Antrum Biopsies Research Articles

Microplastic in Gastric Fasting Liquid and Associated Gastric Pathology.

To determine the presence of microplastics in the stomach, and the relationship between pathological changes in stomach tissue and microplastics. An analytical study. Place and Duration of the Study: Department of Internal Medicine, Sorgun State Hospital, Yozgat, Turkiye, from December 2022 to November 2023. Fasting gastric fluid sampling and endoscopic sampling including mucosal and submucosal layers from the antrum were performed. The pH values of the gastric fluids were recorded. Samples were analysed gradually by adding iron solution, hydrogen peroxide, and sodium chloride (NaCl) in a beaker at 75 degrees for 30 minutes. Biopsy materials obtained from antrum were examined histopathologically and reported according to the Sydney classification. The relationship between gastric biopsy results and the presence of microplastic was evaluated using Chi-square test. The significance level was taken as p <0.005. The study included 61 individuals. The presence of microplastics was detected in 17 (27.86%) gastric fluid samples obtained from the individuals. A significant correlation was found between increased activity and inflammation in antrum biopsy and the presence of microplastic (χ2 = 8.55 p = 0.014; χ2 = 25.75, p = 0.001). The relationship between atrophy, metaplasia, and Helicobacter pylori in gastric tissue and the presence of microplastic was statistically insignificant (p >0.05). Microplastics were detected in gastric fasting fluid. These materials can cause histopathologic changes and inflammation in the gastric antrum. H. pylori, Intestinal metaplasia, Inflammation, Microplastic, Plastic, Sydney classification.

Prevalence of H. pylori and Gastric Intestinal Metaplasia in BRCA1 and BRCA2 Carriers.

BRCA1 and BRCA2 carriers may be at increased risk for gastric cancer; however, the mechanisms of gastric carcinogenesis remain poorly understood. We sought to determine the prevalence of gastric cancer risk factors Helicobacter pylori (H. pylori) infection and gastric intestinal metaplasia (GIM) among BRCA1/2 carriers to gain insight into the pathogenesis of gastric cancer in this population. A total of 100 unselected BRCA1/2 carriers who underwent endoscopic ultrasound from March 2022 to March 2023 underwent concomitant upper endoscopy with nontargeted gastric antrum and body biopsies. The study population (70% women; mean age 60.1 years) included 66% BRCA2 carriers. H. pylori was detected in one (1%) individual, 7 (7%) had GIM, 2 (2%) had autoimmune atrophic gastritis, and no gastric cancers were diagnosed. Among BRCA1/2 carriers, H. pylori prevalence was low and GIM prevalence was similar to that in the general population; however, identification of H. pylori or GIM may help inform future gastric cancer risk management strategies in BRCA1/2 carriers. Prevention Relevance: Evaluating the burden of H. pylori infection and GIM among BRCA1/2 carriers is warranted to better understand the mechanisms of gastric carcinogenesis and to help inform risk management strategies for gastric cancer among this at-risk population.

Low prevalence of gastric intestinal metaplasia and Helicobacter pylori on surveillance upper endoscopy in Lynch syndrome.

Lynch syndrome (LS) increases the risk of numerous different cancers including gastric cancer. While some current guidelines recommend empiric gastric biopsies be performed during upper gastrointestinal cancer surveillance in Lynch syndrome (LS), the yield of these biopsies and the prevalence of gastric intestinal metaplasia (GIM) and Helicobacter pylori (HP) in LS remains unknown. Herein we analyze 165 consecutive individuals with LS who underwent upper endoscopic surveillance with biopsies of the gastric antrum and body being performed universally in all individuals. Of the study cohort, 6.7% of universally biopsied individuals with LS had GIM and/or HP (5.5% GIM, 3.6% HP). Biopsies of the gastric body did not increase rates of GIM/HP identification compared to antral biopsies alone. GIM was detected on subsequent surveillance in 2.2% of individuals without prior GIM, which may represent either newly developed GIM or GIM that was missed on a prior upper endoscopy due to sampling error. These findings support inclusion of at least baseline gastric antrum biopsies as a routine component of all standard surveillance upper endoscopies performed in LS.

