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Objective Based on gender differences,this paper discusses the characteristics of facial color diagnosis in male and female patients with metaplastic chronic atrophic gastritis(CAG),and explores the pathological mechanism of different gender patients from the perspective of TCM pathogenesis,so as to provide personalized reference for TCM prevention and treatment of metaplastic CAG.Methods In this study,the complexion information of patients with chronic non atrophic gastritis(CNG)and CAG was collected by MT-BX-01 four-diagnostic instrument.The color colorimetric characteristics of male and female metaplastic CAG patients and CNG patients were analyzed by case-control study.Results In female patients,the L value and a value of liver region in CAG with mild intestinal metaplasia(IM)group,moderate and severe IM were significantly lower than those in CNG group(P<0.05).In male patients,the L value of spleen region in CAG with moderate and severe IM group was significantly higher than that in CNG group(P<0.05).Conclusion There is a certain gender difference in the facial color characteristics of patients with metaplastic CAG.The facial chromaticity value of female patients with metaplastic CAG changes most significantly in the liver area,while that of male patients mainly in the spleen area.It is suggested that the incidence of female metaplastic CAG is mostly related to liver,while that of male is mostly related to spleen,which provides a personalized method for clinical diagnosis and treatment of metaplastic CAG based on gender differences.
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Objective:To investigate the correlation of atrophy and intestinal metaplasia (IM) stage with gastric cancer and to optimize biopsy strategy.Methods:Data of patients who underwent endoscopy and five-point biopsy at Shandong Provincial Hospital between November 2020 and October 2022 were collected. The baseline characteristics of gastric cancer and non-gastric cancer patients, as well as the occurrence and severity of atrophy and IM in different areas were compared. Logistic regression analysis was used to evaluate the correlation of operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging with gastric cancer. The Kendall tau correlation coefficient was used to compare the consistency of different biopsy strategies (two-point, three-point, and four-point) with the standard five-point biopsy in OLGA and OLGIM staging. Receiver operating characteristic (ROC) curve analysis was further performed to compare the diagnostic performance of different biopsy strategies in identifying the OLGA and OLGIM Ⅲ-Ⅳ stage.Results:A total of 122 patients were included in the analysis, with age of 61.0±10.0 years. Multivariate analysis showed that OLGA staging was not associated with gastric cancer ( P=0.788), while OLGIM Ⅲ-Ⅳ staging was significantly correlated with gastric cancer ( P=0.006, OR=3.39, 95% CI: 1.41-8.17). The occurrence of atrophy and IM were higher in lesser curvature of the antrum [56.6% (69/122) and 66.4% (81/122)] and incisura angularis [57.4% (70/122) and 52.5% (64/122)], with higher severity, while lower in greater curvature of the corpus [2.5% (3/122) and 5.7% (7/122)], with lower severity. The consistency of four-point and three-point biopsies with standard five-point biopsy in OLGA and OLGIM staging was high. The consistency of three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus was exceptionally high among them, with correlation coefficients of 0.969 and 0.987, respectively. Conclusion:OLGIM Ⅲ-Ⅳ stages increase the risk of gastric cancer. Three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus are recommended for the screening and monitoring of atrophy or IM.
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[Objective]To summarize Director CHEN Yongcan's experience in treating chronic atrophic gastritis with intestinal metaplasia the pathogenesis of"deficiency in origin and toxin accumulation".[Methods]Through following Director CHEN Yongcan's outpatient service,sorting out and analyzing typical medical cases,combined with the view of Director CHEN in clinical practice,it summed up his experience in treating chronic atrophic gastritis with intestinal metaplasia from three aspects:core pathogenesis,syndrome differentiation and treatment,prescription and medication,and a proved case was attached to support the treatment.[Results]Chronic atrophic gastritis with intestinal metaplasia is one of the key links in the occurrence and development of gastric cancer.Director CHEN Yongcan believes that the"deficiency in origin and toxin accumulation"is the core pathogenesis of chronic atrophic gastritis with intestinal metaplasia."Deficiency in origin"means deficiency in the spleen and stomach,insufficiency of vital Qi;"toxin accumulation"namely turbidity-toxicity stays stagnation,accumulated and hidden.Taking the cold-heat complex syndrome as the basic point for syndrome differentiation and treatment,it's called for keeping the balance of cold and heat.According to the proportion of deficiency and excess,he treats the disease with the syndrome.The prescription is mainly self-made prescription Shiwei Xiexin Decoction,which can detoxify and benefit vital Qi.If spleen deficiency causes kidney deficiency,kidney-nourishing herbs should be added to solve this condition.If there're Qi and blood stasis,flower herbs are preferred for use.Aiming at the difference between phlegm toxin,stasis toxin and heat toxin,three pairs of triplet herbs which include Cremastrae Pseudobulbus-Salvia chinensis-Actinidia Valvata Dunn,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae and Taraxacum mongolicum-Scutellariae Barbatae Herba-Hedyotis Diffusa are selected for treatment.The syndrome differentiation of the case was spleen deficiency and toxin accumulation,and complex cold-heat.The treatment was invigorating the spleen and detoxifying,and adjusting cold-heat in balance,and Shiwei Xiexin Decoction was used,considering the combination of blood stasis and toxin accumulation,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae were selected.At the follow-up visit,because of obstruction of Qi and blood and imbalance of Qi movement,and Sanhua Baicao Drink to gently promote depression.In the third visit,considering age growth,the liver and kidney were gradually declining,the long-term illness damaged primordial Qi,and the Sijun Zhenyuan Decoction was used to invigorate the spleen and tonify the kidney,consolidate the basis and cultivate primordial Qi.[Conclusion]Director CHEN's experience in differentiating and treating chronic atrophic gastritis with intestinal metaplasia from"deficiency in origin and toxin accumulation"is unique and effective,which is worthy of promotion and learning.
