Malignant Gastric Disease Research Articles

Difficulties of Differential Diagnosis of Peptic Ulcer and Stomach Cancer

Introduction. Stomach cancer is a serious problem of modern medicine and is one of the most common malignant diseases in the world, being in fourth place among the causes of death from cancer. Most patients seek medical help in the late stages of the disease and, as a result, mortality during the first year after diagnosis is about 50 %.Description. A case of clinical observation of a patient with diagnosed ring-cell carcinoma of the stomach is presented. In the course of the description, key aspects that require attention in determining risk factors, examination tactics and management of a patient with suspected malignant gastric disease are highlighted.Conclusions. Detection of the disease in the early stages allows not only to significantly increase the patient’s chances of a complete cure, but also to carry out therapy using the most gentle methods. The differential diagnosis of peptic ulcer disease and infiltrative gastric cancer is particularly difficult. Comprehensive clinical, laboratory and instrumental examination of patients contributes to the early establishment of a correct diagnosis and, as a result, timely surgical treatment.

Incidence of Post-therapeutic Malignancies in Benign and Malignant Gastric Diseases, Human Leukocyte Antigen-restricted Human Endogenous Retrovirus Gene-derived Peptides, and Survival

Incidence of Post-therapeutic Malignancies in Benign and Malignant Gastric Diseases, Human Leukocyte Antigen-restricted Human Endogenous Retrovirus Gene-derived Peptides, and Survival

CT imaging of benign and malignant gastric disease: A pictorial review

Category: Gastrointestinal

Artificial Intelligence in the Diagnosis of Upper Gastrointestinal Diseases.

Artificial intelligence (AI) has enormous potential to support clinical routine workflows and therefore is gaining increasing popularity among medical professionals. In the field of gastroenterology, investigations on AI and computer-aided diagnosis (CAD) systems have mainly focused on the lower gastrointestinal (GI) tract. However, numerous CAD tools have been tested also in upper GI disorders showing encouraging results. The main application of AI in the upper GI tract is endoscopy; however, the need to analyze increasing loads of numerical and categorical data in short times has pushed researchers to investigate applications of AI systems in other upper GI settings, including gastroesophageal reflux disease, eosinophilic esophagitis, and motility disorders. AI and CAD systems will be increasingly incorporated into daily clinical practice in the coming years, thus at least basic notions will be soon required among physicians. For noninsiders, the working principles and potential of AI may be as fascinating as obscure. Accordingly, we reviewed systematic reviews, meta-analyses, randomized controlled trials, and original research articles regarding the performance of AI in the diagnosis of both malignant and benign esophageal and gastric diseases, also discussing essential characteristics of AI.

Prevalence of Helicobacter pylori infection and the incidence of the associated malignant and peptic ulcer disease (PUD) at Nelson Mandela Academic Hospital: a retrospective analysis

Background H. pylori infection is associated with both benign and malignant gastrointestinal diseases. However, no studies have been conducted locally describing the prevalence of H. pylori and its associated GIT diseases. The objectives of this study are to determine the prevalence of H. pylori, and the incidence of PUD and gastric malignancies among patients who are infected with H. pylori or who have the stigmata of previous exposure to H. pylori. Material and methods Data was collected retrospectively from files of adult patients with upper gastro-intestinal symptoms from January to December, 2012. The gastric mucosal biopsy specimens were analyzed for the presence of H. pylori, chronic gastritis, PUD, and gastric malignancies. Results Of 156 records there were 70 (45%) males and 86 (55%) females, with a median age of 56.5. The prevalence of H. pylori was 54.5%; 95% of 156 had chronic gastritis (CG). Ninety-sever percent of the 85 H. pylori positive and 93% of the 71 H. pylori negative patients had CG. However, the difference was not statistically significant (97% vs 93%, p = 0.322). The incidence of PUD was 16% and 10 (6.4%) had gastric malignancies, of which four (2.7%) and three (2%) were antral intestinal-type and proximal diffuse types, respectively. Three (2%) had gastric MALT lymphoma. The risk of both gastric malignancies and PUD was demonstrated to increase with advancing age. Discussion and conclusion The prevalence of H. pylori was equivalent to the global prevalence; however, high prevalence of CG may be indicative of high local infection rate. The incidence of H. pylori and/or chronic gastritis-associated intestinal-type gastric adenocarcinoma, MALT lymphoma, and PUD is equivalent to that reported globally. Advancing age and active H. pylori infection or stigmata of past exposure thereto are associated with increased risk of peptic ulcers and malignant gastric diseases.

Association of cagA Positive Helicobacter pylori Infection and Laryngeal Squamous Cell Carcinoma: A PCR Approach.

