- Email: [email protected]
(079). Gastroesophageal reflux and chronic gastric volvulus: Three case reports
AB38
Gastro-oesophageal reflux disease / Arab Journal of Gastroenterology 10 (2009) AB36–AB44
t-tests for continuous variables while categorical variables were assessed using chi-square tests for equal proportion. p < 0.05 was considered as statistically significant. Results: Two hundred and fifty-two patients were included. One hundred and thirty-seven patients (54.4%) were included in group 1 (with esophagitis). There were more males (84 males) in group 1 than in group 2 (47 patients) (p = 0.01). The mean age was greater in group 1 than in group 2: 54.70 versus 44.90 years (p = 0.41). Alcohol (36 versus 13 patients) and tobacco (14 versus 4 patients) were more taken in group 1 (p = 0.003). ORL manifestations were significantly more present in group 1: 7 patients versus 2 patients in group 2 (p = 0.01). hiatal hernia was more frequently associated with esophagitis: 66 patients in group1 versus 34 patients in group 2 (p = 0.05). Improvement in symptoms and endoscopic lesions was more frequently observed in group 1. Conclusions: Erosive esophagitis was more frequent in males, in older patients, when there was a hiatal hernia and improvement was more rapidly get in this population. doi:10.1016/j.ajg.2009.07.152
(078)
Nutcracker esophagus and gastro-esophageal reflux association R. Goubraim, I. Serraj, L. Amrani, M. Nya, N. Amrani EFD-Hepatogastroenterology Unit, Ibn Sina University Hospital, Rabat, Morocco
Background: The association of gastro-esophageal reflux disease (GERD) and nutcracker esophagus is rare. Angina-like chest pain could be a manifestation of both pathologies. The role of acid reflux in the development of chest pain in patients with nutcracker esophagus is controversed. We report two cases of nutcracker esophagus associated with GERD. Case reports: Case report 1: A 40 year-old woman presented angina-like chest pain and dysphagia. Cardiologic assessment and gastroscopy were normal. Twenty-four hours esophageal pH monitoring revealed pathologic reflux. In spite of proton-pump inhibitors (PPI), chest pain persists and esophageal manometry was performed. It showed nutcracker esophagus. Case report 2: A 56 year-old woman was admitted for precordialgia. She underwent coronary angioplasty for ischemic cardiopathy one year before. Cardiologic exams were normal. Twenty-four hours esophageal pH monitoring revealed pathological reflux with significant association between symptoms and reflux episodes. She received PPI without clinical improvement. Esophageal manometry revealed nutcracker esophagus. Discussion and conclusion: Twenty-four hours esophageal pH monitoring coupled to symptom index study should be performed in patients presenting non-cardiac chest pain. GERD can explain this symptom. If symptoms persist under antireflux treatment, an esophageal manometry should be done to search motility disorders. Nutcracker esophagus is the most commonly found manometric abnormality. Treatment of this association is difficult. It is based on high dose of PPI. Efficiency of calcium channel blockers and nitrates is controversed. doi:10.1016/j.ajg.2009.07.153
(079)
Gastroesophageal reflux and chronic gastric volvulus: Three case reports I. Atitar, M. Raiss, F. Raissouni, A. Hrora, M. Ahallat Surgical Clinic ‘‘C’’, Ibn Sina Hospital, Rabat, Morocco
Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. There is acute volvulus which is a surgical emergency and chronic volvulus characterized by non specific symptoms as symptomatic gastroesophageal reflux (GER). The aim of this communication is to underline the interest to explore simple symptoms as GER in order to diagnose one of most diagnosis emergency and surgical challenge: gastric volvulus. Case reports: Case report no. 1: A 60 year-old woman, with 7 months history of symptomatic GER and post-prandial vomiting. Clinical examination was normal. Upper endoscopy revealed a normal oesophageal mucosa and stomach was impossible to explore (torsion?). The gastroesophageal contrast opacification (GECO) showed intra-thoracic gastric volvulus. The patient had a laparoscopic treatment of the hernia associated to diaphragmatic evisceration’s refection. The control 6 months after the surgery showed a clinical improvement. Case report no. 2: A 65 year-old woman, admitted for GER, pyrosis, post prandial vomiting. Clinical examination was normal. Upper endoscopy showed a large hiatal hernia (HH). A GECO and thoracoabdominal computed tomography scan revealed mixed HH and an intra-thoracic stomach. The patient was treated by laparoscopic repear. The clinical