Gastric Erosions Research Articles

Carbon Nanoparticles in Mongolian Medicine Alleviate Acute Gastric Ulcer Induced by Ethanol by Regulating Fas/FasL Pathway.

The consumption of large amounts of ethanol can directly lead to acute gastric mucosal bleeding, edema, and erosion, while long-term drinking has been associated with gastric ulcers. Previous research has demonstrated that Har Gabur, a traditional Mongolian medicine, alleviates gastric ulcers through the physical adsorption of its carbon components. It is well known that the immune response has an important role in gastric ulceration. In the present study, we used an ethanol-induced injury cell and mice model to investigate whether Har Gabur can inhibit the immune response stimulated by ethanol and identify the active constituents of Har Gabur involved in this process. We found that Har Gabur significantly repressed the activated Fas/FasL signal pathway and endogenous Bax/Bcl-2 apoptosis pathway. The molecular mechanism of the protective effect most likely involved the transcription or mRNA stability, as Har Gabur remarkably reversed the change in mRNA level of apoptosis-related genes induced by ethanol. Har Gabur operated in a cell-state-specific manner in vivo without inducing adverse effects in normal mice. Importantly, GO was identified as the main active ingredient of Har Gabur for gastric ulcers.

Artificial intelligence for diagnosing gastric lesions under white-light endoscopy.

The ability of endoscopists to identify gastric lesions is uneven. Even experienced endoscopists may miss or misdiagnose lesions due to heavy workload or fatigue or subtle changes in lesions under white-light endoscopy (WLE). This study aimed to develop an artificial intelligence (AI) system that could diagnose six common gastric lesions under WLE and to explore its role in assisting endoscopists in diagnosis. Images of early gastric cancer, advanced gastric cancer, submucosal tumor, polyp, peptic ulcer, erosion, and lesion-free gastric mucosa were retrospectively collected to train and test the system. The performance of the system was compared with that of 12 endoscopists. The performance of endoscopists with or without referring to the system was also evaluated. A total of 29,809 images from 8947 patients and 1579 images from 496 patients were used to train and test the system, respectively. For per-lesion analysis, the overall accuracy of the system was 85.7%, which was comparable to that of senior endoscopists (85.1%, P = 0.729) and significantly higher than that of junior endoscopists (78.8%, P < 0.001). With system assistance, the overall accuracies of senior and junior endoscopists increased to 89.3% (4.2%, P < 0.001) and 86.2% (7.4%, P < 0.001), respectively. Senior and junior endoscopists achieved varying degrees of improvement in the diagnostic performance of other types of lesions except for polyp. The diagnostic times of senior (3.8 vs 3.2s per image, P = 0.500) and junior endoscopists (6.2 vs 4.6s per image, P = 0.144) assisted by the system were both slightly shortened, despite no significant differences. The proposed AI system could be applied as an auxiliary tool to reduce the workload of endoscopists and improve the diagnostic accuracy of gastric lesions.

O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?

Abstract Introduction Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature. Methods 9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT. Results N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis. Conclusion LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile. Take-home message Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.

Hybrid Laparoscopic and Endoscopic Management of Gastric Band Erosion Resulting in Bowel Obstruction

While laparoscopic gastric banding is not as prevalent, the management of patients with a history of gastric banding remains a concern. Gastric bands have been noted to erode and can migrate through the bowel leading to a variety of issues. We were able to successfully manage this almost completely endoscopically without the need for a bowel enterotomy for retrieval. This allowed for enhanced patient recovery and avoided the morbidity associated with bowel enterotomy which is commonly done in these settings.

Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings.

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10-88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.