Helicobacter pylori is a gram-negative bacillus causing benign and malignant gastric diseases such as gastroesophageal reflux (GER). In larynx, H. pylori causes chronic inflammation and mucosal destruction that may lead to malignant changes. Although, H. pylori poses several virulence factors, cagA is probably the main factor in this regard. To evaluate the role of cagA gene in laryngeal squamous cell carcinoma (LSCC), a case-control study was conducted on patients with laryngeal complaints during 2010-2012. Seventy-two patients with LSCC (case group) and 72 patients without malignancy (control group) were included in the study. The H. pylori and cagA factor were assessed in laryngeal specimen of patients with PCR technique. 33% of patients in case group (24 patients) and 45.8% (33 patients) of control group were positive for H. pylori. CagA gene was present in 13.8% (10 patients) of case group specimens and 31.9% (23 patients) of control group. This difference was statistically significant with Mantel-Haenszel statistical test analyses. The results showed that patients with LSCC have significantly lower incidence of laryngeal H. pylori infection and cagA virulence factor than those without LSCC. Findings from this study support the protective effect of H. pylori infection against laryngeal cancer.

Expression of ZBTB8A in gastric cancer and its clinical significance

To investigate the expression of ZBTB8A (zinc finger and BTB domain containing 8A) in gastric cancer tissues and its clinical significance. Level of ZBTB8A mRNA in human normal gastric cell line GES-1, human gastric cancer cell line SGC7901 and MGC803 was detected by real-time PCR. Levels of ZBTB8A mRNA and protein in cancer tissues, adjacent cancer tissues from 104 cases with primary gastric cancer and normal gastric mucosal tissues from 40 cases without malignant gastric diseases were detected by RT-PCR and immunohistochemistry, respectively. Association between ZBTB8A expression and clinicopathology was analyzed. ZBTB8A mRNA expressions in SGC7901, MGC803 and GES-1 cells were 0.00138±0.00015, 0.00158±0.00021, 0.00036±0.000055, respectively, and differences among SGC7901, MGC803 and GES-1 were significant respectively (all P<0.05). ZBTB8A mRNA expression was significantly up-regulated in cancer tissues as compared to adjacent cancer tissues and normal tissues (0.0152±0.0126 vs. 0.0070±0.0061 and 0.0079±0.0036, all P>0.05), while no significant difference was found between adjacent cancer tissues and normal tissues (P>0.05). ZBTB8A expression was significantly associated with invasive depth, lymph node metastasis, tumor stage, and degree of adenocarcinoma differentiation (all P<0.05), but not with age, gender, histological type,gross type (all P>0.05). ZBTB8A may be a potential carcinogenic factor in gastric carcinoma, and may also be involved in gastric adenocarcinoma cell differentiation, cancer invasion and metastasis.

Role of the apparent diffusion coefficient in the differential diagnosis of gastric wall thickening

To evaluate the role of the apparent diffusion coefficient (ADC) measurement made using diffusion-weighted magnetic resonance imaging (DWMRI) in the differential diagnosis of benign and malignant gastric wall thickening. Axial T2-weighted and DWMRI at b 600 and b 1000 s/mm(2) gradients were performed in 94 patients (44 patients with gastric malignancy and 50 patients with benign gastric diseases) with gastric wall thickening which was detected by multidetector computed tomography (MDCT). The ADC values of the gastric lesions and healthy gastric walls in patients with gastric malignancies and in patients with benign gastric diseases were used in the differential diagnosis of benign and malignant lesions of the stomach. The mean ADC values were lower in patients with gastric malignancies (1.62 ± 0.57 and 1.40 ± 0.33 at b 600 and b 1000, respectively) compared to those with healthy gastric walls (2.95 ± 0.59 and 2.18 ± 0.48) and benign gastric diseases (3.08 ± 0.52 and 2.34 ± 0.42) at b 600 and b 1000 gradients (P < 0.0001). The ADC measurement on DWMRI may be used to differentiate between benign and malignant gastric diseases.

Prealbumin Levels as a Useful Marker for Predicting Infectious Complications After Gastric Surgery

Background/ObjectivesPreoperative nutritional status is associated with postoperative complications. Prealbumin, a visceral protein, is sensitive to protein malnutrition. The objective of this study is to evaluate the role of preoperative prealbumin levels as a marker for predicting complications after gastric surgery. MethodsAn observational study was performed on 183 patients who underwent gastric surgery due to benign or malignant gastric disease at Seoul National University Hospital (SNUH) between August 2009 and October 2010. Preoperative prealbumin levels were also measured. Nutritional variables such as prealbumin (cutoff value, 18 mg/dL), albumin, body mass index (BMI), and clinicopathologic data were collected. Postoperative hospital stay, 30-day complications and mortality rate were obtained to investigate outcomes. ResultsThe complication rate was 52% in the abnormal prealbumin group (n = 23) and 24% in the normal prealbumin group (n = 160; p = 0.005). The complication rate was higher in patients with low preoperative albumin levels (<3.5 g/dL) and abnormal BMI (<18.5 kg/m2), but the differences were not statistically significant. Comorbidity of diabetes mellitus (DM), resection extent, combined resection, TNM stage and prealbumin levels were associated with complications. In multivariate analysis, DM and combined resection were significantly correlated with complications (p = 0.001 for each). In subgroup analysis, resection extent, approach, combined resection, TNM stage, and prealbumin levels were significantly associated with infectious complications. Multivariate analysis identified combined resection (p = 0.001) and prealbumin levels (p = 0.032) as independent variables. ConclusionsPreoperative prealbumin levels could be a useful marker for predicting complications, especially infectious complications, after gastric surgery.

