Gastrin Levels Research Articles

S3615 Gastric Neuroendocrine Tumor of Indeterminate Type

Introduction: Gastric neuroendocrine tumors (GNETs) are rare tumors making up less than 2% of gastric polyps. Type I GNETs are most common (70-80%) and are associated with atrophic gastritis, pernicious anemia, iron deficiency, elevated gastrin, and high gastric pH. These are typically small, low-grade, and may be multifocal. Type II tumors are also associated with elevated gastrin levels but a low pH, as seen in Zollinger-Ellison syndrome. Type III tumors are larger and more aggressive and occur sporadically in the setting of normal gastric mucosa, normal gastrin levels, and normal pH. Here we discuss an unusual case of GNET which does not fit into either category. Case Description/Methods: A 70-year-old white male with history of gastroesophageal reflux disease (GERD) on chronic proton pump inhibitor (PPI) presented for esophagogastroduodenoscopy (EGD) for worsening GERD symptoms. EGD revealed 2 polyps in the body – each was 4-5 mm and was removed with hot snare. A few smaller polyps were removed with biopsy forceps. The gastric mucosa was grossly normal. Sydney protocol biopsies were obtained. The 2 larger polyps returned as well-differentiated GNETs, grade 1 (Ki-67 index 2.5%). The smaller polyps returned as areas of intestinal metaplasia (IM), but Sydney protocol biopsies did not reveal H. pylori, atrophic gastritis, or IM. EGD was repeated off PPI for 1 week and fasting labs were obtained. Gastric pH was 1, serum gastrin was 78 pg/mL (normal), vitamin B12 and ferritin were normal, and intrinsic factor and parietal cell antibodies were negative. (Figure) Discussion: This case highlights a scenario in which a GNET is difficult to categorize based on classic criteria. As type III lesions are very aggressive with high risk of metastasis, distinguishing between type I and type III lesions is paramount. While grossly and histologically resembling a type I GNET (multifocal, small, low-grade), the GNETs in this case were present in the absence of atrophic gastritis, and the patient had a normal gastrin and low gastric pH off PPI. The lack of atrophic gastritis and normal gastrin levels are more suggestive of a type III tumor, but one would expect a single, large, high-grade GNET in that case. As PPI use has increased in the past 30 years, so has incidence of GNETs; it is possible that a chronic, PPI-induced “hyper-gastrin” state was responsible for this patient’s GNETs and that gastrin normalized once PPI was discontinued. More studies are needed to further categorize GNETs with indeterminate features.Figure 1.: Gastric Polyp.

S3560 Who Knows When It All Began? A Case of Autoimmune Gastritis

Introduction: Gastritis is a common entity that manifests as erythema of the gastric mucosa seen on EGD. The most common cause of Gastritis is infection, specifically H pylori. Atrophic gastritis is suggested endoscopically by loss of rugal folds and appearance of the submucosal vessels. Autoimmune Metaplastic Atrophic Gastritis (AMAG) is a subtype and is suggested pathologically by full thickness chronic inflammation, oxyntic gland destruction, prominent eosinophils, metaplasia, or parietal cell pseudohypertrophy. Endoscopic surveillance remains controversial. Management strategies include eradication of H pylori infection. We present a case of AMAG assoc with Lupus. Case Description/Methods: A 45-year-old Caucasian female with history of Lupus presented with persistent, dull, aching epigastric pain aggravated by solid food intake and anemia. She had no previous history of H pylori, no previous use of antacids, NSAIDs, or digestive enzymes. When she was younger, she had iron deficiency anemia thought to be solely nutritional or related to heavy menses. Her Mother had Hashimoto's thyoiditis. Laboratory work up showed mild microcytic anemia Ferritin 253 ng/mL, Iron 143 ug/dL while on Iron supplementation. EGD showed loss of rugal folds with edematous change in fundus and body. Biopsy showed chronic gastritis with intestinal metaplasia. Repeat EGD in 1 year showed loss of rugal folds and pallor to the mucosa. Biospies were done according to mapping protocol for intestinal metaplasia of greater and lesser curvature of antrum, incisura and body showed atrophic/autoimmune gastritis. Gastrin level was 1419 pg/mL, Antiparietal cell Antibody 108.1 Units (>24 U being positive), and Intrinsic factor Ab was low 1.0 AU/mL (Cut off is 1.1 AU/mL). She was managed with Iron supplementation, assessment for other vitamin deficiencies (B12 and folate were normal), and with yearly surveillance EGDs with mapping due to presence of intestinal metaplasia (Figure). Discussion: The endoscopic findings in Atrophic Gastritis can be very subtle. It is important that endoscopists are aware of these findings in order to better identify this illness. Additionally regimented biopsies per protocol ensure that this diagnosis is not missed. Beyond eradication of H. pylori further surveillance measures remain controversial. These should be considered on a case by case basis taking family history, region, smoking history, age, comorbidities, obesity, and alcohol consumption into consideration. More research is required to make universal screening guidelines.Figure 1.: Stomach showing atrophic folds.

