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"Upper gastrointestinal bleeding is one of the emergency conditions in the field of gastroenterology and variceal blending is the. most common cause of it. Gastric varices accounts only 5% to 10% of all causes of upper gastrointestinal bleeding respectively, but it could be fatal and difficult to control despite provision of adequate therapy. Early diagnosis and appropriate management may decrease the morbidity and mortality of gastric variceal bleeding."

"ABSTRACTPurposeThe lymphatic flow along the posterior gastric artery (PGA) is considered of possible clinical importance in terms of lymphatic metastasis; however, little is known about the lymph nodes (LNs) around this artery. The purpose of this study was to establish if LNs exist around the PGA and to evaluate their clinical implications.MethodsWe examined the tissues surrounding the PGA from 21 cadavers to search for LNs. We also investigated the patterns of lymphatic metastases in patients who underwent surgery for gastric neoplasms at our institute to detect their presence along the PGA.ResultsThe PGA was identified in 11 cadavers, and LNs around the PGA were detected microscopically in 2 of these. Lymphatic metastasis directly to the LNs at the splenic artery without any metastases was regarded as skip metastasis along the PGA. Skip metastasis was found in two of ten patients who underwent surgery for remnant gastric cancer.ConclusionsThe existence of LNs around the PGA was confirmed, and based on our findings, lymphatic metastasis through the PGA is possible in patients with remnant gastric cancer."

"Background: Thin study aimed to investigate gastric mucosa mucous layer thickness in portal hypertensive gastropathy (PHG) compare to normal mucosa in functional dyspepsia and its correlation with several variables such as child class, severity of esophageal varices and gastropathy.

Materials and Methods: Biopsy specimens were taken from the antrum and corpus from both group of patients with PHG and functional dyspepsia. The specimen was given cryometric for frozen section. Tissue were sliced by sagital section II urn, placed in object glass, fixed and stained to evaluate mucous thickness and giemsa stained to observe Helicobacter pylori. Measurement of mucous thickness was done upward muscularis mucosa started from upper epithelial layer from faveale tip until outer mucous layer on 15 points which were marked randomly and calculate the mean value by micrometer (/jm).

Results: Mean value of antral mucous thickness in PHG was 13.30 ± 6.5 fim, while in the functional dyspepsia it was 25.59 ± 5.66 /an. Statistical analysis for both kinds of mucous thickness was p<0.001. Mean corpus mucous thickness in PHG was 10.6 ± 6.81 /jm, while mucous thickness in dyspepsia was 32.54 ± 6.51 fjm. Statistical analysis revealed p<0.001. This result showed significant difference of mucous thickness of antrum and corpus statistically between PHG and dyspepsia as control group.

Conclusion: The study had proven the presence of decreased gastric mucosa mucous layer thickness in corpus and antrum in PHG. Thus, therapeutic approach to increase mucous thickness must be considered in patients with PHG."

"Gastric epithelial cells apoptosis induced by Helicobacter pylori depends on microhial and host factors. Apoptosis on mitochondrial level by Bc!2 family protein is the main pathway for Helicobacter pylori induced gastric epithelial cells apoptosis, though there are roles for apoptosis through Fas receptors or TNF. Imbalance between proliferation and apoptosis gastric epithelial cells determines the risk for neoplastic transformation. Increase of gastric epithelial cells apoptosis seems to have an obligation for initiating secondary hyperproliferative response. If altruistic cellular death fails to oppose this process, uncontrollable cellular growth leading to neoplastic transformation will occur."

"Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to evaluated the difference of mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 - 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa."

"Latar Belakang: Pasien dengan keganasan gaster berisiko tinggi mengalami malnutrisi. Terapi kuratif utama pada pasien keganasan gaster adalah tindakan operasi, sehingga diperlukan dukungan terapi medik gizi perioperatif yang dapat menunjang perbaikan status gizi, kapasitas fungsional, dan kualitas hidup.Metode: Pasien pada serial kasus adalah dua laki-laki dan dua perempuan, berusia 34-64 tahun, dengan diagnosis tiga pasien dengan karsinoma gaster, dan satu pasien gastrointestinal stromal tumor gaster stadium lanjut. Terapi medik gizi praoperasi diberikan dalam bentuk oral dan parenteral. Pada enam jam sebelum tindakan operasi, dua pasien mendapatkan nutrisi parenteral, dan dua pasien mendapatkan nutrisi oral. Pasien pascaoperasi juga mendapatkan nutrisi enteral dini dalam 48 jam pertama.Hasil: Pasien pasca gastrektomi selama mendapatkan nutrisi perioperatif, tiga pasien mengalami proses penyembuhan luka yang baik, sedangkan satu pasien mengalami komplikasi pascaoperasi berupa fistula enterokutan yang kemudian mengalami pemulihan, dan satu pasien mengalami hiperglikemia dipengaruhi oleh tindakan pankreatektomi distal. Lama masa rawat inap pasien antara 21-31 hari. Semua pasien pascaoperasi mengalami peningkatan kapasitas fungsional.

