Chronic Atrophic Gastritis Patients Research Articles

Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG.

ObjectiveThe aim of this study was to integrate the serum exosomal miRNA miR-122-5p with canonical serological biomarkers for the non-invasive screening of chronic atrophic gastritis (CAG) patients.MethodsmiR-122-5p and U6 were amplified by the quantitative reverse transcription polymerase chain reaction (RT-qPCR), gastrin (GAS), pepsinogen I (PG-I), and PG-II and were measured by ELISA. The area under the receiver operating characteristic (ROC) curves and their correlation were analyzed.ResultsIn the present study, GAS level and PG-I/PG-II ratio (PGR) were increased in CAG group, but there was no significant difference in PG-I or PG-II levels between CAG group and chronic non-atrophic gastritis (CNAG) group. Only GAS level and PG-I/PG-II ratio were significantly correlated with atrophy, and not any other clinicopathologic factors. Expression of hsa-miR-122-5p positively correlated with GAS level, PG-I level, and PGR, while it negatively correlated with PG-II level; however, none of them had significant difference. The combination of GAS, PGR, and hsa-miR-122-5p presented as a better model for non-invasive screening of CAG compared to others.ConclusionThese results suggested that serum exosomal hsa-miR-122-5p combined with GAS and PGR would elevate accuracy and specificity in non-invasive screening of CAG.

Effect of gastric microbiota on quadruple Helicobacter pylori eradication therapy containing bismuth.

BACKGROUND Helicobacter pylori (H. pylori) is an important pathogen that can cause a variety of diseases. Yet, full eradication of H. pylori remains a significant challenge in clinical practice. H. pylori and other microbial communities have complex interactions in the unique gastric microecological environment. However, it is not clear whether the interactions have any effect on the therapeutic effect of H. pylori.AIMThe aim was to investigate the characteristics of the gastric microbiota with H. pylori infection and the influence on the H. pylori eradication treatment.METHODSPatients with H. pylori infection underwent gastroscopy and received treatment for eradication. The prescription included esomeprazole 20 mg bid, Livzon Dele 220 mg bid, amoxicillin 1000 mg bid, and clarithromycin 500 mg bid for 14 d. Patients who did not respond to treatment and failed eradication were compared with those who achieved eradication by 1:2 propensity matching. High-throughput sequencing of the gastric mucosal microbiota was performed, and the results were evaluated by alpha diversity analysis, beta diversity analysis, species correlation analysis, and metabolic pathway correlation analysis.RESULTSThe eradication rate of all the patients was 95.5% (171/179). Twenty-four patients were enrolled in the study after propensity-matched scoring. There were eight cases in the failure group (patients who did not respond well to therapy) and 16 cases in the success group. The majority phyla in the two groups were the same, and included Proteobacteria, Bacteroides, Firmicutes, Actinomycetes, and Fusobacteria. The microbial diversity in the failure group had a decreasing trend (P = 0.092) and the species abundance was significantly lower (P = 0.031) compared with the success group. The high rate of H. pylori eradication was associated with Rhodococcus, Lactobacillus, and Sphingomonas, as they were significantly enriched in the successful group (P < 0.05). Veronococcus and Cilium were enriched in the mucosa of chronic atrophic gastritis patients compared with chronic superficial gastritis patients (P = 0.0466 and 0.0122, respectively). In both study groups, H. pylori was negatively correlated with other bacterial genera. More bacterial genera were directly related to H. pylori in the successful group compared with the failure group.CONCLUSIONThe effectiveness of quadruple H. pylori eradication therapy containing bismuth depended on gastric microbiota, and the high rate of H. pylori eradication was associated with the presence of Rhodococcus, Lactobacillus, and Sphingomonas.

Acupuncture Regulates Serum Differentially Expressed Proteins in Patients with Chronic Atrophic Gastritis: A Quantitative iTRAQ Proteomics Study.

