H pylori infection and reflux oesophagitis: A case-control study

AIM： To examine the relationship between Hpylori and gastro-oesophageal reflux disease （GORD） in Iran. METHODS： In this study 51 GORD patients （referred to endoscopy at Taleghani hospital） were compared with 49 age-sex matched controls. Diagnosis of H pylori was made by gastric mucosal biopsy and rapid urease test （positive if the result of one or both diagnostic methods was positive）. Updated Sydney system was used to report histopathological changes. RESULTS： The frequency of H pylori infection based on rapid urease test and histology was 88.2% （45） in patients and 77.6% （38） in controls, which showed no significant difference. The frequency of H pylori infection was significantly higher in the antrum than in the corpus and cardia. The mean activity, inflammation, and gastritis scores were also higher in the antrum of patients than in the antrum of controls. The mean scores were significantly higher in the corpus of controls than in the corpus of patients. Diffuse active gastritis was observed in a significantly larger number of controls, while the frequency of diffuse chronic gastritis was higher in patients. There in the frequency of other patients and controls. was no significant difference histological findings between.CONCLUSION： H pylori infection cannot prevent GORD in this region.

Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.