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Introducción. En Asia y Europa, el sistema OLGA ha sido útil como marcador de riesgo de cáncer gástrico. Sin embargo, su utilidad en poblaciones de alto riesgo en Colombia aún se desconoce. Objetivo. Establecer si los estadios OLGA se asocian con un mayor riesgo de cáncer y displasia en una población de alto riesgo en Colombia y determinar la capacidad diagnóstica de la escala para evaluar dicho riesgo. Materiales y métodos. Se realizó un estudio multicéntrico con pacientes con cáncer gástrico y displasia (casos), y pacientes con atrofia y metaplasia intestinal (controles), provenientes de tres centros de una zona de alto riesgo de cáncer gástrico en Colombia. Se incluyeron 506 pacientes cuyo estudio endoscópico e histopatológico fue realizado mediante el sistema de Sydney y la estadificación de OLGA propuesta por Rugge. El efecto de cada variable de interés sobre la enfermedad (cáncer gástrico y displasia) se evaluó mediante modelos bivariados y multivariados. Un valor de p menor de 0,05 se consideró estadísticamente significativo. Resultados. Los estadios elevados del sistema OLGA (III-IV) se asociaron con un mayor riesgo de displasia y cáncer gástrico (OR ajustado = 8,71; IC95 % = 5,09-14,9; p=0,001) con una sensibilidad del 54,9 %, especificidad del 89,3 % y una razón de probabilidad positiva de 5,17. Conclusiones. El estadio OLGA es un marcador de riesgo de cáncer gástrico y displasia en la población de estudio. Se recomienda su implementación como estrategia para optimizar el diagnóstico oportuno y el seguimiento de pacientes con mayor riesgo.
Introduction. The OLGA system has been proved to be useful in Asia and Europe as a risk marker of gastric cancer. However, its usefulness in high-risk populations in Colombia is still unknown. Objective. To assess potential associations between the OLGA staging system and an increased risk of gastric cancer and dysplasia in a high-risk Colombian population and to establish diagnostic capacity of the scale to assess the risk. Materials and methods. We carried out a multicenter study including patients with cancer and dysplasia (cases) and patients with atrophy and intestinal metaplasia (controls). A total of 506 patients were recruited from three centers in an area with a high risk population in Colombia. The endoscopic and histopathologic studies were evaluated according to the Sydney system and the OLGA staging system proposed by Rugge. The effect of each variable on the disease (gastric cancer and dysplasia) was evaluated using bivariate and multivariate models. Statistical significance was set considering a p value inferior to 0.05. Results. Advanced stages of the OLGA system (III-IV) were associated with a higher risk of dysplasia and gastric cancer (adjusted OR = 8.71; CI95% = 5.09-14.9; p=0.001), sensitivity=54.9%, specificity=89.3% and positive likelihood ratio=5.17. Conclusions. The OLGA staging system is a risk marker for gastric cancer and dysplasia in the studied population. We recommend its implementation to improve the timely diagnosis and follow-up of patients with the highest cancer risk.
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Objective:To investigate the correlation of serum pro-gastrin-releasing peptide (ProGRP), sugar chain antigen 242(CA242), procalcitonin(PCT) levels in patients with chronic atrophic gastritis (CAG) with intestinal metaplasia and Helicobacter pylori(Hp) infection and prognosis.Methods:One hundred patients with CAG intestinal metaplasia in Emergency General Hospital were selected as the research objects, and they were divided into infection group (75 cases) and non-infected group (25 cases) according to whether they had Hp infection. The clinical data, levels of serum ProGRP, CA242, and PCT were compared between the two groups, and the diagnostic value of the combination of serum indicators in the diagnosis of Hp infection in CAG intestinal metaplasia patients and their correlation with prognosis were analyzed.Results:The degree of atrophy and intestinal metaplasia in the infected group were higher than those in the non-infected group ( P<0.05). The levels of serum ProGRP, CA242 and PCT in the infected group were higher than those in the non-infected group: (159.41 ± 42.38) ng/L vs. (105.84 ± 18.29) ng/L, (7.24 ± 2.28) kU/L vs. (4.12 ± 1.30) kU/L, (3.84 ± 1.12)μg/L vs. (2.57 ± 0.82) μg/L, there were statistical differences ( P<0.05). The results of Spearman analysis showed that the levels of ProGRP, CA242, PCT had positive correlation with atrophy degree ( r = 0.614, 0.629, 0.672, P<0.05), and had positive correlation with intestinal metaplasia degree ( r = 0.574, 0.591, 0.603, P<0.05). The area under the curve (AUC) for the combined diagnosis of Hp infection in patients with CAG intestinal metaplasia by serum ProGRP, CA242, and PCT was 0.874 (95% CI 0.793 - 0.932), the diagnostic sensitivity and specificity were 76.00% and 92.00%, respectively. The incidence of gastric neoplasms in patients with Hp positive combined diagnosis of serum ProGRP, CA242, and PCT within 2 years (11.86%) was higher than that of negative patients (0), but the difference was not statistically significant ( P>0.05). Conclusions:The levels of serum ProGRP, CA242 and PCT in patients with CAG intestinal metaplasia are closely related to Hp infection. The combination of various indicators has high application value in the diagnosis of Hp infection.
