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Chronic nausea is a widespread functional disease in children with numerous comorbidities. High-resolution electrogastrogram (HR-EGG) has shown sufficient sensitivity as a noninvasive clinical marker to objectively detect distinct gastric slow wave properties in children with functional nausea. We hypothesized that the increased precision of magnetogastrogram (MGG) slow wave recordings could provide supplementary information not evident on HR-EGG. We evaluated simultaneous pre- and postprandial MGG and HR-EGG recordings in pediatric patients with chronic nausea and healthy asymptomatic subjects, while also measuring nausea intensity and nausea severity. We found significant reductions in postprandial dominant frequency and normogastric power, and higher levels of postprandial bradygastric power in patients with nausea in both MGG and HR-EGG. MGG also detected significantly lower preprandial normogastric power in patients. A significant difference in the mean preprandial gastric slow wave propagation direction was observed in patients as compared with controls in both MGG (control: 180 ± 61°, patient: 34 ±72°

The motility patterns in the gastrointestinal tract are regulated, in part, by bioelectrical events known as slow waves (SWs). Understanding temporal and spatial features of gastric SWs can help reveal the underlying causes of functional motility disorders.This study investigated the ability of source localization techniques to characterize the spatial signatures of SW activity using simulated and experimental magnetogastrography data.Two SW propagation patterns (antegrade and retrograde) with two rhythms (normogastric and bradygastric) were used to simulate magnetic fields using 4 anatomically realistic stomach and torso geometries. Source localization was performed utilizing the equivalent current dipole (ECD) and the equivalent magnetic dipole (EMD) models.In the normogastric simulations when compared with the SW activity, the EMD model was capable of identifying the SW propagation in the lateral, antero-posterior, and supero-inferior axes with the median correlation coefficients of 0.66, 0.53, and 0.83, respectively, whereas the ECD model produced lower correlation scores (median: 0.52, 0.44, and 0.44). Moreover, the EMD model resulted in distinct and opposite spatial signatures for the antegrade and retrograde propagation. Similarly, when experimental data was used, the EMD model revealed antegrade-like signatures where the propagation was mostly towards the third quadrant in the supero-inferior (preprandial: 49%, postprandial: 35%) and antero-posterior (preprandial: 49%, postprandial: 50%) axes.The EMD model was able to identify and classify the spatial signatures of SW activities, which can help to inform the interpretation of non-invasive recordings of gastric SWs as a biomarker of functional motility disorders.

Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.

A Dieulafoy’s lesion is a rare cause of massive gastrointestinal (GI) bleeding. It represents an abnormally dilated submucosal artery that erodes the overlying epithelium in the absence of a primary ulcer. These lesions are usually located in the stomach, nevertheless, they have been found in all areas of the GI tract, including the oesophagus, duodenum and colon. Bleeding episodes are often self-limited, although bleeding can be recurrent and profuse. The case describes a 50-year-old woman who developed haemorrhagic shock secondary to a rectal Dieulafoy’s lesion and discusses the diagnostic and therapeutic approaches.

Nociceptive afferents innervate the stomach and send signals centrally to the brain and locally to stomach tissues. Nociceptive afferents can be detected with a variety of different markers. In particular, substance P (SP) is a neuropeptide and is one of the most commonly used markers for nociceptive nerves in the somatic and visceral organs. However, the topographical distribution and morphological structure of SP-immunoreactive (SP-IR) axons and terminals in the whole stomach have not yet been fully determined. In this study, we labeled SP-IR axons and terminals in flat mounts of the ventral and dorsal halves of the stomach of mice. Flat-mount stomachs, including the longitudinal and circular muscular layers and the myenteric ganglionic plexus, were processed with SP primary antibody followed by fluorescent secondary antibody and then scanned using confocal microscopy. We found that (1) SP-IR axons and terminals formed an extensive network of fibers in the muscular layers and within the ganglia of the myenteric plexus of the whole stomach. (2) Many axons that ran in parallel with the long axes of the longitudinal and circular muscles were also immunoreactive for the vesicular acetylcholine transporter (VAChT). (3) SP-IR axons formed very dense terminal varicosities encircling individual neurons in the myenteric plexus; many of these were VAChT immunoreactive. (4) The regional density of SP-IR axons and terminals in the muscle and myenteric plexus varied in the following order from high to low: antrum-pylorus, corpus, fundus, and cardia. (5) In only the longitudinal and circular muscles, the regional density of SP-IR axon innervation from high to low were: antrum-pylorus, corpus, cardia, and fundus. (6) The innervation patterns of SP-IR axons and terminals in the ventral and dorsal stomach were comparable. Collectively, our data provide for the first time a map of the distribution and morphology of SP-IR axons and terminals in the whole stomach with single-cell/axon/synapse resolution. This work will establish an anatomical foundation for functional mapping of the SP-IR axon innervation of the stomach and its pathological remodeling in gastrointestinal diseases.

The purpose of the present study was to study tablet disintegration by direct visualization, in vivo and in vitro. Based on literature data, a standard conventional paracetamol (CP) tablet, Panodil®, and a rapidly absorbed paracetamol (RP) tablet, Panodil® Zapp, were chosen as model systems to study tablet disintegration in the human stomach. Based on the obtained in vivo results, an in vitro disintegration method was designed to reproduce the visualized disintegration process occurring in the human stomach. For the clinical study, CP and RP tablets fastened to digital endoscopic camera capsules were administered to fasted human volunteers (n = 4). The disintegration time and process were visualized by the real time video recordings, using the endoscopic camera capsule. The average disintegration time was found to be 26 ± 13 min and 10 ± 7 min, for CP (n = 4) and RP (n = 4) tablets, respectively. It was possible to reproduce the in vivo disintegration data in vitro using a USP 2 dissolution apparatus with 250 mL of viscous Fasted State Simulated Gastric Fluid (vFaSSGF*), simulating the rheological profile of human fasted state gastric fluid following administration of a glass of water. The viscosity of the simulated fasted state gastric fluid was found to have a large impact on the disintegration time of the tested immediate release tablets. Therefore, it is recommended to mimic gastric fluid viscosity during in vitro tablet disintegration studies.

Currently, there is no accurate noninvasive measurement system to diagnose gastrointestinal (GI) motility disorders. Wireless skin patches have been introduced to provide an accurate noninvasive measurement of GI myoelectric activity which is essential for developing neuro-stimulation devices to treat GI motility disorders. The aim of this study is to compare the external and internal electrical signal measurements in ambulatory pigs.Yucatan pigs underwent placement of internal electrodes on the stomach, small intestine, and colon. Wires were brought through the abdominal wall. Signals were collected by a wireless receptor. Four external patches were placed on the abdominal skin to record the signals simultaneously. Pigs were kept for 6 d while the sensors were continuously recording the data from both systems.Internal sensors detected rich signals from each organ. The stomach had a dominant frequency that ranged from 4 to 4.5 cpm, with occasional higher frequencies at 2, 3 and 4 times that. Small intestine signals had their primary energy in the 12-15 cpm range. Colon signals primarily displayed a dominant broad peak in the 4-6 cpm region. External skin patches detected a substantial fraction of the activities measured by the internal electrodes. A clear congruence in the frequency spectrum was observed between the internal and external readings.Internally measured myoelectrical signals confirmed different patterns of rhythmic activity of the stomach, small intestine, and colon. Skin patches provided GI myoelectric measurement with a range of frequencies that could be useful in the diagnosis and treatment of motility disorders.

