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Objective: To compare serum levels of pepsinogen I (PGI), pepsinogen II (PGII), and gastrin-17 (G-17) among patients with gastritis, gastric ulcer, and gastric cancer, and to assess the effectiveness of these biomarkers individually and in combination for screening gastric cancer., Methods: Serum levels of PGI, PGII, and G-17 were measured using enzyme-linked immunosorbent assay (ELISA) in 50 patients with gastric cancer, 60 with chronic gastritis, and 60 with gastric ulcer from February 2020 to June 2021. The diagnostic value of these biomarkers was analyzed through sensitivity, specificity, and ROC curve assessments., Results: Serum PGI levels were significantly lower in patients with advanced gastric cancer compared to those with early gastric cancer (P < .05), while PGII and G-17 levels were significantly higher in advanced-stage patients (P < .05). The combined ROC curve analysis of PGI, PGII, and G-17 yielded an area under the curve (AUC) of 0.933, indicating higher diagnostic accuracy than any of the markers alone. Statistically significant differences were noted between the combined and individual tests (Z = 2.376, P < .05). Patients with PGI levels lower than 17.21 ng/ml had a worse prognosis compared to those with higher levels. Similarly, patients with PGII levels greater than 74.65 ng/ml and G-17 levels greater than 17.03 pmol/L had poorer prognoses. Additionally, higher G-17 levels were associated with significantly lower serum PGI levels., Conclusions: Patients with low expression of PGI have a poorer prognosis, and those with high expression of PGII and G-17 also have a poor prognosis. Combining the three indicators has clear value for the screening and prognostic evaluation of gastric cancer, making it worthy of clinical promotion and application.

A woman in her 20s presented with 6 weeks of fever, persistent vomiting and 28% loss of body weight. Symptoms were refractory to treatment with antiemetics and broad spectrum antibiotics.Further investigation via oesophageogastroduedenoscopy revealed a large gastric ulcer and pyloric stricture, causing gastric outlet obstruction (GOO). Biopsies of the stomach and duodenum showed plasma cell infiltration with a large proportion being IgG4 positive.Treatment with methylprednisolone, and later prednisolone, quickly improved inflammatory markers and symptoms. Balloon dilatation of the pyloric stricture also improved vomiting, allowing eventual re-establishment of oral nutrition. The patient made a full recovery with maintenance treatment on mycophenolate mofetil.IgG4-related disease (IgG4-RD) is a multisystem disorder with unpredictable presentation. The case highlights diagnostic challenges in IgG4-RD and identifies it as a rare differential in upper gastrointestinal symptoms. To our knowledge this is the first published case of IgG4-RD in the duodenum causing GOO., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Conflict of interest All authors have no conflict of interest to disclose.

A Japanese woman presented with gastric antral ulcers accompanied by erosion and edema, demonstrating a chronic pattern of improvement and recurrence for more than six years. The patient had no relevant treatment history, and Helicobacter pylori infection was ruled out. Other potential etiologies contributing to gastric ulcers were eliminated on the basis of endoscopic biopsy and blood laboratory findings. Consequently, the patient was diagnosed with idiopathic gastric antral ulcer. This disease is often overlooked, and the chronological endoscopic images provided in this report can be used as a reference.

Introduction: There are uncertainties surrounding the spectrum of upper gastrointestinal (UGI) diseases in sub-Saharan Africa. This is mainly due to the limitations of data collection and recording. We previously reported an audit of UGI endoscopic diagnoses in Zambia spanning from 1977 to 2014. We now have extended this analysis to include subsequent years, in order to provide a more comprehensive picture of how the diagnoses have evolved over 4 decades., Methods: We combined data collected from the endoscopy unit at the University Teaching Hospital (UTH) in Lusaka during a previous review with that collected from the beginning of 2015 to the end of 2021. Since 2015, an electronic data base of endoscopy reports at the UTH was kept. The electronic data base was composed of drop-down menus that allowed for standardised reporting of findings. Collected data were coded by two experienced endoscopists and analysed., Results: In total, the analysis included 25,849 endoscopic records covering 43 years. The number of endoscopic procedures performed per year increased drastically in 2010. With the exception of the last 2 years, the proportion of normal endoscopies also increased during the time under review. In total, the number of gastric cancer (GC) cases was 658 (3%) while that of oesophageal cancer (OC) was 1168 (5%). The number of GC and OC diagnoses increased significantly over the period under review, (p < 0.001 for both). For OC the increase remained significant when analysed as a percentage of all procedures performed (p < 0.001). Gastric ulcers (GU) were diagnosed in 2095 (8%) cases, duodenal ulcers (DU) in 2276 (9%) cases and 239 (1%) had both ulcer types. DU diagnosis showed a significantly decreasing trend over each decade (p < 0.001) while GU followed an increasing trend (p < 0.001)., Conclusions: UGI endoscopic findings in Lusaka, Zambia, have evolved over the past four decades with a significant increase of OC and GU diagnoses. Reasons for these observations are yet to be established., (© 2024. The Author(s).)