A rare cause of hemorrhagic shock: Antrum biopsy under rivaroxaban

Direct oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban, and rivaroxaban),) are used in the management of patients with atrial fibrillation, ischemic heart disease, venous thromboembolism, and valvular heart disease. These drugs also increase the risk of gastrointestinal (GI) bleeding from luminal sources such as ulcers or diverticula and after endoscopic procedures.1-2 Rivaroxaban is a direct competitive inhibitor of factor Xa and limits thrombin generation in a dose dependent manner.6 Although no serious bleeding was reported in the endoscopic mucosal biopsy performed under rivaroxaban in the literature. in our case, hemorrhagic shock developed due to leakage in the biopsy area as a result of antrum biopsy performed under rivaroxaban.

IL-1 Polymorphism and Helicobacter pylori Infection Features: Highlighting VNTR’s Potential in Predicting the Susceptibility to Infection-Associated Disease Development

Genetic polymorphisms at the IL-1 cluster are associated with increased Helicobacter pylori (H. pylori)-associated disease risk in an ethnically dependent manner. Due to the corroborated role of IL-1β in H. pylori infection progression, our aim is to depict the impact of IL1B rs1143627 and rs16944 as well as the IL1RN variable number of identical tandem repeats (VNTR) on the clinical and biological features of Moroccan H. pylori-infected patients. A total of 58 patients with epigastralgic pain were referred to the gastroenterology department for histopathological and clinical analysis. DNA extraction from antrum and fundus biopsies and PCR-RFLP were performed to detect polymorphisms. As a result, VNTR was significantly associated with IL-1β antrum levels (p-value = 0.029), where the *1/*4 genotype showed a positive association with upregulated cytokine levels in the antrum and was clustered with H. pylori-infected patients' features and higher levels of IL-1β in the antrum and fundus. Likewise, *1/*1 genotype carriers clustered with severe gastritis activity and H. pylori density scores along with low levels of IL-1β in the antrum and fundus, while the *1/*2 genotype was clustered with non-infected-patient features and normal IL-1β levels. In conclusion, VNTR might be an interesting predictor to identify patients at risk of developing H. pylori-associated pathologies.

Antibiotic Resistance of Helicobacter pylori and Related Risk Factors in Yangzhou, China: A Cross-Sectional Study.

The antibiotic resistance of Helicobacter pylori (H. pylori) is a common cause of treatment failure. Previous studies showed that H. pylori resistance may be related to some characteristics of patients. This study intended to investigate the resistance of H. pylori to five commonly used antibiotics and risk factors in Yangzhou, China. We recruited the subjects who joined the endoscopic screening program organized by the Affiliated Hospital of Yangzhou University between April 2018 and September 2019 and endoscopists would take biopsy samples from the antrum and the corpus of the stomach. The antrum biopsy specimens were used to culture H. pylori. Next, we extracted DNA from H. pylori strains and performed the specific DNA amplification. Finally, we use gene chip technology to test the susceptibility to clarithromycin, levofloxacin, metronidazole, amoxicillin and tetracycline. Multivariate logistic analyses were also performed to determine the risk factors for antibiotic resistance of H. pylori. A total of 461 H. pylori strains were finally collected. The resistance rate of H. pylori to clarithromycin, levofloxacin, metronidazole, amoxicillin and tetracycline was 41.0%, 44.9%, 38.8%, 6.3% and 1.1%, respectively. In addition, 16 multi-resistance patterns were detected, and strains resistant to all five antibiotics were not found. Multivariate analysis showed that past medical history and clinical outcomes were significantly associated with the resistance to clarithromycin. Drinking, gastrointestinal symptoms and a family history of gastric cancer were significantly associated with the resistance of H. pylori to levofloxacin. Especially gastrointestinal symptoms were significantly associated with the resistance of H. pylori to any antibiotic. The resistance rates of H. pylori to clarithromycin, levofloxacin and metronidazole were very high in Yangzhou, China, various factors were related to bacterial resistance, and grasping these influencing factors can guide treatment.