Zinc Acetate Dihydrate Tablet-associated Gastric Lesions

Objective This study aimed to determine the prevalence and endoscopic features of zinc acetate dihydrate tablet-associated gastric lesions. Methods We retrospectively examined the endoscopic features of 47 patients taking zinc acetate dihydrate tablets who underwent esophagogastroduodenoscopy. Results Gastric mucosal alterations, including redness, erosions, ulcers, and adhesion of the white coat, were observed in 29 of 47 patients (61.7%). Among patients with gastric lesions (group A), there was a significantly higher percentage of symptomatic patients in comparison to patients without lesions (group B) (65.5% vs. 22.2%; p<0.01). The background characteristics of the two groups did not differ to a statistically significant extent. On esophagogastroduodenoscopy, mucosal redness (n=27, 93.1%), erosions (n=26, 90.0%), adhesion of the white coat (n=25, 86.2%), and ulcers (n=9, 31.0%) were observed. None of the 19 patients who previously underwent esophagogastroduodenoscopy had gastric lesions before starting zinc acetate dihydrate. Esophagogastroduodenoscopy was performed after the cessation of zinc acetate dihydrate intake in six patients, and revealed the resolution of gastric lesions. Conclusion Gastric lesions were observed in 29 of 47 patients who were taking zinc acetate dihydrate tablets. The most common endoscopic findings were mucosal redness (93.1%), erosions (90.0%), adhesion of the white coat (86.2%), and ulcers (31.0%). Although the exact pathogenesis is uncertain, we believe that understanding the unique manifestations of this gastric lesion will help physicians manage adverse events in patients taking zinc acetate dihydrate tablets.

A death due to complications following late-onset congenital diaphragmatic hernia in a young child

Congenital diaphragmatic hernia (CDH) is a rare anatomical birth defect, causing the diaphragm fails to fuse completely, leaving a defect and causing herniation of the abdominal viscera towards the thoracic cavity. Though most cases of CDH are symptomatic and diagnosed in the early stages of life some asymptomatic cases may go undetected and later detect as incidental or may present with respiratory or gastrointestinal symptoms. We report a case of late-onset CDH which leads to a rapidly fatal medical emergency causing challenges in clinical diagnosis. An eight-year-old previously healthy schoolgirl was admitted to a primary care hospital following recurrent upper abdominal pain, nausea, and vomiting for a duration of 3 consecutive days. According to the parents she has taken treatment from a general practitioner. She was afebrile, hypotensive, tachycardic, and drowsy and was found unresponsive during transfer to a tertiary care hospital and was pronounced dead. On opening the thoracic cavity, it was noted that some of the abdominal contents like the entire stomach, duodenum, and proximal part of the small intestine, splenic flexure of the transverse colon were present within the left hemi thorax causing left lung hypoplasia, thoracic midline shift, intestinal compression, and elevated luminal pressure causing gastric erosions and chemical peritonitis. This case highlights the importance of higher clinical vigilance and the value of early diagnosis and timely medical attention to relatively uncommon but surgically correctable conditions like CDH.

Common Endoscopic Findings in Anemic Patients Presenting with Upper Gastrointestinal Bleeding

Introduction: Upper gastrointestinal (GI) endoscopies frequently have a theoretical indication in elderly patients. Indeed, iron deficiency anemia (IDA) is an indication for GI endoscopies in 5% to 10% of internal medicine inpatients older than 85 years. The prevalence of anemia reaches 25% among geriatric populations, and 20% to 30% of anemia cases are found to be owing to iron deficiency in patients older than 65 years. Weight loss and isolated GI symptoms are additional indications for GI endoscopy. The present study was conducted to determine the endoscopic findings in anemic patients with upper GI hemorrhage presenting to district general Hospital Materials &amp; Methods: Our study was conducted in Gastroenterology department, district general Hospital as a descriptive cross sectional study since 10th January 2021 to 31st March 2022. Results: Out of total 300 patients with upper GI hemorrhage and resulting anemia included in this study, there were 184 male and 116 female patients with a male to female ratio of 1.7:1, and mean age of 48.09±15.71 years. The most common cause of upper GI hemorrhage was found to be esophageal varices (55.5%) followed by peptic ulcer (36.6%), gastric erosions (5.8%), Mallory-Weiss tear (1.3%) and esophagitis (0.5%). Conclusion: Variceal bleeding is the most common endoscopic finding in the patients with UGIB. Other lesser common causes include erosions of the gastric and esophageal mucosa. Keywords: Gastrointestinal Hemorrhage; Endoscopy, Gastrointestinal; Esophageal &amp; Gastric Varices; Peptic Ulcer; Esophagitis, Peptic.