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Precancerous lesions of gastric cancer (PLGC) is a pathological change accompanied by intestinal metaplasia and dysplasia on the basis of chronic atrophic gastritis. It is also an important stage of "inflammation-cancer transformation" on gastric mucosa. Paying attention to the intervention of PLGC has important value and significance for the secondary prevention of gastric cancer. PLGC has the characteristics of occult onset, toxin damaging collaterals, and long course of disease, which is highly consistent to the pathogenesis characteristics of incubative pathogenic factors. Based on the relevance of incubative pathogenic factors and PLGC, treatment of PLGC from the perspective of incubative pathogenic factors should be mainly strengthening the spleen and stomach, and combined with the methods of regulating qi and dissipating dampness, and removing blood stasis and detoxification. It should also pay attention to the prognosis.Paying attention to the body-mind treatment can reduce the re-occurrence , so as to provide a new way of thinking for treating PLGC from incubative pathogenic factors.
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Objective:To evaluate the clinical effect of treatment of activating blood and removing blood stasis, invigorating the spleen and soothing the liver for the patients with gastric collateral stasis syndrome and chronic atrophic gastritis (CAG).Methods:Randomized controlled trial. A total of 68 CAG patients admitted to the Huairou Hospital of Traditional Chinese Medicine from January 2018 to January 2021 who met the selection criteria were divided into 2 groups according to the random number table method, with 34 in each group. The control group received conventional western medicine treatment, such as inhibition of acid, protecting the gastric mucosa, and the observation group was treated with Traditional Chinese Medicine (TCM) herbal prescription of activating blood and removing blood stasis, invigorating the spleen and soothing the liver. Both groups were treated for 12 weeks. TCM symptom scores were performed before and after treatment. The serum level of pepsinogen Ⅰ(PG Ⅰ), pepsinogen Ⅱ (PGⅡ) were detected by ELISA, and the PG Ⅰ/PG Ⅱ ratio was calculated. Gastroscopic biopsy was performed to observe the changes of intestinal metaplasia of gastric mucosa and glandular atrophy, and to evaluate the clinical efficacy.Results:The total responsive rate was 85.3% (29/34) in the study group and 58.8% (20/34) in the control group. There was significant difference between the two groups ( χ2=9.35, P=0.030). After treatment, the scores of stomachache, fullness of feeling in the observation group were significantly lower than those in the control group ( t=2.97, 3.80, P<0.05). After treatment, the level of serum PG Ⅰ[(76.21 ± 17.35) mg/L vs. (66.8 ± 18.77) mg/L, t=2.15] and PG Ⅰ/PG Ⅱ [(4.67 ± 0.99) vs. (3.90± 1.25), t=2.81] in the study group were significantly higher than those in the control group ( P<0.05), and PG Ⅱ [(16.36 ± 1.85) mg/L vs. (17.42 ± 2.05) mg/L, t=2.24] was significantly lower than that of the control group ( P<0.05). After treatment, intestinal metaplasia and glandular atrophy was significantly more improved or reversed than those in the control group ( χ2=20.67,9.33, P<0.05). Conclusion:The methods of activating blood and removing blood stasis, invigorating the spleen and soothing the liver can reverse the precancerous lesions of patients with gastric collateral stasis syndrome of chronic atrophic gastritis and have a good prognosis.
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Objetivos: Se buscó determinar si las endoscopias que cumplieron el protocolo Sydney en una población de Antioquia tuvieron una detección mayor de H. pylori y sus lesiones asociadas que las endoscopias que sólo tomaron muestras de antro. Materiales y métodos: Realizamos un estudio retrospectivo, trasversal y descriptivo. Se incluyeron pacientes adultos sometidos a endoscopia superior. Se dividieron los pacientes en dos grupos según si se siguió o no el protocolo Sydney y se midió la frecuencia de detección de H. pylori, y lesiones premalignas. Resultados: Se incluyeron 261 participantes, a 88 se les tomó el protocolo de Sydney y a 173 se les tomaron muestras exclusivamente de antro gástrico. La indicación principal de endoscopia fue dispepsia (35,6%). La detección de H. pylori, gastritis atrófica y metaplasia intestinal fue del 36,4%, 19,3% y 20,5% respectivamente en el grupo Sydney, y 30,1%, 11,6% y 9,8% en el grupo control. En el grupo Sydney, la detección de H. pylori fue mayor en antro y cuerpo (26,1%) que en antro (6,8%) o cuerpo (3,4%) por separado. La detección de gastritis atrófica y metaplasia intestinal fue mayor en antro solamente (10,2% y 11,4% respectivamente) que en antro y cuerpo o cuerpo por separado. Conclusiones: La omisión del protocolo Sydney reduce la detección de H. pylori, gastritis atrófica y metaplasia intestinal en un 9,4%, 29,4% y 27,7% respectivamente. Se debe implementar el protocolo sistemáticamente en todo centro de endoscopia digestiva.
