A Multi-task Neural Network for Image Recognition in Magnetically Controlled Capsule Endoscopy.

BACKGROUND AND AIMS: Physicians are required to spend a significant amount of reading time of magnetically controlled capsule endoscopy. However, current deep learning models are limited to completing a single recognition task and cannot replicate the diagnostic process of a physician. This study aims to construct a multi-task model that can simultaneously recognize gastric anatomical sites and gastric lesions. METHODS: A multi-task recognition model named Mul-Recog-Model was established. The capsule endoscopy image data from 886 patients were selected to construct a training set and a test set for training and testing the model. Based on the same test set, the model in this study was compared with the current single-task recognition model with good performance. RESULTS: The sensitivity and specificity of the model for recognizing gastric anatomical sites were 99.8% (95% confidence intervals: 99.7-99.8) and 98.5% (95% confidence intervals: 98.3-98.7), and for gastric lesions were 98.8% (95% confidence intervals: 98.3-99.2) and 99.4% (95% confidence intervals: 99.1-99.7). Moreover, the positive predictive value, negative predictive value, and accuracy of the model were more than 95% in recognizing gastric anatomical sites and gastric lesions. Compared with the current single-task recognition model, our model showed comparable sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (p < 0.01, except for the negative predictive value of ResNet, p > 0.05). The Areas Under Curve of our model were 0.985 and 0.989 in recognizing gastric anatomical sites and gastric lesions. Furthermore, the model had 49.1 M parameters and 38.1G Float calculations. The model took 15.5 ms to recognize an image, which was less than the superposition of multiple single models (p < 0.01). CONCLUSIONS: The Mul-Recog-Model exhibited high sensitivity, specificity, PPV, NPV, and accuracy. The model demonstrated excellent performance in terms of parameters quantity, Float computation, and computing time. The utilization of the model for recognizing gastric images can improve the efficiency of physicians' reports and meet complex diagnostic requirements.

A Machine Learning-Driven Surface-Enhanced Raman Scattering Analysis Platform for the Label-Free Detection and Identification of Gastric Lesions.

Background: Gastric lesions pose significant clinical challenges due to their varying degrees of malignancy and difficulty in early diagnosis. Early and accurate detection of these lesions is crucial for effective treatment and improved patient outcomes. Methods: This paper proposed a label-free and highly sensitive classification method for serum of patients with different degrees of gastric lesions by combining surface-enhanced Raman scattering (SERS) and machine learning analysis. Specifically, we prepared Au lotus-shaped (AuLS) nanoarrays substrates using seed-mediated and liquid-liquid interface self-assembly method for measuring SERS spectra of serum, and then the collected spectra were processed by principal component analysis (PCA) - multi-local means based nearest neighbor (MLMNN) model to achieve differentiation. Results: By employing this pattern analysis, AuLS nanoarray substrates can achieve fast, sensitive, and label-free serum spectral detection. The classification accuracy can reach 97.5%, the sensitivity is higher than 96.7%, and the specificity is higher than 95.0%. Moreover, by analyzing the PCs loading plots, the most critical spectral features distinguishing different degrees of gastric lesions were successfully captured. Conclusion: This discovery lays the foundation for combining SERS with machine learning for real-time diagnosis and recognition of gastric lesions.

Prevalence of squamous gastric disease in Colombian equids at slaughter: A postmortem comparative study among horses, donkeys and mules.

Equine Gastric Ulcer Syndrome (EGUS) occurs with variable prevalence in horses, donkeys, and mules. Due to the particularities of the mucous membranes, the syndrome is made up of Squamous Gastric Disease (ESGD) and Glandular Gastric Disease (EGGD). Given the multifactorial nature and multiple classification systems of the syndrome, significant differences have been reported between prevalence studies performed ante mortem, which are even more remarkable when compared with postmortem evaluations. This study aimed to determine the presence and grade of squamous gastric disease in horses, donkeys and mules immediately after slaughter. The postmortem examination considered the inspection of the squamous region (cardia, dorsal fundus, and margo plicatus) and the classification of the observed lesions. The general prevalence of ESGD in the entire population of study was 83.3 % (78 %, 89 %, and 83 % for horses, donkeys, and mules, respectively), compromising the margo plicatus in all cases. 75 % had more than 5 lesions and 50 % had deep lesions, lesions of varying severity and/or evidence of recent/active bleeding. The prevalence of ESGD was similar in horses, donkeys, and mules subjected to similar handling conditions prior to slaughter, including long-distance traveling, fasting, and stress factors.

