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Transabdominal ultrasound is a valuable diagnostic approach for evaluating the gastrointestinal tract and related disorders. This dynamic examination provides real-time visualization of the digestive tube and surrounding structures, assessment of peristaltic movements, estimation of compressibility of intestinal loops, and recognition of painful spots requiring specific attention. Since ultrasound imaging is non-invasive, painless, reproducible, inexpensive and requires no special preparation, it is used as a major diagnostic tool in emergency settings and in outpatient follow-up of several disorders. Costs, encompassing both accessibility and actual procedural expenses, are lower than those associated with other diagnostic techniques. However, the incorporation of gastro-intestinal ultrasound (GIUS) in clinical practice has not been widely used on a global scale. The purpose of this paper is to provide an overview of the execution techniques as well as the main areas of application for GIUS. Through illustrative iconographic representation, emphasis was placed on its potential within the diagnostic and therapeutic pathway of various acute and chronic gastrointestinal disorders.

Massive digestive disorders of neonatal calves, clinically manifested as diarrhea causing severe dehydration, toxemia, immunodeficiency and metabolic disorders, induce huge economic losses in animal husbandry. Etiopathogenetic lesions of the digestive organs are characterized by significant polymorphism, including a wide range of various (physiological, sanitary and infectious) factors. Massive gastroenteritises in neonatal calves are primarily caused by such infectious agents as viruses, bacteria and protozoa. Massive diarrheas are registered in 70–80% of newborn calves by the end of the first day of life. Diseased newborn calves die on day 5–10 and mortality ranges from 15 to 55%. Rotavirus, coronavirus, pestivirus, parvovirus, enterovirus and kobuvirus, along with bacteria, are most frequently detected in faecal samples collected from neonatal calves with diarrhea. Diagnostic and vaccine products for prevention of these infections have been developed in the Russian Federation. At the end of the 20th – the beginning of the 21st century a large number of cattle were imported to Russia from the countries affected with different contagious diseases (USA, Denmark, France, Slovakia, Austria, Hungary, Germany, the Netherlands, Australia, Finland, etc.). Despite the high activity and field effectiveness of vaccines against rotavirus and coronavirus infections and viral diarrhea, massive neonatal calf diarrheas causing significant economic losses were registered in a number of large-scale livestock farms. Torovirus as well as the above-mentioned pathogens were detected in fecal samples from diseased calves. This report provides data on torovirus infection indicating a wide geographical distribution of animal torovirus in many countries of the world. All this suggests the need to take into account torovirus infection when conducting epizootological investigations in farms affected with massive gastrointestinal diseases of neonatal calves.

Background: Frozen Sections (FS) are used to assess margins, for staging, and primary diagnosis. FS guide intraoperative treatment decisions in oncological gastro-intestinal tract surgeries and further management of the patients. Aim: To analyze the distribution, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of frozen sections in gastrointestinal pathology in our institution during the period of 3 years (2016–2018). Material and Methods: This study was an audit to determine the accuracy of FS reports by comparing them with the paraffin section (PS) reports. The FS diagnoses and their PS diagnoses were noted in 1704 gastrointestinal surgeries during the period from 2016 to 2018. Discrepancies were noted and slides of discrepant cases were reviewed to determine the cause. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated using the standard formulae. Results: Out of 1704 cases, correct diagnosis on frozen section was made in 1649 cases (96.77%), 20 (1.17%) were deferred cases, and 35 (2.05%) were discrepant cases. The commonest discrepancies were seen in the primary diagnosis of the gall bladder and gastrectomy margins. The commonest causes for discrepancies were interpretation errors and technical errors. Sensitivity was 91.71%, specificity was 99.69%, positive predictive value was 98.84%, negative predictive value was 97.68%, and accuracy was 97.92%. Conclusion: FS diagnosis is a reliable guide to surgeons for intraoperative management. Studying deep cuts and careful sampling at frozen sections will help reduce discrepancies.

To advance the diagnostic accuracy of juvenile polyposis syndrome, an important yet often difficult diagnosis, we describe in detail a new and medically significant presentation. This hereditary and high-risk GI cancer syndrome is often associated with hereditary hemorrhagic telangiectasia, as in this 47-year-old female patient with a SMAD4 germline pathogenic mutation. Total gastrectomy revealed giant gastric folds with inflamed foveolar hyperplasia consuming most of the gastric cardia and body but sparing the antrum. Together, this gross and histologic pathology mimics Ménétrier’s disease, an exceedingly rare and acquired protein-losing hypertrophic gastropathy. Classical gastric juvenile polyposis almost always and principally involves the antrum with multiple distinctive inflammatory polyps rather than the newly illustrated giant gastric folds of this case. No reports of giant gastric folds in juvenile polyposis have appeared in the literature. The distinction between juvenile polyposis and Ménétrier’s disease is essential due to their disparate clinical outcomes and management. The differential considerations for giant gastric folds and inflamed gastric foveolar hyperplasia are fully reviewed. On the basis of this report, the differential for giant gastric folds must now expand to include juvenile polyposis syndrome. Genetic testing for pathogenic germline mutations of the 2 known causative genes of this syndrome, namely SMAD4 and BMPR1A, are readily available and should become part of the evaluation of giant gastric folds, particularly in view of the neoplastic and hereditary aspects of juvenile polyposis syndrome.