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Background: Patients with gastric malignancy have high risk of malnutrition. The main curative therapy in patients with gastric malignancies is surgery, so it requires the support of perioperative nutritional therapy which could support the improvement of nutritional status, functional capacity, and quality of life.

Methods: Patients in this case series were two men and two women, aged 34-64 years, and the diagnosis of three patients are advanced gastric carcinoma, and one patient with advanced gastric gastrointestinal stromal tumor. Preoperative nutritional therapy was given in oral and parenteral route. At six hours before surgery, two patients received parenteral nutrition, and two patients received oral nutrition. All patients also got early enteral nutrition in the first 48 hours after surgery.

Results: Patients after gastrectomy during obtaining perioperative nutrition, three patients experienced a good wound healing process, while one patient experienced postoperative complications in the form of enterocutaneous fistula which later recovered, and one patient experienced hyperglycemia that affected by distal pancreatectomy. The length of stay for patients was between 21-31 days, after surgery all patients had increased functional capacity.

Conclusion: Perioperative nutritional therapy in gastric malignancies patients undergoing gastrectomy could help improve the nutritional status and functional capacity."

"Background: Esophagitis implies an organic damage of the esophagus due to several pathophysiologic factors, predominantly: (1) degree of gastric acid secretion (gastric pH), whereabouts are rapidly or slowly to be mucosal breaks onto esophagus were under the influe nced by: (a) gastric pH 54 and (b) the contact of gastric acid into esophageal mucosal. (2) Lower esophageal sphincter (LES) as a important lactor lor antifetlux mechanisms, which antireflux mechanism cannot senre as a barrier system whenever tone of LES comes down until 510 mml-lg that causes feeble resting LES pressure. Esophageal injuries are recognized endoscopicaliy by the presence of the Savary-Millers classification (1985), but there are not definitely which ones principally to pathophysiologic factor. Methods: This was a consecutive non-random sampling cross sectional study Thirty subject from 127 patients with dyspepsia undergoing elective upper-endoscopic examination with collecting of the gastric juice and biopsies of tower esophageal mucosal, also esophageal manometric examination. Before that, clinical inclusive and exclusive criterias until laboratory examination were performed. Significant interval was 95%. Analyzing data with Fisher?s Exact Test One-Tail to correlate between gastric pH and hypotonic LES into esophagitis. Results: Esophagilis prevalence was 22. 8%. Fisher's Exact Test One-Tail to correlate esophagitis with gastric pH E 4 was significant (p=0.013798), but with hypotonic LES (tones of LES S 10 mmHg) was not (p=0.60269). The combined roles or' gastric pH and tones of LES into esophagitis are included: (1) Frequency of roles of pH E 4 and hypotonic LES are 48.2% (2) Frequency of role of pH < 4 without hypotonic of LES are 33.3%. (3) Frequency of role of hypotonic LES without pH S4 are 11. 1% and (4) Frequency of esophagitis without roles of pH $4 and hypotonic ol LES are 7.4%. Conclusions: The sum of gastric pH 5 4 and hypotonic of LES together are more than each separate factor. Onto statistically was significant between esophagitis and gastric pH, but there is no correlation with tones ol LES. So, gastric pH plays a more important role than LES."

