Serum Gastrin Levels Research Articles

Distinct Features of Autoimmune Gastritis in Patients with Open-Type Chronic Gastritis in Japan

In Asia, the incidences of Helicobacter pylori infection and gastric cancer are high, but their association with autoimmune gastritis (AIG) is unclear. This was a retrospective cohort study of patients endoscopically diagnosed with chronic gastritis between 2005 and 2017. AIG was diagnosed according to anti-parietal cell antibody positivity. Laboratory, histological findings, and gastric cancer incidence were compared between AIG and non-AIG patients. The AIG group had more females and a higher rate of thyroid disease. Serum levels of gastrin were significantly higher in AIG patients (mean 1412 and 353 pg/mL, p < 0.001). The endoscopic findings included a significantly higher percentage of corpus-dominant atrophy in AIG (31.67%) than in non-AIG (7.04%) patients (p < 0.001). Clusters of ECL cells were observed in 28% of AIG patients and 7% of non-AIG patients (p = 0.032). The cumulative incidence of gastric cancer at 5 and 10 years was 0% and 0.03% in the AIG group and 0.03% and 0.05% in the non-AIG group, and no significant difference in gastric cancer incidence was observed. Despite significant differences in gastrin levels between AIG and non-AIG patients, there was no evidence of an impact of AIG on the incidence of gastric cancer.

S2939 A Not so Common Finding of Dyspepsia

INTRODUCTION: Dyspepsia is a common symptom that around 20% of the population has one time or another developed. Of those who complain of this symptom, most do not seek medical care and of those that are referred for evaluation, 75% have no organic cause for their symptom. Of the most common findings, peptic ulcer disease, drug-induced dyspepsia or biliary source are a few causes of dyspepsia. However, less commonly gastric malignancy has been discovered as a potential cause as shown in this case. With the rise in incidence due to awareness and detection, suspicion should also be kept even with a nonspecific symptom of dyspepsia. CASE DESCRIPTION/METHODS: 51 year old female with obesity, hypertension and diabetes was evaluated for dyspepsia and reflux. The last year the patients symptoms have progressively worsened despite diet modifications and proton pump inhibitor twice daily. She denied any weight loss or abdominal pain, no dysphagia or intractable vomiting. She was referred for endoscopic evaluation as an outpatient. On EGD >10 nodules less than 1cm in size were discovered mostly in the body of the stomach. There was also a single, dominant mass 2.5 cm in diameter that was resected. Pathology returned as well-differentiated gastric neuroendocrine tumors with a low KI-67 labeling index <3% and immunostain for chromogranin was positive. Separate mucosal biopsies showed chronic active H. pylori gastritis and findings consistent of autoimmune/atrophic gastritis. Fasting gastric pH testing gave an esophageal pH of 6.9 and gastric pH of 6.5, helping to confirmed the diagnosis of type 1 gastric neuroendocrine tumor (NET). Labs showed an elevated gastrin level 2,288 pg/mL, vitamin B12 level 144 pg/mL and chromagranin A level of 1,141 ng/mL. Staging was done with a 68Ga-Dotatate PET/CT that showed focal uptake in the body of the stomach but no other uptake. Lastly, she was started on therapy with octreotide acetate LAR depot 20 mg monthly and intramuscular vitamin b12 injection. DISCUSSION: Gastric NETs has seen a steady rise of incidence as reported to NIH SEER program. With increased awareness, better detection rate during upper endoscopy and classification systems in place, better understanding and treatment modalities are available. Gastric NET is characterized by type 1, 2 and 3 and differentiated by tumor features, gastric pH and serum gastrin level among other things. From this it allows us to determine the risk of metastasis, 5-year survival and treatment modalities that are best suited for each disease.Figure 1.: Single nodule was noted in the antrum during upper endoscopy.Figure 2.: Retroflexed view of body of the stomach with several gastric nodules of multiple sizes. Loss of rugae folds in the body of stomach.Figure 3.: Solid, dominant mass large than 2 cm in the body of the stomach.

S2202 Post-Surgical Presentation of Zollinger–Ellison Syndrome Following Resection of Endometrioid Neuroendocrine Tumor