Alveolar rhabdomyosarcoma (ARMS) is a malignant tumor with skeletal muscle differentiation that usually occurs in soft tissues of the extremities or trunk. To date, only a few cases of primary gastric ARMS have been reported. Herein, we describe a case of ARMS in a man in his 80s and present a literature review. A submucosal tumor-like lesion was detected endoscopically. Histologically, the tumor cells exhibited a poorly differentiated morphology with hyperchromatic nuclei. Neuroendocrine markers, such as synaptophysin and CD56, were positive, and neuroendocrine carcinoma (NEC) was considered a differential diagnosis. However, both myogenic markers and OLIG2, which reflect FAX3 or FAX7 fusion, were positive, leading to a diagnosis of ARMS. Primary gastric ARMS is an extremely rare condition. Better awareness of this entity and its similarity to NEC is necessary for appropriate diagnosis and treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Okuno et al.)

ABSTRACT BACKGROUND: Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis. OBJECTIVE: Evaluate the correlation of anatomopathological findings on ileitis between pathologists and endoscopists. METHODS: A retrospective, cross-sectional study, between 2013 and 2017. Examination report, indications for colonoscopy, and medical records were evaluated to identify whether the colonoscopic findings were clinically significant. Anatomopathological samples were reviewed by a pathologist expert in gastrointestinal tract. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age and those with previous intestinal resections were excluded. The correlation was assessed using the kappa coefficient index. RESULTS: A total of 5833 colonoscopies were conducted in the study period and 3880 cases were included. Ileal alterations were observed in 206 cases, with 2.94% being clinically significant. A hundred and sixty three biopsies were evaluated using the kappa index, resulting in agreement among pathologists of 0.067 and among pathologist and endoscopist of 0.141. CONCLUSION: It was observed that despite the low concordance between pathologists and endoscopists, there was no change in patient outcomes. This study confirms the importance of knowledge of the main anatomopathological changes related to ileitis by pathologists and endoscopists, making the best diagnosis and follow-up.

Introduction. Sarcina organisms are rare, gram-positive, sugar-fermenting cocci, identifiable in tissues only by histologic examination or molecular testing. Since its discovery, the pathogenicity and relevance of Sarcina in the human gastrointestinal tract has remained ill-defined. A recent literature review of 66 reported examples demonstrated the potential for severe complications such as emphysematous gastritis and gastric perforation. In pediatrics, colonization is associated with mucosal alterations and/or gastrointestinal dysmotility/obstruction with variable outcomes, including death secondary to gastric perforation. Yet, the features of Sarcina colonization within the gastrointestinal tract of adolescents are poorly understood and rarely reported. Methods. We present the gastrointestinal histopathological findings and the complete history of 4 pediatric patients with Sarcina colonization at our institution. Additionally a literature review with focus in the keywords “Sarcina” and “gastrointestinal’ was performed, and the clinical and histopathological features of all previously reported examples of Sarcina in the gastrointestinal tract of pediatric patients were summarized. Results. All 4 patients had delayed gastric emptying, 3 of them due to neurologic disease, and one with pyloric obstruction due to duodenal ulceration with Helicobacter gastritis. In the 3 patients with available esophageal biopsies, it was associated to esophagitis with increased intraepithelial eosinophils. Conclusion. The potential pathogenicity of Sarcina colonization in the gastrointestinal tract of pediatric patients needs to be reevaluated. Due to potential serious complications, the identification of these organisms in the gastrointestinal tract sample should be reported and warrants further evaluation for possible gastrointestinal dysmotility or other mucosal alterations. [ABSTRACT FROM AUTHOR]

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Alpha synuclein has a key role in the pathogenesis of Parkinson's disease (PD), Dementia with Lewy Bodies (LBD) and Multiple System Atrophy (MSA). Immunotherapies aiming at neutralising toxic αSyn species are being investigated in the clinic as potential disease modifying therapies for PD and other synucleinopathies. In this study, the effects of active immunisation against αSyn with the UB-312 vaccine were investigated in the Thy1SNCA/15 mouse model of PD. Young transgenic and wild-type mice received an immunisation regimen over a period of 6 weeks, then observed for an additional 9 weeks. Behavioural assessment was conducted before immunisation and at 15 weeks after the first dose. UB-312 immunisation prevented the development of motor impairment in the wire test and challenging beam test, which was associated with reduced levels of αSyn oligomers in the cerebral cortex, hippocampus and striatum of Thy1SNCA/15 mice. UB-312 immunotherapy resulted in a significant reduction of theαSyn load in the colon, accompanied by a reduction in enteric glial cell reactivity in the colonic ganglia. Our results demonstrate that immunisation with UB-312 prevents functional deficits and both central and peripheral pathology in Thy1SNCA/15 mice. [ABSTRACT FROM AUTHOR]

