Role of serum matrix metalloproteinase in the diagnosis of gastric cancer.

OBJECTIVE: To determine the clinical value of a matrix metalloproteinase (MMP) antibody array in diagnosing gastric cancer (GC). METHODS: In this prospective study, serum samples of patients with GC (n=66) and non-neoplastic gastric disease (NGD; n=34) were collected between November 2017 and July 2018. The quantitative measurement of 10 MMP-related proteins was done using MMP arrays and compared between the two groups. RESULTS: The serum levels of MMPs 3, 8, 9 and tissue inhibitor of metalloproteinases (TIMPs) 1 and 2 were significantly higher in the GC group than in the NGD group (p<0.05). The area under curve (AUC) of the 10 MMP proteins for the diagnosis of GC varied between 0.500 and 0.658. The total AUC of all MMPs was 0.897 (95% CI: 0.837-0.957). The total AUC of the five MMPs (MMPs 3, 8, 9, and TIMPs 1 and 2) was 0.821 (95% CI: 0.733-0.909) for diagnosing GC. Also, the 10-factor and 5-factor predictive models had good diagnostic ability for early GC with an AUC of 0.865 (95% CI: 0.753-0.977) and 0.749 (95% CI: 0.600-0.898), respectively. CONCLUSIONS: The detection of multiple serum MMPs with protein biochip technology is promising to be used as a novel non-invasive tool for facilitating early diagnosis or screening of GC.

A randomized, double blind, controlled, multi center study of Ilaparazole in the treatment of reflux esophagitis-Phase III clinical trial.

AIM AND BACKGROUND: Proton pump inhibitors (PPIs) are the main drugs for the treatment of reflux esophagitis. Phase II clinical trials showed that, compared with Esomeprazole, the new PPI Ilaparazole is great in terms of efficacy for reflux symptoms relief and curling for esophagitis. The aim of this study was to confirm suitable dose of Ilaparazole in the treatment of reflux esophagitis. METHODS: This study used a randomized, double-blind, parallel positive drug control, multi-center design. A total of 537patients diagnosed as reflux esophagitis by gastroscopy were randomly divided into Ilaparazole group (n = 322, Ilaparazole 10 mg QD) and esomeprazole group (n = 215, Esomeprazole 40 mg QD). The patients in the two groups were treated for 8 weeks. Heartburn and reflux symptoms prior to treatment, and 2, 4 and 8 weeks after the treatment were assessed. Gastroscopy was performed after 4 weeks of treatment. Unhealed patients within 4 weeks underwent gastroscopy again at the end of 8 weeks. RESULTS: A total of 471 cases completed the treatment. In Esomeprazole and Ilaparazole groups. After 8 weeks treatment, the healing rate in Esomeprazole group and Ilaparazole group were 82.79% (94.94%) and 83.54% (92.50%), respectively. The corresponding rate difference [Ilaparazole-esomeprazole] was 0.75% (-2.44%) and the two-sided 95% CI was -5.72 to 7.22 (-6.90 to 2.01). The symptom disappearance rates for FAS (PPS) were 75.81% (82.02%) and 76.71% (80.36%) P = 0.8223 (0.7742). Adverse reactions related to the drugs were: 10.70% and 11.80%, (P = 0.7817). CONCLUSIONS: The efficacy and safety of Ilaparazole (10 mg/day) in treating reflux esophagitis was similar to esomeprazole (40 mg/day). Ilaparazole (10 mg/day) can be used in the treatment of esophagitis. The clinical trial registration number of the study is NCT 02860624.

Metabolic profiles of gastric cancer cell lines with different degrees of differentiation.

Gastric cancer is a commonly found malignant tumor, yet research on biomarkers of gastric cancer still face tremendous challenges. This study is the first to use gas chromatography-mass spectrometry (GC-MS) to measure and compare the metabolic profiles of gastric cancer cell lines with varying degrees of differentiation (MKN-28, SGC-7901, and AGS) with that of a normal gastric epithelial cell line (GES-1). OPLS-DA models were established to distinguish gastric cancer cell lines from a normal gastric epithelial cell line. In this study, we identified 278 metabolites, of which 111 show similarity scores greater than 700. Most notably, 6 metabolites (alanine, α-ketoisocaproic acid, proline, glyceric acid, pantothenic acid, and adenosine) showed varying expression levels between gastric cancer cell lines and a normal gastric epithelial cell line. These metabolites are potential biomarkers of gastric cancer and may be of great significance for the diagnosis, treatment and prognosis of gastric cancer patients.

