Sucralfate and carbenoxolone in the treatment of functional disturbances following partial gastrectomy

30 patients submitted to partial gastrectomy (Billroth II) who later suffered digestive complaints (pain, "heartburn", bilious vomiting) showed gastric hyperemia, oedema and some erosions of the gastric stump when examined by endoscopy, the presence of cancer having been excluded by biopsy. These patients were randomly allocated into 2 groups of 15, one of which was treated with sucralfate (1 g 4 times), and the other with carbenoxolone (50 mg 4 times), daily for 8 weeks. After sucralfate the endoscopic finding showed a clear improvement in the gastric wall, accompanied by the almost complete disappearance of the complaint symptoms, in 13 cases (86.6%). After carbenoxolone the same improvement was observed at the endoscopy in 12 cases (80%), with similar recovery from symptoms. Nevertheless, no histological changes that could be attributed to the treatments were observed. In those patients whose endoscopic pattern remained unchanged by either drug, the complaints did not show any relief. No side-effects were detected during either of these drug treatments, each of which showed a similar therapeutic efficacy.     

Stomach cancer after partial gastrectomy for benign ulcer disease

We followed for 25 to 33 years 6459 patients who had undergone partial gastrectomy for benign ulcer disease to determine the incidence of stomach cancer. The overall risk was no different from that among sex- and age-matched controls from the Swedish Cancer Registry (standardized incidence ratio = 0.96; 95 percent confidence limits, 0.78 and 1.16). However, when the patients were classified according to the duration of follow-up after operation, sex, surgical procedure, diagnosis at the time of operation, and age at operation, differences in risk were observed between the subgroups. After adjustment for potential confounding variables, the average adjusted risk increased 28 percent (adjusted standardized incidence ratio = 1.28; 95 percent confidence limits, 1.11 and 1.49) for each successive five-year interval after operation. The adjusted risk was greater among women than men (adjusted standardized incidence ratio = 1.96; 95 percent confidence limits, 1.18 and 3.24). Patients who had undergone a Billroth I anastomosis had a lower crude risk, both overall (standardized incidence ratio = 0.40; 95 percent confidence limits, 0.20 and 0.71) and after we controlled for other confounding variables (adjusted standardized incidence ratio = 0.27; 95 percent confidence limits, 0.12 and 0.62), than did those who had undergone a Billroth II procedure. The adjusted risk of stomach cancer was greater among patients operated on for gastric ulcer than among those operated on for duodenal ulcer (adjusted standardized incidence ratio = 2.21; 95 percent confidence limits, 1.45 and 3.35). Risk decreased with increased age at operation. Between successive strata of age at operation (less than 39, 40 to 49, 50 to 59, and greater than or equal to 60 years of age), the adjusted risk decreased on the average by about half (adjusted standardized incidence ratio = 0.52; 95 percent confidence limits, 0.41 and 0.66).     

Ueber Osteomalacia und Rachitis

Ohne Zusammenfassung     

Retrospective study of Campylobacter-like organisms in patients undergoing partial gastrectomy.

One hundred and five stoma biopsy specimens and 108 corpus biopsy specimens from 108 patients who had undergone a partial gastrectomy because of peptic ulcer disease were examined retrospectively for the presence of Campylobacter-like organisms and gastritis. In the corpus biopsy specimens Campylobacter-associated gastritis was found in 55 (71%) of the cases and in 42 (48%) of the stoma biopsy specimens. It is concluded that Campylobacter-like organisms have a role in gastritis after partial gastrectomy, although this role is more prominent in the corpus region. The role of Campylobacter pylori in peptic ulcer disease is not clinically important.     

Cimetidine for anastomotic ulcers after partial gastrectomy. A randomized controlled trial.

In a randomized double-blind multicenter trial, 15 outpatients with endoscopically proved anastomotic ulceration after Billroth I or Billroth II partial gastrectomy received cimetidine, 1 g daily over eight weeks, or a placebo. All patients also received antiacid. The ulcer healed completely in all seven cimetidine-treated patients and in one of the eight placebo-treated patients (P less than 0.01). Ulcers not healed during the double-blind phase of the trial were all subsequently healed on open cimetidine treatment. There was a trend toward improvement of daytime symptoms in favor of cimetidine (P = 0.06), and nighttime symptoms were significantly relieved during the initial four weeks of cimetidine treatment P = 0.02). We conclude that cimetidine, 1 g daily, promotes healing of anastomotic ulcers after partial gastrectomy.     

Reactions of pulmonary phagocytes following partial hepatectomy

Zymosan administration into the trachea of rats led to intensified infiltration of the lungs by macrophages which migrated to alveolar and bronchial cavities, and the inflow of these cells was accompanied by their increased chemiluminescence and by elevation in acid phosphatase and cathepsin D activities. After partial hepatectomy, the zymosan-induced inflow of cells into the airways was much less pronounced, and no enzyme activation was observed, but the chemiluminescence of airway cells remained high. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 119, N ^o 5, pp. 477–479, May, 1995 Presented by V. P. Kaznacheev, Member of the Russian Academy of Medical Sciences     

The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density

Summary Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P < 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P < 0.002) and urinary excretion of hydroxyproline (P < 0.003) was found in the gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P < 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.Abbreviations DPA/SPA dual/single-photon absorptiometry - BMD bone mineral density - QCT quantitative computed tomography - PICP carboxy-terminal propeptide of type I procollagen - 250HD₃ 25-hydroxy-vitamin D - iPTH parathyroid hormone - OC osteocalcin - BMC bone mineral content     

Metastatic gastric stump cancer occurring six years after a partial gastrectomy for gastric ulcer

Gastric stump cancer (GSC) is known to occur following partial gastrectomy for benign diseases. The risk is believed to increase four-to-five-fold 20 years after gastrectomy. We report a 41-year-old man with metastatic adenocarcinoma of the gastric stump six years after he underwent a partial gastrectomy for a gastric ulcer, following a major rebleeding episode. We highlight the need for identification of patients at risk of developing gastric stump cancer-especially as it has now been described in patients who underwent gastric bypass surgery for obesity-a population that continues to increase.     

Histological appearances of the gastric mucosa 15--27 years after partial gastrectomy.

Sixty-three patients, who had had a partial gastrectomy 15--27 years previously, were examined by endoscopy and multiple mucosal biopsies. No patient had a completely normal gastric mucosa; they showed varying degrees of gastritis, intestinal metaplasia, and dysplasia: 21% had significant dysplasia, and these are regarded as an 'at-risk' group requiring frequent follow-up examinations. One patient had severe dysplasia (carcinoma-in-situ), but no case of infiltrating carcinoma was found.