Duodenal Ulcer Scar Research Articles

Skin prick test as an approach to guide food introduction while ensuring Crohn’s disease remission in a child

Nutritional therapy through exclusive enteral nutrition (EEN) is successful with Crohn’s disease (CD), but most patients relapse when returning to a normal diet. Personalized and sustainable diets over time have not been tried. This pioneering case report shows the successful response to the use of a skin prick test (SPT) with a 0.5 mm cutoff and a combination of parameters to guide the diet of a child with CD, ensuring continued remission and a regular diet over a follow-up period of 3 years. The 5-year-old patient had a history of chronic diarrhea. Laboratory showed anemia, hypoalbuminemia, high erythrocyte sedimentation rate (ESR), and fecal calprotectin (FCP) > 2,100 µg/g. Endoscopies revealed duodenal ulcer scar and ulcerative pancolitis. Simple endoscopic score for CD score (SES-CD) = 16 (severe). Pathology showed CD. EEN started with a polymeric formula, later moving to an elemental formula due to a suboptimal response. Medication included prednisolone, mesalazine, azathioprine, and methotrexate. Foods were introduced guided by the SPT and included 54 protein extracts from food tested every 3–4 months. The patient has clinical and histological remission despite having lamb, turkey, eggs, cereals (including wheat), and fish in his diet. FCP has been measured with every change in diet and maintained at < 100 µg/g with the reintroduction of food, with the exception of fish and eggs which, despite a negative SPT, gave mild symptoms and raised FCP to 223 µg/g. Both eggs and fish were successfully reintroduced (FCP < 100 µg/g) after 7 and 11 months respectively from failed reintroduction. This innovative approach based on SPT and strict clinical and follow-up inflammatory markers can potentially ensure remission, reintroducing foods with objective parameters, and improving the patient’s quality of life.

En bloc resection by polypectomy with over-the-scope clip for a neuroendocrine tumor located in a duodenal bulb pocket.

Neuroendocrine tumors (NETs) are located primarily in the submucosal layer and require careful resection. Conventional endoscopic mucosal resection (EMR) has a risk of positive deep resection margins. En bloc resection is more feasible in endoscopic submucosal dissection (ESD); however, in the duodenum, there is a heightened risk of intraoperative or delayed perforation owing to the thin duodenal wall and effects of inflowing bile and pancreatic juices [1]. The use of an over-the-scope (OTS) clip during polypectomy can greatly reduce the perforation risk [2] and is reportedly safe for duodenal NETs [3]. However, its use during polypectomy to resect NETs located in the pocket of a duodenal ulcer scar has not been reported. We report the use of this method for the safe, rapid, en bloc resection of such tumors located in the anterior wall of the duodenal bulb ([Fig. 1], [Fig. 2], [Video 1]).

Gallstone ileus in a middle-aged male with an atypical history: a case report

Currently, gallstone ileus is an unusual complication of cholelithiasis (0.3–3.0 %) and a rare cause of mechanical bowel obstruction (0.1–4.0 %). The rarity of the condition makes it impossible to plan the large prospective randomized clinical trials, so the analysis of case reports is significant for decision making in the management of gallstone ileus. We report a case of gallstone ileus in a middle-aged male who had a history of surgery for duodenal ulcer perforation in past. A combination of peptic ulcer disease and cholelithiasis is based on a reduced gastrointestinal hormones secretion. Clinical specialists need to consider information about the greater frequency and asymptomatic clinical course of gallstone disease against a background of duodenal ulcer. Duodenal ulcer scar and bulbar deformity may promote to the cholecystoduodenal fistula formation. In the presence of an acute bowel obstruction symptoms and the absence of gallbladder instrumental examination results, it is possible to recommend the prior gastroduodenoscopy for the pre-operative pneumobilia detection. The optimal surgical approaches for acute gallstone ileus are still controversial.

Concurrence of Helicobacter pylori Infection and Its Associated Factors in Korean Couples.

