1/11. Importance of duodeno-gastro-esophageal reflux in the medical outpatient practice.BACKGROUND/AIMS: The role of acid and duodeno-gastro-esophageal reflux (DGER), also termed bile reflux, in esophageal mucosal injury is controversial. Several recent developments, especially availability of the recent bilirubin monitoring device (Bilitec), have resulted in clarifications in this area. In order to better understand the role of acid and DGER in esophageal mucosal injury, we summarized the recent publications in this area. METHODOLOGY: review of published medical literature (medline) on the clinical consequence of esophageal exposure to gastric acid or DGER. RESULTS: Recent data suggest that esophageal ph monitoring and pH > 7 is a poor marker for reflux of duodenal contents into the esophagus. DGER in non-acidic environments (i.e., partial gastrectomy patients) may cause symptoms but does not cause esophageal mucosal injury. Acid and duodenal contents usually reflux into the esophagus simultaneously, and may be contributing to the development of Barrett's metaplasia and possibly adenocarcinoma. proton pump inhibitors decrease acid and DGER by reducing intragastric volume available for reflux and raising intragastric pH. The promotility agent cisapride decreases DGER by increasing LES pressure and improving gastric emptying. CONCLUSIONS: 1) The term "alkaline reflux" is a misnormer and should no longer be used in referring to reflux of duodenal contents. 2) Bilitec is the method of choice in detecting DGER and should always be used simultaneously with esophageal pH-monitoring for acid reflux. 3) DGER alone is not injurious to esophageal mucosa, but can result in significant esophageal mucosal injury when combined with acid reflux. 4) Therefore, controlling esophageal exposure to acid reflux by using proton pump inhibitors also eliminates the potentially damaging effect of DGER.- - - - - - - - - - ranking = 1keywords = bile (Clic here for more details about this article) |
2/11. risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction.BACKGROUND: A reflux of pancreatic juice into the biliary tract caused by pancreaticobiliary maljunction (PBM) has been considered important in the development of biliary tract carcinogenesis in choledochal cysts. We excised extrahepatic bile ducts in patients with choledochal cysts to terminate the reflux of pancreatic juice. We investigated whether this surgery could stop the development of the residual bile duct carcinoma. methods: Fifty-six patients with a diagnosis of PBM with choledochal dilatation underwent surgical excision of extrahepatic bile ducts. We applied a person-year method to compare the relative risks (observed number/expected number) of biliary tract carcinoma before and after surgery. RESULTS: In 3 patients, bile duct carcinoma developed in residual dilated segments 19 years 6 months, 8 years 8 months, and 2 years 5 months, respectively, after surgery. Although the relative risk in the post-surgery group was slightly decreased by surgery, it was still high compared with that of the general population. CONCLUSIONS: The incidence of bile duct carcinoma is still high, even after excision of extrahepatic bile ducts in PBM patients with choledochal dilatation. For these patients, careful long-term follow-up is necessary, especially after operations that leave the dilated bile ducts, such as cases of Todani's type IV-A.- - - - - - - - - - ranking = 2370.5055160354keywords = extrahepatic, bile duct, duct, bile (Clic here for more details about this article) |
3/11. Pyloric atresia: an attempt at anatomic pyloric sphincter reconstruction.BACKGROUND: The standard method of surgical correction of pyloric atresia is gastro-duodenostomy. The authors report a case of pyloric atresia associated with junctional epidermolysis bullosa, treated with a new technique of pyloric sphincter reconstruction by gastric and duodenal mucosa cul-de-sacs advancement and end-to-end anastomosis. methods: The patient was a premature 2,100-g baby girl. X-ray showed gastric dilatation suggesting a congenital gastric obstruction. At surgery a pyloric atresia was found, with the appearance of a well-vascularized solid cord about 1.5 cm long. By longitudinal pyloromyotomy the cul-de-sacs of gastric and duodenal mucosa were reached and then isolated in the respective gastric and duodenal sides to obtain better mobilization. The mucosal cul-de-sacs, thus mobilized, were advanced easily into the pyloric canal, opened longitudinally, and were sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed diagonally above the reconstructed pyloric neocanal. RESULTS: The postoperative course was uneventful: oral feeding was started on the 11th postoperative day. At 4 year follow-up the child was well; no gastrointestinal disorders were present, confirmed by x-ray barium meal and by HIDA technetium Tc 99m hepatic scintiscan, which excluded any bilious duodeno-gastric reflux. CONCLUSION: This technique of pyloric sphincter reconstruction allows preservation of the pyloric sphincter, whose sphincter muscular layer, although hypoplastic, is present in cases of pyloric atresia.- - - - - - - - - - ranking = 0.20760934802559keywords = obstruction (Clic here for more details about this article) |
