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PubMed2004

[Ulcerative colitis and eosinophilic corpus gastritis].

Ulcerative colitis seldom associated with nutritive and/or salicylate allergy. Authors present a case of both allergic events at the course of the disease. In 1996 a 19-year-old girl was referred with a history of blood in stool as well as diarrhoea, suggesting ulcerative proctitis. Biopsy revealed ulcerative colitis of the rectum mucosa with eosinophilic infiltration and 20% peripheral eosinophilia was found. Allergic origin and worm infection were ruled out, and after tinidazol treatment, four year elapsed without any signs or symptoms. In December 2000 blood in stools and upper abdominal complaints developed without peripheral eosinophilia. Gastroscopy and biopsy showed a mild chronic gastritis. Olsalazine, budesonide enema and famotidin treatment were started, but then later changed to mesalazine and pantoprazol, because of the constant stomach complaints. The next five months passed without any symptoms. The patient had to break off her seashore journey in July 2000 because of stomach complaints, vomiting and exsiccosis. Peripheral eosinophilia (27.3%) was evident. Gastroscopy revealed erosive ulcers and the biopsy showed eosinophilic gastritis. Biopsies from the jejunum, duodenum and antrum as well as enteroscopy and biopsies from the rectum showed mild eosinophilic infiltration. An allergy test proved the presence of IgE against salicylate, egg protein, seafood protein and the lymphocyte transformation test was also positive against salicylate. Oral food challenges proved to be negative and the amino-salicylate treatment was stopped. After a temporary symptom free period, bloody stools reappeared in May 2003; the peripheral eosinophilia still existed, but had decreased (22.2%). Esomeprazol, and methyl-prednisolone containing enema (40 mg/day/2 weeks) followed by budesonide enema twice a week resulted in a symptom free period and peripheral eosinophilia became almost normalised (6.2%). The authors report a case having ulcerative proctitis first, than nutritive and salicylate allergy with eosinophilic gastritis and a proctitis flare-up thereafter.

Adult↗
PubMed2004

[Endoscopic retrograde cholangio-pancreatography after conventional Billroth II resection].

INTRODUCTION: The ERCP examination after Billroth II gastrectomy is more difficult than in patients with normal anatomy. The success rate is smaller and the complication rate is higher in this situation. AIM: The author compares their results of ERCP performed in patients with conventional Billroth II gastrectomy to the literature data. He analyses the different solutions of technical difficulties on the basis of his own experiences and the literature. PATIENTS AND METHOD: ERCP was tried in 26 patients with Billroth II gastrectomy between 1st March, 1997 and 1st December, 2003 in 37 cases. Indications were: obstructive jaundice in 25 patients and postoperative pancreas fistula in 1 patient. 32 investigations were performed with duodenoscope, 5 with gastroscope. Duodenoscopy was preceded by gastroscopy in 15 cases. RESULTS: The examination was successful in 22 patients (84.6%). Exact diagnosis was achieved in 19 patients (73%), and endoscopic therapy was needed in 15 cases. The therapeutic interventions were successful in 10 patients. CONCLUSION: In author's opinion only ERCP with therapeutic aim gives reason to perform it. He found the balloon dilation of sphincter of Oddi and the needle-knife papillotomy controlled by stent insertion the more effective and safe method to prepare the common bile duct interventions than push-sphincterotomy. Previously performed gastroscopy may facilitate to find the afferent loop and to get there by duodenoscopy.

Aged↗
PubMed2004

The correlation between cytopenia and esophageal varices in patients with liver cirrhosis.

