Introduction. H. pylori infection occurs secondary to the bacterial colonisation of the stomach and the first portion of the small intestine. Patients infected with H. pylori can develop gastritis, peptic ulcer, gastric cancer, and MALT lymphoma. H. pylori infection is defined as a type I carcinogen by the WHO, and its role in gastric carcinogenesis is sustained by many studies.
Objectives. The objective of this study was the description and correlation of the endoscopic aspect of the gastric mucosa in the Helicobacter pylori infection and the incidence in a selected patient group.
Material and method. The study was conducted in the “Dr Carol Davila” Central Military University Emergency Hospital, Section of Gastroenterology, Department of digestive endoscopy, during a period of 12 months (2012--2013) on 1690 consecutive examinations on patients with ages between 18 and 92 years, with a retrospective cohort analytic study. As diagnosis method of the individuals infected with H. pylori, upper digestive endoscopy was used.During the intervention, biopsieswere taken and rapid urease tests were performed.
Results. Regarding the variation of these endoscopic aspects within the examined population, we determined the fact that we encounter in the highest percentage gastritis with all its forms according to the Sidney classification (described below) which represents 59.3%, followed by endoscopic determination with a normal aspect in 18.8% of cases, then follows ulcer with a percentage of 10.33%, followed by duodenitis with 8.67%, and finally the most severe conditions, gastric cancer and lymphoma, reaching only 2.70% and 0.18%, respectively, of the general population examined endoscopically.
Background. Colonoscopy is a common performed procedure in Gastroenterology, and it’s widely used for diagnosis, treatment and surveillance of a wide range of conditions and symptoms. Properly performed, it’s generally safe, more accurate than a virtual colonoscopy and well-tolerated by patients. The completion of a colonoscopy is defined by cecal intubation with the visualization of colonic mucosa and distal terminal ileum when it’s possible.
Patients and methods. We reviewed retrospectively all consecutive endoscopies database of the lower digestive tract, done over a period from 2014-2017 in our clinic. The recommended completion based on the latest guidelines ranges from 90-95% completion rate according to the indication.
Results. 11214 consecutive colonoscopies were done. Overall cecal intubation was successful in 9456 procedures (87.3%). If we exclude the interventional procedures (414 procedures), where cecal intubation was not necessary, the main reasons of non-intubation were due to intolerance of the patients (388 patients), followed on the second place by patients with obstructive cancer (299 patients). The presence of diverticulosis, poor preparation for colonoscopy and post-surgical adhesions were significant findings in non-successful procedures.
Conclusions. In normal daily practice, colonoscopy is completed in 88.01% of the procedures but we think that this result will stimulate the efforts to incorporate more quality measures and time in our endoscopy laboratory.
The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.
Background. Groove pancreatitis or paraduodenal pancreatitis represents a rare type of pancreatitis, and can be classified into cystic dystrophy of the duodenal wall in heterotopic pancreas, paraduodenal cyst or myoadenomatosis.
Case presentation. We present a case of a 58 year old man, drinker and smoker who was admitted in the Department of Gastroenterology for abdominal pain, weight loss and nausea. From his history we have noticed frequent presentations of recurrent acute pancreatitis in the last two years. Laboratory tests have revealed cholestasis, high value of lipase and high value of amylase, with normal value of CA 19.9. The magnetic resonance from the last two years showed the same appearances: a large and edematous head of pancreas, a thickening of the wall of adjacent duodenum and an inhomogeneous area with cystic transformation in the head of the pancreas. We performed endoscopic ultrasound with fine needle aspiration. The histopathological result showed only inflammatory cells. We have established the diagnosis of groove pancreatitis.
Conclusion. Groove pancreatitis represents a rare condition, with an incidence of 0.4%-14% on biopsies. Endoscopic ultrasound is the best method for diagnosis, it could evaluate also the duodenal wall.
Appendiceal epithelial tumors are a rare finding in comparison with the incidence of colorectal cancer that is approximately 100-fold higher. As appendiceal neoplasms and colorectal cancer have a different clinical and tumoral behavior, these tumors are classified separately in the various tumor classifications. Most appendiceal neoplasms are found during surgery or postoperatively in appendectomy specimens. Given the possibility of neoplastic peritoneal dissemination, the lack of symptoms is a serious problem.
However, the percentage of appendiceal tumors that is incidentally discovered by imaging is increasing over time. Primary adenocarcinoma of the appendix is exceedingly rare and frequently has an extremely poor prognosis because it is diagnosed in advanced stages.
Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss surgery technique, but the impact on esophageal physiology and esophagogastric junction is still debatable. The aim of our study was to evaluate the manometric changes of the lower esophageal sphincter (LES) after LSG in order to indicate LES manometry pre- procedure.
Methods: In a prospective study we evaluated clinically, with upper gastrointestinal endoscopy, and high-resolution esophageal manometry 45 morbidly obese patients before, and 6-12 months after LSG.
Results: The BMI (body mass index) decreased from 46.28±5.79 kg/m2 to 32.28±4.65 kg/m2 postoperatively (p <0.01), with a reduction of ~14 kg/m2 of BMI, 39.9 (±11.9) kg body weight and 29.9 (± 6.2)% of the TWL (Total Weight Loss index), in a median interval of 7.9 months. Gastroesophageal reflux disease (GERD) prevalence increased from 17.8% to 31.1% postoperatively, with new GERD onset in 22.2%, but mild symptomatology (the median GERDHRQL score increased from 1.56 to 2.84 points). Postoperatory reflux was associated with lower esophageal sphincter (LES) hypotonia, shortening of LES length and IIGP (increased intragastric pressure). Hiatal hernia repair rate was 17.8%, and proton pump inhibitor consumption 20%. After weight loss, the 10 cases of esophagitis discovered preoperatively cured, but 3 patients were diagnosed with de novo esophagitis. The prevalence of manometric dysmotility after LSG was 28.9%, lower than before surgery (44.4%).
Conclusion: Even if GERD remains the main limitation of LSG, the high-resolution esophageal manometry has proved useful and should be implemented in morbidly obese evaluation protocol, to better select the bariatric procedure.