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PubMed2006

Are endoscopy nurses at risk of infection with Helicobacter pylori from their work?

BACKGROUND: In response to studies suggesting risk of occupational transmission of Helicobacter pylori (HP) to endoscopy staff, this cross-sectional study of seroprevalence to HP in gastroscopy nurses working in West of Scotland hospitals (an area of high endemicity of HP infection) was performed to determine if they were at excess risk relative to peers working in surgical specialities but without gastroscopy exposure. The study aimed to fulfil employer's duties to carry out a suitable risk assessment required by health and safety legislation. METHOD: This cross-sectional study compares the seroprevalence of HP in gastroscopy nurses and comparators drawn from orthopaedic and trauma units in 10 hospitals during 1998. A directly administered questionnaire collated exposure information on occupational and non-occupational risk factors for infection. Venepuncture was performed for latex agglutination test for IgG to HP. Confounding by socio-economic factors was controlled for by multivariate analysis. RESULTS: Of the 222 participants, 74 were endoscopy staff (84% response) and 148 (59%) were comparators. Of these, 32.4% of gastroscopy and 33% of comparators were seropositive for HP (OR 0.97, P > 0.9, 95% CI 0.5-1.8). No association was found between gastroscopy exposure variables (frequency, years) or exposure to all endoscopy procedures and HP. Significant associations were found for age, childhood deprivation and greater number of siblings. CONCLUSION: No excess HP infection was found in gastroscopy nurses. Duties imposed by the health and safety legislation appear discharged by normal infection control procedures. Socio-economic factors are key determinants of HP status.

Adult↗
PubMed1999

Identification of factors that influence tolerance of upper gastrointestinal endoscopy.

OBJECTIVE: Unsedated gastroscopy is unpleasant for some patients. The identification of factors related to tolerance would permit the selection of patients for sedation. The aim of the present study was to identify these factors. METHODS: Five hundred and nine patients underwent diagnostic gastroscopy after the administration of topical pharyngeal anaesthesia, without sedation. Patients were grouped as to whether they had undergone prior examinations or not. Tolerance was assessed with a visual analogue scale and a questionnaire. RESULTS: Two hundred and seventy-three (54%) patients underwent gastroscopy for the first time, and 236 (46%) patients had prior experience. Patient tolerance was poor in 84 of 273 (31%) patients undergoing gastroscopy for the first time, and in 61 of 236 (26%) patients with prior experience. Logistic regression analysis identified the following variables related to poor tolerance: (a) in patients undergoing gastroscopy for the first time: presence of gag reflex (odds ratio (OR) = 3.42, 95% confidence interval (CI) 1.90-6.17), apprehension (OR = 2.57, CI 1.33-4.95), young age (OR = 0.95, CI 0.93-0.98) and high level of anxiety (OR = 1.91, CI 0.96-3.89); (b) in patients with prior experience: apprehension (OR = 4.21, CI 1.93-9.20), poor tolerance of prior examinations (OR = 4.92, CI 1.93-12.5) and female (OR = 2.23, CI 1.09-4.57). CONCLUSIONS: The above-mentioned factors are predictive of poor tolerance, and may enable the identification of those patients who might benefit more from sedation for gastroscopy.

Adolescent↗
PubMed1993

Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy: a randomised controlled double blind trial.

To investigate the effects of supplemental oxygen on cardiac rhythm during gastroscopy, 103 patients aged over 60 were randomised to receive either supplemental oxygen or air at 2 litres/minute during the procedure. Pulse rate, blood pressure, oxygen saturation, and a Holter cardiac trace were monitored before, during, and for one hour after the gastroscopy. A wide range of electrocardiographic abnormalities were recorded in both oxygen and air groups, of which ventricular and supraventricular ectopic beats were the most common. There were no significant differences in the rate of occurrence of any clinically important cardiac abnormality either between the oxygen and air groups or between the three monitored periods before, during, and after gastroscopy. There were significantly fewer patients, however, with supraventricular extra systoles when oxygen was given during gastroscopy (p < 0.05). Although supplemental oxygen during gastroscopy significantly improved oxygen saturation (p < 0.001; 95% confidence intervals for the difference between the means: 2.9 to 4.7), there was no correlation between oxygen saturation and any electrocardiographic changes. It is concluded that electrocardiographic abnormalities are common in patients over 60, but this study found no evidence that they are induced by gastroscopy. Supplemental oxygen increases oxygen saturation but does not reduce the incidence of clinically important cardiac arrhythmias.