A vast amount of works is devoted to studying the heart rate variability (HRV). The article covers a literature review on modern concepts about heart rate variability as a method for estimation of mechanisms of physiological functions regulation in a human body, standard methods of the analysis and opportunities of clinical application. The heart rhythm is the indicator of the deviations arising in vegetative nervous system, and change of heart rhythm — the earliest prognostic sign of many diseases. In clinical practice, the analysis of HRV finds wider application in basic diseases in gastroenterological practice (gastroesophageal reflux disease, peptic ulcer, irritable bowel syndrome), interaction of compartments of the vegetative nervous system in various gastroenterological pathologies. Patients with different pathologies of digestive system are examined using the up-to-date Precise-diagnostics to determine adaptive and vegetative disorders in State Institution “Institute of Gastroenterology of Medical Sciences of Ukraine”. Precise-diagnostics defines stress level and possible risk to predict complications in patients with gastrointestinal diseases. The treatment using the virtual reality is used for patients with revealed disorders. The Precise-diagnostics uses a unique cloud-based algorithm to quickly analyze an ECG interpretation and produces within seconds a detailed report based on HRV аnalysis and the full range of the standardized Minnesota Code classification system for electrocardiographic findings. Cloud and the PRECISE Report are the latest medical innovations developed and being brought to market by Precise Cardiology Limited. They are unique detailed cloud-based electrocardiogram instant interpretation products aimed initially at the GP and medical diagnostic companies but with wider potential beyond including artificial intelligence enhancement.

Objective: Appendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess the association of appendicolith characteristics with appendicitis severity., Design: This prospective predefined MAPPAC-trial (ClinicalTrials.gov NCT03257423) substudy included patients with CT diagnosed appendicitis presenting with an appendicolith. CT visible appendicoliths were harvested at surgery, measured and characterised by morphological examination complemented with micro-CT and micro-X-ray fluorescence spectroscopy. Patients were categorised into two groups: appendicolith appendicitis without other complications and appendicolith appendicitis with complications (appendiceal gangrene, perforation and/or abscess). The association of appendicolith classification and characteristics with appendicitis severity was evaluated., Results: Of 78 patients with a CT appendicolith, 41 appendicoliths were collected and classified based on the degree of hardness into three classes. The hardest appendicoliths (class 3) were less common (19.5%) presenting with a stone-hard outer layer and concentrically layered inner structure around a core. The layered inner structure was also observed in class 2 appendicoliths, but was absent in soft, class 1 appendicoliths. Appendicolith hardness or measures (maximum length, diameter and weight) were not associated with appendicitis severity. The spatial distribution of the main inorganic elements of calcium and phosphorus varied within most appendicoliths., Conclusion: This updated classification confirms categorisation of CT visible appendicoliths into three classes based on their physical and chemical characteristics. The data on clinical and aetiopathological characteristics of appendicoliths is scarce and using this systematic classification would add to this understanding., Competing Interests: Competing interests: EMu is currently working as full-time Medical Advisor for Biocodex Nordics. PS reports receiving personal fees for lectures form Merck and Orion Pharma. AJH reports receiving personal fees for lectures from BioCodex, Merck and Pfizer. All other authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

An 11-year-old boy was brought to the emergency department with a week-long history of widespread pain in his upper abdomen that worsened with deep breathing and eating, sialorrhea, food impaction sensation, and a recent fever. Ten months prior, he had similar symptoms and was diagnosed with a pharyngeal phlegmon. He was treated with antibiotics and dexamethasone. In the current episode, he presented with mild elevation of inflammatory markers, a slight deviation of the trachea on chest X-ray, and a tubular esophageal duplication was identified on a thoracic CT, with its opening observed during the endoscopic study. The patient was admitted for further treatment with fluids, analgesia, and antibiotics, and showed improvement over the next seven days with no significant incidents. Esophageal duplications are a rare congenital anomaly and their exact cause is unknown. Typically found in the posterior mediastinum and lower esophagus, they can cause symptoms such as pain, dysphagia, regurgitation, and malnutrition. Surgical or endoscopic resection can be a treatment option for these malformations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Craveiro Costa et al.)

Neurofibromas are considered benign peripheral nerve sheath tumors containing Schwann cells, fibroblasts, and perineurial cells. They are commonly associated with familial disorders. Isolated colonic neurofibromas are very rare. In this report, we discuss a case of a patient who presented to the gastroenterology clinic with a week-long occurrence of abdominal pain and bleeding. She underwent a colonoscopy in which three sentinel polyps of benign appearance, ranging in size from 4 mm to 10 mm, were removed during the procedure. The pathology report indicated that the distal rectal polyp contained a submucosal neurofibroma with SOX10+, desmin-, CD117-, DOG1-, CD34+. While NF1-associated neurofibromas harbor the risk of malignant transformation into malignant peripheral nerve sheath tumors (MPNSTs), the malignancy potential for isolated colonic neurofibromas remains uncertain due to their rarity. The clinical significance of isolated colonic neurofibromas is yet to be defined; therefore, the optimal management strategy remains uncertain. Close monitoring is advocated to both exclude the possibility of neurofibromatosis and be vigilant about the risk of malignant transformation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, He et al.)

