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

The results and procedures of interposed jejunal pouch after total gastrectomy for gastric cancer are reported. Basic requirements of reconstruction after total gastrectomy are 1) formation of a food reservoir, 2) maintenance of duodenal continuity, 3) avoidance of reflux esophagitis, 4) gradual emptying of reservoir into the small intestine. Since 1950's, several procedures of gastric substitutes have been reported. But they were not widely performed. Because scientific evaluation of the value of gastric substitutes was difficult and the operative procedures were time consuming and complicated. With an increasing ratio of early gastric cancer in 1990's, the importance of post-operative QOL, such as food intake and body weight maintenance, in patients after total gastrectomy has been recognized. Our procedure is a double lumen jejunal pouch distal to a interposed jejunum. The length of interposed jejunum is 20 cm and that of pouch is 10 cm. Using surgical staplers, this procedure is safe and simple. Jejunal pouch interposition leads to a satisfactory symptomatic and nutritional result in gastrectomized patients.
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PMID:[Jejunal pouch interposition after total gastrectomy]. 925 4

Several problems are associated with gastric resection, including the dumping syndrome, reflux esophagitis, and malabsorption. A better understanding of the pathophysiological changes will shed light on new and improved therapy. Serum levels of seven circulating gastrointestinal hormones following a standardized solid meal and a brief score of symptoms were evaluated in 10 patients after partial distal gastrectomy and 12 patients after total gastrectomy, both groups reconstructed by Billroth II anastomosis, and 9 age-matched healthy controls. Patients underwent resection for gastric cancer and were studied 45 +/- 10 months after surgery. At the time of study, the patients had adapted well to surgery and no longer exhibited the severe symptoms of dumping seen immediately post-operatively. In contrast, the total gastrectomy patients exhibited the symptoms of reflux esophagitis. The gastrointestinal hormone changes could be divided into three patterns; obtunded responses (gastrin, PP), normal release (motilin, GIP) and increased secretion (CCK, neurotensin, PYY). In these, the early reaction of neurotensin correlated with the scores of late dumping syndrome and reflux esophagitis. In the literature, many gastrointestinal hormones have been shown to respond as an enhancement rather than adaptation. In other gastrointestinal hormones, secretin belonged to the obtunded type and enteroglucagon were classified in the increased type. However, pathophysiological significance of these hormonal changes remained uncertain. The late adaptive changes in gastrointestinal hormone secretion may help to compensate for loss of gastric motor function which accompanies gastric resection. On the other hand, these hormonal changes may exacerbate the esophageal reflux following gastrectomy.
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PMID:Gastrointestinal hormone in dumping syndrome and reflux esophagitis after gastric surgery. 940 15

The Authors describe their last 10 years experience in gastric surgery. They report the results obtained in 12 gastric resections performed for complications following gastric and/or duodenal peptic ulcers, in 33 cases of total gastrectomies (34%), and 48 cases of subtotal gastrectomies (49%) for early and advanced cancer. The results lead to interesting conclusions: first of all achieving a wide jejunojejunostomy between the afferent and the efferent loop the problems related to gastric resection (as postoperative sequelae, dumping syndrome, reflux esophagitis, alkaline gastritis, etc.) are avoided. Problems regarding lymphadenectomy in patients submitted to subtotal gastrectomy (D2-D3) are then reported. After a brief history of gastric reconstruction following gastric resection the evolution in surgical techniques and the results obtained during the last 10 years are described. The good long term results allow to conclude that our strategy in gastric surgery ensures a good quality of life of the patients as well as a radical operation in case of gastric cancer.
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PMID:[Gastric resection and subtotal gastrectomy. Principles and updated surgical technique]. 947 83

