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Indian Journal of Anaesthesia Aug 2022Point-of-care ultrasonography (USG) of the gastric antrum can help to evaluate the aspiration risk and improve the safety of anaesthesia. The aim was to assess the...
BACKGROUND AND AIMS
Point-of-care ultrasonography (USG) of the gastric antrum can help to evaluate the aspiration risk and improve the safety of anaesthesia. The aim was to assess the gastric antrum in term parturients scheduled for elective caesarean section using bedside USG.
METHODS
After obtaining institutional ethics committee approval and written informed consent, 250 term parturients (≥36 weeks gestational age) with body mass index 18.5-30 kg/m, and scheduled for elective caesarean delivery were included in this study. The parturients were instructed to follow standard fasting guidelines. In the preoperative area, ultrasonographic examinations were performed 15 min before the scheduled time of the caesarean section. The primary outcome was the qualitative assessment (grade 0-2) of the gastric antrum, and the secondary outcome was the quantitative assessment (antral cross-sectional area [CSA]) of gastric antrum in supine and right lateral decubitus (RLD) position. Data analysis was done using Statistical Package for Social Sciences Software (version 19).
RESULTS
Among the 234 parturients who completed the study, 191 exhibited grade 0 antrum, 42 had grade 1 antrum, and one parturient had grade 2 antrum. Overall, 83% of participants had an antral CSA ≤4.25 cm [95% confidence interval (CI), 2.52-5.67 cm] in the RLD position, equivalent to an estimated gastric volume of ≤43 ml (95% CI, 32-68 mL) or ≤1.5 ml/kg (95% CI, 0.49-1.23 ml/kg).
CONCLUSION
Majority of fasted term parturients scheduled for elective caesarean section had a grade 1 gastric antrum on bedside USG. This study also establishes cutoff values of antral CSA and gastric volume in both supine and RLD position for fasted term parturients.
PubMed: 36262725
DOI: 10.4103/ija.ija_727_21 -
Archives of Iranian Medicine Oct 2022Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the...
BACKGROUND
Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality.
METHODS
This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP).
RESULTS
Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients.
CONCLUSION
Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.
Topics: Male; Humans; Middle Aged; Pyloric Antrum; Retrospective Studies; Sewage; Common Bile Duct; Duodenum; Cholangiopancreatography, Endoscopic Retrograde; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 37542403
DOI: 10.34172/aim.2022.110 -
Cellular Oncology (Dordrecht) Jun 2021The purpose of this study was to characterize alterations in mucosa-associated microbiota in different anatomical locations of the stomach during gastric cancer...
PURPOSE
The purpose of this study was to characterize alterations in mucosa-associated microbiota in different anatomical locations of the stomach during gastric cancer progression and to identify associations between Helicobacter pylori infection and gastric microbial changes in patients with gastric cancer.
METHODS
Twenty-five H. pylori negative subjects with chronic gastritis and thirty-four subjects with gastric cancer were recruited, including H. pylori negative and positive patients with tumors in the antrum and the corpus. Gastric mucosa-associated microbiota were determined by 16S ribosomal RNA gene sequencing using a 454 sequencing platform.
RESULTS
We found that individuals with chronic gastritis from three different anatomical sites exhibited different microbiota compositions, although the microbial alpha diversity, richness and beta diversity were similar. Compared to patients with chronic gastritis, the gastric microbiota compositions were significantly different at the order level in the antrum and the corpus of patients with gastric cancer, which was dependent on the H. pylori infection status. Microbial alpha diversity and species richness, however, were similar between chronic gastritis and gastric cancer cases and independent of H. pylori status. The microbial community structure in patients with gastric cancer was distinct from that in patients with chronic gastritis. In addition, we found that the presence of H. pylori markedly altered the structure in gastric corpus cancer, but only mildly affected the antrum.
CONCLUSION
Our data revealed distinct niche-specific microbiota alterations during the progression from gastritis to gastric cancer. These alterations may reflect adaptions of the microbiota to the diverse specific environmental habitats in the stomach, and may play an important, as yet undetermined, role in gastric carcinogenesis.
Topics: Aged; Cardia; Disease Progression; Female; Gastric Mucosa; Gastritis; Gastrointestinal Microbiome; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Pyloric Antrum; Stomach Neoplasms
PubMed: 33770413
DOI: 10.1007/s13402-021-00596-y -
Veterinary Surgery : VS Jul 2021To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs.