Development of a novel multipoint traction device for gastric and colorectal endoscopic submucosal dissection and evaluation of its efficacy and safety.

BACKGROUND: Proper traction allows safer and easier endoscopic submucosal dissection; however, single-point traction may not be sufficient. In this study we assessed the safety, efficacy, and feasibility of our newly developed multipoint traction device. METHODS: During an ex vivo study using a Konjac training model, two experts and two trainees resected 80 mock lesions of 20-mm diameter by performing endoscopic submucosal dissection with and without multipoint traction. The primary outcome was the success rate of the procedure involving traction. The secondary outcomes were the submucosal dissection time, dissection speed, and perforation during endoscopic submucosal dissection. During the in vivo study, to clarify the initial clinical outcomes, we used data from the electronic medical record of patients at our institution who underwent gastric and colorectal endoscopic submucosal dissection, which was performed by experts with our newly developed multipoint traction device, from March to December 2022. RESULTS: The ex vivo study indicated that all traction procedures were successful. Higher resection speeds were observed with endoscopic submucosal dissection with traction than without traction (P < 0.001). Perforations were not observed. During the first in vivo clinical study, traction was feasible during 20 gastric and colorectal endoscopic submucosal dissection procedures. No adverse events occurred. CONCLUSIONS: Our multitraction device can increase the submucosal dissection speed and simplify endoscopic submucosal dissection techniques, thus safely reducing technical challenges. The application of this device for endoscopic submucosal dissection could lead to safer and more efficient procedures. Clinical registration UMIN Clinical Trials Registry, Japan (registration number UMIN000053384).

Drug-induced mucosal alterations observed during esophagogastroduodenoscopy.

Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract, i.e., the esophagus, stomach, and duodenum. These include pill-induced esophagitis, desquamative esophagitis, worsening of gastroesophageal reflux, chemotherapy-induced esophagitis, proton pump inhibitor-induced gastric mucosal changes, medication-induced gastric erosions and ulcers, pseudomelanosis of the stomach, olmesartan-related gastric mucosal inflammation, lanthanum deposition in the stomach, zinc acetate hydrate tablet-induced gastric ulcer, immune-related adverse event gastritis, olmesartan-asso-ciated sprue-like enteropathy, pseudomelanosis of the duodenum, and lanthanum deposition in the duodenum. For endoscopists, acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions. This minireview aims to provide essential information on drug-induced mucosal alterations observed on esophagogastroduodenoscopy, along with representative endoscopic images.

Sulfuric Acid Ingestion: May the Severity of the Metabolic Acidosis be Considered as a Predictive Sign of Late Damage to the Gastrointestinal Tract?

Introduction: Caustic substances ingestion results in a complex syndrome. The patient characteristics and severity of injury are important prognostic predictors. The monitoring of clinical changes and the multidisciplinary approach are necessary to prevent death in the early stages of the poisoning. Case description: The case report describes the suicide of a woman by ingestion of a large amount of 15% sulfuric acid for suicidal purposes (15-20 ml). The initial conditions were stable, and no changes were found on a CT scan. However, the main sign was a severe metabolic acidosis. After 7 hours, haematemesis and oedema of the larynx appeared, and oro-tracheal intubation and ICU admission were necessary. Consequent progressive haemodynamic deterioration with persistent severe metabolic acidosis, increasing lactates and septic shock appeared. A new CT scan with contrast was performed 22 hours later detecting diffuse perforations and liquid in pleurae and abdomen. A pleural sample showed necrotic liquid. The death was 24 hours after ingestion and no surgical treatment was performed because of the diffuse lesions to the thoracoabdominal districts. Conclusions: Early detection of gastroenteric lesions and the monitoring of clinical changes are mandatory to avoid the death of the patient. Gastroenteric perforations require an immediate radiological evaluation and surgical treatment. The clinical case report states the severity of prognosis was related to high doses of sulfuric acid ingestion. The immediate metabolic acidosis is related to quick subsequent severe systemic pathological lesions of the gastrointestinal tract. The severity of absorption metabolic acidosis, consequently, may be an early and prognostic sign of the late chest and abdominal lesions. LEARNING POINTS: Severity of metabolic acidosis after sulfuric acid ingestion may anticipate late damage to the gastrointestinal tract.

Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review.

Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.

Does Portal Hypertension Increase the Risk of Helicobacter pylori Infection and Pre-Malignant Gastric Lesions?

Background and Aims: The presence of portal hypertension in cirrhotic patients is a major prognostic factor associated with the development of severe complications and increased mortality. The gold standard for diagnosing portal hypertension is the hepatic venous pressure gradient. More recently, spleen stiffness has emerged as a new and non-invasive diagnostic tool, and has already been included in the last Baveno VII guidelines. The exact prevalence of Helicobacter pylori infection, pre-malignant lesions and their relation to portal hypertension have never been described. The aim of our study was to evaluate the relationship between the presence of portal hypertension assessed via liver and spleen elastography and Helicobacter pylori infection and pre-malignant gastric lesions. Methods: An observational study was conducted, including consecutive patients admitted from December 2020 to December 2022. All patients underwent upper endoscopy and were also subjected to liver and spleen elastography (using the new probe of 100 Hz) by the same blinded operator in a tertiary center. Results: We included 155 cirrhotic patients, with a mean age of 64.1 years (±8.8), and 81.3% were male. The most common etiology was alcoholic liver disease (72.9%). The median value of liver stiffness measurement was 24.4 kPa [3.1-75.0], and the spleen stiffness measurement was 49.1 kPa [12.8-100.0]. Akin to endoscopic findings, 50.3% presented esophageal varices, 5.2% gastric atrophy, 11.6% gastric metaplasia, and 32.9% portal hypertension gastropathy. Regarding histologic findings, we found that 34.8% presented H. pylori infection, 35.5% gastric atrophy (OLGA 1-58.2%) and 38.7% gastric metaplasia (OLGIM 1-63.3%). Liver stiffness and spleen stiffness measurements were associated with the presence of portal hypertensive gastropathy (p < 0.01), but not with H. pylori infection or pre-malignant gastric lesions. Conclusions: Although present in almost one third of cirrhotic patients, H. pylori infection and pre-malignant gastric lesions are not associated with liver stiffness and spleen stiffness measurements. On the other hand, we found an association between liver stiffness and spleen stiffness measurements and portal hypertensive gastropathy.

Histopathological and Immunohistochemical Mechanisms of Bone Marrow-Derived Mesenchymal Stem Cells in Reversion of Gastric Precancerous Lesions.

BACKGROUND: Gastric cancer (GC) stands as one of the most prevalent cancer types worldwide, holding the position of the second leading cause of cancer-related deaths. Gastric lesions represent pathological alterations to the gastric mucosa, with an elevated propensity to advance to gastric cancer. Limited research has explored the potential of stem cells in the treatment of gastric lesions. METHODS: This study aimed to explore the potential of intravenous transplantation of labeled bone marrow-derived mesenchymal stem cells (BMMSCs) to inhibit the progression of precancerous gastric lesions. RESULTS: In the gastric lesion disease model group, the rat tissue exhibited noteworthy mucosal atrophy, intestinal metaplasia, dysplasia, and inflammatory cell infiltration. Following the infusion of BMMSCs, a notable decrease in gastric lesions was found, with atrophic gastritis being the sole remaining lesion, which was confirmed by morphological and histological examinations. BMMSCs that were colonized at gastric lesions could differentiate into epithelial and stromal cells, as determined by the expression of pan-keratin or vimentin. The expression of vascular endothelial growth factor was significantly elevated following BMMSC transplantation. BMMSCs could also upregulate the production of humoral immune response cytokines, including interleukin (IL)-4 and IL-10, and downregulate the production of IL-17 and interferon-gamma, which could be highly associated with the cellular immune response and inflammation severity of the lesions. CONCLUSIONS: BMMSC transplantation significantly reduced inflammation and reversed gastric lesion progression.

The effect of incorporating domain knowledge with deep learning in identifying benign and malignant gastric whitish lesions: A retrospective study.

