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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four cases of endoscopically proven gastroduodenal fistulae (double pyloric canal) are presented, and ten case reports in the literature are reviewed. The fistula develops from a penetrating gastric ulcer. Presumably, the ulcer becomes adherent to adjacent duodenum and penetrates further to establish a fistulous connection, which ultimately becomes lined with mucosa, creating a second pyloric canal. Fistulae between the lesser curve of the antrum and superior fornix of the duodenal bulb were the commonest (9 out of 14). Fistulae also form between the lesser curve of the body of the stomach and the duodenal bulb or fourth part of the duodenum. Gastro-gastric fistula and a fistula into the inferior fornix of the duodenal bulb from a pyloric ulcer have been described. In two of the four cases in this series fistulae had formed from the greater curve of the antrum to the inferior fornix of the duodenal bulb, an entity not previously described. Radiologic appearances may be confused with an antral carcinoma, an ulcerating carcinoma, Crohn's disease, or lymphoma. The presence of previous ulceration and evidence of scarring should aid in avoiding confusion with malignancy. The term gastroduodenal fistula is suggested to describe double pyloric canal.
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PMID:Gastroduodenal fistulae and double pyloric canal. 66 55

The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
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PMID:[Erroneous laparotomy in emergency surgery]. 177 33

Three cases of granulomatous inflammation in gastric biopsies showing Campylobacter pylori infestation are described. This type of reaction to Campylobacter pylori has not previously been described, and occurred in 1.1% of gastric biopsies containing Campylobacter-like organisms (CLO), in this series of all gastric biopsies submitted for histological examination during one year. Two other cases each showed a mucosal granuloma: one was a patient with Crohn's disease and the other had foreign body giant cells in a biopsy of the edge of a healing gastric ulcer. Each of our three CLO-positive cases with granulomas showed scanty CLO's only. Thus, although granulomatous inflammation associated with CLO's is uncommon as a proportion of all CLO-positive gastric biopsies, these currently represent the commonest condition associated with granulomas in gastric biopsies, in our experience.
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PMID:Granulomatous gastritis associated with Campylobacter pylori. 276 75

A prospective study was carried out in 51 patients admitted for abdominal complaints of at least 1 year's duration. Despite previous hospitalization for the same complaints, no certain diagnosis had been established. After systematic diagnostic procedures in the Medical Dept., Rikshospitalet, 33 patients were given a psychosomatic and 18 patients an organic primary diagnosis. The organic diseases were three cases of Crohn's disease, two of cancer, two of duodenal ulcers, one of gastric ulcer, two of gastroduodenitis, five of postresection syndrome, one of lactose intolerance, one of hyperthyroidism, and one of degeneration of the columna. The patients' condition was registered after 1 year of individual treatment. There was a significant decrease in the number of symptoms, in the psychosomatic score of anxiety, depression, and stress, and in days on sick leave and consultation with physicians in connection with the second compared with the first hospitalization for the whole group, for the psychosomatic group, and for the patients with upper gastrointestinal disease. Increased vitality based on muscular testing was also indicated in the same groups of patients. The study suggests that patients with uncharacteristic abdominal disorders may need a thorough examination at least once in the course of their illness; on the one hand, this may help patients with psychosomatic disease to cope better with their problems, and, on the other hand, primary organic lesions may be difficult to diagnose on the grounds of simple screening procedures.
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PMID:A prospective study of patients with uncharacteristic abdominal disorders. 389 79

Sera from 111 patients with various gastro-intestinal (GI) diseases were studies for the presence of antibodies to human serum albumin (HSA), bovine serum albumin (BSA) and ovalbumin (OA) by passive haemagglutination assay. The antibody titre to BSA was higher than that to HSA or OA. The anti-BSA antibody was demonstrated in upper GI diseases i.e. esophageal cancer, gastric ulcer, gastric cancer and duodenal ulcer, and not in lower GI disease i.e. Crohn's disease, ulcerative colitis and colon cancer. Both the mean titre and the incidence of the anti-BSA antibody tended to be higher in women than in men, and the titre was in a positive correlation with serum gamma-globulin levels. Sephadex G-200 column chromatography revealed that the anti-BSA antibody was widely distributed between void volume and 7S fraction.
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PMID:Anti-albumin antibodies in sera of patients with gastro-intestinal disease. 714 Nov 96

