WorldWideScience

Sample records for bile reflux

  1. Bile Reflux

    Science.gov (United States)

    ... commonly used to soothe inflammation associated with GERD, gastritis, ulcers and other digestive problems. However, licorice contains ... Minn. Dec. 15, 2014. March 04, 2015 Original article: http://www.mayoclinic.org/diseases-conditions/bile-reflux/ ...

  2. Clinical pathology of primary bile reflux gastritis

    Directory of Open Access Journals (Sweden)

    Ping YAO

    2011-05-01

    Full Text Available Objective To analyze the clinical and pathological features of primary bile reflux gastritis(BRG.Methods Endoscopy,Helicobacter pylori(H.pylori detection,and histopathologic examination were performed in 218 patients with primary BRG(observed group and 236 patients with simple chronic gastritis(SCG,control group as identified by gastroscope in order to analyze the endoscopic abnormalities,the frequency of H.pylori infection,pathological features and scores of inflammation.Results The frequency of H.pylori infection was 39.0%(85/218 in the observed group,which was significantly lower than that in the control group [52.1%(123/236].The topographic abnormalities of the antral mucosa as detected by gastroscopy,i.e.,congestion,hemorrhagic spots,erosion were not significantly different between BRG and SCG patients(P > 0.05.The scores of chronic and active inflammation were higher in patients when H.pylori infection was present than in patients without H.pylori infection in both groups(P < 0.05.The scores of inflammation,the detection rates of the antral intestinal metaplasia,antral atrophy and atypical hyperplasia were all higher in observed group than in control group(P < 0.05.The incidence of lengthening of gastric pits,telangiectasis or interstitial edema in BRG patients was also significantly higher than those in SCG patients(P < 0.05.Conclusions Primary BRG shows features of chemical gastritis with a higher tendency toward mucosal atrophy,intestinal metaplasia and atypical hyperplasia.Gastropic examination and biopsy should be emphasized.

  3. The Histological and Immunohistochemical Aspects of Bile Reflux in Patients with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Andreas Nakos

    2011-01-01

    Full Text Available Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI. The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53 of patients with GERD and in 13% (2/15 of controls (=0.02. Severe esophageal lesions were significantly more common in BRI (+ patients (14/25 compared to BRI (− ones (=0.0049. Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  4. The histological and immunohistochemical aspects of bile reflux in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Nakos, Andreas; Kouklakis, Georgios; Pitiakoudis, Michail; Zezos, Petros; Efraimidou, Eleni; Giatromanolaki, Alexandra; Polychronidis, Alexandros; Liratzopoulos, Nikolaos; Sivridis, Efthimios; Simopoulos, Konstantinos

    2011-01-01

    Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI). The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53) of patients with GERD and in 13% (2/15) of controls (P = 0.02). Severe esophageal lesions were significantly more common in BRI (+) patients (14/25) compared to BRI (-) ones (P = 0.0049). Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  5. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors

    Institute of Scientific and Technical Information of China (English)

    Luigi Monaco; Antonio Brillantino; Francesco Torelli; Michele Schettino; Giuseppe Izzo; Angelo Cosenza; Natale Di Martino

    2009-01-01

    AIM: To determine the prevalence and characteristics of bile reflux in gastroesophageal reflux disease (GERD) patients with persistent symptoms who are nonresponsive to medical therapy.METHODS: Sixty-five patients (40 male, 25 female;mean age, 50 ± 7.8 years) who continued to report symptoms after 8 wk of high-dose proton pump inhibitor (PPI) therapy, as well as 18 patients with Barrett's esophagus, were studied. All patients filled out symptom questionnaires and underwent endoscopy,manometry and combined pH-metry and bilimetry.RESULTS: There were 4 groups of patients: 22 (26.5%)without esophagitis, 24 (28.9%) grade A-B esophagitis,19 (22.8%) grade C-D and 18 (21.6%) Barrett's esophagus. Heartburn was present in 71 patients (85.5%) and regurgitation in 55 (66.2%), with 44 (53%)reporting simultaneous heartburn and regurgitation. The prevalence of pathologic acid reflux in the groups without esophagitis and with grades A-B and C-D esophagitis was 45.4%, 66.6% and 73.6%, respectively. The prevalence of pathologic bilirubin exposure in these 3 groups was 53.3%, 75% and 78.9%, respectively. The overall prevalence of bile reflux in non-responsive patients was 68.7%. Pathologic acid and bile reflux was observed in 22.7% and 58.1% of non-esophagitic patients and esophagitic patients, respectively.CONCLUSION: The high percentage of patients poorly responsive to PPI therapy may result from poor control of duodenogastroesophageal reflux. Many patients without esophagitis have simultaneous acid and bile reflux, which increases with increasing esophagitis grade.

  6. Evaluation of bile reflux in HIDA images based on fluid mechanics.

    Science.gov (United States)

    Lo, Rong-Chin; Huang, Wen-Lin; Fan, Yu-Ming

    2015-05-01

    We propose a new method to help physicians assess, using a hepatobiliary iminodiacetic acid scan image, whether or not there is bile reflux into the stomach. The degree of bile reflux is an important index for clinical diagnosis of stomach diseases. The proposed method applies image-processing technology combined with a hydrodynamic model to determine the extent of bile reflux or whether the duodenum is also folded above the stomach. This condition in 2D dynamic images suggests that bile refluxes into the stomach, when endoscopy shows no bile reflux. In this study, we used optical flow to analyze images from Tc99m-diisopropyl iminodiacetic acid cholescintigraphy (Tc99m-DISIDA) to ascertain the direction and velocity of bile passing through the pylorus. In clinical diagnoses, single photon emission computed tomography (SPECT) is the main clinical tool for evaluating functional images of hepatobiliary metabolism. Computed tomography (CT) shows anatomical images of the external contours of the stomach, liver, and biliary extent. By exploiting the functional fusion of the two kinds of medical image, physicians can obtain a more accurate diagnosis. We accordingly reconstructed 3D images from SPECT and CT to help physicians choose which cross sections to fuse with software and to help them more accurately diagnose the extent and quantity of bile reflux.

  7. Milk /sup 99/Tcsup(m)-EHIDA test for enterogastric bile reflux

    Energy Technology Data Exchange (ETDEWEB)

    Mackie, C.R.; Wisbey, M.L.; Cuschieri, A. (Ninewells Hospital and Medical School, Dundee (UK))

    1982-02-01

    The study and clinical assessment of enterogastric bile reflux has been restricted for want of a simple non-invasive test for its detection and quantification. This paper describes such a test in which biliary excretion scintigraphy has been combined with a milk meal provocation. Two of 10 healthy volunteers studied showed probable reflux of approximately 5 per cent of total initial abdominal field activity. Among 73 patients studied, 37 patients showed definite reflux of up to 47 per cent. Reflux occurred in 19 of 22 post-gastric surgery patients and in 7 of 22 patients with peptic ulcer disease, gastritis or gastro-oesophageal reflux. None of 7 patients with 'non-specific' abdominal pain showed any reflux, but 11 of 22 patients with gallstone disease or previous cholecystectomy showed reflux of up to 35 per cent, including 9 of 11 patients with loss of gallbladder reservoir function.

  8. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  9. The effect of bile reflux on the intragastric pH

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Oblective To observe the effect of bile reflux on the intragastric pH. Methods We used ambulatory intragastric pH monitoring along with simultaneous Bilitec 2000 to measure the pH and absorbance of the mixed gastric juice diluted with bile with increasing bilirubin concentration in vitro and the yellow and clear gastric juice aspirated under endoscopy. In vivo,we studied 20 functional dispepsia patients for 24 h with simultaneous intragastric pH and bilirubin monitoring. Results In vitro dilutions,the absorbance value reached to 0. 900 while the concentration was only 20% ,but when the pH of the solution was more than 4,it′s concentration was already up to 60%. The mean absorbance of the yellow gastric juice(0. 348± 0. 131) was significantly higher than that of the clear juice (0. 008 ± 0. 003)(P<0.05). The pH of 80% yellow gastric juice was less than 4, the percentage was not significantly different from the clear samples (81%) (P>0. 05). The pH showed no correlation with the absorbance in the yellow and clear groungs. Eight of the 12 patients with the spontaneous nocturnal episcodes of alkalinization had simultaneous increase of absorbance,4 of the 8 subjects with no aikalinization had increase of absorbance. Gonclusion In some concentration,bile reflux affect little on the intragastric pH.

  10. Effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation

    Institute of Scientific and Technical Information of China (English)

    Chao Zhang; Zhan-Kui Liu; Pei-Wu Yu

    2004-01-01

    AIM: To investigate the effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation.METHODS: Concenration of bile acid and total bacterial counts (TBC) in gastric juice were measured in 49 patients with peptic ulcer before and after gastrectomy. One year after the operation, sample of gastric mucosa taken from all the patients were used for histological examination.RESULTS: The concentration of gastric bile acid was significantly increased in group B-Ⅰ, or B-Ⅱ and SV+A than that in group HSV (P<0.05-0.01). The abnormal histological changes in the remnant gastric mucosa were more common in the first 2 groups than in the last group.CONCLUSION: The type of gastrtectomy can affect bile reflux. The abnormal histological changes in the remnant gastric mucosa are closely related to the elevation of bile acid concentration and increase of TBC in gastric juice. HSV can effectively prevent bile reflux and keep the gastric physiological functions stable.

  11. 长期胆汁反流对大鼠胃黏膜的影响%Effects of Chronic Bile Reflux on the Gastric Mucosa of Rats

    Institute of Scientific and Technical Information of China (English)

    王学伟; 曹勤; 唐剑敏

    2012-01-01

    目的:建立模拟人体生理性胆汁反流的大鼠模型,观察长期胆汁反流对大鼠腺胃和前胃黏膜的影响.方法:13只Sprague-Dawley大鼠于十二指肠的胆总管开口下端截断,于大鼠前胃大弯侧行胃-空肠吻合,胆汁反流1年后,研究大鼠腺胃和前胃黏膜的病理特点,并采用免疫组化方法,研究胆汁反流对腺胃黏膜胃泌素表达的影响.结果:长期胆汁反流导致腺胃腺体显著增生、扩张,并出现异型增生和癌变,溃疡和肠化生相对少见;前胃鳞状上皮显著增生和角化,并出现角化珠和角化囊肿,肠化生相对少见,无溃疡和肿瘤发生.长期胆汁反流还可导致大鼠腺胃黏膜胃泌素表达显著增高.结论:长期胆汁反流可导致大鼠胃黏膜腺上皮和鳞状上皮显著增生,并发生异型增生和癌变,这可能与腺胃高胃泌素表达有关;肠化生和溃疡相对少见.%Objective:To establish a rat model that could simulate the physiological bile reflux in human beings, and to study the pathological effects of chronic bile reflux on the mucosa of glandular stomach and forestomach in rats. Methods:The duodenum of 13 Sprague -Dawley rats were transected below the opening of the common bile duct, and gastrojejunostomy was performed at the greater curvature of the forestomach. After the rats showed bile reflux for 1 year, the pathological features of the glandular stomach and forestomach mucosa were studied. The effect of bile reflux on gastrin expression in the glandular sto - mach mucosa was also studied by using immunohistochemistry. Results: Chronic bile reflux caused significant hyperplasia and expansion of gastric gland in the glandular stomach. Dysplasia and canceration also developed, whereas ulcer and intestinal metaplasia were relatively rare. In the forestomach, the squamous epithelium showed significant hyperplasia and keratinization along with keratin pearls and keratocysts, while intestinal metaplasia was relatively

  12. Effect of omeprazole on symptoms and ultrastructural esophageal damage in acid bile reflux

    Institute of Scientific and Technical Information of China (English)

    Carlo Calabrese; Anna Fabbri; Mauro Bortolotti; Giovanna Cenacchi; Scialpi Carlo; Desiree Zahlane; Mario Miglioli; Giulio Di Febo

    2005-01-01

    AIM: To value whether omeprazole could induce the healing of DIS and regression of symptoms in patients with DGER.METHODS: We enrolled 15 symptomatic patients with a pathological esophageal 24-h pH-metry and bilimetry.Patients underwent endoscopy and biopsies were taken from the distal esophagus. Specimens were analyzed at histology and transmission electron microscopy (TEM).Patients were treated with omeprazole 40 mg/d for 3 mo and then endoscopy with biopsies was repeated. Patients with persistent heartburn and/or with an incomplete recovery of DIS were treated for 3 more months and endoscopy with biopsies was performed.RESULTS: Nine patients had a non-erosive reflux disease at endoscopy (NERD) while 6 had erosive esophagitis (ERD). At histology, of the 6 patients with erosive esophagus,5 had mild esophagitis and 1 moderate esophagitis. No patients with NERD showed histological signs of esophagitis.After 3 mo of therapy, 13/15 patients (86.7%, P<0.01)showed a complete recovery of DIS and disappearance of heartburn. Of the 2 patients treated for 3 more months,complete recovery of DIS and heartburn were achieved in one.CONCLUSION: Three or 6 mo of omeprazole therapy led to a complete regression of the ultrastructural esophageal damage in 86.7% and in 93% of patients with DGER, NERD and ERD respectively. The ultrastructural recovery of the epithelium was accompanied by regression of heartburn in all cases.

  13. 幽门螺杆菌感染与胆汁反流的临床关系%Clinical Relationship between Helicobacter Pylori Infection and Bile Reflux

    Institute of Scientific and Technical Information of China (English)

    宋敏

    2016-01-01

    Objective:To explore the clinical relationship between infection of helicobacter pylori and bile reflux.Method:256 patients underwent gastroscopy in our hospital from January 2014 to June 2014 were selected,according to the results of gastroscopy,they were divided into A group and B group, the patients of A group with bile reflux,while the patients of B group without bile reflux.All patients underwent rapid urease test, and according to the judgement of the detection with Helicobacter pylori infection,positive rate of Helicobacter pylori infection in two groups were compared.Result:There were 28 cases in the A group and the positive rate of helicobacter pylori was 32.1%. However,there were 228 cases in the B group and the positive rate of helicobacter pylori was 67.1%, the difference was statistically significant(P<0.01).Conclusion:The refluent bile can inhibit or kill helicobacter pylori.%目的:探讨幽门螺杆菌感染与胆汁反流的临床关系。方法:选取2014年1-6月于笔者所在医院行胃镜检查的256例患者,根据胃镜检查结果,分为A组、B组,A组患者均存在胆汁反流,B组患者无胆汁反流。所有患者均行快速尿素酶试验检测,并根据其检测结果判定有无幽门螺杆菌感染,比较两组患者幽门螺杆菌感染的阳性率。结果:A组28例,幽门螺杆菌阳性率为32.1%,B组228例,幽门螺杆菌阳性率为67.1%,两组比较差异有统计学意义(P<0.01)。结论:反流的胆汁可能能够抑制或杀灭幽门螺杆菌。

  14. 胆胃舒颗粒治疗胆汁反流性胃炎临床研究%Danweishu Granule in the Treatment with Bile Reflux Gastritis

    Institute of Scientific and Technical Information of China (English)

    谢刚兆; 许东升; 党中勤

    2012-01-01

    Objective:Observe the clinical curative effect of Danweishu granule in the treatment of biliary and stomach stagnated heat type bile reflux gastritis. Methods: 120 cases were randomly divided into the treatment group and control group,60 cases of each group. The treatment group was given Danweishu granule and the control group was given Domperidone Maleate Tablets, Ranitidine and ulcer 1mm,4 weeks as one course of treatment. Results:In the treatment group:43 cases recovery,8 cases markedly improved,4 cases effective , 5 cases ineffective, the effective rate was 91. 7% . In the control group: 33 cases recovery ,4 cases markedly improved, 2 cases etfec-tive.,21 cases ineffective, the effective rate was 65.0%. Compared the effective power, the difference was statistically significant(P < 0. 05 ). Conclusion: Danweishu granule can obviously improve clinical symptoms of bile reflux gastrilis and gastroscope index, prevent bile regurgitation and improve pathological changes of stomach lining with safe, reliable and easy to accept.%目的:观察胆胃舒颗粒治疗胆胃郁热型胆汁反流性胃炎的临床疗效.方法:120例患者随机分为治疗组60例和对照组60例.治疗组采用三九免煎中药胆胃舒颗粒口服,对照组口服多潘立酮片、雷尼替丁、硫糖铝,两组均连续治疗4周为1疗程.结果:治疗组痊愈43例,显效8例,有效4例,无效5例,有效率为91.7%.对照组痊愈33例,显效4例,有效2例,无效21例,有效率为65.0%.两组有效率比较,差异有统计学意义(P<0.05).结论:胆胃舒颗粒能明显改善胆汁反流性胃炎患者临床症状及胃镜学指标,阻止胆汁反流,改善胃黏膜的病变.

  15. 胆汁反流对胃内pH值的影响%The effect of bile reflux on the intragastric pH

    Institute of Scientific and Technical Information of China (English)

    龚均; 张茹; 罗金燕; 朱有玲; 王学勤

    2001-01-01

    Objective To observe the effect of bile reflux on theintragastric pH.Methods We used ambulatory intragastric pH monitoring along with simultaneous Bilitec 2000 to measure the pH and absorbance of the mixed gastric juice diluted with bile with increasing bilirubin concentration in vitro and the yellow and clear gastric juice aspirated under endoscopy.In vivo,we studied 20 functional dispepsia patients for 24 h with simultaneous intragastric pH and bilirubin monitoring.Results In vitro dilutions,the absorbance value reached to 0.900 while the concentration was only 20%,but when the pH of the solution was more than 4,it′s concentration was already up to 60%. The mean absorbance of the yellow gastric juice(0.348±0.131) was significantly higher than that of the clear juice(0.008±0.003) (P<0.05).The pH of 80% yellow gastric juice was less than 4, the percentage was not significantly different from the clear samples (81%) (P>0.05). The pH showed no correlation with the absorbance in the yellow and clear groungs. Eight of the 12 patients with the spontaneous nocturnal episodes of alkalinization had simultaneous increase of absorbance, 4 of the 8 subjects with no alkalinization had increase of absorbance.Conclusion In some concentration,bile reflux affect little on the intragastric pH.%目的 观察胆汁反流对胃内pH值的影响。方法 对不同浓度胆汁和胃液的混合液及内镜下抽取的黄染和无黄染胃液,测定pH和胆红素吸光值;20例功能性消化不良患者同步监测24h胃内pH和胆红素吸光值。结果 胆汁浓度为20%时吸光值已达0.900,而pH仍在1.0左右;浓度为60%时pH始上升达4以上。黄染组pH<4的病例占80%,吸光值为0.348±0.131,无黄染组pH<4的病例占81%,吸光值为0.008±0.003,pH和吸光值之间无明显相关性。12例有夜间自发性碱波者8例同步有胆红素吸光值升高,8例无夜间自发性碱波者4例有胆红素吸光值升高。结论 在一定

  16. Clinical study of influence of bile reflux on gastric mucosa of different sexual patients%胆汁反流对不同性别患者胃黏膜影响的临床研究

    Institute of Scientific and Technical Information of China (English)

    常丽丽; 来文辉; 杨慧君; 张志红

    2015-01-01

    、胃溃疡发生率男性高于女性,差异有统计学意义(P<0.05);炎症+肠化+胃小凹增生、炎症+异型增生、肠化+异型增生、肠化+胃小凹增生、胃炎性增生性息肉、胃底腺息肉、胃癌、HP 感染二者之间检出率差异无统计学意义(P>0.05)。结论胆汁反流可造成胃黏膜各种损害,男性和女性之间胆汁反流高峰年龄、相关危险因素、内镜和病理表现有一定的差异;HP 感染发生率无性别差异。%Objective To investigate the influence of bile reflux on gastric mucosa of different sexual patients. Methods From January 2014 to January 2015, 664 patients with gastric bile reflux were selected through gastroscopy in the first hospital of Shijiazhuang city and their gender, age, hobby (include diet, alcohol, tobacco), past medical history, anxiety and/or depression state evaluation results were recorded, meanwhile endoscopic manifestation, pathological results and HP test results were observed; the difference of bile reflux peak age, related risk factors, the effects on the gastric mucosa between male patients and female patients were comparatively analyzed. Results (1) Among 664 patients with gastric bile reflux, male patients were 305 cases, which detection rate was 6.75%. meanwhile female patients were 359 cases, which detection rate was 7.02%; the difference between male and female was statistically significant(P0.05); before 70 years, whether the patients were male or female, bile reflux rate increased along with aging; after the 70 years old, bile reflux rate decreased along with aging; male reflux detection peak was at the age of 51 to 60 years, female reflux detection peak was at the age of 41 to 50 years; female bile reflux peak age was earlier than male’s (P0.05). (5) Pathological examination: the incidence of inflammation, inflammation accompany with hyperplasia of gastric pit in female was more than in male; the difference was statistically

  17. 儿童胆汁反流性胃炎与幽门螺杆菌感染的关系%Correlation between Bile Reflux Gastritis and Helicobacter Pylori Infection in Children

    Institute of Scientific and Technical Information of China (English)

    赵煜; 张书红; 刘风林; 李娟; 李妍

    2014-01-01

    目的:探讨儿童胆汁反流性胃炎(BRG)与幽门螺杆菌(HP)感染之间的关系。方法258例胆汁反流性胃炎患儿为BRG组,1749例无胆汁反流的胃黏膜炎症患儿为对照组,根据病情分级(轻度、中度、重度)将BRG患儿分为3组,根据胆汁反流程度(Ⅰ度、Ⅱ度、Ⅲ度)将BRG患儿再分为3组,对各组间HP感染率进行分析。结果 BRG组HP感染率为46.12%(119/258),高于对照组的34.02%(595/1749),差异有统计学意义。BRG组中病情轻度、中度和重度患者的HP感染率分别为40.86%(38/93)、45.53%(56/123)和59.52%(25/42),差异无统计学意义(χ2=4.089, P>0.05)。BRG组中按胆汁反流Ⅰ度、Ⅱ度和Ⅲ度患者的阳性率分别为37.32%(53/142)、53.68%(51/95)和71.43%(15/21),差异有统计学意义(χ2=12.022,P<0.01)。结论在儿童患者中HP感染是BRG的致病因素之一,随HP感染率增高,胆汁反流程度加重。%Objective To assess the relationships between bile reflux gastritis (BRG) and Helicobacter pylori infec-tion in children. Methods A total of 258 BRG cases were included in BRG group and 1 749 gastric mucosal inflammation cases without bile reflux were used as control group. Children with BRG were divided into three groups according to the dis-ease classification and they were also sub-divided into three groups according to the bile reflux indexing. The infection rates of Helicobacter pylori were analyzed in different groups. Results Compared to control group (34.02%), the infection rate of Helicobacter pylori was significantly higher in BRG group (46.12%). The infection rates of Helicobacter pylori infection were 40.86%(38/93), 45.53%(56/123) and 59.52%(25/42) in patients with mild, moderate and severe infections. There was no significant difference between them (χ2=4.089, P>0.05). The positive rates of Helicobacter pylori infection were 37.32%(53/142), 53.68%(51/95) and 71

  18. Clinical Observation of Terra Merita Stomach- Regulating Decoction on Treating Bile Reflux Gastritis%郁金和胃汤治疗胆汁反流性胃炎临床研究

    Institute of Scientific and Technical Information of China (English)

    饶洪

    2011-01-01

    目的:观察郁金和胃汤治疗胆汁反流性胃炎的疗效.方法:门诊选取胆汁反流性胃炎115例,按随机数字表法分为两组,运用郁金和胃汤治疗77例为治疗组,用西药治疗的38例为对照组.结果:治疗组治愈率58.44%,有效率93.51%;对照组治愈率23.68%,有效率71.05%.两组比较有显著性差异(P<0.05).结论:郁金和胃汤具有疏肝利胆、清热化湿、健脾和胃的作用,治疗胆汁反流性胃炎疗效显著.%Objective: To observe the clinical observation of terra merita Stomach - Regulating Decoction to treat bile reflux gastritis.Methods: All 115 outpationt of terra merita stomach were randomly divided into two groups. 77 cases of patients were treated with erra merita Stomach - Regulating Decoction, compared to 45 cases of patients was treated with western medicine. Observing the clinical curative effect of two groups. Results: The cure rate is 58.44% in treatment team and 23.68% in control team, total effective rate is 93.51% in treatment team and and 71.05 % in control team. There is significant difference in two teams ( P < 0. 05 ). Conclusion: Erra merita Stomach- Regulating Decoction paly a role in disperse the depressed liver- energy and cholagogue, clean heat dissipating dampness and invigorate the spleen and regulating stomach, the curative effect of treating on bile reflux gastritis is striking.

  19. Amylase activity in human bile.

    Science.gov (United States)

    Donaldson, L A; Joffe, S N; McIntosh, W; Brodie, M J

    1979-03-01

    The mean amylase level in 42 human bile samples was 154 IU/l and there was no significant difference in the amylase activity of 32 paired serum and bile samples. Estimation of the amylase thermolability of bile showed it to be similar to that of serum. This suggests that the amylase activity in bile may have filtered through the liver from the hepatic circulation rather than refluxed from the pancreatic duct. The presence of amylase in human bile provides further evidence that the liver might have a role in the regulation of serum amylase.

  20. Meta-analysis of the efficacy of the hydrotalcite treating bile reflux gastritis%铝碳酸镁治疗胆汁反流性胃炎效果的Meta分析

    Institute of Scientific and Technical Information of China (English)

    罗金键

    2014-01-01

    目的 评价铝碳酸镁(商品名:达喜)治疗胆汁反流性胃炎的疗效.方法 采用Cochrane系统评价的方法,检索Medline、康健循证医学知识仓库西文生物医学文献数据库、中国生物医学文献数据库(CBM disk)、维普信息数据库、中国医院数字图书馆、万方医学文献数据库,评价纳入研究的方法学质量,提取有效数据.对照组为对症支持治疗;研究组采用对症支持治疗联合铝碳酸镁1.0g,3次/d,餐后嚼碎服.采用RevMan4.2软件进行Meta分析.结果 共纳入11项随机临床对照研究(770例患者).Meta分析结果显示:研究组与对照组相比,治疗胆汁反流性胃炎临床症状有效率差异有统计学意义,合并效应量比值比为 6.18(95%置信区间:3.89 ~9.81),Z值为7.72,P<0.01;胆汁反流消失率差异有统计学意义,合并效应量比值比为4.81(95%置信区间:3.25 ~7.12),Z值为7.85,P<0.01;发表偏倚分析显示散点多集中分布在图形左侧,明显不对称,存在发表偏倚.结论 本研究结果提示目前研究不支持铝碳酸镁治疗胆汁反流性胃炎临床症状有效率及胆汁反流消失率高于非铝碳酸镁治疗者,有必要补充高质量的文献后重新进行Meta分析,进一步评价,急需开展高质量的多中心、大样本、前瞻性、随机、双盲临床试验.%Objective To evaluate the efficacy of the hydrotalcite treating bile reflux gastritis.Methods Data from medline,Health knowledge of evidence based medicine warehouse Western biomedical literature database,Wanfang database,CBM disk,VIP information database and china hospital digital library were searched and the references of related studies were checked.The textbooks and meeting reports related to hydrotalcite were manually searched.The quality of included studies was evaluated.Data was extracted into a specially designed extraction form.Control group adopted symptomatic and supportive treatment; study group had symptomatic and

  1. 浅析胆胃康胶囊治疗胆汁反流性胃炎的临床观察%Clinical Observation of Bile Reflux Gastritis Treated with Danweikang Capsules

    Institute of Scientific and Technical Information of China (English)

    杨洪英; 仝瑞民; 段复华; 周全; 余泽云

    2015-01-01

    目的:对胆胃康胶囊治疗胆汁反流性胃炎的临床有效性进行分析,并考察其安全性。方法使用胆胃康胶囊与荆花胃康胶囊对照治疗,对胁肋疼痛、胃脘痛、呕吐、胃反、口苦烧灼症进行了临床对照研究。结果胆胃康胶囊治疗胆汁反流性胃炎的有效率为92.7%,荆花胃康胶囊有效率为73.9%,两组比较,Z=7.452,P=0.000。胆胃康组治疗前后比较,WBC平均下降1.62×1012个/L, t=3.647,P=0.001。N平均下降17.04个百分点,t=6.254,P=0.000。B超检查,阴性率51.1%,χ2=228.593,P=0.000。胃镜检查,胃黏膜炎症分级:0、+级分别增加46例、34例,++、+++级分别减少1例、79例。Z=8.456,P=0.000。结论从远期疗效看,胆胃康胶囊具有多层面、靶点治疗胆汁反流性胃炎的优势,其作用优于荆花胃康胶囊。%Objective To analyze the clinical effectiveness on bile reflux gastritis treated with dan-weikang capsules and investigate its safety. Methods Danweikang capsules and jinhuaweikang capsules were taken for the clinical controlled study in treatment of hypochondriac pain,epigastric pain,vomiting,acid reflex,bitter taste in the mouth and burning sensation in the stomach. Results The effective rate of danwei-kang capsules was 92. 7% in treatment of bile reflux gastritis and that of jinhuaweikang capsules was 73. 9%. In comparison of the two groups,Z=7. 452 and P=0. 000. In danweikang group,before and after treatment,WBC was reduced to 1. 62 × 1012 cells/L averagely,t =3. 649,P =0. 001. N was reduced by 17. 04% averagely,t=6. 254,P=0. 000. In ultrasonic B test,the negative rate was 51. 1%,χ2 =228. 593,P=0. 000. In gastroscopy,for gastric mucosa inflammation grading:46 cases and 34 cases were graded as 0 and + respectively,and 1 case and 79 cases were graded as ++ and +++. Z=8. 456,P=0. 000. Conclu-sion For the long-term efficacy,danweikang capsules present the multiple and target-point advantages in

  2. 铝碳酸镁片联合莫沙必利治疗胆汁反流性胃炎疗效的Meta分析%Meta Analysis of Hydrotalcite Tablets Combined with Mosapride for Treating Bile Reflux Gastritis

    Institute of Scientific and Technical Information of China (English)

    谢日升; 曾光

    2016-01-01

    目的:利用循证医学方法,系统评价铝碳酸镁片联合莫沙必利治疗胆汁反流性胃炎的疗效及上腹部饱胀不适缓解率。方法通过计算机检索中文数据库,收集铝碳酸镁片联合莫沙必利片治疗胆汁反流性胃炎临床研究。按纳入及排除标准筛选文献,由2位评价者筛选文献、提取资料并行方法学质量评价,数据分析采用Revman 5.1软件,通过检验异质性,并根据异质性结果选择相应的效应模型,最后绘制漏斗图评定有无发表偏倚。结果治疗组临床治疗有效率[ RR=1.20,95% CI (1.15,1.25)]、上腹饱胀不适缓解率[ MD=-0.38,95% CI (-0.71,-0.05)]方面均优于对照组,两组差异均有统计学意义。结论现有证据表明,铝碳酸镁片联合莫沙必利在治疗胆汁反流性胃炎上有一定疗效。%Objective To systematically evaluate the efficacy and improvement of bloating remission rate of Hydrotalcite Tablets combined with mosapride in the treatment of bile reflux gastritis. Methods The data of the Chinese database were retrieved for clinical trials of hydrotalcite combined with mosapride in treating bile reflux gastritis. According to inclusion and exclusion criteria, 2 reviewers performed the screening, data extraction, and methodological quality assessment. Revman 5. 1 software was used to perform data analysis, by checking the heterogeneity and heterogeneity of the results based on selection the corresponding effects model, to finally draw the funnel for as-sessing whether the publication bias. Results According to the results of meta-analyses, the trial groups were better than the control groups in terms of overall efficacy [ RR=1. 20, 95% CI:1. 15, 1. 25 ] , rate of bloating remission [ MD= -0. 38, 95% CI: -0. 71, -0. 05 ] , with statistically significant difference. Conclusion The results show that Hydrotalcite Tablets combined with mosapride is effective in the treatment of

  3. Diagnosis and clinical implications of pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Hajime Anjiki; Naoto Egawa; Masanao Kurata; Goro Honda; Kouji Tsuruta

    2008-01-01

    The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice.A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall,as occurs in pancreaticobiliary maljunction (PBM);in such cases,sphincter action does not functionally affect the junction.As the hydropressure within the pancreatic duct is usually greater than in the bile duct,pancreatic juice frequently refluxes into the biliary duct (pancreatobiliary reflux) in PBM,resulting in carcinogenetic conditions in the biliary tract.Pancreatobiliary reflux can be diagnosed from elevated amylase level in the bile,secretinstimulated dynamic magnetic resonance cholangiop ancreatography,and pancreatography via the minor duodenal papilla.Recently,it has become obvious that pancreatobiliary reflux can occur in individuals without PBM.Pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without PBM.Since few systemic studies exist with respect to clinical relevance and implications of the pancreatobiliary reflux in individuals with normal pancreaticobiliary junction,further prospective clinical studies including appropriate management should be performed.

  4. Clinical Research of Combined Treatment of Traditional Chinese Medicine and Western Medicine in the Treatment of Bile Reflux Gastritis%中西医结合治疗胆汁反流性胃炎临床研究

    Institute of Scientific and Technical Information of China (English)

    郭爱莲

    2012-01-01

    Objective: To observe the clinical effect of combined treatment of traditional Chinese medicine and "western medicine in the treatment of bile reflux gastritis. Methods: 128 cases were randomly divided into the treatment group and control group on average,64 cases of each group. The control group was given western medicine (Ranitidine Capsules and Dompcridonc tablets).The treatment group was given Lidantiaoganjianweitongfufang based on the control group,28 days as a course of treatment. Observe clinical curative effect, adverse reactions and recurrence. Results:The effective rate was 96. 87% in treatment group and 68. 75% in control group, the difference was statistically significant (P<0.01). Both two groups had no obvious adverse reaction. The difference of recurrence rate was statistically significant after 2 months follow-up(P <0. 01). Conclusion: Combined treatment of traditional Chinese medicine and western medicine in the treatment of bile reflux gastritis has remarkable clinical effect.%目的:观察中西医结合治疗胆汁反流性胃炎的临床疗效.方法:将128例患者随机平均分为治疗组与对照组,每组各64例.对照组给予西药(雷尼替丁胶囊、多潘立酮片)治疗;治疗组在对照组基础上加服中药自拟利胆调肝健胃通腑方,28 d为1疗程,观察两组临床疗效、不良反应及复发情况.结果:治疗组有效率为96.87%,对照组有效率为68.75%,两组有效率比较,差异有统计学意义(P<0.01);两组均未发现明显不良反应;2个月后随访,复发率比较,差异有统计学意义(P<0.01).结论:中西医结合治疗胆汁反流性胃炎临床效果显著.

  5. Gastroesophageal reflux.

    Directory of Open Access Journals (Sweden)

    Yanet Hidalgo Marrero

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

  6. Vesicoureteral reflux and reflux nephropathy

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.

    Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incontinence of the ureterovesical junction, mostly affecting a pediatric population. During micturition cystourethrography (MCU) reflux into the kidney - intrarenal reflux (IRR) - is occasionally seen. In areas with IRR the kidney surface may subsequently be depressed and the papillae retracted (reflux nephropathy (RN)). VUR may lead to hypertension and/or end-stage renal failure. Most commonly, VUR is discovered during evaluation for urinary tract infection, but it may also be present in patients with hypertension, toxemia of pregnancy, chronic renal failure and proteinuria, and it may be found in siblings of patients with VUR. For the time being VUR is demonstrated at radiographic MCU, whereas RN is diagnosed by demonstration of focal scars and of abnormal parenchymal thickness at urography. In children with VUR and no abnormalities of calyces or parenchymal defects standardized measurement of the parenchymal thickness at three sites may identify kidneys which are likely to develop focal scars. Quantitation of focal scarring should be performed in connection with a measure of the overall kidney size. The occurrence of IRR is dependent of the papillary morphology, intrapelvic pressure and urine flow. There may be an important relationship between renal ischemia and IRR in producing a 'vicious circle of deleterious effects' which, combined with parenchymal extravasation, may lead to RN. Treatment of VUR includes medical and surgical management. Since renal scarring may occur in infancy, prevention should focus on infants and young children. Infants and young children with severe VUR may have normal urograms. Therefore a MCU should also be performed, preferably with the recommended standardized technique. (orig.).

  7. Comparative evaluation of scintigraphy and upper gastrointestinal tract endoscopy for detection of duodenogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Mittal, B.R.; Ibrarullah, Mohammad; Agarwal, D.K.; Maini, Atul; Ali, Wasif; Sikora, S.S.; Das, B.K. (Sanjay Gandhi Postgraduate Inst. of Medical Sciences (India))

    1994-08-01

    Duodenogastric reflux, the reflux of duodenal bile into stomach, when suspected clinically requires an objective evaluation for proper management. In this study hepatobiliary scintigraphy in 91 patients of different clinical conditions was evaluated for presence of duodenogastric reflux. Upper gastrointestinal endoscopy was also performed in 44 of these patients. On scintigraphy duodenogastric reflux was present in 26 (29%) of 91 patients. Upper gastrointestinal endoscopy revealed presence of refluxed bile in the stomach in 12 (27%) of 44 patients. In the same groups of patients scintigraphy detected reflux in 18 (41%) of 44 patients. This shows that hepatobiliary scintigraphy is superior to upper gastrointestinal endoscopy in detection of duodenogastric reflux and also has the advantage of being non-invasive and physiological. (author).

  8. Gastric Reflux on Routine Tc-99m DISIDA hepatobiliary Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Wook; Lee, Heon Young [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1995-06-15

    Reflux of bile and digestive enzymes from the small bowel and duodenum into stomach has been observed in patients with various gastroduodenal diseases. Tc-99m iminodiacetic acid derivatives hepatobiliary scan has been used as a noninvasive method to detect duodenogastric reflux. Sometimes, gastric reflux can be observed incidentally on routine Tc-99m DISA hepatobiliary scintigraphy. To evaluate the clinical meaning of gastric reflux on routine Tc-99m DISIDA hepatobiliary scan, we analyzed 36 patients showed gastric reflux incidentally on the routine Tc-99m-DISIDA hepatobiliary scintigraphy from December 1991 to June 1995 in Chungnam National University Hospital. The results were as follows: 1) The gastric reflux was observed in 2.3% of 1,553 cases of routine Tc-99m DISIDA Hepatobiliary scintigraphy for 43 months. 2) Nineteen percent of patients with gastric reflux had the past medical history of operations on stomach or biliary system. And that history was more prevalent in patients with reflux than those without reflux, significantly (p<0.01). 3) On fiberoptic gastroduodenpscopic examination, 87% of the patients with gastric reflux had the gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, duodenal cancer and ampullary diverticulosis. We thought that the gastric reflux can be observed considerably in patients without any operation history on stomach or duodenum, although the operation history is more prevalent in patients with gastric reflux than those without reflux, significantly and most of patients with gastric reflux on routine Tc-99m DISIDA scan has various gastroduodenal diseases.

  9. Reflux oesophagitis in the rat : the damaging action of pancreatic juice : the development of mural fibrosis

    NARCIS (Netherlands)

    H.J. Mud

    1981-01-01

    textabstractThe results obtained in a recent study of surgically induced reflux oesophagitis in rats (Kranendonk, 1980) prompted the study presented in this thesis. In the randomized study by Kranendonk (1980) the reflux of pancreatic juice invariably resulted in oesophagitis; admixture of bile and/

  10. Gallbladder carcinoma associated with pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa; Bunsei Nobukawa

    2006-01-01

    AIM: To detect the patients with and without pancreaticobiliary maljunction who had pancreatobiliary reflux with extremely high biliary amylase levels.METHODS: Ninety-six patients, who had diffuse thickness (>3 mm) of the gallbladder wall and were suspected of having a pancreaticobiliary maljunction on ultrasonography, were prospectively subjected to endoscopic retrograde cholangiopancreatography, and bile in the common bile duct was sampled. Among them,patients, who had extremely high biliary amylase levels (>10000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients with and without pancreaticobiliary maljunction were examined.RESULTS: Seventeen patients had biliary amylase levels in the common bile duct above 10000 IU/L, including 11 with pancreaticobiliary maljunction and 6 without pancreaticobiliary maljunction. The occurrence of gallbladder carcinoma was 45.5% (5/11) in patients with pancreaticobiliary maljunction, and 50% (3/6) in those without pancreaticobiliary maljunction.CONCLUSION: Pancreatobiliary reflux with extremely high biliary amylase levels and associated gallbladder carcinoma could be identified in patients with and without pancreaticobiliary maljunction, and those patients might be detected by ultrasonography and bile sampling.

  11. 雷贝拉唑和铝碳酸镁治疗胆囊切除术后伴胆汁反流性胃炎作用比较分析%Effect comparative analysis of rabeprazole and hydrotalcite in the treatment of gastritis caused by cholecystectomy combined bile reflux

    Institute of Scientific and Technical Information of China (English)

    赖祥桂

    2015-01-01

    目的:比较雷贝拉唑和铝碳酸镁治疗胆囊切除术后伴胆汁反流性胃炎的临床疗效。方法:2012年11月-2013年11月收治胆汁反流性胃炎患者96例,随机分成雷贝拉唑组、铝碳酸镁组、雷贝拉唑联合铝碳酸镁组3组,每组32例。雷贝拉唑组采用雷贝拉唑药物治疗,铝碳酸镁组采用铝碳酸镁咀嚼片治疗,联合用药组采用雷贝拉唑与铝碳酸镁联合治疗。对比3组患者的治疗效果与不良反应发生情况。结果:雷贝拉唑组的治疗总有效率56.25%,铝碳酸镁组的治疗总有效率53.13%,联合用药组治疗总有效率93.75%,3组比较疗效差异具有统计学意义(P<0.05)。雷贝拉唑组的不良反应发生率12.5%,铝碳酸镁组的不良反应发生率9.375%,联合用药组的不良反应发生率3.125%,3组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论:雷贝拉唑联合铝碳酸镁治疗胆囊切除术后伴胆汁反流性胃炎能有效提高患者治疗效果,改善患者临床症状,降低不良反应发生率,值得各医疗机构在临床上大力推广应用。%Objective:To compare the curative effect of rabeprazole and hydrotalcite in the treatment of gastritis caused by cholecystectomy combined bile reflux.Methods:96 cases of patients with gastritis caused by cholecystectomy combined bile reflux from November 2012 to November 2013 were randomly divided into the rabeprazole group,the hydrotalcite group and the rabeprazole joint hydrotalcite group,with 32 cases in each group.The rabeprazole groups were treated with rabeprazole;the hydrotalcite group were treated with hydrotalcite group;the rabeprazole joint hydrotalcite group were treated with rabeprazole joint hydrotalcite.The therapeutic effect and adverse reactions of the three groups were compared.Results:The total effective rate of the rabeprazole group was 56.25%;that of the hydrotalcite group was 53.13%;that of the rabeprazole

  12. Laryngopharyngeal reflux in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Yung-Chih Lai; Pa-Chun Wang; Jun-Chen Lin

    2008-01-01

    AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and dis-close factors contributing to the development of LPR.METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled.ings for the diagnosis of LPR. We used validated ques-tionnaires to identify the presence of laryngopharyn-geal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.RESULTS: The prevalence rate of LPR in studied sub-jects with reflux esophagitis was 23.9%. Age, hoarse-ness and hiatus hernia were factors significantly as-sociated with LPR. In 23 patients with a hiatus hernia,the group with LPR was found to have a lower trend of esophagitis grading.CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagi-tis. The importance of hiatus hernia deserves further study.

  13. Reflux symptom questionnaire in the diagnosis of reflux oesophagitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li; MENG Ling-mei; ZHANG Dong-hong; HUANG Shu-mei; QU Xue-fu; ZHOU Li-ya; LIN San-ren; DING Shi-gang; HUANG Yong-hui; GU Fang; LI Yuan; ZHANG Jing; YAN Xiu-e

    2007-01-01

    @@ Reflux symptom questionnaire (RSQ) is a useful tool in epidemiological study of gastroesophageal reflux disease (GERD),(1,2) but the correlation between RSQ and the refluX oesophagitis (RE) is still unclear.

  14. Familial vesicoureteral reflux

    OpenAIRE

    朴, 勺; 新井, 豊; 友吉, 唯夫; 吉田, 修

    1983-01-01

    Primary vesicoureteral reflux was seen in 2 siblings in a family of 5 (1 daughter and 2 sons). Voiding cystogram of elder sister, who complained of fever and backache, showed bilateral reflux at the age of 6. Left reflux disappeared soon but right reflux persisted. Right antireflux operation was performed at the age of 9, but right renal function deteriorated gradually. Right nephrectomy was done at the age of 12 because of persistent pyuria and renal stones. The second case was her younger b...

  15. [Reflux nephropathy in absence of obvious vesicoureteral reflux].

    Science.gov (United States)

    Vino, L; Pedrolli, A; Portuese, A; Dal Cerè, M; Pizzini, C; Sinaguglia, G; Fanos, V

    2000-01-01

    Although the majority of patients with vesicoureteric reflux presents DMSA scan alterations, parenchimal renal scars are found also in children without vesicoureteric reflux. Two clinical cases of reflux nephropathy without evidence of reflux are presented. Several explanations could be advocated to justify this picture, including haematogenous source of infection, inadequate timing and/or procedure of cystouretrography, intermittency of reflux, ascending bacteria, previous presence of reflux, and appearance of controlateral reflux during the natural history of a monolateral documented reflux. Tailored diagnostic and therapeutic strategy should discussed for each patient.

  16. The Law of Reflux

    OpenAIRE

    Sproul, Michael

    2010-01-01

    The law of reflux is explained using an example of backed money. In the example, government-issued money is backed by the government’s assets (mainly taxes receivable) while bank-issued money is backed by the bank’s assets. The value of both kinds of money is determined by the amount of backing held per unit of money issued. The example shows that reflux maintains money’s value, not by assuring that excessive issues of money reflux to their issuers, but by providing people with access to the ...

  17. Refractory gastroesophageal reflux disease

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  18. A Fiber Optic System For The Detection Of Entero-Gastric Reflux

    Science.gov (United States)

    Falciai, R.; Baldini, F.; Conforti, G.; Cosi, F.; Scheggi, A. M...; Bechi, P.

    1989-01-01

    The study and the development of an optical fiber sensor for entero-gastric and non-acid gastro-esophageal reflux is described. The working principle, based on the spectrophotometric properties of the bile, which constitutes the main part of the reflux, differs from the traditional measurement method, based on pH monitoring. The measuring apparatus is described as well as experimental "in vitro" and preliminary "in vivo" tests are reported.

  19. Effect of pancreatic biliary reflux as a cofactor in cholecystitis.

    Science.gov (United States)

    Amr, Abdel Raouf; Hamdy, Hussam Mohamed; Nasr, Magid Mahmoud; Hedaya, Mohammed Saied; Hassan, Ahmed Mohamed Abdelaziz

    2012-04-01

    This study assessed the effect of pancreatico-biliary reflux (PBR) as co-factor in the process of chronic cholecystitis by measurement of the levels of active pancreatic enzyme amylase in gallbladder bile and serum of patients undergoing cholecystectomy. Pancreatic Amylase levels in bile from the gallbladder and serum were measured during surgery in 68 patients with chronic calcular cholecystitis subjected to elective open or laparoscopic cholecystectomy in the National Hepatology and Tropical Medicine Research Institution and Theodore Bilharz Research Institute. Bile amylase was detected in 64 patients (94.1%) indicating pancreatico-biliary reflux. Biliary amylase level ranged from 20-50 IU/L in 42 patients (61.76%), below 20 IU/l in 14 patients (20.59%), over 50 IU/L in 8 patients (11.76%) and undetectable in two patients. According to gallbladder bile amylase, the incidence of Occult PBR in patients operated upon for chronic calcular cholecystitis was 94.1%. The reason should be clarified by further research and wider scale study. Routinely investigating biliary amylase in every patient having cholecystitis can be a method for early detection of precancerous lesions.

  20. Gastroesophageal reflux disease: A review of surgicaldecision making

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Gastroesophageal reflux disease (GERD) is a verycommon disorder with increasing prevalence. It isestimated that up to 20%-25% of Americans experiencesymptoms of GERD weekly. Excessive reflux ofacidic often with alkaline bile salt gastric and duodenalcontents results in a multitude of symptoms for thepatient including heartburn, regurgitation, cough, anddysphagia. There are also associated complications ofGERD including erosive esophagitis, Barrett's esophagus,stricture and adenocarcinoma of the esophagus. Whilefirst line treatments for GERD involve mainly lifestyleand non-surgical therapies, surgical interventions haveproven to be effective in appropriate circumstances.Anti-reflux operations are aimed at creating an effectivebarrier to reflux at the gastroesophageal junction andthus attempt to improve physiologic and mechanicalissues that may be involved in the pathogenesis ofGERD. The decision for surgical intervention in thetreatment of GERD, moreover, requires an objectiveconfirmation of the diagnosis. Confirmation is achievedusing various preoperative evaluations includingambulatory pH monitoring, esophageal manometry,upper endoscopy (esophagogastroduodenoscopy) andbarium swallow. Upon confirmation of the diagnosisand with appropriate patient criteria met, an antirefluxoperation is a good alternative to prolongedmedical therapy. Currently, minimally invasive gastroesophagealfundoplication is the gold standard forsurgical intervention of GERD. Our review outlines themany factors that are involved in surgical decisionmaking.We will review the prominent features thatreflect appropriate anti-reflux surgery and presentsuggestions that are pertinent to surgical practices,based on evidence-based studies.

  1. Gastroesophageal reflux - discharge

    Science.gov (United States)

    ... vegetables, such as citrus fruits, pineapple, tomatoes, or tomato-based dishes (pizza, chili, and spaghetti). Avoid items ... your stress and watch for stressful, tense times. Stress can bother your reflux ... medicines with plenty of water. When you start a new medicine, remember to ...

  2. Biomarkers of Reflux Disease.

    Science.gov (United States)

    Kia, Leila; Pandolfino, John E; Kahrilas, Peter J

    2016-06-01

    Gastroesophageal reflux disease (GERD) encompasses an array of disorders unified by the reflux of gastric contents. Because there are many potential disease manifestations, esophageal and extraesophageal, there is no single biomarker of the entire disease spectrum; a set of GERD biomarkers that each quantifies specific aspects of GERD-related pathology might be needed. We review recent reports of biomarkers of GERD, specifically in relation to endoscopically negative esophageal disease and excluding conventional pH-impedance monitoring. We consider histopathologic biomarkers, baseline impedance, and serologic assays to determine that most markers are based on manifestations of impaired esophageal mucosal integrity, which is based on increased ionic and molecular permeability, and/or destruction of tight junctions. Impaired mucosal integrity quantified by baseline mucosal impedance, proteolytic fragments of junctional proteins, or histopathologic features has emerged as a promising GERD biomarker.

  3. Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

    Institute of Scientific and Technical Information of China (English)

    Suk Keu Yeom; Seung Wha Lee; Sang Hoon Cha; Hwan Hoon Chung; Bo Kyung Je; Baek Hyun Kim; Jong Jin Hyun

    2012-01-01

    AIM:To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD)on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC).METHODS:This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD.All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acidenhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions.Of the five patients with choledochal cysts,four underwent pyloruspreserving pancreaticoduodenectomy.RESULTS:The five cases of choledochal cysts were classified as Todani classification I.In three of the six patients with AUPBD,injected contrast media reached the distal CBD and pancreatic duct on delay images,suggesting biliopancreatic reflux.In two of these six patients,a band-like filling defect was noted in the CBD on pre-fatty meal images,which decreased in size on delayed post-fatty meal images,suggesting pancreatico-biliary reflux of pancreatic secretions,and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L.In one of the six patients with AUPBD,contrast media did not reach the distal CBD due to multiple CBD stones.CONCLUSION:Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

  4. Current perspectives on reflux laryngitis.

    Science.gov (United States)

    Asaoka, Daisuke; Nagahara, Akihito; Matsumoto, Kenshi; Hojo, Mariko; Watanabe, Sumio

    2014-12-01

    Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease (GERD). With the increase of GERD patients, the importance of LPR is acknowledged widely. However, the pathophysiology of LPR is not understood completely and the diagnostic criteria for LPR remain controversial. Unfortunately, a gold standard diagnostic test for reflux laryngitis is not available. Recently, an experimental animal model for reflux laryngitis was developed to investigate the pathophysiology of reflux laryngitis. An empirical trial of lifestyle modification and proton pump inhibitor therapy is a reasonable approach for LPR symptoms. Alternatives after failure with aggressive medical treatment are limited and multichannel intraluminal impedance and pH monitoring is currently the best alternative to detect nonacid reflux. Additional prospective and evidence-based research is anticipated.

  5. [Vesicoureteral reflux in adults].

    Science.gov (United States)

    Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco

    2011-01-01

    Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy.

  6. Vesicoureteric reflux in children

    Directory of Open Access Journals (Sweden)

    Jameela A Kari

    2013-01-01

    Full Text Available Aim: This study aimed to identify the differences between primary and secondary vesicoureteric reflux (VUR and the effect of associated bladder abnormalities on kidney function. Patients and Methods: We retrospectively reviewed the medical records of children with VUR who were followed up at King Abdulaziz University Hospital from January 2005 to December 2010. The review included results of radiological investigations and kidney function tests. We used Chi-square test for statistical analysis and paired t-test to compare group means for initial and last creatinine levels. Results: Ninety-nine children were included in this study. Twenty (20.2% had primary VUR, 11 had high-grade VUR, while 9 had low-grade reflux. All children with low-grade VUR had normal dimercaptosuccinic acid (DMSA. Renal scars were present in 72% of the children with high-grade VUR. The mean creatinine levels (initial and last for both groups were normal. Seventy-nine (79.8% children had secondary VUR, which was due to posterior urethral valves (PUV (46.8%, neurogenic bladder caused by meningomyelocele (25.3%, non-neurogenic neurogenic bladder (NNB (21.5%, or neurogenic bladder associated with prune belly syndrome (6.3%. Children with NNB, meningomyelocele and PUV had high creatinine at presentation with no considerable worsening of their kidney functions during the last visit. Renal scars were present in 49.4% of the children with secondary VUR. Conclusion: Children with primary VUR and normal bladder had good-functioning kidneys, while those with secondary VUR associated with abnormal bladder caused by NNB, spina bifida or PUV had abnormal kidney functions. DMSA scans were useful in predicting higher grades of VUR in children with primary reflux.

  7. Prevalence of pancreaticobiliary reflux in symptomatic cholelithiasis and its significance

    Directory of Open Access Journals (Sweden)

    TP Bohara

    2014-01-01

    Full Text Available Aims: Pancreaticobiliary reflux (PBR is reflux of pancreatic enzymes into the biliary tree which occurs as a result of an anamoly of pancreaticobiliary junction (PBJ or functionally impaired sphincter. PBR is associated with changes in biliary epithelium and is known to cause benign and malignant biliary pathology. Various authors have reported prevalence of PBR in patients with normal PBJ ranging from 20 % to 83.5 %. With aim to detect the prevalence of PBR in patients with symptomatic cholelithiasis in Nepalese population we conducted this study. Materials and methods: Thirty patients undergoing elective laparoscopic cholecystectomy (LC for symptomatic cholelithiasis were included in the study. History, physical findings and relevant investigations including liver function test, serum amylase and abdominal ultrasound were recorded. Bile sample for amylase was taken from gall bladder during LC percuatneously before manipulation of calot’s triangle and common bile duct. Bile amylase level above serum amylase level was considered positive for PBR. Results: Mean age of the patient was 37.27 (± 14.41 years. Out of 30, 6 (20 % patients were male and 24 (80 % were female. Mean BMI was 21.58 (± 3.2. PBR reflux was present in 66.7 % of patients out of which 2 were male and 18 were female that was not statistically significant (p = 1.41 when compared with patients without PBR. Conclusion: PBR occurs in patient with cholelithiasis and has role in pathogenesis of gallstones disease and gall bladder carcinoma. Long term surveillance would be required to ascertain the significance of detection of PBR after LC. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9666

  8. The effect of famotidine on gastroesophageal and duodeno-gastro-esophageal refluxes in critically ill Patients

    Institute of Scientific and Technical Information of China (English)

    Ying Xin; Ning Dai; Lan Zhao; Jian-Guo Wang; Jian-Ming Si

    2003-01-01

    AIM: To investigate t he effect of famotidine ongastroesophageal reflux (GER) and duodeno-gastro-esophageal reflux(DGER) and to explore it's possiblemechanisms. To identify the relevant factors of the reflux.METHODS: Ninteen critically iii patients were consecutivelyenrolled in the study. Dynamic 24 hours monitoring of GERand DGER before and after administration of famotidine wasperformed. The parameters of gastric residual volume,multiple organ disorder syndrome (NODS) score, acutephysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoreand PEEP were recorded. Paired ttest; Wilcoxon signedranks test and Univariate analysis with Spearman's rankcorrelation were applied to analyse the data.RESULTS: Statistical significance of longest acid reflux,reflux time of pH<4 and fraction time of acid reflux wasobserved in ten critically ill patients before and afteradministration. Pvalue is 0.037, 0.005, 0.005 respectively.Significance change of all bile reflux parameters wasobserved before and after administration. Pvalue is 0.007,0.024, 0.005, 0.007, 0.005. GER has positive correlationwith APACHE Ⅱ score and gastric residual volume withcorrelation coefficient of 0.720, 0.932 respectively.CONCLUSION: GER and DGER are much improved afterthe administration of famotidine. GER is correlated withAPACHE Ⅱ score and gastric residual volume.

  9. Early bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Jae Myung Cha; Myung-Hwan Kim; Se Jin Jang

    2007-01-01

    Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings,and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.

  10. Bile acid sequestrants

    DEFF Research Database (Denmark)

    Hansen, Morten; Sonne, David P; Knop, Filip K

    2014-01-01

    Bile acids are synthesized in the liver from cholesterol and have traditionally been recognized for their role in absorption of lipids and in cholesterol homeostasis. In recent years, however, bile acids have emerged as metabolic signaling molecules that are involved in the regulation of lipid...... and glucose metabolism, and possibly energy homeostasis, through activation of the bile acid receptors farnesoid X receptor (FXR) and TGR5. Bile acid sequestrants (BASs) constitute a class of drugs that bind bile acids in the intestine to form a nonabsorbable complex resulting in interruption...... of the enterohepatic circulation. This increases bile acid synthesis and consequently reduces serum low-density lipoprotein cholesterol. Also, BASs improve glycemic control in patients with type 2 diabetes. Despite a growing understanding of the impact of BASs on glucose metabolism, the mechanisms behind their glucose...

  11. Painful Bile Extraction Methods

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    It was only in the past 20 years that countries in Asia began to search for an alternative to protect moon bears from being killed for their bile and other body parts. In the early 1980s, a new method of extracting bile from living bears was developed in North Korea. In 1983, Chinese scientists imported this technique from North Korea. According to the Animals Asia Foundation, the most original method of bile extraction is to embed a latex catheter, a narrow rubber

  12. Physiology of bile secretion

    Institute of Scientific and Technical Information of China (English)

    Alejandro Esteller

    2008-01-01

    The formation of bile depends on the structural and functional integrity of the bile-secretory apparatus and its impairment,in different situations,results in the syndrome of cholestasis.The structural bases that permit bile secretion as well as various aspects related with its composition and flow rate in physiological conditions will first be reviewed.Canalicular bile is produced by polarized hepatocytes that hold transporters in their basolateral (sinusoidal) and apical (canalicular) plasma membrane.This review summarizes recent data on the molecular determinants of this primary bile formation.The major function of the biliary tree is modification of canalicular bile by secretory and reabsorptive processes in bileduct epithelial cells (cholangiocytes) as bile passes through bile ducts.The mechanisms of fluid and solute transport in cholangiocytes will also be discussed.In contrast to hepatocytes where secretion is constant and poorly controlled,cholangiocyte secretion is regulated by hormones and nerves.A short section dedicated to these regulatory mechanisms of bile secretion has been included.The aim of this revision was to set the bases for other reviews in this series that will be devoted to specific issues related with biliary physiology and pathology.

