Inactive Gastritis Research Articles

Crystal-Storing Histiocytosis of the Stomach

Abstract Introduction/Objective Crystal-storing histiocytosis (CSH) is an infrequently seen lesion comprised of eosinophilic histiocytes filled with refractile crystalline structures that most often have been characterized as IgG kappa restricted monoclonal immunoglobulins. The etiology for the mechanism of accumulation of the immunoglobulins is incompletely elucidated but numerous mechanisms have been postulated, including overproduction, faulty secretion, and impaired breakdown. Though CSH itself is a benign lesion, it has repeatedly been noted to be a harbinger of a concurrent or developing lymphoproliferative disorder. Literature review revealed a wide age range of presentations with no gender predilection and reports of this lesion occurring most commonly in the bone, kidneys, lungs, lymph nodes, and head and neck region. The gastrointestinal tract is uncommonly involved, with the stomach being the most frequently cited location. Reports of CSH in this setting have noted simultaneous infections with Helicobacter pylori and a range of associated lymphomas. Methods/Case Report We report a lesion from the stomach of a 45 year old female endoscopically described as containing patchy atrophic and nodular mucosa that was biopsied for gastric mapping in a patient with a reported history of autoimmune atrophic gastritis but without confirmatory antibodies on serology. Immunohistochemical stains highlighted a CD68 positive, smooth muscle myosin and cytokeratin negative, population of cells with cytoplasmic kappa positivity. CSH was diagnosed in a background of chronic inactive gastritis of both the antrum and fundus without evidence of H. pylori via staining or associated extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue on biopsy. Recent imaging revealed no concerning lymphadenopathy, lytic lesions, or masses. Results (if a Case Study enter NA) NA Conclusion Increasing pathologists’ awareness of this entity and its potential to be a paraneoplastic lesion is crucial, as further work-up is needed to exclude an underlying hematolymphoid neoplastic process.

Host repair polymorphisms and H. pylori genes in gastric disease outcomes: Who are the guardian and villains?

Gastric cancer (GC) is the fourth-leading cause of cancer-related mortality. The intestinal subtype of GC comes after the cascade of Correa, presenting H. pylori infection as the major etiological factor. One of the main mechanisms proposed for the progression from a more benign gastric lesion to cancer is DNA damage caused by chronic inflammation. Polymorphisms in DNA repair genes can lead to an imbalance of host DNA damage and repair, contributing to the development of GC. From there, we evaluated the risk of polymorphisms in DNA repair system genes in progressive gastric diseases and their association with the H. pylori genotype. This study included 504 patients from two public hospitals in Brazil’s north and northeast regions. The samples were classified into active and inactive gastritis, metaplasia, and GC. Polymorphisms in the DNA repair genes MLH1-93G > A, APE1 2197 T > G, XRCC1 28,152 G > A, MGMT 533 A > G, and XRCC3 18,067C > T were investigated by RFLP-PCR and H. pylori genotype by PCR. Statistical analyses were conducted using EPINFO 7.0., SNPSTAT, and CART software. The XRCC1 (GA) polymorphic allele stood out because it was associated with a lower risk of more severe gastric disease progression. Haplotypes of XRCC1 (GA) associated with some genotypes of MGMT, XRCC3, MLH1, and APE1 also showed protection against the progression of gastric diseases. XRCC3 (CT) showed a decreased risk of gastric disease progression in women, while a risk 1.3x to GC was observed in the MLH1 (A) polymorphic allele. The interaction between H. pylori genes and the host showed that the H. pylori cagE gene was the most important virulence factor associated with a worse clinical outcome, even overlapping with the XRCC1 polymorphism, where the MLH1 polymorphism response varied according to vacA alleles. Our results show the relevance of XRCC1 G > A for genome integrity, sex influence, and interaction between H. pylori virulence factors and XRCC1 and MLH1 genotypes for gastric lesion outcomes in Brazilian populations.