Equine gastric ulcer syndrome (EGUS) is currently one of the more frequent diseases in horses. We aimed to identify changes in the salivary proteome in horses with EGUS at diagnosis and after successful treatment by using gel proteomics. Saliva samples were collected from nine horses with EGUS before and after treatment and nine matched healthy controls. SDS-PAGE (1DE) and two-dimensional gel electrophoresis (2DE) were performed, and significantly different protein bands and spots were identified by mass spectrometry. Horses with EGUS had increases in proteins such as adenosine deaminase (ADA), triosephosphate isomerase, keratins and immuno-globulin heavy constant mu and decreases in carbonic anhydrase (CA), albumin and prolactin-induced protein. These changes would indicate various physiopathological mechanisms involved in this disease, such as the activation of the immune system, decreased stomach defence mechanisms and inflammation. The treated horses presented lower expression levels of thioredoxin (TRX) after a successful treatment, in proteomics analysis and also measured with a commercially available ELISA kit. Overall, horses with EGUS have protein changes in their saliva when measured with gel proteomics compared with healthy horses, and they also showed changes after successful treatment. These proteins could be potential biomarkers for detection and monitoring treatment response in EGUS., Competing Interests: Declaration of Competing Interest The authors of this manuscript have no financial or personal relationships that could potentially influence the content and findings presented in the manuscript. We confirm that there are no affiliations with organizations or entities that have a direct interest in the subject matter discussed in the article. Our commitment to transparency and integrity in research is paramount, and we assure you that the research was conducted objectively and without any external influences that could compromise the validity of the results. We adhere to the highest ethical standards in the preparation and submission of this manuscript to Research in Veterinary Science., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Endoscopic diagnosis is essential for predicting the curability of early gastric cancer (EGC; R0 resection) before treatment, but the relationship between ulcerative lesions and clinical outcomes remains unclear. We aimed to investigate the effect of proton pump inhibitor (PPI) or potassium-competitive acid blocker (P-CAB) on the morphological changes of ulcerative EGCs and its relevance to the clinical outcomes., Methods: Altogether, 143 patients with differentiated ulcerative EGC that were resected by endoscopic submucosal dissection were retrospectively identified and divided into the following two cohorts depending on their PPI/P-CAB administration status: PPI/P-CAB (n = 76) and non-PPI/P-CAB (n = 67) cohorts. Furthermore, in each cohort, the patients were further divided into the improved and unimproved subgroups based on the ulcerative changes., Results: In the PPI/P-CAB cohort, the deep submucosal invasion and lymphovascular invasion rates were significantly higher in the unimproved subgroup than in the improved subgroup, resulting in a significantly lower R0 resection rate. Contrarily, no significant differences were found between the two subgroups in the non-PPI/P-CAB cohort. The significance of PPI/P-CAB administration was observed only in the ulcerative EGCs with open-type atrophy (R0 resection rate; improved vs. unimproved, 90.9% vs. 48.0%, p = 0.001). When the finding of improved ulcer with PPI/P-CAB administration was used as the indication of endoscopic resection in ulcerative EGCs with open-type atrophy, high sensitivity (78.9%) and accuracy (76.3%) rates for the curability were observed, which were higher than those of conventional endoscopic diagnosis alone (p = 0.021)., Conclusion: PPI or P-CAB administration might contribute to the potential selection of ulcerative EGCs, enabling endoscopic curative resection., (© 2024 S. Karger AG, Basel.)

Background: The latest magnet-controlled capsule endoscopy (MCCE) system can examine the water-distended stomach, duodenum, and the small bowel. We assessed the use of MCCE as the first diagnostic tool in patients with acute upper gastrointestinal bleeding (AUGIB)., Methods: This was a prospective cohort study that enrolled patients admitted with AUGIB from two teaching hospitals. Patients underwent MCCE as the initial diagnostic modality. Our primary endpoint was the diagnostic yield of MCCE. The subsequent care of these patients was guided by MCCE findings., Results: Of 100 enrolled patients, 99 (mean age 54 years, 70.7% men) with a median Glasgow-Blatchford score of 6 (IQR 3-9) underwent MCCE. In three patients, MCCE found active bleeding (two duodenal ulcers and Dieulafoy's lesion). The overall diagnostic yield of MCCE was 95.8% (92 lesions in 96 patients); five in the esophagus (Mallory Weiss tears 2, varices 1, and esophagitis 2), 51 in the stomach (gastric erosions 26, gastric ulcers 14, cancer 3, GIST 3, gastric polyps 3, antral vascular ectasia 1,angiodysplasia 1), 32 in the duodenum (ulcers 28, erosions 3, polyp 1), and four in the small bowel (ulcers 2, an erosion with a nonbleeding vessel 1, Meckel's diverticulum 1). Fifty-two (52.5%) patients were discharged without endoscopy. Forty-five (45.5%) patients underwent inpatient esophagogastroduodenoscopy (EGD), which found an antral ulcer and six duodenal ulcers in addition., Conclusions: In stable patients with AUGIB, MCCE can be used as a diagnostic tool. EGD should follow in patients with an inadequate view of the duodenum., (© 2023 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