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Chronic atrophic gastritis with intestinal metaplasia is a necessary stage for chronic gastritis to develop into gastric cancer.Chen Yongcan believes that the theory of"yang transforming into qi and yin forming shape"can explain the development and diagnosis of chronic atrophic gastritis with intestinal metaplasia.The deficiency of"yang transforming into qi"leads to too much"yin forming shape",which changes the physiological function of the spleen and stomach,and then develops into the pathological process of chronic atrophic gastritis with intestinal metaplasia.Based on the theory of"yang transforming into qi and yin forming shape",the pathogenesis of this disease was briefly analyzed.In clinical treatment,the state of yin and yang was first identified,and the treatment principle of tonifying yang qi to remove yin turbidity was put forward to achieve the purpose of treating both manifestation and root causes.
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@#Objective To investigate the correlation between MEX3A and differentiation characteristics of gastric cancer and intestinal metaplasia,and its combination with caudal-related homeobox transcription factor 2(CDX2)and mucin 2(MUC2)and mucin 5AC(MUC5AC)to determine the role of carcinogenic intestinal metaplasia.Methods From January 2010 to December 2014,a total of 410 cases of gastric cancer and paracarcinoma paraffin-embedded tissue samples were selected from the Central Hospital Affiliated to Shenyang Medical College and the Second Hospital Affiliated to Shenyang Medical College.According to pathological diagnosis,they were divided into control group(mild superficial gastritis,79 cases),intestinal metaplasia group(149 cases)and gastric cancer group(182 cases).The expressions of MEX3A,CDX2,MUC2 and MUC5AC were detected by immunohistochemistry.Results MEX3A was highly expressed in gastric cancer group and intestinal metaplasia group,especially diffuse gastric cancer,poorly differentiated gastric cancer and type Ⅲ intestinal metaplasia(P<0.05).CDX2 and MUC2 were highly expressed in gastric cancer group and intestinal metaplasia group,especially intestinal type gastric cancer,highly and moderately differentiated gastric cancer,type Ⅰ and type Ⅱ intestinal metaplasia(P<0.05).The expression of MUC5AC was high in control group and low in gastric cancer group and intestinal metaplasia group,especially in intestinal type gastric cancer,type Ⅰ and type Ⅲ intestinal metaplasia(P<0.05).Gastric cancer and intestinal metaplasia differentiation were negatively correlated with MEX3A and MUC5AC expression,but positively correlated with CDX2 and MUC2 expression(P<0.05).MEX3A was negatively correlated with the expression of CDX2 and MUC2,and positively correlated with the expression of MUC5AC in gastric cancer(P<0.05).MEX3A was negatively correlated with the expression of CDX2 and MUC2 in intestinal metaplasia(P<0.05),while CDX2 was positively correlated with the expression of MUC2(P<0.05).Conclusion MEX3A is negatively correlated with gastric cancer and intestinal metaplasia differentiation.Gastric cancer is characterized by high MEX3A expression and low CDX2 and MUC2 expression.
