (GERD) (reported by 18 studies), obesity (reported by 6 studies), and hiatal hernia (reported by 6 studies). Interval to surgical revision was 5.58 ± 2.46 years (range, 1.5-9.4 yr). Upper endoscopy at revision was performed for all patients; esophageal manometry and pH monitoring were reported in 6 and 4 studies, respectively. Mean body mass index (BMI) at revision was 37.56 ± 5.02 kg/m2 (range, 31.4-44 kg/m2). Mean excess weight loss was 69.74% reported by 12 studies. Delta BMI reported by 7 studies was 10.41 kg/m2. The rate of perioperative complications was 16.7%, including mostly stenosis, leakage, ventral hernia, and small bowel obstruction. Mean improvement rate of GERD was 92.62% with a mean follow-up of 25.64 ± 16.59 months reported in 20 studies. RYGB seems to be an efficient surgical treatment option in failed anti-reflux procedures, but should be performed in experienced centers for selected patients, since the rate of perioperative and long-term complications must be minimized. Cooperation between bariatric and reflux surgeons is essential to offer patients with obesity and GERD the best long-term outcome.
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Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy.
| | - Nadia de Falco
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece; Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France; Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), INSERM, UMR 1188, Université de La Réunion, Saint Denis, France
| | | | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Braghetto I, Triadafilopoulos G, de Paula GA, Hevia M, Lanzarini E, Figueredo E, Durand L, Korn O. If Pills Don't Work, Try Staples: Surgery for Barrett's Esophagus Complicating Progressive Systemic Sclerosis. Dig Dis Sci 2023; 68:3879-3885. [PMID: 37634186 DOI: 10.1007/s10620-023-08064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Italo Braghetto
- Department of Surgery, University of Chile, Santos Dumont 999, Santiago, Chile.
| | | | | | - Macarena Hevia
- Gastroenterology Division, University of Chile, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, University of Chile, Santos Dumont 999, Santiago, Chile
| | | | - Luis Durand
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Owen Korn
- Department of Surgery, University of Chile, Santos Dumont 999, Santiago, Chile
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Bhat S, Dubey N, Gan SW, Frampton C, Stranz C, Prasad S, Barazanchi AWH, Kanhere H. Efficacy and safety of laparoscopic Roux-en-Y gastric bypass in symptomatic patients following fundoplication failure: a meta-analysis. Esophagus 2023; 20:184-194. [PMID: 36348250 DOI: 10.1007/s10388-022-00969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022]
Abstract
Revisional surgery may be required in a subset of patients who remain symptomatic despite undergoing laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD). While revisional LF (RLF) is feasible in these patients, laparoscopic Roux-en-Y gastric bypass (LRYGB) may serve as an alternative, although its efficacy and safety remains unknown. This study aimed to determine the outcomes of LRYGB in symptomatic patients following failed LF for GERD. MEDLINE, EMBASE, and PubMed databases were systematically searched for studies reporting LRYGB outcomes in symptomatic adults despite undergoing LF for GERD. Postoperative symptom resolution, recurrence of heartburn and dysphagia, proton pump inhibitor (PPI) use, and body mass index (BMI) reduction were assessed to determine LRYGB efficacy. Postoperative morbidity and mortality were used to evaluate LRYGB safety. Twenty-two studies with 1523 patients were included. Pooled rates of symptom resolution, recurrence of heartburn and dysphagia, PPI use, morbidity, and mortality were 71.6% (95% CI 59.4-86.4), 15.6% (8.9-27.3), 20.7% (12.5-34.3), 29.6% (18.8-46.5), 39.5% (29.9-52.3), and 2.2% (1.2-4.0), respectively, following LRYGB. Similar rates were observed after RLF. However, BMI reduction was significantly greater after LRYGB compared with RLF (mean difference 6.1 kg/m2, 4.8-7.4; p < 0.0001). LRYGB resulted in symptom relief in a majority of patients, and proved comparable to RLF regarding symptom recurrence and PPI use. Morbidity and mortality following LRYGB also did not differ from RLF. However, LRYGB was associated with considerably greater weight loss relative to RLF. Therefore, LRYGB is efficacious and an acceptable revisional procedure in symptomatic GERD patients who have previously undergone LF.
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Affiliation(s)
- Sameer Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1023, New Zealand
| | - Nandini Dubey
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1023, New Zealand
| | - Siang Wei Gan
- Department of General Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | | | - Conrad Stranz
- Department of General Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Shalvin Prasad
- Department of General Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Ahmed W H Barazanchi
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1023, New Zealand.