  13. Biomarkers for Gastroesophageal Reflux in Respiratory Diseases

    Directory of Open Access Journals (Sweden)

    Össur Ingi Emilsson

    2013-01-01

    Full Text Available Gastroesophageal reflux (GER is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use in most patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further.

  14. [Therapeutic principles in gastroesophageal reflux].

    Science.gov (United States)

    Chassany, O; Elkharrat, D; Bergmann, J F; Segrestaa, J M

    1995-01-01

    Gastroesophageal reflux is a common disease. Its chronic course, even if mild, is sometimes complicated by erosive oesophagitis. Drug therapy acts against gastric acidity and motility disorders. Treatment of gastroesophageal reflux disease has three aims: improvement of symptoms and quality of life, healing erosive lesions and prevention of symptomatic and endoscopic relapses. Non-drug measures are always useful, even if their efficacy is not well established. Initial therapy of a symptomatic reflux or mild oesophagitis is most of the time effective (antacids, prokinetics, H2 receptor antagonists). Proton-pump inhibitors are also effective in healing and preventing severe oesophagitis. Questions about long-term treatment adverse events with powerful acid inhibitors, such as hypergastrinemia and the risk of gastric carcinoid tumours seem to be resolved. Studies are requested to define the optimal long-term maintenance treatment with cisapride, H2 receptor antagonists or proton-pump inhibitors at low doses in prevention of symptomatic and mild oesophagitis relapses.

  15. Relationship between reflux and laryngeal cancer

    NARCIS (Netherlands)

    Coca-Pelaz, A.; Rodrigo, J.P.; Takes, R.P.; Silver, C.E.; Paccagnella, D.; Rinaldo, A.; Hinni, M.L.; Ferlito, A.

    2013-01-01

    Gastroesophageal reflux disease (GERD), or its variation known as laryngopharyngeal reflux (LPR), has been recognized as a potential cause of several laryngeal disorders. Patients with laryngeal cancer have lifestyle risk factors, especially tobacco and alcohol consumption, that play an etiological

  16. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Shih, Wei-Jen; Magoun, S.; Wierzbinski, B.; Ryo, U-Yun [Kentucky Univ., Lexington, KY (United States). Medical Center; Lee, Jong-Kang

    1995-11-01

    Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients` duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: occurrence of duodenogastric reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p<0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients. (author).

  17. Treatment of uncomplicated reflux disease

    Institute of Scientific and Technical Information of China (English)

    Joachim Labenz; Peter Malfertheiner

    2005-01-01

    Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended.Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.

  18. Radiologic diagnosis of gastro-oesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G.; Soekjer, H.; Johansson, K.E.; Tibbling, L.

    In 149 patients, a standardized radiologic method for the detection of gastro-oesophageal reflux was applied and compared with the results obtained at endoscopy and by a manometric reflux test. Radiologic reflux was recorded in 53 patients, of whom 25 had reflux without abdominal compression and 51 with compression. At least one of the other two types of examination disclosed pathologic conditions in all but 2 of 53 patients. Oesophagitis was significantly more severe among the patients with reflux observed at radiography. The presence of hiatal incompetence with reflux only to the hiatal hernia but not to the oesophagus was not a strong indicator of gastro-oesophageal reflux disease. Hiatal hernia was present in a significantly larger number of the patients with reflux at radiography than in those without reflux. Increased width of the hiatus gave stronger evidence for reflux disease than in patients with a normal hiatus. Thus, the width of the hiatus also had a bearing on the diagnosis of gastro-oesophageal reflux disease.

  19. Diagnostic value of the reflux sign in cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao (Ehime Univ., Shigenobu (Japan). School of Medicine)

    1990-09-01

    This study reviewed 27 patients with the reflux sign in cholescintigraphy to assess its diagnostic value in detecting incomplete obstruction of the common bile duct (CBD). After at least 5 hours of fasting 5 mCi of Tc-99m PMT or Tc-99m (p-butyl) IDA was injected intravenously and serial images were recorded before and after administration of 10 {mu}g of ceruletide diethylamine (caerulein). The reflux sign was determined to be positive when increased radioactivities in the right or left hepatic duct (minor reflux: MIR) or more peripheral intrahepatic ducts (major reflux; MAR) were recognized after gallbladder stimulation. The reflux sign was found in 30 of 266 consecutive studies. Direct and/or indirect X-ray cholangiograms were available in 27 (MIR; 13, MAR; 14), including juxtapapillary duodenal diverticulum (8), biliary dyskinesia (6), CBD stone (5), chronic pancreatitis (4), gallbladder stone (4), duodenal ulcer (2), chronic cholecystitis (2), CBD adenoma, duodenal papillitis, pancreatic pseudocyst, acute cholangitis, chronic hepatitis, and postgastrectomy (1 each). The caliber of the CBD on X-ray cholangiogram ranged from 4 to 16 mm. CBD dilatation of more than or equal to 10 mm was found in 23% of the MIR and in 79% of the MAR. Apparent stenosis of the CBD was found in 8% of the MIR and in 36% of the MAR. There was no significant difference in the ejection fraction of the gallbladder between MIR and MAR. MAR sign seemed to correspond to an increase in the caliber of the common hepatic duct more than 2 mm after caerulein injection on DIC. Persistent stasis of RI in the biliary system was found in 36% of the MAR. Duodenum appearance time of RI was prolonged by more than 60 min in 54% of the MIR and in 79% of the MAR. When the MAR sign was interpreted as positive for incomplete obstruction of the CBD including apparent stenosis of the CBD and/or CBD stone, the sensitivity, specificity, and accuracy were 89%, 67%, and 74%, respectively. (J.P.N.).

  20. Bile acids for viral hepatitis

    DEFF Research Database (Denmark)

    Chen, Weikeng; Liu, J; Gluud, C

    2007-01-01

    Trials have assessed bile acids for patients with viral hepatitis, but no consensus has been reached regarding their usefulness.......Trials have assessed bile acids for patients with viral hepatitis, but no consensus has been reached regarding their usefulness....

  1. [Bile acids in the bile in diabetes mellitus].

    Science.gov (United States)

    Slivka, O Ia; Zelinskiĭ, B A; Zelinskiĭ, S Ts

    1979-01-01

    Hepatic and gall bladder bile of healthy persons (8) and of patients with severe form of diabetes mellitus (17) was studied. Paer chromatography was applied for determination of cholic, chenodeoxycholic, deoxycholic bile acids and their conjugates with glycin and taurine. An absolute content and percentage of glycodeoxycholic and glycochenodeoxycholic bile acids were increased, and glycochenodeoxycholic acid content and taurates proportion were decreased in the gall bladder and hepatic bile of diabetic patients. The data obtained pointed to disturbed hepatic function in severe diabetes mellitus; it was expressed in suppression of bile acids synthesis and conjugation, and also in depression of transformation of deoxycholic into cholic acid.

  2. Bile acid interactions with cholangiocytes

    Institute of Scientific and Technical Information of China (English)

    Xuefeng Xia; Heather Francis; Shannon Glaser; Gianfranco Alpini; Gene LeSage

    2006-01-01

    Cholangiocytes are exposed to high concentrations of bile acids at their apical membrane. A selective transporter for bile acids, the Apical Sodium Bile Acid Cotransporter (ASBT) (also referred to as Ibat; gene name Slc10a2)is localized on the cholangiocyte apical membrane. On the basolateral membrane, four transport systems have been identified (t-ASBT, multidrug resistance (MDR)3,an unidentified anion exchanger system and organic solute transporter (Ost) heteromeric transporter, OstαOstβ. Together, these transporters unidirectionally move bile acids from ductal bile to the circulation. Bile acids absorbed by cholangiocytes recycle via the peribiliaryplexus back to hepatocytes for re-secretion into bile.This recycling of bile acids between hepatocytes and cholangiocytes is referred to as the cholehepatic shunt pathway. Recent studies suggest that the cholehepatic shunt pathway may contribute in overall hepatobiliary transport of bile acids and to the adaptation to chronic cholestasis due to extrahepatic obstruction. ASBT is acutely regulated by an adenosine 3', 5'-monophosphate (cAMP)-dependent translocation to the apical membrane and by phosphorylation-dependent ubiquitination and proteasome degradation. ASBT is chronically regulated by changes in gene expression in response to biliary bile acid concentration and inflammatory cytokines.Another potential function of cholangiocyte ASBT is to allow cholangiocytes to sample biliary bile acids in order to activate intracellular signaling pathways. Bile acids trigger changes in intracellular calcium, protein kinase C (PKC), phosphoinositide 3-kinase (PI3K), mitogenactivated protein (MAP) kinase and extracellular signalregulated protein kinase (ERK) intracellular signals.Bile acids significantly alter cholangiocyte secretion,proliferation and survival. Different bile acids have differential effects on cholangiocyte intracellular signals,and in some instances trigger opposing effects on cholangiocyte secretion

  3. Reflux composition influences the level of NF-κB activation and upstream kinase preference in oesophageal adenocarcinoma cells.

    Science.gov (United States)

    McAdam, E; Haboubi, H N; Griffiths, A P; Baxter, J N; Spencer-Harty, S; Davies, C; Jenkins, G J

    2015-02-01

    Oesophageal adenocarcinoma (OA) incidence is rising and prognosis is poor. Understanding the molecular basis of this malignancy is key to finding new prevention and treatment strategies. Gastroesophageal reflux disease is the primary cause of OA, usually managed with acid suppression therapy. However, this often does little to control carcinogenic bile acid reflux. The transcription factor nuclear factor kappa B (NF-κB) plays a key role in the pathogenesis of OA and its activity is associated with a poor response to chemotherapy, making it an attractive therapeutic target. We sought to decipher the role of different bile acids in NF-κB activation in oesophageal cell lines using short, physiologically relevant exposure times. The effect of an acidic or neutral extracellular pH was investigated concurrently, to mimic in vivo conditions associated with or without acid suppression. We found that some bile acids activated NF-κB to a greater extent when combined with acid, whereas others did so in its absence, at neutral pH. The precise composition of an individual's reflux, coupled with whether they are taking acid suppressants may therefore dictate the extent of NF-κB activation in the oesophagus, and hence the likelihood of histological progression and chemotherapy success. Regardless of pH, the kinase inhibitor of κB kinase was pivotal in mediating reflux induced NF-κB activation. Its importance was confirmed further as its increased activation was associated with histological progression in patient samples. We identified further kinases important in acid or bile induced NF-κB signalling in oesophageal cells, which may provide suitable targets for therapeutic intervention.

  4. Duodenogastral reflux and its influence on manifestation of morphological changes of gastric mucosa

    Directory of Open Access Journals (Sweden)

    Stepanov Yu.M.

    2015-09-01

    Full Text Available Among the diseases of the gastroduodenal zone chronic gastritis (CG occupies one of the leading positions. One of the main forms of CG is reflux gastritis (RG based on long-term location of duodenal content in the gastric antrum, so-called duodenal reflux (DR. It is well known that stable inflammatory response of the gastric mucosa (GM appears under the influence of bile acid and gastric juice, leading to chronic antral gastritis followed by gradual development of atrophy, metaplasia and dysplasia appearance. Therefore the aim of our work was to investigate the influence of the DR on the course of chronic hepatitis and morphological changes in the gastric mucosa. We observed 70 patients with chronic RG, aged from 22 to 59 years, average age – 43,5±1,2 years. The control group consisted of 25 healthy individuals of both sexes aged from 19 to 39 years. As a result it was found out that pain and dyspeptic syndromes caused problems most of all. While studying the content of bile acids in gastric juice of all patients examined it was higher (1,42±0,05 g/L in comparison with the control group (0,65±0,04 g/L. Content of bile acids in groups of RG patients with atrophy and without it was analyzed. The role of DR as an independent factor of recomposing changes in GM in chronic RG was proved.

  5. Esophageal motility abnormalities in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Irene; Martinucci; Nicola; de; Bortoli; Maria; Giacchino; Giorgia; Bodini; Elisa; Marabotto; Santino; Marchi; Vincenzo; Savarino; Edoardo; Savarino

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  6. Esophageal motility abnormalities in gastroesophageal reflux disease.

    Science.gov (United States)

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-05-06

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  7. Reflux perception and the esophageal mucosal barrier in gastroesophageal reflux disease

    NARCIS (Netherlands)

    P.W. Weijenborg

    2016-01-01

    Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Heartburn, regurgitation and chest pain are the key symptoms. Patients with reflux symptoms often have more than average reflux of acidic contents in the esophagus. However, frequently there is

  8. Interplay between vesicoureteric reflux and kidney infection in the development of reflux nephropathy in mice.

    Science.gov (United States)

    Bowen, Samantha E; Watt, Christine L; Murawski, Inga J; Gupta, Indra R; Abraham, Soman N

    2013-07-01

    Vesicoureteric reflux (VUR) is a common congenital defect of the urinary tract that is usually discovered after a child develops a urinary tract infection. It is associated with reflux nephropathy, a renal lesion characterized by the presence of chronic tubulointersitial inflammation and fibrosis. Most patients are diagnosed with reflux nephropathy after one or more febrile urinary tract infections, suggesting a potential role for infection in its development. We have recently shown that the C3H mouse has a 100% incidence of VUR. Here, we evaluate the roles of VUR and uropathogenic Escherichia coli infection in the development of reflux nephropathy in the C3H mouse. We find that VUR in combination with sustained kidney infection is crucial to the development of reflux nephropathy, whereas sterile reflux alone fails to induce reflux nephropathy. A single bout of kidney infection without reflux fails to induce reflux nephropathy. The host immune response to infection was examined in two refluxing C3H substrains, HeN and HeJ. HeJ mice, which have a defect in innate immunity and bacterial clearance, demonstrate more significant renal inflammation and reflux nephropathy compared with HeN mice. These studies demonstrate the crucial synergy between VUR, sustained kidney infection and the host immune response in the development of reflux nephropathy in a mouse model of VUR.

  9. Personal Experience in TCM Treatment of Reflux Esophagitis

    Institute of Scientific and Technical Information of China (English)

    洪流

    2003-01-01

    @@ Reflux esophagitis falls into the category of reflux gastroesophagopathy. It is characterized by inflammation, erosion, ulcer formation and fibrosis of the esophageal mucous membrane due to reflux of the content of the stomach and duodenum into the esophagus.

  10. Treatment of vesicoureteric reflux by endoscopic injection of Teflon.

    OpenAIRE

    1984-01-01

    Thirteen girls with grade III-V vesicoureteric reflux were treated by endoscopic injection of Teflon paste behind the intravesical ureter. Fourteen of the 18 treated ureters showed complete absence of reflux after one injection of Teflon. Three ureters required a second injection of Teflon for successful treatment of the reflux. One ureter with grade IV reflux was converted to grade II reflux. Properly carried out, this procedure corrects reflux. It takes less than 15 minutes, may be done as ...

  11. Cough in asthma triggered by reflux episodes.

    Science.gov (United States)

    Mehta, Devendra; He, Zhaoping; Padman, Raj

    2014-05-01

    With combined pH and impedance monitoring, non-acid, as well as acid reflux episodes, are more commonly detected immediately prior to cough in asthma in children. Gastroesophageal reflux should be evaluated as a trigger for cough in difficult childhood asthma.

  12. Reflux Revisited: Advancing the Role of Pepsin

    Directory of Open Access Journals (Sweden)

    Karna Dev Bardhan

    2012-01-01

    Full Text Available Gastroesophageal reflux disease is mediated principally by acid. Today, we recognise reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognising pharyngeal acidification using a miniaturised pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit.

  13. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  14. Surgery for Bile Duct (Cholangiocarcinoma) Cancer

    Science.gov (United States)

    ... Situation Bile Duct Cancer Treating Bile Duct Cancer Surgery for Bile Duct Cancer There are 2 general ... also help plan the operation to remove it. Surgery for resectable cancers For resectable cancers, the type ...

  15. A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma.

    Science.gov (United States)

    Sai, Jin-Kan; Suyama, Masafumi; Kubokawa, Yoshihiro

    2006-07-28

    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.

  16. A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa

    2006-01-01

    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 19900 IU/L and that of the gallbladder was 127000 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.

  17. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    Science.gov (United States)

    Watson, David I; Immanuel, Arul

    2010-04-01

    Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

  18. Bile acids for viral hepatitis

    DEFF Research Database (Denmark)

    Chen, Weikeng; Liu, J; Gluud, C

    2003-01-01

    The viral hepatitides are common causes of liver diseases globally. Trials have assessed bile acids for patients with viral hepatitis, but no consensus was reached regarding their usefulness.......The viral hepatitides are common causes of liver diseases globally. Trials have assessed bile acids for patients with viral hepatitis, but no consensus was reached regarding their usefulness....

  19. Intrahepatic Transposition of Bile Ducts

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

  20. Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients.

    Science.gov (United States)

    Savarino, Edoardo; Carbone, Roberto; Marabotto, Elisa; Furnari, Manuele; Sconfienza, Luca; Ghio, Massimo; Zentilin, Patrizia; Savarino, Vincenzo

    2013-11-01

    The aim of the study was to characterise gastro-oesophageal reflux (GOR) in idiopathic pulmonary fibrosis (IPF). 40 consecutive IPF patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal oesophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration. 40 consecutive patients with interstitial lung disease other than IPF (non-IPF patients) and 50 healthy volunteers were also enrolled. IPF patients had significantly higher (p<0.01) oesophageal acid exposure (median (interquartile range (IQR)) 9.25 (4.7-15.4)% versus 3.3 (1.4-7.4)% versus 0.7 (0.2-4.2)%, number of acid (median (IQR) 45 (23-55) versus 32 (19-44) versus 18 (10-31)), weakly acidic (median (IQR) 34 (19-43) versus 21 (11-33) versus 18 (15-28)) and proximal reflux (median (IQR) 51 (26.5-65.5) versus 20 (9.5-34.5) versus 9 (5-20)) events compared to non-IPF patients and healthy volunteers, respectively. Pulmonary fibrosis HRCT scores correlated well with reflux episodes in both the distal (r(2)=0.567) and proximal (r(2)=0.6323) oesophagus. Patients with IPF had more bile acids and pepsin (p<0.03) in bronchoalveolar lavage fluid (BALF) (62% and 67%, respectively) and saliva (61% and 68%, respectively) than non-IPF patients (25% and 25% in BALF, and 33% and 36%, respectively, in saliva) and controls (0% and 0% in BALF and saliva, respectively). Acid GOR is common in IPF, but weakly acidic GOR may also occur. Patients with IPF had a risk of pulmonary aspiration of gastric contents. Outcome studies with intense antireflux therapy are needed.

  1. Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group

    Directory of Open Access Journals (Sweden)

    Flora Filho Rowilson

    1999-01-01

    Full Text Available The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD. Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM criteria and distributed into three age groups: Group A: 14 - 24 years of age. Group B: 25 - 54; and Group C: 55 - 64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05, having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

  2. [Pancreato-biliary maljunctions and congenital cystic dilatation of the bile ducts in adults].

    Science.gov (United States)

    Kianmanesh, R; Régimbeau, J M; Belghiti, J

    2001-08-01

    Pancreato-biliary maljunctions (PBM) in adults are defined by the presence of an abnormally long common pancreato-biliary duct (more than 15 mm long) formed outside the duodenal wall and/or by high amylase level in the bile. The high amylase level in the bile is the functional expression of a chronic toxic reflux of pancreatic juices into the biliary tree. The presence of the PBM have two basic consequences: (i) formation of congenital cystic dilatations of the bile duct (CCBD) during embryogenesis and (ii) cancerous degeneration of extrahepatic bile ducts including the gall bladder. CCBD are commonly found in Southeast of Asia and in Japan where more than two-thirds of the worldwide cases are reported. Women are more frequently touched. The main manifestations are pain, cholangitis and acute pancreatitis. Cancerous degeneration mainly due to chronic pancreatico-biliary reflux consecutive to the presence of PBM is the most serious complication of CCBD. Its global incidence is about 16% and increases by age and after cysto-digestive derivations widely performed in the past. In 80% of the cases a cholangiocarcinoma involving the extrahepatic portion of the biliary tree including dilated segments such as the gall bladder and/or cystic wall is found. The treatment of choice of most common types of CCBD with PMD is complete excision of most of the sites where cancer may arise and should interrupt the pancreato-biliary reflux. This treatment significantly reduces the incidence of bile duct cancer to 0.7%. However, despite the absence of mortality, the overall morbidity rates reach from 20% to 40%. In the complete excision, the entire common bile duct from porta hepatis to the intrapancreatic portion of the choledochus and the gall bladder are resected. The bile continuity is assured by a hepatico-jejunal Y anastomosis. When there is no CCBD, the high risk of gall bladder cancer in the presence of a PBM justifies by itself a preventive cholecystectomy even if no biliary

  3. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... Sponsorship Opportunities Log In Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  4. Pancreaticobiliary reflux as a high-risk factor for biliarymalignancy: Clinical features and diagnostic advancements

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Pancreaticobiliary junction is composed of complexstructure with which biliary duct and pancreatic ductassemble and go out into the ampulla of Vater duringduodenum wall surrounding the sphincter of Oddi.Although the sphincter of Oddi functionally preventsthe reflux of pancreatic juice, pancreaticobiliary reflux(PBR) occurs when function of the sphincter of Oddihalt. The anatomically abnormal junction is termedpancreaticobiliary maljunction (PBM) and is characterizedby pancreatic and bile ducts joining outside of theduodenal wall. PBM is an important anatomical findingbecause many studies have revealed that biliarymalignancies are related due to the carcinogenetic effectof the pancreatic back flow on the biliary mucosa. Onthe other hand, several studies have been published onthe reflux of pancreatic juice into the bile duct withoutmorphological PBM, and the correlation of such caseswith biliary diseases, especially biliary malignancies, isdrawing considerable attention. Although it has longbeen possible to diagnose PBM by various imagingmodalities, PBR without PBM has remained difficult toassess. Therefore, the pathological features of PBRwithout PBM have not been yet fully elucidated. Lately,a new method of diagnosing PBR without PBM hasappeared, and the features of PBR without PBM shouldsoon be better understood.

  5. [Severe laryngitis associated to gastroesophageal reflux].

    Science.gov (United States)

    Botto, Hugo; Antonioli, Cintia; Nieto, Mary; Cocciaglia, Alejandro; Cuestas, Giselle; Roques Revol, Magdalena; López Marti, Jessica; Rodríguez, Hugo

    2014-02-01

    There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

  6. Is obesity associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Cheol Woong Choi; Gwang Ha Kim; Chul Soo Song; Soo Geun Wang; Byung Joo Lee; Hoseok I; Dae Hwan Kang; Geun Am Song

    2008-01-01

    AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD)METHODS: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-h dual-probe pH monitoring from July 2003 to December 2006.The association between body mass index (BMI) and parameters about gastroesophageal or gastropharyngeal reflux was examined in univariate and multivariate analyses.RESULTS: A total of 769 patients (307 men and 462 women; mean age 50.7 years) were finally enrolled. Most variables showing gastroesophageal reflux was higher in the obese patients than the patients with normal BMI.There was no difference in all the variables showing gastropharyngeal reflux according to the BMI. After adjustment for age, sex, alcohol intake and smoking,obese patients demonstrated an about 2-fold increase in risk of GERD compared with patients with normal BMI (OR, 1.9; 95 CI, 1.3-2.9), but overweight patients did not demonstrate increased risk of GERD (OR, 1.2; 95 CI,0.8-1.7). Both obese patients and overweight patients did not demonstrated increased risk of GPRD compared with patients with normal BM[ (OR, 1.1; 95 CI, 0.8-1.7;and OR, 0.9; 95 CI, 0.6-1.3, respectively).CONCLUSION: Obesity is not associated with GPRD reflux while it is associated with GERD.

  7. Small saphenous vein: where does reflux go?

    Directory of Open Access Journals (Sweden)

    Guillermo Gustavo Rossi

    2013-06-01

    Full Text Available BACKGROUND: The anatomy of small saphenous vein (SSV is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS: In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%; subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm = 15/60 cases (25%; subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%; subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION: On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.

  8. Management of gastroesophageal reflux disease.

    Science.gov (United States)

    Tutuian, Radu; Castell, Donald O

    2003-11-01

    Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

  9. Bladder Dysfunction and Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Ulla Sillén

    2008-01-01

    Full Text Available In this overview the influence of functional bladder disturbances and of its treatment on the resolution of vesicoureteral reflux (VUR in children is discussed. Historically both bladder dysfunction entities, the overactive bladder (OAB and the dysfunctional voiding (DV, have been described in conjunction with VUR. Treatment of the dysfunction was also considered to influence spontaneous resolution in a positive way. During the last decades, however, papers have been published which could not support these results. Regarding the OAB, a prospective study with treatment of the bladder overactivity with anticholinergics, did not influence spontaneous resolution rate in children with a dysfunction including also the voiding phase, DV and DES (dysfunctional elimination syndrome, most studies indicate a negative influence on the resolution rate of VUR in children, both before and after the age for bladder control, both with and without treatment. However, a couple of uncontrolled studies indicate that there is a high short-term resolution rate after treatment with flow biofeedback. It should be emphasized that the voiding phase dysfunctions (DV and DES are more severe than the genuine filling phase dysfunction (OAB, with an increased frequency of UTI and renal damage in the former groups. To be able to answer the question if treatment of bladder dysfunction influence the resolution rate of VUR in children, randomized controlled studies must be performed.

  10. Cylindrical dilatation of the choledochus: a special type of congenital bile duct dilatation.

    Science.gov (United States)

    Todani, T; Watanabe, Y; Fujii, T; Toki, A; Uemura, S; Koike, Y

    1985-11-01

    Cylindrical dilatation of the choledochus develops in 20% of patients with congenital bile duct dilatation and usually has acute-angled unions of the pancreatobiliary ductal system. Symptoms generally develop in patients over 1 year of age. The patients frequently complain of abdominal pain, vomiting, and fever as in those with acute pancreatitis. Ultrasonography and infusion cholangiography are the most useful tools in making a correct diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic juice through anomalous ductal unions is commonly observed. This is responsible for biliary perforation in infancy and possibly carcinoma arising in the bile duct. The amylase concentration in the serum at the time of epigastric pain often is high, which leads to the diagnosis of acute pancreatitis. However, evidence of pancreatic inflammation is seldom noted. Accordingly, amylase in the bile may enter the circulating blood through the denuded epithelium or sinusoids of the liver. Excision of the whole extrahepatic duct along with hepaticoenterostomy would be essential for the treatment of cylindrical dilatation of the bile duct, especially when an anomalous ductal union is present.

  11. Effects of bile acids on human airway epithelial cells: implications for aerodigestive diseases

    Directory of Open Access Journals (Sweden)

    Adil Aldhahrani

    2017-03-01

    Full Text Available Gastro-oesophageal reflux and aspiration have been associated with chronic and end-stage lung disease and with allograft injury following lung transplantation. This raises the possibility that bile acids may cause lung injury by damaging airway epithelium. The aim of this study was to investigate the effect of bile acid challenge using the immortalised human bronchial epithelial cell line (BEAS-2B. The immortalised human bronchial epithelial cell line (BEAS-2B was cultured. A 48-h challenge evaluated the effect of individual primary and secondary bile acids. Post-challenge concentrations of interleukin (IL-8, IL-6 and granulocyte−macrophage colony-stimulating factor were measured using commercial ELISA kits. The viability of the BEAS-2B cells was measured using CellTiter-Blue and MTT assays. Lithocholic acid, deoxycholic acid, chenodeoxycholic acid and cholic acid were successfully used to stimulate cultured BEAS-2B cells at different concentrations. A concentration of lithocholic acid above 10 μmol·L−1 causes cell death, whereas deoxycholic acid, chenodeoxycholic acid and cholic acid above 30 μmol·L−1 was required for cell death. Challenge with bile acids at physiological levels also led to a significant increase in the release of IL-8 and IL6 from BEAS-2B. Aspiration of bile acids could potentially cause cell damage, cell death and inflammation in vivo. This is relevant to an integrated gastrointestinal and lung physiological paradigm of chronic lung disease, where reflux and aspiration are described in both chronic lung diseases and allograft injury.

  12. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... Disorders Overview of Gallbladder and Bile Duct Disorders Cholecystitis Gallstones Biliary Pain Without Gallstones Narrowing of the ... ducts are blocked, the gallbladder may become inflamed ( cholecystitis ). Biliary pain without gallstones (acalculous biliary pain) can ...

  13. Bile acid sequestrants for cholesterol

    Science.gov (United States)

    ... ency/patientinstructions/000787.htm Bile acid sequestrants for cholesterol To use the sharing features on this page, ... are medicines that help lower your LDL (bad) cholesterol . Too much cholesterol in your blood can stick ...

  14. Relationship between acid pocket and acid reflux in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    姚东英

    2014-01-01

    Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease(GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory

  15. Diagnostic value of reflux sign in cholescintigraphy after administration of a gallbladder contracting agent. Comparison with X-ray cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao; Shimono, Reiko; Murase, Kenya; Koito, Hikaru; Iio, Atsushi; Hamamoto, Ken.

    1989-01-01

    This study explored the diagnostic value of cholescintigraphy in evaluating biliary passage, focusing on reflux sign in which radioactivity in the left hepatic duct or peripheral intrahepatic duct was increased after intramuscular injection of caerulein. Reflux sign was observed in 28 (12%) of 237 patients examined during the past four years from 1983 to 1987. Twenty five patients simultaneously undergoing X-ray cholangiography were eligible for this study, consisting of four each with common bile duct (CBD) stone, dilated CBD, biliary dyskinesia, and chronic pancreatitis, three with gallbladder stone, two with duodenal ulcer, and one each with adenoma of the CBD, pancreatic pseudocyst, duodenal diverticle, and acute cholangitis. The dilated CBD of 10 mm or more was seen in 13 patients (52%) and CBD stenosis was seen in 6 patients (24%). There was no correlation between reflux sign and gallbladder contraction. Prolonged RI gassage and pooling within the CBD were shown in 17 patients (68%) and 8 patients (28%), respectively. Major reflux sign was considered to reflect the CBD diameter increased by drip infusion of caerulein. It is useful in determining biliary passage in the lower end of the CBD and slight CBD dilatation. (Namekawa, K).

  16. Gastro-oesophageal Reflux Disease: An Update

    Directory of Open Access Journals (Sweden)

    T Murphy

    2015-09-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a disorder in which reflux of stomach contents causes troublesome symptoms and/or complications and which affects health-related quality of life. It is one of the commonest disorders and appears to be increasing in incidence. The mechanisms leading to reflux are complex and multifactorial. The lower oesophageal sphincter (LES is an important part of the gastro-oesophageal barrier. Transient LES relaxations (TLESRs lead to reflux as these vagally mediated motor patterns cause relaxation of the LES and also result in oesophageal shortening and inhibition of the crural diaphragm. Heartburn and regurgitation are the characteristic symptoms of GERD. A clinical diagnosis of GERD can be made with typical symptoms. Oesophagitis is seen in a minority of patients with GERD. Lifestyle modification is widely advocated for patients with GERD. For short-term relief of symptoms of mild GERD, antacids/alginates are frequently used but they do not heal oesophagitis. Both histamine 2 receptor antagonists (H2RA and proton pump inhibitors (PPI have been shown to heal and prevent relapse of oesophagitis, although PPIs have been shown to be superior. The PPIs are the recommended first-line therapy for erosive oesophagitis and initial management of non-erosive reflux disease. Maintenance PPI therapy should be given to patients with oesophagitis, those who have recurrence of symptoms after discontinuation of medication and for those with complications of GERD.

  17. Assessment of duodenogastric reflux by combined continuous intragastric pH and bilirubin monitoring

    Institute of Scientific and Technical Information of China (English)

    Fei Dai; Jun Gong; Ru Zhang; Jin-Yan Luo; You-Ling Zhu; Xue-Qin Wang

    2002-01-01

    AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance.METHODS: 30 healthy volunteers were divided into twogroups: standard diet group (Group 1) 18 cases, free diet group (Group 2) 12 cases. Each subjects were subjected to simultaneous 24 hour intragastric pH and spectrophotometric bilirubin concentration monitoring (Bilitec 2000).RESULTS: There was no difference of preprandial phasebilirubin absorbance between two groups. The absorbanceof postprandial phase was significantly increased in group 2than group 1. There was no difference between preprandialphase and postprandial phase absorbance in group 1.Postprandial phase absorbance was significantly higher ingroup 2. In a comparison of bile reflux with intragastric pHduring night time, there were 4 types of reflux:Simultaneous increase in absorbance and pH in only 19.6%, increase in bilirubin with unchanged pH 33. 3 %, pHincrease with unchanged absorbance 36. 3 %, and bothunchanged in 10. 8 %. Linear regression analysis showed nocorrelation between percertage total time of pH < 4 aridpercentage total time of absortance > 0. 14, r=0.068, P<0.05.CONCLUSION: Because of the dietary effect, highabsorbance fluids or foods should be avoided in detection.Intrsgastric pH and bilirubin monitoring separately predictthe presence of duodenal (and/or pancreatic) reflux and bilereflux. They can not substitute for each other. The detectionof DGR is improved if the two parameters are combinedsimultanoously.

  18. Gene expression in Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats

    Institute of Scientific and Technical Information of China (English)

    Peng Cheng; Jun Gong; Tao Wang; Chen Jie; Gui-Sheng Liu; Ru Zhang

    2005-01-01

    AIM: To investigate the difference of gene expression profiles between Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats.METHODS: Eight-week-old Sprague-Dawley rats were treated esophagoduodenostomy to produce gastroduodenoesophageal reflux, and another group received sham operation as control. Esophageal epithelial tissues were dissected and frozen in liquid nitrogen immediately for pathology 40 wk after surgery. The expression profiles of 4 096 genes in reflux esophagitis and Barrett's esophagus tissues were compared with normal esophageal epithelium by cDNA microarray.RESULTS: Four hundred and forty-eight genes in Barrett'sesophagus were more than three times different from those in normal esophageal epithelium, including 312 up regulated and 136 down-regulated genes. Two hundred and thirty-twogenes in RE were more than three times different from those in normal esophageal epithelium, 90up-regulated and 142 down-regulated genes. Compared to reflux esophagitis, there were 214 up-regulated and 142 down-regulated genes in Barrett's esophagus. CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux can develop esophagitis and Barrett's esophagus gradually.The gene expression level is different between reflux esophagitis and Barrett's esophagus and the differentially expressed genes might be related to the occurrence and development of Barrett's esophagus and the promotion or progression in adenocarcinoma.

  19. Gastroesophageal reflux diagnosed by occlusal splint tintion.

    Science.gov (United States)

    Cebrián-Carretero, José Luis; López-Arcas-Calleja, José María

    2006-01-01

    The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

  20. Endocrine and paracrine role of bile acids

    Institute of Scientific and Technical Information of China (English)

    Verena Keitel; Ralf Kubitz; Dieter H(a)ussinger

    2008-01-01

    Bile acids are not only important for the absorption of dietary lipids and fat soluble vitamins but are signalling molecules with diverse endocrine and paracrine functions.Bile acids regulate bile acid,lipid and glucose metabolism and modulate temperature and energy homeostasis.Furthermore,bile acids can not only promote cell proliferation and liver regeneration but can also induce programmed cell death.Bile acid functions are mediated through different pathways which comprise the activation of nuclear hormone receptors,of intracellular kinases and of the plasma membranebound,G-protein coupled bile acid receptor TGR5/Gpbar-1.

  1. Helicobacter pylori and gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Nigro Casimiro

    2008-07-01

    Full Text Available Abstract Background The nature of the relationship between Helicobacter pylori and reflux oesophagitis is still not clear. To investigate the correlation between Helicobacter pylori infection and GERD taking into account endoscopic, pH-metric and histopathological data. Methods Between January 2001 and January 2003 a prospective study was performed in 146 patients with GERD in order to determine the prevalence of Helicobacter pylori infection at gastric mucosa; further the value of the De Meester score endoscopic, manometric and pH-metric parameters, i.e. reflux episodes, pathological reflux episodes and extent of oesophageal acid exposure, of the patients with and without Helicobacter pylori infection were studied and statistically compared. Finally, univariate analysis of the above mentioned data were performed in order to evaluate the statistical correlation with reflux esophagitis. Results There were no statistically significant differences between the two groups, HP infected and HP negative patients, regarding age, gender and type of symptoms. There was no statistical difference between the two groups regarding severity of symptoms and manometric parameters. The value of the De Meester score and the ph-metric parameters were similar in both groups. On univariate analysis, we observed that hiatal hernia (p = 0,01, LES size (p = 0,05, oesophageal wave length (p = 0,01 and pathological reflux number (p = 0,05 were significantly related to the presence of reflux oesophagitis. Conclusion Based on these findings, it seems that there is no significant evidence for an important role for H. pylori infection in the development of GERD and erosive esophagitis. Nevertheless, current data do not provide sufficient evidence to define the relationship between HP and GERD. Further assessments in prospective large studies are warranted.

  2. Unconjugated secondary bile acids activate the unfolded protein response and induce golgi fragmentation via a src-kinase-dependant mechanism

    Science.gov (United States)

    Sharma, Ruchika; Quilty, Francis; Gilmer, John F.; Long, Aideen; Byrne, Anne-Marie

    2017-01-01

    Bile acids are components of gastro-duodenal refluxate and regarded as causative agents in oesophageal disease but the precise mechanisms are unknown. Here we demonstrate that a specific subset of physiological bile acids affect the protein secretory pathway by inducing ER stress, activating the Unfolded Protein Response (UPR) and causing disassembly of the Golgi apparatus in oesophageal cells. Deoxycholic acid (DCA), Chemodeoxycholic acid (CDCA) and Lithocholic acid (LCA) activated the PERK arm of the UPR, via phosphorylation of eIF2α and up-regulation of ATF3, CHOP and BiP/GRP78. UPR activation by these bile acids is mechanistically linked with Golgi fragmentation, as modulating the UPR using a PERK inhibitor (GSK2606414) or salubrinal attenuated bile acid-induced effects on Golgi structure. Furthermore we demonstrate that DCA, CDCA and LA activate Src kinase and that inhibition of this kinase attenuated both bile acid-induced BiP/GRP78 expression and Golgi fragmentation. This study highlights a novel mechanism whereby environmental factors (bile acids) impact important cellular processes regulating cell homeostasis, including the UPR and Golgi structure, which may contribute to cancer progression in the oesophagus. PMID:27888615

  3. The Mystery and Misery of Acid Reflux in Children

    Science.gov (United States)

    Davenport, Mike; Davenport, Tracy

    2006-01-01

    When a child is sick, parents want answers. They want to know what is wrong, what they can do, and how to get their child healthy--pronto. Regrettably, there are some puzzling illnesses affecting children that are surrounded by mystery. One of them is gastroesophageal reflux (GER), otherwise known as acid reflux--or "reflux" for short. Reflux…

  4. Bile acids for primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Chen, Weikeng; Gluud, C

    2003-01-01

    Bile acids have been used for treating primary sclerosing cholangitis, but their beneficial and harmful effects remain unclear.......Bile acids have been used for treating primary sclerosing cholangitis, but their beneficial and harmful effects remain unclear....

  5. [Alginates in therapy for gastroesophageal reflux disease].

    Science.gov (United States)

    Avdeev, V G

    2015-01-01

    This article presents evidence of the prevalence of gastroesophageal reflux disease (GERD) and highlights its main treatment options. Among its medications, particular emphasis is laid on alginates and their main mechanisms of action are described. There is information on the efficacy of alginates, including the alginate-antacid Gaviscon Double Action, in treating GERD. Recommendations for how to administer these drugs are given.

  6. Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

    Institute of Scientific and Technical Information of China (English)

    Samuel; C; Lüthold; Mascha; K; Rochat; Peter; Bhler

    2010-01-01

    AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP...

  7. A proteomic analysis of human bile

    DEFF Research Database (Denmark)

    Kristiansen, Troels Zakarias; Bunkenborg, Jakob; Gronborg, Mads

    2004-01-01

    We have carried out a comprehensive characterization of human bile to define the bile proteome. Our approach involved fractionation of bile by one-dimensional gel electrophoresis and lectin affinity chromatography followed by liquid chromatography tandem mass spectrometry. Overall, we identified ...

  8. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy.

    Science.gov (United States)

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-07-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux.

  9. Experimental and theoretical study of reflux condensation

    Energy Technology Data Exchange (ETDEWEB)

    Bakke, Knut

    1997-12-31

    This thesis studies the separation of gas mixtures in a reflux condenser. also called a dephlegmator. Reflux condensation is separation of a gas mixture, in reflux flow with condensing liquid, under continuous heat removal. A numerical model of a dephlegmator for binary mixtures was developed. The model may readily be extended to multi-component mixtures, as the solution method is based on a matrix solver. Separation of a binary mixture in a reflux condenser test rig is demonstrated. The test facility contains a single-tube test section that was designed and built as part of the project. Test mixtures of propane and n-butane were used, and a total of 15 experiments are reported. Limited degree of separation was achieved due to limited heat transfer area and narrow boiling point range of the test mixture. The numerical model reproduces the experimental data within reasonable accuracy. Deviation between calculated and measured properties is less than 6% of the measured temperature and less than 5% of the measured flow rate. The model is based on mechanistic models of physical processes and is not calibrated or tuned to fit the experimental data. The numerical model is applied to a number of separation processes. These case studies show that the required heat transfer area increases rapidly with increments in top product composition (light component). Flooding limits the amount of reflux liquid. The dephlegmator is suitable for separation of feed mixtures that are rich in light components. The gliding temperature in the dephlegmation process enables utilization of top product as refrigerant, with subsequent energy saving as a result. 61 refs., 50 figs., 34 tabs.

  10. Vesicoureteral reflux in adults studied by computerized radionuclide cystography

    Energy Technology Data Exchange (ETDEWEB)

    Kinn, A.C.; Jacobsson, H.; Schnell, P.O. (Depts. of Urology Diagnostic Radiology and Hospital Physics, Karolinska Sjukhuset, Stockholm (Sweden))

    1991-01-01

    Direct radionuclide cystography in a computerized method as described by Willi and Treves was used in adults with recurrent pyelites but without evidence of obstruction. Reflux was observed in 15 out of 38 patients. In patients with neurogenic bladder dysfunction or megaureters, reflux began early during the bladder filling and attained higher volumes than in those with uncomplicated pyelitis, who has minor reflux appearing mainly during voiding. Bladder capacity and detrusor compliance were lower in patients with reflux than in those without reflux. The low radiation exposure in radionuclide cystography permits observation of the urodynamic course of urinary reflux and correlation to the intravesical volume and pressure. The method is sensitive, and minorl refluxed volumes can be detected. Radionuclide cystrography can therefore be recommended for checking or surgical results and for follow-up of patients with neurogenic bladder dysfunction. (au).

  11. Peristaltic flow of a fluid in a porous channel: A study having relevance to flow of bile within ducts in a pathological state

    CERN Document Server

    Maiti, S; 10.1016/j.ijengsci.2011.05.006

    2011-01-01

    The paper deals with a theoretical study of the transport of a fluid in a channel, which takes place by the phenomenon of peristalsis. A mathematical analysis of the said problem has been presented. The analysis involves the application of a suitable perturbation technique. The velocity profile and the critical pressure for the occurrence of reflux are investigated with particular emphasis by using appropriate numerical methods. The effects of various parameters, such as Reynolds number, pressure gradient, porosity parameter, Darcy number, slip parameter, amplitude ratio and wave number on velocity and critical pressure for reflux are investigated in detail. The computed results are compared with a previous analytical work and an experimental investigation reported earlier in existing scientific literatures. The results of the present study are in conformity to both of them. The study has got some relevance to the physiological flow of bile in the common bile duct in a pathological state. It reveals that in t...

  12. Bile acids in regulation of intestinal physiology.

    LENUS (Irish Health Repository)

    Keating, Niamh

    2009-10-01

    In addition to their roles in facilitating lipid digestion and absorption, bile acids are recognized as important regulators of intestinal function. Exposure to bile acids can dramatically influence intestinal transport and barrier properties; in recent years, they have also become appreciated as important factors in regulating cell growth and survival. Indeed, few cells reside within the intestinal mucosa that are not altered to some degree by exposure to bile acids. The past decade saw great advances in the knowledge of how bile acids exert their actions at the cellular and molecular levels. In this review, we summarize the current understanding of the role of bile acids in regulation of intestinal physiology.

  13. Does a melatonin supplement alter the course of gastroesophageal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Mariusz; H; Madalinski

    2011-01-01

    Symptomatic gastro-esophageal reflux disease(GERD) is a very common disease.The consequence of GERD is not only erosive esophagitis,but also esophageal stricture,Barrett’s esophagus and extra-esophageal damage(including the lungs,throat,sinuses,middle ear and teeth).GERD and Barrett’s esophagus are also identif ied as major risk factors for esophageal carcinoma.Therapy with melatonin prevents esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals,then further studies are required in humans to establish whether a melatonin supplement is able to protect the patients with GERD from erosions,Barrett’s and neoplasia.

  14. Diagnostic Approach to Reflux in 2007

    Directory of Open Access Journals (Sweden)

    Sumit Dave

    2008-01-01

    Full Text Available There is ongoing controversy regarding the association between vesicoureteric reflux (VUR, recurrent urinary tract infections (UTI, and renal damage. Despite this, routine work up for VUR is still recommended after febrile UTI in most children. The present article reviews the indications and imaging modalities available for VUR diagnosis. Alternative newer techniques like MR cystography and voiding urosonography are discussed. The increasing evidence of the role of DMSA scans in managing children with VUR is highlighted.

  15. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  16. Diagnosis and treatment of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Raul; Badillo; Dawn; Francis

    2014-01-01

    Gastroesophageal reflux disease(GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical,atypi-cal and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms,these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations,further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis,peptic stricture,Barrett’s esophagus,esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification,medical therapy and surgical therapy. Life-style modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids,histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy,others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gas-troesophageal reflux disease.

  17. [Bile phospholipids; function and significance].

    Science.gov (United States)

    Salvioli, G; Salati, R

    1977-09-19

    The part played by phospholipides in the genesis of cholesterol gallstone considered. This is present in patients who frequently present a lecithin synthesis defect at hepatic level since precursors are used for forming triglycerides. Nevertheless polyunsaturated phosphatidicholine has a negative influence on the SB + PL/C ratio in the bile of T-tube subjects receiving 2 g of substance i.v. for 5 days.

  18. Current surgical treatment for bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Masatoshi Makuuchi

    2007-01-01

    Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

  19. Vesical-ureteral reflux in children; Reflux vesico-ureteral chez l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Desvignes, V.; Palcoux, J.B. [Hotel-Dieu, 63 - Clermont-Ferrand (France); Cochat, P. [Hopital Edouard-Herriot, 69 - Lyon (France)

    1995-12-31

    The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child`s age, the associated diseases and the child`s and parents` compliance. (authors). 22 refs., 2 figs.

  20. Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Review

    Directory of Open Access Journals (Sweden)

    Ahmed Fahim

    2011-01-01

    Full Text Available The histological counterpart of idiopathic pulmonary fibrosis is usual interstitial pneumonia, in which areas of fibrosis of various ages are interspersed with normal lung. This pattern could be explained by repeated episodes of lung injury followed by abnormal wound healing responses. The cause of the initiating alveolar epithelial injury is unknown, but postulated mechanisms include immunological, microbial, or chemical injury, including aspirated gastric refluxate. Reflux is promoted by low basal pressure in the lower oesophageal sphincter and frequent relaxations, potentiated by hiatus hernia or oesophageal dysmotility. In susceptible individuals, repeated microaspiration of gastric refluxate may contribute to the pathogenesis of IPF. Microaspiration of nonacid or gaseous refluxate is poorly detected by current tests for gastroesophageal reflux which were developed for investigating oesophageal symptoms. Further studies using pharyngeal pH probes, high-resolution impedance manometry, and measurement of pepsin in the lung should clarify the impact of reflux and microaspiration in the pathogenesis of IPF.

  1. Bile acids stimulate chloride secretion through CFTR and calcium-activated Cl- channels in Calu-3 airway epithelial cells.

    Science.gov (United States)

    Hendrick, Siobhán M; Mroz, Magdalena S; Greene, Catherine M; Keely, Stephen J; Harvey, Brian J

    2014-09-01

    Bile acids resulting from the aspiration of gastroesophageal refluxate are often present in the lower airways of people with cystic fibrosis and other respiratory distress diseases. Surprisingly, there is little or no information on the modulation of airway epithelial ion transport by bile acids. The secretory effect of a variety of conjugated and unconjugated secondary bile acids was investigated in Calu-3 airway epithelial cells grown under an air-liquid interface and mounted in Ussing chambers. Electrogenic transepithelial ion transport was measured as short-circuit current (Isc). The taurine-conjugated secondary bile acid, taurodeoxycholic acid (TDCA), was found to be the most potent modulator of basal ion transport. Acute treatment (5 min) of Calu-3 cells with TDCA (25 μM) on the basolateral side caused a stimulation of Isc, and removal of extracellular Cl(-) abolished this response. TDCA produced an increase in the cystic fibrosis transmembrane conductance regulator (CFTR)-dependent current that was abolished by pretreatment with the CFTR inhibitor CFTRinh172. TDCA treatment also increased Cl(-) secretion through calcium-activated chloride (CaCC) channels and increased the Na(+)/K(+) pump current. Acute treatment with TDCA resulted in a rapid cellular influx of Ca(2+) and increased cAMP levels in Calu-3 cells. Bile acid receptor-selective activation with INT-777 revealed TGR5 localized at the basolateral membrane as the receptor involved in TDCA-induced Cl(-) secretion. In summary, we demonstrate for the first time that low concentrations of bile acids can modulate Cl(-) secretion in airway epithelial cells, and this effect is dependent on both the duration and sidedness of exposure to the bile acid.

  2. Scintigraphic evaluation of enterogastric reflux using /sup 75/Se-HCAT: Methodology and first clinical observations

    Energy Technology Data Exchange (ETDEWEB)

    Furno, A.; Sciarretta, G.; Malaguti, P.; Fagioli, G.; Pozzato, R.

    1987-08-01

    The aim of this study was to assess the possibility of detecting enterogastric reflux (EGR) by /sup 75/Se-HCAT cholescintigraphy. The lowest detectable activity in the gastric area at different concentrations of the radiotracer in the gallbladder was preliminary measured both in a plastic phantom and in an in vivo model. Ten patients were studied after a single oral administration of 1480 KBq /sup 75/Se-HCAT. Gamma camera imaging was carried out for five consecutive days during both fasting and after meal ingestion. In our in vivo model an EGR corresponding to 1% of gallbladder content on day one and 8% on day five was detected. In three out of five patients in whom bile was present in the stomach at endoscopy, /sup 75/Se-HCAT cholescintigraphy demonstrated an EGR, while in three out of five patients in whom endoscopy was negative, /sup 75/Se-HCAT cholescintigrahy detected EGR either during fasting or after meal ingestion. As EGR is not constant, Se-HCAT may be a useful tracer of bile to detect EGR over a prolonged period of time and in different physiological conditions.

  3. Renal Agenesis with Full Length Ipsilateral Refluxing Ureter

    Directory of Open Access Journals (Sweden)

    DilipKumar Pal

    2016-04-01

    Full Text Available Unilateral renal agenesis with vesicoureteral reflux in the ipsilateral full length ureter is a rare phenomenon. Herein we report a case of 10-year old boy who presented with recurrent urinary tract infections. No renal tissue was identified on left side in various imaging studies. Micturating cystourethrogram (MCUG showed left sided refluxing and blind ending ureter. Left ureterectomy was done because of recurrent UTI in the refluxing system.

  4. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

    Institute of Scientific and Technical Information of China (English)

    Nicola de Bortoli; Andrea Nacci; Edoardo Savarino; Irene Martinucci; Massimo Bellini; Bruno Fattori; Linda Ceccarelli

    2012-01-01

    AIM:To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale,GIS; visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD),pathological acid exposure time (AET) in the absence of esophageal erosions (NERD),and a positive correlation between symptoms and refluxes (hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52 (14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41),linear indentation in the medial edge of the vocal fold (31/41),vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients

  5. Intestinal metaplasia in gallbladder correlates with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary duct.

    Science.gov (United States)

    Sakamoto, Hirotsugu; Mutoh, Hiroyuki; Ido, Kenichi; Satoh, Shin; Kumagai, Machio; Hayakawa, Hiroko; Tamada, Kiichi; Sugano, Kentaro

    2009-12-01

    We reported previously that intestinal metaplasia in the gallbladder is strongly associated with expression of caudal-related homeobox transcription factor Cdx2. It has been documented that occult pancreatobiliary reflux, even in the absence of pancreaticobiliary maljunction, is associated with elevated risk of biliary malignancy. We ascertained the correlation between intestinal metaplasia in the gallbladder and occult pancreatobiliary reflux. In 196 patients with a normal pancreaticobiliary ductal arrangement who had undergone laparoscopic cholecystectomy, we performed intraoperative cholangiography and measured amylase levels in bile sampled from the gallbladder. The cutoff value for high cystic amylase was defined as a biliary amylase level higher than the normal upper limit of serum amylase (215 IU/L). We also retrospectively reviewed the cholecystectomized tissue specimens to investigate the presence of intestinal metaplasia and expression of Cdx2. Then, we explored the relationship between intestinal metaplasia in the gallbladder and occult choledocho-pancreatic reflux. Intestinal metaplasia was found in 16.8% (33/196) of the gallbladders. The prevalence of choledocho-pancreatic reflux revealed by intraoperative cholangiography was not significantly different between cases with intestinal metaplasia (5/33, 15.2%) and those without (25/163, 15.3%; P = .81). However, in cases with intestinal metaplasia, the rate of high cystic amylase (13/33, 39.4%) was significantly higher compared with cases without intestinal metaplasia (26/163, 16.0%, P = .005). In conclusion, intestinal metaplasia in the gallbladder is significantly correlated with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement.

  6. Pepsin and bile acid concentrations in sputum of mustard gas exposed patients

    Directory of Open Access Journals (Sweden)

    Ashraf Karbasi

    2013-01-01

    Full Text Available Background/Aim: Gastro-esophageal reflux has been suggested to be associated with several pulmonary complications such as asthma, and post-transplant bronchiolitis obliterans (BO. Pepsin or bile salts in the sputum is shown to be an optimal molecular marker of gastric contents macro/micro aspiration. In this study, we investigated sputum pepsin as a marker of micro-aspiration in sulfur mustard (SM exposed cases compared to healthy controls. Materials and Methods: In a case controlled study, 26 cases with BO and 12 matched healthy controls were recruited and all cases were symptomatic and their exposure to SM was previously documented during Iran-Iraq conflict. Pepsin levels in sputum and total bile acids were measured using enzymatic assay. The severity of respiratory disorder was categorized based upon the spirometric values. Result: The average concentration of pepsin in sputum was higher in the case group (0.29 ± 0.23 compared with healthy subjects (0.13 ± 0.07; P ± 0.003. Moreover, the average concentration of bile acids in the sputum cases was not significantly different in comparison to the controls ( P = 0.5. Conclusion: Higher pepsin concentrations in sputum of SM exposed patients compared with healthy control subjects indicate the occurrence of significantly more gastric micro-aspiration in SM exposed patients.

  7. Gastroesophageal reflux. Reflujo gastroesofágico.

    Directory of Open Access Journals (Sweden)

    Lauro A. Melo Aguilera

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

    Aunque muchos lactantes tienen grados menores de reflujo gastroesofágico, se reconoce que entre 1:3,000 a 1:10,000 tiene un reflujo patológico o sintomático. Cerca del 90 % de los niños vomita durante las primeras 6 semanas de vida, debido primariamente a la inmadurez fisiológica del mecanismo antirreflujo. Sin embargo, en el 60 % de los casos el reflujo desaparece antes de los 18 meses, incluso sin tratamiento. Un 30 % mantiene la sintomatología convirtiéndose en patológico, y de ellos, el 10 % desarrolla problemas serios, alrededor de un 5 % esofagitis con estenosis y entre el 1 y el 5 % la muerte relacionada con aspiración. Se presenta la Guía de Buenas Prácticas Clínicas para reflujo gastroesofágico, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, marzo de 2005.

  8. Vesicoureteral reflux: From prophylaxis to surgery

    Science.gov (United States)

    Blais, Anne-Sophie; Bolduc, Stéphane; Moore, Katherine

    2017-01-01

    Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

  9. Molecular interactions between bile salts, phospholipids and cholesterol : relevance to bile formation, cholesterol crystallization and bile salt toxicity

    NARCIS (Netherlands)

    Moschetta, Antonio

    2002-01-01

    Cholesterol is a nonpolar lipid dietary constituent, absorbed from the small intestine, transported in blood and taken up by the liver. In bile, the sterol is solubilized in mixed micelles by bile salts and phospholipids. In case of supersaturation, cholesterol is kept in vesicles with phospholipid

  10. New insights into aerophagia, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Hemmink, G.J.M.

    2009-01-01

    Gastro-oesophageal reflux is a physiological phenomenon and occurs in every healthy subject approximately 40 times every day. Twenty percent of the general western population experiences reflux symptoms such as heartburn, regurgitation, and retrosternal pain at least once a week. Gastro-oesophageal

  11. Bile acid biosynthesis and its regulation

    Directory of Open Access Journals (Sweden)

    Areta Hebanowska

    2010-10-01

    Full Text Available Bile acid biosynthesis is the main pathway of cholesterol catabolism. Bile acids are more soluble than cholesterol so are easier to excrete. As amphipathic molecules they participate in lipid digestion and absorption in the intestine and they help to excrete free cholesterol with bile. They are also ligands for nuclear receptors regulating the expression of genes involved in cholesterol metabolism. Interconversion of cholesterol into bile acids is an important point of its homeostasis. Seventeen enzymes are engaged in this process and many of them are cytochromes P450. Bile acid synthesis initiation may proceed with the “classical” pathway (starting with cholesterol hydroxylation at the C7α position or the “alternative” pathway (starting with cholesterol hydroxylation at the C27 position. Two additional pathways are possible, though their quantitative significance is small (initiated with cholesterol hydroxylations of C24 and C25 positions. Oxysterols produced are not only intermediates of bile acid biosynthesis but also important regulators of metabolism. Bile acid biosynthesis takes place in the liver, but some enzymes are also present in other organs, where they participate in regulation of cholesterol metabolism. Those enzymes are potential targets for new drugs against cholesterol metabolism disturbances. This article is a brief description of the bile acid biosynthesis pathway and participating enzymes.

  12. Successful Endoscopic Therapy of Traumatic Bile Leaks

    Directory of Open Access Journals (Sweden)

    Matthew P. Spinn

    2013-02-01

    Full Text Available Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP after traumatic bile duct injury secondary to blunt (motor vehicle accident or penetrating (gunshot trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%. The mean duration of follow-up was 85.6 days (range 54-175 days. There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.

  13. A rare case of bile duct cyst

    Institute of Scientific and Technical Information of China (English)

    Qing-Gang Wang; Shu-Tian Zhang

    2009-01-01

    Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types Ⅱ and Ⅱ bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

  14. Analytical Investigation of a Reflux Boiler

    Science.gov (United States)

    Simon, William E.; Young, Fred M.; Chambers, Terrence L.