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ABSTRACT Background: Gastric atrophy (GA) and intestinal metaplasia (IM) are early stages in the development of gastric cancer. Evaluations are based on the Updated Sydney System, which includes a biopsy of the incisura angularis (IA), and the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM) gastric cancer risk staging systems. Objective: To compare the OLGA and OLGIM classifications with and without IA biopsy. In addition, to determine the prevalence of Helicobacter pylori (HP) and pre-neoplastic changes (GA and IM) in different biopsied regions and to identify the exclusive findings of IA. Methods: Observational, prospective, descriptive, unicentric study with 350 patients without a diagnosis of gastric cancer, who underwent upper digestive endoscopy with biopsies at Gastroclínica Itajaí, from March 2020 to May 2022. The histopathological classification of gastritis followed the Updated Sydney System, and the gastric cancer risk assessment followed the OLGA and OLGIM systems. The methodology applied evaluated the scores of the OLGA and OLGIM systems with and without the assessment of the IA biopsy. Statistical analysis was performed using descriptive measures (frequencies, percentages, mean, standard deviation, 95% confidence interval). Ranks were compared using the Kruskal-Wallis or Wilcoxon tests. To analyze the relationship between the frequencies, the bilateral Fisher's exact test was used. Wilson's score with continuity correction was applied to the confidence interval. Results: The median age was 54.7 years, with 52.57% female and 47.43% male patients. The comparison between the used biopsies protocol (corpus + antrum [CA] vs corpus + antrum + incisura angularis [CAI]) and the OLGA and OLGIM stages showed a significant decrease in both staging systems when the biopsy protocol restricted to the corpus and antrum was applied (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). The prevalence of pre-malignant lesions (GA, IM and dysplasia) of the gastric mucosa was (33.4%, 34% and 1.1%, respectively) in the total sample. The antrum region exhibited significantly higher numbers of alteration (P<0.001), except for HP infection, which was present in 24.8% of the patients. Conclusion: Incisura angularis biopsy is important because it increased the number of cases diagnosed in more advanced stages of intestinal metaplasia and atrophy. The study had limitations, with the main one being the relatively small sample size, consisting mostly of healthy individuals, although mostly elderly.
RESUMO Contexto: A atrofia gástrica (AG) e a metaplasia intestinal (MI) são estágios iniciais do desenvolvimento do câncer gástrico. As avaliações são baseadas no Sistema de Sydney Atualizado, que inclui uma biópsia da incisura angular (IA), e nos sistemas de estadiamento de risco de câncer gástrico Operative Link on Gastritis Assessment (OLGA) e Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM). Objetivo: Comparar as classificações OLGA e OLGIM com e sem biópsia da IA. Além disso, determinar a prevalência de Helicobacter pylori (HP) e alterações pré-neoplásicas (AG e MI) em diferentes regiões biopsiadas e identificar os achados exclusivos da IA. Métodos: Estudo observacional, prospectivo, descritivo, unicêntrico, com 350 pacientes sem diagnóstico de câncer gástrico, submetidos à endoscopia digestiva alta com biópsias na Gastroclínica Itajaí, no período de março de 2020 a maio de 2022. A classificação histopatológica da gastrite seguiu o Sistema de Sydney Atualizado, e a avaliação do risco de câncer gástrico seguiu os sistemas OLGA e OLGIM. A metodologia aplicada avaliou os escores dos sistemas OLGA e OLGIM com e sem a avaliação da biópsia da IA. A análise estatística foi realizada por meio de medidas descritivas (frequências, porcentagens, média, desvio padrão, intervalo de confiança de 95%). As classificações foram comparadas usando os testes de Kruskal-Wallis ou Wilcoxon. Para analisar a relação entre as frequências, foi usado o teste exato de Fisher bilateral. O escore de Wilson com correção de continuidade foi aplicado ao intervalo de confiança. Resultados: A idade média foi de 54.7 anos, com 52.57% de pacientes do sexo feminino e 47.43% do sexo masculino. A comparação entre o protocolo de biópsias utilizado (corpo + antro [CA] vs corpo + antro + incisura angular [CAI]) e os estágios OLGA e OLGIM mostrou uma diminuição significativa em ambos os sistemas de estadiamento quando o protocolo de biópsia restrito ao corpo e ao antro foi aplicado (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). A prevalência de lesões pré-malignas (GA, MI e displasia) da mucosa gástrica foi de (33.4%, 34% e 1.1%, respectivamente) na amostra total. A região do antro exibiu um número significativamente maior de alterações (P<0.001), com exceção da infecção por HP, que estava presente em 24.8% dos pacientes. Conclusão: A biópsia de IA é importante porque aumentou o número de casos diagnosticados em estágios mais avançados de MI e AG. O estudo teve limitações, sendo a principal delas o tamanho relativamente pequeno da amostra, composta principalmente por indivíduos saudáveis, embora em sua maioria idosos.