Морфофункциональные изменения СОЖ откормочных свиней при хеликобактериозе

Abstract. The purpose is to study the features of morphofunctional changes in the gastric mucosa of fattening pigs in gastric ulcer disease and to establish a possible correlation between pathological changes and colonization of the gastric mucosa of H. suis. Methods. The study is based on pathoanatomic, microscopic, molecular genetic and histological research methods. Results. In 86 % of cases, significant pathomorphological changes in the gastric mucosa of pigs were detected during a pathoanatomical autopsy. Spiral-shaped microorganisms in smears were found in 28 %, H. suis DNA on the gastric mucosa – in 76 %. In the examined samples in which H. DNA was found. suis in the gastric mucosa, 76.3 % revealed various pathologies in the esophagus, 92% revealed various pathologies on the gastric mucosa. In 24 %, when H. suis DNA was not detected, 33.3 % showed no visible damage and 66.7 % revealed various pathologies. The results of the correlation between morphological changes in the gastric mucosa and its infection with helicobacter reached the limits of statistical reliability. Histological methods revealed that active chronic gastritis was detected in 48.0 %, inactive chronic gastritis was detected in 34.0 % and the norm (almost the norm) was found in 8.0 %. Chronic gastritis during exacerbation was reliably diagnosed in 55.2 % of cases when H. suis DNA was detected on the gastric mucosa. Chronic gastritis during remission was diagnosed in 34.2 % of cases when H. suis DNA was detected on the gastric mucosa. The results presented in the work reflect the undoubted connection between the presence of H. suis and the development of gastritis in pigs.

Clinicopathologic Characterization of Sarcina ventriculi in the Upper Gastrointestinal Tract.

The bacterium Sarcina ventriculi (SV) is rarely identified in the upper gastrointestinal (GI) tract and has been associated with diverse clinical presentations. We aimed to characterize the clinicopathologic features of SV in the GI tract. Seventeen specimens (3 gastrectomy and 14 biopsy specimens) with histologic diagnosis of SV were identified and analyzed. The patients (9 female, 8 male) had a median age of 65 (range 32-86) years. Five (30%) patients presented acutely with GI bleeding or altered mental status. Other relevant symptoms included abdominal pain (n = 6, 35%), diarrhea (n = 4, 24%), dysphagia/dyspepsia (n = 3, 18%), and nausea/vomiting (n = 3, 18%). SV organisms were mainly identified in the stomach (n = 14, 82%), rarely at the gastroesophageal junction (n = 2, 12%), esophagus (n = 2, 12%), or duodenum (n = 1, 6%). Endoscopically, retained food debris was found in 5 of 13 (38%) examined patients. Histologically, the majority of specimens (12 out of 17, 71%) showed mild alterations including reactive gastropathy, inactive gastritis, or reflux (Grade 1). The other 5 specimens (29%) demonstrated erosion, ulcer, necrosis, or perforation (Grade 2). The most commonly associated comorbidities were diabetes mellitus (n = 10, 59%), gastroparesis/outlet obstruction (n = 10, 59%), and gastroesophageal reflux disease (n = 6, 35%). Upon follow-up, 3 (18%) patients with acute phlegmonous gastritis died shortly after gastrectomy. Our case series, the largest reported so far, describes a spectrum of histologic severity associated with SV infection. Diabetes and gastroparesis/outlet obstruction manifested as retained food debris endoscopically are common findings with SV, and may provide a growth medium for this organism and provoke pathogenicity contributing to fatality in acute conditions.

Effect of Histopathological Findings of Gastric Specimens Resected During Laparoscopic Sleeve Gastrectomy on Weight Loss Success: A Retrospective Analysis of 599 Patients.

Even though there aren't enough studies on long-term outcomes, laparoscopic sleeve gastrectomy (LSG)is the most common procedure amongweight loss surgeries. In this study, we aimed to evaluate the histopathological results of resected stomach specimens of patients who underwent LSG and to analyze the effect of histopathological results on weight loss success. The patients were divided into two groups according to histopathological results of the pathology specimens: abnormal (chronic active gastritis, chronic inactive gastritis, neoplasias) and normal. If the excess weight loss percentage (EWL%) values were over 70% at the end of the first year following LSG, the patients were considered successful in terms of weight loss. The groups were compared in terms of age, gender, preoperative body mass index (BMI) value, as well as postoperative first-year BMI, EWL%, total weight loss percentage (TWL%), and successful patient percentage. A total of 599 patients were included in this study. When the patients were dichotomized according to their pathology results as normal or abnormal, 101 (%83.5) of the patients with normal pathology results had EWL% greater than 70%. On the contrary, 356 (74.5%) of the patients with abnormal pathology results had EWL% greater than 70%, and this difference was statistically significant (p=0.038). Patients with normal histopathologic examination results of resected gastric specimens after LSG are more successful than the patient population with abnormal histopathologic results in terms of the percentage of patients with EWL% above 70 at the end of the first postoperative year. We recommend routine histopathologic analysis of gastric specimens after LSG in severely obese patients.

