Reflux Gastritis Research Articles

Incidence and management of acid peptic disorders in sickle cell disease patients in Western Odisha

Background: Sickle cell disease (SCD) is a chronic hemolytic disorder characterized by the presence of crescent-shaped red blood cells. Abdominal pain is the common presenting symptom in adults with SCD. Among the patients who are not in crisis, it is estimated that one third of patients with homozygous SCD with chronic recurrent epigastric pain has endoscopic evidence of peptic ulcer disease. Aims and Objectives: This study was undertaken with an aim to analyze the incidence and management of acid peptic disorders among SCD patients in Western Odisha. Materials and Methods: A prospective study was done considering 88 homozygous SCD patients. All the patients underwent upper gastrointestinal endoscopy (UGIE) with gastric antral biopsy and rapid urease test (RUT). Cases with Helicobacter pylori were administered a 14 days course of three drug regimen of anti H. pylori drugs and followed-up to 6 weeks of beginning the treatment with repeat UGIE and RUT. Results: Out of 88 cases, 19 cases had duodenal ulcer (21.6%) which was significantly high than patients with gastric ulcer (13.6%). Other findings were gastroesophageal reflux disease and gastritis. About 93.5% of patients became RUT negative after taking anti H. pylori medication. Conclusion: SCD patients with acid peptic disorder constitute a sizeable proportion of patients attending surgical outpatient department and indoor department of surgery. Conservative treatment with life style modification can effectively improve the symptoms of acid peptic disease.

Evaluation of acute toxicity and antiulcer activity of Pepgard tablet: An Ayurvedic formulation.

In traditional Indian medicine, several plants have been used to treat gastrointestinal disorders, including gastric ulcers. Pepgard tablet is an Ayurvedic compound formulation widely used in clinical practice as an antacid for treating nonulcer dyspepsia, gastroesophageal reflux, and drug-induced gastritis. Evaluation of acute toxicity of Pepgard tablet and antiulcer activity against gastric ulcer induced by aspirin plus pyloric ligation in albino rats. Acute toxicity was studied as per OECD 425 guideline at a limit dose of 2000 mg/kg in female albino rats. Antiulcer activity was assessed by aspirin plus pyloric ligation model at two dose levels (90 and 180 mg/kg, po). Gastric juice parameters, stomach tissue parameters, and histopathological study along with an assessment of ulcer index were assessed. Pepgard did not produce any toxicity or lethality at a limit dose of 2000 mg/kg and was found safe in female albino rats. Pepgard at both dose levels showed an antiulcer effect as evidenced by an increase in pH value, decreased acidity, and peptic activity of gastric juice along with a decrease in ulcer index and increased antioxidant status of damaged gastric mucosa as revealed by an increase in catalase, glutathione, etc., in stomach homogenate of albino rats. The present study of Pepgard tablet revealed its safety in acute toxicity studies and can be categorized as substances with low health hazard potential. Pepgard has been shown to be effective as an antacid, anti-ulcer, and to have gastroprotective effects against experimentally-induced ulcerogenesis in albino rats.

Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study.

We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs). This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS). Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD. This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

Laparoscopic choledochoduodenostomy: Old wine new bottle

BACKGROUND: Choledocholithiasis is a common medical condition in medical sciences requiring intervention. Among various available techniques Choledochoduodenostomy (CDD),the old age technique is being performed by laparoscopic means. AIM: To study the Laparoscopic choledochoduodenostomy as a surgical option in case of choledocholithiasis. PATIENTS AND METHODS:This is a prospective study, conducted on 159 patients, diagnosed as a case of choledocholithiasis and operated through laparoscopic CDD, and later on followed up to three year in a structured manner for early and long term complications esp. Sump syndrome. RESULTS: Abdominal pain with jaundice was most common presenting complaint. 65.40% had secondary stones, while 10.06% and 5.66% had retained and recurrent stones respectively.8.5% had alkaline reflux gastritis in post operative period , which was managed conservatively, none developed Sump syndrome. CONCLUSION: Laparoscopic CDD is one of the minimally invasive option for choledocholithiasis with less complications.

