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Figure 3-12 A pancreatic rest, "heterotopic pancreas," noted in the stomach. It is a submucosal lesion with a characteristic central umbilication.

Figure 3-13 Erosive gastritis secondary to salicylates.

Figure 3-13 Erosive gastritis secondary to salicylates.

Figure 3-14 A large, deep gastric ulcer with nodular edges. Extensive biopsy samples must be taken to exclude malignancy. If the ulcer is benign, it must be followed with repeated biopsies to complete healing.

Figure 3-15 A leiomyoma of the gastric fundus. These are submucosal lesions that may bleed due to superficial ulceration.

Figure 3-16 Fundic gland polyps of the stomach are worrisome appearing and should be confirmed with a biopsy. However, they have no malignancy potential.

Figure 3-17 Linitus plastica is an infiltrating submucosally spreading carcinoma of the stomach with a poor prognosis. Small superficial biopsy samples may cause the diagnosis to be missed; a "large particle" snare biopsy may be required to obtain sufficient tissue.

Figure 3-18 "Watermelon stomach," a condition that is responsible for gastrointestinal bleeding and anemia, is due to multiple angiodysplasias in the gastric mucosa. Laser or argon beam coagulation may be effective in ablating these lesions.

Figure 3-19 An isolated gastric varix in a patient with left-sided portal hypertension.
Figure 3-20 A duodenal bulb ulcer with a "visible vessel" In Its base.

Figure 3-21 Multiple flat adenomas In the duodenum of a patient with familial adenomatous polyposis.

Figure 3-22 An anglodysplasla In the duodenal bulb. These are easily ablated with Injection or coagulation therapy, or both.

Figure 3-23 A preoperative endoscopic retrograde cholangiopancreatogram in a patient with an unusual ultrasound examination demonstrates a "double gallbladder"; this is useful information for the surgeon.

TABLE 3-1 -- Clinical Indications for Gastric Emptying Scans

Unexplained nausea or vomiting

Nonulcer dyspepsia with upper abdominal bloating, early satiety, or anorexia

Diabetics with poor glycemic control when gastroparesis may be a cause

Postgastrectomy syndrome with stasis or dumping symptoms

Severe gastroesophageal reflux unresponsive to aggressive acid suppression

Suspected intestinal pseudo-obstruction

Objective assessment of response to medical therapy

From Camilleri M, Hasler, W.L., Parkman, H.P., et al.: Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology, 115:747, 1998.

obstructions distal to the duodenum even in patients with gastric stasis because liquid contrast material will pass into the small bowel despite poor gastric motility. Assessment of gastroduodenal dysmotility begins with the measurement of gastric emptying rates. The scintigraphic gastric emptying scan has replaced solid radiopaque markers, barium-impregnated solids, and gastric intubation with saline infusion (Hunt's

13, test) as the standard in the measurement of gastric transit. Experimental methods of measuring gastric emptying include ultrasonography, breath excretion of 13 CO2 , and magnetic resonance imaging.[ ]

The radionuclide GES is the most common method of measuring gastric emptying and can be used as a screening test for delayed or accelerated gastric dysmotility. Patient preparation includes a 12-hour fast, abstention from drugs that affect motility for 48 hours, and attention to blood sugar levels in diabetics. Patients with diabetes should inject their insulin with the test meal to avoid hyperglycemia, which can worsen gastroparesis.

A GES is used to quantify the transfer of a radiolabeled meal from the stomach to the duodenum. A GES can be performed with a solid or liquid meal that contains a radioisotope, which can be detected with a gamma camera and quantified with a computer program. The solid-phase GES, which involves a solid meal, is clinically useful because it is reproducible and noninvasive. The solid-phase GES is more sensitive than the liquid-phase study in the detection of gastroparesis because delayed liquid emptying occurs late in severe gastroparesis. Solid-phase GESs use a radioisotope, such as 99m Tc sulfur colloid, mixed with a standard meal. The residual gastric radioisotope is detected with a gamma camera positioned over the stomach. GES traditionally reported T half-life, or time to 50% emptying of the ingested product. A useful

[44, selective strategy in clinical practice is to report findings at fixed time intervals of 2 and 4 hours. The 2-hour scan is more accurate in the detection of accelerated gastric emptying, and the 4-hour scan is more accurate in the detection of delayed gastric emptying. The optimal method of testing, choice of meal and radioisotope, data analysis, and interpretation are dependent on local expertise. The reproducibility of GES measurements may vary up to 15%, so physicians should make decisions based on sound clinical judgments and unequivocal results before a motility disorder is diagnosed or excluded.

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Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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