Gastric cystica profunda(GCP)is an uncommon but underestimated gastric lesion.Its precancerous potential determines its significance.In addition to previous mucosa injury due to operations,biopsy or polypectomy,chroni...Gastric cystica profunda(GCP)is an uncommon but underestimated gastric lesion.Its precancerous potential determines its significance.In addition to previous mucosa injury due to operations,biopsy or polypectomy,chronic active and atrophic gastritis may also lead to the development of GCPs.By carefully examining the stomach and taking biopsy samples from the susceptible regions,the stage of atrophy can be determined.Chronic atrophic gastritis is a risk factor for cancer evolvement and it can also contribute to GCPs formation.GCPs frequently occur close to early gastric cancers(EGCs)or EGC can arise from the cystic glands.Endoscopic resection is an effective and minimally invasive treat-ment in GCP.展开更多
Chronic atrophic gastritis(CAG)is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa,reducing the stomach's ability to secrete gastric juice and pepsi...Chronic atrophic gastritis(CAG)is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa,reducing the stomach's ability to secrete gastric juice and pepsin,and interfering with its normal physiological function.Multiple pathogenic factors contribute to CAG incidence,the most common being Helicobacter pylori infection and the immune reactions resulting from gastric autoimmunity.Furthermore,CAG has a broad spectrum of clinical manifestations,including gastroenterology and extraintestinal symptoms and signs,such as hematology,neurology,and oncology.Therefore,the initial CAG evaluation should involve the examination of clinical and serological indicators,as well as diagnosis confirmation via gastroscopy and histopathology if necessary.Depending on the severity and scope of atrophy affecting the gastric mucosa,a histologic staging system(Operative Link for Gastritis Assessment or Operative Link on Gastritis intestinal metaplasia)could also be employed.Moreover,chronic gastritis has a higher risk of progressing to gastric cancer(GC).In this regard,early diagnosis,treatment,and regular testing could reduce the risk of GC in CAG patients.However,the optimal interval for endoscopic monitoring in CAG patients remains uncertain,and it should ideally be tailored based on individual risk evaluations and shared decision-making processes.Although there have been many reports on CAG,the precise etiology and histopathological features of the disease,as well as the diagnosis of CAG patients,are yet to be fully elucidated.Consequently,this review offers a detailed account of CAG,including its key clinical aspects,aiming to enhance the overall understanding of the disease.展开更多
BACKGROUND The Correa sequence,initiated by Helicobacter pylori(H.pylori),commonly progresses to gastric cancer through the stage of chronic atrophic gastritis(CAG).Although eradication of H.pylori only reduces the ri...BACKGROUND The Correa sequence,initiated by Helicobacter pylori(H.pylori),commonly progresses to gastric cancer through the stage of chronic atrophic gastritis(CAG).Although eradication of H.pylori only reduces the risk of gastric cancer,it does not eliminate the risk for neoplastic progression.Yiwei Xiaoyu granules(YWXY)are a commonly used composite preparation in Chinese clinics.However,the pursuit of excellence in clinical trials and the establishment of standardized animal experiments are still needed to contribute to full understanding and application of traditional Chinese medicine in the treatment of CAG.AIM To demonstrate the effectiveness of YWXY in patients with CAG and spleenstomach deficiency syndrome(DSSS),by alleviating histological scores,improving response rates for pathological lesions,and achieving clinical efficacy in relieving DSSS symptoms.METHODS We designed a double-blind,randomized,controlled trial.The study enrolled seventy-two H.pylori-negative patients(mean age,52.3 years;38 men)who were randomly allocated to either the treatment group or control group in a 1:1 ratio,and treated with 15 g YWXY or 0.36 g Weifuchun(WFC)tablet combined with the respective dummy for 24 wk.The pre-randomization phase resulted in the exclusion of 72 patients:50 participants did not meet the inclusion criteria,12 participants declined to participate,and 10 participants were excluded for various other reasons.Seven visits were conducted during the study,and histopathological examination with target endoscopic biopsy of narrow-band imaging was requested before the first and seventh visits.We also evaluated endoscopic performance scores,total symptom scores,serum pepsinogen and gastrin-17.RESULTS Six patients did not complete the trial procedures.Treatment with YWXY improved the Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM)stage,compared with WFC(P<0.05).YWXY provided better relief from symptoms of DSSS and better improvement in serum gastric function,compared with WFC(P<0.05).CONCLUSION YWXY compared with WFC significantly reduced the risk of mild or moderate atrophic disease,according to OLGIM stage,significantly relieved symptoms of DSSS,and improved serum gastric function.展开更多
[Objectives]To observe the effect of Jianpi Xiaowei Decoction on gastric function and quality of life in elderly patients with chronic atrophic gastritis(CAG)of liver-stomach heat stagnation type.[Methods]Seventy-two ...[Objectives]To observe the effect of Jianpi Xiaowei Decoction on gastric function and quality of life in elderly patients with chronic atrophic gastritis(CAG)of liver-stomach heat stagnation type.[Methods]Seventy-two elderly patients with CAG of liver-stomach stagnation-heat type were randomly divided into study group and control group.The two groups were treated with Jianpi Xiaowei Decoction and Rabeprazole Enteric-coated Tablets respectively.The curative effect of TCM syndromes,serum pepsinogen I and II(PG-I and PG-II),gastrin-17(G-17)and quality of life(SF-36 table)scores of gastric function indicators before and after treatment were observed.[Results]After treatment,the total effective rate of the study group was 97.22%(35/36),which was significantly higher than that of the control group 77.78%(28/36)(P<0.05).Before treatment,there was no significant difference in the levels of gastric function indicators between the two groups(P>0.05).After treatment,the indicators of the study group were significantly lower than those of the control group(t=12.239,6.010,5.928,10.420,P<0.05).Before treatment,there was no significant difference in SF-36 scores between the two groups(P>0.05).After treatment,the SF-36 scores in the study group were significantly lower than those in the control group(t=3.520,10.335,11.300,9.693,P<0.05).[Conclusions]Jianpi Xiaowei Decoction can achieve significant curative effect in the treatment of CAG with liver and stomach stagnation heat type in the elderly,and can significantly improve the key gastrointestinal hormone levels and quality of life of elderly patients.It is worthy of promotion in the same clinical cases.展开更多
BACKGROUND The Chinese medicine Yangyin Huowei mixture(YYHWM)exhibits good clinical efficacy in the treatment of chronic atrophic gastritis(CAG),but the mechanisms underlying its activity remain unclear.AIM To investi...BACKGROUND The Chinese medicine Yangyin Huowei mixture(YYHWM)exhibits good clinical efficacy in the treatment of chronic atrophic gastritis(CAG),but the mechanisms underlying its activity remain unclear.AIM To investigate the therapeutic effects of YYHWM and its underlying mechanisms in a CAG rat model.METHODS Sprague-Dawley rats were allocated into control,model,vitacoenzyme,and low,medium,and high-dose YYHWM groups.CAG was induced in rats using Nmethyl-N′-nitro-N-nitrosoguanidine,ranitidine hydrochloride,hunger and satiety perturbation,and ethanol gavage.Following an 8-wk intervention period,stomach samples were taken,stained,and examined for histopathological changes.ELISA was utilized to quantify serum levels of PG-I,PG-II,G-17,IL-1β,IL-6,and TNF-α.Western blot analysis was performed to evaluate protein expression of IL-10,JAK1,and STAT3.RESULTS The model group showed gastric mucosal layer disruption and inflammatory cell infiltration.Compared with the blank control group,serum levels of PGI,PGII,and G-17 in the model group were significantly reduced(82.41±3.53 vs 38.52±1.71,23.06±0.96 vs 11.06±0.70,and 493.09±12.17 vs 225.52±17.44,P<0.01 for all),whereas those of IL-1β,IL-6,and TNF-αwere significantly increased(30.15±3.07 vs 80.98±4.47,69.05±12.72 vs 110.85±6.68,and 209.24±11.62 vs 313.37±36.77,P<0.01 for all),and the protein levels of IL-10,JAK1,and STAT3 were higher in gastric mucosal tissues(0.47±0.10 vs 1.11±0.09,0.49±0.05 vs 0.99±0.07,and 0.24±0.05 vs 1.04±0.14,P<0.01 for all).Compared with the model group,high-dose YYHWM treatment significantly improved the gastric mucosal tissue damage,increased the levels of PGI,PGII,and G-17(38.52±1.71 vs 50.41±3.53,11.06±0.70 vs 15.33±1.24,and 225.52±17.44 vs 329.22±29.11,P<0.01 for all),decreased the levels of IL-1β,IL-6,and TNF-α(80.98±4.47 vs 61.56±4.02,110.85±6.68 vs 89.20±8.48,and 313.37±36.77 vs 267.30±9.31,P<0.01 for all),and evidently decreased the protein levels of IL-10 and STAT3 in gastric mucosal tissues(1.11±0.09 vs 0.19±0.07 and 1.04±0.14 vs 0.55±0.09,P<0.01 for both).CONCLUSION YYHWM reduces the release of inflammatory factors by inhibiting the IL-10/JAK1/STAT3 pathway,alleviating gastric mucosal damage,and enhancing gastric secretory function,thereby ameliorating CAG development and cancer transformation.展开更多