Objectives: We sought to determine whether the endoscopies that met the Sydney protocol in a population of Antioquia had a greater detection of H. pylori and their associated lesions than the endoscopies that only took antrum samples. Materials and methods: We carried out a retrospective, cross-sectional and descriptive study. Adult patients undergoing upper endoscopy were included. Patients were divided into two groups depending on Sydney protocol compliance. The detection frequency was measured for H. pylori and premalignant lesions. Results: 261 participants were included, 88 from which biopsies were taken with the Sydney protocol and 173 with biopsies taken exclusively from the gastric antrum. The main endoscopy indication was dyspepsia (35.6%). The detection of H. pylori, atrophic gastritis and intestinal metaplasia was 36.4%, 19.3% and 20.5% respectively in the Sydney group, and 30.1%, 11.6% and 9.8% in the control group. In the Sydney group, the detection of H. pylori was higher in the antrum and body (26.1%) than in antrum (6.8%) or body (3.4%) separately. The detection of atrophic gastritis and intestinal metaplasia was higher in antrum only (10.2% and 11.4% respectively) than in antrum and body or body separately. Conclusions: The omission of the Sydney protocol reduces the detection of H. pylori, atrophic gastritis and intestinal metaplasia by 9.4%, 29.4% and 27.7% respectively. The protocol must be implemented systematically in every gastrointestinal endoscopy center.
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Helicobacter pylori es un microrganismo que se considera que afecta al 50% de la población. Se realizó un estudio con diseño no experimental, correlacional y transversal, con el objetivo de determinar la asociación de los resultados de pruebas diagnósticas de infección por H. pylori a través de biopsia obtenida por endoscopía superior y prueba de antígeno de la superficie en mues-tras de heces en 100 pacientes atendidos en el Servicio de Gastroenterología del Centro Clínico Quirúrgico Ambulatorio (Hospital del Día) Efrén Jurado López del Instituto Ecuatoriano de Seguridad Social (IESS), en la ciudad de Guayaquil, Ecuador, durante 2019. La media de la edad en la muestra de estudio fue 37,5 años, con un predominio del género femenino (78%). El 65% de las pruebas de antígeno para la detección de H. pylori en heces resultaron negativas. Los repor-tes de las pruebas de antígeno en heces e histopatología permitieron apreciar diferencias entre estos, pero con predominio de las coincidencias en los diagnósticos positivos. Existió una asocia-ción estadísticamente significativa entre las lesiones inflamatorias de la mucosa gástrica producto de la gastritis crónica atrófica y la infección por H. pylori. Los resultados de las dos pruebas diag-nósticas tuvieron una correlación lineal positiva y débil con significación estadística.
Helicobacter pylori is a microorganism that affects 50% of the population worldwide. A study with a non-experimental, correlational, and cross-sectional design was carried out in order to determine the association of the results of diagnostic tests for H. pylori infection through biopsy obtained by upper endoscopy and surface antigen test in samples of feces in 100 patients. These ones were treated at the Gastroenterology Service of the Ambulatory Surgical Clinic Center (Hospital del Día) Efrén Jurado López of the Ecuadorian Institute of Social Security (IESS), in the city of Guayaquil, Ecuador, during 2019. The mean age in the study sample was 37.5 years old, with a predominance of the female gender (78%). 65% of stool antigen tests for H. pyloriwere negative. The reports of the stool antigen test and histopathology allowed to appreciate differences between them, but with a predominance of the coincidences in the positive diagno-ses. There was a statistically significant association between the inflammatory lesions of the gastric mucosa because of chronic atrophic gastritis and the infection by H. pylori. The results of the two diagnostic tests had a positive and weak linear correlation with statistical significance
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Humans , Male , Female , Adult , Helicobacter pylori , Gastric Mucosa , Gastritis, Atrophic , Diagnostic Tests, Routine , Gastritis , InfectionsABSTRACT
Traditional Chinese Medicine (TCM) alone or combined with western medicine has obvious clinical therapeutic effects on chronic atrophic gastritis, especially in improving symptoms and reversing lesions, based on the basic pathogenesis of chronic atrophic gastritis with deficiency in origin and excess in superficiality. The therapeutic methods include invigorating spleen, activating blood circulation and detoxification. The main mechanism is to inhibit cell proliferation, induce apoptosis, change the micro-environment, reduce the degree of inflammation, repair damaged mucosa and improve immune function.