4/11. Disappearance of the common bile duct signal caused by oral negative contrast agent on MR cholangiopancreatography.We report a case in which the signal of the common bile duct disappeared owing to reflux of oral negative contrast agent on MR cholangiopancreatography (MRCP). The patient had previously undergone endoscopic sphincterotomy; after endoscopic sphincterotomy, it is known that patients develop reflux of the duodenal contents into the bile duct. Radiologists should be aware that MRCP of patients who have the possibility of bile counterflow may be hindered by oral negative contrast agents.- - - - - - - - - - ranking = 212.10241291589keywords = bile duct, duct, bile (Clic here for more details about this article) |
5/11. Sonographic demonstration of duodenobiliary reflux with soda enhancement.cholangitis rarely occurs after sphincteroplasty if there is no biliary obstruction. We report the case of a patient who developed recurrent cholangitis despite having a patent biliary tract after sphincteroplasty. Duodenobiliary reflux was demonstrated on sonography after enhancement of the reflux flow with a novel oral contrast agent, a carbonated soda beverage. Sonography with contrast enhancement provided by soda solution may prove satisfactory to detect duodenobiliary reflux after sphincteroplasty safely, effectively, and economically.- - - - - - - - - - ranking = 0.20760934802559keywords = obstruction (Clic here for more details about this article) |
6/11. A case of pancreatic cyst containing gall sludge.A case of acquired retention cyst of the pancreas containing gall sludge was reported. gallstones or gall sludge recognized in pancreatic cysts has not been reported. Histological examination suggested that the gall sludge in the pancreatic cyst was caused by the reflux of bile into the pancreatic duct through the papilla of Vater. However, endoscopic retrograde cholangiopancreatography showed no anomalous junction of the pancreatico-biliary ductal system. crystallization of the components of bile can occur in the pancreas even in a case without anomalous junction of the pancreatico-biliary ductal system.- - - - - - - - - - ranking = 7.7076385633876keywords = duct, bile (Clic here for more details about this article) |
7/11. A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma.A 62-year-old man with progressive thickening of the gallbladder wall visited our outpatient clinic. The biliary amylase level in the common bile duct was 19,900 IU/L and that of the gallbladder was 127,000 IU/L, although endoscopic retrograde cholangiopancreatography revealed no pancreaticobiliary maljunction. histology demonstrated a moderately differentiated adenocarcinoma of the gallbladder. Pancreatobiliary reflux and associated gallbladder carcinoma were confirmed in the present case, in the absence of a pancreaticobiliary maljunction. Earlier detection of the pancreatobiliary reflux and progressive thickening of the gallbladder wall might have led to an earlier resection of the gallbladder and improved this patient's poor prognosis.- - - - - - - - - - ranking = 35.183735485982keywords = bile duct, duct, bile (Clic here for more details about this article) |
8/11. intestinal obstruction diagnosed by cholescintigraphy.Radionuclide cholescintigraphy provides useful information about the dynamics of bile flow through the liver, gallbladder, bile ducts, and intestines. Besides helping to diagnose acute cholecystitis, it may provide other meaningful information to effectively alter the patient's management. Preoperative diagnosis of intestinal obstruction was made on routine cholescintigraphy and was proved subsequently at surgery.- - - - - - - - - - ranking = 37.22178222611keywords = bile duct, duct, bile, obstruction (Clic here for more details about this article) |
9/11. Standing views to differentiate gallbladder or bile leak from duodenal activity on cholescintigrams.Confusing a gallbladder or bile leak with duodenal activity is a common source of error in the interpretation of cholescintigrams. Techniques such as supplementary oblique views, delayed views, the "water test," dynamic display and combined cholescintigraphy and ultrasound have been used with varying degrees of success. As illustrated in two cases, supplementary standing views provide a simple alternative method to differentiate gallbladder from small bowel activity.- - - - - - - - - - ranking = 5keywords = bile (Clic here for more details about this article) |
10/11. Quantitative evaluation of bile diversion surgery utilizing 99mTc HIDA scintigraphy.This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by 99mTc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative 99mTc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier weight loss. The enterogastric reflux indices of 10 asymptomatic control patients after Billroth II gastrectomy ranged from 4% to 45%. 99mTc HIDA scintigraphy is useful in evaluating patients before and after bile diversion surgery, and demonstrates the quantitative decrease in enterogastric reflux after such surgery.- - - - - - - - - - ranking = 5keywords = bile (Clic here for more details about this article) |
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