Pyloroduodenal Stenosis Research Articles

Агрессивные и протективные факторы желудочного сока у больных со стенозом пилородуоденальной зоны язвенного генеза

Цель: оценить агрессивные и протективные свойства желудочного сока у больных со стенозом пилородуоденальной зоны язвенного генеза в зависимости от его степени. Материалы и методы. В отделении хирургии органов пищеварения ГУ «Институт гастроэнтерологии НАМН У­краины» за 2014–2019 годы обследовано 157 больных с различной степенью стеноза пилородуоденальной зоны язвенного генеза. Из них для изучения желудочной кислото- и слизепродукции было отобрано 92 пациента с компенсированным и субкомпенсированным стенозом, среди которых 71 мужчина, 21 женщина в возрасте от 38 до 56 лет, средний возраст (45,3 ± 5,2) года. Больные были разделены на 2 группы в зависимости от степени стеноза: 1 группа — 57 больных с компенсированным стенозом, 2 группа — 35 больных с субкомпенсированным стенозом. Контрольную группу составили 20 практически здоровых лиц. В желудочном содержимом определяли: уровень pH, концентрацию пепсина, гликопротеинов, гексозаминов, фукозы, сиаловых кислот. Результаты. Анализ изучения уровней кислото- и слизепродукции у больных со стенозом пилородуоденальной зоны различной выраженности показал, что у пациентов с субкомпенсированным стенозом отмечалось увеличение частоты гиперацидной секреции на 21,1 % (р < 0,05), существенное повышение уровня пепсина (р < 0,05), уменьшение концентрации общих гликопротеинов (р < 0,05) (за счет существенного уменьшения концентрации фукозы и гексозаминов) по сравнению с пациентами с компенсированным стенозом, которым была более свойственна нормацидная секреция. Полученные нами данные о дисбалансе факторов агрессии и защиты желудочного содержимого позволили нам сформировать различные адаптационно-компенсаторные варианты их соотношения: 1 (гиперреактивный) — одно­временное повышение факторов агрессии и защиты; 2 (компенсаторный) — повышение уровня агрессивных факторов, нормальная концентрация защитных факторов; 3 (декомпенсаторный) — повышение уровня агрессивных факторов, снижение уровня факторов защиты. Выводы. Выявлено, что прогрессирование степени стеноза пилородуоденальной зоны язвенного генеза из компенсированного в субкомпенсированный сопровождается достоверным преобладанием факторов агрессии над факторами защиты желудочного сока и истощением функциональных возможностей слизепродуцирующего аппарата желудка. В результате выделения трех вариантов соотношения факторов агрессии и защиты желудочного сока (гиперреактивный, компенсаторный, декомпенсаторный) установлено, что декомпенсаторный вариант достоверно чаще встречается у пациентов с субкомпенсированным стенозом пилородуоденальной зоны, а значит, риск прогрессирования степени стеноза у таких больных значительно выше по сравнению с другими вариантами соотношений. Обнаруженные варианты соотношений факторов агрессии и защиты у пациентов со стенозом дают возможность дифференцированного подхода к выбору тактики лечения (мини-инвазивного эндоскопического или комбинированного эндо- и лапароскопического метода).

Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review

IntroductionPneumatosis cystoides intestinalis (PCI) is a rare condition, which can affect the entire gastro-intestinal tract. It can be idiopathic or most often secondary to various diseases. The causes remain multiple and the stenosing peptic ulcer is one of them. We report three case reports of pneumatosis cystoides with pneumoperitoneum intestinalis secondary to stenosing pyloro-duodenal peptic ulcer. Case presentationWe report a case series of three patients with PCI that presented to the emergency department with a reassuring clinical picture with the discovery in imaging of a pneumoperitoneum. All our patients presented with a pyloro-duodenal stenosis secondary to a complicated peptic ulcer, one of which was treated surgically and the other two endoscopically. DiscussionThe objective of this report is to provide an update on pneumatosis cystoides intestinalis secondary to stenosing pyloro-duodenal peptic ulcer, by specifying its etiopathogenic, diagnostic and therapeutic characteristics. ConclusionKnowledge of this pathology is necessary in order to avoid unnecessary abusive surgery.