Free amino acid profiling of gastric juice as a method for discovering potential biomarkers of early gastric cancer.

Background: Prior studies showed that aromatic amino acids (AAAs) could be used as potential gastric juice biomarkers in screening gastric cancer (GC). To identify new biomarkers for early diagnosis of GC, the characteristics of gastric juice free amino acid (GJFAA) profiling was determined. Method: First, gastric juice was collected from 130 consecutive patients who underwent gastroscopy. They were divided into GC group (n = 47) and non-neoplastic gastric disease (NGD) group (n = 83) according to the pathological diagnosis. The concentrations of 34 GJFAAs were examined by amino acid analyzer. Multivariate and univariate analyses were used for comparing the alterations of GJFAA profiles between the two groups. Then candidate differential GJFAAs were verified by LC-MS/MS in another set of patients, which included 32 GC patients and 38 NGD patients. The diagnostic performance of GJFAAs was evaluated by ROC curve. Results: Significant alterations in GJFAA profiles were observed in GC patients compared to NGD patients in the training set. A total of 14 amino acids were screened as differential GJFAAs. Leucine, threonine and serine were the most frequently altered. Combined AUC of the three non-AAAs [0.869 (95% CI, 0.805-0.934)] was superior to the combined three AAAs [0.841 (95% CI, 0.773-0.908)]. In addition, a combined AUC comprisingthe six ones was further improved to 0.871 (95% CI, 0.809-0.933) in the diagnosis of GC. A similar variation trend and diagnostic value were observed in the validation set. Conclusion: This study indicates the potential of GJFAA profiling as a promising approach for the early detection and screening of GC.

Non-pylori Helicobacters (NHPHs) Induce Shifts in Gastric Microbiota in Helicobacter pylori-Infected Patients.

To explore the effects of gastric non-H. pylori Helicobacter species(NHPH) on the structure and potential function of gastric microbiota, we employed 16S rRNA gene sequencing on 164 gastric biopsy specimens from NHPH (H. suis, H. felis, H. salomonis) /H. pylori coinfection individuals, H. pylori monoinfection individuals and healthy controls. The results demonstrated that marked structural and functional variations between H. pylori mono- and coinfection samples (HPHS, HPHF, HPHM). The changes in bacterial structure induced by NHPH are mainly attributed to their ability of gastric acid secretion inhibition as well as bacterial chemotaxis. Both the HPHS and HPHF groups showed significant increases in phylotype richness and significant decreases in ß diversity, but this trend was not found in HPHM group. Regarding the top five phyla and top thirty-five genera, the HPHS and HPHF groups had similar variation trends in relative abundance. The increased relative abundance levels of the genera Vibrio, Pseudoalteromonas, Photobacterium, and Clostridium were associated with increases in predicted signal transduction/metabolic pathways among the three coinfection groups. The relative abundance levels of bacteria involved in the formation of N-nitroso compounds were significantly decreased in the HPHS and HPHF groups (e.g., Streptococcus, Neisseria, Haemophilus, Veillonella, Clostridium, etc.). The significantly decreased relative abundance levels of the phyla Firmicutes and Bacteroidetes in the HPHS and HPHF groups were associated with the observed increases in predicted lipid metabolism pathways. The results in this study implied that NHPH can arouse the variation of structure and function of gastric microbiota, which may pave the way to further research on the pathogenesis of gastric diseases.

Gastric Juice-Based Real-Time PCR for Tailored Helicobacter Pylori Treatment: A Practical Approach.

