[Abscess formation due to lost stones during laparoscopic cholecystectomy].
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Abdominal Abscess↗
Biomedical subjects
R J L F Loffeld
Publications and source records attributed to R J L F Loffeld.
Reflux esophagitis in patients with partial gastrectomy and Billroth I or II reconstruction.
BACKGROUND: Data on the occurrence of reflux esophagitis and Barrett's esophagus in patients with Billroth I or II resection is sparse. For this reason a cross-sectional study was done in order to assess reflux disease in Billroth resection. METHODS: Consecutive patients were included in the study. Coincidental pathology (hiatus hernia, ulcer, esophagitis, and cancer) was noted. RESULTS: Over a period of 12 years, 370 consecutive patients with a partial gastrectomy were seen (268 Billroth II, 102 Billroth I) and three groups of patients were identified. Group 1 included 64 patients (17%) with a hiatus hernia; group 2, 16 patients (4%) with reflux esophagitis; and group 3, 290 patients (78%) with only a Billroth resection. Reflux disease occurred significantly more often in men than in women (7.5% vs. 2%, p<0.05). There was no difference in type of resection or in the presence of reflux esophagitis. Four patients had an esophageal cancer (only one adenocarcinoma). CONCLUSION: Only a minority of patients with partial gastrectomy has signs of esophagitis in the long term.
Journal Article↗
Gastro-oesophageal reflux disease--experience in daily practice: symptoms and symptom assessment.
Gastro-oesophageal reflux disease is one of the most common medical problems in daily practice, with many guidelines on diagnosis and treatment available. The prevalence and incidence of reflux disease are rising. In a period of 10 years, the incidence of reflux oesophagitis has almost doubled, as has the number of pills and tablets of acid-suppressive therapy sold. The decreased number of patients with severe reflux oesophagitis is indicative of increased public awareness. Heartburn and regurgitation are the hallmarks of reflux disease. The symptom score in patients with the mild reflux oesophagitis is significantly higher than it is in patients presenting with severe oesophagitis, NERD or Barrett's oesophagus. Patients with mild oesophagitis also suffer from more reflux. Dysphagia is often the only presenting symptom in severe oesophagitis. Patients with reflux oesophagitis have a significantly higher symptom score than patients with Barrett's oesophagus. The scores for heartburn and acid regurgitation are significantly higher in reflux oesophagitis. The primary goal of treatment is complete clinical remission and prevention of long-term complications. In a study with a follow-up of 4.5 to 7.5 years in patients with reflux oesophagitis it was shown that 85% still used acid-suppressive therapy, mostly on a daily basis. However, the majority were never completely free of reflux. Despite the fact that the degree of reflux oesophagitis correlates with the risk of relapse, also patients in whom initially the most severe grade of reflux oesophagitis (grades III and IV) was diagnosed no longer use medication. Treatment of reflux disease with acid suppressants is a major component in national and international drug budgets, and health-care authorities and insurance companies are eager to reduce these budgets. Since diagnosis and treatment are already discussed in many guidelines, cut-backs could be achieved in patients on maintenance therapy. For this reason, more data have to be assessed on therapy outcome in cases of chronic maintenance therapy. Guidelines for maintenance or on-demand therapy are necessary.
Gastroesophageal Reflux↗
Fatal aspiration of polyethylene glycol solution.
Endoscopy of the colon requires adequate cleansing of the entire bowel. Several laxative regimens have been propagated, but bowel preparation with polyethylene glycol (PEG) solution is popular because of the easy application and good cleansing results. Although very safe in daily use, complications of this bowel-cleansing procedure have been reported and aspiration of the PEG solution is a possible and serious hazard. A case report is presented of a patient who aspirated the PEG solution and ultimately died because of respiratory failure.
Aged, 80 and over↗
Multiple cysts in the liver autosomal dominant polycystic liver disease.
