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PubMed1975

Occult gastrointestinal bleeding. An evaluation of available diagnostic methods.

Occult gastrointestinal bleeding was defined as continued bleeding in spite of a normal series of roentgenorgrams of the upper part of the gastrointestinal tract, barium enema, and sigmoidoscopy. Twenty-six such patients were treated. A thorough systematic evaluation, including gastroscopy, colonoscopy, visceral angiography, and isotopic scanning, was done preoperatively. Using colonoscopy and arteriography, nearly 60% of the bleeding sites were identified. Seventy-six percent of the lesions identified were in the terminal part of the ileum or the ascending colon. Exploratory laparotomy should be performed for life-threatening hemorrhage or as a diagnostic test only after a thorough preoperative evaluation. If results of a complete preoperative evaluation including arteriography were normal, then the likelihood of finding a discrete cause of bleeding at laparotomy was high (80%). A systematic evaluation and diligence of both physcian and patient in localizing the site of bleeding are essential.

Abdomen↗

PubMed1979

Gastric lymphoma vs adenocarcinoma. A diagnostic problem.

The prevalence of gastric lymphoma is increasing relative to gastric carcinoma. The differentiation between these two diagnoses can be difficult, but it is important from the standpoint of treatment and prognosis. These case reports illustrate that the results of gastroscopy, biopsy, and cytology may be misleading. If there is any question at the time of exploration, a biopsy and frozen section should be obtained before proceeding further or before closing the abdomen without resection. The pathologic diagnosis will determine the operation and postoperative treatment to be carried out.

Adenocarcinoma↗

PubMed1986

Cancer detection in biopsy specimens taken from different types of gastric lesions.

From January 1974 to October 1983, 5072 gastroscopies were performed in 3351 patients with a total of 14,554 biopsy specimens taken from 2565 lesions in the stomach. The endoscopic diagnoses and their histologic counterparts were recorded and the diagnostic yield of specimens from each type of lesion analyzed. Gastric adenocarcinoma was finally diagnosed in 139 patients. The diagnosis was delayed, from 1 to 4 months, in five patients because of false-negative diagnoses. These patients all had ulcerating cancers. Moreover, early gastric cancer was mainly of the ulcerating type. Accordingly, an ulcer lesion is the most important one to biopsy. Only four cancers were found in 959 benign-appearing gastritic lesions. Twenty-one patients with negative biopsy results at the first endoscopy were later shown to have cancer. When these biopsy specimens were re-examined, malignant lymphoma was found in one and adenocarcinoma in three cases. In spite of false-negative endoscopic findings, nonrepresentative biopsy material and false-negative histologic reports, the combination of biopsy results and clinical judgement led to correct and timely treatment in nearly all patients.

Adenocarcinoma↗

PubMed1993

Screening of esophageal and gastric cancer by occult blood bead detector.

A previously described bead method used to detect blood is simple, cheap, and effective; it can be repeated periodically. In 11 provinces in China, 233,825 persons (age range, 30-70 years) were screened. A positive occult blood test result was found in 28,557 persons (12%). Of these, 16,918 underwent a gastroscopy, resulting in the detection of 581 cancers that were located in similar frequencies in the esophagus, gastric cardia, and gastric body; 70% of the lesions were in an early or moderately advanced stage. Among 119 patients with early-stage cancer, the 3-year survival rate was 98.3%. After preliminary screening of cancer, the 4-year follow-up found a mortality rate in the group with negative occult blood test results that was only 25% of that of the positive group. Preliminary yearly screening would detect more early cancers and fewer advanced cancers. The mortality rate of esophageal and gastric cancer might be reduced drastically.

Adult↗

PubMed1983

Causes and clinical significance of gastritis following Billroth II resection for duodenal ulcer.

Billroth II resection was carried out in 1000 duodenal ulcer patients in the period 1948-1956. Twenty-two to thirty years later, gastroscopy and biopsy was performed in 196 of 423 survivors. Chronic atrophic gastritis appeared in 93 per cent of the cases, 47 per cent showed slight and 46 per cent severe changes. Seven per cent had normal mucosa. The microscopic grade of gastritis proved to be independent of age, alcohol and tobacco consumption and serum gastrin. No correlation between clinical status, such as dumping, diarrhoea, vomiting and pain, haematological parameters and the microscopic grade of gastritis, could be found. It is suggested that gastritis might be caused by reflux of bile, pancreatic and intestinal juices, and that postgastrectomy symptoms and anaemia do not depend on the microscopic grade of gastritis.

