The recommendation to discontinue low-dose aspirin (LDA) during the periprocedural period of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains controversial in patients at low thrombotic risk. If continuation of LDA does not increase bleeding risk, gastric ESD could be safely performed under sustained antiplatelet effects, benefiting patients. This study aimed to evaluate whether continuation of LDA is non-inferior to discontinuation regarding ESD-related bleeding risk in patients with low thrombotic risk. Patients with gastric mucosal neoplasms and low thrombotic risk who were taking LDA were eligible. Participants were randomly assigned to either the Discontinuation or Continuation group. No prophylaxis was performed except for cauterizing exposed vessels at the ulcer base. The primary endpoint was the incidence of ESD-related major bleeding. A total of 551 patients were enrolled. In the modified intent-to-treat analysis, the incidence of ESD-related major bleeding (95% CI) was 7.6% (4.8-11) in the Discontinuation group (n=276) and 10% (6.9-14) in the Continuation group (n=275), yielding a risk difference of 2.5% (-2.3 to 7.4). The upper limit of the two-sided 90% CI (6.6%) exceeded the predefined non-inferiority margin (Δ5%, P = 0.157). The per-protocol analysis supported this negative result, with a risk difference of 4.4% (-0.5 to 9.5). Two patients in the Continuation group developed cerebral infarction. The non-inferiority of LDA continuation over discontinuation for ESD-related major bleeding in gastric ESD was not demonstrated. Therefore, discontinuation of LDA during the periprocedural period is recommended for patients with low thrombotic risk. (UMIN000013177).

To investigate the clinicopathological characteristics of neuroendocrine(NE) cell dysplasia in gastric oxyntic gland mucosa. The clinical data of the patients with gastric mucosal NE cell dysplasia who underwent endoscopic submucosal dissection or endoscopic mucosal resection treatment at Xiangcheng County People's Hospital and the 989th Hospital of the Joint Logistics Support Force from January 2011 to October 2024 were retrospectively included. The clinical and endoscopic manifestations of the patients were analyzed, and their pathological morphological characteristics were observed in combination with immunohistochemical staining. A total of 15 patients were included, aged 54 years (32-69 years), including 6 males and 9 females. There were a total of 25 lesions (4 and 3 patients with 2 and 3 lesions, respectively) lincluding 21 lesions in the gastric body (84.0%) and 4 lesions in the gastric fundus (16.0%). Paris classification: 24 cases (96.0%) were classified as 0-Ⅱa type, 1 case (4.0%) as 0-Ⅱc type, with a median lesion diameter of 11.0 mm (2.0-36.0 mm). Narrowband imaging under endoscopy showed glandular duct disorder and abnormal blood vessels, and the mucosal features were consistent with autoimmune gastritis changes. Histological examination showed intrinsic glandular atrophy accompanied by intestinal metaplasia, and NE cells in mucosal hyperplasia presented as solid micro nodules (≤150 μm), arranged in a beam or glandular pattern. Enlarged micro nodules (>150 μm), fusion, sprout, and micro infiltration foci or single-cell infiltration can be seen, as well as nodules with newly formed stroma. It can be seen that the nodules are located within the mucosal muscle or above the lamina propria. Immunohistochemistry showed positive synaptic and chromaffin in NE cells, with nodules smaller than 0.5 mm in diameter and no submucosal infiltration. Sixteen (64.0%) cases of dysplasia lesions were accompanied by G1 grade neuroendocrine tumors, with continuous cell shape and unclear boundaries between the two. Gastric NE cell dysplasia is a precursor lesion of neuroendocrine tumors, and the key to diagnosis lies in identifying interstitial infiltration.