Does Chronic Use of High Dose Proton Pump Inhibitors Increase Risk for Pancreatic Cancer?

To analyze whether use of proton pump inhibitors increase the risk for pancreatic cancer in a mouse model and human clinical cohorts. p48-Cre/LSL-KrasG12D mice that develop precancerous pancreatic intraepithelial neoplasia (PanINs) were treated with low- or high-dose proton pump inhibitors (PPIs) orally for 1 and 4 months. The mechanism for the cholecystokinin receptor 2 (CCK-2R) activation was investigated in vitro. Two resources were employed to analyze the risk of pancreatic cancer in human subjects with PPI use. Serum gastrin levels were increased 8-fold (P < 0.0001) in mice treated with chronic high-dose PPIs, and this change correlated with an increase (P = 0.02) in PanIN grade and the development of microinvasive cancer. The CCK-2R expression was regulated by microRNA-148a in the p48-Cre/LSL-KrasG12D mice pancreas and in human pancreatic cancer cells in vitro. Proton pump inhibitor consumption in human subjects was correlated with pancreatic cancer risk (odds ratio, 1.54). A validation analysis conducted using the large-scale United Kingdom Biobank database confirmed the correlation (odds ratio, 1.9; P = 0.00761) of pancreatic cancer risk with PPI exposure. This investigation revealed in both murine models and human subjects, PPI use is correlated with a risk for development of pancreatic cancer.

S3642 Neuroendocrine Tumor Diagnosed While Performing Upper Endoscopy Surveillance of Gastric Intestinal Metaplasia

Introduction: Gastric neuroendocrine tumors (GNET) are rare tumors arising from the enterochromaffin cells of the gastric mucosa, which comprise less than one percent of all gastric neoplasms and around eight percent of all gastrointestinal neuroendocrine tumors. Endoscopic resection is considered the best treatment option for type 1 GNETs. However, due to the rarity of this entity, no specific management guidelines are currently available. Case Description/Methods: We present a case of an asymptomatic 47-year-old female diagnosed with a neuroendocrine tumor via upper endoscopy performed for surveillance of gastric intestinal metaplasia. She was found to have several gastric polyps (Figure), of which two had immunohistochemistry (IHC) and histology suggestive of well-differentiated neuroendocrine tumor (grade one). Notably, these polyps were found amidst the backdrop of chronic gastritis and elevated chromogranin (638.9) and gastrin (1088) levels. Biopsy results from one gastric polyp showed ink margin positive for tumor and the patient is currently scheduled to undergo endoscopic ultrasound (EUS) with polypectomy to ensure complete removal of tumors with clean margins. Discussion: GNETs are classified into three distinct subtypes based on serum gastrin levels. Literature suggests that type 1 and type 2 GNETs are usually discovered incidentally on endoscopy. They appear as either multiple small polypoid lesions or as multiple smooth hemispherical submucosal lesions. Notably, type 1 GNETs are found commonly in the setting of atrophic gastric mucosa while type 2 GNETS are found in hypertrophic gastric mucosa. Of note, there has been growing literature on the increasing incidence of GNET type 1 in patients with gastric metaplasia in the setting of chronic atrophic gastritis. Our case supports the literature and emphasizes the importance of being able to identify the gross morphology of GNET while carrying a high index of suspicion for this rare yet clinically relevant entity. Furthermore, the origin of neuroendocrine tumor from gastric metaplasia is intriguing and invites further studies for understanding the pathophysiology.Figure 1.: Multiple inflammatory gastric polyps (blue arrows) visualized on upper endoscopy.