This retrospective study analysed the case records of 200 patients in the Department of Gastroenterology, Singapore General Hospital from February 2000 to January 2001 who had liver cirrhosis and underwent gastroscopy for the detection of varices. The aim of this study was to determine any relationship between leucopenia, thrombocytopenia and the occurrence of esophageal varices in a cirrhotic population. Our results showed that the diagnostic yield of varices grade 2 and 3 was 6.3% if platelet count was > 150,000/mm3, 25% if platelet count was 100,000 to 150,000/mm3, 38.9% if platelet count was 50,000-99,000/mm3 and 100% if platelet count was <50,000/mm3. Similarly, the diagnostic yield of varices grade 2 and 3 was 19.4% if total white count was > 4,000/mm3, 66.7% if total white count was 3,000- 4,000/mm3 and 94.8% if total white count was < 3,000/mm5. We conclude that thrombocytopenia and leucopenia can be used to stratify risk for occurrence of esophageal varices in cirrhotic patients and gastroscopy will have a high yield for varices when platelet count is < 150,000/mm3 or total white is < 4,000/mm.

Adult↗
PubMedDate not supplied

Experience with endoscopy at Bin Jalawi Hospital K.S.A.

BACKGROUND: Presentation of gastrointestinal disorders may vary in different communities. This study was carried out in town of Hafoof in Eastern zone of Saudi Arabia. Purpose of the study was to observe pattern of presentation, age, sex, smoking status, haemoglobin levels, serological markers for hepatitis, endoscopic findings, histopathology, presence of H. Pylori or otherwise in biopsy materials taken during the endoscopic procedures in patients undergoing endosopic examinations. Findings of 230 endoscopies are presented. METHODS: All patients who underwent endoscopy in Bin Jalawi Hospital KSA, between December 1999 and September 2001 were included in the study. Data regarding above mentioned features was collected. Patients under went gastroscopy, colonoscopy and injection sclerotherapy. Biopsies were taken and histopathological studies were carried out. RESULTS: Data of 187 gastroscopies, 12 sclerotherapy sessions and 31 sigmoidoclonoscopies is presented. Antral Gastritis was most commonly seen pathology. Gastric and esophageal varices, erosive gastritis, carcinoma oesophagus, duodenitis and oesophagitis were among the other common pathologies. Age of the subjects ranged between 15 and 80 years. Hepatitis B surface antigen was detected in 13 Patients and Hepatitis C antibodies were reported positive in 21 samples. CONCLUSIONS: This data reflects pattern of findings encountered on endoscopies in Hafoof area of KSA, this may assist in comparing the pattern of presentation in this centre with other centers within and outside Saudia.

Adolescent↗
PubMed2005

Wireless capsule endoscopy in the diagnostic of small intestine angiodysplasia in chronic uremic patient.

Gastroenteric bleeding due to angiodysplasia (AD) is a relatively common occurrence in patients with end-stage renal failure. Gastric and colon angiodysplasic lesions can be easily revealed by endoscopic procedures, whereas lesions of the small intestine are more difficult to detect. Imaging modalities used in the diagnostic imaging algorithm for the detection of small-bowel AD, include non-invasive methods like enema-helical computer tomography,(99m)Tc-labelled red blood cell scintigraphy, and angiography, and invasive methods such as intraoperative enteroscopy. We report the cases of 3 hemodialysis patients with recurrent episodes of gastrointestinal bleeding, caused by small-bowel AD diagnosed by means of wireless-capsule endoscopy. In all cases, previous gastroscopy and colonoscopy were unrevealing. Wireless-capsule endoscopy consists in swallowing a capsule endoscope (11 mmx27 mm) which contains a miniature video camera, a light source, batteries, and a radio transmitter. Video images are transmitted by means of radio telemetry to aerials taped to the body that allow images to be captured. Moving images from a period as long as 6 h are stored on a portable recorder. Wireless-capsule endoscopy may prove valuable in the assessment of gastrointestinal bleeding in uremic patients with unrevealing results at gastroscopy and colonoscopy.

Adult↗
PubMed2005

[Observation on therapeutic effect of acupuncture combined with drug for treatment of intestinal metaplasia of chronic atrophic gastritis].