OBJECTIVE
To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs.
STUDY DESIGN
Cadaveric and prospective clinical study.
ANIMALS
Five dog cadavers for the cadaveric study; 12 dogs for the clinical study.
METHODS
The pyloric antrum was affixed to the abdominal wall laparoscopically by applying a series of straps. The cadaveric study assessed potential challenges during the procedure and stomach mucosal penetration. For the clinical study, the total duration of surgery, time to complete the gastropexy, and the number of straps used were recorded. Ultrasound evidence of adhesion, complications, and weight were monitored at 7, 30, and 90 days after surgery. Owner satisfaction was evaluated at the 6-month follow-up.
RESULTS
The total duration of surgery was 25.8 minutes (range, 19-39; SD, 6.7), and the time to complete the gastropexy was 10.1 minutes (range, 7-19; SD, 3.9). The linear regression analysis revealed an inverse correlation between the time to complete the gastropexy and the order of the surgeries (r = 0.75, P < .05). No complications were recorded. Ultrasound examination was used to confirm gastropexy at all follow-ups.
CONCLUSION
Laparoscopic gastropexy with AFS was performed in both cadavers and clinical animals with minimal complications. Persistent adhesion was demonstrated during ultrasound evaluations and in one postmortem evaluation.
CLINICAL SIGNIFICANCE
This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.
Topics: Animals; Dog Diseases; Dogs; Gastropexy; Laparoscopy; Prospective Studies; Stomach Volvulus
PubMed: 33175434
DOI: 10.1111/vsu.13543 -
World Journal of Clinical Cases Nov 2020Plexiform fibromyxoma (PF) is a rare mesenchymal tumor of the stomach. The clinical features of PF frequently include upper abdominal pain, abdominal discomfort,...
BACKGROUND
Plexiform fibromyxoma (PF) is a rare mesenchymal tumor of the stomach. The clinical features of PF frequently include upper abdominal pain, abdominal discomfort, hematemesis, melena, pyloric obstruction and an upper abdominal mass. We herein report a case of PF resected by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.
CASE SUMMARY
The patient was admitted to hospital, due to a 1-wk history of an abdominal space-occupying lesion identified during a health examination. He underwent complete resection by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy. During the operation, the tumor was located in the anterior wall of the gastric antrum (approximately 7 cm × 6 cm × 5.5 cm) and did not show evidence of invasion of the serosa. Histology showed that the tumor cells were oval fibroblast-like and spindle-shaped cells, with numerous thin-walled blood vessels and abundant myxoid stroma. Cellular atypia and mitosis were both rare. Immunohistochemistry showed that the tumor cells were immunoreactive for smooth muscle actin, S-100 and CD-10, but were negative for CD-117, CD-34, DOG-1, and ALK. In this case, S-100 was positive and no significant disease was observed during the follow-up period.
CONCLUSION
The fact that PF is a rare tumor with only a few cases in this region can lead to misdiagnosis of this entity and pose a real diagnostic challenge for general surgeons and pathologists when encountering such patients and differentiating PF from other primary tumors of gastric mesenchymal origin. Our report may help increase awareness of this rare, but important new disease entity.
PubMed: 33344555
DOI: 10.12998/wjcc.v8.i22.5639 -
Neurogastroenterology and Motility Nov 2023Coping with the ingested food, the gastric regions of fundus, corpus, and antrum display different motility patterns. Intrinsic components of such patterns involving...
BACKGROUND
Coping with the ingested food, the gastric regions of fundus, corpus, and antrum display different motility patterns. Intrinsic components of such patterns involving mechanosensitive enteric neurons (MEN) have been described in the guinea pig gastric corpus but are poorly understood in the fundus and antrum.
METHODS
To elucidate mechanosensitive properties of myenteric neurons in the gastric fundus and antrum, membrane potential imaging using Di-8-ANEPPS was applied. A small-volume injection led to neuronal compression. We analyzed the number of MEN and their firing frequency in addition to the involvement of selected mechanoreceptors. To characterize the neurochemical phenotype of MEN, we performed immunohistochemistry.