Effects of Hyperbaric Oxygen Therapy on the Expression of FGF, MMP-9 and Occludin in the Repair of Gastric Mucosal Erosions

Effects of Hyperbaric Oxygen Therapy on the Expression of FGF, MMP-9 and Occludin in the Repair of Gastric Mucosal Erosions

Comparison of the mid-term outcomes of banded and non-banded sleeve gastrectomy: safety, food tolerance, and weight regain

BackgroundLong-term weight regain (WR) after sleeve gastrectomy (SG) is a major challenge. Laparoscopic banded SG (BSG) was introduced to overcome pouch dilation and, consequently, WR; however, its mid-and long-term outcomes have not been sufficiently demonstrated.ObjectiveThis study retrospectively evaluated the mid-term weight loss efficacy and morbidity over at least a 4-year follow-up after laparoscopic banded SG using a MiniMizer Gastric Ring® and laparoscopic non-banded SG.MethodThe data of 1586 bariatric surgeries were retrospectively evaluated. To ensure homogeneity in our study cohort, propensity score matching (PSM) was performed.ResultsThe final cohort comprised 1392 patients: the non-banded SG (n = 1260) and BSG (n = 132) groups. In our matched cohort (SG, n = 655 and BSG, n = 132), WR was noted in 4 (3.0%) and 71 (10.8%) patients in the BSG and SG groups, respectively. Gastric band erosion or slippage was not noted in the BSG cohort. The levels of cholesterol and triglyceride were similar in the two groups. Postoperative glycemic control was significantly reduced in the BSG group.ConclusionAlthough the percentage of weight loss achieved in the BSG group was low in the first year postoperatively, the mid-term (sustained) weight loss associated with BSG was superior to that associated with non-banded SG. BSG is a safe procedure with no significant mid-term band-related morbidity; its impact on the resolution of comorbidities is equivalent and perhaps superior to SG.

Repeated Treadmill Running Attenuates Indomethacin‐caused Gastric Injury in Rats with Streptozotocin‐induced Diabetes

Diabetes is one of the most common chronic diseases leading to disability and death. Physical activity has a beneficial effect on all vital functions of the body under the norm as well as pathology including diabetes. Previously we have shown that treadmill running attenuates the vulnerability of gastric mucosa to ulcerogenic action of indomethacin (IM). The aim of the study was to investigate the effect of treadmill running on the vulnerability of the gastric mucosa to ulcerogenic action of IM in rats with streptozotocin‐induced diabetes. Diabetes was induced by a single injection of streptozotocin (STZ, 70 mg/kg, ip). Two regimens of treadmill running, repeated (Experiment 1) and single (Experiment 2), were used. There were four groups of rats in each experiment: two groups (running and sedentary) treated with STZ and two groups (running and sedentary) treated with vehicle of STZ (control). In Experiment 1 daily repeated treadmill running was initiated 7 days before STZ (or its vehicle) administration and continued daily 7 days after STZ administration. The intensity and duration of treadmill running gradually increased from 10 to 15 cm/s and from 10 to 20 min/day, respectively. In Experiment 2 only single treadmill session (15 cm/s, 15 min) was initiated 7 days after STZ (or its vehicle) administration. In both experiments, IM (35 mg/kg, sc) was administered immediately after completion of treadmill session in preliminary (24 h) fasted rats 7 days after STZ injection. Gastric erosion was examined 4 h after IM administration. Glucose level, body weight, water consumption and plasma corticosterone levels were also measured. Signs of diabetes (an increase of glucose level, loss of body weight, an increase of water consumption and elevation of plasma corticosterone levels) were developed 1 week after STZ administration. IM administration caused the gastric erosion 4 h after the injection. STZ‐induced diabetes aggravated ulcerogenic action of IM: the mean area of gastric erosion was significantly greater in rats with STZ injection compared to that in control animals. Repeated as well as single treadmill running did not significantly affect the signs of diabetes. However, repeated daily treadmill running resulted in a significant decrease of the area of gastric erosion in rats with STZ‐induced diabetes as well as control (non‐diabetic) rats compared to corresponding sedentary groups. A single running, before IM administration, reduced the area of gastric erosion in non‐diabetic rats, but it did not affect the gastric injury in rats with STZ‐induced diabetes. The data suggest that regular physical activity started before STZ‐induced diabetes can protect the gastric mucosa against the ulcerogenic action of IM.