OBJECTIVE: To search for an effective method for treatment of intestinal metaplasia of gastric mucosa in the patient of chronic atrophic gastritis. METHODS: Fifty-one cases of chronic atrophic gastritis with intestinal metaplasia were randomly divided into a treatment group (n = 26) and a control group (n = 25). The treatment group were treated with acupuncture at main acupoints: Zhongwan (CV 12), Zusanli (ST 36), Neiguan (PC 6), Gongsun (SP 4), and oral administration of modified Sijunzi Decoction, and the control group with the modified Sijunzi Decoction. After treatment for 3 months, clinical symptoms, results of gastroscopy and pathological changes of gastric mucosa were compared between the two groups. RESULTS: There was no significant difference in improvement of the clinical symptoms between the two groups (P > 0.05); the total effective rate of 88.46% for gastroscopy in the treatment group was better than 64.00% in the control group (P < 0.05); and the total effective rate of 84.62% for pathological improvement of intestinal metaplasia in the treatment group was superior to 64.00% in the control group (P < 0.05). CONCLUSION: Acupuncture combined with Chinese drug is a better therapy for intestinal metaplasia of gastric mucosa in the patient of chronic atrophic gastritis.

Acupuncture Points↗
PubMed1992

[Esophagogastroduodenoscpy by the surgeon].

In 1990, 123 gastroscopies were performed by surgeons in the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. Seventy-five percent of these procedures were done on a diagnostic basis and twenty-five percent were controls. Endoscopy includes diagnostic, therapeutic and control procedures of numerous surgical diseases. It is thus important for the general surgeon to be committed in the endoscopic management of these pathologies. Furthermore, preoperative gastroscopy can influence or modify the operative technique. By his nearly inborn knowledge of anatomy, tissue consistency and texture, the surgeon has a priceless advantage to learn, practice and teach endoscopy. Therefore, teaching programs in surgical endoscopy should be widely created and developed in university and teaching hospitals to allow young surgeons a systematic and progressive training during their residency.

Duodenal Diseases↗
PubMed2006

[Gastric acid reflux and reflux esophagitis in children].

OBJECTIVE: To evaluate the significance of gastric acid reflux in children with reflux esophagitis (RE). METHODS: Twenty-four-hour esophageal pH monitoring and gastroscopy were performed in 180 children suffered from vomiting. The relationship between RE, non-esophagitis (NE), non-erosive reflux disease (NERD) and gastroesophageal reflux (GER) was analyzed. RESULTS: Sixty-five of the 180 patients were confirmed as having RE by endoscopy. Among them, the number of cases with grades I, II and III RE according to the diagnostic criteria by endoscopy was 37, 19 and 9 cases, respectively, while the other 115 cases were diagnosed as NE. The positive rate of acid reflux in RE group was 58.5% (38/65), while it was 42.6% (49/115) in NE group (chi(2) = 4.179, P < 0.05). All parameters of acid reflux in RE group except for the episode of reflux and the number of reflux longer than 5 min were significantly higher than those in NE group. None of the parameters of acid reflux except for Boix-Ochoa score in grade III RE patients was significantly higher than that in both grade II and grade I RE cases. However, the difference in acid reflux parameter between grade I and grade II RE patients had not reached statistical significance. The results also showed that the positive rate of pathological acid reflux was 48.3% (87/180). Among them, 38 cases were RE, while other 49 cases were NERD. The difference in acid reflux between these two groups was not significant. CONCLUSIONS: Gastric acid reflux may play a major role in the development of RE in children, but may not be a sole pathogenic factor. The degree of acid reflux is not closely correspondent to the severity of RE. Acid reflux may not completely contribute to RE. Gastroscopy is very important for patients with reflux symptom.

Adolescent↗
PubMed1991

[Chronic gastritis and Helicobacter pylori infection on the Ivory Coast. A series of 277 symptomatic patients].