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Harsh Kanhere
- Department of General Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Division of Surgery, University of Adelaide, Adelaide, SA, 5005, Australia
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Braghetto I, Korn O, Figueroa-Giralt M, Valenzuela C, Burgos AM, Mandiola C, Sotomayor C, Villa E. LAPAROSCOPIC REDO FUNDOPLICATION ALONE, REDO NISSEN FUNDOPLICATION, OR TOUPET FUNDOPLICATION COMBINED WITH ROUX-EN-Y DISTAL GASTRECTOMY FOR TREATMENT OF FAILED NISSEN FUNDOPLICATION. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1678. [PMID: 36102488 PMCID: PMC9462863 DOI: 10.1590/0102-672020220002e1678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Laparoscopic Nissen fundoplication fails to control the gastroesophageal reflux in almost 15% of patients, and most of them must be reoperated due to postoperative symptoms. Different surgical options have been suggested. AIMS: This study aimed to present the postoperative outcomes of patients submitted to three different procedures: redo laparoscopic Nissen fundoplication alone (Group A), redo laparoscopic Nissen fundoplication combined with distal gastrectomy (Group B), or conversion to laparoscopic Toupet combined with distal gastrectomy with Roux-en-Y gastrojejunostomy (Group C). METHODS: This is a prospective study involving 77 patients who were submitted initially to laparoscopic Nissen fundoplication and presented recurrence of gastroesophageal reflux after the operation. They were evaluated before and after the reoperation with clinical questionnaire and objective functional studies. After reestablishing the anatomy of the esophagogastric junction, a surgery was performed. None of the patients were lost during follow-up. RESULTS: Persistent symptoms were observed more frequently in Group A or B patients, including wrap stricture, intrathoracic wrap, or twisted fundoplication. In Group C, recurrent symptoms associated with this anatomic alteration were infrequently observed. Incompetent lower esophageal sphincter was confirmed in 57.7% of patients included in Group A, compared to 17.2% after Nissen and distal gastrectomy and 26% after Toupet procedure plus distal gastrectomy. In Group C, despite the high percentage of patients with incompetent lower esophageal sphincter, 8.7% had abnormal acid reflux after surgery. CONCLUSIONS: Nissen and Toupet procedures combined with Roux-en-Y distal gastrectomy are safe and effective for the management of failed Nissen fundoplication. However, Toupet technique is preferable for patients suffering from mainly dysphagia and pain.
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Azzam RS, Azzam GB, Nasi A. WIRELESS PH MONITORING AND CONVENTIONAL ESOPHAGEAL PH MONITORING: COMPARATIVE STUDY OF DISCOMFORT, LIMITATIONS IN DAILY ACTIVITIES AND COMPLICATIONS. ACTA ACUST UNITED AC 2021; 34:e1566. [PMID: 34008710 PMCID: PMC8121045 DOI: 10.1590/0102-672020210001e1566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022]
Abstract
Background:
The catheter of the esophageal pH monitoring is associated with nasal and throat discomfort, and different behave in patients. The capsule of the wireless pH monitoring may cause chest pain and complications.
Aim:
To compare the wireless and conventional pH monitoring concerning the degree of discomfort and limitations in daily activities, complications, ability to diagnose pathological reflux, and costs.
Methods: Twenty-five patients with symptoms of gastroesophageal reflux were prospectively submitted, in a simultaneous initial period, to 24-hour catheter esophageal pH monitoring and 48-hour wireless system. After removing each system, patients underwent a specific clinical questionnaire.
Results:
Fifteen patients (60%) pointed a higher discomfort in the introduction of the capsule (p=0.327). Discomfort and limitations in daily activities were lower on 2nd day (p<0.05); however, continued to be expressive (32% to 44%). Chest pain occurred in 13 (52%) patients. The diagnostic gain of pathological reflux was 12% with the wireless system (p=0.355).
Conclusions:
1) There is no significant difference between the discomfort mentioned in the introduction of the capsule and the catheter; 2) during reflux monitoring, the wireless system provides significant less discomfort and limitations in daily activities; 3) there is no significant difference between the two methods in the ability to diagnose pathological reflux; 4) wireless pH monitoring has higher cost.
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Affiliation(s)
- Rimon Sobhi Azzam
- Hospital das Clínicas, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Ary Nasi
- Hospital das Clínicas, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Lopes LR, Chaim FHM, Santos IGG, Coelho Neto JDS, Tercioti V, Antonio Possato Ferrer J, Andreollo NA. Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus. JSLS 2021; 24:JSLS.2020.00061. [PMID: 33447006 PMCID: PMC7791092 DOI: 10.4293/jsls.2020.00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial. Methods Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital. Results Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months. Conclusions Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.