Gastrointestinal bleeding is believed to cause iron-deficiency anemia (IDA). The information concerning ideal evaluation of the gastrointestinal tract and exact findings in patients with IDA is scant. The aim of this study was to prospectively evaluate patients with IDA for gastrointestinal lesions potentially causing IDA at a US Army Teaching Medical Center with Gastroenterology Fellowship. Seventy patients with IDA had esophagogastroduodenoscopy (EGD) and colonoscopy, and if this evaluation was unremarkable, then small bowel biopsy was obtained at EGD to evaluate for celiac disease. Enteroclysis was done if endoscopic evaluation was negative. At endoscopy, at least one lesion potentially accounted for the IDA in 50 (71%) patients. At colonoscopy, 21 (30%) patients had 22 lesions (four colon cancer, seven adenoma > 1 cm, six vascular malformation, four severely bleeding hemorrhoids, one ileal Crohn's); at EGD, 39 (56%) patients had 43 lesions (11 gastric erosion, 10 esophagitis, four vascular malformation, four celiac disease, three gastric cancer, three gastric ulcer, three duodenal ulcer, two gastric polyp > 1 cm, one duodenal lymphoma, one esophageal cancer, and one duodenal Crohn's). Twelve (17%) patients had both upper and lower gastrointestinal tract lesions. Twenty-four of 32 (75%) patients with positive fecal occult blood test had potentially bleeding lesions compared to 24 of 38 (63%) patients with negative fecal occult blood test (P > 0.05). Six of nine patients with malignancy had positive fecal occult blood test. Twenty patients with normal endoscopy and small bowel biopsy had normal enteroclysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. 778 48

After establishing the benign nature of a gastric ulcer, the treatment is primarily medical. This medical therapy is aimed to alleviate symptoms, to heal the ulcer and to prevent relapses. Based on the history of non-steroidal anti-inflammatory drugs (NSAIDs) and the Helicobacter pylori-status, gastric ulcer patients can be divided into four categories (1) H. pylori positive plus NSAID-use, (2) H. pylori positive without NSAID use, (3) NSAID use with negative H. pylori-status, (4) Negative H. pylori-status and no NSAID use. Patients taking NSAIDs should stop this therapy if possible. Patients with gastric H. pylori infection should be treated by a regimen of a proton pump inhibitor with at least two appropriate antibiotics. This treatment will result in early alleviation of symptoms, rapid healing of the ulcer and prophylaxis of ulcer relapse. In patients with gastric ulcer who cannot stop NSAIDs, maintenance therapy with prostaglandins or potent antisecretory drugs should be considered. The few patients with gastric ulcer who do not take NSAIDs and do not have gastric H. pylori infection should be treated by antisecretory drugs, and they should be carefully followed endoscopically to exclude malignant (carcinoma, lymphoma) or non-peptic (Crohn's disease) disease. All patients with gastric ulcer should be re-endoscoped to verify complete ulcer healing. Surgery may be considered in gastric ulcer patients with complications, in those with severe dysplasia of the gastric mucosa, and in those who are not able or willing to take the medication.
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PMID:Therapy and prevention of gastric ulcer. 916 95