Only a few reports have established the importance of chronic gastritis and Helicobacter pylori infection in Africa. The aim of this study was to ascertain the prevalence of chronic gastritis and Helicobacter pylori infection in a symptomatic population in Abidjan, Côte-d'Ivoire. The study included 277 consecutive patients referred for gastroscopy. Two hundred nine patients complained of abdominal pain without gastroduodenal ulcer or cancer: 26 had a duodenal ulcer, 23 had a gastric ulcer, and 6 had gastric cancer. The remaining 14 patients underwent gastroscopy for various other reasons. Chronic gastritis was present in 89 percent of cases, of which 96 percent showed signs of activity. There were four cases of lymphocytic gastritis. Patients with antral chronic gastritis were older (39.43 +/- 14.3 years) than those with normal antral mucosa (33.7 +/- 12 years, P less than 0.05). Helicobacter pylori was present in 91.3 percent of cases, representing all patients with active chronic gastritis, and 60 percent of the patients with normal gastric mucosa. Chronic gastritis was present in 86 percent of patients with abdominal pain, in 100 percent of those with duodenal of gastric ulcer, and Helicobacter pylori were observed in 90, 100, and 91 percent of the same patient groups, respectively. This study demonstrates the high prevalence of chronic gastritis and the very high level of Helicobacter pylori infection in Ivorian patients complaining of various gastrointestinal symptoms. The usefulness and feasibility of therapeutic trials still have to be investigated.

Adolescent↗
PubMed2006

The survey on the practice of gastroenterology in Romania.

AIM OF THE STUDY: To get data on the current practice of Gastroenterology in Romania. MATERIAL AND METHOD: We obtained data regarding the number of gastroenterologists in Romania from the Centre of Statistics of the Ministry of Health and Family (CSMHF) and the National Centre of Training for Medical Personnel (NCTMP). We sent a questionnaire to all the Centers of Gastroenterology in Romania inquiring about the number of gastroenterologists and fellows, and about the gastroenterological procedures performed. We compared these data to that of 17 European countries. RESULTS: The total number of gastroenterologists in Romania on January 1, 2005 was 175 (123 specialists and 52 senior consultants), and the total number of fellows in training was 133. Romania has a small number of gastroenterologists - 0.83/100,000 inhabitants, expected to reach approximately 1.4/100,000 inhabitants in 2010. Regarding the abilities in gastroenterological procedures, we obtained data from 98 gastroenterologists. They have good performances in diagnostic gastroscopy (97%), colonoscopy (81.6%), abdominal ultrasound (79.6%), but a poor performance in ERCP (10.2%). Less than half of the gastroenterologists (46.9%) perform proctologic procedures. Data regarding the training program of the Romanian fellows are disappointing: only 69.1% of them perform gastroscopy, 33.8% colonoscopy, 2.9% ERCP, 64.7% abdominal ultrasound and 14.7% proctology. CONCLUSIONS: The number of gastroenterologists in Romania seems low compared with most European countries. They do not acquire a uniform satisfactory mastering of gastroenterological procedures during their training program. This should be improved according to the guidelines of the European Diploma of Gastroenterology.

Digestive System Surgical Procedures↗
PubMed2006

Prevalence of intestinal metaplasia in the distal esophagus in patients endoscopically suspected for short Barrett's esophagus.

The clinical importance of Barrett's esophagus is related to its correlation to adenocarcinoma. The diagnosis is based on histologic demonstration of specialized intestinal metaplasia in the distal esophagus. The aim of this study was to assess the prevalence of intestinal metaplasia of the distal esophagus in a population submitted to gastroscopy not selected for reflux disease, and with columnar lined distal esophagus between 0.5 and 2 cm. Four biopsies in the distal esophagus were done in 224 patients undergoing routine gastroscopy. Patients were not selected for gastroesophageal reflux. Other clinical parameters were recorded to assess any possible association. In four Centers 224 patients received endoscopy with biopsies demonstrating specialized intestinal metaplasia in 21% of cases. No association was present among the patients with esophagitis or hiatal hernia, as well as with reflux symptoms. A significant association was present in over 70 (females), as well as with the presence of antral intestinal metaplasia demonstrated in 45 patients by gastric biopsies. No other significant associations were present. Biopsy samplings can diagnose the presence of intestinal metaplasia during endoscopy in patients endoscopically suspected for Barrett's esophagus: at present there is not clear evidence to promote this screening to achieve mortality reduction of esophageal adenocarcinoma.

