Clinicopathologic and endoscopic characteristics of ten patients with gastric hamartomatous inverted polyp: a single center case series.

BACKGROUND: Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP. METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection. RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective. CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.

Total gastrectomy due to emphysematous and necrotizing gastritis associated with Sarcina ventriculi in an 18-year-old patient.

An 18-year-old woman with no pathological history, admitted to Emergency Department with abdominal pain and vomiting after consuming alcohol and cannabis in the last 36 hours. On physical examination, she presented with abdominal distention, signs of peritoneal irritation and sepsis. Abdominal computed tomography showed gastric, esophageal and duodenal distension, gastric and portal pneumatosis and the presence of free intra-abdominal fluid. An exploratory laparotomy was performed revealing extensive gastric necrosis. Then, total gastrectomy with stapled Roux-en-Y anastomosis was required. Histopathology of the gastric tissue confirmed extensive images of transmural emphysematous and necrotizing gastritis, and allowed to identify established Sarcina ventriculi infection.

Emphysematous gastritis associated with mucormycosis in a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation.

We present the case of a 37-year-old male who was admitted to our hospital with fever, weakness, limb pain for six days and dyspnea for 14 hours. The patient had no immune related diseases and was rapidly diagnosed with fulminant myocarditis, which progressed to severe cardiogenic shock during the early stage. Subsequently, he was treated with V-A extracorporeal membrane oxygenation (ECMO). It is worth mentioning that the patient's peripheral blood was taken for metagenomic next-generation sequencing (mNGS) upon admission and the results did not find any pathogenic bacteria. However, there was no further examination (such as coronary angiography and myocardial biopsy) to determine the etiology of myocarditis.

Iodinated BSA Nanoparticles for Macrophage-Mediated CT Imaging and Repair of Gastritis.

The development of a specific and noninvasive technology for understanding gastritic response together with efficient therapy is an urgent clinical issue. Herein, we fabricated a novel iodinated bovine serum albumin (BSA) nanoparticle based on gastritic microenvironment for computed tomography (CT) imaging and repair of acute gastritis. Derived from the characteristic mucosa defect and inflammatory cell (e.g., macrophage and neutrophil) infiltration in acute gastritis, the pH-sensitive nanoparticles can sedimentate under acidic conditions and be uniformly distributed in the defected mucosal via the phagocytosis of inflammatory cells. Hence, enhanced CT images can clearly reveal the mucosal morphology in the nanoparticle-treated gastritic rat over a long time window comparison with nanoparticle-treated healthy rats and clinical small-molecule-treated gastritic rat. In addition, we have discovered that nanoparticles can repair the atrophic gastric mucosa to a normal state. This repair process mainly stems from inflammatory immune response caused by phagocytized nanoparticles, such as the polarization of proinflammatory macrophages (M1) to anti-inflammatory macrophages (M2). The biocompatible nanoparticles that avoid the inherent defects of the clinical small molecules have great potential for accurate diagnosis and treatment of gastritis in the early stage.

Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis.

OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.

Ischemic gastritis and severe diabetic ketoacidosis.

Ischemic gastritis (IG) is an extremely rare entity due to the rich gastric vascularization. The present case is the ideal setting to suspect this condition.

[A case of corrosive gastritis caused by accidental ingestion of calcium chloride that resulted in gastric stenosis and penetration].

A Japanese woman in her 40s came to our emergency room with vomiting and upper abdominal pain after drinking a bottle of milk tea at home. She had a history of bipolar disorder. Blood tests revealed hypercalcemia (calcium level of 18.6mg/dl). Abdominal computed tomography depicted thickening of the gastric wall and hyperabsorbed material in the stomach. Upper gastroduodenal endoscopy showed extreme mucosal redness from the gastric body to the pylorus. The hypercalcemia improved with intravenous infusion of zoledronic acid. The patient had not been taking any medication that could have caused hypercalcemia. Later, her father drank the same bottle of milk tea at home and developed upper abdominal pain. He was admitted to the hospital because of vomiting, and computed tomography showed hyperabsorbed material in the stomach, as in his daughter's case. Computed tomography of the bottle of milk tea revealed a highly absorbent substance. The bottle was sent to the forensics laboratory for testing, and it was found to contain calcium chloride. Thus both patients had consumed a beverage containing calcium chloride, and corrosive gastritis was diagnosed. Despite fasting and intravenous drip therapy, the first patient underwent a total gastrectomy because of severe stenosis and perforation of the gastric lumen.

The role of linked color imaging in endoscopic diagnosis of Helicobacter pylori associated gastritis.

