Search Results (81)

Chronic atrophic gastritis and intestinal metaplasia (IM) are gastric precancerous conditions (GPCs) associated with an increased risk of gastric cancer. Early detection and accurate characterization of GPC are therefore crucial for risk stratification and the implementation of preventive strategies. In the absence of clear mucosal changes observed through white-light imaging (WLI) or virtual chromoendoscopy, endocytoscopy can help unveil the presence of GPC by enabling in vivo assessment of nuclear and cellular structures at ultra-high magnification. Endocytoscopy is typically performed using WLI following dye-based staining of the mucosa. In this case, we demonstrate that combining endocytoscopy with the texture and color enhancement imaging (TXI) mode substantially improves the assessment of the gastric mucosa. In a 61-year-old man undergoing esophagogastroduodenoscopy, WLI showed multifocal erythema in the stomach, without clearly visible lesions on either WLI or narrow-band imaging. Conventional endocytoscopy revealed multiple small spots of IM with characteristic changes in glandular structures, which were even more evident when using the TXI mode. Histological analysis of targeted biopsies confirmed small foci of IM in both the antrum and corpus. The patient was enrolled in a surveillance program because of his clinical background. The combination of endocytoscopy with the TXI mode significantly enhances the delineation of mucosal and cellular architecture, supporting a more accurate optical diagnosis. Full article

Background: Proximal gastrectomy (PG) with double tract reconstruction (DTR) offers organ preservation for early gastric cancers, leading to reduced vitamin B12 deficiency, less weight loss, and improved quality of life. The JCOG1401 study confirmed excellent long-term outcomes for PG in stage I gastric cancer. However, in locally advanced proximal gastric cancer (LAPGC), preserving the gastric body and lymph node station 4d may compromise margin clearance and adequate lymphadenectomy. Methods: We propose a modified PG that removes the distal esophagus, gastroesophageal junction (GEJ), cardia, fundus, and gastric body, preserving only the antrum and performing DTR. Lymphadenectomy is also adapted, removing stations 1, 2, 3a, 4sa, 4sb, 4d, 7, 8, 9, 10 (spleen preserving), 11, and lower mediastinal nodes (stations 19, 20, and 110), while preserving stations 3b, 5, and 6. Indications for this procedure include GEJ (Siewert type II and III) and proximal gastric cancers with ≤2 cm distal esophageal involvement and ≤5 cm gastric involvement. Results: In our initial experience with 14 patients, we achieved R0 resection in all patients, adequate lymph node harvest (median 24 nodes, IQR 18–38), and no locoregional recurrences at a median follow-up of 18 months. We also found favorable postoperative weight loss, reflux, and anemia in the PG cohort. Conclusion: While larger studies and long-term data are still needed, our early results suggest that modified PG—despite sparing only the antrum—retains the key benefits of PG over total gastrectomy, including better weight maintenance and improved hemoglobin levels, while maintaining oncologic outcomes for LAPGC. Full article

Background: This study aims to investigate the association between pyroptosis and the outer membrane virulence factor of H. pylori in patients with gastritis and ulcers. Methods: DNA, RNA, and protein were extracted from a single tissue sample taken from the antrum region of the stomach of volunteer patients. The expression of bacterial outer membrane virulence genes was analyzed at the gene level, and the expression levels of key pyroptosis markers were compared between H. pylori-infected and uninfected gastritis and ulcer patient groups. Results: H. pylori infection induced significant alterations in the expression levels of pyroptosis markers, including ASC, NLRP3, caspase-1, GSDMD, IL-18, and IL-1β, indicating a strong association with gastritis and ulcer pathology. Statistically significant correlations were observed between elevated levels of these markers and the activation of caspase-1 across different patient cohorts, supporting effective detection of pyroptosis. Both pro and active forms of caspase-1, GSDMD, IL-18, and IL-1β were assessed, revealing pyroptotic activity in specific patient samples. The vacA m2 allele showed a distinct ASC response in gastritis versus ulcer patients and was associated with increased GSDMD expression in ulcerative cases. Along with the babB gene, this allele appears to play a critical role in the interaction between H. pylori virulence and host pyroptotic responses. A statistically significant negative association was identified between the presence of the H. pylori alpA gene and Gasdermin D expression (odds ratio = 0, p < 0.01), suggesting that Gasdermin D was absent in all alpA-positive samples. Conclusion: This study provides novel insights into the interrelation between the virulence factors of H. pylori and pyroptosis in gastritis and ulcer diseases. Our findings demonstrate that H. pylori infection significantly alters the expression levels of pyroptosis markers, including ASC, NLRP3, caspase-1, GSDMD, IL-18, and IL-1β, in gastric tissues. Notably, the vacA m2 allele was associated with a differential response in ASC expression among patients with gastritis and ulcers, correlating with increased GSDMD levels in ulcerative conditions. The presence of the H. pylori alpA gene is markedly associated with the lack of Gasdermin D activation, indicating a possible suppressive function or immune evasion tactic. These results underscore the critical role of H. pylori virulence determinants in modulating pyroptosis and suggest that understanding this relationship may pave the way for developing targeted therapeutic strategies to mitigate H. pylori-associated pathologies. Full article

