The value of oral contrast-enhanced gastric ultrasonography in the diagnosis and staging of benign peptic ulcer.

We evaluate the value of oral contrast-enhanced gastric ultrasonography (OCUS) by comparing it with conventional gastroscopy in diagnosing and staging benign peptic ulcer. From July 2018 to December 2020, 44 patients with gastroscopy-confirmed benign peptic ulcers (a total of 45 ulcers were detected), who also received OCUS, were retrospectively reviewed. Each patient's ultrasound images were compared with gastroscopy and pathology findings. The characteristics of ultrasonic images of different stages of ulcer were analysed. A total of 43 ulcers were detected by OCUS in 44 patients with benign peptic ulcers. There were no false positive results among the OCUS exams, but two ulcers were misdiagnosed. OCUS for benign peptic ulcer staging also shows acceptable clinical practice results. OCUS is useful for detecting and staging benign peptic ulcer, and may be considered an alternative method for conventional gastroscopy. OCUS is especially useful in the follow-up of BPU treatment, but futher study is needed to improve the diagnostic accuracy of benign and malignant ulcers.

Gastrocolic fistula as a rare complication of a benign gastric ulcer.

We report a case of a 77-year-old man presented with abdominal pain, melena and weight loss.He underwent endoscopic evaluation revealed a 1.2cmX0.6cm ulcer of the greater curve of the antrum stomach and a 1.3cm fistulous tract .The gastroscope can smoothly enter the transverse colon through the fistula tract, and we can be able to visualize the colon wall and feces.After the diagnosis of gastrocolic fistula based on endoscopic findings. The patient was referred for surgical evaluation and underwent laparotomy. The patient subsequently underwent en-bloc resection of the fistula, a segment of the transverse colon, gastric perforation repair, intestinal adhesion lysis and peritoneal drainage. Examination of the specimen revealed a fistulous communication between the stomach and resected transverse colon segment. Finally, the patient was discharged 10 days after operation and without further complication.

Gastric ulcer with liver penetration.

A 54-year-old male with previous history of chronic hepatitis C complained of postprandial epigastric discomfort and weight loss. Esophagogastroduodenoscopy revealed a large gastric ulcer on the lesser antral curvature, with biopsies showing granulation tissue and inflammatory activity without other significant changes. Despite therapy with double-dose proton pump inhibitor, the ulcer had not healed or diminished in size at reevaluation endoscopy eight weeks later. Biopsies were repeated and again only revealed granulation tissue and inflammation. The patient undergone partial gastrectomy where fibrotic adhesions to liver and peritoneum were noted. Remarkably, macroscopical analysis of the surgical specimen revealed an hepatic fragment adherent to the ulcer and histopathological examination was consistent with liver penetration. Liver penetration is a rare but important complication that must be considered in the differential diagnosis of medically refractory gastric ulcers, even in the absence of hepatic tissue in endoscopic biopsies.

Diagnostic utility of abdominal ultrasound for detecting non-perforated gastroduodenal ulcers in dogs.

BACKGROUND: Abdominal ultrasound is frequently used to detect non-perforated gastroduodenal ulcers in dogs. Studies assessing the diagnostic utility of abdominal ultrasound for the detection of non-perforated gastroduodenal ulcers have yielded mixed results. No studies to date have investigated the effects of patient bodyweight, breed, sex, age, ulcer aetiology (neoplastic or inflammatory) or location on the diagnostic accuracy of abdominal ultrasound. METHODS: Retrospective, multicentre study to evaluate the diagnostic utility of abdominal ultrasonography for the diagnosis of non-perforated gastroduodenal ulceration in dogs. RESULTS: Sixty-one dogs met the inclusion criteria. Ulcers were detected during ultrasound examination in 18 of 61 dogs, yielding a sensitivity of 29.5% (95% confidence interval 18.8%-42.7%). Ulcers in the pyloric region were detected more frequently than those in the duodenum; however, location was not significantly associated with the ability of ultrasound to detect lesions (p = 0.41). No associations were identified between the ability of ultrasound to detect an ulcer and patient bodyweight (p = 0.45), breed (p = 0.98), sex (p = 0.90), age (p = 0.94), and neoplastic versus inflammatory nature of ulcerative lesions (p = 0.93). CONCLUSION: The diagnostic utility of ultrasound as the sole modality for the detection of non-perforated gastroduodenal mucosal ulceration is poor. The authors therefore recommend the use of additional modalities when ulcerative lesions are suspected.