Prevalence of Esophageal Eosinophilia, Eosinophilic Esophagitis, and Lymphocytic Gastritis in Children with Celiac Disease: A Saudi Tertiary Center Experience.

Celiac disease (CD) is an immune-mediated enteropathy that has been associated with other immune-related gastrointestinal disorders, such as eosinophilic esophagitis (EoE) and lymphocytic gastritis (LG). To our knowledge, this is the first study in Saudi Arabia that has described such an association. To evaluate the prevalence of EoE and LG in children and adolescents with CD. This was a retrospective cross-sectional study of all pediatric patients (aged 0-18 years) with CD following up at King Abdulaziz University Hospital, between January, 2014, and December, 2021. The study examined clinical, demographic, endoscopic, and histopathological data. Seventy-five patients with CD were included in the analysis. The median age was 12 years (range, 2-18 years). Male constituted 54.7% of the overall cohort (n = 41). The most common clinical symptoms were short stature (54.7%), weight loss (34.7%), abdominal pain (33.3%), abdominal distension (29.3%), anorexia (29.3%), diarrhea (24%), and vomiting (21.3%). The esophageal biopsy results reported were basal cell hyperplasia in 24 patients (32.9%), esophageal eosinophilia in 23 patients (31.5%), and EoE in 3 patients (4.1%). The gastric biopsy results were normal in 40 patients (53.3%). The most common abnormality was chronic inactive gastritis with no Helicobacter pylori (HP) infection (16%). LG was found in 3 patients (4%). The prevalence of EoE in this cohort of patients with CD was lower than the prevalence recorded in a number of other studies. Further studies are needed to determine the effects of a gluten-free diet (GFD) on EOE and LG.

Russell body gastritis: a case series and review of literature

Abstract Introduction/Objective Russell body gastritis is considered a rare finding characterized by Russell body-containing plasma cells in the lamina propria. Patients typically present with nonspecific findings. In this study, clinical and histopathological features of 3 cases with incidental findings of Russell body gastritis (RBG).<quillbot-extension- portal></quillbot-extension-portal> Methods/Case Report The Epic SlicerDicer tool was used to identify institutional cases between April 2022 to April 2023 using the keyword “Russell Body”. Using the PubMed database, we searched for articles published between January 2003 and April 2023, with the keyword "Russell body gastritis". Studies that described novel RBG cases were included.<quillbot-extension- portal></quillbot-extension-portal> Results (if a Case Study enter NA) The three cases were female with a mean age of 47 (42-51). Two patients were presented with chronic dyspepsia and one patient was being evaluated for right upper quadrant pain. The endoscopic finding for one patient was significant for multifocal erythematous gastric mucosa and the other two patients had unremarkable findings. Biopsies from the three patients revealed active gastritis in 2 cases and inactive chronic gastritis in 1 case. A dense accumulation of plasma cells with Mott cells and Russell bodies were identified in the lamina propria. Helicobacter pylori was identified on H. pylori stain in one case. Upon further investigation, CD138 highlights the plasma cells and kappa and lambda ISH demonstrated polyclonal plasma cells and cytokeratin AE1:AE3 was negative for a carcinoma A review of 64 previously reported cases of RBG shows that the average age of presentation is 63. Half of the cases were associated with Helicobacter pylori infection. Other associated conditions include multiple myeloma (3%) and HIV (6%). There have been 12 cases with monoclonal plasma cells with 10 cases of kappa-type monoclonality (including one case of duodenitis) and 1 case of lambda-type monoclonality.<quillbot-extension-portal></quillbot- extension-portal> Conclusion Most cases of RBG have been linked with helicobacter pylori. However, the underlying etiology is not well understood. Differentials include plasmacytoma, MALToma, and signet ring carcinoma. The clinical significance and its long-term effect remain unknown. Our report is the largest review of RBG. With its wide range of clinical presentations, additional cases are to define this entity better.<quillbot-extension-portal></quillbot-extension-portal>

