RESUMO
Bile reflux or duodenogastric reflux (DGR), refers to the retrograde flow of duodenal contents (mainly bile) into the stomach; capable of producing chemical damage to the mucosa, and triggering mutations towards the development of intestinal metaplasia, dysplasia and even gastric cancer. OBJECTIVE: This study aimed to estimate the prevalence of primary bile reflux in cholecystectomized patients and to identify whether cholecystectomy is a risk factor for development of DGR. MATERIALS AND METHODS: An analytical cross-sectional and observational study was conducted, in which all patients who underwent upper digestive endoscopy from February to June 2023 in a private endoscopic center in Lima, Peru, were included. According to the endoscopic report, patients were divided into two groups as those with DGR and those without DGR. Demographic characteristics, history of cholecystectomy, and endoscopic findings were statistically analyzed. 408 patients were included. RESULTS: The mean age of the population was 48.18 ± 16.82 years; 61.52% were female. The prevalence of DGR was 25.74% in the population, while in cholecystectomized patients it was 52.11%. The prevalence of DRG in patients with a history of cholecystectomy was 2.58 times compared to patients without cholecystectomy (p<0.001). Age ≥50 years also behaved as a risk factor for RDG (p=0.025). No significant difference in diabetes, Helicobacter pylori infection or smoking were found. CONCLUSION: In conclusion, a history of cholecystectomy as well as age were found to be risk factors for development of primary DGR.
Assuntos
Refluxo Biliar , Refluxo Duodenogástrico , Infecções por Helicobacter , Helicobacter pylori , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Refluxo Duodenogástrico/complicações , Refluxo Duodenogástrico/epidemiologia , Refluxo Biliar/complicações , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Estudos Transversais , Fatores de Risco , Colecistectomia/efeitos adversosRESUMO
BACKGROUND: Studies indicate sleeve gastrectomy (SG) as a factor of aggravation or even emergence of symptoms of gastroesophageal reflux disease. Accelerated gastric emptying is described as a mitigating factor. SG may be potentiated by adding a pyloroplasty, although with the potential risk of resulting in duodenogastric alkaline reflux. The objective was to standardize sleeve gastrectomy with pyloroplasty in rats, analyze the complementation in terms of mortality and weight evolution, and conduct assessments on gastric emptying, intestinal transit, and genesis of possible duodenogastric reflux. METHODS: Ninety-three male Wistar rats were divided into a pilot study (standardization of the surgical technique and the scintigraphic study), and the main study. They were then subdivided into the SHAM group, the sleeve gastrectomy (SG) group, and the sleeve gastrectomy with pyloroplasty (SGP) group. After 3 months, the animals were submitted to two scintigraphic experiments and histological analysis of gastric biopsies. RESULTS: The surgical groups (SG and SGP) lost initially more weight than the SHAM group, and the gastric emptying and intestinal transit in the first were more accelerated. However, no difference was found between the SG and SGP groups. Scintigraphic and histological analyses did not reveal statistical differences among the SG and SGP groups regarding gastroesophageal and duodenogastric refluxes. CONCLUSIONS: Pyloroplasty did not affect weight reduction or increase duodenogastric reflux, after three postoperative months in this animal model of sleeve gastrectomy.
Assuntos
Refluxo Duodenogástrico , Obesidade Mórbida , Animais , Refluxo Duodenogástrico/cirurgia , Gastrectomia/métodos , Esvaziamento Gástrico , Masculino , Obesidade Mórbida/cirurgia , Projetos Piloto , Ratos , Ratos WistarRESUMO
PURPOSE: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. METHODS: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. RESULTS: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). CONCLUSIONS: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.
Assuntos
Adenocarcinoma , Refluxo Duodenogástrico , Omeprazol , Inibidores da Bomba de Prótons , Adenocarcinoma/etiologia , Adenocarcinoma/prevenção & controle , Animais , Refluxo Duodenogástrico/complicações , Mucosa Gástrica , Humanos , Omeprazol/farmacologia , Inibidores da Bomba de Prótons/farmacologia , Ratos , Ratos WistarRESUMO
RESUMEN El síndrome de Pinza Aortomesentérica o "Síndrome de Wilkie" es una entidad muy rara, se caracteriza por una pérdida de peso impor-tante y vómitos de alimentos parcialmente digeridos. La sospecha diagnóstica se fundamenta por la presencia de factores predisponen-tes y/o de riesgo. Estudios imagenológicos como un esofagogastroduodeno seriado y ecografía Doppler permiten su confirmación. El tratamiento primario se apoya en una adecuada nutrición. Frente al fracaso del tratamiento médico, se indica el manejo quirúrgico con diferentes técnicas para resolver la oclusión. Se presenta el caso de una adolescente con oclusión gastroduodenal crónica, fallo en el tratamiento médico y resolución quirúrgica con buenos resultados.Palabras claves: Síndrome de la arteria mesentérica superior, obstrucción duodenal, reflujo duodenogástrico, laparotomía, anastomosis quirúrgica; gastroparesia.
