Chronic Active Gastritis Research Articles

Identification of helicobacter pylori infection in gastric biopsies: Prevalence and associated histopathology

Introduction: Helicobacter pylori (H. pylori) infection affects about 50% of the world population. It is considered as one of the most common chronic bacterial infection in human and a major concern today because of its relationships with gastrointestinal diseases. Aim and Objectives: The study was conducted with the aim to determine the prevalence of H. pylori in gastric mucosal biopsies, to correlate the findings with age and sex, to identify the various types of histopathological changes associated with H. pylori positive gastric mucosal lesions. Material and Methods: The retrospective study was conducted on 362 cases of gastric mucosal biopsy from January 2017 to December 2019. Histopathological examination of the gastric mucosal biopsies was done for presence of H. pylori and associated mucosal changes. The presence of H.pylori on haematoxylin and eosin was confirmed by giemsa stain. Result: A total number of 362 gastric biopsies were analysed. H. pylori were positive in 148 cases of gastric biopsies, which were seen predominantly in males (58.11%). H.pylori was more prevalent in antral mucosal biopsies with 92.57% than other sites. The prevalence of H.pylori was high in third to fourth decades (38.51%). Morphological feature commonly associated with the organism was lymphoid follicle and the common gastritis was chronic active gastritis. Conclusion: The study reveals that H. pylori infection was prevalent in 40.88 % of gastric mucosal biopsies. The presence of H. pylori was strongly associated with lymphoid follicles. Early identification and treatment for eradication of H.pylori is necessary to prevent gastric complications.

Increased Resistance of Fluoroquinolones among H. pylori isolates from Patients with Gastroduodenal Diseases in Jordan

Recently, Helicobacter pylori has been connected to more than 80% of chronic active gastritis and other gastroduodenal diseases worldwide. Treatment of H. pylori is routinely dependent on the use of multiple antimicrobial agents however, recent data showed the emergence of resistance among clinical strains especially against metronidazole and clarithromycin. This study was conducted to investigate the rate of resistance to different antibiotics that are routinely used in the first line and second line therapies including ciprofloxacin and levofloxacin, tetracycline, amoxicillin, clarithromycin and metronidazole among H. pylori strains isolated from patients with gastroduodenal diseases in Jordan. Both antral and corpus mucosal biopsies from the stomach of patients with positive results of H. pylori stool antigen and urease breath tests were used for the isolation of H. pylori on selective culture media. The standard agar diffusion method was performed to determine the sensitivity of H. pylori clinical isolates against ciprofloxacin and levofloxacin according to CLSI. Among 62 H. pylori clinical strains isolated from gastric biopsies, 21% and 11% were resistant to levofloxacin and ciprofloxacin respectively. Resistance to metronidazole and clarithromycin was found in 90% and 11% respectively. No resistance was observed against amoxicillin, tetracycline and gemifloxacin. The following MIC90 (mg/L) of resistant strains results were obtained at neutral pH 7.3, 64 for metronidazole, 2 for clarithromycin, 2 for ciprofloxacin and 1 for levofloxacin. The present study reported the emergence of increased resistance of fluoroquinolones among H. pylori clinical isolates in Jordan. Concern should be taken into consideration when triple and quadruple therapy regimens are applied for the management of H. pylori infections in our region

SUN-475 Thyroid Extranodal Diffuse Large B-Cell Lymphoma in Setting of Gastric Large B-Cell Lymphoma

Background: We report a case of concomitant thyroid and gastric diffuse large B-cell lymphoma (DLBCL). Clinical Case: A 73 year-old man presented with melena of 2 days duration. EGD revealed a 1.5 x 0.7 cm gastric ulcer. Biopsy revealed marked chronic active gastritis with glandular atypia, positive for H. pylori. Repeat biopsy of the same ulcer post H. pylori treatment demonstrated high-grade B-cell lymphoma. Immunostains were positive for CD20, CD10, BCL6, cyclin D and negative for CD 23 and CD 30. More than 95% of tumor cells expressed Ki-67, while 10% expressed MUM-1 and BCL2. Benign T cells stained positive for CD3 and CD5. FISH was negative for gene rearrangement involving BCL-6/BCL-2 and C-MYC. Staging PET/CT showed hypermetabolic regions involving the stomach wall, large left neck mass and right lung focus. The neck focus had a max SUV 48.5 (8 fold greater than the other sites), that localized to a soft tissue mass measuring 4.9 x 2.7 cm. FNA of the left-sided thyroid mass showed diffuse large B-cell lymphoma with immunostain positive for CD20 and negative for cytokeratin AE1-3, PAX8, and CD 10. The morphology was similar to that of abnormal lymphoid cells in the gastric biopsy. Patient had normal thyroid function tests but positive autoimmune thyroid disease markers (TPO and anti-TG antibody). Treatment with R-CHOP resulted in shrinkage of neck mass. Conclusion: Hypermetabolic regions revealed by PET/CT at distant sites from primary tumor require further evaluation including biopsy as indicated. Clinical correlation and response to chemotherapy can provide supplemental information in the overall assessment of the disease process.