Helicobacter pylori relationship in cases of coexistence of gastritis and gallbladder disease

Purpose: We aimed to investigate the effect of Helicobacter Pylorii (HP) on the development of gallbladder diseases and cholelithiasis and its relationship with gastritis.
 Methods: 282 gastritis cases with follow-up and operated gallbladder material were included in the study. All histomorphological findings, presence of HP and other variables were compared. Active inflammation and presence of HP were examined in the gastritis group. The gallbladder (GB) disease group was evaluated in terms of cholelithiasis, inflammation, cholesterolosis, intestinal and pyloric metaplasia, and the presence of HP.
 Results: Gallbladder HP (+) was higher in female patients than in male patients. The presence of HP in the GB was significantly higher in patients with cholelithiasis than patients without cholelithiasis. The incidence of HP in the GB was higher in patients with active gastritis than in patients with inactive gastritis. The presence of HP in the GB was found to be higher in patients with HP on gastric biopsy. HP was found to be less in cases without cholesterolosis in the GB (p

The Effect of Helicobacter pylori Density on Serum Vitamin B12 and Folate Levels in Patients With Non-atrophic Gastritis.

Introduction Chronic infection with Helicobacter pylori (Hp) is an essential cause of gastrointestinal pathologies in adults. Despite being a microorganism proven to play a role in vitamin B12 deficiency by causing gastric atrophy, Hp's role in patients with non-atrophic gastritis has not been fully explained. Our study investigated whether the presence and density of Hp is related to vitamin B12 and folate deficiencies in patients with non-atrophic gastritis. Methods This retrospective cohort study analyzed the following parameters, vitamin B12, folate, and mean red blood cell volume (MCV) in the hemogram; these were measured simultaneously in patients diagnosed with non-atrophic gastritiswho had undergone gastroscopy to investigate Hp levels. Patients with conditionsthat could have caused vitamin B12 and folate deficiencieswere excluded from the study. The study included 244 patientswho met the criteria. The Sydney classification was used for histopathologic grading and staging of gastric biopsies of patients with gastritis. Results There was no relationship between the presence and density of Hp with vitamin B12 levels. However, folate levels were significantly lower in Hp-positive patients than in Hp-negative patients (p = 0.017). Folate levels were substantially lower in patients with chronic pan-mucosal gastritis than in patients with chronic inactive gastritis (p = 0.034). Statistically, a significant difference was found between folate levels on the basis of neutrophil activity and inflammation score (p = 0.011 and p <0.001, respectively). Conclusions Although there was no statistically significant relationship between the presence and density of Hp and vitamin B12, our study found an association between folate levels and Hp density. This may be associated with the time for the depletion of vitamin B12 and folate stores and the relatively early stage of gastritis. In cases with vitamin B12 and folate deficiencies, appropriate studies should be performed for specific epidemiological reasons in respective fields.

Predictors of anemia without active bleeding signs in patients referred for endoscopy

Abstract Objective: The objective of the present study is to clarify the value of clinic, endoscopic, and histologic variables that may predict anemia in patients performing esophagogastroduodenoscopy for gastrointestinal complaints in the absence of bleeding signs or lower digestive disease. Methods: This study included 654 patients referred for endoscopy that were divided based on biological parameters performed in the same day in the study group (306 patients diagnosed with anemia) and the control group (348 patients without anemia). Results: Anemia is frequent in elderly patients, especially in the presence of premalignant gastric lesions, and it is associated with multiple comorbidities. In two multivariate regression models antivitamin K oral anticoagulants were found to be independently associated with anemia (p = 0.01), but not with antiplatelet therapy, or with non-antivitamin K anticoagulants. Multiple regression models support that epigastric pain and heartburn are inversely associated with anemia, while weight loss remained an independent predictor for simultaneous anemia and premalignant lesions. Non-infectious chronic gastritis (p&lt;0.001) is an independent predictor for anemia and premalignant gastric lesions, increasing the odds of anemia by 2.2 times, while reactive gastropathy is inversely associated. Gastric erosions and ulcer remained independent predictors for concomitant anemia and premalignant lesions. Conclusions: Chronic inactive gastritis and premalignant gastric histologic lesions are predictors for anemia in endoscopic population, while active H. pylori infection is not. Dyspeptic symptoms, epigastric pain (p&lt;0.001,OR 0.2-0.5) and heartburn (p&lt;0.001,OR 0.07-0.3) are inversely associated with anemia alone or associated with premalignant gastric lesions.