Background One unique criterion of colorectal carcinoma (CRC) is the different locations within the colorectum. Different CRC sidedness/locations could have distinct criteria, including risk factors, morphological features, genetic alterations, prognostic factors, and clinical outcomes. Nearly half of the CRC cases occur in the rectal-sigmoid locations, while other colonic locations constitute the other half. Investigating specific protein expression patterns in the rectosigmoid CRC (rsCRC) compared to other colonic (ocCRC) locations helps understand the disease pathogenesis, predict prognosis, and design personalized treatments. This study is the first to compare P16Ink4a and P57KIP2 immunohistochemical (IHC) expression in rsCRC to ocCRC and examine their relationship to disease outcomes in both locations. Materials and methods A comparative cross-sectional study used tissue microarray slides from rsCRC and ocCRC that were immunohistochemically stained by anti-P16Ink4a and P57KIP2 antibodies. A semi-quantitative scoring system classified each marker's expression as positive or negative. The statistical analysis compared clinicopathological features, P16Ink4a and P57KIP2 expressions, and their relationship to clinical outcomes in rsCRC and ocCRC cases. Results One hundred fifty CRCs were distributed into the rsCRC cases (n=86, 57.3%) and the ocCRC cases (n=64, 42.7%). The rsCRC cases had a significantly lower age <40 years (P=0.002), higher frequency of mismatch repair (MMR) proficient status (P=0.003), and perineural invasion (P=0.008), with lower disease-free (DFS) and overall survival (OS) (P=0.03, and P=0.015, respectively). Significantly higher positive P16Ink4a and P57KIP2 IHC expressions were found in the rsCRCs compared to the ocCRCs (P=0.02, and P=0.03, respectively); however, their relationship to the hazards (HR) of recurrence (HR=4.02, P=0.058, and HR=0.36, P=0.14, respectively) and mortality (HR=2.56, P=0.21, and HR=0.23, P=0.58, respectively) in the rsCRC group was statistically nonsignificant. In the ocCRC group, P16Ink4a positivity was significantly associated with a higher disease recurrence and mortality hazard (HR=8.19, P=0.007, and HR=5.57, P=0.037, respectively), while P57KIP2 positivity was significantly associated with a lower mortality hazard (HR=0.12, P=0.027). Conclusion The rsCRCs differ from ocCRCs in clinicopathological criteria and protein expression patterns. Though P16Ink4a and P57KIP2 IHC expressions are higher in the rsCRC than in the ocCRC, their value as outcome predictors is higher in the ocCRCs rather than the rsCRCs. P16Ink4a and P57KIP2 can act as prognostic markers and be suitable targets for therapy modulation in the ocCRC group., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Faculty of Medicine Ethics Committee of Helwan University, Cairo, Egypt issued approval IRB number 44-2024. All work was done following the Helsinki Declaration of 1964 and its subsequent revisions. The cases were received de-identified and coded. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Elkhamisy et al.)

To advance the diagnostic accuracy of juvenile polyposis syndrome, an important yet often difficult diagnosis, we describe in detail a new and medically significant presentation. This hereditary and high-risk GI cancer syndrome is often associated with hereditary hemorrhagic telangiectasia, as in this 47-year-old female patient with a SMAD4 germline pathogenic mutation. Total gastrectomy revealed giant gastric folds with inflamed foveolar hyperplasia consuming most of the gastric cardia and body but sparing the antrum. Together, this gross and histologic pathology mimics Ménétrier's disease, an exceedingly rare and acquired protein-losing hypertrophic gastropathy. Classical gastric juvenile polyposis almost always and principally involves the antrum with multiple distinctive inflammatory polyps rather than the newly illustrated giant gastric folds of this case. No reports of giant gastric folds in juvenile polyposis have appeared in the literature. The distinction between juvenile polyposis and Ménétrier's disease is essential due to their disparate clinical outcomes and management. The differential considerations for giant gastric folds and inflamed gastric foveolar hyperplasia are fully reviewed. On the basis of this report, the differential for giant gastric folds must now expand to include juvenile polyposis syndrome. Genetic testing for pathogenic germline mutations of the 2 known causative genes of this syndrome, namely SMAD4 and BMPR1A, are readily available and should become part of the evaluation of giant gastric folds, particularly in view of the neoplastic and hereditary aspects of juvenile polyposis syndrome. [ABSTRACT FROM AUTHOR]

Gastric adenomyoma, a subtype of pancreatic heterotopia, is a rare mural lesion typically located within the antrum or pylorus consisting of well-formed glands lined by a single layer of bland epithelium embedded within dense smooth muscle bundles. Like most forms of pancreatic heterotopia, gastric adenomyomas are usually incidental findings, but may result in obstructive symptoms, especially if situated within the pyloric channel. Malignant degeneration is exceedingly rare, with existing reports lacking detailed morphologic descriptions. Herein, we discuss the case of a 62-year old female who presented to our institution with two months of early satiety and bloating. Imaging revealed a partially cystic mass within the pyloric wall associated with eccentric gastric wall thickening. Endoscopic fine needle aspiration cytology revealed glands embedded in smooth muscle. Distal gastrectomy ultimately revealed an extremely well-differentiated adenocarcinoma arising in a pre-existing adenomyoma of the pyloric channel. In this report, an extensive review of this rare entity is provided, including detailed morphologic and immunohistochemical findings of our case, differential diagnostic considerations, pitfalls of gastric mural lesions that contain epithelium, and a comprehensive literature review.