Adult↗

PubMed1988

Human gastric perfusion: evidence for non-uniformity of blood flow.

Post-mortem injection studies have demonstrated marked differences in the course and distribution of arterioles in the stomach, but evidence of differential perfusion in man is lacking. Using the non-invasive laser Doppler technique, we studied 38 patients referred for gastroscopy for dyspeptic symptoms. Flux measurements were made at nine sites: distal oesophagus, cardia, mid-body and antrum on lesser and greater curves, and pre- and post-pylorus. In all cases the stomach was macroscopically normal. Flux in the proximal stomach was significantly greater than that in the antrum, (P less than 0.001, Student's t test). This in vivo study demonstrates a flow gradient related to the previously demonstrated anatomical differences.

Blood Flow Velocity↗

PubMed2006

Association between Helicobacter pylori infection and MALT-type lymphoma of the ocular adnexa: clinical and therapeutic implications.

BACKGROUND: The prevalence and the clinical impact of gastric Helicobacter pylori (Hp) infection, as well as its possible correlation with Chlamydia psittaci (Cps) infection and the lymphoma regression rate produced by Hp eradicating antibiotic therapy were investigated in patients with MALT-type lymphoma of the ocular adnexa (OAL). METHODS: During staging, the presence of gastric Hp infection was assessed by gastroscopy and multiple biopsies in 31 OAL patients. Immediately after, Hp-positive patients were treated with eradicating antibiotic therapy, alone or associated with other therapies. RESULTS: Gastric Hp infection was detected in 10 (32%) patients; this feature did not correlate with patients' characteristics and disease. Four Hp-positive patients were treated with Hp-eradicating antibiotics therapy as exclusive strategy (assessable for response), none of them showed lymphoma regression. Conversely, 6 Hp-positive patients were treated with antibiotic therapy concurrently with other therapies, achieving lymphoma regression in all cases. Three Hp-positive patients with Cps-positive lymphoma were treated with doxycycline at relapse, resulting in two CR and one PR, which lasted 24+, 20+, and 18+ months, respectively. One of these patients achieved a CR after doxycycline despite the chronic persistence of Hp infection, whereas Cps-eradication was confirmed in the analysis of PBMC samples. CONCLUSIONS: Gastric Hp infection, even if common among OAL patients, does not influence clinical presentation. Hp-eradicating antibiotic therapy is not active against OAL. Cps-eradicating antibiotic therapy with doxycycline induces lymphoma remission irrespectively of the persistence of Hp infection.

Adult↗

PubMed2006

Advantage of pancreaticogastrostomy in detecting recurrent intraductal papillary mucinous carcinoma in the remnant pancreas: a case of successful re-resection after pancreaticoduodenectomy.

Recently there has been an increase in the number of case reports detailing the recurrence of cancer in the pancreatic remnants following surgical resection of intraductal papillary mucinous carcinoma (IPMC) of the pancreas. A case is presented here to indicate the advantage of pancreaticogastrostomy (PG) in terms of postoperative follow-up after pancreaticoduodenectomy (PD) for IPMC. A 68-year-old man underwent PD for IPMC of the pancreatic head, and the cut margin of the pancreatic duct was diagnosed as having no cancer but moderately dysplastic epithelium by an intraoperative frozen section of histology. Thus, we decided to proceed with a PG rather than pancreaticojejunostomy (PJ) in order to facilitate easier postoperative examinations. Eight years and 6 months later, during a routine follow-up examination, duct dilation of the remnant pancreas was detected by magnetic resonance imaging (MRI). Upon examination by endoscopic gastroscopy, the anastomotic site was found to be covered with a large amount of mucin from which we easily obtained both cytologic and biopsied specimens, which subsequently proved positive for cancer. In line with our diagnosis of recurrent IPMC, the patient underwent a second surgery (resection of the remnant pancreas, total pancreatectomy) and postoperative histology confirmed that indeed the patient had experienced recurrent IPMC with no nodal involvement or invasion beyond the pancreatic confines. Based on this experience, we decided to recommend PG for all patients deemed to be at high risk for the recurrence of cancer in the pancreatic remnants following PD for IPMC of the pancreatic head.

Adenocarcinoma, Mucinous↗

PubMed1984

Gastric cancer in young patients.

