Gastrointestinal Endoscopic Findings Research Articles

Upper gastrointestinal endoscopic findings in adolescents at Lacor Hospital, Uganda.

Fiberoptic endoscopy is a highly efficient diagnostic tool, which is now being increasingly used, in the pediatric age group. This study has been carried out to demonstrate indications for and common findings of endoscopy in children. We retrospectively reviewed the medical records for endoscopy indication and result of children who had endoscopy between Jan 2000 to June 2005. We analyzed 135 children who were referred for upper gastrointestinal endoscopy. There were 38 boys and 97 girls. The mean age was 16 years (SD+/-1.4293). The main indications comprised epigastric pain (67.4%), dyspepsia (11.9), hematemesis (8.9%), recurrent abdominal pain (3%) recurrent vomiting (3%), and miscellaneous (5.8%). Endoscopic diagnose included duodenal ulcer (14.8%) and gastritis (12.6%); duodenal scarring (5.2%), bile reflux (5.2%) duodenitis (4.4%) and miscellaneous 6.4%. In Upper gastrointestinal endoscopy is a diagnostic procedure in children with gastrointestinal disorder. Gastritis and duodenal disease are commonly seen in children, hence must be included in differential diagnosis of children with digestive complaints and its management.

“Test, score and scope”: A selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referred from primary care

Objective. To test the ability of pre-endoscopic clinical evaluation to predict clinically relevant findings of upper gastrointestinal endoscopy. Material and methods. Patients (341) who had been referred to upper gastrointestinal endoscopy for further evaluation of dyspeptic symptoms were included in this prospective, single-blinded study. Prior to endoscopy, the patients underwent a standardized clinical evaluation consisting of 1) a symptom questionnaire, 2) serological testing for Helicobacter pylori antibody and 3) determination of blood hemoglobin. Based upon this evaluation, patients were assigned to one of three defined risk groups. Group A comprised patients with known risk factors for diseases that would require further therapeutic or diagnostic management. Patients in groups B and C had no such risk factors. Patients in group C had heartburn or regurgitation as a predominant symptom, whereas patients in group B did not. The prevalence of clinically relevant findings upon upper endoscopy was then compared for these three groups. Results. The prevalence of clinically relevant endoscopic findings in risk groups A, B and C were 20.1, 2.4 and 1.6%, respectively (p<0.01 for both A versus B and A versus C). Furthermore, 89% of those with clinically relevant endoscopic findings belonged to group A, which comprised a total of 45% of the patients studied. In groups B and C, the prevalence of disease was similar to the area-specific prevalence in the general population without dyspeptic symptoms. Conclusions. By using a simple standardized questionnaire, H. pylori serology and a hemoglobin reading in the evaluation of dyspeptic patients under 45 years of age, the need for endoscopy can be reduced by 55%.

The Findings of Upper Gastrointestinal Endoscopy Before and After the Living-Donor Liver Transplantation: Reflux Esophagitis Is the Frequent Complication after the Transplantation

Portal hypertension, stress induced by operation, immunosupressive agents, and Helicobacter pylori may affect the findings of upper gastrointestinal endoscopy before and after the liver transplantation. Relatively small graft is one of characteristics of living-donor liver transplantation. The effects of living-donor liver transplantation on upper gastrointestinal endoscopic finding have not been examined well. Patients and Methods: Twenty-eight adult patients underwent living-donor liver transplantation were included in the present study. Upper gastrointestinal endoscopy was performed in 20 patients before and 22 patients after the transplantation. Results: Esophageal varix was seen in all of 18 cases with liver cirrhosis before transplantation. All of them were disappeared after transplantation. Portal hypertensive gastropathy was positive in 65% of patients. Twelve patients were classified as mild and one patient was classified as severe (McCormack's classification). According to Toyonaga's classification, 8 patients were classified as grade 1 and 4 patients were classified as grade 2. All of them were disappeared after the transplantation. Only 1 patient (5.0%) had grade A (Los Angeles classification) esophagitis before the transplantation. However, 6 out of 22 (27.3%) patients (grade C: 2, grade B: 1, grade A: 1, discoloring type: 2) had reflux esophagitis after the transplantation. Two patients had gastric or duodenal ulcer before the transplantation, however, no patient suffered from gastric nor duodenal ulcer after the transplantation. Before the transplantation, Helicobacter pylori positive rate was 33.3% (3/9). After the transplantation, only 1 out of 21 (4.8%) patients were Helicobacter pylori positive by culture of the gastric mucosa. Number of isolated bacteria by general microbiological culture of the gastric mucosa was not increased in the patients after the transplantation compared with control patients. Conclusion: The living-donor liver transplantation had curative effects on esophageal varix and portal hypertensive gastropathy. However, reflux esophagitis was a complication encountered following liver transplantation. Helicobacter pylori positive rate was low in the patients after the liver transplantation.

