Katsue Nakamura

The course of gastric polypoid lesion (5)

The cases we have observed since September 1967 are with 429 polypoid lesions. As its item the eases with ATP are 32 with 38 lesions and the ratio against total polypoid lesions is 8.9 per cent. And also 2 lesions showed group I[, 1 lesion group IV and the others were all group III . The average age of the patients was 62.4 and the operated cases were 15 with 18 lesions. The period of the longest observed case was 68 months since discovered. The case enlarged and new developed polypold lesion is each one. We have experienced a confused ease which was diagnosed of group IV in the first histological examination due to biopsy, and in fact was group III by further examination of the completely polypectomized tissue. Then, we have an idea that the classification of polypoid lesion, in especially ATP, must be discussed with exact histological examination by completely polypectomized tissue and have cut off 4 lesions, making use of our special instrument for polypeetomy. But, having observed completely polypectomized portion in the stomach because of clarification of developmental mechanism of the ATP, we can not refer to it in this meeting.

Blind loop syndrome

SIBO should be suspected in the presence of irritable bowel syndrome (IBS)-like symptoms and/or malabsorption syndrome occurring in the presence of disorders predisposing to SIBO development. Predisposing conditions include functional dyspepsia, achlorhydria (eg, gastric atrophy or chronic administration of proton pump inhibitors), chronic pancreatitis, cystic fibrosis, immunodeficiency, hypothyroidism, intestinal obstruction and/or stagnation (eg, adhesion, strictures, tumours), diverticular disease, coeliac disease and liver disease. SIBO is often a recurrent disorder, depending on the nature of any predisposing condition. The most common diagnostic tool is represented at present by a hydrogen breath test. However, the gold standard for diagnosis of SIBO is aspiration and direct culture of the jejunal aspirate. Management is with antibiotic treatment and management of any underlying cause. Many different antibiotics have been advocated but there is no consensus regarding the most effective antibiotics or duration of treatment. In addition to antibiotic treatment, prebiotics or probiotics have been studied: Prebiotics alter gut bacteria indirectly by favoring growth of certain bacterial species. Probiotics are postulated to enhance gut barrier function, decrease inflammatory response, stabilise gut flora and potentially modulate visceral hypersensitivity. There is no strong evidence for the use of prebiotics or probiotics for treating SIBO.