A retrospective review of the Roswell Park Memorial Institute experience and literature review of gastric carcinoma in young adults reveals that long-term survival is rarely achieved. The primary correctable cause of failure is a very long delay in diagnosis, a result of both reluctance to initiate diagnostic studies and inaccuracy of routine upper gastrointestinal series. A high index of suspicion and liberal utilization of gastroscopy and gastric cytology combined with an aggressive surgical approach to gastric pathology would probably lead to improved survival for the young gastric carcinoma patients.

Adult↗

PubMed1990

Primary gastric lymphoma: a prospective analysis of 12 cases and review of the literature.

The clinicopathological features of 12 cases of primary lymphoma of the stomach are reviewed, and the efficacy of various treatment modalities is evaluated. The presenting symptomatology and the radiological signs were found to be similar to those of gastric carcinoma. Gastroscopy and computed tomography (CT) proved to be effective diagnostic and staging tools. There were two patients of stage I, seven patients of stage II, and three patients of stage IV. Multimodal therapy involving judiciously combined surgery, radiation therapy, and chemotherapy produced early complete remission in all the nine patients with localized disease, and all of them are disease-free at a minimum follow-up period of 12 months. These results are irrespective of whether surgery formed part of the treatment regimen. The relevant literature is reviewed, and the present status of the efficacy of nonsurgical therapy is evaluated.

Adolescent↗

PubMed2002

No impact of repeated endoscopic screens on gastric cancer mortality in a prospectively followed Chinese population at high risk.

BACKGROUND: Gastric cancer (GC) is the leading cause of cancer deaths in China. Our study prospectively evaluated the impact of repeated endoscopic screens on GC mortality in a high-risk population in China. METHODS: Between 1989 and 1999, a population-based gastroscopic screening was conducted in 4,394 residents of Linqu County, China, a region with the highest rates of GC worldwide. Residents ages 35 to 64 years received initial gastroscopies with biopsies in 1989. Repeated endoscopies were performed in 1994 and 1999. Cancer occurrences and deaths were actively monitored throughout the entire period until July 2000. Mortality from GC was compared with expected values based on mortality rates obtained for Linqu in the 1990-1992 Chinese Cancer Mortality Survey. RESULTS: Between March 1989 and July 2000, 39,303 person-years were accumulated; 85 new GCs occurred, 29 (34.5%) were in early stage. Fifty-eight cases (68%) were identified at one of the screens. The number of observed deaths from GC (37) was close to the expected (36.8). The standardized mortality ratio was 1.01 (95% CI 0.72-1.37) for the entire cohort, 1.13 (95% CI 0.77-1.57) for males, and 0.65 (95% CI 0.26-1.32) for females. CONCLUSIONS: Despite high population coverage with repeated screens, no reduction in GC mortality was observed in this high-risk population in China.

Adult↗

PubMed1996

Laparoscopic resection of gastric leiomyoblastoma.

Smooth muscle gastric tumors represent 2% of resected neoplasms of the stomach. Clinically, they are often silent and incidentally found at endoscopy or radiologic examination. These tumors can be histologically classified as benign (leiomyoma) or malignant (leiomyoblastoma), but clinical behavior is not strictly related to this classification. When symptomatic, they are present with anemia in 50% of cases due to mucosal ulceration. Surgical removal of the tumor is the accepted therapy, leaving a margin of surrounding free tissue: this treatment can be performed by laparoscopy, usefully associated with gastroscopy. We present one case of a patient with severe anemia due to bleeding from an ulcerated leiomyoblastoma 5 cm in diameter that we resected with combined gastroscopic-laparoscopic technique. We isolated the portion of gastric wall where the mass was located and resected the specimen under gastroscopic control. The postoperative period was uneventful, and the patient recovered promptly with minimal pain and discomfort.

Aged↗

PubMed1992

Endoscopic evaluation of the effect of ketoprofen, ibuprofen and aspirin on the gastroduodenal mucosa.

Endoscopic lesions of the gastric mucosa were evaluated in 12 healthy volunteers after administration of single doses of ketoprofen (25 mg), ibuprofen (200 mg) and aspirin (500 mg) in a randomized, double-blind, cross-over study. The grades of the lesions (according to Lanza's scale) were lower after the administration of ketoprofen than aspirin and were comparable to ibuprofen. An endoscopic score greater than 1 was observed in 3 cases after ibuprofen or ketoprofen, and in 8 cases after aspirin. At a time when low, single doses of NSAIDs are widely used as analgesics, gastroscopy makes it possible directly to assess the local aggressivity of these molecules. In this way it was possible to demonstrate that the local toxicity of NSAIDs was lower than that of aspirin.