ABSTRACT Superior mesenteric artery syndrome or "Wilkie syndrome" is a very rare entity, characterized by significant weight loss and vomiting of partially digested food. The diagnostic suspicion is based on the presence of predisposing and/or risk factors. Imaging studies such as serial esophagogastroduodenum and Doppler ultrasound allow its confirmation. The primary treatment is supported by adequate nutrition. Following the failure of medical treatment, surgical management is indicated with different techniques to resolve the occlusion. We present the case of a teenager with chronic gastroduodenal occlusion, failure in medical treatment and surgical resolution with good results.Keywords: Superior mesenteric artery syndrome; duodenal obstruction; duodenogastric reflux; laparotomy; anastomosis, surgical; gas-troparesis
Assuntos
Humanos , Feminino , Adolescente , Síndrome da Artéria Mesentérica Superior , Anastomose Cirúrgica , Refluxo Duodenogástrico , Gastroparesia , Laparotomia , Artérias MesentéricasRESUMO
Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.(AU)
Assuntos
Animais , Ratos , Omeprazol/administração & dosagem , Adenocarcinoma/veterinária , Refluxo Duodenogástrico/tratamento farmacológico , Refluxo Duodenogástrico/veterináriaRESUMO
Abstract Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.
Assuntos
Humanos , Animais , Ratos , Omeprazol/farmacologia , Adenocarcinoma/etiologia , Adenocarcinoma/prevenção & controle , Refluxo Duodenogástrico/complicações , Inibidores da Bomba de Prótons/farmacologia , Ratos Wistar , Mucosa GástricaRESUMO
Justificativa: A Doença do Refluxo Gastroesofágico (DRGE) apresenta alta prevalência na população mundial. Uma de suas complicações, é o esôfago de Barrett (EB), uma alteração histológica pré-maligna do epitélio esofágico. O seu diagnóstico se da através do exame endoscópico e posterior confirmação histopatológica. Objetivo: Estimar a concordância diagnóstica, nos casos suspeitos de EB, entre o exame endoscópico e a análise histológica. Métodos: Foram analisados 151 pacientes, retrospectivamente, com suspeita diagnóstica de EB na endoscopia. Os dados foram obtidos a partir de prontuários eletrônicos, entre Julho de 2013 e Julho de 2014. Os laudos anatomopatológicos foram obtidos através de registros do laboratório Byori. Resultados: Entre os 151 pacientes submetidos a biópsias com suspeita endoscópica de EB, 47 (31,1%) obtiveram confirmação diagnóstica através do exame anatomopatológico. Conclusão: A endoscopia digestiva alta é um bom exame para detecção de metaplasia colunar, entretanto, nos casos de esôfago de Barrett, essa eficácia não se reproduziu.
Background: Gastroesophageal Reflux Disease (GERD) has a high prevalence in the world population. One of its complications is Barrett's esophagus (EB), a premalignant histological alteration of the esophageal epithelium. Its diagnosis is given through endoscopic examination and subsequent histopathological confirmation. Objective: Estimate at diagnostic agreement, we have suspense cases of EB, between endoscopic examination and histological analysis. Method: A total of 151 patients were retrospectively with suspected diagnosis of EB at endoscopy. Data were obtained from electronic medical records between July 2013 and July 2014. Anatomopathological reports were obtained from Byori laboratory records. Results: Among the 151 patients who underwent biopsy with endoscopic suspicion of EB, 47 (31.1%) obtained diagnostic confirmation through pathological examination. Conclusion: Upper digestive endoscopy is a good exam to detect columnar metaplasia, however, in Barrett's esophagus cases, this efficacy has not been reproduced.