Influences of Housing Environment on Functional State of the Body after Action of Ulcerogenic Stressor

Here we studied influences of housing environment on functional state of the body after action of ulcerogenic stressor. The effects of ulcerogenic stressor on the gastric mucosa, the hypothalamic‐pituitary‐adrenocortical (HPA) axis reactivity and glucocorticoid receptors in hippocampus, behavior and somatic pain sensitivity were compared in rats kept in enriched environment, social isolation, and standard laboratory conditions (control group). The rats aged 30 days were divided into groups and placed in standard cages 6 rats per cage (control) or 1 rats per cage (isolation) or in enriched cages 6 rats per cage (enriched environment). One month later, all rats (after 24 h fasting) were stressed by cold restraint (10˚C) for 3 h. In 3 h one half of rats in each group were decapitated to examine the gastric mucosa. Another half of rats were subjected to behavior tests (open field and elevated plus maze) and somatic pain sensitivity test (hot plate) as well as the HPA axis reactivity testing by plasma corticosterone levels induced by mild procedural stressor. Glucocorticoid receptor expression was estimated in hippocampus by immunohistochemistry. Body weight gradually increased in all groups during 1 month before exposure of stressor, however, in the isolated rats, the weight gain was greater than that in enriched and control groups. In all groups cold restraint caused the gastric erosion, the mean areas of which were not significantly differed. In behavior tests, the animals of isolated group were approximately equally divided into vulnerable (showing depressive‐like reactions in the open field) and resistant (not differed from the non‐stressed control) to ulcerogenic stress (active subgroup). All isolated rats showed a reduced level of exploratory activity in the elevated plus maze. Rats from enriched environment showed greater motor and exploratory activity, as well as lower anxiety level compared to those in isolated group. Isolated rats were most sensitive to action of pain, whereas rats kept in enriched environment were less sensitive to pain exposure. In the isolated group, the weakest corticosterone release among all groups was observed in response to mild procedural stress. Low HPA stress‐reactivity of isolated rats was combined with enhanced expression of glucocorticoid receptors in the hippocampus indicating a sensitization of the mechanisms of negative glucocorticoid feedback following prolonged social isolation. Thus, social isolation is a stressor leading to weight gain, a decrease in stress reactivity accompanied by an increase of glucocorticoid receptor expression in the hippocampus, a decrease of exploratory activity and increased of somatic pain sensitivity whereas enriched environment exerts beneficial action on functional state of the body: increases motor and exploratory activity, decreases anxiety and somatic pain sensitivity.

Pharmacological Preconditioning by Corticotropin Releasing Factor (CRF) or ACTH Protects the Gastric Mucosa against Ulcerogenic Action of Indomethacin through Involvement of Glucocorticoids

Non‐steroidal anti‐inflammatory drugs (NSAIDs) are widely used as analgesic and anti‐inflammatory drugs. However, adverse effects, including gastrointestinal, renal, cardiovascular side effects, seriously complicate NSAIDs use. Their gastrointestinal side effects are the most known serious complications in patients taking these drugs. Previously we have shown that preconditioning stress attenuates the ulcerogenic action of indomethacin (IM) on the gastric mucosa. According our findings glucocorticoids, released in response to stressor, are gastroprotective hormones and involved in stress preconditioning protective effects. Corticotropin releasing factor (CRF), a major mediator of stress response, stimulates ACTH release through CRF receptors of subtype 1 and ACTH, in turn, stimulates glucocorticoid production. Here we verify the hypothesis that pharmacological preconditioning by CRF or ACTH can protect the gastric mucosa against ulcerogenic action of IM in rats through mechanism associated with glucocorticoids. For this, preliminary fasted (24 h) rats were administered by CRF (2.5 or 5 µg/ kg, ip) or ACTH (1U/kg, ip) 30 min before IM injection (35 mg/kg, sc). Gastric lesions were examined 4 h after IM administration. Plasma corticosterone levels were measured before and 4 h after IM injection. Since the gastrointestinal injury is accompanied by changes in somatic pain sensitivity, we also measured tail flick latencies (tail flick test) before and 4 h after IM. Both CRF and ACTH by itself caused an elevation of plasma corticosterone levels, which was accompanied by an increase of tail flick latencies (analgesic effect). IM administration resulted in the gastric erosion 4 h later. Pretreatment with CRF or ACTH reduced an area of gastric lesions caused by IM (gastroprotective effect). IM‐induced gastric injury was accompanied by an increase of tail flick latencies, which was prevented by CRF (normalization of somatic pain sensitivity). To estimate the role of glucocorticoids in CRF‐induced gastroprotection an inhibitor of corticosterone synthesis metyrapone (30 mg/kg) or CRF receptor type 1 antagonist NBI 27914 (10 mg/kg) or glucocorticoid receptor antagonist RU‐38486 (20 mg/kg) was administered before CRF. Both metyrapone and NBI 27914 injected before CRF administration caused an inhibition of CRF‐induced corticosterone response and prevented protective effect of CRF on the gastric mucosa against the IM‐induced injury. The gastroprotective effect of CRF was also eliminated by the pretreatment with RU‐38486. Thus, CRF as well as ACTH can protect the gastric mucosa against ulcerogenic action of IM. Gastroprotective action of CRF accompanied by normalization of somatic pain sensitivity is provided by mechanism associated with glucocorticoids.

