Epigastric Distension Research Articles

Iridoids rich fraction from Valeriana jatamansi Jones promotes axonal regeneration and motor functional recovery after spinal cord injury through activation of the PI3K/Akt signaling pathway.

Valeriana jatamansi Jones (VJJ), renowned for its extensive history in traditional Chinese medicine and ethnomedicine within China, is prevalently utilized to alleviate ailments such as epigastric distension and pain, gastrointestinal disturbances including food accumulation, diarrhea, and dysentery, as well as insomnia and other diseases. Moreover, the Iridoid-rich fraction derived from Valeriana jatamansi Jones (IRFV) has demonstrated efficacy in facilitating the recuperation of motor functions after spinal cord injury (SCI). This study is aimed to investigate the therapeutic effect of IRFV on SCI and its underlying mechanism. Initially, a rat model of SCI was developed to assess the impact of IRFV on axonal regeneration. Subsequently, employing the PC12 cell model of oxidative damage, the role and mechanism of IRFV in enhancing axonal regeneration were explored using the phosphoinositide-3-kinase (PI3K)/protein kinase B (Akt) signaling pathway inhibitor LY294002. Ultimately, the same inhibitor was administered to SCI rats to confirm the molecular mechanism through which IRFV promotes axonal regeneration by activating the PI3K/Akt signaling pathway. The results showed that IRFV significantly enhanced motor function recovery, reduced pathological injury, and facilitated axonal regeneration in SCI rats. In vitro experiments revealed that IRFV improved PC12 cell viability, augmented axonal regeneration, and activated the PI3K/Akt signaling pathway. Notably, the inhibition of this pathway negated the therapeutic benefits of IRFV in SCI rats. In conclusion, IRFV promote promotes axonal regeneration and recovery of motor function after SCI through activation of the PI3K/Akt signaling pathway.

Effects of TCM external scalding therapy on spleen-stomach deficiency cold stomachache and inflammatory indexes.

To determine the efficacy and safety of traditional Chinese medicine (TCM) external scalding therapy on spleen-stomach deficiency cold stomachache. The medical records of 98 patients with spleen-stomach deficiency cold stomachache treated in the Affiliated Hospital of Jiangnan University from January 2019 to January 2020 were collected and analyzed retrospectively. Among them, 52 patients treated with western medicine were assigned to the control group, while the other 46 patients treated additionally with TCM external scalding therapy were assigned to the observation group. The two groups were compared in terms of serum gastrin (GAS), inflammatory factors and visual analogue scale (VAS) score, adverse reaction rate and symptom remission time. After treatment, the observation group showed a significantly lower GAS level than the control group (P<0.05), along with significantly lower serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) than the control group (all P<0.05). The observation group demonstrated significantly lower VAS score than the control group (P<0.05). The observation group experienced notably shorter remission time of dull epigastric pain, epigastric distension, fatigue and belching and acid reflux than the control group (all P<0.05), and a significantly lower incidence of adverse reactions was found in the observation group than that in the control group (P<0.05). Multivariate analysis revealed that history of alcoholism and treatment method were independent risk factors affecting patient outcomes (all P<0.05). TCM external scalding therapy has shown effectiveness in treating spleen-stomach deficiency cold stomachache. It alleviates stomachache symptoms and also reduces the occurrence of adverse reactions and inflammation, holding great potential for widespread adoption in clinical practice.

Autoimmune gastritis with a gastric hamartomatous inverted polyp and two hyperplastic polyps: a case report

We report an unusual case of autoimmune gastritis (AIG) complicated with a submucosal tumor (SMT) and two pedunculated polyps in a 60-year-old man. The patient was admitted for epigastric distention, heartburn, and anorexia. Endoscopy showed an SMT in the fundus, two pedunculated polyps in the body, and markedly atrophic mucosa of the body and fundus. The SMT, measuring 20 mm in diameter, was resected by endoscopic submucosal dissection and histologically diagnosed as a gastric hamartomatous inverted polyp (GHIP), which is characterized by submucosal glandular proliferation, cystic dilatation, and calcification. The gland structures consisted of foveolar cells and pseudopyloric or mucous-neck cell types. The two pedunculated polyps that were resected by endoscopic mucosal resection were histologically diagnosed as hyperplastic polyps, which are characterized by hyperplastic foveolar glands with pseudopyloric or mucous-neck glands in the inflamed stroma in the mucosa, which consisted of almost the same types of lining cells as the GHIP in the fundus. Findings may indicate the relationship between GHIP, hyperplastic polyp, and AIG. We highlight considering GHIP as a differential diagnosis for an SMT in patients with AIG.