BACKGROUND AND AIM: Early whitish gastric neoplasms can be easily misdiagnosed; differential diagnosis of gastric whitish lesions remains a challenge. We aim to build a deep learning (DL) model to diagnose whitish gastric neoplasms and explore the effect of adding domain knowledge in model construction. METHODS: We collected 4558 images from two institutions to train and test models. We first developed two sole DL models (1 and 2) using supervised and semi-supervised algorithms. Then we selected diagnosis-related features through literature research and developed feature-extraction models to determine features including boundary, surface, roundness, depression, and location. Then predictions of the five feature-extraction models and sole DL model were combined and inputted into seven machine-learning (ML) based fitting-diagnosis models. The optimal model was selected as ENDOANGEL-WD (whitish-diagnosis) and compared with endoscopists. RESULTS: Sole DL 2 had higher sensitivity (83.12% vs 68.67%, Bonferroni adjusted P = 0.024) than sole DL 1. Adding domain knowledge, the decision tree performed best among the seven ML models, achieving higher specificity than DL 1 (84.38% vs 72.27%, Bonferroni adjusted P < 0.05) and higher accuracy than DL 2 (80.47%, Bonferroni adjusted P < 0.001) and was selected as ENDOANGEL-WD. ENDOANGEL-WD showed better accuracy compared with 10 endoscopists (75.70%, P < 0.001). CONCLUSIONS: We developed a novel system ENDOANGEL-WD combining domain knowledge and traditional DL to detect gastric whitish neoplasms. Adding domain knowledge improved the performance of traditional DL, which provided a novel solution for establishing diagnostic models for other rare diseases potentially.

Incidence and risk factors for fever after endoscopic submucosal dissection and its derivative technology for gastric lesions.

Introduction: Fever is one of the postoperative complications of endoscopic submucosal dissection (ESD) and its derivative technology. However, there are few studies on risk factors for fever after ESD and its derivative technology. The aim of this study was to determine the incidence and related risk factors after ESD and its derivative technology for gastric lesions. Materials and methods: A retrospective review of patients with gastric lesions who were treated by ESD and its derivative technology in our hospital from January 2014 to January 2019 was conducted. Results: A total of 1955 patients were included in the present study. A total of 451 (23.1 %) patients presented with fever after ESD and its derived techniques. The highest fever temperature was 37.6 ± 3.12 °C, and the number of days with fever was 1.48 ± 0.85. Through single factor and multiple factor analysis, age (OR: 1.261, 95% CI: 1.009-1.576, p < 0.05), procedure time (OR: 1.457, 95% CI: 1.053-2.016, p < 0.05), postoperative gastric tube placement (OR: 2.098, 95% CI: 1:616-2.723, p < 0.05), intraoperative hemorrhage (OR: 1.537, 95% CI: 1.196-1.974, p < 0.05) and perforation (OR: 1.970, 95% CI: 1.531-2.535, p < 0.05) were independent risk factors for postoperative fever. Conclusion: Age ≥56 years old, procedure time ≥60 min, gastric tube placement, intraoperative hemorrhage and perforation were independent risk factors for postoperative fever after gastric ESD and its derivative technology. Attention should be given to such patients to minimize the risk of postoperative fever.

Inclusion of silage in diets to fattening pigs: effect on gastric ulcers and skin lesions.

Limited access to high-quality feed protein for pigs has made it necessary to evaluate new protein sources that both promote sustainable pig production and meet the nutritional requirements of pigs. Providing pigs with roughage has positive effects on their behaviour and gut health. However, roughage is seldom given as a part of the pigs' diet and often has a long straw length. Knowledge is lacking on the effect of feeding silage with smaller particle size and as a part of the pigs' diet on pig behaviour and welfare. This study evaluated the influence of feeding fattening pigs silage with different particle sizes on aggressive encounters, measured as the number of skin lesions, and on the occurrence of gastric lesions and ulcers. In total, 128 Swedish Yorkshire × Hampshire pigs were fed either a commercial control feed without silage (Pellet-C), or silage mixed with commercial feed, either in a pellet (Pellet-S) or in a total mixed ration (TMR) with chopped (TMR-Ch) or intensively treated silage (TMR-Ex). Skin lesions were assessed twice in the study according to the Welfare Quality® protocol. The first assessment was performed when the pigs were 105 days old and the second assessment at 132 days of age. Gastric lesions were examined in both the pars oesophagea and the pars glandularis region of the stomach. Stomachs were collected after slaughter, and gastric lesions were scored based on established scoring criteria. There was a treatment × assessment interaction on the number of skin lesions on the ear (P = 0.049). Apart from this interaction, no other effect of treatment on the number of skin lesions could be observed between the treatments or the assessment occasions. Treatment had a clear effect on the occurrence of gastric lesions and pigs fed the fresh silage (TMR-Ch and TMR-Ex) had a lower occurrence of gastric lesions and ulcers compared to the pelleted treatments (Pellet-C and Pellet-S) (P = 0.001). This study could not show any clear reduction effect of dietary silage inclusion on skin lesions. However, feeding silage in TMR significantly reduced the occurrence of stomach ulcers.