BackgroundThis study evaluated the prevalence of Helicobacter pylori infection and the risk factors associated with H. pylori transmission among spouses.MethodsWe assessed the spousal concurrence of H. pylori infection using the Campylobacter-like organism (CLO) test under gastro-endoscopy in 132 couples. Based on the CLO test results, participants were categorized into H. pylori concurrent and independent groups. The chi-square test and Student t-test were performed for demographic comparisons between the concurrent and independent H. pylori groups. In addition, multivariate logistic regression analysis was performed to identify factors associated with concurrent H. pylori infection.ResultsThe study revealed that the concurrence rate of H. pylori infection was 42.4% in married Korean couples. The odds ratio (OR) derived from the concurrence of H. pylori infection tended to decrease in older couples (OR, 0.975; 95% confidence interval [CI], 0.949–1.002; P=0.072). Gastric erosion was also associated with a decreased OR for concurrent infection (OR, 0.488; 95% CI, 0.295–0.808; P=0.005). Conversely, active duodenal ulcers were associated with an increased OR for concurrent infections (OR, 6.501; 95% CI, 1.267–33.346; P=0.025). Duodenal ulcer scars tended to increase the OR of concurrent infections (OR, 1.392; 95% CI, 0.815–2.380; P=0.226).ConclusionSpousal transmission and concurrence of H. pylori infection were negatively associated with gastric erosion; however, they were positively associated with active duodenal ulcers. Further studies are warranted to elucidate the mechanisms underlying these findings.

A case of transpapillary removal of choledocholithiasis using a forward-viewing scope by the rendezvous method via the PTGBD route

A 75-year-old woman was referred to our department to be investigated for liver damage. Abdominal computed tomography findings revealed choledocholithiasis with an 11-mm stone. We attempted endoscopic lithotomy using a duodenoscope. However, it was impossible to pass the duodenoscope beyond a gastric deformity with duodenal ulcer scar. The intrahepatic biliary duct was not dilatated, so we performed percutaneous transhepatic gallbladder drainage (PTGBD). Although we attempted percutaneous removal of the stone via the PTGBD route, this was difficult due to the steep angle of the cystic duct junction. We finally succeeded in removing the stone by the rendezvous method via the PTGBD route, as a forward-viewing scope could reach the papilla of Vater. The rendezvous method via the PTGBD route was an effective option for a patient with choledocholithiasis.

Risk Factors for Helicobacter pylori Infection and Endoscopic Reflux Esophagitis in Healthy Young Japanese Volunteers.

Objective The aim of this study was to determine the prevalence and risk factors of reflux esophagitis and Helicobacter pylori (H.pylori) infection and their interrelationship in healthy young Japanese volunteers. Methods Between 2010 and 2016, 550 fifth-year medical students at Saga Medical School, aged 22 to 30 years, underwent upper gastrointestinal endoscopy and completed a questionnaire (frequency scale for symptoms of gastroesophageal reflux disease). H. pylori infection was determined by detecting urinary immunoglobulin G antibodies. Results H. pylori antibodies were detected in 45 of the 550 subjects (8.2%). Endoscopic reflux esophagitis was detected in 38 out of 550 (6.9%): grade A in 37 subjects (97.3%) and grade B in 1. Most subjects with reflux esophagitis were H. pylori-negative (35/37). Nodular gastritis was observed in 33.3% (15/45) of H. pylori-positive subjects. The risk factors for H. pylori infection were drinking well water in childhood, nodular gastritis, and duodenal ulcer scars. The risk factors for endoscopic reflux esophagitis were male gender and obesity (body mass index ≥25). Conclusion This study describes the risk factors for H. pylori infection and reflux esophagitis in healthy young Japanese subjects. The prevalence of reflux esophagitis was relatively high, and the infection rate of H. pylori was low compared with the aged Japanese population.