Pathologic Manifestations of Gastrointestinal and Hepatobiliary Injury in Immune Checkpoint Inhibitor Therapy.

Immune checkpoint inhibitors (CPIs), including cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors and the programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors, are being increasingly used for treating many advanced malignancies. However, CPI therapy is also associated with gastrointestinal and hepatobiliary adverse effects. To review the adverse effects of CPI therapy on the gastrointestinal tract and hepatobiliary system. To describe histopathologic patterns and discuss differential diagnostic considerations in the diagnosis of CPI injuries. Published peer-reviewed literature in the English language and personal experience in the diagnosis of CPI injuries. The pathologic manifestations of CPI therapy-induced gastrointestinal and hepatobiliary injury are broad. The patterns of esophageal CPI injury include lymphocytic inflammation and ulcerative esophagitis, while those of gastric injury include chronic active gastritis, lymphocytic gastritis, focal enhancing gastritis, and periglandular inflammation. The duodenal injury may present as duodenitis with villous blunting and granulomas. We also noticed active colitis, microscopic colitis, chronic active colitis, increased apoptosis, ischemic colitis, and nonspecific inflammatory reactive changes in colonic injuries. The reported histologic features of hepatobiliary injuries are panlobular hepatitis, centrilobular necrosis, portal inflammation with bile duct injury, steatosis, nodular regenerative hyperplasia, and secondary sclerosing cholangitis. In summary, we discuss the pathologic features and differential diagnosis of CPI therapy-induced gastrointestinal and hepatobiliary injury. Recognition of CPI injury is important to determine the proper management that often includes cessation of CPI therapy, and administration of steroids or other immunosuppressive agents, based on severity of injury.

The Prevalence of Helicobacter pylori Infection and Its Associated Risk Factors Among Patients Undergoing Upper Gastrointestinal Diagnosis in Shashemene Referral Hospital in Shashemene, Ethiopia

Background: - Helicobacter pylori infection is the principal cause of chronic active gastritis in developing countries including Ethiopia. Objective:- The main objective of the present study is to evaluate the prevalence of H. pylori infection colonization and its associated risk factors among upper gastrointestinal patients aged ≥14 years. Method:- Hospital-based retrospective and cross-sectional study was conducted at Shashemene referral Hospital among upper gastrointestinal positive patients who underwent diagnosis in the Hospital from September 2012-August 2017. Results:- After organizing the recorded data of the 1966 upper gastrointestinal patients, the overall prevalence of five consecutive years (September 2012-August 2017) H. pylori infection in this study was found to be 30.3% (n= 592/1966). The majority of the patients were in the age range of 20-29 (218/657(33.03%)) and ≥60 (46/149(30.9%)). The overall prevalence of H. pylori in this study dropped from 45.5% in September 2012 -August 2013 to 15.2% in September 2016 - August 2017. The most important risk factors in this study were large family size, age, poor personal hygiene, poor hygiene in nutrition and life style, poor economic status, stress, alcohol, overcrowding and educational level. Marital status of the patients (2.793 OR; 95%CI: p=0.038 < 0.05) and age groups (1.345 OR; 95%CI: p=0.006< 0.05) were statistically significant predictors or were significantly associated with H. pylori infection. In this study the prevalence of H. pylori infection is highest in the youngest group, because of the exacerbation of the youngest to multi substance use, and environmental hygienic condition. Conclusion and recommendation:- This study has shown that gastritis and H. pylori infection were the major problems in the study area and, therefore, further in-depth epidemiological 0research and identification of other potential environmental and personal related risk factors of H. pylori infection and gastritis are suggested. Keywords: Helicobacter Pylori ; gastritis; prevalence; risk factor; Ethiopia; retrospective study; cross–sectional study DOI: 10.7176/JHMN/73-01 Publication date: April 30 th 2020