Clinical, laboratory and ultrasonographic findings in 38 calves with type-4 abomasal ulcer.

BACKGROUND: Type-4 abomasal ulcers (U4) are perforated ulcers causing diffuse peritonitis. This retrospective study describes the clinical, laboratory and ultrasonographic findings in 38 calves with U4. The medical records of 38 calves aged three days to 20 weeks with U4 were scrutinised. RESULTS: The most common clinical findings were poor general health (95%), reduced skin elasticity (95%), rumen atony (91%), abdominal guarding (76%) and positive percussion auscultation and/or swinging auscultation on the right side of the abdomen (75%). The most frequent laboratory findings were increased numbers of segmented neutrophils (87%), eosinopenia (87%), acidosis (84%), azotaemia (79%) and hyponatraemia (79%). The most frequent abdominal ultrasonographic findings were intestinal atony (68%), fluid (67%) and fibrin deposits (58%) in the abdomen. Thirty-five calves were euthanased and three calves died spontaneously. All calves underwent pathological examination. Diffuse peritonitis caused by a transmural abomasal ulcer was the principal diagnosis in all calves. CONCLUSIONS: Perforated abomasal ulcers cause severe illness, and a thorough clinical examination combined with ultrasonographic abdominal examination should lead to a tentative diagnosis.

Cinematic Rendering of a Perforated Benign Gastric Ulcer.

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Coronary artery perforation into the upper gastrointestinal cavity due to gastric ulceration.

An 82-year-old man who had previously undergone a proximal gastrectomy with jejunal interposition surgery for stomach cancer was transferred to our hospital for massive hematemesis and hypotension. His electrocardiogram showed ST-segment elevation in lead ΙΙ, ΙΙΙ, aVF, which confirmed inferior myocardial infarction. Due to active hematemesis, upper endoscopy was performed initially. A visible vessel of gastric ulceration was discovered, and hemostasis was achieved using hemoclips. Subsequently, coronary angiography was performed since the right coronary artery (RCA) segment 4 atrioventricular (AV) was occluded. After thrombectomy and intravascular ultrasound (IVUS), 2.0 mm balloon angioplasty was done, and coronary perforation occurred. During coronary angiography, extravasation of the contrast material into the gastrointestinal cavity was noted. A covered stent was placed across segment 3 to segment 4 descending posteriorly (PD) to stop the blood supply to the perforation site of segment 4 AV. After stenting, adequate re-hemostasis was achieved. The patient was discharged after 28 days. This is the first report of a coronary artery perforation into the gastrointestinal cavity.

A rare complication of severe acute pancreatitis: portal vein compression resulting in an uncontrollable gastric ulcer bleeding.

A 43-year-old male with a diagnosis of severe acute pancreatitis (SAP) was admitted to our hospital. After receiving the step-up approach for three weeks, the patient had a sudden hematemesis (nearly 400 ml). Gastroscopy and computed tomography (CT) were performed on the same day, revealing a gastric ulcer with a hemorrhage and the portal vein was extremely compressed by peripancreatic fluid collections in the retroperitoneal space.

A novel mutation in the SLCO2A1 gene, encoding a prostaglandin transporter, induces chronic enteropathy.

Chronic enteropathy associated with SLCO2A1 gene (CEAS) is caused by loss-of-function mutations in SLCO2A1, which encodes a prostaglandin (PG) transporter. In this study, we report a sibling case of CEAS with a novel pathogenic variant of the SLCO2A1 gene. Compound heterozygous variants in SLCO2A1 were identified in an 8-year-old boy and 12-year-old girl, and multiple chronic nonspecific ulcers were observed in the patients using capsule endoscopy. The splice site mutation (c.940 + 1G>A) of the paternal allele was previously reported to be pathogenic, whereas the missense variant (c.1688T>C) of the maternal allele was novel and had not yet been reported. The affected residue (p.Leu563Pro) is located in the 11th transmembrane domain (helix 11) of SLCO2A1. Because SLCO2A1 mediates the uptake and clearance of PGs, the urinary PG metabolites were measured by liquid chromatography coupled to tandem mass spectrometry. The urinary tetranor-prostaglandin E metabolite levels in the patients were significantly higher than those in unaffected individuals. We established cell lines with doxycycline-inducible expression of wild type SLCO2A1 (WT-SLCO2A1) and the L563P mutant. Immunofluorescence staining showed that WT-SLCO2A1 and the L563P mutant were dominantly expressed on the plasma membranes of these cells. Cells expressing WT-SLCO2A1 exhibited time- and dose-dependent uptake of PGE2, while the mutant did not show any uptake activity. Residue L563 is very close to the putative substrate-binding site in SLCO2A1, R561 in helix 11. However, in a molecular model of SLCO2A1, the side chain of L563 projected outside of helix 11, indicating that L563 is likely not directly involved in substrate binding. Instead, the substitution of Pro may twist the helix and impair the transporter function. In summary, we identified a novel pathogenic variant of SLCO2A1 that caused loss-of-function and induced CEAS.

