Clinical Effect of Jianpi Huoxue Prescription Combined with Acupuncture on Chronic Atrophic Gastritis with Gastric Blood Stasis and Its Impact on Inflammatory Indicators and Gastric Mucosal Function / 中国实验方剂学杂志

ObjectiveTo explore the application effect of Jianpi Huoxue prescription combined with acupuncture in patients with chronic atrophic gastritis （CAG） of gastric blood stasis type. MethodA total of 86 patients with CAG admitted to Wuhan First Hospital from November 2021 to March 2023 were selected and randomly divided into two groups. The control group was treated with conventional Western medicine， while the observation group was treated with Jianpi Huoxue prescription combined with acupuncture. The clinical efficacy， traditional Chinese medicine （TCM） syndrome score， pathological score， negative conversion rate of Helicobacter pylori （Hp）， inflammatory indicators ［neutrophils/lymphocytes （NLR） and interleukin （IL）-1β］， changes in levels of gastric protease （PG） Ⅰ， PG Ⅰ/PG Ⅱ， and gastrin-17 （G-17）， and drug safety during treatment were observed after treatment in both groups. ResultAfter treatment， the total effective rate of the observation group ［95.35% （41/43）］ was significantly better than that of the control group ［79.07% （34/43）］， and the difference was statistically significant （χ2=5.108， P<0.05）. After treatment， the scores of the primary and secondary TCM syndromes in the observation group and the control group were significantly decreased （P<0.05）. After treatment， the scores of primary and secondary TCM syndromes in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia were significantly lower in the observation group and control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the Hp conversion rate in the observation group was significantly increased compared with the control group （P<0.05）. After treatment， the levels of inflammatory indicators NLR and IL-1β in the observation group and control group were significantly lower （P<0.05）， and the levels of inflammatory indicators NLR and IL-1β in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the levels of PGI and PGⅠ/PGⅡ in the observation group and control group were significantly higher （P<0.05）， and the levels of PGI and PGⅠ/PGⅡ in the observation group were significantly higher than those in the control group （P<0.05）. After treatment， the G-17 level of the observation group and the control group was different at different time points （P<0.05）， and the G-17 level of the observation group was higher at different time points than that of the control group （P<0.05）. The G-17 level of the observation group had an increasing trend compared with the control group （P<0.05）. There was no significant difference in the risk of adverse reactions between the two groups. ConclusionThe combination of Jianpi Huoxue prescription and acupuncture can effectively alleviate symptoms， increase Hp negative conversion rate， inhibit inflammation， and regulate PG and G-17 levels in CAG patients， thus controlling or even reversing gastric mucosal atrophy and reducing the probability of its progression to gastric cancer.

Exploring Central Regulatory Effect of Chaishao Liujuntang on Chronic Atrophic Gastritis Rats with Liver Depression and Spleen Deficiency Syndrome Based on Metabolomics / 中国实验方剂学杂志

ObjectiveBased on ultra performance liquid chromatography-mass spectrometry（UPLC-MS） and non-targeted metabolomics technology to discuss the central regulatory effect of Chaishao Liujuntang on chronic atrophic gastritis（CAG） rats with liver-depression and spleen-deficiency， and to look for the correlation between cerebral cortex， hypothalamus and metabolic status of gastric tissues. MethodA CAG rat model with liver-depression and spleen-deficiency was established by chemical induction， hunger and satiety disorders， chronic restraint and tail clamping stimulation， lasting for 16 weeks. Twenty-eight Wistar rats were randomly divided into a blank group of 8 rats and a model group of 20 rats. After the completion of modeling， 4 rats in the model group were taken to observe the pathological changes of gastric mucosa. The remaining model rats were randomly divided into a model group of 8 rats and a Chaishao Liujuntang group of 8 rats. Chaishao Liujuntang group rats were given 5.1 g·kg-1 by gavage， and the remaining rats were given equal volume sterilized water by gavage for 4 weeks. Macroscopic characteristics， behavioral indicators and histopathological changes of the gastric mucosa of rats in each group were observed and compared. UPLC-MS non-targeted metabolomics was used to explore the metabolic regulation effect of Chaishao Liujuntang on the cerebral cortex， hypothalamus and stomach tissues of CAG rats with liver-depression and spleen-deficiency. Pearson correlation coefficient method was used to analyze the correlation between different tissue metabolites. ResultCompared with the model group， the macroscopic characteristics of rats in Chaishao Liujuntang group were improved， such as hair color， mental state and stool properties， and the number of times of crossing and standing in the open field experiment was significantly increased， and the static time of forced swimming was significantly reduced（P<0.01）， and the gastric mucosa atrophy was reduced. The metabolic data from the cerebral cortex of rats in each group identified a total of 3 common potential biomarkers， but not enriched in pathways， 26 common potential biomarkers were identified in the hypothalamus， and the key metabolic pathways involved were mainly enriched in purine metabolism， glycerol phospholipid metabolism， D-glutamine and D-glutamic acid metabolism. Seventeen common potential biomarkers were identified in the stomach， and the key metabolic pathways involved were mainly enriched in thiamine metabolism， valine， leucine and isoleucine biosynthesis， and taurine and taurine metabolism. Correlation analysis of metabolites in different tissues revealed that multiple amino acids and their derivatives mediated metabolic connections between the cerebral cortex， hypothalamus and stomach of rats. ConclusionThe metabolic disorders in the cerebral cortex， hypothalamus and stomach of CAG rats with liver-depression and spleen-deficiency have their own characteristics， mainly manifested by changes in the content of glycerol phospholipids， fatty acids and bile acid metabolites. Moreover， Chaishao Liujuntang may play a central regulatory role in CAG rats with liver-depression and spleen-deficiency by correcting the metabolic disorders of amino acids.