Autoimmune gastritis (AIG) has a strong correlation with gastric neuroendocrine tumors (NETs) and gastric cancer, making its timely and accurate diagnosis crucial for tumor prevention. The endoscopic manifestations of AIG differ from those of gastritis caused by Helicobacter pylori (H. pylori) infection in terms of the affected gastric anatomical regions and the pathological characteristics observed in biopsy samples. Therefore, when diagnosing AIG based on endoscopic images, it is essential not only to distinguish between normal and atrophic gastric mucosa but also to accurately identify the anatomical region in which the atrophic mucosa is located. In this study, we propose a patient-based multitask gastroscopy image classification network that analyzes all images obtained during the endoscopic procedure. First, we employ the Scale-Invariant Feature Transform (SIFT) algorithm for image registration, generating an image similarity matrix. Next, we use a hierarchical clustering algorithm to group images based on this matrix. Finally, we apply the RepLKNet model, which utilizes large-kernel convolution, to each image group to perform two tasks: anatomical region classification and lesion recognition. Our method achieves an accuracy of 93.4 ± 0.5% (95% CI) and a precision of 92.6 ± 0.4% (95% CI) in the anatomical region classification task, which categorizes images into the fundus, body, and antrum. Additionally, it attains an accuracy of 90.2 ± 1.0% (95% CI) and a precision of 90.5 ± 0.8% (95% CI) in the lesion recognition task, which identifies the presence of gastric mucosal atrophic lesions in gastroscopy images. These results demonstrate that the proposed multitask patient-based gastroscopy image analysis method holds significant practical value for advancing computer-aided diagnosis systems for atrophic gastritis and enhancing the diagnostic accuracy and efficiency of AIG. Full article

Background/Objectives: Helicobacter pylori (H. pylori) is a significant global health issue causing chronic gastritis, peptic ulcers, and gastric malignancies. Unfortunately, many, particularly in the Middle East, continue to exhibit alarming rates of prevalence. This study aimed to elucidate local epidemiological patterns of H. pylori and examine its histopathological impact on the gastric mucosa. Methods: This retrospective-cross-sectional study included 805 symptomatic adults (329 males, 476 females) who underwent endoscopic evaluation at King Salman Hospital, Ha’il, Saudi Arabia. Biopsies from the antrum and body were processed using routine formalin fixation and paraffin embedding. Staining with hematoxylin–eosin (H&E) and Giemsa permitted assessment of chronic gastritis and detection of H. pylori. Data were evaluated by IBM SPSS (version 23, IBM Corp., Armonk, NY) for associations among infection, histopathology, and patient characteristics. Results: A total of 727 (90.3%) were H. pylori-positive with marginally higher rates in females (91.2%) than males (89.0%). Infection spanned all age groups, reaching 100% in males aged 60–80 years. Overall chronic GI complications were identified in 726 (99.9%), with chronic gastritis being the most profound histopathologically (19.3%). Lymphoid aggregates in 93.0% biopsies reflected a pronounced immune response. Advanced lesions, including metaplasia (0.8%), atrophy (0.3%), and lymphoma (0.1%), were uncommon, though indicative of potential malignant progression. Despite both sexes exhibiting universal symptoms of gastritis, dyspepsia, and heartburn, there were no statistically significant gender-based differences (p > 0.05); specifically, post-H. pylori signs such as vomiting, nausea, weight loss, bleeding or hematemesis occurred equally in all. Histopathology consistently revealed chronic active gastritis with glandular distortion, lymphoplasmacytic infiltration, and occasional mucosal erosions. Giemsa staining further confirmed abundant spiral shapes underscoring a high bacterial load. Conclusion: These findings highlight the age-specific persistently elevating rates of H. pylori significantly associated with chronic gastric inflammatory complications. Although advanced gastric lesions remain rare, reflecting regional epidemiology, early screening, and sleeve treatment efforts, the potential for malignant transformation makes it imperative for continued vigorous eradication, therapy, and vigilant follow-up to avert severe disease outcomes. Full article