Aged↗
PubMed2003

Audit of investigations in patients with iron deficiency anaemia.

BACKGROUND: Patients with iron deficiency anaemia (IDA) are commonly referred to the gastroenterologists for exclusion of gastrointestinal (GI) pathologies. The British Society of Gastroenterology (BSG) has published a guideline for management of IDA. As recommended by this guideline, all patients should have examinations of both upper and lower GI tract with the exception of pre-menopausal women younger than 45 years old. The primary aim of this audit was to determine how thoroughly patients referred to our unit at the Singapore General Hospital had been investigated. The secondary aim was to determine the yield rate of gastroscopy and lower gastrointestinal investigations (colonoscopy or barium enema) in our patients. METHODS: We reviewed the case notes of patients who underwent gastroscopy for indication of anaemia between the period from April to December 1999. We classified iron deficiency anaemia as having haemoglobin of lower than reference range with either low ferritin level or iron/ TIBC ratio of less than 10%. RESULTS: Of a total of 326 patients reviewed, 172 patients (65 men, 109 women) met the inclusion criteria of IDA. The median age for the group was 59 (Range 16 to 88) years old and there were 107 (62.2%) women. There were 31 female patients younger than 45 years old (group A) and 141 patients in group B which included all the males and females older than 45 years old. Due to the method of data retrieval, all of the patients in group A fulfilled the standard set by the BSG guideline in that they all underwent gastroscopy. In this group, few gastrointestinal pathologies were found (one patient with peptic ulcer and two patients with colonic cancer). In terms of finding potential gastrointestinal causes of IDA, the yield rate of gastroscopy and colonoscopy were 3.2% and 13.6% respectively. In group B, 96 patients (68%) underwent upper and lower gastrointestinal investigations. Evaluation with gastroscopy showed peptic ulcer disease in 31 patients (21.7%) and gastric cancer in 9 patients (6.3%). Only 96 patients (68.1%) in group B had lower gastrointestinal investigations. Twenty-six patients were found to have gastrointestinal disorders (12 patients with colon cancer, 10 colonic polyps, one Crohn's disease, one colonic tuberculosis and two haemorrhoids). The yield rate of gastroscopy and colonoscopy were 31.2% and 25% respectively. CONCLUSION: In this study of patients with confirmed IDA, we found much higher incidence of gastrointestinal disorders in the group of male and postmenopausal women than in the group with premenopausal women. Furthermore, over 30% of patients in this group did not undergo lower gastrointestinal tract investigations as recommended by the BSG guideline. We also found two cases of colonic cancer in the latter group. We would recommend bidirectional endoscopy for postmenopausal women and men with IDA. For premenopausal women, we would recommend similar approach unless there are clinical pointers to dietary iron deficiency or menorrhagia.

Adolescent↗
PubMed2001

[Unexplained weight loss in the elderly: role of gastric fibroscopy, study of a cohort of 77 patients with a 13-month follow-up].