OBJECTIVE: Linked color imaging (LCI), a novel image-enhanced endoscopy, can make it easy to recognize differences in mucosal color. It may be helpful for diagnosing H. pylori associated gastritis and H. pylori infection status. We investigated whether LCI could improve the diagnostic accuracy of H. pylori associated gastritis. MATERIALS AND METHODS: Upper endoscopy was performed for 100 patients using white light imaging (WLI) and LCI. During the exam, endoscopic video was recorded. It was then analyzed by four expert endoscopists. They reviewed these videos for endoscopic diagnosis of atrophic gastritis, metaplastic gastritis, nodular gastritis and H. pylori infection. Tissue biopsies with rapid urease test were done to confirm H. pylori infection status and intestinal metaplasia. RESULTS: Kappa values for the inter-observer variability among the four endoscopists were fair to moderate under WLI and fair to good under LCI. Sensitivity, specificity, positive predictive value and negative predictive value for diagnosing H. pylori infection using WLI were 32.4%, 93.3%, 85.2% and 53.6%, respectively, while those for LCI were 57.4%, 91.3%, 88.7% and 64.3%, respectively. Total diagnostic accuracies for diagnosing H. pylori infection using WLI/LCI were 70.8%/78.8%. The accuracy and sensitivity of LCI for diagnosing H. pylori infection were significantly higher than those of WLI (p < .001 for both). However, there were no significant differences in the accuracy, sensitivity or specificity for diagnosing metaplastic gastritis between LCI and WLI. CONCLUSIONS: LCI has better diagnostic accuracy for H. pylori infection status than WLI. Clinical trial registration number: KCT0003674.

Eosinophilic ascites: an unusual manifestation of eosinophilic gastroenteritis.

INTRODUCTION: Eosinophilic gastroenteritis is an uncommon disorder, characterized by eosinophilic infiltration of the gastrointestinal tract. Clinical presentations are variable. It depends on the involvement of GI layer. Eosinophilic ascites is a rare presentation of eosinophilic gastroenteritis and is often associated with the serosal form. CASE PRESENTATION: In this paper, we present a 26-year-old male with EGE who presented with massive hemorrhagic ascites and was successfully treated with steroids. CONCLUSION: The diagnosis of eosinophilic gastroenteritis requires histopathological examination and is often made after the exclusion of other possible causes of eosinophilia. EGE should be considered in a patient with unexplained hemorrhagic ascites.

More than Just a Hole in the Wall: Evolving Management and Treatment Paradigms of Suppurative Gastritis.

Suppurative gastritis is an uncommon lesion and often an occult cause of upper abdominal pain without florid signs of a septic focus. There are two main phenotypic forms: (1) localized, also referred to as gastric abscess; and (2) diffuse, in which the differential diagnosis includes a more diverse range of benign and malignant lesions. Cross-section imaging such as CT allows for rapid diagnosis and demonstrates the location and extent, but not the specific etiology, of the lesion. High-frequency endoscopic ultrasound (EUS) and fine needle aspiration (FNA) have greatly improved the safety and diagnostic accuracy of suppurative gastritis. EUS/FNA provides an opportunity to arbitrate among infectious and malignant or benign tumors, to identify specific pathogens, and in cases of localized gastric abscesses, for resolution by decompression. More advanced endoscopic procedures are rapidly emerging to supplement EUS/FNA, which already demonstrate the promise of improved, minimally-invasive diagnosis and effective management for the diverse range of lesions causing suppurative gastritis.

Convolutional Neural Network for Differentiating Gastric Cancer from Gastritis Using Magnified Endoscopy with Narrow Band Imaging.

BACKGROUND: Early detection of early gastric cancer (EGC) allows for less invasive cancer treatment. However, differentiating EGC from gastritis remains challenging. Although magnifying endoscopy with narrow band imaging (ME-NBI) is useful for differentiating EGC from gastritis, this skill takes substantial effort. Since the development of the ability to convolve the image while maintaining the characteristics of the input image (convolution neural network: CNN), allowing the classification of the input image (CNN system), the image recognition ability of CNN has dramatically improved. AIMS: To explore the diagnostic ability of the CNN system with ME-NBI for differentiating between EGC and gastritis. METHODS: A 22-layer CNN system was pre-trained using 1492 EGC and 1078 gastritis images from ME-NBI. A separate test data set (151 EGC and 107 gastritis images based on ME-NBI) was used to evaluate the diagnostic ability [accuracy, sensitivity, positive predictive value (PPV), and negative predictive value (NPV)] of the CNN system. RESULTS: The accuracy of the CNN system with ME-NBI images was 85.3%, with 220 of the 258 images being correctly diagnosed. The method's sensitivity, specificity, PPV, and NPV were 95.4%, 71.0%, 82.3%, and 91.7%, respectively. Seven of the 151 EGC images were recognized as gastritis, whereas 31 of the 107 gastritis images were recognized as EGC. The overall test speed was 51.83 images/s (0.02 s/image). CONCLUSIONS: The CNN system with ME-NBI can differentiate between EGC and gastritis in a short time with high sensitivity and NPV. Thus, the CNN system may complement current clinical practice of diagnosis with ME-NBI.

Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis.

OBJECTIVES: Evaluation of Helicobacter pylori infection status (non-infection, past infection, current infection) has become important. This study aimed to determine the usefulness of the Kyoto classification of gastritis for diagnosing H. pylori infection status by endoscopy. METHODS: In this prospective study, 498 subjects were recruited. Seven well-experienced endoscopists blinded to the history of eradication therapy performed the examinations. Endoscopic findings were assessed according to the Kyoto classification of gastritis: diffuse redness, regular arrangement of collecting venules (RAC), fundic gland polyp (FGP), atrophy, xanthoma, hyperplastic polyp, map-like redness, intestinal metaplasia, nodularity, mucosal swelling, white and flat elevated lesion, sticky mucus, depressive erosion, raised erosion, red streak, and enlarged folds. We established prediction models according to a machine learning procedure and compared them with general assessment by endoscopists using the Kyoto classification of gastritis. RESULTS: Significantly higher diagnostic odds were obtained for RAC (32.2), FGP (7.7), and red streak (4.7) in subjects with non-infection, map-like redness (12.9) in subjects with past infection, and diffuse redness (26.8), mucosal swelling (13.3), sticky mucus (10.2) and enlarged fold (8.6) in subjects with current infection. The overall diagnostic accuracy rate was 82.9% with the Kyoto classification of gastritis. The diagnostic accuracy of the prediction model was 88.6% for the model without H. pylori eradication history and 93.4% for the model with eradication history. CONCLUSIONS: The Kyoto classification of gastritis is useful for diagnosing H. pylori infection status based on endoscopic findings. Our prediction model is helpful for novice endoscopists. (UMIN000016674).

Can image-enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting?

Endoscopic diagnosis of Helicobacter pylori (H. pylori) infection, the most common cause of gastric cancer, is very important to clarify high-risk patients of gastric cancer for reducing morbidity and mortality of gastric cancer. Recently, the Kyoto classification of gastritis was developed based on the endoscopic characteristics of H. pylori infection-associated gastritis for clarifying H. pylori infection status and evaluating risk factors of gastric cancer. Recently, magnifying endoscopy with narrow-band imaging (NBI) has reported benefits of the accuracy and reproducibility of endoscopic diagnosis for H. pylori-related premalignant lesions. In addition to NBI, various types of image-enhanced endoscopies (IEEs) are available including autofluorescence imaging, blue laser imaging, and linked color imaging. This review focuses on understanding the clinical applications and the corresponding evidences shown to improve the diagnosis of gastritis based on Kyoto classification using currently available advanced technologies of IEEs.

Application of convolutional neural networks for evaluating Helicobacter pylori infection status on the basis of endoscopic images.

BACKGROUND AND AIM: We recently reported the role of artificial intelligence in the diagnosis of Helicobacter pylori (H. pylori) gastritis on the basis of endoscopic images. However, that study included only H. pylori-positive and -negative patients, excluding patients after H. pylori-eradication. In this study, we constructed a convolutional neural network (CNN) and evaluated its ability to ascertain all H. pylori infection statuses. METHODS: A deep CNN was pre-trained and fine-tuned on a dataset of 98,564 endoscopic images from 5236 patients (742 H. pylori-positive, 3649 -negative, and 845 -eradicated). A separate test data set (23,699 images from 847 patients; 70 positive, 493 negative, and 284 eradicated) was evaluated by the CNN. RESULTS: The trained CNN outputs a continuous number between 0 and 1 as the probability index for H. pylori infection status per image (Pp, H. pylori-positive; Pn, negative; Pe, eradicated). The most probable (largest number) of the three infectious statuses was selected as the 'CNN diagnosis'. Among 23,699 images, the CNN diagnosed 418 images as positive, 23,034 as negative, and 247 as eradicated. Because of the large number of H. pylori negative findings, the probability of H. pylori-negative was artificially re-defined as Pn -0.9, after which 80% (465/582) of negative diagnoses were accurate, 84% (147/174) eradicated, and 48% (44/91) positive. The time needed to diagnose 23,699 images was 261 seconds. CONCLUSION: We used a novel algorithm to construct a CNN for diagnosing H. pylori infection status on the basis of endoscopic images very quickly. ABBREVIATIONS: H. pylori: Helicobacter pylori; CNN: convolutional neural network; AI: artificial intelligence; EGD: esophagogastroduodenoscopies.