Assuntos
Humanos , Esôfago de Barrett , Refluxo Duodenogástrico , Endoscopia , Histologia , MetaplasiaRESUMO
A duodenojejunite proximal (DJP) é caracterizada por acentuada inflamação nos segmentos proximais do intestino delgado, principalmente em duodeno e porção proximal de jejuno. A origem é considerada infecciosa, mas os agentes envolvidos ainda não são completamente esclarecidos. Foram revisados 17 casos de duodenojejunite proximal (DJP) atendidos no Hospital Veterinário Anhembi Morumbi, no período de janeiro de 2005 a dezembro de 2012. O objetivo do trabalho foi identificar a taxa de prevalência da doença, a sobrevivência dos animais acometidos e avaliar os parâmetros físicos encontrados nos animais sobreviventes. A quantidade do refluxo enterogástrico produzido nas primeiras 24 horas e o tempo que os animais se mantiveram com refluxo foram avaliados entre os animais sobreviventes e não sobreviventes. Não houve predisposição quanto à raça, idade ou sexo. Neste estudo retrospectivo, não foi possível associar o mau prognóstico à quantidade de refluxo produzido e os animais que não sobreviveram mantiveram refluxo enterogástrico por tempo prolongado (>72 horas).(AU)
The duodentis-proximal jejunitis proximal (DJP) is a condition that cause inflammation in the gastrointestinal tract and damage in the proximal segments of the small intestine, mainly in the duodenum and proximal jejunum. Were reviewed 17 duodentis-proximal jejunitis proximal (DJP) attended at the Anhembi Morumbi Veterinary Hospital, from January 2005 to December 2011. The objective was to identify the prevalence rate of disease, the survival rate of disease in affected animals and evaluate the physical parameters found in the surviving horses. The enterogastric reflux amount produced in the first 24 hours and the period that the animals remained with reflux were evaluated between survivor's animals and no survivor's animals. No predisposition was found from age or gender. In this retrospective study, it was not possible to associate the bad prognosis to reflux count, The animals that not survived kept enterogastric reflux prolonged time (> 72 hours).(AU)
La duodeno-yeyunitis proximal (DPJ) es caracterizada por una acentuada inflamación en los segmentos proximales del intestino delgado, principalmente en el duodeno porción proximal del yeyuno. El origen es considerado infeccioso, pero los agentes envueltos todavía no han sido completamente esclarecidos, fueron revisados 17 casos de duodeno-yeyunitis proximal (DPJ) atendidos en el hospital veterinario Anhembi Morumbi, en el periodo de enero 2005 a diciembre de 2011. El objetivo del trabajo fue identificar la tasa de prevalencia de la enfermedad, la sobrevivencia de los animales afectados y evaluar los parámetros físicos encontrados en los animales sobrevivientes. La cantidad de reflujo entero-gástrico producido en las primeras 24 horas y el tiempo que los animales se mantuvieron con reflujo fueron evaluados entre los animales sobrevivientes y no sobrevivientes. No hubo predisposición por raza, edad o sexo en este estudio, no fue posible asociar un mal pronóstico en cuanto a la cantidad de reflujo producido, sim embargo los animales que no sobrevivieron mantuvieron un reflujo entero-gástrico por tiempo prolongado (> 72 horas).(AU)
Assuntos
Animais , Cavalos/fisiologia , Duodenopatias/veterinária , Doenças do Jejuno/veterinária , Inflamação/veterinária , Refluxo Duodenogástrico , Dilatação Gástrica/veterináriaRESUMO
A duodenojejunite proximal (DJP) é caracterizada por acentuada inflamação nos segmentos proximais do intestino delgado, principalmente em duodeno e porção proximal de jejuno. A origem é considerada infecciosa, mas os agentes envolvidos ainda não são completamente esclarecidos. Foram revisados 17 casos de duodenojejunite proximal (DJP) atendidos no Hospital Veterinário Anhembi Morumbi, no período de janeiro de 2005 a dezembro de 2012. O objetivo do trabalho foi identificar a taxa de prevalência da doença, a sobrevivência dos animais acometidos e avaliar os parâmetros físicos encontrados nos animais sobreviventes. A quantidade do refluxo enterogástrico produzido nas primeiras 24 horas e o tempo que os animais se mantiveram com refluxo foram avaliados entre os animais sobreviventes e não sobreviventes. Não houve predisposição quanto à raça, idade ou sexo. Neste estudo retrospectivo, não foi possível associar o mau prognóstico à quantidade de refluxo produzido e os animais que não sobreviveram mantiveram refluxo enterogástrico por tempo prolongado (>72 horas).
The duodentis-proximal jejunitis proximal (DJP) is a condition that cause inflammation in the gastrointestinal tract and damage in the proximal segments of the small intestine, mainly in the duodenum and proximal jejunum. Were reviewed 17 duodentis-proximal jejunitis proximal (DJP) attended at the Anhembi Morumbi Veterinary Hospital, from January 2005 to December 2011. The objective was to identify the prevalence rate of disease, the survival rate of disease in affected animals and evaluate the physical parameters found in the surviving horses. The enterogastric reflux amount produced in the first 24 hours and the period that the animals remained with reflux were evaluated between survivor's animals and no survivor's animals. No predisposition was found from age or gender. In this retrospective study, it was not possible to associate the bad prognosis to reflux count, The animals that not survived kept enterogastric reflux prolonged time (> 72 hours).