Comparison of gastric-jejunum pouch anastomosis and Billroth-II reconstructions after distal gastrectomy: a propensity score matching analysis

PurposeOur study aimed to make a propensity score matching (PSM) analysis on the clinical application of gastric-jejunum pouch anastomosis (GJPA) and Billroth-II anastomosis after distal gastrectomy.MethodsWe collected clinical data from 249 patients who received distal gastrectomy from January 2016 to July 2020. According to the reconstruction method used, all patients were divided into the Billroth-II group and the GJPA group. Clinical data and operation complications were analyzed.ResultsThe clinical characteristics of the 2 groups were comparable after PSM. In the Billroth-II group, the incidence rate of delayed gastric emptying was higher than that in the GJPA group. Fewer patients suffered reflux gastritis in the GJPA group. The RGB (residue, gastritis, and bile) scores related to the severity of bile reflux into the remnant stomach, gastritis, and residue were higher in the Billroth-II group. Postoperative nutritional status and Visick classification demonstrated that postoperative subjective feelings in the GJPA group were improved significantly.ConclusionThe application of GJPA in reconstruction after distal gastrectomy is safe, economical, and reliable. This reconstruction improved the quality of life of patients. It is worth popularizing widely in clinical settings.

Analysis of Risk Factors and Establishment of a Prediction Model for Endoscopic Primary Bile Reflux: A Single-Center Retrospective Study.

Background: Endoscopic primary bile reflux is one of the main diagnostic criteria for bile reflux gastritis (BRG). Presently, the risk factors and prediction models of endoscopic primary bile reflux (EPBR) in gastropathy patients who cannot or will not undergo endoscopy due to contraindications are not clear. Thus, this study aimed to evaluate the risk factors of EPBR and to establish and verify a prediction model.Methods: A series of 844 patients (564 subjects with EPBR and 280 control subjects) were retrospectively selected for this study and divided into a training set (n = 591) and a validation set (n = 253) according to the usual ratio of 70:30% for the subsequent internal validation of the logistic regression model for EPBR. Fifteen parameters that might affect the occurrence of EPBR were collected. Subsequently, univariate and stepwise logistic regression analyses were introduced to reveal the risk factors and the multivariate prediction model. An R package was dedicated to the corresponding internal validation of the EPBR model.Results: The univariate analysis showed that gender, age, smoking, Helicobacter pylori (H. pylori) infection status, metabolic syndrome (MS), non-steroidal anti-inflammatory drugs (NSAIDs) use history, and previous medical histories of chronic liver diseases, cholelithiasis, and erosive gastritis were statistically significant between the two groups (P < 0.05). Multivariate regression described that being a male [OR (95%confidence interval (CI)) = 2.29 (1.50–3.50), P < 0.001], age≥45 years old [OR (95% CI) = 4.24 (2.59–6.96), P < 0.001], H. pylori infection status [OR (95% CI) = 2.34 (1.37–4.01), P = 0.002], MS [OR (95% CI) = 3.14 (1.77–5.54), P < 0.001], NSAIDs use history [OR (95% CI) = 1.87 (1.03–3.40), P = 0.04], cholelithiasis history [OR (95% CI) = 3.95 (2.18–7.18), P < 0.001] and erosive gastritis history [OR (95% CI) = 6.77 (3.73–12.29), P < 0.001] were the risk factors for the occurrence of EPBR. Based on the results of these risk factors, an EPBR prediction model with an adequate calibration and excellent discrimination was established [area under the curve (AUC): 0.839, 95% CI = 0.806–0.872].Conclusions: Being a male, age ≥ 45 years old, H. pylori infection, histories of MS, NSAIDs use, cholelithiasis, and erosive gastritis appear to be the risk factors for EPBR, and our favorable prediction model might be an option for the prediction of EPBR.