Gastric Duplication in a Preterm Neonate

Background: Gastrointestinal (GI) duplication is defined as a spherical structure with a muscular coat and is lined by a mucous membrane. It is a rare congenital anomaly. Clinical Description: A preterm baby born, delivered at 31 weeks, was diagnosed with respiratory distress syndrome and managed as per hospital protocol. While being weaned off from nasal continuous positive airway pressure, feeding was started. He developed vomiting and epigastric distension within 6 h. Management: The baby was investigated for the cause, and an early-onset sepsis was excluded. X-ray abdomen showed distended stomach and gas shadows in the bowel loops. Ultrasound did not reveal any gastric outlet obstruction, but significant gaseous distension of the stomach prompted us to make a dye study of the upper GI tract, which revealed cystic outpouching of the stomach that communicated with the gastric lumen. Similar findings were seen on computed tomographic scanning. Exploratory laparotomy performed revealed a large cyst communicating with the stomach at the lesser curvature. This was dissected out entirely from the margin of the stomach. Histopathology revealed highly congested cyst wall with an inner lining of gastric epithelium and gastric glands and an outer smooth muscle coat, confirming a gastric duplication cyst. Conclusion: Gastric duplication should be considered as a differential in newborns with feed intolerance, epigastric distension, and significant distension of the stomach. Although serial radiological investigations provide supportive evidence for this condition, the diagnostic confirmation is obtained by gross inspection and histopathology. In view of high risk of malignant transformation, surgical resection of the entire cyst remains the most definitive management.

Gastric volvulus presented with an upside-down stomach.

A 4-year-8-month-old girl (weight: 14.5 kg, 3rd–15th percentile) without any underlying disease was admitted because of the progressively frequent episodes of abdominal pain along with a nonbilious but coffee-ground emesis for four days. Physical examination revealed epigastric distension with the tympanic sounds upon percussion. Laboratory tests showed hyponatremia and hypokalemia. Abdominal radiograph disclosed an exaggeratedly distended stomach (arrowheads) and an infrarenal mass shadow (arrows, Fig. 1A).

Gallbladder Adenosquamous Cancer with Situs Inversus Totalis: A Case Report and Literature Review

BackgroundSitus inversus totalis (SIT) is a rare genetic congenital disease, characterized with complete right-to-left inversion of all the internal organs. We herein describe a meaningful case which was diagnosed as gallbladder adenosquamous carcinoma, a rare histology type of gallbladder cancer, with SIT.Case PresentationA 59-year-old Chinese woman was admitted for persistent epigastric distention and intermittent abdominal pain. The abdominal CT scan revealed a huge mass at the gallbladder bottom, involving the adjacent transverse colon and liver. En-bloc radical resection of the gallbladder cancer, including partial colectomy and hepatectomy with regional node dissection, followed by colocolostomy and Roux-en-Y choledochojejunostomy, was successfully performed. Pathology analysis indicated an adenosquamous carcinoma with positive adenocarcinoma markers (CK7, CK19) and squamous carcinoma markers (CK5/6, P63).ConclusionThe SIT anomaly might increase the risk of malignancies by sharing genome mutations, suggesting the importance of surveillance in the SIT settings.

Aggressive primary gastric lymphoma (PGL) masquerading as hepatocellular cancer (HCC) in alcoholic cirrhosis

BackgroundThe gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis.Case presentationA middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL.ConclusionsThe case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.