Colecistectomía como factor de riesgo para reflujo duodenogástrico

El reflujo biliar o reflujo duodenogástrico (RDG) es el flujo retrógrado del contenido duodenal (principalmente bilis) hacia el estómago, capaz de producir daño químico a la mucosa y desencadenar mutaciones hacia el desarrollo de metaplasia intestinal, displasia e incluso, cáncer gástrico. El objetivo de este estudio fue estimar la prevalencia del reflujo biliar primario en pacientes colecistectomizados e identificar si la colecistectomía es un factor de riesgo para el RDG. Se realizó un estudio observacional transversal analítico, en el que fueron incluidos todos los pacientes que se realizaron endoscopía digestiva alta entre febrero y junio del 2023, en un centro endoscópico privado en la ciudad de Lima, Perú. De acuerdo al reporte endoscópico, los pacientes fueron divididos en dos grupos: con RDG y sin RDG. Se analizaron estadísticamente las características demográficas, el antecedente de colecistectomía y los hallazgos endoscópicos. Fueron incluidos 408 pacientes. La edad media de la población fue 48,18 ± 16,82años; el 61,52% fueron mujeres. La prevalencia de RDG fue de 25,74% en la población y de 52,11% en pacientes colecistectomizados. La prevalencia de RDG en pacientes colecistectomizados fue 2,58 veces en comparación a los pacientes sin colecistectomía (p< 0,001). La edad ≥50 años también se comportó como factor de riesgo para RDG (p=0,025). No hubo diferencias significativas respecto a diabetes, infección por Helicobacter pylori ni consumo de tabaco. En conclusión, el antecedente de colecistectomía y la edad demostraron ser factores de riesgo para el desarrollo de RDG primario.

Bile reflux or duodenogastric reflux (DGR), refers to the retrograde flow of duodenal contents (mainly bile) into the stomach; capable of producing chemical damage to the mucosa, and triggering mutations towards the development of intestinal metaplasia, dysplasia and even gastric cancer. Objective: This study aimed to estimate the prevalence of primary bile reflux in cholecystectomized patients and to identify whether cholecystectomy is a risk factor for development of DGR. An analytical cross-sectional and observational study was conducted, in which all patients who underwent upper digestive endoscopy from February to June 2023 in a private endoscopic center in Lima, Peru, were included. According to the endoscopic report, patients were divided into two groups as those with DGR and those without DGR. Demographic characteristics, history of cholecystectomy, and endoscopic findings were statistically analyzed. 408 patients were included. The mean age of the population was 48.18 ± 16.82 years; 61.52% were female. The prevalence of DGR was 25.74% in the population, while in cholecystectomized patients it was 52.11%. The prevalence of DRG in patients with a history of cholecystectomy was 2.58 times compared to patients without cholecystectomy (p<0.001). Age ≥50 years also behaved as a risk factor for RDG (p=0.025). No significant difference in diabetes, Helicobacter pylori infection or smoking were found. In conclusion, a history of cholecystectomy as well as age were found to be risk factors for development of primary DGR.

Sistema OLGA (Operative Link on Gastritis Assessment) como marcador para cáncer gástrico y displasia en una población colombiana de alto riesgo: estudio multicéntrico

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.

Genotipos de virulencia de Helicobacter pylori y su asociación con lesiones precursoras de malignidad gástrica y parámetros histológicos en pacientes colombianos / Helicobacter pylori virulence genotypes and their relationship with precursor lesions of gastric malignancy and histological parameters in infected patients in Colombia

Se determinó la presencia de los genotipos de virulencia de Helicobacter pylori y su asociación con las lesiones precursoras de malignidad gástrica y parámetros histológicos en pacientes con síntomas de dispepsia del suroccidente de Colombia. Se realizó reacción en cadena de polimerasa (PCR) para la caracterización genética de vacA, cagA, babA2 y sabA. Se empleó la prueba de chi cuadrado o Fischer para evaluar la asociación de cada genotipo sobre el desenlace clínico. En los pacientes con lesiones precursoras de malignidad gástrica se encontró que el 86,3% presentaron el genotipo vacA s1/m1, el 68,1% cagA+ y los genotipos babA2+ y sabA+ con el 68,8% y 55,8%, respectivamente. También, se demostró la asociación entre los genotipos de virulencia y el grado severo de infiltración de células polimorfonucleares. Además, se encontró una asociación entre la combinación de los genes vacA/cagA, vacA/sabA y babA2/sabA. Este estudio proporciona evidencia acerca de la asociación de los genotipos de virulencia del H. pylori y la inflamación gástrica en pacientes infectados.

