Major Endoscopic Findings Research Articles

Measured levels of positive transglutaminase 2 antibodies are not associated with presentation or incidental endoscopic findings at celiac disease diagnosis

Objectives It has been suggested that celiac disease could be diagnosed non-invasively in adults with transglutaminase antibody (TGA) levels >10x upper limit of normal (ULN). It is, however, unclear if high values signify more advanced disease and higher risk of co-morbidities. We investigated the association between the TGA levels, clinical characteristics and non-celiac endoscopic findings. Methods Medical data on 450 celiac disease patients at diagnosis were collected. They were further divided into those with high positive (>10x ULN, n = 164), moderately positive (1–10x ULN, n = 219), and negative (n = 67) TGA. Results Median age of patients was 50 years and 60% were women. Patients with negative TGA were older (median age 58 vs. 51 vs. 46 years respectively, p = 0.002) and had more often weight loss (27% vs. 10% vs. 9%, p < 0.001) and abdominal pain or dyspepsia (40% vs 27% vs. 22%, p = 0.017) than did those with moderately positive/high TGA. The groups did not differ in sex, BMI, or other symptoms. Major endoscopic findings included one esophageal adenocarcinoma presenting with dysphagia, six esophagitis, three gastric ulcers, and 39 H. Pylori or other active gastritis. High, moderately positive or negative TGA levels were not associated with these findings in crude or age-adjusted analyses. Conclusions Presentation was similar in patients with moderate or high levels of TGA, whereas patients with negative TGA were different. The level of TGA was not associated with incidental endoscopic findings and the only malignancy presented with an alarm symptom atypical to celiac disease.

Value of Alarm Features in Dyspepsia for Predicting Significant Organic Lesions in Endoscopy

Background: For a long older age and the presence of alarm features are regarded as indications for prompt endoscopy in patients with dyspepsia. We aimed to find out the value of alarm features in diagnosing serious organic upper gastrointestinal lesions in patients with dyspepsia. Material &amp; methods: In this observational study clinical variables and endoscopic findings of consecutive patients with dyspepsia were recorded in a semi-structured questionnaire. Univariate and multivariate logistic regression was done stepwise to identify predictors for endoscopic findings. A simplified predictor model was built with the age and the presence of any predictor alarm feature to find out the diagnostic accuracy of this model for the significant endoscopic lesion. Results: Among 304 patients (M=134, F=170) one or more alarm features were present in 193 cases (63.5%). Significant organic lesions were found in 84(27.6%) cases. Age ≥ 45 years (OR 2.608), abdominal lump (OR 4.489) and family history of upper gastrointestinal cancer (OR 3.880) were found as independent predictors of major endoscopic findings. Using a simplified predictor model of age ≥ 45 years or the presence of any predictive alarm feature, sensitivity, specificity, positive predictive value, and negative predictive value were 32.4 %, 82.5 %, 79.8% and 36.4% respectively for a significant endoscopic lesion. For upper gastrointestinal cancers, these values were 6%, 100.0%, 100.0% and 47.3% respectively. Conclusion: The predictive value of the age and the presence of alarm features alone are not optimal for significant endoscopic findings in patients with dyspepsia. A newer and more accurate predictive model is a time demand for organic UGI lesions, especially for malignancies. J Bangladesh Coll Phys Surg 2023; 41: 132-140

The yield of upper gastrointestinal endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia

Background and aims Upper gastrointestinal (GI) endoscopy is frequently performed in patients with upper abdominal symptoms. Although guidelines recommend withholding an endoscopy in the absence of alarm symptoms, dyspeptic symptoms remain a predominant indication for endoscopy. We aimed to investigate the yield of upper GI endoscopy in patients with low-risk dyspeptic symptoms. Methods We conducted an analysis in a prospectively maintained endoscopy reporting database. We collected the results of all upper GI endoscopy procedures between 2015 and 2019 that was performed in adult patients aged <60 years with dyspeptic symptoms. Patients with documented alarm symptoms were excluded. We categorized endoscopic findings into major and minor endoscopic findings. Results We identified 26,440 patients with dyspeptic symptoms who underwent upper GI endoscopy. A total of 13,978 patients were considered low-risk and included for analysis (median age 46 years, interquartile range (IQR) [36–53], 62% female). In 11,353 patients (81.2%), no endoscopic abnormalities were detected. Major endoscopic findings were seen in 513 patients (3.7%) and minor endoscopic findings in 2178 patients (15.6%). Endoscopic findings indicative of upper GI cancer were reported in 47 patients (0.3%), including 16 (0.1%) oesophageal, 28 (0.2%) gastric and 5 (0.04%) duodenal lesions. Despite an initial unremarkable endoscopy result, 1015 of 11,353 patients (8.9%) underwent a follow-up endoscopy after a median of 428 days [IQR 158–819]. This did not lead to the additional identification of malignancy. Conclusions The yield of upper GI endoscopy in low-risk (<60 years, no alarm symptoms) patients with dyspepsia is very limited. This study further supports a restrictive use of upper GI endoscopy in these patients.