Манометрія у хворих з пілородуоденальним стенозом виразкового ґенезу

Манометрія у хворих з пілородуоденальним стенозом виразкового ґенезу

Fast-track recovery for perforated duodenal ulcer

To study the outcomes of fast-track recovery in patients with perforated duodenal ulcer (PDU). There were 138 patients with PDU who underwent surgical treatment for the period from January 1, 2015 to December 31, 2019. Patients were divided into 3 groups: main group, control group 1 (CG-1) and control group 2 (CG-2). The main group (fast-track group, FT-group) included 51 patients who underwent laparoscopic suturing of PDU followed by enhanced recovery (fast-track). CG-1 comprised 44 patients who underwent open suturing of PDU and conventional perioperative treatment. CG-2 consisted of 43 patients who underwent laparoscopic suturing and conventional perioperative treatment. Complications were assessed using Clavien-Dindo grading system. In the FT group, postoperative complications were observed in 2 patients (3.92%). Anemia of mixed genesis (Clavien-Dindo grade II) was diagnosed in 1 patient and left-sided lower lobe pneumonia in another one (grade II). There were no deaths. Mean length of hospital-stay was 3.86 days. In the 1st control group, the largest number of complications was observed (n=12, 27.27%) including 9 extra-abdominal complications (pulmonary disorders (II) - 7 patients (15.9%); sepsis (IVB) - 1 (2.27%), delirium (IVA) - 1 patient (2.27%), postoperative wound seroma (IIIA) - 1 (2.27%) patient). Intra-abdominal complications consisted of compensated pyloroduodenal stenosis (II) in 1 (2.27%) case, recurrent bleeding from acute gastric and duodenal ulcers (IIIB) in 1 (2.27%) patient. Mortality rate was 4.54% (n=2) in this group (progressive multiple organ failure). Mean length of hospital-stay was 7.56 days. In the 2nd control group, postoperative complications included extra-abdominal (pulmonary disorders (II) - pneumonia in 4 (9.3%) cases, spontaneous pneumothorax (IIIA) in 1 (2.32%) case) and intra-abdominal events (duodenitis (II) in 1 (2.32%) patient and compensated pyloroduodenal stenosis (II) in another 1 (2.32%) patient). There were no lethal outcomes in this group. Mean length of hospital-stay was 6.7 days. Treatment outcomes in patients with perforated duodenal ulcer confirmed an effectiveness of laparoscopic suturing and complete abdominal sanitation. These measures create the prerequisites for fast track recovery in urgent surgical practice. FT-protocol of inpatient management is followed by reduced hospital-stay and less incidence of postoperative complications. Moreover, this approach promotes early and safe discharge of patients.

Current state of elective surgery for peptic ulcer

To analyze the current state of elective surgery for peptic ulcer and to assess its significance for improving the results of treatment of this disease. The analysis included elective procedures for peptic ulcer performed in the surgical department of Tula Regional Clinical Hospital in the period from 2011 to 2015. These data were compared with those for the period 1996-2000 in order to objectively identify current changes in surgery for peptic ulcer. The interval between both periods was 10 years. The main group consisted of 47 patients with peptic ulcer who underwent surgery in 2011-2015. The control group included 254 patients who underwent similar procedures in 1996-2000. Annual number of elective procedures for peptic ulcer decreased 5 times. There was advanced mean age in the main group, 29.8% of patients in the main group were older than 60 years, in the control group - 23%. Male/female ratio in the main group was 1:1, in the control group - 5:1. Prolonged ulcer history was observed in 10.6% of patients of the main group and 3.2% - in the control group. At the end of the last century, the greatest number of scheduled operations was performed for duodenal ulcer, now - for stomach ulcer. There was increased incidence of surgery for post-resection gastric syndrome (17 and 4.8% in both groups, respectively). We noted similar indications for elective surgical treatment of peptic ulcer in both groups. However, the negative feature of current period is significant augmentation of patients with decompensated pyloroduodenal stenosis. The structure of elective operations in 2011-2015 was characterized by significant proportion of decompensated complications of peptic ulcer as a result of prolonged medication. Prolonged postoperative hospital-stay and increased postoperative mortality were noted in the main group. Reduced number of elective procedures for peptic ulcer is associated with changed structure of patients undergoing surgery. Unreasonable prolonged medication aggravates patient state and adversely affects the results of surgical treatment. The current state of elective surgery for peptic ulcer does not correspond to the objective to improve the results of treatment of this disease.