A man presented with nausea, vomiting, abdominal pain and diarrhoea. Cross-sectional imaging of the abdomen and pelvis showed gastric pneumatosis. He was treated conservatively with broad-spectrum antibiotics, bowel rest, nasogastric tube placement for gastric decompression and intravenous proton pump inhibitor therapy. He developed an upper gastrointestinal bleed during hospitalisation and underwent an esophagogastroduodenoscopy (EGD) which revealed a large >50 mm cratered gastric ulcer. Initial biopsy was inconclusive for malignancy thus a repeat EGD was scheduled however prior to that procedure he returned to the emergency department with severe abdominal pain. CT of the abdomen and pelvis showed recurrence of gastric pneumatosis. Repeat EGD showed a 4 mm linear gastric ulcer and repeat biopsies showed gastric mucosa with moderate chronic inactive gastritis without any metaplasia, dysplasia, carcinoma or amyloid. He was once again treated successfully with conservative measures and discharged after short hospitalisation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Gastric ulcers have been reported in a range of cetacean species. Bottlenose dolphins (Tursiops spp.), the most common cetacean species held in captivity, are known to experience gastric ulcers in both wild and captive environments. Documented causes of gastric ulceration include bacterial infection by Helicobacter sp., parasitic infections, high dietary histamine and foreign body ingestion. Gastric ulceration without any obvious cause might be related to stress. Currently, the most accurate way to determine the presence of gastric ulcers in captive dolphins is through direct examination of the stomach mucosa using endoscopy (gastroscopy); a procedure that requires substantial animal training and specialised medical equipment. In this study, we investigate whether cytology of the gastric fluid, collected through the less intensive method of intubation, can be used as an alternative to gastroscopy to predict the presence and severity of gastric ulcers in eight captive bottlenose dolphins at uShaka Sea World, South Africa. An ulcer grading scale was developed to quantify the severity of the dolphins' gastric ulcers observed using gastroscopy. Gastric ulcer severity was then compared with the cytological data collected from gastric fluid samples taken during the gastroscopic examinations. The cytological findings were consistent with other studies, but ulcer severity was not found to be linked to the cytological parameters measured. From these results we suggest that routine cytology of the gastric fluid is not a viable alternative to gastroscopy for diagnosing gastric ulcers in bottlenose dolphins., (© 2023 The Authors. Zoo Biology published by Wiley Periodicals LLC.)

Rationale: Gastric mucosal ulcer caused by drug overdose is very rare in clinical practice, and here is a case of gastric antral ulcer caused by drug overdose., Patient Concerns: A 35-year-old housewife from a mountainous region in China took 48 Ibuprofen Sustained-Release capsules (300 mg/capsule) orally at 1 time. Because of severe tingling in the upper abdomen accompanied by a sharp increase in blood pressure, she came to the doctor 48 hours later., Diagnoses: Gastric antral ulcer (multiple stage A1), duodenococcitis, chronic nonatrophic gastritis, Helicobacter pylori infection, moderate depression, and cognitive impairment., Interventions: Acid suppression, antihypertensive and a series of symptomatic treatments., Outcomes: All somatic symptoms disappeared after a follow-up visit 2 months later., Lessons: This case provides valuable information to the clinic, through the compilation of literature and case analysis, the author found that paying attention to mental health, to women in poor areas and to women from families of low education level are indispensable in medical diagnosis and treatment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: There is no consensus on whether a gastroscopic biopsy is necessary during the emergency treatment of gastrointestinal (GI) diseases such as gastric ulcer bleeding. In this study, we examined the clinical utility and safety of an emergency gastroscopic biopsy for the assessment of gastric ulcer bleeding., Methods: We enrolled 150 patients with a single bleeding gastric ulcer after emergency gastroscopy (EG) from April 2020 to April 2022. The patients were randomly divided into the biopsy and no biopsy groups, and they were followed-up until June 2022 to examine whether recurrent gastric ulcer bleeding had occurred., Results: Re-bleeding occurred in 15 out of 150 (10%) patients. We diagnosed malignancies in 17 (11.3%) patients and validated 14 (9.3%) of them during the initial gastroscopy procedure. Factors that could predict the occurrence of gastric ulcer re-bleeding with biopsy during EG included an absence of ischemic heart disease (odds ratio [OR] = 0.395, confidence interval [CI]: 0.24-0.65, p  ≤ .005), renal disease (OR = 1.74, CI: 0.77-1.59, p  ≤ .005), and using warfarin or oral anticoagulants (OR = 11.953, CI: 3.494-39.460, p  ≤ .005). No significant differences were observed in 60-day bleeding ( p  = .077) and the duration of hospitalization ( p  = .700) between the two groups., Conclusions: Patients undergoing biopsy during EG did not exhibit an increased risk of re-bleeding compared with those who did not undergo a biopsy. An early biopsy facilitates an early pathologic diagnosis, early clinical intervention, safe discharge of low-risk patients, and improved outcomes in high-risk patients.

We report the isolation of Helicobacter ailurogastricus, a Helicobacter species that infects cats and dogs, from a person with multiple refractory gastric ulcers. In addition to H. suis, which infects pigs, Helicobacter species that infect cats and dogs should be considered as potential gastric pathogens in humans.

The authors discuss the peculiarities of the terminology of gastric and duodenal ulcers. A clinical, endoscopic and morphological study (determination of the relative area and density of sex hormone receptors in the mucous membrane of the antrum of the stomach) of 760 patients of different ages and genders was carried out. It was found that six clinical parameters (duration of anamnesis, frequency of occurrence of concomitant pathology, epigastric discomfort, belching, heartburn, hereditary predisposition) and two morphological parameters (optical density of estrogen and progesterone receptors) statistically significantly differed in men and women over 60 years old suffering from duodenal ulcer, not gastric localization. The results obtained are consistent with the data of the medical literature, according to which, sexual differences in the pathogenesis of ulceration are more characteristic of ulcers of duodenal localization. Considering that sex differences in the pathogenesis of duodenal ulcers, unlike gastric ulcers, persist until old age, the authors call for a separate study of stomach ulcers and duodenal ulcers, which will probably lead to the need not to combine them two different diseases.