Clinical Characteristics of Upper Gastrointestinal Bleeding in Hemodialysis Patients

Upper gastrointestinal bleeding (UGIB) frequently occurs in hemodialysis (HD) patients. But, clinical characteristics of UGIB in HD patients are not well reported yet.Objective: This study was designed to compare the clinical characteristics of UGIB between HD patients and normal population with intact renal function.Methods: This study enrolled 24 HD patients with UGIB. Age‐ and sex‐matched 26 patients with UGIB and normal renal function were selected as control group during the same period. Of the cases with UGIB, esophageal variceal bleedings due to liver cirrhosis were excluded in this study. We investigated the results of treatment and UGIB‐associated mortality for 3 months after the event and then compared previous gastrointestinal (GI) symptoms (Sx), endoscopic findings, treatment results, and mortality between HD patients and control.Results: The results are summarized in the table. HD patients (n = 24) Control (n = 26) p value Age (years) 60±11 61±11 0.702 Sex [male/female (%)] 62.5/37.5 53.8/46.2 0.536 Previous GI Sx [asymptomatic/ symptomatic (%)] 33.3/66.7 65.3/34.7 0.024 Endoscopic diagnosis [vascular ectasia/others (%)] 45.8/54.2 15.3/84.7 0.020 Primary treatment [endoscopic/medical (%)] 70.8/29.2 61.5/38.5 0.488 Results of treatment Success/rebleeding (%) 75.0/25.0 92.4/7.6 0.095 Patient survival/UGIB‐ related death (%) 83.3/16.7 100/0 0.046 Conclusion: Previous gastrointestinal symptoms were less frequent in HD patients than normal population with intact renal function. In contrast, HD patients had higher incidence of vascular ectasia and mortality than normal population with intact renal function.

Hamartoma de glándulas de Brunner y anisakiasis: ¿una asociación etiológica?

Brunner's gland hamartoma is a rare duodenal tumor generally localized in the duodenal bulb. Normally assymptomatic, it might cause upper gastrointestinal bleeding or intestinal obstruction. The diagnosis is based on upper gastrointestinal endoscopic or barium examination findings, and its treatment includes surgical or endoscopic resection, with an optimum prognosis. We present the case of a 59-year-old woman who was admitted to the hospital with an upper gastrointestinal bleeding picture. Endoscopic examination showed an ulcerated polyp in duodenal bulb which was cut with polipectomy wire. Histological slides showed a parasitic granuloma within a Brunner's gland hamartoma. Skin prick test and specific IgE determination were positive for Anisakis. Up to our knowledge, this association has never been described before.

Gastric lipoma successfully treated by endoscopic unroofing

A 64‐year‐old Japanese man was diagnosed with a tumor of the stomach. From the findings of an upper gastrointestinal endoscopy, computed tomography scan and endoscopic ultrasonography, the tumor was suggestive of a gastric lipoma. He was successfully treated by an endoscopic unroofing technique. There remained residual tumor just after unroofing, but it disappeared a month later. There remained only a scar and there has been no recurrence.

Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi.