Aged↗
PubMedDate not supplied

Clinical evaluation of the short half-life injectable benzodiazepine midazolam, and of the specific antagonist flumazenil in upper digestive tract endoscopy.

In a first step, midazolam 0.1 mg/kg, midazolam 0.05 mg/kg and diazepam 0.15 mg/kg administered intravenously were blindly evaluated as a sedating preparation in 3 groups of each 30 patients undergoing gastroscopy. Although amnesia is better with midazolam 0.1 mg/kg, the induced sedation is protracted, which is not to be wished in ambulatory patients. On the other side, diazepam 0.15 mg/kg was locally less well tolerated. Taking into consideration the efficacy and the general and local tolerance, the dose of midazolam 0.05 mg/kg seems the best compromise. In a second step, the specific benzodiazepine antagonist flumazenil was blindly evaluated at two intravenous doses, 1 mg and 0.5 mg, against placebo for reversal of midazolam (0.1 mg/kg) induced sedation in gastroscopy patients. 1 mg of flumazenil (and to a lesser degree 0.5 mg) suppresses the sedation and amnesia induced by midazolam and normalizes attention and sensori-motor functions. However a certain degree of resedation can reappear 45-60 min. after the administration of flumazenil. Though this phenomenon did not alter the tests measuring attention and sensorimotor functions and the recovery of memory (contrary to placebo), it incites to be cautious when the drug is given to ambulatory patients.

Amnesia↗
PubMedDate not supplied

[Dyspepsia and Helicobacter (Campylobacter) pylori. Results of a randomized therapeutic trial using amoxicillin versus placebos].

A population of non ulcer dyspepsia outpatients with a normal gastroscopy was assessed. Clinical complaints, the type of the gastritis, its activity and bacterial density were evaluated. Helicobacter pylori (HP) was sought by histology, urease test and culture, on 3 distinct locations. HP was found in 62 p. cent of the patients, always in association with gastritis. Urease test and histology had the same sensitivity in the detection of HP. A randomized double blind study with amoxicillin vs placebo was carried out in 23 patients. At the end of 4 week treatment, a gastroscopy with biopsies was performed. The amoxicillin treated patients were significantly cured or improved. HP was undetectable or the bacterial density was decreased in this group. After amoxicillin, urease test was more sensitive than histology. HP might be involved in the pathophysiology of non ulcer dyspepsia in patients where HP was found.

Adult↗
PubMed1990

[14C-urea breath test to diagnose gastric Helicobacter pylori colonization].

Helicobacter pylori (H. pylori), ex-Campylobacter pylori, is now considered to be the causative agent of active chronic gastritis in humans and may be diagnosed by histology, gram-stain, culture, urease test or noninvasively by 14C-urea breath test. The aim of this study was to determine the sensitivity, specificity, and reproducibility of the breath test as compared with the microbiological (culture) "gold standard". Forty-one subjects were studied. Gastroscopy was performed in all participants and 2 antral mucosa biopsy specimens were taken for urease test and microbiological (gram-stain and culture) studies. The breath test was performed within one week after the gastroscopy. After fasting overnight, a control breath sample was obtained and a standard meal was offered to delay gastric emptying. Then, the participants drank 5 microCi of 14C-urea in 20 ml of water and breath samples were collected at 10, 15, 30 and 60 min in a hyamine-ethanol solution with a p-H indicator. A repeat test was performed in 9 subjects to assess test reproducibility. Twenty-nine subjects (71 percent) were Hp positive and 12 (29 percent) H. pylori negative. A highly significant difference (p less than 0.0001) was observed in 14CO2 exhalation in colonized and non-colonized subjects in samples collected at all times studied. As compared with culture we found that the breath test was 97 percent sensitive and 100 percent specific. We conclude that 14C-urea breath test is a simple, inexpensive, sensitive, and reliable method to detect H. pylori colonization. It is a useful test to epidemiologic and therapeutic trials.

Adult↗
PubMed1989

[Surgical treatment of hemorrhaging gastroduodenal ulcer. Individually adapted indications].