The role of antral histopathology in diagnosing paediatric celiac disease.

The aim of this study was to evaluate the diagnostic potential of gastric antrum histology in children suspected of having celiac disease (CD). The present retrospective study was performed on 224 patients who were suspected of having CD and had several duodenal and one gastric antrum biopsies. They were divided into 2 groups based on the definite diagnosis of CD. The statistical analysis was performed using SPSS version 22 software. Receiver operating characteristic (ROC) curves were drown and the area under the curves (AUCs) was calculated. Article authorized by the Editor-in-Chief. Based on MARSH criteria, out of 224 patients, 124 were diagnosed as definite CD and 100 patients comprised the non-celiac group. The AUC for the mean of all pathological tests was estimated to be 0.90 (p < 0.001). The pooled AUC for the combination of 3 pathologic findings with the highest AUCs (cell, crypt, and gland size) was estimated to be 0.89 (p < 0.001). We observed that the histological changes we found in the gastric antrum were identical to those found in the duodenum of paediatric CD patients. Because providing abiopsy from the gastric antrum is easier than getting multiple biopsies from the duodenum, we suggest using the criteria mentioned in this study in other studies with larger sample sizes.

Evaluation of the diagnosis of helicobacter pylori from stomach biopsy samples by staining methods

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

Endoscopic Evaluation and Helicobacter Pylori Prevalence in Dyspeptic Patients with Chronic Kidney Disease

Abstract: Objective: Dyspepsia is a common symptom in chronic kidney disease (CKD) as well as in the normal population and may develop due to functional or organic causes. In the literature, there are different results about dyspepsia symptoms, upper gastrointestinal tract lesions and Hp prevalence in CKD. In this study, endoscopic findings and the prevalence of Helicobacter Pylori (Hp) in dyspeptic chronic kidney patients were investigated and compared with the normal population. Materials and Methods: 67 patients with dyspeptic CKD (52 hemodialysis, 6 continuous ambulatory peritoneal dialysis, 9 predialysis) and 63 age and gender-matched control groups were included in our study. Gastrointestinal symptom scoring, upper endoscopic examination, histopathological examination of gastric antrum and corpus biopsies taken during this period, and rapid urease test (RUT) for Hp were performed on all cases included in the study. Results: Gastrointestinal symptom scores were not different between the CKD and control groups (6.2±2.5 vs 7.7±3.6) (p&gt;0.05). Although the prevalence of Hp in the CKD group (44.8%) was lower than the control group (54%) according to gastric biopsy findings, there was no difference between them (p&gt;0.05). In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis in the CKD group, and the difference between them was significant (p&lt;0.05). When compared with histopathological evaluation, the sensitivity (78% vs. 79%) and specificity (95% vs. 93%) of the urease test were similar in the CKD and control groups in both groups. Conclusion: Gastrointestinal symptom score and Hp prevalence in chronic kidney disease were similar to the control group. No correlation was found between Hp and gastrointestinal symptom score. In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis was more common in the CKD group.

Rare variation: the absence of both the celiac trunk artery and the common hepatic artery

BackgroundKnowledge of celiac trunk anatomy is important in gastrointestinal surgery, hepatopancreatobiliary surgery, transplantation and interventional radiology. Variations in the celiac trunk are common and should be predicted prior to these interventions.MethodsA 58-year-old woman was admitted to our department for surgical treatment of gastric cancer (GC) confirmed by gastroduodenoscopy and gastric antrum biopsy. In the contrast-enhanced computed tomography (CT), we found an absence of both the celiac trunk artery (CA) and the common hepatic artery (CHA). Therefore, we used computerized three-dimensional (3D) vascular reconstruction technology to reconstruct the abdominal trunk and its branch vessels before operation.ResultsComputerized 3D vascular reconstruction confirmed an extremely rare vascular anomaly: the absence of both CA and CHA. The splenic artery (SA) and gastroduodenal artery (GDA) originated from the abdominal aorta (AA). The left gastric artery (LGA) originated from the AA directly above the junction of SA and the GDA. The left hepatic artery (LHA) originated from the left gastric artery (LGA). The right hepatic artery (RHA) originated from the superior mesenteric artery (SMA). Laparoscopic radical resection of GC was performed. This anomaly was also confirmed intraoperatively. This patient was discharged on the 10th day after surgery without any postoperative complication. There were no signs of tumor recurrence during the 6-month follow-up.ConclusionCorrect identification of abnormal abdominal large blood vessels and their relationship with tumors before surgery is of great significance to avoid intraoperative blood vessel damage, major postoperative complications and the missing of lymph node dissection.