Carbohydrates can both protect against infection and act as targets promoting infection. Mucins are major components of the slimy mucus layer covering the fish epithelia. Mucins can act as decoys for intimate pathogen interaction with the host afforded by binding to glycosphingolipids in the host cell membrane. We isolated and characterized glycosphingolipids from Atlantic salmon skin, gill, stomach, pyloric caeca, and intestine. We characterized the glycosphingolipids using liquid chromatography - mass spectrometry and tandem mass spectrometry and the glycan repertoire was compared with the glycan repertoire of mucins from the same epithelia. We also investigatediAeromonas salmonicida/ibinding using chromatogram and microtiter well based binding assays. We identified 29 glycosphingolipids. All detected acid glycans were of the ganglio-series (unless shorter) and showed a high degree of polysialylation. The non-acid glycans were mostly composed of the neolacto, globo, and ganglio core structures. The glycosphingolipid repertoire differed between epithelia and the proportion of the terminal moieties of the glycosphingolipids did not reflect the terminal moieties on the mucins from the same epithelia.iA. salmonicida/idid not bind the Atlantic salmon glycosphingolipids. Instead, we identified thatiA. salmonicida/ibinding to sialic acid occurred to α2-6 Neu5Ac but not to α2-3 Neu5Ac. α2-6 Neu5Ac was present on mucins whereas mainly α2-3 Neu5Ac was found on the glycosphingolipids, explaining the difference iniA. salmonicida/ibinding ability between these host glycoconjugates.iA. salmonicida´s/iability to bind to Atlantic salmon mucins, but not the glycosphingolipids, is likely part of the host defence against this pathogen.

Delayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP).An Institutional Review Board-exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05.A total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality.Retrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.

BACKGROUND AND PURPOSE: Nausea is associated with the hormonal secretion of vasopressin and adrenaline, although their actions in inducing nausea is poorly understood. Here, we have investigated their actions on human stomach muscle. EXPERIMENTAL APPROACH: Muscle strips were suspended in tissue baths and neuronal-/non-neuronally-mediated contractions were measured. Custom software analysed eight motility parameters defining spontaneous phasic non-neuronally mediated contractions. Receptor distributions were assessed by qPCR and immunofluorescence. KEY RESULTS: V1A receptors and α1 -adrenoceptors were located on muscle as well as interstitial cells of Cajal (ICCs). Myogenic contractions of human proximal and distal stomach (respectively, 2.6 ± 0.1 and 2.7 ± 0.0 per minute; n = 44) were larger in the distal area (1.1 ± 0.1 and 5.0 ± 0.1 mN), developing relatively slowly (proximal) or rapidly (distal). Vasopressin caused tonic (proximal) or short-lived (distal) increases in muscle tone and increased myogenic contraction amplitude, frequency and rate (acting at V1A receptors; thresholds 10-11 -10-10 M); by contrast, cholinergically mediated contractions were unaffected. Oxytocin acted similarly to vasopressin but less potently, at OT receptors). Adrenaline increased (10-10 -10-5 M; α1 -adrenoceptors) and decreased (≥10-6 M; β-adrenoceptors) muscle tone and enhanced/reduced myogenic contractions. Cholinergically mediated contractions were reduced (α2 -adrenoceptors). Combined, vasopressin (10-9 M) and adrenaline (10-8 M) increased muscle tone and phasic myogenic activity in a synergistic manner. CONCLUSIONS AND IMPLICATIONS: Vasopressin and adrenaline increased human gastric tone and myogenic contraction amplitude, rate of contraction and frequency. In combination, their actions were further increased in a synergistic manner. Such activity may promote nausea.

The stomach is a bioreactor and an important intersection of biochemical reactions that affect human health. Lipid peroxidation of meat in the stomach medium generates malondialdehyde (MDA), which is absorbed from the gut into human plasma and modifies low-density lipoprotein (LDL) to MDA-LDL. We found in the stomach medium (pH 3.0) a high antioxidant activity of vitamin E against meat lipid peroxidation, almost 35-fold higher than at pH 6.3. In the stomach medium, the antioxidant activity of vitamin E on meat lipid peroxidation was 20-fold higher than that of catechin. Vitamin E, at pH 3.0, acts synergistically with metmyoglobin (MbFe

Purpose The variables possibly enabling the prediction of gastric wall thickness during laparoscopic sleeve gastrectomy remain undetermined. The aim of the study was to identify preoperative factors affecting gastric wall thickness in patients undergoing laparoscopic sleeve gastrectomy. Methods The measurements of the double-wall thickness of gastric specimen excised during sleeve gastrectomy were taken at three locations after 15 s of compression with an applied pressure of 8 g/mm2. Statistical calculations were used to determine the influence of preoperative weight loss and other perioperative parameters on gastric wall thickness. Results The study involved one hundred patients (78 female; 22 male). The thickest tissue was observed at the antrum with the mean value 2.55 mm (range 1.77–4.0 mm), followed by the midbody, mean 2.13 mm (range 1.34–3.20 mm), and the fundus, mean 1.69 mm (range 0.99–2.69 mm). Positive relationships were found between gastric wall thickness and both preoperative weight loss and age in all three measured locations; p Conclusion Preoperative weight loss should be considered an important factor influencing gastric wall thickness. Age and gender can also be helpful in predicting the varying tissue thickness. Anatomical region is a key factor determining thickness of the stomach walls.

A common source of concern about digital pathology (DP) is that limited resolution could be a reason for an increased risk of malpractice. A frequent question being raised about this technology is whether it can be used to reliably detectThe method we propose is based on the Warthin-Starry (W-S) silver stain which allows faster detection of HP in virtual slides. A software tool, based on regular expressions, performed a specific search to select 679 biopsies on which a W-S stain was done. From this dataset 185 virtual slides were selected to be assessed by WSI and compared with microscopy slide readings. To determine whether HP infections could be accurately diagnosed with machine learning. AI was used as a service (AIaaS) on a neural network-based web platform trained with 468 images. A test dataset of 210 images was used to assess the classifier performance.In 185 gastric biopsies read with DP we recorded only 4 false positives and 4 false negatives with an overall agreement of 95.6%. Compared with microscopy, defined as the "gold standard" for the diagnosis of HP infections, WSI had a sensitivity and specificity of 0.95 and 0.96, respectively. The ROC curve of our AI classifier generated on a testing dataset of 210 images had an AUC of 0.938.This study demonstrates that DP and AI can be used to reliably identify HP at 20X resolution.

A bezoar is a mass of indigestible foreign material found in the gastrointestinal tract, usually in the stomach. Trichobezoars are the second most common bezoars which are usually found in young psychiatric patients. A 15-year-old female patient presented with signs of intestinal obstruction and acute abdomen. The preoperative investigations revealed a perforated appendix, and an exploratory laparotomy was performed. Intraoperative findings showed presence of a mass of hair in the stomach along with a long tail extending into the small intestine. Postoperatively, the patient's condition worsened and she died because of complications of perforation peritonitis on day 3. Early diagnosis of Rapunzel syndrome can help in making early interventions. The prognosis of incidental detection of this condition depends on the accompanying cause.

Miniature energy storage devices simultaneously combining high energy output and bioavailability could greatly promote the practicability of green, safe, and nontoxic in vivo detection, such as for noninvasive monitoring or treatment in the gastrointestinal tract, which is still challenging. Herein, we report ingestible and nutritive zinc-ion-based hybrid micro-supercapacitors (ZMSCs) consisting of an edible active carbon microcathode and zinc microanode, which can be inserted into a standard-sized capsule and ingested in a pig stomach. With features including flexibility, light weight, and shape adaptability, a single microdevice displays a high energy density of 215.1 μWh cm

Gastric ulcers secondary to gastric ischaemia is rare because of the rich blood supply of the stomach. We present a case where a patient with history of atherosclerotic vascular disease (ASCVD) presented with unintentional weight loss and failure to thrive for several months. Initial imaging studies ruled out any active malignancy. Oesophagogastroduodenoscopy revealed multiple shallow gastric ulcers. CT angiography was performed in later course of the hospital stay, which demonstrated a high-grade stenosis at the origin of both the superior mesenteric artery and the coeliac trunk. This combination stenosis is a rare finding, which can lead to ischaemia of the stomach by blocking the stomach’s dual blood supply. Although the patient underwent revascularisation attempt with stent placement, she expired due to critical postoperative condition. This case signifies the importance of keeping a low threshold for suspicion for gastric ischaemia in patients with ASCVD risk factors and unexplained weight loss.

