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Background/Aim: Gastric cancer and its precancerous lesions represent a significant public health concern. A subset of gastric cancers exhibits mutations in the TP53 gene, often accompanying distinctive morphologic alterations. This study aimed to assess the diagnostic efficacy of p53 immunostaining in real-world clinical settings. Patients and Methods: A retrospective analysis was conducted on 50 cases of gastric tumors and tumor-like lesions, wherein p53 immunostaining played a pivotal diagnostic role. The staining pattern of p53 was examined in conjunction with clinicopathologic parameters. Results: Mutant p53 staining pattern demonstrated a significant association with high-grade nuclear atypia (p<0.001), highgrade dysplasia, and tubular adenocarcinoma (p<0.001), as well as microsatellite instability status (p=0.034). Furthermore, the diagnostic utility of p53 immunostaining was evident in scenarios where: 1) biopsy specimens contained few tumor cells, 2) pathologic evaluation of resection margins was limited by cauterization artifacts, and 3) distinction between low-grade and high-grade gastric dysplasia was challenging. Conclusion: P53 immunostaining can be helpful for the diagnosis of gastric tumor and tumorlike lesions, and accurate pathologic margin evaluation, particularly in lesions demonstrating intestinal-type differentiation and some degree of nuclear atypia. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this study, it was aimed to retrospectively investigate the presence of H. pylori with Modified Giemsa and Hematoxylin & Eosin in gastric antrum biopsy samples of patients who applied to Ordu University hospital with dyspeptic complaints. Also, cross-sections were stained with Giemsa, Wright's eosin methylene blue and modified Giemsa dyes to compare their effectiveness in diagnosis. The population of the study consisted of 2679 gastric biopsy samples sent to the pathology laboratory between 2014 and 2018. Gastric biopsy samples were screened, and samples stained with Hematoxylin & Eosin, Giemsa and Periodic Acid Schift (PAS) were re-examined for H. pylori In the microscopic examination, the samples were also evaluated in terms of intestinal metaplasia, activation and atrophy. In the study, 37 negative, 31 mildly positive, 31 moderately positive and 31 severely positive samples were randomly selected, in addition to routine staining methods. Selected samples were re-sectioned, stained with Giemsa and Wright's eosin dye, and Mayg Grunwald-Giemsa (MGG) dye, Giemsa and Wright's eosin methods were compared. A total of 2679 patients, 49.15% male and 50.85% female, were included in the study. The mean age of patients aged 17-93 was 50.42±15.32. H. pylori positivity was found to be 46.8% in the study. It was determined in the study that there was a significant association between H. pylori severity and inflammation (p<0.01). The increase in H. pylori severity also increased the incidence of activation positivity. The ratio of atrophic patients (56.4%) was higher in patients with severe H. pylori positivity (43.6%). Conclusion: It was observed that the incidence of the bacterium was high in Ordu province, and it was suggested that the public should be informed about the transmission and prevention ways of H. pylori. Moreover, since similar results were obtained with the staining methods applied in the study, it was concluded that Giemsa and Wright's eosin dyes can be used because they are easy and cheap to diagnose. [ABSTRACT FROM AUTHOR]

Introduction: Lymphoid aggregates (LA) in gastric biopsies have traditionally been linked to Helicobacter pylori (HP) gastritis and other inflammatory and neoplastic conditions. In the literature review on this subject, it is seen that the studies are limited and the number of patients in the studies is low. The aim of this study was to evaluate the relationship between the incidence of LA and patient's age, gender, HP, and other gastric mucosal pathologies in pathological examinations of gastric mucosal biopsies in a large series. Materials and Methods: Endoscopic gastric mucosal biopsies taken from 1427 adult patients due to dyspeptic complaints were evaluated in terms of the relationship of LA with age, gender, HP, inflammation, gastric activity, and intestinal metaplasia (IM). Results: LA was associated with HP positivity, age, inflammation, activity, and IM. No relationship was found with gender. Conclusion: In our study, relatively young age, HP, and presence of inflammation were independent risk factors for lymphoid aggregates. [ABSTRACT FROM AUTHOR]

Introduction: ABO blood group, a genetically determined trait for Helicobacter pylori, has been considered as a potential risk factor. Blood groups have also been investigated as a risk factor for H. pylori-related stomach cancer. This study aimed to investigate the relationship between the ABO blood types and H. pylori positivity, H. pylori-related premalignant gastric lesions, age, and gender in people in the present region. Materials and Methods: Patients who went through endoscopy for various complaints, from whom biopsy was taken during the process, and who knew their blood type were included in the study. The demographic characteristics of the patients, their blood groups, and their place of residence were recorded. H. pylori positivity and premalignant gastric lesion conditions were determined by evaluating the pathology results. Results: A total of 160 patients, 81 (51%) of whom were female and 79 (49%) of whom were male, were included in the study. H. pylori positivity was found to be 59.2% in women and 37.9% in men, and the difference was statistically significant (P < 0.05). The blood group of 69 of the patients (43%) were A, 53 of the patients (33%) were 0, 29 of the patients (18%) were B, and nine of the patients (6%) were AB. There was no statistically significant difference between H. pylori positivity and ABO blood groups. The relationship between premalignant gastric lesions and blood groups was not statistically significant. Conclusion: This study showed that there was no significant relationship between ABO blood groups and H. pylori positivity and premalignant gastric lesions, while age and gender were important in H. pylori positivity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Several US subgroups have increased risk of gastric cancer and gastric intestinal metaplasia (GIM) and may benefit from targeted screening. We evaluated demographic and clinical risk factors for GIM and examined the interaction between race/ethnicity and birthplace on GIM risk. METHODS: We identified patients who had undergone esophagogastroduodenoscopy with gastric biopsy from 3/2006-11/2016 using the pathology database at a safety net hospital in Houston, Texas. Cases had GIM on >=1 gastric biopsy histopathology, whereas controls lacked GIM on any biopsy. We estimated odds ratios and 95% confidence intervals (CI) for associations with GIM risk using logistic regression and developed a risk prediction model of GIM risk. We additionally examined for associations using a composite variable combining race/ethnicity and birthplace. RESULTS: Among 267 cases with GIM and 1,842 controls, older age (vs <40 years: 40-60 years adjusted odds ratios (adjORs) 2.02; 95% CI 1.17-3.29; >60 years adjOR 4.58; 95% CI 2.61-8.03), Black race (vs non-Hispanic White: adjOR 2.17; 95% CI 1.31-3.62), Asian race (adjOR 2.83; 95% CI 1.27-6.29), and current smoking status (adjOR 2.04; 95% CI 1.39-3.00) were independently associated with increased GIM risk. Although non-US-born Hispanics had higher risk of GIM (vs non-Hispanic White: adjOR 2.10; 95% CI 1.28-3.45), we found no elevated risk for US-born Hispanics (adjOR 1.13; 95% CI 0.57-2.23). The risk prediction model had area under the receiver operating characteristic of 0.673 (95% CI 0.636-0.710) for discriminating GIM. DISCUSSION: We found that Hispanics born outside the United States were at increased risk of GIM, whereas Hispanics born in the United States were not, independent of Helicobacter pylori infection. Birthplace may be more informative than race/ethnicity when determining GIM risk among US populations. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence of Helicobacter pylori (H. pylori) and related histopathological lesions in gastric mucosa samples in this single-center study. Methods: Esophagogastroduodenoscopy and endoscopic biopsy reports of 1605 elective cases were retrospectively evaluated. Histopathological examination was evaluated according to the Sydney classification. The data were analyzed according to the prevalence of H. pylori, age, gender, gastric atrophy and intestinal metaplasia rates, and the distribution of the study group in the population below 40 years old and over 40 years old. Results: 584 males (Mean age 51.5 ± 16.5 years) and 1021 females (mean age 49.6 ± 16 years), (p = 0.03), a total of 1605 cases were included in the study. The rate of atrophy, metaplasia and H. pylori positivity in total study population were 0.2%, 16%, 71%, respectively. The rate of atrophy in men and women were 1.2% and 0.8%, respectively (p = 0.006). The rate of metaplasia in men and women were 20.9% and 13.7%, respectively (p <0.001). In the population under 40 years of age, the rates of gastric atrophy and intestinal metaplasia were 0.7% and 2.5%, respectively (p = 0.02), above the age of 40, these rates were determined as 10.8% and 18.4%, respectively. (p <0.001). Conclusion: According to the data of our center, the prevalence of H. pylori is high. In addition, the rate of intestinal metaplasia is relatively high in the male population over the age of 40. [ABSTRACT FROM AUTHOR]