The aim of this research was to determine the presence of Helicobacter pylori virulence genotypes and their association with precursor lesions of gastric malignancy and histological parameters in patients with dyspepsia symptoms in southwestern Colombia. Polymerase chain reaction (PCR) was used for the genetic characterization of vacA, cagA, babA2 and sabA. The chi-square or Fischer test were used to evaluate the association between each genotype and the clinical outcome. We found that 86.3% of the patients with precursor lesions of gastric malignancy presented the vacA s1/m1 genotype, 68.1% had the cagA+ genotype and 68.8% and 55.8% had the babA2+ and sabA+ genotypes, respectively. Our results show association between virulence genotypes and severe degree of polymorphonuclear cell infiltration. In addition, we found an association between the combination of vacA/cagA, vacA/sabA and babA2/sabA genes. This study provides evidence about the association of H. pylori virulence genotypes and gastric inflammation in infected patients.

Efecto regenerador gástrico del consumo de Petroselinum sativum L. (perejil) en ratas con gastritis inducida por etanol

El objetivo del presente trabajo fue determinar el efecto regenerador gástrico del consumo de Petroselinum sativum L. (perejil) en ratas con gastritis inducida por etanol. Se realizó un estudio analítico, experimental clásico, transversal, prospectivo. Se trabajó con 36 ratas Wistar machos (250 ± 30 g.p.c.) distribuidas aleatoriamente en 6 grupos (n=6). Los grupos II-VI fueron sometidos a ayuno de 24 horas para inducirles úlcera gástrica administrándoles 10 mL/kg.p.c. de etanol al 70% vía orogástrica. Después de una hora, se procedió a sacrificar al grupo II para observar el daño ulceroso en el estómago. Después, se elaboró el extracto acuoso de hojas frescas de perejil (EAHP) y se administró a los demás grupos el siguiente tratamiento por vía orogástrica durante 3 días: grupo III, 10 mL/kg.p.c. de solución de NaCl al 0,9%; y EAHP a los grupos IV-VI (150, 300 y 600 mg/kg.p.c., respectivamente). Enseguida, las ratas fueron sometidas a ayuno de 24 horas para luego ser sacrificadas por desnucamiento. Posteriormente, se les realizó una laparotomía para la extracción del estómago. El EAHP generó mayor producción de moco gástrico en las dosis de 300 mg/kg.p.c. con 78,03% y de 600 mg/kg.p.c. con 80,52% (p<0,05). Esto concordó con lo observado histológicamente en la mucosa gástrica, mostrando solo signos de inflamación de la submucosa en los grupos que consumieron EAHP (IV-VI), en comparación con necrosis fibrinoide de los grupos que no lo consumieron (II y III). En conclusión, el consumo de EAHP tiene un efecto regenerador gástrico en ratas con gastritis inducida por etanol.

Our objective is to determine the gastric regenerative effect of Petroselinum sativum L. (parsley) consumption in rats with ethanolinduced gastritis. We developed an analytical, experimental, classical, cross-sectional, prospective study. We worked with 36 male Wistar rats (250 ± 30 g.p.c.) randomly distributed into 6 groups (n=6). Groups II-VI were subjected to a 24-hour fast to induce gastric ulcer by administering 10 mL/kg.p.c. of 70% ethanol via orogastric. After one hour, group II was sacrificed to observe the ulcerative damage in the stomach. Afterward, the aqueous extract of fresh parsley leaves (EAHP) was prepared, and the following treatment was administered to the other groups through the orogastric route for 3 days: group III, 10 mL/kg.p.c. 0.9% NaCl solution; and EAHP to groups IV-VI (150, 300, and 600 mg/Kg.p.c., respectively). The rats were then fasted for 24 hours before being sacrificed by breaking their necks. Subsequently, a laparotomy was performed to extract the stomach. The EAHP generated greater production of gastric mucus in the doses of 300 mg/kg.p.c. with 78.03% and 600 mg/kg.p.c. with 80.52% (p<0.05). This was consistent with what was observed histologically in the gastric mucosa, showing only signs of inflammation of the submucosa in the groups that consumed EAHP (IV-VI), compared with fibrinoid necrosis in the groups that did not consume it (II and III). In conclusion, the consumption of EAHP has a gastric regenerative effect in rats with ethanol-induced gastritis.

Sarcina ventriculi associated gastritis: Mimicking lymphoma on endoscopy

Sarcina Ventriculi is a gram-positive anaerobic coccus rarely reported in patients with delayed gastric emptying, emphysematous gastritis, gastric ulcers, and perforation. So far, less than 30 cases of sarcina isolated from the stomach have been reported. Herein, we describe a case of a 66-year-old male with a history of persistent epigastric pain and regurgitation. The upper gastrointestinal (GI) endoscopy revealed gastric erythema, edema, ulceration, and food bezoar. A gastric biopsy was done to rule out lymphoma. On histopathological examination, sarcina Ventriculi was identified. This organism is likely to get underreported as it may not be that obvious on routinely stained biopsies. Given its association with life-threatening illness such as emphysematous gastritis and perforation, awareness of this organism is important. It's presence in gastric biopsies must be mentioned in the report and should prompt the clinicians to investigate further for functional causes of delayed gastric emptying and gastric outlet obstruction like occult malignancy.