Primary retroperitoneal neuroendocrine tumours (NETs) are extremely rare, and many a times, these are metastatic lesions with known or unknown primary location, most commonly arising from the stomach, duodenum, small intestine and rectum. NETs arising from the duodenum are more commonly seen in the first part of the duodenum followed by the second part. The incidence is increasing because of easy accessibility to endoscopies and cross-sectional imaging. In NETs, lymph node (LN) metastasis occurs commonly when the tumour size is more than 2 cm. In contrast, LN metastasis occurs even with subcentimetric lesions, especially the ampullary variant of NETs. A patient presented to us with mild abdominal pain and found to have retroduodenal mass. On evaluation found to be a metastatic LN deposit of NET with the primary arising from the first part and supra-ampullary part of duodenum.

Lymphoepithelial carcinoma (LEC) is an entity mostly frequent in the nasopharynx, which represents 40% of all neoplasms. The incidence’s not exclusive of a geographic area; however, it has an endemic distribution in Southeast Asia and Eskimos. LEC is not exclusive of the nasopharynx, has also been reported in other anatomical areas, such as the sinonasal tract, nasolacrimal duct, oral cavity, oropharynx, salivary glands, thymus, hypopharynx, oesophagus, stomach, trachea, lung and others. Non-nasopharyngeal and nasopharyngeal LEC have the same microscopic features, but the nasopharyngeal is more likely associated with Epstein-Barr virus. LEC has been approved by the WHO. LEC located in the larynx is quite rare and worthy of attention for its implication in the treatment and prognosis. We present a case of LEC treated in our ENT department in a middle-aged man.

This ATLAS presents in appended form the complete monographic study on the subject. The idea is to bring the results out of the "heavier" didactic format required for the scientific presentation and at the same time to systematize all the information needed for the subsequent clinical research. The present excerpt from monographic work seeks to introduce the possibility that oncological diseases become chronic (like diabetes). The theoretical basis on which we refer is the fact that cancer cells feed only on carbohydrates. In turn, there is evidence that some nitrile glycosides have anti-cancer properties. The study is divided into four parts presented in the form of goals. Proceeding from the particular to the general, the fine molecular structure and all possible biochemical reactions of Amygdalin are examined. By itself, it is highly toxic to the physiologically active animal cell. Amygdalin has NO pronounced antitumor properties. In the first goal, he examines precisely the acceptable form for admission. It is concluded that the active anticancer molecular form is a stoichiometric mixture of the amide and carboxyl derivative of the nitrile glycoside. The second goal is to study the exact action of the anti-tumor product already introduced. After an extremely precise biochemical and mathematical analysis, a series of biochemical cycles of the exact passage of the product through the digestive system, penetration into the blood, approach to cancer cells and selective passage through their cell membrane have been deduced. The third goal is to define the chemical and pharmaceutical molecular forms. 54 methodological and/or pharmaceutical models with hundreds of variables for each are reviewed and analyzed here. The fourth goal (it is this purpose that is separately brought out in this edition) presents the interpretable prediction of anticancer susceptibility of glycosidic amides. The affinities of the pharmaceutical form to each known cancer cell line are reviewed. The results surpass many times all anti-cancer drugs and with significantly reduced toxicity. In an additional part, a generalized clinical control is presented. When conducting the treatment, it is also vitally important to not divert the therapy process to irreversible pathology. Result: The cancer can become chronic and become a practically curable disease., The theoretical basis is based on - https://doi.org/10.5281/zenodo.7295357 | Full calculations are posted here*: https://doi.org/10.5281/zenodo.7550371 | *- the information is constantly updated - choose the current version at the moment, {"references":["Cadow, J., Born, J., Manica, M., Oskooei, A., & Martínez, M. R. (2020). PaccMann: a web service for interpretable anticancer compound sensitivity prediction. Nucleic Acids Research, 48(W1), W502-8. doi:10.1093/nar/gkaa327","Christopher, A. (2017). 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Tachygastria is a gastric dysrhythmia (4 to ≤9 cycles per minute, cpm) associated with gastric hypomotility and gastrointestinal disorders. Healthy preterm infants spend more time in tachygastria than adults; however, normative values are not defined. We sought to determine the percent of time preterm infants spend in tachygastria.We conducted a longitudinal, prospective cohort study with weekly electrogastrography (EGG) recordings in 51 preterm34 weeks' gestation and 5 term (reference) infants. We calculated percentage recording time in tachygastria (% tachygastria) and determined the mean ± standard deviation (SD) across EGG sessions. Mixed effects model was performed to test weekly variance in % tachygastria and gestational age effect. Successive pre- and post-prandial measurements were obtained to assess reproducibility of % tachygastria. We compared time to achieve full feeds between subjects with % tachygastria within 1 SD from the mean versus % tachygastria1 SD from mean.Three hundred seventy-six EGG sessions were completed (N = 56). Mean % tachygastria was 40% with SD ±5%. We demonstrated no change in % tachygastria across 9 postnatal weeks (P = 0.70) and no gestational age effect. No difference was demonstrated between successive pre- (P = 0.91) and post-prandial (P = 0.96) % tachygastria. Infants with 35%-45% tachygastria (within 1 SD from mean) had higher gestational age and less time to achieve full feeds than infants with35% or45% tachygastria.EGG is a reproducible tool to assess % tachygastria in preterm infants. Clinical significance of increased or decreased % tachygastria needs further investigation to validate if 35%-45% tachygastria is safe for feeding.

To overcome the increasing burden on pathologists in diagnosing gastric biopsies, we developed an artificial intelligence-based system for the pathological diagnosis of gastric biopsies (AI-G), which is expected to work well in daily clinical practice in multiple institutes. The multistage semantic segmentation for pathology (MSP) method utilizes the distribution of feature values extracted from patches of whole-slide images (WSI) like pathologists' "low-power view" information of microscopy. The training dataset included WSIs of 4511 gastric biopsy tissues from 984 patients. In tissue-level validation, MSP AI-G showed better accuracy (91.0%) than that of conventional patch-based AI-G (PB AI-G) (89.8%). Importantly, MSP AI-G unanimously achieved higher accuracy rates (0.946 ± 0.023) than PB AI-G (0.861 ± 0.078) in tissue-level analysis, when applied to the cohorts of 10 different institutes (3450 samples of 1772 patients in all institutes, 198-555 samples of 143-206 patients in each institute). MSP AI-G had high diagnostic accuracy and robustness in multi-institutions. When pathologists selectively review specimens in which pathologist's diagnosis and AI prediction are discordant, the requirement of a secondary review process is significantly less compared with reviewing all specimens by another pathologist.

Delayed bowel function (DBF) and postoperative ileus (POI) are common gastrointestinal complications after surgery. There is no reliable imaging study to help diagnose these complications, forcing clinicians to rely solely on patient history and physical exam. Gastric point of care ultrasound (POCUS) is a simple bedside imaging technique to evaluate gastric contents but has not been evaluated in postoperative patients.Twenty colorectal patients were enrolled in this pilot study. Patients were categorized as either full or empty stomach based upon their postoperative day one gastric POCUS exams and previously published definitions. The primary outcome was GI-3 recovery, a dual end point defined as tolerance of solid food and either flatus or bowel movement. Secondary outcomes were length of stay, emesis, time to first flatus, time to first bowel movement, nasogastric tube placement, aspiration events, and mortality.Nine of 20 patients had a full stomach postoperatively. Patients with full stomachs were younger and received greater perioperative opioid doses (74.0 ± 28.2 v 42.6 ± 32.9 morphine equivalents, P = 0.0363) compared to empty stomach patients. GI-3 recovery occurred significantly later for patients with postoperative day 1 full stomachs (2.1 ± 0.4 versus 1 ± 0 days, P = 0.00091).Based upon this pilot study, gastric POCUS may hold promise as a noninvasive and simple bedside modality to potentially help identify colorectal patients at risk for postoperative DBF and POI and should be evaluated in a larger study.