Pancreatic ascites managed with a conservative approach: a case report

BackgroundPancreatic ascites refers to the massive accumulation of pancreatic fluid in the peritoneal cavity and is a rare entity. Chronic alcoholic pancreatitis is the most common cause. Ascites is commonly seen in patients with alcoholic liver disease and is usually a consequence of portal hypertension. Biliary pancreatitis, pancreatic trauma and cystic duplications of biliopancreatic ducts, ampullary stenosis, or ductal lithiasis are the remaining causes.Case presentationA 53-year-old Chhetri man, a chronic alcoholic, presented with epigastric pain and abdominal distension. He had made several previous visits to a local hospital within the past 6 months for a similar presentation. Serum alkaline phosphatase 248 IU/L, serum amylase 1301 IU/L, and lipase 1311 IU/L were elevated while serum calcium was decreased (1.5 mmol/l). Ascitic fluid amylase was elevated (2801 IU/L). A computed tomography scan of his abdomen revealed features suggestive of acute-on-chronic pancreatitis. The case was managed with a conservative approach withholding oral feedings, starting total parenteral nutrition, paracentesis, octreotide, and pigtail drainage.ConclusionPancreatic ascites is a rare entity. Diagnosis is suspected with raised ascitic fluid amylase in the presence of pancreatic disease. Such cases can be managed by conservative approach or interventional approach. We managed this case through a conservative approach.

Pancreatic fistula after pancreatoduodenectomy due to compression of the superior mesenteric vessels: a case report

BackgroundPancreatic fistula is a common complication after pancreaticoduodenectomy, which could be caused by: soft pancreatic tissue, pancreatic duct diameter < 3 mm and body mass index ≥25 kg/m2. Here we report a case of pancreatic fistula due to obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels.Case presentationA 68-year-old man was admitted to our ward due to intermittent epigastric distension and pain. After various examinations and treatments, he was diagnosed with middle bile duct cancer. Pancreaticoduodenectomy was performed, and pancreaticojejunostomy and hepaticojejunostomy were completed by lifting the jejunal loop from behind the superior mesenteric vessels to the upper region of the colon. On postoperative day 9, the patient developed acute diffuse peritonitis, and on postoperative day 10, the patient underwent a second exploratory laparotomy, during which it was confirmed that the pancreatic fistula was caused by obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels, then the patient recovered and was discharged alive after retrograde drainage in the jejunum.ConclusionsThe superior mesenteric vessels after pancreaticoduodenal surgery can compress the jejunal loop and cause obstruction leading to serious complications, and it is recommended that general surgeons should avoid lifting the jejunal loop from the posterior aspect of the superior mesenteric vessels to complete the anastomosis.

Surgical indication and strategy for liver hemangioma in the caudate lobe: a multi-institutional retrospective analysis with 137 patients

ObjectiveTo investigate the surgical indication and tactics for liver hemangioma in the caudate lobeMethodsFrom January 1994 to July 2019, 137 patients, including 51 males and 86 females with the average age of 49.2 years old were diagnosed with liver hemangioma in caudate lobe and received treatment at five tertiary referral hospitals. Clinical features, correlations between tumor size and clinical manifestations, treatments, and prognosis were analyzed.ResultsOf the 137 patients identified, 40 (29.20%) patients were asymptomatic, whereas other 94 patients had clinical symptoms mainly presented as upper abdominal discomfort, epigastric distention, upper abdominal dull pain, nausea, and vomiting. Fifteen (93.75%), 18 (39.13%), and 7 (10.45%) patients presented no clinical symptoms among those tumor size was less than 3 cm (D ≤ 3 cm, n = 16), 3 cm < D ≤ 6 cm (n = 46), and 6 cm < D ≤ 9 cm (n = 67), respectively, while all 8 patients with tumor larger than 9 cm were symptomatic. Tumor diameter was obviously associated with the presence of clinical symptoms. In follow-up period, 7 patients in the conservative group (n = 39) received surgery because of tumor growth or symptom appearance. Totally 105 patients received operation including partial resection or isolated complete resection of caudate lobe and caudate lobe resection combined with liver segment resection, right liver resection, or left liver resection. All operations went smoothly, and no severe complications appeared.ConclusionTumor diameter was obviously associated with the presence of clinical symptoms in patients with hemangioma in caudate lobe. Surgical therapy is not recommended for asymptomatic patients and available for patient who has symptoms. Effective surgical strategies should be put into use to reduce operative bleeding.