PURPOSE: In case of unexplained weight loss, chest X-ray, abdominal ultrasonography and gastroscopy are usually recommended. However, gastroscopy is not usually performed in elderly patients. METHODS: We evaluated 77 patients (mean age: 80 +/- 8 years) hospitalized in our geriatric unit between January 1995 and May 1997 for unexplained weight loss. All patients underwent chest X-ray, abdominal ultrasonography and gastroscopy. RESULTS: These investigations led to diagnosis in respectively 17, 15 and 46 patients. The etiology of weight loss was unique in 47 patients, while in 30 other patients at least two or three causes could be described. Gastroscopy appeared to be the most useful test, as it allowed description of eight cases of cancer, 29 cases of peptic ulcer, two cases of candidosis, and one case of actinomycosis in patients who did not present any clinical sign. CONCLUSION: Sixty-five patients were followed-up for a mean period of 13 +/- 21 month; 33 patients died. The condition of 23 patients improved either slightly or definitely. Simple investigations led to diagnosis in 95% of the cases. However, 42% of the patients died within 3 months. Gastroscopy appears to be the most valuable test, leading to diagnosis in more than half of the cases. With adapted treatment, the condition of 75% of the patients with gastro-intestinal lesions improved.

Abdomen↗
PubMed2000

Optimal propofol plasma concentration during upper gastrointestinal endoscopy in young, middle-aged, and elderly patients.

BACKGROUND: Suitable propofol plasma concentrations during gastroscopy have not been determined for suppressing somatic and hemodynamic responses in different age groups. METHODS: Propofol sedation at target plasma concentrations from 0.5 to 4.0 microgram/ml were performed randomly in three groups of patients (23 per group) who were undergoing elective outpatient gastroscopy: ages 17-49 yr (group 1), 50-69 yr (group 2), and 70-89 yr (group 3). Plasma propofol concentration in which 50% of patients do not respond to these different stimuli were determined by logistic regression: verbal command (Cp50ls), somatic response to gastroscopy (Cp50endo), and gag response to gastroscopy (Cp50gag). Hemodynamic responses were also investigated in the different age groups. RESULTS: Cp50ls concentrations were 2.23 microgram/ml (group 1), 1.75 microgram/ml (group 2), and 1.40 microgram/ml (group 3). The Cp50endo values in groups 1 and 2 were 2.87 and 2.34 microgram/ml, respectively, which were significantly higher than their respective Cp50ls values. Cp50endo value in group 3 was 1.64 microgram/ml, which was close to its Cp50ls value. Because of a high degree of interpatient variability, Cp50gag could not be defined. Systolic blood pressure response decreased with increasing propofol concentrations. CONCLUSIONS: The authors determined the propofol concentration necessary for gastroscopy and showed that increasing age reduces it. Propofol concentration that suppresses somatic response induces loss of consciousness in almost all young patients.

Adolescent↗
PubMed2001

[Assessment of the need of 24-hour availability of endoscopy].

BACKGROUND: Endoscopy is the cornerstone of the diagnosis and treatment of acute conditions in the upper part of the gastrointestinal tract. The need for 24-hour availability of gastroscopy for these conditions has not previously been assessed. MATERIAL AND METHODS: We assessed the need for emergency gastroscopy in cases of acute upper gastrointestinal bleeding and obstruction by foreign bodies. The assessment was made by a gastroenterologist before gastroscopy was performed, and was based on the available clinical data for the period lasting from admission to hospital to the time of examination. RESULTS: A total of 162 patients were referred and examined. About half of them arrived at the hospital outside working hours. Of these, 47% were assessed as being in need of emergency gastroscopy. We therefore found that emergency gastroscopy outside working hours was needed twice a month per 100,000 people. INTERPRETATION: Round-the-clock endoscopy should be available at acute-care hospitals in the same way as other emergency help.

Adult↗
PubMed1989

Does endoscopy really help the surgeon evaluate gastric cancer?

To determine whether gastroscopy helps the surgeon in preoperative planning and decision-making in patients with gastric cancer, the authors reviewed the charts of 100 consecutive patients with surgically proven gastric cancer. The findings from gastroscopy, upper gastrointestinal series and computed tomography were evaluated for their ability to define the anatomic site of the lesion, proximal and distal extent of gastric involvement, presence of a mass or ulceration and the sensitivity of diagnosis. The sensitivity of endoscopic biopsy and brush cytology were also determined. Gastroscopy was found to be the most sensitive diagnostic test, both in recognizing the presence of an abnormality (100% versus 86% versus 76% respectively) and the possibility of a malignant condition (88% versus 71% versus 76%); in addition, endoscopic biopsy and brush cytology were diagnostic in 90% and 70% of patients, respectively. Gastroscopy and upper gastrointestinal series were equally accurate in determining proximal or distal extent of tumour. The authors concluded that gastroscopy is the most sensitive diagnostic test in patients with gastric cancer; upper gastrointestinal series does not add significantly useful information to the preoperative evaluation. Computed tomography can assess regional and distant metastasis, but its contribution as to the local extent of the tumour is limited.