The pathogenesis of eosinophilic esophagitis involves immunoglobulin G4 (IgG4) deposition. However, the relationship between IgG4 and eosinophilic gastroenteritis (EGE) is unclear. To investigate gastrointestinal deposition of IgG4 in EGE. Biopsies of the esophagus, stomach, and small intestine were evaluated in patients with and without EGE. Immunohistochemical staining for IgG4 was performed, and the proportions of the stained areas were compared. Sera from patients with EGE were assayed for food-specific IgG4, including egg white, wheat, rice, soy, and cow milk. Seventeen patients were included in this study (EGE group, n = 10; control group, n = 7). Compared with the control group, the proportion of IgG4-stained area in the EGE group was approximately threefold higher (40.2% [32.3–49.5]) vs. 12.1% [4.0–21.9], p = 0.014) in the esophagus, fivefold higher in the stomach (17.3% [11.1–26.2] vs. 3.7% [1.5–5.2], p = 0.014), and sixfold higher in the small intestine (28.0% [15.0–33.2] vs. 4.5% [2.6–9.8], p = 0.019). There was no significant association between the proportion of IgG4-stained area and the number of infiltrating eosinophils. Serum egg white-specific IgG4 levels were correlated with the proportion of IgG4-stained areas in the small intestine (R = 0.7, p = 0.035). IgG4 accumulated within the gastrointestinal mucosa in EGE. The positive correlation between serum egg white-specific IgG4 levels and the proportion of IgG4-stained areas in the small intestine suggests a role for IgG4 in the disease pathophysiology.

The goal of this study was to use polymeric konjac glucomannan (KGM), Kollidon VA 64 (KVA64), and glutaraldehyde to ameliorate stomach specific floating microspheres (SSFM) using domperidone (DoN) to increase in vivo bioavailability and emerging health pathologies. The SSFM were made using the emulsion cross-linking process, and the polymer was chosen based on its ability to get cross-linked. The thermodynamic parameters were used to determine the AL classes of phase solubility curves using ideal complexes produced with KVA64. The optimal interaction constants at 25 and 37°C were found to be 116.14 and 128.05 M-1, respectively. The prepared SSFM had an average particle size (PS) of 163.71 ± 2.26 mm and a drug content of 96.66 ± 0.32 %. It can be determined from in vitro drug release experiments that drug release is good in terms of regulated drug release after 12 h ( 92.62 ± 2.43 %). The SSFMs were approximately sphere-shaped and had smooth surfaces, according to the morphological data. SSFMs were investigated using Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), and differential scanning calorimetry (DSC), and no chemical structural changes were identified. The SSFMs produces a considerable gastric residence time with optimal DoN release and absorption in stomach fluid, and the mean residence time ( 17.36 ± 1.4 h) and t 1 / 2 ( 10.47 ± 0.6 h) were considerably longer ( p < 0.05 ) than those obtained following i.v. treatment ( MRT = 8.42 ± 1.2 h; t 1 / 2 = 9.07 ± 0.7 h). The SSFMs maintained good physical stability for three months when stored at room temperature.

The current methods for treatment of giant gastric bezoars mainly include chemical dissolution, endoscopic fragmentation, and surgical removal, which often have limited curative effects or generate multiple adverse events. Therefore, there is an urgent need to find new methods to overcome such a dilemma. The aim of this study was to evaluate the safety, efficacy, and feasibility of a novel guidewire-based tangential sawing fragmentation (GTSF) technique to treat giant gastric bezoars.This retrospective single-center study was performed in the Department of Gastroenterology and Hepatology, Sichuan Academy of Medical SciencesSichuan Provincial People's Hospital. Ten patients with giant bezoars were consecutively enrolled from December 8, 2019 to April 8, 2021. We treated the 10 patients with the GTSF technique, recorded the GTSF procedure, and followed the patients with gastroscopy 2 weeks after the procedure.All patients were successfully treated by the GTSF technique, and the giant bezoar was broken into small pieces (2 cm in diameter). The average operation time was 21.73 minutes, and the average fragmentation time was 8.06 minutes. Ten patients treated with the GTSF technique attained satisfactory treatment results, with no acute adverse events or alimentary canal injury during the procedure, and no bezoar residue remained as shown by gastroscopy 2 weeks after the procedure.The GTSF technique is a safe, effective, and feasible method for removing giant bezoars and can be considered as an alternative treatment of this disease.

The consistency of the associations between gastric mucosal microbiome and gastric cancer across studies remained unexamined. We aimed to identify universal microbial signatures in gastric carcinogenesis through a meta-analysis of gastric microbiome from multiple studies. Compositional and ecological profiles of gastric microbes across stages of gastric carcinogenesis were significantly altered. Meta-analysis revealed that opportunistic pathobionts Fusobacterium, Parvimonas, Veillonella, Prevotella and Peptostreptococcus were enriched in GC, while commensals Bifidobacterium, Bacillus and Blautia were depleted in comparison to SG. The co-occurring correlation strengths of GC-enriched bacteria were increased along disease progression while those of GC-depleted bacteria were decreased. Eight bacterial taxa, including Veillonella, Dialister, Granulicatella, Herbaspirillum, Comamonas, Chryseobacterium, Shewanella and Helicobacter, were newly identified by this study as universal biomarkers for robustly discriminating GC from SG, with an area under the curve (AUC) of 0.85. Moreover, H. pylori-positive samples exhibited reduced microbial diversity, altered microbiota community and weaker interactions among gastric microbes. Our meta-analysis demonstrated comprehensive and generalizable gastric mucosa microbial features associated with histological stages of gastric carcinogenesis, including GC associated bacteria, diagnostic biomarkers, bacterial network alteration and H. pylori influence.

Ghrelin is a polypeptide hormone mainly synthesised from the stomach. Ghrelin also affects carbohydrate metabolism, the gastrointestinal system, the cardiovascular system and cell proliferation. Currently, increasing levels of obesity coupled with sedentary lifestyles have led to increased interest in the study of appetite-controlling factors and herbal agents. One of this plants used for phytotherapy is black cumin (Nigella sativa, N. sativa). Thymoquinone is the principal bioactive component of black cumin seed essential oil. The aim of the present study was to evaluate the possible effects of different doses and routes of administration of thymoquinone on ghrelin expression in the stomach. Thirty-five adult female Sprague Dawley rats were divided into five groups as first group (1 mg/kg thymoquinone, ip), second group (2 mg/kg thymoquinone, ip), third group (10 mg/kg thymoquinone, ip), fourth group (20 mg/kg thymoquinone, gavage), and control group (no treatment) and each group consisted of 7 rats. The histological structure was demonstrated with Crossman's trichrome staining. The presence of ghrelin in stomach sections was demonstrated by using the streptavidin-biotin-complex immunohistochemical method. According to our results, the immunohistochemical reaction in epithelial and glandular cells was weak in all experimental groups compared to the control group. Based on our immunohistochemical findings, it is concluded that thymoquinone treatment in both routes of administration decreases the expression of stomach ghrelin. The observation of immunoreactions of different severity in experimental groups indicate that thymoquinone did not inactivate ghrelin in the stomach, but ghrelin expression varied according to the route of administration and dose.