S1655 Increased Prevalence of Achlorhydria With Age in an Asian Population: Should We Be Screening for Achlorhydria in Patients Aged 50 and over: 22 Years Experience From a Large Hospital

Introduction: Achlorhydria (AC) is a state in which the stomach is unable to produce hydrochloric acid. AC can be categorized as either permanent or temporary based on its causes. It can lead to several conditions including pernicious anemia (PA) which can cause irreversible neurological deficits. Diagnostic techniques of AC can be easily performed during esophagogastroduodenoscopy (EGD) by staining Congo red on the gastric mucosa. Methods: This analysis involved a large single center retrospective study aimed at determining the prevalence of AC in Thailand among EGD patients. Results: A total of 3,597 patients underwent EGD including Congo red staining method at the Vichaiyut Hospital from January 2010 to December 2019; 223 ones were excluded due to concurrent use of proton pump inhibitors. Results revealed that 18 from 3,374 patients (0.53%) had AC. Seven presented with permanent AC (5F, 2M) (median age = 69 years; range 58-92; Table). All 7 patients were found to have high levels of serum gastrin (mean = 2,485 pg/ml; S.D. = 689 pg/ml) and were pathologically confirmed with intestinal metaplasia. All 7 patients with permanent AC were found only when they were over 55 years old. Among 11 patients with temporary AC (5M, 6F: mean age 73.4 years; SD = 13.2 years), all had gastrointestinal Helicobacter pylori bacterial infection after being examined. After successful treatment for H. pylori and re- examination with Congo red, AC was absent among patients with temporary AC. All 11 patients with temporary AC were found only when they were over 45 years old. If counting only patients over 45 years of age, the prevalence of AC was 0.68% (18/2,614). No adverse events arising from Congo red occurred (Figure). Conclusion: Achlorhydria (AC) is relatively rare. Permanent and temporary AC were found only when they were over 55 and 45 years old, respectively. Staining Congo red on gastric mucosa can be safely and routinely incorporated into the EGD procedure for early detection of AC. We recommended a low-cost screening test such as serum vitamin B levels for screening only in patients aged 50 and over.Figure 1.: Congo red changes its color from red to dark blue or black in an acidic environment. Table 1. - Characteristics of patients with permanent AC Patients’s number Age (years) Serum Vitamin B12 (pg/mL)(normal value = 187-883 pg/mL) Anti-Intrinsic factor Serum gastrin level (pg/mL) 1 58 2000 Positive 2000 2 86 2000 Positive 3000 3 69 405 Positive 3000 4 69 224 Negative 1300 5 80 1642 Positive 3000 6 92 265 Positive 3000 7 68 100 Negative 2100

S3640 Myoclonic Jerks and Chronic Diarrhea; The Challenges of Zollinger-Ellison Syndrome

Introduction: Zollinger-Ellison Syndrome (ZES) is a rare disorder caused by hypersecretion of gastrin, causing peptic ulcer disease (PUD) and diarrhea. In most cases, inappropriate gastrin secretion is from duodenal or pancreatic neuroendocrine tumors (gastrinoma). Diagnosis of gastrinoma can be delayed as symptoms are nonspecific and can be misdiagnosed as other GI disorders. Case Description/Methods: A 79yo female with DM, HTN, and peptic ulcer disease presented with myoclonic jerks and watery diarrhea. She was found to have severe hypomagnesemia and acute kidney injury (AKI). Notably she had diarrhea for months with several admissions with similar symptoms. Prior workup including celiac serology, vasoactive intestinal peptide level, fecal calprotectin, and colonoscopy were inconclusive. Lomotil was started for possible irritable bowel syndrome (IBS) with partial response. On this admission, stool osmolar gap was < 50, chromogranin A 8224 ng/mL and gastrin 596 pg/mL. MRI of the abdomen showed a 2.5cm mass-like thickening in the distal gastric antrum. Endoscopy showed gastritis and duodenal ulcers. EUS with FNA of the mass was inconclusive. Octreoscan revealed a somatostatin receptor-bearing neuroendocrine tumor (NET) in the distal stomach. She underwent distal gastrectomy and peri-pancreatic LN resection after hospitalization. Histopathology confirmed a well-differentiated NET with metastasis. Her diarrhea resolved and chromogranin A and gastrin normalized, 90 ng/mL and 43 pg/mL respectively. (Figure) Discussion: Chronic diarrhea is a main symptom of gastrinomas. Diagnosis can be challenging due to the rarity of ZES and as many disorders cause diarrhea. Many patients are diagnosed with more common conditions such as IBS and GERD. Initial evaluation in suspected cases includes Gastrin levels which can be falsely elevated in patients on chronic PPI. Most gastrin-producing tumors arise in the duodenum (75%) and pancreas (20%). Less than 5% of patients have a tumor in the stomach, peri-pancreatic lymph nodes, liver, bile ducts, or ovary. EGD can show prominent gastric folds and pathology can be nonspecific. In patients with suspected ZES, chest and abdominal imaging can identify intra or extra-abdominal lesions. Octreoscan can localize the tumor’s primary location and any metastasis. Consideration of ZES in patients with chronic diarrhea with timely evaluation and treatment can prevent the complications such as electrolyte abnormality, PUD, and decreases risk of metastasis.Figure 1.: a,b. Duodenal Ulcers. Image c. 2.5 cm mass-like thickening with restricted diffusion in the distal gastric antrum suspicious for neoplasm with an adjacent 1.5 cm lymphadenopathy.