A 45-year-old woman was admitted because of abdominal pain and a feeling of fullness. Ultrasound and CT scan of the abdomen showed a massively enlarged liver with hundreds of cysts and displacement of the right kidney. There were no cysts in the kidneys. Because several members of her family also had multiple cysts in the liver, the diagnosis of autosomal dominant polycystic liver disease (PCLD) was made. Genetic analysis demonstrated a protein kinase C substrate 80 K-H (PR KCSH) gene mutation (1338-2A>G) and confirmed the clinical diagnosis. A brief review of the genetics and possible treatments is given.
Calcium-Binding Proteins↗
The consequences of lost gallstones during laparoscopic cholecystectomy.
Laparoscopic cholecystectomy has become the preferred surgical technique for symptomatic gallstone disease. The technique generally is safe. probably one of the most common intra-operative complications is gallbladder perforation with stones spreading into the peritoneal cavity. In this paper the sequelae of lost gallstones after laparoscopic cholecystectomy and the diagnostic problems facing the clinician are reviewed. Abscesses and fistula formation in the abdominal wall occur. A long delay can be present between the initial operation and the complications of the lost stones. Although rupture of the gallbladder is usually noticed during preparation and retrieval, the surgeon may not be aware of losing stones. due to the long delay, the occurrence of intra-abdominal abscesses and fistula is often not linked to the prior procedure.
Cholecystectomy, Laparoscopic↗
[Guideline "Dyspepsia"].
For the management of patients with dyspepsia a multidisciplinary working party has made recommendations, i.e. about indications for prompt endoscopy, the management of dyspeptic complaints of recent onset, the application of diagnostic tests and treatment of recurrent dyspepsia and the indications for long term use of acid suppressants. Endoscopy is indicated in every patient with alarm symptoms, i.e. blood loss, dysphagia, weight loss or anemia in combination with dyspepsia. Age alone is not a decisive factor in this. Given the good prognosis of recent onset dyspepsia, the application of diagnostic tests is generally not required. Treatment should be restricted to antacids or H2 receptor antagonists. Only in case of persistent or recurring complaints, diagnostic tests or another treatment (Helitobacter pylori diagnostic tests, empirical treatment or endoscopy) should be considered. Testing for H. pylori is especially effective in patients at risk for peptic ulcer disease: those with recurrent complaints, and those with a history of peptic ulcer, without typical reflux symptoms or those with a history ofpeptic ulcer. Short term empirical treatment with a proton pump inhibitor is especially effective in patients with typical reflux symptoms. Endoscopy is the only way to rule out malignancy, and should be used to solve serious diagnostic uncertainty in patient or physician. The only indication for continuous proton pump inhibitor treatment is severe oesophagitis. All other patients with less severe reflux disease should preferably be treated on either on demand or intermittent basis. Long term proton pump inhibitor treatment is not indicated for patients with peptic ulcer disease or functional dyspepsia.
Antacids↗
The annual yield of diagnostic endoscopy of the lower digestive tract.
BACKGROUND: Endoscopy of the colon and rectum has become a standard diagnostic procedure. No data are presented in the literature on the annual yield or on morbidity patterns. A large, cross-sectional, single-center study was done in order to detect the annual yield of endoscopy of the colon and rectum. METHODS: All consecutive endoscopies performed over an 11-year period were included. All files from a random year were taken in order to collect data on the indication for the endoscopy. A standardized endoscopy report was used. RESULTS: Over the 11-year period, 11,550 consecutive endoscopies of the lower digestive tract were performed. Seven hundred and fourteen procedures were excluded because they were done as a direct follow-up after the index procedure. The majority of endoscopies were scheduled as colonoscopy. The most common endoscopic diagnoses made each year remained constant in number. Cancer was diagnosed in 4-6% of cases, inflammation in 9-15%, polyps in 9-16%, and diverticular disease in 21-37%. The percentage of women undergoing the procedure each year ranged from 54% to 59%, that of men from 41% to 46%. CONCLUSION: From this study it can be concluded that the annual yield of endoscopy of the lower digestive tract remains rather constant. No major changes in morbidity are noted.
Journal Article↗
Diverticulosis of the colon is rare amongst immigrants living in the Zaanstreek region in the Netherlands.