Background: Helicobacter pylori is a globally prevalent pathogen and a major contributor to gastric diseases, including chronic gastritis, peptic ulcer disease, and gastric cancer. This study investigates the prevalence, distribution, and clinical relevance of its key virulence genes, vacA and cagA, in a Peruvian patient cohort. Materials and Methods: Fifty-one gastric biopsies were collected from patients with a presumptive diagnosis of H. pylori-induced gastritis at Hospital Carlos Alberto Seguín Escobedo in Arequipa, Peru, in March 2024. Two biopsies per patient—one from the antrum and one from the gastric body—were obtained during endoscopy. DNA extraction was performed using the Quick-DNA Fungal/Bacterial Kit (Zymo Research, USA). Molecular identification of H. pylori was conducted via PCR targeting the glmM gene, while the vacA and cagA virulence genes were detected using specific primers. Statistical analyses, including Pearson’s chi-square and Mann–Whitney tests, were applied to assess associations between virulence gene presence and clinical or histopathological variables. Results: Among the gastric biopsies, the vacA gene was detected in 37.3% of samples, while cagA was present in 17.6%. Statistical analysis revealed significant associations between vacA and specific clinical and endoscopic features, including erythematous gastropathy, nodular gastritis, and emetic syndrome, suggesting its localized role in disease pathogenesis. Additionally, the presence of cagA was significantly linked to moderate inflammatory intensity in gastric body biopsies, indicating its association with more severe histopathological outcomes. Chronic gastritis was the most common histopathological finding, with moderate intensity correlating strongly with the presence of virulence genes. Conclusions: These findings highlight substantial regional variability in the distribution and pathogenicity of H. pylori genotypes. This study underscores the importance of incorporating molecular diagnostics into routine clinical practice to improve diagnostic accuracy and inform region-specific therapeutic strategies. This is particularly crucial in endemic regions like Peru, where unique environmental and genetic factors may influence infection dynamics and disease outcomes. Full article

Background and Clinical Significance: Upper gastrointestinal (GI) bleeding is a common emergency, typically requiring prompt intervention. This case report presents a unique situation where apparent GI bleeding was ultimately identified as anaphylaxis triggered by accidental wasp ingestion. Such cases are rare, underscoring the need for a broad differential diagnosis in atypical presentations. Case Presentation: A 53-year-old male with a history of heavy alcohol use presented with presumed acute hematemesis, hypotension, and tachycardia. An initial examination revealed mild anemia and elevated liver enzymes. An urgent upper GI endoscopy showed severe esophagitis with no signs of active or stigmata of recent bleeding; instead, two dead wasps were found in the gastric antrum. Further inquiry revealed that the patient had recently consumed a home-brewed alcoholic beverage, likely contaminated with the wasps. The patient’s symptoms were then attributed to anaphylaxis from venom exposure rather than hemorrhagic shock. The patient’s condition improved with antihistaminic therapy, and he was discharged with follow-up recommendations. Conclusions: This case highlights the importance of considering rare but critical diagnoses, such as insect-induced anaphylaxis, in patients presenting with presumed GI bleeding. It reinforces the value of thorough history taking, prompt endoscopy, and systematic management in assessing and treating atypical emergency presentations. Full article