Gastritis is a condition characterized by inflammation of the gastric mucosa, which can lead to various complications if not properly managed. The prevalence of gastritis in Indonesia is relatively high, primarily due to irregular eating habits and a lack of public awareness about disease prevention. This outreach activity aimed to increase public awareness and knowledge about gastritis through a pharmaceutical education program conducted in Watugolong Village, Krian District, Sidoarjo Regency. The method used involved interactive counseling sessions including lectures, leaflets/brochures, and presentations, followed by pre-tests and post-tests to measure the effectiveness of the education. The results showed an increase in public understanding of gastritis, with post-test scores rising by 20% compared to the pre-test. This demonstrates that pharmaceutical education can be an effective strategy to raise public awareness regarding gastritis prevention.

Background . Reactions caused by cytokine production are of particular importance in the development of inflammation in H. pylori infection. The gene polymorphisms determine the corresponding protein production level, which affects the outcomes of inflammatory processes. In H. pyloriassociated gastritis, proinflammatory cytokines predominate. In the work were the TNFα gene polymorphisms analyzed. The aim is to study the effect of TNFα -308 G/A (rs1800629) gene polymorphisms on the clinical features of H.pylori infection in a large industrial center of Russia. Materials and methods. TNFα gene polymorphisms in patients with different forms of H. pylori infection were determined by allele-specific PCR. Results. It was found that the risk of H. pylori associated diseases is higher in carriers of the GG TNFα – 308 G/A genotype. This genotype is characteristic of patients with erosive and ulcerative processes in the mucous membrane of stomach and duodenum. The risk of developing atrophic gastritis when infected with H. pylori is associated with the A allele and the GA genotype. Conclusions. The study of the TNFα -308 G/A genetic polymorphisms makes it possible to identify individuals with a high risk of H. pylori infection, the occurrence of destructive diseases of stomach and duodenum, and those at risk of developing precancerous mucosal changes in the form of atrophic H. pylori-associated gastritis in order to provide timely prevention and treatment.

Recurrence of intraductal papillary mucinous neoplasms (IPMNs) in the remnant pancreas after surgery is a significant clinical challenge. A 68-year-old woman was incidentally found to have a 50-mm mixed-type intraductal papillary mucinous carcinoma (IPMC) in the pancreatic head during a health check. She underwent subtotal stomach-preserving pancreaticoduodenectomy with pancreatogastrostomy. Pathology revealed intestinal-type IPMC (pStage IA) with venous invasion and negative margins. Adjuvant oral S-1 chemotherapy was administered for six months. Eighteen months later, she developed rapid increases in HbA1c and tumor markers. Computed tomography showed 8-mm main pancreatic duct dilation in the remnant pancreas. Upper gastrointestinal endoscopy revealed a papillary tumor extending into the gastric mucosa, and biopsy confirmed adenocarcinoma. She was diagnosed with recurrent IPMC in the remnant pancreas and underwent total pancreatectomy with splenectomy. Intraoperative gastric endoscopy determined the extent of gastric wall resection. Postoperative chylous leakage occurred but resolved, and she was discharged on day 26. Pathology revealed non-invasive gastric-type IPMC, distinct from the intestinal-type lesion in the initial surgery. This case represents a rare metachronous recurrence of gastric-type IPMC following resection of intestinal-type IPMC, emphasizing the need for vigilant long-term surveillance and awareness of potential histologic subtype changes.

Integrative Unani pharmacotherapy in chronic gastroesophageal reflux disease: A case report.

The current work provides a comprehensive structural insight into the foregut of the Arabian jerboa (Jaculus loftusi), using anatomical examination with histological and histochemical methods. The research included five adult male jerboas, collected from Aljouf desert in Saudi Arabia. The foregut consisted of an esophagus and a unilocular stomach, which matched the anatomy of most rodents. The esophageal mucosa has longitudinal folds, lined by keratinized epithelium, presenting a star-shaped lumen. The lamina propria lacked both lymphatic nodules and esophageal glands. The gastric lining consisted of simple columnar epithelium, which formed deep rugae while displaying multiple gastric pits. The fundic glands contained mucous neck cells, parietal cells, and chief cells, whereas the corpus glands were longer and denser, and the pyloric glands were coiled, lacking aforementioned cells. The histochemical analysis revealed that the gastric mucosa, along with the pit surface lining cells, exhibited strong Periodic Acid Schiff positivity and mild Alcian Blue staining. The stomach epithelium exhibits dominance of neutral mucins over acidic mucins as indicated by the histochemical analysis. The obtained results provide a comprehensive insight into the modifications of the Arabian jerboa's foregut, highlighting its architectural specializations for the desert habitat.