Genomic diversity of Helicobacter pylori populations from different regions of the human stomach

ABSTRACT Individuals infected with Helicobacter pylori harbor unique and diverse populations of quasispecies, but diversity between and within different regions of the human stomach and the process of bacterial adaptation to each location are not yet well understood. We applied whole-genome deep sequencing to characterize the within- and between-stomach region genetic diversity of H. pylori populations from paired antrum and corpus biopsies of 15 patients, along with single biopsies from one region of an additional 3 patients, by scanning allelic diversity. We combined population deep sequencing with more conventional sequencing of multiple H. pylori single colony isolates from individual biopsies to generate a unique dataset. Single colony isolates were used to validate the scanning allelic diversity pipelines. We detected extensive population allelic diversity within the different regions of each patient’s stomach. Diversity was most commonly found within non-coding, hypothetical, outer membrane, restriction modification system, virulence, lipopolysaccharide biosynthesis, efflux systems, and chemotaxis-associated genes. Antrum and corpus populations from the same patient grouped together phylogenetically, indicating that most patients were initially infected with a single strain, which then diversified. Single colonies from the antrum and corpus of the same patients grouped into distinct clades, suggesting mechanisms for within-location adaptation across multiple H. pylori isolates from different patients. The comparisons made available by combined sequencing and analysis of isolates and populations enabled comprehensive analysis of the genetic changes associated with H. pylori diversification and stomach region adaptation.

New CagL Amino Acid Polymorphism Patterns of Helicobacter pylori in Peptic Ulcer and Non-Ulcer Dyspepsia

Background and Objectives: Helicobacter pylori infection is associated with chronic gastritis, ulcers, and gastric cancer. The H. pylori Type 4 secretion system (T4SS) translocates the CagA protein into host cells and plays an essential role in initiating gastric carcinogenesis. The CagL protein is a component of the T4SS. CagL amino acid polymorphisms are correlated with clinical outcomes. We aimed to study the association between CagL amino acid polymorphisms and peptic ulcer disease (PUD) and non-ulcer dyspepsia (NUD). Materials and Methods: A total of 99 patients (PUD, 46; NUD, 53) were enrolled and screened for H. pylori by qPCR from antrum biopsy samples. The amino acid polymorphisms of CagL were analyzed using DNA sequencing, followed by the MAFFT sequence alignment program to match the amino acid sequences. Results: Antrum biopsy samples from 70 out of 99 (70.7%) patients were found to be H. pylori DNA-positive. A positive band for cagL was detected in 42 out of 70 samples (PUD, 23; NUD, 19), and following this, these 42 samples were sequenced. In total, 27 different polymorphisms were determined. We determined three CagL amino acid polymorphism combinations, which were determined to be associated with PUD and NUD. Pattern 1 (K35/N122/V134/T175/R194/E210) was only detected in PUD patient samples and was related to a 1.35-fold risk (p = 0.02). Patterns 2 (V41/I134) and 3 (V41/K122/A171/I174) were found only in NUD patient samples and were linked to a 1.26-fold increased risk (p = 0.03). Conclusions: We observed three new patterns associated with PUD and NUD. Pattern 1 is related to PUD, and the other two patterns (Patterns 2 and 3) are related to NUD. The patterns that we identified include the remote polymorphisms of the CagL protein, which is a new approach. These patterns may help to understand the course of H. pylori infection.

