No abstract available.
Alcohol Drinking ; Antacids/therapeutic use ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/complications/*diagnosis ; Gastroesophageal Reflux/complications/*diagnosis ; Humans ; Risk Factors ; Sex Factors

We performed this study to evaluate the prevalence of reflux esophagitis and/or hiatal hernia in patients referred to a medical center and to examine the relationship between endoscopic reflux esophagitis and hiatal hernia. The study was carried out in 1,010 patients referred to Yong Dong Severance Hospital for upper gastrointestinal endoscopy because of symptoms related to the gastrointestinal tract from September 1994 to March 1996. The presence of hiatal hernia was defined as a circular extension of the gastric mucosa of 2 cm or more above the diaphragmatic hiatus. Reflux esophagitis was found in 5.3% of patients, hiatal hernia in 4.1%, duodenal ulcer in 7.2% and gastric ulcer in 8.2%. The prevalence rates of reflux esophagitis and hiatal hernia in males were significantly higher than those in females. Thirty-two percent of patients with reflux esophagitis had hiatal hernia. In patients without reflux esophagitis, hiatal hernia was found in only 2.5% (p<0.01). There was no significant association between the presence of hiatal hernia and the degree of esophagitis on endoscopy. Duodenal ulcer was the second most common endoscopic abnormality found in patients with reflux esophagitis. The prevalence rate of reflux esophagitis and/or hiatal hernia at a medical center is relatively low compared to peptic ulcer disease and other reports from the Western countries. Our study confirms the close association between reflux esophagitis and hiatal hernia.
Adolescence ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/epidemiology ; Esophagitis, Peptic/complications* ; Female ; Hernia, Hiatal/epidemiology ; Hernia, Hiatal/complications* ; Human ; Korea/epidemiology ; Male ; Middle Age ; Sex Factors

PURPOSE: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). MATERIALS AND METHODS: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. RESULTS: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). CONCLUSIONS: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.
Esophagitis, Peptic* ; Esophagus ; Gastrectomy* ; Humans ; Incidence ; Laparoscopy ; Medical Records ; Nutritional Status ; Postoperative Complications ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The purpose of this study is to evaluate the safety and feasibility of a proximal gastrectomy with a double tract reconstruction using remnant antrum in patients with early upper gastric cancer. METHODS: Between July 2003 and June 2005, we analyzed 45 patients with early upper gastric cancer, with 19 patients receiving a proximal gastrectomy with double tract reconstruction using the remnant antrum (Group A) and 26 receiving a total gastrectomy with a Roux-en Y anastomosis(Group B). We retrospectively analyzed the clinical characteristics (age, sex, operation time, duration of postoperative hospital stay, duration of follow-up), pathologic characteristics, postoperative nutritional status, complications, and recurrence rates between the two groups. RESULTS: There were no significant differences in the clinical characteristics of the two groups. However, the operation time of group A was significantly longer than group B. The total protein and albumin levels at 3 months, the serum iron and calcium levels by 6 months, and BMI at 3 and 6 months were significantly higher in group A than group B. There were no significant differences of postoperative complications between the two groups. However, the rate and degree of reflux esophagitis in group A were significantly lower than group B. CONCLUSION: Proximal gastrectomy with double tract reconstruction using the remnant antrum is a safe, feasible, function-preserving surgery for early upper gastric cancer.
Calcium ; Esophagitis, Peptic ; Gastrectomy ; Humans ; Iron ; Length of Stay ; Nutritional Status ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Billroth II gastroenterostomy is a typical reconstruction method after distal gastrectomy for gastric carcinoma, but it has problems, especially frequent reflux esophagitis. Various methods have been tried to address this problem. Among them are Braun enteroenterostomy and Roux-en-Y gastroenterostomy, which are performed separately according to the size of the gastric remnant. The aim of our study was to determine whether these applications are compatible. MATERIALS AND METHODS: Between September 2003 and April 2007, we performed Roux-en-Y gastroenterostomy operations (14 patients) when the size of the gastric remnant was <10%, Braun enteroenterostomy (17 patients) when the size was between 10 and 20%, and Billroth II gastroenterostomy (14 patients) when the size was between 20 and 40% after subtotal gastrectomy for gastric cancer by a single surgeon at our hospital. We analyzed the results of each treatment. We evaluated the symptoms and endoscopic findings using questionnaires and hospital records. To evaluate nutritional states, we reviewed albumin and hemoglobin levels and body weight changes. RESULTS: All operations were performed safely mortality was 0% and postoperative complications were 8.9%. On endoscopy, reflux gastritis was observed to occur in 7.63%, 18.65% and 40.0%, respectively, of patients who had undergone Roux-en-Y, Braun and Billroth II operations (P=0.13). Reflux esophagitis was observed in 1 patient in the Roux-en-Y group and 1 patient in the Braun group. Endoscopic gastrostasis was observed in 2 patients in the Roux-en-Y group, one of which was thought to cause reflux esophagitis. Patients in the Roux-en-Y group and Braun groups ingested a lower volume of food than did those in the Billroth II group (respectively, 7.1%, 0.0% and 28.7%) and complained less of postprandial discomforts (respectively, 14.3%, 23.5% and 57.1%) and reflux symptoms (respectively 0.0%, 11.8% and 42.9%). CONCLUSION: The application of Braun enteroenterostomy and Roux-en-Y gastroenterostomy to the small gastric remnant may be effective for reducing reflux symptoms and abdominal discomfort after distal gastric resection. We recommend Roux-en-Y gastroenterostomy when the size of the gastric remnant is <10%, and Braun anastomosis in the others. It will need to be determined which reconstructive procedure is better for many different conditions.
Body Weight ; Endoscopy ; Esophagitis, Peptic ; Gastrectomy ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Hemoglobins ; Hospital Records ; Humans ; Postoperative Complications ; Surveys and Questionnaires ; Stomach Neoplasms