Helicobacter pylori Infection Do Not Influence the Determination of Fractional Exhaled Nitric Oxide / 胃肠病学

Background: Helicobacter pylori (Hp) infection induces inflammation in gastric mucosa, and the production of nitric oxide (NO) may increase in response to the inflammation. However, the correlations between NO concentration in exhaled air and the severity of gastric inflammation and Hp infection are not clear. Aims: To explore the influence of Hp infection on fractional exhaled nitric oxide (FeNO), an indicator of airway inflammation, and the relationship between FeNO and severity of gastric inflammation. Methods: Adult patients who accepted

Guidelines for Diagnosis and Treatment of Chronic Gastritis in China (2022, Shanghai) / 胃肠病学

Chronic gastritis is a commonly seen disease; clinicians have always attached to the importance of understanding its etiology and clinical manifestations, standardizing its diagnosis and treatment, and preventing its progression to cancers. Based on the consensus opinions on the diagnosis and treatment of chronic gastritis in the past three editions, and referring to the international consensuses and guidelines on the management of precancerous lesions of gastric mucosa, it is of clinical value and feasibility to formulate the guidelines for the diagnosis and treatment of chronic gastritis in line with China′s national conditions. This guideline was initiated by Chinese Society of Gastroenterology, with major members of the Cancer Collaboration Group of Chinese Society of Gastroenterology serving as the convenors and authors. Based on the internationally accepted principles and methods of guideline development and the extensive collection of opinions from gastroenterologists and physicians, 53 evidence-based recommendations were given for nine major clinical problems related to chronic gastritis, aiming to improve the diagnosis, treatment and management of chronic gastritis.

Mechanism of Polygonum capitatum in treatment of Helicobacter Pylori associated gastritis by network pharmacology, microarray data analysis and molecular docking / 中国药理学通报

Aim To explore the mechanism of Polygonum capitatum(PC)in the treatment of Helicobacter Pylori associated gastritis(HAG). Methods The databases were used to identify the target of PC active compounds and HAG-related genes,and the intersection was taken to obtain the potential targets of PC treatment of HAG. The interaction network diagram of “drug-active compound-target-disease” and the protein-protein interaction(PPI)network of potential target protein interaction in HAG treated by PC were constructed by software Cytoscape 3.6.0. The important nodes in the network were screened by several topological indexes,and the GO and KEGG enrichment were analyzed by STRING database to obtain the potential signaling pathway of PC in the treatment of HAG. The binding ability of PC active components with key target proteins was observed by molecular docking method. On this basis,the related targets of PC in the treatment of HAG were verified in vivo and in vitro experiments. Results The PC active compounds and targets were identified through the database,and the “drug-active compound-target-disease” network diagram and the PPI network of potential target proteins were constructed. Combined with several topological indexes,the PPI network of potential target-protein interaction was analyzed,and 52 hub genes were screened. Further bioinformatics analysis and high-throughput sequencing revealed that PC exerted an effect on HAG through the Akt/NF-κB/NLRP3 pathway. Based on this,it was found that PC could reduce IL-18 and IL-1β in HAG GES-1 cells and HAG SD rats,up-regulate Akt and its phosphorylation level and reduce NF-κB expression,inhibit the activation of NLRP3 inflammatory body,so as to improve HAG inflammatory response. Conclusions PC could exert a therapeutic effect on HAG by activating Akt and its phosphorylation level,and inhibiting the expression of NF-κB and NLRP3 inflammasome related factors. This study provides a theoretical basis for explaining the mechanism of PC in the treatment of HAG.

Mechanism of Modified Danggui Shaoyao San in treatment of chronic atrophic gastritis based on network pharmacology and experimental verification / 中国药理学通报

Aim To predict the targets of Modified Danggui Shaoyao San ( MDSS) in the treatment of chronic atrophic gastritis ( CAG) based on network pharmacology and vertify the results based on experim-ention. Methods TCMSP, SWISS TARGETS, GENE CARDS and OMIM databases were used to screen the therapeutic targets of MDSS for CAG. STRING database and Cytoscape software were used to construct the protein interaction network and screen the core targets. Metascape database was used for GO analysis and KEGG enrichment pathways. And molecular docking was used for target validation. CAG rat model was pre¬pared by N-methyl-N'-nitroso-N-nitroguanidine free drink combined with sodium salicylate gastric lavage. The pathology of rat gastric mucosa was observed by hematoxylin-eosin staining,and the ultrastructure of ep¬ithelial cells was observed by transmission electron mi-croscopy. The serum IL-6 and IL-10 content was detected by enzyme-linked immunosorbent assay, and the expression of JAK2, STAT3 , p-STAT3 , c-MYC mRNA and protein in rats was detected by qPCR and Western blot. Results MDSS acted on 189 targets, mainly involved in response to oxidative stress and apoptotic signaling pathway. KEGG analysis related to pathways in cancer and JAK-STAT signaling pathway. The experimental results showed that the MDSS could improve the degree of atrophy of gastric mucosa in CAG rats and improve the status of epithelial cells, down-regulate the serum IL-6 content of CAG rats, up-regulate the IL-10 content, and reduce the expression of JAK2, STAT3 , p-STAT3 , c-MYC mRNA and protein in gastric mucosa with statistical significance. Conclusions MDSS treats CAG through multiple active ingredients, targets, and pathways, the mechanism of which may be related to the inhibition of the JAK2/STAT3 signaling pathway.