Atrophic gastritis and intestinal metaplasia may progress to gastric malignancy.Non-invasive serum biomarkers have been extensively studied and proven to be useful as a screening tool to stratify risk and identify pat...Atrophic gastritis and intestinal metaplasia may progress to gastric malignancy.Non-invasive serum biomarkers have been extensively studied and proven to be useful as a screening tool to stratify risk and identify patients for endoscopy to detect early gastric cancer.These non-invasive biomarkers have been endorsed and recommended by many international consensus guidelines.In this letter,we reviewed the literature and evidence supporting the use of serum biomarkers as a dynamic test to monitor the status of atrophic gastritis.展开更多
BACKGROUND Autoimmune gastritis(AIG)is a progressive,chronic,immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor.Gastr...BACKGROUND Autoimmune gastritis(AIG)is a progressive,chronic,immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor.Gastrointestinal symptoms such as dyspepsia and early satiety are very common,being second in terms of frequency only to anemia,which is the most typical feature of AIG.AIM To address both well-established and more innovative information and knowledge about this challenging disorder.METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 10 years.RESULTS A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.CONCLUSION AIG can cause a range of clinical manifestations,including dyspepsia.The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion,gastric motility,hormone signaling,and gut microbiota,among other factors.Managing dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in AIG.While proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease,they may not be appropriate for AIG.Prokinetic agents,antidepressant drugs,and non-pharmacological treatments may be of help,even if not adequately evidence-based supported.A multidisciplinary approach for the management of dyspepsia in AIG is recommended,and further research is needed to develop and validate more effective therapies for dyspepsia.展开更多
BACKGROUND The incidence of type I gastric neuroendocrine neoplasms(gNENs)has increased significantly over the past 50 years.Although autoimmune gastritis(AIG)increases the likelihood of developing gNENs,the exact inc...BACKGROUND The incidence of type I gastric neuroendocrine neoplasms(gNENs)has increased significantly over the past 50 years.Although autoimmune gastritis(AIG)increases the likelihood of developing gNENs,the exact incidence and prevalence of this association remain unclear.AIM To evaluate the incidence and prevalence of type I gNENs in a cohort of patients with a histological diagnosis of AIG.METHODS Patients with a histological diagnosis of AIG were enrolled between October 2020 and May 2022.Circulating levels of CgA and gastrin were assessed at enrollment.Included patients underwent regular endoscopic follow-up to detect gastric neoplastic lesions,enterochromaffin-like(ECL)cell hyperplasia,and the development of gNEN.RESULTS We included 176 patients[142 women(80.7%),median age 64 years,interquartile range(IQR)53–71 years]diagnosed with AIG between January 1990 and June 2022.At enrollment.One hundred and sixteen patients(65.9%)had ECL hyperplasia,of whom,29.5%had simple/linear,30.7%had micronodular,and 5.7%had macronodular type.The median follow-up time was 5(3–7.5)years.After 1032 person-years,33 patients developed a total of 50 type I gNENs,with an incidence rate of 0.057 person-years,corresponding to an annual cumulative incidence of 5.7%.Circulating CgA levels did not significantly differ between AIG patients who developed gNENs and those who did not.Conversely,gastrin levels were significantly higher in AIG patients who developed gNENs[median 992 pg/mL IQR=449–1500 vs 688 pg/mL IQR=423–1200,P=0.03].Calculated gastrin sensitivity and specificity were 90.9%and 1.4%,respectively,with an overall diagnostic accuracy of 30%and a calculated area under the gastrin receiver operating characteristic curve(AUROC or AUC)of 0.53.CONCLUSION Type I gNENs are a significant complication in AIG.Gastrin’s low diagnostic accuracy prevents it from serving as a marker for early diagnosis.Effective strategies for early detection and treatment are needed.展开更多
BACKGROUND Mucosal patterns(MPs)observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty,cracked,and mottled.Furthermore,we hypothesized that the spotty pattern may change to the ...BACKGROUND Mucosal patterns(MPs)observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty,cracked,and mottled.Furthermore,we hypothesized that the spotty pattern may change to the cracked pattern after Helicobacter pylori(H.pylori)eradication.AIM To further substantiate and comprehensively investigate MP changes after H.pylori eradication in a larger number of patients.METHODS We included 768 patients who were diagnosed with atrophic gastritis with evaluable MP using upper gastrointestinal endoscopy at the Nishikawa Gastrointestinal Clinic,Japan.Among them,325 patients were H.pylori-positive,and of them,101 patients who underwent upper gastrointestinal endoscopy before and after H.pylori eradication were evaluated for post-eradication MP changes.The patients’MPs were interpreted by three experienced endoscopists who were blinded to their clinical features.RESULTS Among 76 patients with the spotty pattern before or after H.pylori eradication,the pattern disappeared or decreased in 67 patients[88.2%,95%confidence interval(CI):79.0%-93.6%),appeared or increased in 8 patients(10.5%,95%CI:5.4%-19.4%),and showed no change in 1 patient(1.3%,95%CI:0.2%-7.1%).In 90 patients with the cracked pattern before or after H.pylori eradication,the pattern disappeared or decreased in 7 patients(7.8%,95%CI:3.8%-15.2%),appeared or increased in 79 patients(87.8%,95%CI:79.4%-93.0%),and showed no change in 4 patients(4.4%,95%CI:1.7%-10.9%).In 70 patients with the mottled pattern before or after H.pylori eradication,the pattern disappeared or decreased in 28 patients(40.0%,95%CI:29.3%-51.7%),appeared or increased in 35 patients(50.0%,95%CI:38.6%-61.4%),and showed no change in 7 patients(10.0%,95%CI:4.9%-19.2%).CONCLUSION After H.pylori eradication,MPs changed from spotty to cracked in most patients,which may help endoscopists easily and precisely evaluate H.pylori-related gastritis status.展开更多
BACKGROUND Chronic atrophic gastritis is a persistent disorder of the digestive system where the gastric mucosa epithelium and glands undergo atrophy,leading to a decrease in their number and thinning of the gastric m...BACKGROUND Chronic atrophic gastritis is a persistent disorder of the digestive system where the gastric mucosa epithelium and glands undergo atrophy,leading to a decrease in their number and thinning of the gastric mucosa.It is worth noting that the prevalence of chronic atrophic gastritis is higher in China compared to the global average,and it is also considered a precancerous condition for gastric cancer.AIM To evaluate the efficacy of Huangqi Jianzhong decoction in treating chronic atrophic gastritis.Chronic atrophic gastritis is a persistent illness characterized by the progressive disappearance of healthy gastric glands due to repeated injury.Huangqi Jianzhong decoctions are widely used in China to treat chronic atrophic gastritis.However,there is limited scientific evidence regarding their efficacy in treating this illness.METHODS The present meta-analysis adhered to the PRISMA guidelines and used the Cochrane Collaboration methodology.We performed a comprehensive search for clinical trials investigating the use of Huangqi Jianzhong decoction in treating chronic atrophic gastritis published until January 2023.The risk of bias and the quality of the included studies were evaluated using the Cochrane Handbook guidelines.Finally,a meta-analysis was conducted using the RevMan 5.4 softRESULTS This study included a total of 13 articles,comprising 1269 samples.The meta-analysis was conducted on these 13 articles,yielding the following results:I2=0%,P=0.60,[RR=1.24,95%CI:1.18 to 1.30,P<0.00001].The forest plot analysis of the Helicobacter pylori clearance rate revealed I2=0%,P=0.36,[RR=1.20,95%CI:1.05 to 1.38,P=0.009].The forest plot of PG-I level showed I2=99%,P<0.00001,[MD=4.99,95%CI:-1.59 to 11.58,P=0.14].The forest plot of stomach pain demonstrated I2=54%,P=0.04,[MD=-0.63,95%CI:-0.68 to-0.58,P<0.00001].The forest plot of reflux indicated I2=82%,P=0.0009,[MD=-0.48,95%CI:-0.63 to-0.33,P<0.00001].The forest plot of recurrence rate exhibited I2=0%,P=0.92,[RR=0.15,95%CI:0.04 to 0.66,P=0.01].The forest plot of adverse reactions showed no heterogeneity in outcome data,[RR=1.07,95%CI:0.53 to 2.17,P=0.86].CONCLUSION This study demonstrated that Huangqi Jianzhong decoction improved various factors in adults with chronic atrophic gastritis.These factors included the total effective rate,Helicobacter pylori clearance rate,symptoms such as stomachache and acid reflux alleviation,and recurrence rates.