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Abstract In Argentina, despite the important studies conducted on the prevalence of infection and the antibiotic resistance of Helicobacter pylori, there are no reports simultaneously analyzing a profile of virulence factors of the bacterium and polymorphisms in cytokine genes in patients with different alterations in the gastric mucosa (including intestinal metaplasia, IM). Our aim was to evaluate H. pylori genotypes in 132 adult patients with chronic gastritis presenting three different histological findings (inactive chronic gastritis, active chronic gastritis IM( and active chronic gastritis IM+) along with SNP-174 G>C in the IL-6 gene. cagA, vacA and babA2 genes were analyzed by multiplex PCR. The -174 G>C SNP IL-6 gene was analyzed by PCR-RFLP. Patients with active chronic gastritis IM+ showed the highest proportion of the cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG and cagA(+)/vacAm1s1/babA2(+)/IL-6GG combinations (p<0.05). There was 4-5 times greater probability of finding patients presenting the GG genotype for SNP-174 G>C IL-6, which in turn were infected with the most virulent H. pylori genotypes -cagA(+), cagA(+)/vacAm1s1 and cagA(+)/vacAm1s1/babA2- in the ACGIM+ group in comparison to the ICG group. Our results provide regional data to the idea that the transition towards severe alterations in the gastric mucosa would be the result of a balance between specific factors of H. pylori and inherent host factors. This fact can be useful to identify patients at greater risk and to select those individuals requiring appropriate eradication treatment to prevent progression to gastric cancer.
Resumen En Argentina, a pesar de los importantes estudios realizados sobre la prevalencia de infección y la resistencia a antibióticos de Helicobacter pylori, no existen reportes que analicen simultáneamente un perfil de factores de virulencia de la bacteria y polimorfismos en genes de citoquinas en pacientes con diferentes alteraciones en la mucosa gástrica (incluida la metaplasia intestinal [MI]). Nuestro objetivo fue evaluar genotipos de H. pylori en 132 pacientes adultos con gastritis crónica, con tres diferentes hallazgos histológicos (gastritis crónica inactiva [GCI], gastritis crónica activa [MI(] y gastritis crónica activa [MI+]), junto con el SNP-174 G>C en el gen de IL- 6. Los genes cagA, vacA y babA2 se analizaron mediante PCR multiplex. El SNP-174 G>C IL-6 se analizó mediante PCR-RFLP. Los pacientes con gastritis crónica activa MI+ mostraron la mayor proporción de combinaciones cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG y cagA(+)/vacAm1s1/babA2(+)/IL-6GG (p<0,05). Hubo 4-5 veces mayor probabilidad de encontrar pacientes con el genotipo GG en SNP-174 G>C IL-6 y a su vez infectados con los genotipos más virulentos de H. pylori-cagA(+), cagA(+)/vacAm1s1 y cagA(+)/vacAm1s1/babA2-en el grupo gastritis crónica activa MI+ en comparación con el grupo GCI. Nuestros resultados aportan datos regionales a la idea de que la transición hacia alteraciones más graves en la mucosa gástrica resultaría de un equilibrio entre factores específicos de H. pylori y factores inherentes al huésped. Esto puede ser útil para identificar pacientes con mayor riesgo y seleccionar aquellos individuos que requieran un apropiado tratamiento de erradicación para prevenir la progresión al cáncer gástrico.
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Male primary adenocarcinoma of urethra is rare clinically. A patient with primary adenocarcinoma of posterior urethra complicated with intestinal metaplasia was admitted and underwent urethral mass resection. The tumor recurred 3 months after surgery and no further treatment was given for personal reasons. The purpose of this report is to improve clinicians' understanding of urethral cancer, so that patients can undergo more accurate diagnosis and treatment.
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Objective@#To explore the microbial correlation between oral tongue coating (TC) and gastric mucosa (GM) in patients with gastric intestinal metaplasia (GIM).@*Methods@#The present study recruited 1360 volunteers for upper gastrointestinal cancer screening. The microbiota in TC and GM were profiled by long-read sequencing of full-length 16S rRNA gene. The microbial diversity, community structure, and linear discriminant analysis effect size (LEfSe) were analyzed by the software Visual Genomics. SparCC correlation analysis was used to construct the commensal network and the graphical display was conducted by R software.@*Results@#The population included 44 patients with precancerous GIM, and 28 matched controls with negative rapid urease test (RUT) and non-symptomatic chronic superficial gastritis (CSG). No significant difference in diversity was observed between GIM patients and controls in TC or GM microbiota (P > 0.05). Patients had a higher percentage of 41 – 60 co-occurring operational taxonomic units (OTUs) between TC and GM than controls (34.1% vs. 25.0%) (P < 0.05). The LEfSe showed that TC Prevotella melaninogenica and three gastric Helicobacter species (i.e., Helicobacter pylori, Helicobacter pylori XZ274, and Helicobacter pylori 83) were enriched in patients with GIM. Furthermore, GIM patients with positive RUT had a lower percentage of co-occurring OTUs over 20 (P < 0.05), and lower abundances of gastric Veillonella, Pseudonocardia, and Mesorhizobium than those with negative RUT (P < 0.05). The commensal network between TC and GM was more complex in GIM patients than in controls. GIM patients with positive RUT demonstrated more bacterial correlations between TC and GM than those with negative RUT. Finally, the serum ratio of PG-I/II was negatively correlated with three gastric Helicobacter species (Helicobacter pylori, Helicobacter pylori XZ274, and Helicobacter pylori 83) in patients with negative RUT (P < 0.05), and negatively correlated with two TC species (Fusobacterium nucleatum subsp. nucleatum and Campylobacter showae) in patients with positive RUT (P < 0.05).@*Conclusion@#The development of GIM potentiated the commensal network between oral TC and GM, providing microbial evidence of the correlation between TC and the stomach.