Introduction: Seeds may be found in gastrointestinal tissue samples, and their multifaceted appearance may be challenging. The aim is to report a rough incidence of pathology samples which show seeds, specify the most frequent sample types and show an iconography of the most commonly identified seeds.Materials and Methods: Between 2017 and 2020, all gastrointestinal pathology cases in which seeds/seed parts were found, were collected and seed type described by referencing a seed image library.Results: Fifty cases with complete seeds/seed parts were collected: 16 colonic resections for colorectal cancer and diverticulosis, 13 appendiceal resections for appendicitis, 1 gastric resection. Fifteen cases were found in polypectomy specimens and 5 cases in colorectal endoscopic biopsies. Most frequent seed types were tomato, kiwi, blueberry, and blackberry seeds.Conclusion: Seeds may be found in up to 4% of specimens; their recognition may be useful to exclude parasitic infections as well as in forensic sciences.

Biopsies of liver mass lesions are encountered frequently in general surgical pathology practice. The clinical differential diagnosis is typically hepatocellular carcinoma (HCC) versus metastatic adenocarcinoma. There are a variety of HCC variants that show a range of morphological appearances. The presence of malignant glands in the liver prompts the pathologist to consider adenocarcinoma, either metastatic or primary intrahepatic cholangiocarcinoma. It is important to remember that some variant patterns of HCC can show pseudoglandular growth. In this article, we present a case of fibrolamellar carcinoma that showed predominantly pseudoglandular growth to highlight the importance of a systematic approach and the routine use of a panel of immunohistochemical stains (HepPar1, CK7, and CD68). [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

This review aims to present a comprehensive overview of the current landscape of artificial intelligence (AI) applications in the analysis of tubular gastrointestinal biopsies. These publications cover a spectrum of conditions, ranging from inflammatory ailments to malignancies. Moving beyond the conventional diagnosis based on hematoxylin and eosin-stained whole-slide images, the review explores additional implications of AI, including its involvement in interpreting immunohistochemical results, molecular subtyping, and the identification of cellular spatial biomarkers. Furthermore, the review examines how AI can contribute to enhancing the quality and control of diagnostic processes, introducing new workflow options, and addressing the limitations and caveats associated with current AI platforms in this context., (Copyright © 2024 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Primary retroperitoneal mucinous cystic neoplasm (PRMCN) is extremely rare, and its etiology, pathogenesis, and prognosis remain unclear with histology being similar to ovarian or pancreatic counterparts. We herein report an unusual case of PRMCN with malignant transformation leading to multifocal invasive adenocarcinoma in the small and large bowel from our institution.The patient was a 23-year-old overweight woman presenting with fever, nausea, vomiting, abdominal pain, and 17 cm cystic lesion in the right mid abdomen which was exerting mass effect on the liver and right ureter. She underwent right hemicolectomy and en bloc resection of retroperitoneal mass with a subsequent pathology diagnosis of multifocal invasive moderately to poorly differentiated adenocarcinoma arising from a primary retroperitoneal mucinous cystic neoplasm with low and high grade dysplasia. The adenocarcinoma was identified in the serosa and muscularis propria of the small and large intestines. Immunohistochemically tumor cells were positive for CK7, pankeratin and MOC-31 with high Ki67 proliferative index, and negative for CK20, CDX-2, PAX-8, TTF-1, calretinin and WT1. Subsequent thorough oncologic, radiologic and tumor marker workup failed to identify any primary tumors in our patient with nineteen months surveillance after surgery being recurrence-free.There are no pathognomonic clinical or radiological findings for primary retroperitoneal mucinous cystic neoplasm, making the preoperative diagnosis challenging. Delay in diagnosis and treatment may lead to complications such as rupture, infection, and malignant transformation like in our case. Surgical resection and pathology report are crucial to facilitate accurate diagnosis and treatment.

The aim of this study was to conduct a systematic review of the association between gut microbiota and prognosis after colorectal cancer surgery. The review was conducted according to the PRISMA guidelines. A systematic literature search was conducted in PubMed, Embase, and Scopus. Studies examining the association between gut microbiota and survival after colorectal cancer surgery were identified. Secondary outcomes were association with cancer stage and immune infiltration of tumor. A total of 27 studies were included in the review. Fusobacterium nucleatum was the most frequently examined bacterium, and the meta‐analysis showed that high level of F. nucleatum was significantly associated with decreased overall survival, hazard ratio of 1.63 (95% confidence interval 1.23–2.16) for unadjusted data, and hazard ratio of 1.47 (95% confidence interval 1.08–1.98) for adjusted data. Association between higher tumor stage and F. nucleatum was reported in ten studies, and two studies found an association with unfavorable tumor infiltration of immune cells. Three out of five studies examining Bacteroidesfragilis found an association with decreased survival, advanced tumor stage, or unfavorable immune infiltration of tumor. High levels of F. nucleatum and possibly B. fragilis were associated with worse prognosis after surgery for colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Sonography of the gastrointestinal (GI) tract is a practical, safe, inexpensive, and reproducible diagnostic tool for the evaluation, diagnosis, and follow-up of infectious bowel disease. The modality is rapidly gaining prominence among clinicians on a global scale. In the United States, however, ultrasound of the bowel remains underutilized primarily due to insufficient experience among radiologists and sonographers in performing sonographic bowel assessment. This lack of experience and knowledge results in misinterpretations, missed diagnoses, and underutilization of this modality in patients with acute abdomen, with the majority of GI pathology on sonography discovered incidentally. Objectives: This article aims to demonstrate the characteristic sonographic findings associated with GI infectious processes as well as provide dedicated ultrasound protocols for evaluation of the GI tract. Conclusion: This article serves a twofold purpose, raising awareness of the utility of this imaging modality within the radiology community and also providing practical teaching points for sonographic evaluation of infectious disorders of the GI tract. [ABSTRACT FROM AUTHOR]