INTRODUCTION: Zollinger–Ellison syndrome (ZE) may present as lymph node metastases at initial presentation. Here we report a case of ZE following resection of endometrioid small cell neuroendocrine carcinoma and endometrioid adenocarcinoma. CASE DESCRIPTION/METHODS: A 76-year-old Caucasian female presented with heavy vaginal bleeding. CT scan revealed an enlarged uterus measuring 6.2 × 5.4 cm. The patient underwent uneventful laparoscopic hysterectomy with bilateral salpingo-oophorectomy and bilateral sentinel lymph node dissection. Pathological examination demonstrated stage IB mixed endometrioid adenocarcinoma and small cell neuroendocrine carcinoma. Gastrin immunostaining was negative. The patient presented three months after completing chemotherapy (one month following radiation treatment with brachytherapy) with black stool in addition to watery diarrhea for more than 6 months. The patient denied taking aspirin or nonsteroidal anti-inflammatory drug and was not taking a proton pump inhibitor (PPI). Esophagogastroduodenoscopy (EGD) demonstrated multiple non-bleeding superficial gastric ulcers with clean ulcer bases (Forrest Class III) in the antrum and prepyloric region. No ulcers were identified in the duodenum. An elevated serum gastrin level (538 pg/mL) was noted the day after EGD while not on PPI therapy. Somatostatin receptor-based imaging (Ga-68 Dotatate- PET/CT) revealed avid left paraesophageal node uptake measuring 11 × 8 mm. Stool helicobacter pylori antigen test was negative. Serum calcium (9.2 mg/dL), renal function and PTH were within normal limits. After five months, follow up EGD demonstrated two persistent (2-3 mm) clean based ulcerations in the posterior gastric wall. Gastric fluid demonstrated pH of 1 despite Pantoprazole 40 mg twice a day for 4 months. Endoscopic ultrasound examination demonstrated an ill-defined 14 × 7 mm heterogenous lymph node in the region of the lymph node noted on PET scan, which was sampled by fine needle aspiration, revealing scant lymphoid tissue insufficient for pathologic diagnosis. DISCUSSION: Here the diagnosis of ZE was based on a combination of persistent gastric ulcerations in the presence of elevated serum gastrin, gastric pH < 2, and somatostatin receptor-based imaging, despite our being unable to identify a primary lesion. Our case illustrates the importance of utilizing multiple modalities in establishing a presumptive diagnosis of ZE.Figure 1.: Multiple clean based ulcers in the gastric antrum and prepyloric region.Figure 2.: Persistent clean based ulcerations in the gastric antrum.Figure 3.: Left paraesophageal node uptake (Ga-68 Dotatate- PET/CT).

S2948 Long-Term Proton Pump Inhibitor-Induced Gastric Microcystic Glandular Changes Leading to Gastric Wall Thickening

INTRODUCTION: Long term (LT) proton pump inhibitor (PPI) induced gastric microcystic glandular mucosal changes could lead to significant gastric wall thickening which must be further evaluated to exclude underlying neoplastic process. CASE DESCRIPTION/METHODS: An 81-year-old male with GERD and Barrett’s esophagus (BE) on chronic omeprazole 40mg BID was evaluated by endoscopic ultrasound (EUS) for 1cm gastroesophageal junction (GEJ) sub epithelial lesion (SEL) seen on EGD and thickened gastric mucosa (2.6 cm) normalizing just proximal to GEJ identified on an otherwise negative CT abdomen done to evaluate for epigastric pain. EGD showed irregular carpet-like thickened gastric folds with cobble stoning sparing the gastric antrum. EUS showed a small cystic SEL at GEJ and marked diffuse thickening of gastric body mucosa (16 mm) with intact muscularis propria and absence of regional lymphadenopathy. Endoscopic biopsies revealed no H. pylori but gastric mucosa with microcystic glandular changes consistent with gastric mucosal trophic changes secondary to chronic PPI use. Due to BE however, patient was continued on PPI. DISCUSSION: PPIs remain the cornerstone for GERD treatment. Adverse effects from inappropriate PPI use are more clinically manifested in the elderly population. These include drug-drug interactions and increased risk of LT PPI adverse effects on digestive and extra-digestive organs (such as dementia, decreased bone density, and community acquired pneumonia). LT PPI use can lead to fundic gland polyp formation, small intestinal bacterial overgrowth, and collagenous colitis. Gastric trophic changes were found to occur secondary to LT PPI use in the form of parietal cell protrusion into the gastric lumen and fundic gland polyp formation resulting from increased serum gastrin level. Hypertrophic changes due to LT PPI induce gastric mucosal changes that can be appreciated endoscopically as gastric cobblestone-like lesions (GCLL). Sparing of the antrum in our patient of such changes can be explained by parietal cells being anatomically present in gastric fundic glands located primarily in the gastric fundus and body. Histopathology of gastric biopsies in these cases show fundic microcystic glandular change, parietal cell hyperplasia, and cytoplasmic vacuolation. A gastroenterologist should be familiar with such changes due to LT PPI use and, yet, must biopsy the gastric mucosa to exclude any underlying gastric infiltrative and neoplastic process.Figure 1.: Endoscopic view of gastric corpus showing thickened folds, carpet like polypoid lesions.Figure 2.: Radial EUS showing markedly thickened gastric mucosa and intact muscularis propria.Figure 3.: Histopathology of gastric corpus biopsies showing microcystic glandular conformation.

Effects of early oral feeding after radical total gastrectomy in gastric cancer patients.