展开更多
Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifest...Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifestations of mandibular acne did not improve. At the time of initial examination, telangiectasia (TE), post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), atrophic scars (ASs), and a hypertrophic scar (HS) with induration were observed on the right neck. We diagnosed this as an acne vulgaris complication. HS lesions were topically treated by injecting triamcinolone acetonide, and the patient was prescribed 8.1 g/day of oral Saireito (Japanese herb). Adapalene benzoyl peroxide gel and topical tacrolimus hydrate ointment were used to treat PIE and TE. Both HSs and PIE improved;however, TE and AS did not improve. Currently, the patient is under observation. We consider this to be a very rare concurrent occurrence of diverse complications of acne vulgaris, and present the following case study.展开更多
Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmissio...Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroupof patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG.展开更多
Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures ...Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures inappropriate for location （metaplastic atrophy）. Epidemiological data suggest that CAG is associated with two different types of tumors： Intestinal-type gastric cancer （GC） and type I gastric carcinoid （T I GC）. The pathophysiological mechanisms which lead to the development of these gastric tumors are different, It is accepted that a multistep process initiating from Helico- bacterpylori-related chronic inflammation of the gastric mucosa progresses to CAG, intestinal metaplasia, dysplasia and, finally, leads to the development of GC. The T I GC is a gastrin-dependent tumor and the chronic elevation of gastrin, which is associated with CAG, stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of T I GC. Thus, several events occur in the gastric mucosa before the development of intestinatype GC and/ or T I GC and these take several years. Knowledge ofCAG incidence from superficial gastritis, its prevalence in different clinical settings and possible risk factors as- sociated with the progression of this condition to gastric neoplasias are important issues. This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.展开更多
AIM To explore the correlation between serum vitamin B12 level and peripheral neuropathy in patients with chronic atrophic gastritis(CAG). METHODS A total of 593 patients diagnosed with chronic gastritis by gastroscop...AIM To explore the correlation between serum vitamin B12 level and peripheral neuropathy in patients with chronic atrophic gastritis(CAG). METHODS A total of 593 patients diagnosed with chronic gastritis by gastroscopy and pathological examination fromSeptember 2013 to September 2016 were selected for this study. The age of these patients ranged within 18-to 75-years-old. Blood pressure, height and weight were measured in each patient, and the body mass index value was calculated. Furthermore, gastric acid, serum gastrin, serum vitamin and serum creatinine tests were performed, and peripheral nerve conduction velocity and Helicobacter pylori(H. pylori) were detected. In addition, the type of gastritis was determined by gastroscopy. The above factors were used as independent variables to analyze chronic gastritis with peripheral neuropathy and vitamin B12 deficiency risk factors, and to analyze the relationship between vitamin B12 levels and peripheral nerve conduction velocity. In addition, in the treatment of CAG on the basis of vitamin B12, patients with peripheral neuropathy were observed. RESULTS Age, H. pylori infection, CAG, vitamin B9 and vitamin B12 were risk factors for the occurrence of peripheral nerve degeneration.Furthermore,CAG and H. pylori infection were risk factors for chronic gastritis associated with vitamin B12 deficiency. Serum vitamin B12 level was positively correlated with sensory nerve conduction velocity in the tibial nerve(R = 0.463). After vitamin B12 supplementation, patients with peripheral neuropathy improved. CONCLUSION Serum vitamin B12 levels in patients with chronic gastritis significantly decreased, and the occurrence of peripheral neuropathy had a certain correlation. CAG and H. pylori infection are risk factors for vitamin B12 deficiency and peripheral neuropathy. When treating CAG, vitamin B12 supplementation can significantly reduce peripheral nervous system lesions. Therefore, the occurrence of peripheral neuropathy associated with vitamin B12 deficiency may be considered in patients with CAG. Furthermore, the timely supplementation of vitamin B12 during the clinical treatment of CAG can reduce or prevent peripheral nervous system lesions.展开更多
Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundu...Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundus and leads to hypochlorhydria, hypergastrinemia and inadequate production of the intrinsic factor. As a result, the stomach’s secretion of essential substances, such as hydrochloric acid and intrinsic factor, is reduced, leading to digestive impairments. The most common is vitamin B12 deficiency, which results in a megaloblastic anemia and iron malabsorption, leading to iron deficiency anemia. However, in the last years the deficiency of several other vitamins and micronutrients, such as vitamin C, vitamin D, folic acid and calcium, has been increasingly described in patients with CAAG. In addition the occurrence of multiple vitamin deficiencies may lead to severe hematological, neurological and skeletal manifestations in CAAG patients and highlights the importance of an integrated evaluation of these patients. Nevertheless, the nutritional deficiencies in CAAG are largely understudied. We have investigated the frequency and associated features of nutritional deficiencies in CAAG in order to focus on any deficit that may be clinically significant, but relatively easy to correct. This descriptive review updates and summarizes the literature on different nutrient deficiencies in CAAG in order to optimize the treatment and the follow-up of patients affected with CAAG.展开更多
AIM: To investigate the effect of H pylori eradication on atrophic gastritis and intestinal metaplasia (IM).METHODS: Two hundred and fifty-nine patients with atrophic gastritis in the antrum were included in the study...AIM: To investigate the effect of H pylori eradication on atrophic gastritis and intestinal metaplasia (IM).METHODS: Two hundred and fifty-nine patients with atrophic gastritis in the antrum were included in the study, 154 patients were selected for H pylori eradication therapy and the remaining 105 patients served as untreated group. Gastroscopy and biopsies were performed both at the beginning and at the end of a 3-year follow-up study. Gastritis was graded according to the updated Sydney system.RESULTS: One hundred and seventy-nine patients completed the follow-up, 92 of them received H pylori eradication therapy and the remaining 87 H pyloriinfected patients were in the untreated group. Chronic gastritis, active gastritis and the grade of atrophy significantly decreased in H pylori eradication group (P＜0.01). However, the grade of IM increased in H pylori -infected group (P＜0.05).CONCLUSION: H pylori eradication may improve gastric mucosal inflammation, atrophy and prevent the progression of IM.展开更多
BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastri...BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastric cancer mass screening.However,skilled doctors for interpretation of X-ray examination are decreasing due to the diverse of inspections.AIM To evaluate the effectiveness of stomach regions that are automatically estimated by a deep learning-based model for CAG detection.METHODS We used 815 gastric X-ray images(GXIs)obtained from 815 subjects.The ground truth of this study was the diagnostic results in X-ray and endoscopic examinations.For a part of GXIs for training,the stomach regions are manually annotated.A model for automatic estimation of the stomach regions is trained with the GXIs.For the rest of them,the stomach regions are automatically estimated.Finally,a model for automatic CAG detection is trained with all GXIs for training.RESULTS In the case that the stomach regions were manually annotated for only 10 GXIs and 30 GXIs,the harmonic mean of sensitivity and specificity of CAG detection were 0.955±0.002 and 0.963±0.004,respectively.CONCLUSION By estimating stomach regions automatically,our method contributes to the reduction of the workload of manual annotation and the accurate detection of the CAG.展开更多
AIM: To study the effects of He-Ne laser irradiation on experimental chronic atrophic gastritis (CAG) in rats.METHODS: Sixty-three male adult Wistar rats were randomly divided into five groups including normal control...AIM: To study the effects of He-Ne laser irradiation on experimental chronic atrophic gastritis (CAG) in rats.METHODS: Sixty-three male adult Wistar rats were randomly divided into five groups including normal control group, model control group and three different dosages He-Ne laser groups. The chronic atrophic gastritis (CAG)model in rats was made by pouring medicine which was a kind of mixed liquor including 2% sodium salicylate and 30% alcohol down the throat for 8 wk to stimulate rat gastric mucosa, combining with irregular fasting and compulsive sporting as pathogenic factors; 3.36, 4.80, and 6.24J/cm2doses of He-Ne laser were used, respectively for three different treatment groups, once a day for 20 d. The pH value of diluted gastric acid was determined by acidimeter,the histopathological changes such as the inflammatory degrees in gastric mucosa, the morphology and structure of parietal cells were observed, and the thickness of mucosa was measured by micrometer under optical microscope.RESULTS: In model control group, the secretion of gastric acid was little, pathologic morphological changes in gastric mucosa such as thinner mucous, atrophic glands, notable inflammatory infiltration were found. After 3.36 J/cm2 dose of He-Ne laser treatment for 20 d, the secretion of gastric acid was increased (P＜0.05), the thickness of gastric mucosa was significantly thicker than that in model control group (P＜0.01), the gastric mucosal inflammation cells were decreased (P＜0.05). Morphology, structure and volume of the parietal cells all recuperated or were closed to normal.CONCLUSION: 3.36J/cm2 dose of He-Ne laser has a significant effect on CAG in rats.展开更多
AIM: To investigate the effects of interleukin-8 (IL-8 ), macrophage migration inhibitory factor (MIF ) gene polymorphisms, Helicobacter pylori (H. pylori ) infection, on the risk of developing severe chronic atrophic...AIM: To investigate the effects of interleukin-8 (IL-8 ), macrophage migration inhibitory factor (MIF ) gene polymorphisms, Helicobacter pylori (H. pylori ) infection, on the risk of developing severe chronic atrophic gastritis (SCAG) and intestinal metaplasia (IM). METHODS: A total of 372 cases were selected from a cohort study in Linqu County, a high risk area for gastric cancer (GC) in northern China. To obtain a sufficient group size, patients with normal or superficial gastritis were included. Based on an average follow-up period of 56 mo, the 372 cases were divided into no progres-sion group (no histological progression from normal or superficial gastritis, n = 137), group Ⅰ (progressed from normal or superficial gastritis to SCAG, n = 134) and group Ⅱ (progressed from normal or superficial gastritis to IM, n = 101). IL-8 , MIF gene polymorphisms were detected by polymerase chain reaction-based denaturing high-performance liquid chromatography analysis and DNA sequencing. RESULTS: An increased risk of SCAG was found in subjects with IL-8-251 AA genotype [odds ratio (OR) = 2.62, 95% CI: 1.23-5.72] or IL-8-251 A allele carriers (AA + AT) (OR = 1.81, 95% CI: 1.06-3.09). An elevated risk of IM was found in subjects with IL-8-251 AT genotype (OR = 2.27, 95% CI: 1.25-4.14) or IL-8-251 A allele carriers (OR = 2.07, 95% CI: 1.16-3.69). An increased risk of SCAG was found in subjects with MIF-173 GC genotype (OR = 2.36, 95% CI: 1.38-4.02) or MIF-173 C allele carriers (GC + CC) (OR = 2.07, 95% CI: 1.21-3.55). An elevated risk of IM was found in subjects with MIF-173 CC genotype (OR = 2.27, 95% CI: 1.16-4.46) or MIF-173 C allele carriers (OR = 3.84, 95% CI: 1.58-9.34). The risk of SCAG and IM was more evident in subjects carrying IL-8-251 A allele (OR = 6.70, 95% CI: 1.29-9.78) or MIF-173 C allele (OR = 6.54, 95% CI: 2.97-14.20) and positive for H. pylori infection. CONCLUSION: IL-8-251 and MIF-173 gene polymorphisms are significantly associated with the risk of SCAG and IM in a population with a high risk of GC in Linqu County, Shandong Province, China.展开更多
BACKGROUND Chronic atrophic gastritis(CAG)is a common disease of the digestive system with pathological characteristics of a decreasing number,or disappearance,of inherent glands of the gastric mucosa.CAG has been def...BACKGROUND Chronic atrophic gastritis(CAG)is a common disease of the digestive system with pathological characteristics of a decreasing number,or disappearance,of inherent glands of the gastric mucosa.CAG has been defined as a precancerous condition of gastric cancer.Intestinal metaplasia or intraepithelial neoplasia accompanying atrophied glands of the stomach is regarded as one of the most important precancerous lesions of gastric cancer.As a common malignant tumour,gastric cancer remains without a satisfactory therapy and its pathogenesis remains unclear,seriously threatening human life.Therefore,some scholars have proposed to prevent the incidence of gastric cancer by avoiding precancerous lesions.If CAG can be reversed,the incidence of gastric cancer can be substantially reduced.To reverse and prevent CAG and study its pathogenesis and therapy,it is necessary to develop an ideal,safe,stable,animal model.AIM To study a rapid,stable,and safe method of establishing a mouse model of human CAG.METHODS Six-week-old Kunming mice were divided into a phosphate buffered solution control group,a Helicobacter pylori(H.pylori)group,an N-methyl-N'-nitroguanidine(MNNG)group,an ammonia water group,and a group combining H.pylori,MNNG,and ammonia water(hereinafter referred to as the combined group).The mice were administrated with drinking water containing ammonia or infected with H.pylori through gavage.At the 30th,60th,90th,and 120th day after the last H.pylori infection,mice were selected randomly to collect their gastric mucosa for hematoxylin eosin staining,terminal nick-end labelling staining detection,and immunohistochemical staining for Bax and Bcl-2.In addition,H.pylori was isolated,cultured,and identified,and its extent of colonisation calculated.Blood was collected to detect inflammatory factors interleukin(IL)-1β,IL-8,and tumor necrosis factor(TNF)-αand immune function markers CD4 and CD8 to confirm successful establishment of the CAG model.RESULTS The combined group showed slight CAG at the 90th day and moderate CAG at the 120th day,while other groups did not show CAG at that time.CONCLUSION The combination of H.pylori,MNNG,and ammonia is an effective method of developing a mouse model of human CAG.展开更多
文摘Gastric cystica profunda(GCP)is an uncommon but underestimated gastric lesion.Its precancerous potential determines its significance.In addition to previous mucosa injury due to operations,biopsy or polypectomy,chronic active and atrophic gastritis may also lead to the development of GCPs.By carefully examining the stomach and taking biopsy samples from the susceptible regions,the stage of atrophy can be determined.Chronic atrophic gastritis is a risk factor for cancer evolvement and it can also contribute to GCPs formation.GCPs frequently occur close to early gastric cancers(EGCs)or EGC can arise from the cystic glands.Endoscopic resection is an effective and minimally invasive treat-ment in GCP.