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Introducción: La gastritis eosinofílica es una enfermedad infrecuente caracterizada por la presencia de eosinofilia hística, que afecta las diferentes capas de la pared intestinal. Este tipo de gastritis se caracteriza por una infiltración eosinofílica intensa que puede afectar solo la mucosa gástrica o todas sus capas hasta la serosa. La presentación clínica difiere de la posición y la extensión de la infiltración del eosinófilo, así como también su profundidad a través de la pared del intestino. Objetivo: Presentar el caso de un paciente diagnosticado y tratado como una gastritis eosinofílica. Caso clínico: Paciente masculino, raza blanca, de 47 años de edad, que acudió al Servicio de Gastroenterología del Hospital Universitario Manuel Ascunce Domenech, de la provincia Camagüey; en octubre de 2019. Refirió que durante los dos últimos meses había consultado en atención primaria de forma esporádica por molestias epigástricas, estos episodios cedían con pautas cortas de antiácidos. Los síntomas comenzaron agudizarse y se hicieron más resistentes al tratamiento, apareciendo náuseas, vómitos y pérdida de peso marcada. Se decidió comenzar la realización de estudios analíticos al paciente. Conclusiones: El resultado del estudio histológico fue infiltrado inflamatorio crónico severo con presencia de eosinófilos más del 50 % que se extiende a todas las capas con epitelio glandular reactivo, concluyó como una gastritis eosinofílica.
Introduction: Eosinophilic gastroenteritis is a rare disease characterized by the presence of tissue eosinophilia, which affects the different layers of the intestinal wall.This type of gastritis is characterized by an intense eosinophilic infiltration that can affect only the gastric mucosa or all its layers up to the serosa. The clinical presentation differs on the position and extent of the eosinophil infiltration, as well as its depth through the bowel wall. Objective: To present the case of a patient diagnosed and treated as eosinophilic gastritis. Case report: A 47-year-old white male patient from Camagüey province, who attends the Gastroenterology Service of the Manuel Ascunce Domenech University Hospital, Camagüey province; in October 2019. He reported that during the last two months he had consulted primary care sporadically due to epigastric discomfort, these episodes subsided with short courses of antacids. The symptoms began to worsen and became more resistant to treatment, with nausea, vomiting and marked weight loss appearing. It was decided to start performing analytical studies on the patient. Conclusions: The result of the histological study was a severe chronic inflammatory infiltrate with the presence of eosinophils more than 50% that extends to all layers with reactive glandular epithelium, concluding it as eosinophilic gastritis.
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Objective:To explore an ideal method for establishing a mouse model of chronic atrophic gastritis (CAG).Methods:CAG mouse models were established with five different modeling methods ( N-methyl- N′-nitro- N-nitrosoguanide (MNNG), sodium salicylate, sodium deoxycholate, Helicobacter pylori infection, and combinations of them) in BALB/c and C57 mice. The effect of each modeling method was evaluated by histological observation of gastric mucosa, plasma biochemical parameters, inflammatory response score, and the expression of anti-inflammatory factors. Results:The results of histological observation of gastric mucosa showed that all of the 5 methods could successfully establish CAG mouse models. In BALB/c mice, compared with the healthy control group, significant features of CAG accompanied with intestinal metaplasia was found in the model group established by combination of MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate. From the results of serological detection, compared with the normal control group, the mRNA expression levels of related anti-inflammatory factors interleukin-2, interleukin-10, interleukin-13 and growth differentiation factor-15 of each model group decreased, which indicated that the mice of each CAG model group had different degrees of inflammation. The results of plasma biochemical parameters indicated that plasma gastrin of each group decreased and the ratio of pepsinogen Ⅰ and pepsinogen Ⅱ significantly dropped. The above results demonstrated that in BLAB/c mice, MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate was better than other four modeling methods. For C57 mice, it was also found that simple chemical drug mutagenesis and Helicobacter pylori replication method both could successfully establish CAG models. No matter from pathological observation, relative expression of anti-inflammatory factors and analysis of plasma biochemical parameters, the effects of combination of the two methods was better. Conclusion:The CAG mouse model established by MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate can provide a certain reference for the establishment and application of mouse model in CAG experiments in the future for pharmacological research.