Prevalence of Helicobacter pylori Infection in Military Personnel from Northeast China: A Cross-Sectional Study.

PurposeHelicobacter pylori infection is an important cause of peptic ulcer disease and gastric cancer. Current knowledge regarding epidemiology of H. pylori infection in military personnel has insufficiently been updated. This cross-sectional study aimed to estimate the prevalence of H. pylori infection in military personnel and to compare the prevalences in military and civilian groups.Patients and MethodsWe retrospectively enrolled the subjects who underwent 14C-urea breath tests at the Department of Gastroenterology of the General Hospital of Northern Theater Command between January 2017 and July 2020. Subjects were divided into military and civilian groups. H. pylori infection and major endoscopic findings were reviewed.ResultsOverall, 23,496 subjects were eligible, including 2282 subjects in the military group and 21,214 subjects in the civilian group. In the overall analysis, the prevalence of H. pylori infection was not significantly different between military and civilian groups (33.9% versus 34.4%, P=0.592). In the population aged 17–25 years, the prevalence of H. pylori infection was significantly higher in the military group than in the civilian group (35.6% versus 25.9%, P=0.001). Both 14C-UBT and endoscopy were performed in 547 inpatients, including 83 military inpatients and 464 civilian inpatients. There was a significantly higher prevalence of H. pylori in inpatients with peptic ulcer and/or gastric cancer than in those without (65.5% versus 41.4%, P=0.001).ConclusionAmong the adolescent population, H. pylori infection may be more common in military personnel as compared to the civilians. Well-designed prospective studies should be required to validate such a high prevalence and to explain its potential causes.

Low prevalence of upper endoscopic gastrointestinal findings despite high frequency of alarm symptoms at the time of diagnosis in adult coeliac disease

Exclusion of organic disorders involving the upper gastrointestinal (UGI) is a mandatory step before considering a biopsy-avoidance diagnostic strategy for adult coeliac disease. We aim to evaluate the prevalence of alarm symptoms and coincidental UGI endoscopic findings at the time of diagnosis of coeliac disease. To develop consensus criteria to identify patients with coeliac disease requiring a gastroscopy and to evaluate whether alarm symptoms prompting gastroscopy were predictive of endoscopic findings. Presenting symptoms and UGI endoscopic findings at diagnosis of coeliac disease were collected retrospectively in 278 adult patients with coeliac disease diagnosed in Pavia between January 1999 and December 2017. A panel of experts developed criteria to evaluate which clinical scenarios warrant gastroscopy, which was then applied retrospectively to patients diagnosed in Pavia. At least one alarm symptom was present in 177/278 patients, 121/278 met our criteria for gastroscopy. Major UGI endoscopic findings included 3 cases of autoimmune atrophic gastritis, 19 oesophagitis and 20 Helicobacter pylori infections. No organic disorders were found. Prevalence of major endoscopic findings did not differ between patients who met our criteria and those who did not. Despite the high prevalence of alarm symptoms at diagnosis, coincident major UGI endoscopic findings are rare in adult coeliac disease. These results may be relevant for future developments in coeliac disease diagnosis in adults.

Epstein-Barr virus infection in ulcerative colitis: a clinicopathologic study from a Chinese area