S3745 An Uncommon Case of Helicobacter pylori-Negative Gastric MALT Lymphoma

Introduction: Gastric MALT (mucosa-associated lymphoid tissue) lymphoma is a type of non-Hodgkin's lymphoma with concomitant H. pylori infection. Approximately 5-10% of patients are not. Recent studies on H. pylori-negative gastric MALT lymphomas have suggested that H. pylori eradication therapy is effective in a proportion of patients with this disease and could even be considered a first-line treatment. Here, we present this uncommon and unique case. Case Description/Methods: A 58-year-old man, with PMH of prostate cancer and DVT not on anticoagulation, was initially admitted for seizures and altered mental status under the impression of bacterial meningitis. He had an upper GI bleed during the same hospitalization, and an inpatient upper endoscopy showed a Forrest 1a ulcer in the gastric fundus s/p clipping (Fig 1A). A repeat upper endoscopy three months later showed gastric erythema and a 6 mm non-bleeding healing gastric ulcer in the fundus (Fig 1B). The pathology report of antrum biopsy showed fundic and transitional zone gastric mucosa, mild chronic gastritis without intestinal metaplasia or dysplasia, and the presence of a few atypical lymphocytes. The body biopsy showed fundic/body type gastric mucosa, and findings were compatible with low-grade B-cell lymphoma, favoring extranodal marginal zone lymphoma of MALT lymphoma (Fig 1C). The patient was empirically treated for H. pylori with Bismuth-based quadruple therapy. The patient improved on follow-up with GI. Hematology-Oncology is currently planning for FISH for t(11;18) and/or MYD88 mutation status to assist in the differential, as the H. pylori strain was negative on biopsy. Discussion: Several theories describe pathways for lymphoid proliferation in H. pylori-negative patients, but the exact mechanism has yet to be determined. Currently, it is deemed multifactorial. There is a high incidence of translocation (11;18)(q21;q21) in H. pylori-negative MALT lymphomas is seen. Using radiation therapy for patients with early-stage (Lugano I/II) gastric MALT lymphomas that are negative for H. pylori infection is recommended, with clinical remission rates of up to 100%. Conversely, organ-preserving therapy has no added benefit and surgical treatment is rarely pursued. Therefore, it is recommended to eliminate the presence of H. pylori and evaluate for this translocation. Recent studies have suggested that H. pylori eradication therapy is effective in some proportion of these patients and could be considered a first-line treatment.Figure 1.: A) Upper endoscopy image of Forrest Class 1a ulcer s/p two clips. There is a spurting gastric ulcer with spurting hemorrhage. B) Upper endoscopy of gastric erythema and a 6 mm non-bleeding healing gastric ulcer in the fundus. C) Pathology: Low power view, H&E stain, of antrum biopsy showing fundic and transitional zone gastric mucosa, mild chronic gastritis without intestinal metaplasia or dysplasia, and the presence of a few atypical lymphocytes Immunohistochemistry studies showed atypical lymphocytes CD20+, CD79a+, PAX5+, CD5-, CD10-, BCL6-, BCL2+, CD43+, CyclinD1-, BCL6, and CD10, highlighting very small, scattered, disrupted germinal centers. CD3 and CD5 highlighted numerous admixed T-cells. Ki-67 was overall low (5-10%). Kappa(ish) and Lambda(ish) stains showed that the plasma cells were kappa-restricted, and had low mitotic activity, supporting the diagnosis of marginal zone lymphoma.

The influence of gastric atrophy on Helicobacter pylori antibiotics resistance in therapy-naïve patients

