No abstract available.
Adenocarcinoma* ; Barrett Esophagus* ; Bile Reflux* ; Bile*

BACKGROUND/AIMS: The role of Helicobacter pylori in bile reflux gastritis (BRG) is uncertain. We show the role of H. pylori and pathology in BRG. METHODS: Thirty seven patients, including 5 patients who had undergone subtotal gastrectomy, were diagnosed with BRG by gastroscopic findings of bile-stained mucosa with hyperemia/ erosions. We measured total bile acid (TBA) concentration and compared the H. pylori positivity between BRG patients and 70 non-BRG patients. We showed how often we could see the pathologic findings of reactive gastritis in BRG and compared the grade of lymphoplasma cell and neutrophil infiltration between H. pylori positive and negative group in BRG. RESULTS: TBA concentration of 10 patients was 7,376.7+/-5,482.6micro mol/L. H. pylori positive rate of BRG was 45.9% and that of non-BRG was 70% (p=0.015). The gastric pit elongation and tortuosity were found only in 3 cases with gastric surgery. The grade of lymphoplasma cell and neutrophil infiltration was 2.41+/-0.51 and 1.88+/-0.86 in H. pylori positive BRG and 1.55+/-0.69 and 0.55+/-0.76 in H. pylori negative BRG, respectively (p<0.001). CONCLUSIONS: H. pylori infection in BRG was lower than that in non-BRG. The gastric pit elongation and tortuosity of BRG were not seen often. The lymphoplasma cell and neutrophil infiltration were relatively sparse in H. pylori negative BRG.
Bile Reflux* ; Bile* ; Duodenogastric Reflux ; Gastrectomy ; Gastritis* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Mucous Membrane ; Neutrophil Infiltration ; Pathology

BACKGROUND/AIMS: It is suggested that postsurgical gastritis is mainly caused by the enterogastric reflux, but the pathogenesis and association with symptoms are not clearly established. The aims of this study were to investigate the role of duodenogastric reflux in postsurgical gastritis and to evaluate the relationship between an intragastric pH study and an intragastric bile reflux study. METHODS: The 33 patients with Billroth-II gastrectomy and 10 healthy volunteers were enrolled. After the endoscopy, we performed a simultaneous intragastric pH and a bile reflux study. RESULTS: The symptomatic patients with Billroth-II gastrectomy showed a greater increase in bilirubin reflux than the asymptomatic patients and normal controls. There was a significant association of gastritis with the presence of symptoms, but not with duodenogastric reflux. Intragastric bile reflux(% time> bilirubin absorbance 0.14) was not closely related with intragastric pH(% time> pH 4). CONCLUSIONS: The duodenogastric reflux was associated with symptoms but not with postsurgical gastritis. There was no close relationship between the intragastric pH study and the intragastric bile reflux study.
Bile ; Bile Reflux ; Bilirubin ; Duodenogastric Reflux* ; Endoscopy ; Gastrectomy* ; Gastritis* ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration

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

Ampullary adenoma is rare but clinically important because it is a premalignant lesion. Use of endoscopic gastroduodenoscopy has increased detection of adenoma of the major duodenal papilla. Endoscopic papillectomy is a promising technique to supplant surgical ampullectomy, because it is less aggressive and more stable. However, various complications include bleeding, perforation, pancreatitis and cholangitis. We describe pancreatic and biliary strictures associated with cholangitis, and bile reflux through the pancreatic duct to the minor duodenal papilla after endoscopic papillectomy. Pancreatic and biliary strictures have not been hitherto reported complications. We performed endoscopic papillary balloon dilatation, minor papilla papillotomy and inserted a drain tube through the accessory pancreatic duct.
Adenoma ; Ampulla of Vater ; Bile ; Bile Reflux ; Cholangitis ; Constriction, Pathologic ; Dilatation ; Hemorrhage ; Pancreatic Ducts ; Pancreatitis