Biomarcadores evolutivos de cáncer gástrico en Nariño / Evolutionary biomarkers of gastric cancer in Nariño

Objetivo: Dilucidar el papel de la coevolución del genoma humano y de Helicobacter pylori en la patogenesis gástrica en población de Nariño-Colombia. Materiales y Métodos: Se aisló Helicobacter pylori de biopsias gástricas obtenidas de 292 pacientes con enfermedad gástrica de Nariño. El diagnóstico histológico se realizó por la clasificación de Sydney. Se incluyeron 252 cepas de H. pylori para el análisis MLST, que las asignó a poblaciones ancestrales (hpAfrica1, hpAfrica2, hpEurope, hpEAsia). Para los análisis evolutivos humanos se utilizó Immunochip y el software ESTRUCTURE para determinar proporciones de ascendencia por comparación con 712 secuencias globales de base MLST de H. pylori (http://pubmlst.org/helicobacter). Resultados: Las cepas de H. pylori en Nariño se derivan de cuatro poblaciones ancestrales: Africa (AA1), Europea (AE1 y AE2) y Asia Oriental (AEA). Los aislamientos contenían fracciones sustanciales de ancestría africana AA1 en la costa, y europea, AE2 en la región montañosa. Debido a que la población de montaña tenía un mínimo de ancestría africana del huésped, nos preguntamos si AA1 aumentaba la gravedad de las lesiones gástricas en los sujetos con baja ancestría africana. Tal escenario podría significar una coadaptación interrumpida: disrupción de la coevolución humano-H. pylori. Cuando consideramos a las 56 personas con menos del 17,6% de ancestria africana, encontramos que todas las personas que portaban H. pylori con >19,8% de ancestría africana AA1, n = 20 tenían lesiones severas. Conclusión: Las relaciones coevolutivas humano-H. pylori son biomarcadores importantes de enfermedad gástrica, y la interrupción de estas relaciones desenlazan lesiones gástricas mas avanzadas en Nariño.

Objective: To elucidate the role of the coevolution of the human genome and Helicobacter pylori in gastric pathogenesis in a population from Nariño-Colombia. Materials and Methods: Helicobacter pylori was isolated from gastric biopsies obtained from 292 patients with Nariño gastric disease. The histological diagnosis was made by the Sydney classification. 252 H. pylori isolates were included for MLST analysis, which assigned them to ancestral populations (hpAfrica1, hpAfrica2, hpEurope, hpEAsia). Immunochip was used for human evolutionary analyses. STRUCTURE software to determine ancestry proportions by comparison with 712 global H. pylori MLST base sequences (http://pubmlst.org/helicobacter). Results: The H. pylori strains in Nariño derive from four ancestral populations: African (AA1), European (AE1 and AE2), and East Asian (AEA). The isolates contained substantial fractions of AA1 African ancestry on the coast, and AE2 European ancestry in the mountains. Because the mountain population had minimal African ancestry of the host, we wondered if AA1 increased the severity of gastric lesions in subjects of low African ancestry. Such a scenario could signify disrupted coadaptation: disruption of human-H. pylori coevolution. When we considered the 56 individuals with less than 17.6% African ancestry, we found that all individuals carrying H. pylori with >19.8% AA1 African ancestry, (n = 20) had severe lesions. Conclusion: Human and H. pylori coevolutionary relationships are important biomarkers of gastric disease, and disruption of these relationships results in more advanced gastric lesions in Nariño-Colombia.