Chronic gastric ulcer is a rare disease in childhood. The article presents data on the epidemiology and etiology of the disease in children, describes the case of a chronic gastric ulcer complicated by penetration into the liver, perforation, development of abdominal sepsis, with a fatal outcome in a 7-year-old girl.

Strongyloidiasis, a parasitic infestation by Strongyloides stercoralis, involves the gastrointestinal tract with a spectrum from duodenitis to enterocolitis. However, gastric involvement with the manifestation of upper gastrointestinal bleeding is an extremely rare condition due to Strongyloides stercoralis. Due to irregular excretion of larvae, unclear symptoms, paucity of effective diagnostic tools and low parasitic load, makes clinicians difficult to reach the diagnosis of strongyloidiasis. Here, we present a case of upper gastrointestinal bleeding due to a large gastric ulcer whose aetiology was identified to be Strongyloides stercoralis infection of the gastric region by the diagnosis of exclusion., Keywords: gastric ulcer; gastrointestinal haemorrhage; Strongyloides stercoralis; strongyloidiasis.

Gastroduodenal ulcer disease is characterized by ulceration of the stomach or duodenum, with ulcer lesions occurring more frequently in the duodenum. Serious complications of this disease include bleeding, perforation of the ulcer and penetration into surrounding organ. Our report presents the case of an older man who had a gastric ulcer penetrating into the pancreas. This was not diagnosed at the time of the penetration. The patient came to our care for recurrent hematemesis without a proven source of bleeding. During the diagnostic process, the presence of an intramural gastric tumor was suspected. An excision of the suspected lesion was successfully performed at our clinic, followed by histological confirmation of perforated ulcer. The postoperative course was complicated by the development of a pancreatic fistula. However, conservative treatment resulted in complete recovery of the patient.

Malignant transformation of gastric ulcer can result in gastric cancer, hence an accurate gastric ulcer classification method is of vital importance. Despite marvelous progress has been achieved in recent years, there are still many challenges in diagnosis of gastric ulcer. In this paper, we propose a mechanism to mimic gastroenterologist's behaviours based on deep learning techniques, by integrating the segmented malignancy suspicious masks with gastroscopic images for gastric ulcer classification, which instructs the model to focus on the area where symptoms occur for gastric ulcer diagnosis. Specifically, a U-Net-type deep neural network is built to segment the suspicious pathological regions from gastroscopic images, then the segmented regions are treated as an attention channel of gastroscopic images for the gastric ulcer classification by a ResNet-type deep neural network. Experiments on a real gastroscopic dataset with 900+ patient cases demonstrate that our proposed approach achieves much better performance for gastric ulcer diagnosis, compared with standard method with only gastroscopic images.

Introduction: Although it usually involves extranodal sites such as the gastrointestinal tract in more than 80% of cases, mantle cell lymphoma is considered a rare cause of gastrointestinal bleeding, especially severe and life-threatening bleeding., Patient Concern: A 60-year-old man with peptic ulcer disease, who presented with severe upper gastrointestinal (GI) bleeding and large gastric ulcer., Diagnosis: Primary gastric mantle cell lymphoma., Interventions: He was treated conservatively with blood transfusion and started on Traneximic acid for 3 days. Then, the patient underwent urgent hemostatic radiotherapy., Outcomes: The patient became stable and kept in the hospital for monitoring with a definite diagnosis of stage IV Mantle cell lymphoma is made., Conclusion: Mantle cell lymphoma should be kept in mind when assessing massive upper GI bleeding, as an unusual cause of bleeding gastric ulcer, given that bleeding is an uncommon presenting feature of GI lymphoma., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