Castleman disease in the hepatic-gastric space: A case report

BACKGROUNDCastleman disease, also known as giant lymph node hyperplasia, was first reported in 1956. It is a rare benign proliferative pathological change of the lymph nodes.CASE SUMMARYThe patient, a 33-year-old woman, had epigastric distension for half a year. Examinations were performed in a local hospital. Computed tomography scan showed round soft tissue nodules, about 5.45 cm in diameter, in the hepatic-gastric space. Endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration was performed on the patient. Rapid on-site evaluation, hematoxylin eosin staining and histopathology of the puncture smear was performed. According to the Diff-Quik staining and hematoxylin eosin staining results of preoperative endoscopic ultrasound guided fine needle aspiration puncture smears as well as the immunohistochemistry results, Castleman disease was highly suspected. A sufficient preoperative evaluation was made, and a precise surgical plan was developed. Postoperative pathology confirmed Castleman disease.CONCLUSIONEndoscopic ultrasound guided fine needle aspiration can extract internal tissues of the tumor for histological and cytological examinations and provide accurate diagnosis as much as possible. Therefore, a sufficient preoperative evaluation can be made, and a precise surgical plan can be developed.

2687 A Rare Case of Organoaxial Volvulus of the Stomach

INTRODUCTION: Gastric volvulus is an uncommon and potentially life-threatening clinical entity characterized by rotation of the stomach along its long or short axis provoking variable degrees of gastric outlet obstruction. Clinical presentation varies between acute and chronic volvulus. Here we present a rare case of chronic organoaxial volvulus presenting with dysphagia. CASE DESCRIPTION/METHODS: The patient is an 87 year old male with a medical history of hypertension, obstructive sleep apena, multi-nodular goiter (with thyroid resection resulting in vocal cord paralysis) who was referred to the gastroenterology clinic for dysphagia. The patient states he had dysphagia to solids for one year. The patient denied associated nausea, vomiting, hematemesis, hematochezia, constipation or unintended weight loss. Complete blood count and comprehensive metabolic panel at that time were unremarkable. Physical exam was also unremarkable. Given his symptoms a barium swallow was ordered to further evaluate his gastrointestinal tract. This was done and showed no evidence of esophageal obstruction or esophageal mass, but did incidentally find organoaxial rotation of the stomach. The patient was scheduled to undergo upper esophagogastroduodenoscopy, but was non-compliant with the appointment and lost to follow up. DISCUSSION: Acute gastric volvulus usually presents with sudden onset abdominal or chest pain, severe retching with occasional vomiting, and epigastric distention. Chronic gastric volvulus on the in contrast can present with a complete absence of symptoms to non- specific symptoms, such as abdominal pain, dyspepsia, dysphagia, acid reflux, nocturnal cough, hiccups, non-bilious vomiting, weight loss, and anemia. Diagnosis of gastric volvulus is conventionally achieved with chest radiograph, upper barium studies or CT- scan. Regardging treatment of acute symptomatic gastric volvulus, nasogastric decompression is usually the first step, followed by surgery. Some patients at high risk for surgery, mainly elderly, can also be treated endoscopically with adequate decompression and reduction of the stomach and placement of a gastrostomy tube to gastropexy the stomach to the abdominal wall.

Duodenal obstruction due to windsock deformity in a 13 year old female

A 13 year old presented with epigastric distension and pain, with bilious vomiting of 1 week duration. There was no history of dyspepsia but patient was constipated. Plain abdominal radiograph reveal a grossly dilated stomach and first part of duodenum. However, a barium meal showed the dilatation progressing to the third part of the duodenum with trickling of contrast into the collapse fourth part of the duodenum near the ligament of Treizt. Duodenotomy at laparotomy confirmed a membrane causing windsock deformity in the duodenum which was excised and patient has since been well. This is a delayed and rare presentation of this anomaly which call for a consideration among causes of upper gastrointestinal obstruction.