Ancestros de Helicobacter pylori de una zona de Nariño con alto riesgo de cáncer gástrico / Helicobacter pylori ancestors from an area of Nariño with high risk of gastric cancer

Objetivo: Determinar la ancestría de Helicobacter pylori aislado de pacientes provenientes de una zona de alto riesgo de cáncer gástrico del departamento de Nariño. Materiales y Métodos: Se incluyeron 16 pacientes con síntomas de dispepsia e infectados con Helicobacter pylori. Se utilizaron biopsias gástricas para el cultivo de Helicobacter pylori y subsecuente secuenciación del genoma total por Illumina MiSeq, 2x300 pb. El ensamblaje y anotación de los genomas se procedió mediante el uso de los algoritmos SPAdes y RASTtk. Las proporciones ancestrales de Helicobacter pylori se determinaron por STRUCTURE con el modelo de mezcla. Las diferencias entre estas proporciones se establecieron con las pruebas H de Kruskal Wallis y post hoc. Resultados: La estructura de la población de Helicobacter pylori deriva de cuatro poblaciones ancestrales: Ancestral Europa (AE) (61.2%), Ancestral Africa1 (AA1) (35.7%), Ancestral Este de Asia (AEA) (3%) y Ancestral Africa2 (AA2) (0.1%), siendo significativas las diferencias entre las proporciones de los ancestros de Helicobacter pylori (p<0.05). Se identificaron diferencias estadísticamente significativas entre: AA2 y AEA (p=0.022); AA2 y AA1 (p<0.05); AA2 y AE (p<0.05); AEA y AA1 (p=0.014) y AEA con AE (p<0.05), sin embargo, no se encontró diferencias significativas entre AA1 y AE (p=0.098), evaluadas por post hoc. Conclusión: Helicobacter pylori que coloniza la mucosa gástrica de una población de alto riesgo de cáncer gástrico en Nariño, deriva su acervo genético principalmente de ancestros europeos y africanos, confiriéndole a la bacteria alta capacidad competitiva asociada al desarrollo de lesiones severas en nichos gástricos amerindios.

Objective: To determine the ancestry of Helicobacter pylori isolated from patients from a high-risk area for gastric cancer in the department of Nariño. Materials and Methods: Sixteen patients with dyspepsia symptoms and infected with Helicobacter pylori were included. Gastric biopsies were used for Helicobacter pylori culture and subsequent whole genome sequencing by Illumina MiSeq, 2x300 bp. Genome assembly and annotation proceeded by using the SPAdes and RASTtk algorithms. The ancestral proportions of Helicobacter pylori were determined by STRUCTURE with the mixture model. Differences between these proportions were established with Kruskal Wallis and post hoc H-tests. Results: The population structure of Helicobacter pylori derived from four ancestral populations: Ancestral Europe (AE) (61.2%), Ancestral Africa1 (AA1) (35.7%), Ancestral East Asia (AEA) (3%) and Ancestral Africa2 (AA2) (0.1%), with differences between the proportions of Helicobacter pylori ancestors being significant (p<0.05). Statistically significant differences were identified between: AA2 and AEA (p=0.022); AA2 and AA1 (p<0.05); AA2 and AE (p<0.05); AEA and AA1 (p=0.014) and AEA with AE (p<0.05), however, no significant differences were found between AA1 and AE (p=0.098), evaluated by post hoc. Conclusion: Helicobacter pylori colonizing the gastric mucosa of a population at high risk of gastric cancer in Nariño, derives its gene pool mainly from European and African ancestors, giving the bacterium highly competitive capacity associated with the development of severe lesions in Amerindian gastric niches.

A Preliminary Study on the Relationship between Gastric Lesions and Anti-Inflammatory Drug Usage in Heavy Pigs.