While gastrointestinal (GI) tuberculosis (TB) accounts for 1%-3% of all TB cases worldwide, TB of the stomach is extremely rare and accounts for 1%-2% of all GI TB. Little is known about this entity, and most data are obtained from case reports. We report a case of a woman in her 60s who presented with a 2-week history of generalised weakness, fatigue and shivering, with severe loss of appetite on background history of dyspepsia and significant weight loss for the preceding 2 years. Upper endoscopy revealed a large gastric ulcer. Biopsy and histopathology revealed caseating granulomas with numerous acid-fast bacilli detected with Ziehl-Neelsen stain. She was diagnosed with gastric TB. Subsequently, she was also diagnosed with pulmonary, adrenal and colonic involvement., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Many domesticated horses have gastric ulcers which can be diagnosed and graded during gastroscopy. A distinction should be made between equine squamous gastric disease (ESGD), which is caused by exposure of the mucosa to acid, and equine glandular gastric disease (EGGD), thought to occur when mucosal defence mechanisms are compromised. Horses with gastric ulcers may, but do not always, show clinical signs such as poor appetite, mild colic, discomfort during girthing, behavioural changes and reduced performance. The mainstay of treatment is blocking acid production using the proton pump inhibitor omeprazole. Treatment is usually successful in cases of ESGD, but less so for EGGD, where treatment duration is longer and for which sucralfate may be added or alternatives necessary, such as misoprostol, a prostaglandin analogue. To prevent recurrence of ulcers known risk factors, such as high concentrate diets, intense exercise and stress should be avoided or minimized., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Goal: The aim of this study was to evaluate current practice in gastric ulcer follow-up to establish diagnostic yield and predictors of malignancy., Background: Repeat gastroscopy is routinely performed to confirm gastric ulcer healing and exclude malignancy. However, the incidence of malignancy at follow-up endoscopy is low, without consensus regarding case selection and timing., Study: New gastric ulcers diagnosed on gastroscopy at 2 institutions in Australia were identified through keyword search of endoscopy reports over a 5-year period (2013 to 2017). Data collected included patient demographics, clinical presentation, and endoscopic and histologic findings from initial and subsequent gastroscopies., Results: Of 795 patients, repeat gastroscopy was performed in 440 (55%). Malignancy was diagnosed in 52 (7%) with 83% identified at initial gastroscopy. Eight cancers were identified at repeat gastroscopy with malignancy yield of 2% (8/440). Three were diagnosed in patients with benign initial ulcer histology (3/286, 1%). One cancer was diagnosed during follow-up in a patient with benign histology but no repeat gastroscopy (1/286, 0.3%). Predictors of benign ulcers were absence of endoscopic suspicion [odds ratio (OR) 0.1 (0.03-0.13), P≤0.005], complete healing on repeat gastroscopy [OR 0.5 (0.34-0.70), P=0.036] and benign initial histology [OR 0.12 (0.43-0.90), P≤0.005]., Conclusions: Seven percent of new gastric ulcers were malignant with most identified with biopsy on initial gastroscopy. Malignancy yield from follow-up gastroscopy was 2%. Diagnostic yield of endoscopic follow-up may be low in ulcers with benign appearance and adequate histology. However, current practice of repeat gastroscopy is warranted in the absence of patient-based and lesion-based predictors of malignancy., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Enteric fever is a systemic disease caused by Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi, characterized by high fever and abdominal pain. Most patients with enteric fever improve within a few days after antibiotic treatment. However, some patients do not recover as easily and develop fatal life-threatening complications, including intestinal hemorrhage. Lower gastrointestinal bleeding has been reported in 10% of cases. However, upper gastrointestinal bleeding has rarely been reported in patients with enteric fever. We present a case of gastric ulcer hemorrhage caused by enteric fever., Case Presentation: A 32-year-old woman, complaining of fever lasting four days and right upper quadrant pain and melena that started one day before admission, consulted our hospital. Abdominal computed tomography revealed mild hepatomegaly and gastroscopy revealed multiple active gastric ulcers with flat black hemorrhagic spots. The melena of the patient stopped on the third day. On the fifth admission day, she developed hematochezia. At that time, Salmonella enterica serovar Typhi was isolated from the blood culture. The antibiotic regimen was switched to ceftriaxone. Her hematochezia spontaneously resolved the following day. Finally, the patient was discharged on the 12th admission day without clinical symptoms. However, her fever recurred one month after discharge, and she was readmitted and Salmonella enterica serovar Typhi was confirmed again via blood culture. She was treated with ceftriaxone for one month, and was discharged without complications., Conclusion: Our case showed that although rare, active gastric ulcers can develop in patients with enteric fever. Therefore, upper and lower gastrointestinal bleeding should be suspected in patients with enteric fever, especially showing relapsing bacteremia., (© 2022. The Author(s).)

Objective: To improve the safety and reliability of gastric ulcer treatment, the emergence of digestive endoscopy technology in recent years has become a conventional method for the diagnosis of peptic ulcer bleeding. Endoscopic characteristics can judge the severity of patients more accurately and comprehensively, provide a basis for follow-up treatment, and judge the prognosis., Methods: 298 patients with a suspected gastric ulcer who underwent laryngeal gastroduodenal endoscopy and confirmed gastroduodenal ulcer in our hospital in recent half a year were randomly selected. Olympus cv-170 electronic gastroscope machine was used to carry out gastroscopy for patients with gastric ulcers, analyze, and judge the number of bleeding cases in different stages of treatment, such as lesion type, lesion location, patient age, and gender. The statistics of bleeding cycle and bleeding volume, prognosis recovery, and the correlation of different risk levels were analyzed., Results: After examination and diagnosis, the patients were followed up for one year. According to the number of bleeding cases, bleeding cycle, and bleeding volume of patients with different ulcer locations in the acute stage, healing stage, and scar stage, the distribution of bleeding cases of different ulcer locations in different stages was roughly the same, and there was no significant difference. The proportion of bleeding cases in the acute stage was the highest, while the proportion in the healing stage was the lowest. The number of bleeding cases, bleeding cycle, bleeding volume, and related symptoms in patients with gastric ulcers during the treatment were significantly correlated with those in the acute stage, healing stage, and scar stage. There was no significant difference in the distribution of bleeding in one year among different stages of ulcer in the same age group, however, the bleeding in one year would be more serious with the increase of age in different age groups. Gender differences have a great impact on the bleeding of the ulcer within one year. It usually shows that the bleeding of ulcers in males is more serious than that in females., Conclusion: The location and pathological development of gastric ulcers can be found in time through gastroscopy, and the status of gastroscopy can be analyzed. Most gastric ulcers are acute bleeding. The amount of bleeding has little correlation with the stage of gastric ulcer, and it is related to the location of bleeding. The older the age, the greater the amount of bleeding, and the amount of bleeding in men is greater than that in women. In the treatment of gastric ulcers, gastroscopy, as a doctor's examination and treatment method, effectively improves the safety and reliability of clinical treatment of gastric ulcer bleeding and reduces the adverse risk., Competing Interests: The authors declare no conflicts of interest ., (Copyright © 2022 He Xiaohua.)