SERUM LEVELS OF IL-8 IN PATIENTS WITH CHRONIC ACTIVE GASTRITIS AND PEPTIC ULCER DISEASE

The majority of researchers discover associations between H. pylori (Hp) and serum IL-8 production with the stage of chronic inflammation. Data on IL-8 levels in chronic gastritis (CG) and a gastroduodenal ulcer (GDU) are insufficient, and often controversial. All patients with chronic active gastritis (CAG) and GDU were divided into 4 subgroups: patients with GDU and found Hp infection according to common methods (GDU+Hp), patients with GDU and no documented Hp infection (GDU), patients with CAG and found Hp infection according to common methods (CAG+Hp), and patients with CAG with no documented Hp infection (CAG). The highest serum IL-8 levels were seen in patients with GDU+Hp, whereas the lowest ones were observed in patients with CAG. Men have the lowest IL-8 levels in the CAG+Hp subgroup as compared with other subgroups. The IL-8 values were significantly different from higher values in women. The rate of fecal Oantigen of H. pylori LPS found using the coagglutination test is 86%. The highest levels of O-antigen of H. pylori LPS were detected in the CAG subgroup. In patients with GDU+Hp, the levels of O-antigen of H. pylori LPS were significantly higher as compared with the GDU subgroup. So patients with GDU, especially those with GDU+Hp, and with CAG, have active IL-8 production. Coagglutination to detect O-antigen of H. pylori LPS in feces used along with common methods increases the probability to confirm that the patients (especially those with chronic gastritis) are infected with this microbe.

Laparoskopik Sleeve Gastrektomi Materyallerinde Histopatolojik Bulguların Değerlendirilmesi

Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeuti coption in patients with morbid obesity that debate about the value of routine histopathologi cal examination of LSG. Also the effect of Helicobacterpylori colonization of the stomach of patient sunder going LSG is unclear. Ouraim is to analyze there sults of histopathological examination of LSG specimensan didentify the prevalence of Helicobacterpylori. This study is a retrospective study of the patients who underwent LSG for the treatment of morbid obesity in our hospital between 2014-2018. Sex, age, histopathologi calfindings in the surgical specimens and prevalenceof Helicobacterpylori(HP) infection were analyzed. Gastricspecimens of a total of 110 patients( 90females, 20 males; meanage 38 ± 11.9years)were analyzed in this study.Themost common histopathological findings in the surgical specimens were chronicin active gastritis (57.3%,n=63),chronic active gastritis ( 34.5%, n= 38),intestinal metaplasia (6.4%, n=7), fundic gland polyp (1.8%,n=2), parietal cellhy pertrophia (0.9 %, n=1). Fourty eight (43.6%) patients were foundto be HP positive. There was statistically significant correlation between gastritis and HP infections. The majority of patients who underwent LSG had pathological findings in resected specimens.It is concluded that the pathological evaluation of the LSG specimens is necessary because of the clinical significance of HP infection and intestinal metaplasia.

From This Month's Histopathology

From This Month's Histopathology

Morphological spectrum of immune check-point inhibitor therapy-associated gastritis.

Immune check-point inhibitors are frequently used in the treatment of a variety of solid tumours. The mechanism of action of these drugs involves up-regulation of cytotoxic T cells, which can lead to a lack of self-tolerance and immune-related adverse events, including those involving the gastrointestinal tract. This study was performed to characterise the histological features of immune check-point inhibitor therapy-associated gastritis. Gastric biopsies from patients on immune check-point inhibitor therapy with clinical suspicion of drug-associated gastrointestinal injury were identified. The predominant histological pattern of injury, distribution of injury, degree of tissue eosinophilia and prominence of apoptosis were recorded. Presenting symptoms, treatment and follow-up data were obtained by medical chart review. The 12 patients included in the study group were treated with ipilimumab, nivolumab or pembrolizumab for a variety of tumours. Symptoms at presentation included nausea, vomiting and diarrhoea. Chronic active gastritis with intra-epithelial lymphocytosis and prominent apoptosis was seen in eight of 12 patients, and was the most useful combination for the diagnosis of drug-induced gastritis in these patients. Four patients showed focal enhancing gastritis with a lymphohistiocytic cuff around inflamed glands reminiscent of Crohn's disease. One of those four patients was homozygous for the ATG16L1 Crohn's disease-associated gene variant, but had no history of inflammatory bowel disease. Ten patients responded to medication withdrawal and steroid therapy, while two required treatment with infliximab. Awareness of the morphological spectrum of immune check-point inhibitor therapy-associated gastritis is important for the accurate diagnosis and prompt management of these patients.