Comparison of Serum Trefoil Factor-3 to Endoscopy in Diagnosing Helicobacter Pylori Associated Gastric Ulcer.

BACKGROUND AND AIM OF THE WORK: Helicobacter pylori-associated gastric ulcer (H.pylori-GU) is a serious condition, not only because H.pylori is identified as a grade 1 carcinogen but also because GU is a precancerous condition. Identification and treatment of H.pylori-GU may prevent the sequential progression of dysplasia to carcinoma. Trefoil factor 3 (Tf3) has been implicated in gastric mucosal repair. We compared serum Tf3 to gastric endoscopy in diagnosing H.pylori-GU. SUBJECTS AND METHODS: The study included eighty patients suffering from H.pylori induced gastritis, forty of which presented with GU. Gastric endoscopy with slide urease test was used to diagnose H.pylori-GU. Serum Tf3 level was determined using an enzyme immunoassay in all patients as well as thirty healthy volunteers. RESULTS: Serum Tf3 showed a significant stepwise decrease among the studied groups. It was significantly lower in patients compared to the control group (p<0.001). Furthermore, it was lower in those with GU compared to those without GU (p=0.023). Based on a receiver operating characteristic curve generated cut off value of 2.4 ng/mL, the diagnostic performance of serum Tf3 as a biomarker of H.pylori-GU revealed a diagnostic specificity of 42.5%, sensitivity of 67.5%, positive and negative predictive values of 54% and 56.67% respectively. CONCLUSION: Although serum Tf3 showed significant variation in H.pylori-GU, further studies are warranted to confirm its role in the pathogenesis of gastric ulcers.
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The yield, effectiveness and safety of gastroscopy in management of early postbariatric upper gastrointestinal pain.

BACKGROUND: Upper gastrointestinal (GI) symptoms are prevalent among patients after -bariatric surgeries. Gastroscopy is an important procedure to investigate symptoms. Our primary aim was to evaluate the yield, effectiveness and safety of gastroscopy procedure obtained in a 3-months period after bariatric operation for exploring upper GI symptoms origin. METHODS: Single center, retrospective study at the EMMS Nazareth Hospital from 2010 to 2018. All patients who underwent gastric-bypass (either Roux-en-Y[R-en-Y] or Mini-gastric bypass [MGB]) and who experienced early upper GI symptoms were included in the study. RESULTS: A total of 428 were included in the study. Among them, 154 patients (36%) underwent R-en-Y surgery and 274 (64%) underwent MGB. Baseline characteristics were similar in the two groups. The mean age in the R-en-Y group was 42.3±10.8 vs. 42.8±11.2 in the MGB group. Thirty-nine patients underwent gastroscopy, more in the R-en-Y group compared to MGB group (11.6% vs. 7.6%, P<0.005). In the MGB group, more patients had normal surgical anatomy (23.1%) vs. 12.8% in the R-en-Y group, and the prevalence of erosive esophagitis was 14.2% in the MBG group vs. 5.5% in the R-en-Y group, P<0.005. On the other hand, marginal ulcer was more frequent after R-en-Y than MGB surgery (16.6% vs. 9.5%, P<0.005). No procedural related complication was observed in both groups. CONCLUSIONS: Upper GI symptoms in the early postbariatric surgery period are common with most endoscopic examination revealing normal postsurgical anatomy. In this setting, gastroscopy is safe, without procedural related complications.

Ultrasonographic documentation of type-3 abomasal ulcer in a cow with left displacement of the abomasum.