    1996-01-01

    A thermal model of a single Ultralight Fabric Reflux Tube (UFRT) was constructed and tested against data for an array of such tubes tested in the NASA-JSC facility. Modifications to the single fin model were necessary to accommodate the change in radiation shape factors due to adjacent tubes. There was good agreement between the test data and data generated for the same cases by the thermal model. The thermal model was also used to generate single and linear array data for the lunar environment (the primary difference between the test and lunar data was due to lunar gravity). The model was also used to optimize the linear spacing of the reflux tubes in an array. The optimal spacing of the tubes was recommended to be about 5 tube diameters based on maximizing the heat transfer per unit mass. The model also showed that the thermal conductivity of the Nextel fabric was the major limitation to the heat transfer. This led to a suggestion that the feasibility of jacketing the Nextel fiber bundles with copper strands be investigated. This jacketing arrangement was estimated to be able to double the thermal conductivity of the fabric at a volume concentration of about 12-14%. Doubling the thermal conductivity of the fabric would double the amount of heat transferred at the same steam saturation temperature.

  15. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Nagano; Kenichi Matsuo; Katsuya Gorai; Kazuya Sugimori; Chikara Kunisaki; Hideyuki Ike; Katsuaki Tanaka; Toshio Imada; Hiroshi Shimada

    2006-01-01

    We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.

  16. Gastroesophageal reflux in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Kuijten, R H; Arends, J W

    1992-02-01

    In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.

  17. Bile acid metabolism in ileostomy patients.

    Science.gov (United States)

    Huibregtse, K; Hoek, F; Sanders, G T; Tytgat, G N

    1977-04-01

    In ten ileostomy patients, a 14C-cholylglycine breath test was performed. The 14CO2 in the exhaled air and the 14C bile acid quantity and composition and fat content in the subsequent 24 h ileostomy effluent were determined and compared to the values in twenty healthy controls. The results show that in ileostomy patients only minor bile acid-deconjugation occurs in vivo. Deconjugation in the ileostomy bags was found to be mainly responsible for the absence of conjugated bile acids in many of the ileostomy effluent samples. Secondary bile acids were not present in these patients, as determined by TLC. The fecal fat and bile acid excretion was found to be in the normal range in ileostomy patients provided no concomitant ileum resection was present.

  18. Bile acids in health and disease

    DEFF Research Database (Denmark)

    Krag, E; Thaysen, E H

    1996-01-01

    improved. Important physiological research on the mechanisms of hepatic bile flow was conducted. An intestinal perfusion model served as a tool providing information on absorption kinetics and on transmucosal water and electrolyte movements. The gallstone disease, liver diseases, inflammatory bowel disease...... to the understanding of the factors involved in the solubility of cholesterol in bile. The growing international understanding of the potential importance of the bile acids in health and disease gave raise to a substantial Danish contribution in the 1970s and 1980s in parallel with international achievements. Emphasis......, fat malabsorption, and other intestinal disorders were studied. The 'idiopathic ileopathy' as a cause for bile acid malabsorption causing diarrhoea was established as a new disorder. Thus, in the time period concerned, substantial Danish contributions emerged on major and minor topics of the bile acid...

  19. [Bile composition in patients with chronic pancreatitis].

    Science.gov (United States)

    Dronov, O I; Koval's'ka, I O; Shvets', Iu P; Vesel's'kyĭ, S P

    2013-05-01

    There was investigated a hepatic bile in 50 persons, aged 35-58 years old, including 20--practically healthy persons (I group), 20 patients, suffering chronic fibrose-degenerative pancreatitis (CHFDP) without jaundice syndrome (II group) and 10 patients, suffering CHFDP with jaundice syndrome (III group). There were determined the contents of the bile acids, the lipids and electrolytic contents of bile. A trustworthy difference in the bile contents was registered in patients, suffering CHFDP with the jaundice syndrome and without it, comparing with such in healthy persons. This have had permitted to add the complex of medicinal preoperative preparation of these patients substantially, and to apply the electrolytes content of a bile to apply as an additional diagnostic marker.

  20. Bile resistance mechanisms in Lactobacillus and Bifidobacterium

    Directory of Open Access Journals (Sweden)

    Lorena eRuiz

    2013-12-01

    Full Text Available Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Most of the probiotic bacteria currently available in the market belong to the genera Lactobacillus and Bifidobacterium, and specific health-promoting activities, such as treatment of diarrhea or amelioration of gastrointestinal discomfort, have been attributed to them. In order to be able to survive the gastrointestinal transit and transiently colonise our gut, these bacteria must be able to counteract the deleterious action of bile salts, which are the main components of bile. Bile salts are detergent-like biological substances synthesised in the liver from cholesterol. Host enzymes conjugate the newly synthesised free bile acids in the liver with the amino acids glycine or taurine, generating conjugated bile salts. These compounds are stored in the gall bladder and they are released into the duodenum during digestion to perform their physiological function, which is the solubilisation of fat coming from diet. These bile salts possess strong antimicrobial activity, since they are able to disorganize the structure of the cell membrane, as well as trigger DNA damage. This means that bacteria inhabiting our intestinal tract must have intrinsic resistance mechanisms to cope with bile salts. To do that, Lactobacillus and Bifidobacterium display a variety of proteins devoted to the efflux of bile salts or protons, to modify sugar metabolism or to prevent protein misfolding. In this manuscript, we review and discuss specific bile resistance mechanisms, as well as the processes responsible for the adaptation of bifidobacteria and lactobacilli to bile.

  1. Composite score of reflux symptoms in diagnosis of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Jin-Hai Wang; Jin-Yan Luo; Lei Dong; Jun Gong; Ai-Li Zuo

    2004-01-01

    AIM: To evaluate the significance of the composite score of reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD), and to determine the relationship of the composite score with reflux esophagitis (RE) and pathological gastroesophageal reflux (PGER).METHODS: Upper digestive endoscopy and /or 24-h esophageal pH monitoring were performed in 244 subjects.Of these, 54 were consecutive patients attending our clinic with symptoms suggestive of GERD, and 190 were randomly selected from 2532 respondents who participated in our previous general population-based study on GERD. A standardized questionnaire was used to classify both the frequency and severity of typical symptoms of GERD(heartburn, acid and food regurgitation) using a 4-score scale, and the composite score of main reflux symptoms(score index: SI, range from 0 to 18) were calculated for every subject. RE was diagnosed according to the SavaryMiller criteria. Subjects with abnormal pH-metry (DeMeester score more than 14.7) were considered to have PGER.GERD patients were defined as the subjects with RE and/or PGER.RESULTS: The sensitivity of SI in the diagnosis of GERD was inversely associated with SI, but the specificity tended to increase with increased SI. With the cut-off of 8, the SI achieved the highest accuracy of 70.0%, with a sensitivity of 78.6% and a specificity of 69.2% in diagnosing GERD,followed by the cut-off of 3, which had an accuracy of 62.1%,a sensitivity of 96.4% and a specificity of 34.6%. The prevalence of RE, PGER and GERD was strongly associated with increased SI (P<0.01), but there was no significant association between the severity of RE and SI (P>0.05).Among patients with RE, 69.2% had PGER, and 30.8%were confirmed to have negative findings of pH monitoring.Among patients with PGER, 52.9% were identified to have RE and 47.1% had negative endscopic findings in esophagus.CONCLUSION: According to the composite score of main reflux symptoms, the diagnosis of GERD can

  2. 隐性胰胆反流75例分析%Occult pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    钟征翔; 邬万新; 赵凤庆; 邹洪兴; 俞方荣; 周俊; 许浏; 徐鹿平; 孙建良

    2008-01-01

    目的 研究隐性胰胆反流的发生率及其对胆囊上皮不典型增生和癌变的影响.方法 对2006年7月至2008年2月期间择期行胆道手术或行ERCP检查的956例患者常规作胆汁淀粉酶测定,对手术切除胆囊标本行病理检查,观察不典型增生和癌变的发生率.结果 754例患者中发现隐性胰胆反流75例,发生率为9.9%.反流组和对照组胆汁淀粉酶分别为(7701±20 378)IU/L和(16±51)IU/L,差异有统计学意义(P<0.01).反流组中胆囊癌及不典型增生发生率分别为3.4%(2/58)和31.0%(18/58),均高于对照组(P<0.05).反流组中伴有癌变和不典型增生病例的胆汁淀粉酶值高于不伴有癌变和不典型增生的病例(9194±10 399 IU/L vs.2388±2745 IU/L,P<0.01).结论 在胆胰管汇合正常者中隐性胰胆反流是客观存在的,它促进了胆囊不典型增生和癌变的发生.%Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopanereatography (ERCP), bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobihary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701±20 378 IU/L and 16±51 IU/L, respectively ( P <0. 01 ).Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliaryreflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux ( P <0. 05). In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder

  3. Transport and biological activities of bile acids.

    Science.gov (United States)

    Zwicker, Brittnee L; Agellon, Luis B

    2013-07-01

    Bile acids have emerged as important biological molecules that support the solubilization of various lipids and lipid-soluble compounds in the gut, and the regulation of gene expression and cellular function. Bile acids are synthesized from cholesterol in the liver and eventually released into the small intestine. The majority of bile acids are recovered in the distal end of the small intestine and then returned to the liver for reuse. The components of the mechanism responsible for the recycling of bile acids within the enterohepatic circulation have been identified whereas the mechanism for intracellular transport is less understood. Recently, the ileal lipid binding protein (ILBP; human gene symbol FABP6) was shown to be needed for the efficient transport of bile acids from the apical side to the basolateral side of enterocytes in the distal intestine. This review presents an overview of the transport of bile acids between the liver and the gut as well as within hepatocytes and enterocytes. A variety of pathologies is associated with the malfunction of the bile acid transport system.

  4. Circadian dysregulation disrupts bile acid homeostasis.

    Directory of Open Access Journals (Sweden)

    Ke Ma

    Full Text Available BACKGROUND: Bile acids are potentially toxic compounds and their levels of hepatic production, uptake and export are tightly regulated by many inputs, including circadian rhythm. We tested the impact of disrupting the peripheral circadian clock on integral steps of bile acid homeostasis. METHODOLOGY/PRINCIPAL FINDINGS: Both restricted feeding, which phase shifts peripheral clocks, and genetic ablation in Per1(-/-/Per2(-/- (PERDKO mice disrupted normal bile acid control and resulted in hepatic cholestasis. Restricted feeding caused a dramatic, transient elevation in hepatic bile acid levels that was associated with activation of the xenobiotic receptors CAR and PXR and elevated serum aspartate aminotransferase (AST, indicative of liver damage. In the PERDKO mice, serum bile acid levels were elevated and the circadian expression of key bile acid synthesis and transport genes, including Cyp7A1 and NTCP, was lost. This was associated with blunted expression of a primary clock output, the transcription factor DBP, which transactivates the promoters of both genes. CONCLUSIONS/SIGNIFICANCE: We conclude that disruption of the circadian clock results in dysregulation of bile acid homeostasis that mimics cholestatic disease.

  5. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  6. LINX(™) Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.

    Science.gov (United States)

    Bonavina, Luigi; DeMeester, Tom R; Ganz, Robert A

    2012-12-01

    Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. The laparoscopic Nissen fundoplication is the surgical gold standard; however, the level of technical difficulty and its side effects have limited its use to less than 1% of the GERD population. These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX(™) Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary.

  7. Diagnosis of intrarenal reflux and its role in pathogenesis of reflux nephropathy in children

    Energy Technology Data Exchange (ETDEWEB)

    Fujimatsu, Akiko [Kurume Univ., Fukuoka (Japan). School of Medicine

    2000-06-01

    We compared newly developed radionuclide cystography with conventional contrast voiding cystography (VCG) with regard to their diagnostic usefulness of intrarenal reflux (IRR) in children. Based on the imaging findings, we assessed the role of IRR in the pathogenesis of reflux nephropathy (RN). Among the ureters which revealed IRR diagnosed by radionuclide cystography, 38.9% (7 out of 18 ureters) of the cases examined by VCG had IRR. In the case of VCG, the sensitivity and specificity of IRR detection were 33.3% and 100%, respectively. There was a statistical correlation between the presence/absence of IRR and vesicoureteral reflux (VUR). RN was significantly correlated with advanced grade of VUR associated with IRR. Among 9 kidneys of the subjects who had suffered from urinary tract infection (UTI) only once, IRR was detected in 33.3% (3/9) and RN in 66.7% (2/3). From these findings, conventional contrast VCG is considered not effective for the diagnosis of IRR. Moreover, it is suggested that VUR complicated with IRR is deeply associated with the development of RN. In addition, it is suggested that UTI might be related to the onset of IRR. (author)

  8. [Roxatidine acetate in therapy of reflux esophagitis].

    Science.gov (United States)

    Friedrich, P; Botzler, R; Mayershofer, R; Kriech, W

    1996-06-10

    A total of 3409 patients with gastro-oesophageal reflux disease were treated with roxatidine acetate. 60.7% of the patients received a daily dose of 2 x 75 mg roxatidine acetate, and the median duration of treatment was 5 weeks. Symptoms improved in about 90% of patients. For 1687 patients, endoscopic findings were available at the beginning and end of the treatment period. The overall endoscopic healing rate was 65.3%, and, depending on the initial finding (if), decreased from 92.9% (if: Savary-Miller stage I) to 67.5% (if: stage II), 40.7% (if: stage III), and to 22.5% (if: stage IV). Twenty-one patients experienced adverse events during the course of treatment, which, however, were either only minor or not related to the use of roxatidine acetate.

  9. Gastroesophageal Reflux in Children with Refractory Asthma

    Directory of Open Access Journals (Sweden)

    Alaa S. Deeb

    2010-07-01

    Full Text Available Objectives: To investigate the association between clinical and macroscopic findings of GER and severity of refractory asthma (statistical study.Methods: A prospective study in a university-based practice of 75 children who were diagnosed with refractory asthma because they exhibited no satisfactory response for at least three months of treatment. Medical history, physical examination, spirometrical measurements and prick skin test were conducted on all patients. Endoscopic and macroscopic evaluations for esophagitis were performed on all patients regardless of the presence of GER symptoms.Results: Endoscopy was done for 75 children with refractory asthma. GER was symptomatic in 65% of all patients with no statistical significance (p>0.05 and the most frequent symptom was abdominal pain (67%. The frequency of these symptoms was 50% in mild asthma, 58% in moderate asthma and 72% in severe asthma with no statistical significance (p>0.05. The frequency of macroscopic esophagitis was 71%, distributed in three asthmatic groups as in order of 75% in mild asthma, 58.3% in moderate asthma and 76.6% in severe asthma (p>0.05. Regarding the relationship between GER and nocturnal attacks or spasmodic cough, the frequency of the latest was 66.7%. The differences have no statistical significance regarding GER symptoms (p>0.05, but they are statistically significant regarding the reflux esophagitis (p<0.05. Also endoscopic reflux was as frequent as76.3% in non allergic patients, and this result is statistically significant (p<0.05.Conclusion: In spite of the fact that there was no relationship between the severity of asthma and the symptoms of GER, or its endoscopic findings, the frequency of GER in asthmatic children was higher than its frequency in other children.

  10. Laser-guided repair of complex bile duct strictures.

    NARCIS (Netherlands)

    Gulik, T. van; Beek, J.; Reuver, P. de; Aronson, D.C.; Delden, O. van; Busch, O.; Gouma, D.

    2009-01-01

    BACKGROUND: The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. AIM: We describe a technique to identify the prestenotic bile du

  11. A Role of the Bile Salt Receptor FXR in Atherosclerosis

    NARCIS (Netherlands)

    Hageman, Jurre; Herrema, Hilde; Groen, Albert K.; Kuipers, Folkert

    2010-01-01

    This study reviews current insights into the role of bile salts and bile salt receptors on the progression and regression of atherosclerosis. Bile salts have emerged as important modifiers of lipid and energy metabolism. At the molecular level, bile salts regulate lipid and energy homeostasis mainly

  12. [Correlations of bile acids in the bile of rats in conditions of alloxan induced diabetes melitus].

    Science.gov (United States)

    Danchenko, N M; Vesel'skyĭ, S P; Tsudzevych, B O

    2014-01-01

    The ratio of bile acids in the bile of rats with alloxan diabetes was investigated using the method of thin-layer chromatography. Changes of coefficients of conjugation and hydroxylation of bile acids were calculated and analyzed in half-hour samples of bile obtained during the 3-hour experiment. It has been found that the processes of conjugation of cholic acid with glycine and taurine are inhibited in alloxan diabetes. At the same time a significant increase of free threehydroxycholic and dixydroxycholic bile acids and conjugates of the latter ones with taurine has been registered. Coefficients of hydroxylation in alloxan diabetes show the domination of "acidic" pathway in bile acid biosynthesis that is tightly connected with the activity of mitochondrial enzymes.

  13. Therapeutic effect of DA-9601 on chronic reflux gastritis induced by sodium taurocholate in rats

    Institute of Scientific and Technical Information of China (English)

    Tae Young Oh; Chang Yell Shin; Yong Sung Sohn; Dong Hwan Kim; Byoung Ok Ahn; Eun Bang Lee; Cho Hyun Park

    2005-01-01

    AIM: To investigate the therapeutic effects of DA-9601 on sodium taurocholate (TCA)-induced chronic reflux gastritis in SD rats.METHODS: In this study, we have investigated the therapeutic effects of DA-9601 on chronic erosive and atrophic gastritis induced by 6 mo of TCA administration (5 mmol/L in drinking water) in SD rats. RESULTS: Four weeks of DA-9601 administration (0.065%, 0.216% in rat chow), following the withdrawal of TCA treatment, resulted in a significant decrease in total length of erosions in rats in a dose-dependent manner. Furthermore, the indicators of atrophic gastritis, such as reduced mucosal thickness and reduction in the number of parietal cells, were improved by the administration of DA-9601 in a dose-related manner. DA-9601 also attenuated inflammatory cell infiltration and the proliferation of collagenous fiber in the gastric mucosa. The improvement in the reduction of the gastric mucus was observed in the rats receiving a high dose of DA-9601 (0.216%). The therapeutic effect of DA-9601 on experimental chronic erosive gastritis was superior to that of rebamipide (1.08% in rat chow). Biochemical analyses showed increased mucosal prostaglandin E2 and reduced glutathione levels by DA-9601 treatment. CONCLUSION: We suggest that DA-9601 is apromising agent for the treatment of chronic erosive and atrophic gastritis with an etiological factor of bile reflux. Increasedmucosal prostaglandin E2 and reduced glutathione by DA-9601 treatment may be therapeutic mechanisms for chronic erosive and atrophic gastritis.

  14. Bile canalicular changes and defective bile secretion in Opisthorchis viverrini-infected hamsters.

    Science.gov (United States)

    Charoensuk, Lakhanawan; Pinlaor, Porntip; Laothong, Umawadee; Yongvanit, Puangrat; Pairojkul, Chawalit; Nawa, Yukifumi; Pinlaor, Somchai

    2014-12-01

    Infection with the liver fluke Opisthorchis viverrini (Digenea) (Poirier, 1886) causes bile duct injury and periductal fibrosis by chronic overproduction of inflammatory-mediators and eventually results in cholangiocarcinoma development. While extensive research works have been done on O. viverrini infection-associated changes of bile ducts and periductal fibrosis, little attention was paid on morphological and biochemical changes of the bile canaliculi (BC), the origin of bile flow. We aimed to investigate the morphological and functional alterations of BC in the liver of hamsters infected with O. viverrini at one and three months post-infection. Ultrastructural changes of BC showed dilatation of BC and significant reduction of the density of microvilli as early as at one month post-infection. Immunohistochemistry revealed that CD10, a BC marker, expression was reduced early as one month post-infection. The mRNA expression of the genes encoding molecules related to bile secretion including bile acid uptake transporters (slc10a1 and slco1a1), bile acid dependent (abcb11) and independent (abcc2) bile flow and bile acid biosynthesis (cyp7a1 and cyp27a1) were significantly decreased at one month post-infection in association with the reduction of bile volume. In contrast, the expression of the mRNA of bile acid regulatory genes (fxr and shp-1) was significantly increased. These changes essentially persisted up to three months post-infection. In conclusion, O. viverrini infection induces morphological and functional changes of BC in association with the decrease of bile volume.

  15. Allelic variation of bile salt hydrolase genes in Lactobacillus salivarius does not determine bile resistance levels.

    LENUS (Irish Health Repository)

    Fang, Fang

    2009-09-01

    Commensal lactobacilli frequently produce bile salt hydrolase (Bsh) enzymes whose roles in intestinal survival are unclear. Twenty-six Lactobacillus salivarius strains from different sources all harbored a bsh1 allele on their respective megaplasmids. This allele was related to the plasmid-borne bsh1 gene of the probiotic strain UCC118. A second locus (bsh2) was found in the chromosomes of two strains that had higher bile resistance levels. Four Bsh1-encoding allele groups were identified, defined by truncations or deletions involving a conserved residue. In vitro analyses showed that this allelic variation was correlated with widely varying bile deconjugation phenotypes. Despite very low activity of the UCC118 Bsh1 enzyme, a mutant lacking this protein had significantly lower bile resistance, both in vitro and during intestinal transit in mice. However, the overall bile resistance phenotype of this and other strains was independent of the bsh1 allele type. Analysis of the L. salivarius transcriptome upon exposure to bile and cholate identified a multiplicity of stress response proteins and putative efflux proteins that appear to broadly compensate for, or mask, the effects of allelic variation of bsh genes. Bsh enzymes with different bile-degrading kinetics, though apparently not the primary determinants of bile resistance in L. salivarius, may have additional biological importance because of varying effects upon bile as a signaling molecule in the host.

  16. Bile acid signaling and biliary functions

    Directory of Open Access Journals (Sweden)

    Hannah Jones

    2015-03-01

    Full Text Available This review focuses on various components of bile acid signaling in relation to cholangiocytes. Their roles as targets for potential therapies for cholangiopathies are also explored. While many factors are involved in these complex signaling pathways, this review emphasizes the roles of transmembrane G protein coupled receptor (TGR5, farnesoid X receptor (FXR, ursodeoxycholic acid (UDCA and the bicarbonate umbrella. Following a general background on cholangiocytes and bile acids, we will expand the review and include sections that are most recently known (within 5–7 years regarding the field of bile acid signaling and cholangiocyte function. These findings all demonstrate that bile acids influence biliary functions which can, in turn, regulate the cholangiocyte response during pathological events.

  17. Synthesis of todorokite by refluxing process and its primary characteristics

    Institute of Scientific and Technical Information of China (English)

    FENG; Xionghan; LIU; Fan; TAN; Wenfeng; LIU; Xiangwen; HU

    2004-01-01

    Single phase and well-crystallined todorokite were synthesized by heating and refluxing process from birnessite as a precursor. The average chemical composition of the synthesized todorokites by refluxing for 8 h and for 24 h was Mg0.19MnO2.11(H2O)1.15 and Mg0. 17-MnO2.10(H2O)0.88, respectively. The crystallinity of the todorokite increased and no other phase was produced with increasing refluxing period. The synthesized todorokites have the same morphologies and the similar structural characteristics with the natural todorokites and hydrothermally synthesized samples. The chemical compositions of the synthetic tordorokites by refluxing process are close to those of todorokites synthesized by hydrothermal process, except a higher average oxidation state of Mn for the former.

  18. Quantitative assay for the detection of vesicoureteral reflux in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Linden, A.; Schnippering, H.G.; Ritzl, F.

    1984-04-01

    Using a method in which the camera computer system is adjusted for the individual patient, a quantitative isotopic micturition cystourethrogram (Nuclear Cystogram) can be obtained with less radiation exposure for the patient and more sensitively compared to the equivalent X-ray micturition cysto-urethrogram. Less than 0,1 ml reflux urine can be measured and it can be determined whether reflux occurs during bladder filling or emptying.

  19. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    OpenAIRE

    Agrawal Vikesh; Rangarajan Venkatesh; Kamath Tejaswini; Borwankar S

    2009-01-01

    Aim : Evaluation of vesicoureteric reflux (VUR) in children by bladder volume graded direct radionuclide cystogram (BVG DRC). This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units) with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG) and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two...

  20. Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease.

    Science.gov (United States)

    Dziekiewicz, M A; Karolewska-Bochenek, K; Dembiński, Ł; Gawronska, A; Krenke, K; Lange, J; Banasiuk, M; Kuchar, E; Kulus, M; Albrecht, P; Banaszkiewicz, A

    2016-01-01

    Gastroesophageal reflux disease is common in adult patients with interstitial lung disease. However, no data currently exist regarding the prevalence and characteristics of the disease in pediatric patients with interstitial lung disease. The aim of the present study was to prospectively assess the incidence of gastroesophageal reflux disease and characterize its features in children with interstitial lung disease. Gastroesophageal reflux disease was established based on 24 h pH-impedance monitoring (MII-pH). Gastroesophageal reflux episodes (GERs) were classified according to widely recognized criteria as acid, weakly acid, weakly alkaline, or proximal. Eighteen consecutive patients (15 boys, aged 0.2-11.6 years) were enrolled in the study. Gastroesophageal reflux disease was diagnosed in a half (9/18) of children. A thousand GERs were detected by MII-pH (median 53.5; IQR 39.0-75.5). Of these, 585 (58.5 %) episodes were acidic, 407 (40.7 %) were weakly acidic, and eight (0.8 %) were weakly alkaline. There were 637 (63.7 %) proximal GERs. The patients in whom gastroesophageal reflux disease was diagnosed had a significantly higher number of proximal and total GERs. We conclude that the prevalence of gastroesophageal reflux disease in children with interstitial lung disease is high; thus, the disease should be considered regardless of presenting clinical symptoms. A high frequency of non-acid and proximal GERs makes the MII-pH method a preferable choice for the detection of reflux episodes in this patient population.

  1. 胆囊上皮不典型增生与隐性胰胆反流%Development of epithelial dysplasia in gallbladder with occult pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    钟征翔; 邬万新; 赵凤庆; 邹洪兴; 俞方荣

    2008-01-01

    Objective To investigate the role of occult pancreatobiliary reflux in gallbladder car-cinogenesis. Methods The blood amylase and gallbladder bile amylase were measured, respectively,to diagnosis the occult pancreatobiliary reflux in 340 patients receiving selective cholecystectomy. The dysplasia and the proliferation activity in mucosa of gallbladders were detected histopathologically and immunohistochemieally. Results The incidence of occult pancreatobiliary reflux was 9.4% (32/340). One case of carcinoma and 11 cases of dysplasia were found in the 32 gallbladders with occult pancre-atobiliary reflux. The incidence of carcinoma and dysplasia was 37.5% in gallbladders with occult pan-creatobiliary reflux, which was higher than the control group with dysplasia incidence of 8.4% (P=0.006). The average Ki67 index was 24.4% in gallbladders with occult pancreatobiliary reflux, which was higher than the control group with Ki67 index of 13.2% (P=0.014). Conclusion The occult pancreatobiliary reflux is an important factor to induce gallbladder cancer.%目的 评价隐性胰胆反流与胆囊癌变的关系.方法 检测340例择期胆囊切除术病人血液和胆囊胆汁淀粉酶确定隐性胰胆反流.组织病理学观察隐性胰胆反流胆囊标本的不典型增生发生率以及免疫组化观察胆囊黏膜上皮的增殖活性.结果 340例择期胆囊切除标本中隐性胰胆反流发生率为9.4%(32/340).32例隐性胰胆反流标本中发生胆囊癌1例.不典型增生11例.胆囊癌和不典型增生发生率为37.5%(12/32).对照组发生不典型增生发生率8.4%(26/308),两组差异有显著意义(P=0.006).隐性胰胆反流的胆囊上皮的Ki67指数平均为24.4%,高于对照组13.2%(P=0.014).结论 隐性胰胆反流是胆囊癌发生重要的诱因.

  2. Differential expression of cholangiocyte and ileal bile acid transporters following bile acid supplementation and depletion

    Institute of Scientific and Technical Information of China (English)

    N. Sertac Kip; Konstantinos N. Lazaridis; Anatoliy I. Masyuk; Patrick L. Splinter; Robert C. Huebert; Nicholas F. LaRusso

    2004-01-01

    AIM: We have previously demonstrated that cholangiocytes,the epithelial cells lining intrahepatic bile ducts, encode two functional bile acid transporters via alternative splicing of a single gene to facilitate bile acid vectorial transport.Cholangiocytes possess ASBT, an apical sodium-dependent bile acid transporter to take up bile acids, and t-ASBT, a basolateral alternatively spliced and truncated form of ASBT to efflux bile acids. Though hepatocyte and ileal bile acid transporters are in part regulated by the flux of bile acids,the effect of alterations in bile acid flux on the expression of t-ASBT in terminal ileocytes remains unclear. Thus, we tested the hypothesis that expression of ASBT and t-ASBT in cholangiocytes and ileocytes was regulated by bile acid flux. METHODS: Expression of ASBT and t-ASBT message and protein in cholangiocytes and ileocytes isolated from pairfed rats given control (C) and 1% taurocholate (TCA) or 5% cholestyramine (CY) enriched diets, were assessed by both quantitative RNase protection assays and quantitative immunoblotting. The data obtained from each of the control groups were pooled to reflect the changes observed following TCA and CY treatments with respect to the control diets.Cholangiocyte taurocholate uptake was determined using a novel microperfusion technique on intrahepatic bile duct units (IBDUs) derived from C, TCA and CY fed rats.RESULTS: In cholangiocytes, both ASBT and t-ASBT message RNA and protein were significantly decreased in response to TCA feeding compared to C diet. In contrast,message and protein of both bile acid transporters significantly increased following CY feeding compared to C diet. In the ileum, TCA feeding significantly up-regulated both ASBT and t-ASBT message and protein compared to C diet, while CY feeding significantly down-regulated message and protein of both bile acid transporters compared to C diet. As anticipated from alterations in cholangiocyte ASBT expression, the uptake of

  3. Gene expression changes associated with Barrett's esophagus and Barrett's-associated adenocarcinoma cell lines after acid or bile salt exposure

    Directory of Open Access Journals (Sweden)

    Sahbaie Peyman

    2007-06-01

    Full Text Available Abstract Background Esophageal reflux and Barrett's esophagus represent two major risk factors for the development of esophageal adenocarcinoma. Previous studies have shown that brief exposure of the Barrett's-associated adenocarcinoma cell line, SEG-1, or primary cultures of Barrett's esophageal tissues to acid or bile results in changes consistent with cell proliferation. In this study, we determined whether similar exposure to acid or bile salts results in gene expression changes that provide insights into malignant transformation. Methods Using previously published methods, Barrett's-associated esophageal adenocarcinoma cell lines and primary cultures of Barrett's esophageal tissue were exposed to short pulses of acid or bile salts followed by incubation in culture media at pH 7.4. A genome-wide assessment of gene expression was then determined for the samples using cDNA microarrays. Subsequent analysis evaluated for statistical differences in gene expression with and without treatment. Results The SEG-1 cell line showed changes in gene expression that was dependent on the length of exposure to pH 3.5. Further analysis using the Gene Ontology, however, showed that representation by genes associated with cell proliferation is not enhanced by acid exposure. The changes in gene expression also did not involve genes known to be differentially expressed in esophageal adenocarcinoma. Similar experiments using short-term primary cultures of Barrett's esophagus also did not result in detectable changes in gene expression with either acid or bile salt exposure. Conclusion Short-term exposure of esophageal adenocarcinoma SEG-1 cells or primary cultures of Barrett's esophagus does not result in gene expression changes that are consistent with enhanced cell proliferation. Thus other model systems are needed that may reflect the impact of acid and bile salt exposure on the esophagus in vivo.

  4. A PROPOSITION FOR THE DIAGNOSIS AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN - A REPORT FROM A WORKING GROUP ON GASTROESOPHAGEAL REFLUX DISEASE

    NARCIS (Netherlands)

    VANDENPLAS, Y; ASHKENAZI, A; BELLI, D; BOIGE, N; BOUQUET, J; CADRANEL, S; CEZARD, JP; CUCCHIARA, S; DUPONT, C; GEBOES, K; GOTTRAND, F; HEYMANS, HSA; JASINSKI, C; KNEEPKENS, CMF; KOLETZKO, S; MILLA, P; MOUGENOT, JF; NUSSLE, D; NAVARRO, J; NEWELL, SJ; OLAFSDOTTIR, E; PEETERS, S; RAVELLI, A; POLANCO, [No Value; SANDHU, BK; TOLBOOM, J

    1993-01-01

    In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux

  5. Gastroesophageal reflux disease correlation with posterior laryngitis

    Directory of Open Access Journals (Sweden)

    Dimitrijević Milovan

    2009-01-01

    Full Text Available Background/Aim. Over the last years numerous studies have been performed dealing with mutual relations among gastroesophageal reflux disease (GERD and numerous diseases of the upper airways. The aim of the present study was to establish possible causal relationship between GERD and posterior laryngitis (PL. Methods. The study included 103 patients with gastrointestinal complaints. Diagnostic procedure included a medical history, gastroscopy and laryngeal directoscopy. The obtained data processed using classic methods of the descriptive statistics, as well as Pearson's chi-square test, Student's t test, rank sum test and Fisher's parametric analysis of variance. Results. Out of the total number of 103 examined patients, 33 (32% were diagnosed with PL, while GERD was diagnosed in five of the examined patients all belonging to the PL group (15% of the patients with PL. In the remaining patients, PL was caused by other factors. All the patients with GERD had PL and globus sensation while 80% of GERD patients had prominent symptom of pain. Conclusion. The results of the study are indicative of the causal relationship between GERD and PL.

  6. Pulmonary manifestations of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Gaude Gajanan

    2009-01-01

    Full Text Available Gastroesophageal reflux disease (GERD may cause, trigger or exacerbate many pulmonary diseases. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. A primary care physician often encounters patients with extra esophageal manifestations of GERD in the absence of heartburn. Patients may present with symptoms involving the pulmonary system; noncardiac chest pain; and ear, nose and throat disorders. Local irritation in the esophagus can cause symptoms that vary from indigestion, like chest discomfort and abdominal pain, to coughing and wheezing. If the gastric acid reaches the back of the throat, it may cause a bitter taste in the mouth and/or aspiration of the gastric acid into the lungs. The acid can cause throat irritation, postnasal drip and hoarseness, as well as recurrent cough, chest congestion and lung inflammation leading to asthma and/or bronchitis/ pneumonia. This clinical review examines the potential pathophysiological mechanisms of pulmonary manifestations of GERD. It also reviews relevant clinical information concerning GERD-related chronic cough and asthma. Finally, a potential management strategy for GERD in pulmonary patients is discussed.

  7. Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

    Directory of Open Access Journals (Sweden)

    Theodore Liakakos

    2009-01-01

    Full Text Available Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.

  8. Taurolithocholate impairs bile canalicular motility and canalicular bile secretion in isolated rat hepatocyte couplets

    Institute of Scientific and Technical Information of China (English)

    Norihito Watanabe; Tatehiro Kagawa; Sei-ichiro Kojima; Shinji Takashimizu; Naruhiko Nagata; Yasuhiro Nishizaki; Tetsuya Mine

    2006-01-01

    AIM: To investigate the effects of taurolithocholate (TLC)on the canalicular motility in isolated rat hepatocyte couplets (IRHC).METHODS: TLC was added to IRHC at concentrations of 10 and 50 μmol/L, respectively. In each group, five time-lapse movies containing 3 representative bile canaliculi were taken under phase-contrast microscopy for 12 h. The number of bile canalicular contractions and the intervals between consecutive canalicular contractions were calculated. Furthermore, the effects of TLC on IRHC were examined by transmission electron microscopy.RESULTS: The bile canalicular contractions were spontaneous and forceful in the controls. Active vesicular movement was observed in the pericanalicular region. Immediately after the addition of TLC, the bile canaliculi were deformed, and canalicular bile was incorporated into the vacuoles. The canaliculi were gradually dilated, and canalicular contractions were markedly inhibited by TLC. The vesicular movements became extremely slow in the pericanalicular region. The number of canalicular contractions significantly decreased in the TLC-treated groups, as compared with that in the controls. The time intervals were prolonged, as the TLC dosage increased,indicating that bile secretion into the canaliculi was impaired with TLC. Transmission electron microscopy revealed the lamellar transformation of the canalicular membranes in IRHC treated with TLC.CONCLUSION: TLC impairs both the bile canalicular contractions and the canalicular bile secretion, possibly by acting directly on the canalicular membranes in TLCinduced cholestasis.

  9. Role of Bile Acids and Bile Acid Receptors in Metabolic Regulation

    NARCIS (Netherlands)

    Lefebvre, Philippe; Cariou, Bertrand; Lien, Fleur; Kuipers, Folkert; Staels, Bart

    2009-01-01

    Lefebvre P, Cariou B, Lien F, Kuipers F, Staels B. Role of Bile Acids and Bile Acid Receptors in Metabolic Regulation. Physiol Rev 89: 147-191,2009; doi: 10.1152/physrev.00010.2008. - The incidence of the metabolic syndrome has taken epidemic proportions in the past decades, contributing to an incre

  10. Effect of bile acids on digestion

    Directory of Open Access Journals (Sweden)

    O. O. Stremoukhov

    2013-12-01

    Full Text Available Studying the effects of different bile acids in the body in recent years significantly increased the understanding of their physiological functions. The role of bile acids is to transfer to Striated border of enterocytes lipids in high micellar concentration and subsequent return them to the water layer in the molecular form. The rate of diffusion of molecules or particles is inversely proportional to the square root of the magnitude of their molecular weight. Main components of the glycoprotein complex (GPC allows to preserve the natural structure of mucosa. Previous physicochemical experiments on GPC established presence of bile acids (3,5 to 10 mg/ml, enzymes (amylase and lipase, amino acids (from 10150 to 29500 ug/ml in the complex. Objective. The aim was to study the influence of bile on fat filtration on the model of GPC. Method and Materials. Soaked filters were put on the tubes: with bile - the first, water - the second group, GPC bile at a dose of 25 mg/kg - the third group. Then on each filter was poured 2 ml of liquid fat. 30 minutes after the start of the experiment the amount of liquid fat that passes through the filter was measured. Results and Discussion. As established in the first group (bile medical, the amount of liquid fat, which passed through the filter amounted to 1,85±0,02 ml. In the second group (water - 0,30 ± 0,03 ml. In the third group (GPC 25 mg/kg - 1,75±0,02 ml. After that the impact of GPC bile in emulsification of fats was studied. 1 ml of vegetable oil and 1,5 ml of purified water were contributed in three series of tubes. The first series of test tubes left unchanged. In the other two 2 ml in 2 series - medical bile in 3 series - GPC bile were added. Tubes were shaken in all series. In the first (control series observed the formation of turbid fluid - emulsion. However, in a few seconds instability of the emulsion was detected. In the second and third series of tubes formation of stable emulsions which are

  11. Bile Acid Signaling in Liver Metabolism and Diseases

    Directory of Open Access Journals (Sweden)

    Tiangang Li

    2012-01-01

    Full Text Available Obesity, diabetes, and metabolic syndromes are increasingly recognized as health concerns worldwide. Overnutrition and insulin resistance are the major causes of diabetic hyperglycemia and hyperlipidemia in humans. Studies in the past decade provide evidence that bile acids are not just biological detergents facilitating gut nutrient absorption, but also important metabolic regulators of glucose and lipid homeostasis. Pharmacological alteration of bile acid metabolism or bile acid signaling pathways such as using bile acid receptor agonists or bile acid binding resins may be a promising therapeutic strategy for the treatment of obesity and diabetes. On the other hand, bile acid signaling is complex, and the molecular mechanisms mediating the bile acid effects are still not completely understood. This paper will summarize recent advances in our understanding of bile acid signaling in regulation of glucose and lipid metabolism, and the potentials of developing novel therapeutic strategies that target bile acid metabolism for the treatment of metabolic disorders.

  12. Hepatic bile acids and bile acid-related gene expression in pregnant and lactating rats

    Directory of Open Access Journals (Sweden)

    Qiong N. Zhu

    2013-08-01

    Full Text Available Background. Significant physiological changes occur during pregnancy and lactation. Intrahepatic cholestasis of pregnancy (ICP is a liver disease closely related to disruption of bile acid homeostasis. The objective of this study was to examine the regulation of bile acid synthesis and transport in normal pregnant and lactating rats.Materials and Methods. Livers from timed pregnant SD rats were collected on gestational days (GD 10, 14 and 19, and postnatal days (PND 1, 7, 14 and 21. Total bile acids were determined by the enzymatic method, total RNA was isolated and subjected to real time RT-PCR analysis. Liver protein was extracted for western-blot analysis.Results. Under physiological conditions hepatic bile acids were not elevated during pregnancy but increased during lactation in rats. Bile acid synthesis rate-limiting enzyme Cyp7a1 was unchanged on gestational days, but increased on PND14 and 21 at mRNA and protein levels. Expression of Cyp8b1, Cyp27a1 and Cyp7b1 was also higher during lactation. The mRNA levels of small heterodimer partner (SHP and protein levels of farnesoid X receptor (FXR were increased during pregnancy and lactation. Bile acid transporters Ntcp, Bsep, Mrp3 and Mrp4 were lower at gestation, but increased during lactation. Hepatic Oatp transporters were decreased during pregnancy and lactation.Conclusion. Hepatic bile acid homeostasis is maintained during normal pregnancy in rats, probably through the FXR-SHP regulation. The expression of bile acid synthesis genes and liver bile acid accumulation were increased during lactation, together with increased expression of bile acid efflux transporter Bsep, Mrp3 and Mrp4.

  13. Bile acid formation in primary human hepatocytes

    Institute of Scientific and Technical Information of China (English)

    Curt Einarsson; Ewa Ellis; Anna Abrahamsson; Bo-G6ran Ericzon; Ingemar Bj rkhem; Magnus Axelson

    2000-01-01

    AIM To evaluate a culture system for bile acid formation in primary human hepatocytes in comparison with HepG2 cells. METHODS Hepatocytes were isolated from normal human liver tissue and were cultured in serum-free William's E medium. The medium was collected and renewed every 24 h. Bile acids and their precursors in media were finally analysed by gas chromatography-mass spectrometry. RESULTS Cholic acid ( CA ) andchenodeoxycholic acid (CDCA) conjugated with glycine or taurine accounted for 70% and 25% of total steroids. A third of CDCA was also conjugated with sulphuric acid. Dexamathasone and thyroid hormorm alone or in combination did not significantly effect bile acid formation. The addition of cyclosporin A (10 μmol/L) inhibited the synthesis of CA and CDCA by about 13% and 30%, respectively. CONCLUSION Isolated human hepatocytes in primary culture behave as in the intact liver by converting cholesterol to conjugated CA and CDCA. This is in contrast to cultured HepG2 cells, which release large amounts of bile acid precursors and unconjugated bile acids into the medium.

  14. Bile acid formation in primary human hepatocytes

    Institute of Scientific and Technical Information of China (English)

    Curt Einarsson; Ewa Ellis; Anna Abrahamsson; Bo-G ran Ericzon; Ingemar Bj rkhem; Magnus Axelson

    2000-01-01

    AIM To evaluate a system for bile acid formation in human hepatocytes in comparison with HepG2 cells.METHODS Hepatocytes were isolated from normal human liver tissue and were cultured in serum-freeWilliam's E medium. The medium was collected and renewed every 24 h. Bile acids and their precursors inmedia were finally analysed by gas chromatography-mass spectrometry.RESULTS Cholic acid (CA) and chenodeoxycholic acid (CDCA) conjugated with glycine or taurineaccounted for 70% and 25% of total steroids. One third of CDCA was also conjugated with sulphuric acid.Dexamethasone and thyroid hormone alone or in combination did not significantly affect bile acid formation.The addition of cyclosporin A (10 tm) inhibited the synthesis of CA and CDCA by about 13% and 30%,respectively.CONCLUSION Isolated human hepatocytes in primary culture behave as in the intact liver by convertingalmost quantitatively cholesterol to conjugated CA and CDCA. This is in contrast to cultured HepG2 cells,which release large amounts of bile acid precursors and unconjugated bile acids into the medium.

  15. Bile Acid-Induced Suicidal Erythrocyte Death

    Directory of Open Access Journals (Sweden)

    Elisabeth Lang

    2016-04-01

    Full Text Available Background/Aims: In nucleated cells, bile acids may activate cation channels subsequently leading to entry of Ca2+. In erythrocytes, increase of cytosolic Ca2+ activity triggers eryptosis, the suicidal death of erythrocytes characterized by phosphatidylserine exposure at the cell surface and cell shrinkage. Eryptosis is triggered by bile duct ligation, an effect partially attributed to conjugated bilirubin. The present study explored, whether bile acids may stimulate eryptosis. Methods: Phosphatidylserine exposing erythrocytes have been identified utilizing annexin V binding, cell volume estimated from forward scatter, cytosolic Ca2+ activity determined using Fluo-3 fluorescence, and ceramide abundance at the erythrocyte surface utilizing specific antibodies. Results: The exposure of human erythrocytes to glycochenodesoxycholic (GCDC and taurochenodesoxycholic (TCDC acid was followed by a significant decrease of forward scatter and significant increase of Fluo-3 fluorescence, ceramide abundance as well as annexin V binding. The effect on annexin V binding was significantly blunted, but not abolished by removal of extracellular Ca2+. Conclusion: Bile acids stimulate suicidal cell death, an effect paralleled by and in part due to Ca2+ entry and ceramide. The bile acid induced eryptosis may in turn lead to accelerated clearance of circulating erythrocytes and, thus, may contribute to anemia in cholestatic patients.

  16. LINX(®) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux.

    Science.gov (United States)

    Bonavina, Luigi; Saino, Greta; Lipham, John C; Demeester, Tom R

    2013-07-01

    Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant 'therapy gap' in the treatment of GERD remains evident in current clinical practice. The LINX(®) Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients.

  17. A Study on the Relationship between Reflux Esophagitis and Periodontitis.

    Science.gov (United States)

    Adachi, Kyoichi; Mishiro, Tomoko; Tanaka, Shino; Yoshikawa, Hiroo; Kinoshita, Yoshikazu

    2016-01-01

    Objective Metabolic syndrome and dental erosion have been demonstrated to correlate with gastroesophageal acid reflux disease (GERD), while periodontitis has been reported to have a positive relationship with metabolic syndrome. However, no correlation between periodontitis and GERD has yet been reported. We therefore investigated the relationship between periodontitis and GERD. Methods The subjects consisted of 280 individuals who visited the Health Center for a detailed medical checkup examination. Each underwent upper endoscopy and periodontitis examinations, with the latter performed by measuring the concentrations of lactate dehydrogenase and hemoglobin in saliva. The subjects were divided into those with positive and negative periodontitis findings, and the prevalence rates of endoscopically proven reflux esophagitis, dyslipidemia, hypertension, and hyperglycemia were compared. Results The number of subjects positive for periodontitis was 93, while 187 had negative findings. The prevalence of reflux esophagitis was not different between the positive and negative groups (8.6% vs. 8.0%). In addition, a multiple logistic regression analysis did not identify a positive relationship between the presence of periodontitis and reflux esophagitis. On the other hand, dyslipidemia and hypertension were more frequently observed in the subjects that were positive for periodontitis. Conclusion We did not find an association between periodontitis and reflux esophagitis in the present study. On the other hand, the presence of periodontitis was found to correlate with hypertension and dyslipidemia.

  18. Is ineffective esophageal motility associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Kyung Yup Kim; Gwang Ha Kim; Dong Uk Kim; Soo Geun Wang; Byung Joo Lee; Jin Choon Lee; Do Youn Park; Geun Am Song

    2008-01-01

    AIM: To evaluate the association between IEM and gastropharyngeal reflux disease (GPRD) in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms.METHODS: A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms (e.g. globus, hoarseness, or cough) were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups.RESULTS: A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups.CONCLUSION: There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.

  19. Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To analyze the spectrum and risk factors of gastroesophageal reflux disease (GERD) based on presenting symptoms and endoscopic findings. METHODS: A cross-sectional survey in a cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version Reflux Disease Questionnaire (RDQ) and other items recording the demographic characteristics and potential risk factors for GERD. Subjects were defined as having GERD symptoms according to the RDQ score (>12). All subjects were endoscopied and the definition and severity of erosive esephagitis were evaluated by Los Angeles classification.The statistical analysis was performed with SPSS13.0 programs. RESULTS: Of 2231 recruited participants, 701 (31.40%) patients were diagnosed as having GFRD while 464 (20.80%) patients had objective findings of reflux esophagitis (RE). Of those 464 patients, only 291 (13.00%) were reported as subjects with GERD symptoms. A total of 528 (23.70%) patients were found to have GERD symptoms, including 19.50% patients with grade A or B reflux esophagitis, 0.90% with grade C and 0.40% with grade D. On multivariate analysis, old age,male, moderate working burden, divorced/widowed and strong tea drinking remained as significant independent risk factors for erosive esophagitis. Meanwhile, routine usage of greasy food and constipation were considered as significant independent risk factors for non-erosive reflux disease (NERD).CONCLUSION: GERD is one of the common GI diseases with a high occurrence rate in China and its main associated factors include sex, anthropometrical variables and sociopsychological characteristics.

  20. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  1. Supramolecular Complexes Formed in Systems Bile Salt-Bilirubin-Silica

    Science.gov (United States)

    Vlasova, N. N.; Severinovskaya, O. V.; Golovkova, L. P.

    The formation of supramolecular complexes between bilirubin and primary micelles of bile salts has been studied. The association constants of bile salts and binding of bilirubin with these associates have been determined. The adsorption of bilirubin and bile salts from individual and mixed aqueous solutions onto hydrophobic silica surfaces has been investigated. The interaction of bilirubin with primary bile salt micelles and the strong retention in mixed micelles, which are supramolecular complexes, result in the adsorption of bilirubin in free state only.

  2. Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, K.E.; Ask, P.; Boeryd, B.; Fransson, S.G.; Tibbling, L.

    1986-01-01

    In a study comprising 100 patients referred to a surgical clinic with symptons suggestive of gastro-oesophageal reflux disease, the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly corelated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux, and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensivity for radiologic, manometric and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

  3. Omeprazole for Refractory Gastroesophageal Reflux Disease during Pregnancy and Lactation

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1998-01-01

    Full Text Available Symptomatic gastroesophageal reflux is a common complication of pregnancy and lactation. However, the safety of many effective medical therapies, including oral proton pump inhibitors, has not been well defined. The administration of oral omeprazole to a 41-year-old female during the third trimester of pregnancy, after ranitidine and cisapride failed to control her refractory gastroesophageal reflux, is reported. No adverse fetal effects were apparent, and the patient elected to continue omeprazole therapy (20 mg/day while breastfeeding. Peak omeprazole concentrations in breast milk (58 nM, 3 h after ingestion were less than 7% of the peak serum concentration (950 nM at 4 h, indicating minimal secretion. Although omeprazole is a potentially useful therapy for refractory gastroesophageal reflux during pregnancy and lactation, further data are needed to define better its safety and efficacy.

  4. Applying the ALARA concept to the evaluation of vesicoureteric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Richard S.; Diamond, David A. [Children' s Hospital Boston, Department of Urology, Boston, MA (United States); Chow, Jeanne S. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)

    2006-09-15

    The voiding cystourethrogram (VCUG) is a widely used study to define lower urinary tract anatomy and to diagnose vesicoureteric reflux (VUR) in children. We examine the technical advances in the VCUG and other examinations for reflux that have reduced radiation exposure of children, and we give recommendations for the use of imaging studies in four groups of children: (1) children with urinary tract infection, (2) siblings of patients with VUR, (3) infants with antenatal hydronephrosis (ANH), and (4) children with a solitary functioning kidney. By performing examinations with little to no radiation, carefully selecting only the children who need imaging studies and judiciously timing follow-up examinations, we can reduce the radiation exposure of children being studied for reflux. (orig.)

  5. Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD

    Directory of Open Access Journals (Sweden)

    Selfie

    2015-12-01

    Full Text Available Gastroesophageal reflux disease (GERD was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.

  6. [Gastro-esophageal reflux and chronic respiratory diseases].

    Science.gov (United States)

    Dirou, S; Germaud, P; Bruley des Varannes, S; Magnan, A; Blanc, F-X

    2015-12-01

    Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases.

  7. Bethanechol versus antiacids in the treatment of gastroesophageal reflux.

    Science.gov (United States)

    Levi, P; Marmo, F; Saluzzo, C; Dell'Olio, D; Ansaldi, N; Giuliani, L; Guardamagna, O; Mostert, M; Ponzone, A

    1985-12-01

    To compare the efficacy of bethanechol in the treatment of gastroesophageal reflux with that of antiacids, a prospective, cross-over study was undertaken, in which 20 affected infants and children were randomized into two groups on 6-week alternate bethanechol and antiacids oral medication. Patients were evaluated clinically and by esophageal pH-metry before and after each treatment. Clinical score amelioration was achieved earlier than reflux number reduction and with similar incidence in both groups of patients, irrespectively to the initial medication; moreover, the differences in the degree of improvement between the two groups after either treatment were not found to be significant. These results fail to show that bethanechol is more effective than antiacids in controlling gastroesophageal reflux; moreover, bethanechol is more difficult to administer and offers a higher rate of undesired side effects.

  8. The Association between Childhood Overweight and Reflux Esophagitis

    Directory of Open Access Journals (Sweden)

    Nirav R. Patel

    2010-01-01

    Full Text Available Background. In adults, it has been shown that obesity is associated with gastroesophageal reflux disease (GERD and GERD-related complications. There are sparse pediatric data demonstrating associations between childhood overweight and GERD. Objective. To investigate the association between childhood overweight and RE. Methods. We performed a retrospective chart review of 230 children (M : F=114 : 116 who underwent esophagogastroduodenoscopy (EGD with biopsies between January 2000 and April 2006. Patient demographics, weight, height, clinical indications for the procedure, the prevalence of BMI classification groups, the prevalence of RE and usage of anti-reflux medications were reviewed. For these analyses, the overweight group was defined to include subjects with BMI≥ 85th percentile. The normal weight group was defined to include subjects with BMI 5th to 85th percentile. Results. Among the 230 subjects, 67 (29.1% had BMI percentiles above the 85th percentile for age and gender. The prevalence of RE in the overweight group did not differ significantly from that in the normal weight group (23.9% versus 24.5%, resp.. Overweight subjects taking anti-reflux medications clearly demonstrated a higher prevalence of biopsy-proven RE compared to overweight subjects not taking anti-reflux medications (34.1% versus 7.7%, =.009. Conclusions. There was no significant difference in the prevalence of biopsy-proven RE in the overweight group compared to the normal weight group. However, the prevalence of RE was significantly higher in overweight subjects on anti-reflux medications compared to overweight subjects not taking anti-reflux medications. This finding emphasizes the importance of early recognition and treatment of GERD for the overweight pediatric patients with symptoms in conjunction with weight loss program for this population to reduce long-term morbidities associated with GERD.

  9. Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

    Science.gov (United States)

    Dziekiewicz, Marcin A; Banaszkiewicz, Aleksandra; Urzykowska, Agnieszka; Lisowska, Aleksandra; Rachel, Marta; Sands, Dorota; Walkowiak, Jaroslaw; Radzikowski, Andrzej; Albrecht, Piotr

    2015-01-01

    Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

  10. The gut microbiome, probiotics, bile acids axis, and human health.

    Science.gov (United States)

    Jones, Mitchell Lawrence; Tomaro-Duchesneau, Catherine; Prakash, Satya

    2014-06-01

    The human gut microbiome produces potent ligands to bile acid receptors, and probiotics could act as therapeutics of bile acid dysmetabolism. A recent study in Cell Reports demonstrates that probiotic VSL#3 affects bile acid deconjugation and excretion, as well as the gut-liver FXR-FGF15 axis.

  11. Beyond intestinal soap-bile acids in metabolic control

    NARCIS (Netherlands)

    Kuipers, Folkert; Bloks, Vincent W.; Groen, Albert K.

    2014-01-01

    Over the past decade, it has become apparent that bile acids are involved in a host of activities beyond their classic functions in bile formation and fat absorption. The identification of the farnesoid X receptor (FXR) as a nuclear receptor directly activated by bile acids and the discovery that bi

  12. A case of fascioliasis in common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Ham, Soo Youn; Park, Cheol Min; Chung, Kyu Byung; Lee, Chang Hong; Park, Seung Chul; Choi, Sang Yong; Lim, Han Jong [Korea University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    A case of Fascioliasis of common bile duct is confirmed by visualization of adult fluke. Fascioliasis caused by Fasciola hepatica, is common parasitic disease in cattle and sheep. Human is an accidental host. ERCP demonstrated irregular linear conglomerated filling defects in common bile duct. Through surgical intervention, we found adult flukes of F. hepatica and adenomatous hyperplasia of common bile duct.

  13. Unmet Needs in the Treatment of Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Dickman, Ram; Maradey-Romero, Carla; Gingold-Belfer, Rachel; Fass, Ronnie

    2015-07-30

    Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the ther-apeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, main-tenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any fu-ture development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the afore-mentioned areas of unmet need.

  14. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Wirth, Hans-Peter

    2016-06-01

    Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma.

  15. Reflux and acid peptic diseases in the elderly.

    Science.gov (United States)

    Soumekh, Amir; Schnoll-Sussman, Felice H; Katz, Philip O

    2014-02-01

    Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher rate of complications such as erosive esophagitis, Barrett esophagus, and esophageal cancer. Moreover, the elderly may be more sensitive to the morbidity and mortality of the available treatments for GERD. A careful and vigilant approach to the diagnosis, monitoring, and treatment of reflux disease in the elderly is warranted.

  16. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.

  17. Bile acids for primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Poropat, Goran; Giljaca, Vanja; Stimac, Davor

    2011-01-01

    Primary sclerosing cholangitis is a progressive chronic cholestatic liver disease that usually leads to the development of cirrhosis. Studies evaluating bile acids in the treatment of primary sclerosing cholangitis have shown a potential benefit of their use. However, no influence on patients...

  18. Double common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Srdjan P Djuranovic; Milenko B Ugljesic; Nenad S Mijalkovic; Viktorija A Korneti; Nada V Kovacevic; Tamara M Alempijevic; Slaven V Radulovic; Dragan V Tomic; Milan M Spuran

    2007-01-01

    Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

  19. 13.7.Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920141 Relationship between endotoxemiaand humoral immunity during biliary shock.CHI Pan (池畔),et al.Dept Liv & Bili Surg,UnionHosp,Fujian Med Coll.Chin J Digest 1991; 11(8):141-143.The authors observed dynamically the changesof plasma endotoxin (ET),bile ET and immunolo-

  20. Cefotaxime and desacetyl cefotaxime in human bile

    OpenAIRE

    1983-01-01

    Ten patients were injected with 2 g cefotaxime i. v. The antibacterial activity in the bile was measured by the agar diffusion test and the concentrations of cefotaxime and desacetyl cefotaxime were determined by high performance liquid chromatography. The values found allow the use of cefotaxime in infectious biliary diseases.

  1. Familial occurrence of congenital bile duct dilatation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Congenital bile duct dilatation (CBD) that developed in a parent and son is presented.Familial occurrence of CBD is rare,with only a few male cases having been reported.Since the initial report of CBD occurring in siblings in 1981,a total of 20 cases (10 pairs) have been published as of 2007.Clinical and genetic features of CBD are discussed.