In the late follow-up period after gastrectomy conduction for gastric cancer using antireflux muff-like esophago-jejunal anastomosis 587 patients were examined. Mild reflux esophagitis was revealed in 29 (4.9%), moderate--in 9 (1.5%) of patients. Cicatricial stenosis of anastomosis have occurred in 127 (8.5%) of patients, including an early one--in 70.1% and the late--in 29.9%. The dilation using tubular bougies, passed along the guide, proved effective in the treatment of early stenosis. The stenosed part was cut through the endoscope with subsequent bougienage for the late stenosis.
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PMID:[Reflux esophagitis and cicatricial stenosis of the muff-like esophageal-small intestine anastomosis after performing a gastrectomy for stomach cancer]. 961 50

The endoscopic diagnosis of early esophageal and gastric cancers located within 2 cm above and below the esophagogastric junction (EGJ) is discussed. We reviewed 25 cases (10 mucosal cancers and 15 submucosal cancers). Histologically, early cancers frequently appeared as type IIc lesions (16/25: 64%). There was no relationship between tumor size and the depth of invasion of cancer lesions, and most of the lesions were well or moderately differentiated carcinomas. Endoscopically, homogenous redness with a thin white coating, some granular appearance, and easy bleeding were very important factors for the diagnosis of early gastric cancer. For superficial esophageal cancer, differential diagnosis from reflux esophagitis is correctly performed with the endoscopic dye (lugol)-staining method and biopsy. In order not to overlook early cancer at the EGJ, this area should be observed with sufficient air inflation by the U-turn or J-turn method using a frontal-view panendoscope.
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PMID:[Endoscopic diagnosis of early cancer in the esophagogastric junctional region]. 984 40

Gastroesophageal reflux disease (GERD) is responsible for a high proportion of digestive symptoms attributable to the upper gastrointestinal tract. Helicobacter pylori (H. pylori) is the main etiologic factor in chronic gastritis and gastroduodenal ulcer disease, but its relation with GERD has not yet been established. The aim of this paper is to review the relationship between H. pylori and GERD, trying to answer the question whether a nexus of "friendship" or "hate" exists between them. Although H. pylori may, in theory, represent a cause for GERD, available data suggest that the infection is not a risk factor for the development of GERD, and the microorganism could even represent a protective factor against this disease. The antisecretory effect of proton pump inhibitors (PPIs) seems to depend on the presence of the infection and H. pylori eradication has, therefore, negative consequences on the efficacy of antisecretory drugs (although its possible clinical relevance, precisely in patients with GERD, remains unknown). Moreover, H. pylori eradication in patients with duodenal ulcer disease is associated in some studies, but not in others, with a higher incidence of GERD, although the reported reflux esophagitis is usually mild. It can be concluded, from these data, that investigating or treating H. pylori infection is not recommended in patients with GERD (when these patients do not need PPI maintenance therapy). Finally, it has recently been recommended to eradicate H. pylori infection in those patients with GERD needing long-term treatment with omeprazole, as some studies have reported that this drug induces, in presence of the microorganism, an atrophic gastritis, with the consequent theoretic risk of gastric cancer. However, several arguments against this attitude can be postulated, and noteworthy are the following: many studies suffer important methodological defects, several authors report contrary results, and the possibility that H. pylori could play, as previously mentioned, a protective role against GERD. It may be concluded, therefore, that the indication of eradicating H. pylori in patients with GERD and maintenance therapy with PPIs, although supported by several arguments, cannot be considered as definitively established. In conclusion, H. pylori and GERD seem to have, in any case, a "friendly" relationship, although it may be transformed into one of "hate" when PPIs enter the scene.
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PMID:Helicobacter pylori and gastroesophageal reflux disease: friends or foes? 1037 Jun 61