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Objective:To evaluate the clinical efficacy of Shaoyao-Bawei Decoction combined with moxibustion in the treatment of spleen stomach weakness syndrome of chronic atrophic gastritis (CAG). Methods:The 98 CAG patients admitted to the Zhaoqing Gaoyao District People’s Hospital from January 2019 to January 2021 who met the selection criteria were divided into 2 groups according to the random number table method, with 49 in each group. The control group received conventional western medicine treatment, and the observation group was treated with Shaoyao-Bawei Decoction combined with moxibustion on the basis of the control group. TCM symptom scores were performed before and after treatment, the levels of IL-6, IL-8 and TNF-α were detected by ELISA, and the levels of serum motilin (MLT), gastrin-17 (G17) and gastrin (gas) were detected by radioimmunoassay, the safety of medication was observed and the clinical efficacy was evaluated. Results:The total effective rate was 93.9% (46/49) in the observation group and 71.4% (35/49) in the control group. There was significant difference between the two groups ( χ2=8.611, P=0.043). After treatment, the scores of epigastric burning, fullness in stomach, dull appetite, dry mouth and bitter mouth, shortness of breath and unwillingness to speak, general lassitude, pale tongue, small and weak pulse in the observation group were significantly lower than those in the control group ( t=12.061, 7.331, 6.869, 5.975, 5.208, 10.567, 8.738, 8.631, respectively, all Ps<0.01), and the levels of serum IL-6, IL-8 and TNF-α were significantly lower than those in the control group ( t=8.573,13.423,12.099, respectively, all Ps <0.01). After treatment, the level of serum MLT (154.52 ± 26.25 ng/L vs. 180.26 ± 28.13 ng/L, t=4.488) in the observation group was lower than that of the control group ( P<0.01); the levels of G17 (14.28 ± 1.75 pmol/L vs. 10.28 ± 1.06 pmol/L, t=-7.966) and GAS (24.73 ± 3.42 ng/L vs. 19.02 ± 3.38 ng/L, t=-13.115) in the observation group were significantly higher than those in the control group ( t=-7.966 and -13.115, respectively, all Ps<0.01). During the treatment, the incidence of adverse reactions was 8.16% (4/49) in the observation group and 6.12% (3/49) in the control group, and there was no significant difference between the two groups ( χ2=0.152, P=0.695). Conclusion:Shaoyao-Bawei Decoction combined with moxibustion can alleviate the clinical symptoms of CAG patients with spleen stomach weakness syndrome, regulate the level of inflammatory cytokines, promote the recovery of gastrointestinal function and improve the clinical curative effect.
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Objective:To evaluate the clinical efficacy of Wanfu-Qutong Decoction combined with esomeprazole in the treatment of chronic atrophic gastritis (CAG). Methods:A total of 106 CAG patients who met the inclusion criteria from June 2017 to June 2019 were randomly divided into two groups with 53 in each group. The control group took esomeprazole magnesium enteric coated tablets, and the observation group took Wanfu-Qutong Decoction on the basis of the control group. Both groups were treated continuously for 3 months. TCM syndrome score was performed before and after treatment, and the new Sydney system intuitive simulation score method was used to score the histopathology of gastric mucosa. The levels of gastrin 17 (G-17), pepsinogen (PGⅠ , PGⅡ) and the PG Ⅰ/Ⅱ were measured by ELISA. Results:The total effective rate was 96.2% (51/53) in the observation group and 79.2% (42/53) in the control group. There was significant difference between the two groups ( χ2=7.414, P<0.01). After treatment, the scores of epigastric pain, fullness, liking temperature and pressing, vomiting clear water, eating less and staying foolish, and limb burnout in the observation group were significantly lower than those in the control group ( t values were 2.788, 3.632, 3.816, 1.590, 2.183, 2.103, respectively, all Ps<0.05), and the scores of chronic inflammatory reaction, inflammatory activity, atrophy degree, dysplasia and intestinal metaplasia in the mucosa were significantly lower than those in the control group ( t values were 2.983, 2.106, 2.106, 3.773, 1.922, 3.095, respectively, all Ps<0.05). After treatment, the serum G-17 [(14.47 ± 3.06) pmol/L vs. (10.67 ± 2.47) pmol/L, t=10.510] and PG Ⅰ [(130.31 ± 14.79) μg/L vs. (102.36 ± 12.63) μg/L, t=8.178] and PG Ⅰ/Ⅱ [(10.45 ± 0.48) vs. (9.17 ± 0.72), t=2.104] in the observation group were significantly higher than those in the control group ( P<0.01 or P<0.05). Conclusion:Wanfu-Qutong Decoction combined with esomeprazole tablets can effectively improve the clinical symptoms of CAG patients, regulate the levels of G-17, PG Ⅰ , PG Ⅱ and PGⅠ/Ⅱ, and promote the repair of gastric mucosa.
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RESUMEN La metaplasia intestinal gástrica y la gastritis atrófica son condiciones precancerosas conocidas (CPCs) del estómago, lo que significa que los pacientes con CPCs están en riesgo de desarrollar cáncer gástrico y, por lo tanto, el diagnóstico y la categorización de riesgo para estos pacientes es un tema relevante. El objetivo de esta revisión es proporcionar una actualización sobre el problema, el diagnóstico y el manejo de las CPCs con énfasis en el papel de la detección endoscópica adecuada.
ABSTRACT Gastric intestinal metaplasia and atrophic gastritis are a known precancerous condition (PCC) of the stomach, meaning that patients with PCC are at risk for gastric cancer and so, diagnosis and risk categorization for these patients is relevant. The aim of this review is to provide an update regarding the problem, diagnosis, and management of PCCs with an emphasis on the role of appropriate endoscopic detection.