A gastric juice-based real-time polymerase chain reaction (PCR) assay was established to identify Helicobacter pylori infection, clarithromycin susceptibility and human CYP2C19 genotypes and to guide the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy. From January 2013 to November 2014, 178 consecutive dyspeptic patients were enrolled for collection of gastric biopsy samples and gastric juice by endoscopy at the Peking University Third Hospital; 105 and 73 H. pylori-positive and -negative patients, respectively, were included in this study. H. pylori infection was defined as samples with both a strongly positive rapid urease test (RUT) and positive H. pylori histology. A series of primers and probes were distributed into four reactions for identifying the H. pylori cagH gene coupled with an internal control (Rnase P gene), A2142G and A2143G mutants of the H. pylori 23S rRNA gene, and single-nucleotide polymorphisms (SNPs) G681A of CYP2C19*2 and G636A of CYP2C19*3. The E-test and DNA sequencing were used to evaluate the H. pylori clarithromycin susceptibility phenotype and genotype. The SNPs CYP2C19*2 and CYP2C19*3 were also evaluated by nucleotide sequencing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this gastric juice-based real-time PCR assay were evaluated by comparing with the same measures obtained through gastric biopsy-based PCR and culture. The H. pylori diagnostic sensitivities of the culture, PCR, and gastric biopsy- and gastric juice-based real-time PCR assays were 90.48% (95/105), 92.38% (97/105), 97.14% (102/105) and 100% (105/105), respectively; the specificities of the above methods were all 100%. Higher false-negative rates were found among the gastric biopsy samples assessed by culture (10.48%, 11/105), PCR (7.62%, 8/105) and real-time PCR (2.86%, 3/105) than in gastric juice by real-time PCR. Regarding clarithromycin susceptibility, a concordance of 82.98% (78/94) and discordance of 17.02% (16/94) were observed among the different methods, discrepancies that mainly represent differences between the H. pylori clarithromycin susceptibility phenotype and genotype. Three coinfections of susceptible and resistant strains were detected, with resistant-to-susceptible ratios of 1.16, 3.44, and 8.26. The CYP2C19 genotyping results from gastric juice by real-time PCR were completely in accordance with those obtained from biopsy samples by conventional PCR. This gastric juice-based real-time PCR assay is a more accurate method for detecting H. pylori infection, clarithromycin susceptibility and CYP2C19 polymorphisms. The method may be employed to inform the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy.

A Randomized, Double-blind, Active-Controlled, Multi-center Study of Ilaprazole in the Treatment of Reflux Esophagitis.

BACKGROUND AND OBJECTIVE: Proton pump inhibitors (PPIs) are the main drugs for the treatment of reflux esophagitis. Previous studies have indicated ilaprazole to be safer and more effective in treating duodenal ulcers as compared with omeprazole. Being a novel PPI, ilaprazole may be used in the treatment of reflux esophagitis. The purpose of this study was to evaluate the safety and efficacy of ilaprazole tablets in the treatment of reflux esophagitis. METHODS: This study used a randomized, double-blind, multi-center, active-comparison design. The patients were randomly divided into an ilaprazole group (10 mg once daily and 15 mg once daily) and an esomeprazole group (40 mg once daily). Both the groups were treated for 8 weeks. Heartburn and reflux symptoms prior to treatment, and 4 and 8 weeks after the treatment were assessed. Gastroscopy was performed after 4 and 8 weeks. The healing rate after 4 weeks treatment was compared. If esophagitis was healed at the end of 4 weeks, patients did not undergo gastroscopy at the end of 8 weeks. RESULTS: Three hundred and twenty-five patients were enrolled in this study. The 4-week full analysis set (per-protocol set) healing rates in the esomeprazole 40-mg group, the ilaprazole 10-mg group, and the ilaprazole 15-mg group were: 71.43 % (78.89 %), 81.31 % (86.73 %), and 71.70 % (81.40 %), respectively, p = 0.1595 (0.4122); the 8-week healing rates were 84.76 % (93.33 %), 88.79 % (94.90 %), and 85.85 % (97.67 %), respectively, p = 0.6689 (0.4049). Drug-related adverse events rate were 10.48 %, 14.02 %, and 15.09 %, respectively, in the three groups (p = 0.6114). CONCLUSION: The efficacy and safety of ilaprazole (10 mg/day, 15 mg/day) in treating reflux esophagitis was similar to esomeprazole (40 mg/day). Ilaprazole (10 mg/day) has a smaller dosage, hence it should be considered more in clinical uses. TRIAL REGISTRATION: ClinicalTrials.gov NCT01107938.

Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment: A Randomized Trial.

BACKGROUND: With markedly increased antibiotic resistance and unsatisfactory efficacies of common empiric eradication regimens in the mainland of China, tailored therapy may be the best choice to achieve good efficacy. This study compared the eradication rates, safety, and compliance of tailored therapy to those of triple therapy plus bismuth and concomitant therapy in the naïve patients with Helicobacter pylori infection. MATERIALS AND METHODS: Between September 2013 and April 2014, 1050 patients with H. pylori infection at three tertiary hospitals were randomly assigned to 10-day treatment with tailored, triple plus bismuth, or concomitant regimens. In tailored therapy, medications were adjusted according to clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype. The antimicrobial susceptibility testing (E test) was performed. Eradication status was assessed 4-12 weeks after treatment. RESULTS: The eradication rate was significantly higher in tailored group than in triple plus bismuth and concomitant groups in both intention-to-treat (88.7 vs 77.4 vs 78.3%, p < .001) and per-protocol (93.3 vs 87.0 vs 87.4%, p = .021) analyses in a setting with high antibiotic resistance (clarithromycin 48.8%, metronidazole 65.7%, and dual resistance 35.3%). Significantly, fewer adverse effects occurred in tailored group than in concomitant group (22.0 vs 31.7%, p = .018). The eradication rates of dual clarithromycin and metronidazole resistance, isolated clarithromycin resistance, isolated metronidazole resistance, and dual susceptible were 78.7, 82.4, 94.8, and 94.4% in triple therapy plus bismuth and 75.9, 87.2, 92.9, and 95.2% in concomitant therapy, respectively. CONCLUSIONS: First-line tailored therapy achieves significantly higher eradication rates and fewer side effects, compared to triple therapy plus bismuth and concomitant therapy in a setting with high rates of clarithromycin and metronidazole resistance.

Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study.

BACKGROUND: Helicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy. METHODS: Patients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth-Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ2 test and t-test were used, respectively, for enumeration and measurement data. RESULTS: There were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546). CONCLUSIONS: Based on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.

Therapeutic effect of esophageal foreign body extraction management: flexible versus rigid endoscopy in 216 adults of Beijing.

BACKGROUND: The aim of this study was to assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FB) in adults. MATERIAL AND METHODS: A retrospective analysis was conducted on the medical records of 216 adult patients with esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012. RESULTS: The success rate of FB extraction was 100% (142/142) in patients treated with RE compared to 97.3% (72/74) in those treated with FE (P=0.045). The total incidence of complications in RE-treated patients was lower than that in FE-treated patients (28.2% vs. 45.9%, P=0.009), but the perforation rate was higher (5.6% vs. 1.4%, P=0.135). The incidences of total complications and perforation were associated with the duration of FB impaction in patients who underwent RE (both P<0.05) but not in patients who underwent FE. RE was more frequently used in extraction of FBs located in the upper esophagus (88.7%, 126/142) compared to FE (60.8%, 45/74) (P<0.05). The size of extracted FB was significantly larger in patients treated with FE compared to those treated with RE (P<0.05). CONCLUSIONS: Both RE and FE were effective in the extraction of esophageal FB. However, the perforation rate and the need for general anesthesia were higher in RE-associated extraction. FE may be the preferred endoscopic treatment for the extraction of esophageal FB, except possibly for those impacted in the upper esophagus. FB extraction may produce better outcomes if endoscopy is employed early.

[The clinical significance of typical reflux symptoms in diagnosing gastroesophageal reflux disease].