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Reparative perineural hyperplasia is an incidental and probably underreported reactive histologic finding thus far only reported in the setting of healing wounds or adjacent to a dermatofibroma in cutaneous specimens. It is characterized by a focal concentric proliferation of cytologically bland spindled perineurial cells and is hence considered a benign histologic mimic of neoplastic perineural invasion. Thus, it may present a diagnostic pitfall and we therefore consider it as a valuable entity to be aware of. To the best of our knowledge, this brief case report is the first to convey that reparative perineural hyperplasia may also occur in the gastrointestinal tract. It may therefore be a ubiquitous reactive histological phenomenon relating to previous surgical or traumatic wounds in various sites, that is, outside the thus far established setting of skin reexcision specimens.

Gastropleural fistula (GPF) is a pathological communication between stomach and pleural cavity. GPF is described rarely in adults following bariatric surgery, iatrogenic perforations, complicated empyema thoracis, penetrating chest trauma, perforated malignant gastric ulcers, and invasive tumors. GPF in children is extremely rare. The authors describe a female child with leukemia, who presented with left-sided pneumonia and chylothorax. After a delay of around 3 wk she was diagnosed with GPF, which was due to a perforated gastric ulcer induced by high-dose steroids which she was receiving as chemotherapy. She was managed with repair of GPF and had a favorable outcome., (© 2021. Dr. K C Chaudhuri Foundation.)

Primary hyperparathyroidism is characterised by autonomous production of parathyroid hormone resulting in hypercalcaemia. It is estimated that 12% of these patients present with peptic ulcer-related symptoms. The pathophysiological mechanism is not well established, but studies reveal serum calcium activating gastrin cell calcium receptors ultimately resulting in increased gastric acid production leading to peptic ulcer disease. A patient presented acutely to our service with peptic ulcer perforation in the context of incidentally elevated serum calcium levels. Further inpatient investigations lead to the diagnosis of primary hyperparathyroidism as the first manifestation of this patient's disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: currently, the non-steroid anti-inflammatory drugs constitute a veritable object of auto medication throughout the world. The goal of this study was to evaluate the endoscopic and clinical aspects of gastro-duodenal ulcer secondary to taking of non-steroid anti-inflammatory of various sources., Methods: this was a cross-sectional study which was conducted between July 2016 and December 2017. All adult patients admitted to hospital for clinical symptoms suggestive of gastroduodenal involvement after taking anti-inflammatory drugs and having undergone upper digestive endoscopy were included in this study. Data analysis was done with Epi-info version 7 Software., Results: a total of 114 patients were included, the mean age was 47.18±26 years with a male predominance (64.9%). Among the patients, only 1.75% had taken a non-steroid anti-inflammatory (NSAIDs) from pharmacy. The NSAIDs used were of different types: diclofenac, aceclofenac, aspirin and non-selective NSAIDs. For each drug used, more than half were derived from the streets. Clinically we noted: the dyspepsia (38.58%), hemorrhages (11.40%), the ulcerous syndrome (77.19%), haematemesis (19.29%), haematemesis associated with melena (37.71%), and the rectorrhagia in 6.14 of cases. The specific endoscopic lesions were bulbar ulcer (45.61%), gastric ulcers (20.17%), antral ulcerations (5.26%) and acute gastritis (9.64%), esophagitis (7.89%), esophageal varices (6.14%), and uncomplicated hiatal hernia in 7.01% of cases., Conclusion: the serious gastroduodenal lesions observed in this study and due to use of NSAIDs are mainly attributable to unauthorized molecules due to safety concerns. It would be necessary to conduct sensitization days at the community level and in each health facility., Competing Interests: The authors declare no competing interests., (Copyright: Oumar Traoré et al.)

BACKGROUND Cameron lesions are linear erosions and ulcers on the crests of gastric mucosal folds in the neck of a hiatal hernia and can be difficult to diagnose and treat. This report is of a case of chronic iron deficiency in a 61-year-old woman with a late diagnosis of a Cameron lesion, who did not respond to a single treatment with the proton pump inhibitor (PPI) pantoprazole, but was then treated with oral poloxamer 407 with hyaluronic acid and chondroitin sulfate in addition to PPI. CASE REPORT We report the case of a 61-year-old women with recurrent iron-deficiency anemia, first diagnosed 40 years prior to her presentation at our Endoscopy Unit, and an ongoing melena. We discovered an intrahiatal gastric mucosal defect, which we at first treated with proton pump inhibitors and sucralfate. After a follow-up gastroscopy revealed the persistence of the lesion, we decided to incorporate into the treatment a gel-like substance containing, among others, hyaluronic acid and chondroitin sulfate, and observed that the lesion resolved completely. CONCLUSIONS This report highlights that Cameron lesions should be considered in patients with hiatal hernia who have iron-deficiency anemia and can be diagnosed on upper endoscopy. Further clinical studies are required to determine the role of combined poloxamer 407 with hyaluronic acid and chondroitin sulfate in the management of Cameron lesions.