Histopathological Findings in Turkish Patients Undergoing Sleeve Gastrectomy: Is Histopathologic Examination of Sleeve Gastrectomy Specimens Clinically Important?

Sleeve gastrectomy (SG) is a widely used surgical method in the treatment of obesity. This study aimed to reveal the histopathological changes in SG materials and to investigate the prevalence of clinically important lesions requiring follow-up. Three hundred five patients' data who underwent SG were analyzed. Cases were divided into three groups as normal, chronic inactive gastritis (CIG), and chronic active gastritis (CAG). Age, gender, and body mass index (BMI) of the three groups and the differences in the gastritis parameters of CIG and CAG groups were compared. Thirty-three patients (10.8%) were in the normal group, 145 (47.5%) were in the CIG group, and 127 (41.6%) were in the CAG group. Preoperative endoscopic examination was performed in all cases, but Helicobacter pylori (HP) treatment was not applied. HP were detected in 39.3%, atrophy in 3.9%, intestinal metaplasia (IM) in 4.9%, and lymphoid follicle (LF) in 30% of the cases. Inflammation, atrophy, IM, LF, and HP were significantly higher in the CAG group. The proton pump inhibitor (PPI)-related changes were seen in 20 cases and it was more frequent in the CIG group. Intramucosal signet ring cell carcinoma was detected in 1 case. Endocrine cell hyperplasia and dysplasia were present in 7 cases with CAG. Multiple grade 1 neuroendocrine tumors were detected in just 1 case. In our SG specimens, HP and clinically important lesions were significantly higher in the CAG group. Pathological examination should be carefully done as the lesions detected in SG specimens can change patient management.

Diagnostic Testing Accuracy for Helicobacter pylori Infection among Adult Patients with Dyspepsia in Cuba's Primary Care Setting.

Evidence of the effectiveness of the tests used to diagnose Helicobacter pylori (H. pylori) in primary healthcare is limited. This cross-sectional study aims to assess the accuracy of tests used for to diagnose H. pylori infection in primary care patients and its relationship with gastroduodenal pathologies. Over 12 months, 173 primary care patients with dyspeptic symptoms were referred for upper gastrointestinal endoscopy to obtain gastric biopsies, and venous blood was extracted from them. H. pylori infection was detected using a rapid urease test (RUT), real-time polymerase chain reaction (RT-PCR), H. pylori-IgG ELISA, and Western blot (WB). The culture and histological findings were used as the reference standard for H. pylori infection. H. pylori prevalence was 50%. There were no significant differences between men and women overall or by age group. The presence of H. pylori was associated with chronic moderate gastritis and its absence with chronic inactive gastritis, as well as the combination of gastritis and gastric lesions (p < 0.05). RUT and ELISA H. pylori -IgG tests showed the highest overall performance (accuracy 98.9% and 84.4%), followed by WB and RT-PCR (accuracy 79.3% and 73.9%). These findings support the notion that combined invasive and noninvasive methods, such as RUT and H. pylori-IgG ELISA, can be a primary diagnostic screening tool for detecting H. pylori among adult dyspeptic patients in Cuba's primary care setting.

