Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?

AIM:To investigate the necessity and correctness of acid suppression pre-and post-gastrectomy among gastric carcinoma(GC)patients.METHODS:From June 2011 to April 2013,99 patients who were diagnosed with GC or adenocarcinoma of the gastroesophageal junction(typeⅡorⅢ)and needed surgical management were enrolled.They all underwent gastrectomy by the same operators[35undergoing total gastrectomy(TG)plus Roux-en-Y reconstruction,34 distal gastrectomy(DG)plus Billroth I reconstruction,and 30 proximal gastrectomy(PG)plus gastroesophagostomy].We collected and analyzed their gastrointestinal juice and tissues from the preoperational day to the 5th day post-operation,and 6 mo post-surgery.Gastric pH was detected with a precise acidity meter.Gastric juice contents including potassi-um,sodium and bicarbonate ions,urea nitrogen,direct and indirect bilirubin,and bile acid were detected using Automatic Biochemical Analyzer.Data regarding tumor size,histological type,tumor penetration and tumornode-metastasis(TNM)stage were obtained from the pathological records.Reflux symptoms pre-and 6 mo post-gastrectomy were evaluated by reflux disease questionnaire(RDQ)and gastroesophageal reflux disease questionnaire(GERD-Q).SPSS 16.0 was applied to analyze the data.RESULTS:Before surgery,gastric pH was higher than the threshold of hypoacidity(4.25±1.45 vs 3.5,P=0.000),and significantly affected by age,tumor size and differentiation grade,and potassium and bicarbonate ions;advanced malignancies were accompanied with higher pH compared with early ones(4.49±1.31vs 3.66±1.61,P=0.008).After operation,gastric pH in all groups was of weak-acidity and significantly higher than that pre-gastrectomy;on days 3-5,comparisons of gastric pH were similar between the 3 groups.Six months later,gastric pH was comparable to that on days 3-5;older patients were accompanied with higher total bilirubin level,indicating more serious reflux(r=0.238,P=0.018);the TG and PG groups had higher RDQ(TG vs DG:15.80±5.06 vs 12.26±2.14,P=0.000;PG vs DG:15.37±3.49 vs 12.26±2.14,P=0.000)and GERD-Q scores(TG vs DG:10.54±3.16 vs9.15±2.27,P=0.039;PG vs DG:11.00±2.07 vs 9.15±2.27,P=0.001)compared with the DG group;all gastric juice contents except potassium ion significantly rose;reflux symptom was significantly associated with patient’s body mass index,direct and indirect bilirubin,and total bile acid,while pH played no role.CONCLUSION:Acidity is not an important factor causing unfitness among GC patients.There is no need to further alkalify gastrointestinal juice both pre-and postgastrectomy.

Helicobacter pylori infection, gastrin and cyclooxygenase-2 in gastric carcinogenesis

Gastric cancer is one of the most frequent neoplasms and a main cause of death worldwide, especially in China and Japan. Numerous epidemiological, animal and experimental studies support a positive association between chronic Helicobacter pylori(H. pylori) infection and the development of gastric cancer. However, the exact mechanism whereby H. pylori causes gastric carcinogenesis remains unclear. It has been demonstrated that expression of cyclooxygenase-2(COX-2) is elevated in gastric carcinomas and in their precursor lesions. In this review, we present the latest clinical and experimental evidence showing the role of gastrin and COX-2 in H. pylori-infected patients and their possible association with gastric cancer risk.

Gastroenteric tube feeding: Techniques, problems and solutions

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despite the benefits and widespread use of enteral tube feeding,some patients experience complications.This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special aspects.We conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding syndrome.The literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,hyperglycemia.Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most common.Complications associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.

Laparoscopy-assisted distal gastrectomy for advanced gastric cancer with situs inversus totalis:A case report

Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are located opposite to their usual positions. Occasionally,patients with this condition are diagnosed with malignant tumors. We report a case of a 60-yearold woman with gastric cancer and SIT. Laparoscopyassisted distal gastrectomy(LADG) with D2 lymph node dissection and Billroth Ⅱ anastomosis were performed successfully on the patient by careful consideration of the mirror-image anatomy. The operation required 230 min, and no intraoperative complications occurred. The final pathological report was p T4 a N0M0,according to the American Joint Committee on Cancer 7th edition staging guidelines. The postoperative course was favorable, and the patient was discharged on postoperative day 8. We believe that this is the first case of LADG with D2 lymphadenectomy reported in a SIT patient with advanced gastric cancer.