BACKGROUNDGastric cancer (GC) is a heavy burden in China. Nutritional support for GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIMTo prospectively explore the safety, feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODSThis study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given early oral feeding (EOF group) after surgery, and the other 101 patients were given the traditional feeding strategy (control group) after surgery. Perioperative clinical data were recorded and analyzed. The primary endpoints were gastrointestinal function recovery time and postoperative complications, and the secondary endpoints were postoperative nutritional status, length of hospital stay and expenses, etc.RESULTSCompared with the control group, patients in the EOF group had a significantly shorter postoperative first exhaust time (2.48 ± 1.17 d vs 3.37 ± 1.42 d, P = 0.001) and first defecation time (3.83 ± 2.41 d vs 5.32 ± 2.70 d, P = 0. 004). In addition, the EOF group had a significant shorter postoperative hospitalization duration (5.85 ± 1.53 d vs 7.71 ± 1.56 d, P < 0.001) and lower postoperative hospitalization expenses (16.60 ± 5.10 K¥ vs 21.00 ± 7.50 K¥, P = 0.014). On the 5th day after surgery, serum prealbumin level (214.52 ± 22.47 mg/L vs 204.17 ± 20.62 mg/L, P = 0.018), serum gastrin level (246.30 ± 57.10 ng/L vs 223.60 ± 55.70 ng/L, P = 0.001) and serum motilin level (424.60 ± 68.30 ng/L vs 409.30 ± 61.70 ng/L, P = 0.002) were higher in the EOF group. However, there was no significant difference in the incidence of total postoperative complications between the two groups (P = 0.507).CONCLUSIONEarly oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function, improve postoperative nutritional status, reduce length of hospital stay and expenses while not increasing the incidence of related complications, which indicates its safety, feasibility and potential benefits for gastric cancer patients.

Influence of hypergastrinemia secondary to long-term proton pump inhibitor treatment on ECL cell tumorigenesis in human gastric mucosa

Proton pump inhibitor (PPI) therapy causes hypergastrinemia, which could promote the development and progression of neuroendocrine tumors (NETs). Concerns have been raised about the safety of long-term PPI use due to a possible increased risk of NETs. This study aimed to investigate the association between hypergastrinemia and the risk of NETs. Twenty outpatients presenting with serum gastrin levels greater than 400 pg/mL after long-term PPI treatment were registered in this study. Immunohistochemical analyses for chromogranin A (CgA), Ki67, gastrin and CCK/B gastrin receptor (CCKBR) were performed, and positive cell numbers were counted. There were no NET or gastric epithelial neoplasia cases observed among any of the 20 patients examined throughout the PPI treatment period. Histologically, ECL cell hyperplasia were shown in all patients. However, no relationship was found between serum gastrin levels and the number of CgA positive ECL cells. There was also no relationship between serum gastrin levels and the proportion of Ki67 positive cells or the density of CCKBR positive cells. The data indicate no relationship may exist between NETs and hypergastrinemia secondary to PPI treatment in patients having no, or mild, atrophic gastritis.

A Comparison of Baseline Clinical Characteristics of Autoimmune Gastritis Patients with and without Type-1 Gastric Carcinoid Tumor

Objectives : Autoimmune gastritis (AIG) is an antibody-mediated autoimmune disease and characterized by gastric parietal cell loss. Type-1 gastric carcinoid tumor (GCT) is a disease that mostly develops on the basis of AIG. The aim of this study is to determine similarities and differences of baseline clinical parameters between these two disorders.&#x0D; Methods: Patients diagnosed as AIG both without gastric carcinoid tumor (n:197) and with GCT (n:40) between 2004 and 2015 at Ankara University Faculty of Medicine, Department of Gastroenterology, were included in this analysis. Data of initial signs and symptoms, basal blood count-anemia parameters, laboratory investigations, serum gastrin levels, anti parietal cell antibody (APCA) status, serological helicobacter pylori (Hp) markers and serum chromogranine A (CgA) levels of patients were obtained, and baseline parameters of these disorders were compared&#x0D; Results: Patient groups were similar in age and gender. Hemoglobin, iron, total iron binding capacity (TIBC), ferritin, vitamin B12 levels, APCA and HpIgG positivity rates and concomitant autoimmune thyroid disease prevalence were also similar. Median gastrin level in AIG+GCT patients was significantly higher compared to the AIG without GCT (807 vs. 1307 pg/ml; p:0.006). ROC analysis revealed that a 1000 pg/ml threshold value for serum gastrin level is able to distinguish these two disorders with 65% sensitivity and 65% specificity rates (area under the curve: 0.65;p:0.006). The serum CgA level did not significantly differ between patient groups.&#x0D; Conclusion: High serum gastrin but not CgA levels may be useful in deciding which patients should be followed closely in AIG.

Tu1503 ENDOSCOPIC AND HISTOLOGICAL CHARACTERISTICS OF NEW GASTRIC FINDINGS THAT APPEARED WITH STRONG ACID SECRETION SUPPRESSOR (P-CAB).