OBJECTIVE: To explore the clinical significance of typical reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD). METHODS: Consecutive patients older than 16 years, who initially visited department of gastroenterology at clinic of Peking University Third Hospital from May 9, 2012 to Dec 31, 2012, were required to complete a self-reported GERD questionnaire. Upper endoscopy was performed in some selected patients. RESULTS: A total of 18 987 patients were enrolled with a response rate of 91.5%. The prevalence of symptom-defined GERD was 13.6% (2 579/18 987). A total of 4 357 (22.9%) patients underwent the upper endoscopy, and the diagnostic rates of reflux esophagitis, Barrett's esophagus, peptic ulcer disease, and upper gastrointestinal malignancy were 13.1% (572/4 357), 1.8% (78/4 357), 10.5% (456/4 357), and 1.7% (75/4 357), respectively. The incidence of reflux esophagitis was 22.7% (216/951) in patients with reflux symptoms and 10.5% (356/3 406) (P < 0.001) in patients without reflux symptoms, 2.7% (26/951) and 1.5% (52/3 406), respectively (P = 0.013) for Barrett's esophagus; 6.8% (65/951) and 11.5% (391/3 406), respectively (P < 0.001) for peptic ulcer disease; 1.7% (16/951) and 1.7% (59/3 406), respectively (P = 0.917) for upper gastrointestinal malignancy. CONCLUSIONS: GERD is one of the major diseases at gastroenterology clinic. Typical reflux symptoms suggest a diagnosis of GERD. But some patients with peptic ulcer disease or upper gastrointestinal malignancy can also present typical reflux symptoms. Upper endoscopy is valuable to avoid the misdiagnosis of other disorders.

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study.

BACKGROUND: Helicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years. METHODS: From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group (T; n = 276) or a placebo group (P; n = 276). In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination. RESULTS: Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P = 0.176). When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group (n = 6) was much higher than that in the T group (n = 0, P = 0.013). CONCLUSIONS: Hp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis. Hp eradication is helpful for reducing the risk for gastric cancer, especially in the early stage of Hp infection.

A comparative study of sequential therapy and standard triple therapy for Helicobacter pylori infection: a randomized multicenter trial.

OBJECTIVES: Studies conducted in large populations of patients and providing full information on Helicobacter pylori (H. pylori) antibiotic resistance are needed to determine the efficacy of sequential therapy (SQT) against this pathogen. This study compared eradication rates with SQT and standard triple therapy (STT), and evaluated the impact of antibiotic resistance on outcomes. METHODS: The study population included adults with positive H. pylori culture presenting at four centers in China between March 2008 and December 2010. Patients were randomly assigned to 10 days of treatment with esomeprazole, amoxicillin, and clarithromycin (STT; n=140) or to 5 days of treatment with esomeprazole and amoxicillin, followed by 5 days of esomeprazole, clarithromycin, and tinidazole (SQT; n=140). Eradication was assessed 8-12 weeks after treatment. RESULTS: There was no significant difference between the eradication rates achieved with STT (66.4% (95% confidence interval (CI) 59.3-74.3)) and SQT (72.1% (65.0-79.3); P=0.300) in either the intention-to-treat analysis or the per-protocol analysis (72.7% (65.6-79.7) and 76.5% (69.7-83.3), respectively; P=0.475). Clarithromycin resistance (CLA-R, odds ratio (OR)=8.34 (3.13-22.26), P<0.001) and metronidazole resistance (MET-R, OR=7.14 (1.52-33.53), P=0.013) both independently predicted treatment failure in the SQT group. Patients in the SQT group with dual CLA-R and MET-R had a lower eradication rate (43.9%) than those with isolated CLA-R (88.9%, P=0.024) or isolated MET-R (87.8%, P<0.001). CONCLUSIONS: H. pylori eradication rates with STT and SQT were compromised by antibiotic resistance. SQT may be suitable in regions with high prevalence of isolated CLA-R, but it is unsatisfactory when both CLA-R and MET-R are present.

MicroRNA-21 stimulates gastric cancer growth and invasion by inhibiting the tumor suppressor effects of programmed cell death protein 4 and phosphatase and tensin homolog.

