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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among the more indicative complications encountered in gastrectomized patients, particularly in those cases where the Billroth II technique is used, bile and/or pancreatic reflux is undoubtedly one of the most important manifestations. The abolition of the "sphincteric" function of the pylorus creates a pathophysiological condition of the above-mentioned type when the surgery is not combined with specific antireflux techniques or when particular situations obtain which make alkaline reflux inevitable. These pathophysiological disorders lead to a "chronic gastritis of the stump", which often exhibits differing symptomatic pictures. There are patients in whom there is no correspondence between the anatomo-pathological and symptomatic pictures and who do not suffer at all, phereas there are others (5-35%) who complain of severe symptoms such as epigastric pain aggravated by ingestion of food, reduction in weight, nausea, bile vomiting and often haemorrhagic stillicide with consequent sideropaenic hypochromic anaemia. Taking the above-mentioned considerations as their starting point, the authors set out to investigate these complications more thoroughly in the pathology of gastrectomized patients by means of the long-term follow-up of such patients coming to them for observation after having been subjected to surgical therapy in the form of Billroth II gastric resection (gastro-enterostomy according to Balfour-Kroenlein, or according to Hofmeister-Fininsterer). The study, which is currently still in progress, involves a thorough clinical examination of the symptoms complained of as well as radiological, gastroscopic, histological and haematochemical investigations. The authors report on their preliminary results.
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PMID:[Alkaline reflux after gastric resection using the Billroth II method]. 668 Aug 88

Eighteen patients with postgastrectomy reflux gastritis were treated between 1970 and 1981 by Roux-en-Y diversion. All of the patients had a typical history of midepigastric burning pain and the majority had bilious vomiting as well. The diagnosis was confirmed by endoscopic results and histopathologic study of the gastric mucosa. Twelve surviving patients--one patient died postoperatively--experienced a dramatic relief of the symptoms. In five patients, gastrointestinal tract complaints reappeared but did not have the typical character of reflux gastritis. The macroscopically apparent gastritis subsided completely after revisional operations; while the histologic signs and symptoms of chronic gastritis remained. The Roux-en-Y diversion for patients with post-gastrectomy reflux gastritis proved to be a safe and relatively simple procedure with a high chance of relieving the complaints of the patient. The preoperative and postoperative gastric mucosal biopsies were not of much use in confirming the diagnosis or substantiation of the beneficial effect of the remedial operation.
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PMID:The surgical treatment of postgastrectomy reflux gastritis. 671 Feb 93

Two cases with intractable vomiting due to gastroparesis, a rare feature of diabetic autonomic neuropathy, are described. Both required surgical treatment. In the first a gastroenterostomy was complicated by reflux gastritis requiring a revision operation; in the second a gastrojejunostomy was successful. Electron microscopic studies of the vagus nerve in one of the cases showed a severe reduction in the density of unmyelinated axons, the surviving axons tending to be of small calibre. The severity of the abnormalities supports the view that diabetic gastroparesis is related to vagal denervation.
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PMID:Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology. 674 45

The results of antrectomy performed for recurrent peptic ulceration after vagotomy and drainage are frequently marred by bilious vomiting. Consequently, there has been interest in combining antrectomy with Roux-en-Y drainage to prevent this complication. The experience of one surgeon in revisional gastric surgery has been studied retrospectively. Thirty-six patients have been reviewed in detail, 24 of whom had a combined antrectomy and Roux-en-Y anastomosis: 16 for recurrent peptic ulceration, 2 for non-ulcer dyspepsia and 6 for bile reflux gastritis. None of these has required reoperation, and 12 of the 16 with recurrent ulcers have had a good result. Four of 12 who underwent antrectomy alone subsequently required biliary diversion. Combining antrectomy with a Roux-en-Y anastomosis prevents postoperative bile reflux gastritis and thereby the need for further revision on this account. The results of this approach compare well with those of other procedures used in the treatment of recurrent peptic ulceration.
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PMID:Combined antrectomy and Roux-en-Y anastomosis in the surgical treatment of recurrent peptic ulceration. 681 80

Total fundoplication gastroplasty was designed to combine the low anatomic recurrence rate of gastroplasty with the effectiveness of reflux control obtained by total wrap. The problems requiring evaluation are anatomic recurrence, continued reflux, dysphagia, inability to belch or vomit, and gas bloat, all of which have been described in procedures employing a total wrap. Five hundred consecutive patients were analyzed 6 to 60 months following operation. There were no deaths and a 3.6% incidence of short-term operative morbidity. Follow-up was available clinically in 98.4% (495 patients), radiologically in 89.6% (448), and manometrically in 69.5% (347). Two patients have anatomic recurrence (0.4%) and none has reflux. Excellent results occurred in 93.4% (467), improvement in 5% (25), and poor results in 1.6% (eight). Repeat operation was necessary in 0.4% (two) for recurrence and in 0.8% (four) for severe dysphagia. The other problems were minor dysphagia in 2.2% (11), gastritis in 1.2% (six), late cholelithiasis in 0.4% (two), and continued pain with poor results in 0.4% (two). The length of the gastroplasty tube and the subdiaphragmatic position of the high-pressure zone (HPZ) did not affect the result of the operation. A long tube and unwrapped supradiaphragmatic HPZ was present in 18.8% (94); none had reflux or major dysphagia. Total length of the gastroplasty wrap was 3 to 4 cm in the first 200 and the incidence of major dysphagia was 5% (10). Reducing the length of fundoplication to 1.5 to 2 cm reduced the incidence of dysphagia to 1.7% (five). Other problems of gastritis and difficulty with belching and vomiting occurred in a random fashion. This procedure is effective in reflux control, prevents anatomic recurrence and, if the completed fundoplication is maintained at 1.5 to 2 cm, yields a low incidence of significant dysphagia.
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PMID:Total fundoplication gastroplasty. Long-term follow-up in 500 patients. 684 90