1034 Measures of Obesity and Risk of Gastric and Duodenal Ulcers

G A A b st ra ct s the recurrence of LDA-related peptic ulcers has not been reported. We conducted a randomized, double-blind, double-dummy, active-controlled trial to assess the efficacy, doseresponse relationship and safety of rabeprazole for peptic ulcer recurrence in Japanese patients in long-term LDA therapy. Methods: Patients were eligible for the trial if they had an endoscopically confirmed gastric or duodenal ulcer scars and were receiving long-term LDA (81 mg/day or 100 mg/day) therapy for cardiovascular and cerebrovascular protection. Patients on long-term LDA therapy were also eligible if they had a previous history of endoscopically confirmed active peptic ulcers, but did not present them at baseline endoscopy. Patients were randomly segregated into three groups receiving rabeprazole 10 mg once daily (standard dose in Japan), rabeprazole 5 mg once daily or teprenone (mucosal protective agent commercially available in Japan) 50 mg three times per day as an active control. The primary endpoint was recurrence of gastric and duodenal ulcers over 24 weeks. Secondary endpoints included an occurrence of bleeding ulcers with stigmata of recent hemorrhage or drop in hemoglobin level of more than 2 g/dl, changes from baseline in the modified Lanza score (endoscopic scoring system for gastroduodenal damage) or upper gastrointestinal symptom score, and newly-developed erosive esophagitis. Results: Among 472 randomized patients, 452 patients (rabeprazole 10 mg, n=151; rabeprazole 5 mg, n= 150; teprenone 150 mg, n=151) constituted the full analysis set. The cumulative recurrence rates of gastric and duodenal ulcers over 24 weeks in the 5and 10-mg rabeprazole groups were 2.8% and 1.4%, respectively, and both were significantly lower than that in the teprenone group (21.7%). The cumulative occurrence rate of bleeding ulcers over 24 weeks in the teprenone group was 6.1%, while bleeding ulcers were not observed in the 5or 10-mg rabeprazole groups. The rates of worsening in the modified Lanza and upper gastrointestinal symptom scores in the 5and 10-mg rabeprazole groups were significantly lower than those in the teprenone group. Significantly fewer patients developed erosive esophagitis in the 5 mg rabeprazole group (2%) and 10 mg rabeprazole group (0%), compared with the teprenone group (8.6%). Rabeprazole was well-tolerated at both doses. Conclusions: Rabeprazole prevents the recurrence of gastroduodenal ulcers with no evidence of a major dose response effect in patients taking LDA, and is well-tolerated.

1033 Underestimation of Small Bowel Bleeding in Users of Nonselective Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Low-Dose Aspirin (ASA): A Prospective Study

G A A b st ra ct s the recurrence of LDA-related peptic ulcers has not been reported. We conducted a randomized, double-blind, double-dummy, active-controlled trial to assess the efficacy, doseresponse relationship and safety of rabeprazole for peptic ulcer recurrence in Japanese patients in long-term LDA therapy. Methods: Patients were eligible for the trial if they had an endoscopically confirmed gastric or duodenal ulcer scars and were receiving long-term LDA (81 mg/day or 100 mg/day) therapy for cardiovascular and cerebrovascular protection. Patients on long-term LDA therapy were also eligible if they had a previous history of endoscopically confirmed active peptic ulcers, but did not present them at baseline endoscopy. Patients were randomly segregated into three groups receiving rabeprazole 10 mg once daily (standard dose in Japan), rabeprazole 5 mg once daily or teprenone (mucosal protective agent commercially available in Japan) 50 mg three times per day as an active control. The primary endpoint was recurrence of gastric and duodenal ulcers over 24 weeks. Secondary endpoints included an occurrence of bleeding ulcers with stigmata of recent hemorrhage or drop in hemoglobin level of more than 2 g/dl, changes from baseline in the modified Lanza score (endoscopic scoring system for gastroduodenal damage) or upper gastrointestinal symptom score, and newly-developed erosive esophagitis. Results: Among 472 randomized patients, 452 patients (rabeprazole 10 mg, n=151; rabeprazole 5 mg, n= 150; teprenone 150 mg, n=151) constituted the full analysis set. The cumulative recurrence rates of gastric and duodenal ulcers over 24 weeks in the 5and 10-mg rabeprazole groups were 2.8% and 1.4%, respectively, and both were significantly lower than that in the teprenone group (21.7%). The cumulative occurrence rate of bleeding ulcers over 24 weeks in the teprenone group was 6.1%, while bleeding ulcers were not observed in the 5or 10-mg rabeprazole groups. The rates of worsening in the modified Lanza and upper gastrointestinal symptom scores in the 5and 10-mg rabeprazole groups were significantly lower than those in the teprenone group. Significantly fewer patients developed erosive esophagitis in the 5 mg rabeprazole group (2%) and 10 mg rabeprazole group (0%), compared with the teprenone group (8.6%). Rabeprazole was well-tolerated at both doses. Conclusions: Rabeprazole prevents the recurrence of gastroduodenal ulcers with no evidence of a major dose response effect in patients taking LDA, and is well-tolerated.

Acute pancreatitis due to a duodenal ulcer.

Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

Cystic fibrosis, gastroduodenal inflammation, duodenal ulcer, and H. pylori infection: The “cystic fibrosis paradox” revisited

In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is uncommon (CF paradox). Helicobacter pylori (HP) infection is the main cause for duodenal ulceration and its prevalence in CF patients is controversial. The objective of this study is to evaluate HP prevalence, gastric histology, and duodenal ulceration in adult FC patients. 32 adult CF patients were submitted to (13)C-urea breath test and serum immunoblotting test for HP diagnosis. Among them, 20 patients were submitted to endoscopy. 19/32 (68%) patients showed positive serology. Endoscopy showed erosive duodenitis (15%), and duodenal ulcer scar in 10%. On duodenal histology, 94.5%, showed active inflammation and 66.7% gastric metaplasia. HP infection prevalence in adult CF patients was similar to that of general Brazilian population. CF patients have all the duodenal spectrum of alterations, including duodenal ulcer. CF paradox may not exist.

Invasive Gastric Mucormycosis Which Was Managed Nonsurgically after Deceased Donor Liver Transplantation

Introduction: We experienced an unusual infection which was invasive gastric mucormycosis after deceased donor liver transplantation and managed with not surgery but conservative management so that we are reporting it. Case report: A 46 years old female patient was admitted via the emergent center for hepatic encephalopathy. She was diagnosed as liver cirrhosis associated with hepatitis B in 2008. At the time of admission, abdominal CT showed advanced liver cirrhosis with splenomegaly, a duodenoscopy showed portal hypertensive gastropathy and duodenal ulcer scar, and the Model for End-Stage Liver Disease (MELD) score was 30. She underwent uneventful liver transplantation on 17th day after admission and due to massive bleeding she underwent another operation for bleeding control on the next day. At the time of liver transplantation the MELD score was 42. On the postoperative day (POD) 3, she started to eat, and on the POD 7, she was transferred to a general ward. On the POD 9, she presented first fever (38.7°C). Under the impressions of pneumonia, urinary tract infection, catheter related infection, and intra-abdominal infection, piperacillin-tazobactam was started. Vancomycin was added later. On the POD 18, she had a new onset of fever (39.0°C) and abdominal CT showed that disappeared normal mucosal enhancement and thinned wall in stomach greater curvature of cardia, high body (Figure 1).[Figure 1]Endoscopic examination was done and it showed that along with greater curvature side of cardia to mid body of stomach, a 10cm sized yellowish lesion which was thought to be omentum was noticed (Figure 2).[Figure 2]So we went on exploration only to find there was nothing wrong with the stomach, at least outside of the stomach. Gastric biopsies and cultures identified mucormycosis. From the findings of the previous exploration and the condition of the patient including infective endocarditis, we decided not to operate. We started Amphotericin B and had long period of conservative management with some changes in antibiotics. The invasive gastric mucormycosis was improved, but other infections made her worse. At 8 months after transplantation, she died of multiorgan failure. Conclusion: Invasive gastric mucormycosis could be managed with nonsurgically.

Interobserver variation in the endoscopic diagnosis of gastroduodenal ulcer scars: implications for clinical management of NSAIDs users

BackgroundA clinical history of peptic ulcer has been reported to be associated with a high rate of ulcer recurrence in nonsteroidal anti-inflammatory drug (NSAID) users. Therefore, it is a very important issue to precisely know the previous history prior to NSAIDs administration. To clarify the possible difficulty to identify the history, we determined the sensitivity and diagnostic concordance of endoscopy for the identification of ulcer scars indicative of previous clinical history of peptic ulcer diseases.MethodsThe first study enrolled 200 consecutive patients with a clinical history of gastric or duodenal ulcers previously confirmed by esophagogastroduodenoscopy. The sensitivity of endoscopy for identifying scars was determined for these patients. In the second study, the extent of interobserver agreement was determined for 47 endoscopists who identified ulcer scars in endoscopic photographs of 30 sites of previous active gastric ulcers and 30 sites of previous active duodenal ulcers. The kappa coefficient of reliability was calculated to measure the interobserver agreement on the diagnosis of ulcer scars.ResultsOut of 190 patients eligible for analysis, 104 (54.7%) were found to have gastric or duodenal ulcer scars on endoscopy; there were no gastric or duodenal ulcer scars seen in the remaining patients (45%). In the second study, the kappa values for endoscopic diagnosis of gastric and duodenal ulcer scars were 0.14 (95% CI 0.13-0.16) and 0.29 (95% CI 0.27-0.32), respectively. The addition of indigo-carmine chromoendoscopy did not provide a statistically significant improvement in diagnostic concordance in patients with gastric ulcer scar since the kappa value for chromoendoscopic diagnosis was 0.15; 95% CI 0.13-0.17 as low as for un-contrasted scars.ConclusionsThe sensitivity and concordance of endoscopic diagnosis of gastric and duodenal ulcer scars are not satisfactory for the use of endoscopy only to identify previous ulcer disease. To avoid the overlooking the previous clinical history of peptic ulcer diseases, the diagnosis of peptic ulcer scar has to be carefully done prior to NSAIDs administration.