Human immunodeficiency virus (HIV) seropositive patients frequently experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H. pylori gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive patients at the Kenyatta National Hospital. The aim of the study was to determine the prevalence of H. pylori gastric mucosal infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive patients. A hospital-based prospective case-control study. Kenyatta National Hospital, Endoscopy Unit. Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as well as 52 HIV seronegative age and gender matched controls). Both cases and control subjects underwent upper GIT endoscopy and biopsies were taken according to a standard protocol. H. pylori detection was done by the rapid urease test and histology, and H. pylori gastric mucosal infection was considered to be present in the presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and CD4+ peripheral lymphocyte counts were determined using flow cytometry. H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and 84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori decreased with decreasing peripheral CD4+ lymphocyte counts. Median CD4+ lymphocyte count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%), which was often associated with presence of oral candidiasis and, together with erosions, ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT Kaposi's sarcoma, and one gastric lymphoma. H. pylori prevalence was not significantly different between HIV positive and HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive patients and was often associated with oral thrush.

Gastroesophageal Endoscopic Findings and Gastrointestinal Symptoms in Preterm Neonates With and Without Perinatal Indomethacin Exposure

ABSTRACTBackgroundThe aim of this study was to investigate whether perinatal indomethacin treatment has effects on the development of esophageal and gastric lesions in preterm infants and to evaluate other potential etiologic factors behind these lesions.MethodsSixty‐nine infants were born at less than 33 weeks' gestation. Forty‐five of these infants underwent treatment with perinatal indomethacin (study group) and 24 did not (control group). All underwent upper gastrointestinal tract endoscopy and biopsy during the neonatal period. The correlation between gastrointestinal symptoms, abnormal endoscopic findings, and the factors correlating with the development of esophageal and gastric mucosal lesions was evaluated.ResultsAbnormal endoscopic findings were equally common in the study group (77.8%) and in controls (83.3%). There was no dependence between gastrointestinal symptoms and endoscopic findings because only 15 infants (21.7%) were symptomatic before endoscopy. The interval between endoscopy and the last perinatal indomethacin dose correlated significantly with abnormal esophageal findings and gastric mucosal lesions. Shorter duration of enteral feeding before endoscopy correlated with greater risk of abnormal esophageal findings. Older gestational age and need of ventilator treatment at the time of endoscopy remained the risk factors associated with abnormal gastric findings.ConclusionsEsophageal and gastric lesions diagnosed by endoscopy correlate poorly with the gastrointestinal symptoms of patients. Short duration of enteral feeding seems to be correlated with an increased risk of esophageal mucosal lesions, increasing gestational age and ventilator treatment with gastric mucosal lesions, and perinatal indomethacin with esophageal and gastric mucosal lesions in preterm infants. Ventilator‐treated preterm infants not receiving enteral nutrition and patients with indomethacin exposure might benefit from ulcer prophylaxis.

Gastroesophageal endoscopic findings and gastrointestinal symptoms in preterm neonates with and without perinatal indomethacin exposure.

The aim of this study was to investigate whether perinatal indomethacin treatment has effects on the development of esophageal and gastric lesions in preterm infants and to evaluate other potential etiologic factors behind these lesions. Sixty-nine infants were born at less than 33 weeks' gestation. Forty-five of these infants underwent treatment with perinatal indomethacin (study group) and 24 did not (control group). All underwent upper gastrointestinal tract endoscopy and biopsy during the neonatal period. The correlation between gastrointestinal symptoms, abnormal endoscopic findings, and the factors correlating with the development of esophageal and gastric mucosal lesions was evaluated. Abnormal endoscopic findings were equally common in the study group (77.8%) and in controls (83.3%). There was no dependence between gastrointestinal symptoms and endoscopic findings because only 15 infants (21.7%) were symptomatic before endoscopy. The interval between endoscopy and the last perinatal indomethacin dose correlated significantly with abnormal esophageal findings and gastric mucosal lesions. Shorter duration of enteral feeding before endoscopy correlated with greater risk of abnormal esophageal findings. Older gestational age and need of ventilator treatment at the time of endoscopy remained the risk factors associated with abnormal gastric findings. Esophageal and gastric lesions diagnosed by endoscopy correlate poorly with the gastrointestinal symptoms of patients. Short duration of enteral feeding seems to be correlated with an increased risk of esophageal mucosal lesions, increasing gestational age and ventilator treatment with gastric mucosal lesions, and perinatal indomethacin with esophageal and gastric mucosal lesions in preterm infants. Ventilator-treated preterm infants not receiving enteral nutrition and patients with indomethacin exposure might benefit from ulcer prophylaxis.