In the pediatric population, the associations of Helicobacter pylori with gastritis, gastric ulcer, duodenitis and duodenal ulcer, and with duodenal gastric surface metaplasia and disorders of the D cell- G cell axis resulting in hypergastrinemia, are well established and in many ways resemble their counterparts in adults. Eradication of H pylori invariably results in the reversal of these diseases with time. There are also suggestions that gastric surface metaplasia is more extensive in children with H pylori, and may be the site of duodenal H pylori infection and associated duodenal erosions or ulcers. There is no consensus as to whether H pylori in children is more or less severe than in adults. In one pediatric cohort, H pylori was associated with increased intensity of inflammation, while other studies suggest that acute inflammation may be less intense in children overall but that chronic inflammation may be increased in intensity, including lymphoid hyperplasia, which in turn may correlate with endoscopic nodularity. Lymphoid hyperplasia and nodular gastritis appear to be more frequent in children than in adults and usually regress following H pylori eradication. However, in children, other diseases or morphological abnormalities, including some loss of glands (atrophy), occasionally intestinal metaplasia, lymphoproliferative diseases including low grade mucosal-associated lymphoid tissue lymphoma, lymphocytic gastritis and hypertrophic gastritis/Menetrier's disease, are much less frequently associated with H pylori than in adults. Other associations are rarely seen in children, primarily because the time required for these to develop takes the individual to adulthood; for example, while intestinal metaplasia occurs in the pediatric population, the complications of adenoma/dysplasia and carcinoma are rare. In adults, inflammatory and hyperplastic polyps, atrophic gastritis and pernicious anemia, and in some patients granulomas (granulomatous gastritis), may also be associated with H pylori infection. Greater awareness of the spectrum of diseases associated with H pylori may well lead to their increased recognition in the pediatric population. Some diseases, particularly Crohn's disease, but also human immunodeficiency virus infection, have a negative association with H pylori that appears not to be simply a result of the excess antibiotic therapy that these patients receive. These variations in association and reactions to H pylori, some of which are age-related, may allow the different host responses to H pylori that occur in humans to be examined.
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PMID:Pathobiology of Helicobacter pylori infection in children. 1051 59

Repeated sessions of unilateral extracorporeal shock wave lithotripsy (ESWL) were performed in a patient with multiple bilateral calycolithiasis who suffered from Crohn's disease of long duration and from recurrent gastric ulcers. To achieve complete clearance of stones from the left kidney it was necessary to apply 10,000 shock waves during seven sessions within five weeks. This number is exceedingly high compared to average total doses which were applied to other patients of our group (920 SW per one session). For the treatment was used an electrohydraulic lithotripter (Medipo). A surgical reconstruction of the abdominal wall which had been planned long before was made six weeks after the last ESWL session. The postoperative course was complicated by bleeding gastric ulcer of which the patient died despite an intensive treatment. The autopsy and histology revealed no damage of kidney tissue or adjacent organs caused by ESWL.
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PMID:An absence of changes in kidney tissues after an enormous number of shock waves. 1183 Sep 15

Dyspepsia is a common clinical problem. Its causes include peptic ulcer disease, gastroesophageal reflux, and functional (nonulcer) dyspepsia. A detailed clinical description of pain does not reliably differentiate the cause. Approximately 80% of gastroscopies are performed for the investigation of dyspepsia. "Gastritis" is diagnosed endoscopically in 59% of all stomachs, although in only 3% are the changes severe. Pathologic examination of unselected gastric biopsy specimens reveals that abnormalities are present in 62-73%, but there is only a weak correlation between endoscopic and histologic findings. For these reasons, it is recommended that endoscopic examination should always be accompanied by biopsy. Ideally, biopsies should be taken in a systematic fashion to include sampling of antrum and corpus. Recent evidence suggests that gastric infection by Helicobacter pylori initially presents as a superficial gastritis. Later it may become atrophic with development of intestinal metaplasia. The onset of atrophic changes may be related to the duration of infection, the strain of the infecting organism, associated dietary factors, or as-yet undefined host factors related to immunity. Persistent superficial gastritis predisposes to duodenal ulcer and gastric mucosa-associated lymphoid tissue lymphoma. Atrophic gastritis predisposes to gastric ulcer and adenocarcinoma. Evidence is accumulating that in some patients, pernicious anemia may be an end result of H. pylori-induced atrophic gastritis. Reactive gastropathy is a relatively common finding in gastric biopsies; in most instances it is associated with either reflux of duodenal contents or therapy with nonsteroidal anti-inflammatory drugs. Lymphocytic gastritis, eosinophilic gastritis, and the gastritis associated with Crohn's disease are distinct morphologic entities. Lymphocytic gastritis and eosinophilic gastritis have a variety of clinical associations. Carditis is a controversial topic: currently opinions are divided as to whether it is the result of gastroesophageal reflux or a proximal extension of H. pylori infection from the remainder of the stomach.
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PMID:Gastritis and carditis. 1269 98


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