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Resumen Introducción: Helicobacter pylori juega un papel fundamental en la cascada de carcinogénesis del cáncer gástrico tipo intestinal; sin embargo, no existe claridad respecto a su prevalencia en condiciones preneoplásicas que generan cambio en el microambiente de la mucosa. Actualmente se recomienda la vigilancia endoscópica por protocolo de Sydney cada 2 a 3 años, pero no es clara la presencia de H. pylori en la región subcardial y el fondo gástrico. Objetivo: determinar la prevalencia y localización gástrica del H. pylori en pacientes con condiciones preneoplásicas. Materiales y métodos: estudio de corte transversal en adultos con diagnóstico previo de atrofia o metaplasia intestinal que ingresaron a endoscopia de control, a quienes se les tomaron biopsias del antro, cuerpo, incisura angularis, región subcardial y fondo gástrico. Se realizó un análisis descriptivo de los resultados por regiones gástricas. Resultados: se recolectó la información de 160 pacientes con una prevalencia de H. pylori del 37,5 %, la cual fue en aumento de proximal a distal iniciando con una prevalencia de 12,5 % en la región subcardial hasta una prevalencia de 30,6 % en el antro; hubo un patrón similar en la prevalencia de lesiones preneoplásicas. Se observó una mayor presencia de lesiones avanzadas (displasia, carcinoma) en la incisura. Conclusiones: la prevalencia de H. pylori en condiciones premalignas evidenció una mayor presencia en las regiones distales en comparación con las proximales, y es más frecuente en la región antral y menor en la región subcardial. En cuanto a la distribución gástrica de atrofia y metaplasia, se encontró mayor compromiso en el antro y la incisura, y es baja en la región subcardial y el fondo.
Abstract Introduction: Helicobacter pylori infection plays a critical role in the carcinogenesis cascade of intestinal gastric cancer. However, its prevalence in preneoplastic conditions generating changes in the gastric mucosa is unclear. Currently, endoscopic surveillance using the Sydney protocol is suggested every 2 to 3 years, but the presence of H. pylori infection in the subcardial region and gastric fundus is ill-defined. Objective: to determine the prevalence and gastric location of H. pylori infection in patients with preneoplastic conditions. Materials and methods: a cross-sectional study in adults with a previous diagnosis of atrophy or intestinal metaplasia who entered control endoscopy and were antrum, body, incisura angularis, subcardial region, and gastric fundus biopsied. A descriptive analysis of the results by gastric regions was performed. Results: data from 160 patients with a prevalence of H. pylori of 37.5% were collected. It increased from proximal to distal, starting with a 12.5% prevalence in the subcardial region to a 30.6% prevalence in the antrum. In addition, there was a similar pattern in the prevalence of preneoplastic lesions. Furthermore, advanced lesions (dysplasia, carcinoma) were observed in the incisura. Conclusions: the prevalence of H. pylori in precancerous conditions showed a high presence in the distal regions compared to the proximal ones, and it is more frequent in the antrum and lower in the subcardial region. As for the gastric distribution of atrophy and metaplasia, more involvement was found in the antrum and angular notch and lower in the subcardial region and fundus.