文摘Chronic atrophic gastritis(CAG)is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa,reducing the stomach's ability to secrete gastric juice and pepsin,and interfering with its normal physiological function.Multiple pathogenic factors contribute to CAG incidence,the most common being Helicobacter pylori infection and the immune reactions resulting from gastric autoimmunity.Furthermore,CAG has a broad spectrum of clinical manifestations,including gastroenterology and extraintestinal symptoms and signs,such as hematology,neurology,and oncology.Therefore,the initial CAG evaluation should involve the examination of clinical and serological indicators,as well as diagnosis confirmation via gastroscopy and histopathology if necessary.Depending on the severity and scope of atrophy affecting the gastric mucosa,a histologic staging system(Operative Link for Gastritis Assessment or Operative Link on Gastritis intestinal metaplasia)could also be employed.Moreover,chronic gastritis has a higher risk of progressing to gastric cancer(GC).In this regard,early diagnosis,treatment,and regular testing could reduce the risk of GC in CAG patients.However,the optimal interval for endoscopic monitoring in CAG patients remains uncertain,and it should ideally be tailored based on individual risk evaluations and shared decision-making processes.Although there have been many reports on CAG,the precise etiology and histopathological features of the disease,as well as the diagnosis of CAG patients,are yet to be fully elucidated.Consequently,this review offers a detailed account of CAG,including its key clinical aspects,aiming to enhance the overall understanding of the disease.
基金Supported by the National Natural Science Foundation of China,No.81904175Chongqing Health Planning Commission Project,No.ZY201802063,No.2019ZY013111,No.2022QNXM061+1 种基金Chongqing Performance Incentive Project,No.jxyn2021-1-1Chongqing Technology Innovation and Application Development Special Key Project,No.CSTB2022TIAD-KPX0187.
文摘BACKGROUND The Correa sequence,initiated by Helicobacter pylori(H.pylori),commonly progresses to gastric cancer through the stage of chronic atrophic gastritis(CAG).Although eradication of H.pylori only reduces the risk of gastric cancer,it does not eliminate the risk for neoplastic progression.Yiwei Xiaoyu granules(YWXY)are a commonly used composite preparation in Chinese clinics.However,the pursuit of excellence in clinical trials and the establishment of standardized animal experiments are still needed to contribute to full understanding and application of traditional Chinese medicine in the treatment of CAG.AIM To demonstrate the effectiveness of YWXY in patients with CAG and spleenstomach deficiency syndrome(DSSS),by alleviating histological scores,improving response rates for pathological lesions,and achieving clinical efficacy in relieving DSSS symptoms.METHODS We designed a double-blind,randomized,controlled trial.The study enrolled seventy-two H.pylori-negative patients(mean age,52.3 years;38 men)who were randomly allocated to either the treatment group or control group in a 1:1 ratio,and treated with 15 g YWXY or 0.36 g Weifuchun(WFC)tablet combined with the respective dummy for 24 wk.The pre-randomization phase resulted in the exclusion of 72 patients:50 participants did not meet the inclusion criteria,12 participants declined to participate,and 10 participants were excluded for various other reasons.Seven visits were conducted during the study,and histopathological examination with target endoscopic biopsy of narrow-band imaging was requested before the first and seventh visits.We also evaluated endoscopic performance scores,total symptom scores,serum pepsinogen and gastrin-17.RESULTS Six patients did not complete the trial procedures.Treatment with YWXY improved the Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM)stage,compared with WFC(P<0.05).YWXY provided better relief from symptoms of DSSS and better improvement in serum gastric function,compared with WFC(P<0.05).CONCLUSION YWXY compared with WFC significantly reduced the risk of mild or moderate atrophic disease,according to OLGIM stage,significantly relieved symptoms of DSSS,and improved serum gastric function.
基金Supported by National Natural Science Foundation of China (82374546)The Ninth Batch of Suzhou Gusu Health Key Talents Project (GSWS2023015).
文摘[Objectives]To observe the effect of Jianpi Xiaowei Decoction on gastric function and quality of life in elderly patients with chronic atrophic gastritis(CAG)of liver-stomach heat stagnation type.[Methods]Seventy-two elderly patients with CAG of liver-stomach stagnation-heat type were randomly divided into study group and control group.The two groups were treated with Jianpi Xiaowei Decoction and Rabeprazole Enteric-coated Tablets respectively.The curative effect of TCM syndromes,serum pepsinogen I and II(PG-I and PG-II),gastrin-17(G-17)and quality of life(SF-36 table)scores of gastric function indicators before and after treatment were observed.[Results]After treatment,the total effective rate of the study group was 97.22%(35/36),which was significantly higher than that of the control group 77.78%(28/36)(P<0.05).Before treatment,there was no significant difference in the levels of gastric function indicators between the two groups(P>0.05).After treatment,the indicators of the study group were significantly lower than those of the control group(t=12.239,6.010,5.928,10.420,P<0.05).Before treatment,there was no significant difference in SF-36 scores between the two groups(P>0.05).After treatment,the SF-36 scores in the study group were significantly lower than those in the control group(t=3.520,10.335,11.300,9.693,P<0.05).[Conclusions]Jianpi Xiaowei Decoction can achieve significant curative effect in the treatment of CAG with liver and stomach stagnation heat type in the elderly,and can significantly improve the key gastrointestinal hormone levels and quality of life of elderly patients.It is worthy of promotion in the same clinical cases.
基金Supported by the Project of Regional Collaborative Innovation of Xinjiang Uygur Autonomous Region,No.2022E01008the Graduate Innovation Project of Xinjiang Medical University,No.CXCY2023012.
文摘BACKGROUND The Chinese medicine Yangyin Huowei mixture(YYHWM)exhibits good clinical efficacy in the treatment of chronic atrophic gastritis(CAG),but the mechanisms underlying its activity remain unclear.AIM To investigate the therapeutic effects of YYHWM and its underlying mechanisms in a CAG rat model.METHODS Sprague-Dawley rats were allocated into control,model,vitacoenzyme,and low,medium,and high-dose YYHWM groups.CAG was induced in rats using Nmethyl-N′-nitro-N-nitrosoguanidine,ranitidine hydrochloride,hunger and satiety perturbation,and ethanol gavage.Following an 8-wk intervention period,stomach samples were taken,stained,and examined for histopathological changes.ELISA was utilized to quantify serum levels of PG-I,PG-II,G-17,IL-1β,IL-6,and TNF-α.Western blot analysis was performed to evaluate protein expression of IL-10,JAK1,and STAT3.RESULTS The model group showed gastric mucosal layer disruption and inflammatory cell infiltration.Compared with the blank control group,serum levels of PGI,PGII,and G-17 in the model group were significantly reduced(82.41±3.53 vs 38.52±1.71,23.06±0.96 vs 11.06±0.70,and 493.09±12.17 vs 225.52±17.44,P<0.01 for all),whereas those of IL-1β,IL-6,and TNF-αwere significantly increased(30.15±3.07 vs 80.98±4.47,69.05±12.72 vs 110.85±6.68,and 209.24±11.62 vs 313.37±36.77,P<0.01 for all),and the protein levels of IL-10,JAK1,and STAT3 were higher in gastric mucosal tissues(0.47±0.10 vs 1.11±0.09,0.49±0.05 vs 0.99±0.07,and 0.24±0.05 vs 1.04±0.14,P<0.01 for all).Compared with the model group,high-dose YYHWM treatment significantly improved the gastric mucosal tissue damage,increased the levels of PGI,PGII,and G-17(38.52±1.71 vs 50.41±3.53,11.06±0.70 vs 15.33±1.24,and 225.52±17.44 vs 329.22±29.11,P<0.01 for all),decreased the levels of IL-1β,IL-6,and TNF-α(80.98±4.47 vs 61.56±4.02,110.85±6.68 vs 89.20±8.48,and 313.37±36.77 vs 267.30±9.31,P<0.01 for all),and evidently decreased the protein levels of IL-10 and STAT3 in gastric mucosal tissues(1.11±0.09 vs 0.19±0.07 and 1.04±0.14 vs 0.55±0.09,P<0.01 for both).CONCLUSION YYHWM reduces the release of inflammatory factors by inhibiting the IL-10/JAK1/STAT3 pathway,alleviating gastric mucosal damage,and enhancing gastric secretory function,thereby ameliorating CAG development and cancer transformation.
