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Helicobacter pylori (H. pylori) remains the most-researched etiological factor for gastric inflammation and malignancies. Its evolution towards gastric complications is dependent upon host immune response. Toll-like receptors (TLRs) recognize surface and molecular patterns of the bacterium, especially the lipopolysaccharide (LPS), and act upon pathways, which will finally lead to activation of the nuclear factor-kappa B (NF-kB), a transcription factor that stimulates release of inflammatory cytokines. MicroRNAs (MiRNAs) finely modulate TLR signaling, but their expression is also modulated by activation of NF-kB-dependent pathways. This review aims to focus upon several of the most researched miRNAs on this subject, with known implications in host immune responses caused by H. pylori , including let-7 family, miRNA-155, miRNA-146, miRNA-125, miRNA-21, and miRNA-221. TLR-LPS interactions and their afferent pathways are regulated by these miRNAs, which can be considered as a bridge, which connects gastric inflammation to pre-neoplastic and malignant lesions. Therefore, they could serve as potential non-invasive biomarkers, capable of discriminating H. pylori infection, as well as its associated complications. Given that data on this matter is limited in children, as well as for as significant number of miRNAs, future research has yet to clarify the exact involvement of these entities in the progression of H. pylori -associated gastric conditions.

Non-invasive biomarkers, such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, may predict inflammation in various disorders, including gastritis, according to recent data. Nevertheless, various studies reported an association between Helicobacter pylori (H pylori) and immune thrombocytopenia in both adults and pediatric patients. The objective of our study was to evaluate the impact of pediatric gastritis, caused or not by H pylori infection on erythrocytes, their parameters, thrombocytes, mean platelet volume, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).We performed a prospective, case-control study on 151 patients aged between 1 and 17 years who presented with chronic dyspeptic symptoms. An upper digestive endoscopy with gastric biopsies and a complete blood count was performed in each case.Control group consisted of 67 patients with normal histological findings, while the two study groups were divided into group 1-H pylori-induced gastritis (31 patients) and group 2-non-H pylori-induced gastritis (53 patients). Children from the rural area were more likely to develop both types of gastritis (P < .01). No significant difference was found between either of the study groups and control group in terms of platelets, mean platelet volume, NLR and PLR (P > .05). However, significantly higher values of lymphocytes were associated with non-H pylori-induced gastritis (P < .01). Comparison of the two study groups did not reflect any significant differences in terms of hematological parameters. When assessing these constants in relation to gastritis severity, severe gastritis led to a compelling decrease in hemoglobin (Hb) and hematocrit (Htc) levels. The comparison of parameters between severe, moderate, and mild gastritis did not reveal any significant results.Childhood and adolescent gastritis does not produce a significant effect upon platelet counts, their mean volume, PLR or NLR, according to our study. An important increase in lymphocyte count might predict non-H pylori pediatric gastritis. Moreover, severe gastritis might result in an important decrease in Hb and Htc levels.

Primary duodenal cancer is a rare entity accounting for only 0.3% of all gastrointestinal cancers. Histopathologically, most duodenal cancers are mucin-producing adenocarcinomas, 34% being poorly differentiated. Signet-ring cell (SRC) carcinoma is extremely uncommon in the duodenum. Herein, we report a rare case of SRC carcinoma associated with poorly differentiated adenocarcinoma of the non-ampullary duodenum in a 74-year-old woman. The patient was admitted to the hospital for persistent epigastric pain, significant weight loss and hypochromic microcytic anemia. Esophago-gastro-duodenoscopy revealed a protruded lesion, with ulceration in the second portion of the duodenum, above the papilla. The patient was referred to surgery and pancreatico-duodenectomy with lymph node dissection was performed. The tumor consisted predominately of SRCs, Periodic Acid Schiff (PAS)-Alcian blue positive. The tumor cells were CDX2, cytokeratin (CK) 7 and CK 18/8 positive, which suggested a primary upper gastrointestinal tract site of origin. Immunostaining for mucin (MUC) 2 and MUC5AC was also positive demonstrating the duodenal goblet cells differentiation with a mixed gastric-foveolar and intestinal phenotype. Based on the morphological features and the immunohistochemical profile, a diagnosis of SRC carcinoma associated with poorly differentiated adenocarcinoma of the non-ampullary duodenum was set.

Background and Aims: The pathogenesis of gastric cancer involves premalignant changes of the gastric mucosa. An accurate estimation of the topography and severity of these lesions represents an important step in detecting premalignant lesions, thereby classifying patients into low or high risk of developing gastric cancer. We prospectively analyzed the diagnostic performance of narrow-band imaging with magnification endoscopy (NBI-ME) for assessing premalignant gastric lesions during real-time examination., Patients, Materials and Methods: A total number of 59 patients were examined by NBI-ME and target biopsies of the antrum, corporeal, and incisura angularis levels. Modified endoscopic patterns were classified into three groups: type A [tubulo-villous mucosal pattern with regular microvessels, or the light blue crest (LBC) sign], type B [disappearance of normal subepithelial capillary network (SECN) pattern], and type C [irregular mucosal pattern (IMP) and∕or irregular vascular pattern (IVP)]. The endoscopic diagnosis was compared to histological findings (the gold standard). The NBI-ME results were assessed for accuracy, sensitivity, specificity, and negative and positive predictive values in detecting intestinal metaplasia, atrophic gastritis and dysplasia., Results: Analysis of endoscopic patterns showed a good correlation with premalignant lesions (p<0.05). Type A pattern showed 80.2% accuracy, 80.43% sensitivity and 80% specificity [area under receiver operating characteristic (AUROC) of 0.8] in detecting intestinal metaplasia. Diagnostic performance for assessment of atrophic gastritis was not ideal (69.5% accuracy, 83.72% sensitivity, 56.04% specificity, AUROC 0.69). Pattern C represents a reliable endoscopic marker for the diagnosis of dysplasia (91.1% accuracy, 83.3% sensitivity, 91.81% specificity, AUROC 0.87). The extension of precancerous lesions was estimated during endoscopic examination., Conclusions: NBI-ME represents a valuable tool in the assessment of premalignant gastric lesions, thereby categorizing patients into low and high risks of developing gastric cancer. The applicability of the method in routine practice is promising, as it helps shape the follow up protocol of patients with premalignant lesions of the stomach. It is worth mentioning that, this method requires standardization, additional training, and expertise.

Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare submucosal, mesenchymal tumor of the digestive tract, of unknown etiology. We present an unusual case of a 62-year-old female patient, investigated for intermittent nausea, vomiting, abdominal pain and anemia. Narrow-band imaging (NBI) endoscopy showed a polypoid tumor with normal coverage mucosa prolapsing through the pylorus. The tumor was surgically removed. Histopathological (HP) examination revealed the presence of spindle cells with uniform nuclei exhibiting no mitotic activity. The inflammatory cells were predominantly represented by eosinophils. The vascular component was prominent suggesting a vascular lesion. We put emphasis on the presentation of this particular case because of its scarcity among the other types of gastric polyps, suspicion for features of malignancy, and the particularities of the clinical presentation, consisting of intermittent gastric outlet obstruction ("ball valve syndrome") accompanied by weight loss and anemia. The differential diagnosis of other benign or malignant gastric lesions was based on endoscopic, computed tomography and HP aspects.