BACKGROUND: Data on prevalence of diverticulosis related to ethnicity or race in the Western world are very sparse. A cross-sectional study was done in patients undergoing endoscopy of the colon in order to assess the prevalence of diverticulosis and relate the presence to ethnicity. METHODS: An analysis was undertaken of the endoscopy reports from all consecutive patients undergoing endoscopy of the colon. As a reference group all patients in whom no abnormalities were detected were used. In the Zaanstreek region a large population of immigrants, mostly of Turkish descent, is present. These immigrants were studied separately. RESULTS: In a period of 12 years 3004 patients were diagnosed with diverticulosis. Of these 2975 were authentic Dutch. The remainder 29 patients were immigrants. Diverticulosis was diagnosed significantly more often in immigrant men (P < 0.0001). Immigrants with diverticulosis were significantly younger than the authentic Dutch, P < 0.001. There was no major difference in representation of immigrants with diverticular disease in different age cohorts. The reference group consisted of 3356 patients. In this group 2998 patients were authentic Dutch, while 358 patients were immigrants. There was no difference in numbers of men and women amongst the immigrants. Of the patients with a normal colon and rectum 11% is immigrant. In the group of patients with diverticulosis only 0.9% was immigrant. CONCLUSION: This study clearly shows that prevalence of diverticular disease is very low in immigrants. The majority of these immigrants are of Turkish descent. In addition, the majority of immigrants with diverticulosis was male.
Adult↗
Cytokeratin phenotyping does not help in distinguishing oesophageal adenocarcinoma from cancer of the gastric cardia.
BACKGROUND: It is sometimes difficult to distinguish between cardia cancer and oesophageal cancer. AIMS: To evaluate whether cytokeratin (CK) expression of the tumour can be of value in differentiating between the two tumour types. METHODS: Consecutive patients with a malignant tumour in the oesophagus or stomach were recruited. Biopsy specimens were taken for routine haematoxylin and eosin staining. One tissue block with representative tissue was selected for immunohistochemical staining (CK7 and CK20). RESULTS: Endoscopically located adenocarcinoma of the oesophagus was present in 84 patients (64 men, 20 women; mean age, 68 years; range, 44-91). Cancer located primarily in the gastric cardia was present in 63 patients (42 men, 21 women; mean age, 68 years; range, 42-88). The histological diagnosis was metastasis from a primary tumour outside the oesophagus or stomach in 19 patients. The patients were divided into three groups for the immunohistochemical analysis. Patients in group A had definite oesophageal cancer, group B patients had a definite carcinoma located in the gastric cardia, and group C patients had an obstructing tumour distal in the oesophagus at the level of the diaphragm, which could not be passed with the endoscope. Paraffin wax embedded material was available from 122 patients for immunostaining and CK analysis. There was no significant difference in expression or distribution of CK7 or CK20 in the three groups of patients. CONCLUSION: CK phenotyping cannot distinguish between cancer arising from a Barrett's oesophagus and carcinoma originating in the gastric cardia.
Adenocarcinoma↗
Helicobacter pylori, obesity and gastro-oesophageal reflux disease. Is there a relation? A personal view.
The incidence and prevalence of gastro-oesophageal reflux disease is rising. Changing dietary habits and increasing body weight can be held responsible. In several studies a close relation was found between body weight and the occurrence of reflux disease. It may be concluded that there is a definite relation between body mass index and the occurrence of reflux disease. H. pylori probably also plays a role. H. pylori causes changes in fundic leptin levels and plasma levels of ghrelin. Eradication of H. pylori infection can increase appetite leading to a rise in body mass index due to a higher caloric intake. H. pylori can be a 'protective' factor against the development of overweight. Since only a minority of overweight or obese patients with gastro-oesophageal reflux disease will lose weight successfully, medical treatment with effective acid suppression will be the mainstay of the treatment of reflux disease in patients with a high body mass index.
Gastroesophageal Reflux↗
Case 2. Intracardiac metastasis from a Merkel cell carcinoma.