KEY RESULTS
In the gastric fundus, 16% of the neurons reproducibly responded to mechanical stimulation and thus were MEN. Of those, 83% were cholinergic and 19% nitrergic. In the antrum, 6% of the neurons responded to the compression stimulus, equally distributed among cholinergic and nitrergic MEN. Defunctionalizing the sensory extrinsic afferents led to a significant drop in the number of MEN in both regions.
CONCLUSION
We provided evidence for MEN in the gastric fundus and antrum and further investigated mechanoreceptors. However, the proportions of the chemical phenotypes of the MEN differed significantly between both regions. Further investigations of synaptic connections of MEN are crucial to understand the hardwired neuronal circuits in the stomach.
Topics: Guinea Pigs; Humans; Animals; Gastric Fundus; Neurons; Stomach; Intestine, Small; Cholinergic Agents; Pyloric Antrum
PubMed: 37702071
DOI: 10.1111/nmo.14674 -
Annual International Conference of the... Jul 2020Interstitial Cells of Cajal (ICC) are specialized pacemaker cells that generate and actively propagate electrophysiological events called slow waves. Slow waves regulate...
Interstitial Cells of Cajal (ICC) are specialized pacemaker cells that generate and actively propagate electrophysiological events called slow waves. Slow waves regulate the motility of the gastrointestinal tract necessary for digesting food. Degradation in the ICC network structure has been qualitatively associated to several gastrointestinal motility disorders. ICC network structure can be obtained using confocal microscopy, but the current limitations in imaging and segmentation techniques have hindered an accurate representation of the networks. In this study, supervised machine learning techniques were applied to extract the ICC networks from 3D confocal microscopy images. The results showed that the Fast Random Forest classification method using Trainable WEKA Segmentation outperformed the Decision Table and Naïve Bayes classification methods in sensitivity, accuracy, and F-measure. Using the Fast Random Forest classifier, 12 gastric antrum tissue blocks were segmented and variations in ICC network thickness, density and process width were quantified for the myenteric plexus ICC network (the primary pacemakers). Our findings demonstrated regional variation in ICC network density and thickness along the circumferential and longitudinal axis of the mouse antrum. An inverse relationship was observed in the distal and proximal antrum for density (proximal: 9.8±4.0% vs distal: 7.6±4.6%) and thickness (proximal: 15±3 μm vs distal: 24±10 μm). Limited variation in ICC process width was observed throughout the antrum (5±1 μm).Clinical Relevance- Detailed quantification of regional ICC structural properties will provide insights into the relationship between ICC structure, slow waves and resultant gut motility. This will improve techniques for the diagnosis and treatment of functional GI motility disorders.
Topics: Animals; Bayes Theorem; Interstitial Cells of Cajal; Mice; Pyloric Antrum; Supervised Machine Learning
PubMed: 33018253
DOI: 10.1109/EMBC44109.2020.9176445 -
Neurogastroenterology and Motility Dec 2022To investigate the effects of simo decoction (SMD) on the gastric motility of diabetic rats.
BACKGROUND
To investigate the effects of simo decoction (SMD) on the gastric motility of diabetic rats.
METHODS
Diabetic rats were gavaged with various doses of SMD (0.15, 1.5, and 3.0 ml/kg/d) or saline, and their blood glucose levels and body weight were monitored. Gastric emptying and antral motility were assessed by phenol red retention and contractions of antral strips, respectively. The levels of substance P (SP), vasoactive intestinal peptide (VIP), and neurogenic nitric oxide synthase (nNOS) in the gastric antrum were determined by real-time polymerase chain reaction and Western blot.
RESULTS
Gastric emptying was delayed in diabetic rats (p < 0.01 vs. non-diabetic controls) but accelerated after SMD administration (p < 0.01). The contractions of antral strips were reduced in diabetic rats (p < 0.01 vs. non-diabetic controls) but improved after SMD intervention (p < 0.05). The mRNA expressions of SP, VIP, and nNOS in diabetic rats were downregulated compared with non-diabetic controls (all p < 0.01). Simo decoction treatment did not affect the expression of these factors in diabetic rats. The protein levels of SP, VIP, and nNOS in diabetic rats were decreased (p < 0.01), increased (p < 0.01), and comparable (p > 0.05), respectively, in comparison with non-diabetic controls. Simo decoction administration increased SP protein expression (p < 0.01) and decreased the levels of VIP (p < 0.01) and nNOS (p < 0.01) in diabetic rats.