Factors associated with failure of Helicobacter pylori eradication.

Helicobacter pylori (Hp) infection is closely related to chronic active gastritis, peptic ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer, and is also associated with some parenteral diseases. Eradication of Hp can significantly improve gastric mucosal inflammatory response, prevent or delay gastric mucosal atrophy, intestinal metaplasia and its development, partially reverse atrophy, and reduce the risk of gastric cancer in varying degrees. In recent years, the eradication failure rate has increased. There are many reasons for the failure of Hp eradication. Previous studies have suggested that Hp resistance to antibiotics is the main cause of eradication failure, but recent studies have found that poor compliance is the main reason.

P104 PEDIATRIC CROHN’S DISEASE PRESENTINAG AS GENITAL EDEMA

Abstract Two 12 year old boys presented to pediatric urology with chief complaints of genital swelling who were eventually diagnosed with Crohn’s disease. Patient 1 presented with swelling, erythema and discomfort of his penis. He did not respond to topical hydrocortisone or oral antibiotics. With history of short stature he was referred to pediatric GI. He had oral ulcerations and perianal skin tag, but denied abdominal pain or diarrhea. Weight was at the 3rd percentile height was at the 2nd percentile. He had Hgb of 12.2, and iron saturation of 8 with normal ESR and CRP. ASCA IgA was normal but IgG was elevated at 66 (normal &amp;lt;20). Endoscopy revealed erythema with linear ulcerations in the stomach and aphthous ulcerations of the colon with erythema and edema of the ileocecal valve with inability to intubate it. Pathology demonstrated mild chronic active gastritis and mild chronic active colitis with granulomas. Magnetic resonance enterography (MRE) showed mild enhancement at the ileocecal area. Budesonide improved the penile erythema but did not change the edema. He was then started on methotrexate and infliximab with no improvement of the edema. Topical tacrolimus did not resolve edema. At age 15 he had surgical resection of the indurated subcuticular penile tissues with pathology revealing fibrotic stroma with lymphoplasmacytic inflammation and rare granulomas. He has recovered well from his penile procedure with a dramatic improvement in the cosmetic appearance, with no recurrence of the penile edema. Patient 2 had scrotal edema, erythema, and discomfort. A scrotal ultrasound demonstrated moderate to severe scrotal edema without epididymitis, orchitis, or abscess. He was prescribed a dose of prednisone and diphenhydramine. Swelling improved but he presented a month later with recurrent scrotal edema and pain and was prescribed doxycycline for a presumed diagnosis of cellulitis along with recommendations for ice, compression and elevation. He returned to the ER the next day due to serous seepage from the scrotum. Upon follow up in urology, a pediatric gastroenterology referral was performed as a family history of Crohn’s disease in the mother, maternal aunt, and maternal grandmother was noted. Labs revealed a slightly elevated ESR of 17, elevated CRP of 7.3 (normal &amp;lt;0.5), negative ASCA, and mildly elevated fecal calprotectin of 193. Endoscopy revealed aphthous ulcerations in the duodenal bulb and patchy erythema of the terminal ileum. Pathology revealed mild reflux esophagitis, mild reactive changes in the stomach, mild chronic duodenitis, and mild active ileitis. MRE was normal. He was treated with budesonide and mesalamine with subsequent improvement in the scrotal edema. Patients presenting as genital edema as their initial Crohn’s presentation is rare and it is important for providers to be aware of this rare manifestation. Epitheliod granuloma in the bowel. Epitheliod granuloma in penile tissue.

High-definition optical magnification with digital chromoendoscopy detects gastric mucosal changes in dyspeptic-patients.