Clinical Features of Collagenous Gastritis / 中国医学科学院学报

Objective To analyze the clinical characteristics of collagenous gastritis (CG) and provide evidence for the precise diagnosis and treatment of CG.Methods Published case reports and case series were collected from PubMed,CNKI,and Wanfang Med Online with the key words of collagenous gastritis,collagenous gastroduodenitis,collagenous gastrointestinal diseases,and gastric mucosal nodules.The demographic and clinical information of each case was collected.Results According to the extent of collagen deposition in the digestive tract,94 CG cases included in this study were assigned into upper digestive tract (UDT)-CG,total digestive tract (TDT)-CG and other groups.The UDT-CG group included 52 cases (57.69% females and 42.31% males) with a median age of 14.50 (11.00,25.75) years old.There were 17 cases in the TDT-CG group,including 70.59% females and 29.41% males,with a median age of 15.00 (9.50,48.50) years old.The other group contained 25 cases,(64.00% females and 36.00% males) with a median age of 25.00 (15.50,59.50) years old.The main clinical manifestations in the UDT-CG group were anemia (59.62%) and diarrhea (17.31%),and those in the TDT-CG group were anemia (29.41%) and diarrhea (94.12%).The nodular appearance of gastric mucosa was observed in 75.00% cases in the UDT-CG group and 35.29% cases in the TDT-CG group.In the initial treatment,symptomatic therapy and hormonal therapy respectively relieved the symptoms in 75.00% (30/40) and 100% (3/3) cases in the UDT-CG group and 57.14% (4/7) and 83.33% (5/6) cases in the TDT-CG group.In the retreatment,symptomatic therapy and hormone therapy respectively achieved the remission rates of 100.00% (3/3) and 88.89% (8/9) in the UDT-CG group and 80.00% (4/5) and 66.67% (2/3) in the TDT-CG group.Conclusions CG,a rare disease of gastric collagen deposition,mainly occurs in young patients,and females are more susceptible than males.The clinical manifestations of CG are nonspecific,and anemia,abdominal pain,diarrhea,weight loss,and gastrointestinal bleeding are the common symptoms of CG.Nodular appearance of gastric mucosa is a relatively specific endoscopic feature of CG.There is no standardized treatment for CG.Symptomatic treatment is commonly adopted to improve the quality of life of the patients,and hormones can be added when necessary.

Gastric cancer risk assessment based on serum pepsinogen / Монголын Анагаах Ухаан

Introduction@#Cases of gastric cancer have been declining worldwide in recent years. However, gastric cancer incidence increased in the last decade in Mongolia. In Mongolia, over 80% of gastric cancer cases are diagnosed during the late stage. Several studies have revealed that serum pepsinogens (PGs) level reflects, indirectly, histological and functional characteristics of the gastric mucosa.@*Goal@#We aimed to evaluate the risk of gastric cancer and its precancerous condition based on serum PGI, PGI/II biomarkers.@*Materials and Methods@#This case-control study enrolled 114 subjects, including patients with gastric cancer (n=36), atrophic gastritis (n=40) and healthy controls (n=138). The questionnaires were obtained to determine risk factors. Serum PGI, PGII, and H. pylori IgG levels were measured by ELISA (Pepsinogen I ELISA; Pepsinogen II ELISA; H.Pylori IgG ELISA; BIOHIT Plc, Helsinki, Finland). PGI to PGII ratio was calculated. Patients were classified into the ABC(D) group according to Miki K approach. Also, we developed new scoring system based on some risk factors and serum PGI, PGI/II ratio. Logistic regressions were performed to evaluate risk and expressed by odds ratio (OR) and 95% confidence intervals (95%CI).@*Results@#Mean age of the subjects was 60±10.9 years. H.Pylori was positive in 67 subjects. The serum PGI and PGI/II ratio levels were significantly decreased in gastric cancer and atrophic gastritis groups compared to the healthy control. According to classification ABC(D), group D (OR 5.04, 95% CI 1.13-22.50) had higher proportion of atrophic gastritis cases, group C (OR 6.19, 95% CI 1.04-36.78) had higher proportion of gastric cancer cases than others. Additionally, we created a risk prediction scoring system with a score ranging from 0 to 7, based on variables age, family history of gastric cancer, prior disease history, PGI and PGI/II ratio levels. For the atrophic gastritis patients, 17 (42.5%) were classified into medium-risk category (OR 4.49, 95% CI 1.38-14.58) and 17 (42.5%) were classified into high-risk category (OR 7.69, 95% CI 2.16-27.43). Whereas, 11 (30.6%) patients with gastric cancer were classified into medium-risk category (OR 4.35, 95% CI 1.13-16.85), 21 (58.3%) were classified into high-risk category (OR 14.25, 95% CI 3.60-56.43).@*Conclusion@#The methods based on serum PGI and PGI/II may identify a high risk population of gastric cancer and atrophic gastritis.