Effects of Electrical Spinal Cord Stimulation on the Activity of the Hypothalamic‐Pituitary‐Adrenocortical System and the Sensitivity of the Gastric Mucosa to Ulcerogenic Stimuli

Our previous results of two areas of unrelated researches are the basis of the present study. We demonstrated previously that the hypothalamic‐pituitary‐adrenocortical (HPA) axis is gastroprotective component of the brain‐gut axis and stress‐induced glucocorticoids are gastroprotective hormones but not ulcerogenic ones (Filaretova et al., 2016). At the same time recently electrical spinal cord stimulation began to be used for both experimental studies of motor functions regulation and rehabilitation of motor functions in patients with spinal cord injury (Gerasimenko et al., 2021; Moshonkina et al., 2016). The spinal cord stimulation directed to the activation of spinal locomotor related networks affected visceral systems as well. The aim of the present experimental work was to verify whether electrical spinal cord stimulation may activate the HPA axis and affect a sensitivity of the gastric mucosa to ulcerogenic stimuli in rats. Two ulcerogenic stimuli were used in anesthetized rats: 1) prolonged gastric ischemia/reperfusion (I/R, 30 min occlusion of celiac artery followed by 3 h of reperfusion); 2) indomethacin administration (IM, 35 mg/kg, sc). For spinal stimulation, stainless steel wire electrodes (AS632; Cooner Wire, California, USA) were fixed in fasciae between T11‐12 and L1–L2 vertebrae of anesthetized animals. Electrodes for recording motor responses to stimulation placed to the muscles of the hind limbs. A‐M System, Model 2100 stimulator was used for spinal cord stimulation. At the beginning motor thresholds determined by stimulation with monopolar rectangular pulses (1 ms). Then the spinal cord was stimulated with a frequency 30 Hz and a subthreshold current (350–700 μA) in order to exclude the influence of movements for 20 min. Sham‐stimulated (control) rats were subjected to the same manipulations except for the stimulation itself. The concentration of corticosterone in blood plasma was determined using commercial ELISA kits. The spinal cord stimulation resulted in an increase of blood glucocorticoid level 1 h later suggesting an activation of the HPA axis. The spinal stimulation, applied 1 h before the onset of ulcerogenic stimuli, also significantly attenuated gastric erosion formation induced by I/R and IM as well. The data suggest that the electrical spinal cord stimulation may activate the HPA axis and affect a sensitivity of the gastric mucosa to ulcerogenic stimuli in rats producing gastroprotective effect. We consider the results as a basis for further research to verify a possibility of an involvement of glucocorticoids in the mechanisms that may provide the beneficial effects of spinal neuromodulation.

Importance and Role of Upper Gastrointestinal Endoscopy in Diagnosis of Recurrent Abdominal Pain in Children

Objective: The purpose of this study is to determine the effectiveness of upper gastrointestinal endoscopy in diagnosis of recurrent abdominal pain in children. Study Design:Retrospective study. Place and Duration: Department of Gastroenterology, HITEC-IMS Taxila Cantt. 1st July 2021-31st Dec 2021 Methods:There were 78 children of both genders with ages &gt;14 years were presented in this study. After obtaining the authority's informed written permission, we took detailed demographic information, such as age, gender, weight, and symptoms, for all of the recruited patients. All the patients were underwent for upper gastrointestinal endoscopy to diagnose recurrent abdominal pain. Prevalence of dyspepsia and H.pylori infection was also recorded among children. We used SPSS 23.0 to analyze complete data. Results: Among 78 children, 42 (53.8%) were boys and 36 (46.2%) were girls. Majority of the patients 45 (57.7%) were ages between 4-8 years followed by 9-14 years 25 (32.1%) and 8 (10.3%) were in age group 1-3 years. Most common symptom was anemia, followed by vomiting, haematemesis, melena and weight loss. Frequency of dyspepsia was found in 22 (28.2%) and helicobacter pylori found in 29 (37.2%) children. Most common diagnosis of endoscopy was gastritis found in 33 (42.3%) case, gastric erosions in 14 (17.9%) cases, hiatus hernia in 8 (10.3%) cases and remaining were gastric ulcer, gastric polyp and duodenitis. Hypoxemia, apnea and aspirationwere the most common complications found in our study. Conclusion: In this study, we found that upper gastrointestinal endoscopy remains an essential tool in the evaluation of RAP in children because it allows for accurate diagnosis of GI causes of RAP, despite reported complications such as hypoxemia, apnea, aspiration and choking, cardiac arrhythmias, bacteremia, perforation, and bleeding. Keywords:Upper GI Endoscopy, Findings, Complications, Children