Previous studies have shown that pharmacological manipulations with stress-related hormones such as corticotropin-releasing factor and thyrotropin-releasing hormone induce neuroplasticity in brainstem vagal neurocircuits, which modulate gastric tone and motility. The prototypical antistress hormone oxytocin (OXT) has been shown to modulate gastric tone and motility via vagal pathways, and descending hypothalamic oxytocinergic inputs play a major role in the vagally dependent gastric-related adaptations to stress. The aim of this study was to investigate the possible cellular mechanisms through which OXT modulates central vagal brainstem and peripheral enteric neurocircuits of male Sprague-Dawley rats in response to chronic repetitive stress. After chronic (5 consecutive days) of homotypic or heterotypic stress load, the response to exogenous brainstem administration of OXT was examined using whole cell patch-clamp recordings from gastric-projecting vagal motoneurons and in vivo recordings of gastric tone and motility. GABAergic currents onto vagal motoneurons were decreased by OXT in stressed, but not in naïve rats. In naïve rats, microinjections of OXT in vagal brainstem nuclei-induced gastroinhibition via peripheral release of nitric oxide (NO). In stressed rats, however, the OXT-induced gastroinhibition was determined by the release of both NO and vasoactive intestinal peptide (VIP). Taken together, our data indicate that stress induces neuroplasticity in the response to OXT in the neurocircuits, which modulate gastric tone and motility. In particular, stress uncovers the OXT-mediated modulation of brainstem GABAergic currents and alters the peripheral gastric response to vagal stimulation. NEW & NOTEWORTHY The prototypical antistress hormone, oxytocin (OXT), modulates gastric tone and motility via vagal pathways, and descending hypothalamic-brainstem OXT neurocircuits play a major role in the vagally dependent adaptation of gastric motility and tone to stress. The current study suggests that in the neurocircuits, which modulate gastric tone and motility, stress induces neuroplasticity in the response to OXT and may reflect the dysregulation observed in stress-exacerbated functional motility disorders.

Equine squamous gastric disease (ESGD) is common in horses and poses a serious welfare problem. Several risk factors have been identified and ESGD is routinely treated with omeprazole. Fourteen mares, previously used as embryo recipients and diagnosed with ESGD, were selected. Horses were confined to individual stalls, exercised once daily, and fed ad libitum hay, 1 kg of a low starch compound complementary feed and a mineral supplement. Half of the horses received a compound containing hydrolysed collagen (supplement) and the other half did not (control). At the start of the study, ESGD scores were 3.57 and 3.36 for the supplement and control group, respectively. After 4 weeks, the ESGD grades were significantly reduced in both groups (1.89 and 1.43, respectively, p < 0.01), and healing (ESGD < 2) occurred in 7 out of 14 horses. No treatment effect was observed (p = 0.75), and it was concluded that the change in husbandry overshadowed any potential effect of the compound. Severe ESGD can improve, and even heal, with the provision of a diet of ad libitum forage and a small amount of a compound complementary feed, without the use of omeprazole. A predictable daily routine, with a limited number of dedicated caretakers, may have contributed to the improvement of gastric health.

Heterotopic gastric mucosa is rare in the paediatric population, but it can pose a diagnostic challenge. This pathology can occur in any part of the digestive tract, from the oropharynx to the anorectal area. Most cases are observed in the esophagus, duodenum and hepatobiliary system, but the presence of this tissue in the rectum is extremely rare. Purpose - conduct a clinical description of a rare pathology in children in order to pay the doctors` attention to the need for comprehensive diagnosis of patients with hematochezia. Clinical case. We present a clinical case of a child with heterotopia of the gastric mucosa into the rectum. Symptoms included hematochezia and anal pain during the act of defecation, general weakness, and decreased appetite. These manifestations were observed for two years with periods of exacerbations and remissions on the background of conservative treatment. The final diagnosis was made on the basis of a biopsy of nodular formations of the rectum, detected by colonoscopy. Conclusions. Given the negative impact of the disease manifestations on the patient's quality of life and the potential risk of malignant transformation, the possibility of heterotopic gastric mucosa in the rectum with indeterminate bleeding from the lower gastrointestinal tract should be considered and a complete examination, including biopsy, should be performed. Once the diagnosis is confirmed, radical surgical removal is recommended. Initial conservative treatment with proton pump inhibitors provides only short-term relief and is accompanied by periods of exacerbation and remission. The final treatment is always surgical or endoscopic excision of the heterotopic mucosa. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors., Гетеротопная слизистая оболочка желудка редко встречается в педиатрической популяции, однако может представлять диагностическую проблему. Эта патология может возникнуть в любом отделе пищеварительного тракта - от ротоглотки до аноректальной области. Большинство случаев наблюдаются в пищеводе, двенадцатиперстной кишке и гепатобилиарной системе, однако наличие этой ткани в прямой кишке является чрезвычайно редким явлением. Цель. Провести клиническое описание редкой патологии у детей, чтобы привлечь внимание врачей к необходимости проведения комплексной диагностики пациентов с гематохезией. Клинический случай. Представлен клинический случай ребенка с гетеротопией слизистой оболочки желудка в прямую кишку. Симптоматика включала гематохезию и анальную боль во время акта дефекации, общую слабость, снижение аппетита. Эти проявления наблюдались в течение двух лет с периодами обострений и ремиссий на фоне консервативного лечения. Окончательный диагноз установлен на основе биопсии нодулярных образований прямой кишки, выявленных по данным колоноскопии. Выводы. Учитывая негативное влияние проявлений этого заболевания на качество жизни пациента и потенциальный риск злокачественной трансформации, следует учитывать возможность наличия гетеротопической слизистой оболочки желудка в прямой кишке при неопределенном кровотечении из нижних отделов желудочно-кишечного тракта и проводить полное обследование, в том числе биопсию. После подтверждения диагноза рекомендуется радикальное хирургическое удаление. Начальное консервативное лечение ингибиторами протонной помпы приносит лишь непродолжительное облегчение и сопровождается периодами обострений и ремиссии. Окончательным лечением всегда является хирургическое или эндоскопическое иссечение гетеротопической слизистой оболочки. Исследование выполнено в соответствии с принципами Хельсинкской декларации. На проведение исследований получено информированное согласие родителей, ребенка. Авторы заявляют об отсутствии конфликта интересов., Гетеротопна слизова оболонка шлунка рідко зустрічається в педіатричній популяції, проте може становити діагностичну проблему. Ця патологія може виникнути в будь-якому відділі травного тракту - від ротоглотки до аноректальної ділянки. Більшість випадків спостерігаються в стравоході, дванадцятипалій кишці та гепатобіліарній системі, проте наявність цієї тканини в прямій кишці є надзвичайно рідкісним явищем. Мета - провести клінічний опис рідкісної патології у дітей, щоб привернути увагу лікарів до необхідності проведення комплексної діагностики пацієнтів з гематохезією. Клінічний випадок. Наведено клінічний випадок дитини з гетеротопією слизової оболонки шлунка в пряму кишку. Симптоматика включала гематохезію та анальний біль під час акту дефекації, загальну слабкість, зниження апетиту. Ці прояви спостерігалися протягом двох років із періодами загострень і ремісій на тлі консервативного лікування. Остаточний діагноз встановлено на основі біопсії нодулярних утворень прямої кишки, виявлених за даними колоноскопії. Висновки. Враховуючи негативний вплив проявів цього захворювання на якість життя пацієнта та потенційний ризик злоякісної трансформації, слід враховувати можливість наявності гетеротопічної слизової оболонки шлунка в прямій кишці за невизначеної кровотечі з нижніх відділів шлунково-кишкового тракту та проводити повне обстеження, у тому числі біопсію. Після підтвердження діагнозу рекомендується радикальне хірургічне видалення. Початкове консервативне лікування інгібіторами протонної помпи приносить лише нетривале полегшення та супроводжується періодами загострень і ремісії. Остаточним лікуванням завжди є хірургічне або ендоскопічне висічення гетеротопічної слизової оболонки. Дослідження виконано відповідно до принципів Гельсінської декларації. На проведення досліджень отримано інформовану згоду батьків, дитини. Автори заявляють про відсутність конфлікту інтересів.