Frequency of HER2/neu overexpression in adenocarcinoma of the gastrointestinal system

AIM:To determine the frequency of HER2/neu protein overexpression in gastric(group A),small intestine(group B),and colorectal(group C)adenocarcinoma.METHODS:A descriptive,cross-sectional study was performed on 50 cases of gastrointestinal adenocarcinoma(stomach,small intestine,and colorectal);11from group A,8 from group B,and 31 from group C.The samples were grossed and processed in the pathology department,and sections were stained with HE(hematoxylin and eosin stain)for histopathological confirmation of malignancy(well-differentiated,moderately-differentiated,and poorly-differentiated).The confirmed samples were processed for immunomarker study of HER2/neu.RESULTS:HER2/neu protein overexpression was found in 33(66%)patients overall(P=0.000).Out of 33HER2/neu positive subjects,23(69.6%)were from group C,while the remaining 10(30%)were from group A.None of the patients from group B had positive HER2/neu protein overexpression.No protein overexpression or membrane staining in<10%tumor cells was observed in 17(34%)patients,which were labeled as score"0"and considered negative for HER2/neu protein overexpression.Faint/weak staining(in≥10%of tumors cells)were observed in 8(16%)patients and given the"1+"score.Similarly 13(26%)patients reported moderate staining(in≥10%tumor cells)and were thus labeled as"2+",and strong staining(in≥10%tumors cells),labeled as"3+",was observed in 12(24%)patients.Out of 50 patients,26(52%)were suffering from grade-Ⅱmalignancy,16(32%)from grade-Ⅰ,and 8(16%)from grade-Ⅲ.There was highly significant association between tumor grades and HER2/neu protein overexpression(P=0.0000).CONCLUSION:HER2/neu protein is credibly overexpressed in colon and gastric adenocarcinomas in immunohistochemistry.There is significant association between grade of tumor and HER2/neu protein overexpression.

足三里穴位注射治疗胃大部分切除术后胃功能性排空障碍的临床效果

目的观察足三里穴位注射治疗胃大部分切除术后胃功能性排空障碍的临床效果。方法选取2021年12月至2022年5月南昌市第三医院的60例胃大部分切除术后胃功能性排空障碍患者作为研究对象,采用随机数字表法将其分为注射组和常规组,每组各30例。常规组患者进行常规保守治疗,注射组患者在常规组基础上采用足三里穴位注射治疗。比较两组患者的临床疗效、胃排空功能恢复时间、胃肠减压量、腹痛和腹胀发生情况。结果注射组患者的治疗总有效率高于常规组,差异有统计学意义(P<0.05)。注射组患者的肠鸣音恢复时间、饮食恢复时间均短于常规组,胃肠减压量多于常规组,差异有统计学意义(P<0.05)。治疗前,两组患者的腹痛和腹胀发生率比较,差异无统计学意义(P>0.05);治疗后,两组患者的腹痛、腹胀发生率低于治疗前,且注射组患者的腹痛、腹胀发生率低于常规组,差异有统计学意义(P<0.05)。结论足三里穴位注射治疗胃大部分切除术后胃功能性排空障碍患者的临床效果较佳,可有效缩短胃排空功能恢复时间,加大胃肠减压量,减少腹痛、腹胀发生情况。

全国名中医凌湘力教授运用“和衡”法辨治胃癌的经验

凌湘力教授是全国名中医,第四批、第五批、第六批全国老中医药专家学术经验继承工作指导老师,博士生导师,首批中医师承博士后合作导师,贵州省首届名中医。凌老治疗胃癌时谨守正虚邪盛之病因病机,辨证施治,采用“和衡”之法,以脾胃为要,或健脾养胃,或疏肝和胃,或滋阴健脾,或调和气血,或平调寒热,多法合用,共奏脏腑、气血、阴阳、寒热调和,机体平衡之功。

