Postoperative Gastritis Research Articles

Frequency of Immediate Post-operative Gynecologic and Obstetric Complications in a Tertiary Care Center in Karachi

Objective: Postoperative complications are commonly observed during gynecologic and obstetric surgeries that could be controlled by timely management. The factors that involve in these complications could be related with patient or surgeon as well. Therefore, the aim of this study was to determine the frequency of immediately reported postoperative complications in gynecologic and obstetric surgeries in a tertiary care center.
 Methodology: A retrospective study was conducted in the Department of Obstetrics and Gynecology of Hamdard hospital, Karachi. The duration of this study was 1 year from July 2018 – June 2019. A total of 200 adult female patients of 18 to 65 years having elective or emergency surgical procedure were included in the study. Data was analysed by using SPSS version-16. Mean standard deviation was calculated for age and hospitalization stay. Frequencies and percentages were calculated for presence of comorbidities such as obesity, anaemia and diabetes mellitus and postoperative complications.
 Results: The study results showed the mean age was reported 32.04±7.79 years and mean hospital stay was observed 3.38±1.08 days. Comorbidities revealed that 26(13.0%) were obese, 89(44.5%) were anemic and 6(3.0%) had diabetes. Postoperative Nausea and Vomiting was the most common complication observed in 110(55.0%) women followed by fever that was reported in 69(34.5%) cases. Three patients (1.5%) were found to have Paralytic lleus, 23(11.5%) reported abdominal distention, postoperative gastritis was reported in 15(7.5%) cases, bleeding per vagina observed in 7(3.5%) women. Wound dehiscence was found in 2(1.0%) cases and Wound Infection in 10(5.0%) women.
 Conclusion: The present study concluded that post-operative nausea and vomiting were observed in most of the patients followed by fever subsequent to gynecologic and obstetric surgeries. Additionally, the incidence of wound infection and wound dehiscence were observed low.

The importance of an innervated and intact antrum and pylorus in preventing postoperative duodenogastric reflux and gastritis.

This study has investigated the relationship between duodenogastric reflux, gastritis and certain symptoms 6-12 months after three operations for uncomplicated duodenal ulcer. The operations studied were proximal gastric vagotomy (PGV, 20 cases), truncal vagotomy and pyloroplasty (TV+P, 22 cases) and truncal vagotomy and antrectomy (TV+A, 21 cases). Duodenogastric reflux was assessed both by a radiological technique and by measuring the concentration of bilirubin in the gastric aspirate before and after operation. Incidence and severity of postoperative gastritis were determined by endoscopic biopsy. Symptoms were assessed by symptomatic score and Visick grading. There was a significant correlation between duodenal reflux and histological evidence of both severe superficial gastritis and glandular atrophy (P less than 0-01). There was also a close association between the degree of reflux and the presence of severe heartburn, epigastric pain and bile vomiting after operation. The amount of reflux did not differ before operation. There was significantly less reflux following PGV than after either TV+P (P less than 0-025) or TV+A (P less than 0-001). The results indicate that an operation which preserves an innervated and intact antrum and pylorus will protect against postoperative duodenogastric reflux, gastritis and symptoms.

The endoscopic evaluation of gastritis, gastric remnant residue, and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies.