H. pylori infection is associated with various gastroduodenal diseases such as gastritis, peptic ulcer, gastric cancer, gastric MALT lymphoma. H. pylori infection is suggested that it plays a role as protective factor not promoting factor for reflux esophagitis and GERD. Epidemiological studies showed lower prevalence of H. pylori infection in reflux esophagitis and Barrett's esophagus comparing the control. Increased occurrence of reflux esophagitis after curing of H. pylori infection was reported. However, the relationship between H. pylori infection and reflux esophagitis has not been actually made clear. Also the mechanism of reflux esophagitis occurrence after H. pylori eradication is not obscure.
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PMID:[Helicobacter pylori infection and eradication]. 1100 6

Since the causative role of Helicobacter pylori in peptic ulcer and gastritis was established, a number of advances have been made. Helicobacter virulence factors have been identified, the changes it causes in gastric acid secretion has been elucidated, and the entire genome of H. pylori has been mapped. Multiple lines of evidence indicate a strong link between the bacterium and noncardia gastric cancer. The infection can be confidently diagnosed by noninvasive serologic tests and the urea breath test. Triple therapy is almost always curative, and the infection almost never recurs in Canadian adults, but eradicating the bacteria in the absence of peptic ulcer only rarely leads to resolution of dyspepsia. New studies suggest that treating Helicobacter may increase the risk of peptic esophagitis and adenocarcinoma of the esophagus and cardia.
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PMID:Helicobacter and disease: still more questions than answers. 1104 91

A total of 40 patients (28 males, 12 females; mean age, 56.6 years; range, 41-72 years), 1-1.5 years (mean, 1.4 years) after subtotal gastrectomy for early gastric cancer (Billroth I, D2 lymph node dissection, curability A) were divided into 2 groups according to the occurrence of interdigestive migrating motor complex (IMMC), phase III from the duodenum, and their postoperative quality of life was compared. Results were as follows: (i) patients in the IMMC, phase III positive group (28 patients) had evidently more appetite and ate more food, with less decrease in body weight compared with the IMMC, phase III negative group (12 patients); and (ii) patients in the IMMC, phase III positive group had clearly less symptoms, such as early dumping symptoms (systemic symptoms), symptoms of reflux esophagitis (e.g. heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distention, and borborygmus, compared with the negative group. These results showed more satisfactory quality of life in the IMMC, phase III positive group compared with the negative group.
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PMID:Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with distal subtotal gastrectomy for early gastric cancer. 1107 27

A total of 30 patients (18 men, 12 women; 43-79 years, mean 58.9 years) 1.0 to 1.5 years (mean 1.25 years) after distal gastrectomy for early gastric cancer (Billorth I, D2 lymph node dissection, curability A) were divided into two groups based on the occurrence of interdigestive migrating motor complex (IMMC) phase III (pIII) from the duodenum and their postoperative gastrointestinal symptoms. They were compared before and after cisapride therapy (at an oral dose of 7.5 mg/day for 3 months). Results were as follows. Before cisapride therapy: (1) Patients in the IMMC-pIII-positive group (n = 20) had more appetite and ate more food with less decrease in body weight than those in the IMMC-pIII-negative group (n = 10); (2) patients in the IMMC-pIII-positive group clearly had fewer symptoms, such as early dumping (systemic) symptoms, symptoms of reflux esophagitis (e.g., heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distension, and borborygmus, than the IMMC-pIII-negative group. After cisapride therapy: eight patients (80%) in the IMMC-pIII-negative group became IMMC-pIII-positive, and their appetite and food consumption were obviously improved; body weight increased in six patients (60%), with alleviation of other abdominal symptoms and disappearance of the early dumping syndrome. These results showed a more satisfactory condition in regard to gastrointestinal symptoms in the IMMC-pIII-positive group than in the IMMC-pIII-negative group. It is concluded that cisapride therapy results in the occurrence of IMMC-pIII and subsequently alleviates various abdominal symptoms, contributing to the improved postoperative gastrointestinal condition of patients after gastrectomy.
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PMID:Relation between gastroduodenal interdigestive migrating motor complex and postoperative gastrointestinal symptoms before and after cisapride therapy following distal gastrectomy for early gastric cancer. 1107 71


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