Morfología y repercusiones diagnóstico-terapéuticas de las lesiones preneoplásicas gástricas / Morphology and diagnostic determinants of gastric precancerous conditions

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.

Efficacy Observation of Electroacupuncture at the Three Groups of Stomach-Meridian Acupoints for Chronic Superficial Gastritis / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture (EA) at the three groups of Stomach- Meridian acupoints in treating chronic superficial gastritis (CSG) and its effect on serum gastrin level and electrogastrogram, for providing clinical evidence for the experimental result of the three groups of Stomach-Meridian acupoints.Method Sixty-six CSG patients were divided into a treatment group and a control group by using stratified random method, 33 cases in each group. The treatment group was intervened by EA at the three groups of Stomach-Meridian acupoints, while the control group was intervened by EA with ordinary acupoints selection. The intervention was given once a day, successive 6 sessions as a treatment course, for 4 courses in total. The CSG symptoms and syndrome score, serum gastrin content, average amplitude of electrogastrogram, mean waveform frequency, and the percentage of gastric dysrhythmias were observed before and after the intervention, and the clinical efficacies were compared.Result The total effective rate was 90.9％ in the treatment group, versus 87.9％ in the control group, and the between-group difference was statistically insignificant (P>0.05). The total scores dropped significantly in both groups after the treatment (P<0.05), and there was no significant difference in comparing the total score between the two groups after the treatment (P>0.05). The serum gastrin contents declined significantly in both groups after the intervention (P<0.05), and there was no significant between-group difference in comparing the serum gastrin content after the treatment (P>0.05); the average amplitude and mean waveform frequency of preprandial and postprandial electrogastrogram increased significantly in both groups after the treatment (P<0.05), and the percentage of gastric dysrhythmias dropped significantly (P<0.05); after the treatment, there were no significant between-group differences in comparing the average amplitude, mean waveform frequency and the percentage of gastric dysrhy- thmias of preprandial and postprandial electrogastrogram (P>0.05).Conclusion EA at the three groups of Stomach- Meridian acupoints can effectively improve the symptoms, down-regulate serum gastrin, help gastric motility, and restore gastric rhythm of CSG patients; its efficacy is equivalent to that of the classic acupoints group, i.e. Neiguan (PC6), Zhongwan (CV 12), and Zusanli (ST 36).

Efficacy Observation of Electroacupuncture at the Three Groups of Stomach-Meridian Acupoints for Chronic Superficial Gastritis / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture (EA) at the three groups of Stomach- Meridian acupoints in treating chronic superficial gastritis (CSG) and its effect on serum gastrin level and electrogastrogram, for providing clinical evidence for the experimental result of the three groups of Stomach-Meridian acupoints.Method Sixty-six CSG patients were divided into a treatment group and a control group by using stratified random method, 33 cases in each group. The treatment group was intervened by EA at the three groups of Stomach-Meridian acupoints, while the control group was intervened by EA with ordinary acupoints selection. The intervention was given once a day, successive 6 sessions as a treatment course, for 4 courses in total. The CSG symptoms and syndrome score, serum gastrin content, average amplitude of electrogastrogram, mean waveform frequency, and the percentage of gastric dysrhythmias were observed before and after the intervention, and the clinical efficacies were compared.Result The total effective rate was 90.9％ in the treatment group, versus 87.9％ in the control group, and the between-group difference was statistically insignificant (P>0.05). The total scores dropped significantly in both groups after the treatment (P<0.05), and there was no significant difference in comparing the total score between the two groups after the treatment (P>0.05). The serum gastrin contents declined significantly in both groups after the intervention (P<0.05), and there was no significant between-group difference in comparing the serum gastrin content after the treatment (P>0.05); the average amplitude and mean waveform frequency of preprandial and postprandial electrogastrogram increased significantly in both groups after the treatment (P<0.05), and the percentage of gastric dysrhythmias dropped significantly (P<0.05); after the treatment, there were no significant between-group differences in comparing the average amplitude, mean waveform frequency and the percentage of gastric dysrhy- thmias of preprandial and postprandial electrogastrogram (P>0.05).Conclusion EA at the three groups of Stomach- Meridian acupoints can effectively improve the symptoms, down-regulate serum gastrin, help gastric motility, and restore gastric rhythm of CSG patients; its efficacy is equivalent to that of the classic acupoints group, i.e. Neiguan (PC6), Zhongwan (CV 12), and Zusanli (ST 36).