Gastric lesions in pigs cause welfare and economic losses. Their prevalence in heavy pigs reared for premium products (e.g., Parma ham) requires further investigation. Stress, nutrition, and farm management are known risk factors, but the effects of steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) are largely unknown. The aim of this study was to evaluate the prevalence of gastric lesions in Italian heavy pigs and their possible association with the use of anti-inflammatory drugs. A total of 9371 pig stomachs from 76 farms were evaluated. Among these, 20.3% showed no lesions, while 30.7%, 42.1%, and 6.8% were scored 1, 2 and 3, respectively. A tendency for an inverse relationship with farm size emerged. The use of steroids and NSAIDs was estimated by calculating a treatment incidence per 1000 (TI1000) in a subset of 36 farms. At least one prescription for NSAIDs and/or steroids was found in 80.6% of the farms (55.6% used NSAIDs and 63.9% used steroids). Median TI1000 was 0.07 (range: 0-30.1) and 0.18 (range: 0-6.2) for NSAIDs and steroids, respectively. Gastric scores were positively associated with NSAID use, but not with steroid use. Although the role of these drugs in gastric lesions needs to be further clarified, these findings suggest a cautious use of non-selective NSAIDs.

A multi-omics study to investigate the progression of the Correa pathway in gastric mucosa in the context of cirrhosis.

BACKGROUND: Patients with liver cirrhosis (LC) are prone to gastric mucosa damage. We investigated the alterations of gastric mucosa in LC patients and their possible mechanisms through multi-omics. RESULTS: We observed significant gastric mucosa microbial dysbiosis in LC subjects. Gastric mucosal microbiomes of LC patients contained a higher relative abundance of Streptococcus, Neisseria, Prevotella, Veillonella, and Porphyromonas, as well as a decreased abundance in Helicobacter and Achromobacter, than control subjects. The LC patients had higher levels of bile acids (BAs) and long-chain acylcarnitines (long-chain ACs) in serum. The gastric mucosal microbiomes were associated with serum levels of BAs and long-chain ACs. Transcriptome analyses of gastric mucosa revealed an upregulation of endothelial cell specific molecule 1, serpin family E member 1, mucin 2, caudal type homeobox 2, retinol binding protein 2, and defensin alpha 5 in LC group. Besides, the bile secretion signaling pathway was significantly upregulated in the LC group. CONCLUSIONS: The alterations in the gastric mucosal microbiome and transcriptome of LC patients were identified. The impaired energy metabolism in gastric mucosal cells and bile acids might aggravate the inflammation of gastric mucosa and even exacerbate the Correa's cascade process. The gastric mucosal cells might reduce bile acid toxicity by bile acid efflux and detoxification. TRIAL REGISTRATION: ChiCTR2100051070.

Epidemiology, Risk Factors for Gastric Cancer and Surveillance of Premalignant Gastric Lesions: A Prospective Cohort Study of Central Saudi Arabia.

(1) Background: Saudi Arabia (SA) is a country with a low incidence of gastric cancer (GC). In this study, we sought to assess the epidemiology of GC, its clinicopathological profiles, and its association with risk factors as well as to identify premalignant gastric lesions (PGL) and examine neoplastic progression. (2) Methods: This five-year prospective study screened for GC and PGL in asymptomatic Saudi patients, aged 45-75 years (n = 35,640) and living in Al Kharj, Riyadh province in central SA. Those who were positive in a high-sensitivity guaiac fecal occult blood test (HSgFOBT+) and had negative results in colonoscopy offered to undergo upper GI endoscopy (n = 1242). Factors associated with GC were examined. (3) Results: The five-year participation rate was 87% (1080/1242). The incidence rate of GC was 26.9 new cases per 100,000 population per year (9.6 new cases per year/total population at risk-35,640), and it was 8.9 cases per 1000 persons per year among the 1080 subjects with HSgFOBT+ and negative colonoscopy results. The five-year mortality rate was 67% among patients with GC (n = 48), 3.0% among participants in the gastric screening program (n = 1080) and 0.09% among the original population participating in the colorectal screening program (n = 35,640). Intestinal-type adenocarcinoma was the most frequent type (77%), with the tumor most commonly located in the antrum (41%). Overall, 334 participants had PGL, and seven of them (2.1%) showed neoplastic progression to GC during the follow-up. Factors associated with GC were age, Helicobacter pylori (HP) infection, obesity (body mass index BMI > 30), smoking, a diet of salty preserved foods, low income and a family history of GC. (4) Conclusions: The incidence of GC is low in central SA, but screening for PGL and GC among patients with HSgFOBT+ and negative colonoscopy may prevent or result in the early treatment of GC. HP eradication, normal body weight, not smoking and adhering to a healthy diet can reduce the risk of GC. The resulting data provide important input for the improvement of national guidelines.