Immunohistochemistry and special stains play an increasingly important role in gastrointestinal pathology practice. In neoplastic disorders they are used to confirm the diagnosis, identify prognostic/predictive features, and screen for an underlying genetic syndrome. In nonneoplastic disorders they can identify an infectious organism, clarify the inflammatory infiltrate present, and confirm a tissue deposition. In this review we discuss the most important and topical of these stains, especially ones which require special care in interpretation. It should be emphasized that, in cases with equivocal or unexpected staining patterns, the results should be interpreted in the appropriate clinical, endoscopic and morphologic context. [ABSTRACT FROM AUTHOR]

This paper presents the evaluation of the use of insecticides in the agricultural production of the Kursk region. Studied territorial load dominant crop insecticides in a complex region for the period 2006-2013, were ranked the region in terms of territorial load insecticides. Estimated figures on theenvironmental risk of the formation of the pathology of the gastrointestinal tract of the adult population of the Kursk region in the intensive use of insecticides. Environmentally sensitive identified pathologies such as gastric ulcer and duodenal ulcers, gastritis and duodenitis, functional bowel disorders, diseases of the pancreas.

Studies have shown that exposure to organophosphates (OPs) is associated with increased frequency of gastrointestinal diseases. In order to evaluate the effect of dysfunction of detoxification system on the development of gastrointestinal pathology, we studied «esterase status» (activity of acetylcholinesterase, butyrylcholinesterase and paraoxonase 1 (PON1)) among workers at the plants providing storage and disposal of OPs. The enzymatic activity of PON1 was significantly increased in individuals who had prolonged direct contact with the OPs. It was shown that among all gastrointestinal diseases included in this study PON1 activity was increased in patients with chronic esophagitis and chronic gastritis as compared to workers without gastrointestinal diseases (p