Background/aim: Gastric cancer and its precancerous lesions represent a significant public health concern. A subset of gastric cancers exhibits mutations in the TP53 gene, often accompanying distinctive morphologic alterations. This study aimed to assess the diagnostic efficacy of p53 immunostaining in real-world clinical settings., Patients and Methods: A retrospective analysis was conducted on 50 cases of gastric tumors and tumor-like lesions, wherein p53 immunostaining played a pivotal diagnostic role. The staining pattern of p53 was examined in conjunction with clinicopathologic parameters., Results: Mutant p53 staining pattern demonstrated a significant association with high-grade nuclear atypia (p<0.001), high-grade dysplasia, and tubular adenocarcinoma (p<0.001), as well as microsatellite instability status (p=0.034). Furthermore, the diagnostic utility of p53 immunostaining was evident in scenarios where: 1) biopsy specimens contained few tumor cells, 2) pathologic evaluation of resection margins was limited by cauterization artifacts, and 3) distinction between low-grade and high-grade gastric dysplasia was challenging., Conclusion: P53 immunostaining can be helpful for the diagnosis of gastric tumor and tumor-like lesions, and accurate pathologic margin evaluation, particularly in lesions demonstrating intestinal-type differentiation and some degree of nuclear atypia., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Upper gastrointestinal endoscopy is a common procedure done for suspected cases of gastric malignancies. Histopathological examination of gastric tissue has been a gold standard for the diagnosis. Imprint smears of the gastric biopsy specimen is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of gastric biopsy imprint cytology as compared to the histopathology. Materials and Methods: Imprint smears were made from all cases of gastric biopsy specimens taken from suspected cases of gastric malignancies. They were evaluated by three pathologists and categorized in to negative for malignancy, suspicious of malignancy and positive for malignancy. The diagnosis given by imprint smears was compared with histopathology. With the help of sensitivity, specificity & accuracy and Kappa score, the agreement between the imprint smear and histopathology was determined. Results: Among the total 79 cases, 49 cases were chronic non specific gastritis and 22 were adenocarcinoma. The sensitivity, specificity, and overall accuracy of gastric biopsy imprint smear were 92.0%, 98.11% and 94.93% respectively. Kappa core was 0.88. Conclusions: The gastric biopsy imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of gastric malignancies.

INTRODUCTION: American Indian and Alaska Native (AI/AN) populations have higher gastric cancer rates than the general US population. This study provides a comprehensive overview of incidence rates among AI/AN persons during 2005-2016 compared with non-Hispanic whites (whites). METHODS: Population-based cancer registry data for 2005-2016 were linked with the Indian Health Service patient registration databases to address racial misclassification. Age-adjusted gastric cancer incidence rates were expressed per 100,000 per year. Incidence and trend analyses were restricted to purchased/referred care delivery area counties in 6 geographic regions, comparing gastric cancer incidence rates for AI/AN vs white populations in the United States. RESULTS: Gastric cancer rates were higher in the AI/AN compared with white populations in nearly every US region. Incidence rates for central/distal portions of the stomach were higher in AI/AN individuals compared with whites. Rates of later stage gastric cancer were higher in AI/AN populations overall and in every region except the Pacific Coast and East. Incidence rates decreased significantly over time in both populations. Declining rates in the AI/AN populations were driven by changes in the Pacific Coast and Northern Plains regions. DISCUSSION: AI/AN populations have a disproportionately high incidence of gastric cancer, especially in Alaska. High incidence in the central/distal portions of the stomach among AI/AN populations likely reflects a high prevalence of Helicobacter pylori infection in these populations. These data can be used to develop interventions to reduce risk factors and improve access to health services among AI/AN people at high risk for gastric cancer. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Clinical & Experimental Medicine is the property of Archives of Clinical & Experimental Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Helicobacter pylori Infections are associated with different gastric disorders. Also, the infection of H. pylori is related with some virulence factors genes that can be used in molecular diagnoses. One hundred patients biopsy of dyspepsia that advised by the physician to have clinical indications for an endoscopy in the gastrointestinal clinic of the hospitals. Only ten biopsies (10%) produce positive cultures for H. pylori. the majority positive cases (60%) were male and (40%) were female. the aged distribution for positive cases were mostly between 25-35 years old. Out of the 10 DNA extracts isolated from gastric biopsies, the prevalence of genes were 10 (100%), 7 (70%), 5 (50%) and 7 (70%) for a region of 16S rRNA gene, IceA1 gene, G1mM gene and IceA2 gene of H. pylori were amplified by PCR. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is known to interfere with gastric acid secretion. One of the most potent gastrointestinal hormones in triggering gastric acid secretion is gastrin. However, the role of Helicobacter pylori in increasing serum gastrin levels remains controversial. Objective: To determine the relationship between Helicobacter pylori infection with serum gastrin-17 levels in dyspepsia patients in the Endoscopic Unit Department of Internal Medicine, Dr. Soetomo General Hospital Surabaya. Methods: This study used a cross-sectional method that enrolled thirty of dyspepsia patients underwent endoscopy and gastric biopsy in the endoscopic unit of the Department of Internal Medicine Dr. Soetomo General Hospital Surabaya. The patients were divided into two groups, i.e., fifteen patients infected with Helicobacter pylori and not. Determination of Helicobacter pylori infection was using histopathological examination. In the other hands, gastrin-17 fasting serum levels were measured by ELISA method. results: The results showed median of gastrin-17 serum levels in the H. pylori-infected group {3.97 (0.54-19.43)} were higher than the uninfected group {1.28 (0.62- 2.71)}. From the statistical test, there was a significant difference between the two groups (p = 0.002) with the mediumvalue relationship between Helicobacter pylori infection and gastrin-17 serum levels (η = 0.478). conclusion: There was a relationship between Helicobacter pylori infection with increased of gastrin-17 serum levels in dyspeptic patients. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of Helicobacter Pylori (HP) is up to 90% in developing countries, whereas it is less than 40% in developed countries. This study aims to determine the prevalence of HP in Van city and its region and to investigate the relationship between the presence of HP and the clinical, endoscopic appearance Material and Methods: A total of 367 cases that presented with the dyspeptic complaints to the Gastroenterology outpatient-clinic and underwent upper-gastrointestinal endoscopy and gastric biopsies between July/2017-March/2019 were included in the study. The patients included in the study were divided into three age-groups (1-5 years, 6-10 years, 11-18 years). The clinical complaints, endoscopic findings were recorded in all patients. The relationship between HP positivity and clinical complaints, the endoscopic appearance was analyzed. Results: The presence of HP was found in 234(63.8%) patients. However, the incidence of HP was 63.8% in all patients; it was found 34.6% between 1-5 years, 61.8% between 6-10 years, and 71.2% between 11-18 years, respectively. The duodenal ulcer was found in 8.5%(20/234) of HP positive cases, and 3.5%(5/133) of HP negative cases. In predicting the presence of HP, the ulcer specificity was determined 96%, the sensitivity was 8.5%, the positive predictive value was 80%, and the negative predictive value was found 37.4% Conclusion: HP should be considered in patients with recurrent and chronic abdominal pain. Endoscopic appearance of nodular antral gastritis and the ulcer should suggest HP infection. The high rate of activity and chronicity in HP positive cases indicates the importance of HP eradication therapy. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is to compare distal oesophagus of persons with and without gastric reflux in terms of bacterial load and presence of certain bacterial species. Methods and Results: Two biopsy specimens were obtained from the distal oesophagus at 5 cm above the gastroesophageal junction of each of the 50 patients (20 with normal oesophagus and 30 with reflux oesophagitis) under endoscopic examination and used for histological examination and DNA isolation. We used a real‐time PCR‐based assay to quantify the bacterial load and the presence of certain bacterial species from one of the biopsy samples. The biopsy specimens taken from the patients with reflux oesophagitis were consistent with gastroesophageal reflux disease (GERD). The bacterial load did not significantly differ between the groups (P < 0·005). Conclusion: While there was no difference between the bacterial load in the two groups, variation was observed in bacterial species. Most of the bacteria identified in distal oesophagus of the patients with gastroesophageal reflux were Gram negative. Significance and Impact of the Study: The human oesophagus was considered sterile until quite recently. Molecular techniques displayed the presence of a diverse bacterial species in the oesophagus. Although it is known that dysbiosis in the oesophagus causes GERD, and that Barrett's oesophagus can trigger the development of oesophageal adenocarcinoma, its etiopathogenesis is not clear. A limited number of published studies support the importance of the present study. [ABSTRACT FROM AUTHOR]