Since the number of H.pylori-infected persons decreases rapidly, it is expected that acid-related diseases will continue to increase in Japan. The need for gastric acid secretion suppressors is expected to increase in the future. There are several known gastric findings associated with the use of conventional proton pump inhibitors (PPIs). However, there are no reports of gastric findings associated with the use of potassium competitive acid blocker (P-CAB) a more potent gastric acid secretion suppressor. This time we found a new gastric finding associated with the use of P-CAB. This gastric finding is white granular findings with slight elevation similar the White Glove Appearance (WGA) which is known as gastric cancer cases. Since we named this finding White Granule with Small Elevation (WGSE), we introduce WGSE of this finding with endoscopic and histological analysis. <Case 1> A 57-year-old woman was given esomeprazole (EPZ) 20 mg / day and steroid for eosinophilic gastroenteritis. When esomeprazole was changed to Vonoprazan (VPZ) 20 mg / day because erosive gastritis was apparent by endoscopy, WGSE was observed in the gastric fundic gland area. WGSE worsened with continuing VPZ and the dose was reduced to 10 mg / day. Then WGSE gradually decreased and finally disappeared when medicine was changed to famotidine 40 mg / day. <Case 2> A 75-year-old woman was started on VPZ 20 mg for severe reflux esophagitis and maintenance therapy was performed at 10 mg / day. WGSE was observed in the gastric fundic gland area. The change to EPZ 20mg / day is being considered if symptoms are stable in the future. The WGSE histological findings were so similar the WGA observed in gastric cancer cases. Its characteristic finding showed a cystic dilated duct with accumulated gastric secretions. It could be detected WGSE under only continuous P-CAB use, not observed when using PPI. In addition, WGSE decreased with tapering of P–CAB. WGSE were completely disappeared with the change to H2 receptor antagonist. Therefore, we consider that WGSE is to be a specific change with continued use of P-CAB. Previous reports have said that WGA is sometimes observed in autoimmune gastritis with hypergastrinemia, so we have been believed that hypergastrinemia due to strong gastric acid suppression is the most important cause of WGSE. The highest serum gastrin levels of our cases were 1,750 pg/ml and 4,500 pg/ml, those were markedly high level. Although hypergastrinemia occurs with continued PPI use too, no WGSE has been reported. In other words, it is thought to be a gastric finding peculiar to continued use of P-CAB with severe hypergastrinemia. When using P-CAB in the future, it is necessary to pay attention to the appearance of WGSE. Our study found WGSE, the first stomach finding that was especially apparent when using P-CAB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

MON-339 Secondary Hyperparathyroidism Due to Decrease 1 Alpha Hydroxylase Activity

•Our patient is a 63-year-old African American female with medical history significant for hypertension, class 1 obesity, osteoarthritis of knees who initially presented to the adult ambulatory clinic on 9/19/2013 with complaints of body aches and bone pain. Labs were remarkable for a serum calcium level of 9.8 mg/dl, serum phosphorous of 4.7 mg/dl, and serum parathyroid hormone level of 166 pg/ml (15-65 pg/ml), normal GFR and serum vitamin 25-OH D of 62. A DEXA scan was performed which showed mild osteopenia wof 1.0 (0.8-1.8), serum 1,25 - OH vitamin D of <8 pg/ml, normal alpha and beta carotene level, negative endomysial antibodies and normal magnesium level. A diagnosis of secondary hyperparathyroidism with unclear etiology was made. Same treatment was continued and a follow up in 3 months with repeat labs was advised. Repeat PTH went up to 281pg/ml but serum calcium and phosphate remained normal. Based on normal serum 25 OH vitamin D and low 1, 25 OH vitamin D, patient was started on calcitriol 0.25 mg daily. On next follow up in 3 months PTH decreased to 203pg/ml and 1, 25 OH vitamin D level normalized (35pg/ml). MEN was excluded with normal serum free metanephrine and gastrin levels. On subsequent visits DEXA scan normalized and PTH further trended downward to 101.7 pg/ml. Patient was discharged from endocrine clinic back to the PCP. • •Patient continued to follow up in adult medicine clinic but calcitriol fall off of patient’s medication list likely due to an error. Patient was off of calcitriol for 6 months but continue to take calcium vitamin D.PTH trended up to 186pg/ml and then to 350pg/ml. A referral to endocrinology was made again and a parathyroid sestamibi scan was obtained which did not reveal any abnormal uptake. Serum calcium, phosphate, magnesium and vitamin OH 25 vitamin D remained normal. •Patient was started back on calcitriol 0.5 mg daily and PTH again started to trend downward. The last PTH was down to 82 on March 20th 2019 with normal serum calcium, phosphate, magnesium and eGFR. The final diagnosis was secondary hyperparathyroidism due to decrease 1 alpha hydroxylase activityith a T score of −1.5 at left forearm. A diagnosis of primary hyperparathyroidism was made by the PCP and patient was started on calcium vitamin D and Fosamax and was referred to endocrinology for further evaluation. • •Further testing in the endocrine clinic revealed 24-hour urine calcium of 49 mg (100-300) and urine creatinine. This case report concludes that low 1-alpha hydroxylase activity should be considered as a cause of secondary hyperparathyroidism in a patient with normal GFR and 25-OH vitamin D level