Long-term disease free survival of gastric mixed adenoneuroendocrine carcinoma treated with multimodality therapy: A case report.

Gastric mixed adenoneuroendocrine carcinoma, a rare malignant type of stomach tumor, is composed of components of adenocarcinoma and neuroendocrine tumor. This type of neoplasm usually has a poor prognosis since both components are malignant. A 65-year-old male presented with norexia, epigastric distention, abdominal and lumbar pain. Contrast computed tomography scan of the abdomen verified multiple lesions merged into a large mass. Histolopathological examination of the specimen from digestive endoscopy was verified to be gastric mixed adenoneuroendocrine carcinoma. The patient received a multimodality treatment of chemotherapy, surgical resection with radiotherapy and still remains alive with no evidence of metastasis or recurrence for over 5 years. The authors suggest that multimodality therapy may be beneficial and necessary to effictively treat mixed adenoneuroendocrine carcinoma.

Surgical Treatment and Chemotherapy of Adult Primary Liver Sarcoma: Experiences from a Single Hospital in China

Background: The aim of this study is to improve the preoperative diagnostic accuracy and treatment results by investigating the clinical features and prognosis of primary liver sarcoma (PLS). Methods: Clinical data, surgical treatments, adjuvant chemotherapy, and prognosis of 17 PLS patients whose diseases were pathologically confirmed were retrospectively analyzed. Results: The main clinical symptoms included epigastric pain in 9 patients, epigastric distention in 7, and loss of appetite in 4; these symptoms were detected during the postoperative follow-up for gastric carcinoma in 1. The resection rate was 64.7% (12/17), including R0 resection in 10 patients and R1 resection in 2, and laparotomy with biopsy in 5. Five patients accepted an adjuvant selective hepatic artery infusion chemotherapy (mitomycin C 16–20 mg+ 5-fluorouracil 5.0 g+ epirubicin 40–50 mg), and 4 accepted adjuvant systemic chemotherapy (vincristin, cisplatin, cyclophosphamide, and adriamycin). All 5 patients with simple laparotomy died within 1 year, and the overall 1-, 3-, and 5-year survival rates for all patients were 58.8% (10/17), 29.4% (5/17) and 11.7% (2/17), respectively, whereas those were 100.0% (10/10), 50.0% (5/10), and 20.0% (2/10) for R0 resected patients respectively. Conclusions: The diagnosis of PLS is difficult before operation due to its nonspecific manifestations, and the high survival rate can be achieved by radical resection with adjuvant chemotherapy.

Clinical characteristics of 88 cases of acute pancreatitis in children of different age