Background:Opportunistic Epstein–Barr virus (EBV) infection in patients with ulcerative colitis (UC) has attracted increasing attention. This study aimed to evaluate the clinicopathological characteristics and clinical outcomes of UC with intestinal EBV infection and to explore the predictive value of blood EBV DNA for the presence of EBV in the intestine.Methods:Both peripheral blood and intestinal biopsies from 92 consecutive UC inpatients were included in this study. Normal colonic mucosal tissues from 20 colon cancer patients were used as controls. EBV testing and assessment were performed by EBV-DNA polymerase chain reaction (PCR), EBV-encoded small RNA in situ hybridization (EBER-ISH) and immunohistochemistry.Results:A total of 36 patients (39.1%) had UC with superimposed EBV colitis [EBER greater than 2/high-power field (HPF)]. EBER counts and disease activity were significantly correlated (p < 0.05). The major endoscopic findings revealed more irregular and longitudinal ulcers in patients with superimposed EBV colitis (p = 0.016, p = 0.021, respectively). Age, steroid dependence, and irregular ulcerations were identified as possible risk factors. The best EBER cut-off point for outcome prediction was 2.5/HPF. At a cut-off value of 2035 copies/ml, the sensitivity and specificity of the blood EBV-DNA PCR analysis for predicting EBV presence in the intestine were 76.5% and 68.5%, respectively. EBV-infected cells in UC with high EBV concentrations mainly included B lymphocytes by clinicopathology, and the infection might have progressed from the latent to the lytic phase of the EBV life cycle.Conclusion:The EBER count is positively correlated with disease activity. The best cut-off point for outcome prediction is 2.5/HPF. A high EBV viremia load may effectively predict EBV presence in the colonic mucosa.

Anisakiasis: The risks of seafood consumption.

Japanese cuisine is now popular worldwide, and consumption of raw fish has thus increased at sushi bars and Japanese restaurants outside Japan. Anisakiasis, also known as herring-worm disease, is caused by ingesting larval nematodes in raw seafood and is a common illness in Japan. However, due to the rising popularity of Japanese food, gastroenterologists outside Japan need to be familiar with this disease. We treated 158 patients presenting with acute gastrointestinal manifestations caused by anisakiasis from April 1991 to April 2000. One or more nematodes were removed endoscopically within 48 h of presentation in 44% of these patients, which resulted in prompt resolution of symptoms. Major endoscopic findings were gastric ulcer accompanied by hemorrhage, erosion, redness, and edema of the gastric mucosa in areas penetrated by larvae and other areas. Endoscopy was valuable for the diagnosis and treatment of anisakiasis. We recommend endoscopy in suspected cases of anisakiasis. Moreover, it is desirable to combine complementary tests such as immunological tests/IgE measurement. As the popularity of Japanese cuisine increases, reports of anisakiasis are likely to be more frequent in countries other than Japan.

The Correlation of Endoscopic Findings and Clinical Features in Korean Patients with Scrub Typhus: A Cohort Study.

Scrub typhus is an infectious disease caused by Orientia tsutsugamushi-induced systemic vasculitis, but the involvement of the gastrointestinal tract and the endoscopic findings associated with scrub typhus are not well understood. We performed a prospective study and recommend performing esophagogastroduodenoscopy (EGD) for all possible scrub typhus patients, regardless of gastrointestinal symptoms. Gastrointestinal symptoms, endoscopic findings and clinical severity based on organ involvement and ICU admission were analyzed. Gastrointestinal symptoms occurred in up to 76.4% of scrub typhus patients. The major endoscopic findings were ulcers (43/127, 33.9%). Interestingly, 7.1% (9/127) of the patients presented with esophageal candidiasis. There was no correlation between the presence or absence of gastrointestinal symptoms and the endoscopic grade (P = 0.995). However, there was a positive correlation between the clinical severity and the endoscopic findings (P = 0.001). Sixty-three percent of the patients presented with erosion or ulcers on prospectively performed endoscopic evaluations, irrespective of gastrointestinal symptoms. Gastrointestinal symptoms did not reflect the need for endoscopy. Scrub typhus patients could have significant endoscopic abnormalities even in the absence of gastrointestinal symptoms.

Endoscopic and histological findings and Helicobacter pylori status in patients with reflux and/or dyspeptic symptoms: a recent Greek cohort study.