Clinical results of observation of the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope

Esophagogastroduodenoscopy through the oral cavity of patients who have undergone percutaneous endoscopic gastrostomy (PEG) causes some distress and puts these patients at risk of aspiration pneumonia. The aim of this study was to evaluate results for the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope. The study subjects were 43 patients, who underwent exchange of a PEG button or tube, 20-French or more in diameter. After PEG buttons or tubes were extracted from the gastrostomy tract, an ultrathin endoscope was inserted through the gastrostomy tract. The stomach and the duodenal bulb were observed and the esophagus was observed in retrograde passage. A new PEG button or tube was then inserted. The rate of successful insertion into the esophagus and duodenal bulb, the observation of the gastrostomy site in retroversion in the stomach, and the endoscopic findings were analyzed. Ninety-nine examinations were carried out. The esophagus could be observed in 95 (96.0%), the duodenum in 92 (92.9%) and the gastrostomy site in the stomach in all. Gastric polyps were detected in four patients, gastric erosions in two, reflux esophagitis in two, polypoid lesion at the gastrostomy tract in two, gastric ulcer scar in one, duodenal ulcer scar in one, early gastric cancer in one and recurrent esophageal cancer in one. Neither discomfort nor complications occurred during transgastrostomic endoscopy. Observation of the upper gastrointestinal tract by transgastrostomic endoscopy using an ultrathin endoscope during a gastrostomy button or tube replacement may be useful and safe.

Association of endoscopic appearances with dyspeptic symptoms

The relationship between endoscopic appearances such as endoscopic gastritis and duodenitis and dyspeptic symptoms has not been clearly demonstrated. We aimed to clarify the association of endoscopic appearances with Helicobacter pylori infection, histological severity of gastritis, and dyspeptic symptoms in a Japanese population. We enrolled 87 dyspeptic and 93 nondyspeptic subjects in this study. All subjects underwent gastroscopy, and patients with active peptic ulcer disease, reflex esophagitis with erosion, polyps >1 cm, or cancer were excluded. Endoscopic appearances in patients with dyspeptic symptoms and in those without were assessed retrospectively on the basis of endoscopic images. The degree of atrophy by the Kimura-Takemoto classification system was also assessed. Helicobacter pylori infection status was examined by histology or antibody against H. pylori. Histological severity of inflammation and glandular atrophy in the antrum were assessed according to the updated Sydney System. The odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression using the variables age, sex, H. pylori infection status, and all endoscopic appearances. The degree of atrophy tended to be lower among dyspeptic patients (P = 0.06). Among all endoscopic appearances, the liner redness (friability) in the antrum (OR = 3.90, 95% CI = 1.20-12.64) and duodenal ulcer (DU) scarring (OR = 3.41, 95% CI = 1.08-10.79) were independently associated with dyspepsia. Histological severity of inflammation and glandular atrophy were not associated with dyspeptic symptoms. Also, no correlation was found between endoscopic appearances and any of the different subgroups of dyspeptic symptoms. Patients with friability in the antrum and DU scar, which correlated with dyspeptic symptom showed some of communal symptoms such as epigastric pain, epigastric discomfort, hypochondriac pain, early satiation/postprandial fullness, and belching, but they differed considerably with respect to H. pylori positivity and the histological severity of gastritis. Some endoscopic appearances such as friability in the antrum and DU scarring may be associated with dyspeptic symptoms, and endoscopic appearances may be useful markers to perform clinical implementation reflecting an individual's pathophysiology of dyspeptic symptoms.