7155 A study of endoscopic diagnosis of gastrointestinal acute graft-versus-host disease after hematopoietic stem cell transplantation.

Background and Aim: Gastrointestinal graft-versus-host disease(GVHD) after allogeneic hematopietic cell transplantaion presents a range of upper and lower gastrointestinal endoscopic and historogic abnormalities. To determine whether there are charasteristic endoscopic findings in gastrointestinal mucosa in acute GVHD. Subjects and Methods: From 1997 to 1999, 28 of 32 patients (22 men and 10 women, 32.7 years old of mean age) receiving allogeneic hematopietic cell transplantaion were diagnosed as acute GVHD. Thirteen (8 men and 5 women, 34.2 years old of mean age) of 28 patients with GVHD took gastrointestinal endoscopy because of gastrointestinal symptoms. Clinical syptoms, laboratory findings, bacterial and viral infections, endoscopic and histologic findings were retrospectively studied in these patients. Apoptosis was studied by the TUNEL method. Result:1) Upper gastrointestinal endoscopic findings in two of 15 patients showed gross edema and hemorrhagic erosions in the stomach. One patient demonstorated necrotic mucosa in the duodenum. Histologic findings showed crypt epithelial apoptosis and moderate infiltration of lymphocytes in these patients. On the other hand, 12 patients had subtly erythematous gastric mucosa without apoptosis. 2)Colonoscopic findings showed massive defects of colonic mucosa in one of three patients and erythematous mucosa in two patients. Historogical findings of these patients demonstrated crypt epithelial apoptosis and and severe infiltration of lymphocytes. No patients had infections of cytomegalo virus and Helicobacter pylori. Conclusion : 1) Characteristic appearances of gastrointestinal endoscopic findings are grossly edematous and erosive mucosa in patients with acute GVHD. Moreover, mucosal lesions in the intestine tended to be more severe than those in the stomach. 2) A combination of endoscopic and histologic analysis with careful testing for intestinal infection is useful to make a diagnosis of acute gastrointestinal GVHD.

Endoscopic ultrasonography and endoscopic retrograde pancreatography in the diagnosis of chronic pancreatitis

Background: The diagnosis of chronic pancreatitis (CP) in the early stages is often problematic. Endoscopic retrograde pancreatography (ERP), secretin test and computed tomography are not sensitive enough to detect the early stages of CP. The aim of this study was to investigate the features of CP in endoscopic ultrasonography (EUS) in patients with unexplained abdominal pain and/or suspected CP. Methods: Thirty‐four consecutive patients in whom CP was suspected after reviewing their history, abdominal ultrasonography and upper gastrointestinal endoscopy findings underwent EUS. Endoscopic ultrasonography was performed by an author who was aware of the history but blinded to the ERP results. Nineteen patients underwent ERP. Endoscopic ultrasonography was used to evaluate parenchymal changes (echogenic foci, echo pattern, prominent interlobular septa, lobularity, cyst and cavities) and ductal changes (dilatation, echogenicity of duct wall, irregularity, side branch ectasia, tortuousity). Results: Nine patients were found to be normal with regard to EUS examination. Abnormal studies for EUS were 25, while for ERP they were 17. The agreement between ERP and EUS was 100% in the 14 patients with moderate and severe disease. The diagnosis of early or mild CP was established with EUS in 11 patients. Endoscopic retrograde pancreatography, which was performed in five of the patient groups with mild disease, was normal in two patients and showed mild changes in three patients. Conclusions: Endoscopic ultrasonography may contribute to establishing the diagnosis and severity of CP found by ERP. Prospective randomized studies and long‐term follow up of patients are needed in order to determine the role of EUS in the diagnosis of early CP.