Aims: There is evidence that four or five gastric cancer biopsies are required for accurate HER2 interpretation. However, the number of biopsies that need to be taken to reach this number of viable cancer biopsies is without evidence. This study aimed to address this gap by assessing the number of biopsies required to gain at least four viable biopsies containing cancer. Methods and results: A total of 105 consecutive biopsy cases of gastric and oesophageal adenocarcinoma were retrieved from files. Only definite cancer diagnoses were included; missed cancers or unproven cases were not considered. The cases were reviewed and the number of biopsies taken, and the number containing viable tumour was recorded. In total, 667 biopsies were taken, of which 471 had viable tumour (70.6%). Seventy of 105 cases (67%) had four viable tumour biopsies, but only 47 of 105 (45%) had five viable tumour biopsies. In order to have a >90% chance of having four viable tumour biopsies, seven needed to be taken, while 10 or more were required for a >90% chance of five viable tumour biopsies. Mathematically, using a 0.7 probability for a single biopsy, eight biopsies would be required for a 94% chance of at least four viable tumour biopsies. Conclusion: In our large upper GI cancer centre, many biopsy cases do not contain sufficient material for adequate HER2 assessment. In order to meet the four‐biopsy requirement for adequate HER2 assessment in >90% of cases, at least eight biopsies need to be taken, while 10 biopsies would be required for the 5‐cancer biopsy threshold. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance in Helicobacter pylori has reached alarming levels and is compromising traditional empiric treatment of H. pylori . Antimicrobial susceptibility testing is routinely performed for infectious diseases when there is a risk of resistance and is now recommended to guide therapy for H. pylori . This mini-review overviews the current diagnostics for H. pylori with a focus on tests that enable susceptibility-guided treatment, including molecular tests performed directly on stool and endoscopically collected specimens., Competing Interests: All authors are employed by Mayo Clinic. R.P. reports grants from ContraFect, TenNor Therapeutics Limited, and BIOFIRE and is a consultant to PhAST, Day Zero Diagnostics, and HealthTrackRx; monies are paid to Mayo Clinic. Mayo Clinic and R.P. have a relationship with Pathogenomix. R.P. has research supported by Adaptive Phage Therapeutics. Mayo Clinic has a royalty-bearing know-how agreement and equity in Adaptive Phage Therapeutics. R.P. is a consultant to Abbott Laboratories and CARB-X and has a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued. R.P. receives honoraria from the NBME, Up-to-Date and the Infectious Diseases Board Review Course. A.S. is a consultant to Merck & Co. The other authors have no relevant disclosures.

Objective: The aim of this retrospective study was to evaluate the application of hydro-CT using sinogram-affirmed iterative reconstruction (SAFIRE) in the diagnosis of gastric cancer. Material/Methods: Low-dose hydro-CT was performed on 30 patients with suspicion of gastric cancer in gastroscopy. The raw data were reconstructed with SAFIRE. Images were retrospectively analyzed by two experienced radiologists in tandem who were blinded to the gastroscopy results. The results of the gastric biopsy were treated as a standard of reference. We compared the diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric cancer using the chi-square test with Yates' correction. A P value of less than 0.05 was considered statistically significant. Results: The diagnosis of gastric cancer was confirmed in a histopathological examination in 25 (83.3%) patients, while in the remaining 5 cases (16.7%) benign gastric ulceration or gastritis was diagnosed. In 23 cases (92%) a correct diagnosis of gastric cancer was made in hydro-CT. The accuracy of endoscopy was at the level of 83.3%. There was no significant difference in the correctness of the diagnosis of gastric cancer in endoscopy and hydro-CT (p>0.05). For the diagnosis of gastric cancer with hydro-CT, sensitivity of 100%, specificity of 80%, a positive predictive value of 95.8%, and a negative predictive value of 100% were calculated. Conclusions: Low-dose hydro-CT using SAFIRE may be considered as a valuable diagnostic method for the diagnosis of gastric cancer, especially for patients who have contraindications to endoscopy or gastric biopsy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the relationship between the CT features of the primary-site gastric cancer and the concurrent existence or postoperative recurrence of hepatic metastasis.Materials and Methods: From January 2013 to July 2016, 125 patients with advanced gastric cancer who were evaluated by gastroscopy and contrast-enhanced CT at our institution were included. Eleven patients had hepatic metastasis at the time of diagnosis (synchronous hepatic metastasis). Five patients had hepatic recurrence after surgery (metachronous hepatic metastasis, median follow-up period of 313 days), and another 56 patients had no hepatic recurrence during follow-up period (negative hepatic metastasis, median follow-up period of 1102 days). Two radiologists independently reviewed the CT images and they determined the peak enhancement phase, and then measured the CT attenuation value of the gastric lesion for each phase. We compared the parameters of synchronous, metachronous and negative hepatic-metastasis. We calculated diagnostic performance of CT for diagnosing synchronous and metachronous hepatic metastasis.Results: The peak enhancement was significantly diff ;erent between the three groups for both readers (reader 1, p = 0.0001; reader 2, p = 0.0002). Most of the synchronous and metachronous hepatic metastasis had peak enhancement in the arterial or portal phase. The CT attenuation values of synchronous and metachronous hepatic metastasis were significantly higher than those of negative hepatic metastasis in the delayed phase according to both readers (reader 1, p = 0.0003; reader 2, p = 0.0002). In predicting synchronous hepatic metastasis using peak enhancement, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.7%, 89.3%, 57.1%, 94.3%, and 86.6% for reader 1, and 54.5%, 94.6%, 66.7%, 91.4%, and 88.1% for reader 2. In predicting metachronous hepatic metastasis, the sensitivity, specificity, PPV, NPV, and accuracy were 60.0%, 89.3%, 33.0%, 94.3%, and 86.9% for reader 1, and 40.0%, 94.6%, 40.0%, 94.6%, and 90.2% for reader 2.Conclusion: Our study showed that gastric cancer with synchronous and metachronous hepatic metastasis tends to show early enhancement with a washout pattern on contrast-enhanced CT. This feature would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Infection with Helicobacter pylori (H. pylori) causes persistent gastritis that may progress to fatal gastric cancer. The cytotoxin-associated gene A protein (CagA), encoded by the cytotoxin-associated gene A (cagA) is the main virulence factor associated with more severe clinical outcomes. It is further divided into Western-type CagA and East Asian-type CagA. The East Asian-type CagA induces more cytoskeleton changes and is more likely to be associated with gastric cancer. Aim of the study: In the current study we aimed to identify the most prevalent H. pylori cagA genotype among Egyptian patients suffering from dyspepsia and to examine its possible correlation with the associated clinical condition. Patients and methods: Four biopsies were obtained from the antrum and angularis from each of 113 adult patients, who underwent upper endoscopy at the Endoscopy Unit, Theodor Bilharz Research Institute (TBRI) Hospital for the analysis of H. pylori by rapid urease test and detection of 16S rRNA. Nested PCR assay was used to determine cagA genotype. Results: Sixty (53.1%) dyspeptic patients were found infected with H. pylori. Although Egypt has a high prevalence of H. pylori infection, low prevalence of cagA was detected (26.5%). Western type cagA is the predominant type (62.5%) while East Asian type was not detected and others (37.5%) remain uncharacterized. Western-genotype cagA genotype was found in 80% of patients with peptic ulcer disease and 40% of patients with gastritis. Conclusion: Absence of the more virulent East Asian cagA genotype, which is the strongest risk factor for gastric carcinogenesis, may explain the very low gastric cancer rate among Egyptian population compared to other parts of the world. This finding demands further molecular studies using whole genome sequencing and more samples to determine the exact uncharacterized cagA genotype to identify the actual risk in developing gastroduodenal diseases in Egypt. [ABSTRACT FROM AUTHOR]