To determine the relationship between Barrett's esophagus (BE) and features of gastroesophageal acid reflux, 24 h esophageal pH monitoring was performed in 90 patients. The patients were divided into 3 groups: 31 subjects with BE, 21 with mild esophagitis and 38 with severe esophagitis. The following parameters were evaluated: the percentage time of pH < 4; the number of reflux episodes over 5 min; the duration of longest episodes and DeMeester score over total period and the auterior three parameters in erect and supine position. All these parameters in BE were significantly different from those with mild esophagitis (P < 0.01) and not significantly different from those with severe esophagitis (P > 0.05). During supine position all the above parameters in BE were significantly different from those with reflux esophagitis (P < 0.05). It is concluded that the quantity of acid reflux is not an important factor in development of BE in gastroesophageal reflux (GER), and the acid reflux in supine position might be important in development of BE in GER.
Barrett Esophagus/etiology ; Barrett Esophagus/*physiopathology ; Esophagitis, Peptic/etiology ; Gastroesophageal Reflux/*complications ; Hydrogen-Ion Concentration ; Supine Position

OBJECTIVETo evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects.

METHODSA retrospective study was performed on 53 nasopharyngeal carcinoma (NPC) patients with dysphagia, who received cervical esophagostomy. The nutritional status of these patients was measured at five given time before and after operation. The occurrence of pneumonia and reflux esophagitis before and after operation was recorded, and the quality of life based on SF-36 quality of life (QOL) scale was studied.

RESULTSAfter operation, the nutritional status of these patients improved substantially, including the weight, levels of hemoglobin, total protein, albumin and transferring (P<0.05). The pneumonia-infection decreased from 60.38% (32/53) before operation to 15.22% (7/46) after operation (χ(2)=21.04, P<0.01). The incidences of reflux esophagitis decreased from 26.42% (14/53)without operation to 6.52% (3/46) after operation (χ(2)=5.00, P<0.01). Meanwhile, the status of physical health, mental health as well as physical function and social function of these patients were improved significantly at 1 month, 6 months, 1 year and 2 years after operation (P<0.05).

CONCLUSIONCervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.