La duodeno-yeyunitis proximal (DPJ) es caracterizada por una acentuada inflamación en los segmentos proximales del intestino delgado, principalmente en el duodeno porción proximal del yeyuno. El origen es considerado infeccioso, pero los agentes envueltos todavía no han sido completamente esclarecidos, fueron revisados 17 casos de duodeno-yeyunitis proximal (DPJ) atendidos en el hospital veterinario Anhembi Morumbi, en el periodo de enero 2005 a diciembre de 2011. El objetivo del trabajo fue identificar la tasa de prevalencia de la enfermedad, la sobrevivencia de los animales afectados y evaluar los parámetros físicos encontrados en los animales sobrevivientes. La cantidad de reflujo entero-gástrico producido en las primeras 24 horas y el tiempo que los animales se mantuvieron con reflujo fueron evaluados entre los animales sobrevivientes y no sobrevivientes. No hubo predisposición por raza, edad o sexo en este estudio, no fue posible asociar un mal pronóstico en cuanto a la cantidad de reflujo producido, sim embargo los animales que no sobrevivieron mantuvieron un reflujo entero-gástrico por tiempo prolongado (> 72 horas).
Assuntos
Animais , Cavalos/fisiologia , Doenças do Jejuno/veterinária , Duodenopatias/veterinária , Inflamação/veterinária , Dilatação Gástrica/veterinária , Refluxo DuodenogástricoRESUMO
OBJECTIVE: to evaluate the influence of Duodenal reflux in histological changes of the gastric mucosa of rats infected with Helicobacter pylori submitted to pyloroplasty. METHODS: after two weeks of acclimation, we infected 30 male Wistar rats with Helicobacter pylori. We randomly divided them into three groups: one submitted to pyloroplasty, another to partial gastrectomy and the third, only infected, was not operated. After six months of surgery, euthanasia was carried out. Gastric fragments were studied by light microscopy to count the number of H. pylori, and to observe the histological changes (gastritis, metaplasia, dysplasia and neoplasia). We confirmed these changes by immunohistochemistry using the molecular markers PCNA and TGF-beta. RESULTS: the animals submitted to pyloroplasty had higher percentage of colonization by H. pylori (median=58.5; gastrectomy=16.5; control=14.5). There was a positive correlation between the amount of H. pylori and the occurrence of chronic gastritis present in the antral fragments. Neoplasia occurred in 40% of rats from the group submitted to pyloroplasty. The staining with PCNA and TGF-ß confirmed the histopathological changes visualized by optical microscopy. CONCLUSIONS: the antral region was the one with the highest concentration of H. pylori, regardless of the group. There was a positive correlation between the appearance of benign disorders (chronic gastritis, metaplasia, dysplasia) and cancer in mice infected with H. pylori submitted to pyloroplasty. OBJETIVO: avaliar a influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica de ratos, infectados por Helicobacter pylori, submetidos à piloroplastia. MÉTODO: após duas semanas de aclimatação, 30 ratos machos da raça Wistar, foram infectados com o microorganismo patogênico H. pylori. De forma aleatória, foram divididos em três grupos: um submetido à piloroplastia, outro à gastrectomia parcial e o terceiro, apenas infectados, não foi operado. Após seis meses de operados, procedeu-se a eutanásia. Os fragmentos gástricos foram estudados por microscopia óptica, para a contagem da quantidade de H. pylori, e para a observação das alterações histológicas (gastrite, metaplasia, displasia e neoplasia). A confirmação dessas alterações foi feita por imuno-histoquímica, utilizando os marcadores moleculares PCNA e TGFbeta. RESULTADOS: os animais submetidos à piloroplastia tiveram maior percentual de colonização por H. pylori (mediana=58,5; gastrectomia=16,5; controle=14,5). Houve correlação positiva entre quantidade de H. pylori e ocorrência de gastrite crônica presente nos fragmentos do antro. Ocorreu 40% de neoplasia no grupo submetido à piloroplastia. A marcação de PCNA e TGF-beta confirmou as alterações histopatológicas visibilizadas à microscopia óptica. CONCLUSÕES: a região do antro foi a que apresentou a maior concentração de H. pylori, independente do grupo. Houve correlação positiva entre e o aparecimento de alterações benignas (gastrite crônica, metaplasia, displasia), e de neoplasia nos ratos infectados com H. pylori submetidos à piloroplastia.
Assuntos
Refluxo Duodenogástrico/complicações , Mucosa Gástrica/patologia , Infecções por Helicobacter/complicações , Helicobacter pylori , Animais , Refluxo Duodenogástrico/cirurgia , Gastrectomia , Infecções por Helicobacter/cirurgia , Masculino , Piloro/cirurgia , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
ABSTRACT Objective: to evaluate the influence of Duodenal reflux in histological changes of the gastric mucosa of rats infected with Helicobacter pylori submitted to pyloroplasty. Methods: after two weeks of acclimation, we infected 30 male Wistar rats with Helicobacter pylori. We randomly divided them into three groups: one submitted to pyloroplasty, another to partial gastrectomy and the third, only infected, was not operated. After six months of surgery, euthanasia was carried out. Gastric fragments were studied by light microscopy to count the number of H. pylori, and to observe the histological changes (gastritis, metaplasia, dysplasia and neoplasia). We confirmed these changes by immunohistochemistry using the molecular markers PCNA and TGF-beta. Results: the animals submitted to pyloroplasty had higher percentage of colonization by H. pylori (median=58.5; gastrectomy=16.5; control=14.5). There was a positive correlation between the amount of H. pylori and the occurrence of chronic gastritis present in the antral fragments. Neoplasia occurred in 40% of rats from the group submitted to pyloroplasty. The staining with PCNA and TGF-ß confirmed the histopathological changes visualized by optical microscopy. Conclusions: the antral region was the one with the highest concentration of H. pylori, regardless of the group. There was a positive correlation between the appearance of benign disorders (chronic gastritis, metaplasia, dysplasia) and cancer in mice infected with H. pylori submitted to pyloroplasty.