PURPOSE: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. MATERIALS AND METHODS: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. RESULTS: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). CONCLUSIONS: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
Bile ; Bile Reflux ; Gastrectomy* ; Gastric Stump ; Gastritis ; Hand ; Humans ; Methods ; Prospective Studies ; Stomach Neoplasms*

PUPOSE: Some patients develop gastroesophageal reflux disease (GERD) after a gastrectomy for stomach cancer. Therefore, we conducted this research to gain an understanding of esophageal acidity and motility change. MATERIALS AND METHODS: From July 2002 to March 2004, the cases of 15 randomized patients with stomach cancer who underwent a radical subtotal gastrectomy (RSG) with Billroth I(B-I) reconstruction (n=12) or a radical total gastrectomy (RTG) with Roux-en-Y (R-Y) gastroenterostomy (n=3) were analyzed. We investigated the clinical values of the ambulatory 24-hour pH monitoring and esophageal manometry in these patients, just before discharge from the hospital after an operation. RESULTS: GERD was present in three patients (20%). Compared with two reconstructive procedures, 3 of the 12 patients in the RSG with B-I group had GERD; however, none of RTG with R-Y group had GERD. Compared with pathologic stage, 2 of 9 patients in stage I, 1 of 2 patients in stage II, none of 3 patients in stage III, and none of 1 patient in stage IV had GERD. Esophageal manometry was performed in 10 patients. Nonspecific esophageal motility disorder (NEMD) was present in 7 patients. CONCLUSION: Some patients had GERD as a complication following a gastrectomy for stomach cancer. We suspect that the postoperative esophageal symptom is due to not only bile reflux but also gastroesophageal acid reflux. Therefore, careful observation is recommended for the detection of GERD.
Bile Reflux ; Esophageal Motility Disorders ; Gastrectomy* ; Gastroenterostomy ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Stomach Neoplasms* ; Stomach*

PURPOSE: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. MATERIALS AND METHODS: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. RESULTS: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. CONCLUSION: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.
Bile Reflux ; Classification ; Gastrectomy* ; Gastric Bypass* ; Gastric Stump ; Gastritis ; Gastroenterostomy* ; Humans ; Laparoscopy ; Medical Records ; Postgastrectomy Syndromes

Humans ; Bile Reflux/complications* ; Cross-Sectional Studies ; Risk Factors ; Gastric Mucosa

OBJECTIVETo explore the clinical efficacy and safety of acupuncture in treating gastroesophageal reflux (GER).

METHODSSixty patients with confirmed diagnosis of GER were randomly assigned to two groups. The 30 patients in the treatment group were treated with acupuncture at acupoints Zhongwan (CV 12), bilateral Zusanli (ST36), Sanyinjiao (SP6), and Neiguan (PC6), once a day, for 1 week as a therapeutic course, with interval of 2-3 days between courses; the 30 patients in the control group were administered orally with omeprazole 20 mg twice a day and 20 mg mosapride thrice a day. The treatment in both group lasted 6 weeks. Patients' symptoms and times of reflux attacking were recorded, the 24-h intraesophageal acid/bile reflux were monitored, and the endoscopic feature of esophageal mucous membrane was graded and scored at three time points, i.e., pre-treatment (T0), immediately after ending the treatment course (T1) and 4 weeks after it (T2). Besides, the adverse reactions were also observed.

RESULTSCompared with those detected at T0, 24-h intraesophageal pH and bile reflux, endoscopic grading score and symptom score were all decreased significantly at T1 in both groups similarly (P<0.01), showing insignificant difference between groups (P>0.05). These indices were reversed at T2 to high level in the control group (P<0.05), but the reversion did not occur in the treatment group (P>0.05). No serious adverse reaction was found during the therapeutic period.

CONCLUSIONAcupuncture can effectively inhibit the intraesophageal acid and bile reflux in GER patients to alleviate patients' symptoms with good safety and is well accepted by patients.

Acupuncture Therapy ; adverse effects ; Adolescent ; Adult ; Aged ; Bile Reflux ; complications ; physiopathology ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Young Adult