Objective To identify differentially expressed proteins (DEPs) in sera of patients with chronic atrophic gastritis (CAG) using isobaric tags for relative and absolute quantitation (iTRAQ) and to explore acupuncture's mechanism in CAG. Methods Peripheral sera from 8 healthy volunteers (HC), 8 chronic nonatrophic gastritis (NAG) patients, 8 CAG patients, and 8 CAG patients who underwent acupuncture treatment (CAG + ACU) were collected followed by labeling with iTRAQ reagent for protein identification and quantification using two-dimensional liquid chromatography-tandem mass spectrometry (2D-LC-MS/MS). Representative DEPs were selected through bioinformatics, and proteins were verified by enzyme-linked immunosorbent assay (ELISA). Results A total of 4,448 unique peptides were identified, corresponding to 816 nonredundant proteins. A 1.4-fold difference was used as the threshold. Compared with the HC group, 75 and 106 DEPs were identified from CAG and NAG groups, respectively. Compared with the CAG group, 110 and 66 DEPs were identified from the NAG and CAG + ACU groups, respectively. The DEPs were mainly involved in protein binding and the Notch signaling pathway-related proteins, and the upregulated proteins included actin-binding proteins (thymosin beta-4, tropomyosin-4, profilin-1, transgelin-2), while the downregulated proteins included Notch2 and Notch3. After acupuncture, the expression of these proteins in CAG patients was less differentiated from that in healthy people. The level of the above 6 proteins were verified by ELISA, and the results were similar to the results of iTRAQ analysis. Conclusions Actin-binding proteins and Notch signaling pathway-related proteins were correlated with the development and progression of CAG and thus are potential diagnostic markers for CAG. Acupuncture may play a role in regulating actin-binding proteins and Notch signaling pathway-related proteins to play a therapeutic role in CAG.

Integrated analyses of miRNA and mRNA profiles in leukocytes and serums in traditional Chinese medicine (TCM)-defined Pi-qi-deficiency syndrome and Pi-wei damp-heat syndrome resulting from chronic atrophic gastritis

BackgroundTo investigate the microRNA (miRNA)-gene interactions underlying leukocyte functions and characteristics, especially the potential serum biomarkers, implicated in the traditional Chinese medicine (TCM)-defined Pi-qi-deficiency syndrome (PQDS) and Pi-wei damp-heat syndrome (PDHS) resulting from chronic atrophic gastritis (CAG).MethodsUsing RNA/miRNA-sequencing approach, compared with healthy control population, we identified the PDHS- or PQDS-specific miRNAs and genes in leukocytes or serums, especially the Zheng (syndrome)-specific miRNA-gene interactions, and further decoded their functions and pathways.ResultsDespite being the TCM-defined Zhengs resulting from the same disease of CAG, the Zheng-specific genes and miRNAs were not same. The PDHS-specific leukocyte genes were mainly involved in defense and immune responses, including NOD-like receptor signaling and several synapses-related pathways. The expression upregulation of PDHS-specific genes enriched in the neutrophil degranulation pathway, indicated the enhanced leukocyte degranulation activation. The PQDS-specific genes in leukocytes were implicated in inflammatory response, extracellular matrix (ECM) organization and collagen catabolism. They could be enriched in MAPK and IL17 signaling and helper T cell differentiation pathways, especially the pathways associated with cell-to-cell adhesion/junction and communication such as cell adhesion molecules, ECM organization and ECM-receptor interaction, probably contributing to the characteristics and functions of leukocytes. Also, the experimentally-supported miRNA-gene interactions, concerned with COL4A2, COL26A1, SPP1 and PROCR, were implicated in the regulation of pathways related to cell-to-cell adhesion/junction and communication, suggesting the potential roles of the PQDS-specific miRNA-gene interactions for the characteristic and functional changes of leukocytes. Interestingly, the PQDS-specific miRNAs in the serums and the corresponding leukocytes, seemed to have the common roles in contributing to the characteristics and functions of leukocytes. Importantly, the hsa-miR-122-5p could be a potential biomarker, capable of being contained and carried in plasma exosomes and much higher expression in both the leukocytes and corresponding serums in the CAG patients with PQDS rather than PDHS.ConclusionsThese results may provide new insights into the characteristic and functional changes of leukocytes in the two Zhengs, PDHS and PQDS, especially the miRNA-mediated gene regulation underlying leukocyte characteristics and functions, with potential leukocyte and serum biomarkers for future application in integrative medicine.Trial registration ClinicalTrials.gov, NCT02915393. Registered on September 17, 2016.

Efficacy and safety of massage therapy for chronic atrophic gastritis: A protocol for systematic review and meta-analysis.