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Objective:A prospective, multicenter randomized controlled clinical research was conducted to explore the diagnostic value of the new optical staining technology for domestic endoscope, spectral focused imaging (SFI) and variable intelligent staining technology (VIST), for gastric precancerous lesions.Methods:Patients who intended to undergo gastroscopy between August 2020 and May 2021 were randomly divided into the white light group and the new optical staining group at the First Hospital of Hebei Medical University, Shanghai Tenth People's Hospital and the Second Affiliated Hospital of Soochow University. A sequential examination method was applied (white light to new optical staining or new optical staining to white light). The endoscopic diagnostic results and the detection results of Helicobacter pylori ( HP) of the two groups were recorded. At the same time, such five variables as gastric mucosal atrophy, intestinal metaplasia, fold enlargement, nodular gastritis and diffuse redness were evaluated for the risk of gastric cancer in the two groups. Results:A total of 419 cases were enrolled, including 208 cases in the white light group and 211 cases in the new optical staining group. Compared with pathological findings, the detection rates of gastric inflammation, atrophy, intestinal metaplasia, low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia and advanced cancer lesions in the white light group were 28.9%, 40.4%, 64.9%, 17.8%, 0.5% and 0.5% respectively; while those in the new optical staining group were 30.8%, 42.7%, 62.6%, 15.2%, 2.8% and 0.5%. There were no significant differences in the detection rates between the two groups ( P>0.05). Compared with pathology, the sensitivity, the specificity, the accuracy, the positive predictive value and the negative predictive value for gastric mucosal atrophy in the white light group were 92.9%, 61.3%, 74.0%, 61.9% and 92.7% respectively and those in the new optical staining group (SFI mode) were 94.4%, 64.5%, 77.3%, 66.4% and 94.0% respectively. The above 5 measures for gastric mucosal intestinal metaplasia were 68.1%, 72.6%, 69.7%, 82.1% and 55.2% in the white light group, and 87.1%, 89.9%, 88.2%, 93.5% and 80.7% in the new optical staining group (VIST mode), with significant difference between the two groups ( P<0.05). In terms of HP infection with 13C-urea breath test ( 13C-UBT) results as the gold standard, the above 5 measures were 90.2%, 84.3%, 87.4%, 86.8% and 88.2% in the white light group and 92.6%, 77.1%, 85.4%, 82.2% and 90.1% in the new optical staining group respectively. The proportion of high-risk gastric lesions in the new optical staining group was higher in cases of a gastric cancer risk score≥ 4 ( P<0.05). Conclusion:The new optical staining technology of domestic endoscopy has higher diagnostic value for gastric mucosal intestinal metaplasia. Gastroscopy is helpful for the detection of precancerous lesions with gastric cancer risk score as a tool. The new optical staining technology of domestic endoscopy is similar to imported endoscopy in diagnosing gastric precancerous lesions and HP infection, which is an effective means to detect gastric mucosal precancerous lesions.
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ObjectiveTo investigate the influencing factors of intestinal metaplasia or atypical hyperplasia in chronic atrophic gastritis （CAG） patients and establish a prediction model. MethodThe clinical records and laboratory examination data of 335 CAG patients treated in the department of gastroenterology of the Second Affiliated Hospital of the Anhui University of Chinese Medicine from June 2016 to June 2021 were collected. Single and multiple Logistic regression analyses were used to explore the influencing factors of intestinal metaplasia or atypical hyperplasia in CAG patients by SPSS 26.0. A prediction model was constructed based on the data of the related influencing factors. In addition, 115 CAG patients diagnosed in the First Affiliated Hospital of Anhui Medical University from June 2019 to June 2021 were selected as external validation samples to verify and evaluate the prediction efficiency of the constructed prediction model. ResultMultiple Logistic regression analysis showed that pepsinogen Ⅰ［odds ratio（OR） 0.994，95% confidence interval（CI） （0.990，0.999），P<0.05］，the number of focus［OR 6.765，95% CI（3.831，11.945），P<0.01］， and Helicobacter pylori （Hp） infection［OR 0.546，95% CI（0.335，0.888），P<0.05］ were independent risk factors for intestinal metaplasia or atypical hyperplasia in CAG patients（P<0.05）. The formula of the prediction model is as follows：P=-1.558+0.606×Hp infection-0.006×pepsinogen Ⅰ+1.912×the number of focus. The receiver operating characteristic （ROC） curve showed the specific parameters as below： the area under the ROC curve of 0.76，the Youden index of 0.443，the best cut-off value of 0.52，sensitivity of 0.533，and specificity of 0.910. The prediction model was applied to the data of patients in the validation group for validation，and the predictive efficiency of the model was tested by decision curve analysis （DCA）. The results showed that the model had a good fit and high predictive value. ConclusionPepsinogen Ⅰ，the number of focus， and Hp infection are independent risk factors for intestinal metaplasia or atypical hyperplasia in CAG patients. The prediction model constructed based on these factors has a good fit and high predictive value，which can provide references for the classification of CAG patients and the formulation of individual treatment protocols.