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Humans , Stomach/pathology , Gastritis, Atrophic/diagnosis , Intestines/pathology , Diagnostic Techniques, Digestive System , Metaplasia/diagnosisABSTRACT
Background: Gastric cancer, especially intestinal-type gastric cancer, is considered as the result of the process of non-atrophic gastritis-atrophic gastritis-dysplasia-carcinogenesis. Aims: To explore the phenotypic characteristics and differentially expressed genes (DEGs) enrichment pathway of inflammatory cells between gastritis that prone to canceration (atrophic gastritis) and gastritis that not prone to canceration (non-atrophic gastritis). Methods: The datasets of GSE2669, GSE83389, GSE106656 and GSE27411 were downloaded from GEO database. DEGs were screened by R language and verified by GSE116312 dataset. DEGs screened from 3 datasets of 'non-atrophic gastritis-atrophic gastritis' were overlapped with inflammatory cell phenotypic characteristic genes. REACTOME and KEGG analyses of DEGs were performed. Results: A variety of DEGs in the 'normal gastric mucosa-non-atrophic gastritis-atrophic gastritis' dynamic process were screened, and 5 common genes were verified by GSE116312 dataset. A total of 85 inflammatory cell phenotypic characteristic genes were screened from 3 datasets. The percentage of neutrophil was high during 'normal gastric mucosa-non-atrophic gastritis' process while the percentages of fibroblast and macrophage were high during 'non-atrophic gastritis-atrophic gastritis' process. REACTOME and KEGG analyses showed that DEGs of inflammatory cell phenotype during 'non-atrophic gastritis-atrophic gastritis' process were mainly enriched in IL-10, IL-4 and IL-13 signaling pathways and antigen presentation pathway. Conclusions: Macrophage, neutrophil and fibroblast are the inflammatory cell phenotypic characteristics of gastritis with cancerous potential, which enriched in IL and antigen presentation pathways.
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Background: Artificial intelligence (AI) is a research hotspot in various fields of medicine at present. Its powerful image recognition and processing ability make it having a strong advantage in the field of digestive endoscopy. Aims: To construct a gastroscopy image recognition system based on AI, and to explore its value in the diagnosis of chronic atrophic gastritis (CAG). Methods: A total of 3 813 gastroscopy images were collected from patients who underwent gastroscopy and biopsy for pathological examination from April 2018 to August 2020 at Qingdao Municipal Hospital, including 1 927 images of CAG and 1 886 images of chronic non-atrophic gastritis (CNAG). Among them, 3 055 images were selected as training set (CAG/CNAG, 1 541/1 514) and 379 images (CAG/CNAG, 193/186) as the adjustment set, the remaining images as the test set. Deeping learning model was trained and verified. The receiver operating characteristic curve (ROC curve) and P-R curve were calculated. The sensitivity, specificity and accuracy of deep learning model and that of 3 less experienced endoscopists, 3 experienced endoscopists for diagnosis of CAG were compared. Results: The area under ROC curve of deep learning model for CAG was 0.916 8, the area under P-R curve was 0.931 6, and sensitivity was 89.1%, specificity was 74.2%, accuracy was 81.8%. The sensitivity, specificity and accuracy of deep learning model were superior to the three less experienced endoscopists, and even superior to some of the experienced endoscopists. Conclusions: The CAG diagnostic model based on deep learning technology has high sensitivity, specificity and accuracy, and can effectively identify CAG and assist the clinical endoscopists to diagnose CAG in gastroscopy.
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Background: Endoscopic screening is an effective approach for detecting early gastric cancer. The interval of endoscopic surveillance should be defined based on the risk stratification of gastric cancer, so as to improve the screening efficiency. Aims: To investigate whether gastric cancer risk could be stratified according to endoscopic atrophic gastritis grading. Methods: Subjects who underwent gastroscopy at least two times between Jan. 2015 and Dec. 2019 at the 900th Hospital of Joint Logistics Support Force, PLA were enrolled in a retrospective study. The demographic data and information on endoscopy were recorded. The extent and degree of gastric atrophy under endoscopy was graded using Kimura-Takemoto classification system. Then the subjects were allocated into mild group (none atrophy and C-1), moderate group (C-2 and C-3) and severe group (O-1, O-2 and O-3) based on the grading. The correlation of endoscopic grading of atrophy with the risk of gastric cancer was analyzed. Results: A total of 8 736 subjects were enrolled, 4 154 were in mild group (47.6%), 2 409 in moderate group (27.6%), and 2 173 in severe group (24.9%). The mean endoscopic follow-up time was (1 052±643) d, and the mean endoscopic surveillance interval was (518±271) d. The overall coincidence rate of endoscopic diagnosis and pathological diagnosis for atrophy was 88.9%. During the follow-up period, gastric cancer was detected in 41 cases; the detection rates of mild group, moderate group and severe group were 0.07%, 0.54% and 1.15%, respectively (P<0.001). Conclusions: The risk of gastric cancer can be stratified according to the endoscopic atrophic gastritis grading, which is helpful for the decision of individualized endoscopic surveillance interval.