Background:Chronic atrophic gastritis (CAG) is an established precursor of gastric carcinoma with high prevalence worldwide. It is a typical complex gastro-intestinal disease with multiple influence factors, of which exact mechanisms remain unelucidated. Therefore, an ideal strategy to relieve CAG is urgently needed. In recent years, massage therapy has been increasingly accepted by CAG patients due to its lower costs, fewer unwanted side effects and safety for clinical use. In this systematic review, we aim to evaluate the effectiveness and safety of massage therapy for patients with chronic atrophic gastritis.Methods:We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating chronic atrophic gastritis: Wanfang and Pubmed Database, China National Knowledge Infrastructure Database, Cochrane Central register of controlled trials, Cumulative Index of Nursing and Allied Health Literature, and Excerpta Medica database. Each database will be searched from inception to September 2020. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses.Result:This proposed study will evaluate the effectiveness and safety of massage therapy for patients with chronic atrophic gastritis. The outcomes will include changes in CAG relief and adverse effect.Conclusion:This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with chronic atrophic gastritis.Dissemination and ethics:The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.

Efficacy of Banxia Xiexin decoction for chronic atrophic gastritis: A systematic review and meta-analysis.

BackgroundBanxia Xiexin decoction (BXD), a classical formula of traditional Chinese medicine (TCM), has been wildly used for chronic atrophic gastritis (CAG) patients with the cold-heat complex syndrome in China, and achieved satisfied effects. However, the clinical effects of it remains unclear.PurposeThe purpose of this article is to evaluate the clinical efficacy and safety of BXD for CAG treatment.MethodsWe searched seven electronic databases including Ovid, Embase, PubMed, Cochrane Library, Wan-fang database, VIP (Chinese Scientific Journals Database) and CNKI (China National Knowledge Infrastructure) from their inception to September 21, 2020. We used Jadad scale and Cochrane Collaboration’s risk of bias tool to make evaluation of methodological quality. Revman 5.3 statistical software was used for statistical processing to evaluate the clinical efficacy and safety of BXD.Results26 randomized controlled trials (RCTs) totaling 1985 patients were identified for analysis. Meta-analysis showed that BXD treatment was more effective (RR 1.29; 95%CI 1.24, 1.35; P<0.00001) and safe (MD 0.33; 95%CI 0.18, 0.58; P = 0.0002) than Chinese patent medicine + western medicine. Furthermore, BXD had improvement on symptoms scores such as stomach distending pain, and belching. Besides, BXD was more effective in inhibiting Helicobacter Pylori (HP), improving HP-related inflammation, and relieving the degree of glandular atrophy, intestinal metaplasia (IM), and dysplasia of gastric mucosa (GM).ConclusionsThe meta-analysis showed that BXD was more effective and safer for CAG patients than the control group. However, due to limitations of methodological quality and small sample size of the included studies, further standardized research of rigorous design should be needed.

Association of MTHFR C677T polymorphism with severity and localization of chronic atrophic gastritis patients without Helicobacter pylori infection: a case control study

BackgroundPrevious reports indicate that the methylenetetrahydrofolate reductase (MTHFR) 677C > T polymorphism plays a role in gastric cancer. However, whether it influences the development and progression of atrophic gastritis remains ambiguous. We aimed to determine the possible relationship between MTHFR C677T polymorphism and the severity of atrophic gastritis.MethodsA total of 128 patients without Helicobacter pylori infection were included in the study. The severity of gastric atrophy was assessed by pathological diagnosis using OLGA and OLGIM Gastritis Staging System. MTHFR 677C > T genotyping was performed by digital fluorescence molecular hybridization. Categorical variables were analyzed by percentages using the χ2 test.ResultsIn this study, the TT genotype was significantly more frequent among Helicobacter pylori-negative patients aged ≤44 years (age ≤ 44 years vs. > 44 years, P = 0.039). Patients with TT genotype showed a higher ratio of incisura with atrophy or intestinal metaplasia (TT vs. CC + CT, P = 0.02). Furthermore, TT genotype was associated with more severe lesions compared with the CC + CT genotypes (TT vs. CC + CT for atrophy: P = 0.07; for intestinal metaplasia: P = 0.01; for moderate-to-severe lesions: P = 0.01). OLGA and OLGIM stages III-IV were observed more frequently in patients with TT genotype compared with CC + CT genotypes (for OLGA: P = 0.003; for OLGIM: P = 0.036).ConclusionsThe MTHFR 677C > T TT genotype showed an increased risk of moderate-to-severe lesions by OLGA and OLGIM stages, and these results indicate that MTHFR C677T polymorphism may act as a predictive marker for precancerous gastric lesions, especially in Helicobacter pylori-negative patients aged ≤44 years.