A CASE OF ANNULAR PANCREAS IN A MALE ADULT

Annular pancreas is a rare congenital anomaly, which consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. We reported a case of symptomatic annular pancreas in a 40 year old man admitted to our hospital complaining of abdominal pain, nausea and vomiting without body weight loss in January 2000. The patient underwent laparoscopic cholecystectomy for acalculous cholecystitis in September 1996. Initially, he was diagnosed with duodenal stenosis due to a duodenal ulcer scar, but laboratory data showed no abnormalities. His symptoms did not improve with medication or endoscopic balloon dilatation. Duodenograpy revealed a narrow segment with a smooth mucosal surface in the 2nd portion of the duodenal loop in the duodenum, and a computed tomography (CT) scan demonstrated a thickened pancreas head around this narrow segment. We were therefore able to diagnose annular pancreas. A duodeno-duodenostomy was performed in March 2000. The patient's postoperative course was uneventful, and he was discharged from our hospital on the 19th postoperative day. Although define diagnosis of annular pancreas is frequently made at laparotomy, the development of a recurrent imaging modality might assist in the preoperative diagnosis.

Molecular relationships of Helicobacter pylori strains in a family with gastroduodenal disease

Objective: Few studies have examined the genetic relationships of Helicobacter pylori strains affecting family members. Our aim was to do so. Methods: We characterized H. pylori isolates obtained from members of a single family presenting with various gastroduodenal diseases to examine H. pylori bacterial genetic similarity. Endoscopic evaluation with gastric mapping was performed on each individual to establish clinical and histological disease. Genomic DNA extracted from each H. pylori isolate was used to generate DNA fingerprints for each strain by REP-PCR. vacA genotypes and cagA presence were established by PCR. Results: Gastrointestinal diseases among the five members of this family included gastric adenocarcinoma in a 52-yr-old man (index patient), gastric MALT-lymphoma in the 73-yr-old mother; intestinal metaplasia (IV) and atrophic gastritis in the 48-yr-old brother; intestinal metaplasia (I-III) in the 47-yr-old brother, and a duodenal ulcer scar in the 42-yr-old sister. REP-PCR DNA fingerprints of H. pylori isolates from the index patient, his mother, and both of his brothers were identical or highly similar. By contrast, the H. pylori DNA fingerprint from the sister was markedly different from the H. pylori DNA fingerprints from the other family members. All isolates had the genotype cagA-positive and vacA slb/ml mosaic genotype. Conclusions: The DNA fingerprints of H. pylori strains obtained from members of this family with malignancy or premalignant histological disease were identical or highly similar and markedly different from the H. pylori DNA fingerprint from the sibling with duodenal ulcer disease. All H. pylori isolates within the family possessed genetic markers of enhanced virulence (presence of the cagA gene and vacA sl/ml mosaicism). In addition to host genetics and environmental factors, these findings suggest that infection with genetically similar H. pylori strains is a significant factor in determining the clinical outcome of an infection with H. pylori.

咽喉頭異常感症と胃・十二指腸粘膜病変

The stomach and duodenum of 76 patients with abnormal sensations in the throat were examined by esophagogastroduodenal panendoscopy, and the results were compared with those of 91 patients with abdominal complaints. Of the 76 patients,10 patients (13.0%)had severe gastric or duodenal disease (gastric ulcer, duodenal ulcer or verrucous gastritis),35 patients (46.0%) had slight disease (erosive gastritis, duodenitis or gastric duodenal ulcer scar), and 29 pateints (38.0%) were normal.Antiulcer drugs were significa n tly effective in alleviating the abnormal sensation in the throat in patients with severe gastric or duodenal disease, but had only a placebo effect in patients with slight disease. An abnormal sensation in the throat may be induced by hyperconstriction of the cervical muscles through central reflex of the vagus nerve, which is stimulated by gastroduodenal disease.

Gastroduodenal peptic ulcers, duodenal adhesions, and upper gastrointestinal motility disturbances in patients who have undergone cholecystectomy.