Revisión narrativa de la literatura sobre manejo con medicina homeopàtica de pacientes con síntomas de gastritis / Narrative review of the literature on management with homeopathic medicine of patients with symptoms of gastritis

Las enfermedades del aparato digestivo son frecuentes y en ocasiones incapacitantes para la vida diaria y laboral. Dentro de ellas la gastritis es una de las que más incidencia tiene en el mundo entero. En gran parte de los casos la gastritis está acompañada de la infección por Helicobacter Pylori, bacteria que está relacionada con el cáncer de estómago. Los tratamientos que actualmente se llevan a cabo en la medicina tradicional, además de que son muy agresivos, todavía dejan muchas dudas sobre sus efectos secundarios y los daños que pueden llegar a provocar en el organismo, dentro de ellos el cáncer. Por eso mismo se ha visto el incremento en la utilización de las terapias alternativas para el manejo de la gastritis, dentro de ellas la homeopatía, la cual ha tenido una muy buena aceptación y resultados, pero desafortunadamente, todos estos avances no están lo suficientemente documentados. Para la realización de éste trabajo primero se hizo una Revisión Narrativa de la Literatura existente en los últimos 20 años, encontrando en las bases de datos que algunos remedios homeopáticos han demostrado resultados favorables en el manejo de la gastritis y tienen publicaciones muy interesantes en la literatura, pero la gran mayoría de remedios sólo se encuentran relacionados en las materias médicas. Sin embargo, este trabajo logró establecer los medicamentos homeopáticos útiles en la gastritis basándose en los síntomas que reportan las principales Medicinas Internas conocidas, como son las de: Harrison, Cecil y Farreras. Tomando éstos síntomas se pasaron al lenguaje repertorial homeopático, luego se realizó un ejercicio repertorial que nos revela varios remedios policrestos muy valiosos para el manejo de los síntomas de la gastritis. Además se realizó otra repertorización buscando sólo remedios pequeños, que nos pone delante de los ojos, opciones medicamentosas muy útiles que probablemente nunca habríamos pensado. Dentro de los remedios policrestos y semipolicrestos que se encontró tenían la mejor cobertura de síntomas de gastritis están: Arsenicum álbum, Nux vómica, Sulphuricumacidum, Sulphur, Magnesia carbónica, Lycopodium, KaliBichromicum, Iris Versicolor, Graphites, Crocus sativa, Carbovegetabilis, ArgentumNitricum, Bismuthum, Anacardiumorientale, Phosphorus, Plumbummetallicum, Bryonia, NatrumMuriaticum, Lachesis, China officinalis y Pulsatilla. Dentro de los pequeños remedios se encontraron en los primeros 5 lugares: ArsenicumIodatum, Tabacum, SecaleCornutum, FerrumPhosphoricum y Oxalicumacidum; los cuales son incluidos en la tabla de resultados de medicamentos para gastritis, junto con los policrestos y otros remedios de gran valor en el manejo de la gastritis. Este trabajo será de gran ayuda y motivación especialmente para los médicos que trabajamos con la homeopatía, para seguir publicando cada vez con mayor dedicación y detalle con el fin de dar a conocer todas las maravillas que la homeopatía nos demuestra día a día.