and radiological control 6th months after surgery were normal. Case report no. 3: A 60 year-old woman, presents since 12 years GER, heartburn, and regurgitation. Clinical examination was normal. GECO showed a large para-hiatal hernia and gastric volvulus. The patient had a laparoscopic repear of her hernia. The clinical control 6 months after surgery showed the persistence of symptoms. GEOC control revealed the presence of stomach into abdominal cavity and the persistence of a sliding HH. The patient received proton pump inhibitors with clinical improvement 1 month later. Discussion and conclusion: Chronic gastric volvulus is characterized by non specific symptoms dominated by post-prandial abdominal pain and symptomatic GER; such as the case of our 3 patients. It is a diagnosis emergency and therapeutic challenge because it may transform on acute form and may lead to gastric strangulation with a risk of ischemia and necrosis. The most common causes of gastric volvulus are diaphragmatic abnormalities as hiatal hernia and diaphragmatic evisceration. The diagnosis is suspected when chest X-ray shows high air-fluid level in the chest, and it is confirmed by GEOC and computed tomography scan. Gastric volvulus requires surgical treatment, mainly by laparoscopic approach. It includes specifically volvulus reduction, reintegration of the stomach into the abdominal cavity in cases of intra-thoracic migration, and correction of causal factors. Chronic gastric volvulus is a rare entity. It is a diagnosis and therapeutic emergency and requires clinical and radiological exploration of some seemingly simple symptoms as GER. doi:10.1016/j.ajg.2009.07.154
(080)
Surgical approach of Barrett’s adenocarcinoma H.O. El Malki a,b, M. Chenna a, B. Serji a, O. Mouaquit a, R. Mohsine a, L. Ifrine a, A. Belkouchi a a Clinique Chirurgicale ‘‘A’’, Hôpital Ibn Sina, Université Mohammed V Souissi, Rabat, Morocco b Centre de Recherche en Epidémiologie Clinique et Essais Thérapeutiques, Faculté de Médecine et de Pharmacie de Rabat, Morocco
Introduction: The incidence of adenocarcinoma arising from Barrett’s oesophagus is dramatically increasing. The purpose of this retrospective study was to report our experience in the surgical management of these patients. Methods: Between January 1990 and December 2003, 13 patients with adenocarcinoma on Barrett’s oesophagus were observed. There
Gastro-oesophageal reflux disease / Arab Journal of Gastroenterology 10 (2009) AB36–AB44
t-tests for continuous variables while categorical variables were assessed using chi-square tests for equal proportion. p < 0.05 was considered as statistically significant. Results: Two hundred and fifty-two patients were included. One hundred and thirty-seven patients (54.4%) were included in group 1 (with esophagitis). There were more males (84 males) in group 1 than in group 2 (47 patients) (p = 0.01). The mean age was greater in group 1 than in group 2: 54.70 versus 44.90 years (p = 0.41). Alcohol (36 versus 13 patients) and tobacco (14 versus 4 patients) were more taken in group 1 (p = 0.003). ORL manifestations were significantly more present in group 1: 7 patients versus 2 patients in group 2 (p = 0.01). hiatal hernia was more frequently associated with esophagitis: 66 patients in group1 versus 34 patients in group 2 (p = 0.05). Improvement in symptoms and endoscopic lesions was more frequently observed in group 1. Conclusions: Erosive esophagitis was more frequent in males, in older patients, when there was a hiatal hernia and improvement was more rapidly get in this population. doi:10.1016/j.ajg.2009.07.152
(078)
Nutcracker esophagus and gastro-esophageal reflux association R. Goubraim, I. Serraj, L. Amrani, M. Nya, N. Amrani EFD-Hepatogastroenterology Unit, Ibn Sina University Hospital, Rabat, Morocco
Background: The association of gastro-esophageal reflux disease (GERD) and nutcracker esophagus is rare. Angina-like chest pain could be a manifestation of both pathologies. The role of acid reflux in the development of chest pain in patients with nutcracker esophagus is controversed. We report two cases of nutcracker esophagus associated with GERD. Case reports: Case report 1: A 40 year-old woman presented angina-like chest pain and dysphagia. Cardiologic assessment and gastroscopy were normal. Twenty-four hours esophageal pH monitoring revealed pathologic reflux. In spite of proton-pump inhibitors (PPI), chest pain persists and esophageal manometry was performed. It showed nutcracker esophagus. Case report 2: A 56 year-old woman was admitted for precordialgia. She underwent coronary angioplasty for ischemic cardiopathy one year before. Cardiologic