Background/Objectives: Although Helicobacter pylori (H. pylori) eradication therapy is important for preventing gastric cancer (GC), the occurrence of GC after H. pylori eradication remains a problem. In this study, the aim was to identify risk factors for GC after H. pylori eradication by comparing long-term histological, endoscopic, and serological evaluations of patients with and without GC. Methods: Patients who underwent H. pylori eradication therapy at Oita University Hospital between June 1997 and August 2013 and were followed for at least 3 years with long-term endoscopy, histology, and serum biochemical tests were included, and the GC (215 cases) and non-GC (11 cases) groups were compared. Results: The GC group was older than the non-GC group at the time of eradication, had lower serum pepsinogen I/II levels, had severe endoscopic atrophic changes, had higher activity at the antrum, and inflammation and intestinal metaplasia (IM) at the corpus on updated Sydney system scoring. On long-term follow-up after eradication, the GC group had a wider range of endoscopic mucosal atrophy and a lower serum pepsinogen I/II ratio at any time point. Conclusions: Endoscopic mucosal atrophy and the serum pepsinogen I/II ratio are useful predictors of GC in patients post H. pylori eradication at any time point. Full article

Objectives: The indications for endoscopic submucosal dissection (ESD) for gastric adenoma and gastric cancer have expanded, leading to an increase in the number of patients with high procedural complexity. Post-ESD perforations prolong hospital stays and increase costs. However, no studies have focused on detecting micro-perforations during ESD. This study aimed to identify signs of perforation using abdominal ultrasound during gastric ESD. Materials and methods: This pilot study analyzed 50 patients who underwent abdominal ultrasound (VScan Air™, GE Healthcare) during ESD at Samsung Medical Center (March 2023–July 2024). Perforation was assessed via ultrasound, and post-procedure X-rays were performed for three days to detect free air. Results: Among 50 patients (median age 60, 76.1% male), the median procedure time was 60 min. Lesions were most common in the antrum (30.4%) and lesser curvature (17.4%). Pathology revealed 32.6% well-differentiated and 10.9% moderately differentiated adenomas, with 15.2% showing high-grade dysplasia. Free air was detected in three patients after procedures involving the body wall of the stomach. Abdominal US showed indirect signs of perforation, including an abnormal peritoneal line, hyperechoic shadowing, and an absence of normal gas patterns, confirmed by X-ray. Conclusions: Abdominal US is a simple, useful tool for rapid detection of perforation during ESD, enabling timely intervention. Further multicenter studies are needed to confirm these findings. Full article

Background/Objectives: Gastric cancer (GC) incidence remains high worldwide, and the survival rate is poor. GC develops from atrophic gastritis (AG), associated with Helicobacter pylori (Hp) infection, passing through intestinal metaplasia and dysplasia steps. Since Hp eradication does not exclude GC development, further investigations are needed. New data suggest the possible role of unexplored gastric microbiota beyond Hp in the progression from AG to GC. Aimed to develop a score that could be used in clinical practice to stratify GC progression risk, here was investigate gastric microbiota in AG Hp-negative patients with or without high-grade dysplasia (HGD) or GC. Methods: Consecutive patients undergoing upper endoscopy within an endoscopic follow-up for AG were considered. The antrum and corpus biopsies were used to assess the microbiota composition along the disease progression by sequencing the 16S ribosomal RNA gene. Statistical differences between HGD/GC and AG patients were included in a multivariate analysis. Results: HGD/GC patients had a higher percentage of Bacillus in the antrum and a low abundance of Rhizobiales, Weeksellaceae and Veillonella in the corpus. These data were used to calculate a multiparametric score (Resident Gastric Microbiota Dysbiosis Test, RGM-DT) to predict the risk of progression toward HGD/GC. The performance of RGM-DT in discriminating patients with HGD/GC showed a specificity of 88.9%. Conclusions: The microbiome-based risk prediction model for GC could clarify the role of gastric microbiota as a cancer risk biomarker to be used in clinical practice. The proposed test might be used to personalize follow-up program thanks to a better cancer risk stratification. Full article