BackgroundAntibiotic susceptibility of Helicobacter pylori to antibiotics may vary among different niches of the stomach. The progression of chronic H. pylori gastritis to atrophy changes intragastric physiology that may influence selection of resistant strains.AimTo study the antibiotic resistance of H. pylori taking the severity of atrophic gastritis in antrum and corpus into account.MethodsHelicobacter pylori-positive patients (n = 110, m = 32, mean age 52.6 ± 13.9 years) without prior H. pylori eradication undergoing upper gastrointestinal (GI) endoscopy for dyspeptic symptoms were included in a prospective study. Patients were stratified into three groups depending on the grade of atrophy: no atrophy (OLGA Stage 0), mild atrophy (OLGA Stage I–II) and moderate/severe atrophy (OLGA Stage III–IV). Two biopsies each from the antrum and the corpus and one from the angulus were taken and assessed according to the updated Sydney system. H. pylori strains were isolated from antrum and corpus biopsies and tested for antibiotic susceptibility (AST) for amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin by the agar dilution methods. A Chi-square test of independence with a 95% confidence interval was used to detect differences in the proportion of patients with susceptible and resistant H. pylori strains.ResultsAmong 110 patients, primary clarithromycin resistance (R) was 30.0%, both in the antrum and corpus; metronidazole resistance accounted for 36.4 and 34.5% in the antrum and corpus; and levofloxacin was 19.1 and 22.7% in the antrum and corpus, respectively. Resistance rates to amoxicillin, tetracycline, and rifampicin were below 5%. Dual antibiotic resistance rate was 21.8%, and triple resistance rate was 9.1%. There was a significant difference in the resistance rate distribution in antrum (p < 0.0001) and corpus (p < 0.0001). With increasing severity of atrophy according to OLGA stages, there was a significant increase in clarithromycin-R and metronidazole-R.ConclusionIn treatment-naïve patients, antibiotic resistance and heteroresistance were related to the severity of atrophy. The high clarithromycin resistance in atrophic gastritis suggests that H. pylori antibiotic susceptibility testing should always be performed in this condition before selecting the eradication regimen.

Relationship between mucosal TNF-α expression and Th1, Th17, Th22 and Treg responses in Helicobacter pylori infection

Helicobacter pylori (H. pylori)-induced gastric inflammation in the gastric mucosa and significantly increases the risk of developing gastritis and peptic ulcer disease (PUD). The objective of this research is to determine the role of tumor necrosis factor-α (TNF-α) expression in the gastric mucosa of patients with H. pylori-associated gastritis and PUD compared to uninfected patients, and we determined the relation between TNF-α expression and Th1/Th17/Th22, and Treg cells. Fifty-five patients with H. pylori-associated gastritis, 47 patients with H. pylori-associated PUD, and 48 uninfected patients were in this research. Antrum biopsy was used to detect H. pylori, virulence factors and histopathological assessments. Expression of TNF-α in the infected group was significantly higher than the uninfected group. Also, cagA/oipA-positive infected patients induce significantly more TNF-α expression than do cagA/oipA-negative infected patients. Expression of TNF-α was significantly increased in the PUD group than the gastritis group. Notably, TNF-α expression had a significant positive correlation with the frequency of Th1/Th17/Th22 lymphocytes in the PUD group. These findings indicate the importance of increasing TNF-α with Th1, Th17, Th22 responses increase as an important risk factor for PUD in context of H. pylori infection.

Differential Proteomics of Helicobacter pylori Isolates from Gastritis, Ulcer, and Cancer Patients: First Study from Northwest Pakistan.

Background and Objective: Helicobacter pylori is a human-stomach-dwelling organism that causes many gastric illnesses, including gastritis, ulcer, and gastric cancer. The purpose of the study was to perform differential proteomic analysis on H. pylori isolates from gastritis, ulcer, and gastric cancer patients. Materials and Methods: H. pylori was isolated from antrum and fundus biopsies obtained from patients who visited the Department of Gastroenterology. Using nano-LC-QTOF MS/MS analysis, differentially regulated proteins were identified through proteome profiling of pooled samples of H. pylori isolated from gastritis, ulcer, and gastric cancer patients. Antigenic scores and cellular localization of proteins were determined using additional prediction tools. Results: A total of 14 significantly regulated proteins were identified in H. pylori isolated from patients with either gastritis, ulcer, or gastric cancer. Comparative analysis of groups revealed that in the case of cancer vs. gastritis, six proteins were overexpressed, out of which two proteins, including hydrogenase maturation factor (hypA) and nucleoside diphosphate kinase (ndk) involved in bacterial colonization, were only upregulated in isolates from cancer patients. Similarly, in cancer vs. ulcer, a total of nine proteins were expressed. Sec-independent protein translocase protein (tatB), involved in protein translocation, and pseudaminic acid synthase I (pseI), involved in the synthesis of functional flagella, were upregulated in cancer, while hypA and ndk were downregulated. In ulcer vs. gastritis, eight proteins were expressed. In this group, tatB was overexpressed. A reduction in thioredoxin peroxidase (bacterioferritin co-migratory protein (bcp)) was observed in ulcer vs. gastritis and cancer vs. ulcer. Conclusion: Our study suggested three discrete protein signatures, hypA, tatB, and bcp, with differential expression in gastritis, ulcer, and cancer. Protein expression profiles of H. pylori isolated from patients with these gastric diseases will help to understand the virulence and pathogenesis of H. pylori.