以胃息肉为表现的神经内分泌肿瘤的临床特点分析

目的:分析22例以胃单发或者多发息肉为表现的胃神经内分泌肿瘤的临床特征,避免临床对胃神经内分泌肿瘤的漏诊。方法:搜集2016年9月至2021年3月在南充市中心医院胃镜室行胃镜检查并经最终病理结果证实为胃神经内分泌肿瘤患者的临床资料,分析其性别、年龄、肿瘤发生部位、息肉多发单发情况、肿瘤浸润深度、肿瘤分级,于白光胃镜下、窄带成像放大胃镜下(ME+NBI)观察病变的临床特点。结果:经病理证实的22例胃神经内分泌肿瘤患者的具体情况如下:性别:女性16例,男性6例;年龄:位于45~70岁之间,中位年龄50.05岁;病灶部位:贲门2例、胃底5例、胃体15例;以胃息肉多发为表现者15例,以胃息肉单发为表现者7例;病灶大小在0.5~0.8 cm之间,肿瘤浸润深度以黏膜层为主,分级为G1级。在白光胃镜下大多表现为顶部糜烂、粗糙;NBI+ME表现为微结构增粗、形态不规则,微血管多变粗、形态不规则。结论:在临床胃镜检查过程中,需要警惕以胃息肉为表现的肿瘤可能是胃神经内分泌肿瘤。

慢性萎缩性胃炎患者血清生长激素水平的研究

目的 探讨生长激素 (GH)在慢性萎缩性胃炎 (ChronicatrophicgastritisCAG)中的表达及临床意义。方法 3 1例CAG和 3 1例正常对照者采用年龄配对分组分成三对六组 ,采用化学荧光免疫方法测定血清GH水平。CAG患者经胃镜、病理和免疫组化 (HIDABPAS)检测萎缩及肠化生程度。采用非参数方法统计处理分析。结果 CAG患者血清GH水平中位数为 0 0 7ng/ml,而“正常”对照组为 0 .3 7ng/ml,CAG血清GH平均水平较“正常”对照组明显下降 (P <0 0 1)。在青年人CAG的血清GH平均水平为0 0 65ng/ml,而在“正常”青年对照组则为 0 2 55ng/ml,中年组则分别为 0 0 7ng/ml和 0 460ng/ml,经统计两者P值分别是 0 0 2和0 0 1。老年组血清GH平均水平在CAG为 0 0 95ng/ml,对照组则为 0 3 60ng/ml,P =0 0 52。不同萎缩程度血清GH平均水平随着萎缩程度加重而GH水平下降。不同程度肠化血清GH平均水平 ,也有随着肠化加重而逐渐下降的趋势 ,但二者P值分别为 0 55和0 0 78。结论 CAG患者存在着血清GH水平低下 。

腹部闭合性损伤致胃肠道破裂的平扫CT诊断

目的 探讨平扫CT在诊断腹部闭合性损伤致胃肠道破裂中的作用。方法 对我院收治的 2 0例手术证实为外伤性胃肠道破裂患者的CT片及其病史行回顾性分析。至少两位以上放射科医师一起阅片。结果 2 0例闭合性损伤胃肠道破裂患者行平扫CT发现腹腔积液 18例、气腹 18例、胃内容物外漏 2例、肠壁改变 14例、肠系膜改变 15例。结论 平扫CT可以准确、快速。

腹腔镜胃十二指肠穿孔修补27例体会

目的总结腹腔镜胃、十二指肠穿孔修补经验。方法对27例胃十二指肠穿孔患者施行腹腔镜修补术。结果 22例十二指肠穿孔、5例胃窦穿孔均行腹腔镜修补,平均住院5.2d,无术中及术后并发症。结论腹腔镜胃十二指肠穿孔修补术具有安全、可靠、患者恢复快和痛苦少等优点。对胃穿孔须考虑溃疡恶变或胃癌情况,术中须切取穿孔边缘组织行冰冻切片检查,以便及时发现胃癌,进行根治性治疗。