RESUMO Objetivo: avaliar a influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica de ratos, infectados por Helicobacter pylori, submetidos à piloroplastia. Método: após duas semanas de aclimatação, 30 ratos machos da raça Wistar, foram infectados com o microorganismo patogênico H. pylori. De forma aleatória, foram divididos em três grupos: um submetido à piloroplastia, outro à gastrectomia parcial e o terceiro, apenas infectados, não foi operado. Após seis meses de operados, procedeu-se a eutanásia. Os fragmentos gástricos foram estudados por microscopia óptica, para a contagem da quantidade de H. pylori, e para a observação das alterações histológicas (gastrite, metaplasia, displasia e neoplasia). A confirmação dessas alterações foi feita por imuno-histoquímica, utilizando os marcadores moleculares PCNA e TGFbeta. Resultados: os animais submetidos à piloroplastia tiveram maior percentual de colonização por H. pylori (mediana=58,5; gastrectomia=16,5; controle=14,5). Houve correlação positiva entre quantidade de H. pylori e ocorrência de gastrite crônica presente nos fragmentos do antro. Ocorreu 40% de neoplasia no grupo submetido à piloroplastia. A marcação de PCNA e TGF-beta confirmou as alterações histopatológicas visibilizadas à microscopia óptica. Conclusões: a região do antro foi a que apresentou a maior concentração de H. pylori, independente do grupo. Houve correlação positiva entre e o aparecimento de alterações benignas (gastrite crônica, metaplasia, displasia), e de neoplasia nos ratos infectados com H. pylori submetidos à piloroplastia.
Assuntos
Animais , Masculino , Ratos , Helicobacter pylori , Infecções por Helicobacter/complicações , Refluxo Duodenogástrico/complicações , Mucosa Gástrica/patologia , Piloro/cirurgia , Distribuição Aleatória , Infecções por Helicobacter/cirurgia , Ratos Wistar , Refluxo Duodenogástrico/cirurgia , GastrectomiaRESUMO
The aim of this study was to detect apical inflammatory root resorption (AIRR) associated with periapical lesion using cone beam computed tomography (CBCT) and scanning electronic microscopy (SEM). This clinical study evaluated AIRR in 88 root apexes, from 52 permanent teeth of 14 patients, extracted for different reasons. The patients were submitted to a clinical interview, review of dental/medical histories and clinical/imaging examinations for treatment planning. All selected teeth showed unrestorable condition because of the extensive coronal breakdown due to carious lesions, and root canal infection associated with periapical lesions. CBCT images were obtained from the patients with the aim of diagnosing the periapical diseases which showed complex or doubtful conditions. Two examiners assessed the presence or absence of AIRR. Apices were also analyzed under SEM. Chi-square test was used to compare the imaging methods for detection of AIRR. The level of statistical significance was set at 5%. AIRR associated with root canal infection and apical periodontitis was found in 61.4% of the cases studied by using SEM, and at least half of the cases by CBCT. The microscopic analysis remains as a reference standard against the imaging method to identify AIRR.
O objetivo deste estudo foi detectar reabsorção radicular inflamatória apical (RRIA) associada à lesão periapical utilizando tomografia computadorizada de feixe cônico (TCFC) e microscopia eletrônica de varredura (MEV). Este estudo clínico avaliou RRIA em 88 ápices radiculares de 52 dentes permanentes de 14 pacientes, extraídos por diferentes motivos. Os pacientes foram submetidos a uma entrevista clínica, revisão da história médica/dental, exames clínicos e de imagem para o plano de tratamento. Todos os dentes selecionados apresentaram condição não restaurável devido à extensa perda de estrutura dental associada a lesões cariosas, e infecção do canal radicular associada a lesões periapicais. TCFC foram obtidas dos pacientes com o objetivo de diagnosticar as alterações periapicais que se mostraram complexas ou duvidosas. Dois examinadores avaliaram a presença ou ausência de RRIA. Os ápices foram também analisados por MEV. O teste do qui-quadrado foi usado para comparar os métodos de detecção de RRIA. O nível de significância foi estabelecido em 5%. RRIA associada à infecção do canal radicular e periodontite apical foi encontrada em 61,4% dos casos estudados usando MEV, e pelo menos metade dos casos utilizando TCFC. A análise microscópica continua a ser o padrão frente a métodos de imagens para a identificação de RRIA.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bilirrubina/metabolismo , Refluxo Duodenogástrico/diagnóstico , Dieta , Refluxo Duodenogástrico/metabolismo , Tecnologia de Fibra Óptica/instrumentação , Concentração de Íons de Hidrogênio , Período Pós-Prandial , Distribuição AleatóriaRESUMO
PURPOSE: To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.