BACKGROUND: Ultrasonographic documentation of perforated abomasal ulcer has not been published till now. This report describes the clinical, ultrasonographic and postmortem findings in a Jersey cow with type-3 abomasal ulcer and left displacement of the abomasum (LDA). CASE REPORT: The main clinical findings were abnormal demeanour, rumen atony and tympany, positive foreign body tests, positive auscultation and simultaneous ballottement on the left side, abdominal guarding and loss of negative pressure in the abdominal cavity. The tentative diagnosis was peritonitis and LDA. Abdominal ultrasonography produced images typical of LDA, and in one location between the abdominal wall and abomasum there was a layer of fibrin, a fibrin clot, a break in the abomasal contour, suggestive of a perforated ulcer, and partial obstruction of this gap with fibrin. The diagnosis of perforated abomasal ulcer with subsequent peritonitis was confirmed during postmortem examination. CONCLUSIONS: The examination of this case shows that under certain circumstances, ultrasonographic imaging of a perforated abomasal ulcer in a cow is possible. Antemortem diagnosis of type-3 abomasal ulcer is preferable to relying on exploratory laparotomy and/or post-mortem examination.

Clinical, laboratory and ultrasonographic findings in 94 cows with type-1 abomasal ulcer.

INTRODUCTION: This study included 94 cows aged 2.1 to 12.0 years (5.2 ± 2.05 years) that were examined at a referral clinic because of type-1 abomasal ulcer. The most common clinical findings were poor general health status (94%), partial or complete anorexia (93%), congested scleral vessels (89%), decreased skin surface temperature (76%), decreased or absent faecal output (72%), abdominal guarding (59%), tachypnoea (56%), rumen atony (53%) and positive percussion and simultaneous auscultation and/or ballottement and simultaneous auscultation on the right side (53%). The most common laboratory findings were hypokalaemia (68%), positive base excess (60%) and azotaemia (51%). The chloride concentration of rumen fluid was increased in 48% of the cows. The diagnosis of type-1 ulcer was made during laparotomy and/or postmortem examination. One or more concurrent diseases were diagnosed in 97% of the cows. Seventy-eight (83%) cows were euthanased immediately after the initial examination, during laparotomy or after unsuccessful treatment, and eight (8.5%) cows died, and all were examined postmortem. Eight (8.5%) cows were discharged and six of these made a complete recovery.

INTRODUCTION: La présente étude a inclus 94 vaches âgées de 2,1 à 12,0 ans (5,2 ± 2,05 ans) qui ont été examinées dans une clinique de référence en raison d'un ulcère de la caillette de type 1. Les signes cliniques les plus courants étaient un mauvais état de santé général (94%), une anorexie partielle ou complète (93%), des vaisseaux scléraux congestionnés (89%), une diminution de la température de la surface de la peau (76%), une diminution ou une absence de débit fécal (72%), une défense abdominale (59%), de la tachypnée (56%), une atonie du rumen (53%) et une percussion positive avec auscultation simultanée (PSA) et / ou ballottement et auscultation simultanée (BSA) du côté droit (53%). Les résultats de laboratoire les plus courants étaient l'hypokaliémie (68%), l'excès de base positif (60%) et l'azotémie (51%). La concentration en chlorure du liquide du rumen a augmenté chez 48% des vaches. Le diagnostic d'ulcère de type 1 a été posé lors de la laparotomie et/ou de l'autopsie. Une ou plusieurs maladies concomitantes ont été diagnostiquées chez 97% des vaches. Soixante-dix-huit vaches (83%) ont été euthanasiées immédiatement après l'examen initial, pendant la laparotomie ou après un traitement infructueux, et huit vaches (8,5%) sont mortes. Toutes ont été examinées post-mortem. Huit vaches (8,5%) sont sorties de clinique et six d'entre elles ont complètement récupéré.

Gastric schwannoma with giant ulcer and lymphadenopathy mimicking gastric cancer: a case report.

BACKGROUND: Gastric schwannomas are rare benign tumors originating from the intramuscular plexus of the stomach and account for just 2.6% of gastric mesenchymal tumors. Gastric schwannoma (GS) with a surface ulcer is very rare. Herein, we report a rare case of an ulcer-bearing GS, which in conjunction with multiple enlarged regional lymph nodes, readily mimicked gastric cancer (GC). CASE PRESENTATION: A 79-year-old female presented with poor appetite and intermittent vomiting of gastric contents during the past month. Gastroscopy revealed a giant crateriform ulcer within the stomach body (at the angular notch). Its raised and indurated border was fragile and bled easily. GC was thus suspected. Contrast-enhanced computer tomography (CT) revealed a mild enhancement of the corresponding irregularly thickened gastric wall, and an annular zone of mucosal discontinuity. Enlarged regional lymph nodes were also found, making GC with metastases of lymph nodes our primary concern. 18F-fluorodeoxyglueose position emission tomography (18F-FDG PET)/CT was then performed for further staging. Obviously increased FDG uptake was shown in the gastric lesion ((maximum standardized uptake value (SUVmax) 14.6), but no FDG uptake was observed in the enlarged regional lymph nodes. Given the strong suspicion of GC, subtotal gastrectomy was performed. GS was revealed by postoperative pathology, with no evidence of metastasis in the 13 resected lymph nodes. CONCLUSIONS: This was a rare case of GS with a giant surface ulcer and multiple enlarged regional lymph nodes. The uptake of 18F-FDG in the tumor was substantially higher than previously published literature reports. Under these circumstances, it is difficult to be differentiated from GC.