Background: Grading of equine gastric ulcer syndrome (EGUS) is undertaken in clinical and research settings, but the reliability of EGUS grading systems is poorly understood., Hypothesis/objectives: Investigate interobserver and intraobserver reliability of an established ordinal grading system and a novel visual analog scale (VAS), and assess the influence of observer experience., Animals: Sixty deidentified gastroscopy videos., Methods: Six observers (3 specialists and 3 residents) graded videos using the EGUS Council (EGUC) system and VAS. Observers graded the videos three 3 for each system, using a cross-over design with at least 1 week between each phase. The order of videos was randomized for each phase., Methods: Interobserver and intraobserver reliability were estimated using Gwet's agreement coefficient with ordinal weights applied (AC2) for the EGUC system and the intraclass correlation coefficient (ICC) for the VAS., Results: Using the EGUC system, interobserver reliability was substantial for squamous (AC2 = 0.69; 95% confidence interval [CI], 0.57-0.80) and glandular mucosa (AC2 = 0.72; 95% CI, 0.70-0.75), and intraobserver reliability was substantial for squamous (AC2 = 0.80; 95% CI, 0.71-0.90) and glandular mucosa (AC2 = 0.80; 95% CI, 0.74-0.86). Interobserver reliability using the VAS was moderate for squamous (ICC = 0.64; 95% CI, 0.31-0.96) and poor for glandular mucosa (ICC = 0.35; 95% CI, 0.06-0.64), and intraobserver reliability was moderate for squamous (ICC = 0.74; 95% CI, 0.62-0.86) and glandular mucosa (ICC = 0.56; 95% CI, 0.39-0.72)., Conclusions and Clinical Importance: The EGUC system had acceptable intraobserver and interobserver reliability and performed well regardless of observer experience. Familiarity and observer experience improved reliability of the VAS., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)

Introduction: The incidence of peptic ulcer disease decreased due to proton pump inhibitors and Helicobacter pylori eradication. Bleeding from peptic ulcer decreased, as well, although perforation did not decrease and it is permanently between 2–10%. This is a potential surgical emergency, the mortality can reach up to 25% and the morbidity 50%, respectively. Urgent surgical intervention in the right time can improve the results. Aim: To compare the morbidity, mortality, the length of hospital stay and duration of operating time in open and laparoscopic repair of perforated peptic ulcer. Results: A cohort of 55 patients were operated on with perforated peptic ulcer from 01.01.2017 to 30.06.2019 31 open (51.36%) and 24 laparoscopic (43.63%) operations were performed from which 4 (16.6%) needed conversion to open approach. The average age of 23 men and 8 women were 56.3 and 70.3 years respectively in the open operations group, while 13 men and 11 women with average age of 49.7 and 53.7 years was in the laparoscopic operations group. Within 30 days the number of complications were 5 in the open and 2 in the laparoscopic group (p = 0.45). The average duration of operation was 51.95 minutes (30–85) in the open and 63.41 minutes (25–110) in the laparoscopic group (p = 0.13). 6 from the open group with average age of 74.3 years and 2 from the laparoscopic group with average age of 68.5 years died within 30 days (p = 0.44). The average length of stay was 7.13 (5–16) days in the open and 6.19 (4–13) days in the laparoscopic group (p = 0.24). The average size of the perforation was 7.4 mm (3–20) in the open and 5.3 mm (3–10) in the laparoscopic group (p = 0.14). Free air was seen in the abdominal cavity in 25 cases (80%) of the open and in 11 cases (54%) of the laparoscopic group. Conclusion: Early diagnosis, prompt supportive care and antibiotic treatment and urgent surgical intervention are essential to improve outcomes. The standard operation is the simple suture with pedicled omental flap which can be performed by either open or laparoscopic surgical repair. Laparoscopic method spreads slowly, the learning curve is longer and it needs more expertise but the morbidity is lower than that of the open surgery. The morbidity does not increase after conversion according to the literature so if there is no contraindication and there is enough expertise it should be suggested as the first choice.

Introduction: Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate., Methods: We reviewed the records of consecutive 211,347 general population subjects from 1991 to 2015., Results: During the 25 years, the prevalence of GU and DU has gradually decreased (from 3.0% to 0.3% and from 2.0% to 0.3%) whereas that of RE has markedly increased (from 2.0% to 22%). The prevalence of Helicobacter pylori (HP) infection has decreased from 49.8% (in 1996) to 31.2% (in 2010). Multivariable logistic regression analyses demonstrated that HP infection was positively associated with GU/DU and negatively associated with RE with statistical significance. The panel data analyses showed that reduced rate of HP infection is proportionally correlated with decrease of GU/DU and inversely correlated with increase of RE. It is further suggested other latent factors should be important for changed prevalence of these three acid-related diseases. Age-period-cohort analysis indicated the significant association of older age, male gender, and absence of HP infection with RE., Conclusions: The prevalence of GU and DU has gradually decreased whereas that of RE has markedly increased in Japan. Inverse time trends of peptic ulcer and reflux esophagitis are significantly associated with reduced prevalence of HP infection. KEY MESSAGES The prevalence of gastric and duodenal ulcer has gradually decreased whereas that of reflux esophagitis has markedly increased in Japan. The prevalence of Helicobacter pylori infection in Japan has greatly decreased from 49.8% to 31.2% during the 14 years (from 1996 to 2010). Inverse time trends of peptic ulcer and reflux esophagitis are associated with reduced prevalence of Helicobacter pylori infection with statistical significance.