Adenocarcinoma↗
PubMed2004

[Sedation in digestive endoscopy. Results of a hospital survey in Catalonia (Spain)].

INTRODUCTION: The need for sedation is increasing in digestive endoscopy units (DEU). There are no data on the use of sedation in DEU in Catalonia (Spain). OBJECTIVE: To evaluate the use of sedation in DEU in Catalonia. MATERIAL AND METHOD: A questionnaire on the practice of sedation was designed and sent to the heads of medical and nursing staff of the DEU of 63 public and private hospitals in Catalonia. Two mailings were sent with an interval of three months between each. The questionnaire included 62 items on the characteristics of the hospital and the DEU, number of explorations, frequency of sedation use, drugs employed, participation of an anesthesiologist, use of monitoring, and complications. RESULTS: Forty-four DEU (70%) corresponding to 31 public hospitals and 13 private hospitals completed the questionnaire. Evaluation of sedation patterns was based on 105,904 explorations performed in the various DEU (56,453 gastroscopies, 47,278 colonoscopies and 2,173 endoscopic retrograde cholangiopancreatographies (ERCP) in 2001. Sedation, sedation-analgesia or anesthesia was used in 17% of gastroscopies, 61% of colonoscopies and 100% of ERCP. Sedation was administered by an anesthesiologist in 7% of gastroscopies, 25% of colonoscopies and 38% of ERCP. Anesthesiologist administration was more frequent in private than in public centers (gastroscopies: 25% vs. 2%; colonoscopies: 57% vs. 9%, p < 0.001). No deaths associated with the use of sedation were reported. Eighty-nine percent of the DEU complied with standard recommendations for the practice of sedation. CONCLUSIONS: In Catalonia, the use of sedation is highly variable, depending on the endoscopic procedure and the DEU. Use of sedation in infrequent in gastroscopy, fairly widespread in colonoscopy and routine in ERCP. Anesthesiologist administration is significantly more frequent in private hospitals. Most DEU follow standard sedation practices.

Anesthesia↗
PubMed2000

[The prediction of the endoscopic diagnosis in the dyspepsia patient: the value of the predominating presenting symptom and the initial clinical presumption].

AIM: To assess, in our patient population, whether upper gastrointestinal symptoms can be used to predict the presence of relevant pathology on endoscopy. PATIENTS AND METHODS: In the first retrospective phase, 311 gastroscopies, indicated for dyspeptic symptoms were selected. The gastroscopies were performed by the same endoscopist from April 1998 to March 1999. Patients were divided into four groups according to the main presenting symptom (epigastralgia, epigastralgia with pyrosis, pyrosis with nonspecific symptoms). The positive and negative predictive value, as well as the overall sensitivity and specificity of each group of symptoms for the presentation of a relevant pathology were calculated. In the second, prospective, phase an attempt was made, based on the clinical history taken in the initial consultation, to predict the results of the gastroscopies of 77 dyspeptic patients. There were four possibilities: normal or not relevant, esophagitis, ulcer and neoplasia. The positive predictive value, negative predictive value, sensitivity and specificity of the diagnostic hypothesis were calculated. RESULTS: a) Retrospective phase: the overall positive predictive value of dyspeptic symptoms to predict relevant pathology was 0.38. The highest positive predictive value corresponded to symptoms of pyrosis (0.48). Dividing the patients into groups according to age (older or younger than 45 years) did not improve the predictive value of symptoms. b) Prospective phase: the highest positive predictive value corresponded to "pathology without relevance" (0.7). The prediction of ulcer only gave a positive predictive value of 0.55. CONCLUSION: The main presenting symptom is not a good predictor of whether relevant pathology will be found on gastroscopy. The initial diagnostic hypothesis is not a sufficiently effective tool to accurately detect which patients will most benefit from gastroscopy.

