AIM: To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis.METHODS: A total of 49 patients diagnosed with dyspepsia and chronic gastritis u...AIM: To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis.METHODS: A total of 49 patients diagnosed with dyspepsia and chronic gastritis underwent 24-h ambulatory andsimultaneous monitoring of intragastric bilirubin absorbance and pH values, and then they were divided into bile refluxpositive group and bile reflux negative group. Severity of pathological changes in gastric mucosa including activeinflammation, chronic inflammation, intestinal metaplasia, atrophy and dysplasia as well as Helicobacter pylori (H pylori) infection at the corpus, incisura and antrum were determined respectively according to update Sydney system criteria. The profiles of gastric mucosal lesions in the two groups were compared, and correlations between time-percentage of gastric bilirubin absorbance ＞0.14 and severity of gastric mucosal lesions as well as time-percentage of gastric pH ＞4 were analyzed respectively. RESULTS: Thirty-eight patients (21 men and 17 women, mean age 44.2 years, range 25-61 years) were found existing with bile reflux (gastric bilirubin absorbance ＞0.14) and 11 patients (7 men and 4 women, mean age 46.2 years,range 29-54 years) were bile reflux negative. In dyspepsia patients with bile reflux, the mucosal lesions such as active inflammation, chronic inflammation, intestinal metaplasia, atrophy or H pylori infection in the whole stomach, especially in the corpus and incisura, were significantly more severe than those in dyspepsia patients without bile reflux. Moreover, the bile reflux time was well correlated with the severity of pathological changes of gastric mucosa as well as H pylori colonization in the near-end stomach, especially in the corpus region. No relevance was found between the time of bile reflux and pH ＞4 in gastric cavity. CONCLUSION: Bile reflux contributes a lot to mucosal lesions in the whole stomach, may facilitate H pylori colonization in the corpus region, and has no influence on acid-exposing status of gastric mucosa in patients with dyspepsia or chronic gastritis.展开更多
[Objectives]The purpose was to study the clinical efficacy and safety of Banxia Xiexin decoction in treating bile reflux gastritis(BRG).[Methods]Randomized controlled trial was adopted to conduct scientific and standa...[Objectives]The purpose was to study the clinical efficacy and safety of Banxia Xiexin decoction in treating bile reflux gastritis(BRG).[Methods]Randomized controlled trial was adopted to conduct scientific and standardized assessment on the risk of bias in the included articles.With overall effect and epigastric pain relief as indices,meta-analysis was performed,and sensitivity and safety analysis was conducted on the included literature.[Results]A total of 13 articles were included,involving a total of 1478 patients.The results of meta-analysis show that the efficacy of Banxia Xiexin decoction alone and Banxia Xiexin decoction-Western medicine combination is better than that of Western medicine alone.[Conclusions]Banxia Xiexin decoction is safe and effective in treating bile reflux gastritis.However,as the 13 articles included are all low in quality and there is a certain degree of publication bias,the objectivity of the results is affected to some extent.展开更多
AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gast...AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and Billroth II group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with Billroth II reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.展开更多
The long-term use of proton pump inhibitors(PPIs)exacerbates corpus atrophic gastritis in patients with Helicobacter pylori(H.pylori)infection.To identify a potential mechanism for this change,we discuss interactions ...The long-term use of proton pump inhibitors(PPIs)exacerbates corpus atrophic gastritis in patients with Helicobacter pylori(H.pylori)infection.To identify a potential mechanism for this change,we discuss interactions between pH,bile acids,and H.pylori.Duodenogastric reflux,which includes bile,occurs in healthy individuals,and bile reflux is increased in patients with gastroesophageal reflux disease(GERD).Diluted human plasma and bile acids have been found to be significant chemoattractants and chemorepellents,respectively,for the bacillus H.pylori.Although only taurine conjugates,with a pKa of 1.8-1.9,are soluble in an acidic environment,glycine conjugates,with a pKa of 4.3-5.2,as well as taurine-conjugated bile acids are soluble in the presence of PPI therapy.Thus,the soluble bile acid concentrations in the gastric contents of patients with GERD after continuous PPI therapy are considerably higher than that in those with intact acid production.In the distal stomach,the high concentration of soluble bile acids is likely to act as a bactericide or chemorepellent for H.pylori.In contrast,the mucous layer in the proximal stomach has an optimal bile concentration that forms chemotactic gradients with plasma components required to direct H.pylori to the epithelial surface.H.pylori may then colonize in the stomach body rather than in the pyloric antrum,which may explain the occurrence of corpus-predominant gastritis after PPI therapy in H.pylori-positive patients with GERD.展开更多
BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infection of the gastric submucosa and is related to septicemia,direct gastric mucosal injury,or the direct influence of infection or inflammation in neighboring...BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infection of the gastric submucosa and is related to septicemia,direct gastric mucosal injury,or the direct influence of infection or inflammation in neighboring organs.Here,we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage.CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d.Physical examination showed stable vital signs,icteric sclera,diffuse abdominal tenderness,and muscle guarding.Laboratory tests showed hyperbilirubinemia and bandemia.Contrast computed tomography(CT)of the abdomen showed a dilated common bile duct and left subphrenic abscess.Left subphrenic abscess drainage revealed bilious fluid,and infected biloma was confirmed.Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening.Esophagogastroduodenoscopy(EGD)showed an edematous,hyperemic gastric mucosa with poor distensibility.The gastric mucosal culture yielded Enterococcus faecalis.PG was diagnosed based on imaging,EGD findings,and gastric mucosal culture.The patient recovered successfully with antibiotic treatment.CONCLUSION PG should be considered in patients with intraabdominal infection,especially from infected organs adjacent to the stomach.展开更多
目的系统评价根除幽门螺杆菌(Helicobacter pylori,H.pylori)对治疗H.pylori(+)的胆汁反流性胃炎患者的影响。方法检索中国知网、维普中文期刊数据库、万方数字化期刊全文数据库、PubMed、Web of Science、Cochrane Library数据库,收集...目的系统评价根除幽门螺杆菌(Helicobacter pylori,H.pylori)对治疗H.pylori(+)的胆汁反流性胃炎患者的影响。方法检索中国知网、维普中文期刊数据库、万方数字化期刊全文数据库、PubMed、Web of Science、Cochrane Library数据库,收集进行H.pylori根除治疗的胆汁反流性胃炎的随机对照试验,检索时限为建库至2023年8月。共纳入6篇文献,并对其进行数据提取和改良Jadad量表质量评价。采用RevMan 5.4.1软件对纳入文献的总有效率、H.pylori根除率、症状评分进行Meta系统评价。结果纳入的6篇文献均为高质量文献。H.pylori根除组在总有效率(MD=1.49,95%CI:1.30~1.72,Z=5.53,P<0.00001)和H.pylori根除率方面(MD=3.83,95%CI:2.33~6.29,Z=5.31,P<0.00001)均优于未根除H.pylori组,腹痛评分(MD=-0.64,95%CI:-1.30~0.02,Z=1.91,P=0.06)和腹胀评分(MD=-0.11,95%CI:-0.45~0.23,Z=0.63,P=0.53)方面差异均无统计学意义。结论对于H.pylori(+)的胆汁反流性胃炎患者的治疗,根除H.pylori治疗可以提高其治疗总有效率、H.pylori根除率,但在缓解腹痛、腹胀症状上无显著意义。展开更多
基金Supported by the Digestive Key Laboratory Opening Foundation of Ministry of Public Health, No. WKL200004
文摘AIM: To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis.METHODS: A total of 49 patients diagnosed with dyspepsia and chronic gastritis underwent 24-h ambulatory andsimultaneous monitoring of intragastric bilirubin absorbance and pH values, and then they were divided into bile refluxpositive group and bile reflux negative group. Severity of pathological changes in gastric mucosa including activeinflammation, chronic inflammation, intestinal metaplasia, atrophy and dysplasia as well as Helicobacter pylori (H pylori) infection at the corpus, incisura and antrum were determined respectively according to update Sydney system criteria. The profiles of gastric mucosal lesions in the two groups were compared, and correlations between time-percentage of gastric bilirubin absorbance ＞0.14 and severity of gastric mucosal lesions as well as time-percentage of gastric pH ＞4 were analyzed respectively. RESULTS: Thirty-eight patients (21 men and 17 women, mean age 44.2 years, range 25-61 years) were found existing with bile reflux (gastric bilirubin absorbance ＞0.14) and 11 patients (7 men and 4 women, mean age 46.2 years,range 29-54 years) were bile reflux negative. In dyspepsia patients with bile reflux, the mucosal lesions such as active inflammation, chronic inflammation, intestinal metaplasia, atrophy or H pylori infection in the whole stomach, especially in the corpus and incisura, were significantly more severe than those in dyspepsia patients without bile reflux. Moreover, the bile reflux time was well correlated with the severity of pathological changes of gastric mucosa as well as H pylori colonization in the near-end stomach, especially in the corpus region. No relevance was found between the time of bile reflux and pH ＞4 in gastric cavity. CONCLUSION: Bile reflux contributes a lot to mucosal lesions in the whole stomach, may facilitate H pylori colonization in the corpus region, and has no influence on acid-exposing status of gastric mucosa in patients with dyspepsia or chronic gastritis.