Orexin A associates with inflammation by interacting with OX1R/OX2R receptor and activating prepro-Orexin in cancer tissues of gastric cancer patients

ObjectiveGastric cancer (GC) has been become the second leading cause for cancer-associated death. This study aimed to investigate Orexin A levels and associated receptors in tumor tissues of GC patients. Patients and methodsForty-six consecutive gastric cancer patients (GC, n=46) and 13 chronic atrophic gastritis patients (CAG, n=13) were recruited. Meanwhile, 18 health individuals visiting Medical Examination Department were involved as control (N group, n=18). ELISA was used to examine Orexin A concentration. Immunohistochemistry assay was used to examine OX1R and OX2R. HE staining was applied to evaluate inflammation. qRT-PCR was employed to detect OX1R, OX2R, prepro-Orexin mRNAs. Serum Helicobacter pylori (H. pylori) infection was measured. ResultsOrexin A expression in GC patients was significantly up-regulated compared to N group and CAG group (p<0.05). Orexin A expression was increased in CAG group compared to N group (p<0.05). Gastric cancer tissues exhibited significantly obvious inflammation compared to N group and CAG group (p<0.05). OX1R and OX2R expressions were significantly down-regulated in GC group compared to N group and CAG group (p<0.05). OX1R and OX2R were lower significantly in GC group compared to CAG group (p<0.05). Prepro-Orexin was significantly depleted in tumor tissues of GC group compared to N group and CAG group (p<0.05). Orexin A expression was un-associated with gender, age and differential grades (p>0.05). CAG and GC patients demonstrated higher H. pylori infection rates. ConclusionOrexin A was associated with inflammation by interacting with OX1R/OX2R receptor and activating prepro-Orexin in tumor tissues of gastric cancer patients.

Chronic atrophic gastritis: Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI

Chronic atrophic gastritis (CAG) is an underdiagnosed condition characterised by translational features going beyond the strict field of gastroenterology as it may manifest itself by a variable spectrum of gastric and extra-gastric symptoms and signs. It is relatively common among older adults in different parts of the world, but large variations exist. Helicobacter pylori-related CAG [multifocal] and autoimmune CAG (corpus-restricted) are apparently two different diseases, but they display overlapping features. Patients with cobalamin and/or iron deficiency anaemia or autoimmune disorders, including autoimmune thyroiditis and type 1 diabetes mellitus, should be offered screening for CAG. Pepsinogens, gastrin-17, and anti-H. pylori antibodies serum assays seem to be reliable non-invasive screening tools for the presence of CAG, helpful to identify individuals to refer to gastroscopy with five standard gastric biopsies in order to obtain histological confirmation of diagnosis. Patients with CAG are at increased risk of developing gastric cancer, and they should be estimated with histological staging systems (OLGA or OLGIM). H. pylori eradication may be beneficial by modifying the natural history of atrophy, but not that of intestinal metaplasia. Patients with advanced stages of CAG (Stage III/IV OLGA or OLGIM) should undergo endoscopic surveillance every three years, those with autoimmune CAG every three-five years. In patients with CAG, a screening for autoimmune thyroid disease and micronutrient deficiencies, including iron and vitamin B12, should be performed. The optimal treatment for dyspeptic symptoms in patients with CAG remains to be defined. Proton pump inhibitors are not indicated in hypochlorhydric CAG patients.

Koumiss consumption induced changes in the fecal metabolomes of chronic atrophic gastritis patients

Abstract Our previous research showed that koumiss intervention could alleviate symptoms of chronic atrophic gastritis (CAG) via the modulation of gut microbiota. The present work aimed to further decipher the mechanism of the observed functional effect by analyzing changes in the fecal metabolomes of these patients. Significant modulation was observed in the levels of metabolites relating to several pathways, namely biosynthesis of primary and secondary bile acid, as well as metabolism of unsaturated fatty acid, linoleic acid and arachidonic acid, phenylalanine, and retinol. Koumiss treatment also decreased the level of some fecal proinflammatory markers, as evidenced by significant decrease in the fecal interleukin 38 (P

Clinical efficacy of Huxiang-Yangwei powder combined with conventional western medicine on gastric motility and gastrointestinal hormones in patients with chronic atrophic gastritis