"Latar belakang. Studi pH lambung pada pasien sirosis hati masih kontroversi Penelitian ini bertujuan untuk mengetahui adanya perbedaan pH lambung pada pasien sirosis hati dengan gastropati hipertensi portal GHP ringan dan berat. Metode Penelitian. Potong lintang dengan cara konsekutif pada pasien yang datang ke poliklinik gastro enterologi dan hepatologi RSCM pada periode Maret - Mei 2014 sebanyak enam puluh dua pasien sirosis hati dengan GHP dilakukan pemeriksaan endoskopi untuk menilai derajat gastropati sesuai klasifikasi McCormack dan pemeriksa pH lambung dengan menggunakan pH meter. Hasil. Dari 62 subjek didapatkan 50 subjek 80 6 berjenis kelamin laki laki dan perempuan 12 subjek 19 4 GHP paling banyak disebabkan oleh hepatitis C 56 5 hepatitis B 32 3 non hepatitis 8 1 dan alkohol 3 2 Rerata pH lambung pada seluruh pasien sirosis hati dengan GHP adalah 2 13 Rerata pH lambung pada pasien sirosis hati dengan GHP ringan 2 00 lebih rendah dibandingkan kelompok GHP berat 2 25 dengan perbedaan yang bermakna.

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Background. Studies show gastric pH in cirrhosis patient still in controversy Aim of this study to know differences of gastric pH in liver cirrhosis patient withmild and severe portal hypertensive gastropathy

Methods. Cross sectional method with consecutive to all liver cirrhotic patientwho came to gastroenterology and hepatology clinic in Ciptomangunkusumo hospital Sixty two liver cirrhosis patients with portal hypertensive gastropathyunderwent endoscopy to measure degree of gastropathy based on McCormack classification and measured mean basal gastric pH with pH metry.

Result. There are 50 male subject 80 6 and 12 female subject 19 4 participating in this research Portal hypertensive gastropathy mostly caused by hepatitis C 56 5 hepatitis B 32 3 non hepatitis 8 1 and alcohol 3 2 Mean of gastric pH in all liver cirrhosis patient with portal hypertensive gastropathy was 2 13. The mean gastric pH in liver cirrhosis patient with mildportal hypertensive gastropathy 2 00 mEq L lower than the gastric pH in severeportal hypertensive gastropathy 2 25 mEq L with significant differences."

"ABSTRAKLatar Belakang: Malnutrisi terjadi pada 80 karsinoma gaster. Pasien kanker yang menjalani pembedahan memerlukan dukungan nutrisi perioperatif dengan tujuan meningkatkan status gizi, mengurangi sensitivitas insulin dan menurunkan proses katabolisme. Metode: Pasien serial kasus adalah perempuan dengan rentang usia 28-74 tahun dengan diagnosis karsinoma gaster stadium lanjut. Terapi medik gizi prabedah diberikan dalam bentuk nutrisi oral dan enteral untuk mendukung kecukupan status gizi. Enam jam menjelang pembedahan, tiga pasien mendapatkan nutrisi parenteral formula glukosa asam amino dengan kandungan 15 g protein dan 37,5 g asam amino, sedangkan satu pasien dengan penyakit penyerta diabetes melitus tipe 2 mendapatkan nutrisi berupa cairan glukosa 50 g. Hasil: Pasien diberikan nutrisi enteral dini 2-30 jam pascabedah gastrektomi disertai dengan dukungan nutrisi parenteral. Hanya satu pasien mengalami kenaikan glukosa darah pascabedah hari pertama, namun glukosa darah terkontrol dengan pemberian insulin. Klinis dan penyembuhan luka pascabedah baik, pasien mendapatkan nutrisi oral pada 3 ndash; 7 hari pascabedah. Kesimpulan: Terapi medik gizi perioperatif pada karsinoma gaster memberikan hasil yang baik pada outcome bedah.

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ABSTRACT<>br>Objective Almost 80 gastric carcinoma patients was malnourished. Perioperative nutrition aims to support nutrition status, reduce insulin resistance and lower hypercatabolic state. Methods Four patients in this case series were female, age ranged 28-74 years with end stage gastric carcinoma. Preoperative nutrition was given by oral and enteral to support nutrition status. Six hours prior to surgery, patients were given preoperative nutrition glucose amino acid formula in three patients and dextrose formula in one patient. Glucose amino acid formula contains 15 g protein and 37,5 g amino acid, while dextrose formula contains 50 g glucose. Results All of patients have early enteral nutrition within 2 ndash 30 hours postoperative. Only one patient have risen blood glucose level, but had been controlled by administer insulin. Postoperative wound healing were good, the patients have oral nutrition within 3 ndash 7 days postoperative. Conclusion Perioperative nutrition supports good clinical outcomes in gastric carcinoma patients."