Pathological and Histological Aspects of Biliary Reflux After Mini-Gastric Bypass

Background: One anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) is considered to be the best alternative to Roux-en-Y gastric bypass due to the shorter operative time and fewer possible complications. Objectives: The purpose of this study is to determine biliary reflux in patients who undergo OAGB/MGB with a hand-sewn gastroenteroanastomosis, and OAGB/MGB with a linear stapled gastroenteroanastomosis. Materials and Methods: This prospective-retrospective study includes the results of treatment of 122 obese patients who underwent laparoscopic OAGB/MGB. Patients were divided into two clinical groups depending on the method of performing gastroenteroanastomosis. In the postoperative period, the possibility of developing biliary reflux was assessed using fibrogastroscopy with biopsy of the gastric mucosa. Histopathology of biopsy materials was evaluated. Microscopy of biopsy specimens was performed by a pathologist who evaluated each sample of gastric tissue in accordance with the system for determining the biliary reflux index (BRI). Results: With fibrogastroscopy, 9 (15.5%) cases in the study group and 16 (26.6%) cases in the control group, biliary reflux was diagnosed. In the study group of patients, BRI >14 was determined in 3 patients (5.153%). In the control group of patients, BRI >14 was found in 7 cases (10.94%). The difference is significant (p < 0.05). Conclusion: Determination of the BRI index in patients undergoing an OAGB/MGB can be used as a screening method to diagnose biliary reflux for its prevention and the development of tactics for the further management of patients with a high risk of complications associated with the toxic effects of aggressive bile. Hand-sewn gastroenteroanastomosis carries less risk of bile reflux gastritis and anastomositis than stapled gastroenteroanastomosis. Clinical Trial Registration number NCT04845438

S3133 Peptic Ulcers and Decompensated Heart Failure Induced by Excessive Alka-Seltzer® Use

Introduction: Alka-Seltzer® is an over the counter medication that contains acetylsalicylic acid (aspirin) and is advertised to treat heartburn, acid indigestion, sour stomach and pain. We describe a case of peptic ulcers and decompensated heart failure possibly induced by excessive use of Alka-Seltzer®. Case Description/Methods: A 69 year old man presented to the hospital for dyspnea and lower extremity edema over one week. He was seen by cardiology and initiated on diuretics for newly diagnosed decompensated heart failure. While undergoing cardiac evaluation, he reported melena. After further questioning, the patient endorsed indigestion and heartburn for which he used 10-20 tablets of Alka-Seltzer® daily for relief. He was placed on pantoprazole and subsequently underwent upper endoscopy which revealed large clean based (Forrest III) ulcers in the antrum with negative immunohistochemical staining for H.pylori. His volume status improved and he was discharged on pantoprazole with interval follow up and instructions to avoid Alka-Seltzer®. Discussion: Alka-Seltzer® contains sodium bicarbonate, acetylsalicylic acid (aspirin), and anhydrous citric acid. Acetylsalicylic acid (aspirin) inhibits cyclooxygenase-1 (COX-1) which in turn impairs gastric and duodenal cytoprotection. Due to the aspirin content, Alka-Seltzer® tablets likely increase the risk of PUD. Additionally, each tablet contains 567 mg of sodium, rendering cardiac patients at risk of acute heart failure. Based on the amount of tablets ingested, our patient consumed at least 3,250 mg aspirin and 5,000 mg sodium daily. A low sodium diet is recommended to prevent heart failure exacerbations, typically less than 3 grams daily. The sodium intake received from the Alka-seltzer® tablets likely precipitated our patient’s heart failure. Although we are unable to determine if the patient had underlying PUD, it is highly plausible that he developed PUD from his Alka-Seltzer® use or at least worsened his ulcers. It's imperative that patients and physicians are educated regarding supplement contents and their potential effects and interactions.Figure 1.: A. Literature Review, Study Analysis. B. Literature Review Inclusion and External Criterias and Outcomes of Interest. C. Proposed Treatment Algorithm for Bile Reflux Gastritis.