Assuntos
Adenocarcinoma/prevenção & controle , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Refluxo Duodenogástrico/complicações , Neoplasias Gástricas/prevenção & controle , Tiazinas/administração & dosagem , Tiazóis/administração & dosagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Animais , Progressão da Doença , Refluxo Duodenogástrico/cirurgia , Masculino , Ilustração Médica , Meloxicam , Piloro/patologia , Distribuição Aleatória , Ratos , Ratos Wistar , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.
Assuntos
Animais , Masculino , Ratos , Adenocarcinoma/prevenção & controle , /administração & dosagem , Refluxo Duodenogástrico/complicações , Neoplasias Gástricas/prevenção & controle , Tiazinas/administração & dosagem , Tiazóis/administração & dosagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Progressão da Doença , Refluxo Duodenogástrico/cirurgia , Ilustração Médica , Piloro/patologia , Distribuição Aleatória , Ratos Wistar , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.(AU)
Assuntos
Animais , Ratos , Estômago/anatomia & histologia , Neoplasias/patologia , Refluxo Duodenogástrico , Ratos/classificaçãoRESUMO
O Helicobacter pylori, é tido como o principal fator de risco para o carcinoma gástrico. Diferentes estudos experimentais em animais procuram relacionar essa carcinogênese a outros fatores carcinógenos sem sucesso. Neste estudo, procurou-se avaliar-se em ratos, se há correlação entre o refluxo duodenogástrico, o Helicobacter pylori e o desenvolvimento do câncer gástrico ou de seus precursores. Para tal, realizou-se nos três grupos de ratos (n de dez por grupo) as técnicas de: piloroplastia precedida de infecção, gastrectomia subtotal precedida de infecção e um grupo no qual foi praticada apenas a infecção. Apois seis meses, analisou-se as alterações da mucosa, comparando-se os três grupos. As alterações da mucosa pesquisadas foram as seguintes: gastrites, metaplasias, displasias e neoplasias epiteliais. Ao término do estudo, foi encontrado, no grupo submetido a piloroplastia precedida de infecção um alto percentual de alterações epiteliais. Conclui-se que, no rato, a operação de piloroplastia, levou ao maior desenvolvimento da população do Helicobacter pylori, que se relaciona com as lesões pré- malignas e o adenocarcinoma gástrico
Helicobacter pylori is considered the main risk factor for gastric carcinoma. Different experimental studies in animals seek to relate this carcinogenesis to other carcinogenic factors without success. This study sought to evaluate in rats, if there was a correlation between duodenogastric reflux, Helicobacter pylori and the development of gastric cancer or its precursors. To this end, it was carried out in three groups of rats the techniques: pyloroplasty, subtotal gastrectomy and only infection. After six months, the changes in mucosa were analyzed comparing the three groups. The mucosal changes reseached were: gastritis, metaplasia, dysplasia and epithelial neoplasms. At the end of the study, was found in the group that underwent pyloroplasty a high percentage of epithelial alterations and these correlated with the population of Helicobacter pylori. It is concluded that in the rat, the operation of pyloroplasty led to increased colonization of the population of Helicobacter pylori and is related with the development of benign lesions and gastric cancer
Assuntos
Animais , Masculino , Feminino , Ratos , Refluxo Duodenogástrico , Helicobacter pylori/patogenicidade , Neoplasias Gástricas , Antro Pilórico/cirurgia , Gastrite , Gastrectomia/métodos , Imuno-Histoquímica , Mucosa Gástrica/lesões , Piloro/cirurgiaRESUMO
OBJETIVO: Determinar a sensibilidade da seriografia do esôfago, estômago e duodeno (SEED) para o diagnóstico da doença do refluxo gastroesofágico (DRGE) em recém-nascidos prematuros, tendo como padrão ouro a monitoração prolongada do pH esofágico distal, e descrever a presença de anormalidades anatômicas do tubo digestivo. MATERIAIS E MÉTODOS: Foram incluídos no estudo 41 recém-nascidos, com média de 1.243,9 g, apresentando sinais/sintomas de DRGE e resultados alterados na monitoração do pH (índice de refluxo > 10 por cento). A SEED foi realizada logo que as condições clínicas dos recém-nascidos foram estáveis para a realização dos exames radiológicos. RESULTADOS: A monitoração prolongada do pH e a SEED foram realizadas com 49,8 e 66,8 dias de vida, respectivamente. A sensibilidade da seriografia foi de 56,1 por cento (IC 95 por cento: 39,9-71,2 por cento). Refluxo significativo foi observado em 41,4 por cento dos casos, refluxo médio em 44,8 por cento e refluxo pequeno em 13,8 por cento. A SEED identificou apenas um caso de hérnia de hiato. CONCLUSÃO: A SEED apresentou baixa sensibilidade para a DRGE em prematuros e não se associou com a gravidade do refluxo, na comparação com a monitoração do pH, sendo, entretanto, útil no diagnóstico de alteração anatômica.