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Objective To evaluate the gastric microbiome in patients with chronic superficial gastritis (CSG) and intestinal metaplasia (IM) and investigate the influence of Helicobacter pylori (H. pylori) on the gastric microbiome. Methods Gastric mucosa tissue samples were collected from 54 patients with CSG and IM, and the patients were classified into the following four groups based on the state of H. pylori infection and histology: H. pylori-negative CSG (n=24), H. pylori-positive CSG (n=14), H. pylori-negative IM (n=11), and H. pylori-positive IM (n=5). The gastric microbiome was analyzed by 16S rRNA gene sequencing. Results H. pylori strongly influenced the bacterial abundance and diversity regardless of CSG and IM. In H. pylori-positive subjects, the bacterial abundance and diversity were significantly lower than in H. pylori-negative subjects. The H. pylori-negative groups had similar bacterial composition and bacterial abundance. The H. pylori-positive groups also had similar bacterial composition but different bacterial relative abundance. The relative abundance of Neisseria, Streptococcus, Rothia, and Veillonella were richer in the I-HP group than in G-HP group, especially Neisseria (t=175.1, P<0.001). Conclusions The gastric microbial abundance and diversity are lower in H. pylori- infected patients regardless of CSG and IM. Compared to H. pylori-positive CSG group and H. pylori-positive IM, the relative abundance of Neisseria, Streptococcus, Rothia, and Veillonella is higher in H. pylori-positive patients with IM than in H. pylori-positive patients with CSG, especially Neisseria.
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Humanos , Mucosa Gástrica/microbiologia , Gastrite Atrófica/microbiologia , Microbioma Gastrointestinal/genética , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Metaplasia , RNA Ribossômico 16S/genética , Neoplasias GástricasRESUMO
Objective:To evaluate the impact of artificial intelligence (AI) system on the diagnosis rate of precancerous state of gastric cancer.Methods:A single center self-controlled study was conducted under the premise that such factors were controlled as mainframe and model of the endoscope, operating doctor, season and climate, and pathology was taken as the gold standard. The diagnosis rate of precancerous state of gastric cancer, including atrophic gastritis (AG) and intestinal metaplasia (IM) in traditional gastroscopy (from September 1, 2019 to November 30, 2019) and AI assisted endoscopy (from September 1, 2020 to November 15, 2020) in the Eighth Hospital of Wuhan was statistically analyzed and compared, and the subgroup analysis was conducted according to the seniority of doctors.Results:Compared with traditional gastroscopy, AI system could significantly improve the diagnosis rate of AG [13.3% (38/286) VS 7.4% (24/323), χ2=5.689, P=0.017] and IM [33.9% (97/286) VS 26.0% (84/323), χ2=4.544, P=0.033]. For the junior doctors (less than 5 years of endoscopic experience), AI system had a more significant effect on the diagnosis rate of AG [11.9% (22/185) VS 5.8% (11/189), χ2=4.284, P=0.038] and IM [30.3% (56/185) VS 20.6% (39/189), χ2=4.580, P=0.032]. For the senior doctors (more than 10 years of endoscopic experience), although the diagnosis rate of AG and IM increased slightly, the difference was not statistically significant. Conclusion:AI system shows the potential to improve the diagnosis rate of precancerous state of gastric cancer, especially for junior endoscopists, and to reduce missed diagnosis of early gastric cancer.
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Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could be reversed to a certain extent. Clinical studies demonstrated that Lamb′s tripe extract and vitamin B12 capsule exhibited significant reversal effects on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb′s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.
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Background: Gastric mucosal atrophy and intestinal metaplasia (IM) are precancerous conditions of gastric cancer. Although Moluodan has been used in the treatment of chronic atrophic gastritis (CAG), there is little study on efficacy evaluation of Moluodan based on pathological stages. Aims: To assess the efficacy of Moluodan on reversal of gastric mucosal atrophy and IM based on OLGA and OLGIM staging systems, and to analyze the related factors. Methods: A total of 104 patients with CAG and IM from October 2019 to January 2022 at Xijing Hospital of Air Force Medical University were enrolled retrospectively in this study. All the patients received Moluodan treatment (one bag each time, three times daily) for 6 months. Changes of OLGA and OLGIM stages before and after treatment, and the related factors affecting the efficacy were analyzed. Results: After treatment with Moluodan for 6 months, the reversal rates for gastric mucosal atrophy and IM were 47.1% (49/104) and 51.0% (53/104), respectively, and the overall efficacy was 65.4% (68/104). There were 49.3% (34/69) and 52.4% (22/42) of patients with higher OLGA and OLGIM stages (III-) reversed to lower stages (0-Ⅱ), respectively. In addition, patients with OLGA and OLGIM stage III- showed a higher reversal rate than those with stage -Ⅱ (all P0.05). Conclusions: Moluodan could reverse gastric mucosal atrophy and IM effectively in patients with CAG, which suggests that Moluodan has good potential in prevention of gastric cancer.