CONCLUSIONS
Simo decoction improved gastric dysmotility of diabetic rats possibly by upregulating SP and downregulating VIP and nNOS.
Topics: Rats; Animals; Diabetes Mellitus, Experimental; Rats, Sprague-Dawley; Drugs, Chinese Herbal; Pyloric Antrum; Gastric Emptying; Vasoactive Intestinal Peptide; Substance P
PubMed: 36111645
DOI: 10.1111/nmo.14450 -
Neurogastroenterology and Motility May 2020Enteric nervous system (ENS) abnormalities have been implicated in delayed gastric emptying but studies exploring potential treatment options are limited by the lack of...
BACKGROUND
Enteric nervous system (ENS) abnormalities have been implicated in delayed gastric emptying but studies exploring potential treatment options are limited by the lack of an experimental animal model. We examined the ENS abnormalities in the mouse stomach associated with aging, developed a novel model of gastroparesis, and established a new approach to measure gastric emptying.
METHODS
A modified gastric emptying assay was developed, validated in nNOS mice, and tested in mice at multiple ages. Age-related changes in ENS structure were analyzed by immunohistochemistry. Gastric aganglionosis was generated in Wnt1-iDTR mice using focal administration of diphtheria toxin (DT) into the anterior antral wall.
KEY RESULTS
Older mice (>5 months) exhibit hypoganglionosis in the gastric antrum and a decreased proportion of nNOS neurons as compared to younger mice (age 5-7 weeks). This was associated with a significant age-dependent decrease in liquid and solid gastric emptying. A novel model of gastric antrum hypoganglionosis was established using neural crest-specific expression of diphtheria toxin receptor. In this model, a significant reduction in liquid and solid gastric emptying is observed.
CONCLUSIONS & INFERENCES
Older mice exhibit delayed gastric emptying associated with hypoganglionosis and a reduction in nNOS-expressing neurons in the antrum. The causal relationship between antral hypoganglionosis and delayed gastric emptying was verified using a novel experimental model of ENS ablation. This study provides new information regarding the pathogenesis of delayed gastric emptying and provides a robust model system to study this disease and develop novel treatments.
Topics: Aging; Animals; Disease Models, Animal; Enteric Nervous System; Female; Gastric Emptying; Gastroparesis; Male; Mice, Inbred C57BL; Mice, Knockout; Neurons; Nitric Oxide Synthase Type I; Pyloric Antrum
PubMed: 31773831
DOI: 10.1111/nmo.13766 -
Journal of Muscle Research and Cell... Jun 2021Coordinated gastric smooth muscle contraction is critical for proper digestion and is adversely affected by a number of gastric motility disorders. In this study we...
Coordinated gastric smooth muscle contraction is critical for proper digestion and is adversely affected by a number of gastric motility disorders. In this study we report that the secreted protein Mfge8 (milk fat globule-EGF factor 8) inhibits the contractile responses of human gastric antrum muscles to cholinergic stimuli by reducing the inhibitory phosphorylation of the MYPT1 (myosin phosphatase-targeting subunit (1) subunit of MLCP (myosin light chain phosphatase), resulting in reduced LC20 (smooth muscle myosin regulatory light chain (2) phosphorylation. Mfge8 reduced the agonist-induced increase in the F-actin/G-actin ratios of β-actin and γ-actin1. We show that endogenous Mfge8 is bound to its receptor, α8β1 integrin, in human gastric antrum muscles, suggesting that human gastric antrum muscle mechanical responses are regulated by Mfge8. The regulation of gastric antrum smooth muscles by Mfge8 and α8 integrin functions as a brake on gastric antrum mechanical activities. Further studies of the role of Mfge8 and α8 integrin in regulating gastric antrum function will likely reveal additional novel aspects of gastric smooth muscle motility mechanisms.
Topics: Antigens, Surface; Humans; Milk Proteins; Muscle Contraction; Muscle, Smooth; Myosin Light Chains; Myosin-Light-Chain Phosphatase; Phosphorylation; Pyloric Antrum
PubMed: 34085177
DOI: 10.1007/s10974-021-09604-y