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Query: UMLS:C0024623 (gastric cancer)
 36,219 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of adenocarcinoma in Barrett's esophagus following a total resection of the gastric remnant. A 52-year-old man had undergone a distal gastrectomy for gastric cancer at 33 years of age and a total resection of the gastric remnant for local recurrence of the gastric cancer at 35 years of age. Repeated endoscopic examinations revealed the sequence of reflux esophagitis and Barrett's esophagus. Furthermore, adenocarcinoma in Barrett's esophagus was detected in December, 1989. A subtotal esophagectomy was performed in January, 1990. The elevated lesion in the lower esophagus showed coarse lobulation and measured 7.4 x 3.2 cm. The histologic type was that of well-differentiated adenocarcinoma, with the invasion limited to the muscularis mucosae without lymph node involvement. Severe dysplasia was seen adjacent to the definite carcinoma. The case supports the acquired theory of pathogenesis for Barrett's esophagus and suggests that reflux esophagitis after total gastrectomy may result in a dysplasia-carcinoma sequence.
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PMID:Adenocarcinoma in Barrett's esophagus following total resection of the gastric remnant: a case report. 133 73

The results of surgical treatment of 158 patients with gastric cancer, using the original techniques for the esophago-gastric and esophago-intestinal anastomoses formation, have been summarized. Gastrectomy was performed in 65.2%, subtotal proximal reaction of the stomach--in 8.9%, subtotal distal resection--in 25.9% of the patients. The postoperative lethality was 3.2%. At late complex examination, I stage reflux esophagitis after gastrectomy was observed in 3 (3.4%) patients, after proximal gastric resection--in 1 (8.3%). After the operation, 32 (20.3%) patients are alive for 5 and more years.
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PMID:[Radical surgical treatment of patients with cancer of the stomach]. 150 52

The etiopathogenesis of ulcer disease is comprehensive and many experimental and clinical data failed to prove the primary cause of the disease. Although much has been learned concerning the pathophysiological mechanism which appear important in the development of ulcer disease, our present knowledge of the etiology of this disease is incomplete. Depression of the gastric acid secretion still remains the main treatment approach, although the cytoprotective drugs are interesting therapeutic challenge. Etiology of the peptic ulcer disease is not solved yet, but the defense mechanisms of the gastric mucosa are much more clear what will lead to better understanding of the defense mechanisms in the gastric cancer. Omeprazole is an interesting new drug healing peptic ulcer in almost 100% of the patients. A philosophic question may be asked: "Do we need to know the etiology of the disease in order to be able to treat it properly?" Omeprazole heals the ulcer and, in fact, we do not know its etiology. In the cost-benefit ratio, the most widely used drugs are still H2-receptor antagonists and sucralfate, and omeprazole is reserved for the patients with resistant ulcer disease, Zollinger-Ellison syndrome and severe reflux esophagitis.
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PMID:[New findings in the etiopathogenesis of ulcers and reevaluation of therapy]. 196 Oct 77

From 1977 to 1984 six-hundred non selected patients with megaesophagus were prospectively examined through 722 endoscopies. 347 (57.8%) were men and 253 (42.2%) women the age ranged from 11 to 87 years (mean 45.7). 499 (90.2%) out of 553 patients had positive serologic test for Chagas' disease. 480 were non treated patients and 120 were previously treated. The following endoscopic findings were found: stasis esophagitis--15 (2.5%), reflux esophagitis--41 (6.5%), stenosis of esophagus--8 (1.3%), cancer of esophagus--5 (0.8%), hiatal hernia--3 (0.5%), esophageal varices--2 (0.3%), leukoplasia--1 (0.2%), duodeno-gastric biliary reflux--173 (30.4%), chronic gastritis--109 (18.2%), gastric ulcer--10 (1.8%), gastric polyp--2 (0.4%), gastric cancer--1 (0.2%), megabulbus--9 (1.6%), duodenal ulcer--10 (1.8%) and duodenitis--5 (1.9%). The cancer of esophagus and megaesophagus association in our results was lower than those reported by others; this may be due to the inclusion of early cases of megaesophagus in our patients. The high incidence of duodeno-gastric biliary reflux in the chagasic megaesophagus is claimed by the authors to be due to an antrum-pyloric-duodenal dyskinesia secondary to intrinsic denervation caused by Chagas' disease. Finally the authors recommend the endoscopy as a routine procedure in the megaesophagus in order to detect these associated morbid conditions.
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PMID:[Endoscopy in megaesophagus. Prospective study of 600 cases]. 393 52

A total gastrectomy was performed in 49 patients with early gastric cancer, and the effectiveness of this procedure was evaluated by reviewing the hospital files of the patients. The reasons for this total gastrectomy were as follows: (1) lymph node dissection for 22 patients, (2) surgeon's choice in reconstruction for 10 patients, (3) modification of the surgery from subtotal to total gastrectomy for seven patients, (4) synchronous multiple cancers for seven patients, and (5) cancer in a stomach remnant for three patients. Of 49 patients, 42 had the cancerous lesions in the upper portion of their stomachs. Lymph node involvement occurred in 5 patients, but not in the supra- or infrapyloric lymph nodes. Postoperative complications such as anastomotic leakage, reflux esophagitis and pancreatic fistula occurred in five, four, and two patients, respectively. Postoperative death, including two patients who died within 30 days after the surgery, occurred in 5 patients. Our study showed that total gastrectomy resulted in excessive unnecessary surgery in 39 out of 49 patients (79.6%). We conclude that a total gastrectomy should not be performed on patients with early gastric cancer except for synchronous multiple cancers and for cancers in a stomach remnant.
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PMID:Total gastrectomy for early gastric cancer. 756 86