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Carcinoma, Merkel Cell↗
Prevalence of gastroesophageal reflux disease in immigrants living in the Zaanstreek region in the Netherlands.
Racial differences in the incidence of reflux disease are reported but data on differences in ethnicity are rare. A study was undertaken to assess the prevalence of reflux disease, defined as the presence of reflux esophagitis, in immigrants and correlate the results with native inhabitants living in the same region. Consecutive patients with hiatus hernia and defective lower esophageal sphincter closure as well as reflux esophagitis were included. A large population of people of Turkish descent and a small contingent of people from northern Africa and the Middle East were studied separately. Reflux disease was diagnosed in 4165 patients. One hundred and sixty-seven (4%) were of Turkish descent, and 26 (0.6%) originated from Africa and the Middle East. Reflux disease occurred significantly less often in immigrants, 24% versus 55.5% (P < 0.0001). There was no difference relating to gender in the presence of reflux disease in native Dutch patients, while the number of men in the immigrant group with the condition was significantly higher than women; 51% versus 72%, respectively (P < 0.0001). The majority of immigrants only suffered from mild reflux esophagitis (P < 0.001). Immigrants with reflux disease are significantly younger than native Dutch patients, mean age 42 years versus 57 years, respectively (P < 0.0001). Reflux disease is less prevalent in immigrants, mostly people of Turkish descent. If the condition is present in this population, the majority of patients is male and belongs to the younger age cohorts.
Adult↗
Helicobacter pylori and gastro-oesophageal reflux disease: a cross-sectional epidemiological study.
BACKGROUND: H. pylori infection is accompanied by a lower prevalence of reflux disease. There is still an ongoing debate as to whether H. pylori actually protects against the development of reflux oesophagitis or is merely an epiphenomenon. A cross-sectional study was performed to study the relation of H. pylori with reflux oesophagitis, hiatus hernia and Barrett's oesophagus. MATERIAL AND METHODS: Consecutive patients undergoing upper gastrointestinal endoscopy in a period of ten years were studied. Included were patients with active reflux oesophagitis and/or hiatus hernia and/or Barrett's oesophagus. As a reference group, patients without macroscopic abnormalities were included. H. pylori was detected applying routine diagnostic modalities. RESULTS: In the ten years 11,691 consecutive patients were studied. Reflux oesophagitis was seen in 1535 patients, 307 patients had Barrett's oesophagus and a hiatus hernia was present in 2116 patients. The reference group consisted of 5341 patients. H. pylori was significantly less often detected in patients with reflux oesophagitis or Barrett's oesophagus compared with the reference group, 20 vs 29% (p<0.001). Also presence of H. pylori was significantly lower in patients with hiatus hernia 20 vs 29% (p<0.0001). CONCLUSION: The present study confirms, in a very large group of patients studied in one single centre, the findings of earlier papers. Patients without H. pylori gastritis suffer more often from reflux disease. There is a relation between H. pylori and reflux disease. However, the consequence of this relation will not be the same in every patient.
Adult↗
Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy.
BACKGROUND: In the literature a lot of epidemiological data is present but little is known on the yearly incidence of oesophagitis and Barrett's oesophagus. For this reason a cross-sectional study was done to explore the yearly incidence of these conditions in patients sent for upper gastrointestinal endoscopy. METHODS: All patients diagnosed with reflux oesophagitis, Barrett's oesophagus or hiatus hernia in a 10-year period were included. RESULTS: In the period of 10 years 11,691 consecutive patients underwent endoscopic examination. Oesophagitis was diagnosed in 1,633 patients, Barrett's oesophagus in 275, and hiatus hernia without oesophagitis in 1,407 patients. The number of patients with oesophagitis almost doubled, while the number of patients with hiatus hernia or Barrett's oesophagus remained constant each year in this time period. The number of men diagnosed with oesophagitis or Barrett's oesophagus was significantly higher than the number of women. Hiatus hernia occurred significantly more often in women, and was present in 79-88% of patients with active reflux oesophagitis. CONCLUSION: This study clearly shows that the incidence of reflux oesophagitis shows a marked increase. The incidence doubled in a period of ten consecutive years. This data should be kept in mind in planning future health-care resources. It can be expected that the use of acid suppressive therapy will be rising in the years to come.