文摘[Objectives]The purpose was to study the clinical efficacy and safety of Banxia Xiexin decoction in treating bile reflux gastritis(BRG).[Methods]Randomized controlled trial was adopted to conduct scientific and standardized assessment on the risk of bias in the included articles.With overall effect and epigastric pain relief as indices,meta-analysis was performed,and sensitivity and safety analysis was conducted on the included literature.[Results]A total of 13 articles were included,involving a total of 1478 patients.The results of meta-analysis show that the efficacy of Banxia Xiexin decoction alone and Banxia Xiexin decoction-Western medicine combination is better than that of Western medicine alone.[Conclusions]Banxia Xiexin decoction is safe and effective in treating bile reflux gastritis.However,as the 13 articles included are all low in quality and there is a certain degree of publication bias,the objectivity of the results is affected to some extent.
文摘AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth Ⅱ reconstruction. METHODS A total of 158 patients who underwent laparoscopyassisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University(Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y(group U) and Billroth II group(group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B(7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach p H values were lower than 7 and group B p H values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis(P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION Compared with Billroth II reconstruction, uncut Rouxen-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.
文摘The long-term use of proton pump inhibitors(PPIs)exacerbates corpus atrophic gastritis in patients with Helicobacter pylori(H.pylori)infection.To identify a potential mechanism for this change,we discuss interactions between pH,bile acids,and H.pylori.Duodenogastric reflux,which includes bile,occurs in healthy individuals,and bile reflux is increased in patients with gastroesophageal reflux disease(GERD).Diluted human plasma and bile acids have been found to be significant chemoattractants and chemorepellents,respectively,for the bacillus H.pylori.Although only taurine conjugates,with a pKa of 1.8-1.9,are soluble in an acidic environment,glycine conjugates,with a pKa of 4.3-5.2,as well as taurine-conjugated bile acids are soluble in the presence of PPI therapy.Thus,the soluble bile acid concentrations in the gastric contents of patients with GERD after continuous PPI therapy are considerably higher than that in those with intact acid production.In the distal stomach,the high concentration of soluble bile acids is likely to act as a bactericide or chemorepellent for H.pylori.In contrast,the mucous layer in the proximal stomach has an optimal bile concentration that forms chemotactic gradients with plasma components required to direct H.pylori to the epithelial surface.H.pylori may then colonize in the stomach body rather than in the pyloric antrum,which may explain the occurrence of corpus-predominant gastritis after PPI therapy in H.pylori-positive patients with GERD.
文摘BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infection of the gastric submucosa and is related to septicemia,direct gastric mucosal injury,or the direct influence of infection or inflammation in neighboring organs.Here,we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage.CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d.Physical examination showed stable vital signs,icteric sclera,diffuse abdominal tenderness,and muscle guarding.Laboratory tests showed hyperbilirubinemia and bandemia.Contrast computed tomography(CT)of the abdomen showed a dilated common bile duct and left subphrenic abscess.Left subphrenic abscess drainage revealed bilious fluid,and infected biloma was confirmed.Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening.Esophagogastroduodenoscopy(EGD)showed an edematous,hyperemic gastric mucosa with poor distensibility.The gastric mucosal culture yielded Enterococcus faecalis.PG was diagnosed based on imaging,EGD findings,and gastric mucosal culture.The patient recovered successfully with antibiotic treatment.CONCLUSION PG should be considered in patients with intraabdominal infection,especially from infected organs adjacent to the stomach.