NEW ONSET SYMPTOMATIC OESOPHAGO-GASTRIC DISEASE FOLLOWING RENAL TRANSPLANTATION: ENDOSCOPIC FINDINGS IN THE MODERN IMMUNOSUPPRESSIVE ERA

328 Historically, upper gastrointestinal complications, in particular peptic ulceration, were the cause of significant morbidity and mortality to transplant recipients. The aim of this study was to determine the prevalence and nature of foregut disease in the renal transplant population during an era of modern immunosuppression and anti-ulcer prophylaxis. Information was prospectively entered into a computer database over a 3-year period during which 236 patients underwent renal transplantation. For all patients with new upper gastrointestinal symptoms, data was collected with regards the presentation, investigation and the treatment received. Twenty patients (8.5%) developed symptomatic foregut disease. All patients had received anti-ulcer prophylaxis consisting of histamine receptor antagonists (HA, n=118) or proton pump inhibitors (PPI, n=118). Symptoms were reported in 11 (9%) receiving HA's and 9 (7.6%) of PPI treated patients. All individuals complained of epigastric pain and in addition 5 reported "reflux" and 2 had dysphagia. The findings of upper gastrointestinal endoscopy consisted of: Helicobacter pylori (HP) negative gastritis (n=6); HP positive gastritis (n=1); Gastro-oesophageal reflux disease (n=4); Cytomegalovirus (CMV) gastritis (n=5); Candidal oesophagitis (n=3); CMV oesophagitis (n=1). Patients with Candida and CMV were treated with appropriate antimicrobial therapy and the individual with HP +ve gastritis received irradication therapy. The 10 patients with "non-infective" causes were equally divided between HA and PPI groups, and were prescribed long-term PPI's. All patients are now asymptomatic and no patient required surgical intervention. The spectrum of gastrointestinal disease in the transplant population differs markedly to the general population with a high prevalence of opportunistic infection. The low prevalence of HP-related disease may be due to our own "irradication therapy" of HA/PPI and co-trimoxazole, which is used as prophylaxis against Pneumocystis infection.

Studies on vitamin B12 status in the elderly--prophylactic and therapeutic consequences.

Because of the large liver stores (about 5 mg), low turnover rate (0.143%) and small daily requirement (3 micrograms), vitamin B12 deficiency does not occur under normal circumstances. This is not the case in individuals with chronic inflammatory or trophic changes at vitamin B12 absorption sites. Without supplementation, vitamin B12 deficiency can be expected within 5 years of gastrectomy. Characteristic features of type A gastritis are hyposecretion and mucosal atrophy in the fundus and body of the stomach, with absent intrinsic factor. In the small intestine, active and/or passive absorption is impaired by extensive ileal resection, exocrine pancreatic insufficiency and chronic inflammatory disorders such as Crohn's disease. Definitive plasma concentrations cannot be quoted for vitamin B12 deficiency. Dietary habits, subjective symptoms, hematological laboratory results, function tests and gastrointestinal endoscopic and histological findings must all be taken into account in the diagnosis. Modern diagnostic parameters, such as methylmalonic acid and homocysteine serum assays, are useful for achieving early diagnosis and hence optimal treatment. With their assured availability, parenteral vitamin B12 preparations remain the treatment of choice. Results from vitamin B12 bioavailability studies in healthy subjects suggest that > 300 micrograms probably suffices as an oral maintenance dose after parenteral loading. Further well-documented cases are needed in order to establish whether these doses are adequate in malabsorption syndromes and gastrointestinal diseases. Various case reports indicate the value of prophylactic and therapeutic oral vitamin B12 administration, especially in disorders of homocysteine metabolism, a substance postulated as a further important risk factor for atherosclerosis.