OBJECTIVE: To determine the sensitivity of upper gastrointestinal (UGI) series, adopting the 24-h esophageal pH monitoring as the gold standard in the diagnosis of gastroesophageal reflux disease (GERD) in preterm newborns, besides describing the presence of anatomical abnormalities in the digestive tube. MATERIALS AND METHODS: The present study included 41 neonates with average birth weight of 1,243.9 g, presenting signs/symptoms of GERD and abnormal 24-h esophageal pH monitoring (reflux index > 10 percent). The UGI series was performed as soon as the infants' clinical conditions were considered sufficiently stable. RESULTS: The 24-h pH monitoring and UGI series were performed respectively at 49.8 and 66.8 days of life. The UGI series sensitivity was of 56.1 percent (CI 95 percent: 39.9-71.2 percent). The reflux index was significant in 41.4 percent, moderate in 44.8 percent, and mild in 13.8 percent of the cases. Only one case of hiatus hernia was identified by UGI series. CONCLUSION: Upper gastrointestinal series has demonstrated low sensitivity in the diagnosis of GERD in preterm newborns and was not associated with the reflux severity as compared with pH monitoring. However, it is useful in the detection of anatomical abnormalities in the upper gastrointestinal tract.
Assuntos
Humanos , Recém-Nascido , Refluxo Duodenogástrico , Monitoramento do pH Esofágico , Refluxo Gastroesofágico , Recém-Nascido Prematuro , RadiografiaRESUMO
PURPOSE: To study the expression of heme-oxygenase-1 (HO-1), an enzyme induced by oxidative stress, in specimens obtained from an experimental model in rats that evaluated the role of gastric and duodenal reflux in esophageal carcinogenesis. METHODS: Esophageal specimens embedded in paraffin obtained from different experimental groups of rats were used for immunohistochemistry analysis of HO-1 expression. The rats had been divided into the following groups and were killed after 22 weeks: (1) cardioplasty to induce acid reflux; (2) esophagoduodenal anastomosis to induce duodenal reflux; (3) no treatment; (4) cardioplasty + diethylnitrosamine (DEN); (5) esophagoduodenal anastomosis + DEN; and (6) DEN. The study sample comprised 3 specimens from each group with the most severe histopathological lesions found on each study branch. RESULTS: The expression of HO-1 was seen only in rat specimens submitted to esophagoduodenal anastomosis (Groups 2 and 5), and the analysis of mean fluorescence intensity revealed a significant increase of HO-1 expression (4.8 and 4.6 fold, respectively) when compared with the control group (Group 3) (p<0.05). The main target for HO-1 induction was the inflammatory cells inside the tumor or in subepithelial areas. Rats exposed to gastric reflux had no HO-1 expression. CONCLUSION: Reflux esophagitis induced by reflux of duodenal contents, which provoked considerable oxidative stress, may play an important role in esophageal carcinogenesis. Acid reflux did not induce oxidative stress in this experimental model.(AU)
OBJETIVO: Estudar a expressão da HO-1 (enzima induzida pelo estresse) em diferentes peças esofágicas obtidas de um estudo experimental em ratos que avaliou o papel do refluxo gastroesofágico e duodeno esofágico na carcinogênese experimental. MÉTODOS: Blocos de parafina contendo peças de esôfago provenientes de um estudo experimental com ratos foram utilizados para verificar a expressão imunohistoquímica da HO-1. Os ratos haviam sido divididos nos seguintes grupos: (1) Cardioplastia com o objetivo de promover refluxo ácido, (2) Anastomose esofagoduodenal para indução de refluxo misto (ácido e biliar), (3) sem tratamento (controles), (4) cardioplastia + dietil-nitrosamina (DEN), (5) Anastomose esofagoduodenal + DEN, (6) DEN. Amostras contendo três peças de cada grupo com as lesões histopatológicas mais graves encontradas em cada braço do estudo foram escolhidas para avaliação da expressão imunoistoquímica da HO-1. RESULTADOS: A expressão da HO-1 foi observada somente nas peças de esôfago de ratos submetidos à anastomose esofagoduodenal (Grupos 2 e 5) e analise da intensidade média da fluorescência demonstrou uma diferença significativa na expressão da HO-1 nesses grupos quando comparada com o grupo controle (4,8 e 4,6 vezes respectivamente) (p<0,05). As células inflamatórias localizadas dentro dos tumores e nas regiões adjacentes ao epitélio foram as que mais intensamente expressaram a HO-1. Ratos expostos ao refluxo ácido (gástrico) apresentaram pouca ou nenhuma atividade da HO-1. CONCLUSÃO: Esofagite de refluxo induzida pelo refluxo com conteúdo duodenal provocou considerável estresse oxidativo, que parece exercer um papel importante na carcinogênese esofágica. O refluxo puramente ácido não foi capaz de induzir estresse oxidativo nesse modelo experimental(AU)