The Generation and Application of Monoclonal Antibodies to Detect SAPCD2 Expression in Precancerous and Malignant Gastric Lesions.

Background: Suppressor APC domain containing 2 (SAPCD2) is involved in cell cycle regulation and its mRNA levels are higher in cancer tissues. But, the function of SAPCD2 in cancer development remains unclear. Objective: To generate mouse monoclonal antibodies (mAbs) specific to SAPCD2 and thus clarify the function of SAPCD2 in the development of gastric carcinoma (GC). Methods: Purified SAPCD2-GST immunized BALB/c mouse spleen cells were collected and fused with myeloma cells to obtain monoclonal antibody hybridoma. A group of monoclonal antibodies exhibiting high specificity and sensitivity against SAPCD2 has been generated and characterized by IHC, WB, IP, IF, and ELISA. By immunohistochemical analysis, the SAPCD2 expression was evaluated in 228 clinical samples of gastric mucosal lesions, including precancerous lesions and GC samples. Results: We identified a highly specific and sensitive clone of s12 in eukaryotic cells and performed an IHC analysis. We found that 81.3% of 107 GC tissues were SAPCD2-positive, compared with the 26.2% in the matched adjacent normal-appearing tissues (P<0.001). Furthermore, among the 121 gastritis tissues, SAPCD2 was overexpressed in precancerous gastric lesions such as dysplasia (Dys, 78.9%), intestinal metaplasia (IM, 44.7%), and chronic atrophic gastritis (CAG, 6.1%) compared with that in chronic non-atrophic gastritis (CNAG, 3.2%) (P<0.001). The SAPCD2-positivity rate was 81.3% in GC, suggesting that the expression of SAPCD2 increased with the severity of the lesion (P<0.001). Conclusion: In summary, we have described novel monoclonal antibodies against SAPCD2, which are highly expressed in GC tissues and may serve as the basis for an early clinical marker for GC development.

Allium vegetable intake associated with the risk of incident gastric cancer: a continuous follow-up study of a randomized intervention trial.

BACKGROUND: Allium vegetable components have antibacterial, antioxidative, and immune modulation properties, thus potentially exhibiting antitumor effects. Despite evidence from case-control studies, prospective studies linking allium vegetables with gastric cancer (GC) have been sparse. OBJECTIVE: In a prospective study, we examined whether allium vegetable intake would change the risk of GC occurrence and whether the associations would be modified by vitamin supplementation, garlic supplementation, and Helicobacter pylori (H. pylori) treatment. METHODS: The study was conducted on the basis of the Shandong Intervention Trial, a randomized, placebo-controlled, factorial-designed trial (1995-2003) in a well-recognized high-risk area for GC in China. Participants were continuously followed up to December 2017 for 22.3 y (1995-2017). A total of 3229 subjects were included, with information on the intake of allium vegetables (garlic vegetables and scallions), collected by structured questionnaires in 1994. The associations of total and individual allium vegetable intake with the risk of GC were examined, respectively. RESULTS: During the follow-up, 144 incident cases of GC were identified. Garlic vegetable intake was associated with a decreased risk of incident GC (P-trend = 0.02; OR: 0.83; 95% CI: 0.70, 0.98, per 1 kg/y increment), whereas scallion intake showed no association (P-trend = 0.80). An inverse association of the risk of GC with total allium vegetable and garlic vegetable intake was particularly stronger among those receiving the placebo for vitamin supplementation or garlic supplementation, indicating potential effect modifications by nutritional supplementation on allium vegetable intake and the risk of developing GC. Similar findings were found for analyses of the combined prevalence of dysplasia or GC. CONCLUSIONS: We found a significant reduction in the risk of developing GC with increasing dietary intake of allium vegetables, particularly garlic vegetables. The findings add to the literature on the potential inverse association of garlic vegetable intake with the risk of GC, therefore holding public health implications for dietary recommendations. This trial was registered at clinicaltrials.gov as NCT00339768.

Gastric ectopic pancreas in magnetic resonance imaging: A review of 2 cases.

Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.