Comparison of biopsy and serological methods of diagnosis of Helicobacter pylori infection and the potential role of antibiotics

Objective: Endoscopic biopsy and serological methods were compared for their ability to detect Helicobacter pylori infection in patients undergoing upper gastrointestinal endoscopy at a state university hospital. Methods: Subjects were characterized on the basis of gastrointestinal symptoms, endoscopic findings, socioeconomic and demographic features, and the use of certain medications, tobacco, and alcohol. Current infection was detected in gastric antral specimens by rapid urease testing, histopathology, and bacterial culture. Serum levels of IgG to H. pylori were measured by ELISA. Results: Of 240 subjects, 115 (47.9%) were currently infected as determined by rapid urease testing, histopathology, and/or culture results, whereas 63.3% had elevated anti- H. pylori IgG levels ( p < 0.001). This difference in the prevalence of current infection and seropositivity was preserved when the study population was analyzed according to age, race, gender, and other characteristics. Prior use of antibiotics was associated with a significant reduction in the frequency of H. pylori infection. Conclusions: Serological evidence of H. pylori infection was consistently greater than the prevalence of infection documented by biopsy methods in this study, suggesting suppression or recent clearance of infection. Further studies are needed to examine the factors that may affect the detection of H. pylori infection.

CYP2C19 Genotype and Phenotype Determined with Omeprazole in Patients with Acid-Related Disorders with and without Helicobacter pylori Infection

Background: Omeprazole is to a major extent metabolized by cytochrome P450 isozyme CYP2C19. The aims of this study were to compare the phenotype of CYP2C19 determined by omeprazole with the genotype and to determine the effect of Helicobacter pylori infection on the metabolism of omeprazole. Methods: One-hundred and forty-three Caucasian patients with acid-related disorders assessed with a combination of gastrointestinal symptoms and upper endoscopic findings were given 20 mg omeprazole orally. Three hours after intake, omeprazole and 5-hydroxyomeprazole plasma concentrations were determined with high-performance liquid chromatography, and the phenotype for metabolic capacity was expressed as metabolic ratio (MR). Genotyping of defect alleles (CYP2C19*2 and *3) was performed by polymerase chain reaction amplification. One hundred eleven patients were tested after the first dose of omeprazole and 32 patients after repetitive administration (median time, 30 days). H. pylori serology was determined with enzyme-linked immunosorbent assay at the time of phenotyping. Results: Genotypically, 2.8% had two mutated alleles and were poor metabolizers (PM), and 22.4% were heterozygous extensive metabolizers (EM). Among the 111 patients who received the first omeprazole dose, 4 patients had MR >5?that is, belonged to the PM phenotype. Two of these had PM genotype (both CYP2C19*2/*2), and two had an EM genotype (CYP2C19*1/*1 and *1/*3), indicating that they have still unidentified mutations. In the heterozygous EM group the mean MR was higher in patients who had been on continued omeprazole treatment than in those given the first dose (5.7 versus 2.5, P = 0.02). There were no significant differences in MR and omeprazole concentrations between H. pylori-negative (43%) and -positive (57%) patients. Conclusion: In all but two patients with probable unidentified mutations there was agreement between the CYP2C19 phenotype determined by omeprazole and the genotype. The metabolism of omeprazole in patients with acid-related disorders is genetically determined and without relation to H. pylori infection.

Successful preoperative diagnosis of a cholecystogastric fistula using endoscopic retrograde cholangiography: Report of a case

A 64-year-old woman who presented with pyrexia and severe right upper quadrant abdominal pain was suspected of a having a cholecystogastric fistula by the abdominal plain radiograph and gastrointestinal endoscopic findings. The diagnosis was established preoperatively by endoscopic retrograde cholangiography (ERC), following which a cholecystectomy and fistulectomy with resection of the extrahepatic bile duct and hepaticojejunostomy were performed. The patient has remained well since her discharge from hospital.

Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty

Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty

Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty.