Adolescent↗
PubMed1976

Evaluation of gastric ulcerations.

All gastric ulcers diagnosed during the period November, 1969-May, 1974, were prospectively evaluated by roentgenography, fiberoptic gastroscopy, directed biopsy, and brush cytology. Gastroscopy was performed routinely in patients with radiologic diagnosis of gastric ulcer or questionable findings, and in symptomatic individuals with negative roentgenograms. A total of 123/142 ulcers, 109 benign, 14 malignant, were available for complete follow-up. Gastroscopy was correct in 106 of 109 benign ulcers visualized. Roentgenoscopy demonstrated 91 of 109, of which 7 were incorrectly called carcinoma. Gross diagnosis was correct by gastroscopy in 11 of 14 malignant ulcers. Radiology visualized 6 of 14; gross diagnosis was correct in 1 of 6 (5 called benign). Directed gastroscopic biopsy was negative for malignant changes in all 109 benign and 3 of 14 malignant ulcers. Total complete gastroscopic diagnostic failures were 4 of 123, for an overall accuracy of 96.7%. Overall roentgenographic accuracy was 70.8%.

Biopsy↗
PubMedDate not supplied

Rapid serological diagnosis of Helicobacter pylori: a need for caution and re-evaluation.

Screening for Helicobacter pylori in dyspeptic patients may improve selectivity for gastroscopy. Rapid serological tests based on ELISA technique are cheap, readily available and simple to use in the clinical setting. However local evaluation is essential in order to validate these techniques. Fifty-six dyspeptic patients (aged less than 45 yr) had a rapid serological test (Helisal) performed prior to gastroscopy. At gastroscopy H. pylori status was assessed using culture and histology. The Helisal sensitivity was 80 per cent, specificity 82 per cent. Screening patients with the Helisal test would have missed 6 patients with peptic ulcer disease and 2 with oesophagitis. The Helisal test did not perform satisfactorily as a screening test in selection of patients for gastroscopy.

Adolescent↗
PubMed1998

Endoscopic and pathological manifestations of the gastrointestinal tract in familial amyloidotic polyneuropathy type I (Met30).

OBJECTIVES: To evaluate the characteristic changes in the gastrointestinal tract in familial amyloidotic polyneuropathy (FAP) (Met30), both fibre gastroscopy and colonoscopy studies were performed in FAP (Met30) patients. Microscopic changes were also examined in autopsied and biopsied materials from patients with FAP, and compared with data from autopsied samples from patients with AL amyloidosis, and secondary amyloidosis patients. DESIGN: Endoscopic and histopathological study. SETTING: Kumamoto University Hospital, Kumamoto, Japan. SUBJECTS: Nine patients with FAP (Met30) underwent fibre gastroscopy and colonoscopy. Six autopsied and 23 biopsied gastrointestinal samples from FAP patients, four from autopsied amyloidosis (including two myeloma associated form), and two from autopsied secondary amyloidosis patients were examined for histopathological study. MAIN OUTCOME MEASURES: Fibre gastroscopy and colonoscopy were employed for macroscopic study. Congo red and H-E staining were performed for histopathological study. Macroscopic changes in the gastrointestinal tract and microscopic differences in the amyloid distribution pattern were compared between the different types of amyloidosis. RESULTS: Fibre gastroscopy and colonoscopy for nine FAP patients revealed that four showed a fine granular appearance in the duodenum, three showed lack of lustre, and two showed mucosal friability in the gastrointestinal tract; however, no macroscopic abnormality was observed in four other FAP patients. Histopathological examination of tissue from FAP patients revealed that, although a small amount of amyloid was recognized in the submucosa perivascular layer, a significant amount of amyloid was seen in and around the nerves of the gastrointestinal tract, but very little in Auerbach's nerve plexus. In total, the amount of deposited amyloid in the tissues was small compared with that in other types of systemic amyloidosis, such as AL and secondary amyloidosis. CONCLUSION: These results suggest that the major reason why FAP patients show such severe gastrointestinal symptoms, compared with other types of systemic amyloidosis, may be because of the deposition of a significant amount of amyloid in the nerves in the gastrointestinal tract.