Surgical treatment of ulcerative pyloroduodenal stenosis

To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.

VIDEO-ASSISTED GASTROENTEROSTOMY PILORODUDODENAL STENOSISIN PATIENTS WITH SENIOR AND SENIOR AGE

Introduction. The immediate results of surgical treatment of 80 patients with pyloroduodenal stenosis of older age groups, operated in the traditional way and with the use of endovideosurgical techniques, were analyzed. An optimal variant of preoperative preparation with inclusion of early enteral therapy and nutritional support was offered, which allowed to reduce the degree of hypovolemia and tissue dehydration, to correct the water-electrolyte balance and acid-base state. The incidence of postoperative complications and mortality in both groups were studied. Individualized surgical tactics that allowed to reduce the number of postoperative complications and lethality were proposed.

Management of peptic pyloroduodenal stenosis in Sylvanus Olympio teaching hospital in Lome (Togo).

This study's aim was to describe the management of ulcerous pyloroduodenal stenosis in Sylvanus Olympio teaching hospital of Lomé (Togo). It was a retrospective study of medical files of all patients managed for peptic pyloroduodenal stenosis at the visceral surgery department of Sylvanus Olympio teaching hospital in Lomé (Togo) from january 1(st), 2002 to december 31(th), 2011. Twenty-five patients were selected. Mean age was 38±7.4 years. Sex-ratio was 5. Twenty four patients underwent upper digestive tract endoscopy, completed by upper gastrointestinal series in 18 cases. One patient had only an upper gastrointestinal series. Pyloroduodenal stenosis was improved by antisecretory therapy in 3 cases. Twenty two patients underwent laparotomy. Truncal vagotomy was performed in 15 cases associated with pyloroplasty in 8 cases, and gastrojejunostomy in 7 cases. An antrectomy was performed in 5 cases. Selective vagotomy was associated with pyloroplasty in 1 case, and a gastrojejunostomy in 1 case. One patient died in postoperative period. Functional results were classified VisickI (17 cases) andII (4 cases). Peptic pyloroduodenal stenosis affects young adults. Its tight nature requires association of upper gastrointestinal series and esophagogastroduodenoscopy for diagnosis. Its surgical treatment is exclusively performed by laparotomy at present. Mortality is low and functionnal prognosis is good.

The electrophysiological characteristics of the motor activity of the gastrointestinal tract following selective proximal vagotomy in the patients presenting with ulcerative pyloroduodenal stenosis

The electrophysiological characteristics of the motor activity of the gastrointestinal tract following selective proximal vagotomy in the patients presenting with ulcerative pyloroduodenal stenosis

Оценка электрофизиологических показателей компенсации моторики желудка у пациентов с язвенным пилородуоденальным стенозом

Оценка электрофизиологических показателей компенсации моторики желудка у пациентов с язвенным пилородуоденальным стенозом

An evaluation of gastric scintigraphy pre- and postpyloroduodenal peptic stenosis dilation

The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.

ULTRASONIC SCANNING IN DIFFERENTIAL DIAGNOSTICS OF VARIOUS FORMS OF ULCERAL STENOSIS

The ultrasonic scanning of the stomach and initial parts of the duodenum at 38 patients with ulceral pyloroduodenal stenosis is made. The criterion of differential diagnostics of the various forms of the stenosis is revealed.

Polyneuropathie sensitivomotrice au cours d'une poussée de maladie de Crohn

A 22-year-old man developed an axonal sensorimotor polyneuropathy and an episode of pyloroduodenal stenosis at the same time. Rectal biopsy established the diagnosis of Crohn's disease. The etiologic investigations were negative. The neurological and gastrointestinal troubles improved and followed a parallel course. Without vitamin deficiency or metronidazole treatment, peripheral polyneuropathy is a rare event in Crohn's disease. An autoimmune cause is suspected.