S3725 A Rare Hybrid gNET: The Neoplastic Jack of All "Grades"

Introduction: Gastric neuroendocrine tumors (gNETs) are rare malignancies which arise from enterochromaffin-like cell (ECL) precursors within the gastric mucosa. There are 4 classifications of gNETs primarily based on size, number of lesions, serum gastrin level, tissue invasion, proliferation index and immunohistochemistry. Applying a combination of factors, gNETs are typically classified into one of these four categories with relative ease. The following case highlights an exceedingly rare hybrid presentation of gNET containing features of all four classification subtypes. Case Description/Methods: A 78-year-old female with a past medical history of hypertension, diabetes mellitus, chronic kidney disease and gastroesophageal reflux disease (GERD) initially presented with worsening symptoms of GERD. The patient denied any alarm symptoms but did endorse persistence of reflux symptoms despite proton pump inhibitor use. Screening EGD with EUS showed polyps which were removed with mucosal resection. Initial pathology illustrated well differentiated gNET. She underwent a DOTA-TATE PET/CT scan which showed heterogenous uptake involving the gastric body reflecting focal gNET without evidence of metastatic disease. The patient underwent total gastrectomy and esophagojejunostomy with upper GI series revealing no evidence of anastomotic leak. On subsequent pathology, at least 46 semi pedunculated gastric polyps were identified of which the greatest tumor dimension was 0.6 cm with a mitotic rate less than 2 mitoses/2mm2. Pathology and immunohistochemistry revealed well differentiated gNET, grade 1 and 2, staining positivity for Chromogranin A (CgA), synaptophysin, CD56, and CAM 5.2 with a Ki67 proliferation index > 6%. Patient’s serum gastrin was within normal limits at 51pg/ml and 24-hour urine 5-HIAA revealed a normal level of 5.7 mg/24hr. She was referred to a geneticist for massive parallel sequencing also known as next generation sequencing (NGS). (Figure) Discussion: This case displays a rare, hybrid presentation of gNET with features of all four classification subtypes. The positive synaptophysin, normal serum gastrin and increased Ki67 index are characteristic of gNET Type 3 and 4 which carry a poor prognosis. Type 3 and 4 however, are typically large ( >2cm), single tumors. This patient had many, smaller tumors with positive CgA staining commonly seen in Type 1 and 2. Hybrid gNETs are extremely uncommon neoplasms which create both a diagnostic and therapeutic challenge requiring a truly multidisciplinary effort.Figure 1.: Ga-68 Dotatate PET-CT showing diffuse heterogenous uptake in the gastric body.

S2567 Vaping-Induced Duodenal Ulcer

Introduction: Vaping, or electronic cigarette use has tremendously increased. It is estimated a population of five million is involved in vaping each year. While lung injury associated with vaping has gained national attention, the systemic burden of vaping has not been established. To date, there is no current report on the prevalence of gastrointestinal symptoms alone in association with vaping, yet it has been reported that 90% of patients who present with lung injury also have gastrointestinal symptoms. This raises the concern that vaping may also result in gastrointestinal injury such as seen with tobacco smoking and use of nicotine products. To our knowledge, vaping has not been shown to be associated with gastrointestinal ulcers or peptic ulcer disease. Case Description/Methods: We report a case of a 19-year-old male who was admitted to the intensive care unit for concern of hemorrhagic shock after presenting with hematemesis from a duodenal ulcer. The patient had no other medical history or known risk factors for peptic ulcer disease. However, he did report a seven-month history of vaping marijuana and THC products through a vaping pen for several hours per day prior to his onset of gastrointestinal symptoms and eventual hematemesis. Patient gastrin levels were normal. Gastric biopsies were negative for H Pylori. He denied using NSAIDS, including BC powders and goody powders. Discussion: This case emphasizes the need for clinicians to obtain a medical history of vaping when assessing patients with gastrointestinal symptoms. Future research in vaping should evaluate if the various compounds in vaping products or if the different methods of vaping can cause adverse gastrointestinal side effects such as ulcers.