Gastric lymphofollicular hyperplasia (GLFH) is characterized by large lymphoid nodules in the lamina propria. Its etiology and immunohistochemical characteristics are poorly understood. This study analyzed 41 canine GLFH cases, including clinical, endoscopic, histopathological, and immunohistochemical evaluations. Young French Bulldogs (75.06%) were the most affected. Endoscopically, lymphoid nodules were identified in both the antrum and gastric body. Lymphoid follicle diameters were similar in the gastric body (mean 295.587 μm) and antrum (mean 294.641 μm). Associated lesions included glandular atrophy, lymphoplasmacytic inflammation, and fibrosis. Minimal, moderate, and severe colonization with Helicobacter-like organisms (HLOs) were observed in 20, 6, and 3 cases, respectively. B-cell lymphocytes positive for Bcl6 and Pax5 were localized centrally in large follicles, surrounded by CD3+ T lymphocytes. Small follicles lacked germinal centers and showed mixed T and B lymphocytes. A positive correlation was found between the follicle diameter and both HLOs colonization (p = 0.049) and follicular hyperplasia (p < 0.001). A regression analysis indicated that HLOs colonization and hyperplasia accounted for 42.3% of follicle diameter variance (R² = 0.423, p < 0.001). Additional studies are required to investigate potential correlations between GLFH and HLOs, as well as to assess the role of this lesion in the progression to neoplasia. Full article

Background/Objectives: Cisplatin, a common chemotherapy agent, is well known to cause severe side effects in the gastrointestinal and nervous systems due to its toxic and pro-inflammatory effects. Although pharmacological manipulation of the endocannabinoid system (ECS) can alleviate these side effects, how chemotherapy affects the ECS components in these systems remains poorly understood. Our aim was to evaluate these changes. Methods: Male Wistar rats received cisplatin (5 mg/kg, i.p.) or saline on day 0 (D0). Immediately after, serial X-rays were taken for 24 h (D0). Body weight was recorded (D0, D1, D2 and D7) and behavioural tests were performed on D4. On D7, animals were euthanized, and gastrointestinal tissue, dorsal root ganglia (DRGs) and brain areas were collected. Expression of genes related to the ECS was assessed via Rt-PCR, while LC-MS/MS was used to analyse endocannabinoid and related N-acylethanolamine levels in tissue and plasma. Results: Animals treated with cisplatin showed a reduction in body weight. Cisplatin reduced gastric emptying during D0 and decreased MAGL gene expression in the antrum at D7. Despite cisplatin not causing mechanical or heat sensitivity, we observed ECS alterations in the prefrontal cortex (PFC) and DRGs similar to those seen in other chronic pain conditions, including an increased CB₁ gene expression in L4/L5 DRGs and a decreased MAGL expression in PFC. Conclusions: A single dose of cisplatin (5 mg/kg, i.p.), subnoxious, but capable of inducing acute gastrointestinal effects, caused ECS changes in both gastrointestinal and nervous systems. Modulating the ECS could alleviate or potentially prevent chemotherapy-induced toxicity. Full article

Organic acids (OAs) are employed in animal feed to regulate gastrointestinal disorders and diarrhoea thanks to their ability to modulate the gastrointestinal environment and their antimicrobial capacity. However, there is not enough evidence regarding the most adequate OA and its effectiveness in rabbit farming. Therefore, the aim of this study was to screen and evaluate the response of young rabbits to six OAs, administered via drinking water, at three different concentrations (pH levels). Organic acids (acetic, ACET; formic, FOR; propionic, PROP; lactic, LAC; citric, CIT; and butyric, BUT) were tested at three concentrations (pH 3, 4, and 5). A negative control (CON; non-acidified water) was also included. We used 240 weaned rabbits (28 days old) divided into 2 batches. In each batch, animals were randomly allocated to 1 of the 19 experimental treatments and were housed in group cages of 6 animals per cage, treatment, and batch. Among the 240 rabbits, an additional cage with 6 animals was included to determine the initial physiological state of the animals. All animals were fed with commercial pelleted feed throughout the whole experiment. The duration of the study was 7 days, until 35 days of age. At 31 and 35 days of age, in each batch, three animals per day and treatment were slaughtered. The pH of the digestive contents in the fundus, antrum, duodenum, jejunum, ileum, and cecum, as well as the gastric pepsin enzyme activity, was measured. Water and feed consumption per cage and individual body weight (BW) were recorded daily. The type and dosage of OAs affected water intake. ACET 3, PROP 3, and BUT 3 reduced water intake compared to CON, negatively impacting feed intake and weight gain. FOR and CIT acids led to the highest BW and weight gain at 35 days, compared to PROP, LAC, and BUT (p < 0.05); showing ACET intermediate values. While OAs had limited effects on gastric and small intestine pH, acidified water at pH 4 and 5 lowered ileum and caecum pH (p < 0.05) compared to pH 3. Acidified water at pH 4 showed the highest (p < 0.05) pepsin activity compared to pH 3 and pH 5. Considering the limited sample size and short-term assessment period of our screening test, the OAs with the highest potential for use in post-weaning rabbits were FOR, ACET, and CIT at pH 4. The selected combinations did not exhibit any early adverse effects in young rabbits. These results should be further confirmed in a broader population of animals. It would also be advisable to extend the application of OAs over longer periods to evaluate their effects throughout the entire growing period of rabbits. Full article