Liver condition in pyloroduodenal ulcerative stenosis and its changes after vagotomy with drainage operations

Complex clinical and morphological study of the liver in 102 patients with pyloroduodenal stenosis of ulcerous etiology was carried out. Decrease in the level of total protein in blood serum and changes of sediment samples were observed only in extremely decompensated stenosis. Study of absorption, excretory function of hepatocytes using Bengal pink-labeled131I test showed that in pyloroduodenal stenosis there was a tendency to slow down the processes of dye absorption by liver, in 66% of patients dye excretion was delayed. Rheographic studies revealed decreased hepatic arterial blood flow, apparently, caused by obstruction of portal blood inflow, as evidenced by increased pulse wave propagation time, decreased rheographic index value and changes of curve shape.

Treatment of patients with pyloroduodenal ulcers complicated by stenosis

Gastric resection for duodenal ulcers, which has been the operation of choice for the past decades, cannot be considered perfect. Postoperative mortality in this disease is 4-5% [3, 5], and in patients with pyloroduodenal stenosis 2,511,5% [1, 8]. In addition, almost 30% of the operated patients have post-resection complications, primarily dumping syndrome. Disability is also high: during the first year after surgery, the number of disabled people in groups IIIII reaches almost 50% [2, 5]. That is why in recent years, various organ-preserving and organ-sparing operations have been developed for duodenal ulcer. Of these, preference is given to selective proximal vagotomy. In the presence of stenosis, this operation has to be combined with various gastric drainage interventions. Our country has already accumulated a lot of experience in conducting such combined operations [3-6]. More physiological in comparison with gastric resection, they still have some disadvantages. The main one, perhaps, is the non-proportional and rapid flow of gastric contents into the duodenum, as a result of which some patients may develop dumping syndrome, and the constant yawning of the outlet part of the stomach after pyloroplasty can lead to duodenogastric reflux with the subsequent development of a rather severe and difficult-to-treat complication-reflux gastritis [11, 12]. Our observations also confirm this. Of the 94 patients who underwent drainage operations, 6 had dumping syndrome, and 23 had reflux gastritis. We have a particularly negative attitude towards cytoplasty. After it, both dumping syndrome, reflux gastritis, and restenosis can develop, which one of our patients had.

THE INTERRELATIONSHIP BETWEEN BLEEDING, PERFORATION, AND STENOSIS IN DUODENAL ULCERATION

The interrelationship of gastrointestinal bleeding, acute perforation, and pyloroduodenal stenosis was examined in a hospital series of 1,457 patients with duodenal ulcers. The proportion of each complication among the total number of ulcer patients after various periods of ulcer symptoms was determined. There was little variation in the proportion with bleeding as the duration of symptoms increased, whereas the proportion with perforation decreased and the proportion with stenosis increased with increasing duration of ulcer dyspepsia. The association of bleeding with perforation (26 patients) was more common than the association of bleeding with stenosis (12 patients), and more so than the association of perforation with stenosis (4 patients). To explain the paradoxical relationship of perforation and stenosis it was proposed that perforation occurred when the pathological process in ulceration was such that there was more tissue destruction. than tissue repair, and that stenosis would result if there was more tissue repair than tissue destruction

Studies on Duodenal Ulcer&lt;xref ref-type="fn" rid="fn1"&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/xref&gt;&lt;subtitle&gt;1. THE CLINICAL EVIDENCE FOE THE EXISTENCE OF TWO POPULATIONS&lt;/subtitle&gt;

Secretory and clinical characteristics of 339 hospital patients with uncomplicated duodenal ulcers, 182 with pyloro-duodenal stenosis, 124 operated upon in Copenhagen by proximal vagotomy and 174 in whom bleeding or perforation was the reason for admission were studied. The results indicate that all duodenal ulcer subjects secrete more acid than normal, but that in approximately half of them acid secretion to maximal stimulation does not rise outwith the range of normal and most of these are of O blood group. These patients are classified as Type I duodenal ulcer. The character of acid hypersecretion beyond two standard deviations of the mean of the maximal acid output in normal subjects appears to be determined mainly by the possession of A, B and AB blood group: these hypersecreting ulcer patients are classified as Type II. The complications of perforation and bleeding and stenosis are linked mostly to the O group subjects and not to acid hypersecretion as such, but the strongest family prevalence is in the A, B, AB series and in them also the disease appears earlier. A hypothesis is presented to explain the aetiology of the two types.