OBJECTIVES Histological discrepancies between biopsy and resection specimens are common. In this study, we aimed to analyze the risk factors predicting histological upgrade or downgrade of biopsy‐diagnosed gastric low‐grade dysplasia (LGD). METHODS: The medical records of patients with 104 biopsy‐diagnosed gastric LGD from January 2011 to December 2017 were collected. The association of endoscopic characteristics with histological discrepancies between the biopsy and resection specimens was analyzed. The risk factors for histological upgrade were studied using the multivariate analysis. RESULTS: Among the 104 lesions, 88 were removed by endoscopic resection and 16 were monitored. The upgrade and downgrade rates of the pathological diagnosis were 48.9% and 12.5%, respectively. Lesion size >20 mm, surface redness and positive results in magnifying endoscopy with narrow band imaging (ME‐NBI) were risk factors for histological upgrade. Compared with the negative ME‐NBI group, the positive ME‐NBI group had a higher upgrade rate (56.8% vs 7.1%) but a lower downgrade rate (2.7% vs 64.3%). In addition, 11 of the 16 the gastric LGD with negative ME‐NBI findings were monitored, and all 11 lesions regressed to gastritis during follow‐up. CONCLUSIONS: Endoscopic resection should be recommended in cases of LGD showing surface redness, with a lesion size of >20 mm or positive ME‐NBI result, whereas regular follow‐up may be an option for LGD with negative ME‐NBI result. [ABSTRACT FROM AUTHOR]

Abstract: Background: Infections with gastric Helicobacter spp. are associated with gastritis, peptic ulceration, and malignancies. Helicobacter pylori is the most prevalent Helicobacter species colonizing the human stomach. Other gastric non‐H. pylori helicobacters (NHPHs) have been described in 0.2%‐6% of human patients with gastric disorders. Nevertheless, due to difficulties in the diagnosis of NHPH infections and lack of routine screening, this is most likely an underestimation of their true prevalence. To the best of our knowledge, no studies have been performed in the presence of Helicobacter spp. in children suffering from gastric disorders in Southern Turkey. Materials and methods: In total, 110 children with gastric complaints were examined at the Cukurova University Balcali hospital, Turkey. Gastroscopy was performed to evaluate the presence of gastric mucosal lesions. Biopsies of the pyloric gland zone were taken for histopathological analysis, rapid urease testing, and presence of Helicobacter spp. DNA by PCR. Results: Based on the PCR results, the prevalence of Helicobacter spp. was 32.7% (36/110). H. pylori was found in 30.9% (34/110), H. suis in 1.8% (2/110), and H. heilmannii/H. ailurogastricus in 0.9% (1/110) of the human patients. A mixed infection with H. pylori and H. suis was present in one patient. The presence of mucosal abnormalities, such as nodular inflammation, ulceration, and hyperemia, as well as gastritis, was significantly higher in Helicobacter spp. positive patients. Conclusion: Helicobacter pylori, H. suis, and H. heilmannii/H. ailurogastricus were present in children with gastric complaints. Infection with these pathogens may be involved in the development of gastritis and ulceration. [ABSTRACT FROM AUTHOR]

The present case study aimed to evaluate the effect of gastroscopic biopsy of gastric ulcer margins and healed sites in the diagnosis of early gastric cancer. A total of 513 patients who were diagnosed with gastric ulcers using gastroscopy between January 1999 and December 2013 were included in the present study and were divided into either the experimental or the control group. In the control group, samples were only taken from the ulcer margin, whereas in the experimental group samples were taken from the ulcer margin and from the ulcer base. In the experimental group, a routine biopsy of the ulcer margin was performed on first examination, and recheck by gastroscopy was performed from the second week. For ulcers that remained unhealed, a biopsy of the ulcer margin was subsequently conducted; however, for healed or almost healed ulcers, a biopsy of the ulcer base was conducted. The duration of follow‑up by gastroscopy ranged between 1 week and 24 months. For the control group, a biopsy of the ulcer margin was conducted using the conventional method. The detection rate of the experimental group was 3.88% (9/232), with 4 cases of gastric cancer confirmed from examinations of the ulcer base. The detection rate of the control group was 1.07% (3/281), which was significantly decreased compared with that of the experimental group (P=0.0345). Overall, patients who underwent regular follow‑up gastroscopy following treatment exhibited a markedly increased detection rate of early gastric cancer, suggesting that early cancer may occur in healed gastric ulcer sites. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to detect virulence genes of Helicobacter pylori (H.pylori) cagA, babA2 and hpa in gastric biopsies from patients with different stages of gastritis by polymerase chain reaction to correlate the presence of genes with the severity of the diseases. Method: A total of 80 non repetitive gastric biopsies from antrum of the stomach were obtained from the patients and subjected to study for histological examination, unease activity, culture for H.pylori, and polymerase chain reaction studies of virulence genes cagA, babA2 and hpa. Results: The most frequent detected gene by PCR was hpa (66.7%) and followed by cagA and babA2 (61.6%) for each. There was significant association between the three genes (P=0.0001). The study of the association between the virulence gene of H.pylori and different clinical symptoms revealed significant association of dyspepsia with cagA(P=0.001) babA2 and hpa (P=0.0001), regurgitation with cagA and babA2(P=0.002),vomiting with cagA and babA2 (P=0.01, P=0.002, respectively) and nausea with cagA and babA2 (P=0.0001, P=0.03, respectively). The virulence genes were detected in gastric ulcer. The degree of inflammation in histopathological examination was also statistically significant associated with the presence of virulences genes cagA (P=0.01), babA2 (p=0.0001) and hpa (P=0.0001). The present study highlights the presence of virulence genes in H.pylori associated with gastric ulcer. The genes cagA, babA2 and hpa are prevalent among the strains affecting the patients. Moreover, these genes are associated with marked clinical and pathological severity. The genes are significantly associated with each other. Further studies are recommended to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (HP) colonization is common in severely obese patients undergoing bariatric surgery. HP eradication treatment could influence the evolution of weight loss and metabolic markers after bariatric surgery.Objective: To assess the influence of HP eradication in the clinical course of morbid obesity patients treated with bariatric surgery (gastric bypass (LRYGB) and sleeve gastrectomy (LSG))Methods: Retrospective analysis of a prospective cohort of 229 patients that underwent bariatric surgery between 2010 and 2013 in Hospital del Mar. HP infection was tested preoperatively by gastric biopsy and, if positive, treated with omeprazole, clarithromycin, and amoxicillin for 14 days. Patients were followed at 3, 6, 12, 18, and 24 months after bariatric surgery. Short-term weight loss and metabolic outcomes were evaluated.Results: HP treated (HPt) patients had a greater reduction in BMI at 3 months after LSG (ΔBMI (kg/cm2) 8.5 ± 4.1 vs 11.3 ± 3.05 kg/m2; p = 0.004) and a reduction in the evolution of triglyceride levels from baseline to 12 months (p = 0.014) compared to HP-negative (HP−) subjects. Also, non-diabetic HPt patients had a greater reduction in glucose levels at all time points that was maintained up to 24 months after LRYGB (p = 0.003). No differences were observed in total and LDL cholesterol levels, HOMA-IR, or HbA1C.Conclusions: Preoperative HP eradication has a short-term influence on some metabolic parameters after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background and Aim: Reddish depressed lesions (RDLs) frequently observed in patients following Helicobacter pylori eradication are indistinguishable from gastric cancer. We examined the clinical and histological feature of RDLs and its relevant endoscopic diagnosis including magnifying narrow-band imaging (M-NBI). Methods: We enrolled 301 consecutive patients with H. pylori eradication who underwent endoscopy using white light imaging (WLI). We examined the prevalence and host factors contributing to the presence of RDLs. Next, we used M-NBI in 90 patients (104 RDLs), and compared the diagnostic efficacy between M-NBI and WLI groups using propensity-score matching analysis. Results: In 301 patients after eradication, 117 (39%) showed RDLs. Male, open-type atrophy, and gastric cancer history were risk factors for RDLs. A gastric biopsy was needed in 83 (71%) during WLI observation and only 2 were diagnosed with adenocarcinoma. In M-NBI group, a biopsy was performed in 21 (20%), and 9 were diagnosed with adenocarcinoma. A biopsy was required in fewer patients, and the positive predictive value of a biopsy was statistically higher in M-NBI than in the WLI group (p < 0.01). Conclusions: RDLs are frequently observed in high-risk patients for gastric cancer after eradication. M-NBI demonstrated significantly superior diagnostic efficacy with respect to RDL. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) has gained popularity in the last 10 years for its good results in weight loss and comorbidity control. However, guidelines on the pathological examination of the specimen are lacking. The aim of this retrospective study was to determine the usefulness of the routine specimen examination when presurgery endoscopy (upper gastrointestinal endoscopy, UGIE) and multiple gastric biopsies are part of the preoperative work-up.Methods: A retrospective review of records of the patients submitted to LSG between January 2012 and August 2017 was carried out. Sex, age, histopathology findings in the presurgery endoscopy biopsies and surgical specimen, and the prevalence of Helicobacter pylori infection were analyzed.Results: A total of 925 patients entered the study group (mean age = 44.1 years, Females = 80.3%, BMI = 44.58 kg/m2). The most common histopathology pattern in the endoscopy biopsies and in the surgical specimens was inactive chronic gastritis (64.4 and 55.6%, respectively). Helicobacter pylori infection was 24.6 and 2.48%, respectively. Ninety-nine percent (n 796) of patients with non-significant endoscopy biopsy findings showed the same patterns in specimen analysis. Only three patients (0.3%) who had intestinal presurgery metaplasia were positive in the specimen analysis, and two cases of gastric stromal neoplasms (gastrointestinal stromal tumor and gastric leiomyoma) were found intraoperatively.Conclusion: Most of the findings are non-significant and can be predicted if UGIE plus multiple biopsies is routinely included in the bariatric work-up with significant cost reduction. In those patients who had a significant finding prior to the surgery or intraoperatively, the pathological examination of the specimen is recommended. [ABSTRACT FROM AUTHOR]