Helicobacter pylori infection: A balance between bacteria and host

In Argentina, despite the important studies conducted on the prevalence of infection and the antibiotic resistance of Helicobacter pylori, there are no reports simultaneously analyzing a profile of virulence factors of the bacterium and polymorphisms in cytokine genes in patients with different alterations in the gastric mucosa (including intestinal metaplasia, IM). Our aim was to evaluate H. pylori genotypes in 132 adult patients with chronic gastritis presenting three different histological findings (inactive chronic gastritis, active chronic gastritis IM− and active chronic gastritis IM+) along with SNP-174 G>C in the IL-6 gene. cagA, vacA and babA2 genes were analyzed by multiplex PCR. The -174 G>C SNP IL-6 gene was analyzed by PCR-RFLP. Patients with active chronic gastritis IM+ showed the highest proportion of the cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG and cagA(+)/vacAm1s1/babA2(+)/IL-6GG combinations (p<0.05). There was 4-5 times greater probability of finding patients presenting the GG genotype for SNP-174 G>C IL-6, which in turn were infected with the most virulent H. pylori genotypes -cagA(+), cagA(+)/vacAm1s1 and cagA(+)/vacAm1s1/babA2- in the ACGIM+ group in comparison to the ICG group. Our results provide regional data to the idea that the transition towards severe alterations in the gastric mucosa would be the result of a balance between specific factors of H. pylori and inherent host factors. This fact can be useful to identify patients at greater risk and to select those individuals requiring appropriate eradication treatment to prevent progression to gastric cancer.

Endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without Helicobacter pylori infection: a retrospective observational study

BackgroundThe endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type have not been fully investigated in relation to Helicobacter pylori infection status. We compared the morphology, color, and location of these lesions between patients with and without H. pylori infection.MethodsWe retrospectively enrolled 165 patients (180 lesions) from 10 institutions. We divided the patients into the (i) Hp group (patients with current H. pylori infection [active gastritis, n = 13] and those with past infection [inactive gastritis, n = 76]) and (ii) uninfected group (H. pylori-uninfected patients, n = 52). We compared the clinical and endoscopic features of the two groups. We also performed an analysis between (i) lesions with atrophy of the surrounding gastric mucosa (atrophy group) and (ii) lesions without atrophy of the surrounding gastric mucosa (non-atrophy group).ResultsThe average age was older in the Hp group than in the uninfected group (68.1 ± 8.1 vs. 63.4 ± 8.7 years, p < 0.01). Although the difference was not statistically significant (p = 0.09), multiple lesions were observed in 9 of 89 patients (10.1%) in the Hp group and in only 1 of 52 patients (1.9%) in the uninfected group. Meanwhile, significant differences were observed in the prevalence of lesions located in the gastric fornix or cardia (uninfected group: 67.3% vs. Hp group: 38.0%, p < 0.01), with an elevated morphology (80.0% vs. 56.0%, p < 0.01), with a subepithelial-like appearance (78.2% vs. 42.0%, p < 0.01), and with a color similar to that of the peripheral mucosa (43.6% vs. 25.0%, p = 0.02). The male-to-female ratio, lesion size, and presence or absence of vascular dilatation or black pigmentation on the surface were not different between the two groups. In the analysis comparing lesions with and without mucosal atrophy, the prevalence of multiple lesions was significantly higher (p = 0.02) in the atrophy group (5/25 patients, 20.0%) than in the non-atrophy group (7/141 patients, 5.0%).ConclusionsThe endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without H. pylori infection.

Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis.

Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.

Histopathological findings in laparoscopic sleeve gastrectomy specimens: Are pathological examinations necessary?

Objective: The objective of this study is to determine the prevalence of gastric histopathological findings in patients who underwent laparoscopic sleeve gastrectomy (LSG) in our hospital and to add more data to the published literature on the characteristics of the resected LSG samples. Material and Methods: The pathology reports of the patients were retrospectively analyzed to identify all patients with consecutive morbidly obesity who underwent LSG from January 2015 to December 2019. All patients underwent gastroscopy in the preoperative period. Results: The study analyzed 800 patient reports. No specific pathological finding was observed in 230/800 (28.75%) of the patients, which was reported as normal. Specific pathological findings were present in 570 (71.25%) patients. Cases of chronic inactive gastritis (400 patients [50%] ), chronic active gastritis (134 patients [16.7%] ), intestinal metaplasia (2 patients [0.2%] ), low-grade dysplasia (1 patient [0.12%] ), stromal tumor (7 patients [0.87%] ), Neuroendocrine (NE) cell hyperplasia (7 patients [0.87%] ), fundic gland polyps (3 patients [0.37%] ), granulomatous gastritis (1 patient [0.12%] ), acute gastritis (1 patient [0.12%] ) and ectopic pancreas (1 patient [0.12%] ) were recorded. Conclusion: Surgeons should be aware of the high unexpected histopathological prevalence in bariatric patients. Although our study did not find any malignant pathological result, we believe that routine postoperative pathological examination and preoperative endoscopy are necessary for medicolegal reasons.