Objective To observe clinical effect of Huxiang-Yangwei powder combined with conventional western medicine on gastric motility and gastrointestinal hormones in patients with chronic atrophic gastritis. Methods A total of 100 patients with chronic atrophic gastritis according to the inclusion criteria were randomly divided into the observation group and the control group, with 50 cases in each group. The control group was given routine symptomatic treatment. Based on the treatment of control group, the observation group was given Huxiang-Yangwei powder therapy. After 1 month, the gastroscope score, pathological tissue score, gastric motility index (gastric motility rhythm, gastroelectric rhythm and gastric antrum motility), and the improvement of plasma gastrointestinal hormone (MTL, GAS, SS) were compared. Results The total effective rate of the observation group was 92.0% (42/50), and the total effective rate of the control group was 78.0% (39/50), with statistically significant (Z=-2.978, P=0.003). After treatment, the under gastroscope score (0.59 ± 0.06 vs. 1.23 ± 0.17, t=4.877) and the pathological organization score (0.65 ± 0.08 vs. 1.33 ± 0.19, t=5.096) of the observation group were significantly lower than those of the control group (P<0.05). After treatment, the gastric motility rhythm (76.15% ± 8.77% vs. 62.35% ± 7.31%, t=5.301), gastroelectric rhythm (81.02% ± 9.23% vs. 73.02% ± 8.43%, t=5.286), gastric antral motility (0.012 ± 0.002 Ω vs. 0.008 ± 0.001 Ω, t=4.160) of the observation group were significantly higher than those of the control group (P<0.05). After treatment, the plasma MTL (246.73 ± 31.82 pg/ml vs. 203.86 ± 27.91 pg/ml, t=5.832), GAS (49.55 ± 6.25 pg/ml vs. 35.81 ± 4.63 pg/ml, t=5.126), SS (17.35 ± 2.76 pg/ml vs. 15.01 ± 2.60 pg/ml, t=4.970) of the observation group were significantly higher than those of the control group (P<0.05). Conclusions The application of Huxiang-Yangwei powder in the treatment of chronic atrophic gastritis patients can repair gastric mucosa, regulate gastrointestinal hormone levels and increase gastric motility. Key words: Gastritis, atrophic; Huxiang-Yangwei powder; Gastric emptying; Prokinetic drugs (TCD); Motilin; Plastering therapy

Clinical study on treatment of chronic atrophic gastritis with Weisu granule combined with quadruple therapy

Objective To evaluate the effect of Weisu granule combined with conventional therapy in treatment of chronic atrophic gastritis (CAG). Methods A total of 99 CAG patients who met the inclusion criteria were randomly divided into control group (49 cases) and observation group (50 cases) according to random number table method. The control group was treated with quadruple therapy, while the observation group was treated with Weisu granule on the basis of the control group. Both groups were treated for 90 days. Interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) were detected by ELISA. The scores of TCM symptoms between the two groups before and after treatment were compared. Adverse reactions during treatment were observed and recorded. The eradication rate of H.pylori was measured by 14C urea breath test, and the clinical efficacy was evaluated. Results The total effective rate was 92.0% (46/50) in the observation group and 73.5% (36/49) in the control group. There were significant differences between the two groups (χ2=5.975, P=0.015). After treatment, the level of serum IL-6, hs-CRP and TNF-α in the observation group was significantly lower than those in the control group (t=7.112, 7.753, 9.310, respectively, all P<0.01). After treatment, the scores of symptoms such as abdominal distension and pain, emotional disturbance, hypochondrium pain and belching in both groups decreased (P<0.01), and those in the observation group was significantly lower than those in the control group (t=12.892, 12.451, 10.596, respectively, P<0.01). The eradication rate of H.pylori was 90.0% (45/50) in the observation group and 24.5% (12/49) in the control group. There was a significant difference between the two groups (χ2=43.381, P<0.01). Conclusions The Weisu granule combined with quadruple therapy has a definite theraputic effect. It can improve the clinical symptoms of patients, improve the clearance rate of H.pylori, and alleviate inflammation. Key words: Gastritis, atrophic; Weisu cranule; Quadruple therapy; Therapies, investigational

Clinical study on Anzhong-Fuyuan decoction combined with western routine therapy for helicobacter pylori positive chronic atrophic gastritis