Background and aims: The prevalence of Helicobacter pylori (H. pylori) tends to be lower in Western countries such as central Europe compared with Asia. The virulence of H. pylori is influenced by its subtype composition, most importantly by the presence or absence of different types of cytotoxin-associated gene A(CagA). This study aimed to assess the prevalence of H. pylori and its respective CagA phenotype in a large retrospective cohort of patients with gastric cancer or duodenal ulcer at a Western tertiary referral institution. Methods: H. pylori positive gastric biopsy samples from patients diagnosed with the afore mentioned diseases within the past 25 years were re-evaluated by histology for H. pylori and status of gastritis. Confirmed H. pylori positive cases were processed for immunohistochemistry (IHC) for H. pylori,CagA, and EastAsiantype CagA. Results: The prevalence of H. pylori positive gastric biopsy samples decreased from 20.7% to 2.3% within the study period. Among the gastric cancer patients, the H. pylori positive rate was 16.6%, and didn’t show significant changes over time (p = 0.38). Contrary, the H. pylori positive rate of duodenal ulcer decreased significantlyfrom 40% to 5% (p = 0.01). Within H. pylori positive groups ofboth diseases, CagA was highly detected at IHC (86% and 78%, respectively). Except for a few patients originating from East Asian countries, all CagA detected in this study were of Western type. Conclusion: In this first Western investigation on the chronological prevalence of H. pylori and its most relevant subtypes, Western type of CagA was highly detected in two important index diseases of the pathogen. This raises further questions about the virulence of this subtype. [ABSTRACT FROM AUTHOR]

Background/Aims: The epidemiology of eosinophilic gastroenteritis remains unclear. We aim to determine the prevalence of eosinophilic gastroenteritis in patients with lower abdominal symptoms. Methods: In a prospective study, colonoscopy was performed on 2,469 consecutive patients. Biopsies were taken from the terminal ileum and ascending, transverse, descending and sigmoid colon in all patients. Results: Sixty-four of the 2,469 patients (2.6%) had eosinophilic gastroenteritis. Only five of the 64 patients (7.8%) with eosinophilic gastroenteritis had endoscopic mucosal abnormalities during colonoscopy. Six of these 64 patients (9.4%) had severe disease at presentation, and seven of these 64 patients (10.9%) required systemic steroid treatment. An elevated absolute peripheral eosinophil count was independently associated with severe disease at presentation (4/6 [66.7%] vs 3/58 [5.2%], p=0.005; odds ratio [OR], 25.320; 95% confidence interval [CI], 2.628 to 243.910), and severe disease at the time of presentation was independently associated with the use of systemic steroid treatment (6/7 [85.7%] vs 0/57 [0%], p=0.008; OR, 18.021; 95% CI, 2.163 to 150.152). Conclusions: The prevalence of eosinophilic gastroenteritis is common, and patients usually present normal- appearing mucosa on colonoscopy. Those with severe disease at presentation usually have a raised absolute peripheral eosinophil count and should be commenced on systemic steroids as an initial therapy. [ABSTRACT FROM AUTHOR]

Background/Aims: Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database. Methods: Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated. Results: Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type. Conclusions: In undifferentiated- type EGC, ESD should be considered in selected patients with tumor sizes <1 cm and SRC histology. [ABSTRACT FROM AUTHOR]