Adult↗
PubMed1996

[Aspiration-induced lung complications following emergency endoscopy in upper gastrointestinal hemorrhage: incidence and localization by thoracic radiography].

PURPOSE: Determination of incidence and mortality of pulmonary pathologies arising after gastroscopy for acute bleeding, of left to right ratio of pulmonary findings in postgastroscopic chest films, and determination of a possible relationship between bleeding activity and frequency of aspiration. METHODS: 174 patients with emergency gastroscopies for upper gastrointestinal haemorrhage with pre-/postendoscopy chest films, retrospective analysis. Of the pulmonary findings, infiltrates and atelectases were considered. RESULTS: After emergency gastroscopy, 16% of patients had infiltrates or atelectases at chest radiography. Mortality within 30 days in the study group was 18%, and 39% among the subgroup with radiologically proven pulmonary complications. The distribution of chest findings between left and right side was 1:1,3. In the subgroup with gastroscopic signs of bleeding the share of postgastroscopic pulmonary findings was slightly superior to that of patients without direct signs of bleeding; however, the difference was statistically not significant. CONCLUSION: Endoscopy-related aspirations do not seem to account for an increased rate of pulmonary complications after emergency gastroscopy.

Adult↗
PubMed2005

Voice disorders and gastroesophageal reflux.

Gastroesophageal reflux (GER) can cause serious voice problems and laryngopharyngeal disorders influencing the patient's quality of life. Forty-three patients with suspected laryngopharyngeal reflux (LPR) were included into a prospective study. The diagnosis was made on the basis of the patient's history, the videoendolaryngoscopy, the oesophago-gastroscopy and the biopsy of the oesophageal mucosa. All the LPR patients were treated with esomeprasol for eight weeks. An acoustic analysis of the vowel /a/ samples was performed in the LPR group before and after the treatment. Thirty-six patients with vocal fold polyps served as the control group for a subjective estimation of the voice problems. All the patients from both groups subjectively evaluated their voice problems using the Voice Handicap Index (VHI) questionnaire. The results of VHI showed that the severity of the voice problems of the patients with LPR could be compared to that experienced by the patients with vocal fold polyps. Videoendolaryngoscopy and history proved LPR in all 43 patients. Oesophago-gastroscopy combined with the histopathological examination of the oesophageal biopsy specimens detected signs of possible GER in 38 patients (88%). The results of the videoendolaryngoscopy combined with a subjective and objective voice assessment, performed before and after treatment with a proton-pump inhibitor, showed a significant improvement in most of the studied parameters by the end of the therapy. In the diagnostics of LPR, the patient's history and videoendolaryngoscopy demonstrated to be superior to oesophago-gastroscopy. Videoendolaryngoscopic assessment of the laryngeal mucosa, and oesophago-gastroscopy supplemented with a biopsy of the oesophageal mucosa, showed to be a convenient diagnostic method when GER and LPR were suspected. Esomeprasol proved to be very effective in the treatment of LPR. LPR should not be overlooked in the treatment of dysphonic patients.

Adolescent↗
PubMed2006

Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach.