Relationship Between NLRP3 Inflammatory Corpuscles and Chronic Atrophic Gastritis Based on "Spleen-mitochondrion Correlation" / 中国实验方剂学杂志

Chronic atrophic gastritis （CAG） is a common and intractable disease in the digestive system characterized by the reduction or disappearance of gastric mucosal glands. The intestinal metaplasia or dysplasia in CAG is called precancerous lesion， which greatly increases the risk of cancerization. Dysactivation of nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） inflammatory corpuscles can release a large number of inflammatory factors， induce inflammatory cascade reactions， and participate in the process of many diseases. As reported， the dysactivation of NLRP3 inflammatory corpuscles can cause long-term chronic inflammatory infiltration of gastric mucosa and induce the development of CAG. Mitochondrial dysfunction plays an important role in the activation of NLRP3 inflammatory corpuscles. The accumulation of reactive oxygen species （ROS） produced by mitochondrial dysfunction is the key to activating NLRP3 inflammatory corpuscles. Professor LIU Youzhang put forward the theory of "spleen-mitochondrion correlation"， which holds that the spleen mainly transports water and grains， generates qi and blood， transports nutrients to the whole body， and supplies energy and materials needed by the body. Adenosine triphosphate （ATP） generated by mitochondria through the circulation of tricarboxylic acid is the main energy source of the human body. The view that both of them serve as human energy processing plants coincides in terms of physiology. Pathologically， spleen deficiency is associated with mitochondrial oxidative phosphorylation dysfunction. Pathological products such as dampness， turbidity， phlegm， and blood stasis due to failure in transportation because of spleen deficiency are consistent with metabolites generated by mitochondrial dysfunction. Based on the theory of "spleen-mitochondrion correlation"， this study discussed the pathogenesis of CAG in traditional Chinese medicine （TCM）， analyzed the relationship between NLRP3 inflammatory corpuscles and the pathogenesis of CAG， and proposed that the activation of NLRP3 inflammatory corpuscles by mitochondrial dysfunction was the modern biological basis of the pathogenesis of spleen deficiency in CAG. The spleen-strengthening method may be related to improving the mitochondrial function and inflammatory response of patients with CAG and alleviating the damage of gastric mucosa， providing a new idea for TCM in the prevention and treatment of CAG.

Transformation of Chronic Atrophic Gastritis into Gastric Cancer and Prevention and Treatment： Based on Spleen Deficiency and Pathogen Stagnation / 中国实验方剂学杂志

Gastric ''inflammation-cancer'' transformation stars from inflammation and ends as gastric cancer （GC）， and the pathogenesis is still unclear. In China， GC features high morbidity and mortality and poor prognosis， influencing the quality of life and physical and mental health of patients. Therefore， it is of great significance to construct the prevention and treatment system for GC. Chronic atrophic gastritis （CAG） plays a key role in the occurrence， development， and outcome of gastric ''inflammation-cancer'' transformation. Modern therapies for CAG generally aim at eliminating causes and alleviating clinical symptoms， which show satisfactory short-term efficacy， but the reverse and recurrence are common. Based on the holistic view， syndrome differentiation-based treatment， and the ''inflammation-cancer'' transformation in modern medicine， traditional Chinese medicine emphasizes both prevention and treatment， with individualized therapies for CAG and GC to control the transformation. According to the pathogenesis of CAG-asthenia in origin and sthenia in superficiality and deficiency-excess in complexity， this study proposed the theory of spleen deficiency and pathogen stagnation in CAG， and believed spleen deficiency， pathogen， and stagnation are respectively the root cause of， the main factor of， and the key to ''inflammation-cancer'' transformation， respectively. Spleen deficiency and pathogen stagnation are closely related to the process of the transformation. For the treatment， the spleen-invigorating and pathogen-eliminating method should be used for invigorating the spleen to consolidate original Qi， improve the blood supply in stomach， and regulate immunity， and eliminating the pathogen to relieve stagnation， reduce the occurrence of non-controllable inflammation， and improve inflammatory micro-environment. As a result， the gastric inflammation is controlled at the early stage and the gastric ''inflammation-cancer'' transformation is blocked. The gastric mucosal lesions are blocked， delayed， or even reversed. This study provides a new idea in clinical diagnosis and treatment of CAG and in the prevention of GC.

Study on the correlation between telomere dysfunction of human gastric mucosa and chronic atrophic gastritis / 中华消化杂志

Objective:To investigate the correlation between telomere dysfunction of human gastric mucosa and chronic atrophic gastritis (CAG).Methods:From February 12, 2019 to July 10, 2020, at Endoscopy Center, Guang′anmen Hospital, China Academy of Chinese Sciences, 30 patients received endoscopy and pathological diagnosed with CAG (CAG group) were collected, and 30 patients with chronic non-atrophic gastritis (CNAG) were collected at the same time (CNAG group). The relative telomere length was detected by real time fluorescent quantitative polymerase chain reaction. The expression of telomere repeat binding factor (TRF) 1, TRF2 and protection of telomere (POT) 1 at protein level were detected by immunohistochemical staining and semi-quantitative analysis. Spearman analysis was used to analyze the correlation between the relative telomere length of gastric mucosa and the protein expression levels of TRF1, TRF2 and POT1. Mann-Whitney U test and independent sample t test were used for statistical analysis. Results:The relative telomere length of the gastric mucosa in the CAG group was shorter than that in the CNAG group (0.67 (0.51 to 1.17) vs. 1.06(0.69 to 1.37)), and the difference was statistically significant ( U=297.00, P=0.024). The protein expression levels of TRF1, TRF2, and POT1 in the CAG group were all higher than those in the CNAG group, respectively (4.26±2.49 vs. 1.86±1.34, 10.12±2.76 vs. 8.78±2.81, 4.22±2.48 vs. 2.53±1.62), and the differences were statistically significant ( t=8.05, 3.23, 5.39; P<0.001, =0.001, and <0.001). In the CAG group, the protein expression levels of TRF2 and POT1 in gastric mucosa were negatively correlated with the relative telomere length ( r=-0.477 and -0.417, P=0.008 and 0.022). Conclusions:The telomere dysfunction is related to the pathogenesis of CAG. The change of telomere binding protein expression level is involved in the shortening of telomere and pathological process of CAG patients.