Gastric cancer remains the second most common GI cancer in the world, and is usually found in men, especially those over 50 years of age. Gastric cancer is a multifactorial disease resulting from the interaction between genetic and environmental factors at the stomach mucosa level. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable. We reported a rare case of young male patient aged 24 years old with advanced gastric adenocarcinoma. The main clinical features were epigastric pain, vomiting, melena and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, that appear edematous, there were hemorrhagic lesions. The histopathologic examination revealed poorly differentiated adenocarcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy or nasojejunostomy tube were performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Background: Gastrointestinal (GI) symptoms in systemic amyloidosis patients are poorly characterized. This purpose of this study is to define the epidemiology and clinical implications of such symptoms. Methods: This was a retrospective cohort study of 583 amyloid patients seen at a tertiary referral center. Of 96 symptomatic patients, 82 received endoscopic biopsies, subsequently grouped into those with histologic evidence of GI amyloid (biopsy proven) vs without (biopsy absent). Key Results: 16.8% of patients had GI symptoms, and had more abnormal NT‐proBNP, cardiac ejection fraction, serum albumin, and alkaline phosphatase (P < .01). Of those who received endoscopy, the sites of highest diagnostic yield were stomach, duodenum and colon. The most common symptom was abdominal pain, nausea, or vomiting (50.0%). Of the symptomatic patients, only 37 (45%) had biopsy proven GI amyloid. Biopsy proven patients more often had cardiac involvement (P < .005), and more often received hematologic therapy or transplant (P = .01). Biopsy absent patients had more frequent neurologic involvement (P = .17). Biopsy status had no significant correlation with other indicators of amyloid burden, GI symptoms or management. Conclusions & Inferences: Nearly one in six amyloid patients have GI symptoms, and half do not have GI amyloid. The type of symptom does not predict endoscopic findings. Most biopsy absent patients are not managed as a functional disorder despite no alternative etiology. Gastroenterologists may have an increased role to play in the care of systemic amyloidosis beyond performing endoscopies, such as evaluating cardiac amyloid patients for concurrent GI amyloid. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is a gastrointestinal pathogen known to be associated with cardiovascular disease (CVD). However, most analyses about the effect of H. pylori infection have been done in patients with a history of CVD but not in healthy subjects. We evaluated the association between H. pylori infection and subclinical atherosclerosis by using cardiac multidetector computed tomography (MDCT) in healthy subjects without previous CVD. From December 2007 to February 2014, 463 subjects who underwent the rapid urease test (CLO test), pulse-wave velocity (PWV) measurement, and MDCT for a self-referred health check-up were enrolled to this study. Helicobacter pylori infection was defined on the basis of CLO test positivity on endoscopic gastric biopsy. Significant coronary artery stenosis was defined as ≥50% stenosis in any of the major epicardial coronary vessel on MDCT. The CLO-positive subjects had a lower high-density lipoprotein-cholesterol (HDL-cholesterol) level compared to the CLO-negative subjects. The incidence of significant coronary stenosis was higher in the CLO-positive group (7.6% vs. 2.9%, P = 0.01). Furthermore, the number of subjects with coronary artery calcium score >0 and log{(number of segments with plaque)+1} were also significantly higher in the CLO-positive group. However, there was no statistical difference in the number of subjects with coronary artery calcium score >100, the prevalence of any plaque nor the plaque characteristics (calcified, mixed, or soft). Pulse-wave velocity (PWV) was neither associated with CLO test positivity. The CLO-positive group was 3-fold more likely to have significant coronary artery stenosis even after adjusting for confounding factors (adjusted odds ratio 2.813, 95% confidence interval 1.051–7.528, P = 0.04). In a healthy population, current H. pylori infection was associated with subclinical but significant coronary artery stenosis. The causal relationship between H. pylori infection and subclinical atherosclerosis in a “healthy” population remains to be investigated in the future. [ABSTRACT FROM AUTHOR]

Objective:Microscopic examination of endoscopic biopsies forms the basis of acute cellular rejection (ACR) monitoring after intestinal transplantation (ITx). The endoscopy findings during acute rejection (AR) are known but a grading system for its severity is lacking. We designed and implemented a five-stage grading score based on acknowledged endoscopic features of AR, to allow a faster preliminary diagnosis of AR and intra- and interpatient comparisons. Methods:Two investigators reviewed and graded the endoscopy reports after 28 ITx using a novel score and correlated the results with pathology findings. Results:We reviewed 512 ileoscopies: 370 examinations (74%) were normal (G0), 59 had mild alterations (erythema, edematous villi-G1) and 36 showed moderate changes (erosions, blunted villi-G2); 17 ileoscopies revealed advanced changes (ulcerations, villus loss-G3). In 18 endoscopies the changes were severe (mucosal loss-G4). Inter-reviewer agreement was very good (kappa = 0.81). Biopsies from 86 endoscopy sessions (17%) indicated ACR with 63 cases having moderate or severe ACR. For mild ACR the sensitivity of the score was 29% and the specificity was 86% whereas the positive (PPV) and negative predictive values (NPVs) were 14% and 93% respectively. During advanced ACR the sensitivity and specificity were 92% and 86%, respectively whereas the PPV and NPV were 49% and 98% respectively. Conclusions:Endoscopy alone has a limited ability to reliably diagnose intestinal ACR. We suggest a novel grading score summarizing ACR findings and allowing comparisons between intestinal graft endoscopies. [ABSTRACT FROM PUBLISHER]

Background: Blood is the most extensively studied body fluid and, because it contains circulating tumour cells (CTCs) and circulating tumour‐derived cell‐free DNA (ctDNA), it may represent a liquid biopsy for cancer. Methods for enrichment and detection of CTCs and ctDNA, their clinical applications and future opportunities in gastrointestinal cancers were the focus of this review. Methods: The PubMed database was searched for literature up to 24 June 2017, with a focus on the past 10 years. Identified articles were further scrutinized for relevant references. Articles were those in English relating to colorectal, gastric and pancreatic cancer. Results: Both CTCs and ctDNA are in low abundance compared with other cellular components of blood, but effective enrichment and highly sensitive techniques are available for their detection. Potential clinical applications of these liquid biopsies include screening, prognostic stratification, therapy administration, monitoring of treatment effect or resistance, and surveillance. Liquid biopsies provide opportunities to reduce the need for invasive tissue sampling, especially in the context of intratumoral heterogeneity and the need for tumour genotyping. Conclusion: Liquid biopsies have applications in gastrointestinal cancers to improve clinical decision‐making. [ABSTRACT FROM AUTHOR]

The human gastric lumen is one of the most hostile environments of the human body suspected to be sterile until the discovery of Helicobacter pylori (H.p.). State of the art next generation sequencing technologies multiply the knowledge on H.p. functional genomics as well as on the colonization of supposed sterile human environments like the gastric habitat. Here we studied in a prospective, multicenter, clinical trial the 16S rRNA gene amplicon based bacterialmicrobiome in a total of 30 homogenized and frozen gastric biopsy samples fromeight geographic locations. The evaluation of the samples for H.p. infection status was done by histopathology and a specific PCR assay. CagA status was determined by a CagA-specific PCR assay. Patients were grouped accordingly as H.p.-negative, H.p.-positive but CagA-negative and H.p.-positive and CagA-positive (n = 10, respectively). Here we show that H.p. infection of the gastric habitat dominates the gastric microbiota in most patients and is associated with a significant decrease of the microbial alpha diversity from H.p. negative to H.p. positive with CagA as a considerable factor. The genera Actinomyces, Granulicatella, Veillonella, Fusobacterium, Neisseria, Helicobacter, Streptococcus, and Prevotella are significantly different between the H.p.- positive and H.p.-negative sample groups. Differences in microbiota found between CagA-positive and CagA-negative patients were not statistically significant and need to be re-evaluated in larger sample cohorts. In conclusion, H.p. infection dominates the gastric microbiome in a multicentre cohort of patients with varying diagnoses. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to evaluate the optimal biopsy site forHelicobacter pyloridetection by comparing the results of rapid urease test (RUT) between the gastric corpus and the antrum. Methods:A biopsy specimen from each subject was obtained from the corpus and from the antrum. For each subject, the two specimens were separately immersed in two different RUT kits. Positive reaction times were measured at 20 minutes and 1, 3, and 24 hours. If either of the two RUT kits showed a positive reaction,H. pyloriinfection was confirmed. Results:A total of 310H. pylori-infected subjects were eligible for study inclusion. Compared with the antrum, positive RUT reaction times in the corpus were shorter when the degree of gastric atrophy was moderate or severe (p = .001 andp < .001, respectively). A multivariate analysis revealed that the factors resulting in a faster positive RUT reaction in the corpus were age ≥50 years (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.10–3.08;p = .021) and severe gastric atrophy (OR = 2.41; 95% CI = 1.13–5.13;p = .023). Also, severe gastric atrophy was an independent factor associated with positive RUT reaction only in the corpus (OR = 5.12; 95% CI = 1.55–16.88;p = .007). Conclusions:In subjects aged ≥50 years or with severe gastric atrophy, biopsy of the corpus mucosa optimized the efficiency ofH. pyloridetection through a faster positive RUT reaction. [ABSTRACT FROM AUTHOR]