S3363 A Case of Progressive Refractory Diarrhea due to Zollinger-Ellison Syndrome

Introduction: A 64-year-old female with a history of diabetes mellitus presents with acute on chronic diarrhea and refractory acid reflux is found to have Zollinger-Ellison syndrome. Case Description/Methods: The patient had a two-year history of non-bloody diarrhea which worsened (7 bowel movements/day) in the two months prior to presentation. She described associated nausea, reflux, and abdominal pain. Notably, her mother had similar symptoms, requiring small bowel resection (records not available). Previous workup included a colonoscopy and an esophagoduodenoscopy (EGD) showing duodenal ulcerations with negative biopsies for celiac disease. She was started on a proton-pump inhibitor (PPI), colestipol, and loperamide without improvement. Medication review, stool infectious studies, and cross-sectional imaging had been unrevealing. On presentation, she had stable vitals and physical exam significant for diffuse abdominal tenderness. Labs were notable for a hemoglobin of 10.2 gm/dL (grams per deciliter) and an acute kidney injury (AKI). Abdominal Computed Tomography (CT) suggested multiple, small duodenal ulcers with a polypoid lesion in the gastric antrum (Figure). EGD revealed esophagitis, multiple small duodenal ulcerations (D1, D2), and gastric mucosal atrophy. Repeat colonoscopy was unremarkable. The fasting gastrin level was 211 pg/mL (picogram per milliliter). The secretin stimulation test showed serum gastrin blood levels of 121, 258, and 483 pg/mL at 2, 5, and 10 minutes respectively consistent with Zollinger-Ellison Syndrome. The Dotatate PET/CT scan showed metastatic somatostatin receptor expressing portocaval adenopathy without a tracer-avid primary neuroendocrine tumor. She was started on lanreotide and is now referred to oncology. Discussion: This case represents an instructive example of Zollinger Ellison Syndrome (ZES), often discussed, but rarely diagnosed. In this case, the patient presented with progressive diarrhea, a subtle family history, and with several prior evaluations. ZES is a rare gastrin-secreting neuroendocrine tumor (NET) associated with multiple endocrine neoplasia (MEN-1), which leads to refractory acid reflux and chronic diarrhea, as seen in our patient. Non-specific gastrointestinal symptoms and empiric PPI use can delay the diagnosis. The gastric pH, gastric level, secretin stimulation, and Dotatate PET/CT are used to evaluate and localize the tumor.Figure 1.: A, B: Computed Tomography (CT) abdomen showed multiple, small duodenal ulcers and 4 millimeter (mm) enhancing polyp at the gastric antrum (red arrows).

S2290 Complete Esophageal Obstruction: A Rare Complication of Zollinger-Ellison Syndrome (ZES)

Introduction: Patients diagnosed with ZES typically have minimal esophageal morbidity given advancements in anti-secretory medications. This case presents a rarely documented sequala of modern-day patients with ZES. Case Description/Methods: A 73-year-old man with history of HIV on HAART and ZES presented with worsening dysphagia to both solids and liquids. In the 2 year interval since his original presentation, his medical therapy was quickly maximized to omeprazole 180 mg/day and famotidine 80 mg/day. He also underwent tumor resection with distal gastrectomy, resection of D1, roux-en-Y hepaticojejunostomy, and truncal vagotomy. During that time his gastrin levels normalized from 1941 to 87. Despite these measures, he had undergone 21 EGDs and 7 esophageal stents for dysphagia secondary to refractory esophageal strictures. He lost 48 lbs over 2 years despite extensive attempts at both enteral and total parental nutrition. In January 2022, he presented with inability to swallow his own secretions and profound weakness from malnutrition. An esophagram was performed (figure 1a) revealing complete esophageal obstruction. An EGD with esophageal lumen restoration was attempted using combined retrograde and anterograde recanalization with 2 operators, 2 EGD scopes, and an EUS needle (figure 1c). Unfortunately, the 2 blind loops appeared to be approximately 6 cm apart in different alignments making lumen restoration unfeasible. The patient was most recently evaluated for esophageal reconstruction by jejunal interposition but was not a candidate due to poor nutritional status. Discussion: ZES is characterized by severe ulcerative disease due to gastric acid hypersecretion via neuroendocrine tumors. Our case is unique because this patient developed complete esophageal obstruction (CEO) despite management with maximal acid suppressive therapy, surgical resection, multiple EGDs with dilations, and numerous esophageal stents. CEO is a rare occurrence characterized by lumen obliteration leading to the inability to tolerate own secretions and most recorded cases are due to radiation-therapy for treatment of head and neck cancers. Given the low incidence, there is no single established method for endoscopic lumen restoration. However recombined retrograde and anterograde recanalization and dilation (CARD) has been shown to be successful for strictures less than 3 cm.Figure 1.: (A) Barium swallow study revealing a high-grade stricture in mid thoracic esophagus followed by another high-grade stricture with complete lumen obstruction. (B) EGD showing blind pouch approximately 35 cm from incisors. (C) Fluoroscopic imaging displaying attempt at combined anterograde and retrograde decannulation and dilation.