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The prognosis of gastric cancer is closely related to the stage, which generally follows the evolution of gastritis and precancerous lesion of gastric cancer. Serology, endoscopy and pathology can be used for gastric cancer risk assessment. Kimura-Takemoto classification, Kyoto classification of gastritis and endoscopic grading of gastric intestinal metaplasia can determine the scope of atrophy and intestinal metaplasia under endoscopy, and can be used for risk assessment of gastric cancer. This article reviewed the current status of research on endoscopic assessment of the risk of gastric cancer.
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Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could also be reversed to a certain extent. Clinical studies demonstrated that Lamb’s tripe extract and vitamin B12 capsule exhibited significant reversal effect on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb’s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.
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Gastric xanthoma, also known as gastric macular tumor or gastric lipid island, is a benign lesion that occurs in the gastric mucosa as a result of fatty deposits. Its etiology and pathogenesis are not yet clear, and may be related to gastric mucosal damage and repair, intestinal metaplasia, and abnormal lipid metabolism. Gastric xanthoma can be seen in any part of the stomach, usually in gastric antrum and pylorus region. Gastric xanthoma is reported to be associated with increased risk of early gastric cancer. This article reviewed the progress of research on correlation between gastric xanthoma and gastric cancer and precancerous lesions.
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Resumen Introducción: se han descrito cambios morfológicos asociados a la infección gástrica por H. pylori como: gastritis crónica superficial, gastritis atrófica, gastritis folicular y metaplasia intestinal. Importancia: La atrofia y la metaplasia gástrica pertenecen a la cascada de cambios histológicos que conducen al cáncer gástrico. Metodología: estudio retrospectivo de corte transversal en el que se analizaron pacientes con dispepsia; durante su examen se practicó endoscopia y biopsias gástricas. Se documentó infección o no por H. pylori y los cambios morfológicos presentes. Resultado: total de casos positivos para infección H. pylori en biopsias gástricas 127/166 (76.5%), casos negativos para infección H. pylori en biopsias gástricas 39/166 (23.4%). Edad promedio 45.38 años, sexo femenino 80/127 (63%), gastritis crónica superficial 61/127 (48%), gastritis nodular 43/127 (33.87%), atrofia gástrica 7/127 (5.5%), metaplasia intestinal 7/127 (5.5%). Biopsias negativas para H.pylori con diagnóstico de atrofia 5/39 (12.8%), con hallazgo de metaplasia fueron: 4/39 (10.2%). Conclusiones: los cambios morfológicos encontrados en biopsias gástricas son similares a la literatura universal. La atrofia y especialmente la metaplasia intestinal son cambios morfológicos asociados a la infección por H.pylori y son a su vez factores de riesgo para el desarrollo del cáncer gástrico que fueron documentados en la serie que presentamos. Hay casos negativos para la infección H.pylori, con cambios superficiales de atrofia y metaplasia por lo que es recomendable hacer estudios adicionales para descartar completamente la infección por H. pylori. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).
Abstract Introduction: morphological changes associated with gastric H. pylori infection have been reported, such as chronic superficial gastritis, atrophic gastritis, follicular gastritis and intestinal metaplasia. Importance: Gastric atrophy and metaplasia are part of the cascade of histological changes that lead to gastric cancer. Methods: a retrospective cross-sectional study analyzing patients with dyspepsia; gastric endoscopy and biopsies were conducted during their exams. The presence or absence of H. pylori infection was documented along with the morphological changes present. Results: a total of 127/166 cases were positive for H.pylori infection on gastric biopsy (76.5%), and 39/166 cases were negative for H. pylori on gastric biopsy (23.4%). The average age was 45.38 years, 80/127 (63%) were female, 61/127 had superficial chronic gastritis (48%), 43/127 (33.87%) had nodular gastritis, 7/127 (5.5%) had gastric atrophy, and 7/127 (5.5%) had intestinal metaplasia. Of the biopsies which were negative for H. pylori, 5/39 (12.8%) had a diagnosis of atrophy, and 4/39 (10.2%) had a finding of metaplasia. in those with a diagnosis of atrophy Conclusions: the morphological changes found in gastric biopsies are similar to those reported in the international literature. Atrophy, and especially intestinal metaplasia, are morphological changes associated with H.pylori infection, and, in turn, risk factors for developing gastric cancer, which were documented in our study. There are H. pylori-negative cases with superficial atrophic and metaplastic changes; thus, it is advisable to carry out further studies to completely rule out H. pylori infection. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).