Assuntos
Animais , Ratos , Refluxo Duodenogástrico/induzido quimicamente , Refluxo Duodenogástrico/veterinária , Refluxo Gastroesofágico/induzido quimicamente , Refluxo Gastroesofágico/veterinária , Dietilnitrosamina/administração & dosagem , Dietilnitrosamina/efeitos adversos , Dietilnitrosamina , Ratos , Ensaios Enzimáticos Clínicos/efeitos adversos , Ensaios Enzimáticos Clínicos/métodos , Ensaios Enzimáticos Clínicos/veterinária , Biomarcadores TumoraisRESUMO
Existen evidencias que tanto los ácidos biliares como el Helicobacter pylori en la mucosa gástrica son capaces de desencadenar un proceso inflamatorio que según su intensidad y persistencia favorecen la aparición de fallas y mutaciones en la replicación celular que se expresan desde una metaplasia, displasia hasta un cáncer. Se realizó un estudio epidemiológico observacional, descriptivo, prospectivo de corte transversal en el Instituto de Gastroenterología, en pacientes con reflujo duodenogástrico y ácidos biliares totales elevados, con el objetivo de conocer la asociación entre la metaplasia intestinal y la presencia o no de Helicobacter pylori. Al concluir la investigación se observó que la metaplasia estuvo presente en 48,7 por ciento de los 39 pacientes estudiados, que existió una asociación estadísticamente significativa (p<0,05) en la distribución de la bacteria en los pacientes con y sin metaplasia intestinal, que los pacientes con reflujo duodenogástrico, a pesar de tener una lesión histológica, presentaron resultados negativos en cuanto a la presencia de Helicobacter pylori. En las muestras con diagnóstico histológico de gastritis crónica severa y atrófica, el 75 por ciento presentaban Helicobacter pylori. La localización de la metaplasia intestinal fue mayor en la región antral (84,3 por ciento). En los pacientes con reflujo duodenogástrico la presencia de Helicobacter pylori no parece estar asociada a grados intensos de metaplasia, aunque el microorganismo se encuentre en todas las categorías, mientras que cuando no hay, la metaplasia tiende a ser menos severa. En el 100 por ciento de los casos la densidad de la bacteria fue ligera
The cytotoxic and cancerous action of bile acids on gastric mucosa is a very interesting subject within the gastroduodenal diseases due to they are able to alter the membrane, the cellular metabolism, to give rise to a inflammatory process, to increase the proliferation, the cell apoptosis and the DNA damage, that according to its intensity and persistence, favor the appearance of failures and mutations in cell replication. With the discovery and characterization of Helicobacter pylori it is considered that according to its intensity and the time of persistence in gastric mucosa provokes damages with failures and cellular mutations. In this sense, a prospective and descriptive study was conducted in the Institute of Gastroenterology in patients presenting with duodenogastric and high total bile acids to know the association between the intestinal metaplasia and the presence or not of Helicobacter pylori. Metaplasia was present in the 48.7 percent of the 39 study patients, that there was a statistically significant association (p< 0.05) in Helicobacter pylori distribution in patients with and without intestinal metaplasia; that patients with duodenogastric reflux, despite of a histological lesion also had a greater frequency of negative results as regards the presence of Helicobacter pylori. In samples with histological diagnosis of severe and atrophic chronic gastritis, 75 percent, respectively, had Helicobacter pylori and in consequence, there was a significant association between presence or not of microorganism and the chronic gastritis intensity. Intestinal metaplasia location was higher in antral region (84.3 percent) and also with a higher ratio of microorganism positivity. In patients with duodenogastric reflux, presence of Helicobacter pylori don't seems to be associated with intense degrees of intestinal metaplasia, although the microorganism is present in all categories, but when there is not Helicobacter pylori, intestinal metaplasia to tend to ...
Assuntos
Humanos , Neoplasias Intestinais/patologia , Refluxo Duodenogástrico/complicações , Estudos Epidemiológicos , Epidemiologia Descritiva , Metaplasia/diagnóstico , Estudos Observacionais como Assunto , Estudos ProspectivosRESUMO
PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.