Endoscopic Removal of an Eroded LINX® Device Using a Mechanical Biliary Lithotriptor

Background: Magnetic sphincter augmentation (MSA) via the surgical placement of a LINX® device (LINX® Reflux Management System, Torax Medical, Shoreview, MN, USA) is an increasingly performed minimally invasive outpatient anti-reflux procedure with a low erosion rate. The most common initial approach to eroded LINX® devices is endoscopic removal. Often endoscopy centers do not have specialized devices to cut through the newer, more durable LINX® systems. In this paper we describe a unique approach for removal of a LINX® with intraluminal erosion using a commonly stocked mechanical biliary lithotripsy device. Case description: A 63-year-old male with a history of GERD and symptomatic type III paraesophageal hernia (PEH) underwent a robotic PEH repair with magnetic sphincter augmentation (1.5T, 17 bead) at an outside hospital. He developed an acute recurrence of his PEH, and subsequent upper endoscopy and contrast esophagram four weeks postoperatively revealed a gastric erosion of the LINX device, which had migrated 6 cm onto the stomach. Attempted endoscopic LINX® removal using the OVESCO remove DC Cutter device was unsuccessful. Using principles of prior endoscopic bariatric lap band foreign body removal, the entire LINX® device was successfully removed with the described biliary lithotriptor technique. Conclusion: Using a common biliary mechanical lithotriptor device and a guidewire to transect the newer 1.5T LINX® Reflux Management System is a safe, effective and familiar technique for endoscopic removal of an eroded MSA device.

Endoscopic Evaluation of Dyspeptic Patient in Tertiary Care Hospital

Objectives: To observe the organic change occurs in dyspeptic patient by upper gastrointestinal endoscopy. Methods: The present prospective, observational, cross-sectional study was conducted at Medicine and Gastroenterology department of Sir Salimullah Medical College & Mitford Hospital, over a period of 6 month from 2019 to 2020.The study population was 200with aged18 years and above, irrespective of sex and who were suffering from dyspeptic symptoms for at least 6 months duration. Data regarding the demographic profile of study population nand endoscopic findings were processed and analyzed using software SPSS (Statistical Package for social science) version 26. Results: It was observed that most of the dyspeptic patients 71%were showing normal endoscopic findings and 29% have abnormal endoscopy findingwhere majority of the patient were 51 – 70 years of age.Out of them 41% of male and 26% of female had organic changes. It was also found that 46% of the patients were smoker and among them 34(37%) had abnormal endoscopic finding where 24(22%) non-smokerpatient had abnormal finding, which were statistically significant (p,0.05) between two group. Among abnormal endoscopic finding, 11% gastric erosions, 08% gastric ulcer, 04% duodenal erosions, 03% duodenal ulcer, 02% reflux oesophagitis, and carcinoma stomach rare 01%. Conclusion: The study concludes that majority of patients with complaints of dyspepsia have no organic lesion and can be considered non ulcer dyspepsia. The common abnormal endoscopic findings included gastric erosion and gastric ulcers relating to dyspepsia. The study findings also suggest that smoking is a risk factor for developing organic changes in dyspeptic patients specially in middle age group. Bangladesh J Medicine July 2022; 33(1) : 3-7

The Protective Effect of Dapsone Against Ethanol, Stress, and Indomethacin-Induced Gastric Erosion in Rats

Several factors contribute to the development of gastric erosions, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and stress. These factors can cause or worsen gastrointestinal ulcers by activating inflammatory pathways or by altering gastric mucosal blood flow. Dapsone is an antimicrobial compound with anti-inflammatory properties. The aim of this study was to evaluate the protective effects of dapsone against gastric erosions induced by alcohol, stress, or indomethacin. Gastric damage was induced in male rats in three different experimental models: ethanol (5 ml/kg, p.o.)-, water-immersion stress-, and indomethacin (30 mg/kg, p.o.)- induced ulcer. Rats in each of these three experimental models were divided into five groups: Normal group, 2. Control group (gastric damage+vehicle), 3. Gastric damage+dapsone 1 mg/kg, 4. Gastric damage+dapsone 3 mg/kg, 5. Gastric damage+dapsone 10 mg/kg. In this study, the J- score ulcer index and histopathological assessment were performed. In addition, inflammatory cytokines levels, NF-κB expression, and MPO activity were determined. Dapsone reduced the tissue injuries and erosion area in all three experimental groups compared to the control group. In addition, serum levels of inflammatory cytokines, TNF-alpha, and IL-1β were reduced in the dapsone treatment groups. The expression of NF-κB and tissue concentration of myeloperoxidase (a marker of neutrophil activation) was also reduced in rats given dapsone. To conclude, dapsone exhibits significant protective effects against the development of experimental gastric erosions in rats, and these effects seem to be related to its anti-inflammatory and antioxidant properties.

Effect of a Cytoprotective Dose of Dehydroleucodine, Xanthatin, and 3-Benzyloxymethyl-5H-furan-2-one on Gastric Mucosal Lesions Induced by Mast Cell Activation

The aim of this study was to determine whether the lactones dehydroleucodine, xanthatin and 3-benzyloxymethyl-5H-furan-2-one, would be effective in an animal model of gastric ulcer induced by mast cell activation. Rats were divided into ten groups. Treatments were repeated for four days. The degree of gastric erosion was assessed with a scoring system and histological preparations. Gastric mast cell morphology was analyzed by histological procedures. Serum serotonin levels were determined as markers of mast cell activation. Statistical analyses were done using ANOVA and Tukey–Kramer test. We demonstrated that the repeated administration of compound 48/80 results in extensive mucosal lesions in the gastric mucosa and that such lesions occurred in association with mast cell degranulation and a significant increase of serum serotonin. We showed that these lesions were prevented by dehydroleucodine, xanthatin, and 3-benzyloxymethyl-5H-furan-2-one and that this effect was similar to that obtained with sodium cromoglycate. In conclusion, the results of the present study indicate that the optimal gastric cytoprotective dose of dehydroleucodine, xanthatin, and 3-benzyloxymethyl-5H-furan-2-one is efficacious in an animal model of gastric ulcer induced by mast cell activation. Our findings suggest that these lactones could be valuable tools for designing novel therapeutic agents for digestive disorders associated with inappropriate mast cell activation.