Effect of herb-partitioned moxibustion at fanwei point on plasma motilin and serum gastrin in patients of diabetic gastroparesis

To explore the clinical therapeutic effect of herb-partitioned moxibustion at fanwei point in patients of diabetic gastroparesis differentiated as spleen and stomach deficiency and retention of turbid dampness as well as its effect mechanism. A total of 134 patients with diabetic gastroparesis were randomized into an observation group and a control group, 67 cases in each one. In the observation group, herb-partitioned moxibustion at fanwei point was adopted, 40 min each time, once a day for 5 times a week. In the control group, itopride hydrochloride tablets were prescribed for oral administration, 50 mg each time, three times a day. A total of 6 weeks of treatment was required in the two groups. Before and after treatment, the gastroparesis cardinal symptom index (GCSI) scores, 4-hour gastric emptying rate, TCM symptom score, as well as the levels of plasma motilin and serum gastrin were observed in the patients of the two groups. Additionally, the clinical therapeutic effect was evaluated in the two groups. After treatment, the score of every item of GCSI, TCM symptom scores and the levels of plasma motilin and serum gastrin were all reduced as compared with those before treatment in the patients of the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). Regarding 4-hour gastric emptying rates, which were increased as compared with those before treatment in the two group (P<0.05), and the rate in the observation group was higher remarkably than that in the control group (P<0.05). The total effective rate was 92.5% (62/67) in the observation group, higher than 74.6% (50/67) in the control group (P<0.05). Herb-partitioned moxibustion at fanwei point relieves the clinical symptoms in the patients with diabetic gastroparesis and increases the gastric emptying rate, which is probably related to the regulation of the levels of plasma motilin and serum gastrin.

Buzhongyiqi Decoction Protects Against Loperamide-Induced Constipation by Regulating the Arachidonic Acid Pathway in Rats.

Constipation is a common gastrointestinal disorder without effective treatment approach. Buzhongyiqi decoction (BZYQD) is a classical formula that has been commonly used for gastrointestinal disorders for nearly 1,000 years. In this study, we aimed to investigate the protective effect of BZYQD against loperamide-induced constipation and its potential mechanism. Rats with loperamide-induced constipation were orally administered BZYQD. BZYQD treatment obviously increased the small intestinal transit rate and alleviated colon tissue pathological damage. Subsequently, serum metabolomics study was performed to identify the metabolites affected by BZYQD. Metabolomics identified that the levels of 17 serum metabolites, including prostaglandin E2 (PGE2), arachidonic acid (AA), and inositol, were significantly changed in BZYQD-treated group compared with those in the loperamide-induced group. Pathway analysis revealed that those metabolites were mainly associated with arachidonic acid metabolism, biosynthesis of unsaturated fatty acids, ascorbate and aldarate metabolism, inositol phosphate metabolism. Additionally, BZYQD treatment down-regulated the cyclooxygenase-2 expression and decrease production of the proinflammatory mediator PGE2. Further study revealed that BZYQD administration decreased serum levels of the inflammatory factors IL-1β and TNF-α, inhibited phosphorylation of the nuclear transcription factor NF-κB, and down-regulated expression of the inflammatory factors IL-1β and IL-6 in the constipated rat colon. Moreover, BZYQD treatment also increased serum levels of inositol, motilin and gastrin, and promoted gastrointestinal motility. In conclusion, the present study suggested that BZYQD exerted a protective effect against loperamide-induced constipation, which may be associated with its role in regulation of multiple metabolic pathways.

Ganjiang granule regulates cecal microflora and serum biochemical components in a rat model of constipation-predominant irritable bowel syndrome

Abstract Objective To investigate the effects of Ganjiang granule (GG) on cecal microflora and serum biochemical components in rats with constipation-predominant irritable bowel syndrome (IBS–C). Methods Twenty-four Sprague–Dawley rats were randomly divided into four groups: control, model, GG, and probiotics. Rats in the model, GG, and probiotics groups received 3 °C tap water intragastrically; rats in the GG group were treated with GG; rats in the probiotics group were treated with probiotics. For all rats, enzyme-linked immunosorbent assay and colorimetry were used to assess serum biochemical components related to gastrointestinal function; 16S rRNA high-throughput sequencing was used to analyze the cecal microflora. Results The serum level of 5-hydroxytryptamine (HT) was higher in the model group than in the control group (Z = −2.082, P = .037). The model group exhibited changes in cecal microflora: the relative abundances of Lactobacillus decreased (Z = −2.882, P = .004) and Dorea increased (t = −3.030, P = .023), compared with the control group. The GG and probiotics groups exhibited normal serum levels of 5-HT. The GG and probiotics groups exhibited improved serum levels of gastrin; the probiotics group exhibited an improved serum level of vasoactive intestinal peptide. Compared with the model group, The GG group exhibited greater relative abundance of Ruminococcus (Z = −2.402, P = .016); the probiotics group exhibited greater relative abundance of SMB53 (Z = −2.823, P = .005) and lower relative abundances of Desulfovibrio (Z = −2.823, P = .005) and Facklamia (Z = −2.608, P = .009). Conclusion The effects of GG on IBS-C may be related to regulation of the serum level of 5-HT, as well as elevated relative abundance of beneficial bacteria in cecal microflora.