  2. Low retinol levels differentially modulate bile salt-induced expression of human and mouse hepatic bile salt transporters

    NARCIS (Netherlands)

    M.O. Hoeke; J.R.M. Plass; J. Heegsma; M. Geuken; D. van Rijsbergen; J.F.W. Baller; F. Kuipers; H. Moshage; P.L.M. Jansen; K.N. Faber

    2009-01-01

    The farnesoid X receptor/retinoid X receptor-alpha (FXR/RXRalpha) complex regulates bile salt homeostasis, in part by modulating transcription of the bile salt export pump (BSEP/ABCB11) and small heterodimer partner (SHP/NR0B2). FXR is activated by bile salts, RXRalpha by the vitamin A derivative 9-

  3. Low Retinol Levels Differentially Modulate Bile Salt-Induced Expression of Human and Mouse Hepatic Bile Salt Transporters

    NARCIS (Netherlands)

    Hoeke, Martijn O.; Plass, Jacqueline R. M.; Heegsma, Janette; Geuken, Mariska; van Rijsbergen, Duncan; Baller, Julius F. W.; Kuipers, Folkert; Moshage, Han; Jansen, Peter L. M.; Faber, Klaas Nico

    2009-01-01

    The farnesoid X receptor/retinoid X receptor-alpha (FXR/RXR alpha) complex regulates bile salt homeostasis, in part by modulating transcription of the bile salt export pump (BSEP/ABCB11 I) and small heterodimer partner (SHP/NR0B2). FXR is activated by bile salts, RXR alpha by the vitamin A derivativ

  4. Bile salt toxicity aggravates cold ischemic injury of bile ducts after liver transplantation in Mdr2+/- mice

    NARCIS (Netherlands)

    Hoekstra, H; Porte, RJ; Tian, Y; Jochum, W; Stieger, B; Moritz, W; Slooff, MJH; Graf, R; Clavien, PA

    2006-01-01

    Intrahepatic bile duct strictures are a serious complication after orthotopic liver transplantation (OLT). We examined the role of endogenous bile salt toxicity in the pathogenesis of bile duct injury after OLT. Livers from wild-type mice and mice heterozygous for disruption of the multidrug resista

  5. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Weusten, Bas L. A. M.; Timmer, Robin; Smout, Andre J. P. M.

    2006-01-01

    OBJECTIVE: In some patients with a physiological esophageal acid exposure, an association between reflux episodes and symptoms can be demonstrated. Besides acidity, other factors such as proximal extent may determine whether a reflux episode is perceived or not. We aimed to investigate the reflux pr

  6. Bile acid signaling in metabolic disease and drug therapy.

    Science.gov (United States)

    Li, Tiangang; Chiang, John Y L

    2014-10-01

    Bile acids are the end products of cholesterol catabolism. Hepatic bile acid synthesis accounts for a major fraction of daily cholesterol turnover in humans. Biliary secretion of bile acids generates bile flow and facilitates hepatobiliary secretion of lipids, lipophilic metabolites, and xenobiotics. In the intestine, bile acids are essential for the absorption, transport, and metabolism of dietary fats and lipid-soluble vitamins. Extensive research in the last 2 decades has unveiled new functions of bile acids as signaling molecules and metabolic integrators. The bile acid-activated nuclear receptors farnesoid X receptor, pregnane X receptor, constitutive androstane receptor, vitamin D receptor, and G protein-coupled bile acid receptor play critical roles in the regulation of lipid, glucose, and energy metabolism, inflammation, and drug metabolism and detoxification. Bile acid synthesis exhibits a strong diurnal rhythm, which is entrained by fasting and refeeding as well as nutrient status and plays an important role for maintaining metabolic homeostasis. Recent research revealed an interaction of liver bile acids and gut microbiota in the regulation of liver metabolism. Circadian disturbance and altered gut microbiota contribute to the pathogenesis of liver diseases, inflammatory bowel diseases, nonalcoholic fatty liver disease, diabetes, and obesity. Bile acids and their derivatives are potential therapeutic agents for treating metabolic diseases of the liver.

  7. The human laryngeal microbiome: effects of cigarette smoke and reflux

    Science.gov (United States)

    Jetté, Marie E.; Dill-McFarland, Kimberly A.; Hanshew, Alissa S.; Suen, Garret; Thibeault, Susan L.

    2016-01-01

    Prolonged diffuse laryngeal inflammation from smoking and/or reflux is commonly diagnosed as chronic laryngitis and treated empirically with expensive drugs that have not proven effective. Shifts in microbiota have been associated with many inflammatory diseases, though little is known about how resident microbes may contribute to chronic laryngitis. We sought to characterize the core microbiota of disease-free human laryngeal tissue and to investigate shifts in microbial community membership associated with exposure to cigarette smoke and reflux. Using 454 pyrosequencing of the 16S rRNA gene, we compared bacterial communities of laryngeal tissue biopsies collected from 97 non-treatment-seeking volunteers based on reflux and smoking status. The core community was characterized by a highly abundant OTU within the family Comamonadaceae found in all laryngeal tissues. Smokers demonstrated less microbial diversity than nonsmokers, with differences in relative abundances of OTUs classified as Streptococcus, unclassified Comamonadaceae, Cloacibacterium, and Helicobacter. Reflux status did not affect microbial diversity nor community structure nor composition. Comparison of healthy laryngeal microbial communities to benign vocal fold disease samples revealed greater abundance of Streptococcus in benign vocal fold disease suggesting that mucosal dominance by Streptococcus may be a factor in disease etiology. PMID:27775059

  8. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    Directory of Open Access Journals (Sweden)

    Agrawal Vikesh

    2009-01-01

    Full Text Available Aim : Evaluation of vesicoureteric reflux (VUR in children by bladder volume graded direct radionuclide cystogram (BVG DRC. This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two patients and 36 renal units were found to have VUR in either of the reflux studies. A VCUG was able to detect 20 units (55.50% and a BVG DRC was able to detect 35 units (97.2%. A VCUG had a test accuracy of 77.8% and a BVG DRC had a test accuracy of 98.6%. There was a positive correlation between bladder volume grades and scarring on a DMSA scan. Conclusions : Like a conventional DRC, BVG DRC is a sensitive and an accurate test. It gives additional information on the reflux phenomenon with respect to bladder filling. The bladder volume graded technique is better than conventional DRC for grading of VUR.

  9. [Severe interstitial lung disease from pathologic gastroesophageal reflux in children].

    Science.gov (United States)

    Ahrens, P; Weimer, B; Hofmann, D

    1999-07-01

    Interstitial lung diseases comprise a heterogeneous group of pulmonary conditions that cause restrictive lung disease of poor prognosis, especially if growth failure, pulmonary hypertension and fibrosis appears. We report on the case of a girl of 11 years of age who suffered from severe nonallergic asthma in early childhood and who developed severe interstitial pulmonary disease caused by gastro-oesophageal reflux at the age of 8 years. This diagnosis was established by lung biopsy, bronchoalveolar lavage and a high amount of lipid-laden alveolar macrophages, 2-level pH measurement and oesophageal biopsy. Because therapy with oral and inhaled steroids failed and Omeprazol showed benificial effects, hemifundoplication according to THAL was performed. At present the lung function is clearly normal and there is no need of any medicaments. Following the history, we can assume the pathological gastro-oesophageal reflux to be the cause of the disease. It is important to state that there were no typical symptoms at any time pointing to gastro-oesophageal reflux disease. The development of pulmonary disease by pathological reflux is very often caused by "silent aspiration". Very typically there are no symptoms such as vomiting, heartburn and pain but only signs of chronic lung disease.

  10. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    OpenAIRE

    Thomas Lendvay

    2008-01-01

    Robotic-assisted laparoscopy (RAL) has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are traine...

  11. The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux

    NARCIS (Netherlands)

    de Jong, [No Value; van Ramshorst, B; Timmer, R; Gooszen, HG; Smout, AJPM

    2004-01-01

    Background: Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. Methods: 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after

  12. Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

    Institute of Scientific and Technical Information of China (English)

    Mike Thomson; Prithviraj Rao; David Rawat; Tobias G Wenzl

    2011-01-01

    AIM: To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were nonacidic.The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058).Median number of non-acid GOR, average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

  13. Urodynamics in boys after prenatally diagnosed vesicoureteric reflux

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens

    1996-01-01

    Over the years, several theories have been presented regarding the pathogenesis of vesicoureteral reflux (VUR) in children without neurological disease or posterior urethral valves. Primary VUR is one of many fetal uropathies detectable by prenatal sonography. Thirteen boys with a prenatal...

  14. Inducing and Aggravating Factors of Gastroesophageal Reflux Symptoms

    Directory of Open Access Journals (Sweden)

    Radhiyatam Mardhiyah

    2016-12-01

    Full Text Available Gastroesophageal reflux disease (subsequently abbreviated as GERD is a disease commonly found in the community. Several factors have been recognized as inducing and aggravating factors of GERD symptoms such as older age, female gender, obesity, smoking habit, alcohol consumption, certain diet and poor eating habit like eating fatty, spicy, and acid food.

  15. Gastroesophageal reflux disease: exaggerations, evidence and clinical practice

    Directory of Open Access Journals (Sweden)

    Cristina Targa Ferreira

    2014-04-01

    Full Text Available OBJECTIVE: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD in children. The association between GERD and cow's milk protein allergy (CMPA, overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children. DATA SOURCE: a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013. DATA SYNTHESIS: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER. Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects. CONCLUSIONS: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.

  16. Erroneous Diagnosis of Gastroesophageal Reflux Disease in Achalasia

    NARCIS (Netherlands)

    B.F. Kessing; A.J. Bredenoord; A.J.P.M. Smout

    2011-01-01

    BACKGROUND & AIMS: Most experienced gastroenterologists have seen one or several cases of achalasia patients who have been erroneously diagnosed with gastroesophageal reflux disease (GERD) or even underwent antireflux surgery. We aim to describe the current knowledge about the diagnostic features of

  17. Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children

    Directory of Open Access Journals (Sweden)

    Hoda M Malaty, J Kennard Fraley

    2009-03-01

    Full Text Available Hoda M Malaty1, J Kennard Fraley1,2, Suhaib Abudayyeh1, Kenneth W Fairly1, Ussama S Javed1, et al1Department of Medicine, 2Children’s Nutrition Research Center (CNRC, 4Department of Pediatrics, 5Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA; 3Department of Gastroenterology, Oregon Health and Science University, Portland, OR, USABackground: The association between body mass index (BMI and gastroesophageal reflux disease (GERD has been extensively studied among adults but few studies have examined such association in children. Aims: 1 to determine the relationship between BMI in children and GERD, and 2 to use the National Center for Health Statistics (NCHS values for BMI as a valid source for comparison. Methods: We identified two cohorts of children aged between two and 17 years who were seen at Texas Children’s Hospital (TCH. The first cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic findings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal reflux (GER who received outpatient gastrointestinal (GI consultation at TCH for any 9th revision of the International Statistical Classification of Diseases (ICD-9 code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded.Measurements: The records for each child namely, age, gender, height, and weight were obtained on the same date as that of the diagnosis. Using the growth curves published by the NCHS, the gender/age specific weight

  18. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal

  19. Technical Limitations in Detection of Gastroesophageal Reflux (GER) in Neonates

    Science.gov (United States)

    Di Fiore, Juliann M.; Arko, Marina; Churbock, Kim; Hibbs, Anna Maria; Martin, Richard J.

    2009-01-01

    Objective Characterize the incidence and possible etiologies of acid reflux events detected by pH and not identified by intraluminal impedance (MII) monitoring. Methods Acid reflux events detected by pH but not identified by MII (pH-only) were documented in 80 preterm and 39 term infants. Reason for failure of MII to detect these events were classified as failure to meet MII scoring criteria, presence of an air bolus, technical artifact, and no change in impedance. Events with no change in impedance were stratified to; 1) low impedance throughout the study (possible esophageal inflammation), 2) transient decrease in pre-event impedance (presence of refluxate), 3) occurrence <30 seconds of a preceding event and 4) no explanation. Results 2572 events were detected by pH with 59% of events not identified by MII. A higher incidence of pH-only events occurred in preterm versus term infants (54±27% vs 42±23%, p=.025, respectively). Thirteen percent of pH-only events were missed due to MII scoring criteria, 12% due to technical artifact, 11% due to an air bolus and 64% had no change in impedance. Of the 978 events with no change in impedance 154 were associated with low impedance throughout the study, 430 with a transient decrease in pre-event impedance, and 175 were preceded by a reflux episode within 30sec. Conclusion There was a high incidence of acid reflux events detected by pH but not identified by MII. This occurred more often in the least mature infants and we speculate that delayed esophageal fluid clearance is the major underlying mechanism. PMID:19581816

  20. Herbert Falk: a vital force in the renaissance of bile acid research and bile acid therapy.

    Science.gov (United States)

    Hofmann, Alan F

    2011-01-01

    Herbert Falk died on August 8, 2008, after a long illness. It was his vision that initiated the Bile Acid Meetings and brought to market chenodeoxycholic acid and ursodeoxycholic acid for the dissolution of cholesterol gallstones as well as the successful treatment of cholestatic liver disease. The 1st Bile Acid Meeting was a small workshop held at the University Hospital of Freiburg in 1970. Great interest in the topic was evident at that small meeting and led to a larger meeting in 1972, whose scope included both the basic and clinical aspects of bile acids. These meetings have continued at biennial intervals, the 2010 meeting being the 21st. The program has always included discussions of the most fundamental aspects of bile acid biosynthesis and metabolism as well as clinical applications of bile acid therapy. The meetings featured brief presentations, ample time for discussion, and imaginative social programs. They have always been flawlessly organized. Social programs usually included a hike through the beautiful countryside of the Black Forest followed by dinner in a rustic restaurant. Herbert Falk took part in these programs, personally welcoming every participant. In the warm glow of the 'Badische' hospitality, friendships developed, and scientific collaborations were often arranged. From a scientific standpoint, there has been enormous progress in understanding the chemistry and biology of bile acids. Herbert Falk established the Windaus Prize in 1978, and the prize has been given to individuals whose contributions moved the field forward. These bile acid meetings have been marvelous, rewarding experiences. We must all be grateful to Herbert Falk's vision in establishing the Falk Foundation that has so generously sponsored these meetings. We also express our gratitude to his widow, Ursula Falk, who continues this worthy tradition.

  1. Bile tract adenomyoma: A case report

    Institute of Scientific and Technical Information of China (English)

    Gui-Ming Shu; Yi-Jun Wang; Zhi Du; Dong-Yan Li; Chang-Li Liu

    2008-01-01

    This paper described a rare case of adenomyoma of common bile duct. The case is a 51-year-old man who was hospitalized for yellow color skin and sclera and itching for 2 mo without abdominal pain. Nothing special was found in physical examination except yellowish skin and sclera. The clinical presentation and Computerized Tomography (CT), Magnetic resonance cholangiopancreatography (MRCP), and ultrasonography suspected a tumor of the distal bile duct. The patient was treated successfully by pancreaticoduodenectomy. Histologically, the lesion consisted of adenoid and myofibrous tissue and moderate atypia. The immunophenotype of the epithelial component was cytokeratin 7+/cytokeratin 20-. The patient has been well without any evidence of recurrence for 12 mo since his operation.

  2. Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

    Science.gov (United States)

    Xie, Chenxi; Wang, Jinhui; Li, Yuwen; Tan, Niandi; Cui, Yi; Chen, Minhu; Xiao, Yinglian

    2017-01-01

    Background/Aims Anti-reflux barrier dysfunction is one of the primary mechanisms in gastroesophageal reflux disease (GERD) pathogenesis. The esophagogastric junction contractile integral (EGJ-CI) is a new metric adopted to evaluate the EGJ contractility, which implies the anti-reflux barrier function. The aim of the current study was to validate this new metric in patients with GERD and its correlation with the esophageal acid exposure, as well as the efficacy of proton pump inhibitor treatment. Methods Ninety-eight patients with GERD and 21 healthy controls were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24-hour multichannel intraluminal impedance-pH monitoring were performed in all patients. Three respiration cycles were chosen at the initial HRM resting frame and the value computed with distal contractile integral tool was then divided by the duration of the cycles to yield EGJ-CI. All the patients were treated with esomeprazole 20 mg twice-daily for 8 weeks. Results EGJ-CI was lower in the patients with GERD than that of the controls (P < 0.05). For patients with GERD, EGJ-CI was lower in those with hiatal hernia (P < 0.05). The new metric correlated with esophageal acid exposure in the supine position (P < 0.05), and it also negatively correlated to the total reflux episodes (P < 0.05). There was no significant difference on EGJ-CI between patients with and without response to the esomeprazole treatment (P = 0.627). Conclusions EGJ-CI reflected the dysfunction of the anti-reflux barrier in patients with GERD, but it had little impact on the esomeprazole response. PMID:27426485

  3. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  4. Bilingüismo en sordos

    OpenAIRE

    Juliarena, Graciela Edith

    2012-01-01

    El presente trabajo se ocupa de conceptualizar al sordo en tanto que sujeto constituido a partir de la adquisición del lenguaje de señas, su relación con la lengua hablada mayoritariamente en el grupo social que cohabita y la productividad de su bilingüismo en función de una comunicación más eficiente con su entorno.

  5. Effect of Nicotine on Gallbladder Bile

    Directory of Open Access Journals (Sweden)

    Anglo-Dutch Nicotine Intestinal Study Group

    1994-01-01

    Full Text Available Several studies have shown that symptomatic gallstones are largely a disease of nonsmokers, which raises the possibility that nicotine may protect against the formation of gallstones. To examine the effect of nicotine on the gallbladder, 32 rabbits were allocated to four groups: controls and three treatment groups in which nicotine tartarate at low, medium and high doses was administered subcutaneously via an osmotic minipump. After 14 days’ treatment the gallbladder was removed and measurements made of gallbladder mucin synthesis, bile mucin concentration, bile acid concentration and cholesterol saturation. Serum nicotine concentrations (ng/mL were (± SE 0.4±0.1, 3.5±0.4, 8.8±0.8 and 16.2±1.8 in the controls and three treatment groups, respectively. Total bile acid concentration increased significantly in all three treated groups with the greatest increase in the group given low dose nicotine (P<0.001. Cholesterol saturation did not differ significantly in any group but soluble mucin concentration in gallbladder bile was significantly reduced (P=0.013, 95% CI: 16 to 111 with high dose nicotine. Gallbladder mucin synthesis, measured by 3H-glucosamine incorporation, did not change significantly with nicotine treatment. Subcutaneous nicotine 2.0 mg/kg/day for 14 days significantly reduced the concentration of biliary mucin, which could potentially reduce cholesterol nucleation and subsequent gallstone formation. This may be one of the mechanisms responsible for the relative reduction in gallstone disease among smokers.

  6. Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

    Science.gov (United States)

    Kamani, Fereshteh; Dorudinia, Atosa; Goravanchi, Farhood; Rahimi, Farzaneh

    2007-04-01

    Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.

  7. Ocular injury secondary to sheep bile exposure

    Science.gov (United States)

    Okullo, Alfin Taddeo; Low, Tim; Baker, Louise Leslie

    2012-01-01

    A 57-year-old abattoir worker was seen at a general practitioner after sheep bile splashed into his left eye. Flourescein examination revealed extensive ulceration involving at least two-thirds of the corneal surface. Copious irrigation with normal saline, application of chloramphenicol ointment and an eye patch resulted in excellent healing within 2 days with return to normal vision for the patient thereafter. PMID:23208813

  8. Bear bile: dilemma of traditional medicinal use and animal protection

    Directory of Open Access Journals (Sweden)

    Nagamatsu Tadashi

    2009-01-01

    Full Text Available Abstract Bear bile has been used in Traditional Chinese Medicine (TCM for thousands of years. Modern investigations showed that it has a wide range of pharmacological actions with little toxicological side effect and the pure compounds have been used for curing hepatic and biliary disorders for decades. However, extensive consumption of bear bile made bears endangered species. In the 1980's, bear farming was established in China to extract bear bile from living bears with "Free-dripping Fistula Technique". Bear farming is extremely inhumane and many bears died of illness such as chronic infections and liver cancer. Efforts are now given by non-governmental organizations, mass media and Chinese government to end bear farming ultimately. At the same time, systematic research has to be done to find an alternative for bear bile. In this review, we focused on the literature, laboratory and clinical results related to bear bile and its substitutes or alternative in English and Chinese databases. We examined the substitutes or alternative of bear bile from three aspects: pure compounds derived from bear bile, biles from other animals and herbs from TCM. We then discussed the strategy for stopping the trading of bear bile and issues of bear bile related to potential alternative candidates, existing problems in alternative research and work to be done in the future.

  9. Bile acids: Chemistry, physiology, and pathophysiology

    Institute of Scientific and Technical Information of China (English)

    Maria J Monte; Jose JG Marin; Alvaro Antelo; Jose Vazquez-Tato

    2009-01-01

    The family of bile acids includes a group of molecular species of acidic steroids with very peculiar physicalchemical and biological characteristics. They are synthesized by the liver from cholesterol through several complementary pathways that are controlled by mechanisms involving fine-tuning by the levels of certain bile acid species. Although their bestknown role is their participation in the digestion and absorption of fat, they also play an important role in several other physiological processes. Thus, genetic abnormalities accounting for alterations in their synthesis, biotransformation and/or transport may result in severe alterations, even leading to lethal situations for which the sole therapeutic option may be liver transplantation. Moreover, the increased levels of bile acids reached during cholestatic liver diseases are known to induce oxidative stress and apoptosis, resulting in damage to the liver parenchyma and, ventually, extrahepatic tissues. When this occurs during pregnancy, the outcome of gestation may be challenged. In contrast, the physical-chemical and biological properties of these compounds have been used as the bases for the development of drugs and as pharmaceutical tools for the delivery of active agents.

  10. Profile of hepatocyte apoptosis and bile lakes before and after bile duct decompression in severe obstructive jaundice patients

    Institute of Scientific and Technical Information of China (English)

    ToarJMLalisang; RadenSjamsuhidajat; NurjatiCSiregar; AkmalTaher

    2010-01-01

    BACKGROUND: Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions. Although decompression of the bile duct has been reported to improve liver functions in animal studies, the mechanism of obstruction differs from that in humans. This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting. METHODS: We conducted a "before and after study" on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression. Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling (TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin (HE) to identify bile lakes. All measurements were independently done by 2 observers. RESULTS: Twenty-one severe obstructive jaundice patients were included. In all patients, excessive hepatocyte apoptosis and bile lakes were apparent. After decompression, the hepatocyte apoptosis index decreased from 53.1 (SD 105) to 11.7 (SD 13.6) (P CONCLUSION: Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice, similar to the findings in animal studies.

  11. The Frequency of Bacterial Agents in the Bile Juice of Patients with Bile Stones and

    Directory of Open Access Journals (Sweden)

    Tajeddin E

    2012-01-01

    Full Text Available Background and objectives: Bile in healthy people is a sterile fluid andpresence of any microorganism can be a marker for a disorder likecholelithiasis. The aim of this study was to determine the frequencyof bacterial agents in the bile of patients with bilestone, malignant pancreaticand biliary diseases.Material and Methods: One hundred and two bile samples were obtained,during six months in 2011, from patients subjected to ERCP in Taleghanihospital, Tehran. First, Patient's clinical data, the type stone, and their diseasestatus were studied, and then the microbiological investigations, such asculture, identification of the bacteria and detection of their counts, drugsusceptibility testing and molecular tests (16s rDNA PCR performed on allthe samples. Higher than 103 bacteria counts for each sample, in the absence ofunderlying infections, was considered as stable colonization. We run SPSSversion 13 to analyze the data.Results: Out of 42(41.1% positive bile culture samples, 59 bacterial isolatesare detected by conventional methods. Of culture negative samples, sevenhave bacterial DNA indicated by PCR method. The most isolated bacteria areE. coli (%34.4, Enterococcus spp. (%19.7, Klebsiella pneumoniae (%18 andPseudomonas aeruginos (18%. The most frequent stones are cholesterol,black pigment and brown pigment, respectively. There is no significantassociation between the diseases, stones and types of bacteria. Previousantibiotic usage (44.6% is meaningfully more than that of other biliaryproblems (p=0.01.Conclusion: The presence of bacteria, Escherchi coli and Entrococcus whichare the most in bile samples, is considered as a risk factor in pathogenesis ofbiliary disorders. Further studies on the pathogenesis and pathophysiologicaleffects of bacteria can help us to clarify the role of bacteria in producing bilestones.Key words: Bile stones, Bacteria, ERCP, Antibiotics.

  12. In vivo multiphoton imaging of bile duct ligation

    Science.gov (United States)

    Liu, Yuan; Li, Feng-Chieh; Chen, Hsiao-Chin; Chang, Po-shou; Yang, Shu-Mei; Lee, Hsuan-Shu; Dong, Chen-Yuan

    2008-02-01

    Bile is the exocrine secretion of liver and synthesized by hepatocytes. It is drained into duodenum for the function of digestion or drained into gallbladder for of storage. Bile duct obstruction is a blockage in the tubes that carry bile to the gallbladder and small intestine. However, Bile duct ligation results in the changes of bile acids in serum, liver, urine, and feces1, 2. In this work, we demonstrate a novel technique to image this pathological condition by using a newly developed in vivo imaging system, which includes multiphoton microscopy and intravital hepatic imaging chamber. The images we acquired demonstrate the uptake, processing of 6-CFDA in hepatocytes and excretion of CF in the bile canaliculi. In addition to imaging, we can also measure kinetics of the green fluorescence intensity.

  13. [Structure and Activity of Fungal Lipases in Bile Salt Solutions].

    Science.gov (United States)

    Bogdanova, L R; Bakirova, D R; Valiullina, Yu A; Idiyatullin, B Z; Faizullin, D A; Zueva, O S; Zuev, Yu F

    2016-01-01

    The changes in structure and catalytic properties of fungal lipases (Candida rugosa, Rhizomucor miehei, Mucor javanicus) were investigated in micellar solutions of bile salts that differ in hydrophilic-lypophilic balance and reaction medium properties. The methods of circular dichroism and tryptophan fluorescence were applied to estimate the changes in peptide structure within complexes with bile salt micelles. Bile salts do not exert a significant influence on the structure of the enzymes under study: in Rh. miehei and M. javanicus lipases the alpha helix content slightly decreased, the influence of bile salts on the C. rugosa structure was not revealed. Despite negligible structural modifications in the enzymes, in bile salt solutions a considerable change in their catalytic properties was observed: an abrupt decrease in catalytic effectiveness. Substrate-bile salts micelles complex formation was demonstrated by the NMR self-diffusion method. The model of a regulation of fungal lipase activity was proposed.

  14. Bile acid sequestrants and the treatment of type 2 diabetes mellitus

    NARCIS (Netherlands)

    Staels, Bart; Kuipers, Folkert

    2007-01-01

    Bile acids promote bile formation and facilitate dietary lipid absorption. Animal and human studies showing disturbed bile acid metabolism in diabetes mellitus suggest a link between bile acids and glucose control. Bile acids are activating ligands of the farnesoid X receptor (FXR), a nuclear recept

  15. A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Y. Vandenplas (Yvan); A. Ashkenazi (A.); D. Belli (D.); N. Boige (N.); J. Bouquet (Jan); S. Cadranel (S.); J.P. Cezard (J.); S. Cucchiara (S.); C. Dupont (C.); K. Geboes (K.); F. Gottrand; H.S.A. Heymans (Hugo); C. Jasinski (C.); C.M.F. Kneepkens (Frank); S. Koletzko (Sybille); P. Milla (Peter); J.F. Mougenot (J.); D. Nusslé (D.); J. Navarro (J.); S.J. Newell (S.); E. Olafsdottir (E.); S. Peeters (S.); A. Ravelli (A.); I. Polanco (I.); B. Sandhu; J.J. Tolboom (Jules)

    1993-01-01

    textabstractIn this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesoph

  16. REFLUX ESOPHAGITIS IN INFANTS AND CHILDREN - A REPORT FROM THE WORKING GROUP ON GASTROESOPHAGEAL REFLUX DISEASE OF THE EUROPEAN-SOCIETY-OF-PEDIATRIC-GASTROENTEROLOGY-AND-NUTRITION

    NARCIS (Netherlands)

    VANDENPLAS, Y; ASHKENAZI, A; BELLI, D; BLECKER, U; BOIGE, N; BOUQUET, J; CADRANEL, S; CEZARD, JP; CUCCHIARA, S; DEVREKER, T; DUPONT, C; GEBOES, K; GOTTRAND, F; HEYMANS, HSA; JASINSKI, C; KNEEPKENS, CMF; KOLETZKO, S; MILLA, P; MOUGENOT, JF; NAVARRO, J; NEWELL, SJ; NUSSLE, D; OLAFSDOTTIR, E; POLANCO, [No Value; RAVELLI, A; SANDHU, BK; TOLBOOM, J

    1994-01-01

    In this article, the Working Group on Gastro-Oesophageal Reflux of the European Society of Paediatric Gastroenterology and Nutrition presents and discusses a definition of reflux esophagitis and recommends a diagnostic approach and therapeutic management for this condition. Histologic criteria for r

  17. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].

    Science.gov (United States)

    Franzius, M; Stolte, M; Porschen, R

    2005-04-01

    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions.

  18. Editorial: Reflux, dyspepsia, and Rome III (or Rome IV?).

    Science.gov (United States)

    Stanghellini, Vincenzo; Frisoni, Chiara

    2010-12-01

    The paper by Xiao et al. in this issue of American Journal of Gastroenterology reports that patients with functional dyspepsia (FD) complaining of epigastric burning have a higher probability to present abnormal gastroesophageal acid reflux, as well as response to proton pump inhibitor therapy than those complaining of epigastric pain, bothersome postprandial fullness, or early satiety. No differences in the above parameters were detected when comparing patients with epigastric pain syndrome and postprandial distress syndrome, as proposed by the Rome III classification of FD. If confirmed, these results contribute to clarify the relationship between FD and gastroesophageal reflux disease and, at the same time, highlight the importance of analyzing individual symptoms rather than clusters of symptoms, when managing patients complaining of upper gastrointestinal symptoms.

  19. Update on childhood urinary tract infection and vesicoureteral reflux.

    Science.gov (United States)

    Bell, Lorraine E; Mattoo, Tej K

    2009-07-01

    Urinary tract infection (UTI) is a leading cause of serious bacterial infection in young children. Vesicoureteral reflux (VUR), a common pediatric urologic disorder, is believed to predispose to UTI, and both are associated with renal scarring. The complex interaction of bacterial virulence factors and host defense mechanisms influence renal damage. However, some renal parenchymal abnormalities associated with VUR are noninfectious in origin. Long-term, renal parenchymal injury may be associated with hypertension, pregnancy complications, proteinuria, and renal insufficiency. Optimal management of VUR and UTI is controversial because of the paucity of appropriate randomized controlled trials; there is a need for well-designed studies. The recently launched Randomized Intervention for children with VesicoUreteral Reflux (RIVUR) study hopefully will provide insight into the role of antimicrobial prophylaxis of UTI in children with VUR.

  20. Can yoga be used to treat gastroesophageal reflux disease?

    Directory of Open Access Journals (Sweden)

    Dharmesh Kaswala

    2013-01-01

    Full Text Available Yoga methods including Pranayama are the best ways to prevent many diseases and their progression. Even though, Yoga is widely practiced, its effects on certain medical conditions have not been studied or reported. Gastroesophageal reflux disease (GERD is one of them. GERD is extremely common condition requiring frequent consumption of over-the-counter or prescribed proton pump inhibitors (PPI. In severe symptoms of GERD and in the presence of multiple etiologies, PPIs are insufficient to relieve the symptoms of gastric reflux. Regular and proper use of the Yoga along with PPI can control the severe symptoms of GERD and can avoid or delay the necessity of invasive procedures. This evidence-based case report focuses on the effects of Yoga on GERD. Our case report showed that regular practice of Kapalbhati and Agnisar kriya along with PPI, patients with hiatal hernia had improvement in severe symptoms of GERD, which were initially refractory to PPI alone.

  1. Can yoga be used to treat gastroesophageal reflux disease?

    Science.gov (United States)

    Kaswala, Dharmesh; Shah, Shamik; Mishra, Avantika; Patel, Hardik; Patel, Nishith; Sangwan, Pravesh; Chodos, Ari; Brelvi, Zamir

    2013-01-01

    Yoga methods including Pranayama are the best ways to prevent many diseases and their progression. Even though, Yoga is widely practiced, its effects on certain medical conditions have not been studied or reported. Gastroesophageal reflux disease (GERD) is one of them. GERD is extremely common condition requiring frequent consumption of over-the-counter or prescribed proton pump inhibitors (PPI). In severe symptoms of GERD and in the presence of multiple etiologies, PPIs are insufficient to relieve the symptoms of gastric reflux. Regular and proper use of the Yoga along with PPI can control the severe symptoms of GERD and can avoid or delay the necessity of invasive procedures. This evidence-based case report focuses on the effects of Yoga on GERD. Our case report showed that regular practice of Kapalbhati and Agnisar kriya along with PPI, patients with hiatal hernia had improvement in severe symptoms of GERD, which were initially refractory to PPI alone. PMID:23930033

  2. Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    Vasitha Abeysuriya; Kemal Ismil Deen; Tamara Wijesuriya; Sujatha Senadera Salgado

    2008-01-01

    BACKGROUND: Few studies have assessed microlfora and their antibiotic sensitivity in normal bile and lithogenic bile with different types of gallstones. METHODS: We performed a case control study of 70 bile samples (35 cholesterol and 35 pigment stones from 51 females and 19 males, aged 21-72 years with a median age of 37 years) from patients who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis, and 20 controls (14 females and 6 males, aged 33-70 years with a median age of 38 years) who underwent laparotomy and had no gallbladder stone shown by ultrasound scan. The bile samples were aerobically cultured to assess microlfora and their antibiotic susceptibility. The procedures were undertaken under sterile conditions. RESULTS: Thirty-eight (54%) of the 70 patients with gallstones had bacterial isolates. Nine isolates (26%) were from cholesterol stone-containing bile and 29 isolates (82%) from pigment stone-containing bile (P=0.01, t test). Twenty-eight of these 38 (74%) bile samples were shown positive only after enrichment in brain heart infusion medium (BHI) (P=0.02, t test). The overall bacterial isolates from bile samples revealed E. coli predominantly, followed by P. aeruginosa, Enterococcus spp., Klebsiella spp. and S. epidermidis. There were no bacterial isolates in the bile of controls after either direct inoculation or enrichment in BHI. CONCLUSIONS: Bacterial isolates were found in pigment stone-containing bile. Non-lithogenic bile revealed no bacteria, showing an association between gallstone formation and the presence of bacteria in bile. Antibiotic sensitivity patterns of isolated organisms were similar irrespective of the type of stone.

  3. The Adsorption Effect of Quaternized Chitosan Derivatives on Bile Acid

    Institute of Scientific and Technical Information of China (English)

    Shu Xian MENG; Ya Qing FENG; Wen Jin LI; Cai Xia YIN; Jin Ping DENG

    2006-01-01

    Three quaternized chitosan derivatives were synthesized and their adsorption performance of bile acid from aqueous solution was studied. The adsorption capacities and rates of bile acid onto quaternized chitosan derivatives were evaluated. The kinetic experimental data properly correlated with the second-order kinetic model, which indicated that the chemical sorption is the rate-limiting step. The results showed that the quaternized chitosan derivatives are favorable adsorbents for bile acid.

  4. Evaluation of the Dental Effects of Laryngopharyngeal Reflux

    Science.gov (United States)

    2015-03-01

    relationship between GERD symptoms and obesity with associated increased body mass index, waist circumference and weight gain (Corley & Kubo, 2006; Hampel...decades (Mokdad, et al., 2001; Ogden, Carroll, Curtin, McDowell, Tabak, & Flegal, 2006; Sturm, 2002). There are a number of generally accepted risk ...slowed gastrointestinal motility. A common 8 misconception is that the speed of eating results in greater risk of reflux has been shown to have no

  5. Bacterial biota in reflux esophagitis and Barrett's esophagus

    Institute of Scientific and Technical Information of China (English)

    Zhiheng Pei; Liying Yang; Richard M Peek; Jr Steven M Levine; David T Pride; Martin J Blaser

    2005-01-01

    AIM: To identify the bacterial flora in conditions such as Barrett's esophagus and reflux esophagitis to determine if they are similar to normal esophageal flora.METHODS: Using broad-range 16S rDNA PCR,esophageal biopsies were examined from 24 patients [9with normal esophageal mucosa, 12 with gastroesophageal reflux disease (GERD), and 3 with Barrett's esophagus].Two separate broad-range PCR reactions were performed for each patient, and the resulting products were cloned.In one patient with Barrett's esophagus, g9 PCR clones were analyzed.RESULTS: Two separate clones were recovered from each patient (total = 48), representing 24 different species, with 14 species homologous to known bacteria,5 homologous to unidentified bacteria, and 5 were not homologous (<97% identity) to any known bacterial 16S rDNA sequences. Seventeen species were found in the reflux esophagitis patients, 5 in the Barrett's esophagus patients, and 10 in normal esophagus patients.Further analysis concentrating on a single biopsy from an individual with Barrett's esophagus revealed the presence of 21. distinct bacterial species. Members of four phyla were represented, including Bacteroidetes,Firmicutes, Proteobacteria, and Actinobacteria.Microscopic examination of each biopsy demonstrated bacteria in intimate association with the distal esophageal epithelium, suggesting that the presence of these bacteria is not transitory.CONCLUSION: These findings provide evidence for a complex, residential bacterial population in esophageal reflux-related disorders. While much of this biota is present in the normal esophagus, more detailed comparisons may help identify potential disease associations.

  6. Effect of bile salts and bile acids on human gastric mucosal epithelial cells

    Institute of Scientific and Technical Information of China (English)

    Yinxue Song; Jun Gong

    2008-01-01

    Objective:To explore the effect of bile salt and bile acid on cultured eternalized human gastric mucosa epithelium GES-1 cells.Methods:Cultured eternalized human gastric mucosa epithelium GES-1 cells were treated with media containing 6 different kinds of bile salts and 3 different kinds of bile acids and their mixture with different concentrations: GCDC(glycochenodeoxycholate), GDC (glycodeoxycholate), GC(glycocholate), TCDC(taurochenodeoxycholate), TDC(taurodeoxycholate), TC (taurocholate), LCA (lithocholicacid), CA(cholic acid), DCA(deoxycholic acid)(50 μ mol/L,250 μ mol/L,500 μ mol/L, 1000 μ mol/L), DY(mixture of bile salts) and DS(mixture of bile acids)(250 μ mol/L,500 μ mol/L,1000 μ mol/L,1500 μ mol/L, 2000 μ mol/L), in comparison with thecontrol group(in normal media without bile salts and bile acids).Cell proliferation was assessed by MTT(3-[4,5-Dimethylthiaolyl]-2,5- diphenyl-tetrazolium bromide) assay for 72 hours with different concentrations and the apoptotic cells were assayed by flow cytometry (FCM) with Annex V-FITC conjugated with propidium iodide(PI) staining for 24 hours with different concentrations(1500,2000 μ mol/L).Results:There was no significant difference in morphology and cell proliferation in GC group after 24-72 h.Low concentration(50 μ mol/L) of GCDC, GDC, TCDC, TDC and TC accelerated gastric epithelial cell growth in a dosage-time dependent manner.At middle concentration (250-500 μ mol/L), it showed positive effect after 24-48 h, while negative effect after 72 h.At high concentration(1000 μ tool/L), it accelerated gastric epithelial cell growth after 24h and show consistent inhibition even leading to necrosis after 48-72 h.LCA and CA showed a positive effect on the concentration of 50 μ mol/L after 24-72 h, while 250-1000 It mol/L showed a trend towards apoptosis after 24-72 h.At 50-500 μ mol/L, DCA showed proliferation after 24 h and apoptosis after 48-72 h, but showed necrosis after 24-72 h at 1000 μ moiFL.DY and DS

  7. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  8. Gallbladder bile composition in patients with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Annika Lapidus; Jan-Erik (A)kerlund; Curt Einarsson

    2006-01-01

    AIM: To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn's disease.METHODS: Gallbladder bile was obtained from patients with Crohn's disease who were admitted for elective surgery (17 with ileallileocolonic disease and 7 with Crohn's colitis). Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids,bile acids, bilirubin, crystals, and crystal detection time (CDT). Cholesterol saturation index was calculated.RESULTS: The biliary concentration of bilirubin was about 50% higher in patients with Crohn's disease than in patients with cholesterol gallstones. Ten of the patients with Crohn's disease involving ileum and three of those with Crohn's colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn's disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn's disease,with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn's colitis probably not due to bile acid malabsorption.CONCLUSION: Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn's disease.

  9. Integrative Treatment of Reflux and Functional Dyspepsia in Children

    Directory of Open Access Journals (Sweden)

    Ann Ming Yeh

    2014-08-01

    Full Text Available Gastroesophageal reflux disease (GERD and functional dyspepsia (FD are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture.

  10. Evaluating kidney damage from vesico-ureteral reflux in children

    Directory of Open Access Journals (Sweden)

    Zaffanello M

    2009-01-01

    Full Text Available To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR, we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000. The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively. However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.

  11. Barrett's esophagus and its correlation with gastroesophageal reflux in Chinese

    Institute of Scientific and Technical Information of China (English)

    Jun Zhang; Xiao-Li Chen; Kang-Min Wang; Xiao-Dan Guo; Ai-Li Zuo; Jun Gong

    2004-01-01

    AIM: To study the prevalence of Barrett's esophagus in Chinese and its correlation with gastroesophageal reflux.METHODS: This study was carried out in a large prospective series of 391 patients who had undergone upper endoscopy.The patients were divided into 3 groups according to the position of squamocolumnar junction (SCJ). Reflux esophagitis (RE) and its degree were recorded. Intestinal metaplasia (IlMl) in biopsy specimen was typed according to histochemistry and HE and alcian blue (pH2.5) staining separately. Results correlating with clinical, endoscopic, and pathological data were analysed.RESULTS: The prevalence of IM endoscopically appearing Long-segment Barrett's Esophagus (LSBE) was 26.53%,Short-segment Barrett's Esophagus (SSBE) was 33.85% and gastroesophageal junction (GFJ) was 34.00% . IM increased with age of above 40 years old and no difference was found between male and female. Twelve were diagnosed as dysplasia (7 low -grade, 5 high-grade), 16 were diagnosed as cardiac adenocarcinoma and 1 as esophageal adenocarcinoma. The more far away the SCJ moved upward above GFJ, the higher the prevalence and the more severe the RE were.CONCLUSION: There was no difference of the prevalence of IM in different places of SCJ, and IM increased with age of above 40 years old. It is important to pay attention to dysplasia in the distal esophagus and gastro-esophageal junction, and adenocarcinoma is more common in cardia than in esophagus. BE is a consequence of gastroesophageal reflux disease.

  12. Animal study for airway inflammation triggered by gastroesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    LAI Yun-gang; WANG Zhong-gao; JI Feng; WU Ji-min; CHEN Xiu; LI Zhen; DONG Shu-kui

    2009-01-01

    Background Gastroesophageal reflux disease with extra-esophageal symptoms, especially those with respiratory istress was attracting more and more attention. The related mechanisms were still in controversy. The purpose of the work was to explore airway inflammation triggered by gastroesophageal reflux.Methods Sixteen Sprague-Dawley rats were used as study group and 9 as control. In the study group, a plastic extender with a trumpet-shaped distal end was inserted into the lower esophagus to dilate the cardia, the pylorus was ligated. One ml of 0.1 mol/L hydrochloric acid was injected into the stomach, While a simple laparotomy was performed for control animals. All animals from two groups were sacrificed 24 hours after operation. Then tracheotomy was carried and the bronchoalveolar lavage fluid was collected in all animals. Cells in the fluid were counted and levels of intedeukin (IL)-5, -6, -8 in it were measured.Results Compared with control group, the study group presented a neutrophil pattem of airway inflammation and an elevated concentration of IL-5, -6, -8 with no significant difference regarding eosinophil count.Conclusion The gastroesophageal reflux-triggered airway inflammation is characterized by a neutrophilic airway inflammation which differed from that caused by asthma, and enhanced levels of IL-5, -6 and -8, which are similar to that caused by asthma.

  13. Fabrication of hydroxyapatite from fish bones waste using reflux method

    Science.gov (United States)

    Cahyanto, A.; Kosasih, E.; Aripin, D.; Hasratiningsih, Z.

    2017-02-01

    The aim of this present study was to investigate the fabrication of hydroxyapatites, which were synthesized from fish bone wastes using reflux method. The fish bone wastes collected from the restaurant were brushed and boiled at 100°C for 10 minutes to remove debris and fat. After drying, the fish bones were crushed, and ball milled into a fine powder. The fish bone wastes were then processed by refluxing using KOH and H3PO4 solutions. The samples were calcined at 900°C and characterized by X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectrometry (FT-IR). The XRD pattern of samples after treatment revealed that the peak of hydroxyapatite was observed and the bands of OH- and PO4 3- were observed by FT-IR. The scanning electron microscope evaluation of sample showed the entangled crystal and porous structure of hydroxyapatite. In conclusion, the hydroxyapatite was successfully synthesized from fish bone wastes using reflux method.

  14. Prevalence of overweightedness in patients with gastro-esophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Luca Piretta; Federico Alghisi; Fiorella Anzini; Enrico Corazziari

    2007-01-01

    AIM: To evaluate whether the prevalence of overweight and obese conditions is increased in gastro-esophageal reflux disease (GERD) patients (with 24-h pathological pH recordings) in comparison to general population.METHODS: A total of 196 consecutive patients (103females, age range 18-83 years) with symptoms of gastro-esophageal reflux (GER) and 24-h pathological esophageal pH-metry. Body mass index (BMI) of the patients was calculated and its distribution (%) was compared with that of the Italian general population as assessed by National Bureau of Census (ISTAT). To evaluate the association of GERD with weight categories,the binomial test was employed. P < 0.05 was considered statistically significant.RESULTS: In males, overweightedness (BMI 25-25.9)was present in 43% of GERD patients vs 41.8% of Italian population (IP) (ns), obesity (BMI ≥ 30) in 10.9% vs9.1% (ns). In females overweight was present in 34.9%of GERD patients vs 25.7% of IP (P < 0.01), obesity in 13.6% of GERD patients vs 9.1% of IP (P < 0.01). No statistically significant differences were noted in different age classes.CONCLUSION: In comparison to the Italian general population, the prevalence of overweightedness and obesity is increased in female but not in male patients with ascertained gastro-esophageal reflux disease.

  15. Bile Acids Trigger GLP-1 Release Predominantly by Accessing Basolaterally Located G Protein-Coupled Bile Acid Receptors

    DEFF Research Database (Denmark)

    Brighton, Cheryl A.; Rievaj, Juraj; Kuhre, Rune E.;

    2015-01-01

    Bile acids are well-recognized stimuli of glucagon-like peptide-1 (GLP-1) secretion. This action has been attributed to activation of the G protein-coupled bile acid receptor GPBAR1 (TGR5), although other potential bile acid sensors include the nuclear farnesoid receptor and the apical sodium......-coupled bile acid transporter ASBT. The aim of this study was to identify pathways important for GLP-1 release and to determine whether bile acids target their receptors on GLP-1-secreting L-cells from the apical or basolateral compartment. Using transgenic mice expressing fluorescent sensors specifically in L...... to either TLCA or TDCA. We conclude that the action of bile acids on GLP-1 secretion is predominantly mediated by GPBAR1 located on the basolateral L-cell membrane, suggesting that stimulation of gut hormone secretion may include postabsorptive mechanisms....

  16. Bile Acid Pool Dynamics in Progressive Familial lntrahepatic Cholestasis With Partial External Bile Diversion

    NARCIS (Netherlands)

    Jericho, Hilary S.; Kaurs, Elizabeth; Boverhof, Renze; Knisely, Alex; Shneider, Benjamin L.; Verkade, Henkjan J.; Whitington, Peter F.

    2015-01-01

    Objectives: Partial external bile diversion (PEBD) is an established therapy for low-gamma-glutamyl transferase (GGT) progressive familial intrahepatic cholestasis (PFIC). This study sought to determine whether the dynamics of the cholic acid (CA) and chenodeoxycholic acid (CDCA) pools in subjects w

  17. Determination of conjugated bile acids in human bile and duodenal fluid by reverse-phase high-performance liquid chromatography.

    Science.gov (United States)

    Bloch, C A; Watkins, J B

    1978-05-01

    A simple mehtod using reverse-phase liquid chromatography is presented for resolution and quantitation of the major conjugated bile acids of man, including the glycine and taurine conjugates of the dihydroxy bile acids, chenodeoxycholic and deoxycholic acid. Using modern, high-performance chromatographic equipment, analysis time is less than 30 minutes. The quantitative range of the method, with detection by refractive index, is 0.05 to 0.1 mumol of bile acid and the limit of detection for an injection sample is 0.01 mumol. This provides a sensitivity sufficient for analysis of dilute duodenal and gallbladder bile with minimal sample preparation.

  18. Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients

    DEFF Research Database (Denmark)

    Lødrup, A; Pottegård, A; Hallas, J;

    2015-01-01

    inhibitors and H2 -receptor antagonists in the year before anti-reflux surgery. METHODS: A nationwide retrospective study of all patients aged ≥18 undergoing first-time anti-reflux surgery in Denmark during 2000-2012 using data from three different sources: the Danish National Register of Patients......, the Danish National Prescription Register, and the Danish Person Register. RESULTS: The study population thus included 2922 patients (median age: 48 years, 55.7% male). The annual proportion of patients redeeming ≥180 DDD of acid-suppressive therapy increased from 17.0% 5 years before anti-reflux surgery......BACKGROUND: Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. AIM: To determine the use of proton pump...

  19. Classification and management of bile duct injuries

    OpenAIRE

    2011-01-01

    To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases...

  20. Role of nucleation of bile liquid crystal in gallstone formation

    Institute of Scientific and Technical Information of China (English)

    Hai-Ming Yang; Jie Wu; Jin-Yi Li; Lin Gu; Min-Fei Zhou

    2003-01-01

    AIM: To explore the role of bile liquid crystal in the process of gallbladder stone formation and to provide bases for preventing and treating cholelithiasis.METHODS: 46 guinea pigs, half males and half females,were randomly divided into control group and stone-causing group. Normal feed and stoneleading feed were used respectively to raise guinea pigs in the control group and stone-causing group. The guinea pigs were killed in three batches during the raising period. Under polarizing microscope, the pattern changes of bile liquid crystal in the gallbladder biles of the guinea pigs in the control group and stone-causing group were dynamicly observed respectively in single-blind trial.RESULTS: It was found that there were few crystals in the guinea pigs′biles of the control group, and their Malta cross was small and scattered, and existed in single form. With the increase of the feeding days, bile liquid crystals grew and Malta cross became bigger with their distribution densified, denser somewhere, but always existed in single form. While those of the stone-causing group had more bile liquid crystals, Malta cross was big and merged in strings.With the increase of the feeding days, bile liquid crystals grew in amount and strings of Malta cross increased and became bigger. The crosses in strings were arranged more and more regularly and they gradually changed into stone crystals.CONCLUSION: Formation of gallbladder stone is a process of nucleation from different substances, and the causing-stone gallbladder bile is a constantly supersaturated solution, and bile liquid crystal is a nucleation factor in the formation of gallbladder stones. The process of nucleation includes gathering, merging and phase-changing of bile liquid crystals.The process of gathering, merging of bile liquid crystal is the key to nucleation.

  1. Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

    LENUS (Irish Health Repository)

    2012-01-31

    BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

  2. Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Woo; Lee, Chang Hee; Park, Yang Shin; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Departments of Radiology, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul (Korea, Republic of); Yoo, Kee Hwan [Korea University College of Medicine, Departments of Pediatrics, Korea University Guro Hospital, Seoul (Korea, Republic of); Je, Bo-Kyung [Korea University College of Medicine, Department of Radiology, Korea University Ansan Hospital, Seoul (Korea, Republic of); Kiefer, Berthold [Oncology Application Development, Siemens Healthcare, Erlangen (Germany)

    2016-06-15

    To compare the diffusion parameters of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the ''reflux'' and the ''non-reflux'' kidneys, and to evaluate the feasibility of using IVIM DWI to predict vesicoureteral reflux (VUR) in children with a urinary tract infection (UTI). Eighty-three kidneys from 57 pediatric patients with a UTI were classified into ''reflux'' and ''non-reflux'' groups according to voiding cystourethrography (VCUG) results. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (PF) were measured and compared in the renal pelvis of both groups. Four indices (D*/ADC, PF/ADC, D*/D, and PF/D) were calculated and receiver operating characteristic (ROC) curve analyses were performed. VURs were detected on VCUG in 21 kidneys. PF and D* were significantly higher in the ''reflux'' group than in the ''non-reflux'' group. The indices were all significantly higher. The PF/D index showed the best diagnostic performance in predicting VUR in children with UTI (A{sub z} = 0.864). PF and D* were significantly higher in the ''reflux'' kidney than in the ''non-reflux'' kidney. Our new index (PF/D) could prove useful for predicting VUR. (orig.)

  3. Two years of experience with robot-assisted anti-reflux surgery

    DEFF Research Database (Denmark)

    Jensen, Jonas Sanberg; Antonsen, Henning Kold; Durup, Jesper

    2017-01-01

    Background and aims Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti...... no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.......-reflux surgery incorporating follow-up and evaluation of possible learning curve. Material and methods Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included...

  4. Hemodynamic patterns of reflux in primary sapheno-popliteal junction incompetence

    Directory of Open Access Journals (Sweden)

    Massimo Cappelli

    2012-12-01

    Full Text Available Duplex ultrasound investigation (DUI has considerably improved the diagnosis of anatomical venous variations in the popliteal region: however, some pitfalls still remain concerning the hemodynamics of incompetent sapheno-popliteal junctions (SPJs. Aims of this study were to assess the prevalence rates of the hemodynamic patterns of reflux, either diastolic or systolic or both, in a large series of patients with SPJ incompetence, and to analyze the origin of the systolic components of the reflux. Four hundred and fiftythree patients, 83 males and 370 females, mean age 58.0 years±SD 13.8 with primary SPJ incompetence (512 limbs underwent preoperative DUI using the Paranà manoeuvre, a dynamic test able to develop systolic and diastolic pressure gradients through the reflex activation of muscle pumps. Of the 512 incompetent SPJs, 420 showed isolated diastolic reflux, 9 isolated systolic reflux and 83 systolic reflux followed by diastolic reflux. Altogether, 92 SPJs over 512 (18% showed a systolic component of the reflux, which originated from the popliteal vein in 78 cases (15% and from the gastrocnemius veins (GVs in 14 cases (3%. In these latter cases, the short saphenous vein and one or more GVs showed a common trunk. Our findings show that the detection of a systolic component of the reflux in incompetent SPJs is not an uncommon event and suggest that treatment strategy should be differentiated according to the origin of the systolic reflux, given their different hemodynamic behavior.

  5. Endoscopic Management of Difficult Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    Christian Ell

    1992-01-01

    Full Text Available More than 90% of all common bile duct concrements can be removed via the endoscopic retrograde route via endoscopic sphincterotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones, however, often still resist conventional endoscopic therapy. Promising new or improved approaches for the treatment of these stones are intracorporeal or extracorporeal shock wave lithotripsy. Shockwave lithotriptors for extracorporeal shockwave lithotripsy are currently available worldwide. However, for the waterbath first generation devices, general anesthesia is required since shockwaves are very painful. Furthermore, an x-ray localization system is essential to visualize the stones after having filled the bile duct over a nasobiliary catheter. An average of two shockwave treatments with additional two to four endoscopic sessions are required. ln tracorporeal lithotripsy promises more comfort and less effort for the patient. Shockwaves are generated either by means of the spark gap principle (electrohydraulic probes or by laser-induced plasma generation. Laser-induced shockwave lithotripsy appears to be more safer, since with dye and solid state lasers, athermal, well-controlled shockwaves can be generateJ without the risks for duct perfo ration (as described for the electrohydraulic system. Furthermore, a recently developed stone-tissue detection system integrated in a new dye laser system enchances the safety of laser-induced lithotripsy. ln consequence, lithotripsy without direct endoscopic control appears possible in selected cases.

  6. Bile pigments in pulmonary and vascular disease

    Directory of Open Access Journals (Sweden)

    Stefan W. Ryter

    2012-03-01

    Full Text Available The bile pigments, biliverdin and bilirubin, are endogenously-derived substances generated during enzymatic heme degradation. These compounds have been shown to act as chemical antioxidants in vitro. Bilirubin formed in tissues circulates in the serum, prior to undergoing hepatic conjugation and biliary excretion. The excess production of bilirubin has been associated with neurotoxicity, in particular to the newborn. Nevertheless, clinical evidence suggests that mild states of hyperbilirubinemia may be beneficial in protecting against cardiovascular disease in adults. Pharmacological application of either bilirubin and/or its biological precursor biliverdin, can provide therapeutic benefit in several animal models of cardiovascular and pulmonary disease. Furthermore, biliverdin and bilirubin can confer protection against ischemia/reperfusion injury and graft rejection secondary to organ transplantation in animal models. Several possible mechanisms for these effects have been proposed, including direct antioxidant and scavenging effects, and modulation of signaling pathways regulating inflammation, apoptosis, cell proliferation, and immune responses. The practicality and therapeutic-effectiveness of bile pigment application to humans remains unclear.

  7. Bile pigments in pulmonary and vascular disease.

    Science.gov (United States)

    Ryter, Stefan W

    2012-01-01

    The bile pigments, biliverdin, and bilirubin, are endogenously derived substances generated during enzymatic heme degradation. These compounds have been shown to act as chemical antioxidants in vitro. Bilirubin formed in tissues circulates in the serum, prior to undergoing hepatic conjugation and biliary excretion. The excess production of bilirubin has been associated with neurotoxicity, in particular to the newborn. Nevertheless, clinical evidence suggests that mild states of hyperbilirubinemia may be beneficial in protecting against cardiovascular disease in adults. Pharmacological application of either bilirubin and/or its biological precursor biliverdin, can provide therapeutic benefit in several animal models of cardiovascular and pulmonary disease. Furthermore, biliverdin and bilirubin can confer protection against ischemia/reperfusion injury and graft rejection secondary to organ transplantation in animal models. Several possible mechanisms for these effects have been proposed, including direct antioxidant and scavenging effects, and modulation of signaling pathways regulating inflammation, apoptosis, cell proliferation, and immune responses. The practicality and therapeutic-effectiveness of bile pigment application to humans remains unclear.

  8. Mechanical properties of the porcine bile duct wall

    Directory of Open Access Journals (Sweden)

    Andersen Helle

    2004-07-01

    Full Text Available Abstract Background and Aim The function of the common bile duct is to transport bile from the liver and the gall bladder to the duodenum. Since the bile duct is a distensible tube consisting mainly of connective tissue, it is important to obtain data on the passive mechanical wall properties. The aims of this study were to study morphometric and biomechanical wall properties during distension of the bile duct. Methods Ten normal porcine common bile ducts were examined in vitro. A computer-controlled volume ramp infusion system with concomitant pressure recordings was constructed. A video camera provided simultaneous measurement of outer dimensions of the common bile duct. Wall stresses and strains were computed. Results The common bile duct length increased by 25% from 24.4 ± 1.8 mm at zero pressure to 30.5 ± 2.0 mm at 5 kPa (p (βε - 1. The circumferential stress-strain curve was shifted to the left when compared to the longitudinal stress-strain curve, i.e. the linear constants (α values were different (p 0.5. Conclusion The porcine bile duct exhibited nonlinear anisotropic mechanical properties.

  9. Activation of CFTR by ASBT-mediated bile salt absorption

    NARCIS (Netherlands)

    Bijvelds, MJC; Jorna, H; Verkade, HJ; Bot, AGM; Hofmann, F; Agellon, LB; Sinaasappel, M; de Jonge, HR

    2005-01-01

    In cholangiocytes, bile salt (BS) uptake via the apical sodium-dependent bile acid transporter (ASBT) may evoke ductular flow by enhancing cAMP-mediated signaling to the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel. We considered that ASBT-mediated BS uptake in the distal

  10. Phosphatidylcholine mobility in bile salt depleted rat liver microsomes

    NARCIS (Netherlands)

    Oliveira Filgueiras, O.M. de; Defize, B.; Echteld, C.J.A. van; Bosch, H. van den

    1980-01-01

    Rat liver microsomes prepared by differential centrifugation are known to contain measurable levels of bile salts. More than 90% of these can be removed by passing the microsomal preparation through a Bio-Gel A-150m column. Bile salt depleted microsomes show a high level (> 95%) of mannose-6-phospha

  11. Further investigations on the macromolecular complex in human bile

    NARCIS (Netherlands)

    Verschure, J.C.M.; Wael, J. de; Mijnlieff, P.F.