Introduction: Gastrointestinal stromal tumours (GIST) are the commonest tumour of mesenchymal origin; favour the stomach, and account for a very small percentage of gastrointestinal tract tumours. Methods: In this retrospective audit of GISTs presenting to the Groote Schuur Hospital surgical and oncological multidisciplinary team (MDT) between 2004 – 2019, gastric GISTs were evaluated as regards presentation, gastric anatomical position, histological subtype with risk stratification, management and outcomes. Results: Of 126 GIST tumours presenting to this MDT, 82 originated in the stomach. Complete histopathological records could be obtained for 64. With an average of 59 years (50 male: 32 female), 18 (28%) presented with a herald bleed. Other common presentations included anaemia, epigastric mass and pain. The tumours were predominantly found in the body and fundus (64%), with a spindle cell subtype predominance (41%). The association between cancer cell subtype and gastric position was not significantly different (p=0.728). Cystic degeneration was found on 11 (17%) analyzed and cell necrosis on 12 (18%). These findings were not related to larger tumor size or prognosis. Five required downstaging with Imatinib prior to surgery. Thirty-seven patients underwent a surgical procedure: 24 wedge resections and 12 anatomical resections. Risk stratification was performed with the modified National Institutes of Health (NIH/Fletcher) score. Twenty-eight cases had inaccurate mitotic counts and couldn't be scored, 17 scored high risk, 9 intermediate risk, 9 low risk and 1 very low risk. Ten patients died of metastatic disease, 34 were discharged with no disease progression after 3 years, 1 patient with disease progression currently remains on Imatinib, and 19 were lost to follow up. Conclusion: Gastric GISTs appear to have a predilection for the proximal stomach; it is unsure whether this is purely due the greater surface area. The spindle cell subtype dominated in the proximal gastric GISTs. Cystic degeneration and cell necrosis did not seem to be related to larger tumours or outcomes.

The most prevalent condition affecting the stomach and duodenum is peptic ulcer disease (PUD), which is linked to Helicobacter pylori (H. pylori) infection. Esophageal, duodenal, and stomach ulcers are all parts of peptic ulcer disease (PUD). Epigastric discomfort is the PUD symptom that commonly occurs. Proton Pump Inhibitors (PPI), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), and antibiotics are widely used to treat PUD, which is caused by an imbalance between offensive and defensive forces. Abdominal discomfort, nausea, vomiting, weight loss, and bleeding or perforation with the complicated disease areonly a few of the symptoms of peptic ulcer disease. Understanding the methodology behind diagnosis and treatment options requires identifying the risk factors and mechanisms that result in PUD. The purpose of this review is to provide a concise summary of key ideas and recent findings in the field of peptic ulcer disease management, etiology, pathophysiology, and epidemiology.

Efficient nutritional assimilation and energy metabolism in the stomachs of yaks contribute to their adaption to harsh environments. Accurate gene expression profile analysis will help further reveal the molecular mechanism of nutrient and energy metabolism in the yak stomach. RT-qPCR is regarded as an accurate and dependable method for analyzing gene expression. The selection of reference genes is essential to obtain meaningful RT-qPCR results, especially in longitudinal gene expression studies of tissues and organs. Our objective was to select and validate optimal reference genes from across the transcriptome as internal controls for longitudinal gene expression studies in the yak stomach. In this study, 15 candidate reference genes (CRGs) were determined according to transcriptome sequencing (RNA-seq) results and the previous literature. The expression levels of these 15 CRGs were quantified using RT-qPCR in the yak stomach, including the rumen, reticulum, omasum and abomasum at five stages: 0 days, 20 days, 60 days, 15 months and three years old (adult). Subsequently, the expression stabilities of these 15 CRGs were evaluated via four algorithms: geNorm, NormFinder, BestKeeper and the comparative CT method. Furthermore, RefFinder was employed to obtain a comprehensive ranking of the stability of CRGs. The analysis results indicate that RPS15, MRPL39 and RPS23 are the most stable genes in the yak stomach throughout the growth cycle. In addition, to verify the reliability of the selected CRGs, the relative expression levels of HMGCS2 were quantified via RT-qPCR using the three most stable or the three least stable CRGs. Overall, we recommend combining RPS15, MRPL39 and RPS23 as reference genes for the normalization of RT-qPCR data in the yak stomach throughout the growth cycle.

The complement system has long been appreciated for its role in bloodborne infections, but its activities in other places, including the gastrointestinal tract, remain elusive. Here, we report that complement restricts gastric infection by the pathogen Helicobacter pylori. This bacterium colonized complement-deficient mice to higher levels than wild-type counterparts, particularly in the gastric corpus region. H. pylori uses uptake of the host molecule L-lactate to create a complement-resistant state that relies on blocking the deposition of the active complement C4b component on H. pylori’s surface. H. pylori mutants unable to achieve this complement-resistant state have a significant mouse colonization defect that is largely corrected by mutational removal of complement. This work highlights a previously unknown role for complement in the stomach, and has revealed an unrecognized mechanism for microbial-derived complement resistance.

Blood supply is especially weak near the gastric fundus. Making the anastomosis in this area would increase the risk of anastomotic leakage (AL). In cervical anastomosis, the gastric conduit needs to travel through the thorax. Therefore, the relative length between the stomach and the thorax is an essential factor in deciding if the poorly supplied area could be removed. This study was to explore if a small relative gastric length was a risk of cervical AL. If all other conditions are equal, could intrathoracic anastomosis be a better choice?Patients who underwent esophagectomy with a preoperative barium swallow in West China Hospital between 2014 and 2017 were included. The length of the greater curvature and the thorax were obtained from the barium esophagogram. The ratio between the length of the greater curvature and the thorax was the relative gastric length calculated from the greater curvature (RGL-G).A total of 782 patients were enrolled in the final analysis. The cervical AL group had a significantly higher ratio of patients with an RGL-G less than 1.3 (26.7% vs. 8.9%, p = 0.003). The multivariate logistic regression proved that RGL-G less than 1.3 was a risk factor for cervical anastomotic leakage (p = 0.012). Correspondingly, RGL-G less than 1.3 was not a risk factor (6.3% vs. 14.3%, p = 0.289) in the intrathoracic anastomosis group.RGL-G less than 1.3 was a new risk factor for cervical AL, but it would not be a problem for intrathoracic anastomosis.

Preoperative fasting is part of routine practice. Children subjected to prolonged preoperative fasting often suffer adverse effects. Consuming a preoperative lollipop may lessen their anxiety and have clinical benefits.To assess the effect of consuming a lollipop on gastric volume and the feasibility of administering a lollipop to a child preoperatively.In this prospective, repeated measures interventional study, we measured gastric antrum volume using ultrasound in children aged 2-18 years. We measured antrum volumes after participants had fasted for a minimum of 6 h for solids and 2 h for clear fluids. They then consumed a standard carbohydrate lollipop, and we repeated the antrum volume measurements after 1 h.Of the 38 patients enrolled, 32 completed the study; four had ingested additional food or liquid, and two were diagnosed with systemic disease the day after data collection. The gastric volume data were normally distributed. The mean volume change was 0.01 ml kgConsuming a standard lollipop did not affect the gastric volume of fasted pediatric patients.

This study was designed to provide more detailed knowledge on the stomach histochemistry and immunohistochemistry in the southern white-breasted hedgehog (Erinaceus concolor). Two animals were used in the present work. Periodic acid Schiff's (PAS) and Alcian blue were used for histochemical purposes. SOX9, gastrin, serotonin, and glucagon markers were traced immunohistochemically. The mucosa was extremely folded in the fundus with numerous opening of glands. The body and pylorus mucosa were almost smooth and equipped with gastric gland openings. A simple columnar epithelium covered the stomach entirely. Cardiac glands region was mucus secreting with both positive and negative reactions to PAS. Fundic mucosa was contained cardiac glands near to the cardia, and toward the body it was divided into the light and dark zones. These zones and body contained proper gastric gland, which constituted of parietal, chief, and mucous neck cells. These glands contained PAS-positive cells on their basal portions. The pyloric glands were mucus secreting but negative for PAS. All gastric glands were Alcian blue-negative, but epithelium showed moderate reaction especially in the pylorus. SOX and gastrin were express highly in the body and fundus. The expression of serotonin and glucagon was rare. Comparatively, some similarities between the stomach of hedgehog and dog can be assumed. The present findings provide additional information concerning the histochemical characteristics and endocrine cells distribution in the stomach of the southern white-breasted hedgehog (Erinaceus concolor). Further detailed studies are required to enhance the current knowledge on histophysiology of the digestive system in this species as a pet and exotic animal. HIGHLIGHTS: The stomach was simple glandular type. The fundus was divided into light and dark zones similar to the dog. The proper gastric glands were periodic acid Schiff's positive at their basal parts.