Expression of let-7a, miR-106b and miR-29b is changed in human gastric cancer.

MicroRNA (miRNA) are small, noncoding RNA sequences that post-transcriptionally regulate the proliferation, activity and apoptosis of human gastric cancer cells by controlling various signaling cascades. Processes that involve miRNA molecules can create a specific network of interactions in a cell, and disruption of its functioning may contribute to the transformation of normal cells into cancerous cells. Aims of our survey were: 1) study the relationship between the expression of selected miRNA types (let-7a, miR-106b, miR-29b, miR-21, miR-155, miR-222) in the gastric mucosa and pathomorphological changes determined by classical histopathological methods, 2) perform in silico analysis to select target genes for selected miRNAs and to perform functional analysis of these genes. Eighty-three subjects (45 women, 38 men; mean age 39±14 years, range: 21-80 years, were examined). Among them were 18 (21.5%) patients with chronic active gastritis, 42 (50.6%) people with chronic inactive gastritis, 9 (10.8%) patients with gastric cancer and 14 (16.9%) patients without histopathological changes. The study demonstrated that mainly the expression of 3 (miR-29b, let-7a miR-106b) out of 6 selected miRNAs are significantly different depending on the site of biopsy (body of the stomach or antrum) and the group of patients. Expression of miR-106b in the antrum and body was the highest in the group of cancer patients and the lowest in patients with chronic active gastritis. The expression of let-7a differed depending on group of patients and location. The highest expression was in the body in the group with inactive gastritis and the lowest in gastric cancer. Patients with cancer had the lowest expression of miR-29b in stomach body and it was the highest in the patients with inactive gastritis in this location. Expression of miR-21 and miR-155 determinations were not statistically significant in comparison to groups or locations, and of miR-222 was not different between the groups, but only in the control group was higher in the antrum than in the body. We conclude that identification of miRNAs may represent a promising modern complementary method in the diagnosis of gastric diseases, especially cancer.

Fecal calprotectin levels used as a noninvasive method for screening for chronic gastritis in pediatric patients. A descriptive study.

Gastritis consists of inflammation of the gastric mucosa and is one of the main causes of dyspeptic symptoms in children. To investigate the presence of inflammation by evaluating fecal calprotectin (FC) in children diagnosed with chronic gastritis. Descriptive study in Pediatric Gastroenterology Department of Ondokuz Mayis University Hospital in Turkey. Between January 2016 and July 2018, FC levels were compared retrospectively in children with chronic gastritis (histopathology-based diagnosis), patients with inflammatory bowel disease (IBD) and healthy children. A total of 67 chronic gastritis patients (61.2% girls) with a mean age of 13.09 ± 3.5 years were evaluated. The mean FC levels were 153.4 μg/g in the chronic gastritis group, 589.7 μg/g in the IBD group and 43.8 μg/g in the healthy group. These levels were higher in chronic gastritis patients than in healthy individuals (P = 0.001) and higher in IBD patients than in the other two groups (P < 0.001). The FC level in the patients with chronic active gastritis (156.3 μg/g) was higher than in those with chronic inactive gastritis (150.95 μg/g) (P = 0.011). Among the patients with chronic active gastritis, the FC level was significantly higher in Helicobacter pylori-positive individuals than in negative individuals (P = 0.031). We confirmed the association between increased FC and chronic gastritis. Elevated FC levels may be seen in patients with chronic active gastritis. In order to be able to use FC as a screening tool for chronic gastritis, further studies in a larger study group are needed.

H. pylori Pattern Gastritis with Negative Helicobacter Immunohistochemical Stain: Does A Specific Comment in Pathology Report Impact Clinical Management?