    1956-01-01

    The formation of complexes in human bile was further studied by the preparation of various synthetic complexes and extracts. These were compared for a number of properties with the natural complex of human gall bladder bile. It appeared that protein is probably and bilirubin quite definitely a const

  12. Differential diagnosis in patients with suspected bile acid synthesis defects

    Institute of Scientific and Technical Information of China (English)

    Dorothea Haas; Hongying Gan-Schreier; Claus-Dieter Langhans; Tilman Rohrer; Guido Engelmann; Maura Heverin; David W Russell

    2012-01-01

    AIM:To investigate the clinical presentations associated with bile acid synthesis defects and to describe identification of individual disorders and diagnostic pitfalls.METHODS:Authors describe semiquantitative determination of 16 urinary bile acid metabolites by electrospray ionization-tandem mass spectrometry.Sample preparation was performed by solid-phase extraction.The total analysis time was 2 min per sample.Authors determined bile acid metabolites in 363 patients with suspected defects in bile acid metabolism.RESULTS:Abnormal bile acid metabolites were found in 36 patients.Two patients had bile acid synthesis defects but presented with atypical presentations.In 2 other patients who were later shown to be affected by biliary atresia and cystic fibrosis the profile of bile acid metabolites was initially suggestive of a bile acid synthesis defect.Three adult patients suffered from cerebrotendinous xanthomatosis.Nineteen patients had peroxisomal disorders,and 10 patients had cholestatic hepatopathy of other cause.CONCLUSION:Screening for urinary cholanoids should be done in every infant with cholestatic hepatopathy as well as in children with progressive neurological disease to provide specific therapy.

  13. Bile acids, farnesoid X receptor, atherosclerosis and metabolic control

    NARCIS (Netherlands)

    Kuipers, Folkert; Stroeve, Johanna H. M.; Caron, Sandrine; Staels, Bart

    2007-01-01

    Purpose of review Bile acids are amphiphilic molecules synthesized from cholesterol exclusively in the liver that are essential for effective absorption of dietary fat. In addition to this classical role', bile acids act as signalling molecules that control their own metabolism by activating the nuc

  14. Isolation and characterization of chicken bile matrix metalloproteinase

    Science.gov (United States)

    Avian bile is rich in matrix metalloproteinases (MMP), the enzymes that cleave extracellular matrix (ECM) proteins such as collagens and proteoglycans. Changes in bile MMP expression have been correlated with hepatic and gall bladder pathologies but the significance of their expression in normal, he...

  15. Chicken bile Matrix metalloproteinase; its characterization and significance

    Science.gov (United States)

    Previous studies from our lab had shown that the avian bile was rich in matrix metalloproteinase (MMP), enzymes implicated in the degradation of extracellular matrices (ECM) such as collagens and proteoglycans. We hypothesized that bile MMP may be evolutionarily associated with the digestion of ECM ...

  16. Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition.

    Directory of Open Access Journals (Sweden)

    Ling Zhang

    Full Text Available Severe acute malnutrition (SAM is a major cause of mortality in children under 5 years and is associated with hepatic steatosis. Bile acids are synthesized in the liver and participate in dietary fat digestion, regulation of energy expenditure, and immune responses. The aim of this work was to investigate whether SAM is associated with clinically relevant changes in bile acid homeostasis.An initial discovery cohort with 5 healthy controls and 22 SAM-patients was used to identify altered bile acid homeostasis. A follow up cohort of 40 SAM-patients were then studied on admission and 3 days after clinical stabilization to assess recovery in bile acid metabolism. Recruited children were 6-60 months old and admitted for SAM in Malawi. Clinical characteristics, feces and blood were collected on admission and prior to discharge. Bile acids, 7α-hydroxy-4-cholesten-3-one (C4 and FGF-19 were quantified.On admission, total serum bile acids were higher in children with SAM than in healthy controls and glycine-conjugates accounted for most of this accumulation with median and interquartile range (IQR of 24.6 μmol/L [8.6-47.7] compared to 1.9 μmol/L [1.7-3.3] (p = 0.01 in controls. Total serum bile acid concentrations did not decrease prior to discharge. On admission, fecal conjugated bile acids were lower and secondary bile acids higher at admission compared to pre- discharge, suggesting increased bacterial conversion. FGF19 (Fibroblast growth factor 19, a marker of intestinal bile acid signaling, was higher on admission and was associated with decreased C4 concentrations as a marker of bile acid synthesis. Upon recovery, fecal calprotectin, a marker of intestinal inflammation, was lower.SAM is associated with increased serum bile acid levels despite reduced synthesis rates. In SAM, there tends to be increased deconjugation of bile acids and conversion from primary to secondary bile acids, which may contribute to the development of liver disease.

  17. Optic properties of bile liquid crystals in human body

    Institute of Scientific and Technical Information of China (English)

    Hai Ming Yang; Jie Wu; Jian Li Zhou; Li Jun He; Xian Fang Xu; Jin Yi Li

    2000-01-01

    AIM To further study the properties of bile liquid crystals, and probe into the relationship between bile liquid crystals and gallbladder stone formation, and provide evidence for the prevention and treatment of cholecystolithissis. METNODS The optic properties of bile liquid crystals in human body were determined by the method of crystal optics under polarizing microscope with plane polarized light and perpendicular polarized light. RESULTS Under a polarizing microscope with plane polarized light, bile liquid crystals scattered in bile appeared round, oval or irregularly round. The color of bile liquid crystals was a little lighter than that of the bile around. When the stage was turned round, the color of bile liquid crystals or the darkness and lightness of the color did not change obviously. On the border between bile liquid crystals and the bile around, brighter Becke-Line could be observed. When the microscope tube is lifted, Becke. Line moved inward, and when lowered,Becke-Line moved outward. Under a perpendicular polarized light, bile liquid crystals showd some special interference patterns, called Malta cross. When the stage was tuming round at an angle of 360°, the Malta cross showed four times of extinction. In the vibrating direction of 45° angle of relative to upper and lower polarizing plate, gypsum test-board with optical path difference of 530 nm was inserted, the first and the third quadrants of Malta cross appeared to be blue, and the second and the fourth quadrants appeared orange. When mica test-board with optical path difference of 147 nm was inserted, the first and the third quadrants of Malta cross appeared yellow, and the second and the fourth quadrants appeared dark grey. CONCLUSION The bile liquid crystals were distributed in bile in the form of global grains. Their polychroism and absorption were slight,but the edge and Becke-Line were very clear. Its refractive index was larger than that of the bile.These liquid crystals were uniaxial

  18. Aberrant bile ducts, 'remnant surface bile ducts,' and peribiliary glands: descriptive anatomy, historical nomenclature, and surgical implications.

    Science.gov (United States)

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Heffron, Thomas G; Skandalakis, John E

    2011-05-01

    The term "aberrant bile ducts" has been used to designate three heterogeneous groups of biliary structures: (1) bile ducts degenerating or disappearing (unknown etiology, diverse locations); (2) curious biliary structures in the transverse fissure; and (3) aberrant right bile ducts draining directly into the common hepatic duct. We report our observations on these three groups. Twenty-nine fresh human livers of stillborns and adults were injected differentially with colored latex and dissected. Adult livers showed portal venous and hepatic arterial branches, and bile ducts not associated with parenchyma, subjacent to and firmly adherent with the liver capsule: elements of ramifications of normal sheaths were present on the liver's surface. These ramifications, having lost parenchyma associated with them, then sequentially lost their portal branches, bile ducts and arterial branches. This process affected the ramifications of the sheaths in the left triangular ligament, adjacent to the inferior vena cava, in the gallbladder bed and anywhere else on the liver's surface and resulted in the presence of bile ducts accompanied by portal venous and/or hepatic arterial branches and not associated with parenchyma for a period of time. This first group represented normal bile ducts that do not meet the criteria of aberration and could be appropriately designated "remnant surface bile ducts." Such changes were not found in the transverse fissures and review of the literature revealed that the curious biliary structures are the microscopic peribiliary glands. The third group met the criteria of aberration and the anatomy of a representative duct is described.

  19. The effect of N-acetyl cysteine on laryngopharyngeal reflux.

    Directory of Open Access Journals (Sweden)

    Payman Dabirmoghaddam

    2013-11-01

    Full Text Available Laryngopharyngeal reflux (LPR is a variant of gastroesophageal reflux disease (GERD in which the stomach contents go up into the pharynx and then down into the larynx. LPR causes a wide spectrum of manifestations mainly related to the upper and the lower respiratory system such as laryngitis, asthma, chronic obstructive pulmonary disease, cough, hoarseness, postnasal drip disease, sinusitis, otitis media, recurrent pneumonia, laryngeal cancer and etc. The object of this study was to examine the effect of N-acetyl Cysteine (NAC with and without Omeprazole on laryngitis and LPR. Ninety patients with laryngitis or its symptoms were referred and randomly assigned into three groups. The first group was treated by Omeprazole and NAC. The second group was treated by Omeprazole and placebo and the last group was treated by NAC and placebo. Duration of treatment was 3 months and all patients were evaluated at the beginning of study, one month and three month after treatment of sign and symptoms, based on reflux symptom index (RSI and reflex finding score (RFS. Based on the results of this study, despite therapeutic efficacy of all treatment protocols, the RSI before and after 3 months treatment had significant difference in (NAS+ Omeprazole and (Omeprazole+ placebo group (P<0.001 in the first group, P<0.001 in the second group and P=0.35 in the third group. Whereas RFS before and after 3 month treatment had significant difference in all groups. (P<0.001 in each group in comparison with itself but this results had not significant difference after 1 month treatment. Our results showed that the combination therapy with Omeprazole and NAC treatment had the most effect on both subjective and objective questionnaire at least after 3 months treatment. Based on the results of the present study, it seems that the use objective tools are more accurate than subjective tools in evaluation of therapeutic effects in patients with GERD-related laryngitis.

  20. Vesicoureteral reflux and antibiotic prophylaxis: why cohorts and methodologies matter

    Science.gov (United States)

    Greenfield, Saul P.; Cheng, Earl; DeFoor, William; Kropp, Bradley; Rushton, H. Gil; Skoog, Steve; Carpenter, Myra

    2016-01-01

    Purpose Published cohorts of children with vesicoureteral reflux placed on antibiotic prophylaxis differ in baseline characteristics and methodology. These data have been combined in meta-analyses to derive treatment recommendations. We analyzed these cohorts in an attempt to understand the disparate outcomes reported. Materials and Methods Eighteen studies were identified from 1987 to 2013. These either retrospectively or prospectively evaluated children with VUR who were on long-term antibiotic prophylaxis. The presenting demographic data, criteria and methods of evaluation were tabulated. Outcomes were compared—specifically recurrent urinary infection and renal scarring. Results Significant differences in baseline characteristics and methodology were identified: gender, circumcision status, grade of reflux, evaluation of bowel and bladder dysfunction (BBD), methodology of urine collection, definition of urinary infection (UTI), measurement of compliance, means of identifying renal scarring. Cohorts with larger numbers of uncircumcised boys had more breakthrough UTI’s. Both infection and renal scarring rates were higher in series with higher grades of reflux. Bagged urine specimens were allowed in 6 series, rendering the data suspect. Children with BBD were excluded from 3 cohorts; only in 1 was BBD correlated with outcome. Compliance was monitored in only 6 studies. Conclusions Sub-populations as well as methodologies vary significantly in published series of children with VUR on anti-biotic prophylaxis. It is inappropriate to combine outcome data from these series in a meta-analysis, since this serves to blur distinctions between these sub-populations. Broad recommendations or guidelines based upon meta-analyses should be viewed with caution. PMID:22910235

  1. Gastroesophageal reflux disease at the turn of millennium

    Institute of Scientific and Technical Information of China (English)

    Lee-Guan Lim; Khek-Yu Ho

    2003-01-01

    Gastroesophageal reflux disease (GERD) has been an area of active research in the Asia-Pacific region in the recent years. This article outlines some of the interesting research findings. It comprises three parts. The first part dealt with recent data on the changing epidemiology of GERD in Asia.The second part summarized published studies on the relationship between GERD and Helicobacter pylori, relevant to the Asia-Pacific region. The last part discussed some of the recent advances in the treatment of GERD.

  2. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Thomas Lendvay

    2008-01-01

    Full Text Available Robotic-assisted laparoscopy (RAL has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are trained in robotics, we anticipate an expansion of the applications of robotics in children. We believe that it is necessary to develop robotic surgery curricula for novice roboticists and residents so that patients may experience improved surgical outcomes.

  3. Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Ott, D.J.; Gelfand, D.W.; Wu, W.C.

    1981-01-15

    A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed.

  4. Gastroesophageal reflux disease update for the primary care physician.

    Science.gov (United States)

    Mitz, H S

    1999-08-01

    Gastroesophageal reflux disease (GERD) is one of the most common ailments that can decrease quality of life to below that of patients with congestive heart failure. Patients can present with typical, atypical, or serious symptoms, either alone or in combination. History, esophagogastroduodenoscopy, and 24-hour pH monitoring can help with the diagnosis; but all are not needed for each patient. This clinical review will help primary care physicians to make a rapid diagnosis, guide subsequent treatment, and indicate when to order additional testing or referral, or both.

  5. Effects of bile acid administration on bile acid synthesis and its circadian rhythm in man

    Energy Technology Data Exchange (ETDEWEB)

    Pooler, P.A.; Duane, W.C.

    1988-09-01

    In man bile acid synthesis has a distinct circadian rhythm but the relationship of this rhythm to feedback inhibition by bile acid is unknown. We measured bile acid synthesis as release of 14CO2 from (26-14C)cholesterol every 2 hr in three normal volunteers during five separate 24-hr periods. Data were fitted by computer to a cosine curve to estimate amplitude and acrophase of the circadian rhythm. In an additional six volunteers, we measured synthesis every 2 hr from 8:00 a.m. to 4:00 p.m. only. During the control period, amplitude (expressed as percentage of mean synthesis) averaged 52% and acrophase averaged 6:49 a.m. During administration of ursodeoxycholic acid (15 mg per kg per day), synthesis averaged 126% of baseline (p less than 0.1), amplitude averaged 43% and acrophase averaged 6:20 a.m. During administration of chenodeoxycholic acid (15 mg per kg per day), synthesis averaged 43% of baseline (p less than 0.001), amplitude averaged 53% and acrophase averaged 9:04 a.m. Addition of prednisone to this regimen of chenodeoxycholic acid to eliminate release of 14CO2 from corticosteroid hormone synthesis resulted in a mean amplitude of 62% and a mean acrophase of 6:50 a.m., values very similar to those in the baseline period. Administration of prednisone alone also did not significantly alter the baseline amplitude (40%) or acrophase (6:28 a.m.). We conclude that neither chenodeoxycholic acid nor ursodeoxycholic acid significantly alters the circadian rhythm of bile acid synthesis in man.

  6. Promotion of PDT efficacy by bile acids

    Science.gov (United States)

    Castelli, Michelle; Reiners, John, Jr.; Kessel, David

    2003-06-01

    We had previously described the use of relatively hydrophobic bile acids, notably UDCA (ursodeoxycholate) for the promotion of the apoptotic response to photodynamic therapy. Further study revealed that this effect occurred only when the target for photodamage was the anti-apoptotic protein Bcl-2. The efficacy of lysosomal photodamage, leading to a cleavage of the protein Bid, was not influenced by UDCA. Moreover, the apoptotic cell death resulting from treatment of cells with the non-peptidic Bcl-2 inhibitor HA 14-1 was also promoted by UDCA. These results are consistent with the proposal that the pro-apoptotic effects of UDCA are directed against Bcl-2, promoting inactivation by HA 14-1 or photodamage.

  7. Intestinal bile acid physiology and pathophysiology

    Institute of Scientific and Technical Information of China (English)

    Olga Mart(I)nez-Augustin; Ferm(I)n Sánchez de Medina

    2008-01-01

    Bile acids (Bas) have a long established role in fat digestion in the intestine by acting as tensioactives,due to their amphipatic characteristics.Bas are reabsorbed very efficiently by the intestinal epithelium and recycled back to the liver v/a transport mechanisms that have been largely elucidated.The transport and synthesis of Bas are tightly regulated in part by specific plasma membrane receptors and nuclear receptors.In addition to their primary effect,Bas have been claimed to play a role in gastrointestinal cancer,intestinal inflammation and intestinal ionic transport.Bas are not equivalent in any of these biological activities,and structural requirements have been generally identified.In particular,some Bas may be useful for cancer chemoprevention and perhaps in inflammatory bowel disease,although further research is necessary in this field.This review covers the most recent developments in these aspects of BA intestinal biology.

  8. Current Advances in the Diagnosis and Treatment of Nonerosive Reflux Disease

    Directory of Open Access Journals (Sweden)

    Chien-Lin Chen

    2013-01-01

    Full Text Available Nonerosive reflux disease (NERD is a distinct pattern of gastroesophageal reflux disease (GERD. It is defined as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal mucosal erosions/breaks at conventional endoscopy. In clinical practice, patients with reflux symptoms and negative endoscopic findings are markedly heterogeneous. The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep, and sustained esophageal contractions. The use of 24-hour esophageal impedance and pH monitoring gives further insight into reflux characteristics and symptom association relevant to NERD. The treatment choice of NERD still relies on acid-suppression therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily for 2–4 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily is recommended. In patients with poor response to appropriate PPI treatment, 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid-reflux-related NERD (hypersensitive esophagus, nonacid-reflux-related NERD, and functional heartburn. The response is less effective in NERD as compared with erosive esophagitis.

  9. Metabolic changes in the lower esophageal sphincter influencing the result of anti-reflux surgical interventions in chronic gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Aron Altorjay; Arpad Juhasz; Viola Kellner; Gellert Sohar; Matyas Fekete; Istvan Sohar

    2005-01-01

    AIM: With the availability of a minimally invasive approach, anti-reflux surgery has recently experienced a renaissance as a cost-effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). We are not aware of the fact whether reflux episodes causing complaints for a long time i.e., at least for one year are associated with metabolic changes in the lower esophageal sphincter, and if so,whether these may influence functional results achieved after anti-reflux surgery.METHODS: Between 1 January 2001 and 31 December 2002 we performed anti-reflux surgery on 79 patients.Muscle samples were taken from the lower esophageal sphincter (LES) in 33 patients during anti-reflux surgery.Inclusion criteria were: LES resting pressure below 10 mmHg and a marked, pH proven acid exposure to the esophagus of at least one year's duration, causing subjective complaints and requiring continuous proton pump inhibitor treatment. Control samples were obtained from muscle tissue in the gastroesophageal junction that had been removed from 17 patients undergoing gastric or esophageal resection. Metabolic and lysosomal enzyme activities and special protein concentrations 16 parameters in total were evaluated in tissue taken from control specimens and tissue taken from patients with GERD. The biochemical parameters of these intra-operative biopsies were used to correlate the results of anti-reflux operations (Visick I and II-III).RESULTS: In the reflux-type muscle, we found a significant increase of the energy-enzyme activities e.g., creatine kinase, lactate dehydrogenase, β-hydroxybutyrate dehydrogenase, and aspartate aminotransaminase-. The concentration of the structural protein S-100 and the myofibrillar protein troponin I were also significantly increased. Among lysosomal enzymes, we found that the activities of cathepsin B, tripeptidyl-peptidase I, dipeptidylpeptidase II, β-hexosaminidase B, β-mannosidase and β-galactosidase were

  10. Exploitation of Bile Acid Transport Systems in Prodrug Design

    Directory of Open Access Journals (Sweden)

    Elina Sievänen

    2007-08-01

    Full Text Available The enterohepatic circulation of bile acids is one of the most efficient recycling routes in the human body. It is a complex process involving numerous transport proteins, which serve to transport bile acids from the small intestine into portal circulation, from the portal circulation into the hepatocyte, from the hepatocyte into the bile, and from the gall bladder to the small intestine. The tremendous transport capacity and organ specificity of enterohepatic circulation combined with versatile derivatization possibilities, rigid steroidal backbone, enantiomeric purity, availability, and low cost have made bile acids attractive tools in designing pharmacological hybrid molecules and prodrugs with the view of improving intestinal absorption, increasing the metabolic stability of pharmaceuticals, specifically targeting drugs to organs involved in enterohepatic circulation, as well as sustaining therapeutically reasonable systemic concentrations of active agents. This article briefly describes bile acid transport proteins involved in enterohepatic circulation, summarizes the key factors affecting on the transport by these proteins, and reviews the use of bile acids and their derivatives in designing prodrugs capable of exploiting the bile acid transport system.

  11. Human bile sorption by cancrinite-type zeolites

    Energy Technology Data Exchange (ETDEWEB)

    Linares, Carlos F. [Laboratorio de Catalisis y Metales de Transicion, Facultad de Ciencias y Tecnologia, Departamento de Quimica, Universidad de Carabobo, Valencia. Edo. Carabobo, Apartado Postal 3336 (Venezuela, Bolivarian Republic of)], E-mail: clinares@uc.edu.ve; Colmenares, Maryi; Ocanto, Freddy [Laboratorio de Catalisis y Metales de Transicion, Facultad de Ciencias y Tecnologia, Departamento de Quimica, Universidad de Carabobo, Valencia. Edo. Carabobo, Apartado Postal 3336 (Venezuela, Bolivarian Republic of); Valbuena, Oscar [Facultad de Ciencias y Tecnologia, Departamento de Biologia, Universidad de Carabobo, Valencia. Edo. Carabobo, Apartado Postal 3336 (Venezuela, Bolivarian Republic of)], E-mail: ovalbuena@uc.edu.ve

    2009-01-01

    A nitrated cancrinite-type zeolite was synthesized from zeolite X, NaOH and NaNO{sub 3} solutions under autogeneous pressure at 80 deg. C for 48 h. This zeolite was characterized by X-ray diffraction (XRD), FT-IR-spectroscopy, scanning electron microscopy (SEM) and BET surface area. XRD, SEM and FT-IR confirmed the presence of nitrated cancrinite-type zeolite without other collateral phases as sodalite. Then, this sodium zeolite was exchanged with potassium and calcium cations and finally, these modified zeolites were reacted with biliar solutions from human gallbladder. Several factors such as: mass of used cancrinite, nature of the exchanged cation and reaction time of the cancrinite-bile solution interactions were studied. The composition of bile solutions (bile acids, phospholipids and bilirubin) was analyzed before and after the cancrinite-bile solution reaction. Results showed that the components of the bile were notably reduced after the contact with solids. Ca-cancrinite, 120 min of reaction time and 500 mg of solids were the best conditions determined for the bile acid reduction in human bile. When the modified zeolites were compared with the commercial cholestyramine, it was found that zeolites were more active than the latter. These zeolites may be an alternative choice to diminish cholesterol levels in hypercholesterolemic patients.

  12. Bile Acid Determination after Standardized Glucose Load in Pregnant Women

    Science.gov (United States)

    Adams, April; Jacobs, Katherine; Vogel, Rachel Isaksson; Lupo, Virginia

    2015-01-01

    Objective Intrahepatic cholestasis of pregnancy (ICP) is a rare liver disorder, usually manifesting in the third trimester and associated with increased perinatal morbidity and mortality. The hallmark laboratory abnormality in ICP is elevated fasting serum bile acids; however, there are limited data on whether a nonfasting state affects a pregnant woman's total bile acids. This study assesses fasting and nonfasting bile acid levels in 10 healthy pregnant women after a standardized glucose load to provide insight into the effects of a glucose load on bile acid profiles. Study Design Pilot prospective cohort analysis of serum bile acids in pregnant women. A total of 10 healthy pregnant women from 28 to 32 weeks' gestation were recruited for the study before undergoing a glucose tolerance test. Total serum bile acids were collected for each subject in the overnight fasting state, and 1 and 3 hours after the 100-g glucose load. Results There was a statistically significant difference between fasting versus 3-hour values. There was no statistically significant difference between fasting versus 1-hour and 1-hour versus 3-hour values. Conclusion There is a difference between fasting and nonfasting total serum bile acids after a 100-g glucose load in healthy pregnant women. PMID:26495178

  13. Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

    Directory of Open Access Journals (Sweden)

    Luigi Corvaglia

    2013-01-01

    Full Text Available Although gastroesophageal reflux (GER is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER’s improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

  14. Strategy for treatment of nonerosive reflux disease in Asia

    Institute of Scientific and Technical Information of China (English)

    Toru Hiyama; Masaharu Yoshihara; Shinji Tanaka; Ken Haruma; Kazuaki Chayama

    2008-01-01

    The paper is to review the clinical and pathophysiologic differences between of nonerosive reflux disease (NERD) and reflux esophagitis (RE),and to propose a treatment strategy for NERD,especially for patients in Asia.A Nedline search was performed regarding the clinical and pathophysiologic differences between NERD and RE,and treatment of NERD and RE.The characteristics of NERD patients in Asia are as follows:(1) high proportion of female patients,(2)low frequency of hiatal hernia,(3) high frequency of H pylori infection,(4) severe glandular atrophy of the gastric mucosa,and (5) frequent resistance to proton pump inhibitor (PPI) therapy.In Asian NERD patients,exposure of the esophagus to acid is not increased,and esophageal motility is normal.These characteristics are similar to those of patients in Western countries.Our recommended first-choice treatment is administration of PPI in combination with a prokinetic agent.However,at present,because there is limited evidence regarding effective treatments for NERD,it is best to try several different treatment strategies to find the best treatment for each patient.

  15. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.

    LENUS (Irish Health Repository)

    Quigley, Eamonn M M

    2012-02-03

    The term "symptomatic gastroesophageal reflux disease" (GERD) refers to those patients who present with the typical GERD symptoms of heartburn and regurgitation, yet do not have endoscopic evidence of esophagitis. The primary goals of managing symptomatic GERD are to control symptoms and improve quality of life. A clinical assessment of the GERD patient can identify important clinical features, such as atypical and extraesophageal symptoms for which acid-suppressive agents tend to be less effective. Performing an endoscopy can further identify the patient as having nonerosive reflux disease, erosive esophagitis, or Barrett\\'s esophagus-diagnoses which can help determine treatment but may not prove predictive of therapeutic response. Determining acid exposure through pH testing can predict therapeutic response, with those revealing an abnormal acid exposure time being more responsive to acid-suppressive therapy. However, the performance of an endoscopy and pH testing on each patient is clearly not practical. Whereas the natural history of symptomatic GERD is still largely undefined, acid-suppressive therapy appears to be the best approach available for both the short-term and long-term management of this disease.

  16. Ursodeoxycholic acid treatment of vanishing bile duct syndromes

    Institute of Scientific and Technical Information of China (English)

    Thomas Pusl; Ulrich Beuers

    2006-01-01

    Vanishing bile duct syndromes (VBDS) are characterized by progressive loss of small intrahepatic ducts caused by a variety of different diseases leading to chronic cholestasis, cirrhosis, and premature death from liver failure. The majority of adult patients with VBDS suffer from primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA), a hydrophilic dihydroxy bile acid, is the only drug currently approved for the treatment of patients with PBC, and anticholestatic effects have been reported for several other cholestatic syndromes. Several potential mechanisms of action of UDCA have been proposed including stimulation of hepatobiliary secretion, inhibition of apoptosis and protection of cholangiocytes against toxic effects of hydrophobic bile acids.

  17. Spontaneous common bile duct perforation due to periampullary growth

    Directory of Open Access Journals (Sweden)

    Pandiaraja Javabal

    2014-06-01

    Full Text Available Spontaneous common bile duct perforations are an unusual cause of acute abdomen. In spontaneous common bile duct perforation, malignant growth is even rare. It is a rare entity usually reported in infants and children due to congenital anomalies. It is rarely reported in adults. In this case report, a 55 - year - old male patient who was diagnosed as a duodenal perforation in the pre - operative period, but the intra - operative findings was common bile duct perforation due to periampullary growth, is reported

  18. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    Directory of Open Access Journals (Sweden)

    Ming-Hsien Wang

    2015-07-01

    Full Text Available Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR. There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth.

  19. Reflux-free cannula for convection-enhanced high-speed delivery of therapeutic agents

    Science.gov (United States)

    Krauze, Michal T.; Saito, Ryuta; Noble, Charles; Tamas, Matyas; Bringas, John; Park, John W.; Berger, Mitchel S.; Bankiewicz, Krystof

    2013-01-01

    Object Clinical application of the convection-enhanced delivery (CED) technique is currently limited by low infusion speed and reflux of the delivered agent. The authors developed and evaluated a new step-design cannula to overcome present limitations and to introduce a rapid, reflux-free CED method for future clinical trials. Methods The CED of 0.4% trypan blue dye was performed in agarose gel to test cannula needles for distribution and reflux. Infusion rates ranging from 0.5 to 50 μl/minute were used. Agarose gel findings were translated into a study in rats and then in cynomolgus monkeys (Macaca fascicularis) by using trypan blue and liposomes to confirm the efficacy of the reflux-free step-design cannula in vivo. Results of agarose gel studies showed reflux-free infusion with high flow rates using the step-design cannula. Data from the study in rats confirmed the agarose gel findings and also revealed increasing tissue damage at a flow rate above 5-μl/minute. Robust reflux-free delivery and distribution of liposomes was achieved using the step-design cannula in brains in both rats and nonhuman primates. Conclusions The authors developed a new step-design cannula for CED that effectively prevents reflux in vivo and maximizes the distribution of agents delivered in the brain. Data in the present study show reflux-free infusion with a constant volume of distribution in the rat brain over a broad range of flow rates. Reflux-free delivery of liposomes into nonhuman primate brain was also established using the cannula. This step-design cannula may allow reflux-free distribution and shorten the duration of infusion in future clinical applications of CED in humans. PMID:16304999

  20. Effects of essential fatty acid deficiency on enterohepatic circulation of bile salts in mice.

    NARCIS (Netherlands)

    Lukovac, S.; Los, L.; Stellaard, F.; Rings, E.H.; Verkade, H.J.

    2009-01-01

    Essential fatty acid (EFA) deficiency in mice has been associated with increased bile production, which is mainly determined by the enterohepatic circulation (EHC) of bile salts. To establish the mechanism underlying the increased bile production, we characterized in detail the EHC of bile salts in

  1. Administration of phosphatidylcholine-cholesterol liposomes partially reconstitutes fat absorption in chronically bile-diverted rats

    NARCIS (Netherlands)

    Nishioka, T; Havinga, R; Tazuma, S; Stellaard, F; Kuipers, F; Verkade, HJ

    2004-01-01

    Background and aims: Intestinal bile deficiency in cholestatic patients leads to fat malabsorption. We addressed the potency of model bile, bile salts and phosphatidylcholine (PC)-cholesterol (CH) liposomes to reconstitute fat absorption in permanently bile-diverted (BD) rats. Methods: The plasma ap

  2. Bile acid-induced virulence gene expression of Vibrio parahaemolyticus reveals a novel therapeutic potential for bile acid sequestrants.

    Directory of Open Access Journals (Sweden)

    Kazuyoshi Gotoh

    Full Text Available Vibrio parahaemolyticus, a bacterial pathogen, causes human gastroenteritis. A type III secretion system (T3SS2 encoded in pathogenicity island (Vp-PAI is the main contributor to enterotoxicity and expression of Vp-PAI encoded genes is regulated by two transcriptional regulators, VtrA and VtrB. However, a host-derived inducer for the Vp-PAI genes has not been identified. Here, we demonstrate that bile induces production of T3SS2-related proteins under osmotic conditions equivalent to those in the intestinal lumen. We also show that bile induces vtrA-mediated vtrB transcription. Transcriptome analysis of bile-responsive genes revealed that bile strongly induces expression of Vp-PAI genes in a vtrA-dependent manner. The inducing activity of bile was diminished by treatment with bile acid sequestrant cholestyramine. Finally, we demonstrate an in vivo protective effect of cholestyramine on enterotoxicity and show that similar protection is observed in infection with a different type of V. parahaemolyticus or with non-O1/non-O139 V. cholerae strains of vibrios carrying the same kind of T3SS. In summary, these results provide an insight into how bacteria, through the ingenious action of Vp-PAI genes, can take advantage of an otherwise hostile host environment. The results also reveal a new therapeutic potential for widely used bile acid sequestrants in enteric bacterial infections.

  3. The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

    Directory of Open Access Journals (Sweden)

    Ashraf Karbasi

    2013-01-01

    Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

  4. Clinical and Morphological Study of Junction of Pancreatico-Biliary Ductal System in Congenital Dilatation of Bile Duct%先天性胆管扩张症的胰胆管连接部的形态与临床观察

    Institute of Scientific and Technical Information of China (English)

    金百祥; 周以明

    1985-01-01

    In the years from 1979 to 1984,42 cases of congenital dilatation of bile duct were admitted.In 14 of them,biliary system was examined morphologically during operation by means of ch01angiopancreatography,percutaneous transhepatic cholangiography and endoscopic retrograde pancreatocholangiography which revealed abhormal long intercommunicating channel with an anomalous junction of the pancreatico-biliary ductal system.Clinical analysis was made of the relation betwean symptoms such as abdominal pain.palpable mass and jaundice.Abdominal pain was found related to elevated serum amylase level.Patients presenting abdominal pain of ten tend to show high amylase level in bile.These findings suggest that there is reflux of bile into pancreatic duct and likewise pancreatic juice into the bile duct in such patients.It also suggests that abdominal pain so often accompanying congenital dilatation of bile duct is due to pancreatitis.%@@ 自1969年Babbitt提出胰胆管合流异常的概念之后,由于各种造影的广泛应用,近年来,文献上有诸多报告.现将本院自1979年起积累之14例胰胆管连接部形态的造影所见,结合临床分析如下.

  5. Antibacterial drug treatment increases intestinal bile acid absorption via elevated levels of ileal apical sodium-dependent bile acid transporter but not organic solute transporter α protein.

    Science.gov (United States)

    Miyata, Masaaki; Hayashi, Kenjiro; Yamakawa, Hiroki; Yamazoe, Yasushi; Yoshinari, Kouichi

    2015-01-01

    Antibacterial drug treatment increases the bile acid pool size and hepatic bile acid concentration through the elevation of hepatic bile acid synthesis. However, the involvement of intestinal bile acid absorption in the increased bile acid pool size remains unclear. To determine whether intestinal bile acid absorption contributes to the increased bile acid pool in mice treated with antibacterial drugs, we evaluated the levels of bile acid transporter proteins and the capacity of intestinal bile acid absorption. Ileal apical sodium-dependent bile acid transporter (ASBT) mRNA and protein levels were significantly increased in ampicillin (ABPC)-treated mice, whereas organic solute transporter α (OSTα) mRNA levels, but not protein levels, significantly decreased in mice. Similar alterations in the expression levels of bile acid transporters were observed in mice treated with bacitracin/neomycin/streptomycin. The capacity for intestinal bile acid absorption was evaluated by an in situ loop method. Increased ileal absorption of taurochenodeoxycholic acid was observed in mice treated with ABPC. These results suggest that intestinal bile acid absorption is elevated in an ASBT-dependent manner in mice treated with antibacterial drugs.

  6. Hepatobiliary Scan in Infantile Spontaneous Perforation of Common Bile Duct

    Energy Technology Data Exchange (ETDEWEB)

    Zeon, Seok Kil; Ryu, Jong Gul; Lee, Eun Young [Keimyung University School of Medicine, Taegu (Korea, Republic of); Lee, Jong Gil [Taegu Fatima Hospital, Taegu (Korea, Republic of)

    1996-03-15

    Spontaneous perforation of CBD in infant is a rare but fatal disease. We report a case of bile leakage from common bile duct in 11 months old girl with progressive abdominal distension and vomiting, preoperatively diagnosed by hepatobiliary scan with Tc-99m-DISIDA, which was confirmed by surgery. Operative cholangiogram showed a small perforation at the confluence of cystic duct and common bile duct with mild fusiform dilatation, and no definite abnormality in confluence of the common bile duct and pancreatic duct. Simple drainage of the free peritoneal bilous fluid and T-tube drainage were performed without any evidence of the complication. Patient was inevitable for 6 months OPD follow-up examination.

  7. Saliva transit in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Cassiani, R A; Mota, G A; Aprile, L R O; Dantas, R O

    2015-10-01

    Saliva is an important factor in the neutralization of the acidity of the refluxed material that comes from the stomach to the esophagus. The impairment of saliva transit from oral cavity to distal esophagus may be one of the causes of esophagitis and symptoms in gastroesophageal reflux disease (GERD). With the scintigraphic method, the transit of 2 mL of artificial saliva was measured in 30 patients with GERD and 26 controls. The patients with GERD had symptoms of heartburn and acid regurgitation, a 24-hour pH monitoring with more than 4.2% of the time with pH below four, 26 with erosive esophagitis, and four with non-erosive reflux disease. Fourteen had mild dysphagia for solid foods. Twenty-one patients had normal esophageal manometry, and nine had ineffective esophageal motility. They were 15 men and 15 women, aged 21-61 years, mean 39 years. The control group had 14 men and 12 women, aged 19-61 years, mean 35 years. The subjects swallowed in the sitting and supine position 2 mL of artificial saliva labeled with 18 MBq of (99m) Technetium phytate. The time of saliva transit was measured from oral cavity to esophageal-gastric transition, from proximal esophagus to esophageal-gastric transition, and the transit through proximal, middle, and distal esophageal body. There was no difference between patients and controls in the time for saliva to go from oral cavity to esophageal-gastric transition, and from proximal esophagus to esophageal-gastric transition, in the sitting and supine positions. In distal esophagus in the sitting position, the saliva transit duration was shorter in patients with GERD (3.0 ± 0.8 seconds) than in controls (7.6 ± 1.7 seconds, P = 0.03). In conclusion, the saliva transit from oral cavity to the esophageal-gastric transition in patients with GERD has the same duration than in controls. Saliva transit through the distal esophageal body is faster in patients with GERD than controls.

  8. Testing of Stirling engine solar reflux heat-pipe receivers

    Energy Technology Data Exchange (ETDEWEB)

    Rawlinson, S.; Cordeiro, P.; Dudley, V.; Moss, T.

    1993-07-01

    Alkali metal heat-pipe receivers have been identified as a desirable interface to couple a Stirling-cycle engine with a parabolic dish solar concentrator. The reflux receiver provides power nearly isothermally to the engine heater heads while de-coupling the heater head design from the solar absorber surface design. The independent design of the receiver and engine heater head leads to high system efficiency. Heat pipe reflux receivers have been demonstrated at approximately 30 kW{sub t} power throughput by others. This size is suitable fm engine output powers up to 10 kW{sub e}. Several 25-kW{sub e}, Stirling-cycle engines exist, as well as designs for 75-kW{sub t} parabolic dish solar concentrators. The extension of heat pipe technology from 30 kW{sub t} to 75 kW{sub t} is not trivial. Heat pipe designs are pushed to their limits, and it is critical to understand the flux profiles expected from the dish, and the local performance of the wick structure. Sandia has developed instrumentation to monitor and control the operation of heat pipe reflux receivers to test their throughput limits, and analytical models to evaluate receiver designs. In the past 1.5 years, several heat pipe receivers have been tested on Sandia`s test bed concentrators (TBC`s) and 60-kW{sub t} solar furnace. A screen-wick heat pipe developed by Dynatherm was tested to 27.5 kW{sub t} throughput. A Cummins Power Generation (CPG)/Thermacore 30-kW{sub t} heat pipe was pushed to a throughput of 41 kW{sub t} to verify design models. A Sandia-design screen-wick and artery 75-kW{sub t} heat pipe and a CPG/Thermacore 75-kW{sub t} sintered-wick heat pipe were also limit tested on the TBC. This report reviews the design of these receivers, and compares test results with model predictions.

  9. Thermo-chemo-radiotherapy for advanced bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Naoto Egawa; Katsuyuki Karasawa; Tadayoshi Matsuda; Kouji Tsuruta; Atsutake Okamoto

    2005-01-01

    AIM: Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dismal prognosis,with a life expectancy of about 6 mo to 1 year. To improve the treatment results of locally advanced bile duct carcinoma, we have been conducting a clinical trial using regional hyperthermia in combination with chemoradiation therapy.METHODS: Eight patients complaining of obstructive jaundice with advanced extrahepatic bile duct underwent thermo-chemo-radiotherapy (TCRT). All tumors were located in the upper bile duct and involved hepatic bifurcation, and obstructed the bile duct completely.Radiofrequency capacitive hyperthermia was administered simultaneously with chemotherapeutic agents once weekly immediately following radiotherapy at 2 Gy.We administered heat to the patient for 40 min after the tumor temperature had risen to 42 ℃. The chemotherapeutic agents employed were cis-platinum (CDDP,50 mg/m2) in combination with 5-fluorouracil (5-FU,800 mg/m2) or methotrexate (MTX, 30 mg/m2) in combination with 5-FU (800 mg/m2). Number of heat treatments ranged from 2 to 8 sessions. The bile duct at autopsy was histologically examined in three patients treated with TCRT.RESULTS: In respect to resolution of the bile duct, there were three complete regression (CR), two partial regression (PR), and three no change (NC). Mean survival was 13.2±10.8 mo (mean±SD). Four patients survived for more than 20 mo. Percutaneous transhepatic biliary drainage (PTBD) tube could be removed in placement of self-expandable metallic stent into the patency-restored bile duct after TCRT. No major side effects occurred. At autopsy, marked hyalinization or fibrosis with necrosis replaced extensively bile duct tumor and wall, in which suppressed cohesiveness of carcinoma cells and degenerative cells were sparsely observed.CONCLUSION: Although the number of cases is

  10. Qualitative and quantitative determination of drotaverine metabolites in rat bile.

    Science.gov (United States)

    Vargay, Z; Simon, G; Winter, M; Szüts, T

    1980-01-01

    After oral and intravenous administration of drotaverin-14C its metabolites were determined in rat bile. Three major metabolites were identified by tlc. All the metabolites appeared in conjugated form. No unchanged drotaverine was detectable in the bile, except after treatment with doses much in excess of the therapeutic range. The ratio of major metabolites to unchanged product was determined by two-dimensional densitometry using a Telechrom Video Densitometer.

  11. A case of peribiliary cysts accompanying bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Tadahiro Takada; Hodaka Amano; Masahiro Yoshida; Takahiro Isaka; Naoyuki Toyota; Keita Wada; Kenji Takagi; Kenichiro Karo

    2006-01-01

    A rare case of peribiliary cysts accompaying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken.Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided.

  12. Bile salts and their importance for drug absorption

    DEFF Research Database (Denmark)

    Holm, René; Müllertz, Anette; Mu, Huiling

    2013-01-01

    in different animal species and an overview of the literature investigating the influence of bile salts on the in vivo performance of different compounds and drug formulations. Generally, there is a positive effect on bioavailability when bile is present in the gastro-intestinal tract, independent...... of the formulation systems, e.g. suspensions, solutions, cyclodextrin complexes or lipid based formulations, but a few exceptions have also been reported....

  13. Bile duct hamar tomas-the von Meyenburg complex

    Institute of Scientific and Technical Information of China (English)

    Valdemir José Alegre Salles; Alexandre Marotta; Jorge Miguel Kather Netto; Manlio Basílio Speranzini; Marcos Roberto Martins

    2007-01-01

    Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by ifbrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

  14. Urinary excretion of bile acid glucosides and glucuronides in extrahepatic cholestasis.

    Science.gov (United States)

    Wietholtz, H; Marschall, H U; Reuschenbach, R; Matern, H; Matern, S

    1991-04-01

    Recently the formation of bile acid glucosides has been described as a novel conjugation mechanism in vitro and in vivo. In 10 patients with extrahepatic cholestasis caused by carcinoma of the head of the pancreas we investigated excretion rates and profiles of urinary bile acid glucosides. Urinary bile acid glucosides and, for comparison, bile acid glucuronides were extracted and characterized according to established methods. In controls total urinary bile acid glucoside excretion was 0.22 +/- 0.03 mumol/24 hr (mean +/- S.E.M.)-in the range of bile acid glucuronide excretion (0.41 +/- 0.06 mumol/24 hr; mean +/- S.E.M.). A gas chromatography-mass spectrometry-characterized trihydroxy bile acid glucoside of still-unknown hydroxyl positions accounted for 65% of total urinary bile acid glucosides. In extrahepatic cholestasis total urinary bile acid glucoside excretion was 0.52 +/- 0.13 mumol/24 hr (mean +/- SEM), yet significantly lower than bile acid glucuronide excretion (1.53 +/- 0.13 mumol/24 hr; mean +/- SEM; p less than 0.001). In cholestasis the primary bile acid derivatives cholic and chenodeoxycholic acid glucosides amounted to 90%, whereas the trihydroxy bile acid glucoside had decreased to 5% of total bile acid glucoside excretion, indicating its alteration during enterohepatic circulation. The data establish the composition and quantity of urinary bile acid glucosides in healthy controls and cholestasis and constitute a quantitative comparison with another glycosidic conjugation reaction, bile acid glucuronidation.

  15. The anti-mutagenic properties of bile pigments.

    Science.gov (United States)

    Bulmer, A C; Ried, K; Blanchfield, J T; Wagner, K-H

    2008-01-01

    Bile pigments, including bilirubin and biliverdin, are endogenous compounds belonging to the porphyrin family of molecules. In the past, bile pigments and bilirubin in particular were thought of as useless by-products of heme catabolism that can be toxic if they accumulate. However, in the past 20 years, research probing the physiological relevance of bile pigments has been mounting, with evidence to suggest bile pigments possess significant antioxidant and anti-mutagenic properties. More specifically, bile pigments are potent peroxyl radical scavengers and inhibit the mutagenic effects of a number of classes of mutagens (polycyclic aromatic hydrocarbons, heterocyclic amines, oxidants). Coincidentally, persons with elevated circulating bilirubin concentrations have a reduced prevalence of cancer and cardio-vascular disease. Despite the encouraging in vitro anti-mutagenic effects of bile pigments, relatively little research has been conducted on their inhibitory capacity in bacterial and cultured cell assays of mutation, which might link the existing in vitro and in vivo observations. This is the first review to summarise the published data and it is our hope it will stimulate further research on these potentially preventative compounds.

  16. Microstructural analysis of bile: relevance to cholesterol gallstone pathogenesis.

    Science.gov (United States)

    Rubin, M; Pakula, R; Konikoff, F M

    2000-07-01

    The study of physical-chemical factors and pathways leading to cholesterol crystallization in bile has important clinical relevance. The major processes in cholesterol gallstone formation can be subdivided into nucleation, formation and precipitation of solid crystals (crystallization), crystal growth, crystal agglomeration and stone growth. A clear understanding of the microstructural events occurring during the earliest stages of these processes in bile is crucial for the identification of factors possibly delaying or preventing precipitation of cholesterol crystals and, therefore, gallstone formation in bile. Detection and characterization of microstructures in native and model biles can be achieved by both direct and indirect techniques. Direct imaging techniques provide more readily interpretable information, but sample preparation problems, particularly for electron microscopy, are a source of artifacts. Moreover, microscopic techniques provide only qualitative data without the possibility to quantitate or to analyse the composition of microstructures. Several indirect techniques have been used to obtain additional microstructural information about nucleating bile. These techniques have the disadvantage of often being model dependent in addition to constraints specific for each method. The systematic, judicious use of a combination of complementary direct and indirect techniques have led to a comprehensive understanding of the various microstructural processes and interactions occurring during bile secretion, flow in the biliary tract and storage in the gallbladder. This forms the basis for our current understanding of cholesterol nucleation, crystallization and gallstone formation.

  17. Incidence of gastro-oesophageal reflux in geriatric clinical patients - a radiological study

    Energy Technology Data Exchange (ETDEWEB)

    Brackins-Romero, J.; Bruening, B.; Beyer, H.K.

    1984-05-01

    Gastro-oesophageal reflux is obviously caused by an insufficiency of the dilatable lower end of the oesophagus. The physiological pressure acting on it corresponds to 15-30 mm Hg so that the gastric juice is prevented from entering the oesophagus. Reflux is associated with a reduction of that pressure. Many causes may be responsible, although hiatal hernia, where confirmed, will only play a secondary part. In half of the 74 examined elderly patients, gastro-oesophageal reflux was confirmed by radiology. About half of these suffered also from hiatal hernia which was a sliding hernia in 75 per cent of the cases. In about 25 per cent of the patients suffering from gastro-oesophageal reflux, signs of oesophagitis were discovered by radiology. There was no correlation between overweight and the incidence of reflux, but hiatus hernia and a positive Broca test were distinctly related to one another. In patients with gastro-oesophageal reflux, vomiting as a key symptom was more frequently confirmed than in patients without reflux.

  18. Salivary transforming growth factor alpha in patients with Sjögren's syndrome and reflux laryngitis

    Directory of Open Access Journals (Sweden)

    Marco Antonio dos Anjos Corvo

    2014-12-01

    Full Text Available Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group.

  19. Endoscopic treatment of vesicoureteral reflux in pediatric patients

    Directory of Open Access Journals (Sweden)

    Jong Wook Kim

    2013-04-01

    Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

  20. [Holter monitoring data in children with gastroesophageal reflux disease].

    Science.gov (United States)

    Apenchenko, Iu S; Shcherbakov, P L; Gnusaev, S F; Ivanova, I I; Rozov, D N

    2014-01-01

    The aim of research is to estimate the functional state of the cardiovascular system in children with gastroesophageal reflux disease (GERD) with the help of Holter monitoring. 117 children of school age were examined: 69 children with GERD and 48 children with chronic gastroduodenitis. All children passed esophagogastroduodenoscopy, 24-hour pH-monitoring, electrocardiography and Holter monitoring. According to Holter monitoring data it was revealed that children with GERD had increased low-frequency components of frequency domain analyses, increased number of nocturnal PVCs and increased time of enhanced dispertion periods. Holter monitoring in patients with GERD can be used to detect preclinical ectopic rhythm, to evaluate autonomic dysfunction by frequency domain analyses, to predict nocturnal symptoms.

  1. Surgery for gastroesophageal reflux disease with Gaucher disease type 2.

    Science.gov (United States)

    Kubo, Hiroyuki; Shimono, Ryuichi; Tanaka, Aya; Fujii, Takayuki; Yasuda, Saneyuki; Koyano, Kosuke; Jinnai, Wataru; Kondo, Sonoko; Kondo, Takeo; Kusaka, Takashi

    2016-07-01

    Gaucher disease, the most common lysosomal storage disease, is sometimes complicated with gastroesophageal reflux disease (GERD). The present patient was a 136-day-old Japanese boy with Gaucher disease type 2. Enzyme replacement therapy and chemical chaperone therapy were successful for the skin disorders, joint contractures, hepatosplenomegaly and thrombocytopenia, but he also had GERD. Accordingly, a Nissen fundoplication with gastrostomy was performed. There was no vulnerability of organs, easy bleeding or difficulty of maintaining the visual field because of hepatosplenomegaly during operation. In the perioperative period, there was no prolonged wound healing or infection. GERD was improved. In the near future, the number of long-term survivors of Gaucher disease will increase due to improvements in medical therapy. Therefore, it is expected that the number of patients requiring fundoplication will also increase. In patients with successful medical therapy, surgical fundoplication can be safely and effectively performed.

  2. Update on Gastroesophageal Reflux and Respiratory Disease in Children

    Directory of Open Access Journals (Sweden)

    Susan R Orenstein

    2000-01-01

    Full Text Available Pediatric respiratory diseases have been linked to gastroesophageal reflux disease (GERD, but evidence regarding the association and its potential mechanisms continues to accumulate, and important aspects remain to be determined. Evidence for the association in two common pediatric respiratory disorders - infantile apnea and asthma in older children - and difficult clinical issues associated with the diagnosis and treatment of these two disorders are reviewed. The provocative embryological and physiological connections between the upper gastrointestinal tract and the respiratory tract, and recent understanding of the compensatory anatomy and physiology that protect the normal individual from respiratory manifestations of GERD are also explored. Dysfunctions of these protections likely underlie the pathophysiology of these disorders.

  3. Individual bile acids have differential effects on bile acid signaling in mice

    Energy Technology Data Exchange (ETDEWEB)

    Song, Peizhen, E-mail: songacad@gmail.com; Rockwell, Cheryl E., E-mail: rockwelc@msu.edu; Cui, Julia Yue, E-mail: juliacui@uw.edu; Klaassen, Curtis D., E-mail: curtisklaassenphd@gmail.com

    2015-02-15

    Bile acids (BAs) are known to regulate BA synthesis and transport by the farnesoid X receptor in the liver (FXR-SHP) and intestine (FXR-Fgf15). However, the relative importance of individual BAs in regulating these processes is not known. Therefore, mice were fed various doses of five individual BAs, including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxoycholic acid (DCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) in their diets at various concentrations for one week to increase the concentration of one BA in the enterohepatic circulation. The mRNA of BA synthesis and transporting genes in liver and ileum were quantified. In the liver, the mRNA of SHP, which is the prototypical target gene of FXR, increased in mice fed all concentrations of BAs. In the ileum, the mRNA of the intestinal FXR target gene Fgf15 was increased at lower doses and to a higher extent by CA and DCA than by CDCA and LCA. Cyp7a1, the rate-limiting enzyme in BA synthesis, was decreased more by CA and DCA than CDCA and LCA. Cyp8b1, the enzyme that 12-hydroxylates BAs and is thus responsible for the synthesis of CA, was decreased much more by CA and DCA than CDCA and LCA. Surprisingly, neither a decrease in the conjugated BA uptake transporter (Ntcp) nor increase in BA efflux transporter (Bsep) was observed by FXR activation, but an increase in the cholesterol efflux transporter (Abcg5/Abcg8) was observed with FXR activation. Thus in conclusion, CA and DCA are more potent FXR activators than CDCA and LCA when fed to mice, and thus they are more effective in decreasing the expression of the rate limiting gene in BA synthesis Cyp7a1 and the 12-hydroxylation of BAs Cyp8b1, and are also more effective in increasing the expression of Abcg5/Abcg8, which is responsible for biliary cholesterol excretion. However, feeding BAs do not alter the mRNA or protein levels of Ntcp or Bsep, suggesting that the uptake or efflux of BAs is not regulated by FXR at physiological and

  4. Elemental diet and bile induced pancreatitis.

    Science.gov (United States)

    Kerstein, M D; Tonkens, R M

    1976-08-01

    The effectiveness of an elemental diet was investigated as both a prophylactic and therapeutic agent in experimental canine pancreatitis. Pancreatitis was induced by operative injection of a bile -saline solution mixture under pressure retrograde into the main pancreatic duct. In addition to a preinjection control sample, serial biopsies were obtained at 30 minute intervals for 90 minutes after injection and fixed for light and electron microscopic examinations. In addition, preoperative and postoperative blood samples were drawn and analyzed for amylase. After operation, half of the dogs from each original group were fed Vivonex-100, the other half from each group, regular laboratory chow, yielding four ultimate groups based on preoperative and postoperative diets. Successful induction of pancreatitis was evaluated by the difference between preoperative and postoperative amylase values, all of which were significant by group at the p less than 0.01 level. No ultrastructural evidence was found for the modification of zymogen granules with the pretreatment elemental diet nor were differences evident, histologically or ultrastructurally, in the severity of pancreatitis between the pretreated and nonpretreated groups. Finally, gross mortality figures demonstrated no efficacy of elemental diet for pretreatment prophylaxis of acute pancreatitis.

  5. Validation of the Reflux Disease Questionnaire into Greek

    Directory of Open Access Journals (Sweden)

    Eirini Oikonomidou

    2012-09-01

    Full Text Available Primary care physicians face challenges in diagnosing and managing gastroesophageal reflux disease (GERD. The Reflux Disease Questionnaire (RDQ meets the standards of validity, reliability, and practicability. This paper reports on the validation of the Greek translation of the RDQ. RDQ is a condition specific instrument. For the validation of the questionnaire, the internal consistency of its items was established using the alpha coefficient of Chronbach. The reproducibility (test-retest reliability was measured by kappa correlation coefficient and the criterion of validity was calculated against the diagnosis of another questionnaire already translated and validated into Greek (IDGP using kappa correlation coefficient. A factor analysis was also performed. Greek RDQ showed a high overall internal consistency (alpha value: 0.91 for individual comparison. All 8 items regarding heartburn and regurgitation, GERD, had good reproducibility (Cohen’s κ 0.60-0.79, while the remaining 4 items about dyspepsia had a moderate reproducibility (Cohen’s κ=’ 0.40-0.59 The kappa coefficient for criterion validity for GERD was rather poor (0.20, 95% CI: 0.04, 0.36 and the overall agreement between the results of the RDQ questionnaire and those based on the IDGP questionnaire was 70.5%. Factor analysis indicated 3 factors with Eigenvalue over 1.0, and responsible for 76.91% of variance. Regurgitation items correlated more strongly with the third component but pain behind sternum and upper stomach pain correlated with the second component. The Greek version of RDQ seems to be a reliable and valid instrument following the pattern of the original questionnaire, and could be used in primary care research in Greece.

  6. Systematic review: questionnaires for assessment of gastroesophageal reflux disease.

    Science.gov (United States)

    Bolier, E A; Kessing, B F; Smout, A J; Bredenoord, A J

    2015-01-01

    Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes.

  7. Asthma and gastroesophageal reflux disease: Effect of longterm pantoprazole therapy

    Institute of Scientific and Technical Information of China (English)

    Calabrese Carlo; Fabbri Anna; Areni Alessandra; Scialpi Carlo; Zahlane Desiree; Di Febo Giulio

    2005-01-01

    AIM: To define the prevalence of gastroesophageal reflux disease (GERD) in mild persistent asthma and to value the effect of pantoprazole therapy on asthmatic symptoms.METHODS: Seven of thirty-four asthmatic patients without GERD served as the non-GERD control group.Twenty-seven of thirty-four asthmatic patients had GERD (7/27 also had erosive esophagitis, sixteen of them presented GERD symptoms. An upper gastrointestinal endoscopy was performed in all the subjects to obtain five biopsy specimens from the lower 5 cm of the esophagus. Patients were considered to have GERD when they had a dilation of intercellular space (DIS)>0.74 μm at transmission electron microscopy.Patients with GERD were treated with pantoprazole,80 mg/day. Forced expiratory volume in one second (FEV1) was performed at entry and after 6 mo of treatment. Asthmatic symptoms were recorded. The required frequency of inhaling rapid acting 32-agonists was self-recorded in the patients' diaries.RESULTS: Seven symptomatic patients presented erosive esophagitis. Among the 18 asymptomatic patients, 11 presented DIS, while all symptomatic patients showed ultrastructural esophageal damage.Seven asymptomatic patients did not present DIS. At entry the mean of FEV1 was 1.91 L in symptomatic GERD patients and 1.88 L in asymptomatic GERD patients.After the treatment, 25 patients had a complete recovery of DIS and reflux symptoms. Twenty-three patients presented a regression of asthmatic symptoms with normalization of FEV1. Four patients reported a significant improvement of symptoms and their FEV1 was over 80%.CONCLUSION: GERD is a highly prevalent condition in asthma patients. Treatment with pantoprazole (80 mg/day)determines their improvement and complete regression.