Objective: To assess the effect of long-term dupilumab on histological, symptomatic and endoscopic aspects of eosinophilic oesophagitis (EoE) in adolescent and adult patients with and without prior use of swallowed topical corticosteroids (STC) or prior inadequate response, intolerance or contraindication to STC., Design: Pre-specified analysis of data from the phase 3 LIBERTY EoE TREET study on patients who received dupilumab 300 mg once a week or placebo for 24 weeks (W24) in parts A and B, and an additional 28 weeks (W52) in part C. Patients were categorised as with/without prior STC use and with/without inadequate/intolerance/contraindication to STC. The proportion of patients achieving ≤6 eosinophils per high-power field (eos/hpf), absolute change in Dysphagia Symptom Questionnaire (DSQ) score, mean change in Endoscopic Reference Score and Histologic Scoring System grade/stage scores were assessed for each subgroup., Results: Regardless of prior STC use, dupilumab increased the proportion of patients achieving ≤6 eos/hpf and improved DSQ score versus placebo at W24, with improvements maintained or improved at W52. The DSQ score and the proportion of patients achieving ≤6 eos/hpf after switching from placebo to dupilumab at W24 were similar to those observed in the dupilumab group at W24, regardless of prior STC use or inadequate/intolerance/contraindication to STC. Improvements in other outcomes with dupilumab were similar in patients with/without prior STC use or inadequate/intolerance/contraindication to STC., Conclusion: Dupilumab 300 mg once a week demonstrated efficacy and was well tolerated in patients with EoE regardless of prior STC use or inadequate response, intolerance and/or contraindication to STC., Trial Registration Number: NCT03633617., Competing Interests: Competing interests: AJB: Dr Falk Pharma, Norgine, Nutricia, Sanofi, SST and Thelial—research funding; Alimentiv, Aqilion, AstraZeneca, Dr Falk Pharma, Laborie, Medtronic, Regeneron Pharmaceuticals and Sanofi—consulting fees. ED: Adare/Ellodi, Allakos, Arena/Pfizer, AstraZeneca, Celgene/Receptos/BMS, GSK, Meritage, Miraca, Nutricia, Regeneron Pharmaceuticals, Revolo and Shire/Takeda—research funding; Abbott, AbbVie, Adare/Ellodi, Aimmune, Akesobio, Alfasigma, ALK, Allakos, Amgen, Aqilion, Arena/Pfizer, Aslan, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, Eupraxia, Ferring, Gossamer Bio, GSK, Holoclara, Invea, Knightpoint, Landos, LucidDx, Morphic, Nexstone Immunology, Nutricia, Parexel/Calyx, Phathom, Regeneron Pharmaceuticals, Revolo, Robarts/Alimentiv, Salix, Sanofi, Shire/Takeda, Target RWE and Upstream Bio—consulting fees; Allakos, Holoclara and Invea—educational funding. IH: Allakos, AstraZeneca, Calyx/Parexel, Eli Lilly, Ellodi/Adare, EsoCap, Gossamer Bio, Nexstone, Pfizer/Arena, Phathom, Receptos/BMS, Sanofi/Regeneron Pharmaceuticals and Shire/Takeda—consulting fees; Allakos, AstraZeneca, Ellodi/Adare, Pfizer/Arena, Receptos/BMS, Regeneron Pharmaceuticals and Shire/Takeda—research funding; Sanofi/Regeneron Pharmaceuticals—speaker fees. AJL: Dr Falk Pharma and EsoCap—consulting fees; Dr Falk Pharma, Ellodi and Regeneron Pharmaceuticals—research funding. CS: Adare Pharmaceuticals, AstraZeneca, Calypso, EsoCap, Dr Falk Pharma, GmbH and Regeneron Pharmaceuticals—consulting fees. AS, EM, JM and XS: employees of Regeneron Pharmaceuticals and may hold stock and/or stock options in the company. EL, LG and LM: employees of Sanofi and may hold stock and/or stock options in the company., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis., Competing Interests: Competing interests: DSB has served as speaker for Abbott, AstraZeneca, Alfasigma, Biocodex, Pfizer, Reckitt Benckiser, Takeda, KRKA, PRO.MED.CS Praha and Dr Reddy’s Laboratories. LGC has served as speaker for Takeda and EMS. FDM has served as consultant for Biohit Healthcare. MD-R has served as consultant for Roche and Medtronic. DD has served as consultant for Reckits, Dr Reddy’s, Zentiva, AbbVie, Terapia and Takeda. EME-O is Editor of Gut. EJK is member of the Editorial Board of Gut. MLe has served as research consultant for Eiken Chemical. MLi has served as speaker for Abbott, AstraZeneca, Alfasigma, Biocodex, KRKA and PRO.MED.CS Praha. TM-B received research grants from: AstraZeneca, BMS, Biohit and Fujirebio; and has been involved in congresses and educational supported by AAA, AstraZeneca, MSD, BMS, Viatris and Pierre Fabre. FM has served as consultant for Phathom and Biocodex. ES has served as speaker for AbbVie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots and Unifarco; has served as consultant for AbbVie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Nestlè, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas, Takeda and Unifarco; and has received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco and Zeta Farmaceutici. NS has served as speaker for Astellas and consultant for Bristol-Myers Squibb. KS has served as consultant for Fuji Film Co. NU has served as speaker for lectures for: Olympus Co, Fuji Film Co, Boston Scientific Japan, Daiichi-Sankyo Co, Takeda Pharmaceutical Co, EA Pharma Co, Otsuka Pharmaceutical Co, AstraZeneca Co, Miyarisan Pharmaceutical Co and AI Medical Service Co., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Mpox is a viral infection caused by the monkeypox virus, a member of the Poxviridae family and Orthopoxvirus genus. Other well-known viruses of the Orthopoxvirus genus include the variola virus (smallpox), cowpox virus and vaccinia virus. Although there is a plethora of research regarding the dermatological and influenza-like symptoms of mpox, particularly following the 2022 mpox outbreak, more research is needed on the gastrointestinal (GI) effects., Objectives: This systematic review is to outline the GI manifestations of the monkeypox virus., Methods: The authors conducted this systematic review using guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search was conducted through the PubMed, EMBASE and MEDLINE databases from January 1958 to June 2023. The authors selected English language papers that discussed the GI symptoms in mpox patients. A manual search was also conducted in the reference sections of these publications for other relevant papers., Results: 33 papers involving 830 patients were selected for this review. The GI manifestations in mpox patients are proctitis, vomiting, diarrhoea, rectal pain, nausea, tenesmus, rectal bleeding and abdominal pain. Although various papers explored transmission routes, one paper established a direct connection between anal-receptive sex transmission route and the development of a GI complication (proctitis). Another study reported that the mode of transmission could potentially impact the occurrence of GI symptoms and severity of the disease. The reviewed papers did not discover a relation between the severity of dermatological and influenza-like symptoms and the GI manifestations mentioned., Conclusion: This systematic review confirms that GI manifestations are observed in mpox patients. GI symptoms of mpox are crucial for gastroenterologists and other healthcare professionals to recognise in order to address patient discomfort and further understand the pathophysiology of the virus., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Graft-versus-host disease (GVHD) is a major complication of hematopoietic stem cell transplantation (SCT), leading to a significant morbidity and mortality. Histologically, gastrointestinal GVHD is characterized by crypt apoptosis and dropout. However, similar histologic features can also be seen in drug-induced injury and opportunistic infection. Knowledge of the timing of biopsy, patient medications, evidence of infection, and presence of GVHD at other organ sites can aid in the correct diagnosis and subsequent management of these patients. This review focuses on the pathologic differential diagnosis of apoptosis in gastrointestinal biopsies obtained from SCT patients., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Summary: The aim of the present study was to characterize a patient‐derived in vitro 3D model (ie tumoroid) established from colorectal adenocarcinoma. This study investigated the growth rate of tumoroids and whether the Kirsten rat sarcoma (KRAS) mutations in the parental tumour accelerate this rate. The tumoroids were established from surgical resections of primary and metastatic colorectal adenocarcinoma from 26 patients. The in vitro growth rate of these tumoroids was monitored by automated imaging and recorded as relative growth rate. The KRAS hotspot mutations were investigated on the parental tumours by Ion Torrent™ next‐generation sequencing. The KRAS mutations were detected in 58% of the parental tumours, and a significantly higher growth rate was observed for tumoroids established from the KRAS‐mutated tumours compared to wild‐type tumours (P < 0.0001). The average relative growth rate (log10) on day 10 was 0.360 ± 0.180 (mean ± SD) for the KRAS‐mutated group and 0.098 ± 0.135 (mean ± SD) for the KRAS wild‐type group. These results showed that the presence of KRAS mutations in parental tumours is associated with an acceleration of the growth rate of tumoroids. The future perspective for such a model could be the implementation of chemoassays for personalized medicine. [ABSTRACT FROM AUTHOR]

Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions of pancreatic ductal adenocarcinoma (PDAC). Current edition of WHO Classification of Tumors of the Digestive System recognizes four different subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) and recommends analysis of mucin expression (MUC1, MUC2, MUC5AC, MUC6) as well as evaluation of architectural and cell differentiation patterns for correct classification. However, there is no consensus on MUC1 expression of IPMN‐lesions in the literature. Current recommendations are based on studies where antibodies against the core MUC1 protein or sialylated MUC1 (tumor associated MUC1), not the fully glycosylated MUC1 were used. We have recently reported that MUC1 is strongly expressed in both gastric and intestinal types IPMN specimens from the cystic wall, obtained by endoscopic ultrasound guided microbiopsy procedure. We have used a commercial MUC1 antibody, validated and recommended for diagnostic use, which recognizes fully glycosylated MUC1. Based on the above, we propose a revision of the WHO Classification, specifying that antibodies against tumor associated MUC1 should be used for IPMN subtyping. [ABSTRACT FROM AUTHOR]

Gaucher Disease arises due to a deficiency in the enzyme glucocerebrosidase and is the most common lysosomal storage disease. This enzyme deficiency leads to the accumulation of glucocerebroside within macrophages (Gaucher cells) and the resulting infiltration of these cells into organs can cause clinical symptoms. There are three types of Gaucher Disease that differ based on the clinical course and the presence or absence of neurological involvement, but classically, Gaucher cell infiltrates impact a patient's spleen, liver, bone marrow and cortex. In this report, we present a case of Type 3 Gaucher Disease involving small bowel mucosa with a mesenteric mass formation. These unusual sites of Gaucher cell deposition likely led directly to uncommonly seen clinical symptoms, including small bowel obstruction and lower gastrointestinal hemorrhage. [ABSTRACT FROM AUTHOR]

Rationale: According to prognosis made by World Health Organization experts, by mid-21st century gastrointestinal disorders will be among the leaders, partially due to lifestyle of a modern man (stress, unhealthy diet, lack of physical exercise, unhealthy habits), environmental pollution, genetically modified and low quality foods.Aim: To provide informational support of activities aimed at improvement of organization of medical care to patients with gastrointestinal disorders and at further development of specialized gastroenterological care to the population of the Moscow Region, its better availability and higher efficacy and quality.Materials and methods: We calculated and analyzed gastrointestinal morbidity in 2014 (according to referrals) among the main age categories (children, adolescents, adults) of the population of the Moscow Region, as well as hospitalization rates and in-hospital mortality. The information was taken from the Federal Statistical Surveillance report forms # 12 and # 14.Results: In 2014, the highest prevalence of gastrointestinal disorders was registered in adolescents, being by 42.7% higher than that in adults and by 11.7% higher than that in children. The leading causes of referrals in all age categories were gastritis and duodenitis, as well as gall bladder and bile tract disorders. The structure of morbidity was characterized by a high proportion of pancreatic disorders, stomach and duodenal ulcers in adults. The rate of hospitalizations due to gastrointestinal disorders was 17.8 cases per 1000 patients, being 17.4‰ in adults and 19.8‰ in children and adolescents. The main reasons for hospitalization in adults were diseases of pancreas (23.9% of all hospitalization due to gastrointestinal disorders), gall bladder and bile tract disorders (16.3%). In children and adolescents, the main reasons for hospitalizations were intestinal disorders (36.4%), gastritis and duodenitis (17.9%). In-hospital mortality from gastrointestinal disorders in adults was 3.3%, in children, 0.02%.Conclusion: The statistical data obtained, as well as the results of the analysis of organization, quality and efficacy of medical care to patients with gastrointestinal disorders can be used for improvement of gastroenterological care at all levels and further development of this service in the region.

This paper presents an assessment of the use of insecticides in agricultural production Kursk region. Studied territorial load dominant insecticides in crop complex region for the period 2006-2010. Ranging of the region in terms of territorial load insecticides. Assessed indicators of relative environmental risk of formation of pathology of the gastrointestinal tract of the child population of the Kursk region in the intensive use of insecticides. Environmentally sensitive identified pathologies such as peptic ulcer and duodenal ulcer, gastritis and duodenitis, functional bowel disorders, gall bladder and bile ducts.