Objective:  To explore the predictive value of serum gastrin (GAS), epidermal growth factor (EGF) levels in gastric ulcer complicated with acute upper gastrointestinal bleeding., Study Design: A descriptive study., Place and Duration of Study: Department of Emergency, Beijing Jiangong Hospital, China, from January 2019 to June 2020., Methodology: One hundred and twenty-five patients with gastric ulcer and acute upper gastrointestinal bleeding were selected as Group A. One hundred and twenty-five patients with gastric ulcer and no upper gastrointestinal bleeding were selected as Group B. Logistic regression analysis was used to analyse the risk factors of gastric ulcer complicated with acute upper gastrointestinal bleeding. The value of serum GAS, EGF in early diagnosis of gastric ulcer with upper gastrointestinal bleeding was evaluated by receiver operating characteristic (ROC) curve., Results: Univariate analysis showed statistically significant differences between Group A and Group B in taking non-steroidal anti-inflammatory drugs (NSAIDs), helicobacter pylori (Hp) infection, serum GAS and EGF (all p <0.001). Logistic regression analysis showed that raised serum GAS and serum EGF were independent risk factors for gastric ulcer and upper gastrointestinal bleeding (both p <0.001). The ROC area of serum EGF to predict gastric ulcer and acute upper gastrointestinal bleeding was 0.810 (95% CI: 0.753-0.867, p <0.001), greater than ROC area of serum GAS. At serum EGF of ≤109.95 pg/mL, had the 84.8%, sensitivity to predict gastric ulcer and acute upper gastrointestinal bleeding with specificity of 68.8%., Conclusion: The predictive value of serum GAS and EGF is high for gastric ulcer complicated with acute upper gastrointestinal bleeding; the predictive value of serum EGF is greater than that of serum GAS. Key Words: Gastric ulcer, Acute upper gastrointestinal bleeding, Serum, Gastrin (GAS), Epidermal growth factor (EGF), Logistic regression, Receiver operating characteristic (ROC) curve.

This case presents an unusually late complication of oesophagectomy 20-years post-surgery, with upper gastrointestinal bleeding. Further investigation revealed a gastric conduit ulcer eroding into the lower lobe of the right lung, forming a fistula with a basal branch of the right pulmonary artery. Upon successful embolisation, the HydroCoil ® was visible on endoscopy. This case highlights the need for lifetime proton pump inhibitor cover post-oesophagectomy and demonstrates that when approaching uncommon presentations of common problems, careful consideration to treatment technique is essential.

A 26-year-old man was admitted to our hospital due to upper abdominal pain. He had previously been diagnosed with gastroduodenal ulcer at 23 and 25 years old and had been treated with proton-pump inhibitors. Endoscopic hemostasis and a biopsy were performed on the hemorrhagic gastroduodenal ulcers. Laboratory and pathologic examinations demonstrated elevated serum IgG4 levels and the infiltration of IgG4-positive plasma cells into the gastroduodenal tissues. Based on the clinicopathologic findings and after excluding other causes, he was diagnosed with IgG4-related gastroduodenal ulcer. We herein report a rare case of IgG4-related disease manifesting as a gastroduodenal ulcer diagnosed by an endoscopic biopsy.

Background: Clinical signs of traumatic reticuloperitonitis and abomasal ulcer are often similar making the disorders difficult to differentiate. The goal of our study was to compare the frequency of individual clinical signs of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine their diagnostic significance. The frequency of the findings "rectal temperature, heart rate, respiratory rate, demeanour, signs of colic, arched back, abdominal guarding, bruxism, scleral vessels, rumen motility, foreign body tests, percussion auscultation, swinging auscultation and faecal colour" of cows with traumatic reticuloperitonitis (TRP, n = 503) and cows with type 1 (U1, n = 94), type 2 (U2, n = 145), type 3 (U3, n = 60), type 4 (U4, n = 87) and type 5 (U5, n = 14) abomasal ulcer were compared, and the reliability indices "diagnostic sensitivity and specificity, positive and negative predictive values and positive likelihood ratio" were calculated. A total of 182 healthy cows served as controls (control group)., Results: None of the cows in the control group had colic, rumen atony or melena, 99% had no abnormalities in demeanor and appetite and did not have a rectal temperature of ≤38.6 or >  40.0 °C, a heart rate >  100 bpm or a respiratory rate >  55 breaths per min, and 95% did not have an arched back or bruxism. The control group was therefore ideal for comparative purposes. Many signs such as mild increase in rectal temperature, scleral congestion and positive foreign body test were non-diagnostic because they occurred in healthy as well as in ill cows. Likewise, differentiation of cows with TRP and abomasal ulcer was not possible based on single clinical variables; a detailed history and a comprehensive assessment of all clinical findings were required for this., Conclusions: The findings of the present study serve as a guide for the veterinarian in the differentiation of cows with traumatic reticuloperitonitis and abomasal ulcer.