Pylorus-preserving gastrectomy (PPG) and transverse gastrectomy (TrG) have been accepted as function-preserving procedures for node-negative early gastric cancer. It is believed that a better quality of life is guaranteed after PPG or TrG compared to that after distal subtotal gastrectomy (DSG) with Billroth type-I reconstruction. However, objective evaluations of the gastric remnant following gastrectomy have not been widely reported, and the real advantages and disadvantages of PPG or TrG over DSG remain unclear. Moreover, the risk of secondary cancer after PPG or TrG is uncertain. Between 1991 and 2000, 834 DSGs were carried out in our institute for preoperatively diagnosed patients with early gastric cancer. The degree of residual gastritis and the amount of diet residue in the gastric remnant were evaluated by annual gastrointestinal endoscopic investigations prospectively for 72 patients after PPG, 95 patients after TrG, and 60 patients after DSG. These analyses were performed using the RGB classification (residue, gastritis, bile). The incidence of disease greater than or equal to grade 2 was calculated, and the time trends of the incidence for each procedure were also studied for 3 years after gastrectomy. In addition, secondary cancer cases in the gastric remnant mucosa were checked for each procedure during this period, and the incidence of secondary cancer after each operation was calculated. The incidence of gastritis, of grade 2 or more, found in the gastric remnant was significantly lower after PPG (1.4%) and TrG (2.1%) than after DSG (43.3%). However, the incidence of moderate or greater residue in the gastric remnant, grade 2 or more, was significantly higher after PPG (45.8%) and TrG (40.0%) than after DSG (11.7%). The analysis of time trends of gastritis and diet residue reflected the significant advantage or disadvantage for each procedure 1 year after surgery. The analysis also included these factors without consideration of elapsed time following surgery. Two patients after PPG (2.8%) and three patients after TrG (3.2%) developed secondary cancer in the gastric remnant. No DSG-treated patient showed new cancer genesis in the remaining stomach. PPG and TrG have the advantage over DSG in preventing postoperative gastritis in the gastric remnant. On the other hand, moderate or greater diet residue in the gastric remnant is more common after PPG or TrG than after DSG. For the risk of carcinogenesis in the remnant gastric mucosa, we could not conclude that there was any apparent difference between these range-limited gastrectomies and conventional DSG. Further study is necessary to determine the significant advantages and disadvantages of using PPG or TrG.

Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers.

AbstractResults after proximal gastric vagotomy (PGV) with ulcer excision for gastric ulcer type I (according to Johnson) show recurrence rates similar to those for duodenal ulcer. In the European Multicenter Trial with 71 patients, symptomatic recurrence was 7.9% at 5 years and the total recurrence (including asymptomatic recurrences) was 17.5%. Recurrent ulcers are mainly gastric ulcers. Treatment of recurrence is, initially, always conservative with antacids or H2‐receptor blockers. From 19 patients with recurrent ulcer after PGV with ulcer excision for gastric ulcer type I reported from 3 prospective trials, 12 were managed conservatively. The operative procedure of choice for recurrence was partial gastric resection with a Billroth I or Billroth II reconstruction. Favorable results for this type of gastric ulcer after PGV may be explained by maintenance of gastric continence for solids, reduction of duodenogastric reflux and of postoperative gastritis. Preoperatively and intraoperatively, malignancy has to be excluded by multiple biopsies and frozen sections. Combined gastric and duodenal ulcers (gastric ulcer type II) may also be treated by PGV in controlled trials so that more data will be available for that rare type of ulcer. Recurrence rates after PGV for pyloric and prepyloric ulcers (gastric ulcer type III) are significantly higher than those for gastric ulcer type I or duodenal ulcers. After 5 years, recurrence rates of 16.4–35% are reported. This may be due to gastric retention, which is a common feature in patients with prepyloric ulcers. In fact, selective gastric vagotomy and drainage or vagotomy and antrectomy give significantly better results. The operation rate for recurrent ulcers after pyloric and prepyloric ulcers following PGV is about 25% because of pyloric stenosis. It is concluded that PGV and ulcer excision seem to be suitable for gastric ulcer type I and probably for type II. Pyloric and prepyloric ulcers should no longer be treated by PGV alone because of high recurrence rates. A drainage procedure should be added. In general, the operation should be performed by experienced surgeons since recurrence rates depend on the number of surgeons involved in clinical trials.

Assessment of Campylobacter-Like Organisms in the Postoperative Stomach, Iatrogenic Gastritis, and Chronic Gastroduodenal Diseases: Preliminary Observations

Campylobacter-like organisms (provisionally named C. pyloridis) were demonstrated in gastric biopsy specimens by histopathologic analysis and bacterial culture. C. pyloridis organisms were found in 12 of 26 patients (46%) with gastric or duodenal ulcer but in none of 10 healthy volunteers without histologic evidence of gastritis. Iatrogenic antral gastritis, induced by 7 days of treatment with nonsteroidal anti-inflammatory drugs, was not associated with the presence of C. pyloridis. Organisms were found in 6 of 24 patients who had undergone gastric operations, but the prevalence of C. pyloridis was not higher in those with symptoms of alkaline reflux gastritis than in asymptomatic postgastrectomy control patients. We conclude that C. pyloridis is less common in patients with drug-induced and postoperative gastritis than in patients with peptic ulcer.