BACKGROUND: British Society of Gastroenterology guidelines recommend that gastrointestinal investigations should be considered in males and post-menopausal women presenting with iron-deficiency anaemia (IDA). AIM: To compare the diagnostic yields and clinical effectiveness of upper and lower gastrointestinal (GI) investigation in detecting malignancy among patients presenting with IDA. DESIGN: Retrospective review of case notes, endoscopy records and radiology reports. METHODS: We reviewed the results of 3798 investigations in 2600 patients presenting to our hospital with IDA from October 1995 to December 2003. The findings of the 2318 gastroscopies were compared with those of the 896 colonoscopies and the 584 barium enemas. Patients diagnosed with GI malignancy were identified and their outcomes determined. RESULTS: Gastroscopy identified 44 patients with newly-diagnosed upper GI cancer (18 oesophageal, 26 gastric). Thus for patients being gastroscoped for IDA, the Numbers Needed to Investigate (NNI) to detect each cancer was 53. Five-year survival for these 44 patients was 10%, so the NNI to identify each curable upper GI malignancy was 527. Colonoscopy or barium enema identified 111 (7.5%) patients with newly diagnosed colorectal cancer, giving a NNI of 13. Their 5-year survival was 35%, giving a NNI to identify each curable colorectal cancer patient of 38. DISCUSSION: Potentially curable gastrointestinal malignancy was diagnosed over 13 times more commonly using colonoscopy or barium enema vs. gastroscopy. For patients presenting with IDA, our findings favour investigating the lower GI tract first, or performing both gastroscopy and colonoscopy during the same endoscopy list.

Adolescent↗
PubMed1978

[Pseudotumours of the stomach. X-ray and endoscopic correlations (author's transl)].

15 patients urgently suspected of gastric cancer on account of clinical and x-ray findings were subjected to preoperative gastroscopy. In all cases, a malignant gastric tumour could be excluded via gastroscopy with biopsy. However, in one remarkable case the clinical and x-ray findings had been so typical of a malignant tumour, that surgery was performed despite negative gastroscopy and biopsy. No tumour was found. The x-ray findings were correlated with those of endoscopy. Three patients had hiatal hernia (in one case combined with varices of the fundus of the stomach) and in one case each large and irregular plication was normal in seven cases. The results are discussed on the basis of the findings and relevant literature. It is concluded from this study that routine preoperative gastroscopy with biopsy is mandatory in clinical and x-ray suspicion of gastric cancer, since it may result in avoidance of surgery in some patients.

Contrast Media↗
PubMedDate not supplied

The course of Helicobacter pylori infection after partial gastrectomy for peptic ulcer disease.

BACKGROUND/AIMS: While the number of patients operated on for peptic ulcer disease is decreasing, many underwent surgery before the Helicobacter pylori era. Some of them later develop ulcer relapses. The aim of this study was to evaluate the course of H. pylori infection in the gastric remnant after surgery for peptic ulcer disease. METHODOLOGY: This study included 90 consecutive partial gastrectomy patients, obtained from gastroscopy registers of the Department of Surgery, Helsinki University Central Hospital, between 1985 and 1988, in whom both pre- and postoperative samples were available. All of the patients had undergone partial gastrectomy at some time between 1925 and 1988. The median interval between operation and reference gastroscopy was 5 years. RESULTS: Twenty-three patients had a recurrent ulcer, and an additional six patients had a history of an earlier ulcer recurrence. Preoperative H. Pylori infection (68%) did not correlate significantly with the ulcer recurrence rate. The recurrence rate was higher in patients with Billroth I (BI) (27%) and Billroth II (BII) (33%) reconstructions than in those with a Roux-en-Y type reconstruction (9%, BII vs Roux-en-Y, p = 0.02, BI vs Roux-en-Y, p = 0.12). At the time of reference gastroscopy, the proportion of H. pylori positive patients was 38%. The presence of H. pylori at the time of reference gastroscopy did not correlate with ulcer recurrence. A recurrent. ulcer was more often found in patients with histologically normal gastric mucosa in the stump than in those with H. Pylori infection (35% and 19%, p = 0.25). CONCLUSIONS: A persistent H. pylori infection is frequently seen in the gastric remnant after operation for peptic ulcer disease, but the infection does not seem to cause ulcer relapses in the gastric stump or in the anastamosis.

Female↗