The Postoperative Stomach

There is an increased risk of cancer after partial gastrectomy especially after 20 years. The gastric mucosa after gastric surgery is not that of extensive chronic gastritis with inflammation. Rather it is a reactive gastropathy with prominent surface and foveolar reactive cellular change and foveolar hyperplasia (corkscrew pits). Beginning between 15 and 20 years after the gastric resection, I would do endoscopy and biopsy screening for dysplasia or overt cancer. I take 4-quadrant biopsies from the region of the stoma (Billroth II) or the gastric side of the gastroduodenal junction (Billroth I). Then biopsy mapping is done by taking multiple biopsies from the lesser and greater curves of the gastric remnant and from the gastric fundus. If endoscopically invisible high grade dysplasia is found and is multifocal, the patient's overall frailty may dictate choosing follow up to cancer rather than removal of the remainder of the stomach. This is one exception to the idea that there is little merit to the follow-up versus removal of low grade dysplasia if identified focally (Weinstein and Goldstein, 1994). In this setting if only low grade dysplasia were discovered on biopsy, I would just continue annual follow-up because the alternative is total gastrectomy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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