Increase in application of emergency gastroscopy together with indications according to "Forrest" criteria, in the course of nine years, resulted in reduction of lethality by 15 per cent among patients who had been surgically treated for bleeding ulcers. Life-threatening postoperative risks were higher without gastroscopy. A critical appraisal is made in this paper of gastroscopic findings, with reference being made to surgical results.

Aged↗
PubMed1989

[Short-term curative effects of daoyin-tuna qigong therapy in 103 cases of chronic atrophic gastritis].

UNLABELLED: Daoyin-Tuna Qigong therapy was applied to 103 cases with chronic atrophic gastritis (CAG). The average duration of disease was 7.8 years. Daoyin-Tuna Qigong exercises were done 4 times a day, 1 hour each time. 79 days made a course and no drug was given. 31 cases were checked with gastroscopy and biopsy, 30 cases with electrogastrogram and 34 cases with immunity detection before and after treatment course. RESULTS: In clinical symptoms, the therapy appeared markedly effective in 72 cases (69.9%). The effective cases were 28 (27.2%). The total effective rate was 97.1%. The body weight of 95 cases (92.2%) increased by 2.4 +/- 1.3 kg on the average at the end of the treatment course, and the capacity for eating was increased by 110 +/- 70 g a day in 99 cases (96.1%). In gastroscopy and pathology examination, the rates of marked effectiveness were 35.5% and 48.4%, the effective 29.0% and 38.7%, the total effective 64.5% and 87.1% respectively. Electrogastrogram check: the frequency and amplitude of the electrogastrogram increased markedly (P less than 0.05) in comparison with the pre-therapy. Immunology examination: E-rosette was 51.3 +/- 8.4% before treatment and 55.3 +/- 7.7% after treatment (P less than 0.05). It is suggested that Daoyin-Tuna Qigong therapy would be a better and new treatment for CAG.

Adolescent↗
PubMed1978

Indomethacin-associated peptic ulceration.

A review has been made of the hospital case notes of 32 patients with indomethacin-associated peptic ulceration seen over a four year period in Dunedin. Ulceration attributed to indomethacin therapy was found to particularly involve elderly women, in contrast to a predominance of males and a younger mean age at diagnosis in non-drug associated ulceration seen over the same period. The indomethacin-associated ulcer patients were more frequently complicated by haematemesis or melaena (two-thirds of cases compared to one-quarter for the group not on drugs) and relative hypochlorhydria was frequently noted at the time of gastroscopy in this group as compared to the other cases. It is suggested that patients warranting prolonged treatment with indomethacin require regular reassessment for any evidence of dyspepsia or anaemia, and that barium meal or gastroscopy are indicated for the presence of even mild abnormality of these types.

Adult↗
PubMed1987

[Early gastric cancer associated with ectopic gastric mucosa (submucosal cysts)].

A 72 year-old man visited our hospital complaining of anorexia and hungry epigastric pain. Gastroscopy and upper G-I series examination established the diagnosis of double gastric cancers. Total gastrectomy, R2 lymphadenectomy and beta anastomosis were performed. The type IIc early cancer lesion at the pyloric vestibule was sm in depth and revealed a histological pattern of tubular adenocarcinoma. The multiple lesions on the anterior and posterior walls of the lesser curvature were a cluster of submucosal cysts, and were partially accompanied by signet-ring cell carcinoma having the depth m. The two lesions were histologically isolated without continuity, and the histology progress was PoHoeta (-) ps(-), Stage I, aw(-), ow(-). Postoperative course was uneventful. Though multiple diffuse ectopic gastric mucosa is seemed to be benign submucosal tumor of the stomach, occasional co-existence of cancer has been frequently reported. Even if the results of gastroscopy and upper G-I series results are negative, there is always a possible risk of overlooking a small cancerous focus. On detecting ectopic gastric mucosa, immediate and thorough resection seems desirable, especially when accompanied by cancer. The pathogenesis of multiple diffuse ectopic gastric mucosa has remained controversial and has been explained by the theory of either congenital or acquired aberration. From the histological findings, the pathogenesis of this case could not be determined.

Adenocarcinoma↗