Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review

BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or clearly show the structure of a hernial sac(HS)and thereby diminishing diagnostic performance for esophageal hiatal hernia(EHH).Contrast-enhanced ultrasound(CEUS)imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.CASE SUMMARY In this case series,we report three patients with clinically-suspected EHH,including two females and one male with an average age of 67.3±16.4 years.CEUS was administered with an oral agent mixture(microbubble-based SonoVue and gastrointestinal contrast agent)and identified a direct sign of supradiaphragmatic HS(containing the hyperechoic agent)and indirect signs[e.g.,widening of esophageal hiatus,hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS,and esophagus-gastric echo ring(i.e.,the“EG”ring)seen above the diaphragm].All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy.Two lesions resolved upon drug treatment and one required surgery.The recurrence rate in follow-up was 0%.The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.CONCLUSION CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.

Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding. During 2005 and 2010, inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed. There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range: 11-86 years). Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD. Their mean hemoglobin level dropped from 12 ± 1.3 g/ dL to 8.7 ± 1.3 g/dL in a 3-d period. Median packed red blood cells units needed for resuscitation was 4 units. Because of uncontrolled bleeding, surgical resection was considered. However, due to the poor surgical candidacy of these patients (n = 3) and /or possible development of short bowel syndrome (n = 6), surgery was not pursued. Likewise angiographic embolization was not considered in any due to the risk of large infarction. All severe GIBs successfully stopped by one or two doses of intravenous infliximab. Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

Lansoprazole ameliorates intestinal mucosal damage induced by ischemia-reperfusion in rats

AIM: To investigate the protective effect of lansoprazoleon ischemia and reperfusion (I/R)-induced rat intestinalmucosal injury in vivo.METHODS: Intestinal damage was induced by clampingboth the superior mesenteric artery and the celiac trunkfor 30 rain followed by reperfusion in male Sprague-Dawleyrats. lansoprazole was given to rats intraperitoneally 1 hbefore vascular clamping.RESULTS: Both the intraluminal hemoglobin and proteinlevels, as indices of mucosal damage, significantlyincreased in I/R-groups comparion with those of sham-operation groups. These increases in intraluminal hemoglobinand protein levels were significantly inhibited by the treatmentwith lansoprazole at a dose of 1 mg/kg. Small intestineexposed to I/R resulted in mucosal inflammation that wascharacterized by significant increases in thiobarbituric acid-reactive substances (TBARS), tissue-associatedmyeloperoxidase activity (MPO), and mucosal content of ratcytokine-induced neutrophil chemoattractant-1 (CINC-1).These increases in TBARS, MPO activities and CINC-1 contentin the intestinal mucosa after I/R were all inhibited bypretreatment with lansoprazole at a dose of 1 mg/kg.Furthermore, the CINC-1 mRNA expression was increasedduring intestinal I/R, and this increase in mRNA expressionwas inhibited by treatment with lansoprazole.CONCLUSION: Lansoprazole inhibits lipid peroxidation andreduces development of intestinal mucosal inflammationinduced by I/R in rats, suggesting that lansoprazole mayhave a therapeutic potential for I/R injury.

Ethanol inhibits the motility of rabbit sphincter of Oddi in vitro

AIM:The rote of the sphincter of Oddi(SO)in ethanol (ETOH)-induced pancreatitis is controversial.Our aim was to characterise the effect of E-I-OH on basal and stimulated SO motility. METHODS:SOs removed from white rabbits were placed in an organ bath(Krebs solution,pH7.4,37℃).The effects of 2 mL/L,4 mL/L,6 mL/L and 8 mL/L of ETOH on the contractile responses of the sphincter were determined. SOs were stimulated with either 0.1 μmol/L carbachol,1 μmol/L erythromycin or 0.1 μmol/L cholecystokinin(CCK). RESULTS:ETOH at a dose of 4 mL/L significantly decreased the baseline contractile amplitude from 11.98±0.05 mN to 11.19±0.07 mN.However,no significant changes in the contractile frequency were observed.ETOH(0.6%) significantly decreased both the baseline amplitude and the frequency compared to the control group(10.50±0.01 mN, 12.13±0.10 mN and 3.53±0.13 c/min,5.5±0.13 cycles(c)/min, respectively).Moreover,0.8% of ETOH resulted in complete relaxation of the SO.Carbachol(0.1 μmol/L)or erythromycin (1 μmol/L)stimulated the baseline amplitudes(by 82% and 75%,respectively)and the contractile frequencies (by 150% and 106%,respectively).In the carbachol or erythromydn-stimulated groups 2-6 mL/L of E-IOH significantly inhibited both the amplitude and the frequency.Interestingly, a 4-5 min administration of 6 mL/L ETOH suddenly and completely relaxed the SO.CCK(0.1 μmol/L)stimulated the baseline amplitude from 12.37±0.05 mN to 27.40±1.82 mN within 1.60±0.24 min.After this peak,the amplitude decreased to 17.17±0.22 mN and remained constant during the experiment.The frequency peaked at 12.8±0.2 c/min, after which the constant frequency was 9.43±0.24 c/min throughout the rest of the experiment.ETOH at a dose of 4 mL/L significantly decreased the amplitude from 16.13±0.23 mN to 14.93±0.19 mN.However,no significant changes in the contractile frequency were observed.ETOH at a dose of 6 mL/L inhibited both the amplitudes and the frequencies in the CCK-stimulated group,while 8 mL/L of ETOH completely relaxed the SO. CONCLUSION:ETOH strongly inhibits the basal,carbachol, erythromycin,and CCK-stimulated rabbit SO motility. Therefore,it is possible that during alcohol-intake the relaxed SO opens the way for pancreatic fluid to flow out into the duodenum in rabbits.This relaxation of the SO may protect the pancreas against alcohol-induced damage.

OBSERVATION ON FREQUENCY SPECTRUM OF ELECTROGASTROGRAM (EGG) IN ACUPUNCTURE TREATMENT OF FUNCTIONAL DYSPEPSIA

Functional dyspepsia is a frequently-encountered clinical syndrome, characterized by fullness and pain in the upper abdomen, belching, sour regurgitation, anorexia, nausea, vomiting, without organic pathologic change, metabolic or psychic diseases. It is closely related with disturbance of gastric motility. Our previous study has indicated that acupuncture has marked therapeutic effects on disturbance of gastric motility. In the present paper, analysis of time-frequency spectrum of EGG was used as indexes, and the clinical therapeutic effects of acupuncture treatment on functional dyspepsia were assessed objectively. The results are reported in the following.