Predictors of Gastrin Elevation Following Proton Pump Inhibitor Therapy.

The goal of this study was to elucidate the most important predictors for elevation of gastrin in patients on long-term PPI therapy through analysis of data from 2 published studies in Icelandic patients with erosive GERD. Gastrin elevation is a known but variable consequence of proton pump inhibitor (PPI) therapy. Concerns have been raised about the clinical importance of chronic PPI induced gastrin elevation. This cross-sectional analysis included patients with endoscopically verified erosive esophagitis receiving long-term PPI therapy. PPI exposure in dosage over weight (mg/kg) and dosage over body surface area (mg/m) was compared with fasting gastrin levels in two separate multiple linear regression models. Data was collected on age, gender, weight, H. pylori infection, smoking, PPI duration and type. Overall data from 157 patients (78 females) were analyzed. Median serum gastrin levels were higher in females than males (92 vs. 60 pg/mL; P=0.001). Simple linear regression showed a correlation between serum gastrin levels and gender (P=0.0008) as well as PPI exposure in mg/kg (P=0.0001) and mg/m (P=0.0001). Multiple linear regression analysis showed that PPI exposure, both in mg/kg (β=0.95 [CI=0.4-1.5]; P=0.001) and mg/m (β=0.02 [CI=0.0-0.0]; P=0.0015) along with female gender (β=0.2 [CI=0.0-0.4]; P=0.02) predicted higher gastrin values. Dosage and female gender seem to play an important role in the development of gastrin elevation on PPI therapy. A significant correlation was found between fasting serum gastrin and dosage of PPIs over weight and body surface area.

Association among helicobacter pylori infection, gastrin level and colorectal cancer in patients aged 50 years and over.

Objectives:To study the correlations among helicobacter pylori infection, gastrin and colorectal cancer in patients aged over 50 years old.Methods:In this study, the patients diagnosed with colorectal cancer treated in the department of digestion of our hospital together with the healthy subjects undergoing colonoscopy for health examination without pathologic findings from August 2016 to July 2019 were enrolled in colorectal cancer or control group. The blood sample was taken in fasting state, and anti-H. pylori IgG and anti-CagA antibodies as well as the level of serum gastrin were measured for all the participants. In addition, the information of each participant including age, gender, obesity, smoking history, alcohol consumption, diabetes mellitus was recorded and analyzed.Results:Four hundred and twenty-eight patients were enrolled in the colorectal group and 207 healthy subjects were enrolled in the control group. There were not significant differences in the positive rate of Ig G and Cag A and family history between the two groups (p>0.05), but there were significant differences in gastrin level, obesity, smoking history, alcohol consumption and diabetes mellitus between the two groups (p<0.05). In addition, the multivariable analysis showed that obesity, smoking history, alcoholism and diabetes mellitus have the strongest influence on the formation of colorectal cancer, while the level of gastrin didn’t show the influence.Conclusions:No significant correlations among H. pylori infection, the level of gastrin, and the occurrence of CRC in patients with a minimum age of 50 years, suggesting elder colorectal cancer patients may have a different carcinogenic mechanism from those younger patients.

DYNAMICS OF GASTRIN LEVEL IN PATIENTS WITH DIABETES MELLITUS 2 TYPE AND CHRONIC GASTRITIS AFTER HELICOBACTER PYLORI ERADICATION THERAPY

The aim: To study the gastrin level dynamics in patients with diabetes mellitus (DM) 2 type and chronic gastritis (CG) on the background of antihelicobacter therapy (AHT). Materials and methods: 60 patients with DM type 2 and HP-associated CG underwent examination. Patients were divided into two groups of 30 patients each: group 1 included patients who received only standard AHT, group 2 - patients who in addition to standard AHT received the drug SB (Normagut, company Mega) 2 capsules 2 times/day. Results: According to our study results yeast SB, not only increase the HP eradication rate but together with the standard AHT contribute to the serum gastrin reduction, which is a gastric acid stimulator, which in turn leads to an improvement in the CG clinical course. Conclusions: Patients with DM type 2 and CG associated with HP should include yeast SB to standard AHT as they reduce side effects from this treatment (by an average of 20%), increase the eradication frequency (by 10%), and also lead to significant decrease in serum gastrin (up to 82.15 ± 2.47 pg/ml).A decrease in serum gastrin levels in patients with HP-associated CG and DM type 2 leads to an improvement in the clinical course of the diseases, namely a decrease in nausea, diarrhea, abdominal pain, and discomfort incidence.

Diagnostic accuracy of selective arterial calcium injection test for localization of gastrinoma.