The frequency of duodenal and gastric ulcer disease, the thickness of the pyloric muscle, and adhesions of the duodenum were evaluated in a routine, consecutive, prospective autopsy series of 100 patients, and the length of the pyloric canal, adhesions of the duodenum, and motility disturbances in the upper gastrointestinal series were studied in a separate radiologic material of 69 symptomatic patients with cholecystectomy in their history. Both series were compared with matched unoperated controls. The frequency of active gastric ulcers and ulcer scars was observed to be increased and that of active duodenal ulcers and ulcer scars decreased among the cholecystectomized patients in the autopsy series (p = 0.01 in both cases). This difference was not as pronounced when only active ulcers were included, but for active duodenal ulcers the difference was still significant (p = 0.04). One-fourth of the cholecystectomized patients but none of the controls had severe adhesions of the duodenum. In the autopsy series the thickness of the pyloric muscle and in the radiologic series the length of the radiologic pyloric canal were thickened/lengthened in an average of 26%/11% in patients who had undergone cholecystectomy (p less than 0.001 and p less than 0.10, respectively). The lengthening of the pyloric canal was in significant positive correlation with the motility disturbance/adhesion score of the upper gastrointestinal series.(ABSTRACT TRUNCATED AT 250 WORDS)

Progression of Antral and Body Gastritis in Patients with Active and Healed Duodenal Ulcer and Duodenitis

The dynamics of the antral and body mucosa has been studied in biopsy specimens obtained during endoscopy of patients with duodenal ulcer (103 cases), patients with duodenal ulcer scars (108 cases), and patients with duodenitis (44 cases). A representative Finnish population sample consisting of 434 subjects was used as reference material. The antral mucosa of all patient series showed an increase in the severity and prevalence of gastritis similar to that of the general population, whereas virtually no progression of gastritis with age was seen in the body mucosa, which remained normal or at the stage of superficial gastritis up to geriatric age. In contrast, in the present controls and in all earlier population samples studied by us so far, there was a significant and steady increase in the severity and prevalence of body gastritis with age. It is concluded that the age behavior of the antral and body mucosa was in duodenal ulcer scars and duodenitis similar to that of patients with active duodenal ulcer. The persistence of normal conditions in the acid-secreting area may serve as one explanation of the strong tendency of the disease to recur. In addition, it is tentatively concluded that in duodenal ulcer disease there are factors that have a 'protecting' influence on the body glands and which are abolished by antrectomy, according to our earlier studies.

Early Re‐Operations after Surgery for Duodenal Ulcer

International Journal of Clinical PracticeVolume 36, Issue 9 p. 297-301 Lead Article Early Re-Operations after Surgery for Duodenal Ulcer N. J. Lygidakis MD, N. J. Lygidakis MD Athens, Greece Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London.Search for more papers by this author N. J. Lygidakis MD, N. J. Lygidakis MD Athens, Greece Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London.Search for more papers by this author First published: 01 September 1982 https://doi.org/10.1111/j.1742-1241.1982.tb08420.x Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume36, Issue9September 1982Pages 297-301 RelatedInformation RecommendedRelationship between Helicobacter pylori infection and gastric metaplasia in the duodenal bulb in the pathogenesis of duodenal ulcerHajime Futami, Misako Takashima, Takahisa Furuta, Hiroyuki Hanai, Eizo Kaneko, Journal of Gastroenterology and HepatologyEffect of Helicobacter pylori eradication on duodenal ulcer scar in patients with no clinical history of duodenal ulcerJ. S. Kim, S. G. Kim, I. J. Choi, M. J. Park, B. G. Kim, H. C. Jung, I. S. Song, Alimentary Pharmacology & TherapeuticsStandard treatment for Helicobacter pylori infection is suboptimal in non-ulcer dyspepsia compared with duodenal ulcer in ChineseW. M. Wong, S. D. Xiao, P. J. Hu, W. H. Wang, Q. Gu, J. Q. Huang, H. H.-X. Xia, S. M. Wu, C. J. Li, M. H. Chen, Y. Cui, K. C. Lai, W. H. C. Hu, C. K. Chan, S. K. Lam, B. C.-Y. Wong, Alimentary Pharmacology & TherapeuticsHelicobacter pylori-positive duodenal ulcer: three-day antibiotic eradication regimenF. Catalano, G. Branciforte, R. Catanzaro, R. Cipolla, C. Bentivegna, A. Brogna, Alimentary Pharmacology & TherapeuticsHelicobacter‐associated duodenitis and gastric metaplasia in duodenal ulcer patientsJAN ERIK Madsen, KÅRE Vetvik, STEINAR Aase, APMIS