Alleviation of loperamide-induced constipation with sticky rice fermented huangjiu by the regulation of serum neurotransmitters and gut microbiota.

Huangjiu is an important component of traditional fermented food. It is produced by cereal fermentation. Sticky rice fermented huangjiu is an abundant source of polysaccharides, oligosaccharides, proteins, amino acids, and flavor compounds (POPAF), and it has been used as a dietary supplement and pharmaceutical ingredient. The purpose of this study is to explore the alleviation of constipation using sticky rice fermented huangjiu, with the aim of providing a basis for the nutritional treatment of constipation. Sticky rice fermented huangjiu was more effective in the alleviation of constipation than same concentration of ethanol treatment on serum neurotransmitters, gut microbiota, and intestinal metabolites in this 17 days constipation mouse model. Compared with ethanol treatment, the administration of sticky rice fermented huangjiu to constipated mice increased gastrointestinal motility. It alleviated the decrease in motilin (27.94%), substance P (13.85%), gastrin (63.46%), 5-hydroxytryptamine (4.55%), and short-chain fatty acid (19.80%) levels, and alleviated the increase in somatostatin levels (9.54%). Furthermore, the administration of sticky rice fermented huangjiu regulated the microbiota-mediated gut ecology through alterations in the characteristic taxa. The results reveal that sticky rice fermented huangjiu may alleviate loperamide-induced constipation by the regulation of serum neurotransmitters and gut microbiota. These findings reveal that huangjiu is endowed with many functional components by cereal fermentation, and the bioactive substances in huangjiu can be separated and applied for medical treatment or diet therapy in the future. © 2022 Society of Chemical Industry.

Nonsense mutation in the novel PERCC1 gene as a genetic cause of congenital diarrhea and enteropathy

Congenital diarrheas and enteropathies (CODEs) constitute a heterogeneous group of individually rare disorders manifesting with infantile-onset chronic diarrhea. Genomic deletions in chromosome 16, encompassing a sequence termed the ‘intestine-critical region (ICR)’, were recently identified as the cause of an autosomal recessive congenital enteropathy. The regulatory sequence within the ICR is flanked by an unannotated open reading frame termed PERCC1, which plays a role in enteroendocrine cell (EEC) function. We investigated two unrelated children with idiopathic congenital diarrhea requiring home parenteral nutrition attending the Irish Intestinal Failure Program. Currently 12 and 19-years old, these Irish male patients presented with watery diarrhea and hypernatremic dehydration in infancy. Probands were phenotyped by comprehensive clinical investigations, including endoscopic biopsies and serum gastrin level measurements. Following negative exome sequencing, PCR and Sanger sequencing of the entire coding region and intron boundaries of PERCC1 were performed for each proband and their parents. In both patients, serum gastrin levels were low and failed to increase following a meal challenge. While no deletions involving the ICR were detected, targeted sequencing of the PERCC1 gene revealed a shared homozygous c.390C > G stop gain variant. We report clinical and molecular findings in two unrelated patients harboring a shared homozygous variant in PERCC1, comprising the first description of a point mutation in this gene in association with CODE. That both parenteral nutrition dependent children with unexplained diarrhea at our institution harbored a PERCC1 mutation underscores the importance of its inclusion in exome sequencing interpretation.

Estimation levels of cholecystokinin, gastrin and secretin in patients with type 2 diabetes mellitus

A diabetic patient with diabetes mellitus experiences high blood sugar levels as a result of low insulin levels or resistance to the medication's effects. The tests were carried out at a medical laboratory using specialized kits, and the 45 patient samples and 45 healthy person samples from both sexes as a control group were dispersed based on the questionnaire form. In contrast to the non-significant rise in serum gastrin and secretin levels, the results demonstrated a substantial increase in cholecystokinin (CCK) levels between the patient and control groups and a significant increase in CCK levels according to gender, type of therapy, and disease history. In conclusion, individuals with diabetes mellitus type 2 may have aberrant blood CCK levels, which require concentration to assess the full scope of their impact on the individual.

Correlation Study between Levels of Gastrin, Serum IGF-1, and GHBP and Growth and Development in Children with Short Stature Based on Big Data Analysis.