  8. Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience

    Directory of Open Access Journals (Sweden)

    Miguel Zerati Filho

    2007-04-01

    Full Text Available OBJECTIVE: We evaluated clinical characteristics of primary vesicoureteral reflux (VUR in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. MATERIALS AND METHODS: From 1975 through 2005, 417 girls (81.6% and 94 boys (18.4% with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. RESULTS: Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%. Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p < 0.001 or Wilcoxon (p < 0.001 test. CONCLUSION: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V. The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

  9. Acid reflux directly causes sleep disturbances in rat with chronic esophagitis.

    Directory of Open Access Journals (Sweden)

    Kenichi Nakahara

    Full Text Available BACKGROUND & AIMS: Gastroesophageal reflux disease (GERD is strongly associated with sleep disturbances. Proton pump inhibitor (PPI therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. METHODS: Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. RESULTS: Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01 accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. CONCLUSIONS: Acid reflux directly causes sleep disturbances in rats with chronic esophagitis.

  10. Findings in cystourethrography that suggest lower urinary tract dysfunction in children with vesicoureteral reflux

    Directory of Open Access Journals (Sweden)

    Ubirajara Barroso Jr

    2004-12-01

    Full Text Available PURPOSE: Children with lower urinary tract dysfunction and vesicoureteral reflux, at cystography assessment, frequently present alterations in the lower urinary tract anatomy such as dilated posterior urethra, irregularity of the bladder wall and diverticula. However, the significance of these findings is unknown. The objective of this study is to evaluate the incidence of these findings, their time of disappearance and their correlation with the severity of the reflux. MATERIALS AND METHODS: 193 children with vesicoureteral reflux, considered simple, in the age group above 5 years at the moment of diagnosis, were analyzed. The recommendation for follow-up of these patients was one voiding cystoureterography (VCUG each year. Only patients with a minimum of 2 VCUGs performed in a period of at least 6 months were considered. The VCUGs were classified as positive and negative in relation to findings that were characteristic of lower urinary tract dysfunction (LUTD. RESULTS: From the 193 children analyzed, 50 (26% presented positive VCUG and 143 negative VCUG. From the patients without symptoms of lower urinary tract dysfunction (n = 135, 12 (9% presented positive VCUG and 123 (91% a negative VCUG. From the patients with negative VCUG, 68 (48% presented unilateral reflux and 75 (52% presented bilateral reflux. From those with positive VCUG, 26 (52% had unilateral reflux and 24 bilateral reflux (48%. This difference was not statistically significant. A higher incidence of grade II reflux was more evident in patients with negative VCUG and degree III in patients with positive VCUG (p < 0.05. CONCLUSIONS: Our study demonstrated that 64% of the patients with LUTD and reflux presented findings in the VCUG that suggest dysfunction.

  11. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    Science.gov (United States)

    Calvet, Xavier; Villoria, Albert

    2013-10-01

    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety.

  12. Differentiation of various traditional Chinese medicines derived from animal bile and gallstone: simultaneous determination of bile acids by liquid chromatography coupled with triple quadrupole mass spectrometry.

    Science.gov (United States)

    Qiao, Xue; Ye, Min; Pan, De-lin; Miao, Wen-juan; Xiang, Cheng; Han, Jian; Guo, De-an

    2011-01-01

    Animal biles and gallstones are popularly used in traditional Chinese medicines, and bile acids are their major bioactive constituents. Some of these medicines, like cow-bezoar, are very expensive, and may be adulterated or even replaced by less expensive but similar species. Due to poor ultraviolet absorbance and structural similarity of bile acids, effective technology for species differentiation and quality control of bile-based Chinese medicines is still lacking. In this study, a rapid and reliable method was established for the simultaneous qualitative and quantitative analysis of 18 bile acids, including 6 free steroids (cholic acid, chenodeoxycholic acid, deoxycholic acid, lithocholic acid, hyodeoxycholic acid, and ursodeoxycholic acid) and their corresponding glycine conjugates and taurine conjugates, by using liquid chromatography coupled with tandem mass spectrometry (LC/MS/MS). This method was used to analyze six bile-based Chinese medicines: bear bile, cattle bile, pig bile, snake bile, cow-bezoar, and artificial cow-bezoar. Samples were separated on an Atlantis dC₁₈ column and were eluted with methanol-acetonitrile-water containing ammonium acetate. The mass spectrometer was monitored in the negative electrospray ionization mode. Total ion currents of the samples were compared for species differentiation, and the contents of bile acids were determined by monitoring specific ion pairs in a selected reaction monitoring program. All 18 bile acids showed good linearity (r² > 0.993) in a wide dynamic range of up to 2000-fold, using dehydrocholic acid as the internal standard. Different animal biles could be explicitly distinguished by their major characteristic bile acids: tauroursodeoxycholic acid and taurochenodeoxycholic acid for bear bile, glycocholic acid, cholic acid and taurocholic acid for cattle bile, glycohyodeoxycholic acid and glycochenodeoxycholic acid for pig bile, and taurocholic acid for snake bile. Furthermore, cattle bile, cow

  13. Vesicoureteral Reflux in the Child with Lazy Bladder Syndrome: The Infrequent Voider

    Directory of Open Access Journals (Sweden)

    Marco Grasso

    2008-01-01

    Therefore we must stress that it is prominently important considering about infrequent micturition in a paediatric case history or a large capacity bladder, possible presence of bladder dysfunction and vesicoureteral reflux too.

  14. Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs.

    Science.gov (United States)

    Brisebois, Simon; Samson, Nathalie; Fortier, Pierre-Hugues; Doueik, Alexandre A; Carreau, Anne-Marie; Praud, Jean-Paul

    2014-08-15

    Reflux laryngitis in infants may be involved not only in laryngeal disorders, but also in disorders of cardiorespiratory control through its impact on laryngeal function. Our objective was to study the effect of reflux laryngitis on non-nutritive swallowing (NNS) and NNS-breathing coordination. Two groups of six newborn lambs, randomized into laryngitis and control groups, were surgically instrumented for recording states of alertness, swallowing and cardiorespiratory variables without sedation. A mild to moderate reflux laryngitis was induced in lambs from the experimental group. A significant decrease in the number of NNS bursts and apneas was observed in the laryngitis group in active sleep (p=0.03). In addition, lower heart and respiratory rates, as well as prolonged apnea duration (plaryngitis group. We conclude that a mild to moderate reflux laryngitis alters NNS burst frequency and autonomous control of cardiac activity and respiration in lambs.

  15. Clinical characteristics of patients with gastroesophageal reflux disease in several centers of Northwest China

    Institute of Scientific and Technical Information of China (English)

    高麦仓

    2013-01-01

    Objective To investigate the clinical characteristics of gastroesophageal reflux disease (GERD) in several endoscopy centers of Northwest China.Methods From September 2008 to September 2009,a questionnaire survey was carried out in the endoscopy centers of four hospitals

  16. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Vestbo, Jørgen;

    2015-01-01

    BACKGROUND AND OBJECTIVE: We tested the hypothesis that gastro-esophageal reflux disease is a risk factor for exacerbations in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Among 9622 participants in the Copenhagen City Heart Study, we identified 1259 individuals with COPD...... and information on gastro-esophageal reflux disease and the regular use of acid inhibitory treatment. These individuals were followed for 5 years with regard to medically treated COPD exacerbations, which we defined as a short course treatment with oral corticosteroids alone or in combination with antibiotics. We...... applied a multivariable Cox regression analysis with adjustment for well-established risk factors associated with COPD exacerbations or gastro-esophageal reflux disease, including COPD severity, and symptoms. RESULTS: Individuals with COPD and gastro-esophageal reflux disease had more chronic bronchitis...

  17. Stillage reflux in food waste ethanol fermentation and its by-product accumulation.

    Science.gov (United States)

    Ma, Hongzhi; Yang, Jian; Jia, Yan; Wang, Qunhui; Tashiro, Yukihiro; Sonomoto, Kenji

    2016-06-01

    Raw materials and pollution control are key issues for the ethanol fermentation industry. To address these concerns, food waste was selected as fermentation substrate, and stillage reflux was carried out in this study. Reflux was used seven times during fermentation. Corresponding ethanol and reducing sugar were detected. Accumulation of by-products, such as organic acid, sodium chloride, and glycerol, was investigated. Lactic acid was observed to accumulate up to 120g/L, and sodium chloride reached 0.14mol/L. Other by-products did not accumulate. The first five cycles of reflux increased ethanol concentration, which prolonged fermentation time. Further increases in reflux time negatively influenced ethanol fermentation. Single-factor analysis with lactic acid and sodium chloride demonstrated that both factors affected ethanol fermentation, but lactic acid induced more effects.

  18. Digestion of phospholipids after secretion of bile into the duodenum changes the phase behavior of bile components.

    Science.gov (United States)

    Birru, Woldeamanuel A; Warren, Dallas B; Ibrahim, Ahmed; Williams, Hywel D; Benameur, Hassan; Porter, Christopher J H; Chalmers, David K; Pouton, Colin W

    2014-08-04

    Bile components play a significant role in the absorption of dietary fat, by solubilizing the products of fat digestion. The absorption of poorly water-soluble drugs from the gastrointestinal tract is often enhanced by interaction with the pathways of fat digestion and absorption. These processes can enhance drug absorption. Thus, the phase behavior of bile components and digested lipids is of great interest to pharmaceutical scientists who seek to optimize drug solubilization in the gut lumen. This can be achieved by dosing drugs after food or preferably by formulating the drug in a lipid-based delivery system. Phase diagrams of bile salts, lecithin, and water have been available for many years, but here we investigate the association structures that occur in dilute aqueous solution, in concentrations that are present in the gut lumen. More importantly, we have compared these structures with those that would be expected to be present in the intestine soon after secretion of bile. Phosphatidylcholines are rapidly hydrolyzed by pancreatic enzymes to yield equimolar mixtures of their monoacyl equivalents and fatty acids. We constructed phase diagrams that model the association structures formed by the products of digestion of biliary phospholipids. The micelle-vesicle phase boundary was clearly identifiable by dynamic light scattering and nephelometry. These data indicate that a significantly higher molar ratio of lipid to bile salt is required to cause a transition to lamellar phase (i.e., liposomes in dilute solution). Mixed micelles of digested bile have a higher capacity for solubilization of lipids and fat digestion products and can be expected to have a different capacity to solubilize lipophilic drugs. We suggest that mixtures of lysolecithin, fatty acid, and bile salts are a better model of molecular associations in the gut lumen, and such mixtures could be used to better understand the interaction of drugs with the fat digestion and absorption pathway.

  19. Unilateral ventricular reflux and asymmetric ventricular distribution of intrathecally introduced contrast medium or tracer

    Energy Technology Data Exchange (ETDEWEB)

    Deisenhammer, E.; Hammer, B.

    Fourteen cases of totally or predominantly unilateral ventricular reflux and stasis of intrathecally injected radioisotope or contrast medium were demonstrated by scintigraphy or computed tomographic cisternography. All showed asymmetric enlargement of the lateral ventricles and nine had ipsilateral brain lesions. Four case reports are presented. The pathophysiologic mechanism of communicating hydrocephalus and possible causes of unilateral ventricular reflux are discussed, as well as indications for ventricular shunt installation.

  20. A belated revelation: from gastroesophageal reflux derived asthma to laryngotracheal irritation even spasm

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The author has been inspired by the Global Evidence-Based Consensus for gastroesophageal reflux (GER),which put forward four extra-esophageal syndromes:reflux cough syndrome,reflux laryngitis syndrome,reflux dental erosion syndrome and the reflux asthma syndrome.The author himself happened to receive five emergency rescue treatments following apparent "bronchial asthma",which was to be diagnosed as GER at his own insistence.PPI resulted in some relief.After being rescued again from suffocation,he had a fundaplication,which was performed at the Englewood Hospital & Medical Center,Englewood,USA in March 2006.The procedure immediately cleared up his "asthma".A month later he brought forth a Center for GER in an army hospital in Beijing,China.Up to now,601 patients with mainly respiratory distress(84%)were treated by Stretta Radiofrequency,58 by surgery and more by PPI.The GER Center is now complete with a ward.GER patients with respiratory distresses turned out to fare better than those with acid regurgitation.A nozzle"shaped pharynx was found in patients with the reflux.Animal study revealed that the refluxate entered into trachea and even lungs.Gradually a hypothesis of a gastrooesophago-laryngo-tracheal reflux took shape.Our modest effort to treat GER-derived respiratory distresses has got off to an encouraging start amid relative shortage of experience and facilities.We would like to share two thoughts with scholars and experts at home and abroad:1.The GER-derived asthma is not asthma,but GER pure and simple;2.The pathogenesis of "asthma" is not asthma,but laryngotracheal irritation/spasm and its sequence.

  1. Complications following endoscopic treatment of vesicoureteric reflux with Deflux(®) - two case studies.

    Science.gov (United States)

    Zyczkowski, Marcin; Prokopowicz, Grzegorz; Zajęcki, Wojciech; Paradysz, Andrzej

    2012-01-01

    The endoscopic injection of vesicoureteric orifices with synthetic or natural materials is a widely recognized method of treating vesicoureteral reflux (VUR). The aim of this study is to present two cases of clinically significant complications following the use of dextranomer/hyaluronic acid copolymer, which led to the progression of the reflux degree, permanent infection of the urinary tract, and the necessity to perform surgical treatment.

  2. Numerical modelling of geothermal and reflux circulation in Enewetak Atoll: Implications for dolomitization

    Science.gov (United States)

    Jones, G.; Whitaker, F.; Smart, P.; Sanford, W.

    2000-01-01

    Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80??? can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls. (C) 2000 Elsevier Science B.V. All rights reserved.Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80 per mil can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls.

  3. Endoscopic treatment of vesicoureteral reflux with a self-detachable balloon system.

    Science.gov (United States)

    Atala, A; Peters, C A; Retik, A B; Mandell, J

    1992-08-01

    There is controversy about the use of polytetrafluoroethylene (Teflon) paste in children for the endoscopic treatment of vesicoureteral reflux due to evidence of particle migration. However, there are definite advantages in treating patients endoscopically. It is evident that the ideal substance should be able to be delivered endoscopically, conserve its volume, and be nonmigratory and nonantigenic. Towards this goal we developed a catheter with an inflatable, detachable and self-sealing silicone balloon that would fit through a 19 gauge cystoscopic needle. Hydroxy-ethyl-methyl acrylate, a hydrophilic polymer that solidifies within 60 minutes after the addition of ferrous sulfate, was chosen as the filling material for the balloon. Conceptually, the sealed balloon would prevent the migration of hydroxy-ethyl-methyl acrylate and the solidified polymer would prevent volume loss. To test this system reflux was created in 6 Hanford mini-pigs by unroofing the ureters bilaterally. In 2 pigs a previously described method of open surgery was used and in the other 4 reflux was created endoscopically using the resectoscope and laparoscopic scissors. The presence of bilateral reflux was confirmed 4 weeks later with a cystogram and the balloon was implanted unilaterally through a cystoscope. The opposite ureter served as an internal control in all animals. A repeat cystogram was performed 2 to 4 weeks after implantation, demonstrating resolution of reflux in the treated side and persistence of reflux in the opposite untreated ureter. Serial cystograms, ultrasound and excretory urography showed no reflux on the implanted side nor any evidence of obstruction. Tissue sections from various organs showed no evidence of particle migration, granuloma formation or inflammatory reaction. Short-term results show that the balloon implants are able to correct reflux without evidence of obstruction.

  4. Longterm outcome of Macroplatique injection for treatment of vesicoureteral reflux in children

    Directory of Open Access Journals (Sweden)

    Elrahmany A. Mohamed

    2014-01-01

    Full Text Available Background: This study examined our experience with one year follow-up of 20 cases of vesicoureteric reflux in children after treatment with Macroplastique ® injection. Patient and Methods: A total of 20 children (31 ureters with primary grades II to V vesicoureteral reflux were treated with subureteral Macroplastique ® injection from 2010 to 2011 and followed for an average of 12 months (range 3 to 24. Vesicoureteral reflux was grade II in 3, III in 7, IV in 9 and V in 12 ureters. Each child underwent pre-operative voiding cystourethrography, abdominopelvic ultrasound, urine analysis/culture, S. creatinine and CBC. Dimercapto-succinic acid scan (DMSA scan and magnetic resonance urography (MRU were done in some patients. Voiding cystourethrography at 3 months was done to rule out persistent reflux. Results: Overall, reflux was corrected in 11 (35.5% ureters and 9 (45% children after a single injection. With repeat injection, reflux was corrected in 16 (51.6% ureters and 11 (55% children, reflux improved/downgrade in 4 (12.9% ureters and 2 (10% children. Correction by grade was 100%, 100%, 9.7%, 9.7% for grades II to V, respectively. There were no surgical complications. None of the cured patients had recurrent reflux during follow-up. There were 9 (45% children who required open ureteral re-implantation for failed injection. Conclusion: Sub-ureteral Macroplastique ® injection therapy could be a primary treatment for low grade VUR (grade III or less in children because it is simple, safe, effective, less invasive, decreased.

  5. Bile acids as endogenous etiologic agents in gastrointestinal cancer

    Institute of Scientific and Technical Information of China (English)

    Harris Bernstein; Carol Bernstein; Claire M Payne; Katerina Dvorak

    2009-01-01

    Bile acids are implicated as etiologic agents in cancer of the gastrointestinal (GI) tract, including cancer of the esophagus, stomach, small intestine, liver, biliary tract, pancreas and colon/rectum. Deleterious effects of bile acid exposure, likely related to carcinogenesis,include: induction of reactive oxygen and reactive nitrogen species; induction of DNA damage; stimulation of mutation; induction of apoptosis in the short term,and selection for apoptosis resistance in the long term.These deleterious effects have, so far, been reported most consistently in relation to esophageal and colorectal cancer, but also to some extent in relation to cancer of other organs. In addition, evidence is reviewed for an association of increased bile acid exposure with cancer risk in human populations, in specific human genetic conditions, and in animal experiments. A model for the role of bile acids in GI carcinogenesis is presented from a Darwinian perspective that offers an explanation for how the observed effects of bile acids on cells contribute to cancer development.

  6. Metabolism of Cholesterol and Bile Acids by the Gut Microbiota

    Directory of Open Access Journals (Sweden)

    Philippe Gérard

    2013-12-01

    Full Text Available The human gastro-intestinal tract hosts a complex and diverse microbial community, whose collective genetic coding capacity vastly exceeds that of the human genome. As a consequence, the gut microbiota produces metabolites from a large range of molecules that host’s enzymes are not able to convert. Among these molecules, two main classes of steroids, cholesterol and bile acids, denote two different examples of bacterial metabolism in the gut. Therefore, cholesterol is mainly converted into coprostanol, a non absorbable sterol which is excreted in the feces. Moreover, this conversion occurs in a part of the human population only. Conversely, the primary bile acids (cholic and chenodeoxycholic acids are converted to over twenty different secondary bile acid metabolites by the gut microbiota. The main bile salt conversions, which appear in the gut of the whole human population, include deconjugation, oxidation and epimerization of hydroxyl groups at C3, C7 and C12, 7-dehydroxylation, esterification and desulfatation. If the metabolisms of cholesterol and bile acids by the gut microbiota are known for decades, their consequences on human health and disease are poorly understood and only start to be considered.

  7. Optimizing Human Bile Preparation for Two-Dimensional Gel Electrophoresis

    Directory of Open Access Journals (Sweden)

    Hao-Tsai Cheng

    2016-01-01

    Full Text Available Aims. Bile is an important body fluid which assists in the digestion of fat and excretion of endogenous and exogenous compounds. In the present study, an improved sample preparation for human bile was established. Methods and Material. The method involved acetone precipitation followed by protein extraction using commercially available 2D Clean-Up kit. The effectiveness was evaluated by 2-dimensional electrophoresis (2DE profiling quality, including number of protein spots and spot distribution. Results. The total protein of bile fluid in benign biliary disorders was 0.797 ± 0.465 μg/μL. The sample preparation method using acetone precipitation first followed by 2D Clean-Up kit protein extraction resulted in better quality of 2DE gel images in terms of resolution as compared with other sample preparation methods. Using this protocol, we obtained approximately 558 protein spots on the gel images and with better protein spots presentation of haptoglobin, serum albumin, serotransferrin, and transthyretin. Conclusions. Protein samples of bile prepared using acetone precipitation followed by 2D Clean-Up kit exhibited high protein resolution and significant protein profile. This optimized protein preparation protocol can effectively concentrate bile proteins, remove abundant proteins and debris, and yield clear presentation of nonabundant proteins and its isoforms on 2-dimensional electrophoresis gel images.

  8. Relationship between occult pancreaticobiliary reflux and biliary diseases%隐匿性胰液反流与胆道疾病间的相关性

    Institute of Scientific and Technical Information of China (English)

    杨慧慧; 李会兵; 刘爽; 刘贤英

    2016-01-01

    目的 探讨隐匿性胰液反流(OPR)与胆道疾病间的相关性.方法 收集44例原发性胆道疾病患者,取血检测血清淀粉酶活性,收集胆总管胆汁,测定胆汁淀粉酶活性,计算胆总管的△胆汁淀粉酶活性(即胆总管胆汁淀粉酶活性-血清淀粉酶活性).以胆总管胆汁淀粉酶活性高于血清淀粉酶活性视为该患者存在OPR,将其纳入OPR组,反之则纳入未发生OPR的对照组.结果 44例胆道疾病患者中32例存在OPR,发生率为72.7%.OPR组患者胆汁淀粉酶、血清淀粉酶活性分别为(1 513±2 725)、(45 ±21)U/L,对照组为(18±14)、(38±16) U/L,OPR组胆汁淀粉酶活性显著高于对照组,差异有统计学意义(P<0.05),而两组血清淀粉酶活性差异无统计学意义.OPR组中单纯胆总管结石患者的OPR发生率为100%,胆汁淀粉酶活性为(1 048±1 317)U/L,△胆汁淀粉酶活性为(996±1 322)U/L;胆总管结石合并胆囊结石患者分别为75%,(2 457 ±3 312)、(2 412 ±3 320) U/L;单纯胆囊结石患者分别为80%,(95±82)、(57±76)U/L;胆总管恶性肿瘤患者为50%,(73±54)、(40±37) U/L.结论 OPR的发生与胆总管结石、胆总管结石合并胆囊结石密切相关,OPR可能是发生胆系结石的主要致病因素之一.%Objective To investigate the relationship between occult pancreaticobiliary reflux (OPR) and biliary diseases.Methods Forty-four patients with primary biliary diseases was enrolled,and serum amylase level was determined,and the bile in common bile duct (CBD) was collected to measure the amylase level,then the △ amylase was calculated,which equals bile amylase level minus serum amylase level.OPR was confirmed if bile amylase level was higher than serum amylase level,otherwise it would be defined as the control group.Results Among the 44 patients with primary biliary diseases,the incidence of OPR was 72.7% (n =32).The bile and serum amylase activity of patients with OPR were (1 513 ± 2 725),(44 ± 21)U

  9. Time esophageal pH < 4 overestimates the prevalence of pathologic esophageal reflux in subjects with gastroesophageal reflux disease treated with proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Sloan Sheldon

    2008-05-01

    Full Text Available Abstract Background A Stanford University study reported that in asymptomatic GERD patients who were being treated with a proton pump inhibitor (PPI, 50% had pathologic esophageal acid exposure. Aim We considered the possibility that the high prevalence of pathologic esophageal reflux might simply have resulted from calculating acidity as time pH Methods We calculated integrated acidity and time pH Results The prevalence of pathologic 24-hour esophageal reflux in both studies was significantly higher when measured as time pH Conclusion In GERD subjects treated with a PPI, measuring time esophageal pH

  10. Modeling the detectability of vesicoureteral reflux using microwave radiometry

    Science.gov (United States)

    Arunachalam, Kavitha; Maccarini, Paolo F.; De Luca, Valeria; Bardati, Fernando; Snow, Brent W.; Stauffer, Paul R.

    2010-09-01

    We present the modeling efforts on antenna design, frequency selection and receiver sensitivity estimation to detect vesicoureteral reflux (VUR) using microwave (MW) radiometry as warm urine from the bladder maintained at fever range temperature using a MW hyperthermia device reflows into the kidneys. The radiometer center frequency (fc), frequency band (Δf) and aperture radius (ra) of the physical antenna for kidney temperature monitoring are determined using a simplified universal antenna model with a circular aperture. Anatomical information extracted from the computed tomography (CT) images of children aged 4-6 years is used to construct a layered 3D tissue model. Radiometric antenna efficiency is evaluated in terms of the ratio of the power collected from the target at depth to the total power received by the antenna (η). The power ratio of the theoretical antenna is used to design a microstrip log spiral antenna with directional radiation pattern over fc ± Δf/2. Power received by the log spiral from the deep target is enhanced using a thin low-loss dielectric matching layer. A cylindrical metal cup is proposed to shield the antenna from electromagnetic interference (EMI). Transient thermal simulations are carried out to determine the minimum detectable change in the antenna brightness temperature (δTB) for 15-25 mL urine refluxes at 40-42 °C located 35 mm from the skin surface. Theoretical antenna simulations indicate maximum η over 1.1-1.6 GHz for ra = 30-40 mm. Simulations of the 35 mm radius tapered log spiral yielded a higher power ratio over fc ± Δf/2 for the 35-40 mm deep targets in the presence of an optimal matching layer. Radiometric temperature calculations indicate δTB >= 0.1 K for the 15 mL urine at 40 °C and 35 mm depth. Higher η and δTB were observed for the antenna and matching layer inside the metal cup. Reflection measurements of the log spiral in a saline phantom are in agreement with the simulation data. The numerical study

  11. Modeling the detectability of vesicoureteral reflux using microwave radiometry

    Energy Technology Data Exchange (ETDEWEB)

    Arunachalam, Kavitha [Department of Engineering Design, Indian Institute of Technology Madras, Chennai (India); Maccarini, Paolo F; Stauffer, Paul R [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); De Luca, Valeria [Department of Information Tech and Electrical Eng., ETH Zurich (Switzerland); Bardati, Fernando [Department of Computer Science, Systems and Production, University of Rome, Tor Vergata, Roma (Italy); Snow, Brent W, E-mail: akavitha@iitm.ac.i [University of Utah and Primary Children' s Medical Center, Salt Lake City, UT (United States)

    2010-09-21

    We present the modeling efforts on antenna design, frequency selection and receiver sensitivity estimation to detect vesicoureteral reflux (VUR) using microwave (MW) radiometry as warm urine from the bladder maintained at fever range temperature using a MW hyperthermia device reflows into the kidneys. The radiometer center frequency (f{sub c}), frequency band ({Delta}f) and aperture radius (r{sub a}) of the physical antenna for kidney temperature monitoring are determined using a simplified universal antenna model with a circular aperture. Anatomical information extracted from the computed tomography (CT) images of children aged 4-6 years is used to construct a layered 3D tissue model. Radiometric antenna efficiency is evaluated in terms of the ratio of the power collected from the target at depth to the total power received by the antenna ({eta}). The power ratio of the theoretical antenna is used to design a microstrip log spiral antenna with directional radiation pattern over f{sub c} {+-} {Delta}f/2. Power received by the log spiral from the deep target is enhanced using a thin low-loss dielectric matching layer. A cylindrical metal cup is proposed to shield the antenna from electromagnetic interference (EMI). Transient thermal simulations are carried out to determine the minimum detectable change in the antenna brightness temperature ({delta}T{sub B}) for 15-25 mL urine refluxes at 40-42 {sup 0}C located 35 mm from the skin surface. Theoretical antenna simulations indicate maximum {eta} over 1.1-1.6 GHz for r{sub a} = 30-40 mm. Simulations of the 35 mm radius tapered log spiral yielded a higher power ratio over f{sub c} {+-} {Delta}f/2 for the 35-40 mm deep targets in the presence of an optimal matching layer. Radiometric temperature calculations indicate {delta}T{sub B} {>=} 0.1 K for the 15 mL urine at 40 {sup 0}C and 35 mm depth. Higher {eta} and {delta}T{sub B} were observed for the antenna and matching layer inside the metal cup. Reflection measurements

  12. Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk.

    Science.gov (United States)

    Yourkavitch, Jennifer; Zadrozny, Sabrina; Flax, Valerie L

    2016-10-14

    The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005-2007), data on reflux and feeding mode were collected by monthly questionnaires. A longitudinal, repeated measures analysis was used, with feeding mode lagged by one month in order to compare reflux incidence among infants fed directly at the breast to infants receiving pumped breast milk. Mothers in both feeding groups had similar characteristics, although a greater proportion feeding at least some pumped milk were primiparous. The number of exclusively breastfed infants decreased steadily between months 2 and 6, although the proportion fed at the breast remained similar over time. An association between feeding mode and reflux incidence was not found; however, the analyses were limited by a small number of reported reflux cases. More studies are needed to further explain the relationship between different feeding modes and infant reflux.

  13. Gastro-oesophageal reflux disease and non-asthma lung disease

    Directory of Open Access Journals (Sweden)

    R. S. Morehead

    2009-12-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection. Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures. Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail. Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

  14. Pyelonephritis, renal scarring, and reflux nephropathy: a pediatric urologist's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Edwin A. [Emory University School of Medicine, Department of Urology, Atlanta, GA (United States)

    2008-01-15

    Imaging of children with a clinical diagnosis of pyelonephritis is performed to characterize the extent of the infection, to identify associated renal injury and to uncover risk factors for future infections and renal damage. Although there is general agreement regarding the need for parenchymal imaging and the need to exclude processes that are either functionally or anatomically obstructive, there is controversy regarding the need for routine cystography, especially when parenchymal involvement has not been documented. A protocol that limits the use of cystography for evaluation of urinary tract infections must assume that the diagnosis of reflux is at least of variable clinical significance. It is now clear that vesicoureteral reflux and reflux nephropathy represent a diverse population that includes both congenital and acquired processes. MR imaging will improve our understanding of vesicoureteral reflux, pyelonephritis and renal scarring and might help us to identify and manage those patients most at risk for recurrent infections and renal injury. To recognize the potential contributions of this newer imaging technique it is helpful to look at our understanding of the pathophysiology of pyelonephritis, reflux and reflux nephropathy. (orig.)

  15. The relationship between helicobacter pylori infection and gastro-esophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Batool M Mahdi

    2011-01-01

    Full Text Available Background : Gastro-esophageal reflux disease is a common condition, affecting 25%-40% of the population. Increasing attention has been paid to the relationship between Helicobacter pylori infection and reflux esophagitis. Aim: The aim of this study was to investigate the association between CagA+ H. pylori and endoscopically proven gastro-esophageal reflux disease. Patients and Methods: The study group included 60 hospital patients with gastro-esophageal reflux disease between 2007 and 2009 as compared with 30 healthy patients from a control group that was age and sex matched. Helicobacter pylori CagA+ was identified by an immunological test (Immunochromatography test (ACON, USA. Results : Helicobacter pylori CagA+ was present in 42/60 (70% of the patients with gastro-esophageal reflux disease and in 11/30 (36.6% patients in the control group (p=0.002. The Odds ratio = 0.8004 with 95% Confidence Interval = from 0.3188 to 2.0094. The relative risk=1.35 that indicates an association between Helicobacter pylori and disease. Conclusions: The presence of Helicobacter pylori is significantly increased in patients with gastro-esophageal reflux disease as compared with the control group.

  16. Is scintigraphy of value in the diagnosis of gastrooesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Kjellen, G.; Brudin, L.; Haakansson, H.O. (Centrallasarettet, Kalmar (Sweden))

    1991-01-01

    110 patients with suspected oesophageal symptoms were investigated by means of oesophageal endoscopy (OE), 24-h pH- metry, and oesophageal scintigraphy (ES). When 24-h pH-metry formed the basis for diagnosis of gastrooesophageal reflux disease (GERD), the sensitivity for ES at abdominal compression was 64%, but no statistically significant differences were found among erect refluxers, supine refluxers, and comibined refluxers. Only 4% of the GERD patients had pathologic oesophageal clearing at ES. The more severe the macroscopic oesophagitis found by OE, the more pronounced were the abnormal findings at 24-h pH-metry and at ES with abdominal compression. Increased postprandial reflux was associated with gastro-oesophageal reflux and hiatal hernia at ES with abdominal compression and the most severe form of oesophagitis, respectively. It is concluded that ES has too low sensitivity to be recommended as a screening test for GERD. Nevertheless, the specificity of 76% can to some extent help us to rule out GERD in patients. 19 refs., 7 tabs.

  17. Bile acid nuclear receptor FXR and digestive system diseases

    Directory of Open Access Journals (Sweden)

    Lili Ding

    2015-03-01

    Full Text Available Bile acids (BAs are not only digestive surfactants but also important cell signaling molecules, which stimulate several signaling pathways to regulate some important biological processes. The bile-acid-activated nuclear receptor, farnesoid X receptor (FXR, plays a pivotal role in regulating bile acid, lipid and glucose homeostasis as well as in regulating the inflammatory responses, barrier function and prevention of bacterial translocation in the intestinal tract. As expected, FXR is involved in the pathophysiology of a wide range of diseases of gastrointestinal tract, including inflammatory bowel disease, colorectal cancer and type 2 diabetes. In this review, we discuss current knowledge of the roles of FXR in physiology of the digestive system and the related diseases. Better understanding of the roles of FXR in digestive system will accelerate the development of FXR ligands/modulators for the treatment of digestive system diseases.

  18. [Postoperative handling in biliodigestive derivation by iatrogenic bile duct injury].

    Science.gov (United States)

    Domínguez, I; Mercado, M A

    2008-01-01

    Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.

  19. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.

    Science.gov (United States)

    Tack, Jan; Deloose, Eveline

    2014-08-01

    Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.

  20. Prophylactic antibiotics in vesicoureteric reflux: Evidence-based analysis

    Directory of Open Access Journals (Sweden)

    M S Ansari

    2009-01-01

    Full Text Available Objectives: The aim of this review was to systematically examine the available evidence for the effectiveness of prophylactic antibiotics in cases of vesicoureteric reflux (VUR. Materials and Methods: We searched the relevant data on medical management of VUR and the date of last search was June 2008. The search included both randomized controlled trials as well as the nonrandomized trials and the data sources were; MEDLINE, online peer reviewed journals, Cochrane database and abstracts from conference proceedings. Results: Barring few most of the studies published on medical management were nonrandomized. Besides being small in number many of these studies were of poor-quality and poorly designed eventually failing in giving a reliable answer in this regard. Few of the studies suggest that the children with low grade VUR might do well even without antibiotic prophylaxis. Conclusions : In the absence of properly designed, randomized controlled trials and long-term follow-up the question of antibiotic prophylaxis in cases of VUR remains unanswered in large part of it. Whether to give prophylactic antibiotics or not would ultimately need a shared decision-making involving both the treating physician and the parents assessing both the risks and the benefits.

  1. A Correlation between Renal Anomalies and Vesicoureteral Reflux

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo; Kim, Young Tong; Kim, Il Young; Shin, Hyeong Cheol [Dept. of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2011-12-15

    To investigate the frequency of vesicoureteral reflux (VUR) in children with renal anomalies a evaluate the correlation between renal anomalies and VUR. Eighty-one children (1 day-8 years) with renal anomalies underwent voiding cystourethrogram between 2006 and 2009 were reviewed. This study included ureteropelvic junction stenosis (n = 32), ureteropelvic duplication (n = 20), multicystic dysplastic kidney (n = 12), fusion anomaly (n = 11), renal agenesis (n = 3), unilateral renal hypoplasia (n = 2), and ectopic kidney (n = 1). The frequency, grade, and location of VUR were evaluated. The grade of VUR according to age and anomaly type was statistically analyzed, and the patients with VUR were followed. The VUR was present in 14 (17.3%); ipsilateral VUR was present in 8 (57.1%), bilateral VUR in 4 (28.6%), and contralateral VUR in 2 (14.2%). VUR was detected in 9 patients under the age of one. There was no statistical correlation between VUR grade and either age or anomaly type of the nine patients showed continuous VUR on up. The frequency of VUR in children with renal anomalies was 17.3%. VUR was most frequently detected in children under the age of one, and VUR grade was not related to age and anomaly type.

  2. Gastroesophagial reflux disease and asthma in pregnant women with dyspnea.

    Directory of Open Access Journals (Sweden)

    Katayoon Bidad

    2014-04-01

    Full Text Available Asthma and gastroesophageal reflux disease (GERD are two common problems in pregnancy and they affect pregnancy in several ways. In this study, we aimed to evaluate GERD and asthma in pregnant women who referred for prenatal care visits. One-hundred and seventy three pregnant women with a complaint of dyspnea were included in the study. A questionnaire was filled and lung function tests were performed. All patients were visited by a respiratory specialist and questionnaires were evaluated by a gastroenterologist. Out of the total number of women studied, 37% were diagnosed to have asthma and 36.4% were non-asthmatics. Twenty six percent of the pregnant women who had symptoms and signs of asthma with normal spirometry were classified as probable to have asthma. GERD was diagnosed in 80.9% of the pregnant women, but it was not significantly higher in asthmatic or probable asthmatic women compared to non-asthmatic ones. However, severity of GERD was significantly higher in asthmatic pregnant women compared to the others. In conclusion, the prevalence of GERD was quite high in pregnant women, irrespective of the fact that they were asthmatic or non-asthmatic. Further studies evaluating women throughout pregnancy will inform us more about this relationship.

  3. Laparoscopy in the management of pediatric vesicoureteral reflux

    Directory of Open Access Journals (Sweden)

    Atul A Thakre

    2007-01-01

    Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

  4. EMPIRIC THERAPY IN OTOLARYNGOLOGIC MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    M. Mohammadi

    2005-04-01

    Full Text Available The review of literature shows that a strong relationship exists between the symptoms of otolaryngologic diseases and gastroesophageal reflux disease (GERD. It is commonly observed that an extended physical examination is needed to determine the occurrence of GERD. This non-randomized,prospective quasi-experimental study was performed to clinically verify the relationship between otolaryngologic symptoms and GERD and to show that a search for GERD is necessary under conditions that patients do not respond to initial routine treatment for otolaryngologic symptoms. Extended physical examination of patients who had been referred to an Ear, Nose and throat (ENThospital revealed that GERD-related laryngeal signs were present in 55 patients. Otolaryngologic symptoms detected in decreasing order of occurrence were posterior nasal drip, chronic pharyngitis, chronic cough, hoarseness, ear pain, chronic throat clearing and pruritus in the ear. Furthermore, 66% of the patients had gastrointestinal symptoms that included heartburn, dysphagia, odynophagia, aspiration, globus hystericus, dyspepsia and foreign body sensation. Signs observed during the physical examination were posterior pharyngitis, granular pharyngitis, inflamed arytenoids, contact granuloma, and pachyderma laryngitis. We administered proton pump inhibitor to all patients and recommended to change their life style. The follow up program was a 6-month period. Only 53 patients showed up for the follow up. The overall response rate to the therapeutic regimen was 83%. In treating otolaryngologic patients, especially those who are resistant to routine treatments, a careful extended physical examination including an indirect laryngoscopy for diagnosis of GERD is recommended.

  5. Psychological modulation in patients surgically intervened for gastroesophageal reflux disease.

    Science.gov (United States)

    Lara, F J Pérez; Carranque, G; Oehling, H; Hernández, J M; Oliva, H

    2014-08-01

    Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates.

  6. Role of PH Monitoring in Laryngopharyngeal Reflux Patients with Voice Disorders

    Science.gov (United States)

    Maldhure, Swati; Chandrasekharan, Ramanathan; Dutta, Amit- Kumar; Chacko, Ashok; Kurien, Mary

    2016-01-01

    Introduction: Laryngopharyngeal reflux (LPR) is considered an important cause of voice disorder. We aimed to determine the frequency of LPR in patients with voice disorder and the association between Koufman Reflux Symptom Index (RSI), Reflux Finding Score (RFS), gastroesophageal reflux disease (GERD), and proximal acid reflux in these patients. Materials and Methods: We performed a prospective study in patients aged more than 18 years presenting at the ear, nose, and throat (ENT) clinic with a change in voice lasting more than 3 weeks. All patients underwent nasopharyngolaryngoscopy and a dual-probe esophageal pH study. LPR was diagnosed by a Koufman RSI of >13 and/or RFS of >7. GERD was diagnosed according to a DeMeester Johnson score of >14.7. Proximal acid reflux was diagnosed if acid exposure time was >0.02% in a proximal pH probe. Results: The study included 30 patients with a voice disorder. The mean age of participants was 38.5 years and 40% of patients were female. Using either of the two criteria, LPR was present in 46.7% of patients, half of whom had GERD. Among the remaining 53.3% patients with a voice disorder and no evidence of LPR, GERD was present in 25%. There was no significant association between the presence of LPR based on RSI (P=1) and GERD or RFS and GERD (P=0.06). Proximal acid reflux was present in only 10% patients with a voice disorder, and there was no significant association of this test with RFS (P=1) or RSI (P=1). Conclusions: Approximately half of the patients with a voice disorder have LPR, and only a subset of these patients have evidence of GERD. Fiberoptic laryngoscopic findings (RFS) complementing RSI appears to be important in diagnosing possible reflux etiology in voice disorders and can be an indicator for instituting anti-reflux therapy. However, there is no significant association between RSI, RFS, and GERD suggesting that these tests evaluate different features of the disease. Proximal acid reflux is uncommon in patients

  7. Congenital double bile duct presenting as recurrent cholangitis in a child

    Directory of Open Access Journals (Sweden)

    K.D. Chakravarty

    2015-12-01

    Full Text Available Double common bile duct (DCBD is a rare congenital anomaly. Most of these bile duct anomalies are associated with bile duct stones, anomalous pancreaticobiliary junction (APBJ, pancreatitis and bile duct or gastric cancers. Early detection and treatment is important to avoid long term complications. Surgical resection of the anomalous bile duct and reconstruction of the biliary enteric anastomosis is the treatment of choice. We report a rare case of DCBD anomaly in a girl, who presented with recurrent cholangitis. She had type Va DCBD anomaly. She underwent successful resection of the bile duct and reconstruction of the biliary enteric anastomosis. Preoperative imaging and diagnosis of the congenital biliary anomaly is very important to avoid intraoperative bile duct injury. Review of the literature shows very few cases of type Va DCBD, presenting with either bile duct stones or APBJ.

  8. Cholangio-venous reflux as a cause of recurrent hyperamylasemia in choledochal dilatation with anomalous pancreaticobiliary ductal union: an experimental study.

    Science.gov (United States)

    Ohkawa, H; Sawaguchi, S; Khalil, B; Ishikawa, A; Yamazaki, Y

    1985-02-01

    Cylindrical choledochal dilatation, associated with anomalous pancreaticobiliary ductal union, causes recurrent episodes of right hypochondrial pain, vomiting, and fever. The symptoms are very often accompanied by hyperamylasemia, which is generally considered to be due to acute pancreatitis. However, our clinical experience and experimental studies have led us to the conclusion that pancreatitis is not the sole cause of hyperamylasemia. In this paper we report our further investigations of the cause of the hyperamylasemia. In 22 mongrel adult dogs, intracholedochal infusion was performed under a continuous hydrostatic pressure of 20 cm H2O for 2 hours. Solutions of amylase from three different sources and a lipase were used in the range of concentrations found clinically in the bile within a cylindrical choledochal dilatation. In the 3 groups, hyperamylasemia was proven by quantitative estimation of serum amylase level and/or by the changes in specific amylase isozymes. Lipase was also shown to transfer into the blood stream. In an additional experiment on 5 dogs, only the extrahepatic biliary tree, including the gallbladder, was infused with a solution of amylase from Bacillus subtilis. This produced no increase in the serum amylase. Our experiments suggest that amylase passes from the hepatocholedochal system into the blood stream. This phenomenon has long been known as cholangiovenous reflux.

  9. Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults

    Directory of Open Access Journals (Sweden)

    Akif Turk

    2014-06-01

    Full Text Available Purpose Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods Thirty two patients (12 female, 20 male with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81% chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Results Reflux was scored as grade 1 in seven (14%, grade 2 in 16 (32%, grade 3 in 21 (42% and grade 4 in six (12% renal units. There was not patient with grade 5 reflux. Fourteen renal units (28% were treated with dextranomer/hyaluronic acid copolymer (group 1 and 36 renal units (72% were treated with polyacrylate polyalcohol copolymer (group 2. The overall treatment success was achieved at 40 renal units (80%. The treatment was successful at 11 renal units (79% in group 1 and 29 renal units (81% in group 2 (p = 0.71. There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00. Conclusions The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

  10. Pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction:Pathologic implications

    Institute of Scientific and Technical Information of China (English)

    Marcelo A Beltrán

    2011-01-01

    Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases.The following aspects were defined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux; (2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction; and (3) Evidence of sphincter of Oddi (SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction.The articles reviewed were selected and classified according to five levels of evidence:LevelⅠ,meta-analysis double-blind randomized clinical trials,Level Ⅱ,cohort non-blinded studies and non-randomized clinical trials,Level Ⅲ, good quality case-control studies and non-randomized cohort studies,Level Ⅳ,case series and poor quality case-control studies,and Level Ⅴ,case report articles and experts' opinion.Evidence levels Ⅱ,Ⅲ,Ⅳ and Ⅴ were found to support biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction.The same levels of evidence were found to support the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and SO dysfunction as the most plausible cause of this condition.Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance, the current evidence does not fully support what has been suggested.Studies with evidence level I have not been undertaken.This is a fascinating subject of study,and if finally supported by evidence level I, the importance of this condition will constitute a major breakthrough in biliary pathology.

  11. Effect of impeller reflux balance holes on pressure and axial force of centrifugal pump

    Institute of Scientific and Technical Information of China (English)

    CAO Wei-dong; DAI Xun; HU Qi-xiang

    2015-01-01

    The size of impeller reflux holes for centrifugal pump has influence on the pressure distribution of front and rear shrouds and rear pump chamber, as well as energy characteristics of whole pump and axial force. Low specific-speed centrifugal pump with Q=12.5 m3/h,H=60 m,n=2950 r/min was selected to be designed with eight axial reflux balance holes with 4.5 mm in diameter. The simulated Q-H curve and net positive suction head (NPSH) were in good agreement with experimental results, which illustrated that centrifugal pump with axial reflux balance holes was superior in the cavitation characteristic; however, it showed to little superiority in head and efficiency. The pressure in rear pump chamber at 0.6 times rate flow is 29.36% of pressure difference between outlet and inlet, which reduces to 29.10% at rate flow and 28.33% at 1.4 times rate flow. As the whole, the pressure distribution on front and rear shrouds from simulation results is not a standard parabola, and axial force decreases as flow rate increases. Radical reflux balance holes chosen to be 5.2 mm and 5.9 mm in diameter were further designed with other hydraulic parts unchanged. With structural grids adopted for total flow field, contrast numerical simulation on internal flow characteristics was conducted based on momentum equations and standard turbulence model (κ-ε). It is found that axial force of pump with radical reflux balance holes of 5.2 mm and 5.9 mm in diameter is significantly less than that with radical reflux balance holes of 4.5 mm in diameter. Better axial force balance is obtained as the ratio of area of reflux balance holes and area of sealing ring exceeds 6.

  12. Effect of Helicobacter pylori Eradication on Reflux Esophagitis Therapy: A Multi-center Randomized Control Study

    Institute of Scientific and Technical Information of China (English)

    Yan Xue; Li-Ya Zhou; San-Ren Lin; Xiao-Hua Hou; Zhao-Shen Li; Min-Hu Chen; Xiu-E Yan

    2015-01-01

    Background:Helicobacterpylori (H.pylori) frequently colonizes the stomach.Gastroesophageal reflux disease (GERD) is a common and costly disease.But the relationship ofH.pylori and GERD is still unclear.This study aimed to explore the effect ofH.pylori and its eradication on reflux esophagitis therapy.Methods:Patients diagnosed with reflux esophagitis by endoscopy were enrolled;based on rapid urease test and Warth-Starry stain,they were divided into H.pylori positive and negative groups.H.pylori positive patients were randomly given H.pylori eradication treatment for 1 0 days,then esomeprazole 20 mg bid for 46 days.The other patients received esomeprazole 20 mg bid therapy for 8 weeks.After treatment,three patient groups were obtained:H.pylori positive eradicated,H.pylori positive uneradicated,and H.pylori negative.Before and after therapy,reflux symptoms were scored and compared.Healing rates were compared among groups.The x2 test and t-test were used,respectively,for enumeration and measurement data.Results:There were 176 H.pylori positive (with 92 eradication cases) and 180 negative cases.Healing rates in the H.pylori positive eradicated and H.pylori positive uneradicated groups reached 80.4% and 79.8% (P =0.911),with reflux symptom scores of 0.22 and 0.14 (P =0.588).Healing rates of esophagitis in the H.pylori positive uneradicated and H.pylori negative groups were,respectively,79.8% and 82.2% (P =0.848);reflux symptom scores were 0.14 and 0.21 (P =0.546).Conclusions:Based on esomeprazole therapy,H.pylori infection and eradication have no significant effect on reflux esophagitis therapy.

  13. Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Awais, Muhammad; Rehman, Abdul; Nadeem, Naila [Aga Khan University Hospital, Department of Radiology, Karachi (Pakistan); Zaman, Maseeh Uz [Aga Khan University Hospital, Nuclear Medicine, Department of Radiology, Karachi (Pakistan)

    2014-07-04

    Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines. Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied. Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan - scarring, hydronephrosis and reduced differential renal function - were compared with presence of vesicoureteric reflux on MCUG. High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively. DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks. (orig.)

  14. Gut microbiota inhibit Asbt-dependent intestinal bile acid reabsorption via Gata4

    NARCIS (Netherlands)

    Out, Carolien; Patankar, Jay V.; Doktorova, Marcela; Boesjes, Marije; Bos, Trijnie; de Boer, Sanna; Havinga, Rick; Wolters, Henk; Boverhof, Renze; van Dijk, Theo H.; Smoczek, Anna; Bleich, Andre; Sachdev, Vinay; Kratky, Dagmar; Kuipers, Folkert; Verkade, Henkjan J.; Groen, Albert K.

    2015-01-01

    Background & Aims: Regulation of bile acid homeostasis in mammals is a complex process regulated via extensive cross-talk between liver, intestine and intestinal microbiota. Here we studied the effects of gut microbiota on bile acid homeostasis in mice. Methods: Bile acid homeostasis was assessed in

  15. Discovering novel bile protection systems in Bifidobacterium breve UCC2003 through functional genomics.

    NARCIS (Netherlands)

    Ruiz, L.; Zomer, A.L.; O'Connell-Motherway, M.; Sinderen, D. van; Margolles, A.

    2012-01-01

    Tolerance of gut commensals to bile salt exposure is an important feature for their survival in and colonization of the intestinal environment. A transcriptomic approach was employed to study the response of Bifidobacterium breve UCC2003 to bile, allowing the identification of a number of bile-induc

  16. Improved annotation of conjugated bile acid hydrolase superfamily members in Gram-positive bacteria.

    NARCIS (Netherlands)

    Lambert, J.M.; Siezen, R.J.; Vos, W.M. de; Kleerebezem, M.

    2008-01-01

    Most Gram-positive bacteria inhabiting the gastrointestinal tract are capable of hydrolysing bile salts. Bile salt hydrolysis is thought to play an important role in various biological processes in the host. Therefore, correct annotation of bacterial bile salt hydrolases (Bsh) in public databases (E

  17. Improved annotation of conjugated bile acid hydrolase superfamily members in Gram-positive bacteria

    NARCIS (Netherlands)

    Lambert, J.M.; Siezen, R.J.; Vos, de W.M.; Kleerebezem, M.

    2008-01-01

    Most Gram-positive bacteria inhabiting the gastrointestinal tract are capable of hydrolysing bile salts. Bile salt hydrolysis is thought to play an important role in various biological processes in the host. Therefore, correct annotation of bacterial bile salt hydrolases (Bsh) in public databases (E

  18. The Farnesoid X receptor - A molecular link between bile acid and lipid and glucose metabolism

    NARCIS (Netherlands)

    Claudel, T; Staels, B; Kuipers, F

    2005-01-01

    Bile acids are the end products of cholesterol metabolism. They are synthesized in the liver and secreted via bile into the intestine, where they aid in the absorption of fat-soluble vitamins and dietary fat. Subsequently, bile acids return to the liver to complete their enterohepatic circulation. T

  19. Alteration of bile acid metabolism in the rat induced by chronic ethanol consumption

    Science.gov (United States)

    Xie, Guoxiang; Zhong, Wei; Li, Houkai; Li, Qiong; Qiu, Yunping; Zheng, Xiaojiao; Chen, Huiyuan; Zhao, Xueqing; Zhang, Shucha; Zhou, Zhanxiang; Zeisel, Steven H.; Jia, Wei

    2013-01-01

    Our understanding of the bile acid metabolism is limited by the fact that previous analyses have primarily focused on a selected few circulating bile acids; the bile acid profiles of the liver and gastrointestinal tract pools are rarely investigated. Here, we determined how chronic ethanol consumption altered the bile acids in multiple body compartments (liver, gastrointestinal tract, and serum) of rats. Rats were fed a modified Lieber-DeCarli liquid diet with 38% of calories as ethanol (the amount equivalent of 4–5 drinks in humans). While conjugated bile acids predominated in the liver (98.3%), duodenum (97.8%), and ileum (89.7%), unconjugated bile acids comprised the largest proportion of measured bile acids in serum (81.2%), the cecum (97.7%), and the rectum (97.5%). In particular, taurine-conjugated bile acids were significantly decreased in the liver and gastrointestinal tract of ethanol-treated rats, while unconjugated and glycine-conjugated species increased. Ethanol consumption caused increased expression of genes involved in bile acid biosynthesis, efflux transport, and reduced expression of genes regulating bile acid influx transport in the liver. These results provide an improved understanding of the systemic modulations of bile acid metabolism in mammals through the gut-liver axis.—Xie, G., Zhong, W., Li, H., Li, Q., Qiu, Y., Zheng, X., Chen, H., Zhao, X., Zhang, S., Zhou, Z., Zeisel, S. H., Jia, W. Alteration of bile acid metabolism in the rat induced by chronic ethanol consumption. PMID:23709616

  20. Ultrasonographic study of postcibal gastro-esophageal reflux and gastric emptying in infants with recurrent respiratory disease

    Institute of Scientific and Technical Information of China (English)

    Agostino Di Ciaula; Piero Portincasa; Leonardo Di Terlizzi; Domenico Paternostro; Giuseppe Palasciano

    2005-01-01

    AIM: To check the utility of postcibal ultrasonography for the evaluation of reflux in relation to gastric emptying in infants with recurrent respiratory symptoms and to link imaging with clinical data.METHODS: Esophageal reflux (hyperechoic retrograde filling) and gastric emptying (antral areas) were quantified before and after ingestion of a standard formula in 35 untreated infants (13 with chronic cough,22 with recurrent bronchitis) and in 31 controls.RESULTS: The prevalence of abnormal (≥8 episodes)postcibal refluxes was 74% in patients and 3% in controls. Number, duration of the longest episode and extent of refluxes were significantly higher in patients compared to controls. Number of refluxes was higher in patients with symptomatic refluxes than in those without.Infants with recurrent bronchitis had more refluxes than those with chronic cough and controls. Extent and timing of gastric emptying were similar in patients and controls.CONCLUSION: Esophageal ultrasonography is a useful and physiological test in infants with recurrent respiratory diseases, which have a high prevalence of abnormal postcibal esophageal reflux and a gastric emptying similar to that of normal controls. Esophageal reflux is more severe in subjects with recurrent bronchitis than in those with chronic cough.

  1. Ventajas y desventajas del bilingüismo

    Directory of Open Access Journals (Sweden)

    Alfredo Ardila

    2012-01-01

    Full Text Available Las personas bilingües tienen que coordinar dos sistemas lingüísticos. Esto implica algunas ganancias, pero también un costo. Las ganancias del bilingüismo incluyen: un incremento de la flexibilidad mental; una superioridad en el desarrollo de aquellas funciones cognitivas relacionadas con la atención y la inhibición; el uso de una cantidad mayor de estrategias cognoscitivas en la solución de problemas; un aumento de la llamada conciencia metalingüística; y una habilidad mayor de comunicación. Entre los costos del bilingüismo se menciona: cierto retraso aparente en la adquisición del lenguaje; una interferencia entre ambos sistemas fonológicos, léxicos y gramaticales; y un posible decremento en el vocabulario en las dos lenguas. Se concluye que existe una gran variabilidad de experiencias lingüísticas en las personas bilingües y un gran número de variables afecta su ejecución en diferentes tareas intelectuales.

  2. Bile acid and immunosuppressive therapy in primary biliary cirrhosis

    NARCIS (Netherlands)

    F.H.J. Wolfhagen (Franciscus)

    1995-01-01

    textabstractPrimary Biliary Cirrhosis (PBC) is a chronic, cholestatic liver disease characterized by non-suppurative destruction of interlobular and septal bile ducts, with subsequent liver damage and eventually development of cirrhosis. The disease is relatively rare with an estimated annual incide

  3. Carbon monoxide and bile pigments: surprising mediators of vascular function.

    Science.gov (United States)

    Durante, William

    2002-08-01

    Heme oxygenase (HO) catalyzes the degradation of heme to CO, iron, and biliverdin. Biliverdin is subsequently metabolized to bilirubin by the enzyme biliverdin reductase. Although long considered irrelevant byproducts of heme catabolism, recent studies indicate that CO and the bile pigments biliverdin and bilirubin may play an important physiological role in the circulation. The release of CO by vascular cells may modulate blood flow and blood fluidity by inhibiting vasomotor tone, smooth muscle cell proliferation, and platelet aggregation. CO may also maintain the integrity of the vessel wall by directly blocking vascular cell apoptosis and by inhibiting the release of pro-apoptotic inflammatory cytokines from the vessel wall. These effects of CO are mediated via multiple pathways, including activation of soluble guanylate cyclase, potassium channels, p38 mitogen-activated protein kinase, or inhibition of cytochrome P450. In addition, the release of bile pigments may serve to sustain vascular homeostasis by protecting vascular cells from oxidative stress and by inhibiting the adhesion and infiltration of leukocytes into the vessel wall. Induction of HO-1 gene expression and the subsequent release of CO and bile pigments are observed in numerous vascular disorders and may provide an important adaptive mechanism to preserve homeostasis at sites of vascular injury. Thus, the HO-catalyzed formation of CO and bile pigments by vascular cells may function as a critical endogenous vasoprotective system. Moreover, pharmacological or genetic approaches targeting HO-1 to the vessel wall may represent a novel therapeutic approach in treating vascular disease.

  4. Bile salt hydrolase of Bifidobacterium longum - Biochemical and genetic characterization

    NARCIS (Netherlands)

    Tanaka, H; Hashiba, Honoo; Kok, Jan; Mierau, Igor

    2000-01-01

    A bile salt hydrolase (BSH) was isolated from Bifidobacterium longum SBT2928, purified, and characterized, Furthermore, we describe for the first time cloning and analysis of the gene encoding BSII (bsh) in a member of the genus Bifidobacterium. The enzyme has a native molecular weight of 125,000 to

  5. Gastroesophageal reflux disease in COPD: links and risks

    Directory of Open Access Journals (Sweden)

    Lee AL

    2015-09-01

    Full Text Available Annemarie L Lee,1–3 Roger S Goldstein1,2,4 1West Park Healthcare Centre, 2Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; 3Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia; 4Department of Medicine, University of Toronto, Toronto, ON, Canada Abstract: COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the

  6. Clinical and endoscopic features of Chinese reflux esophagitis patients

    Institute of Scientific and Technical Information of China (English)

    Wei Li; Shu-Tian Zhang; Zhong-Lin Yu

    2008-01-01

    AIM: To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis (RE).METHODS: A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification.RESULTS: Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75:1 (P < 0.01). The mean age of male and female patients was significantly different (P = 0.01). The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D (P < 0.01). Two hundred and seventy-seven patients were infected with H pylori, the infection rate was low (P < 0.01). Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients (P < 0.01). Esophageal mucosa damages were mainly located at the right esophageal wall.CONCLUSION: The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of H pylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.