Значення кишкової метаплазії та дисплазії у морфологічній діагностиці хворих на хронічний рефлюкс-гастрит

У роботі за допомогою сучасних гістологічних, гістохімічних і морфометричних методів дослідження проаналізовано біоптати 120 хворих на хронічний рефлюкс-гастрит. Під час гістологічного дослідження слизової оболонки шлунка атрофічні процеси спостерігалися у 73,3 % випадків, при цьо­му у 46,7 % до атрофії приєднувалися більш глибокі ураження: кишкова метаплазія та гіперплазія, а у 15 % випадків — дисплазія шлункових залоз. Авторами запропоновано використання інтегрального показника «кишкова метаплазія + дисплазія» як додаткового критерію оцінки тяжкості передракових змін слизової оболонки шлунка у хворих на хронічний рефлюкс-гастрит, вірогідно пов’язаного з гіперплазією шлункових залоз, інфекцією H.руlori, підвищенням рівня нітритів і тенденцією до збільшення рівня нітратів і гастрину.

Encapsulating peritoneal sclerosis in an AMA-M2 positive patient: A case report

BACKGROUNDEncapsulating peritoneal sclerosis (EPS) is hard to diagnose because of nonspecific symptoms and signs. It is a general consensus that EPS is classified as primary and secondary. There have been several studies discovering some high-risk factors such as liver cirrhosis, of which AMA-M2 is a biomarker, and intra-abdominal surgery such as laparoscopic surgery. Imaging studies help to diagnose EPS and exploratory laparotomy might be an alternative if imaging fails. Nowadays, laparotomy plays a key role in treating EPS, especially when medical treatments do not work and medical therapy fails to ease patients’ symptoms.CASE SUMMARYA 58-year-old man complained of unexplained vomiting and abdominal distension 2 mo after laparoscopic cholecystectomy. Increased alkaline phosphatase and liver enzymes were discovered. An autoimmune liver disease test showed that AMA-M2 was positive. A gastroscopy revealed bile reflux gastritis. A magnetic resonance imaging scan showed a slight dilatation of the intrahepatic bile duct. A colonoscopy showed that there was a mucosal eminence lesion in the sigmoid colon (24 cm away from the anus), with a size of 3 cm × 3 cm and erosive surface. At last, the small intestine and the stomach were found to be encased in a cocoon-like membrane during the surgery. The membrane was dissected and adhesiolysis was done to release the trapped organs. The patient recovered and was discharged 44 d after the operation, and there was no recurrence during a follow-up period of 3 mo.CONCLUSIONAMA-M2 is a marker of primary biliary sclerosis and may help to make a preoperative diagnosis of EPS.

EUS-guided duodenojejunostomy for the nonsurgical management of duodenal obstruction in a patient with complicated postsurgical anatomy

A 62-year-old man received a diagnosis of high-grade duodenal GI stromal tumor (GIST), for which he underwent surgical resection and duodenojejunostomy. He later experienced an anastomotic stricture and bowel obstruction requiring revisional loop gastrojejunostomy (A). After revision, he soon after experienced intractable abdominal pain, nausea, and vomiting, which were attributed to duodenal obstruction and bile reflux gastritis.

Clinical Observation on the Treatment of Bile Reflux Gastritis with Modified Qingre Jiangni Recipe

Clinical Observation on the Treatment of Bile Reflux Gastritis with Modified Qingre Jiangni Recipe

Traditional Chinese patent medicine for bile reflux gastritis: a systematic review and network meta-analysis.