A total of 30 consecutive morbidly obese patients, six males and 24 females, who underwent vertical banded gastroplasty (VBG) between January 1992 and December 1994 and were followed up by endoscopy and biopsy were included in this study with the aim to determine the short- and mid-term complications and to investigate alterations in esophageal, gastric, and duodenal mucosa after surgery. All patients underwent endoscopy before operation. Postoperatively, 28 patients were reendoscoped at 6 months, 26 at 12 months, and 22 at 18 months. Biopsies were taken from the lower part of esophagus, just below the esophagogastric junction (vertical part of the partitioned stomach), corpus, antrum, and duodenal bulb. Before operation 5 patients (16.6%) had a hiatus hernia and four of them (13.3%) had esophagitis. Endoscopic gastritis was diagnosed in nine patients (30%) and endoscopic duodenitis in two (6. 6%). Histologically, in 15 patients (50%) esophagitis was recognized; in 24 patients (80%) corpus gastritis; in 27 patients (90%) antral gastritis; and in 23 (76.6%) duodenitis. Helicobacter pylori was found in 20 (66.6%) patients. Postoperatively, three patients developed a mild stoma stenosis and were treated only by passing the endoscope 6 months after operation; one patient, with a severe stoma stenosis, was treated by Eder-Puestow dilatations and surgery. Gastric ulcer was found in two patients 6 and 12 months after surgery. One patient developed an endostomach channel because of staple line dehiscence 18 months after VBG. An increasing incidence of esophagitis and gastritis of the vertical part of the stomach was found at 6 and 12 months. Endoscopic and histologic gastritis of the corpus and antrum, as well as endoscopic and histologic duodenitis decreased gradually after surgery. Our findings suggest that postoperative complications of VBG can be diagnosed by endoscopy, and some of them can easily be managed. Vertical banded gastroplasty causes not only no harm to the esophageal, gastric, and duodenal mucosa but also influences them favorably.

Brief report: evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis.

This study was performed to determine the gastrointestinal symptoms, and endoscopic and histopathological findings in patients on maintenance haemodialysis. Nintey-two patients on haemodialysis were enrolled in this study and 100 consecutive dyspeptic patients referred for endoscopy served as controls. They were interviewed to obtain information regarding GI symptoms and endoscopy was performed and biopsies were taken from antral mucosa for histopathological evaluation and helicobacter identification. Prevalence of GI symptoms in the dialysis group was extremely common (77%); with more cases in those with periods of dialysis longer than 6 months. Endoscopically observed of hiatus hernia was present in 27 patients in the dialysis group versus 14 in the control group (P<0.02). Duodenal ulcers were present in three patients of the dialysis group compared with 16 in the control group (P<0.01). Histologically, chronic superficial gastritis and mucosal atrophy tended to be more common in the dialysed patients, but this difference was not statistically significant. Helicobacter pylori were present in 45 patients in the dialysis group versus 73 in the control group (P<0.01).

Evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis

Purpose of the study. This study was performed to determine the gastrointestinal symptoms, endoscopic and histopathological findings in patients on maintenance haemodialysis. Study design. Ninety-two patients on haemodialysis were enrolled in this study and 100 consecutive dyspeptic patients referred for endoscopy served as controls. They were interviewed to obtain information regarding GI symptoms and endoscopy was performed and biopsies were taken from antral mucosa for histopathological evaluation and helicobacter identification. Results. Prevalence of GI symptoms in the dialysis group was extremely common (77%) ; with more cases in those with periods of dialysis longer than 6 months. Endoscopically observed hiatus hernia was present in 27 patients in the dialysis group versus 14 in the control group (P<0.02). Duodenal ulcers were present in three patients of the dialysis group compared with 16 in the control group (P<0.01). Histologically, chronic superficial gastritis and mucosal atrophy tended to be more common in the dialysed patients, but this difference was not statistically significant. Helicobacter pylori were present in 45 patients in the dialysis group versus 73 in the control group (P<0.01).