Helicobacter pylori multiplex serology in patients with autoimmune atrophic gastritis negative for Helicobacter pylori at histology: A case-control study.

Design and synthesis of new 1,3,4-oxadiazole-1,2,3,4-tetrahydroisoquinoline hybrids as selective COX-2 inhibitors.

Inverted Heterotopic Gastric Mucosa of the Duodenum Presenting as a Subepithelial Lesion.

The objective of the present study was to evaluate the antioxidant and gastroprotective effect of Erica arborea hydroethanolic extract (EAHEx) against diclofenac-induced gastric ulcers in mice and to investigate the possible mechanisms of action through in silico analysis. In vitro results revealed that EAHEx had a significant antioxidant capacity. In vivo, diclofenac administration (150mg/kg) in mice induced extensive damage to the gastric mucosa. Nevertheless, pretreatment with EAHEx (100mg/kg) of mice was observed to provide protection against diclofenac-induced ulcers over ranitidine (20mg/kg) in the sense of not permitting the development of gastric ulcers and also reducing the ulcer index (UI), increasing GSH, enhancing gastric mucus secretion and antioxidant enzyme levels (SOD, CAT, GPx and GST) and reducing MDA. Liquid chromatography analysis of EAHEx identified nine phenolic compounds (flavonoids and phenolic acids) that had in silico high binding energy to the gastric proton pump (H+/K+-ATPase), good membrane permeation, good distribution, and a good elimination profile due to their high solubility compared to omeprazole and ranitidine. E. arborea had antioxidant and anti-ulcer activity, and therefore it is a potential candidate for future drug development.

Helicobacter pylori (H. pylori) is a Gram-negative bacterial agent that colonizes the gastric mucosa and leads to chronic infections. Various techniques are available for the detection of H. pylori; however, many of these methods are invasive, costly, and can only be performed in tertiary laboratories. It is necessary to find cost-effective and non-invasive novel indicators that can identify H. pylori infection and its activity. The objective of this study was to investigate the correlation between the CRP/albumin ratio (CAR), which is frequently analyzed in laboratory settings, and the presence of H. pylori, as well as the activation of H. pylori infection. The medical records of patients who had upper gastrointestinal endoscopy at our hospital were reviewed retrospectively. The data were analyzed using suitable tests with the IBM SPSS 27 software. The study included 613 patients, comprising 375 females (61.2%) and 238 males (38.8%). Among the participants, 327 (53.3%) tested positive for H. Pylori, while 286 (46.7%) tested negative. All patients presented with dyspeptic symptoms, and other indications for UGISE included anemia, gastroesophageal reflux, epigastric discomfort, dysphagia, nausea and vomiting, bleeding, and scanning. Upon comparing the laboratory results of H. pylori-positive and -negative patients, no significant change in CRP values was observed (p > 0.05). The albumin level was statistically considerably elevated in H. pylori-negative pa-tients relative to -positive patients (p = 0.009). The CAR in H. pylori-positive patients was statistically substantially elevated compared to negative ones (p = 0.04). We assert that CAR may serve as a valuable biomarker for confirming the presence of H. pylori infection and for reflecting the systemic inflammatory status of patients.

Agrocybe aegerita polysaccharide alleviates aspirin-associated gastric mucosal injury by regulating the NF-κB and Bax/Bcl-2 signaling pathways.

Vladimiria soulieialleviated ethanol induced gastric ulcer through inhibition of RIP1-RIP3-MLKL necrosome activation.

The impact of multidimensional interactions among Helicobacter pylori infection, tumor microenvironment, and gut microbiota on gastric cancer immune response.