PURPOSE: MicroRNA-21 (miR-21) is abnormally expressed in many solid cancers, such as gastric adenocarcinoma, and regulates some targets involved in cancer initiation and progression. In this study, we investigated the function of miR-21 in two gastric cancer cell lines, as well as its potential targeting of the tumor suppressor genes phosphatase and tensin homolog (PTEN) and programmed cell death protein 4 (PDCD4). METHODS: The first step was to use quantitative (q) RTPCR in order to verify the overexpression of miR-21 in two different gastric cancer cell lines (SGC-7901 and MKN-45) transfected with mIR-21 mimic. Western blotting confirmed the qRT-PCR data in a set of rescue experiments in which miR-21 mimic, inhibitor, and non specific mimic (NSM) were used to transfect the two gastric cancer cell lines. The protein levels of miR-21 targets PTEN and PDCD4 were estimated. Then, we evaluated its effect on tumor growth and invasion potential on the two different gastric adenocarcinoma cell lines. RESULTS: qRT-PCR results proved that miR-21 was overexpressed in gastric cancer cells transfected with miR-21 mimic. Western blot results further suggested that PTEN and PDCD4 were regulated by miR-21, as miR-21 inhibitor increased the expression of PTEN and PDCD4 proteins and significantly reduced cell proliferation, migration and invasion. In the control experiment miR-21 mimic significantly inhibited the expression of PTEN and PDCD4 proteins in the two gastric cell lines, leading to an increase in cell invasion and migration. Furthermore, miR-21 mimic inhibited the apoptosis of the two gastric cancer cell lines. CONCLUSIONS: miR-21 is overexpressed in gastric cancer and its aberrant expression may have important role in gastric cancer growth and dissemination by modulating the expression of the tumor suppressors PTEN and PDCD4, as well as by modulating the pathways involved in mediating cell growth, migration, invasion and apoptosis. Targeting miR-21 may help develop novel therapeutics for gastric cancer, once its pathophysiology is completely investigated.

[Analysis for 171 cases of esophageal foreign bodies impacted in upper esophagus with endoscopic treatment].

OBJECTIVE: To assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FBs) in adults. METHODS: A retrospective analysis was conducted on the medical records of 171 adult patients with the upper esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012. RESULTS: In the study, 126 patients with the upper esophageal foreign body impaction were treated with RE, while 45 patients received FE. (1)The size of FBs in FE group was the same as RE group(P = 0.495, P = 0.125). (2)The period impacted in the esophagus of RE group (25.8 ± 28.6) h was longer than that of FE group (13.9 ± 14.5) h (P = 0.009). (3)71.4% of the patients in RE and 88.9% in FE group went to hospital for treatment within 24 hours from being impacted, while 15.1% in RE group and 8.9% in FE group were between 24 and 48 hours.13.5% in RE and 2.2% in FE group went to hospital beyond 48 hours.(4)The proportion of FBs puncturing into one or two esophageal walls in RE group (67.5%) was higher than that in FE group (35.6%).(5) The positive rates with the upper gastrointestinal barium contrast and chest X-ray or abdominal plain film were 98.3%,23.6% and 100%,14.3% for diagnosing esophageal FBs in RE and FE groups.(6)The successful rate, complication rate and perforation rate were 100%,38.1% and 6.3%and 95.6%,48.9%,and 2.2% in RE and FE groups, respectively with no statistical difference (P > 0.05). CONCLUSION: Both RE and FE were effective in the extraction of upper esophageal FBs with no difference in the complication and perforation rates. But FE was cheaper and no need for general anesthesia.

Chronic gastritis in China: a national multi-center survey.

BACKGROUND: Chronic gastritis is one of the most common findings at upper endoscopy in the general population, and chronic atrophic gastritis is epidemiologically associated with the occurrence of gastric cancer. However, the current status of diagnosis and treatment of chronic gastritis in China is unclear. METHODS: A multi-center national study was performed; all patients who underwent diagnostic upper endoscopy for evaluation of gastrointestinal symptoms from 33 centers were enrolled. Data including sex, age, symptoms and endoscopic findings were prospectively recorded. RESULTS: Totally 8892 patients were included. At endoscopy, 4389, 3760 and 1573 patients were diagnosed to have superficial gastritis, erosive gastritis, and atrophic gastritis, respectively. After pathologic examination, it is found that atrophic gastritis, intestinal metaplasia and dysplasia were prevalent, which accounted for 25.8%, 23.6% and 7.3% of this patient population. Endoscopic features were useful for predicting pathologic atrophy (PLR = 4.78), but it was not useful for predicting erosive gastritis. Mucosal-protective agents and PPI were most commonly used medications for chronic gastritis. CONCLUSIONS: The present study suggests non-atrophic gastritis is the most common endoscopic finding in Chinese patients with upper GI symptoms. Precancerous lesions, including atrophy, intestinal metaplasia and dysplasia are prevalent in Chinese patients with chronic gastritis, and endoscopic features are useful for predicting pathologic atrophy.