Reported is the case of a 23-year-old man who ingested 300 mL of Reglone. He developed vomiting five to 10 minutes after ingestion. Shortly thereafter, he developed renal and central nervous system manifestations of toxicity, followed by cardiovascular collapse and death 14 hours after admission. Autopsy findings revealed esophagitis, tracheitis, gastritis, and ileitis. Prompt, aggressive therapy that included fluid replacement and removal of the toxin was unsuccessful.
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PMID:Diquat intoxication. 685 38

Billroth II resection was carried out in 1000 duodenal ulcer patients in the period 1948-1956. Twenty-two to thirty years later, gastroscopy and biopsy was performed in 196 of 423 survivors. Chronic atrophic gastritis appeared in 93 per cent of the cases, 47 per cent showed slight and 46 per cent severe changes. Seven per cent had normal mucosa. The microscopic grade of gastritis proved to be independent of age, alcohol and tobacco consumption and serum gastrin. No correlation between clinical status, such as dumping, diarrhoea, vomiting and pain, haematological parameters and the microscopic grade of gastritis, could be found. It is suggested that gastritis might be caused by reflux of bile, pancreatic and intestinal juices, and that postgastrectomy symptoms and anaemia do not depend on the microscopic grade of gastritis.
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PMID:Causes and clinical significance of gastritis following Billroth II resection for duodenal ulcer. 686 Sep 6

Although bile reflux into the stomach has been a subject of major interest during the last 15 years, its role in gastric pathology is not fully understood. The simple technique of sampling gastric contents and measuring bile acids is probably the most useful and reliable method available. Whether the reflux always precedes ulceration or is caused in some way by the gastritis remains unresolved, for bile reflux is common in many clinical situations where gastritis is present. After gastric surgery bile has been blamed for the gastritis which occurs as well as symptoms of post prandial epigastric discomfort, heartburn and bile vomiting. This is probably the only clinical situation where further procedures have been examined which specifically divert bile away from the stomach with good results. Bile reflux is also very common in patients with heartburn suggesting that bile and acid are both necessary to produce oesophagitis and heartburn. This is borne out by clinical observations and experimental work in animals. With the exception of those patients who have had gastric surgery, we have little or no evidence of the consequences of bile exclusion from the stomach in other pathological situations.
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PMID:The clinical significance of bile reflux. 694

Twenty seven patients, inspected by endoscope, and diagnosed as having the Mallory-Weiss syndrome, have been studied taking into account their age, sex, background, clinic presentation, manifestations, number of lacerations, associated lesions and evolution. Twenty three of them were males and 4 females. The age average was 46.7 years. Only 8 patients had intra-abdominal increased pressure, suffering retching and vomiting 7 of them, while one had a cough access. Out of the 21 patients that we controlled, 9 were chronic alcoholism while 3 had ethanol intoxication previously. Immediate prior ingestion of salicylates had taken place in 6 patients. The clinical presentation of 22 of them was gastrointestinal bleeding, that is, 4.9% of all the upper endoscopies carried out within the bleeding patients. Single laceration was present in 22 cases, double one in 4, and triple in 1. We have frequently found endoscopy lesions associated, the most common one (37%), was hiatal hernia. They all were medically treated except one, who was operated because of gastric perforation was associated. Just one of the Mallory-Weiss syndrome patient died, due to an associated diffused bleeding gastritis.
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PMID:[Mallory-Weiss syndrome. Considerations on 27 cases]. 697 2

Fifty-six patients were treated surgically for alkaline reflux gastritis, in each a consequence of subtotal gastrectomy and vagotomy for ulcer disease. Of these, 41 available for follow-up, 18 of whom had had Henley loop jejunal interpositioning and the remaining 23 Roux-en-Y (long-loop) gastroenterostomy. The conditions of most patients improved with respect to reflux symptoms of pain, vomiting, and weight loss, but the patients with Roux-en-Y procedure had uniformly better results that did those with the Henley loop. Although the Henley loops in this series of patients may have been too short to be completely effective in preventing bile reflux into the stomach, we prefer the Roux-en-Y diversion because it is technically easier and safer.
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PMID:Surgical management of alkaline reflux gastritis. 707 91


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