BACKGROUNDAccurate detection of gastric infection by Helicobacter pylori (H. pylori) and premalignant lesions are important for effective provision of treatment, preventing the development of gastric neoplasia. Optical enhancement systems with optical magnification improved the identification of mucosal superficial and vascular patterns in patients with dyspepsia.AIMTo evaluate an optical enhancement system with high-definition magnification, for diagnosis of normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy.METHODSA cross-sectional, nonrandomized study from November 2015 to April 2016 performed in a single-tertiary academic center from Ecuador. Seventy-two consecutive patients with functional dyspepsia according to the Rome III criteria, were tested for H. pylori using a stool antigen test and were assigned to an Hp+ group or an Hp− control group. Esophagogastroduodenoscopy with high-definition optical magnification and digital chromoendoscopy was performed, and patients were classified into 4 groups, in accordance to the microvascular-architecture pattern of the mucosa. Interobserver and intraobserver agreement among operators were calculated.RESULTSOf the 72 participants, 35 were Hp+ and 37 were Hp−. Among 10 patients with normal mucosal histology in biopsy samples, 90% had a Type I pattern of microvascular architecture by endoscopy. Among participants with type IIa and type IIb patterns, significantly more were Hp+ than Hp− (32 vs 8), and most (31 out of 40) had histological diagnoses of chronic active gastritis. Two of the three participants with a histological diagnosis of atrophy had a type III microvascular pattern. The type I pattern predicted normal mucosa, type IIa–IIb predicted H. pylori infection, and type III predicted atrophy with sensitivities of 90.0%, 91.4%, and 66.7%, respectively. The intraobserver and interobserver agreements had kappa values of 0.91 and 0.89, respectively.CONCLUSIONHigh-definition optical magnification with digital chromoendoscopy is useful for diagnosis of normal gastric mucosa and H. pylori-associated gastritis with high accuracy, but further studies are needed to determine whether endoscopic diagnosis of gastric atrophy is feasible.

DO H. PYLORI STATUS AND SMALL INTESTINAL BACTERIAL OVERGROWTH DETERMINE THE CLINICAL COURSE OF CHRONIC ACTIVE GASTRITIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS?

The aim: To define clinical peculiarities of chronic active gastritis in patients with type 2 diabetes mellitus (T2DM) considering Helicobacter pylori (HP) status and small intestinal bacterial overgrowth (SIBO). Materials and methods: 172 patients with chronic active gastritis were enrolled in the study, 92 out of them had concomitant T2DM. Symptoms were collected with the questionnaire, HP infection was diagnosed with stool antigen test, SIBO was assessed with glucose hydrogen breath test. Results: 87.5% (n=70) patients with chronic gastritis without DM had epigastric pain, however those with T2DM reported pain only in 41.3% (n=38) cases. Other symptoms included: nausea, bloating, early satiety, postprandial fullness, heartburn, belching and vomiting. HP infection in patients with chronic gastritis and concomitant T2DM is significantly associated with symptoms of epigastric pain (OR=2.78, 95%CI 0.92-8.41), bloating (OR=3.92, 95%CI 1.40-10.99), nausea (OR=2.32, 95%CI 0.85-0.6.30), postprandial fullness (OR=1.45, 95%CI 0.54-3.87) and belching (OR=1.01, 95%CI 0.32-3.16), whereas SIBO - with bloating (OR=8.82, 95%CI 2.88-27.01), nausea (OR=5.15, 95%CI 1.88-14.10) and belching (OR=2.53, 95%CI 0.67-9.52). Conclusions: Patients with T2DM and chronic active gastritis report epigastric pain significantly less than non-diabetics. HP infection probably plays a prominent role in development of epigastric pain in patients with T2DM. Additionally, HP is linked to SIBO, which may lead to bloating, belching and nausea onset.

Povezanost rekurentnog abdominalnog bola i infekcije sa Helicobacter pylori u korelaciji sa nalazom ezofagogastroduodenoskopije

Abstract: Aim: The aim of this research was to determine the association of recurrent abdominal pain and Helicobacter pylori (H. pylori) infection in childhood, in correlation with the finding of an upper endoscopy. Introduction: Recurrent abdominal pain (RAP) was defined according to Apley and Naish's criteria from the year 1959 as at least three or more episodes of abdominal pain lasting longer than three months in children older than 3 years, and severe enough to prevent normal activities in child. The association of RAP and H. pylori has been analyzed in several different researches, and there are conflicting results about their interconnection. However, the etiological association of the presence of H. pylori with the onset and development of acute and chronic active gastritis and duodenal ulcer is known. Material and method: The research protocol included a total of 77/183 (42.07%) children divided by age into three subgroups: preschool age (3 to 6.9 years), school-age (7 to 10.9 years) and adolescent age (11 to 15 years) in whom the diagnosis of RAB was determined by meeting the criteria according to Apley and Naish (1959), and the American Academy of Pediatrics (2005). H. pylori infection was confirmed by enzyme-linked immunosorbent assay (ELISA), while esophagogastroduodenoscopy was performed by the device for upper endoscopy type Olimpus GIF Type Q156, in the endoscopic cabinet of the Clinic for Internal Medicine, University Clinical Center Tuzla. Results: Of the total number of examined children (77), the analyse of Helicobacter pylori infection presence showed the biggest number of positive findings in school age 91.3%, in adolescent age 78.0%, while the smallest number was in preschool age (25.0%). The most common findings of upper endoscopy and microscopic findings were described as: antritis acuta in 16%, gastritis chronica activa et erosiva in 32%, and duodenitis acuta (12%). Conclusion: A significant association of H. pylori infection and RAP are confirmed by positive finding of esophagogastroduodenoscopy, leading to conclusion that immunological testing for the presence of this bacteria is justified. After obtaining a positive finding with confirmed infecion, it is necessary to start with the treatment.

Prevalence and Endoscopic Findings of &amp;lt;i&amp;gt;Helicobacter pylori&amp;lt;/i&amp;gt; Infection among Dyspeptic Patients in Kenya

Background: Helicobacter pylori is the most common cause of chronic human infections worldwide with the highest reported prevalence in Africa. It is associated with numerous upper gastrointestinal diseases such as gastritis, peptic ulcers, and gastric cancer. Endoscopic findings in the stomach usually associated with Helicobacter pylori infections include gastritis and gastro-esophageal reflux disease (GERD), however, these findings are suggestive but not diagnostic of Helicobacter pylori infection. Methods: This was a prospective study conducted between January 2018 and February 2019 at the Aga Khan University Hospital where dyspeptic patients scheduled for gastroduodenoscopy were enrolled. These patients were evaluated for Helicobacter pylori infection by rapid urease test, culture and histopathology. Diagnostic findings and patient history collected from medical files were documented and data analyzed. Results: A total of 487 dyspeptic patients undergoing esophagogastroduodenoscopy (EGD) were enrolled in the study and 199 dyspeptic patients were positive for Helicobacter pylori infection. The prevalence was 54.6% in males and 45.4% in females (p = 0.1546. The most common clinical indication and endoscopic findings were heart burn (25.2%) and gastritis (53.7%). Histopathology revealed that 86.1% of the dyspeptic patients had chronic active gastritis (p < 0.005) and 52.8% of them had H. pylori infection. Conclusions: Classical endoscopic findings such as GERD are not always indicative of H. pylori infection as its association with H. pylori infection was not statistically significant in this study.

Dual time point [18F]Flurodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) with water gastric distension in differentiation between malignant and benign gastric lesions

ObjectivesTo assess diagnostic accuracy and added value of dual time point 18F-FDG PET/CT after gastric distention using oral water in differentiating malignant from benign gastric lesions. MethodsPatients (n = 30, 19 males, mean age 58.6 ± 16.4 years). All patients are known or suspected oncology patients. All patients underwent whole body 18F-FDG PET/CT scan and 2 h delayed PET/CT abdominal images following oral water gastric distension. The best cut off values for early SUVmax (SUVmax1), delayed SUVmax (SUVmax2) and SUVmax2-SUVmax1 (ΔSUVmax) to differentiate benign from malignant lesions were set based on ROC analysis. Data analyzed included in addition; age, sex and 18F-FDG uptake pattern in delayed images. Suspicious gastric lesions were correlated with biopsy in 18 patients (60 %) and with clinical and follow-up imaging (18F-FDG PET/CT, CT or MRI) in 12 patients (40 %). Unpaired t-test was used to compare the mean deference in continuous variables between patients with gastric malignancy and those with benign gastric lesions. Fisher’s exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the most powerful factors to predict malignant lesions. ResultsFifteen patients (50 %) had confirmed malignant gastric lesions. Patients with confirmed gastric malignancy were older (65 ± 13 vs 52 ± 17; p = 0.023) and had significantly higher mean ΔSUVmax (1.29 ± 1.76 vs −0.89 ± 1.59; p = 0.003). The mean SUVmax1 (6.99 ± 6.66 vs 5.31 ± 2.53; p = 0.367) and SUVmax2 (8.29 ± 7.41 vs 4.44 ± 3.34; p = 0.077) although both higher in patients with malignant lesions, they did not reach statistical significance. Sensitivity, specificity, PPV, NPV, and accuracy to detect malignant gastric lesions were highest for lesions with localized uptake pattern in delayed images post water oral contrast as well as for lesions with ΔSUVmax>0. Regression analysis revealed both variables as independent predictors for malignant lesions with odd ratios of 22.9 and 9.5 respectively and final model Chi-Square of 19.9 (p < 0.0001). The model correctly identified 12/15 (80 %) malignant lesions and 13/15 (86.7 %) benign lesions with 2 false positives confirmed as chronic active gastritis with helicobacter pylori and 3 false negatives including 1 signet ring gastric cancer and 1 low grade gastrointestinal stromal tumor (GIST), both with poor 18 F-FDG uptake. ConclusionLocalized uptake pattern in delayed PET/CT images following gastric distention with oral water contrast as well as ΔSUVmax>0 are powerful independent variables to identify malignant gastric lesions with fairly high sensitivity and reasonable accuracy. Malignancies with inherently low 18F-FDG avidity are the main cause of false negatives while active gastritis is the main cause of false positives.

A 17-year-old Girl with Crohn’s Disease: A Case Report

The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total cases colonoscopy at Cipto Mangunkusumo Hospital. In majority population, patients with Crohn’s disease usually diagnosed in their 20s and 30s. However 5-10% of all cases occur early in paediatric. The aim of our case report was to describe clinical presentation, laboratory, imaging study and histopathology finding of Crohn’s disease. A 17-year-old girl had reccurent bloody stool, recurrent diarrhea, recurrent stomatitis, pale, abdominal pain, weight loss, and did not have her period since 16-year-old. Physical examination showed cachexia appearance, old man face, prominent costae, tenderness at abdominal palpation, muscle wasting, severe malnutrition, and abnormal puberty stage. The laboratory findings revealed micrositic hypochromic mild anemia, positive fecal test, faecal calprotectin >2.100 ug/g, and hypoalbuminemia. The abdominal Computerized Tomography (CT) scan showed suspect inflamation process in the intestine. The colonoscopy and Esophago Gastro Duodenoscopy (EGD) finding revealed multiple colon ulcers with skip lesions and pangastritis superficialis. The histopathologic finding revealed an active chronic gastritis and colitis. Patient was diagnosed as Crohn’s disease, urinary tract infection, mild microcytic hypochromic anemia due to chronic dissease, secondary amenorrhea, severe marasmic malnutrition condition III rehabilitation phase. Patient got enteral nutrition with 6 weeks, corticosteroid to induce remission for 10 weeks (include tapering dose), omeprazole, antibiotic for urinary tract infection, albumin, vitamin and micronutrient for malnutrition management. After 10 weeks of treatment she had remission. Diagnosis of Crohn disease in adolescent girl is not easy to establish. However, some symptom of upper and lower gastrointestinal tract, extraintestinal manifestation like secondary amenorhea, faecal calprotectin level >2.100 ug/g, along with support finding from colonoscopy and EGD which revealed multiple ulcers in colon with skip lesions, pangastritis superficialis and histopathology result which showed an active chronic gastritis and colitis can be helpful to diagnose the case.