Pneumatosis cystoides intestinalis: case report and review of literature.

Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.

Utility of Dual Red Imaging for Endoscopic Hemostasis of Gastric Ulcer Bleeding.

Dual red imaging (DRI; Red Dichromatic Imaging (RDI)) is a new type of image-enhanced endoscopy composed of two long wavelengths that together can visualize vessels in the deep submucosa of the gastrointestinal wall. We treated a case of gastric ulcer bleeding in which the bleeding point could be clearly visualized using DRI. A 71-year-old man who was taking warfarin for atrial fibrillation noticed tarry stool, entered a state of hypovolemic shock, and underwent emergency esophagogastroduodenoscopy. The procedure was performed with a GIF-Y0058 prototype endoscope (Olympus Co., Tokyo, Japan) equipped with a DRI mode. An ulcer with active bleeding was found in the upper portion of the stomach, but the massive volume of the bleeding made it difficult to identify the bleeding point using white light imaging (WLI). Upon switching to DRI mode by pushing a button on the endoscope, the bleeding point could be identified rapidly and precisely, as it appeared in a deeper yellow than the surrounding area. Complete hemostasis was thereupon achieved. This case demonstrates that the DRI mode may be useful for detecting bleeding points that are difficult to detect using WLI.

Stomach Deformities Recognition Using Rank-Based Deep Features Selection.

Doctor utilizes various kinds of clinical technologies like MRI, endoscopy, CT scan, etc., to identify patient's deformity during the review time. Among set of clinical technologies, wireless capsule endoscopy (WCE) is an advanced procedures used for digestive track malformation. During this complete process, more than 57,000 frames are captured and doctors need to examine a complete video frame by frame which is a tedious task even for an experienced gastrologist. In this article, a novel computerized automated method is proposed for the classification of abdominal infections of gastrointestinal track from WCE images. Three core steps of the suggested system belong to the category of segmentation, deep features extraction and fusion followed by robust features selection. The ulcer abnormalities from WCE videos are initially extracted through a proposed color features based low level and high-level saliency (CFbLHS) estimation method. Later, DenseNet CNN model is utilized and through transfer learning (TL) features are computed prior to feature optimization using Kapur's entropy. A parallel fusion methodology is opted for the selection of maximum feature value (PMFV). For feature selection, Tsallis entropy is calculated later sorted into descending order. Finally, top 50% high ranked features are selected for classification using multilayered feedforward neural network classifier for recognition. Simulation is performed on collected WCE dataset and achieved maximum accuracy of 99.5% in 21.15 s.

Performing both lateral abdominal radiographs may not improve the visualization of gas in the gastric outflow tract of cats.

Reports in the veterinary literature support three-view abdominal radiographs as a standard of practice for evaluating dogs with suspected gastrointestinal (GI) diseases. The usefulness of three-view abdominal studies has not been evaluated in cats. Images from a prospective crossover group study with 20 healthy cats, and those from a retrospective cohort study of 110 cats, were reviewed and the location and degree of gas was assessed in the gastric outflow tract. Comparisons of the frequency of luminal gas were made between the views and between cats with GI disease versus cats without and between cats having sedation versus those without. Chi-Square analysis was performed with P < .05 being considered significant. No significant difference was found in the location and degree of luminal gas in left versus right lateral views in all cats regardless of the order in which the views were obtained or in cats with GI disease versus cats without. Cats with gastric dilation had a higher overall frequency of gas; those with dilation with homogeneous material were higher than those with dilation with heterogeneous material. A higher frequency of gas was found in sedated cats than nonsedated, but further study is needed to determine the underlying cause. Based on these findings, a three-view abdominal study for cats as a standard of practice may not be necessary, but obtaining the additional lateral view when gastric dilation is present might allow better visualization of the pyloric antrum and duodenum.