Influence of Helicobacter pylori infection on anxiety and depression in patients with chronic gastritis / 中华消化杂志

Objective:To evaluate the influence of Helicobacter pylori ( H. pylori) infection on anxiety and depression in patients with chronic gastritis. Methods:From December 1 2020 to June 30 2021, 387 patients with chronic gastritis who visited the outpatient Department of Gastroenterology, the First Hospital Affiliated to Air Force Medical University were continuously recruited. According to the status of current H. pylori infection, the patients were divided into H. pylori uninfected group and H. pylori infected group. The general demographic information of patients was collected. Hamilton anxiety scale, Hamilton depression rating scale-24, Pittsburgh sleep quality index (PSQI) and gastrointestinal symptom rating scale (GSRS) were filled in. The detection rates of anxiety and depression were compared between the H. pylori uninfected group and the H. pylori infected group according to demographic characteristics. Chi-square test and multiple logistic regression analysis were used for statistical analysis. Results:Finally, 360 patients with chronic gastritis were enrolled, including 200 patients in H. pylori uninfected group and 160 patients in H. pylori infected group. The detection rates of anxiety and depression of the H. pylori infected group were both higher than those of the H. pylori uninfected group (48.1%, 77/160 vs. 30.0%, 60/200; 25.0%, 40/160 vs. 12.5%, 25/200), and the differences were statistically significant ( χ2=12.39 and 9.39, P<0.001 and=0.002). The detection rate of anxiety of male patients in the H. pylori infected group was higher than that in the H. pylori uninfected group (45.1%, 32/71 vs. 24.5%, 27/110); the detection rate of depression of female patients in the H. pylori infected group was higher than that in the H. pylori uninfected group (30.3%, 27/89 vs. 11.1%, 10/90), and the differences were statistically significant ( χ2=8.27 and 10.09, P=0.004 and 0.001). The detection rates of anxiety and depression of patients less than 48 years old in the H. pylori infected group were both higher than those in the H. pylori uninfected group (46.2%, 37/80 vs. 21.9%, 21/96; 20.0%, 16/80 vs. 7.3%, 7/96), and the differences were statistically significant ( χ2=11.73 and 6.20, P=0.001 and 0.013). The detection rates of anxiety and depression of the patients with high school education and below in the H. pylori infected group were higher than those in the H. pylori uninfected group (56.5%, 48/85 vs. 31.7%, 38/120; 32.9%, 28/85 vs. 14.2%, 17/120), and the differences were statistically significant ( χ2=12.57 and 10.24, P<0.001 and =0.001). The results of multivariate analysis showed that H. pylori infection, history of hypertension, PSQI score ≥8, GSRS score ≥7, chronic superficial gastritis and chronic atrophic gastritis were independent risk factors of anxiety in patients with chronic gastritis( P<0.001, =0.013, =0.001, <0.001, =0.036, =0.021), and the risk of anxiety of patients with H. pylori infection was 2.509 times as much as that in uninfected patients (95% confidence interval 1.512 to 4.163). H. pylori infection, PSQI score ≥8, GSRS score≥7, and having overnight dish ≥3 times per week all were independent risk factors of depression in patients with chronic gastritis( P=0.004, =0.002, <0.001, =0.001). The risk of depression in patients with H. pylori infection was 2.563 times as much as that in uninfected patients (95% confidence interval 1.356 to 4.846). Conclusion:H. pylori infection is correlated to anxiety and depression in patients with chronic gastritis, and it is an independent risk factor of anxiety and depression in patients with chronic gastritis.

Characteristics of preliminary clinical diagnosis and treatment for gastritis cystica profunda accompanied with neoplastic lesions / 中华消化内镜杂志