Aim This French study assessed a quick, noninvasive, immuno-chromatographic, Helicobacter pylori ( H. pylori) stool antigen test for detecting infections in children. Methods We enrolled 158 children, with a median age of 8.5 years (range eight months to 17 years), with digestive symptoms suggesting upper gastrointestinal tract disease. Upper digestive endoscopy was performed with gastric biopsy specimens for histology, a rapid urease test, culture test and quantitative real-time polymerase chain reaction. The H. pylori stool antigen test was performed twice for each child and the results were compared to the reference method. Results The reference methods showed that 23 (14.6%) of the 158 children tested were H. pylori positive. The H. pylori stool antigen test showed 91.3% sensitivity, with a 95% confidence interval (95% CI) of 86.9-95.6 and 97% specificity (95% CI 94.3-99.6), 30.84 positive likelihood ratio and 0.09 negative likelihood ratio. The test accuracy was 96.2% (95% CI 93.2-99.1). The two blinded independent observers produced identical H. pylori stool antigen test results and the Kappa coefficient for the H. pylori stool antigen test was one. Conclusion The H. pylori stool antigen test was found to be a consistent, reliable, quick and specific test for detecting the H. pylori infection in children. [ABSTRACT FROM AUTHOR]

Background and Objectives: Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. The diagnosis of PHG is usually made on endoscopy. It is clinically important because it may cause acute massive or insidious blood loss. We present a comprehensive study to ascertain the utility of gastric biopsy in identifying and assessing the presence and degree of pathological changes associated with PHG. Materials and Methods: Histological features of 30 gastric biopsies each from antrum and body of patients of portal hypertension with or without gastric symptoms were studied. They were grouped as Group A patients. Similarly, the histological features of 30 gastric biopsies each from antrum and body of patients of gastritis without portal hypertension were studied and were grouped as Group B patients. The biopsies were studied for mucosal changes such as edema in lamina propria, degree of inflammation, smooth muscle hyperplasia, collagen deposition, foveolar hyperplasia, intestinal metaplasia, presence of Helicobacter pylori, and fibrin thrombi. Results: Most common cause of portal hypertensive gastropathy was alcoholic liver cirrhosis. Histological features such as dilated congested capillaries, edema, extravasated red blood cell (RBC), and smooth muscle hyperplasia are more commonly seen in PHG (Group A) than gastritis (Group B) patients without portal hypertension. Conclusion: Alcoholic cirrhosis is a common cause of PHG. Dilated congested capillaries, edema, extravasated RBC, and smooth muscle hyperplasia are frequently seen in gastric biopsies of PHG patients than gastritis patients. These features are nonspecific. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency of Helicobacter pylori infection (detected by Gastric Biopsy culture and histopathology) in children presenting with recurrent abdominal pain. DURATION: Six months from June 2014 to November 2014. SETTING: Department of Pediatric unit II, Civil Hospital Karachi, DUHS. STUDY DESIGN: Descriptive study, Case series METHODOLOGY: Children 2-15 years of age with either sex, presenting with history of recurrent abdominal pain as per defined criteria were included in the study. Children were excluded from the study if having history of intake of Steroids, antibiotic, NSAIDs, H2 receptor blockers, proton pump inhibitors or bismuth subsalicylate preceding 4 weeks prior to endoscopy, already diagnosed as having H. pylori infection, inflammatory bowel disease, chronic liver disease, acute appendicitis and renal disease. Recurrent abdominal pain (RAP) was diagnosed on the basis of history of recurrent severe abdominal pain occurring at-least once in a month for 3 consequent months. Prior to upper GI endoscopy and biopsy, other causes of recurrent abdominal pain were ruled out by performing appropriate tests that includes complete blood picture, urine detailed examination, stool detailed examination, stool culture and sensitivity, liver function tests, renal function tests, abdominal and pelvic ultra-sonograms. Upper Gastrointestinal endoscopy was performed in all patients RESULTS: Out of 60 cases of RAP 61.7% were males and 38.3% were females. Male to female ratio was 1.60. Mean age of children was 7.71 ± 2.68 years. Mean duration of RAP was 5.55± 1.83 months. Frequency of RAP episodes per month ranged from 3-11 episodes (mean 5.97 ± 2.09). On culture of total 60 biopsy cases H Pylori was positive in 36.7% while it was negative in 63.3% cases. Out of 22children having H. Pylori infection14 were males and 8were females. Mean age of children with H. pylori positive was 8.09 ± 2.18 years. Mean duration of RAP in positive case was 5.77 ±1.88 months. Conclusion: H pylori infection is a major cause of RAP in children and therefore should always be considered in differential diagnosis. Large scale studies are warranted to build national database. [ABSTRACT FROM AUTHOR]

Purpose: Precise localization of tumors and creation of sufficient proximal resection margins are complicated processes during total laparoscopic distal gastrectomy (TLDG) for clinical T1/T2 gastric cancers. Various solutions to this problem have also yielded many disadvantages. In this study, we reviewed a preoperative endoscopic clipping method based on the results of negative biopsy and selective intraoperative radiography. Materials and Methods: A retrospective review of 345 consecutive patients who underwent TLDG and preoperative endoscopic clipping for tumor localization was conducted. During preoperative endoscopy, the endoscopists performed negative biopsies just 1-2 cm selectively above the tumor's upper limit. After confirming the biopsy results, endoscopic metal clips were applied just proximal to the negative biopsy site the day before surgery. Selective intraoperative tumor localization using portable abdominal radiography was performed only when we could not ensure a precise resection line. Results: Negative biopsy was performed in 244 patients. Larger tumor size (P=0.008) and more distally located tumors (P=0.052) were observed more frequently in the negative biopsy group than in the non-negative biopsy group. The non-negative biopsy group had significantly higher frequencies of differentiated tumor types than the negative biopsy group (P=0.003). Of the 244 patients who underwent negative biopsies, 6 had cancer cells in their biopsy specimens. We performed intraoperative radiography in 12 patients whose tumors had difficult-to-determine proximal margins. No tumors were found in the proximal resection margins of any patients. Conclusions: Our tumor localization method is a promising and accurate method for securing a sufficient resection margin during TLDG. [ABSTRACT FROM AUTHOR]

Background The aims of this study were to describe the histology in gastroparesis, specifically to relate histopathology to etiology of gastroparesis (idiopathic and diabetic gastroparesis), gastric emptying, and clinical response to gastric electric stimulation. Methods Full thickness gastric body sections obtained during insertion of gastric stimulator in gastroparetics were stained with Hematoxylin & Eosin, Masson Trichrome and immunohistochemical stains for Neuron-Specific Enolase and c-Kit. Key Results In all, 145 gastroparetics (71 diabetics, 71 idiopathic, 2 post-surgical, and 1 chronic intestinal pseudo-obstruction) had full thickness gastric body biopsies. A lymphocytic infiltrate was seen in the intermyenteric plexus in 22 diabetic and 23 idiopathic gastroparesis patients. Fibrosis was present in the inner circular layer in 13 diabetic and 15 idiopathics and in the outer longitudinal layer in 46 diabetic and 51 idiopathics. Diabetic gastroparesis had less ganglion cells (3.27±1.82 vs 4.81±2.81/hpf; P<.01) and less ganglia (0.90±0.44 vs 1.10±0.50/hpf; P=.01) than idiopathic gastroparesis. Interstitial cells of Cajal ( ICC) count was slightly lower in the inner circular layer in diabetic than idiopathics (2.77±1.47 vs 3.18±1.34/hpf; P=.08). Delayed gastric emptying was associated with reduced ICCs in the myenteric plexus. Global therapeutic response to gastric electric stimulation was inversely related to ganglia/hpf ( R=−.22; P=.008). In diabetics, improvements in nausea, vomiting, and abdominal pain were inversely related to fibrosis. Conclusion and Inferences Histologic assessment of full thickness gastric biopsy specimens allows correlation of histopathology to the gastroparesis disease process, its etiology, gastric emptying, and response to gastric electric stimulation treatment. [ABSTRACT FROM AUTHOR]