To analyze the correlation between the levels of gastrin, serum IGF-1, and GHBP and growth and development in children with short stature (SS) using the big data. By means of retrospective analysis, the clinical data of 42 children with SS admitted to our hospital from October 2020 to October 2021 were selected as the study group, while 30 children with the healthy physical examination results in the corresponding period were selected as the control group to measure the growth and development indices and the levels of gastrin, serum IGF-1, and GHBP. The Pearson correlation analysis was used for the relationship between the levels of gastrin, serum IGF-1, and GHBP and growth and development indices in children with SS, and the targeted intervention measures were formulated by the analysis of experimental data. Compared with the study group, the height, weight, and bone mineral density (BMD) Z-scores of children in the control group were obviously higher (P < 0.001). The levels of gastrin, serum IGF-1, and GHBP in the study group were markedly lower than those in the control group (P < 0.05). The Pearson correlation analysis showed that the gastrin, serum IGF-1, and GHBP of children were positively correlated with growth and development indices (P < 0.001). The levels of gastrin, serum IGF-1, and GHBP in children were distinctly improved after treatment (P < 0.05). The gastrin, serum IGF-1, and GHBP are closely related to the SS, and the effective clinical intervention can better improve the above indicators of children to promote their growth and development.

Hypergastrinemia in Children : A Case Report

Gastrin is an important hormone in the gastrointestinal system that promotes gastric acid secretion. Gastrin hormone is produced by the G-cells in the antrum of the stomach. Besides stimulating gastric acid secretion, gastrin also induces the proliferation of the gut epithelial cells, tissue remodelling, and angiogenesis. Gastrin levels higher than 100-150 pg/ml are known as hypergastrinemia. Hypergastrinemia may cause the hypersecretion of stomach acid, which, if not treated properly, may leads to refractory peptic ulcer, severe gastroesophageal reflux disease (GERD), diarrhea, or death due to complications of refractory peptic ulcer. This case presented a 12 years old boy with a chief complaint of severe epigastric pain in the past month, accompanied by nausea, especially during supine position. The patient had a previous history of esophagitis. He showed no significant changes upon empirical PPI treatment. However, slight improvements were observed after the administration of Helicobacter pylori treatment. The gastrin level in this patient was 198 pg/mL. Upon discharge, the patient was still given PPI treatment. During the follow-up visitation, patient complaints had improved significantly, and the patient was planned to undergo routine evaluations of gastrin.

The Effectiveness of Infant Massage to Increase in Baby Weight in Bpm Inawati

One of the factors in increasing the growth and development of babies is to provide stimulation. Baby massage has many benefits, one of which is increasing the baby's weight, that's because babies who are massaged will experience an increase in vagus nerve tone (10th brain nerve) which will cause an increase in levels of gastrin and insulin absorption enzymes, thus food absorption will increase. getting better which is why the weight of babies who are massaged will increase more than those who are not massaged. Data obtained from BPM Inawati, infants who were given massage from 0-3 months of age had weight gain &gt; 140 grams per week, but there were still many babies who were never given massage. Objective : Knowing the effectiveness of baby massage on increasing baby's weight. The method was Quasi experimental with pretest posttest research type with Control Group Design. The sample in this study was all babies born at BPM Inawati in November-December 2021 as many as 30 people, the sampling technique was the total sample. The results shows that the average baby weight before baby massage was done in the intervention group was 3,276.67 grams and in the control group was 3,511.67 grams. The average baby weight after baby massage in the intervention group was 5,922.33 grams and in the control group was 5,114.33 grams. There is an effectiveness of baby massage on increasing baby's weight (p.value 0.000). The conclusions and suggestions show there is an effectiveness of baby massage on increasing baby's weight (p.value 0.000). It is hoped that health workers, especially midwives, will provide baby massage training for postpartum mothers to do baby massage themselves at home.

Association of serum pepsinogens and gastrin-17 with Helicobacter pylori infection assessed by urea breath test.