Objective To evaluate the efficacy of Anzhong-Fuyuan decoction combined with western routine therapy in the treatment of helicobacter pylori(H.pylori)-positive chronic atrophic gastritis (CAG). Methods A total of 110 H.pylori positive CAG patients who met the inclusion criteria were divided into two groups according to random number table method, 55 in each group. The control group was treated with quadruple therapy. On the basis of the control group, the study group was treated with Anzhong-Fuyuan decoction. Both groups were treated continuously for 40 days. The serum level of pepsinogen I (Pepsinogen Ⅰ, PG Ⅰ), pepsinogen Ⅱ (PG Ⅱ), gastrin (GAS), endothelin (ET), CRP, IL-6 and TNF-α were detected by ELISA. The eradication rate of H.pylori was measured by 14C urea breath test, and the clinical efficacy was evaluated. Results The total effective rate was 92.7% (51/55) in the study group and 78.2% (43/55) in the control group. There were significant differences between the two groups (χ2=4.681, P=0.031). The eradication rate of H.pylori was 89.1% (49/55) in the study group and 76.4% (42/55) in the control group. There was significant difference between the two groups (χ2=3.911, P=0.048). After treatment, the level of serum PGⅠ(84.87 ± 13.95 g/L vs. 78.05 ± 12.69 g/L, t=3.434) and PGⅠ/PGⅡ (6.71 ± 1.26 vs. 5.86 ± 1.13, t=2.861) in the study group was significantly higher than those in the control group (P<0.05), and PGⅡ (12.64 ± 1.94 g/L vs. 13.31 ± 2.10 g/L, t=3.725) was significantly lower than those in the control group (P<0.01). The serum level of gastrin (10.76 ± 3.06 mmol/L vs. 8.11 ± 2.84 mmol/L, t=4.707) was higher than that of control group (P<0.01), endothelin (56.64 ± 4.42 ng/L vs. 60.42 ± 5.13 ng/L, t=4.140) was significantly lower than that of control group (P<0.01). After treatment, the level of CRP, IL-6 and TNF-α in the study group was significantly lower than those in the control group (t=11.100, 9.571 and 8.687, respectively, all Ps< 0.001). Conclusions The Anzhong-Fuyuan decoction combined with routine therapy can significantly enhance the gastric mucosal secretion ability of H.pylori positive CAG patients, increase the ratio of PGⅠ/PGⅡ, promote the repair and regeneration of gastric mucosa, reduce the level of inflammatory cytokines. Key words: Helicobacter pylori; Gastritis, atrophic; Anzhong-Fuyuan decoction; Quadruple therapy; Clinical application

Risk assessment models of integrative medicine indicators for malignant transformation of chronic atrophic gastritis: A registry study protocol

Abstract Objective Traditional Chinese medicine (TCM) and modern medicine have both been used in arresting malignant transformation of chronic atrophic gastritis (CAG) in China with good therapeutic effect. However, no studies have been undertaken to assess the risk of malignant transformation in CAG patients using both modern medicine and TCM features. Our study aimed to develop risk assessment models for malignant transformation of CAG combining indicators of both TCM and modern medicine. These models will facilitate early warning and control of malignant transformation of CAG from the perspective of evidence-based integrative medicine. Methods In the proposed registry study, a total of 1000 eligible CAG patients will be recruited from four hospitals in China. A 10-year follow-up study will be conducted both on-site and off-site to track the events of malignant transformation. Frequency analysis and chi-squared tests will be used to perform the comparative analysis on the prevalence of malignant transformation events and indicators in TCM or modern medicine in different groups. A multivariate Cox proportional hazard model will be used to perform correlation analyses of malignant transformation events and factors of TCM or modern medicine. Conclusion The proposed study has been designed with a large sample size and long follow-up period, in which wide-ranging modern medicine and TCM indicators can be gathered over the whole process of malignant transformation of CAG. Based on this study, risk assessment models for malignant transformation of CAG may be constructed from the perspective of integrative medicine. This may provide clinicians and patients with an optimized early warning system as well as prevention strategies for malignant transformation of CAG.

Network pharmacology based investigation into the effect and mechanism of Modified Sijunzi Decoction against the subtypes of chronic atrophic gastritis

Chronic atrophic gastritis (CAG) is a common digestive disease without specific treatment. According to syndrome differentiation, traditional Chinese medicine (TCM) classified it into different syndromes and has achieved significant therapeutic effects. In this study, immune repertoire sequencing techniques combined with symptom scores, electronic gastroscopy as well as pathologic changes were used to evaluate the effect and the underlying mechanism of Modified Sijunzi Decoction (MSD) in treating CAG. The results showed that MSD could relieve CAG symptoms, improve pathologic changes in CAG with fatigue and tiredness symptom, but with no help in CAG with reversal heat symptom. Moreover, MSD could regulate immune disorders in CAG with fatigue and tiredness symptom, and 7 TCR biomarkers were explored in CAG patients with immune disorders. All these results indicated that MSD is effective in treating CAG patients with fatigue and tiredness symptom by tonifying the spleen qi, suggesting that CAG treatment based on syndrome differentiation is reasonable.