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Background: Chronic atrophic gastritis with intestinal metaplasia is closely related to the development of gastric cancer. Studies have showed that Lamb's Tripe Extract and Vitamin B12 capsule (LTEVB12) may reverse atrophy and intestinal metaplasia by promoting gastric mucosal gland proliferation, inhibiting gland apoptosis and inhibiting oxidative stress response in rats.Aims: To explore the pathological changes and influencing factors of LTEVB12 in treatment of chronic atrophic gastritis with intestinal metaplasia. Methods: A total of 173 patients with chronic atrophic gastritis with intestinal metathesis from June 2018 to June 2019 at Xijing Hospital were enrolled. All patients were treated with LTEVB12 (2 capsules tid). Gastroscopy and gastric mucosal biopsies were performed at 6 months and 12 months after treatment. The therapeutic effect of the drug was evaluated according to the changes of OLGA staging and OLGIM staging before and after treatment. The influencing factors were analyzed by univariate analysis and multivariate analysis. Results: After 6 months of treatment, the effective rates on OLGA staging and OLGIM staging were 49.7% and 32.9%, respectively. After 12 months of treatment, the effective rates on OLGA staging and OLGIM staging were 56.4% and 41.8%, respectively. The total effective rates of 6 months and 12 months treatment were 64.7% and 70.9%, respectively. Univariate analysis showed that education, fried food, statins and antibiotics were correlated with OLGA staging, while age was correlated with OLGIM staging. Multivariate analysis showed that education, fried food and antibiotics were independent factors of OLGA staging. Conclusions: LTEVB12 can significantly reduce the OLGA staging and OLGIM staging in patients with chronic atrophic gastritis with intestinal metaplasia, which suggests that LTEVB12 has the potential to reduce risk of gastric cancer and has the prospects of clinical application in prevention of gastric cancer.
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Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.
Subject(s)
Humans , Precancerous Conditions/diagnosis , Waiting Lists , Helicobacter pylori/isolation & purification , Helicobacter Infections/diagnosis , Dyspepsia/diagnosis , Feces/microbiology , Antigens, Bacterial/analysis , Precancerous Conditions/microbiology , Primary Health Care , Referral and Consultation , Helicobacter Infections/complications , Helicobacter Infections/microbiology , Sensitivity and Specificity , Early Diagnosis , Dyspepsia/microbiology , Endoscopy/statistics & numerical dataABSTRACT
El carcinoma gástrico (CG) de tipo intestinal se origina en un epitelio displásico, que a su vez se desarrolla en medio de una atrofia gástrica (AG) y metaplasia intestinal (MI). La infección por Helicobacter pylori (HP) es la causa más frecuente de AG, causando una pangastritis atrófica multifocal. Entre otras condiciones que producen inflamación crónica de la mucosa gástrica se encuentran también la gastritis autoinmune y la anemia perniciosa. El marco conceptual sobre el cual descansa gran parte de la investigación actual y nuestra comprensión de los cambios que ocurren en la mucosa gástrica se debe a la denominada "cascada de Correa"; quien planteó que la mucosa gástrica crónicamente inflamada, da paso a la AG, que va adquiriendo focos de MI y en dicho epitelio se desarrollará finalmente una displasia (DIS). Se ha acuñado el término lesiones preneoplásicas gástricas (LPG), para referirse a: AG, MI y DIS.Después de la erradicación de HP, se ha demostrado una reducción general de la incidencia de CG; efecto que no es tan claro, cuando la pangastritis por HP ha evolucionado a AG extensa. De tal modo que el efecto de la erradicación de HP medido a través de EC, ha sido poco consistente. La AG grave diagnosticada por histología representa la condición de mayor riesgo. Por otra parte, la MI puede ser de tipo intestinal (delgado-entérica ó incompleta) y la colónica (colónica ó completa) considerándose a esta última, como la variedad de peor pronóstico. El diagnóstico histológico de este tipo de lesiones determina que quien las padece, debe someterse a vigilancia endoscópica. El objetivo de este manuscrito fue resumir la evidencia existente respecto de las LPG, en términos de su caracterización morfológica y sus repercusiones diagnóstico-terapéuticas (significado patológico, graduación del riesgo, vigilancia recomendada; y factores de riesgo).