Objective To investigate the clinical features of acute pancreatitis (AP) in children of different age. Methods From January 2010 to December 2015, pediatric inpatients with AP were searched by pediatric inpatient medical records retrieval system. According to age, patients were divided into three groups: infant and toddler group (age 0 years to three years), preschool group (age >three years to six years) and school-aged group (age >six years to 16 years). The clinical features, etiology and laboratory findings of different age groups were retrospectively analyzed. One-way analysis of variation or rank sum test was performed for measurement data analysis. Chi-square test or Fisher exact probability test was used for the count data analysis. Results A total of 88 pediatric patients (male 38, female 50) were enrolled, and the mean age was (8.8±4.4) years. Infant and toddler group, preschool group and school-aged group were 16, 14, 58 cases, respectively. The average days of hospitalization of infant and toddler group, preschool group and school-aged group were (8.4±1.9), (9.4±2.6) and (7.5±2.5) days, respectively, and the difference was statistically significant (F=3.649, P=0.030). About 93.2% (82/88) pediatric patients had abdominal pain. The incidence rate of epigastric distention of school-aged group (34.5%, 20/58) was higher than those of infant and toddler group (2/16) and preschool-aged group (1/14). The rate of nausea/vomiting of infant and toddler group was significantly higher than those of preschool group and school-aged group (12/16, 4/14 and 46.6% (27/58), respectively), and the differences were both statistically significant (χ2=6.250 and 6.805, both P 0.05). The percentage of obese children of school-aged group was significantly higher than those of infant and toddler group and preschool group (31.0%, 18/58; 1/16 and 1/14, respectively), and the difference was statistically significant (χ2=6.689, P=0.035). In addition, the level of serum total cholesterol of school-aged group was higher than that of infant and toddler group and preschool group ((5.1±0.9), (3.9±0.6) and (4.8±0.8) mmol/L, respectively), and the difference was statistically significant(F=13.855, P<0.01). The positive rates of abdominal ultrasound of infant and toddler group, preschool group and school-aged group were 5/16, 4/14 and 21.1%(12/57), respectively, and there was no statistically significant difference (χ2=0.889, P=0.706). The positive rates of magnetic resonance cholangiopancreatography (MRCP) of infant and toddler group and school-aged group were 4/4 and 5/6, respectively, and which were both higher than those of pancreases computed tomography (CT) examination (4/14 and 51.2%, 22/43) and those of abdominal ultrasound (5/16 and 21.1%, 12/57), and the differences were significant (χ2=6.655 and 15.207, both P<0.05). Conclusions Obese children is more in school-aged children with AP. Children of this age should pay more attention to life style. Nausea or vomiting symptom is more obvious in the infant and toddler children with AP and the condition is more severe. If children of this age with unexplainable vomiting, AP should be considered. Biliary factors are more common in the infant and toddler children with AP. When children are suspected with abnormal structure of pancreatic and biliary ductal system, MRCP should be conducted. Key words: Acute pancreatitis; Clinical characteristics; Etiologies; Children

Primary liver sarcoma: diagnosis and surgical treatment

Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment. Methods The clinical data on the clinicopathological features, surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed. Results Of 17 patients with primary sarcoma of liver, elevation of preoperative serum AFP was detected in one patient (5.9%), HBsAg positivity in 3 patients (17.6%), elevation of CEA in 2 patients (11.8%) and abnormal liver function in 3 patients (17.6%). The main clinical symptoms included epigastric pain in 9 patients, epigastric distention in 7 patients, loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma). Twelve of these 17 patients underwent resection (resection rate 64.7%). Five patients underwent laparotomy and biopsy. Among patients who were treated with surgical resection, 10 patients had R0 resection and 2 patients had R1 resection. Postoperatively, 5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin+ fluorouracil+ epirubicin), and 4 patients were treated with adjuvant systemic chemotherapy (vincristin, cisplatin, cyclophosphamide and Doxorubicin). The postoperative 1, 3 and 5-year overall survival rates for all the patients were 58.8% (10/17), 29.4% (5/17) and 11.7% (2/17), respectively. In patients with liver resection, the survival rates were 83.3% (10/12), 41.6% (5/12) and 16.7% (2/12), and for R0 resection, 100.0% (10/10), 50.0% (5/10) and 20.0% (2/10), respectively. Conclusions The diagnosis of primary sarcoma of liver was difficult before operation. High survival rate could be achieved by radical resection and adjuvant chemotherapy. Key words: Primary liver sarcoma; Liver tumor; Hepatectomy; Chemotherapy

Prevalence of Helicobacter pylori infection in 125 patients with type 2 diabetes and its effects on diabetic gastroparesis