Abstract Introduction/Objective The clinical significance of H. pylori (HP) pattern of gastritis with a negative Helicobacter IHC stain on gastric biopsy is unclear. Some pathologists report this pattern in cases that are highly suggestive of HP infection with a comment raising the possibility of HP infection; however, the subsequent clinical management of these patients has not been well described. Methods/Case Report We conducted a retrospective comparison study of patients with gastric biopsy between 2016 and 2019. Group 1 included patients with chronic active or chronic inactive gastritis and negative HP IHC with a comment stating the gastritis pattern is suggestive of HP. Group 2 included patients with chronic active or chronic inactive gastritis and negative HP IHC with no comment about HP pattern. Results (if a Case Study enter NA) We identified 60 patients in Group 1 which were compared to 63 patients in Group 2. Group 1 more frequently had history of HP (48.3% vs. 29.1%, p&amp;lt;0.05). After diagnosis, Group 1 more frequently received treatment (51.7% vs. 20.6%, p&amp;lt;0.001). Of those who received treatment, Group 1 more frequently received HP treatment (triple or quadruple therapy; 21.7% vs. 1.6%, p&amp;lt;0.001). History of HP did not affect whether a patient was treated (p&amp;gt;0.05). Following post-biopsy HP treatment, more patients in Group 1 received fecal antigen test (23.7% vs. 5.5%, p&amp;lt;0.01). Age, gender, NSAID and PPI use did not differ between groups. Conclusion Adding the diagnostic comment raising the possibility of HP for patients with HP pattern gastritis with negative HP IHC changes clinical management and it is independent of patients’ prior HP history.

S2749 A Rare Cause of Liver Cirrhosis and Gastritis: Primary Gastrointestinal Amyloidosis in a Patient With Multiple Myeloma

Introduction: The most common form, systemic amyloidosis, is characterized by production of amyloidogenic precursor proteins at a site, remote from the organs of amyloid deposition. Case Description/Methods: A 65-year old male with a 25 year history of chronic alcoholism, presented to the emergency department for a 2 week history of non-radiating right upper quadrant abdominal pain associated with pruritus, nausea, coffee ground emesis, and clay colored stools. The exam was notable for icteric sclera, right upper quadrant abdominal tenderness, ascites, and hepatomegaly. Initial work up revealed new onset unexplained elevated liver enzyme. Abdominal Ultrasound was significant for hepatomegaly with perihepatic ascites. The CT scan revealed diffuse liver cirrhosis, periportal lymphadenopathy, and stigmata of portal hypertension including hepatosplenomegaly, intra-abdominal ascites, and varices. Esophagogastroduodenoscopy with endoscopic ultrasound was performed, which showed gastritis, and enlarged porta hepatis, which was ultimately biopsied and sent for cytology and pathology. Given the unexplained elevation of the liver enzymes, and liver biopsy revealed extracellular amyloid deposition in peri-sinusoidal spaces consistent with amyloidosis. Transesophageal echocardiogram which raised suspicion for cardiac involvement with amyloid deposit. Immunoglobulin levels were subsequently investigated and showed elevated IgG antibodies. A K/L free ratio was elevated to 94.7. A myeloma flow cytometry exhibited an IgG kappa monoclonal-gammopathy. Finally, a CT-guided bone marrow biopsy from the iliac crest was obtained, confirming an IgG kappa multiple myeloma with 80% proportion of plasma cells (DS 2A, ISS 3). The patient was started on steroids, and chemotherapy with daratumumab, however his condition was complicated by septic shock, which led to an admission in the ICU followed by endotracheal intubation and multi-organ failure and eventual palliative care. Discussion: Localized GI and hepatic amyloidosis have rarely been described in the literature. This condition poses great diagnostic challenges and warrants extensive work up before definitive diagnosis. Our case highlights the importance of clinical suspicion of GI amyloidosis in patients with constitutional symptoms including fatigue, weight loss, and unexplained liver disease. Once amyloidosis is considered, the diagnosis can be obtained by tissue biopsy from either the GI tract or subcutaneous adipose tissue.Figure 1.: CT scan (A-B) showing hepatosplenomegaly, and peri-splenic varices (arrowheads). Pathologic findings (C-G) of AL type amyloidosis of the luminal gastrointestinal tract. C. Histologic examination (Hematoxylin-Eosin staining) of a gastric antral type mucosa with chronic inactive gastritis and interstitial deposition of pink amorphous material (white asterisk). Histologic examination of liver with amorphous material deposition: Hematoxylin-Eosin staining (black asterisk in D-E), and crystal violet staining (G). F. Vascular wall are almost always involved first in the systemic amyloidosis (Hematoxylin-Eosin staining).