上皮钙粘附素启动区域甲基化与胃癌的相关性

目的 :研究胃癌组织中上皮钙粘附素启动子区域甲基化与胃癌组织学特征和侵袭的关系。方法 :用甲基化特异的聚合酶链反应 ( MSP)及酶切法检测 4 9例胃癌组织中钙粘附素启动区域甲基化状态并予以测序。结果 :低分化腺癌 ( Borrm an ～ 级 )甲基化发生率为 73 .7%,远高于其它病理类型癌发生率 3 3 .3 %( P<0 .0 1) ,有淋巴结转移的甲基化率为 70 .4 %,高于无淋巴结转移的甲基化率者 2 2 .7%( P<0 .0 1)。结论 :钙粘附素启动区域甲基化与胃癌组织学特征及侵袭有相关性 ,可以作为预测胃癌侵袭与转移有价值的指标。

Laryngopharyngeal reflux and Helicobacter pylori

Laryngopharyngeal reflux(LPR) occurs when gastric contents pass the upper esophageal sphincter, causing symptoms such as hoarseness, sore throat, coughing, excess throat mucus, and globus. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position whereas gastroesophageal reflux disease more often occurs in the supine position at night-time or during sleep. Ambulatory 24-h double pH-probe monitoring is the gold standard diagnostic tool for LPR. Acid suppression with proton pump inhibitor on a long-term basis is the mainstay of treatment. Helicobacter pylori(H. pylori) is found in many sites including laryngeal mucosa and interarytenoid region. In this paper, we aim to present the relationship between LPR and H. pylori and review the current literature.

HMG-CoA还原酶抑制剂对胃癌细胞增殖的影响

目的:研究3羟基3甲基戊二烯辅酶A3hydroxy3methylgutarylcoenzymeAHMGCoA还原酶抑制剂对胃癌细胞增殖的影响。方法:采用MTT比色法和流式细胞仪检测胃癌细胞的增殖活性和细胞周期。结果:辛伐他丁可明显降低MNK450胃癌细胞增殖活性、S期细胞比和细胞增殖指数,在浓度大于1μmol/L时,与对照组比较具有显著性差异(P<0.05)。0.2～100μmol/L5种浓度辛伐他丁作用72h后,胃癌细胞增殖抑制率分别为8.0%、18.0%、30.7%、42.6%和51.5%,同时加入10mmol/L甲羟戊酸则可逆转辛伐他丁的抑制作用。1～20μmol/L3种浓度辛伐他丁可阻止胃癌细胞由G1期进入S期;20μmol/L辛伐他丁作用36h后,胃癌细胞S期细胞比从32.1%下降至15.0%,加入10mmol/L甲羟戊酸则可逆转5μmol/L辛伐他丁对胃癌细胞周期的影响。而普伐他丁对胃癌细胞增殖活性无明显影响(P>0.05)。结论:脂溶性HMGCoA还原酶抑制剂辛伐他丁可抑制胃癌细胞生长增殖,提示辛伐他丁具有抗肿瘤特性。

内镜下放置钛镍记忆合金自膨式肠道支架治疗胃-空肠吻合口恶性狭窄的临床观察

对22例胃-空肠吻合口恶性狭窄患者在内镜下放置钛镍记忆合金自膨式肠道支架后,狭窄段直径明显增宽,平均增加(10.21±3.65)mm。48h后所有患者恶心、呕吐症状消失,腹胀明显减轻。进流质饮食无特殊不适,逐渐过渡到无渣饮食,进食逐日增多,体重较前增加,脱水改善。支架置入后患者平均生存期为5.8个月,并发症少,操作简单,费用少,值得推广。

Primary malignant melanoma of the esophagus:A case report

Primary malignant melanoma of the esophagus(PMME)is a malignant tumor which occurs in the melanin cells of esophageal mucosal epithelial basal layer.PMME is a rare disease with an extremely poor prognosis.PMME represents only 0.1%to 0.2%of all esophageal malignant tumors.Dysphagia,retrosternal or epigastric discomfort or pain is the most frequent symptom at presentation.Retrosternal,epigastric discomfort,melena or hematemesis are the major clinical manifestations.The tumor is often located from the middle to lower thoracic esophagus.The characteristic endoscopic finding of PMME is a polypoid lesion that is usually pigmented.Immunohistochemical examination with positive results of S100 protein,HMB45 and neuron-specific enolase allow a definitive diagnosis.PMME metastasizes via hematogenic and lymphatic pathways.Esophagectomy is believed to be an effective approach for localized PMME.Five-year survival rates of 37%or higher have been achieved recently.Herein,we report a case of an 65-year-old female admitted for progressive difficulty in swallowing for more than 4 mo.After upper gastrointestinal endoscopy and biopsy,upper gastrointestinal series and computed tomography examination,the patient accepted radical esophagectomy,and the postoperative pathologic and immunohistochemical examination showed PMME.