We report varicella-zoster virus (VZV) gastritis in a 70-year-old woman postchemotherapy for lymphoma, presenting with abdominal pain, vomiting, and delirium without rash. A gastric biopsy demonstrated viral inclusions but posed a diagnostic challenge as immunohistochemistry for cytomegalovirus and herpes simplex virus were negative, and VZV immunohistochemistry was not available. The patient developed a vesicular rash 7 days after her symptoms began. Molecular testing of the gastric biopsy and a skin swab both confirmed VZV infection. She also had probable involvement of her liver and pancreas based on imaging and serum chemistry, and possible central nervous system involvement. She recovered with appropriate antiviral therapy but later developed a postherpetic neuralgia, and chronic intrahepatic biliary strictures; liver biopsy demonstrated a cholangiopathy of uncertain etiology. A literature review of the pathogenesis, epidemiology and sequelae of VZV infection is included. [ABSTRACT FROM AUTHOR]

Background and study aims: Although the Vienna Classification recommends endoscopic resection for gastric high-grade dysplasia (HGD), many resected lesions are diagnosed as gastric cancer after endoscopic resection. This study aims to evaluate the clinical outcomes of gastric HGD identified by endoscopic forceps biopsy (EFB) after endoscopic submucosal dissection (ESD) and factors associated with discrepant results. Patients and methods: From December 2008 to July 2015, a total of 427 lesions diagnosed as initial HGD by EFB were enrolled. The rate of early gastric cancer (EGC) and factors predicting diagnosis upgrade were analyzed retrospectively. Results: Tumors ranged between 2 and 65 mm in size (median 12.59). En bloc and complete resection rates were 97.4 and 95.3%, respectively. The diagnostic discrepancy rate was 76.3%. Upgrade and downgrade rates of pathological diagnoses were 66.5 and 9.8%, respectively. Central depression (OR 4.151), nodular surface (OR 5.582), surface redness (OR 2.926), lesion location (upper third of the stomach) (OR 3.894), and tumor size ≥10 mm (OR 2.287) were significantly associated with EGC. Nodular surface (OR 2.746), submucosal fibrosis (OR 3.958), lesion location (upper third of the stomach) (OR 6.652), and tumor size ≥10 mm (OR 4.935) significantly predicted invasive submucosal cancer. Conclusions: Central depression, nodular surface, surface redness, lesion location, large tumor size, and submucosal fibrosis were associated with EGC or submucosal cancer. Caution must be used in treating lesions with these features with ESD. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Helicobacter pylori (H. pylori) based on endoscopic biopsy with the help of special stains in gastritis cases. Study Design: Prospective descriptive study. Place and Duration of Study: Histopathology department, Army Medical College Rawalpindi, from Oct 2016 to Mar 2017. Material and Methods: One hundred (100) cases were included in the study. Gastric biopsies of the patients histologically diagnosed as gastritis were included in the study, which were evaluated for the presence of H. pylori with the help of special stain (Modified Giemsa stain). Results: Gastric biopsies of 100 patients, who were diagnosed as gastritis on histopathological examination were analyzed with the help of Giemsa stain for the presence or absence of H. pylori. Out of these 100 cases, 60 were males and 35 were females. Most patients were between the age group of 30-40 years. Histological examination and special stain analysis revealed presence of H. pylori in 30 cases (30%), while rest of the 70 cases (70%) showed no H. pylori. Out of 30 cases positive for H. pylori, 28 cases (93%) had chronic active gastritis, while 2 cases (7%) had no element of activity. Conclusion: Among the cases of chronic gastritis, H. pylori negative gastritis was more common than H. pylori associated gastritis. A significantly decreased frequency of H. pylori in histologically gastritis cases in our population may be due to more frequent use of complete or incomplete therapies against H. pylori by general practitioners at some stage of disease. [ABSTRACT FROM AUTHOR]

H.pylori is one of the most common infections in the world. It causes dyspepsia, chronic gastritis and gastric carcinoma. Spread of the infection from person to person is by oral-oral or faeco-oral route. The aim of the study is to determine the rate of isolation of H.pylori infection from different sites like gastric biopsy, gastric aspirate, saliva and faeces. Patients were selected based on the clinical findings like early satiation, epigastric pain, epigastric burning, bloating, belching and endoscopic findings. Four types of samples-Gastric biopsy, Gastric aspirate, Saliva and Faeces were collected and all the four samples were subjected to Direct Gram Stain, Rapid Urease Test and Culture. Culture was done by inoculating samples onto Skirrows media with cefsulodin and amphotericin B and incubated at 35°C for 3-5 days under microaerophilic conditions. Identification of organism was done based on Gram stain of the colony, oxidase, catalase and urease test. Out of 96 clinically suspected cases of gastritis, H.pylori was isolated in 34(35.41%) patients from Gastric biopsy, 18 (18.75%) patients from Gastric aspirate, 8 (8.33%) patients from saliva and 4 (4.16%) patients from faeces. Among the 96 patients selected 59 were male participants and 37 were female participants with age between 20-60 years. In the present study, we found that H.pylori can be cultured from biopsy, gastric aspirate, saliva and faeces. There are several invasive and non invasive techniques to diagnose H.pylori, each having its own advantages and disadvantages. Non-invasive tests on saliva and faeces sample can play an important role in the diagnosis of H.pylori infection, but has the disadvantage of low sensitivity, whereas invasive tests like gastric biopsy and gastric aspirate are more sensitive. [ABSTRACT FROM AUTHOR]

Helicobacter pylori infection shows a worldwide prevalence of around 50%. However, only a minority of infected individuals develop clinical symptoms or diseases. The presence of H. pylori virulence factors, such as CagA and VacA, has been associated with disease development, but assessment of virulence factor presence requires gastric biopsies. Here, we evaluate the H. pylori recomLine test for risk stratification of infected patients by comparing the test score and immune recognition of type I or type II strains defined by the virulence factors CagA, VacA, GroEL, UreA, HcpC, and gGT with patient's disease status according to histology. Moreover, the immune responses of eradicated individuals from two different populations were analysed. Their immune response frequencies and intensities against all antigens except CagA declined below the detection limit. CagA was particularly long lasting in both independent populations. An isolated CagA band often represents past eradication with a likelihood of 88.7%. In addition, a high recomLine score was significantly associated with high-grade gastritis, atrophy, intestinal metaplasia, and gastric cancer. Thus, the recomLine is a sensitive and specific noninvasive test for detecting serum responses against H. pylori in actively infected and eradicated individuals. Moreover, it allows stratifying patients according to their disease state. [ABSTRACT FROM AUTHOR]

Background: Serologic testing for celiac disease includes tissue transglutaminase and endomysial antibodies. In addition to these tools, assays for deamidated gliadin peptide antibodies have been shown to have sensitivity and specificity that are comparable to tissue transglutaminase testing, and are increasingly being used for celiac disease testing.Aims: The goal of this study is to evaluate the utility of deamidated gliadin peptide (DGP) testing in the setting of a negative tissue transglutaminase (TTG) IgA test.Methods: We reviewed the records of all patients seen at two U.S. celiac disease referral centers and identified those who had an elevated DGP IgA and/or IgG in the setting of a negative TTG IgA. Of these patients, those who underwent duodenal biopsy while on a gluten-containing diet were included. Patients with prior biopsy-proven celiac disease or prior TTG IgA positivity were excluded. The results of the biopsy were used as the gold standard for celiac disease diagnosis, and patients with villous atrophy (Marsh class 3) on duodenal biopsy were considered to have celiac disease.Results: Between the two institutions, 84 patients were identified with negative TTG IgA and positive DGP IgA or IgG who also had duodenal biopsies performed while maintaining a gluten-containing diet. Of these patients, 13 patients (15.5%; 95% CI 8.5-25.0%) were found to have celiac disease on duodenal biopsy.Conclusions: DGP antibody testing can identify cases of celiac disease in TTG-negative individuals, although the low positive predictive value suggests that the yield may be low. [ABSTRACT FROM AUTHOR]