Effect of a combination of Xiaochaihu decoction and teprenone on peripheral blood T lymphocytes in chronic atrophic gastritis, and on expression of COX-2 in gastric mucosa

Purpose: To study the effects of the combined use of Xiaochaihu decoction and teprenone on peripheral blood T lymphocytes in chronic atrophic gastritis (CAG) and gastric mucosal expression of cyclooxygenase-2 (COX-2).Methods: Patients with CAG who were treated at Traditional Chinese Medicine Hospital of Jiaxing from January 2017 to January 2018 were used as subjects. They consisted of observation and control groups (99 patients per group). Both groups were treated with teprenone (50 mg, thrice daily), but patients in the observation group received 200 mL of Xiaochaihu decoction, in addition to teprenone. The treatments were given orally, and lasted for 3 weeks. Comparisons were made between the two groups with respect to the effects of the treatments on peripheral blood T lymphocytes, CAG, and quality of life.Results: Peripheral T lymphocytes, chronic atrophic gastritis and quality of life in patients in the observation group were significantly improved, relative to control group patients. The combined treatment led to a significant decrease in the expression of COX-2. After treatment, there was upregulation in CD3+, CD4+ and CD4+/CD8+ levels in both groups, relative to the corresponding levels prior to drug exposure (p < 0.05). However, the observation group levels of CD3+, CD4+ and CD4+/CD8+ were higher than corresponding control values (t = -14.45, p < 0.001; t = -12.47, p < 0.001; t = -3.49, p < 0.001, respectively). Moreover, results from histopathological studies showed marked improvement in the observation group.Conclusion: A combination treatment of Xiaochaihu decoction and teprenone improves the condition of CAG patients via changes in peripheral blood lymphocytes and COX-2 expression in gastric mucosa.Keywords: Xiaochaihu decoction, Teprenone, Chronic atrophic gastritis, T lymphocytes, Cyclooxygenase-2

Clinical study on self-made Jianpi-Yiqi decoction in the treatment of chronic atrophic gastritis

Objective To evaluate the efficacy of self-made Jianpi-Yiqi decoction in the treatment of chronic atrophic gastritis (CAG). Methods A total of 100 patients with CAG who met the inclusion criteria were randomly divided into two groups, 50 in each group. The control group received oral omeprazole enteric-coated capsules and the observation group oral Jianpi-Yiqi decoction. Both groups were treated for 8 weeks. The clinical efficacy, proliferating cell nuclear antigen (PCNA), B cell lymphoma-2 (Bcl-2), TNF-α and PCNA, Bcl-2 mRNA expression were evaluated and compared. Results The total effective rate was 92.0% (46/50) in the observation group and 80.0% (40/50) in the control group. The difference between the two groups was statistically significant (χ2=9.623, P=0.031). The total effective rate of endoscopy was 94.0% (47/50) in the observation group and 74.0% (37/50) in the control group. The difference between the two groups was statistically significant (χ2=11.254, P=0.026). After treatment, the PCNA (4.36 ± 1.95 μg/mg vs. 8.62 ± 2.43 μg/mg, t=8.465), Bcl-2 (3.06 ± 1.63 μg/mg vs. 7.54 ± 1.73 μg/mg, t=9.316), TNF-α (4.13 ± 1.86 μg/mg vs. 7.29 ± 2.14 μg/mg, t=9.473) in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the PCNA (0.053 ± 0.033 vs. 0.074 ± 0.023, t=2.316), Bcl-2 (0.004 ± 0.003 vs. 0.006 ± 0.002, t=5.842) mRNA expression in the observation group were significantly lower than those in the control group (P<0.05). Conclusions The self-made Jianpi-Yiqi decoction can down-regulate the expression of PCNA, Bcl-2 and TNF-α protein and PCNA and Bcl-2 mRNA in gastric mucosa, improve the symptoms of CAG patients and improve clinical efficacy. Key words: Gastritis, atrophic; Jianpi-Yiqi decoction; Proliferating cell nuclear antigen; Bcl-2; Tumor necrosis factor-alpha; Gastroscopy; Gene expression

Identification of non-invasive biomarkers for chronic atrophic gastritis from serum exosomal microRNAs