轻度胃肠炎伴婴幼儿良性惊厥30例临床分析

目的：探讨轻度胃肠炎伴婴幼儿良性惊厥的临床特征。方法：回顾性分析2004年1月-2012年7月本科收治的轻度胃肠炎伴婴幼儿良性惊厥患儿30例的临床资料，分析患儿的惊厥发生情况、治疗结果和临床检查结果．观察随访1年内患儿疾病复发和后遗症发生情况。结果：30例患儿中，20例（66．7％）于冬季发病，1～2岁患儿占发病总人数的比例为80．0％（24／30），大便轮状病毒检测阳性27例（90．0％）。惊厥发生后静脉注射安定．或10％灌肠后患儿病情均缓解。所有患儿随访1年，未发现疾病复发和后遗症发生、，结论：冬季是轻度胃肠炎伴婴幼儿良性惊厥发病的高发季节，1～2岁为患儿的高发年龄，轮状病毒感染是其主要病因之一。

血清CEA、CA19-9及CA72-4对胃癌的诊断价值

目的:比较癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和糖类抗原72-4(CA72-4)对胃癌的诊断价值,为正确评价三项指标的临床意义提供参考。方法:选择胃癌患者50例(胃癌组),胃息肉患者50例(胃息肉组)及体检健康者52例(正常对照组),采用电化学发光免疫分析法测定三组研究对象血清CEA、CA19-9及CA72-4水平。结果:胃癌组CEA水平(2.9 ng/mL)高于胃息肉组(1.6 ng/mL)及正常对照组(1.4 ng/mL),差异均有统计学意义(P<0.05)。胃癌组CA19-9(4.7 U/mL)及CA72-4水平(1.8 U/mL)高于正常对照组,差异均有统计学意义(P<0.05),但与胃息肉组比较,差异均无统计学意义(P>0.05)。ROC曲线分析显示CEA对胃癌的诊断效能最优,而CA19-9及CA72-4的诊断效能均不及CEA。CA19-9、CA72-4在胃息肉组和正常对照组中假阳性率较高。结论:CEA对胃癌诊断价值最高,而CA72-4和CA19-9假阳性率较高,单独检测不适合作为筛查胃癌的标志物。

ρ型空肠代胃术在全胃切除中的价值

目的探讨胃恶性肿瘤全胃切除后ρ型空肠代胃的作用和意义。方法回顾分析经病理证实的21例全胃切除后ρ型空肠代胃重建消化道的胃恶性肿瘤患者,观察总结患者术后并发症、营养状况、代胃的储存及排空功能和生存情况。结果21例患者均手术顺利,术后恢复良好,无返流性食管炎、吻合口狭窄及倾倒综合症。术后3月血红蛋白、血清蛋白稳定并恢复正常。但术后一年生存率57.5%(8/14),二年生存率28.6%(2/7)。结论ρ型空肠代胃手术安全易掌握,术后并发症低,营养状况良好值得临床运用,但对生存率的影响需进一步观察。

CagA阳性Hp感染与淋巴细胞性胃炎的关系

目的 研究CagA+ Hp感染与淋巴细胞性胃炎的关系。方法 分别计算 5 6例淋巴细胞性胃炎 ,78例健康体检者及 97例慢性浅表性胃炎患者 ,Hp感染率及CagA+ Hp感染率 ,并作组间比较。结果 CagA+ Hp感染率在淋巴细胞性胃炎患者中显著高于健康体检者及慢性浅表性胃炎患者 (P <0 .0 5 )。结论 CagA+ Hp感染与淋巴细胞性胃炎关系密切。这对此类患者行Hp根治提供了重要的证据。