Traditional Chinese Patent Medicine (TCPM) is widely used in the treatment of bile reflux gastritis (BRG). However, there is still a lack of research evaluating the efficacy of specific drugs. Thus, we conducted a reticulated meta-analysis to compare the efficacy of TCPMs in the treatment of BRG. We searched the China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and the Wanfang, and Embase databases, as of February 2021, for publications on the treatment of BRG with Chinese patent medicines in randomized controlled trials (RCTs). The main outcome indicator was the effective rate. The secondary outcome indicators were recurrence rate, traditional Chinese medicine (TCM) symptom score, and gastroscopic mucosal score. The Cochrane bias risk assessment tool was used to evaluate the research quality, and RevMan software (5.2) and Stata software (15.0) were used for the network meta-analysis. A total of 24 studies were included in the meta-analysis. In total, 2,417 patients were included in the meta-analysis, comprising 1,222 patients in the treatment group and 1,195 patients in the control group. The results of the network meta-analysis showed that Weiyankang capsules combined with hydrotalcite had the best effect in the treatment of bile reflux among the 14 interventions. Among the 5 studies that reported recurrence rates, patients administered Shugan Hewei pills had the lowest recurrence rate. A direct comparison showed that TCPMs or TCPMs combined with Western medicines had certain advantages in improving the scores of traditional Chinese medicine symptoms and mucosal scores under gastroscopy. Among all the Chinese patent medicines examined, Weiyankang capsules combined with hydrotalcite appeared to be the best choice for the treatment of BRG. However, due to limitations related to the quantity and quality of the research, more high-quality research needs to be conducted in the future to gather additional evidence. The protocol of this network meta-analysis was registered in PROSPERO with ID CRD42021247873.

Bile in excess

The article presents consideration for the pathogenetic mechanisms of the occurrence of duodenogastric reflux (DGR), duodenogastroesophageal reflux (DGER), their role in the occurrence of biliary reflux gastritis and reflux esophagitis. The fundamental bases for the formation of bile reflux are the failure of the sphincter apparatus, antroduodenal dysmotility, elimination of the natural antireflux barrier. Gallbladder dysfunction and duodenal dysmotility are considered the risk factors for primary DGR. The leading mechanism for the development of DGR, DGER after cholecystectomy is a violation of gastroduodenal motility and gastroduodenal hypertension. These syndromes are formed also at gallstone disease and other organic and functional pathological conditions, including pancreatic insufficiency. The syndrome of chronic duodenal hypertension or «duodenal demon» is manifested by heaviness in the epigastrium, belching, heartburn, nausea, vomiting, flatulence, and stool disorders. It is supplemented by the phenomena of psychosomatic asthenization, decreased mental and physical performance, apathy, and a negative assessment of life prospects. The clinical features of hologenous diarrhea are considered, differential diagnostic signs of diarrhea in chronic duodenal hypertension and irritable bowel syndrome are demonstrated.The clinical and pathogenetic substantiation of the treatment of chronic duodenal hypertension accompanied by hologenous diarrhea with colloidal bismuth preparations is presented. The summary of the comparative analysis has been presented of the physicochemical and structural properties of tablet formulations, containing bismuth tripotassium subcitrate, the original drug De‑Nol (Astellas) and the generic Ulcavis (KRKA). It has been concluded that it is advisable to include Ulcavis in the treatment regimen for patients with hologenous diarrhea.

Meat consumption and risk of 25 common conditions: outcome-wide analyses in 475,000 men and women in the UK Biobank study