文摘Atrophic gastritis and intestinal metaplasia may progress to gastric malignancy.Non-invasive serum biomarkers have been extensively studied and proven to be useful as a screening tool to stratify risk and identify patients for endoscopy to detect early gastric cancer.These non-invasive biomarkers have been endorsed and recommended by many international consensus guidelines.In this letter,we reviewed the literature and evidence supporting the use of serum biomarkers as a dynamic test to monitor the status of atrophic gastritis.
文摘BACKGROUND Autoimmune gastritis(AIG)is a progressive,chronic,immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor.Gastrointestinal symptoms such as dyspepsia and early satiety are very common,being second in terms of frequency only to anemia,which is the most typical feature of AIG.AIM To address both well-established and more innovative information and knowledge about this challenging disorder.METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 10 years.RESULTS A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.CONCLUSION AIG can cause a range of clinical manifestations,including dyspepsia.The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion,gastric motility,hormone signaling,and gut microbiota,among other factors.Managing dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in AIG.While proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease,they may not be appropriate for AIG.Prokinetic agents,antidepressant drugs,and non-pharmacological treatments may be of help,even if not adequately evidence-based supported.A multidisciplinary approach for the management of dyspepsia in AIG is recommended,and further research is needed to develop and validate more effective therapies for dyspepsia.
文摘BACKGROUND The incidence of type I gastric neuroendocrine neoplasms(gNENs)has increased significantly over the past 50 years.Although autoimmune gastritis(AIG)increases the likelihood of developing gNENs,the exact incidence and prevalence of this association remain unclear.AIM To evaluate the incidence and prevalence of type I gNENs in a cohort of patients with a histological diagnosis of AIG.METHODS Patients with a histological diagnosis of AIG were enrolled between October 2020 and May 2022.Circulating levels of CgA and gastrin were assessed at enrollment.Included patients underwent regular endoscopic follow-up to detect gastric neoplastic lesions,enterochromaffin-like(ECL)cell hyperplasia,and the development of gNEN.RESULTS We included 176 patients[142 women(80.7%),median age 64 years,interquartile range(IQR)53–71 years]diagnosed with AIG between January 1990 and June 2022.At enrollment.One hundred and sixteen patients(65.9%)had ECL hyperplasia,of whom,29.5%had simple/linear,30.7%had micronodular,and 5.7%had macronodular type.The median follow-up time was 5(3–7.5)years.After 1032 person-years,33 patients developed a total of 50 type I gNENs,with an incidence rate of 0.057 person-years,corresponding to an annual cumulative incidence of 5.7%.Circulating CgA levels did not significantly differ between AIG patients who developed gNENs and those who did not.Conversely,gastrin levels were significantly higher in AIG patients who developed gNENs[median 992 pg/mL IQR=449–1500 vs 688 pg/mL IQR=423–1200,P=0.03].Calculated gastrin sensitivity and specificity were 90.9%and 1.4%,respectively,with an overall diagnostic accuracy of 30%and a calculated area under the gastrin receiver operating characteristic curve(AUROC or AUC)of 0.53.CONCLUSION Type I gNENs are a significant complication in AIG.Gastrin’s low diagnostic accuracy prevents it from serving as a marker for early diagnosis.Effective strategies for early detection and treatment are needed.
文摘BACKGROUND Mucosal patterns(MPs)observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty,cracked,and mottled.Furthermore,we hypothesized that the spotty pattern may change to the cracked pattern after Helicobacter pylori(H.pylori)eradication.AIM To further substantiate and comprehensively investigate MP changes after H.pylori eradication in a larger number of patients.METHODS We included 768 patients who were diagnosed with atrophic gastritis with evaluable MP using upper gastrointestinal endoscopy at the Nishikawa Gastrointestinal Clinic,Japan.Among them,325 patients were H.pylori-positive,and of them,101 patients who underwent upper gastrointestinal endoscopy before and after H.pylori eradication were evaluated for post-eradication MP changes.The patients’MPs were interpreted by three experienced endoscopists who were blinded to their clinical features.RESULTS Among 76 patients with the spotty pattern before or after H.pylori eradication,the pattern disappeared or decreased in 67 patients[88.2%,95%confidence interval(CI):79.0%-93.6%),appeared or increased in 8 patients(10.5%,95%CI:5.4%-19.4%),and showed no change in 1 patient(1.3%,95%CI:0.2%-7.1%).In 90 patients with the cracked pattern before or after H.pylori eradication,the pattern disappeared or decreased in 7 patients(7.8%,95%CI:3.8%-15.2%),appeared or increased in 79 patients(87.8%,95%CI:79.4%-93.0%),and showed no change in 4 patients(4.4%,95%CI:1.7%-10.9%).In 70 patients with the mottled pattern before or after H.pylori eradication,the pattern disappeared or decreased in 28 patients(40.0%,95%CI:29.3%-51.7%),appeared or increased in 35 patients(50.0%,95%CI:38.6%-61.4%),and showed no change in 7 patients(10.0%,95%CI:4.9%-19.2%).CONCLUSION After H.pylori eradication,MPs changed from spotty to cracked in most patients,which may help endoscopists easily and precisely evaluate H.pylori-related gastritis status.
文摘BACKGROUND Chronic atrophic gastritis is a persistent disorder of the digestive system where the gastric mucosa epithelium and glands undergo atrophy,leading to a decrease in their number and thinning of the gastric mucosa.It is worth noting that the prevalence of chronic atrophic gastritis is higher in China compared to the global average,and it is also considered a precancerous condition for gastric cancer.AIM To evaluate the efficacy of Huangqi Jianzhong decoction in treating chronic atrophic gastritis.Chronic atrophic gastritis is a persistent illness characterized by the progressive disappearance of healthy gastric glands due to repeated injury.Huangqi Jianzhong decoctions are widely used in China to treat chronic atrophic gastritis.However,there is limited scientific evidence regarding their efficacy in treating this illness.METHODS The present meta-analysis adhered to the PRISMA guidelines and used the Cochrane Collaboration methodology.We performed a comprehensive search for clinical trials investigating the use of Huangqi Jianzhong decoction in treating chronic atrophic gastritis published until January 2023.The risk of bias and the quality of the included studies were evaluated using the Cochrane Handbook guidelines.Finally,a meta-analysis was conducted using the RevMan 5.4 softRESULTS This study included a total of 13 articles,comprising 1269 samples.The meta-analysis was conducted on these 13 articles,yielding the following results:I2=0%,P=0.60,[RR=1.24,95%CI:1.18 to 1.30,P<0.00001].The forest plot analysis of the Helicobacter pylori clearance rate revealed I2=0%,P=0.36,[RR=1.20,95%CI:1.05 to 1.38,P=0.009].The forest plot of PG-I level showed I2=99%,P<0.00001,[MD=4.99,95%CI:-1.59 to 11.58,P=0.14].The forest plot of stomach pain demonstrated I2=54%,P=0.04,[MD=-0.63,95%CI:-0.68 to-0.58,P<0.00001].The forest plot of reflux indicated I2=82%,P=0.0009,[MD=-0.48,95%CI:-0.63 to-0.33,P<0.00001].The forest plot of recurrence rate exhibited I2=0%,P=0.92,[RR=0.15,95%CI:0.04 to 0.66,P=0.01].The forest plot of adverse reactions showed no heterogeneity in outcome data,[RR=1.07,95%CI:0.53 to 2.17,P=0.86].CONCLUSION This study demonstrated that Huangqi Jianzhong decoction improved various factors in adults with chronic atrophic gastritis.These factors included the total effective rate,Helicobacter pylori clearance rate,symptoms such as stomachache and acid reflux alleviation,and recurrence rates.
文摘Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifestations of mandibular acne did not improve. At the time of initial examination, telangiectasia (TE), post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), atrophic scars (ASs), and a hypertrophic scar (HS) with induration were observed on the right neck. We diagnosed this as an acne vulgaris complication. HS lesions were topically treated by injecting triamcinolone acetonide, and the patient was prescribed 8.1 g/day of oral Saireito (Japanese herb). Adapalene benzoyl peroxide gel and topical tacrolimus hydrate ointment were used to treat PIE and TE. Both HSs and PIE improved;however, TE and AS did not improve. Currently, the patient is under observation. We consider this to be a very rare concurrent occurrence of diverse complications of acne vulgaris, and present the following case study.
文摘Helicobacter pylori(Hp) is a major human pathogen causing chronic, progressive gastric mucosal damage and is linked to gastric atrophy and cancer. Hp-positive individuals constitute the major reservoir for transmission of infection. There is no ideal treatment for Hp. Hp infection is not cured by a single antibiotic, and sometimes, a combined treatment with three or more antibiotics is ineffective. Atrophic gastritis(AG) is a chronic disease whose main features are atrophy and/or intestinal metaplasia of the gastric glands, which arise from long-standing Hp infection. AG is reportedly linked to an increased risk for gastric cancer, particularly when extensive intestinal metaplasia is present. Active or past Hp infection may be detected by conventional methods in about two-thirds of AG patients. By immunoblotting of sera against Hp whole-cell protein lysates, a previous exposure to Hp infection is detected in all AG patients. According to guidelines, AG patients with Hp positivity should receive eradication treatment. The goals of treatment are as follows:(1) Cure of infection, resolution of inflammation and normalization of gastric functions;(2) possible reversal of atrophic and metaplastic changes of the gastric mucosa; and(3) prevention of gastric cancer. An ideal antibiotic regimen for Hp should achieve eradication rates of approximately 90%, and complex multidrug regimens are required to reach this goal. Amongst the factors associated with treatment failure are high bacterial load, high gastric acidity, Hp strain, smoking, low compliance, overweight, and increasing antibiotic resistance. AG, when involving the corporal mucosa, is linked to reduced gastric acid secretion. At a non-acidic intra-gastric p H, the efficacy of the common treatment regimens combining proton pump inhibitors with one or more antibiotics may not be the same as that observed in patients with Hp gastritis in an acid-producing stomach. Although the efficacy of these therapeutic regimens has been thoroughly tested in subjects with Hp infection, there is a paucity of evidence in the subgroupof patients with AG. Bismuth-based therapy may be an attractive treatment in the specific setting of AG, and specific studies on the efficacy of bismuth-based therapies are needed in patients with AG.
文摘Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures inappropriate for location （metaplastic atrophy）. Epidemiological data suggest that CAG is associated with two different types of tumors： Intestinal-type gastric cancer （GC） and type I gastric carcinoid （T I GC）. The pathophysiological mechanisms which lead to the development of these gastric tumors are different, It is accepted that a multistep process initiating from Helico- bacterpylori-related chronic inflammation of the gastric mucosa progresses to CAG, intestinal metaplasia, dysplasia and, finally, leads to the development of GC. The T I GC is a gastrin-dependent tumor and the chronic elevation of gastrin, which is associated with CAG, stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of T I GC. Thus, several events occur in the gastric mucosa before the development of intestinatype GC and/ or T I GC and these take several years. Knowledge ofCAG incidence from superficial gastritis, its prevalence in different clinical settings and possible risk factors as- sociated with the progression of this condition to gastric neoplasias are important issues. This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.
基金Cangzhou City Science and Technology Plan Projects,No.151302138
文摘AIM To explore the correlation between serum vitamin B12 level and peripheral neuropathy in patients with chronic atrophic gastritis(CAG). METHODS A total of 593 patients diagnosed with chronic gastritis by gastroscopy and pathological examination fromSeptember 2013 to September 2016 were selected for this study. The age of these patients ranged within 18-to 75-years-old. Blood pressure, height and weight were measured in each patient, and the body mass index value was calculated. Furthermore, gastric acid, serum gastrin, serum vitamin and serum creatinine tests were performed, and peripheral nerve conduction velocity and Helicobacter pylori(H. pylori) were detected. In addition, the type of gastritis was determined by gastroscopy. The above factors were used as independent variables to analyze chronic gastritis with peripheral neuropathy and vitamin B12 deficiency risk factors, and to analyze the relationship between vitamin B12 levels and peripheral nerve conduction velocity. In addition, in the treatment of CAG on the basis of vitamin B12, patients with peripheral neuropathy were observed. RESULTS Age, H. pylori infection, CAG, vitamin B9 and vitamin B12 were risk factors for the occurrence of peripheral nerve degeneration.Furthermore,CAG and H. pylori infection were risk factors for chronic gastritis associated with vitamin B12 deficiency. Serum vitamin B12 level was positively correlated with sensory nerve conduction velocity in the tibial nerve(R = 0.463). After vitamin B12 supplementation, patients with peripheral neuropathy improved. CONCLUSION Serum vitamin B12 levels in patients with chronic gastritis significantly decreased, and the occurrence of peripheral neuropathy had a certain correlation. CAG and H. pylori infection are risk factors for vitamin B12 deficiency and peripheral neuropathy. When treating CAG, vitamin B12 supplementation can significantly reduce peripheral nervous system lesions. Therefore, the occurrence of peripheral neuropathy associated with vitamin B12 deficiency may be considered in patients with CAG. Furthermore, the timely supplementation of vitamin B12 during the clinical treatment of CAG can reduce or prevent peripheral nervous system lesions.
文摘Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundus and leads to hypochlorhydria, hypergastrinemia and inadequate production of the intrinsic factor. As a result, the stomach’s secretion of essential substances, such as hydrochloric acid and intrinsic factor, is reduced, leading to digestive impairments. The most common is vitamin B12 deficiency, which results in a megaloblastic anemia and iron malabsorption, leading to iron deficiency anemia. However, in the last years the deficiency of several other vitamins and micronutrients, such as vitamin C, vitamin D, folic acid and calcium, has been increasingly described in patients with CAAG. In addition the occurrence of multiple vitamin deficiencies may lead to severe hematological, neurological and skeletal manifestations in CAAG patients and highlights the importance of an integrated evaluation of these patients. Nevertheless, the nutritional deficiencies in CAAG are largely understudied. We have investigated the frequency and associated features of nutritional deficiencies in CAAG in order to focus on any deficit that may be clinically significant, but relatively easy to correct. This descriptive review updates and summarizes the literature on different nutrient deficiencies in CAAG in order to optimize the treatment and the follow-up of patients affected with CAAG.