Background and Aims: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure to induce weight loss through restrictive physiology. This study was designed to evaluate the fluoroscopic measurement of gastric dimensions after ESG as a predictor of Total Body Weight Loss (TBWL) over time. Methods: Post-ESG patients were enrolled prospectively between August 2013 and August 2019. An upper gastrointestinal (GI) fluoroscopy was obtained within 7 days after the procedure. Two blinded, independent radiologists reviewed fluoroscopic images and measured the gastric lumen transverse diameter in three separate areas of the fundus, body, and antrum. The primary outcome was achieving a TBWL of ten percent or more after ESG. Results: In total, 162 patients were included in the analysis (65% female) and had a mean body mass index (BMI) of 39 ± 6 at baseline. Patients had a mean maximum TBWL of 16.5 ± 8.3%. Respectively, 92%, 75%, and 50% of patients achieved a TBWL of 5%, 10%, or 15% or more. The mean post-procedural UGI gastric fundus/antrum transverse measurement ratio was 1.2 ± 0.6. A higher fundus-to-antrum ratio was significantly associated with a TBWL of 10% or more during follow-up in the multivariable model (OR 2.49, 95% CI 1.31–4.71; p-value 0.005). The prediction score based on the fundus-to-antrum ratio hd an area under the ROC curve of 0.79 (95% CI 0.75–0.83) for predicting a TBWL of 10% or more during follow-up. Conclusions: Measuring gastric the fundus/antrum ratio within one week of endoscopic sleeve gastroplasty (ESG) is a consistent and independent predictive measure of sustained TBWL during long-term follow-up. Full article

Background: Laparoscopic sleeve gastrectomy (LSG) is the most widespread bariatric procedure due to its safety and efficacy. Despite continuous refinement, achieving a globally standardized procedure remains challenging. Moreover, due to its wide adoption, numerous studies have focused on complications associated with the technique, such as gastroesophageal reflux disease (GERD). This study evaluates the impact of antrum size (wide antrectomy versus small antrectomy) in LSG on long-term anthropometric outcomes and complications in patients with morbid obesity. Methods: Body mass index (BMI), percentage of excess weight loss (%EWL) at a 5-year follow-up, GERD Health-Related Quality-of-Life (GERD-HRQL) scores, and obesity-related diseases of patients undergoing LSG with gastric resections starting 2 cm and 6 cm from the pylorus were retrospectively evaluated. Results: Between January 2015 and November 2019, 597 patients who met the criteria for LSG were included in the study. Group A (241 patients) underwent wide antrectomy, while Group B (356 patients) underwent small antrectomy. Weight, BMI, %EWL, and %TWL significantly improved at 6 and 12 months in the wide-antrectomy group. However, these differences diminished by 24 months, with no significant long-term differences in weight loss outcomes between the two groups at 5 years. Conversely, GERD-HRQL scores were significantly better in the small-antrectomy group until 24 months; thereafter, results were comparable between groups over the long term. Conclusions: Therefore, while wide antrectomy may offer superior short-term anthropometric outcomes, both techniques yield similar long-term results regarding weight management and GERD incidence. Larger prospective studies are needed to further address this issue. Full article