Evaluation of the relationship between Helicobacter pylori and duodenal scattered white spots lesions in dyspeptic patients

Giriş ve Amaç: Rutin endoskopik değerlendirmede genellikle karşılaştığımız ve intestinal lenfanjiektazi olarak değerlendirdiğimiz duodenumun dağınık beyaz noktasal lezyonlarının çoğunlukla belirgin bir nedeni veya klinik karşılığı bilinmemektedir. Çalışmamızda dağınık beyaz noktasal lezyonların sıklığını, patolojik karşılığını ve Helicobacter pylori ile olan ilişkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: İç Hastalıkları ve Gastroenteroloji Bilim Dalımız polikliniklerine başvuran ve aynı endoskopist tarafından dispeptik yakınma şikayeti ile gastroskopileri uygulanan toplam 445 hastanın endoskopi bulguları retrospektif olarak değerlendirildi. Endoskopik bulgularında dağınık beyaz noktasal lezyonlar saptanan hastaların antrum ve duodenal biyopsileri alınarak histolojik olarak incelendi. Bulgular: Tüm hastaların %60’ı kadın (n = 245) ve yaşları ortalaması 47.1 yıl idi. İncelenen endoskopik raporlarda 39 (%8.8) hastada dağınık beyaz noktasal lezyonların olduğu saptandı. Dağınık beyaz noktasal lezyonlar saptanan hastaların biyopsilerinde 10 hastada (%26.3) intestinal lenfanjiektazi, 21 hastada (%55.2) kronik nonspesifik duodenit ve 7 hastada (%18.5) Giardia enfeksiyonu saptandı. Dağınık beyaz noktasal lezyonların saptandığı hastaların yarısında (n = 19) Helicobacter pylori pozitif olarak saptandı (p = 0.695). Helicobacter pylori sıklığı patolojik olarak intestinal lenfanjiektazi saptanmış grupta da istatiksel olarak farklı bulunmadı. Sonuç: Dispeptik yakınmalar ile gelen hastaların gastroskopilerinde dağınık beyaz noktasal lezyonların sıklığı %8.8 olarak bulundu. Bu hastaların ancak dörtte birinde patoloji ile konfirme intestinal lenfanjiektazi görülmektedir. Dağınık beyaz noktasal lezyonlar ve intestinal lenfanjiektazi saptanması ile Helicobacter pylori pozitifliği arasında bir ilişki saptanmamıştır. &#x0D; Dispepsi, duodenal dağınık beyaz noktasal lezyonlar, Helicobacter pylori

Malignant Glomus Tumor of the Gastric Antrum with Liver Metastasis in a 35-year-old Female: A Case Report

Glomus tumors (GTs) are mesenchymal tumors derived from modified smooth muscle cells of the glomus body. These tumors account for less than 2% of all soft tissue tumors, and of those less than 1% are malignant. A 35-year-old African American female presented with symptomatic iron deficiency anemia. On esophagogastroduodenoscopy, a 5 cm mass was seen partially obstructing the antrum and tissue biopsy was obtained. The biopsy showed low-grade epithelial mesenchymal neoplasm with features of a glomus tumor. A follow up computed tomography (CT) chest/abdomen/pelvis revealed a 5 cm relatively homogeneous solid mass in the gastric antrum, which appeared most similar to a gastrointestinal stromal tumor. During the planned distal gastrectomy with reconstruction, one hepatic metastasis was identified via intraoperative ultrasound and was confirmed by frozen section consultation to be the same histologic type as the antral mass. Pathologic and immunohistochemical findings were consistent with a malignant gastric glomus tumor with liver metastasis. Most GTs have a benign clinical course making the diagnosis and treatment of malignant GTs an ongoing challenge. The data on glomus tumors of the viscera is limited by the rarity of these tumors, with most of the known presentation and treatment gathered from case reports.