[Complication related factors and efficacy with flexible endoscopy of 101 esophageal foreign bodies].

OBJECTIVE: To analyze the related factors of complications and treatment efficacy with flexible endoscopy for esophageal foreign body (FB). METHODS: In a retrospective study with consecutive data, 101 adults including 52 males and 49 females with esophageal FB impaction between January 2005 and December 2012 admitted into Department of Gastroenterology's Endoscopic Unit at Peking University Third Hospital were included, aged (49 ± 21) years. RESULTS: (1) FB impaction in upper and middle esophagus accounted for 87.1% (n = 88) of all esophageal FBs. No significant difference existed in interval time from impaction to removal of FB impacted between upper, middle and lower esophagus (P > 0.05) . (2) Patients with esophageal FB seeking hospital treatment accounted for 82.2% (n = 83) within 24 h and 99.0% (n = 100) within 48 h. Food lump, fish bone, chicken bone and fruit seeds accounted for 76.2% (n = 77). (3) Positive rates were 91.3% (21/23) and 24.1% (7/29) with upper gastrointestinal barium contrast and chest or abdominal plain film. The success rate was 94.1% (n = 95) with flexible endoscopy for removal of FB. (4) Denture was the most difficult FB for removal. Four patients in all 11 patients with denture impacted were not removed successfully with flexible endoscopy. (5) The complication (except for mild scratch) rate was 48.5% (n = 49) and the perforation rate 3.0% (n = 3) . Whether complications took place or not was independent of age, location of impaction, time from impaction to removal and size of FB (all P > 0.05) , but dependent on piercing into esophageal wall, concomitant with esophageal stricture and types of FB (all P < 0.01) . Whether perforation or not was independent of any above factor. CONCLUSION: Esophageal FB should be removed as soon as possible within 24 h especially for those with sharp edges and piercing into esophageal wall.

High levels of aromatic amino acids in gastric juice during the early stages of gastric cancer progression.

BACKGROUND: Early-stage gastric cancer is mostly asymptomatic and can easily be missed easily by conventional gastroscopy. Currently, there are no useful biomarkers for the early detection of gastric cancer, and their identification of biomarkers is urgently needed. METHODS: Gastric juice was obtained from 185 subjects that were divided into three groups: non-neoplastic gastric disease (NGD), advanced gastric cancer and early gastric cancer (EGC). The levels of aromatic amino acids in the gastric juice were quantitated using high-performance liquid chromatography. RESULTS: The median values (25th to 75th percentile) of tyrosine, phenylalanine and tryptophan in the gastric juice were 3.8 (1.7-7.5) µg/ml, 5.3 (2.3-9.9) µg/ml and 1.0 (0.4-2.8) µg/ml in NGD; 19.4 (5.8-72.4) µg/ml, 24.6 (11.5-73.7) µg/ml and 8.3 (2.1-28.0) µg/ml in EGC. Higher levels of tyrosine, phenylalanine and tryptophan in the gastric juice were observed in individuals of EGC groups compared those of the NGD group (NGD vs. EGC, P<0.0001). For the detection of EGC, the areas under the receiver operating characteristic curves (AUCs) of each biomarker were as follows: tyrosine, 0.790 [95% confidence interval (CI), 0.703-0.877]; phenylalanine, 0.831 (95% CI, 0.750-0.911); and tryptophan, 0.819 (95% CI, 0.739-0.900). The sensitivity and specificity of phenylalanine were 75.5% and 81.4%, respectively, for detection of EGC. A multiple logistic regression analysis showed that high levels of aromatic amino acids in the gastric juice were associated with gastric cancer (adjusted ß coefficients ranged from 1.801 to 4.414, P<0.001). CONCLUSION: Increased levels of tyrosine, phenylalanine and tryptophan in the gastric juice samples were detected in the early phase of gastric carcinogenesis. Thus, tyrosine, phenylalanine and tryptophan in gastric juice could be used as biomarkers for the early detection of gastric cancer. A gastric juice analysis is an efficient, economical and convenient method for screening early gastric cancer development in the general population.