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Affiliation(s)
- Luiz Roberto Lopes
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Fabio Henrique Mendonça Chaim
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Isabella Gusson Galdino Santos
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - João de Souza Coelho Neto
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Valdir Tercioti
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - José Antonio Possato Ferrer
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Nelson Adami Andreollo
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
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Martins BC, Souza CS, Ruas JN, Furuya CK, Fylyk SN, Sakai CM, Ide E. ENDOSCOPIC EVALUATION OF POST-FUNDOPLICATION ANATOMY AND CORRELATION WITH SYMPTOMATOLOGY. ACTA ACUST UNITED AC 2021; 33:e1543. [PMID: 33470373 PMCID: PMC7812682 DOI: 10.1590/0102-672020200003e1543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/12/2020] [Indexed: 02/08/2023]
Abstract
Background:
Upper digestive endoscopy is important for the evaluation of patients
submitted to fundoplication, especially to elucidate postoperative symptoms.
However, endoscopic assessment of fundoplication anatomy and its
complications is poorly standardized among endoscopists, which leads to
inadequate agreement.
Aim:
To assess the frequency of postoperative abnormalities of fundoplication
anatomy using a modified endoscopic classification and to correlate
endoscopic findings with clinical symptoms.
Method:
This is a prospective observational study, conducted at a single center.
Patients were submitted to a questionnaire for data collection. Endoscopic
assessment of fundoplication was performed according to the classification
in study, which considered four anatomical parameters including the
gastroesophageal junction position in frontal view (above or at the level of
the pressure zone); valve position at retroflex view (intra-abdominal or
migrated); valve conformation (total, partial, disrupted or twisted) and
paraesophageal hernia (present or absent).
Results:
One hundred patients submitted to fundoplication were evaluated, 51% male
(mean age: 55.6 years). Forty-three percent reported postoperative symptoms.
Endoscopic abnormalities of fundoplication anatomy were reported in 46% of
patients. Gastroesophageal junction above the pressure zone (slipped
fundoplication), and migrated fundoplication, were significantly correlated
with the occurrence of postoperative symptoms. There was no correlation
between symptoms and conformation of the fundoplication (total, partial or
twisted).
Conclusion:
This modified endoscopic classification proposal of fundoplication anatomy is
reproducible and seems to correlate with symptomatology. The most frequent
abnormalities observed were slipped and migrated fundoplication, and both
correlated with the presence of symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Edson Ide
- Endoscopy Unit, Oswaldo Cruz German Hospital, São Paulo, SP, Brazil
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Camilo SMP, Almeida ÉCDS, Sousa JB, Camilo LP, Etchebehere RM. CHRONIC USE OF PROTON PUMP INHIBITORS AND THE QUANTITY OF G, D, AND ECL CELLS IN THE STOMACH. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2020; 33:e1506. [PMID: 32844883 PMCID: PMC7448853 DOI: 10.1590/0102-672020190001e1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acid inhibition from chronic proton pump inhibitor use and a possible increase in gastrin can lead to changes in the regulation of hydrochloric acid production. However, it has not known whether such chronic use changes the presence of gastrin, delta, and enterochromaffin-like cells in the stomach or the relationship between gastrin and delta cells. AIM To analyze the number of gastrin-producing gastrin cells, somatostatin-producing cells, and histamine-producing cells in patients who were chronic users of proton pump inhibitor, with or without related Helicobacter pylori infection. METHODS Biopsies from 105 patients, including 81 chronic proton pump inhibitor users (experimental group) and 24 controls, were processed immunohistochemically and subjected to counting of gastrin, delta, and enterochromaffin-like cells in high-magnification microscopic fields and in 10 glands. RESULTS Gastrin cell, delta cell, and enterochromaffin-like cells counts were similar across the groups and appeared to be unaffected by Helicobacter pylori infection. The ratio between gastrin cells and delta cells was higher in the chronic users of proton pump inhibitor group than in controls. CONCLUSION Chronic users of proton pump inhibitor does not affect gastrin cell, delta cell, and enterochromaffin-like cell counts significantly, but may alter the ratio between gastrin cells and delta cells.
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Affiliation(s)
- Silvia Maria Perrone Camilo
- Post-Graduate Program in Health Sciences, Clinical Hospital, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Élia Cláudia de Souza Almeida
- Post-Graduate Program in Health Sciences, Clinical Hospital, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Jacqueline Batista Sousa
- Post-Graduate Program in Health Sciences, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
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10
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Surgical Therapy of Esophagus Reflux Disease. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Fundoplication is the most frequently used action in the surgical treatment of gastroesophageal reflux disease (GERD). There are several types of fundoplication. The objective of our study was to identify complications after surgical treatment of GERD.
Material and Methods: We determined several parameters of the monitored and we recorded complications related to surgery: occurrence of surgical, early and late post-surgical complications.