Migration of the staple line is the definition of sliding hiatus hernia in sleeve gastrectomy patients. The main aim was to determine the frequency and measurement of intrathoracic staple line migration and its correlation with GERD symptoms and pH monitoring.This was a prospective clinical trial including all patients who underwent sleeve gastrectomy more than 1 year previously. All the patients underwent computed tomography (CT) imaging, and migration of the proximal end of the suture above the level of the hiatus was measured in mm. All the patients with symptoms suggestive of GERD were assessed using the GERD impact scale (GIS), and wireless 24-h esophageal pH and symptom association monitoring (SAP) were carried out. Analysis of risk factors for postoperative staple line migration was performed.Between March 2018 and December 2018, 194 patients were evaluated (mean age 45.1 ± 11.2 years; 161 females); 88/194 (45.4%) presented an average intrathoracic migration of 16.2 ± 6.9 mm. Thirty-eight of 194 (19.5%) patients presented symptoms suggestive of gastroesophageal reflux. There was a significant relationship between staple line intrathoracic migration and postsleeve GERD symptomatology (p = 0.0004, OR = 4.25 [1.92-9.39]). However, there was no significant correlation between positive 24-h pH monitoring and intrathoracic migration of the staple line (p = 0.1).A migration greater than 17 mm was strongly correlated with postsleeve GERD symptoms but not with positive 24-h pH monitoring.

Background Delayed gastric emptying (DGE) represents the most frequent complication after pancreaticoduodenectomy (PD). Aim of this study was to evaluate the impact of gastrojejunostomy (GJ)orientation on DGE incidence after PD. Methods One-hundred and twenty-one consecutive PDs were included in the analysis and divided in the horizontal (H-GJ group) and vertical GJ anastomosis groups (V-GJ group). Postoperative data and the value of the flow angle between the efferent jejunal limb and the stomach of the GJ anastomosis at the upper gastrointestinal series were registered. Results Seventy-five patients (62%)underwent H-GJ, while 46 patients (38%)underwent V-GJ. The incidence of DGE was significantly lower in the V-GJ group as compared to the H-GJ group (23.9%vs45.3%; p = 0.02). V-GJ was also associated to a less severe DGE manifestation (p = 0.006). The flow angle was significantly lower in case of V-GJ as compared to H-GJ (24.5°vs37°; p = 0.002). At the multivariate analysis, ASA score≥3 (p = 0.02), H-GJ (p = 0.03), flow angle>30°(p = 0.004) and Clavien-Dindo≥3 (p = 0.03) were recognized as independent prognostic factors for DGE. These same factors were independent prognostic features also for a more severe DGE manifestation. Conclusion VGJ and the more acute flow angle appear to be associated to a lower incidence rate and severity of DGE. This modified technique should be considered by surgeons in order to reduce postoperative DGE occurrence.

Gastrostomy tubes (G-tubes) provide long-term feeding assistance to children with severe feeding dysfunction. Although there are a host of complications that occur at home with current pediatric G-tube feeding, their prevalences and outcomes remain relatively unstudied. This study aims to identify and describe such complications.A dual-round survey was administered to 98 participants through the Feeding Tube Awareness Foundation, a 501(c)(3) organization that supports parents and caretakers of G-tube-fed children. Information was collected broadly regarding G-tube complications, causes, and attitudes toward such complications.Infection (56%), itching/irritation/redness (52%), and leakage (51%) were the leading G-tube related complications. The average time that G-tubes were replaced was 3.4 ± 1.2 months as compared to the typical recommended period of up to 6 months. Of the caretakers who had not experienced G-tube displacement, 7.9% wanted to see a change in current G-tubes to address the issue, compared with 75% of those who had experienced displacement. This 67.1% differential in caretakers' attitudes toward G-tubes based on their prior experience with a particular complication was the largest gap among all other listed complications.G-tube complications are prevalent and varied. A sizable portion of G-tube users experience complications severe enough to require intervention. Of these, G-tube displacement is particularly critical and frequently precedes other prevalent complications, namely gastric leakage, infection, and tissue granulation.

The aim of the present study was to analyse clinical data of children referred for disc battery ingestion in order to assess short- and long-term reported injuries and to identify outcome predictors and trends, define the urgency of intervention and refine treatment guidelines.The records of all children admitted to Santobono-Pausilipon Children's Hospital, Naples, Italy for disc battery ingestion from January 2016 to December 2020 were retrospectively reviewed. Odds ratio were computed to assess the association between the different study variables and the rate of complications.We enrolled 118 children. Mild to major complications related to the ingested disc batteries were reported in 12/118 (10.2%) patients. Disc battery oesophageal retention, disc battery diameter20 mm, together with age below 1 year and symptomatic presentation were the most important factors associated with poor clinical outcome.Our data confirm that ingested disc batteries are a serious health hazard and require a timely and qualified medical evaluation. We have identified three predictors of outcome severity: oesophageal retention, large-diameter cells and symptom onset. Disc batteries lodged beyond the oesophagus appear substantially harmless and we may support a more conservative approach.

Objective. To explore the effect of Shugan Jianpi recipe combined with cross moxibustion on biochemical examination indexes and total score of TCM symptoms in patients with spleen-stomach damp-heat diarrhea irritable bowel syndrome (IBS). Methods. Sixty patients with spleen-stomach damp-heat diarrhea (IBS) treated in our hospital from January 2019 to September 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group was treated with Chang Shugan Jianpi recipe, and the study group was treated with Shugan Jianpi recipe combined with cross moxibustion. The curative effect, single symptom score, total score of TCM clinical symptoms, plasma gastrointestinal hormone level, IBS-QOL score, and recurrence were compared. Results. First of all, we compared the curative effects. The study group was significantly effective in 24 cases, effective in 5 cases, and ineffective in 1 case, and the effective rate was 96.67%. In the control group, 13 cases were markedly effective, 10 cases were effective, and 7 cases were ineffective, and the effective rate was 76.67%. The effective rate of the study group was higher compared to the control group ( P < 0.05 ). Secondly, the individual symptom scores were compared. Compared between the two groups, the scores of diarrhea times, stool characteristics, abdominal pain, and abdominal distension in the study group were lower compared to the control group ( P < 0.05 ). After treatment, the total score of TCM clinical symptoms decreased. Compared between the two groups, the total score of TCM clinical symptoms in the study group was lower compared to the control group at 1 week, 2 weeks, and 4 weeks after treatment ( P < 0.05 ). After treatment, the levels of 5-HT and VIP decreased. The levels of 5-HT and VIP in the study group were lower compared to the control group ( P < 0.05 ). The scores of anxieties, health worry, behavioral disorder, social reaction, somatic intention, interpersonal relationship, dietary concern, and sexual behavior in the study group were lower compared to the control group. The IBS-QOL scores were significantly lower compared to the control group ( P < 0.05 ). Finally, we compared the recurrence. The recurrence rate in the study group was lower compared to the control group ( P < 0.05 ). Conclusion. The prescription combined with cross moxibustion has the effect of soothing the liver and invigorating the spleen, resolving dampness and stomach, and can reduce the main clinical symptoms of patients with diarrhea IBS of spleen-stomach damp-heat type, and the overall effect is significant. It can also enhance the emotional state of anxiety and depression and achieve the overall psychological and physical balance and health state, and the recurrence rate is low, which can be further applied in clinic.