Adult↗

PubMed1979

A case of hypertrophic protein losing gastropathy.

A 3 1/2 year old boy presented with a history of vomiting and generalized oedema. Biochemically proven protein losing enteropathy was associated with huge gastric fundal rugae on barium examination. Gastroscopy confirmed the barium findings but biopsy material demonstrated normal mucosa. The condition regressed on a high protein diet. Cytomegalovirus (CMV) was found in the urine after the illness had subsided.

Child, Preschool↗

PubMed1976

Acute gastric mucosal injury during continuous or interrupted aspirin ingestion in humans.

The effect of continuous versus interrupted high-dose aspirin (ASA) for 14 days was evaluated in a randomized double-blind study in 8 rheumatoid arthritis patients. Acute gastric mucosal injury was measured by serial gastroscopy and gastric biopsy. Significant gross mucosal damage was seen in all patients following 3 days of ASA (P less than 0.01) and persisted without significant change in severity to the end of the study. Histologic gastritis in areas free of hemorrhages and erosions was not increased significantly by ASA. In spite of gross mucosal injury, symptoms occurred infrequently. Serum pepsinogen I, but not serum gastrin, increased significantly following 3 days of ASA, and the elevation persisted to the end of the study. The extent of mucosal injury at 14 days was not significantly different in those receiving ASA continuously from those on an interrupted schedule. Thus, gastric mucosal adaptation to ASA in man was not demonstrated.

Arthritis, Rheumatoid↗

PubMed1977

Pseudotumor caused by gastric varices.

On upper-gastrointestinal examination a patient with cirrhosis of the liver was found to have prominent gastric varices presenting as a pseudotumor near the cardia. The diagnosis of varices was confirmed by gastroscopy and angiography. A correct diagnosis is necessary to avoid an ill-advised biopsy or unwarranted surgery.

Adolescent↗

PubMed1979

The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: a gastroscopic and photographic study.

The effects of various nonsteroidal antiinflammatory drugs on the gastric mucosa were endoscopically evaluated in 40 normal volunteers. Eight groups, each containing five subjects were designed: aspirin (3600 mg/d); placebo; ibuprofen (1600 mg/d); ibuprofen (2400 mg/d); indomethacin (100 mg/d); indomethacin (150 mg/d); naproxen (500 mg/d); and naproxen (750 mg/d). All volunteers took medication for seven days and gastroscopy was carried out on day one and day eight. All findings were documented by photography. Severe gastric mucosal injury occurred with aspirin (P less than 0.05), both doses of indomethacin, and the higher dose of naproxen. Lesser changes were seen with the lower dose of naproxen, both doses of ibuprofen and placebo. The higher doses of ibuprofen, indomethacin, and naproxen caused a greater degree of gastric mucosal injury, but statistical significance was achieved only with naproxen (P less than 0.01). Subjective gastrointestinal complaints generally correlated with endoscopic pathology; however, nine volunteers had evidence of severe injury to the gastric mucosa with no symptomatology. This was confined to the patients on indomethacin, naproxen, and ibuprofen. Aspirin patients all had some degree of symptomatology but to a lesser degree than expected in view of the endoscopic findings.

Adult↗

PubMed1983

Gastric adaptation occurs with aspirin administration in man.

Endoscopy has become a standard method to evaluate drug-induced damage to the gastroduodenal mucosa; however, studies defining the time course, extent, and duration of the injury in man are unavailable. We report a systematic endoscopic evaluation of the effect of aspirin administration on the gastric mucosa in normal volunteers. Aspirin (2.6 g/ day) or placebo was administered for 1 or 7 days. Gastroscopy was performed after 1, 2, 4, and 8 days, and every other day thereafter until the lesions resolved. Submocosal hemorrhages and/or focal erosions were present within 24 hr in all subjects. With continuous aspirin administration, injury was maximal within 3 days and then lessened, ie, damage present after 7 days of aspirin was significantly less than after 1 day of therapy. The time to resolution of the damage was also longer following 1 day than after 7 days of aspirin (median 8 days for 1 day of aspirin vs median 3 days for 7 days of aspirin). Thus, gastric mucosal adaptation occurred and was associated both with less damage and with an accelerated healing process. Acute administration of aspirin produced well-defined areas of submucosal hemorrhages within 2 hr of administration; additional doses increased the area of involvement but not necessarily the severity of involvement.

Adult↗