Motor function of the gastrointestinal tract in gastric erosions

The aim is to study motor disorders of the gastrointestinal tract and biliary tract with erosion of the stomach. Materials and methods. Electromyography (EMG) of the gastrointestinal tract and biliary tract was performed in 35 patients with gastric erosions; the control group consisted of 10 patients with gastric ulcer. A morphological study of biopsies of the antrum of the stomach was carried out. Results. Patients with erosion of the stomach were characterized by severe hypermotor dyskinesia of the stomach with a decrease in the motor function of the small intestine and multidirectional changes in the motor function of the colon. Motility of the biliary tract is characterized by an increase in tonic activity with a slight increase in phase activity. Histological examination revealed areas of fibrinoid necrosis in its own plate and foci of destruction of the end sections of the pyloric glands. Conclusion. Motor function of patients with gastric erosion is characterized by a greater power of muscle contractions of the stomach, a smaller power of muscle contractions of the small intestine and multidirectional changes of the power contractions of various sections of the colon.

Study of Endoscopic Findings in First Episode of Upper Gastrointestinal Bleeding

Background and Aims: Upper gastrointestinal bleeding (UGIB) is one of the most common and grave emergencies encountered in Emergency department in Tertiary health care centre in our country. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding. The aim of this study is to assess the endoscopic findings in patients presenting with first episode of UGIB. Methods: This was a hospital based cross sectional study of patients with haematemesis, melena or both who underwent UGI endoscopy at Bir Hospital during January 2019 to January 2020. Patient demographics, site and nature of lesions and risk factors for bleeding were analyzed. Results: Among 72 enrolled patients 48 (66.67 %) were male and 24 (33.3 %) were female. Haematemesis 27% was the most common presenting complain followed by melena 25.5% and fainting/ dizziness 22.5%. Endoscopy was done in all cases and gastric ulcer disease 27.8% was the commonest cause of first episode of UGI bleeding followed by variceal bleeding, gastric erosion and duodenal ulcer, 25%, 16.7%, 12.5% respectively. Conclusions: Peptic ulcer disease was the most common cause of first episode of UGI bleeding in our context. Among peptic ulcer diseases gastric ulcer was more common than duodenal ulcer. Haematemesis and melena were the commonest clinical presentation of UGI bleeding.

Gastric metastasis from pancreatic cancer characterized by mucosal erosion: a case report and literature review

Pancreatic cancer with gastrointestinal tract metastasis is a fairly rare occurrence, and gastric metastasis in such cases has been seldom reported. We herein present a case of gastric involvement secondary to pancreatic cancer in a 74-year-old woman in whom the metastatic lesion only presented as mucosal erosion in the stomach. The patient had a 1-month history of progressive right upper quadrant pain before admission. Computed tomography and endoscopic examinations revealed a solid and hypo-enhancing mass in the head of the pancreas. The patient underwent conventional upper endoscopy before pancreatic biopsy, and mucosal erosion was observed in the gastric pylorus. We obtained gastric and pancreatic biopsies by gastroscopy and endoscopic ultrasound-guided fine needle aspiration, respectively. Pathologically, the biopsies taken from the area of gastric erosion showed poorly differentiated invasive adenocarcinoma that was morphologically consistent with the pancreatic specimens. Moreover, the gastric section showed tumor thrombi within the vessels. Hence, the suspected diagnosis was unresectable pancreatic cancer with gastric metastasis. The patient immediately underwent two courses of chemotherapy, but her condition rapidly deteriorated and she died 2 months later.

Dapsone Attenuates the Severity of Gastric Erosion Induced by Ethanol; Stress; and Indomethacin in Rats: A Pharmacological Approach

Background: Dapsone, as an antimicrobial compound, has shown strong anti-inflammatory properties in clinical and experimental studies. Inflammation in stomach mocusa produce gastric erosion. Several factors contribute to the development of gastric erosions, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and stress. The aim of this study, therefore, was to evaluate the effects of dapsone against gastric erosions-induced by alcohol, stress, or indomethacin in rat.Methods: Gastric damage was induced in male rats in different three experimental models including ethanol (5 ml/kg, p.o.)-, water-immersion stress-, and indomethacin (30 mg/kg, p.o.)- induced gastric injury. Macroscopic lesion scores (the J- score), inflammatory cytokines levels, NF-κB protein expression, MPO activity, and histopathological evaluation were assessed. Results: Induction of erosion in gastric mocusal led to a significant increase in J-score as an index of macroscopic parameter, tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) as biochemical markers, NF-κB and myeloperoxidase (a marker of neutrophil activation, as well microscopic deterioration. Dapsone reduced the tissue injuries and erosion area, serum levels of inflammatory cytokines, the expression of NF-κB and tissue concentration of myeloperoxidase (a marker of neutrophil activation) in all three experimental groups. Furthermore, the histopathological studies revealed the reduction of damages in dapsone treated animals.Conclusions: To conclude, dapsone exhibits significant gastro-protective effects against the development of experimental gastric erosions in rats which seems to be related to its anti-inflammatory properties.