Canine and feline emphysematous gastritis may be differentiated from gastric emphysema based on clinical and imaging characteristics: Five cases.

Gastric pneumatosis is an imaging finding defined as the presence of gas foci in the gastric wall. In humans, this imaging feature can result from one of two separate clinical entities: life-threatening emphysematous gastritis or clinically benign gastric emphysema. This retrospective case series study describes the clinical and imaging features in five animals diagnosed with spontaneous gastric pneumatosis without gastric dilatation-volvulus. Three canine and two feline cases of spontaneous gastric pneumatosis were identified on radiographic and ultrasonographic examinations. In addition to gastric pneumatosis, one dog and two cats presented concomitant systemic signs such as lethargy, hematemesis, anemia, or leukocytosis. Two dogs remained asymptomatic or presented mild gastrointestinal signs. Portal gas was described in two dogs and one cat, and pneumoperitoneum in one dog. These features were not considered clinically significant. The dog and two cats with systemic signs were euthanized due to clinical deterioration and diagnosed with emphysematous gastritis. The gastric pneumatosis of both dogs without systemic signs resolved while on medical management without antibiotic therapy. These latter cases were interpreted as consistent with gastric emphysema. Findings from the current study indicated that gastric pneumatosis can occur without gastric dilatation-volvulus in cats and dogs and that a combination of clinical and imaging characteristics may help to differentiate between potentially life-threatening emphysematous gastritis and relatively benign gastric emphysema. More studies are needed to determine the etiology and risk factors associated with these conditions.

The Effect of Primary Duodenogastric Bile Reflux on the Presence and Density of Helicobacter pylori and on Gastritis in Childhood.

Background and Objectives: Although there are many studies that investigate the relationship between duodenogastric reflux (DGR) and Helicobacter pylori in adult patients, the reported data are contradictory. In addition, there are very few studies in the literature investigating the relationship between DGR and H.pylori in the pediatric age group. In the present study, we investigated the effect of primary DGR on H.pylori and gastritis. Materials and Methods: A total of 361 patients who were referred to the clinic of our hospital with dyspeptic complaints who had an upper gastrointestinal system endoscopy and a gastric biopsy were included in the study. Results: DGR was detected in 45 cases, and 316 cases that did not have DGR were considered as the control group. Comparisons were made between the DGR cases and the control group in terms of risk factors (age, gender), the presence and density of H.pylori, and the presence and severity of gastritis. The average age of the patients who were included in the study was 11.6 ± 4.6 years. A total of 128 (36%) of the cases were male and 233 (64%) were female. DGR was present in 45 (13%) of the cases. The average age of the patients with DGR was 13.9 ± 3.1 years, the average age of the control group was 11.3 ± 4.7, and there were statistically significant differences (p < 0.001). No significant differences were detected in terms of gender between DGR and the control group (p > 0.05). H.pylori (+) was detected in 29 (64%) of patients with DGR, and in 202 (64%) of the control group. No significant differences were detected between H.pylori prevalence (p = 0.947). Gastritis was detected in 37 (82%) of the patients with DGR, and in 245 (77%) of the control group (p = 0.476). No significant differences were detected between the presence and density of H.pylori, gastritis presence, severity and DGR (p > 0.05). Conclusions: The ages of patients with DGR were significantly higher than in the control group, and advanced age was shown to be a risk factor for primary DGR. It was found that the presence of DGR has no effect on the presence and severity of H.pylori. Given this situation, we consider it is important to eradicate H.pylori infection, especially in the case where H.pylori is present together with DGR.

Recognizing emphysematous gastritis.

Emphysematous gastritis is a rare disease caused by gas-forming organisms. This article describes how a CT scan and aggressive IV drug therapy helped clinicians beat the odds for a patient with this high-mortality disease.

Giant Fold Gastritis Induced by Epoprostenol Infusion in Patients With Pulmonary Arterial Hypertension.

BACKGROUND: Epoprostenol infusion is the strongest and most convincing therapeutic strategy for severe pulmonary arterial hypertension (PAH). This study investigated the gastrointestinal side effects of epoprostenol. Methods and Results: The study group of 12 patients treated with epoprostenol (epoprostenol group) and 4 patients without epoprostenol (control group) underwent stomach barium examination, which revealed that the prevalence of giant fold gastritis was significantly higher in the patients treated with epoprostenol (75% in epoprostenol group vs. 0% in control group; P=0.019). CONCLUSIONS: Giant fold gastritis may be an important side effect of epoprostenol infusion.