In this study, we analyzed and characterized differentially expressed proteins in differentiated gastric adenocarcinoma with low-grade atypia for screening potential protein markers. We collected gastric tissue specimens from 90 patients treated at the Pathology Department of the First People's Hospital of Yunnan Province, China, between January 2019 and December 2022. These specimens had been fixed in 10% neutral-buffered formalin and embedded in paraffin. We classified these samples into 3 groups: the control group (normal gastric mucosa), the low-grade atypia group (differentiated gastric adenocarcinoma with low-grade atypia), and the high-grade atypia group (differentiated gastric adenocarcinoma with high-grade atypia), consisting of 30 cases in each group. We analyzed differential proteomes with the data-independent acquisition-mass spectrometry (DIA-MS) methodology and selected 4 differentially expressed proteins that were subjected to immunohistochemistry (IHC) staining for validation. A total of 4406 proteins were identified, among which 598 and 357 proteins were statistically different in the low-grade atypia group as compared with the control group and the high-grade atypia group, respectively. IHC staining showed that the expression of FHL3, CSRP2, and FCGR3A was significantly higher in the low-grade atypia group than in the control group (P <0.05) and significantly higher in the high-grade atypia group than in the low-grade atypia group (P <0.05). FHL2 expression was negative to weakly positive in the control and low-grade atypia groups and not significantly different between the 2 groups, whereas FHL2 expression in the high-grade atypia group was significantly higher than in the control and low-grade atypia groups (P <0.05). Proteomic analysis is helpful for discovering new protein markers. Using a combination of FHL3, CSRP2, and FCGR3A can increase the accuracy of the pathologic diagnosis of differentiated gastric adenocarcinoma with low-grade atypia.

Phlegmonous gastritis is a rare, potentially life-threatening bacterial infection affecting the gastric mucosa and submucosa. Clinical presentation is often non-specific, typically including symptoms such as fever, epigastric vomiting, or hematemesis. Due to its rarity and vague clinical features, diagnosis is frequently delayed, increasing the risk of severe complications such as septic shock and death. We describe the case of a 74-year-old previously healthy female who presented with vomiting, hematemesis, and epigastric pain. Endoscopy revealed diffuse erythema and purulent exudate throughout the stomach, raising suspicion for Phlegmonous gastritis. Although blood and gastric juice cultures were negative, gastric tissue culture identified Cronobacter species. Cronobacter species is an opportunistic pathogen primarily associated with severe infections in neonates, though it has also been reported in immunocompromised adults. The patient responded well to targeted antibiotic therapy and recovered without requiring surgery. This case highlights the diagnostic and therapeutic utility of gastric tissue culture in Phlegmonous gastritis, especially when conventional cultures fail to identify a pathogen. It also underscores the role of Cronobacter species as a rare but relevant pathogen in adult gastrointestinal infections such as Phlegmonous gastritis.

To analyze the effectiveness of original laparoscopic fundoplication in correction of iron-deficiency anemia (IDA) following chronic blood loss from erosive and ulcerative lesions of esophageal and gastric mucosa in patients diagnosed with hiatal hernia (HH). A prospective study included 42 patients with verified HH and concomitant IDA who underwent original laparoscopic fundoplication between 2023 and 2024. All patients underwent a comprehensive diagnostic algorithm including extended laboratory testing with assessment of red blood cell parameters and iron metabolism. Treatment efficacy was evaluated after 6 and 12 months through analysis of clinical and laboratory parameters. Complete regression of gastroesophageal reflux disease was achieved in 39 patients (92.8%). Six-month laboratory monitoring demonstrated normalization of hemoglobin and serum iron levels in 35 out of 37 patients (94.5%). Normal hematological parameters were maintained after 12 months despite the absence of additional iron therapy during the second six-month period. This indicated stable clinical effect of surgical treatment and elimination of primary pathogenetic factor of anemia. These data confirm high efficacy of surgical HH correction in treating refractory IDA associated with Cameron lesions and emphasize the need for timely detection of this pathology to optimize treatment strategy.