Postoperative reflux gastritis: pathophysiology and long-term outcome after Roux-en-Y diversion.

Sixteen patients with clinical features of postoperative gastritis who had been advised to have a Roux-en-Y diversion were studied prospectively. Studies were done pre- and postoperatively (mean follow-up, 4.9 years; range, 3.8 to 6.9), and the findings were compared with those in 11 control subjects with previous enterogastric anastomosis but with no symptoms. The patients had higher concentrations of bile acids and trypsin in gastric samples than did controls. Patients had greater endoscopic changes, although mucosal histologic characteristics were similar in both groups. Administration of aluminum hydroxide or cholestyramine reduced the aqueous concentrations of bile acids in gastric contents. Roux-en-Y diversion virtually eliminated duodenogastric reflux, and gastroscopic appearances returned to normal. However, Roux-en-Y diversion did not change mucosal histologic characteristics. Symptom scores were reduced in the early postoperative period, but bilious vomiting was the only symptom alleviated consistently and permanently. As a treatment for postoperative gastritis, Roux-en-Y diversion offers potential but limited benefits.

Fundal gastritis after billroth-II-type resection in patients with duodenal ulcer.

Of 77 duodenal ulcer patients consecutively subjected to Billroth-II-type gastric resection 56 patients were available for a follow-up study on an average 5.6 years postoperatively. In 43 out of 52 patients single biopsies from the fundal part of the stomach disclosed gastritis, which was associated with atrophic changes in 25 of them. Out of 53 patients 14 had achlorhydria. In 6 of them the production of intrinsic factor was markedly reduced. Manifest iron deficiency occurred in 17 patients. Circulating parietal cell antibodies were found in one patient only. Intrinsic factor antibodies were absent from the sera of all patients. In 49 out of 56 patients reflux to the stomach was demonstrated radiologically. The results suggest that reflux of duodenal contents to the stomach may advance the development of gastritis after gastric surgery. The possible relationship between iron deficiency and gastric mucosal atrophy is discussed. Autoimmunity seems to be without importance as to the postoperative gastritis.

Diagnosis of gastritis: a review and a report of the use of blind biopsy.

IF GASTRITIS is considered to be an inflammatory process and we accept the probability that 3 per cent of the adult population suffer from it, we may understand the value of separating the problem from that of the diffuse processes of the stomach, in order to delineate the state of knowledge of the subject. In this paper, we review the developments that have led to the present knowledge of the condition, and we report a study of 500 blind biopsies. REVIEW OF THE LITERATURE In 1943 Schindler 1 said that the histologic changes of gastritis were well established and that they could be appraised by means of gastroscopy. However, at that time, opinions in the United States differed. They may be summarized as follows. 2, a The common types of gastritis histologically confirmed and observed over the course of seve al years were thought to include: phlegmonous gastritis; acute and suba~ute ulcerative gastritis caused by gastroduodenal ulcers; hemorrhagic aml toxic gastritis; atrophic gastritis due to pernicious anemia or sprue; atrophy and hypertrophy due to circulatory, hepatic, and pulmonary diseases; gastritis associated with disorders of the endocrine system; local chronic primary gastritis; hypertrophic gastritis (simulating carcinoma) ; and diffuse postoperative gastritis. Eusterman a brought an end to the use of" this classification, noting that knowledge was incomplete and that many problems of classification awaited solution and discussion. Such authors as Mc Glone 4 encountered gastritis in 3.9 per cent of 474 patients, while Gold a found endoscopic abnormalities diagnosed as gastritis in 18 of 50 soldiers, a 36 per cent incidence. Gordon 6 stated that in many instances, gastritis seems to be incidental to the course of gastrointestinal neuroses, that is to say, a re

Further Observations on Postoperative Gastritis: Histopathologic Aspects, with a Note on Jejunitis

Further Observations on Postoperative Gastritis: Histopathologic Aspects, with a Note on Jejunitis