The appropriate localization of gastrinoma is still difficult. We aimed to evaluate the diagnostic accuracy of selective arterial calcium injection (SACI) for localization of gastrinomas including multiple lesions. This retrospective study included ten patients with surgically proven gastrinomas (gastrinoma group) and six patients without any findings suggesting Zollinger-Ellison syndrome (non-gastrinoma group). For SACI, calcium gluconate was injected into the arteries supplying pancreas, duodenum, and liver. Blood samples from the hepatic vein were obtained before and 30, 60, and 120 seconds after each injection. The results were considered positive when the increase in serum immunoreactive gastrin (IRG) levels within 60 seconds of calcium gluconate injection were more than 80 pg/mL and more than 20% from baseline. We evaluated the efficacy of SACI by comparing the SACI responses with definitive locations diagnosed by clinical and histopathological findings. In the gastrinoma group, false-positive responses were confirmed in seven of the ten patients. False-negative response was observed in one of the feeding arteries of one patient with gastrinomas in multiple locations. Conversely, the greatest increase in serum gastrin levels from baseline at 30 seconds indicated the true-positive responses in all patients with gastrinomas. In the non-gastrinoma group, calcium gluconate injection into gastroduodenal artery evoked positive responses in five of the six patients. In conclusion, our data suggest the strongest gastrin response evoked by SACI indicates the definitive location in patients with gastrinomas. In contrast, SACI could not accurately locate multiple gastrin-secreting lesions due to poor specificity.

Material Basis of the Difference between Hedysari Radix and Honey-Processed Hedysari Radix in Buzhong Yiqi.

Objective To compare the changes of chemical components of Hedysari Radix (HR) before and after honey-processing, and to explore the material basis of the difference between HR and honey-processed Hedysari Radix (HPHR) in Buzhong Yiqi. Methods Different compounds in aqueous extracts of HR and HPHR were analysed by UPLC-MS. A rat model of spleen qi deficiency was established. The rats were treated with different doses of water extracts of HR or HPHR, and pathological differences in spleen tissue, serum levels of D-xylose, gastrin (GAS) and amylase (AMS) interleukin-2 (IL)-2 and tumour necrosis factor-α (TNF-α), as well as spleen and thymus indices, were used as indicators. Differences in the efficacy of HR and HPHR in Buzhong Yiqi were studied. Results The research showed that compared with the blank group, the spleen tissue of rats in the model group showed spleen tissue damage, which mainly manifested as unclear boundaries between red pulp and white pulp, irregular spleen morphology and irregular arrangement, and the structure of white pulp destruction, less lymphocytes, the number of germinal centers decreased or atrophied. Compared with the model group, the middle and high dose groups of HR and HPHR had protective effects on spleen tissue of spleen-qi deficiency rats, and HPHR had a stronger effect; compared with those in the model group, rats in each treatment group showed remarkably higher serum D-xylose, GAS and AMS levels and thymus and spleen indices, and remarkably lower serum IL-2 and TNF-α levels, among which HPHR group showed better regulation effect than HR group. A total of 16 differential compounds were found in the aqueous extracts of HR and HPHR, of which 10 compounds in HPHR were up regulated, while 6 compounds were down regulated compare to HR. Conclusion The results indicated that both HR and HPHR can improve spleen qi deficiency syndrome of rats, the pharmacodynamic effect of the latter was better than the former. Differences in components of HR and HPHR potentially leading to variations in efficacy.

Effect of Aspiration and Evaluation of Gastric Residuals on Intestinal Inflammation, Bleeding, and Gastrointestinal Peptide Level

To determine the effect of gastric residual aspiration and evaluation on preterm very low birth weight infants' gastrointestinal function, intestinal inflammation, and gastrointestinal mucosal bleeding. This single-center, randomized trial compared omission of gastric residuals vs prefeed gastric residuals in 143 infants ≤32weeks of gestation with a birthweight of ≤1250g for 6weeks after birth. Serum levels of gastrin and motilin were collected between 14 and 21days of life. Stools were collected at 3 and 6weeks of age and analyzed for calprotectin and S100A12 levels. All stools were tested for occult blood for 6weeks. Means for gastrin (P=.999) and motilin (P=.694) were similar between groups and there were no statistically significant differences in adjusted means for transformed calprotectin (P=.580), and S100A12 (P=.212). Both calprotectin (P=.003) and S100A12 (P=.002) increased from week 3 to week 6. The mean percentage of stools positive for occult blood (P=.888) were similar between the groups. Gastrointestinal function, intestinal inflammation, and gastrointestinal mucosal bleeding were similar whether aspiration and evaluation of gastric residuals were eliminated or not, suggesting routinely evaluating gastric residuals before every feeding may be unnecessary. TRIAL REGISTRATION CLINICALTRIALS.GOV:: NCT01863043.