Barrett Esophagus↗
H. pylori and reflux esophagitis in Turkish patients living in the Zaanstreek region in the Netherlands.
There are data on the prevalence is of reflux esophagitis in a population with a high prevalence of H. pylori infection. A cross-sectional study was done in a Turkish population in The Netherlands. A total of 1640 consecutive patients with reflux esophagitis were included. Sixty-one patients were of Turkish descent. Reflux esophagitis occurred significantly more often in ethnically Dutchpeople (overall 33% vs. 9.7%, P < 0.001). H. pylori was present in 60.6% of Turkish patients and in 18.5% of Dutch patients. All Turkish patients only suffered from mild esophagitis. It is concluded that the occurrence of reflux esophagitis is low in a population of Turkish patients with a high prevalence of H. pylori.
Adult↗
Antibiotic resistance of Helicobacter pylori: a cross-sectional study in consecutive patients, and relation to ethnicity.
OBJECTIVES: To assess primary antibiotic resistance in a given population and relate the results to ethnicity. MATERIALS AND METHODS: Consecutive cultures were tested for antibiotic susceptibility with the Etest. Three populations were studied separately: ethnic Dutch people, patients of Turkish descent, and patients originating from Africa and the Middle East. RESULTS: Over a period of 5.5 years, 976 (32%) biopsy specimens from 3010 patients were positive for Helicobacter pylori. Metronidazole and clarithromycin resistance were present in 25.8% and 4.8% of the strains, respectively. The number of metronidazole-resistant strains showed a gradual decrease, while clarithromycin resistance showed a slight increase during the study period. Antimicrobial resistance in patients of Turkish descent and in those originating from Africa or the Middle East was significantly higher than in ethnic Dutch people, 35% and 9.1% versus 21% and 2.9%, respectively (P = 0.003 and P = 0.002). CONCLUSION: It is important to take ethnicity into account when studying antibiotic resistance. The numbers of metronidazole- and clarithromycin-resistant strains can vary considerably between people of different ethnic origin living in the same region.
Anti-Bacterial Agents↗
Changes in prevalence of Helicobacter pylori infection in two groups of patients undergoing endoscopy and living in the same region in the Netherlands.
BACKGROUND: There are few data on the prevalence of Helicobacter pylori in different populations and no data on changes in time. A cross-sectional study was done in a large population of patients undergoing endoscopy in order to relate the presence of H. pylori to ethnic background and to detect changes in time. METHODS: All consecutive patients over a 10-year period were included and biopsy specimens from the gastric antrum were taken for detection of H. pylori. A large population of immigrants living in the Zaanstreek region was studied separately. RESULTS: In the 10-year period, 14,909 consecutive diagnostic upper GI endoscopies were done in 11,691 consecutive patients. Only the first endoscopy done in a patient was included. Of 11,691 patients available for evaluation, there were 5669 men and 6022 women (mean age 55 years, range 4-99). Of these, 3201 (27.4%) were H. pylori-positive and 4988 (42.7%) were H. pylori-negative. No biopsy specimens were available for the remaining 3501 (29.9%) patients. In the group under study, 1309 (11%) patients were immigrants. H. pylori was present significantly more often in men and in immigrants, where prevalence was 75% versus 33% (P < 0.0001). The prevalence of H. pylori showed a marked decrease in both populations during the period of study. Extrapolating trend lines into the future indicates a prevalence of H. pylori below 10% by the year 2009. Among immigrants, this will be reached in approximately 2027. CONCLUSION: This study shows differences in prevalence of H. pylori in different populations. We found a decreasing prevalence that can be explained by the lower acquisition rate of the infection. It is important to be aware of the differences in prevalence of H. pylori in a population composed of different ethnicities.
Adolescent↗