Objective To investigate the prevalence of Helicobacter pylori (H.pylori) infection in type 2 diabetic patients and its effects on diabetic gastroparesis. Methods Prospective clinical case-control study was applied. From January 2011 to December 2013, 125 hospitalized patients with type 2 diabetes and 142 healthy controls without dyspeptic symptoms were enrolled. The prevalence of H. pylori infection and the incidence of gastroparesis in 125 patients with diabetes were investigated in both two groups. The patients with type 2 diabetes were divided into groups according to the course of the disease, and the prevalence of gastroparesis and H. pylori infection of each group were analyzed. The patients with type 2 diabetes and healthy controls confirmed with H. pylori infection were treated with eradication therapy, the rate of eradication of two groups was compared. The improved symptoms of gastroparesis before and after eradication therapy of patients with type 2 diabetes were compared. The chi-square test was performed for statistical analysis. Results The prevalence of H. pylori infection in type 2 diabetic patients was 66.4%(83/125), which was significantly higher than that of healthy control group (51.4%, 73/142) (χ2=5.549, P<0.05). The prevalence of gastroparesis in diabetic patients with the disease course less than 10 years, 10 to 20 years and more than 20 years was 33.8% (27/80), 47.1% (16/34) and 8/11, respectively. The difference was statistically significant (χ2=6.554, P<0.05). The prevalence of H. pylori infection in patients with gastroparesis was 78.4% (40/51), which was significantly higher than that of patients without gastroparesis (58.1%, 43/74) (χ2=4.716, P<0.05). The eradication rate of H. pylori infection in patients with type 2 diabetes was 68.7% (57/83), which was lower than that of healthy control group (87.8%, 36/41), and the difference was statistically significant (χ2=4.385, P<0.05). The incidence of epigastric pain and distension, early satiety and apocleisis before H. pylori eradication in type 2 diabetes patients was 75.9%(63/83), 66.3%(55/83) and 67.5%(56/83), respectively, while after eradication which was 44.6%(37/83), 37.3%(31/83) and 39.8%(33/83) after eradication, respectively. The differences were statistically significant (χ2=15.720, 12.764 and 11.724; all P<0.01). Conclusions The prevalence of H. pylori infection is significantly higher in type 2 diabetic patients, and gastroparesis in type 2 diabetic patients may be correlated with H. pylori infection. The eradication rate in type 2 diabetic patients was lower, and H. pylori eradication therapy can efficiently improve the symptoms of dyspepsia in diabetic patients with gastroparesis. Key words: Helicobacter pylori; Diabetes mellitus, type 2; Gastroparesis; Eradication therapy

Laparoscopic Sleeve Gastrectomy After Two Gastric Bands Removal and the Presence of Gastrojejunostomy: A Video Presentation

Abstract Introduction: In this video, a laparoscopic sleeve gastrectomy (LSG) is presented in an obese, 40-year-old female patient. The patient had 42.2 BMI and no other comorbidities. The patient came to our institution because she could not lose weight after the placement of two gastric bands on her stomach and the presence of a gastrojejunostomy. The runtime of the video is 9 minutes and 27 seconds. Materials and Methods: The patient had undergone placement of the gastric band at the pars flaccida region before ~3 years. The patient gained weight after 2 years from the placement of this gastric band. The surgeon who had placed this first band suggested her second band placement near the pylorus. At the same time, he suggested her construction of a gastrojejunostomy near the pylorus, just before the second band. The gastrojejunostomy was created ~120 cm distally the ligament of Treitz. During the last year, the patient faced several problems with epigastric pain, distension, and weight gain. The symptom...

Dual duodenal obstruction: an abdominal camouflage

Congenital Double Duodenal Obstruction (DDO) is a clinical entity with a combination of annular pancreas and distal duodenal obstruction (either due to duodenal membrane or atresia). Hereby reporting a case of double duodenal obstruction in a 7 years boy, confirmed by barium meal, CECT abdomen and MRI abdomen. Bile-stained vomitus in neonates is the typical presentation of atresia or severe stenosis. Minimal duodenal obstruction in mild stenosis or membrane may present with clinical features, which include polyhydraminos, low birth weight, feeding intolerance, vomiting, failure to thrive, epigastric distension and visible gastric peristalsis. Duodeno-duodenostomy is the surgery of choice in cases of duodenal obstruction due to atresia, diaphragm and annular pancreas. The morbidity and mortality rate of patients with congenital duodenal obstruction is very high. Effective measures such as early diagnosis and intervention, proper preoperative preparation, nutritional support are urgently needed to improve the outcome. Low birth weight and prematurity significantly affect the outcome, associated anomalies account for most of the morbidity and mortality and early diagnosis result in better outcome.