Background: Helicobacter pylori (H. pylori), a gram-negative bacterium that causes gastritis, peptic ulcers, and gastric cancer, infects more than half of the global population. The recommended levofloxacin-based nanotherapy can be deployed to overcome rapid gastric emptying of the drug, inadequate drug concentration at the site of action, and the protective mucosal layer. The research established a goal to design and enhance Levofloxacin Hemihydrate(LH) Mucoadhesive Nanoparticles (LMNP) for better drug retention on stomach mucosa and mucosal adhesion, site-specific prolonged drug delivery against H. pylori. Methodology: The LMNP nanoparticles were prepared through ionic gelation of chitosan (CT), carbopol 974P(CP), and N-Acetylcysteine (NAC) before optimizing them using Central Composite Design (CCD) within Response Surface Methodology. The study used FTIR, DSC, XRD, SEM, particle size, zeta potential, entrapment efficiency (EE%), in vitro cumulative drug release %, and mucoadhesive strength (MS%) tests for characterization. Results and Discussion: The optimized LMNP formulation had a particle size of 245.4 ± 1.254 nm, an EE% of 72 ± 2.246%, and Prolonged drug release over 6 hours with in vitro CDR of 99.98 ± 0.115%, which fits the gastric mucus turnover time. FTIR, DSC, and XRD confirmed the compatibility of drug excipients. SEM revealed uniform spherical particles, and MS% was 62 ± 2.315%. The size of the particles and their entrapment efficiency , mucoadhesive properties, and in vitro cumulative drug release were influenced by CT and CP, but NAC enhanced mucopenetration effects. The CCD model successfully established formulation behavior and confirmed synergistic interactions among the excipients. By enhancing matrix formation and swelling, the combined impact of CT and CP significantly influenced. Conclusion: The LMNP system developed by employing CCD designs and ionic gelation methodology demonstrated promising characteristics for gastric retention and prolonged drug release , which could enhance H. pylori clearance rates. The drug delivery platform presents a practical, biocompatible solution to address challenges in conventional therapy.

Gastrointestinal microbiota dysregulation is recognized as a key factor in the pathogenesis of functional dyspepsia (FD). Previous investigations have focused predominantly on the microbiota associated with the oral, gastric, and duodenal mucosa. However, the intestinal microbiome and fecal metabolome in FD patients remain poorly characterized. This study aims to evaluate their alterations, thereby providing novel insights into the pathophysiological mechanisms of FD. Fecal samples from 30 FD patients and 19 healthy controls (HCs) were subjected to 16S rRNA sequencing and metabolomics to characterize microbial-metabolic profiles, followed by Spearman correlation analysis to explore the associations between differentially abundant taxa and metabolites. Compared with the HCs, the FD group presented greater microbial richness but comparable diversity, along with increased abundances of Akkermansia and Ruminococcus_gnavus_group and decreased levels of Dorea, Collinsella, and Agathobacter (p < 0.05). AUC analysis revealed Akkermansia as a potential biomarker for FD (AUC = 0.848, 95% CI: 0.708-0.988). Furthermore, the levels of the fecal metabolites phosphatidylglycerol (PG) and phosphatidylcholine (PC) were significantly reduced in the FD group (p < 0.05). KEGG enrichment analysis revealed that these metabolites were involved in glycerophospholipid metabolism. Spearman correlation analysis revealed negative associations between Ruminococcus_gnavus_group, Fusobacterium, Erysipelatoclostridium, and PG/PC (p < 0.05). The FD group presented concurrent alterations in the gut microbiome and fecal metabolites. Specifically, gut microbiota-derived metabolites, such as PG and PC, may disrupt host glycerophospholipid metabolism, contributing to FD pathogenesis. Given that this is an exploratory study with a small sample size and cross-sectional design, these results require validation in larger, longitudinal cohorts and should be interpreted with caution.