BackgroundSerum exosomal microRNAs (miRNAs) have been suggested as novel biomarkers for various diseases, especially gastric cancer (GC). But circulating biomarkers for Chronic atrophic gastritis (CAG) which is defined as precancrerous lesions of GC remain largely elusive. To investigate serum exosomal miRNAs that are differently expressed in CAG patients and Chronic nonatrophic gastritis (CNAG) may be helpful for its diagnosis and therapy.MethodsPatients were recruited according to the diagnosis and exclusioncriteria. RNA was extracted from serum exosomes of 30 CAG and 30 CNAG patients. The miRNA expression profiles were analyzed by next generation sequencing and were validated by qRT-PCR. Receiver operating characteristic (ROC) analysis has been used to evaluate the diagnostic value.Results30 CAG patients and 30 CNAG patients were recruited in our study. sRNA-seq results showed that hsa-miR-3591-3p, − 122-3p, and − 122-5p of the top 10 miRNAs (hsa-miR-148a-3p, − 122-3p, − 486-3p, −451a, − 122-5p, − 3591-3p, − 486-5p, −151a-3p, −92a-3p, −320a) were significantly upregulated in exosomes from CAG patients versus those from CNAG patients, but hsa-miR-451a, −151a-3p, and -92a-3p were significantly downregulated. Furthermore, qRT-PCR analysis confirmed that hsa-miR-122-5p and hsa-miR-122-3p were significantly upregulated in CAG samples, but hsa-miR-122-3p hadnot a steable expression. ROC curves showed that the AUC for hsa-miR-122-5p was 0.67 (95% CI 0.52–0.82, SE 62%, SP 86%). A sum of the four miRNAs (panel 1, hsa-miR-122-5p, −451a, −151a-3p, and -92a-3p) did not significantly improve the diagnostic potential (AUC 0.63, 95% CI 0.47 to 0.78). Correlation analysis showed that the expression of hsa-miR-122-5p differed significantly between patients based on atrophic (Moderate atrophic vs. Absent, P value was 0.036.) and IM (compare moderate-severe, absent and mild P values were 0.001 and 0.014, respectively). However, there were no differences between groups based on age, gender, dysplasia, or chronic or active inflammation.ConclusionThese results suggested that hsa-miR-122-5p in serum exosomes might serve as a potential biomarker for CAG diagnosis.Trial registrationChinese Clinical Trial Registy (ChiCTR-IOR-16008027, Date of Registration:2016-03-01).

Psychological distress in patients with chronic atrophic gastritis: the risk factors, protection factors, and cumulative effect

This study aimed to examine the psychological status among Chronic Atrophic Gastritis (CAG) patients and to find the cumulative effects of risk and protective factors. A sample of 101 CAG patients completed the investigation. Hierarchical linear regression was used to find risk and protective factors, and examine the cumulative effects in risk factor index (RFI) and protective factor index (PFI). Results showed that nine symptoms from SCL-90-R were severer among CAG patients than those in adult norm. Risk factors including positive family history of cancer and higher negative life events could predict higher GSI (β = 0.206, p = 0.023; β = 0.398, p < 0.001; R² = 0.203); more household resistant, positive coping and stronger resilience were protective factors and could predict GSI negatively (β = -0.188, p = 0.020; β = -0.350, p = 0.012; β = −0.066, p = 0.621; R² = 0.190). The GSI was positively correlated with RFI (β = 0.338, p < 0.001; R² = 0.113) and negatively related to PFI (β = −0.378, p < 0.001; R² = 0.133). In conclusion, CAG patients suffered from various psychological distress, and the protective factors should be enhanced cumulatively to protect against psychological distress.

Serological Evaluation of Gastric Cancer Risk Based on Pepsinogen and Helicobacter pylori Antibody: Relationship to Endoscopic Findings

Backgrounds and Aims: The serological risk-prediction system combined the pepsinogen (PG) test, and anti-Helicobacter pylori antibody is available for evaluation of gastric cancer risk. In this system, chronic atrophic gastritis (CAG) or H. pylori infection is diagnosed. Subjects with H. pylori negative and PG test negative (group A) are supposed to be those who have never been infected with H. pylori and are at extremely low risk for gastric cancer. However, a certain proportion of patients with CAG has been identified as the extremely low-risk group (group A). Here we examined endoscopic atrophy and investigated its relationship with the ABC classification system. Methods: We examined 540 patients. All patients underwent an endoscopic examination for evaluating corpus atrophy. Fasting sera were collected and serum PGs and anti-H. pylori antibody (Hp-Ab) titer (E-plate Eiken) were evaluated. Results: Of the 540 patients, 306 were classified into group A. However, 136 of them showed signs of endoscopic atrophy (group A with CAG). Group A with CAG frequently comprised the elderly. A new titer cut-off (<3 U/mL) of the Hp-Ab improved the discrimination of group A with CAG by 8%. Conclusion: The prevalence of group A with CAG patients is a critical problem, especially in elderly subjects.