BackgroundThere is limited prospective evidence on the association between meat consumption and many common, non-cancerous health outcomes. We examined associations of meat intake with risk of 25 common conditions (other than cancer).MethodsWe used data from 474,985 middle-aged adults recruited into the UK Biobank study between 2006 and 2010 and followed up until 2017 (mean follow-up 8.0 years) with available information on meat intake at baseline (collected via touchscreen questionnaire), and linked hospital admissions and mortality data. For a large sub-sample (~ 69,000), dietary intakes were re-measured three or more times using an online, 24-h recall questionnaire.ResultsOn average, participants who reported consuming meat regularly (three or more times per week) had more adverse health behaviours and characteristics than participants who consumed meat less regularly, and most of the positive associations observed for meat consumption and health risks were substantially attenuated after adjustment for body mass index (BMI). In multi-variable adjusted (including BMI) Cox regression models corrected for multiple testing, higher consumption of unprocessed red and processed meat combined was associated with higher risks of ischaemic heart disease (hazard ratio (HRs) per 70 g/day higher intake 1.15, 95% confidence intervals (CIs) 1.07–1.23), pneumonia (1.31, 1.18–1.44), diverticular disease (1.19, 1.11–1.28), colon polyps (1.10, 1.06–1.15), and diabetes (1.30, 1.20–1.42); results were similar for unprocessed red meat and processed meat intakes separately. Higher consumption of unprocessed red meat alone was associated with a lower risk of iron deficiency anaemia (IDA: HR per 50 g/day higher intake 0.80, 95% CIs 0.72–0.90). Higher poultry meat intake was associated with higher risks of gastro-oesophageal reflux disease (HR per 30 g/day higher intake 1.17, 95% CIs 1.09–1.26), gastritis and duodenitis (1.12, 1.05–1.18), diverticular disease (1.10, 1.04–1.17), gallbladder disease (1.11, 1.04–1.19), and diabetes (1.14, 1.07–1.21), and a lower IDA risk (0.83, 0.76–0.90).ConclusionsHigher unprocessed red meat, processed meat, and poultry meat consumption was associated with higher risks of several common conditions; higher BMI accounted for a substantial proportion of these increased risks suggesting that residual confounding or mediation by adiposity might account for some of these remaining associations. Higher unprocessed red meat and poultry meat consumption was associated with lower IDA risk.

Roux-en-Y Reconstruction Following Distal Gastrectomy Reduced Endoscopic Reflux Esophagitis in Older Adults: Propensity Score–Matching Analysis

Objective This study aimed to examine the functional outcomes of Roux-en-Y (RY) and Billroth I (BI) reconstruction methods following distal gastrectomy in patients ages ≥75 years with gastric cancer. Summary of background data RY and BI reconstructions are commonly performed after distal gastrectomy. However, no study has compared the 2 procedures in older adults. Methods We identified older patients who underwent RY (n = 103) or BI (n = 71) reconstruction following distal gastrectomy from 2011 to 2018 in our database. Patients in the RY and BI groups were matched by propensity scores, and each group included 62 patients. We compared short-term surgical outcomes and clinical findings at 1 year postoperatively. Additionally, risk factors for endoscopic reflux esophagitis following distal gastrectomy were evaluated. Results Reflux esophagitis, bile reflux, and remnant gastritis were significantly less frequent in RY reconstruction than in BI reconstruction. Moreover, both BI reconstruction and preoperative hiatus hernias were independent risk factors for postoperative endoscopic reflux esophagitis. Although the incidence of postoperative surgical complications following RY and BI was similar, RY was found to cause delayed gastric emptying more frequently than BI. Conclusion RY reconstruction is a favorable procedure to prevent reflux esophagitis in older patients, particularly in those with hiatal hernia.

Symptom resolution of bile reflux gastritis after transoral gastric outlet reduction in a patient with Billroth II anastomosis.

Endoscopic transoral outlet reduction (TORe) utilizing a full thickness endoscopic suturing device is a minimally invasive therapeutic option in bariatric surgery patients who have experienced weight gain, but also can be used in patients who underwent Billroth II (B-II) procedure with biliary reflux symptoms.