  7. Risk factors of gastroesophageal reflux disease in Shiraz, southern Iran

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic, lifestyle and health-seeking behaviors in Shiraz, southern Iran. METHODS: A total of 1978 subjects aged > 35 years who referred to Gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic, lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined.RESULTS: The prevalence of GERD was 15.4%, which was higher in females (17.3%), in rural areas (19.8%),and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%), and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%), taking aspirin (21%)and in subjects with psychological distresses (27.2%)and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%),dyspepsia (30.6%), anxiety (19.5%), nightmares (23.9%)and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%), consumption of herbal medicine (19%), using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%).CONCLUSION: GERD is more common in females, rural and illiterate subjects and correlated with consumption of pickles, occurrence of headache, psychological distress,dyspepsia, halitosis, anxiety, nightmare and restlessness,and a family history of GERD and aspirin intake, but the correlation was negative with consumption of fat and fiber intake.

  8. Correlation of ventilator-associated pneumonia with gastroesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Chun-Yan Zhou

    2016-01-01

    Objective:To explore the correlation of gastroesophageal reflux with ventilator-associated pneumonia (VAP).Methods: A total of 84 patients who were performed with mechanical assisted ventilation in our hospital were included in the study. The pharyngeal and tracheal secretions 2 d (T1), 4 d (T2), and 6 d (T3) after mechanical ventilation were collected, respectively. ELISA was used to detect the pepsin concentration. The clinical pulmonary infection score (CPIS) was performed to the patients in order to analyze the correlation of pepsin concentration with CPIS.Results:The positive rate of pharyngeal pepsin at T1 was 16.7%, at T2 was 54.8%, and at T3 was 78.6%. The positive rate of pepsin was increased with the extending of mechanical ventilation time. The comparison of pepsin concentration in the pharyngeal secretions at T1 between the VAP patients and non-VAP patients was not statistically significant, but the pepsin concentration in the tracheal secretions was significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions at T2 and T3 in the VAP patients was significantly higher than that in the non-VAP patients. The pepsin concentration in the tracheal secretions in the VAP patients was associated with CPIS.Conclusions:The positive rate of pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is increased with the extending of mechanical ventilation time. The positive rate of pepsin concentration in the tracheal secretions at each timing point in the VAP patients is significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is positively correlated with CPIS.

  9. Radiofrequency treatment on respiratory symptoms due to gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    GAO Xiang; TIAN Shu-rui; WANG Zhong-gao; WU Ji-min; JI Feng; ZHANG Cheng-chao; NING Ya-chan; LI Zhi-tong; HU Zhi-wei; CHEN Xiu

    2011-01-01

    Background Diagnosis and treatment for respiratory symptoms (RSs) of gastroesophageal reflux disease (GERD) is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency (RF) treatment on RSs of GERD in a preliminary 12-month follow-up observation.Methods From April 2006 to October 2008,505 GERD patients with mainly respiratory presentations such as wheezing,chronic cough or hoarseness,were treated by endoscopic RF. A questionnaire was completed before and after treatment,using a six-point scale ranging from 0 to 5 to assess symptom severity and frequency. The symptom score was the sum of frequency and severity.Results Symptom scores were significantly improved at the end of the follow-up period. The mean heartburn score decreased from 5.31 to 1.79. The mean regurgitation score decreased from 5.02 to 1.64;mean cough score decreased from 6.77 to 2.85;mean wheezing score decreased from 7.83 to 3.07;and mean hoarseness score decreased from 5.13 to 1.81 (P <0.01). No major complications or deaths occurred. Minor complications included temporary post-procedural retrosternal unease or pain (n=106;21.0%),mild fever (n=86;17.0%),transient nausea/vomiting (n=97;19.2%),and transient dysphagia (n=42;9.3%). Thirty-five (6.9%) patients had recurrence of symptoms. Endoscopic RF treatment was repeated in six patients,and laparoscopic fundoplication was performed in seven.Conclusion Endoscopic RF is an effective and safe means to treat RSs in patients with GERD.

  10. Bile acid-induced necrosis in primary human hepatocytes and in patients with obstructive cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Woolbright, Benjamin L.; Dorko, Kenneth [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Antoine, Daniel J.; Clarke, Joanna I. [MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool (United Kingdom); Gholami, Parviz [Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS (United States); Li, Feng [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Kumer, Sean C.; Schmitt, Timothy M.; Forster, Jameson [Department of Surgery, University of Kansas Medical Center, Kansas City, KS (United States); Fan, Fang [Department of Pathology, University of Kansas Medical Center, Kansas City, KS (United States); Jenkins, Rosalind E.; Park, B. Kevin [MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool (United Kingdom); Hagenbuch, Bruno [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Olyaee, Mojtaba [Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS (United States); Jaeschke, Hartmut, E-mail: hjaeschke@kumc.edu [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States)

    2015-03-15

    Accumulation of bile acids is a major mediator of cholestatic liver injury. Recent studies indicate bile acid composition between humans and rodents is dramatically different, as humans have a higher percent of glycine conjugated bile acids and increased chenodeoxycholate content, which increases the hydrophobicity index of bile acids. This increase may lead to direct toxicity that kills hepatocytes, and promotes inflammation. To address this issue, this study assessed how pathophysiological concentrations of bile acids measured in cholestatic patients affected primary human hepatocytes. Individual bile acid levels were determined in serum and bile by UPLC/QTOFMS in patients with extrahepatic cholestasis with, or without, concurrent increases in serum transaminases. Bile acid levels increased in serum of patients with liver injury, while biliary levels decreased, implicating infarction of the biliary tracts. To assess bile acid-induced toxicity in man, primary human hepatocytes were treated with relevant concentrations, derived from patient data, of the model bile acid glycochenodeoxycholic acid (GCDC). Treatment with GCDC resulted in necrosis with no increase in apoptotic parameters. This was recapitulated by treatment with biliary bile acid concentrations, but not serum concentrations. Marked elevations in serum full-length cytokeratin-18, high mobility group box 1 protein (HMGB1), and acetylated HMGB1 confirmed inflammatory necrosis in injured patients; only modest elevations in caspase-cleaved cytokeratin-18 were observed. These data suggest human hepatocytes are more resistant to human-relevant bile acids than rodent hepatocytes, and die through necrosis when exposed to bile acids. These mechanisms of cholestasis in humans are fundamentally different to mechanisms observed in rodent models. - Highlights: • Cholestatic liver injury is due to cytoplasmic bile acid accumulation in hepatocytes. • Primary human hepatocytes are resistant to BA-induced injury

  11. Gastroesophageal Reflux Symptoms not Responding to Proton Pump Inhibitor: GERD, NERD, NARD, Esophageal Hypersensitivity or Dyspepsia?

    Directory of Open Access Journals (Sweden)

    Mohammad Bashashati

    2014-01-01

    Full Text Available Gastroesophageal reflux (GER is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniques it has been shown that, in addition to acid reflux, the reflux of nonacid gastric and duodenal contents into the esophagus may also induce GER symptoms. It remains unknown how weakly acidic or alkaline refluxate with a pH similar to a normal diet induces GER symptoms. Esophageal hypersensitivity or functional dyspepsia with superimposed heartburn may be other mechanisms of symptom generation, often completely unrelated to GER. Detailed studies investigating the pathophysiology of esophageal hypersensitivity are not conclusive, and definitions of the various disease states may overlap and are often confusing. The authors aim to clarify the pathophysiology, definition, diagnostic techniques and medical treatment of patients with heartburn symptoms who fail PPI therapy.

  12. Reflux extraction and analysis of polyethylene wax in soil 

    Institute of Scientific and Technical Information of China (English)

    XIONG Xiao-li; CHEN Cheng; LUO Xue-gang

    2014-01-01

    An efficient reflux extraction of polyethylene wax (PEW) in soil is presented, followed by molecular structure characterization methods to explore its degradation mechanism. To more realistically simulate the actual degradation of PE film powders in soil, low density PE (M=5 000) powders, being used as simulated PEW residue sample, were uniformly mixed with soil and then recovered by reflux extraction with decahydronaphthalen (decalin) at 90°C for 60 min. The average recovery of PEW from fortified soils was 96.5%with the developed reflux extraction procedure. The recovered PEW residue samples were characterized by infrared spectroscopy (IR), element analysis (EA), X-ray fluorescence (XFR), and high-temperature gel permeation chromatography (GPC). The results from spectra analysis show that there were no significant changes in molecular structures and molecular mass distribution of PEW samples after the reflux extraction, which demonstrate the reliability of this method. These results also indicate that the reflux extraction procedure and analytical methods of characterization could serve as a novel measurement technique to evaluate the degradation of low-density PE powders in soil over time.

  13. Levels of serologic markers of celiac disease in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Sait Bagci; C Nuri Ercin; Zeki Yesilova; Ayhan Ozcan; Bulent Degertekin; Kemal Dagalp

    2006-01-01

    AIM: To investigate the prevalence of celiac disease serologic markers (antigliadin IgA, IgG, and antiendomysial IgA) in patients with reflux esophagitis and to detect the relationship between reflux esophagitis and celiac disease (CD).METHODS: This study was performed prospectively between January 2003 and January 2004. Sixty-eight adult reflux esophagitis patients and 40 people as control group for symptoms related with gastrointestinal system were enrolled in this study. The diagnostic work-up included an accurate medical history with gastrointestinal symptoms, routine laboratory measurements, the detection of antibodies against gliadin (IgA and IgG)and endomysium (IgA), and an upper endoscopy with postbulbar biopsy.RESULTS: IgA-AGA and IgG-AGA were positive at 8.8%and 10.3% in patients with reflux esophagitis. In control group, it was found that 10% people had positive IgAAGA, and 7.5% people had positive IgG-AGA. There was no significant relationship between patients and control group regarding positive IgA-AGA and IgGAGA. The patients and persons in control group had no positive IgA-EMA. On postbulbar biopsies, no finding was detected concerning celiac disease. There were no symptoms and signs for gluten enteropathy in patients and control group.CONCLUSION: This review supports that an association does not exist between celiac disease and reflux esophagitis. We think these diseases exist independently from each other.

  14. Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Andreas Tsapalos; Antonios Dimitrakopoulos; Evanthia Diamanti-Kandarakis; Alexandros D Rapidis; Charis Roussos

    2006-01-01

    AIM: To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients.METHODS: In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia (VAP) and GER > 6% were divided into PEG group (n=16) or non-PEG group (n = 20).Another 11 ventilated patients without reflux (GER<3%) served as control group. Esophageal pH-metry was performed by the "pull through" method at baseline, 2and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue.RESULTS: A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2-15.6) at baseline to 2.7 (0-10.4) on d 7 post-gastrostomy (P<0.01), while the reflux increased from 9 (6.2-22) to 10.8(6.3-36.6) (P<0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r=0.56, P<0.01).CONCLUSION: Gastrostomy when combined with semirecumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

  15. Design of Batch Distillation Columns Using Short-Cut Method at Constant Reflux

    Directory of Open Access Journals (Sweden)

    Asteria Narvaez-Garcia

    2013-01-01

    Full Text Available A short-cut method for batch distillation columns working at constant reflux was applied to solve a problem of four components that needed to be separated and purified to a mole fraction of 0.97 or better. Distillation columns with 10, 20, 30, 40, and 50 theoretical stages were used; reflux ratio was varied between 2 and 20. Three quality indexes were used and compared: Luyben’s capacity factor, total annual cost, and annual profit. The best combinations of theoretical stages and reflux ratio were obtained for each method. It was found that the best combinations always required reflux ratios close to the minimum. Overall, annual profit was the best quality index, while the best combination was a distillation column with 30 stages, and reflux ratio’s of 2.0 for separation of benzene (i, 5.0 for the separation of toluene (ii, and 20 for the separation of ethylbenzene (iii and purification of o-xylene (iv.

  16. Current perspective in the treatment of bile duct injuries

    Directory of Open Access Journals (Sweden)

    Juan Jos and eacute; Granados-Romero

    2016-03-01

    Full Text Available The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient and acute;s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient and acute;s quality of life, and represent less risk of complications in short/long term. [Int J Res Med Sci 2016; 4(3.000: 677-684

  17. Effect of Bile Salt Hydrolase Inhibitors on a Bile Salt Hydrolase from Lactobacillus acidophilus

    Directory of Open Access Journals (Sweden)

    Jun Lin

    2014-12-01

    Full Text Available Bile salt hydrolase (BSH, a widely distributed function of the gut microbiota, has a profound impact on host lipid metabolism and energy harvest. Recent studies suggest that BSH inhibitors are promising alternatives to antibiotic growth promoters (AGP for enhanced animal growth performance and food safety. Using a high-purity BSH from Lactobacillus salivarius strain, we have identified a panel of BSH inhibitors. However, it is still unknown if these inhibitors also effectively inhibit the function of the BSH enzymes from other bacterial species with different sequence and substrate spectrum. In this study, we performed bioinformatics analysis and determined the inhibitory effect of identified BSH inhibitors on a BSH from L. acidophilus. Although the L. acidophilus BSH is phylogenetically distant from the L. salivarius BSH, sequence analysis and structure modeling indicated the two BSH enzymes contain conserved, catalytically important amino residues and domain. His-tagged recombinant BSH from L. acidophilus was further purified and used to determine inhibitory effect of specific compounds. Previously identified BSH inhibitors also exhibited potent inhibitory effects on the L. acidophilus BSH. In conclusion, this study demonstrated that the BSH from L. salivarius is an ideal candidate for screening BSH inhibitors, the promising alternatives to AGP for enhanced feed efficiency, growth performance and profitability of food animals.

  18. Reflux venous flow in dural sinus and internal jugular vein on 3D time-of-flight MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jinhee; Kim, Bum-soo; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Byun, Jae Young [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Seoul (Korea, Republic of)

    2013-10-15

    Reflux venous signal on the brain and neck time-of-flight magnetic resonance angiography (TOF MRA) is thought to be related to a compressed left brachiocephalic vein. This study is aimed to assess the prevalence of venous reflux flow in internal jugular vein (IJV), sigmoid sinus/transverse sinus (SS/TS), and inferior petrosal sinus (IPS) on the brain and neck TOF MRA and its pattern. From the radiology database, 3,475 patients (1,526 men, 1,949 women, age range 19-94, median age 62 years) with brain and neck standard 3D TOF MRA at 3 T and 1.5 T were identified. Rotational maximal intensity projection images of 3D TOF MRA were assessed for the presence of reflux flow in IJV, IPS, and SS/TS. Fifty-five patients (1.6 %) had reflux flow, all in the left side. It was more prevalent in females (n = 43/1,949, 2.2 %) than in males (n = 12/1,526, 0.8 %) (p = 0.001). The mean age of patients with reflux flow (66 years old) was older than those (60 years old) without reflux flow (p = 0.001). Three patients had arteriovenous shunt in the left arm for hemodialysis. Of the remaining 52 patients, reflux was seen on IJV in 35 patients (67.3 %). There were more patients with reflux flow seen on SS/TS (n = 34) than on IPS (n = 25). Venous reflux flow on TOF MRA is infrequently observed, and reflux pattern is variable. Because it is exclusively located in the left side, the reflux signal on TOF MRA could be an alarm for an undesirable candidate for a contrast injection on the left side for contrast-enhanced imaging study. (orig.)

  19. 腹腔镜胃底折叠与食管扩张术治疗儿童胃食管反流病致消化性食管狭窄%Laparoscopic Fundoplication Plus Balloon Dilation for Esophageal Peptic Stricture Caused by Gastroesophageal Reflux in Children

    Institute of Scientific and Technical Information of China (English)

    胡志伟; 汪忠镐; 纪涛; 吴继敏

    2015-01-01

    目的:探讨儿童胃食管反流病(gastroesophageal reflux disease, GERD)致消化性食管狭窄(peptic esophage-al stricture, PES)的临床特点及诊治经验。方法回顾分析1例儿童食管裂孔疝、GERD 致 PES 的诊治经过。结果患儿7岁,表现为吞咽困难、胸骨后疼痛4年,伴发作性憋气3个月。胃镜和上消化道造影诊断:GERD,反流性食管炎(LA-D 级),PES,食管裂孔疝。行食管裂孔疝修补术并腹腔镜下胃底折叠术及内镜下食管扩张术治疗,随访1.5年所有症状明显缓解。结论 PES 是 GERD 引起的严重并发症,通常合并有严重的病理性酸反流、食管炎、胆汁反流、食管裂孔疝和明显的食管动力障碍。抗反流手术加食管扩张治疗可有效控制 GERD,改善 PES 引起的吞咽困难。%Objective To discuss the clinical characteristics of gastroesophageal reflux disease (GERD) in diagnosis and treatment of peptic esophageal stricture (PES) in children. Methods The diagnosis and treatment of a child patient with PES caused by hiatal hernia and gastroesophageal reflux was analyzed and the literature was reviewed. Results A 7-year-old boy suffered from dysphagia and retrosternal pain for 4 years, and accompanying respiratory distress for 3 months. GERD, esophagitis (LA-D), hiatal hernia, PES was diagnosed after gastroscopy and barium study. The symptoms were then successfully treated by laparoscopic fundoplication followed by esophagus balloon dilation. Conclusion PES is a severe complication of GERD. PES is commonly complicated with severe pathological acid reflux, esophagitis, bile reflux, hiatal hernia and evident esophageal motility disorder. The typical presentation of PES is dysphagia. Anti-reflux surgery in addition to esophagus balloon dilation is effective in controlling GERD, and improving dysphagia caused by PES.

  20. Analyses of bile from gallbladders of Arius platystomus, Arius tenuispinis, Pomadasys commersonni and Kishinoella tonggol.

    Science.gov (United States)

    Hassan, Amir; Ahmed, Mansoor; Rasheed, Munawwer; Mansoor, Najia; Khan, Rafeeq Alam; Kamal, Mustafa; Rashid, Mohammad Abdur

    2015-07-01

    Bile from gallbladders of Arius platystomus (Singhara), Arius tenuispinis (Khagga), Pomadasys commersonni (Holoola) and Kishinoella tonggol (Dawan) were derivatised and analysed by GC-MS for identification of bile acids and bile alcohols. Cholic acid and Chenodeoxycholic acid were found as major bile acids in Arius platystomus, Arius tenuispinis and Pomadasys commersonni. Other bile acids identified in Arius platystomus were allochenodeoxycholic acid, allodeoxycholic acid, 3α,7α,12α-trihydroxy-24-methyl-5β-cholestane-26-oic acid, and 3α,7α,12α, 24-tetrahydroxy-5α-cholestane-26-oic acid. Cholesterol was found as major bile alcohol in Arius platystomus, Arius tenuispinis and Pomadasys commersonni. Cholic acid was the major bile acid identified in the bile of Kishinoella tonggol while other bile acids included 3α,7α,12α-tridydroxy-5α-cholestanoic acid and 3α,7α,12α-tridydroxy-5β-cholestanoic acid. Bile alcohol 5β-cyprinol was present in significant amounts with 5β-cholestane-3α,7α,12α,24-tetrol being the other contributors in the bile of Kishinoella tonggol.

  1. Detection of markers of hepatitis viral infection in the tissue of bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    LIU Hou-bao; QIAN Zhen-yu; WANG Bing-sheng; TONG Sai-xiong

    2008-01-01

    @@ Hepatitis B virus (HBV) is an admitted oncogenic virus. Many epidemiological and molecular biological studies have demonstrated that chronic infection with HBV is a major risk factor associated with the development of hepatocellular carcinoma (HCC) and intrahepatic bile duct cancer.1-4 Compared with hepatocytes and intrahepatic bile duct epithelial cells,extrahepatic bile duct epithelial cells have autoploid in embryogenesis,continuity in anatomy and a similar internal environment.The question arises whether extrahepatic bile duct epithelial cells can receive HBV infection or not? The role of hepatitis viral infection in the pathogenesis of bile duct carcinoma has not yet been clarified.although a causative relationship between HBV or HCV infection and extrahepatic bile duct carcinoma has been reported in the literature.5,6 In this study,we focused on the evidence of hepatitis viral infection in tissue of bile duct carcinoma.

  2. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

    Directory of Open Access Journals (Sweden)

    Vor Luvira

    2016-01-01

    Full Text Available Intraductal papillary neoplasm of the bile duct (IPNB is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P. This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

  3. Effects of omeprazole and cisapride treatment in Japanese asthmatics with reflux esophagitis

    Directory of Open Access Journals (Sweden)

    Katsuya Fujimori

    1997-01-01

    Full Text Available In the United States and Europe, gastroesophageal reflux (GER is receiving attention as a potential cause of bronchial asthma. Few Japanese case reports have described this relationship. Therefore, we investigated the effect of omeprazole and cisapride on pulmonary function tests, blood gases and home peak expiratory flow rates (PEFR in six Japanese outpatients with asthma and proven GER. After 8 weeks of treatment, reflux esophagitis had improved in all patients. However, the parameters of pulmonary function showed no change other than a significant post- treatment increase in home PEFR (4.4-27.7% in three patients. These results suggest that anti-reflux (omeprazole and cisapride treatment will produce small improvements in the PEFR in some Japanese asthmatics with GER.

  4. Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

    Institute of Scientific and Technical Information of China (English)

    Takane Azumi; Nobuo Ashizawa; Yoshikazu Kinoshita; Kyoichi Adachi; Kenji Furuta; Shuji Nakata; Shunji Ohara; Kenji Koshino; Masaharu Miki; Terumi Morita; Takashi Tanimura,

    2008-01-01

    AIM: To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD).METHODS: Eighteen patients with erosive esophagitis,10 patients with non-erosive reflux disease (NERD),and 18 normal asymptomatic volunteers were enrolled.Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion.Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment.RESULTS: The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals.CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.

  5. Floral aroma improvement of Muscat spirits by packed column distillation with variable internal reflux.

    Science.gov (United States)

    Matias-Guiu, Pau; Rodríguez-Bencomo, Juan José; Orriols, Ignacio; Pérez-Correa, José Ricardo; López, Francisco

    2016-12-15

    The organoleptic quality of wine distillates depends on raw materials and the distillation process. Previous work has shown that rectification columns in batch distillation with fixed reflux rate are useful to obtain distillates or distillate fractions with enhanced organoleptic characteristics. This study explores variable reflux rate operating strategies to increase the levels of terpenic compounds in specific distillate fractions to emphasize its floral aroma. Based on chemical and sensory analyses, two distillate heart sub-fractions obtained with the best operating strategy found, were compared with a distillate obtained in a traditional alembic. Results have shown that a drastic reduction of the reflux rate at an early stage of the heart cut produced a distillate heart sub-fraction with a higher concentration of terpenic compounds and lower levels of negative aroma compounds. Therefore, this sub-fraction presented a much more noticeable floral aroma than the distillate obtained with a traditional alembic.

  6. Gastroesophageal reflux - correlation between diagnostic methods; Refluxo gastroesofagico - correlacao entre metodos diagnosticos

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Maria das Gracas de Almeida; Penas, Maria Exposito; Fonseca, Lea Mirian Barbosa [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia-Medicina Nuclear; Lemme, Eponina Maria O. [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Clinia Medica-Gastroenterologia; Martinho, Maria Jose Ribeiro [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear

    1999-02-01

    A group of 97 individuals with typical symptoms of gastroesophageal reflux disease (GERD) was submitted to gastroesophageal reflux scintigraphy (GES) and compared to the results obtained from endoscopy, histopathology and 24 hours pHmetry. Twenty-four healthy individuals were used as a control group and they have done only the GERS. The results obtained showed that: (a) the difference in the reflux index (RI) for the control group and the sick individuals was statistically significant (p < 0.0001); (b) the correlation between GERS and the other methods showed the following results: sensitivity, 84%; specificity, 95%; positive predictive value, 98%; negative predictive value, 67%; accuracy, 87%. We have concluded that the scintigraphic method should be used to confirm the diagnosis of GERD and also recommended as initial investiative procedure. (author)

  7. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  8. The Significance of Anti Reflux Effect of Esophago -gastric Anastomosis with Mucosal Valve

    Institute of Scientific and Technical Information of China (English)

    邱社祥; 杨殿才; 蔡辉华

    2001-01-01

    Objective To evaluate the preventive effect of reflux following esophago-gastric anastomosis with mucosal valve. Methods Retrospective analysis of 554 cases of esophageal or cardiac cancer treated in recent 10 years. Of them 207 cases of anastomosis 186 cases of tubular stepler and 161 cases of 1 layer anastomosis were fashioned with this method. The clinical results of these groups were compared. Results There were 51 reflux esophagitis cases found in 548 patients(9.3%). In group A 2 patients had this complication(0.48%). None had anastomotic leakage ,but only 1 patient had anastomotic stricture. The difference of the complications among the 3 groups were significant (P<0.01). Conclusions The results of the first group were better than those of the other two groups. It had less complications, and marked anti reflux effect. The life quality was also better. The technique is simple and easy to perform.

  9. Altered intestinal bile salt biotransformation in a cystic fibrosis (Cftr(-/-)) mouse model with hepato-biliary pathology

    NARCIS (Netherlands)

    Bodewes, Frank A. J. A.; van der Wulp, Mariette Y. M.; Beharry, Satti; Doktorova, Marcela; Havinga, Rick; Boverhof, Renze; Phillips, M. James; Durie, Peter R.; Verkade, Henkjan J.

    2015-01-01

    Background: Cftr(-/-tm1UC) mice develop progressive hepato-biliary pathology. We hypothesize that this liver pathology is related to alterations' in biliary bile hydrophobicity and bile salt metabolism in Cftr(-/-tm1Unc) mice. Methods: We determined bile production, biliary and fecal bile salt- and

  10. The role of duodenogastric reflux in formation of precarcinogenic gastric lesions: An experimental study

    Directory of Open Access Journals (Sweden)

    Zlatić Aleksandar

    2013-01-01

    Full Text Available Introduction. Duodenogastric reflux, commonly encountered as an aftermath of gastroenteroanastomosis, with or without gastric resection (Billroth I, Billroth II, vagotomy and pyloroplastic surgery, is known to cause inflammatory-dystrophic-metaplastic lesions of gastric mucosa. Our objective was to determine the effects of surgery-induced duodenogastric reflux on the development of precarcinogenic lesions or carcinoma in correlation with the reflux duration. Material and Methods. The experiment was performed on three groups of Wistar rats with 1 Billroth II-induced reflux surgery, 2 resection of the Roux-en-Y type reconstruction, and 3 control group with no resection. The aim of the experiment was to study the effects of duodenogastric reflux on the rat gastric mucosa in correlation with two different types of gastroenteroanastomosis 8, 16 and 24 weeks after the surgery. Results. In Billroth II group, hyperplastic changes were observed as early as in week 16. Statistically significant results were recorded in week 24, with 6.7% of metaplastic alterations, including dysplasia of all three degrees, dominantly severe dysplasia in 66.67%, early carcinoma in 20% and gastric carcinoma in 6.67%. In the Roux-en-Y group, gastric mucosa remained predominantly normal (60%, with somewhat increased frequency of gastritis and dysplasia in week 24. In the control group, the finding of normal gastric mucosa was constant. Conclusion. The experiment confirms that direct contact of duodenal juice with gastric mucosa associated with Billroth II resection causes precarcinogenic lesions. Development of adenocarcinoma caused solely by duodenogastric reflux, excluding a carcinogenic agent is possible 20 weeks after the experiment - earlier than suggested by previous researchers.

  11. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options?

    Science.gov (United States)

    Broussard, C N; Richter, J E

    1998-10-01

    Gastro-oesophageal reflux and heartburn are reported by 45 to 85% of women during pregnancy. Typically, the heartburn of pregnancy is new onset and is precipitated by the hormonal effects of estrogen and progesterone on lower oesophageal sphincter function. In mild cases, the patient should be reassured that reflux is commonly encountered during a normal pregnancy: lifestyle and dietary modifications may be all that are required. In a pregnant woman with moderate to severe reflux symptoms, the physician must discuss with the patient the benefits versus the risks of using drug therapy. Medications used for treating gastro-oesophageal reflux are not routinely or vigorously tested in randomised, controlled trials in women who are pregnant because of ethical and medico-legal concerns. Safety data are based on animal studies, human case reports and cohort studies as offered by physicians, pharmaceutical companies and regulatory authorities. If drug therapy is required, first-line therapy should consist of nonsystemically absorbed medications, including antacids or sucralfate, which offer little, if any, risk to the fetus. Systemic therapy with histamine H2 receptor antagonists (avoiding nizatidine) or prokinetic drugs (metoclopramide, cisapride) should be reserved for patients with more severe symptoms. Proton pump inhibitors are not recommended during pregnancy except for severe intractable cases of gastrooesophageal reflux or possibly prior to anaesthesia during labour and delivery. In these rare situations, animal teratogenicity studies suggests that lansoprazole may be the best choice. Use of the least possible amount of systemic drug needed to ameliorate the patient's symptoms is clearly the best for therapy. If reflux symptoms are intractable or atypical, endoscopy can safely be performed with conscious sedation and careful monitoring the mother and fetus.

  12. Controversies in the treatment of gastroesophageal reflux and achalasia

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Andrew J Duffy; Robert L Bell

    2006-01-01

    The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay,faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery (LAR S) as the preferred treatment for Barrett's esophagus and the procedure's potential to reduce the risk of adenocarcinoma of the esophagus.GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed: radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter.Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia: medications,pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LARS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option,pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective non-surgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concerns the

  13. Boldine enhances bile production in rats via osmotic and Farnesoid X receptor dependent mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Cermanova, Jolana [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Kadova, Zuzana [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Deparment of Pharmacology and Toxicology, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove (Czech Republic); Zagorova, Marie [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Hroch, Milos [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Department of Medical Biochemistry, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Tomsik, Pavel [Department of Medical Biochemistry, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Nachtigal, Petr; Kudlackova, Zdenka [Department of Biological and Medical Sciences, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove (Czech Republic); Pavek, Petr; Dubecka, Michaela; Ceckova, Martina; Staud, Frantisek [Deparment of Pharmacology and Toxicology, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove (Czech Republic); Laho, Tomas [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic); Micuda, Stanislav, E-mail: micuda@lfhk.cuni.cz [Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Kralove (Czech Republic)

    2015-05-15

    Boldine, the major alkaloid from the Chilean Boldo tree, is used in traditional medicine to support bile production, but evidence to support this function is controversial. We analyzed the choleretic potential of boldine, including its molecular background. The acute- and long-term effects of boldine were evaluated in rats either during intravenous infusion or after 28-day oral treatment. Infusion of boldine instantly increased the bile flow 1.4-fold in healthy rats as well as in animals with Mrp2 deficiency or ethinylestradiol induced cholestasis. This effect was not associated with a corresponding increase in bile acid or glutathione biliary excretion, indicating that the effect is not related to stimulation of either bile acid dependent or independent mechanisms of bile formation and points to the osmotic activity of boldine itself. We subsequently analyzed bile production under conditions of changing biliary excretion of boldine after bolus intravenous administration and found strong correlations between both parameters. HPLC analysis showed that bile concentrations of boldine above 10 μM were required for induction of choleresis. Importantly, long-term pretreatment, when the bile collection study was performed 24-h after the last administration of boldine, also accelerated bile formation despite undetectable levels of the compound in bile. The effect paralleled upregulation of the Bsep transporter and increased biliary clearance of its substrates, bile acids. We consequently confirmed the ability of boldine to stimulate the Bsep transcriptional regulator, FXR receptor. In conclusion, our study clarified the mechanisms and circumstances surrounding the choleretic activity of boldine. - Highlights: • Boldine may increase bile production by direct as well as indirect mechanisms. • Biliary concentrations of boldine above 10 μM directly stimulate bile production. • Long-term oral boldine administration increases bile acid (BA) biliary secretion. • Boldine

  14. Mucin and phospholipids determine viscosity of gallbladder bile in-patients with gallstones

    Institute of Scientific and Technical Information of China (English)

    Dieter Jungst; Anna Niemeyer; Iris Muller; Benedikta Zundt; Gunther Meyer; Martin Wilhelmi; Reginald del Pozo

    2001-01-01

    AIM An increased viscosity of gallbladder bile has been considered an important factor in the pathogenesis of gallstone disease. Besides lipids and proteins, mucin has been suggested to affect the viscosity of bile. To further clarify these issues we compared mucin, protein and the lipid components of hepatic and gallbladder bile and its viscosity in patients with gallstones.METHODS Viscosity of bile ( mpa. s ) wasmeasured using rotation viscosimetry in regard to the non-Newtonian property of bile at law shear rates.RESULTS Biliary viscosity was markedly higher in gallbladder bile of patients with cholesterol (5.00 ± 0.60 mpa. s, mean ± SEM, n --28) and mixed stones (3.50±0.68 mPa. s; n =8) compared to hepatic bile (0.92 ± 0.06 mpa. s,n -6). A positive correlation between mucin and viscosity was found in gallbladder biles (r=0.65; P<0.001) but not in hepatic biles. The addition of physiologic and supraphysiologic amounts of mucin to gallbladder bile resulted in a dose dependent non linear increase of its viscosity. A positive correlation was determined between phospholipid concentration and viscosity (r = 0.34, P<0.005) in gallbladder biles. However, no correlation was found between total protein or the other lipid concentrations and viscosity in both gallbladder and hepatic biles.CONCLUSION The viscosity of gallbladder bile is markedly higher than that of hepatic bile in patients with gallstones. The concentration of mucin is the major determinant of biliary viscosity and may contribute by this mechanism to the role of mucin in the pathogenesis of gallstones.

  15. Does the Presence of a Hiatal Hernia Affect the Efficacy of the Reflux Inhibitor Baclofen During Add-On Therapy?

    NARCIS (Netherlands)

    H. Beaumont; G.E.E. Boeckxstaens

    2009-01-01

    OBJECTIVES: Reflux inhibitors, like the gamma-aminobutyric acid type B (GABA(B)) receptor agonist, baclofen, block transient lower esophageal sphincter relaxations (TLESRs) and are proposed as an add-on therapy in patients with proton pump inhibitor (PPI)-resistant gastroesophageal reflux. However,

  16. FEATURES OF CLINICAL COURSE OF GASTROESOPHAGEAL REFLUX DISEASE IN NEWLY RECRUITED WITH CONNECTIVE TISSUE UNDIFFERENTIATED DYSPLASIA SYNDROME

    Directory of Open Access Journals (Sweden)

    E.I. Kashkina

    2008-12-01

    Full Text Available The presence of connective tissue undifferentiated dysplasia syndrome against a background of psychological stress at newly recruited can promote the risk of gastroesophageal reflux disease occurrence. To the utmost, correlation between the gastroesophageal reflux disease and such manifestations of connective tissue undifferentiated dysplasia syndrome as asthenic constitution, chest deformation, Gothic palate and hypermobility of joints was found

  17. Prospective randomized controlled trial of an injectable esophageal prosthesis versus a sham procedure for endoscopic treatment of gastroesophageal reflux disease

    NARCIS (Netherlands)

    P. Fockens; L. Cohen; S.A. Edmundowicz; K. Binmoeller; R.I. Rothstein; D. Smith; E. Lin; N. Nickl; B. Overholt; P.J. Kahrilas; N. Vakil; A.M. Abdel Aziz Hassan; G.A. Lehman

    2010-01-01

    This study aimed to assess whether endoscopic implantation of an injectable esophageal prosthesis, the Gatekeeper Reflux Repair System (GK), is a safe and effective therapy for controlling gastroesophageal reflux disease (GERD). A prospective, randomized, sham-controlled, single-blinded, internation

  18. Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications.

    Science.gov (United States)

    Keohane, John; Quigley, Eamonn M M

    2007-08-08

    Functional dyspepsia or nonulcer dyspepsia, and nonerosive reflux disease (NERD) or endoscopy-negative reflux disease, are common reasons for referral to a gastroenterologist. Although there is much confusion with regard to definition, recent research would suggest that these 2 conditions are linked and may represent components in the spectrum of the same disease entity, in terms of both symptoms and pathophysiology. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and Helicobacter pylori infection.

  19. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease

    DEFF Research Database (Denmark)

    Bohnhorst, Idar; Jawad, Samir; Lange, Bibi;

    2015-01-01

    BACKGROUND: An increased coexistence of gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been reported in epidemiologic and register studies, and reflux has been shown more frequently in patients with CRS in studies using esophagus pH manometry compared to participants....... The results were compared with those of a randomly assigned control group from the general Danish population. METHOD: In this case-control study, 82 patients with GERD were examined for CRS using the European Position Paper on Rhinosinusitis and Nasal Polyps criteria, which combine patient history...

  20. Total Reflux Operation of Multivessel Batch Distillation for Separation of Binary Mixtures

    Institute of Scientific and Technical Information of China (English)

    唐克; 白鹏; 李广忠

    2014-01-01

    Multivessel batch distillation (MVBD) is mainly used to separate mixtures with more than two compo-nents. In this article, a new operation mode with MVBD is proposed for separation of binary mixtures under total reflux. A mathematic model is setup for the simulation. The proposed operation policy and the regular operation with constant reflux are compared theoretically and experimentally. The results show that the new operation mode has great advantages in time saving and operation flexibility. MVBD presents great potential for separation with high efficiency.

  1. Screening for vesicoureteral reflux in children using real-time sonography.

    Science.gov (United States)

    Schneider, K; Jablonski, C; Wiessner, M; Kohn, M; Fendel, H

    1984-01-01

    One hundred and ten children, ages 6 days to 14 years, were investigated for vesicoureteral reflux (VUR) using ultrasound before voiding cystourethrography (VCU). Sonographically a VUR was assumed if a retrovesical dilated ureter and/or an increase of the separation of the central renal echo complex (CRC) could be detected. By means of sonography VUR grades III and IV were seen in 100%, grade II in 84% of all cases. There was a false positive rate of 10%. Sonographic reflux study is a sensitive and specific screening and follow-up procedure for VUR.

  2. Technical problems produced by the Bravo pH test in nonerosive reflux disease patients

    Institute of Scientific and Technical Information of China (English)

    Andrés; de; Hoyos; Edgar; Alain; Esparza

    2010-01-01

    AIM: To evaluate the technical failures of the Bravo pH test in a population with nonerosive gastroesophageal reflux disease. METHODS: Over the course of a year, we prospectively studied a population of 66 nonerosive reflux disease patients who received a Bravo pH test. The number and frequency of all technical failures were documented, quantified and analyzed. RESULTS: A total of 66 patients, with a mean age of 41.7 years, were studied. Technical failures occurred in 15.15% of the sample. The most frequent...

  3. Numerical analysis of seawater circulation in carbonate platforms: II. The dynamic interaction between geothermal and brine reflux circulation

    Science.gov (United States)

    Jones, G.D.; Whitaker, F.F.; Smart, P.L.; Sanford, W.E.

    2004-01-01

    Density-driven seawater circulation may occur in carbonate platforms due to geothermal heating and / or reflux of water of elevated salinity. In geothermal circulation lateral contrasts in temperature between seawater and platform groundwaters warmed by the geothermal heat flux result in upward convective flow, with colder seawater drawn into the platform at depth. With reflux circulation, platform-top waters concentrated by evaporation flow downward, displacing less dense underlying groundwaters. We have used a variable density groundwater flow model to examine the pattern, magnitude and interaction of these two different circulation mechanisms, for mesosaline platform-top waters (50???) and brines concentrated up to saturation with respect to gypsum (150???) and halite (246???). Geothermal circulation, most active around the platform margin, becomes restricted and eventually shut-off by reflux of brines from the platform interior towards the margin. The persistence of geothermal circulation is dependent on the rate of brine reflux, which is proportional to the concentration of platform-top brines and also critically dependent on the magnitude and distribution of permeability. Low permeability evaporites can severely restrict reflux whereas high permeability units in hydraulic continuity enhance brine transport. Reduction in permeability with depth and anisotropy of permeability (kv < < kh) focuses flow laterally in the shallow subsurface (<1 km), resulting in a horizontally elongated brine plume. Aquifer porosity and dispersivity are relatively minor controls on reflux. Platform brines can entrain surficial seawater when brine generating conditions cease but the platform-top remains submerged, a variant of reflux we term "latent reflux". Brines concentrated up to gypsum saturation have relatively long residence times of at least 100 times the duration of the reflux event. They thus represent a long-term control on post-reflux groundwater circulation, and

  4. Surgical Intervention for Hepatocellular Carcinoma with Bile Buct Thrombi

    Institute of Scientific and Technical Information of China (English)

    PENGShuyou; LIUYingbin; WANGJianwei; CAIXiujun; MOUYiping; WUYulian; FangHeqing; LIJiangtao; WANGXinbao; XUBin; LIHaijun

    2003-01-01

    Objective: To summarize the experience of surgical intervention for hepatocellular carcinoma(HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis. Methods: From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.Results: The operative procedures included hepatectomy with removel of BDT (n=7), hepatectomy com-bined with extrahepatic bile duct resection (n=4), thrombectomy through choledochotomy (n=3), piggy back orthotopic liver transplantation (n=1). The 1-and 3-year survival rates were 73.3% and 40%, respec-tively. Two patients survived over 5 years. Conclusion: Surgical intervention was effective for patients with HCC and BDT. Operation for recurrent lesion can prolong survival period. Liver transplantation is a new treatment worthy of further investigation.

  5. Pancreatic fistula through the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2002-01-01

    Full Text Available Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transaction. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical limphadenectomy. The patient was treated conservatively by elevation of the drain- age bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen.

  6. Eosinophilic cholecystitis with common bile duct stricture: a rare disease.

    Science.gov (United States)

    Mehanna, Daniel; Naseem, Zainab; Mustaev, Muslim

    2016-05-24

    Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.

  7. Primary sclerosing cholangitis – The arteriosclerosis of the bile duct?

    Directory of Open Access Journals (Sweden)

    Trauner Michael

    2007-01-01

    Full Text Available Abstract Primary sclerosing cholangitis (PSC is a chronic inflammatory disease of unknown aetiology affecting the large bile ducts and characterized by periductal fibrosis and stricture formation, which ultimately result in biliary cirrhosis and liver failure. Arteriosclerosis involves the accumulation of altered lipids and lipoproteins in large arteries; this drives inflammation and fibrosis and ultimately leads to narrowing of the arteries and hypoperfusion of dependent organs and tissues. Knowledge of the causative factors is crucial to the understanding of disease mechanisms and the development of specific treatment. Based on pathogenetic similarities between PSC and arteriosclerosis, we hypothesize that PSC represents "arteriosclerosis of the bile duct" initiated by toxic biliary lipids. This hypothesis is based on common molecular, cellular, and morphological features providing the conceptual framework for a deeper understanding of their pathogenesis. This hypothesis should stimulate translational research to facilitate the search for novel treatment strategies for both diseases.

  8. [Surgical therapy of proximal extrahepatic bile duct tumors (Klatskin tumors)].

    Science.gov (United States)

    Timm, S; Gassel, H-J; Thiede, A

    2007-08-01

    Due to their anatomical position, the tendency of early infiltrative growth and their poor prognosis without treatment, klatskin tumors are challenging concerning diagnosis and therapy. In contrast to other tumors of the gastrointestinal tract, for which exact diagnostic and stage dependent therapeutic guidelines could be formulated, clear recommendations for klatskin tumors are missing. Thus, survival rates after local resection, e. g. resection of the bile duct bifurcation alone, show high rates of R1/2 resection and early tumor recurrence. With an additional hepatic resection formally curative resections and long-term survival can be improved. Extended liver resections including the portal vein provide the highest rates of R0 resections for hilar carcinomas of the extrahepatic bile duct. Survival rates after liver transplantation for klatskin tumors are not yet convincing. Promising first results have been reported for the combination of neoadjuvant treatment and liver transplantation and might show future perspectives for the treatment of klatskin tumors.

  9. Raisin dietary fiber composition and in vitro bile acid binding.

    Science.gov (United States)

    Camire, Mary E; Dougherty, Michael P

    2003-01-29

    Raisins are dried grapes that are popular shelf-stable snacks. Three commercially important types of raisins were studied: sun-dried (natural), artificially dried (dipped), and sulfur dioxide-treated (golden) raisins. Dietary fiber composition was analyzed by AACC method 32-25. Polysaccharides were hydrolyzed, and the resulting sugars were analyzed by colorimetric and gas chomatographic methods. Fructans were measured with a colorimetric kit assay. Total dietary fiber values agreed with published values, with pectins and neutral polysaccharides of mannose and glucose residues predominating. Dipped raisins had over 8% fructans. No fructans were found in fresh grapes. Raisin types varied in their ability to bind bile acids in vitro. Coarsely chopped raisins bound more bile than did finely chopped or whole raisins.

  10. Analysis of ileal sodium/bile acid cotransporter and related nuclear receptor genes in a family with multiple cases of idiopathic bile acid malabsorption

    Institute of Scientific and Technical Information of China (English)

    Marco Montagnani; Anna Abrahamsson; Cecilia G(a)lman; G(o)sta Eggertsen; Hanns-Ulrich Marschall; Elisa Ravaioli; Curt Einarsson; Paul A Dawson

    2006-01-01

    The etiology of most cases of idiopathic bile acid malabsorption (TBAM) is unknown. Tn this study, a Swedish family with bile acid malabsorption in three consecutive generations was screened for mutations in the ileal apical sodium-bile acid cotransporter gene (ASBT; gene symbol, SLC10A2) and in the genes for several of the nuclear receptors known to be important for ASBT expression: the farnesoid X receptor (FXR)and peroxisome proliferator activated receptor alpha (PPARα). The patients presented with a clinical history of idiopathic chronic watery diarrhea, which was responsive to cholestyramine treatment and consistent with IBAM. Bile acid absorption was determined using 75Se-homocholic acid taurine(SeHCAT); bile acid synthesis was estimated by measuring the plasma levels of 7α-hydroxy-4-cholesten-3-one (C4). The ASBT,FXR, and PPARα genes in the affected and unaffected family members were analyzed using single stranded conformation polymorphism (SSCP), denaturing HPLC,and direct sequencing. No ASBT mutations were identified and the ASBT gene did not segregate with the bile acid malabsorption phenotype. Similarly, no mutations or polymorphisms were identified in the FXR or PPARα genes associated with the bile acid malabsorption phenotype. These studies indicate that the intestinal bile acid malabsorption in these patients cannot be attributed to defects in ASBT. In the absence of apparent ileal disease, alternative explanations such as accelerated transit through the small intestine may be responsible for the IBAM.

  11. Lower Rate of Major Bile Duct Injury and Increased Intraoperative Management of Common Bile Duct Stones after Implementation of Routine Intraoperative Cholangiography

    NARCIS (Netherlands)

    Buddingh, K. Tim; Weersma, Rinse K.; Savenije, Rolf A. J.; van Dam, Gooitzen M.; Nieuwenhuijs, Vincent B.

    2011-01-01

    BACKGROUND: Our university medical center is the only center in The Netherlands that has adopted a policy of routine intraoperative cholangiography (IOC) during cholecystectomy. This study aimed to describe the rate of bile duct injury (BDI) and management of common bile duct (CBD) stones before and

  12. The potential influence of genetic variants in genes along bile acid and bile metabolic pathway on blood cholesterol levels in the population

    NARCIS (Netherlands)

    Lu, Y.; Feskens, E.J.M.; Boer, J.M.A.; Müller, M.R.

    2010-01-01

    The liver is currently known to be the major organ to eliminate excess cholesterol from our body. It accomplishes this function in two ways: conversion of cholesterol molecules into bile acids (BAs) and secretion of unesterified cholesterol molecules into bile. BAs are synthesized in the hepatocytes

  13. Diversity of bile salts in fish and amphibians: evolution of a complex biochemical pathway.

    Science.gov (United States)

    Hagey, Lee R; Møller, Peter R; Hofmann, Alan F; Krasowski, Matthew D

    2010-01-01

    Bile salts are the major end metabolites of cholesterol and are also important in lipid and protein digestion, as well as shaping of the gut microflora. Previous studies had demonstrated variation of bile salt structures across vertebrate species. We greatly extend prior surveys of bile salt variation in fish and amphibians, particularly in analysis of the biliary bile salts of Agnatha and Chondrichthyes. While there is significant structural variation of bile salts across all fish orders, bile salt profiles are generally stable within orders of fish and do not correlate with differences in diet. This large data set allowed us to infer evolutionary changes in the bile salt synthetic pathway. The hypothesized ancestral bile salt synthetic pathway, likely exemplified in extant hagfish, is simpler and much shorter than the pathway of most teleost fish and terrestrial vertebrates. Thus, the bile salt synthetic pathway has become longer and more complex throughout vertebrate evolution. Analysis of the evolution of bile salt synthetic pathways provides a rich model system for the molecular evolution of a complex biochemical pathway in vertebrates.

  14. Ursodeoxycholic acid in the Ursidae: biliary bile acids of bears, pandas, and related carnivores.

    Science.gov (United States)

    Hagey, L R; Crombie, D L; Espinosa, E; Carey, M C; Igimi, H; Hofmann, A F

    1993-11-01

    The biliary bile acid composition of gallbladder bile obtained from six species of bears (Ursidae), the Giant panda, the Red panda, and 11 related carnivores were determined by reversed phase liquid chromatography and gas chromatography-mass spectrometry. Bile acids were conjugated solely with taurine (in N-acyl linkage) in all species. Ursodeoxycholic acid (3 alpha, 7 beta-dihydroxy-5 beta-cholan-24-oic acid) was present in all Ursidae, averaging 1-39% of biliary bile acids depending on the species; it was not detected or present as a trace constituent (bears, and its proportion averaged 34% (range 0-62%). Ursodeoxycholic acid averaged 17% of biliary bile acids in the Polar bear (n = 4) and 18% in the Brown bear (n = 6). Lower proportions (1-8%) were present in the Sun bear (n = 2), Ceylon Sloth bear (n = 1), and the Spectacled bear (n = 1). Bile of all species contained taurine-conjugated chenodeoxycholic acid and cholic acid. In some related carnivores, deoxycholic acid, the 7-dehydroxylation product of cholic acid, was also present. To determine whether the 7 beta hydroxy group of ursodeoxycholic acid was formed by hepatic or bacterial enzymes, bile acids were determined in hepatic bile obtained from bears with chronic biliary fistulae. Fistula bile samples contained ursodeoxycholic acid, chenodeoxycholic acid, and a trace amount of cholic acid, all as taurine conjugates, indicating that ursodeoxycholic acid is a primary bile acid formed in the liver in Ursidae.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Microbiota transplantation restores normal fecal bile acid composition in recurrent Clostridium difficile infection.

    Science.gov (United States)

    Weingarden, Alexa R; Chen, Chi; Bobr, Aleh; Yao, Dan; Lu, Yuwei; Nelson, Valerie M; Sadowsky, Michael J; Khoruts, Alexander

    2014-02-15

    Fecal microbiota transplantation (FMT) has emerged as a highly effective therapy for refractory, recurrent Clostridium difficile infection (CDI), which develops following antibiotic treatments. Intestinal microbiota play a critical role in the metabolism of bile acids in the colon, which in turn have major effects on the lifecycle of C. difficile bacteria. We hypothesized that fecal bile acid composition is altered in patients with recurrent CDI and that FMT results in its normalization. General metabolomics and targeted bile acid analyses were performed on fecal extracts from patients with recurrent CDI treated with FMT and their donors. In addition, 16S rRNA gene sequencing was used to determine the bacterial composition of pre- and post-FMT fecal samples. Taxonomic bacterial composition of fecal samples from FMT recipients showed rapid change and became similar to the donor after the procedure. Pre-FMT fecal samples contained high concentrations of primary bile acids and bile salts, while secondary bile acids were nearly undetectable. In contrast, post-FMT fecal samples contained mostly secondary bile acids, as did non-CDI donor samples. Therefore, our analysis showed that FMT resulted in normalization of fecal bacterial community structure and metabolic composition. Importantly, metabolism of bile salts and primary bile acids to secondary bile acids is disrupted in patients with recurrent CDI, and FMT corrects this abnormality. Since individual bile salts and bile acids have pro-germinant and inhibitory activities, the changes suggest that correction of bile acid metabolism is likely a major mechanism by which FMT results in a cure and prevents recurrence of CDI.

  16. Gut microbiota inhibit Asbt-dependent intestinal bile acid reabsorption via Gata4

    Science.gov (United States)

    Out, Carolien; Patankar, Jay V.; Doktorova, Marcela; Boesjes, Marije; Bos, Trijnie; de Boer, Sanna; Havinga, Rick; Wolters, Henk; Boverhof, Renze; van Dijk, Theo H.; Smoczek, Anna; Bleich, André; Sachdev, Vinay; Kratky, Dagmar; Kuipers, Folkert; Verkade, Henkjan J.; Groen, Albert K.

    2017-01-01

    Background & Aims Regulation of bile acid homeostasis in mammals is a complex process regulated via extensive cross-talk between liver, intestine and intestinal microbiota. Here we studied the effects of gut microbiota on bile acid homeostasis in mice. Methods Bile acid homeostasis was assessed in four mouse models. Germfree mice, conventionally-raised mice, Asbt-KO mice and intestinal-specific Gata4-iKO mice were treated with antibiotics (bacitracin, neomycin and vancomycin; 100 mg/kg) for five days and subsequently compared with untreated mice. Results Attenuation of the bacterial flora by antibiotics strongly reduced fecal excretion and synthesis of bile acids, but increased the expression of the bile acid synthesis enzyme CYP7A1. Similar effects were seen in germfree mice. Intestinal bile acid absorption was increased and accompanied by increases in plasma bile acid levels, biliary bile acid secretion and enterohepatic cycling of bile acids. In the absence of microbiota, the expression of the intestinal bile salt transporter Asbt was strongly increased in the ileum and was also expressed in more proximal parts of the small intestine. Most of the effects of antibiotic treatment on bile acid homeostasis could be prevented by genetic inactivation of either Asbt or the transcription factor Gata4. Conclusions Attenuation of gut microbiota alters Gata4-controlled expression of Asbt, increasing absorption and decreasing synthesis of bile acids. Our data support the concept that under physiological conditions microbiota stimulate Gata4, which suppresses Asbt expression, limiting the expression of this transporter to the terminal ileum. Our studies expand current knowledge on the bacterial control of bile acid homeostasis. PMID:26022694

  17. Extracorporeal shock-wave lithotripsy of bile duct stones

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kim, Myung Joon; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Moo Sang; Jo, Jang Hwan; Kim, Byung Ro [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    During the past one and half year, we performed ESWL therapy in 13 patients with common bile duct and intrahepatic duct stones, applying Lithostar-R (Siemens co. West Germany) and analyzed their results. In 13 patients, 9 residual common bile duct stones and 7 intrahepatic duct stones were selected postoperatively. The size of stones were ranged from 0.7 cm to 3.5 cm in diameter. 2 stones were multiple and the remained 14 were single in number. The visualization of stones were done with fluoroscopy after the injection of contrast media via cholangiographic T-tube or ERCP. ESWL were applied continuously until stone disintegration was visible, or upto maximum number of 3500 discharge of shock wave. If not disintegrated upto 3500, patients were underwent second or third lithotripsy session with interval of one week. Our results showed that among 9 common bile duct stones, 4 were completely disintegrated and passed out spontaneously, but 3 partially fragmented and removed by the additional procedure. 2 were failed. Among 7 intrahepatic stones, 3 completely and 2 partially were succeeded. One stone partially fragmented were retained without removal and other one were failed. Skin petechia in all patients were revealed on the entry port of shock wave, but no serous complication was not occurred.

  18. Bile acid receptors and nonalcoholic fatty liver disease

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    With the high prevalence of obesity, diabetes, and otherfeatures of the metabolic syndrome in United States,nonalcoholic fatty liver disease (NAFLD) has inevitablybecome a very prevalent chronic liver disease and isnow emerging as one of the leading indications for livertransplantation. Insulin resistance and derangementof lipid metabolism, accompanied by activation ofthe pro-inflammatory response and fibrogenesis, areessential pathways in the development of the moreclinically significant form of NAFLD, known as nonalcoholicsteatohepatitis (NASH). Recent advances inthe functional characterization of bile acid receptors,such as farnesoid X receptor (FXR) and transmembraneG protein-coupled receptor (TGR) 5, have providedfurther insight in the pathophysiology of NASH andhave led to the development of potential therapeutictargets for NAFLD and NASH. Beyond maintaining bileacid metabolism, FXR and TGR5 also regulate lipidmetabolism, maintain glucose homeostasis, increaseenergy expenditure, and ameliorate hepatic inflammation.These intriguing features have been exploitedto develop bile acid analogues to target pathways inNAFLD and NASH pathogenesis. This review providesa brief overview of the pathogenesis of NAFLD andNASH, and then delves into the biological functions ofbile acid receptors, particularly with respect to NASHpathogenesis, with a description of the associatedexperimental data, and, finally, we discuss the prospectsof bile acid analogues in the treatment of NAFLD andNASH.

  19. Iatrogenic bile duct injuries from biliar y tract surger y

    Institute of Scientific and Technical Information of China (English)

    Umar Ali; Zhen-Hua Ma; Cheng-En Pan; Qing-Yong Ma

    2007-01-01

    BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery. However, bile duct injury is a rare but still one of the most common complications. These injuries sometimes present variably after primary surgery. Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury (IBDI) were managed at the Department of Surgery, First Afifliated Hospital, Xi'an Jiaotong University. All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS: Recovery of the patients was uneventful. All patients were followed-up at the surgical outpatient department for six months to three years. So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries, and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

  20. Diagnosis of Gastroesophageal Reflux Disease Using Real-time Magnetic Resonance Imaging.

    Science.gov (United States)

    Zhang, Shuo; Joseph, Arun A; Gross, Lisa; Ghadimi, Michael; Frahm, Jens; Beham, Alexander W

    2015-07-15

    A small angle (His angle) between the oesophagus and the fundus of the stomach is considered to act as flap valve and anti-reflux barrier. A wide angle results in dysfunction of the oesophagogastric junction and subsequently in gastroesophageal reflux disease (GERD). Here, we used real-time magnetic resonance imaging (MRI) at 50 ms resolution (20 frames per second) in 12 volunteers and 12 patients with GERD to assess transport of pineapple juice through the oesophagogastric junction and reflux during Valsalva. We found that the intra-abdominal part of the oesophagus was bended towards the left side resulting in an angle of 75.3 ± 17.4, which was significantly larger during Valsava (P = 0.017). Reflux and several underlying pathologies were detected in 11 out of 12 patients. Our data visualize oesophagogastric junction physiology and disprove the flap valve hypothesis. Further, non-invasive real-time MRI has considerable potential for the diagnosis of causative pathologies leading to GERD.

  1. Kosten en effecten van esomeprazol in de behandeling van reflux ziekte

    NARCIS (Netherlands)

    I. Buijt; M.J. Al (Maiwenn); F.F.H. Rutten (Frans)

    2002-01-01

    textabstractDoel. Het bepalen van de kosten-effectiviteit van esomeprazol (Nexium(r)) ten opzichte van alle andere in Nederland geregistreerde protonpomp remmers in de behandeling van reflux ziekte. Voor de effectiviteit vormt het hebben van voldoende controle over de symptomen het uitgangspunt. Per

  2. IT IS GASTROESOPHAGEAL REFLUX DISEASE,NOT ASTHMA: A CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    Zhong-gao Wang

    2006-01-01

    @@ THE incidence of gastroesophageal reflux disease (GERD) is high in Western nations. Its extraesophageal manifestations such as asthma, paroxysmal laryngospasm, and excessive throat phlegm, chronic cough, laryngal disorders, postnasal drip, and other lesser ear, nose, and throat symptoms, have been widely recognized and reported.