Exploring the potential of Cinnamomum zeylanicum oil against drug resistant Helicobacter pylori-producing cytotoxic genes.

Thirty-one of sixty dyspeptic patients tested positive for Helicobacter pylori colonization in this study, as determined by histopathology and 16S rRNA. The cytotoxin-associated gene A (cagA) and vacuolating cytotoxin A (vacA) genes were found in 67.7 and 93.5% of H. pylori patients, respectively. The cagA gene was found to be associated with 100% of patients with duodenal erosion and ulceration identified via endoscopy examination. In addition, 86.7% of patients with cancerous and precancerous lesions, glandular atrophy, and intestinal metaplasia identified via histopathology examination. The vacA s1m1 mutation was associated with more severe forms of gastric erosion and ulceration, as well as the presence of precancerous and cancerous lesions. Eighteen (64.3%) of the twenty-eight isolates were classified as multi-drug resistant (MDR) or pan-drug resistant (PDR) H. pylori. Due to a resurgence of interest in alternative therapies derived from plants as a result of H. pylori resistance to the majority of commonly used antibiotics, the inhibitory activity of five essential oils extracted from some commonly used medicinal plants was evaluated in vitro against drug-resistant H. pylori clinical isolates. Cinnamomum zeylanicum essential oil demonstrated the highest anti-H. pylori activity when compared to the other essential oils tested. Cinnamaldehyde was the most abundant compound in C. zeylanicum (65.91%). The toxicological evaluation established the safety of C. zeylanicum oil for human use. As a result, C. zeylanicum essential oil may represent a novel antibacterial agent capable of combating drug-resistant H. pylori carrying cytotoxin genes.

P173 Endoscopic findings in the upper gastrointestinal tract in Crohn’s Disease – highly specific and closely related to Helicobacter pylori negative gastritis

Abstract Background Scientific data indicates that in the course of Crohn’s disease (CD), certain endoscopic abnormalities in the upper gastrointestinal tract (UGIT), such as bamboo joint-like appearance (BJA) in the stomach, may be frequently present. However, there are not many clinical analyses available, in which prevalence of various endoscopic UGIT lesions would be comprehensively evaluated. The purpose of the study was to investigate the characteristic of UGIT involvement in CD, with a particular focus on the Helicobacter pylori (Hp) status, BJA lesions and presence of microscopic changes in the stomach. Methods A total of 565 consecutive patients were prospectively recruited into the study (98 with CD and 467 controls). All individuals underwent upper esophagogastroduodenoscopy (EGD) with biopsy using a high definition endoscope with narrow band image. Chi-square and t-student tests were used for statistical analysis. Results The majority of CD patients (n=77; 79%) were found to have different abnormalities in EGD. Most commonly these were found in the stomach (n = 73; 74%), followed by duodenum (n= 39; 40%) and oesophagus (n=6; 6%). Mucosal redness/edema, BJA in the proximal part of the body and/or fundus, as well as antral erosions were the most prevalent gastric lesions. BJA was present in 44 (45%) of CD patients, and in one individual from the control group (0.002%), p&amp;lt;0.00001. BJA presence among CD patients was irrespective of sex, age, location, duration, intensity or course of the disease, as well as medications taken. Ulcerations and erosions were most commonly found lesions in the duodenum. Most of the CD patients were Hp negative (n = 94; 95.9%), while in the control group the majority of individuals were infected with Hp (57,1%), p&amp;lt;0.0001. Comparison between Hp negative patients with CD and controls revealed that gastric BJA lesions, duodenal ulcers and erosions were present exclusively in CD. These lesions were accompanied by chronic microscopic gastritis in all cases. Finally, the prevalence of microscopic HP negative gastritis was significantly higher in patients with CD than in controls (95.7% vs 15%, p&amp;lt;0.0002). Conclusion Our results demonstrated that chronic Hp negative gastritis is present in nearly all CD patients, and is strongly associated with presence of gastric BJA lesions, as well as ulcerations and erosions of the duodenum. Furthermore, the results of our study support previously reported observations that BJA is a specific lesion for CD and may be used as an endoscopic diagnostic marker. This work was financed by the Program of the Minister of Science and Higher Education - “Regional Initiative of Excellence” in 2019–2022, no. 002/RID/2018/19.