Results: 52 patients (24 men and 28 women) with an average age of 53.3 years were included. The most frequently chosen type of fundoplication was Nissen-Rossetti. The most frequently occurring subjective post-surgery difficulties were temporal dysphagia (11.5%), sensation of nausea and vomiting after eating (3.8 %), pain in the surgical wound, and dyspnoea occurring in all patients after thoracotomy. Early post-surgery complication developed in 6 patients (11.5 %)
Conclusion: Occurrence of complications in the group monitored by us was up to 11.5 % and perioperative mortality was 0 %. Hiatal hernia is frequently found in patients with GERD and it is considered to be one of the major causes for the development of this disease.
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11
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Dib VRM, Ramos AC, Kawahara NT, Campos JM, Marchesini JC, Galvão-Neto M, Guimarães AGDP, Picanço-Junior AP, Domene CE. Does weight gain, throughout 15 years follow-up after Nissen laparoscopic fundoplication, compromise reflux symptoms control? ACTA ACUST UNITED AC 2020; 33:e1488. [PMID: 32428135 PMCID: PMC7236326 DOI: 10.1590/0102-672020190001e1488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Background:
Gastroesophageal reflux disease is defined by the abnormal presence of
gastric content in the esophagus, with 10% incidence in the Western
population, being fundoplication one treatment option. Aim:
To evaluate the early (six months) and late (15 years) effectiveness of
laparoscopic fundoplication, the long term postoperative weight changes, as
well as the impact of weight gain in symptoms control. Methods:
Prospective study of 40 subjects who underwent laparoscopic Nissen’s
fundoplication. Preoperatively and early postoperatively, clinical,
endoscopic, radiologic, manometric and pHmetric evaluations were carried
out. After 15 years, clinical and endoscopic assessments were carried out
and the results compared with the early ones. The presence or absence of
obesity was stratified in both early and late phases, and its influence in
the long-term results of fundoplication was studied, measuring quality of
life according to the Visick criteria. Results:
The mean preoperative ages, weight, and body mass index were respectively,
51 years, 69.67 kg and 25.68 kg/m2. The intraoperative and
postoperative complications rates were 12.5% and 15%, without mortality. In
the early postoperative period the symptoms were well controlled, hernias
and esophagitis disappeared, the lower esophageal sphincter had functional
improvement, and pHmetry parameters normalized. In the late follow-up 29
subjects were assessed. During this period there was adequate clinical
control of reflux regardless of weight gain. In both time periods Visick
criteria improved. Conclusion:
Fundoplication was safe and effective in early and late periods. There was
late weight gain, which did not influence effective symptoms control.
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12
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Degiovani M, Ribas CAPM, Czeczko NG, Parada AA, Fronchetti JDA, Malafaia O. IS THERE A RELATION BETWEEN HELYBACTER PYLORI AND INTESTINAL METAPLASIA IN SHORT COLUMN EPITELIZATION UP TO 10 MM IN THE DISTAL ESOPHAGUS? ACTA ACUST UNITED AC 2019; 32:e1480. [PMID: 31859933 PMCID: PMC6918731 DOI: 10.1590/0102-672020190001e1480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022]
Abstract
Background: The presence of intestinal metaplasia in the distal esophagus (Barrett’s esophagus) is an important precursor of adenocarcinoma. Knowledge of the risk factors and the process by which the Barrett develops is very important and Helicobacter pylori (HP) can contribute to this development. Aim: To analyze the impact of HP in the gastric mucosa with intestinal metaplasia in the distal esophagus in areas of columnar epithelialization smaller than 10 mm in length and epidemiological data on prevalence Method: A retrospective study in which were included 373 consecutive patients diagnosed with columnar epithelium in the distal esophagus was done. In all, HP was investigated by urease and histology, exclusion and inclusion factors were applied and patients were divided into two groups: the first grouping the ones without histological diagnosis of Barrett’s esophagus (235-63%) and the second with it (138-37%). Results: There was no significant difference between HP and non-HP patients in relation to the probability of having intestinal metaplasia (p=0.587). When related to the general group, there was an inverse association between the bacterium and the columnar epithelia in the distal esophagus. Age (p=0.031), gender (p=0.013) and HP (p=0.613) when related together to intestinal metaplasia showed no significant relation. In isolation, when related to age and gender, regardless of HP, results confirmed that patients in more advanced age and women present a higher incidence of intestinal metaplasia. Conclusion: There is an inverse relation between HP and the areas of columnar epithelization in the distal esophagus, regardless of the presence or absence of intestinal metaplasia. Age and gender, regardless of HP, showed higher prevalence in women and in older the number of cases with intestinal metaplasia in the distal esophagus.
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Affiliation(s)
- Matheus Degiovani
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil.,Digestive Endoscopy Service, 9 de Julho Hospital, São Paulo, SP, Brazil
| | | | - Nicolau Gregori Czeczko
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Artur Adolfo Parada
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil.,Digestive Endoscopy Service, 9 de Julho Hospital, São Paulo, SP, Brazil
| | - Juliana de Andrade Fronchetti
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
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