Relationship between colorectal polyps and Helicobacter pylori typing and serum gastrin 17

Objective To investigate the relationship between Helicobacter pylori infection and serum gastrin 17 levels and colorectal polyps. Methods The clinical data of 214 patients with colorectal polyps who underwent gastrointestinal endoscopy at the Affiliated Hospital of Xuzhou Medical University from June 2017 to April 2019 were collected.The specimens were divided into two groups after pathological diagnosis.The group included 126 cases with adenomatous polyps (adenomatous polyps group) and 88 cases with hyperplastic polyps(hyperplastic polyps group). Another 89 patients without obvious abnormality were selected as the control group.Serum Hp antibody was detected by western blot, and serum gastrin 17 levels were quantitatively detected by ELISA.Hp infection rate and serum gastrin 17 levels were compared between the groups. Results The infection rate of 74.2% (66 / 89) type I HP in adenomatous polyp group was significantly higher than that of 55.6% (30 / 54) in proliferative polyp group and 48.7% (19 / 39) in control group, the difference was statistically significant( χ2=5.271, P=0.022; χ2=7.867, P=0.005). The infection rate of type I HP in proliferative polyp group was not statistically significant (P>0.05). The HP infection rate in colorectal polyp group was 66.8% (143 / 214) and 67.1% (96 / 143) respectively, which was significantly higher than that in control group (43.8% (39 / 89) and 48.7% (19 / 39), the difference was statistically significant (χ2=13.87, 4.467, all P<0.05). The infection rate of Hp in colorectal proliferative polyp group was 61.4% (54/88) and adenomatous polyp group was 70.6% (89/126) higher than that in control group (43.8% (39/89), the difference was statistically significant( χ2=5.46, 15.57, all P<0.05). The serum gastrin 17 level in adenomatous polyp group (11.35 (6.67, 20.87) pmol/L)was significantly higher than that in proliferative polyp group (7.88(3.11, 13.07) pmol/L) and control group (5.69 (2.94, 11.37) pmol/L), the difference was statistically significant (Z=4.91, all P<0.05). The serum gastrin 17 level in adenomatous polyps group with type I Hp infection (14.35 (8.12, 23.68) pmol/L) was significantly higher than that of Hp-negative patients (8.42 (2.42, 20.84) pmol/L), and the difference was statistically significant (Z=2.87, P<0.05). Conclusion HP infection is closely related to colorectal polyps, especially adenomatous polyps.The increased level of serum gastrin 17 is a risk factor for colorectal adenomatous polyps.Type I HP infection can increase the level of serum gastrin 17, and it is more closely related to adenomatous polyps. Key words: Colorectal polyps; Adenomatous polyps; Hyperplastic polyps; Helicobacter pylori; Gastrin

2726 Dilemma of Hypercalcemia and Persistent Peptic Ulcer Disease: Case Report and Literature Review

INTRODUCTION: Hypercalcemia has been linked to peptic ulcer disease (PUD), but between the two is not well understood. We are presenting a case of PUD that did not respond to long term twice daily PPI but did improve when the hypercalcemia was corrected with parathyroidectomy. CASE DESCRIPTION/METHODS: A 48-year-old male patient underwent one yearlong evaluation for persistent abdominal pain. His evaluation included three CT scans, EGD as well as octreotide and parathyroid scans. Initially, it was believed that his symptoms were related to severe PUD that did not respond to prescribed medical treatment due to poor patient compliance. He presented to the ED complaining of epigastric pain. Abdominal imaging revealed inflammation and narrowing of the entire duodenum as well as non-obstructive nephrolithiasis. His Calcium level was 11 mg/dl. An EGD revealed many non-bleeding cratered duodenal ulcers in the entire duodenum. An acquired non-obstructing, benign-appearing, intrinsic stenosis was found in the third portion of the duodenum. Biopsies were negative for H. pylori infection. He denied NSAID use. He was discharged on oral PPI therapy twice daily. Two months later, he returned with recurrent abdominal pain after running out of his PPI. CT scan showed persistent inflammatory changes involving the entire duodenum to the jejunum. Serum gastrin level was 201 pg/ml. Calcium level was 10.4 mg/dL. He was treated symptomatically with plans for outpatient push enteroscopy. The patient’s clinical course was complicated by obstructive nephrolithiasis requiring bilateral ureteral stents. Almost one year later, he returned with abdominal pain. Another CT scan showed persistent duodenitis. His labs showed evidence of Hypercalcemia 12 mg/dl. Gastrin Level 382 pg/ml. Octreotide scan was performed and was negative for any active neuroendocrine tumor. Parathyroid scan revealed parathyroid adenoma. The patient underwent parathyroidectomy and did well. He was discharged home on PPI twice daily. He was seen in follow-up and denied any PUD symptoms. DISCUSSION: This patient with severe non-resolving peptic ulcers. Removal of the parathyroid adenoma resulted in complete resolution of his symptoms. The gastric secretory response to hypercalcemia may be responsible for the occurrence of peptic ulcer disease in patients with hyperparathyroidism. In conclusion, serum calcium level must be considered among the usual tests in patients with rare and/or non-specific abdominal symptoms and part of the workup for persistent PUD.