Although reflux esophagitis after subtotal gastrectomy has been noticed by surgeons, the mechanism of its development is obscure. This study was undertaken with the aim of clarifying the role of the lower esophageal sphincter in the development of this abnormality. Manometric studies were carried out on 42 patients with gastric cancer, and on 19 with cholelithiasis. The lower esophageal sphincter pressure was measured using a catheter tip pressure transducer and a rapid pull-through technique, and the results presented as the mean of three measurements. The technical error of this experiment was estimated to be within 2 mmHg by a study of the cholecystectomy patients. After gastrectomy, the lower esophageal pressure decreased in 17 patients, increased in 4 and remained unchanged in 21. A more pronounced decrease in the lower esophageal sphincter pressure was found after Billroth II. Clinical evaluation of the 42 patients revealed symptoms of postgastrectomy regurgitation in 10. Preoperatively, these 10 had lower values of the lower esophageal sphincter pressure followed by a more marked postoperative decrease, as compared with the patients with no regurgitation symptoms. Oral administration of a test meal revealed regurgitation after subtotal gastrectomy. This study suggests that a low value of the pre-operative lower esophageal sphincter pressure, a marked decrease in the pressure after gastrectomy, and Billroth II anastomosis, may be factors that predispose to regurgitation.
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PMID:Lower esophageal sphincter pressure after subtotal gastrectomy and postoperative reflux esophagitis. 772 Dec 50

A 76-year-old male patient suffered from recurrent bacterial pneumonia of the right upper lobe and both lower lobes since 2 years after total gastrectomy for gastric cancer. He was treated with antibiotics repeatedly without complete remission. Meanwhile, chronic cough, purulent sputum, and persistent bilateral pulmonary infiltration developed gradually. Upper digestive tract endoscopy showed moderate reflux esophagitis. For diagnosis, we performed upper digestive tract scintigraphy, a "modified-salivagram", to detect aspiration and GER. Although aspiration was not detected, GER reaching to the upper portion of the esophagus was observed 46 min after taking radio-labeled albumin, and chronic aspiration pneumonia with GER was thus diagnosed. Bed blocks and gragling with ponvidone-iodine after meals and before sleep greatly improved the symptoms of cough and sputum. The bilateral infiltrative shadows disappeared with resolution of symptoms. Chronic aspiration resulting from GER is an important cause of chronic airway infection. Even if a patient with reflux esophagitis is asymptomatic, chronic aspiration pneumonia should be suspected in cases of recurrent or persistent pneumonia in both lower lobes. The "modified-salivagram" is a sensitive test to detect aspiration and GER in hypoacidic states, such as in total gastrectomy and elderly patients.
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PMID:[A case of chronic aspiration pneumonia after total gastrectomy caused by gastroesophageal reflux revealed by a "modified-salivagram"]. 827 18

This study is aimed at a role of Helicobacter pylori (HP) infection in reflux esophagitis of the elderly. 46 patients with reflux esophagitis aged at older than 60 years are selected for this study with informed consent. 43 patients without reflux esophagitis, peptic ulcer, and gastric cancer are used as a control group. In reflux esophagitis, gastric mucosal atrophy is judged as closed type of endoscopic findings in all cases. In control, 27 of 43 patients were judged as open type. Serum pepsinogen I, II ratio is 4.73 +/- 1.28 which is higher significantly than 3.39 +/- 1.69 in control. Serological positive rate of HP antibody is 39.1% in reflux esophagitis. This rate is significantly lower than 62.7% in control. In conclusion, low frequency of chronic HP infection protects gastric mucosa from atrophy, and keeps secretion of gastric acid, resulting in reflux esophagitis of the elderly accompanied with various abnormal esophago-gastric functions.
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PMID:[Gastric mucosal atrophy and prevalence of Helicobacter pylori in reflux esophagitis of the elderly]. 865 65

A 66-yr-old man had undergone a total gastrectomy with esophagojejunostomy for gastric cancer 29 yr previously. Soon after the operation, he began to suffer frequent bile regurgitation and subsequent alkaline reflux esophagitis. A small esophageal tumor was found incidentally above the esophagojejunostomy at a follow-up endoscopy, and he subsequently underwent a lower esophagectomy in 1995. The resected specimen revealed evidence of an early adenocarcinoma arising in a short segment of columnar cell-lined esophagus which had not been grossly evident prior to the esophagectomy. The present case indicates that columnar metaplasia with a neoplastic potential can be induced in the esophagus by the chronic reflux of duodenal contents in the absence of gastric acid.
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PMID:Early esophageal adenocarcinoma arising in a short segment of Barrett's mucosa after total gastrectomy. 879 16

For improved quality of life, limited surgery for early gastric cancer has been preferred over the standard operation with lymph node dissection. Therefore, we have developed a modified technique: the proximal gastrectomy is reconstructed with a short segment of the left colon. The anastomoses of both esophagocolonostomy and colono-gastric remnantstomy are made using stapling devices. A His' angle is formed to reduce reflux esophagitis. We described here the detail of an operative technique.
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PMID:Short segment of left colon substitution following proximal gastrectomy. 890 60


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