The aim of this study was to evaluate the safety of drinking carbohydrate-containing fluids two hours prior to surgery in older adults using ultrasonography.We conducted a nonrandomized and noninferiority comparative study in 60 patients aged over 65 yr who were scheduled for total knee arthroplasty. Patients who were fasted from midnight (fasting group) or who drank 400 mL of a carbohydrate-containing fluid (carbohydrate ingestion group) two hours prior to surgery were matched for age, sex, and body mass index. We measured the cross-sectional area (CSA) of gastric antrum using ultrasound and estimated the gastric fluid volume as the study's primary outcome measure. The noninferiority margin (δ) for the mean difference was predefined as 50 mL. The secondary outcome measures included CSA of the antrum and qualitative gastric volume.The mean (standard deviation) gastric volume was not significantly different between the fasting group and the carbohydrate ingestion group (30.2 [25.4] mL vs 28.4 [35.8] mL; each group, n = 30; P = 0.81). The mean difference in gastric volume was -1.9 mL (95% confidence interval [CI], -17.9 to 14.2), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit (δ = 50 mL). Secondary outcomes were not significantly different between the two groups.Drinking of carbohydrate-containing fluid two hours prior to surgery was noninferior to overnight fasting with respect to residual gastric volume at induction of anesthesia in healthy older adults who undergoing total knee arthroplasty.ClinicalTrials.gov (NCT04514380); registered 14 August 2020.RéSUMé: OBJECTIF: L’objectif de cette étude était d’évaluer l’innocuité de la consommation d’une préparation glucidique deux heures avant une chirurgie chez les personnes âgées à l’aide de l’échographie. MéTHODE: Nous avons mené une étude comparative non randomisée et de non-infériorité chez 60 patients âgés de plus de 65 ans qui devaient bénéficier d’une arthroplastie totale du genou. Les patients étaient à jeun depuis minuit (groupe à jeun) ou avaient bu 400 mL d’une préparation glucidique (groupe d’ingestion de glucides) deux heures avant la chirurgie et ont été appariés pour l’âge, le sexe et l’indice de masse corporelle. Nous avons mesuré la section transversale de l’antre gastrique à l’aide de l’échographie et estimé le volume de liquide gastrique en tant que mesure du critère d’évaluation principal de l’étude. La marge de non-infériorité (δ) pour la différence moyenne a été prédéfinie à 50 mL. Les mesures de critères d’évaluation secondaires comprenaient la section transversale de l’antre et le volume gastrique qualitatif. RéSULTATS: Le volume gastrique moyen (écart type) n’était pas significativement différent entre le groupe à jeun et le groupe d’ingestion de glucides (30,2 [25,4] mL vs 28,4 [35,8] mL; chaque groupe, n = 30; P = 0,81). La différence moyenne de volume gastrique était de -1,9 mL (intervalle de confiance [IC] à 95 %, -17,9 à 14,2), et la limite supérieure de l’IC 95 % était inférieure à la limite de non-infériorité prédéfinie (δ = 50 mL). Aucune différence intergroupe significative n’a été observée dans les critères d’évaluation secondaires. CONCLUSION: La consommation d'une préparation glucidique deux heures avant la chirurgie n'était pas inférieure au jeûne nocturne en ce qui concerne le volume gastrique résiduel à l'induction de l'anesthésie chez les personnes âgées en bonne santé qui bénéficient d'une arthroplastie totale du genou. ENREGISTREMENT DE L'éTUDE: www.ClinicalTrials.gov (NCT04514380); enregistrée le 14 août 2020.

To evaluate the technical feasibility of percutaneous radiologic gastrostomy in patients after partial gastrectomy.This retrospective study included 15 consecutive gastrectomized patients with attempted percutaneous radiologic gastrostomy at our institution between April 2014 and March 2021. When the stomach was sufficiently insufflated to distend below the left anterior subcostal margin, percutaneous radiologic gastrostomy with gastropexy was conventionally performed by the Seldinger technique. When the stomach was still highly positioned and/or overlaid by the other organs, some adjunctive maneuvers, such as hydro-displacement, intragastric balloon support, or cephalad oblique puncture or left intercostal puncture, were employed as modified gastrostomy. Ultrasonography or x-ray or computed tomography fluoroscopy was used for imaging guidance during the gastric puncture. Adequate tube placement was defined as technical success. Technical details, clinical outcomes, and complications were reviewed.One patient underwent percutaneous radiologic jejunostomy instead of gastrostomy because safe gastric access could not be ensured. Seven patients underwent conventional gastrostomy; the other seven underwent modified gastrostomy with no gastropexy. The technical success rate was 100% (7/7) in the conventional group and 85.7% (6/7) in the modified group. The stomach was punctured under x-ray or computed tomography fluoroscopy for conventional gastrostomy. In contrast, the combination of various modalities was used for modified gastrostomy except for one failed case with unintentional transhepatic access. During a median follow-up of 108 days, no major complications occurred.The adequate combination of multimodal imaging guidance and technical modifications could secure radiological creation of gastrostomy for the postsurgical stomach.Level 4, Case Series.

This study examined the rate and course of gastric evacuation (GE) in rainbow trout Oncorhynchus mykiss in relation to meal size, body size and temperature. The GE experiments were performed on small (mean ± 95% C.I., 17.7 ± 0.5 cm total length), medium (22. 9 ± 0.2 cm) and large (28.3 ± 0.3 cm) rainbow trout fed meals of different sizes using commercial food pellets at water temperatures T ranging from 7.8°C to 19.2°C. Estimating the shape parameter of a general power function suggested that the square root function adequately described the GE in rainbow trout independently of meal size. The effects of total body length L and weight W on gastric evacuation rate (GER) were described by simple power functions. The square root function was further expanded by a temperature function with temperature optimum to describe the effect of temperature. The expanded square root function revealed a considerable effect of body size and temperature on the GER of rainbow trout. The GER increased exponentially with rising temperature, reached an optimum at c. 18.5°C and then declined abruptly to zero at c. 21°C. The GER of rainbow trout could thus be described by

Esophagectomy for achalasia is reserved for patients with end-stage disease for whom prior treatment has failed. Esophagectomy can be performed safely through a variety of techniques. Conduit options include stomach, colon, and small intestine. There are many potential complications following esophagectomy. Outcomes of esophagectomy for achalasia are good when performed in experienced surgical centers.

Human gastric development has not been well studied. The generation of human pluripotent stem cell-derived gastric organoids (hGOs) comprising gastric marker-expressing epithelium without an apparent smooth muscle (SM) structure has been reported. We modified previously reported protocols to generate hGOs with muscularis mucosa (MM) from hiPSCs. Time course analyses revealed that epithelium development occurred prior to MM formation. Sonic hedgehog (SHH) and TGF-fl1 were secreted by the epithelium. HH and TGF-fl signal inhibition prevented subepithelial MM formation. A mechanical property of the substrate promoted SM differentiation around hGOs in the presence of TGF-fl. TGF-fl signaling was shown to influence the HH signaling and mechanical properties. In addition, clinical specimen findings suggested the involvement of TGF-fl signaling in MM formation in recovering gastric ulcers. HH and TGF-fl signaling from the epithelium to the stroma and the mechanical properties of the subepithelial environment may influence the emergence of MM in human stomach tissue.

Background : Redo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. The aim of this study was to assess short- and long-term outcomes after RF in childhood. Methods : The study is a follow-up study of patients undergoing RF from 2002-2020 at a teriary care center. Patients/parents were sent questionnaires recording symptoms of recurrent GERD, troublesome side-effects and satisfaction. Retrospective chart review was also performed. Results : 24/28 (86%) patients were included median 9 (1.6 months-17.7 years) years after RF. 16 (67%) had neurologic impairment. Indications for RF was recurrence of GERD (n=18), discomfort or dysphagia from a herniated wrap (n=5) and dysphagia from a slipped fundoplication (n=1). Median operating time was 128 (95-250) minutes. Six (25 %) patients experienced early major complications, of which two were gastrostomy related. Five (21%) patients experienced recurrence after RF. Three of these were symptom free at follow-up with medical treatment or re-RF. The most common symptom at follow-up was stomach pain (37%) and excessive flatulence (38%). 18/22 (95%) patients/parents would choose RF again, and 21/22 would recommend RF to someone in a similar situation. Conclusions : RF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high.