Objective:To investigate the clinical features, characteristics under white-light endoscopy and endoscopic ultrasonography, and treatment strategies of gastritis cystica profunda (GCP) accompanied with or without neoplastic lesions.Methods:Clinical data of 35 patients, who were pathologically diagnosed as having GCP after endoscopic or surgical resection in Beijing Friendship Hospital, Capital Medical University from January 2015 to February 2021, were retrospectively collected, including 27 patients with neoplastic lesions. The demographic information, clinical manifestations, endoscopic features, treatment methods, and pathological results of GCP were summarized.Results:Thirty-five patients with GCP were 68.26±8.08 years old, and mostly male (80.00%, 28/35). The most common symptom was upper abdominal pain, accounting for 31.43% (11/35), and 25.71% (9/35) had no symptoms. Other symptoms included acid reflux, heartburn, abdominal distension, anemia, and choking sensation after eating. The most common site of GCP was cardia (51.43%, 18/35), and the main endoscopic manifestations of GCP were flat mucosal lesions (68.57%, 24/35), mainly 0-Ⅱa and 0-Ⅱa+Ⅱc type lesions, accounting for 66.67% (16/24). The second common endoscopic manifestation was polypoid eminence (20.00%, 7/35). Endoscopic ultrasonography was performed in 15 patients, with main manifestations of uniform hypoechoic with or without cystic echo (73.33%, 11/15). Among the GCP cases, 33 patients received endoscopic resection, and 2 received surgical treatment. The treatment processes were all successfully completed, and en-bloc resection was accomplished for all lesions receiving endoscopy, with the mean endoscopic operation time of 86.13 min. One patient suffered postoperative delayed bleeding after ESD which was stopped by endoscopic hemostasis. Final pathological results showed that the proportion of GCP complicated with neoplastic lesions was 77.14% (27/35), 68.57% (24/35) with early gastric cancer or precursor. Twenty-three cases achieved R0 resection. One case showed positive basal resection margin and vascular invasion, and recurrence happened in situ at the 5th month of follow-up, surgical resection was then performed. The endoscopic complete resection rate was 95.83% (23/24).Conclusion:GCP usually occurs in middle-aged and elderly male, often located in cardia, manifested mainly as flat mucosal lesions and polypoid changes. Endoscopic ultrasonography shows a high diagnostic value for GCP, and endoscopic treatment is safe and effective minimally invasive treatment for GCP.

Curative effects of omeprazole combined with amoxicillin on chronic gastritis in 175 patients / 中国基层医药

Objective:To investigate the curative effects of omeprazole combined with amoxicillin on chronic gastritis and patients' quality of life.Methods:A total of 350 patients with chronic gastritis who received treatment in Jinan Seventh People's Hospital from May 2018 to August 2020 were included in this study. They were randomly divided into control and observation groups ( n = 175/group). The control group was treated with omeprazole, and the observation group was treated with omeprazole combined with amoxicillin. Curative effects, inflammatory factor levels, gastric motility, quality of life score, and the incidence of adverse reactions were compared between the two groups. Results:The response rate in the observation group was significantly higher than that in the control group [95.43% (167/175) vs. 86.86% (155/175), χ2 = 5.59, P = 0.018). Before treatment, there were no significant differences in C-reactive protein, interleukin-6, and tumor necrosis factor-α levels between the two groups (all P > 0.05). After treatment, C-reactive protein, interleukin-6, and tumor necrosis factor-α levels in the observation group were (47.97 ± 8.59) mg/L, (38.82 ± 6.29) μg/L, and (38.77 ± 5.92) μg/L, respectively, which were significantly lower than (51.34 ± 9.77) mg/L, (41.20 ± 7.53) μg/L, (41.09 ± 6.85) μg/L in the control group ( t = 3.42, 3.20, 3.39, all P < 0.05). Before treatment, there were no significant differences in serum gastrin-17 and motilin levels between the two groups (both P > 0.05). After treatment, serum gastrin-17 and motilin levels in the observation group were (380.49 ± 61.27) ng/L and (514.42 ± 68.73) ng/L, respectively, which were significantly higher than (362.25 ± 50.16) ng/L and (495.43 ± 61.36) ng/L in the control group ( t = 3.04, 2.72, both P < 0.05). After treatment, the quality of life score in the observation group was significantly higher than that in the control group ( P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Omeprazole combined with amoxicillin is highly effective on chronic gastritis. The combined therapy can reduce inflammatory responses, improve gastric motility, improve patients' quality of life, and is highly safe.

Curative effects of Shugan Hewei Zhitong Recipe on chronic gastritis complicated by Helicobacter pylori infection / 中国基层医药

Objective:To investigate the curative effects of Shugan Hewei Zhitong Recipe on chronic gastritis complicated by Helicobacter pylori infection. Methods:Eighty-seven patients with chronic gastritis complicated by Helicobacter pylori infection who received treatment in the Huguosi Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, China from July 2018 to June 2020 were included in this study. They were randomly assigned to undergo treatment with either conventional Western medicine ( n = 43, control group) or Shugan Hewei Zhitong Recipe based on conventional Western medicine ( n = 44, observation group) for 2 weeks. Before and after treatment, traditional Chinese medicine syndrome scores were compared between the two groups. Curative effects of Shugan Hewei Zhitong Recipe on chronic gastritis complicated by Helicobacter pylori infection were evaluated. Results:Total response rate in the observation group was significantly higher than that in the control group [91% (40/44) vs. 72% (31/43), χ2 = 5.13, P = 0.024]. In each group, the traditional Chinese medicine symptom score post-treatment was significantly lower than the traditional Chinese medicine symptom score pre-treatment (both P < 0.001). After treatment, the traditional Chinese medicine score of the observation group was significantly lower than that of the control group ( P < 0.05). There were no adverse reactions in each group. Conclusion:Shugan Hewei Zhitong Recipe is safe and effective on chronic gastritis complicated by Helicobacter pylori infection, which is worthy of clinical promotion.