Comparative Study of Modified Silver Nitrate Staining for the Detection of Helicobacter pylori.

Background/Aims: Helicobacter pylori (Hp) infection is associated with a variety of diseases, such as benign lesions, precancerous lesions, and malignant lesions, especially diseases in the digestive system. Most people with Hp infection have mild early symptoms that are not easily noticed. Therefore, the diagnosis and treatment of Hp infection is particularly important. At present, there are many methods to detection Hp infection, but there is a lack of effective detection method with high sensitivity and specificity. On the basis of the existing detection methods, the modified silver nitrate staining method in this study improved the sensitivity and specificity of Hp detection.Materials and Methods:We selected gastric antrum and gastric angle mucosal biopsy tissues from 60 inpatients that were archived in the Pathology Department of Zhongnan Hospital of Wuhan University from July to December 2020. An Hp immunohistochemical assay, histochemical assay kit (methylene blue), and modified silver nitrate staining were used to measure the Hp infection positivity rate.Results:Comparison of Hp sensitivity and specificity among the 3 methods showed that the modified silver nitrate staining method was the most excellent. The sensitivity of modified silver nitrate staining method was 98.3%, which is statistically significantly higher compared with the other 2 methods.Conclusion:The modified silver nitrate staining method for Hp detection is convenient and effective, and could be widely used for clinical Hp detection.

Combined antrum and corpus biopsy protocol improves Helicobacter pylori culture success.

BACKGROUND Helicobacter pylori (H. pylori) causes chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. Eradication rates have fallen, mainly due to antimicrobial resistance. Consensus guidelines recommend that first-line treatment is based on the local prevalence of antimicrobial resistance and that rescue therapies are guided by antimicrobial susceptibility testing (AST). However, H. pylori culture is challenging and culture-based AST is not routinely performed in the majority of hospitals. Optimisation of H. pylori culture from clinical specimens will enable more widespread AST to determine the most appropriate antimicrobials for H. pylori eradication.AIMTo determine whether dual antrum and corpus biopsy sampling is superior to single antrum biopsy sampling for H. pylori culture.METHODSThe study received ethical approval from the joint research ethics committee of Tallaght University Hospital and St. James’s Hospital. Patients referred for upper gastrointestinal endoscopy were invited to participate. Biopsies were collected in tubes containing Dent’s transport medium and patient demographics were recorded. Biopsies were used to inoculate Colombia blood agar plates. Plates were incubated under microaerobic conditions and evaluated for the presence of H. pylori. Statistical analyses were performed using Graphpad PRISM. Continuous variables were compared using the two-tailed independent t-test. Categorical variables were compared using the two-tailed Fisher exact test. In all cases, a P value less than 0.05 was considered significant.RESULTSIn all, samples from 219 H. pylori-infected patients were analysed in the study. The mean age of recruited patients was 48 ± 14.9 years and 50.7% (n = 111) were male. The most common endoscopic finding was gastritis (58.9%; n = 129). Gastric ulcer was diagnosed in 4.6% (n = 10) of patients, while duodenal ulcer was diagnosed in 2.7% (n = 6). Single antrum biopsies were collected from 73 patients, whereas combined antrum and corpus biopsies were collected from 146 patients. There was no significant difference in age, sex or endoscopic findings between the two groups. H. pylori was successfully cultured in a significantly higher number of cases when combined antrum and corpus biopsies were used compared to a single antrum biopsy [64.4% (n = 94/146) vs 49.3% (36/73); P = 0.04)]. CONCLUSIONCombined corpus and antrum biopsy sampling improves H. pylori culture success compared to single antrum biopsy sampling.