Gastric carcinoma (GC) of intestinal type, originates from a dysplastic epithelium, which in turn develops in the midst of gastric atrophy (GA) and intestinal metaplasia (IM). Helicobacter pylori (HP) infection is the most frequent cause of GA, causing a multifocal atrophic pangastritis. Among other conditions that produce chronic inflammation of gastric mucosa are also autoimmune gastritis and pernicious anemia. The conceptual framework on which much of current research rests and our understanding of the changes that occur in the gastric mucosa is due to the so-called "Correa waterfall"; who stated that gastric mucosa chronically inflamed, gives way to the GA, which is acquiring foci of IM and in said epithelium a dysplasia (DIS) will eventually develop. The term precancerous conditions (PCC) of the gastric mucosa have been coined to refer to: GA, IM and DIS. After HP eradication, a general reduction in the incidence of GC has been demonstrated; effect that is not so clear, when pangastritis by HP has evolved to extensive GA. Thus, the effect of HP eradication measured through clinical trials has been inconsistent. Severe GA diagnosed represents the highest risk condition. On the other hand, IM can be enteric (grade I), enterocolic (grade II) or colonic (grade III); considering IM III as the variety with the worst prognosis. Histological diagnosis of gastric PCC, determines that the one who suffers them, must undergo endoscopic surveillance. The aim of this manuscript was to update morphological aspects and diagnostic-therapeutic scope of gastric PCC.
Subject(s)
Humans , Precancerous Conditions/pathology , Stomach Neoplasms/pathology , Precancerous Conditions/microbiology , Stomach Neoplasms/microbiology , Risk Factors , Helicobacter pylori , Helicobacter Infections/complications , Helicobacter Infections/pathology , Risk Assessment , Gastritis, Atrophic/microbiology , Gastritis, Atrophic/pathology , Intestines/microbiology , Intestines/pathology , Metaplasia/microbiology , Metaplasia/pathologyABSTRACT
Objective To analyze the curative effect of teprenone capsule combined with quadruple therapy in the treatment of chronic atrophic gastritis.Methods From June 2013 to June 2017,one hundred and fifty patients with chronic atrophic gastritis admitted to the First Hospital of Ninghai County were retrospectively selected.According to different treatment schemes,they were divided into control group and observation group,with 75 patients in each group.The control group was treated with routine quadruple therapy, and the observation group was treated with teprenone capsule combined with quadruple therapy.The effective rate of the two groups was compared.Results The total effective rate of the observation group was 97.33% ,which was higher than 85.33% of the control group,the difference between the two groups was statistically significant(χ2 =3.197,P<0.05).After treatment,the levels of interleukin-8 and tumor necrosis factor - alpha in the observation group were ( 7.04 ± 1.03 ) ng/L, ( 41.02 ± 1.72)ng/L,respectively,which in the control group were (10.81 ± 1.63)ng/L,(57.35 ± 2.95) ng/L,respectively, the differences between the two groups were statistically significant (t=6.028,7.281,all P <0.05).The gastric mucosa score and the gastrin concentration in the observation group were (1.13 ± 0.32)points,(8.97 ± 2.33)pmol/L, respectively,which in the control group were ( 1. 82 ± 0. 61 ) points, ( 5. 36 ± 1. 52 ) pmol/L, respectively, the differences between the two groups were statistically significant ( t =5. 661, 6. 024, all P <0. 05 ). Conclusion Teprenone capsule combined with quadruple therapy can improve the clinical efficacy and reduce the degree of inflammation in patients with chronic atrophic gastritis,which is worthy of clinical application.
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Objective To establish a rat chronic atrophic gastritis with dysplasia model and observe the effect of Shidan granules on the positive expression of NF-κB p65 in gastric tissues and the extent of IKKβprotein content in gastric tissues of chronic atrophic gastritis with dysplasia model rats. Methods Seventy SPF male Wistar rats were randomly divided into the blank group and 60 into the model group. In addition to the blank group, the modeling group was made using the MNNG-based comprehensive modeling method (150 μg/ml MNNG 5 ml/kg each stomach, containing 0.03％ ranitidine feed, free drinking 0.1％ ammonia), and then model successed at the 28th week. The remaining rats in the modeling group were randomly divided into 5 groups: the model group with intragastric administration of gavage, the western medicine group with intragastric administration of viralin, the Shidan granules group with intragastric administration of low/medium/high concentration Chinese medicine decoction. After 12 weeks of treatment, they were sacrificed and the expression of NF-κB p65 and IKKβ was measured and compared. Results Compared with the model group, the average optical density of NF-κBp65 (0.387 ± 0.011, 0.252 ± 0.022, 0.193 ± 0.003 vs. 0.442 ± 0.035) and the expression level of IKKβ (0.309 ± 0.056, 0.216 ± 0.025, 0.125 ± 0.016 vs. 0.405 ± 0.042) in the low-, middle- and high-dose Shidan granules groups significantly decreased (all Ps<0.01). Conclusions The mechanism of improving the precancerous lesions of gastric cancer by Shidan granules may be achieved by inhibiting the expression of IKK, reducing the abnormal activation of NF-κB.