Carcinoma ; Deglutition Disorders ; complications ; surgery ; Esophagitis, Peptic ; complications ; Esophagostomy ; Humans ; Incidence ; Nasopharyngeal Neoplasms ; complications ; radiotherapy ; Pneumonia ; complications ; Quality of Life ; Radiotherapy ; adverse effects ; Retrospective Studies

PURPOSE: There are two surgical procedures for proximal early gastric cancer (EGC): total gastrectomy (TG) and proximal gastrectomy (PG). This study aimed to compare the long-term outcomes of PG with those of TG. MATERIALS AND METHODS: Between January 2001 and December 2008, 170 patients were diagnosed with proximal EGC at Soonchunhyang University Cheonan Hospital, of which 64 patients underwent PG and 106 underwent TG. Clinicopathologic features, postoperative complications, blood chemistry data, changes in body weight, and oncological outcomes were analyzed and retrospectively compared between both groups. RESULTS: Tumor size was smaller and the number of retrieved lymph nodes was lower in the PG group. The postoperative complication rate was 10.9% in the TG group and 16.9% in the PG group. The incidence of Los Angeles grade C and D reflux esophagitis was significantly higher in the TG group. Hemoglobin level was higher and body weight loss was greater in the TG group at 2, 3, and 5 years postoperatively. The albumin levels at 3 and 5 years were lower in the TG group. There was no significant difference in the 5-year overall survival rates between the two groups (P=0.789). CONCLUSIONS: Postoperative complications and oncologic outcomes were observed to be similar between the two groups. The PG group showed better laboratory data and weight loss than did the TG group. Moreover, severe reflux esophagitis occurred less frequently in the PG group than in the TG group. PG can be considered as an effective surgical treatment for proximal EGC.
Body Weight ; Chemistry ; Chungcheongnam-do ; Esophagitis, Peptic ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate ; Weight Loss

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is known as a major cause of atrophic gastritis and is associated with serum gastrin, pepsinogen, and gastric acid secretion. There is still a controversial association between gastroesophageal reflux disease and H. pylori infection. This study was designed to investigate the relationship among serum gastrin, pepsinogen, and H. pylori infection in the erosive reflux esophagitis (ERD) patients. METHODS: Patients who were diagnosed as ERD by one gastroenterologist at the Kangnam St. Marys hospital were prospectively enrolled. The persons without ERD in the control group were matched for age and sex. We examined the gastrin, pepsinogen I (PG I), PG II, PG I/II ratio, and H. pylori infection. RESULTS: Forty five patients were enrolled in ERD group and 66 persons in control group. The H. pylori infection rate in ERD group was lower than that in the control group (11.1% vs. 43.9%, p<0.001). PG I/II ratio in ERD group was higher than that in the control group (7.0+/-3.1 vs. 5.3+/-2.6, p=0.003). The PG II (p=0.016) and gastrin (p=0.029) in ERD group were lower than those in the control group. BMI in ERD group was higher than that in the control group (24.5 vs. 23.1 kg/m(2), p=0.013). CONCLUSIONS: The H. pylori infection rate in ERD group was lower and PG I/II ratio was higher than that in the control group. Reflux esophagitis is thought to be reversely associated with the atrophy of gastric mucosa.
Adult ; Aged ; Chi-Square Distribution ; Esophagitis, Peptic/diagnosis/*microbiology ; Female ; Gastrins/*blood ; Helicobacter Infections/*complications ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Pepsinogens/*blood

PURPOSE: The aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. MATERIALS AND METHODS: We retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively. RESULTS: Billroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter (173.4+/-44.7 minute, P<0.001) as was time to first flatus (2.8+/-0.8 days, P=0.009), time to first soft diet was significantly faster (4.3+/-1.0 days, P<0.001), and postoperative hospital stay was significantly shorter (7.7+/-4.0 days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients. CONCLUSIONS: Roux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.
Anastomosis, Surgical ; Bile ; Bile Reflux ; Classification ; Diet ; Esophagitis, Peptic ; Flatulence ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms