Antral Gastritis Research Articles

Management of post-COVID antral gastritis associated with hiatal hernia as Urdhwaga-amlapitta through Ayurveda: A case report

Abstract: Gastroesophageal Reflux Disease (GERD) is a condition where the gastric contents come back up into the esophagus. Hiatal hernia is a condition, in which the upper part of the stomach or other internal organs bulges through the hiatus of the diaphragm. When there is a laxity in the hiatus, there may be acid reflux, and the symptoms of GERD may arise. In the present case, a 40-year-old female after recovering from COVID-19 in May 2021 started complaining of symptoms such as severe acid reflux, nausea, vomiting, unsatiety/increased appetite, and gradual weight gain. She consulted general physicians/surgeons who diagnosed the condition as mild antral gastritis and hiatus hernia. After getting allopathic treatment for about three months, no significant relief was observed. After that, the patient visited Ayurveda Hospital in November 2021 and was diagnosed as a case of Urdhwaga-amlapitta (~upward hyperacidity). She was treated with Pitta (~Dosha responsible for regulating body temperature and metabolic activities) pacifying medicines (Avipattikara churna, Madhuyashti churna, Shatavari churna, and Kamadudha rasa) for 42 days along with diet and lifestyle modifications. All the symptoms were reduced during the treatment and after follow-up on the 56th day, the patient completely recovered. This case report gives insight that Ayurveda management can be effective for the management of antral gastritis associated with hiatal hernia.

Is upper gastrointestinal system screening necessary in kidney transplant candidates?

BACKGROUND
 The aim of this study is to present and discuss upper gastrointestinal tract endoscopy findings in renal transplant candidates with a high incidence of gastrointestinal system diseases.
 METHODS
 Between January 2014 and December 2019, patients over the age of 18 who were on dialysis for chronic renal failure and renal transplant candidates at xxx University xxx Hospital were included in the study. Upper gastrointestinal endoscopic findings and pathology results (atrophy, helicobacter pylori and intestinal metaplasia) of the patients were retrospectively evaluated by scanning from the electronic archive system of the hospital.
 RESULTS
 The study included 105 patients. 53 (50.5%) of the patients were male. The mean age of the patients was 44.09 ± 14.16 years and there was no statistically significant difference between male and female sexes (p=0.961). The most common endoscopic findings were pangastritis (44.8%), antral gastritis (27.6%) and esophagitis (16.2%). Only 4 (3.8%) patients had duodenal ulcer. Atrophy was positive in 3 (13%) of 23 patients, HP was positive in 19 (27.1%) of 67 patients and IM was positive in 17 (24.3%) of 56 patients.
 CONCLUSIONS
 Patients who are renal transplant candidates should be reviewed for indication of routine upper endoscopic examination before transplantation to prevent upper GI tract complications that may develop after transplantation.

Impact of selective serotonin receptor inhibitors on gastric histopathology in patients with depression

Objective: Antidepressant medications such as Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) are used in the psychopharmacological treatment for various types conditions. This study aimed to investigate whether SSRIs and SNRIs could reduce gastric intestinal metaplasia. Material Methods: A total of 212 patients who underwent upper gastrointestinal endoscopy plus biopsy in our clinic and were using selective serotonin reuptake inhibitors and other potent serotonin reuptake inhibitors were included in the study. A control group was created with a total of 230 age and gender matched patients who underwent upper gastrointestinal endoscopy plus biopsy but had no SSRI or SNRI usage. Patients’ endoscopic and pathologic findings were recorded retrospectively and compared between the groups. Results: The patient group consisted of 180 (84.9%) male and 32 (15.1%) female patients, while the control group included 175 (76.1%) male and 55 (23.29%) female patients. There was a statistically significant difference between the groups in terms of gender (p=0.020). The rates of erythematous antral gastritis (p<0.001), peptic ulcer (p=0.019), erosive gastropathy (p=0.001) and duodenitis (p=0.002) were statistically significantly lower in the patient group compared to the control group. The rates of H.Pylori(p=0.002), intestinal metaplasia (p=0.013), neutrophil activity (acute inflammation) (p<0.001) and chronic inflammation (p<0.001) were lower in the case group compared to the control group. Conclusion: SSRIs/SNRIs may potentially be used in treating gastrointestinal inflammation and metaplasia. However, further prospective randomised studies with larger series are needed to support our findings.

Gastric Antral Vascular Ectasia as a Reversible Cause of Upper Gastrointestinal Bleeding in the Oldest Old

Abstract Gastric antral vascular ectasia (GAVE) is a rare condition which accounts for 4% of the nonvariceal acute upper gastrointestinal (GI) bleeding. The mean age of diagnosis is 70 years. This condition is often misdiagnosed as hemorrhagic antral gastritis or portal hypertensive gastropathy. In this case report, we report the oldest person to date in the South Asian population with upper GI bleeding caused by GAVE. An 87-year-old, female, known case of chronic obstructive pulmonary disorder and systemic hypertension under medication for 2 years, current smoker, previous alcohol consumer presented to the emergency department with complaints of hematemesis, melena, and easy fatigability. On general physical examination, pallor was present. A provisional diagnosis of chronic anemia secondary to upper GI bleeding was made. Upper GI endoscopy revealed ectatic vessels radiating from the gastric antrum which was diagnosed as GAVE. Blood transfusion was done, and three sessions of argon plasma coagulation were done. In the oldest old, GAVE is an overlooked cause of GI bleeding and persistent severe anemia. It might also mimic the signs and symptoms of GI malignancy. However, the frail older adult and their caretakers must be counseled about its reversibility, good prognosis, and nonmalignant nature. Simple intervention can improve the quality of life in the frail oldest old.

Correlations between Endoscopic and Histopathological Assessment of Helicobacter pylori-Induced Gastric Pathology-A Cross-Sectional Retrospective Study.

Helicobacter pylori (H. pylori) infects about half of the world’s population and can lead to premalignant lesions and gastric cancer. Updated data about the correlation of histopathological diagnostics with endoscopic diagnostics are scarce. The objective of this study was to identify the concordance between endoscopic and histopathologic findings, with a focus on premalignant lesions. We performed a cross sectional, retrospective study over a 4-year period (2017−2021) on adult patients with dyspeptic symptoms and positive RUT (rapid urease test) in a single hospital centre, with a total of 133 patients infected with H. pylori being included in the study. Statistical associations between endoscopic appearance and histopathological results were found for atrophic antral gastritis (p = 0.001), intestinal metaplasia of the antrum (p = 0.018), gastric polyps (p < 0.001) and gastric corpus cancer (p = 0.012). Females were more likely to be diagnosed through endoscopy with gastric atrophy or intestinal metaplasia (p = 0.031), while chronic atrophic gastritis in corpus was more prevalent in patients older than 65 (p = 0.024). Overall, our study reveals only 21% concordance between Giemsa stain and RUT, highlighting the importance of combining rapid testing with endoscopic and histopathological diagnostic methods for a more accurate early diagnosis and prevention of gastric cancer.

Incidence of hiatus hernia among semi-urban population with upper gastrointestinal symptoms: a single cantered study

Background: Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%. These hernias may become symptomatic and lead to gastroesophageal reflux disease (GERD), dysphagia, dyspnoea, and may affect cardiac and respiratory function. Being overweight and elderly are the key risk factors in its development.Other known risk factors include: multiple pregnancies, history of oesophageal surgery, partial or full gastrectomy and certain disorders of the skeletal system associated with bone decalcification and degeneration.Methods: This is a retrospective study done on patients who presented to the surgical outpatient at Trichy SRM Medical College Hospital and Research Centre during the period July 2021 to July 2022.Results: Total of 97 (19.02%) patients presented with lax hiatus 41 (42.27%) and had it exclusively while 5 (5.16%), 31 (31.96%), 10 (10.31%) and 10 (10.31%) had it associated with antral gastritis, diffuse gastritis, pan gastritis and oesophagitis respectively. These values were statistically significant with a p value &lt;0.001. And lax hiatus was more commonly seen among female 56 (57.73%) compared to male 41 (42.27%) and hiatus hernia observed more in male 21 (58.33%) than female 15 (41.67%), there was no statistical significance observed among both the gender.Conclusions: Among the patients those who have presented to the surgery outpatient at Trichy SRM with upper gastrointestinal symptoms and in whom upper GI endoscopy were done the incidence of hiatus hernia was observed to be more prevalent among men compared to women in whom lax hiatus were seen to exist.

An Unusual Cause of Acute Gastroenteritis, Ascites, and Eosinophilia in a 29-Year-Old Woman

An Unusual Cause of Acute Gastroenteritis, Ascites, and Eosinophilia in a 29-Year-Old Woman

S1997 Cecal Bascule: A Rare Cause of Large Bowel Obstruction

Introduction: Cecal bascule is a rare form of cecal volvulus, which is characterized by an anterior and superiorly displaced cecum in turn causing large bowel obstruction. It accounts for 0.01% of adult large bowel obstructions. Here we present a case of cecal bascule in a cirrhotic patient. Case Description/Methods: A 63-year-old female with history of alcoholic cirrhosis (MELD 20) and cesarean section presented to the emergency department with intermittent hematochezia and melena. At admission, she was hemodynamically stable with a hemoglobin of 5.7 g/dL. She underwent esophagogastroduodenoscopy (EGD) which demonstrated small esophageal varices without stigmata of a recent bleed, antral gastritis, and duodenitis. Due to a largely unrevealing EGD, she was scheduled to have a colonoscopy. However, the patient had difficulties tolerating the bowel prep due to increasing abdominal pain. An abdominal X-ray demonstrated a large gaseous lucency in the right mid abdomen below the level of the transverse colon which was concerning for cecal bascule. A computed tomography (CT) scan of the abdomen demonstrated a redundant cecum folding anteriorly with superior rotation into the upper right hemiabdomen without definite point of transition and diffuse small bowel dilation up to 4.3 cm. Findings were consistent with a cecal bascule. Patient underwent an exploratory laparotomy with right hemicolectomy. Patient had a prolonged, complicated post-operative course with multiorgan failure and finally died 30 days after the surgery (Figure). Discussion: Cecal bascule involves the upward folding of the cecum as opposed to an axial twisting of the colon as seen in more common types of cecal volvulus. For this phenomenon to occur, a patient will often have a mobile and redundant cecum that causes the volvulus. This may occur as a congenital anomaly secondary to a failed fusion in development between the ascending colon mesentery and the posterior parietal peritoneum. Additionally, this may be acquired from abdominal adhesions, pregnancy or even after a colonoscopy. Like other types of volvuli, treatment of cecal bascule requires surgical detorsion to prevent further complications. It is therefore important that cecal bascule be identified early for proper surgical planning and appropriate intervention. In our case, the poor outcome was due to the underlying decompensated cirrhosis.Figure 1.: Abdominal X-ray demonstrating a large gaseous lucency in the right mid abdomen near the transverse colon CT of the abdomen demonstrating an anteriorly and superiorly rotated cecum into the upper right hemiabdomen.

Barrett's Esophagus: A Comparison Study between Two Cohorts of Gastroesophageal Reflux Disease.

Barrett's esophagus (BE) is a complication of gastroesophageal reflux disease (GERD). It is seen among 15% of GERD patients as per a population-based study by Ronkainen et&nbsp; al. Barrett's has malignant potential and annual progression to carcinoma depends on the presence or absence of dysplasia. There are various risk factors for the development of BE. We compared two symptomatic cohorts of GERD patients from the same geographical area who were evaluated for the presence of Barrett's and various factors that can contribute to Barrett's Materials and methods: Cross-sectional study. Two GERD cohorts, one from Kottayam and the other from Trivandrum were taken. The presence of Barrett's and the factors contributing to the development of Barrett's were analyzed between the two groups. Since biopsy data of all patients were not available, endoscopically suspected esophageal metaplasia (ESEM) was taken as Barrett's Results: 415 patients were enrolled for the study (203 from Trivandrum and 212 from Kottayam). 192 females (99 from Trivandrum and 93 from Kottayam), and 223 males (104 from Trivandrum and 119 from Kottayam). Barrett's esophagus and especially long-segment Barrett's were significantly more common in Kottayam than Trivandrum (68 vs 22 and 36 vs 9) (p-value &lt;0.001). Among the factors that were traditionally thought to contribute to the development of Barrett's esophagus, age (&gt;50 years) was not statistically significant among the two cohorts (mean age of Trivandrum was 48 years and Kottayam was 49 years). Duration of GERD symptoms was significantly more in the Trivandrum cohort compared to Kottayam (p-value &lt;0.001). Hiatus hernia and body mass index (BMI) were more common in Kottayam. There were no statistically significant differences in erosive esophagitis and antral gastritis (%age?) between the two cohorts. Both Trivandrum and Kottayam belong to the same geographical area and are separated by a distance of only 150 km. The Kottayam cohort is more prone to develop distal esophageal carcinoma as the BE is more in Kottayam. This data also suggests the need for GERD registries so that high-risk population can be targeted and early intervention can lead to a decrease in the incidence of distal esophageal carcinomas.

S3631 March of the Eosinophils: A Case of Eosinophilic Gastroenteritis, Immune Thrombocytopenia, and Iron Deficiency Anemia

Introduction: Eosinophilic gastrointestinal disorders (EGIDs) refer to eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes. Here, we present a case of a young male with immune thrombocytopenia (ITP) and biopsy-proven eosinophilic gastroenteritis that developed iron-deficiency anemia. Case Description/Methods: A 16-year old male with a past medical history significant for autism, ITP, melanoma, allergic rhinitis, and eosinophilic esophagitis presented for evaluation of chronic abdominal pain. He had an EGD in April 2018 that revealed white exudates at the gastroesophageal junction, scattered erosions in the gastric body and fundus, severe antral gastritis, and scattered erosions noted throughout the duodenal bulb. Biopsies were taken and revealed distal eosinophilic esophagitis (greater than 50/HPF), eosinophilic gastritis, and chronic inflammation of the duodenal bulb with Brunner gland hyperplasia and villous blunting. Absolute eosinophil count was higher than 2,000/uL. Given findings of persistent inflammation despite a six-food elimination diet, the patient was started on oral Budesonide, a proton-pump inhibitor, and an H2 receptor blocker. In March 2020, a repeat surveillance EGD with biopsy revealed the duodenum was free of inflammation or other diagnostic abnormalities. Roughly 28 eosinophils/HPF were present in the gastric cardia near the GEJ, and numerous eosinophils remained in the other gastric tissues sampled. B udesonide was discontinued due to patient intolerance. In early 2021, the patient was found to have microcytic anemia. Further Hematologic evaluation revealed low folate and iron levels. He was started on supplemental iron and folic acid, leading to resolution of the anemia. Iron and folate deficiency was believed to be secondary to malabsorption caused by EGE. (Figure) Discussion: Eosinophilic gastrointestinal diseases remain a rare and underexplored clinical entity. While its pathophysiology is not fully understood at this time, TH2 mediated activation of B-cells and subsequent stimulation of eosinophils locally appears to be at play. Given ITP has a TH1 predominant cytokine profile, it is unclear if there is a causal association between the two. Diagnosis of EGID necessitates histological evidence of eosinophilic infiltration of the GI tract in the absence of secondary causes or infiltration elsewhere. Dietary modification to eliminate food allergens is a reasonable initial treatment, glucocorticoids remain the mainstay of pharmacotherapy at this time.Figure 1.: Cross-section of gastric tissue stained with hematoxylin and eosin demonstrating prominent eosinophils (greater than 100 per high-power field) within the lamina propria and gastric epithelium with associated epithelial injury.

S3624 Incidental Finding of Gastric Signet Ring Cell Carcinoma: A Case Report

Introduction: The incidence of Gastric signet ring cell carcinoma (GSRC) has been on the rise in the United States (U.S.). GSRC is estimated to account for approximately 8% to 30% of all gastric cancers in the U.S., and despite this increase in cases, there are no population-wide screening guidelines allowing for early detection. It is notable that GSRC is typically not diagnosed until it has already reached an aggressive stage with a poor prognosis and low chemosensitivity. In this case, we present a patient with a family history of gastric cancer who was incidentally found to have early-stage GSRC on random gastric biopsies taken on endoscopy. Case Description/Methods: A 48-year-old male with family history of gastric cancer in his sibling presented for routine colonscopy. Although asymptomatic, he had an upper esophagogastroduodenoscopy (EGD) at the time of colonoscopy due to interest in screening for cancer. The patient was noted to have mild antral gastritis and gastric biopsies were taken at the time of the procedure. On random 0.7 mm gastric biopsies, the pathology was consistent with GSRC. He then underwent a subsequent EGD with mapping protocol in which biopsies were obtained from the incisura, antrum (lesser and greater curvature), and corpus (lesser and greater curvature). The lesion was found to be restricted to the antrum and he underwent a partial gastrectomy to prevent progression of disease. Discussion: This case describes an asymptomatic patient found to have GSRC on endoscopic biopsies at a time that allowed for early intervention. Currently, there are no definitive guidelines for screening gastric cancer or metaplastic changes in the U.S., placing the decision-making burden onto the physician. In the setting of increasing incidence of gastric cancer in the U.S., establishing and broadening guidelines for screening patients who are at higher risk than the average population, notably those with family history, male sex, tobacco use, and of certain ethnicities, is becoming increasingly important. The odds ratio of a first-degree relative developing gastric cancer is estimated to be anywhere from 2 to 10 depending on the corresponding risk factors and demographics of the patient. Further research is warranted for the development of screening protocols that can guide gastroenterologists on endoscopically screening for metaplastic or cancerous lesions of the stomach. Such guidelines have become a public health necessity given the astoundingly high morbidity and mortality rates of this cancer.

Gastroduodenal endoscopic findings and Seroprevalence of Helicobacter pylori among suspected individuals

The peptic ulcer was developed at appeared recently as a contagious disease, distributed all over the world and the most common cause of this disease is H.pylori. Laboratory diagnosis was used to detect this bacterium by several methods which include invasive and non-invasive methods. . ELISA technique was used to identify IgG, IgM, and IgA antibodies against H. Pylori. All participants underwent endoscopic procedures at the Duhok City/Azadi Hospital/Endoscopy Center, and a highly skilled endoscopist carried out the procedures, As well questionnaire form has been filled out through the interview with the participants to enroll the socio-demographic factors which include occupation, history of treatment, and endoscopic findings. Among the 90 participants, the serological prevalence is 72%, 7%, and 30% of positive antibodies IgG, IgM, and IgA respectively. The housewife group recorded a high percentage of positive IgG whereas low percentages were recorded for the military group. A significant immune reaction of IgG in the student group has been noted. In addition to the housewife group to the positive IgM. The effect of those who had treatment previously has been revealed by positive IgG. Moreover, antral gastritis had a significant relationship with positive IgG by using ELISA. in the conclusion, the Housewives group was more infected with this bacterium, and a significant association was found between antral gastritis and seropositive IgG .

Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study.

Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of 44.4 ± 6.4 kg/m2. The average age of participants was 33.6 ± 10.4 years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.

Gastrointestinal Lesions and Its Associated Factors in Adult Males With Iron Deficiency Anaemia: A Cross-Sectional Study From Tertiary Care Centre of North India.

BackgroundAround 30% of the world's population suffers from iron deficiency anaemia (IDA). The standard evaluation for IDA involves upper and lower endoscopy, which allows for the confirmation of pathology of the gastrointestinal tract (GIT) induced due to IDA through iron malabsorption mechanism or loss of blood. Assessing the prevalence of lesions of GIT of significant nature among males having IDA, was the goal of our study.MethodsOur cross-sectional study was conducted for two years and involved 152 males (adults) with confirmed cases of IDA from the Outpatient (OPD) and In-patient (IPD) in the present hospital. Following collecting consent (both informed and written in nature), patient-specific data was collected in a standardized form, and a blood sample was taken for laboratory testing. The analyses were done at a 5% level of significance; an association was considered significant if the p-value < 0.05.ResultsThe average age of the study participants was 59.6 years. The commonest lesions reported were antral gastritis (9.9%) and H. pylori gastritis (7.2%) in upper GI; and haemorrhoid (9.2%) and anal fissure (3.9%) in lower GI. The overall prevalence of any GI lesions was 65.1%. The GI lesions were significantly associated higher among men with age > 50 years (73.7%). The presence of occult blood in stools (p < 0.0001) and parasites in stools (p=0.0001) were significantly related to the presence of GI lesions.ConclusionGI lesions are frequently detected in males with IDA. Whether it is symptomatic male or asymptomatic male with anaemia refractory to iron treatment, GIT should be evaluated in them.

Evaluation of Helicobacter pylori Infection with Endoscopic, Pathological, and Laboratory Findings

Aim: Helicobacter pylori, the most common bacterial infestation in the gastrointestinal tract. It is known to role in the&#x0D; development of intestinal metaplasia, dysplasia, gastric cancer, and atrophic gastritis. H. pylori infection has been thought to be&#x0D; related with many diseases such as iron deficiency, vitamin b deficiency…In our study, we aimed to evaluate the patients who&#x0D; underwent endoscopic examination in terms of endoscopic, pathological and laboratory (Hemogram and iron values) findings.&#x0D; Material and Methods: Between October 2020 and July 2021, 322 patients who were requested endoscopic examination&#x0D; and laboratory examination due to gastrointestinal system complaints were included in the study.&#x0D; Results: In our study; 152 H. pylori negative cases and 170 Helicobacter pylori positive cases were detected. Helicobacter pylori&#x0D; negative (HP-) group, the number of men was 50 and the number of women was 102. In the HP+ group, the number of men was&#x0D; 61 and the number of women was 109 (P=0.6387). The mean age in the (HP-) group was 51.48 ± 1.260. The mean age in the HP+&#x0D; group was 48.29 ± 1.215 (P=0.0700). HGB value in the HP- group was 13.66 ± 0.1249, and in the HP+ group, it was found 13.95&#x0D; ± 0.1359 (P=0.1194). The mean MCV value was found to be 85.74 ± 0.4877 in the HP- group, and 85.69 ± 0.5860 (P=0.9505) in&#x0D; the HP+ group. The mean Ferritin value in the HP- group was 38.71 ± 2.979, and 44.38 ± 3.195 (P=0.1983) in the HP+ group. In&#x0D; addition, 31 cases with Pangastritis in the HP- group and 54 cases in the HP+ group were detected (p=0.0208).&#x0D; Conclusion: In our study; the endoscopic, laboratory and pathological findings of HP infection were examined, no&#x0D; significant relationship was found between age, gender, HGB, MCV and Ferritin values with HP infection. There is no&#x0D; negative correlation with Antral gastritis and Atrophic gastritis in gastritis cases, a significant correlation was found&#x0D; between pangastritis and HP (p=0.0208)

The relationship between helicobacter pylori infection and nodular antral gastritis in pediatric patients

Helicobacter pylori (H. pylori) is a spiral-shaped gram-negative bacterium that colonizes the gastric mucosa. It is a common infectious agent in children. In this study, we aim to evaluate the demographic data, and the clinical and histopathological findings of pediatric patients that underwent upper gastrointestinal endoscopy (UGSE) in our clinic. Between July 2017 and February 2019, 636 patients applied to the Selcuk University Faculty of Medicine, Pediatric Gastroenterology outpatient clinic with complaints of epigastric abdominal pain and/or dyspeptic complaints. Patients who underwent upper gastrointestinal endoscopy were evaluated retrospectively. Data on age, gender, family history of peptic ulcer disease, and family history of H. pylori were recorded. Endoscopic and histopathological findings were collected from medical records. 235 (36.9%) of the patients participating in the study were male, and 401 (63.1%) were female. H. pylori infection was detected in 277 (43.6%) patients as a result of histopathological examination of H. Pylori, urea breath tests and H. Pylori antigen tests in the stools of patients are included in the study. Nodular antral gastritis was detected in 282 (44.3%) of our patients endoscopically. H. pylori was detected in 83.7% (n: 236) of the 282 patients with nodular antral gastritis. Nodular antral gastritis was observed to be significantly higher in H. pylori-positive patients than in H. pylori-negative cases (odds ratio (OR), 39.16; 95% confidence interval (CI), 24.88-61.64; p: <0.001). Nodular antral gastritis is caused by chronic H. pylori infection. It is predicted that early detection of H. pylori infection in children is important and may decrease complications later in life. Our study shows that all the markers evaluated are very good predictors of H. pylori infection. Positive significant association was found between the prevalence of H. pylori infection and nodular antral gastritis.

Acute gastrointestinal bleeding in Egyptian elderly patients: real-life experience

BackgroundElderly people are a vulnerable group of patients subjected to multiple health problems. Upper gastrointestinal bleeding (UGIB) in older adults is a frequent cause of hospital admissions. The presence of multiple comorbidities and greater medication use influence the clinical outcome.AimThe aim of our work was to analyze the etiology, precipitating factors, management, and outcome of the elderly Egyptian patients (> 65 years old) presenting with acute UGIB.MethodsThree hundred thirty-two patients presenting with acute UGIB. The patients were classified into two groups according to age (elderly, above 65 years old, and young, below 65 years old). Clinical assessment, laboratory tests, and upper endoscopy were done for all patients. They were followed for 1 month.ResultsElderly females showed higher incidence of acute UGIB (45.8% versus 28.9%) with significant P-value (0.001). The incidence of esophageal varices was high in young patients than in the elderly (46.4% vs 35.5%) with P-value (0.045), while the elderly patients showed a higher incidence of esophageal ulcers and gastric mass than the young patients (7.8% vs 2.4%), (6% vs 0%) with P-value (0.025 and 0.013) respectively. Also, there was a higher incidence of peptic ulcer in elderly than young patients but does not reach a significant value with P-value (0.067), while there was no difference between both groups as regards presence of (fundal varix, erosive gastritis, moniliasis, portal hypertensive gastropathy, antral gastritis, bulb duodenitis, post band ulcer, dieulafoy, gastric polyp, and angiodysplasia). Rockall score, duration of hospital stay, and mortality incidence (33.1% vs 15.7%) were high in the elderly than young patients with P-value (< 0.001).ConclusionThe elderly are vulnerable groups who are at high risk of adverse outcome and mortality following acute upper gastrointestinal bleeding.

Chronic gastroduodenitis associated with Helicobacter pylori in combination with giardiasis in children

Background. The results of most scientific studies in recent years have made it possible to reconsider the traditional ideas about the pathogenesis of chronic gastroduodenitis (CGD) from a new perspective. The purpose was to investigate the clinical and endoscopic features of СGD associated with Helicobacter pylori (H.pylori) in combination with giardiasis. Materials and methods. The study included 105 children aged 7–16 years divided into two groups: I — patients with СGD associated with H.pylori (n = 29), II — children with СGD associated with H.pylori in combination with giardiasis (n = 76). The study was conducted on the basis of the gastroenterology department of the Chernivtsi Regional Clinical Hospital during 2020–2021 and included esophagogastroduodenofibroscopy, ultrasound examination of the abdominal cavity, rapid urease test, determination of specific M, A and G immunoglobulins to H.pylori CagA antigen in the blood serum and in feces, fecal examination for Giardia lamblia (G.lamblia) antigen by polymerase chain reaction. Results. The most severe infection of G.lamblia occurred in children aged 9–13 years (17 people out of 29 positive). The number of children with G.lamblia increased between the ages of 7–9 and 10–12 years (p &lt; 0.05, χ2 = 5.236, z = 1.899) and decreased in the age of 13–16 years (p &lt; 0.05, χ2 = 7.144, z = 2.567). Patients with giardiasis complained of irritability (p &lt; 0.05), headache, dizziness, restless sleep, heart pain, and they were more likely to show signs of intoxication and skin syndromes. Children of group I were most often diagnosed with corpus gastritis (p &lt; 0.05), antral gastritis (p &lt; 0.05) or pangastritis (p &lt; 0.05) with focal hyperplasia (p &lt; 0.05), and children of group II — with mainly antral gastritis, as well as severe duodenitis (p &lt; 0.05). A characteristic endoscopic feature in children of group II was follicular duodenitis. Inflammatory process in group II significantly more often (p &lt; 0.05) was severe (81.5 %) and active (77.6 %) and was associated with eosinophilic infiltration (51.3 %), microerosions and foci of lymphoid tissue hyperplasia (6.5 %). Conclusions. The clinical course of СGD associated with H.pylori in combination with G.lamblia is characterized by more pronounced dyspeptic symptoms with signs of intoxication and skin syndromes. According to the results of endoscopic examination, patients suffered from СGD associated with H.pylori infection had esophagitis, corpus gastritis, antral gastritis and pangastritis (p &lt; 0.05) significantly more often. Children with G.lamblia invasion had severe follicular duodenitis (p &lt; 0.05).

Mechanisms for the Sex-Specific Effect of H. Pylori on Risk of Gastroesophageal Reflux Disease and Barrett's Esophagus.

Mechanisms for how Helicobacter pylori infection affects risk of gastroesophageal reflux disease (GERD) and Barrett's esophagus are incompletely understood and might differ by sex. In a case-control study nested in the Melbourne Collaborative Cohort Study with 425 GERD cases and 169 Barrett's esophagus cases (identified at 2007-2010 follow-up), we estimated sex-specific odds ratios for participants who were H. pylori seronegative versus seropositive at baseline (1990-1994). To explore possible mechanisms, we (i) compared patterns of H. pylori-induced gastritis by sex using serum pepsinogen-I and gastrin-17 data and (ii) quantified the effect of H. pylori seronegativity on Barrett's esophagus mediated by GERD using causal mediation analysis. For men, H. pylori seronegativity was associated with 1.69-fold [95% confidence interval (CI), 1.03-2.75] and 2.28-fold (95% CI, 1.27-4.12) higher odds of GERD and Barrett's esophagus, respectively. No association was observed for women. H. pylori-induced atrophic antral gastritis was more common in men (68%) than in women (56%; P = 0.015). For men, 5 of the 15 per 1,000 excess Barrett's esophagus risk from being seronegative were mediated by GERD. Men, but not women, who were H. pylori seronegative had increased risks of GERD and Barrett's esophagus. A possible explanation might be sex differences in patterns of H. pylori-induced atrophic antral gastritis, which could lead to less erosive reflux for men. Evidence of GERD mediating the effect of H. pylori on Barrett's esophagus risk among men supports this proposed mechanism. The findings highlight the importance of investigating sex differences in the effect of H. pylori on risk of GERD and Barrett's esophagus in future studies.

Influence of COVID-19 in the development of delusional ideas disorder. A case report

IntroductionHypochondria is characterized by the presence, for 6 months or more, of a generalized and non-delusional concern with fear of having (or the idea that one has) a serious illness, based on the wrong interpretation of the symptoms. In somatic-type delusional disorder, the delusional idea is fixed, indisputable, and occurs intensely because the patient is fully convinced of the physical nature of the disorder.Objectives To describe a clinical case and make a differential diagnosis of hypochondriac disorder vs somatic-type delusional disorder.MethodsCase report: 61-year-old woman, after suffering from COVID-19, develops a hypochondriacal disorder vs. somatic delusional disorder, presenting anxiety-depressive symptoms and digestive somatic complaints, with a loss of 15 kg of weight. She made frequent visits to doctors and multiple complementary tests discarding organicity. She required involuntary hospital admission for 48 days, and pharmacological treatment with Venlafaxine 150 mg, Olanzapine 5mg, Mirtazapine 30mg and Alprazolam 1mg. The patient presented slow evolution during admission, with ups and downs and stagnation, meriting enteral nutrition due to refusal to ingest, given abdominal kinesthetic hallucinations and digestive evaluation (EDS) with a result of antral gastritis and negative H. pylori. In subsequent follow-ups after partial remission of symptoms, obsessive personality traits are glimpsed, although with better personal functioning.ResultsThe diagnosis at discharge was inconclusive, however the data points to a somatic-type delusional disorder.ConclusionsThe influence of COVID-19 as a triggering factor, social isolation and premorbid personality traits, influence the development of a Somatic Delusional Disorder vs Hypochondriac Disorder, regarding this case.DisclosureNo significant relationships.