BackgroundAssociation of gastric atrophy or cancer with levels of serum pepsinogens, gastrin-17 and anti-Helicobacter pylori IgG antibody have been extensively studied. However, the association of serum pepsinogen and gastrin-17 with H. pylori infection has not been studied in a large population.AimTo investigate the impact of H. pylori infection on serum levels of pepsinogens and gastrin-17.MethodsA total of 354, 972 subjects who underwent health check-ups were included. Serum levels of pepsinogens and gastrin-17 were measured using the enzyme-linked immunosorbent assay. H. pylori infection was detected using 14C-urea breath test (UBT). Multivariable logistic regression analysis was used to investigate the association of serum pepsinogen and gastrin-17 with H. pylori infection.ResultsH. pylori prevalence was 33.18% in this study. The mean levels of pepsinogens and gastrin-17 were higher, while the mean pepsinogen-I/II ratio were lower among H. pylori-positive than -negative subjects. In H. pylori-positive subjects, pepsinogen and gastrin-17 levels correlated positively, whereas the pepsinogen-I/II ratio correlated negatively with UBT values (e.g., the mean serum level of pepsinogen-I in subjects with UBT values in the range of 100-499dpm, 500-1499dpm, and ≥1500dpm was 94.77 ± 38.99, 102.77 ± 43.59, and 111.53 ± 47.47 ng/mL, respectively). Compared with H. pylori-negative subjects, the adjusted odds ratio (aOR) of having pepsinogen-I ≤ 70 ng/mL in the three H. pylori-positive but with different UBT value groups was 0.31 (p<0.001), 0.16 (p<0.001), and 0.08 (p<0.001), respectively; while the aOR of having G-17>5.70 pmol/L was 4.56 (p<0.001), 7.43 (p<0.001), and 7.12 (p<0.001). This suggested that H. pylori-positive subjects with higher UBT values were less likely to have pepsinogen-I ≤70 ng/mL (a serum marker for gastric atrophy), but more likely to have gastrin-17 >5.70 pmol/L (a marker for peptic ulcer).ConclusionsH. pylori-positive subjects with higher UBT values are unlikely to have gastric atrophy, but may have greater risk of severe gastritis or peptic ulcers. Our study suggests that H. pylori-positive patients with high UBT values may benefit the most from H. pylori eradication.

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study

To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen. A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications. There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05). In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.

Efficacy Evaluation of Probiotics Combined with Quadruple Therapy in Treating Helicobacter pylori Infection

To evaluate the efficacy of probiotics combined with quadruple therapy in treating Helicobacter pylori infection, 240 elderly H. pylori-infected patients were recruited and divided equally into control and treatment groups. The control group received quadruple therapy (rabeprazole sodium + colloidal bismuth pectin dry suspension + amoxicillin + clarithromycin), and the treatment group was given additional bifid-triple viable (probiotics composed of Enterococcus, Lactobacillus acidophilus, and Bifidobacterium) capsules orally. The gastric function, inflammatory cytokine levels, gastric mucosa histopathological change scores, clinical symptom scores, clinical efficacy, and adverse reactions were compared between the two groups. Total curative effect rate was higher in the treatment group than the control group. The symptom scores of acid reflux and belching, nausea and vomiting, and epigastric pain were also lower in the treatment group than the control group. Also, the incidence of adverse reactions was lower in the treatment group (20.00%) than the control group (36.67%). Furthermore, the treatment group had higher decrease in gastric mucosa histopathological change scores, gastrin and motilin levels, and interleukin-8, and tumor necrosis factor levels than the control group. In conclusion, probiotics combined with quadruple therapy can suppress release of serum inflammatory cytokines, facilitate digestive function improvement and mucosal healing, elevate H. pylori eradication rate, and reduce therapy-related adverse reactions in H. pylori-infected patients.

Long-term changes in serum gastrin levels during standard dose vonoprazan therapy

Background Long-term acid suppression during vonoprazan therapy causes hypergastrinemia which may induce gastric mucosal changes such as fundic gland and hyperplastic polyps. The aim of this study is to clarify the long-term changes in serum gastrin levels and risk factors for hypergastrinemia. Methods From July 2016 to April 2020, 48 patients receiving vonoprazan 10 mg once daily for more than one year were reviewed. Serum gastrin level was evaluated by radioimmunoassay in a fasting condition (reference range 37–172 pg/ml). Results The baseline median gastrin level was 100 (range, 54–415) pg/ml. The gastrin level over 4 years was 700–1200 pg/ml, which plateaued at 1.5 years. Multivariate analysis revealed factors associated with gastrin levels 12 months after starting vonoprazan and identified severe gastric atrophy as a significant positive risk factor (p = .046). The gastrin level over 4 years in patients with severe gastric atrophy and no atrophy was approximately 900–1500 and 500–1000 pg/ml, respectively. Female gender was also identified as a positive factor, although it was not statistically significant (p = .087). The gastrin level over 4 years in females was approximately 900–1300 pg/ml, greater than in males (500–900 pg/ml). Conclusion A continued increase in gastrin levels was not found during long-term vonoprazan therapy. Severe gastric atrophy is a significant risk factor for hypergastrinemia.