  3. Corpus gastritis in patients with endoscopic diagnosis of reflux oesophagitis and Barrett's oesophagus.

    NARCIS (Netherlands)

    Laheij, R.J.F.; Rossum, L.G.M. van; Boer, W.A. de; Jansen, J.B.M.J.

    2002-01-01

    BACKGROUND: A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. AIM: To determine if corpus gastritis is associated with re

  4. CHRONOBIOLOGICAL APPROACH TO ESTIMATION OF CLINICAL COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    R.V. Lyakisheva

    2008-09-01

    Full Text Available The article presents analysis of ratio of biorhythm in patients with gastroesophageal reflux disease and time of clinical symptoms appearance. Itwas determined thatcircadian rhythm, estimated according to Kerdo index, is correlated with appearance of disease symptoms in 24 hours. Taking into consideration its characteristics while managing drug therapy allows to raise therapy’s efficacy.

  5. Reasons of PEG failure to eliminate gastroesophageal reflux in mechanically ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Ilias Andrianakis; Olga Livaditi; Dimitrios Bakos; Katerina Flevari; Nikos Goutas; Dimitrios Vlachodimitropoulos; Marios-Konstantinos Tasoulis; Alex P Betrosian

    2009-01-01

    AIM: To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).METHODS: Twenty-nine consecutive mechanically ventilated patients were investigated.Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day.Endoscopic and histologic evidence of reflux esophagitis was also carried out.A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.RESULTS: Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG.The mean age, sex, weight and APACHE Ⅱ score were similar in both groups.GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)].Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups ( P = 0.031 and P = 0.020, respectively).Histology revealed no significant differences between the two groups.CONCLUSION: Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.

  6. Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

    Directory of Open Access Journals (Sweden)

    Adel Salah Bediwy

    2014-01-01

    Conclusions: Combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test (C-ACT and FEV1 (% of predicted and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma.

  7. Endoscopic pH Monitoring for Patients with Suspected or Refractory Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Brian G Turner

    2007-01-01

    Full Text Available BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD. The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms.

  8. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility : a systematic review

    NARCIS (Netherlands)

    de Jong, J. R.; Besselink, M. G. H.; van Ramshorst, B.; Gooszen, H. G.; Smout, A. J. P. M.

    2010-01-01

    P>Controversial opinions exist concerning the effect of laparoscopic adjustable gastric banding on gastroesophageal reflux. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. Data are expressed in mean (range). Twenty studies were ident

  9. Reflux heat-pipe solar receivers for dish-electric systems

    Science.gov (United States)

    Andraka, Charles E.; Diver, Richard B.

    1988-04-01

    The feasibility of competitive, modular bulk electric power from the sun may be greatly enhanced by the use of a reflux heat pipe receiver to combine a heat engine with a paraboloidal dish concentrator. This combination represents a potential improvement over previous successful demonstrations of dish-electric technology in terms of enhanced performance, lower cost, longer life, and greater flexibility in engine design. In the reflux (i.e., gravity assisted) heat pipe receiver, concentrated solar radiation causes liquid metal (sodium, potassium, or NaK) to evaporate. The vapor flows to the engine interface heat exchanger, where it condenses and releases the latent heat. The condensate is returned to the receiver absorber by gravity (refluxing), and distributed over the surface by gravity and/or capillary forces in a wick lining the receiver. It is essentially an adaptation of heat pipe technology to the peculiar requirements of concentrated solar flux, and provides many advantages over conventional heated tub receiver technology. This overview paper describes the current status and future plans for the U.S. Solar Thermal Program reflux receiver development program at Sandia National Laboratories. Current work includes conventional mesh wick receivers, sintered metal wicks, and pool boiler receivers. The relative design merits and concerns of the different approaches and technology development test plans are discussed.

  10. Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection

    Directory of Open Access Journals (Sweden)

    Boris Chertin

    2011-01-01

    Full Text Available Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.

  11. Validation and Diagnostic Usefulness of Gastroesophageal Reflux Disease Questionnaire in a Primary Care Level in Mexico

    Science.gov (United States)

    Zavala-Gonzáles, Miguel Angel; Azamar-Jacome, Amyra Ali; Meixueiro-Daza, Arturo; de la Medina, Antonio Ramos; Reyes-Huerta J, Job; Roesch-Dietlen, Federico; Remes-Troche, José María

    2014-01-01

    Background/Aims Different non-invasive diagnostics strategies have been used to assess patients with gastroesophageal reflux. Gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a 6-item, easy to use questionnaire that was developed primarily as a diagnostic tool for GERD in primary care. Our aim was to validate and assess diagnostic utility of GerdQ questionnaire in Mexican patients in the primary care setting. Methods The study was performed in 3 phases: (1) a questionnaire translation and comprehension study (n = 20), (2) are a reproducibility and validation study (50 patients and 50 controls) and (3) a study to assess the clinical utility in 252 subjects with GERD symptoms. Diagnostic accuracy was calculated using endoscopy and/or pH-metry as the gold standard. Results Internal consistency measured by the Cronbach’s α coefficient was 0.81 for patients and 0.90 for healthy controls, with a mixed coefficient of 0.93. Reproducibility for GerdQ was very good and its discriminating validity was 88%. Most of the patients with erosive reflux and non-erosive reflux with abnormal pH-metry had scores > 8, meanwhile most of the patients with functional heartburn and hypersensitive esophagus had < 8. Sensitivity, specificity and positive predictive value of GerdQ com -pared to the gold standard were 72%, 72% and 87%, respectively. Conclusions In Mexico, the GerdQ questionnaire Spanish validated version is useful for GERD diagnosis in the primary care setting. PMID:25273118

  12. Individual bile acids have differential effects on bile acid signaling in mice.

    Science.gov (United States)

    Song, Peizhen; Rockwell, Cheryl E; Cui, Julia Yue; Klaassen, Curtis D

    2015-02-15

    Bile acids (BAs) are known to regulate BA synthesis and transport by the farnesoid X receptor in the liver (FXR-SHP) and intestine (FXR-Fgf15). However, the relative importance of individual BAs in regulating these processes is not known. Therefore, mice were fed various doses of five individual BAs, including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxoycholic acid (DCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) in their diets at various concentrations for one week to increase the concentration of one BA in the enterohepatic circulation. The mRNA of BA synthesis and transporting genes in liver and ileum were quantified. In the liver, the mRNA of SHP, which is the prototypical target gene of FXR, increased in mice fed all concentrations of BAs. In the ileum, the mRNA of the intestinal FXR target gene Fgf15 was increased at lower doses and to a higher extent by CA and DCA than by CDCA and LCA. Cyp7a1, the rate-limiting enzyme in BA synthesis, was decreased more by CA and DCA than CDCA and LCA. Cyp8b1, the enzyme that 12-hydroxylates BAs and is thus responsible for the synthesis of CA, was decreased much more by CA and DCA than CDCA and LCA. Surprisingly, neither a decrease in the conjugated BA uptake transporter (Ntcp) nor increase in BA efflux transporter (Bsep) was observed by FXR activation, but an increase in the cholesterol efflux transporter (Abcg5/Abcg8) was observed with FXR activation. Thus in conclusion, CA and DCA are more potent FXR activators than CDCA and LCA when fed to mice, and thus they are more effective in decreasing the expression of the rate limiting gene in BA synthesis Cyp7a1 and the 12-hydroxylation of BAs Cyp8b1, and are also more effective in increasing the expression of Abcg5/Abcg8, which is responsible for biliary cholesterol excretion. However, feeding BAs do not alter the mRNA or protein levels of Ntcp or Bsep, suggesting that the uptake or efflux of BAs is not regulated by FXR at physiological and

  13. Potency of individual bile acids to regulate bile acid synthesis and transport genes in primary human hepatocyte cultures.

    Science.gov (United States)

    Liu, Jie; Lu, Hong; Lu, Yuan-Fu; Lei, Xiaohong; Cui, Julia Yue; Ellis, Ewa; Strom, Stephen C; Klaassen, Curtis D

    2014-10-01

    Bile acids (BAs) are known to regulate their own homeostasis, but the potency of individual bile acids is not known. This study examined the effects of cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), lithocholic acid (LCA) and ursodeoxycholic acid (UDCA) on expression of BA synthesis and transport genes in human primary hepatocyte cultures. Hepatocytes were treated with the individual BAs at 10, 30, and 100μM for 48 h, and RNA was extracted for real-time PCR analysis. For the classic pathway of BA synthesis, BAs except for UDCA markedly suppressed CYP7A1 (70-95%), the rate-limiting enzyme of bile acid synthesis, but only moderately (35%) down-regulated CYP8B1 at a high concentration of 100μM. BAs had minimal effects on mRNA of two enzymes of the alternative pathway of BA synthesis, namely CYP27A1 and CYP7B1. BAs increased the two major target genes of the farnesoid X receptor (FXR), namely the small heterodimer partner (SHP) by fourfold, and markedly induced fibroblast growth factor 19 (FGF19) over 100-fold. The BA uptake transporter Na(+)-taurocholate co-transporting polypeptide was unaffected, whereas the efflux transporter bile salt export pump was increased 15-fold and OSTα/β were increased 10-100-fold by BAs. The expression of the organic anion transporting polypeptide 1B3 (OATP1B3; sixfold), ATP-binding cassette (ABC) transporter G5 (ABCG5; sixfold), multidrug associated protein-2 (MRP2; twofold), and MRP3 (threefold) were also increased, albeit to lesser degrees. In general, CDCA was the most potent and effective BA in regulating these genes important for BA homeostasis, whereas DCA and CA were intermediate, LCA the least, and UDCA ineffective.

  14. Concepciones del bilingüismo y evaluación de la competencia bilingüe

    NARCIS (Netherlands)

    García, A.M.; Manoiloff, L.; Wagner, M.A.

    2016-01-01

    La investigación psicolingüística y cognitivista del bilingüismo es clave de cara al desarrollo de las ciencias del lenguaje en el siglo XXI. Para propiciar el acercamiento del neófito, este capítulo presenta los principales rudimentos teóricos y metodológicos del campo. Primero, se resumen datos so

  15. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants

    Energy Technology Data Exchange (ETDEWEB)

    Morigeri, C.; Mukhopadhyay, K.; Narang, A. [Postgraduate Institute of Medical Education and Research (PGIMER), Division of Neonatology, Department of Paediatrics, Chandigarh (India); Bhattacharya, A.; Mittal, B.R. [Postgraduate Institute of Medical Education and Research (PGIMER), Department of Nuclear Medicine, Chandigarh (India)

    2008-09-15

    Gastroesophageal reflux (GER) is very common in pre-term infants. The diagnosis based on symptoms is always questionable. The incidence of GER in symptomatic babies varies from 22% to 85%, but literature regarding the incidence of reflux in asymptomatic pre-term infants is lacking. We used radionuclide scintigraphy to evaluate the incidence of GER in symptomatic as well as asymptomatic pre-term neonates and to assess whether symptoms have any relation with positive scintigraphy. We studied 106 pre-term infants (52 symptomatic, 54 asymptomatic) of less than 34 weeks of gestation, who fulfilled the eligibility criteria. Babies were considered symptomatic in the presence of vomiting, regurgitation, apnea, de-saturations, unexplained bradycardia and recurrent lung collapses. Radionuclide scintigraphy was conducted at post-conceptional age of 32-34 weeks when they were clinically stable for 72 h. Feeding was avoided for 2 h preceding the study. {sup 99m}Tc sulphur colloid was administered in a dose of 1.85 MBq (0.05 mCi) in 1 ml, followed by milk (full feed) through an orogastric tube, prior to imaging under a gamma camera. Reflux was graded as low or high, and reflux episodes during the study were counted. The incidence of GER in the symptomatic group was 71.2% and in asymptomatic babies 61.1% (p=0.275). High-grade reflux was more common (71.4%) than low-grade (28.6%) in both groups (p=0.449). Mean number of reflux episodes in 20 min was 4.4{+-}2.4 in symptomatic babies and 4.9 {+-}2.2 in asymptomatic babies (p=0.321). Babies with positive scintigraphy were similar in birth weight, gestation, time to achieve full feeds, weight and age at discharge to those with negative scintigraphy. GER is common in pre-term infants of less than 34 weeks gestation. The incidence of positive scintigraphy and grade of reflux is not significantly different in symptomatic vs. asymptomatic babies. Though radionuclide scintigraphy is a simple, quick and non-invasive investigation in

  16. Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts

    Energy Technology Data Exchange (ETDEWEB)

    Aigner, R.M. [Department of Radiology, Division of Nuclear Medicine, University Hospital, Graz (Austria)]|[Department of Radiology, Division of Nuclear Medicine, LKH-ZRI, A-8036 Graz (Austria); Fueger, G.F.; Nicoletti, R. [Department of Radiology, Division of Nuclear Medicine, University Hospital, Graz (Austria); Schimpl, G.; Sauer, H. [Department of Pediatric Surgery, University Hospital, Graz (Austria)

    1997-11-01

    Background. The study tests the hypothesis that stasis of bile in the Roux-en-Y hepatico-jejunostomy (RYJS) loop might facilitate biliary reflux and cause cholangitis, whereas quicker transit times in hepatico-antrostomy (HAST) might prevent cholangitis. Materials and methods. Cholescintigraphy was performed using Tc99m-trimethyl-Br-IDA in seven RYJS patients and in five HAST patients. Results. The time to peak (T{sub max}) within the RYJS loop occurred between 18 and 50 min postinjection in all patients and the mean transit time (MTT) ranged between 42 and 69 min in 5/7 patients. Prolonged clearance of the tracer from the liver was seen in 2/7 RYJS patients, in whom the MTT was 77 and 240 min, respectively. In the HAST group, the T{sub max} within the anastomosed antrum occurred between 5 and 33 min postinjection, and the MTT ranged between 42 and 44 min in 2/5 patients. Protracted tracer uptake in the liver in one patient and localised tracer retention in the left hepatic bile ducts in 2/5 patients caused prolonged MTTs. Recurrent cholangitis and diarrhoea occurred in 4/7 RYJS patients, but in none of the HAST patients. Elevated gastrin levels after RYJS contrasted sharply to normal gastrin levels after HAST. Conclusion. The findings on cholescintigraphy did not differ significantly between RYJS and HAST and provided no explanation for the distinctly different postoperative clinical course of both surgical methods. Nevertheless, we consider cholescintigraphy to be an efficient and cost-effective diagnostic modality for evaluation of the surgical outcome as regards biliary flow. (orig.) With 5 figs., 1 tab., 11 refs.

  17. Novel Approach to Bile Duct Damage in Primary Biliary Cirrhosis: Participation of Cellular Senescence and Autophagy

    Directory of Open Access Journals (Sweden)

    Motoko Sasaki

    2012-01-01

    Full Text Available Primary biliary cirrhosis (PBC is characterized by antimitochondrial autoantibodies (AMAs in patients' sera and histologically by chronic nonsuppurative destructive cholangitis in small bile ducts, eventually followed by extensive bile duct loss and biliary cirrhosis. The autoimmune-mediated pathogenesis of bile duct lesions, including the significance of AMAs, triggers of the autoimmune process, and so on remain unclear. We have reported that cellular senescence in biliary epithelial cells (BECs may be involved in bile duct lesions and that autophagy may precede the process of biliary epithelial senescence in PBC. Interestingly, BECs in damaged bile ducts show characteristicsof cellular senescence and autophagy in PBC. A suspected causative factor of biliary epithelial senescence is oxidative stress. Furthermore, senescent BECs may modulate the microenvironment around bile ducts by expressing various chemokines and cytokines called senescence-associated secretory phenotypes and contribute to the pathogenesis in PBC.

  18. Solubilization and Interaction Studies of Bile Salts with Surfactants and Drugs: a Review.

    Science.gov (United States)

    Malik, Nisar Ahmad

    2016-05-01

    In this review, bile salt, bile salt-surfactant, and bile salt-drug interactions and their solubilization studies are mainly focused. Usefulness of bile salts in digestion, absorption, and excretion of various compounds and their rare properties in ordering the shape and size of the micelles owing to the presence of hydrophobic and hydrophilic faces are taken into consideration while compiling this review. Bile salts as potential bio-surfactants to solubilize drugs of interest are also highlighted. This review will give an insight into the selection of drugs in different applications as their properties get modified by interaction with bile salts, thus influencing their solution behavior which, in turn, modifies the phase-forming behavior, microemulsion, and clouding phenomenon, besides solubilization. Finally, their future perspectives are taken into consideration to assess their possible uses as bio-surfactants without side effects to human beings.

  19. Use of Omega-3 Polyunsaturated Fatty Acids to Treat Inspissated Bile Syndrome: A Case Report

    Science.gov (United States)

    Jun, Woo Young; Cho, Min Jeng; Han, Hye Seung

    2016-01-01

    Inspissated bile syndrome (IBS) is a rare condition in which thick intraluminal bile, including bile plugs, sludge, or stones, blocks the extrahepatic bile ducts in an infant. A 5-week-old female infant was admitted for evaluation of jaundice and acholic stool. Diagnostic tests, including ultrasound sonography, magnetic resonance cholangiopancreatography, and a hepatobiliary scan, were not conclusive. Although the diagnosis was unclear, the clinical and laboratory findings improved gradually on administration of urodeoxycholic acid and lipid emulsion containing omega-3 polyunsaturated fatty acids (PUFAs) for 3 weeks. However, a liver biopsy was suggestive of biliary atresia. This finding forced us to perform intraoperative cholangiography, which revealed a patent common bile duct with impacted thick bile. We performed normal saline irrigation and the symptom was improved, the final diagnosis was IBS. Thus, we herein report that IBS can be treated with omega-3 PUFAs as an alternative to surgical intervention. PMID:28090475

  20. Carcinogenic potential of duodenal reflux juice from patients with long-standing postgastrectomy

    Institute of Scientific and Technical Information of China (English)

    Zhe Fu Ma; Zhong Yu Wang; Jun Ran Zhang; Peng Gong; Hai Long Chen

    2001-01-01

    AIM To determine, whether study on thecarcinogenic potential of reflux juice frompatients with remote gastrectomy could clarifythe inherent relationship between duodenalreflux and gastric stump cancer.METHODS A total of 37 reflux juice samples(13 Billroth T, 24 Billroth Ⅱ ) were employed inthe present study. A two- stage transformationassay using BALB/c 3T3 cells was carried out totest the initiating or promoting activity of thesesamples.RESULTS Two of 18 (11.1%) reflux samplesexerted initiating activities, whereas 9/19(47.4%) samples enhanced the MNNG-initiafingcell transformation, suggesting the duodenalreflux juice might more frequently possess thetumor-promoter activity (P = 0. 029). In addition,there was no difference in initiating activities ofthe samples irrespective of surgical procedures(P=0.488), while Billroth Ⅱ samples exhibitedstronger tumor-promoter activity than Billroth Ⅰsamples (P = 0.027). Furthermore, the promoteractivities were well correlated with thehistological changes of the stomas (rs = 0.625,P = 0.004), but neither their cytotoxicities norinitiating activities had this correlation( Probabilities were 0.523 and 0.085,respectively).CONCLUSION The duodenal reflux juice frompatients with remote postgastrectomy did havecarcinogenic potential, and suggested thattumor-promoting activity should principallyaccount for the high incidence of gastric cancerin gastrectomy patients. In contrast, it isdifficult to explain the high stump-cancerincidence with the "N-nitroso compounds"theory-a popular theory for the intact stomachcarcinogenesis, and it seemed to be justified tofocus chemoprevention of this cancer on thetumor-promoting potential of reflux juice.

  1. Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Bhavneesh Sharma; Manisha Sharma; Mradul Kumar Daga; Gopal Krishan Sachdev; Elliott Bondi

    2007-01-01

    AIM: To study the effect of combined omeprazole(Ome) and domperidone(Dom) therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph ageal reflux.METHODS: We selected 198 asthmatics with gastro esophageal reflux diagnosed by 24-h esophageal pH moni toring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk (1:1 double-blind randomization). Spirometry was done at baseline and af ter 16 wk of treatment. The primary outcome measures were: mean daily daytime and nighttime asthma symp tom scores. Mean daily reflux symptom scores, albuterol use as rescue medication (number of puffs), daytime and nighttime peak expiratory flow rate (PEFR), postbroncho dilator forced expiratory volume in 1 second (FEV1) and postbronchodilator forced vital capacity (FVC) were sec ondary outcome measures.RESULTS: Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score (17.4% vs 8.9 %), nighttime asthma symptom score (19.6% vs 5.4%), reflux symptom score (8.7% vs 1.6%) and rescue medication use (23.2% vs 3.1%) after antire flux therapy compared to mean change in placebo group (P < 0.001). There was significant improvement in morn ing PEFR (7.9% vs 0.2%), evening PEFR (9.8% vs 0.5%), FEV1 (11.1% vs 3.78%) and FVC (9.3% vs 1.52%) in the antireflux therapy group compared to placebo on comparing the mean change from baseline after 16 wk (P < 0.01).CONCLUSION: Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medi cation use, and improving pulmonary function.

  2. Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

    Institute of Scientific and Technical Information of China (English)

    Kenneth J Vega; Sian Chisholm; M Mazen Jamal

    2009-01-01

    AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classification, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture and reflux-related esophageal ulcer, stricture and hiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

  3. Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties

    Directory of Open Access Journals (Sweden)

    Minu Bajpai

    2013-01-01

    Full Text Available Aims: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR. Materials and Methods: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months. Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI, glomerular filtration rate (GFR, renal scarring, persistence, or appearance of contra-lateral reflux. Results: Grade III VUR was the most common (38% followed by Grade IV (24%, Grade V (17%, Grade II (14%, and Grade I (7%. Most common cause for VUR was Primary (60%, followed by posterior urethral valve (PUV (19%, bladder exstrophy (5%, anorectal malformation (ARM, epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%, split renal functions 1.4 mg/dL (10%. Complete resolution (100% of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2 nd injection. In Grade IV VUR, 1 st injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2 nd injection, and 100% resolution was seen after 3 rd injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. Conclusion: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.

  4. Severity of gastroesophageal reflux disease influences daytime somnolence:A clinical study of:t34 patients underwent upper panendoscopy

    Institute of Scientific and Technical Information of China (English)

    Pál Demeter; Katalin Várdi Visy; N(o)ra Gyulai; R(o)bert Sike; Tamás G T(o)th; János Novák; Pál Magyar

    2004-01-01

    AIM: To asses the relationship between severity of gastroesophageal refluxe disease and Epworth sleepiness scale as an indicator of daytime somnolence.METHODS: One hundred and thirty-four patients underwent an upper panendoscopy as indicated by the typical reflux symptoms and were also investigated with regard to somnolence. Sleepiness was evaluated by Epworth Sleepiness Scale, which was compared to the severity of endoscopic findings (Savary-Miller/modified by Siewert). Patients with psychiatric disorders or being on sedato-hypnotics as well as shift workers were excluded from the study. The relationship between the severity of the reflux disease and daytime somnolence was analyzed with the help of multivariate regression analysis.RESULTS: A positive tendency was found between the severity of the reflux disease and the corresponding Epworth Sleepiness Scale. In the case of the more severe type -Savary-Miller Ⅲ - at least a mild hypersomnia was found.For this group daytime somnolence was significantly higher than in the case of the non-erosive type of Gastroesophageal Reflux Disease representing the mildest stage of reflux disease.CONCLUSION: The severity of Gastroesophageal Reflux Disease influences daytime somnolence.

  5. A causal relationship between cough and gastroesophageal reflux disease (GERD) has been established: a pro/con debate.

    Science.gov (United States)

    Kahrilas, Peter J; Smith, Jaclyn A; Dicpinigaitis, Peter V

    2014-02-01

    Along with upper airway cough syndrome (formerly, postnasal drip syndrome) and eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), gastroesophageal reflux disease (GERD) is generally considered among the most common etiologies of chronic cough. Indeed, cough management guidelines published by numerous respiratory societies worldwide recommend evaluation and treatment of GERD as an integral component of the diagnostic/therapeutic algorithm for the management of chronic cough. However, a significant number of patients with chronic cough presumed due to GERD do not report improvement despite aggressive acid-suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of nonacid or weakly acidic reflux. Further contributing to the controversy are recent studies that demonstrate that patients with chronic cough do not have excessive reflux events relative to healthy volunteers. Although a temporal relationship between cough and reflux events has been suggested by studies utilizing impedance-pH monitoring of reflux events and objective cough recording, consensus is lacking in terms of whether this temporal relationship proves a causal link between reflux and cough. The fourth American Cough Conference (New York, June 2013) provided an ideal forum for the debate of this issue between two internationally recognized experts in the field of reflux and chronic cough.

  6. The effects of short term lipid infusion on plasma and hepatic bile lipids in humans

    OpenAIRE

    Pakula, R; Konikoff, F.; Moser, A.; Greif, F.; Tietz, A; Gilat, T; Rubin, M

    1999-01-01

    BACKGROUND—Patients on parenteral nutrition have an increased incidence of gall bladder sludge and gallstone disease, thought to be related to bile stasis. Intravenous lipid emulsions, especially those containing medium chain triglycerides, have also been shown to have a lithogenic effect on the composition of bile in the gall bladder.
AIMS—To determine whether lipid infusion influences hepatic bile composition in patients with an indwelling T tube following cholecystectomy and choledochotomy...

  7. Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    An ectopic opening of the common bile duct into the duodenal bulb is a very rare congenital malformation of the bile duct, which may cause a recurrent duodenal ulcer or biliary diseases including choledocholithiasis or cholangitis. ERCP plays major role in the diagnosis of this biliary malformation. We report a case of an ectopic opening of the common bile duct into the duodenal bulb, which was detected on the upper gastrointestinal series.

  8. A stated preference investigation into the Chinese demand for farmed vs. wild bear bile.

    Directory of Open Access Journals (Sweden)

    Adam J Dutton

    Full Text Available Farming of animals and plants has recently been considered not merely as a more efficient and plentiful supply of their products but also as a means of protecting wild populations from that trade. Amongst these nascent farming products might be listed bear bile. Bear bile has been exploited by traditional Chinese medicinalists for millennia. Since the 1980s consumers have had the options of: illegal wild gall bladders, bile extracted from caged live bears or the acid synthesised chemically. Despite these alternatives bears continue to be harvested from the wild. In this paper we use stated preference techniques using a random sample of the Chinese population to estimate demand functions for wild bear bile with and without competition from farmed bear bile. We find a willingness to pay considerably more for wild bear bile than farmed. Wild bear bile has low own price elasticity and cross price elasticity with farmed bear bile. The ability of farmed bear bile to reduce demand for wild bear bile is at best limited and, at prevailing prices, may be close to zero or have the opposite effect. The demand functions estimated suggest that the own price elasticity of wild bear bile is lower when competing with farmed bear bile than when it is the only option available. This means that the incumbent product may actually sell more items at a higher price when competing than when alone in the market. This finding may be of broader interest to behavioural economists as we argue that one explanation may be that as product choice increases price has less impact on decision making. For the wildlife farming debate this indicates that at some prices the introduction of farmed competition might increase the demand for the wild product.

  9. The effect of Macrotyloma uniflorum seed on bile lithogenicity against diet induced cholelithiasis on mice

    Directory of Open Access Journals (Sweden)

    Papiya Bigoniya

    2014-01-01

    Conclusions: M. uniflorum seed exerted antilithogenic influence by decreasing the cholesterol hyper-secretion into bile and increasing the bile acid output, thus decreasing the formation of LG bile in mice. The effect was maximum in the AE as it also reduced papillary proliferation of gallbladder and fatty degeneration of the liver. The potential antilithogenic effect of the AE of M. uniflorum may be due to antioxidant property of its rich total polyphenol and tannins content.

  10. Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

    Institute of Scientific and Technical Information of China (English)

    Tae; Hoon; Lee; Sang-Heum; Park; Sae; Hwan; Lee; Chang-Kyun; Lee; Suck-Ho; Lee; Il-Kwun; Chung; Hong; Soo; Kim; Sun-Joo; Kim

    2010-01-01

    The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fai...

  11. Cheese intake lowers plasma cholesterol concentrations without increasing bile acid excretion

    OpenAIRE

    Hjerpsted, Julie Bousgaard; Dragsted, Lars Ove; Tholstrup, Tine

    2016-01-01

    Purpose Cheese is a dairy product with high calcium content. It has been suggested that calcium intake may increase fecal excretion of bile acids that would cause a regeneration of bile acids from hepatic cholesterol and thereby result in a lowering of plasma cholesterol concentrations. We aimed to test this hypothesis by assessing bile acid and calcium concentrations in fecal samples from humans after intake of cheese and butter. Methods The study was a randomized, 2 × 6 weeks crossover, die...

  12. Recurrent pyogenic cholangitis: The pattern of thickening of the extrahepatic bile duct on CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Lim, Jae Hoon; Ko, Young Tae; Lee, Dong Ho; Jeong, Yu Mee; Lee, Eil Seong [Kang Hee University Hospital, Seoul (Korea, Republic of)

    1993-05-15

    The pattern of thickening of the extrahepatic bile duct on computed tomography was analysed in 30 cases with recurrent pyogenic cholangitis diagnosed by surgery (n=19) or by clinical basis (n=11). The mean wall thickness of the extrahepatic bile duct was 3.3 mm (range, 1-6.3 mm). Diffuse thickening of the extrahepatic bile ductal wall was demonstrated in 26 of 30 cases. Diffuse thickening of the extrahepatic bile duct in recurrent pyogenic cholangitis may be differentiated from focal thickening of duct in a common duct cancer or pancreatic cancer.

  13. Changes of gastrointestinal myoelectric activity and bile acid pool size after cholecystectomy in guinea pigs

    Institute of Scientific and Technical Information of China (English)

    Xue-Mei Zhang; Lei Dong; Li-Na Liu; Bi-Xia Chang; Qian He; Qian Li

    2005-01-01

    AIM: To investigate the bile acid pool size after cholecystectomy whether or not correlated to the gastrointestinal migrating myoelectric complex (MMC) in guinea pigs.METHODS: Gallbladder motilities were assessed before cholecystectomy. Furthermore, we continuously monitored interdigestive gastrointestinal motilities using bipolar electrodes in conscious guinea pigs before and after surgery at 4 wk in standard diet group and high cholesterol diet (cholesterol gallstone) group. Total bile acid pool sizes were measured by isotope dilution method at meantime.RESULTS: After cholecystectomy, there were parallel falls in duration of phase Ⅰ, Ⅱ, Ⅲ and MMC cycle duration but increase in amplitude in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones. However, There were not significantly differences. On the other hand, the bile acid pool was definitely small in the GS guinea pigs compared to normal guinea pigs and became slightly smaller after cholecystectomy. Similarly, bile acid in gallbladder bile, fecal bile acid was slightly increased in GS guinea pigs after cholecystectomy, to the same degree as normal. These differences, however, were not significant.CONCLUSION: It is concluded that in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones: (1) Cholecystectomy produce a similar but less marked trend in bile acid pool; and (2) MMC are linked to enterohepatic circulation of bile acids, rather than surgery, which is consistent with changes of the bile acid pool size. As a result, gastrointestinal dyskinesia is not involved in occurrence of postcholecystectomy syndrome.

  14. Self-assembly of micelles in organic solutions of lecithin and bile salt: Mesoscale computer simulation

    Science.gov (United States)

    Markina, A.; Ivanov, V.; Komarov, P.; Khokhlov, A.; Tung, S.-H.

    2016-11-01

    We propose a coarse-grained model for studying the effects of adding bile salt to lecithin organosols by means of computer simulation. This model allows us to reveal the mechanisms of experimentally observed increasing of viscosity upon increasing the bile salt concentration. We show that increasing the bile salt to lecithin molar ratio induces the growth of elongated micelles of ellipsoidal and cylindrical shape due to incorporation of disklike bile salt molecules. These wormlike micelles can entangle into transient network displaying perceptible viscoelastic properties.

  15. Bile Duct Leaks from the Intrahepatic Biliary Tree: A Review of Its Etiology, Incidence, and Management

    Directory of Open Access Journals (Sweden)

    Sorabh Kapoor

    2012-01-01

    Full Text Available Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.

  16. Evaluation of a semiquantitative SNAP test for measurement of bile acids in dogs

    OpenAIRE

    Rachel L. Seibert; Tobias, Karen M.; Ann Reed; Karl R. Snyder

    2014-01-01

    Background. Serum bile acids (SBA) are used as a routine screening tool of liver function in dogs. Serum samples are usually shipped to a referral laboratory for quantitative analysis with an enzymatic chemistry analyzer. The canine SNAP Bile Acids Test (SNAP-BAT) provides an immediate, semi-quantitative measurement of bile acid concentrations in-house. With the SNAP-BAT, bile acids concentrations of 5–30 µmol/L are quantified, and results outside of that range are classified as 30 µmol/L. Ag...

  17. THE CYTOTOXIC EFFECTS OF CRUDE BILE ON HUMAN PANCREATIC CANCER CELL LINES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa-2 cells in RPMI 1640 with or without 1%, 2% and 4% of the purified crude bile (containing total bile acids 10.17mmol/L) was assessed for 2, 4, 6, 8d by using MTT assay to determine inhibitory rate. The cell surface and intracellular ultrastructure of PANC-1 cells was investigated by SEM and TEM at 24h and 48h, respectively. Re sults The proliferation of both cell lines in bile treated medium were greatly retarded (P <0.001). The inhibitory rate of 1%, 2% and 4% bile on Panc-1 cells in 4d were 38%, 60% and 66%, respectively (P <0. 05), on MIA PaCa-2 cells at 4d were 28%, 39% and 52%, respectively (P <0. 05). The cells grown in bile for 48h lost their mi crovilli, their mitochondria and other organelles became vacuolated. Conclusion The bile acids in bile has cytotoxicity on PANC-1 and MIAPACA-2 cells, which may inhibit pancreatic cancer progress in patients clinically.

  18. Effects of bile acids on proliferation and ultrastructural alteration of pancreatic cancer cell lines

    Institute of Scientific and Technical Information of China (English)

    Zheng Wu; Yi Lüi; Bo Wang; Chang Liu; Zuo-Ren Wang,

    2003-01-01

    AIM: Pancreatic cancer in the head is frequently accompanied by jaundice and high bile acid level in serum. This study focused on the direct effects of bile acids on proliferation and ultrastructural alteration of pancreatic cancer.METHODS: Pancreatic cancer cell lines PANC-1, MIA PaCa2 and PGHAM-1 were explored in this study. The cell lines were cultured in media supplemented with certain bile acids,CA, DCA, LCA, TCDC, TDCA and GCA. Their influence on cell growth was measured with MTT assay after 72 h of incubation. Cell cycles of PANC-1 cells in 40 μM of bile acids media were analyzed by flow cytometry. Ultrastructural alteration of PANC-1 cells induced by DCA was observed using scanning and transmission electron microscope (SEM and TEM).RESULTS: At various concentrations of bile acids and incubation time, no enhanced effects of bile acids on cell proliferation were observed. Significant inhibitory effects were obtained in almost all media with bile acids. DCA and CA increased the percentage of G0+G1 phase cells, while GCA and TDCA elevated the S phase cell number. After 48 h of incubation in DCA medium, PANC-1 cells showed some structural damages such as loss of their microvilli and vacuolization of organelles in cytoplasm.CONCLUSION: Bile acids can reduce proliferation of pancreatic cancer cells due to their direct cytotoxicity. This result implies that elevation of bile acids in jaundiced serum may inhibit pancreatic cancer progression.

  19. [Study of crystalline structures of the bile in the diagnosis of cholelithiasis].

    Science.gov (United States)

    Postolov, P M; Bykov, A V; Mishin, S G

    1990-10-01

    Under analysis were results of polarization microscopy of bile in 111 patients with cholelithiasis, 8 patients with acalculous cholecystitis and 8 practically healthy people. It was found that in healthy people there are no crystalline structures in the initial state of bile. The composition of bile from patients with cholelithiasis is characterized by the presence of three types of crystals: solid crystals of cholesterol monohydrate, calcium bilirubinate granules and calcium carbonate microspherolites. Polarization microscopy of bile may be used as a sufficiently simple method of diagnostics of stone disease.

  20. Differential proteomic analysis of outer membrane enriched extracts of Bacteroides fragilis grown under bile salts stress.

    Science.gov (United States)

    Boente, Renata F; Pauer, Heidi; Silva, Deborah N S; Filho, Joaquim Santos; Sandim, Vanessa; Antunes, Luis Caetano M; Ferreira, Rosana Barreto Rocha; Zingali, Russolina B; Domingues, Regina M C P; Lobo, Leandro A

    2016-06-01

    Bacteroides fragilis is the most commonly isolated anaerobic bacteria from infectious processes. Several virulence traits contribute to the pathogenic nature of this bacterium, including the ability to tolerate the high concentrations of bile found in the gastrointestinal tract (GIT). The activity of bile salts is similar to detergents and may lead to membrane permeabilization and cell death. Modulation of outer membrane proteins (OMPs) is considered a crucial event to bile salts resistance. The primary objective of the current work was to identify B. fragilis proteins associated with the stress induced by high concentration of bile salts. The outer membrane of B. fragilis strain 638R was isolated after growth either in the presence of 2% conjugated bile salts or without bile salts. The membrane fractions were separated on SDS-PAGE and analyzed by ESI-Q/TOF tandem mass spectrometry. A total of 37 proteins were identified; among them nine were found to be expressed exclusively in the absence of bile salts whereas eight proteins were expressed only in the presence of bile salts. These proteins are related to cellular functions such as transport through membrane, nutrient uptake, and protein-protein interactions. This study demonstrates the alteration of OMPs composition in B. fragilis during bile salts stress resistance and adaptation to environmental changes. Proteomics of OMPs was also shown to be a useful approach in the identification of new targets for functional analyses.

  1. Hepatic bile acid metabolism in the neonatal hamster: expansion of the bile acid pool parallels increased Cyp7a1 expression levels.

    Science.gov (United States)

    Burke, Katie T; Horn, Paul S; Tso, Patrick; Heubi, James E; Woollett, Laura A

    2009-07-01

    Intraluminal concentrations of bile acids are low in newborn infants and increase rapidly after birth, at least partly owing to increased bile acid synthesis rates. The expansion of the bile acid pool is critical since bile acids are required to stimulate bile flow and absorb lipids, a major component of newborn diets. The purpose of the present studies was to determine the mechanism responsible for the increase in bile acid synthesis rates and the subsequent enlargement of bile acid pool sizes (BAPS) during the neonatal period, and how changes in circulating hormone levels might affect BAPS. In the hamster, pool size was low just after birth and increased modestly until 10.5 days postpartum (dpp). BAPS increased more significantly ( approximately 3-fold) between 10.5 and 15.5 dpp. An increase in mRNA and protein levels of cholesterol 7alpha-hydroxylase (Cyp7a1), the rate-limiting step in classical bile acid synthesis, immediately preceded an increase in BAPS. In contrast, levels of oxysterol 7alpha-hydroxylase (Cyp7b1), a key enzyme in bile acid synthesis by the alternative pathway, were relatively elevated by 1.5 dpp. farnesyl X receptor (FXR) and short heterodimeric partner (SHP) mRNA levels remained relatively constant at a time when Cyp7a1 levels increased. Finally, although simultaneous increases in circulating cortisol and Cyp7a1 levels occurred, precocious expression of Cyp7a1 could not be induced in neonatal hamsters with dexamethasone. Thus the significant increase in Cyp7a1 levels in neonatal hamsters is due to mechanisms independent of the FXR and SHP pathway and cortisol.

  2. Deconjugated Bile Salts Produced by Extracellular Bile-Salt Hydrolase-Like Activities from the Probiotic Lactobacillus johnsonii La1 Inhibit Giardia duodenalis In vitro Growth

    Science.gov (United States)

    Travers, Marie-Agnès; Sow, Cissé; Zirah, Séverine; Deregnaucourt, Christiane; Chaouch, Soraya; Queiroz, Rayner M. L.; Charneau, Sébastien; Allain, Thibault; Florent, Isabelle; Grellier, Philippe

    2016-01-01

    Giardiasis, currently considered a neglected disease, is caused by the intestinal protozoan parasite Giardia duodenalis and is widely spread in human as well as domestic and wild animals. The lack of appropriate medications and the spread of resistant parasite strains urgently call for the development of novel therapeutic strategies. Host microbiota or certain probiotic strains have the capacity to provide some protection against giardiasis. By combining biological and biochemical approaches, we have been able to decipher a molecular mechanism used by the probiotic strain Lactobacillus johnsonii La1 to prevent Giardia growth in vitro. We provide evidence that the supernatant of this strain contains active principle(s) not directly toxic to Giardia but able to convert non-toxic components of bile into components highly toxic to Giardia. By using bile acid profiling, these components were identified as deconjugated bile-salts. A bacterial bile-salt-hydrolase of commercial origin was able to mimic the properties of the supernatant. Mass spectrometric analysis of the bacterial supernatant identified two of the three bile-salt-hydrolases encoded in the genome of this probiotic strain. These observations document a possible mechanism by which L. johnsonii La1, by secreting, or releasing BSH-like activity(ies) in the vicinity of replicating Giardia in an environment where bile is present and abundant, can fight this parasite. This discovery has both fundamental and applied outcomes to fight giardiasis, based on local delivery of deconjugated bile salts, enzyme deconjugation of bile components, or natural or recombinant probiotic strains that secrete or release such deconjugating activities in a compartment where both bile salts and Giardia are present. PMID:27729900

  3. Telmisartan attenuates hepatic fibrosis in bile duct-ligated rats

    Institute of Scientific and Technical Information of China (English)

    En-tong YI; Rui-xia LIU; Yan WEN; Cheng-hong YIN

    2012-01-01

    Aim: To evaluate the antifibrotic effect of telmisartan,an angiotensin Ⅱ receptor blocker,in bile duct-ligated rats.Methods: Adult Sprague-Dawley rats were allocated to 3 groups: sham-operated rats,model rats underwent common bile duct ligation (BDL),and BDL rats treated with telmisartan (8 mg/kg,po,for 4 weeks).The animals were sacrificed on d 29,and liver histology was examined,the Knodell and Ishak scores were assigned,and the expression of angiotensin-converting enzyme (ACE) and ACE2 was evaluated with immunohistochemical staining.The mRNAs and proteins associated with liver fibrosis were evaluated using RTQ-PCR and Western blot,respectively.Results: The mean fibrosis score of BDL rats treated with telmisartan was significantly lower than that of the model rats (1.66±0.87 vs 2.13±0.35,P=0.015).However,there was no significant difference in inflammation between the two groups,both of which showed moderate inflammation.Histologically,treatment with telmisartan significantly ameliorated BDL-caused the hepatic fibrosis.Treatment with telmisartan significantly upregulated the mRNA levels of ACE2 and MAS,and decreased the mRNA levels of ACE,angiotensin Ⅱ type 1 receptor (AT1-R),collagen type Ⅲ,and transforming growth factor β1 (TGF-β1).Moreover,treatment with telmisartan significantly increased the expression levels of ACE2 and MAS proteins,and inhibited the expression levels of ACE and AT1-R protein.Conclusion: Telmisartan attenuates liver fibrosis in bile duct-ligated rats via increasing ACE2 expression level.

  4. Effect of bile acid sequestrants on glycaemic control

    DEFF Research Database (Denmark)

    Hansen, Morten; Sonne, David Peick; Mikkelsen, Kristian Hallundbæk;

    2012-01-01

    In addition to the lipid-lowering effect of bile acid sequestrants (BASs), they also lower blood glucose and, therefore, could be beneficial in the treatment of patients with type 2 diabetes mellitus (T2DM). Three oral BASs are approved by the US Food and Drug Administration (FDA) for the treatment...... of hypercholesterolaemia: colestipol, cholestyramine and colesevelam. The BAS colestimide/colestilan is used in Japan. Colesevelam was recently approved by the FDA for the treatment of T2DM. We plan to provide a systematic review with meta-analysis of the glucose-lowering effect of BASs with the aim to evaluate...

  5. Unusual scintigraphic appearance of perforation of the common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Acevedo, M.O.; Tauxe, W.N.; Scott, J.W.; Aldrete, J.S.

    1983-12-01

    This report deals with the diagnosis of perforation of the common bile duct into the lesser sac by HIDA cholescintigraphy. The first hour images after injection were suggestive of biliary obstruction. Subsequent images demonstrated unusual accumulations of the activity into the lesser sac and retroperitoneal potential spaces. Careful correlation between scintigraphic and surgical findings were undertaken. The case is reported to demonstrate the scintigraphic findings in choledochal perforation and to stress the importance of carrying out late images when the initial ones are abnormal.

  6. Suppression of the HPA Axis During Cholestasis Can Be Attributed to Hypothalamic Bile Acid Signaling.

    Science.gov (United States)

    McMillin, Matthew; Frampton, Gabriel; Quinn, Matthew; Divan, Ali; Grant, Stephanie; Patel, Nisha; Newell-Rogers, Karen; DeMorrow, Sharon

    2015-12-01

    Suppression of the hypothalamic-pituitary-adrenal (HPA) axis has been shown to occur during cholestatic liver injury. Furthermore, we have demonstrated that in a model of cholestasis, serum bile acids gain entry into the brain via a leaky blood brain barrier and that hypothalamic bile acid content is increased. Therefore, the aim of the current study was to determine the effects of bile acid signaling on the HPA axis. The data presented show that HPA axis suppression during cholestatic liver injury, specifically circulating corticosterone levels and hypothalamic corticotropin releasing hormone (CRH) expression, can be attenuated by administration of the bile acid sequestrant cholestyramine. Secondly, treatment of hypothalamic neurons with various bile acids suppressed CRH expression and secretion in vitro. However, in vivo HPA axis suppression was only evident after the central injection of the bile acids taurocholic acid or glycochenodeoxycholic acid but not the other bile acids studied. Furthermore, we demonstrate that taurocholic acid and glycochenodeoxycholic acid are exerting their effects on hypothalamic CRH expression after their uptake through the apical sodium-dependent bile acid transporter and subsequent activation of the glucocorticoid receptor. Taken together with previous studies, our data support the hypothesis that during cholestatic liver injury, bile acids gain entry into the brain, are transported into neurons through the apical sodium-dependent bile acid transporter and can activate the glucocorticoid receptor to suppress the HPA axis. These data also lend themselves to the broader hypothesis that bile acids may act as central modulators of hypothalamic peptides that may be altered during liver disease.

  7. Repression of Salmonella enterica phoP expression by small molecules from physiological bile.

    Science.gov (United States)

    Antunes, L Caetano M; Wang, Melody; Andersen, Sarah K; Ferreira, Rosana B R; Kappelhoff, Reinhild; Han, Jun; Borchers, Christoph H; Finlay, B Brett

    2012-05-01

    Infection with Salmonella enterica serovar Typhi in humans causes the life-threatening disease typhoid fever. In the laboratory, typhoid fever can be modeled through the inoculation of susceptible mice with Salmonella enterica serovar Typhimurium. Using this murine model, we previously characterized the interactions between Salmonella Typhimurium and host cells in the gallbladder and showed that this pathogen can successfully invade gallbladder epithelial cells and proliferate. Additionally, we showed that Salmonella Typhimurium can use bile phospholipids to grow at high rates. These abilities are likely important for quick colonization of the gallbladder during typhoid fever and further pathogen dissemination through fecal shedding. To further characterize the interactions between Salmonella and the gallbladder environment, we compared the transcriptomes of Salmonella cultures grown in LB broth or physiological murine bile. Our data showed that many genes involved in bacterial central metabolism are affected by bile, with the citric acid cycle being repressed and alternative respiratory systems being activated. Additionally, our study revealed a new aspect of Salmonella interactions with bile through the identification of the global regulator phoP as a bile-responsive gene. Repression of phoP expression could also be achieved using physiological, but not commercial, bovine bile. The biological activity does not involve PhoPQ sensing of a bile component and is not caused by bile acids, the most abundant organic components of bile. Bioactivity-guided purification allowed the identification of a subset of small molecules from bile that can elicit full activity; however, a single compound with phoP inhibitory activity could not be isolated, suggesting that multiple molecules may act in synergy to achieve this effect. Due to the critical role of phoP in Salmonella virulence, further studies in this area will likely reveal aspects of the interaction between Salmonella

  8. Gut microbiota, cirrhosis and alcohol regulate bile acid metabolism in the gut

    Science.gov (United States)

    Ridlon, Jason M.; Kang, Dae-Joong; Hylemon, Phillip B.; Bajaj, Jasmohan S

    2015-01-01

    The understanding of the complex role of the bile acid-gut microbiome axis in health and disease processes is evolving rapidly. Our focus revolves around the interaction of the gut microbiota with liver diseases, especially cirrhosis. The bile acid pool size has recently been shown to be a function of microbial metabolism of bile acid and regulation of the microbiota by bile acids is important in the development and progression of several liver diseases. Humans produce a large, conjugated hydrophilic bile acid pool, maintained through positive-feedback antagonism of FXR in intestine and liver. Microbes use bile acids, and via FXR signaling this results in a smaller, unconjugated hydrophobic bile acid pool. This equilibrium is critical to maintain health. The challenge is to examine the manifold functions of gut bile acids as modulators of antibiotic, probiotic and disease progression in cirrhosis, metabolic syndrome and alcohol use. Recent studies have shown potential mechanisms explaining how perturbations in the microbiome affect bile acid pool size and composition. With advancing liver disease and cirrhosis, there is dysbiosis in the fecal, ileal and colonic mucosa, in addition to a decrease in bile acid concentration in the intestine due to the liver problems. This results in a dramatic shift toward the Firmicutes, particularly Clostridium cluster XIVa and increasing production of deoxycholic acid (DCA). Alcohol intake speeds up these processes in the subjects with and without cirrhosis without significant FXR feedback. Taken together, these pathways can impact intestinal and systemic inflammation while worsening dysbiosis. The interaction between bile acids, alcohol, cirrhosis and dysbiosis is an important relationship that influences intestinal and systemic inflammation, which in turn determines progression of the overall disease process. These interactions and the impact of commonly used therapies for liver disease can provide insight into the pathogenesis

  9. Effects of reflux ratio and feed conditions for the purification of bioethanol in a continuous distillation column

    Science.gov (United States)

    Dasan, Y. K.; Abdullah, M. A.; Bhat, A. H.

    2014-10-01

    Continuous distillation column was used for the purification of bioethanol from fermentation of molasses using Saccharomyces cerevisia. Bioethanol produced was at 8.32% (v/v) level. The efficiency of continuous distillation process was evaluated based on reflux ratio, and feed condition. The lab results were validated using COFE simulation Software. The analyses showed that both reflux ratio and feed condition had significant effects on the distillation process. Stages increased from 1.79 to 2.26 as the reflux ratio was decreased from 90% to 45% and the saturated feed produced lower mole fraction of desired product. We concluded that the lower reflux ratio with cold feed condition was suitable for higher mole fraction of top product.

  10. Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2012-01-01

    Full Text Available A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

  11. Refractory gastroesophageal reflux disease Doença do refluxo gastroesofágico refratária

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  12. Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings.

    Science.gov (United States)

    Eren, Erdem; Arslanoğlu, Seçil; Aktaş, Ayşe; Kopar, Aylin; Ciğer, Ejder; Önal, Kazım; Katılmiş, Hüseyin

    2014-04-01

    The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS >7 or RSI >13 was considered reflux positive. Fleiss' kappa (κ) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (κ = 0.078), ventricular obliteration (κ = 0.206), diffuse laryngeal edema (κ = 0.204), and posterior laryngeal hypertrophy (κ = 0.27), intermediate for laryngeal erythema/hyperemia (κ = 0.42) and vocal fold edema (κ = 0.42), and high for thick endolaryngeal mucus (κ = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.

  13. Improvements in ion reflux: An electrodialytic eluent generation and suppression device for ion chromatography.

    Science.gov (United States)

    Elkin, Kyle; Riviello, John; Small, Hamish

    2015-07-17

    This work describes a membrane based electrodialytic ion reflux device (IRD), which uses water as the pumped phase and integrates isocratic and gradient eluent generation and suppression. The current design incorporates several ion exchange membranes to create discrete chambers for suppression and eluent generation, while isolating the electrodes from the analytical stream. A small volume of recycled water can be used as the pumped phase while continuously refluxing the eluent ions. This current design permits electronically controlled eluent generation of at least 16.4μeq KOHmin(-1), while maintaining low suppressed background conductivity (<0.5μS/cm). The device was operated in gradient or isocratic mode continuously for up to 6 weeks. During this period, over 500 gradient and isocratic injections were performed, showing peak retention time precision below 1.5% RSD.

  14. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease

    Science.gov (United States)

    Fass, Ronnie; Frazier, Rosita

    2017-01-01

    Dexlansoprazole modified-release (MR) is the R-enantiomer of lansoprazole and is currently the only proton-pump inhibitor (PPI) with a novel dual delayed release (DDR) formulation. Overall, dexlansoprazole MR demonstrates a similar safety and side-effect profile as lansoprazole. Dexlansoprazole MR has been shown to be highly efficacious in healing erosive esophagitis, maintaining healed esophageal mucosa in patients with erosive esophagitis and controlling symptoms of patients with nonerosive reflux disease (NERD). Recent studies have also demonstrated that dexlansoprazole MR is highly effective in improving nocturnal heartburn, gastroesophageal reflux disease (GERD) related sleep disturbances and bothersome regurgitation. Dexlansoprazole MR is well tolerated and can be taken without regard to food. PMID:28203282

  15. Similar symptom patterns in gastroesophageal reflux patients with and without hiatal hernia.

    Science.gov (United States)

    Antoniou, S A; Koch, O O; Antoniou, G A; Asche, K U; Kaindlstorfer, A; Granderath, F A; Pointner, R

    2013-07-01

    Gastroesophageal reflux disease is a common clinical entity in Western societies. Its association with hiatal hernia has been well documented; however, the comparative clinical profile of patients in the presence or absence of hiatal hernia remains mostly unknown. The aim of the present study was to delineate and compare symptom, impedance, and manometric patterns of patients with and without hiatal hernia. A cumulative number of 120 patients with reflux disease were enrolled in the study. Quality of life score, demographic, symptom, manometric, and impedance data were prospectively collected. Data comparison was undertaken between patients with and without hiatal hernia. A P-value hiatal hernia tended to be older than patients without hernia (52.3 vs. 48.6 years, P hiatal hernia (78.3% vs. 93.9%, P hiatal hernia on manometric and impedance studies. Distinct functional characteristics in patients with and without hiatal hernia may suggest a tailored therapeutic management for these diverse patient groups.

  16. Pulmonary Disease Secondary to Reflux Mimicking Interstitial Pneumonia in Systemic Sclerosis: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ricardo Azêdo de Luca Montes

    2016-01-01

    Full Text Available Systemic sclerosis is a complex disease due to the variety of clinical presentations, often superimposed on other conditions, related or not to the connective tissue. We report a 43-year-old Brazilian woman with limited systemic sclerosis and pulmonary symptoms secondary to gastroesophageal reflux disease, with a clinical presentation similar to a diffuse interstitial lung disease. Because of the frequency of interstitial lung injury due to systemic sclerosis, this was an important differential diagnosis, which could be excluded after optimized treatment of reflux disease, with clinical and radiological improvement. Clinical management of patients with collagen diseases requires clinician skills to identify the natural history and understand its nuances. This is a common situation in clinical practice, but with a few discussions in international literature.

  17. Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Anupender Singh Sidhu; George Triadafilopoulos

    2008-01-01

    The junction between the esophagus and the stomach is a specialized region,composed of lower esophageal sphincter (LES) and its adjacent anatomical structures,the gastric sling and crural diaphragm.Together these structures work in a coordinated manner to allow ingested food into the stomach while preventing reflux of gastric contents across the esophago-gastric junction (EGJ) into the esophagus.The same zone also permits retrograde passage of air and gastric contents into esophagus during belching and vomiting.The precise coordination required to execute such a complicated task is achieved by a finely-regulated high-pressure zone.This zone keeps the junction between esophagus and stomach continuously closed,but is still able to relax briefly via input from inhibitory neurons that are responsible for its innervation.Alterations of the structure and function of the EGJ and the LES may predispose to gastroesophageal reflux disease (GERD).

  18. De novo MEIS2 mutation causes syndromic developmental delay with persistent gastro-esophageal reflux.

    Science.gov (United States)

    Fujita, Atsushi; Isidor, Bertrand; Piloquet, Hugues; Corre, Pierre; Okamoto, Nobuhiko; Nakashima, Mitsuko; Tsurusaki, Yoshinori; Saitsu, Hirotomo; Miyake, Noriko; Matsumoto, Naomichi

    2016-09-01

    MEIS2 aberrations are considered to be the cause of intellectual disability, cleft palate and cardiac septal defect, as MEIS2 copy number variation is often observed with these phenotypes. To our knowledge, only one nucleotide-level change-specifically, an in-frame MEIS2 deletion-has so far been reported. Here, we report a female patient with a de novo nonsense mutation (c.611C>G, p.Ser204*) in MEIS2. She showed severe intellectual disability, moderate motor/verbal developmental delay, cleft palate, cardiac septal defect, hypermetropia, severe feeding difficulties with gastro-esophageal reflux and constipation. By reviewing this patient and previous patients with MEIS2 point mutations, we found that feeding difficulty with gastro-esophageal reflux appears to be one of the core clinical features of MEIS2 haploinsufficiency, in addition to intellectual disability, cleft palate and cardiac septal defect.

  19. [An association between adenoid hypertrophy and exstra-gastroesophageal reflux disease].

    Science.gov (United States)

    Ren, Jianjun; Zhao, Yu; Ren, Xue

    2015-08-01

    Adenoid hypertrophy is a disease that mostly occurs among children of 3-5 years old. It is caused by repeated inflammation and infection of nasopharynx and its adjoin parts, or the adenoid itself, which will finally leads to pathological hyperplasia of adenoid. With so much information we have acquired about this disease, its specific mechanism remains unknown. In recent years, some researches have indicated that adenoid hypertrophy may have something to do with extra-gastroesophageal reflux, in which pepsin plays a very important role, and pepsin will do a series of pathological damages to the upper airway as it reaches the upper respiratory tract. Based on relative domestic and foreign literature, this paper attempts to make a review about the relationship between gastroesophageal reflux and adenoid hypertrophy.

  20. Metformin protects rat hepatocytes against bile acid-induced apoptosis.

    Directory of Open Access Journals (Sweden)

    Titia E Woudenberg-Vrenken

    Full Text Available BACKGROUND: Metformin is used in the treatment of Diabetes Mellitus type II and improves liver function in patients with non-alcoholic fatty liver disease (NAFLD. Metformin activates AMP-activated protein kinase (AMPK, the cellular energy sensor that is sensitive to changes in the AMP/ATP-ratio. AMPK is an inhibitor of mammalian target of rapamycin (mTOR. Both AMPK and mTOR are able to modulate cell death. AIM: To evaluate the effects of metformin on hepatocyte cell death. METHODS: Apoptotic cell death was induced in primary rat hepatocytes using either the bile acid glycochenodeoxycholic acid (GCDCA or TNFα in combination with actinomycin D (actD. AMPK, mTOR and phosphoinositide-3 kinase (PI3K/Akt were inhibited using pharmacological inhibitors. Apoptosis and necrosis were quantified by caspase activation, acridine orange staining and Sytox green staining respectively. RESULTS: Metformin dose-dependently reduces GCDCA-induced apoptosis, even when added 2 hours after GCDCA, without increasing necrotic cell death. Metformin does not protect against TNFα/ActD-induced apoptosis. The protective effect of metformin is dependent on an intact PI3-kinase/Akt pathway, but does not require AMPK/mTOR-signaling. Metformin does not inhibit NF-κB activation. CONCLUSION: Metformin protects against bile acid-induced apoptosis and could be considered in the treatment of chronic liver diseases accompanied by inflammation.