The associations between symptoms and endoscopic findings have not been clearly defined. We aimed to assess the associations of reflux dyspepsia and/or symptoms with specific endoscopic findings, histological findings, as well as the presence of Helicobacter pylori infection and its CagA subtype. A total of 160 patients with dyspeptic and/or reflux symptoms underwent upper gastrointestinal endoscopy. Type and severity of symptoms during the last week were evaluated according to a questionnaire. Biopsy specimens were obtained from the esophagus and stomach. Presence of H. pylori was tested in tissue specimens and its CagA subtype in serum samples. Of the 160 patients, 70% reported reflux, 73.7% dyspeptic symptoms, while 43.7% of patients reported both. The major endoscopic findings were chronic gastritis (n = 134), hiatal hernia (n = 98), and erosive esophagitis (n = 55). There was no significant difference in the endoscopic findings of patients with and without dyspepsia except for the subgroup of ulcer-like dyspeptic patients with significantly more frequently erosive peptic lesions (25% vs. 8.7%, p = .01). Patients with reflux symptoms had more frequently erosive esophagitis (42.9% vs. 14.6%, p = .001). Types of histological lesions, presence of H. pylori infection, and its cagA subtype had no statistical difference with presence or not of any symptoms. Patients with compared with those without reflux or ulcer-like dyspeptic symptoms had endoscopically more frequently erosive esophagitis and erosive peptic lesions, respectively. On the contrary, there is no statistical difference regarding the histological lesions, the presence of H. pylori, and its cagA subtype in all subgroups of patients.

Age and alarm symptoms do not predict endoscopic findings among patients with dyspepsia: a multicentre database study

INTRODUCTIONSymptoms of dyspepsia are common but most patients do not have major upper gastrointestinal pathology. Endoscopy is recommended for dyspeptic patients over the age of 45, or those with certain...

Acid peptic disease in children with type I diabetes mellitus. A complicating relationship.

To determine the prevalence of acid peptic disease among pediatric patients with insulin-dependent diabetes mellitus and to study the effects of acid peptic disease on treatment of insulin-dependent diabetes mellitus. Inception cohort and matched case-control study, with a data set derived from patient and parent interviews and inpatient and outpatient chart reviews. LeBonheur Children's Medical Center, a university-affiliated hospital in Memphis, Tenn. Thirty-one patients with insulin-dependent diabetes mellitus who presented with multiple episodes of symptoms of acid peptic disease were examined by endoscopy. Thirty-one control patients with insulin-dependent diabetes mellitus and transient or no gastrointestinal complaints were matched for age, gender, race, and duration of diabetes. Glycosylated hemoglobin levels, stature, frequency of hospital admissions, and parental history of acid peptic disease. Acid peptic disease occurred with a prevalence of 7% in our population of pediatric patients with insulin-dependent diabetes mellitus. Major endoscopic findings included gastritis confirmed by upper gastrointestinal biopsy (94%), bile staining of gastric mucosa (58%), and bile pooling (52%). Patients with acid peptic disease demonstrated shorter stature, greater frequency of hospital admissions, and greater prevalence of parental acid peptic disease by history than those of controls. In the 18 months following acid peptic disease therapy, hospital admissions for diabetes-related problems decreased by 50%. Acid peptic disease is an underrecognized complicating factor in the treatment of diabetes. Clinical suspicion is necessary to offset compromised diabetes control, compliance to treatment regimens, and/or growth expectations associated with this disease.

Pathologic changes of gastric mucosa colonized by Helicobacter pylori

One hundred eighty-nine consecutive gastric biopsies showing colonization by Helicobacter pylori (HP) were studied. Epigastric pain and bleeding were the clinical presentations in 167 cases (88.4%). Major endoscopic findings were gastritis (n = 72, 38.1%) and ulceration (n = 101, 53.4%). Duodenal ulcer was associated with 32 (44.4%) and 29 (28.7%) cases of gastritis and gastric ulcer, respectively. Histologically, the HP-colonized gastric epithelium showed characteristic degenerative changes that were topographically related to the bacteria but unrelated to the inflammatory infiltrate. Disintegration and loss of apical mucus with formation of epithelial pits was seen in nearly all cases. Other changes included microerosion, conventional erosion, and frank ulceration. Only the disintegration of apical mucus, epithelial pit, and microerosion were specific for HP colonization. These conditions were absent in areas not colonized by HP and in 79 consecutive HP-negative gastric biopsies seen during the same study period. The epithelial degenerative changes in HP-colonized gastric mucosa are easy to recognize in routine hematoxylin-eosin-stained sections and they could serve as histologic guides to the localization of the bacteria. It is proposed that HP-colonized gastric mucosa is a distinct pathologic entity with a pathologic spectrum ranging from active chronic gastritis to erosion and frank ulcer. Damage to the mucin-containing portion of the gastric epithelial cells appears to be the basic cytopathologic effect of HP on the gastric mucosa. As effective specific treatment for HP infection is available, identification of HP colonization in gastric biopsies should be attempted in all cases of gastritis and gastric ulcer.