exams were normal. Twenty-four hours esophageal pH monitoring revealed pathological reflux with significant association between symptoms and reflux episodes. She received PPI without clinical improvement. Esophageal manometry revealed nutcracker esophagus. Discussion and conclusion: Twenty-four hours esophageal pH monitoring coupled to symptom index study should be performed in patients presenting non-cardiac chest pain. GERD can explain this symptom. If symptoms persist under antireflux treatment, an esophageal manometry should be done to search motility disorders. Nutcracker esophagus is the most commonly found manometric abnormality. Treatment of this association is difficult. It is based on high dose of PPI. Efficiency of calcium channel blockers and nitrates is controversed. doi:10.1016/j.ajg.2009.07.153
(079)
Gastroesophageal reflux and chronic gastric volvulus: Three case reports I. Atitar, M. Raiss, F. Raissouni, A. Hrora, M. Ahallat Surgical Clinic ‘‘C’’, Ibn Sina Hospital, Rabat, Morocco
Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. There is acute volvulus which is a surgical emergency and chronic volvulus characterized by non specific symptoms as symptomatic gastroesophageal reflux (GER). The aim of this communication is to underline the interest to explore simple symptoms as GER in order to diagnose one of most diagnosis emergency and surgical challenge: gastric volvulus. Case reports: Case report no. 1: A 60 year-old woman, with 7 months history of symptomatic GER and post-prandial vomiting. Clinical examination was normal. Upper endoscopy revealed a normal oesophageal mucosa and stomach was impossible to explore (torsion?). The gastroesophageal contrast opacification (GECO) showed intra-thoracic gastric volvulus. The patient had a laparoscopic treatment of the hernia associated to diaphragmatic evisceration’s refection. The control 6 months after the surgery showed a clinical improvement. Case report no. 2: A 65 year-old woman, admitted for GER, pyrosis, post prandial vomiting. Clinical examination was normal. Upper endoscopy showed a large hiatal hernia (HH). A GECO and thoracoabdominal computed tomography scan revealed mixed HH and an intra-thoracic stomach. The patient was treated by laparoscopic repear. The clinical and radiological control 6th months after surgery were normal. Case report no. 3: A 60 year-old woman, presents since 12 years GER, heartburn, and regurgitation. Clinical examination was normal. GECO showed a large para-hiatal hernia and gastric volvulus. The patient had a laparoscopic repear of her hernia. The clinical control 6 months after surgery showed the persistence of symptoms. GEOC control revealed the presence of stomach into abdominal cavity and the persistence of a sliding HH. The patient received proton pump inhibitors with clinical improvement 1 month later. Discussion and conclusion: Chronic gastric volvulus is characterized by non specific symptoms dominated by post-prandial abdominal pain and symptomatic GER; such as the case of our 3 patients. It is a diagnosis emergency and therapeutic challenge because it may transform on acute form and may lead to gastric strangulation with a risk of ischemia and necrosis. The most common causes of gastric volvulus are diaphragmatic abnormalities as hiatal hernia and diaphragmatic evisceration. The diagnosis is suspected when chest X-ray shows high air-fluid level in the chest, and it is confirmed by GEOC and computed tomography scan. Gastric volvulus requires surgical treatment, mainly by laparoscopic approach. It includes specifically volvulus reduction, reintegration of the stomach into the abdominal cavity in cases of intra-thoracic migration, and correction of causal factors. Chronic gastric volvulus is a rare entity. It is a diagnosis and therapeutic emergency and requires clinical and radiological exploration of some seemingly simple symptoms as GER. doi:10.1016/j.ajg.2009.07.154
(080)
Surgical approach of Barrett’s adenocarcinoma H.O. El Malki a,b, M. Chenna a, B. Serji a, O. Mouaquit a, R. Mohsine a, L. Ifrine a, A. Belkouchi a a Clinique Chirurgicale ‘‘A’’, Hôpital Ibn Sina, Université Mohammed V Souissi, Rabat, Morocco b Centre de Recherche en Epidémiologie Clinique et Essais Thérapeutiques, Faculté de Médecine et de Pharmacie de Rabat, Morocco
Introduction: The incidence of adenocarcinoma arising from Barrett’s oesophagus is dramatically increasing. The purpose of this retrospective study was to report our experience in the surgical management of these patients. Methods: Between January 1990 and December 2003, 13 patients with adenocarcinoma on Barrett’s oesophagus were observed. There