基金Supported by the Scientific Research Fund of the Health Bureau of Zhejiang Province, No. 2001QN012
文摘AIM: To investigate the effect of H pylori eradication on atrophic gastritis and intestinal metaplasia (IM).METHODS: Two hundred and fifty-nine patients with atrophic gastritis in the antrum were included in the study, 154 patients were selected for H pylori eradication therapy and the remaining 105 patients served as untreated group. Gastroscopy and biopsies were performed both at the beginning and at the end of a 3-year follow-up study. Gastritis was graded according to the updated Sydney system.RESULTS: One hundred and seventy-nine patients completed the follow-up, 92 of them received H pylori eradication therapy and the remaining 87 H pyloriinfected patients were in the untreated group. Chronic gastritis, active gastritis and the grade of atrophy significantly decreased in H pylori eradication group (P＜0.01). However, the grade of IM increased in H pylori -infected group (P＜0.05).CONCLUSION: H pylori eradication may improve gastric mucosal inflammation, atrophy and prevent the progression of IM.
文摘BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastric cancer mass screening.However,skilled doctors for interpretation of X-ray examination are decreasing due to the diverse of inspections.AIM To evaluate the effectiveness of stomach regions that are automatically estimated by a deep learning-based model for CAG detection.METHODS We used 815 gastric X-ray images(GXIs)obtained from 815 subjects.The ground truth of this study was the diagnostic results in X-ray and endoscopic examinations.For a part of GXIs for training,the stomach regions are manually annotated.A model for automatic estimation of the stomach regions is trained with the GXIs.For the rest of them,the stomach regions are automatically estimated.Finally,a model for automatic CAG detection is trained with all GXIs for training.RESULTS In the case that the stomach regions were manually annotated for only 10 GXIs and 30 GXIs,the harmonic mean of sensitivity and specificity of CAG detection were 0.955±0.002 and 0.963±0.004,respectively.CONCLUSION By estimating stomach regions automatically,our method contributes to the reduction of the workload of manual annotation and the accurate detection of the CAG.
基金Supported by the Natural Science Foundation of Hebei Province, No. 301427
文摘AIM: To study the effects of He-Ne laser irradiation on experimental chronic atrophic gastritis (CAG) in rats.METHODS: Sixty-three male adult Wistar rats were randomly divided into five groups including normal control group, model control group and three different dosages He-Ne laser groups. The chronic atrophic gastritis (CAG)model in rats was made by pouring medicine which was a kind of mixed liquor including 2% sodium salicylate and 30% alcohol down the throat for 8 wk to stimulate rat gastric mucosa, combining with irregular fasting and compulsive sporting as pathogenic factors; 3.36, 4.80, and 6.24J/cm2doses of He-Ne laser were used, respectively for three different treatment groups, once a day for 20 d. The pH value of diluted gastric acid was determined by acidimeter,the histopathological changes such as the inflammatory degrees in gastric mucosa, the morphology and structure of parietal cells were observed, and the thickness of mucosa was measured by micrometer under optical microscope.RESULTS: In model control group, the secretion of gastric acid was little, pathologic morphological changes in gastric mucosa such as thinner mucous, atrophic glands, notable inflammatory infiltration were found. After 3.36 J/cm2 dose of He-Ne laser treatment for 20 d, the secretion of gastric acid was increased (P＜0.05), the thickness of gastric mucosa was significantly thicker than that in model control group (P＜0.01), the gastric mucosal inflammation cells were decreased (P＜0.05). Morphology, structure and volume of the parietal cells all recuperated or were closed to normal.CONCLUSION: 3.36J/cm2 dose of He-Ne laser has a significant effect on CAG in rats.
基金Supported by The Grants from Beijing Municipal Science Foundationthe Key Technology Research and Development Program, No. 2002BA711A06+1 种基金the National 973 Project, No.1998051203863 Project, No. 2006A402
文摘AIM: To investigate the effects of interleukin-8 (IL-8 ), macrophage migration inhibitory factor (MIF ) gene polymorphisms, Helicobacter pylori (H. pylori ) infection, on the risk of developing severe chronic atrophic gastritis (SCAG) and intestinal metaplasia (IM). METHODS: A total of 372 cases were selected from a cohort study in Linqu County, a high risk area for gastric cancer (GC) in northern China. To obtain a sufficient group size, patients with normal or superficial gastritis were included. Based on an average follow-up period of 56 mo, the 372 cases were divided into no progres-sion group (no histological progression from normal or superficial gastritis, n = 137), group Ⅰ (progressed from normal or superficial gastritis to SCAG, n = 134) and group Ⅱ (progressed from normal or superficial gastritis to IM, n = 101). IL-8 , MIF gene polymorphisms were detected by polymerase chain reaction-based denaturing high-performance liquid chromatography analysis and DNA sequencing. RESULTS: An increased risk of SCAG was found in subjects with IL-8-251 AA genotype [odds ratio (OR) = 2.62, 95% CI: 1.23-5.72] or IL-8-251 A allele carriers (AA + AT) (OR = 1.81, 95% CI: 1.06-3.09). An elevated risk of IM was found in subjects with IL-8-251 AT genotype (OR = 2.27, 95% CI: 1.25-4.14) or IL-8-251 A allele carriers (OR = 2.07, 95% CI: 1.16-3.69). An increased risk of SCAG was found in subjects with MIF-173 GC genotype (OR = 2.36, 95% CI: 1.38-4.02) or MIF-173 C allele carriers (GC + CC) (OR = 2.07, 95% CI: 1.21-3.55). An elevated risk of IM was found in subjects with MIF-173 CC genotype (OR = 2.27, 95% CI: 1.16-4.46) or MIF-173 C allele carriers (OR = 3.84, 95% CI: 1.58-9.34). The risk of SCAG and IM was more evident in subjects carrying IL-8-251 A allele (OR = 6.70, 95% CI: 1.29-9.78) or MIF-173 C allele (OR = 6.54, 95% CI: 2.97-14.20) and positive for H. pylori infection. CONCLUSION: IL-8-251 and MIF-173 gene polymorphisms are significantly associated with the risk of SCAG and IM in a population with a high risk of GC in Linqu County, Shandong Province, China.
基金Supported by National Natural Science Foundation of China,No.31460023Science Research and Technology Development Project of Guangxi,No.1598025-33
文摘BACKGROUND Chronic atrophic gastritis(CAG)is a common disease of the digestive system with pathological characteristics of a decreasing number,or disappearance,of inherent glands of the gastric mucosa.CAG has been defined as a precancerous condition of gastric cancer.Intestinal metaplasia or intraepithelial neoplasia accompanying atrophied glands of the stomach is regarded as one of the most important precancerous lesions of gastric cancer.As a common malignant tumour,gastric cancer remains without a satisfactory therapy and its pathogenesis remains unclear,seriously threatening human life.Therefore,some scholars have proposed to prevent the incidence of gastric cancer by avoiding precancerous lesions.If CAG can be reversed,the incidence of gastric cancer can be substantially reduced.To reverse and prevent CAG and study its pathogenesis and therapy,it is necessary to develop an ideal,safe,stable,animal model.AIM To study a rapid,stable,and safe method of establishing a mouse model of human CAG.METHODS Six-week-old Kunming mice were divided into a phosphate buffered solution control group,a Helicobacter pylori(H.pylori)group,an N-methyl-N'-nitroguanidine(MNNG)group,an ammonia water group,and a group combining H.pylori,MNNG,and ammonia water(hereinafter referred to as the combined group).The mice were administrated with drinking water containing ammonia or infected with H.pylori through gavage.At the 30th,60th,90th,and 120th day after the last H.pylori infection,mice were selected randomly to collect their gastric mucosa for hematoxylin eosin staining,terminal nick-end labelling staining detection,and immunohistochemical staining for Bax and Bcl-2.In addition,H.pylori was isolated,cultured,and identified,and its extent of colonisation calculated.Blood was collected to detect inflammatory factors interleukin(IL)-1β,IL-8,and tumor necrosis factor(TNF)-αand immune function markers CD4 and CD8 to confirm successful establishment of the CAG model.RESULTS The combined group showed slight CAG at the 90th day and moderate CAG at the 120th day,while other groups did not show CAG at that time.CONCLUSION The combination of H.pylori,MNNG,and ammonia is an effective method of developing a mouse model of human CAG.