Preventing Delayed Gastric Emptying after Whipple'S Procedure - Isolated Roux Loop Reconstruction with Pancreatico-Gastrostomy

Introduction: Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. Methods: All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2018 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. Results: A total of 101 patients were operated using this technique from January 2009 to December 2018. The mean operative time was 260.8 ± 50.3, and the mean operative blood loss was 1,068.0 ± 606.1 ml. Mean gastric emptying time 106.0 ± 6.1 min (89-258 min). 5 out of the 101 (4.9 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Conclusion: Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE

Comparison of different reconstruction procedures after distal gastrectomy in patients with gastric cancer

Objective: To systematically compare the effect of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ in gastric cancer patients after distal gastrectomy by meta-analysis. Methods: Systematic search was conducted on the relevant electronic databases of Pubmed, Embase, Wanfang Database, CNKI and VIP from the established time to August 18, 2019. The randomized controlled trials about comparison of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ were strictly screened and analyzed by the software of Revman 5.3. Procedure and postoperative outcomes were analyzed, respectively. Results: A total of 783 relevant literatures were systematically retrieved, and 6 randomized controlled trials, including 954 patients, finally met the inclusion criteria after strict screening. The results of meta-analysis showed that operative time of Billroth Ⅰ was significantly shorter than that of Roux-en-Y (MD=-37.60, 95%CI:-50.79--24.40, P<0.001), intraoperative bleeding (MD=-21.64, 95%CI:-32.20--11.07, P<0.001) and the number of delayed gastric emptying (RR=0.52, 95%CI: 0.31-0.86, P=0.01) of Billroth Ⅰ were both significantly less than those of Roux-en-Y, while bile reflux (RR=8.17, 95%CI: 2.21-31.53, P=0.002) and residual gastritis (RR=1.75, 95%CI:1.43-2.14, P<0.000 01) of Billroth Ⅰ were both significantly higher than those of Roux-en-Y, other outcomes showed no significant difference. Compared with Roux-en-Y, operative time of Billroth Ⅱ was significantly shorter (MD=-19.73, 95%CI:-32.82--6.64, P=0.003), while bile reflux (RR=17.63, 95%CI: 4.50-69.02, P<0.001), residual gastritis (RR=1.94, 95%CI:1.15-3.26, P=0.01) and reflux esophagitis (RR=3.13, 95%CI: 1.31-7.45, P=0.01) of Billroth Ⅱ were all significantly higher, and there was no significant difference in other outcomes. Conclusion: Compared with Billroth Ⅰ and Billroth Ⅱ, the operation time of Roux-en-Y in gastric cancer patients undergoing distal gastrectomy is longer, but the incidences of bile reflux and residual gastritis are both lower, and the postoperative quality of life seems better.

Continuous Jejunal Pouch and Residual Stomach Anastomosis Combined with Jejunal Lateral Anastomosis: An Improved Method of Gastrointestinal Reconstruction following Distal Gastrectomy

Aim Currently, there is no optimal digestive tract reconstruction technique well recognized by scholars after distal gastrectomy. A new reconstruction method, which was modified from the classic Roux-en-Y procedure, the continuous jejunal pouch and residual stomach anastomosis combined with jejunal lateral anastomosis (Contin-L), was established. In order to fully clarify the superiority of this procedure, this study has conducted a systematic analysis and prepared a summary of the clinical data of patients who underwent distal gastrectomy for gastric cancer. Methods From June 2013 to March 2016, we enrolled 198 patients with gastric cancer who underwent radical D2 distal gastrectomy. According to the reconstruction methods, these patients were divided into three groups: Contin-L (n = 74), Billroth II (n = 59), and Roux-en-Y (n = 65) groups. The operation time for reconstruction, complications, prognostic nutritional index (PNI), and the Visick grading were analyzed. Results Regarding long-term complications, such as reflux gastritis, the Contin-L procedure showed significantly better results than Billroth II (p < 0.0001). Regarding the long-term postoperative nutritional status, such as the PNI and body weight recovery, the Contin-L procedure displayed significantly better results than Billroth II and Roux-en-Y (p < 0.05). Postoperative subjective feelings evaluated by Visick grading were significantly more improved in the Contin-L than in the Billroth II and Roux-en-Y groups (p ≤ 0.01). Conclusions The Contin-L procedure gave full play to the advantages of jejunal continuity, and pouch and lateral anastomoses, which significantly reduced short- and long-term complications, and improved the long-term patient quality of life following the surgical procedure.