Upper Gastrointestinal Bleeding in Critically Ill Patient: Literature Review

Critically ill patients are at risk for stress ulcers in the upper digestive tract. Various risk factors have been associated with this condition. Patients who are critically ill are at risk of bleeding due to stress related mucosal disease (SRMD). Upper gastrointestinal tract problems usually occur as a result of severe physiological stress. Patients may develop gastric erosion and develop stress ulcers with severe gastrointestinal bleeding which can be fatal. Routine pharmacological use of stress ulcer prophylaxis (SUP) does not reduce overall mortality in intensive care patients. This increases the risk of infectious complications, particularly nosocomial pneumonia and Clostridium difficile-associated diarrhea. Early enteral nutrition has been shown to be effective in preventing stress ulceration of the upper gastrointestinal tract in critically ill patients. Routine use of stress ulcer prophylaxis in all critically ill patients may be dangerous and does not appear to be cost-effective. SUP administration must follow an algorithm that clearly balances risks and benefits.

Effect of Probiotic on Repair of Ethanol-induced Gastric Mucosal Erosion in Wistar Rats

Background: Probiotics can increase mucus secretion as a mechanism to improve barrier function and pathogen exclusion. Several Lactobacillus species can increase mucin expression in human intestinal cells. Lactobacillus Plantarum IS-10506 is a probiotic native to Indonesia derived from curd, fermented milk from Sumatra. Research with Lactobacillus Plantarum IS-10506 showed a protective effect as well as a therapeutic effect on intestinal mucosal damage to the ileum. Objective: Analyzing the effect of probiotic Lactobacillus Plantarum IS-10506 on the acceleration of ethanol-induced gastric mucosal erosion regeneration. Method: Experimental research used 48 rats that were fasted and divided into 3 groups those are K1 group control group, group K2 which was treated with ethanol 43%, and group K3 which was treated with ethanol and probiotic Lactobacillus Plantarum IS-10506. Each group was divided into 4 subgroups based on the day of the sacrifice those are days 1, 3, 5, and 7. The treatment of the test animals is done in 7 days. Epithelial defect was measured by using histopathologic scoring by Roger’s Results: The score of Epithelial defect Group K2 was significantly different compared to group K1 (p=0.036), and K3 (p=0.007). The gastric mucosal repair was completed in day 7 in the probiotic group. Conclusion: Probiotic Lactobacillus Plantarum IS-10506 accelerate mucosal repair in etanol induced gastric mucosal injury

Pediatric upper gastrointestinal endoscopic findings in Kaduna, Nigeria

Background Endoscopy is an important diagnostic and interventional procedure for children presenting with gastrointestinal (GI) symptoms. In resource-limited countries like Africa, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. Patients and methods This was a retrospective study of the findings in all children and adolescents referred for upper gastrointestinal endoscopy (UGIE) within a period of 2 years from February 2014 to February 2016. Results In all, 86 children and adolescents were referred for UGIE. There were 32 (37.2%) males and 54 (62.8%) females. The mean age was 13 years. Upper abdominal pain (47.7%), dyspepsia (19.8%), and upper GI bleeding (11.6%) were the major indications for referral. Fourteen (15.1%) patients were found to have normal UGIE findings. Commonest abnormalities seen at endoscopy were gastritis in 18 (22.1%), 14 (16.2%) had hiatus hernia, eight (9.3%) esophageal varices, seven (8.1%) gastric erosions, six (7.0%) had duodenitis, while five (5.8%) patients had esophagitis. Foreign body and duodenal ulcer were seen in three (3.5%) patients each, gastric ulcer and bile reflux in two patients each, while duodenal worms, esophageal atresia, caustic ingestion, and antral diverticular were seen in one (1.2%) patient each. Conclusion This study shows that endoscopy as an investigative tool in pediatric patients has high diagnostic yield with vital therapeutic potential, and is safe in the assessment of GI diseases.