Therapeutic Observation of Warm Needling in Treating Chronic Gastritis / 上海针灸杂志

ObjectiveTo compare the therapeutic efficacy between warm needling and Western medication in treating chronic atrophic gastritis.MethodSixty patients were randomized into an observation group and a control group, 30 cases in each group. The observation group was intervened by warm needling, selecting Guanyuan (CV4), Qihai (CV6), Zusanli (ST36), Xuehai (SP10), and Geshu (BL17); The control group was by Western medication, including Omeprazole, Amoxillin, Metronidazole, etc. The clinical efficacies were compared after 8-week treatment. Besides, gastroscopewas ordered at outset and after 8-week treatment to compare the therapeutic efficacies.ResultIn comparing the clinical symptoms, the total effective rate was 93.3% in the observation group versus 70.0% in the control group (P<0.05); the gastroscope scores dropped significantly in both groups after 8-week treatment (P<0.05), and the score of the observation group was significantly lower than that of the control group (P<0.05). ConclusionAcupuncture-moxibustion can significantly improve the clinical symptoms and gastroscopic results in patients with chronic gastritis, and its therapeutic efficacy is superior to that of Western medication.

Expression of Gastrin,Somatostatin,Proliferating Cell Nuclear Antigen and Fas-Ligand in Mucosa of Gastric Antrum in Children with Chronic Gastritis / 实用儿科临床杂志

Objective To investigate the expression of immunohistochemistry of gastrin(GAS),somatostatin(SS),proliferating cell nuclear antigen(PCNA) and Fas-ligand(Fas-L) in the sinus ventriculi of children with pediatric gastritis and to explore the significance of their expression in the pathogenesis of pediatric chronic gastritis.Methods Fifty cases of the sinus ventriculi mucosa samples were enrolled in 3 groups:chronic gastritis,helicobacter pylori(Hp) positive(group A,n=20);chronic gastritis,Hp negative(group B,n=19);control group,normal sinus ventriculi mucosa,Hp negative(group C,n=11).Immunohistochemistry En Vision were carried out including GAS,SS,PCNA and Fas-L.Results In the expression of GAS and SS,the values of group A and B were comparatively higher than those of group C,but there was no significant difference among them in statistics.In the expression of PCNA,the value of group A was comparatively higher and that of group B.The value difference between 2 groups was significant(P=0.019);in the expression of Fas-L,no significant difference was found among these 3 groups.Conclusions Expressions of GAS and SS both increase in children with chronic gastritis and maybe the increase of GAS and SS play a role in the pathogenesis of pediatric chronic gastritis;Hp infection promotes the multiplication of the sinus ventriculi membrana mucosa epithelium cell in pediatric chronic gastritis.

Structure Characteristics of N-linked Glycans in Salivary Glycoproteins of Chronic Gastritis Patients with Spleen Deficiency / 广州中医药大学学报

【Objective】To analyze the structure of N-linked glycans in salivary glycoproteins and amylase of chronic gastritis(CG)patients with spleen deficiency after stimulation of acid,and to explore the relationship of N-linked glycans structure with salivary amylase activity and splenic hypofunction.【Methods】Iodine-spectrophotometry was used to detect the amylase activity in 47 CG patients with spleen deficiency,15 CG patients with dampness-heat in the spleen and stomach,and 12 healthy volunteers before and after acid stimulation.Method of concanacalin A(ConA) affinity chromatography was used to separate total salivary glycoproteins and amylase and to analyze N-linked glycans structure in 27 CG patients with spleen deficiency,14 CG patients with dampnessheat in the spleen and stomach,and 5 healthy volunteers after acid stimulation.ConA affinity reversed-phase two-dimension chromatography was applied to separate total salivary glycoproteins and to analyze the constitute and distribution of total salivary glycoproteins with different N-linked glycans in 13 CG patients with spleen deficiency,6 CG patients with dampness-heat in the spleen and stomach,and 5 healthy volunteers after acid stimulation.【Results】After acid stimulation,salivary amylase activity in CG with spleen deficiency decreased as compared with that before acid stimulation(P