EPIPHRENIC OESOPHAGEAL DIVERTICULUM – A CASE REPORT

Epiphrenic oesophageal diverticulum is rare world-wide and account for less than 10% of all oesophageal diverticula. We present Mrs O.E. a 64-year old Nigerian of the Yoruba tribe who presented with early satiety and upper abdominal discomfort of five months duration. The early satiety was of insidious onset and had been progressive. This initially made her to reduce the size of her meal intake but eventually progressively led her to taking just a meal per day. This is in contrast with her premorbid intake of three meals per day. She has associated history of regurgitation worse in the recumbent position which she described as containing undigested food. She has no abdominal swelling, odynophagia or dysphagia. No history of haematemesis or melaena. She has weight loss and easy fatigability. The upper abdominal (epigastric) discomfort is characterized as a feeling of peppery, burning sensation which radiates to the back and had no association with meals or with time of the day. It has no relation to posture and said to be worse with consumption of peppery or spicy food substance. Minimally relieved with the use of antacids. No other significant contributory history. Review of systems was also not contributory. Clinical examination was not remarkable. A provisional diagnosis of a suspected Gastric Tumour was made likely a Gastric Lymphoma or Adenocarcinoma to rule out Gastrointestinal Stromal Tumour(GIST). Barium swallow revealed a Distal (Epiphrenic) oesophageal diverticulum. Findings at upper GI Endoscopy include: (1) Distal (Epiphrenic) oesophageal diverticulum (2) Reflux oesophagitis (3) Gastric Atrophy; probably age-related to rule out chronic Helicobacter pylori-infection. Histology revealed Reflux oesophagitis, Mildly active chronic corporeal gastritis with mild atrophy and Chronic non-specific antral gastritis. She was managed conservatively with long term proton pump inhibitor therapy, modification of dietary habits and liberal oral fluid intake with significant clinical improvement and resolution of her symptoms within eight weeks of treatment. She is presently on regular follow-up at our out-patient department. Distal (Epiphrenic) oesophageal diverticulum is rare in our environment. The diagnosis can only be made through radiographic or endoscopic studies. Patients may present with non-specific or dyspeptic symptoms similar to those of acid peptic disorders. In view of this, it is important to carefully evaluate patients with dyspepsia or non-specific upper gastrointestinal symptoms and investigate them in order to ascertain the cause. A delay in the diagnosis and treatment of epiphrenic oesophageal diverticulum may lead to complications which could have been prevented if diagnosed early.

Helicobacter pylori and Epstein–Barr Virus Infection in Gastric Diseases: Correlation with IL-10 and IL1RN Polymorphism

Introduction Helicobacter pylori and Epstein–Barr virus (EBV) infection have recently been shown to be associated with gastric diseases. Polymorphisms in genes encoding cytokines such as interleukin 10 (IL-10) and interleukin 1 Receptor (IL-1RN) influence cytokine secretion levels and appear to contribute to the risk of developing gastroduodenal diseases. To our knowledge, this is the first preliminary study to address the association of coinfection with H. pylori and EBV and their correlation with genetic predisposition in the development of gastric diseases. Methods Gastric biopsy samples of 96 patients with different gastric diseases were used. Results Our results showed that the rate of coinfection was higher in patients with gastric cancer than in patients with normal gastric mucosa, active chronic gastritis, and MALT lymphoma. As regards the characterization of H. pilory strains, the polymorphism s1m1i1 of vacA gene was more frequent in patients with MALT Lymphoma in comparison to others, while the polymorphism s2m2i2 was most frequent in patients with normal gastric mucosa. In addition, patients who tested positive for the cagA gene were more frequently those affected with gastric cancer than those with inactive chronic gastritis. Similarly, the patients with oipA gene ON were more frequently those with gastric cancer than those with inactive chronic gastritis. Conclusion According to our analysis, there was no correlation between coinfection and polymorphisms in genes encoding IL-10 and IL-1RN. We conclude that various factors can be involved in the development of gastric diseases.

Significance of TC9 and TH9 in Helicobacter pylori-induced gastritis.

H pylori plays a critical role in the development of stomach cancer, especially in people affected by the bacteria at an early stage of life. Th9 cells and IL-9 play major roles in immune responses against various infections. IL-9 is influential in chronic or acute inflammation of the mucosa. This study seeks to investigate the possible functions of Tc9, Th9 cells, and IL-9 level in patients with inflammation due to H pylori infection. Eighty-three patients with dyspepsia symptoms and twenty normal subjects with no sign and symptoms of dyspepsia were recruited. Frequencies of T-cell subsets were determined by flow cytometry. Levels of cytokines IL-9 family in the sera and supernatants of antigen-activated PBMCs patients were measured by ELISA and flow cytometry. The participants included 56 females and 47 males with a mean age of 39.2±15.3years. We assigned the infected group into peptic ulcer and gastritis (chronic active and chronic). Frequencies of Tc9, Th17, Tc17, Th17/9, and Tc17/9 increased significantly in the peptic ulcer, chronic active, and chronic gastritis, compared with the uninfected and healthy control groups. A significant increase was seen in IL-9, IL-4, and IL-23 in the chronic active gastritis. Further observed was a significant increase in IL-21 and a decrease in IL-10 in the infected groups. The results revealed that increased Tc9, Th17/9, and Tc17/9 cells appear to be influential in the progression and severity of H pylori infection. Also, increased IL-9 and IL-4 levels and Tc9, Tc17/9, and Th17/9 were seen in chronic active gastritis patients. These findings may provide useful information for a therapeutic targeting of chronic active H pylori infections.