Tumors Arising at Previous Anastomotic Site may have Poor Prognosis in Patients with Gastric Stump Cancer Following Gastrectomy

IntroductionWe analyzed the clinicopathological characteristics and outcomes of patients with gastric stump cancer (GSC) to identify important prognostic factors. Patients and MethodsWe retrospectively reviewed clinical reports of 34 patients with GSC treated at Kochi Medical School from 1982 to 2008 to analyze the clinical and pathological factors that influenced patient survival. ResultsThe median interval between initial and second operation was 15.8 years; this interval was significantly longer in patients diagnosed originally with benign disease than in those with previous malignant disease. Histologically, the incidence of diffuse-type cancer was significantly prominent in patients with previous benign gastric disease than in those with previous malignant gastric disease. The overall 5-year survival rate was 53.3%, with presence of lymph node metastasis and pathological serosal invasion of the tumor associated with poor survival. The final analysis revealed tumor located at anastomosis, tumor size greater than 5 cm, serosal invasion, the presence of lymph node metastasis, and stage III or higher to be significantly associated with poor survival. ConclusionsFollow-up programs after gastrectomy should account for long latency periods of disease. Early detection, attentive observation of anastomotic site, and sufficient surgical resection were important influences on outcome for patients with GSC after Billroth I or Billroth II reconstruction.

Helicobacter pylori

Helicobacter pylori

Immunochemical and molecular-Genetic markers in diagnostics of gastric cancer

Intensive studies of molecular mechanisms responsible for tumor transformation results in identification of new proteins and their genes involved into tumor development. These proteins may be used as markers of tumor transformation of cells and the level of their expression may be evaluated by means of modern highly sensitive and technological methods of analysis. This review summarized literature data on currently used immunohistochemical and molecular genetic markers of gastric cancer. It highlights genetic and epigenetic changes detected in nucleic acids of tumor tissue cells in malignant and benign gastric diseases as well as in the level of DNA circulating in blood of patients with gastric cancer.

Endosonography with electronic longitudinal scan in malignant diseases of the stomach

To assess the significance of endoscopic ultrasonography (EUS) using an electronic longitudinal scan we examined 75 patients. 32 patients suffering from malignant diseases of the stomach (2 early cancers, 22 gastric carcinoma, 4 cancers of the cardia, 2 gastric lymphoma, 2 infiltration from outside). 31 of the 32 patients who had malignant gastric diseases were correctly diagnosed by means of EUS. The positive sensitivity was 96.9%, the positive predictive value was 86.1%. The specificity was 88.4%, the negative predictive value 97.4%. Using sonographical criteria such as thickening of the gastric wall, wall layers, delineation of outer and interior gastric wall, infiltration into the gastric wall, infiltration into neighbouring organs as well as perigastric lymph node, EUS provides reliable determination and staging of gastric tumours. Compared to conventional ultrasonography and gastric endoscopy, EUS affords considerable improvement in the diagnosis of gastric tumours, especially with regard to the identification of the infiltration of the tumour (84.4%), recognition of malignancy (28.1%), identification of the origin of the tumour (21.9%), and of regional lymph node metastases (25%).

Signet-Ring Cell Carcinoma Arising in the Gastric Stump after Duodenopancreatectomy for Ductal Adenocarcinoma of the Pancreas: A Case Report

The development of malignancy in the gastric stump following surgery for peptic ulcer disease is well recognized. There are also few reports on carcinomas occurring after surgery for malignant gastric disease. However, carcinoma of the gastric stump after duodenopancreatectomy is extremely rare. We describe what we believe to be an unusual case of signet-ring cell carcinoma of the gastric stump developing at the anastomotic site 5 years after duodenopancreatectomy for ductal adenocarcinoma of the pancreatic head. We performed remnant gastrectomy and Roux-en-Y gastrojejunostomy as a curative resection. This experience clearly underlies that g astric stump carcinoma (GSC) may mimic metastatic disease recurrence leading to diagnostic confusion after surgery for malignancy. Although an increased risk of gastric stump carcinoma after pancreatoduodenectomy for pancreatic cancer has not been established, the possibility of such a complication should be kept in mind when evaluating patients after gastric resection who present with symptoms of metastatic disease recurrence years after the primary operation. Investigations should be independent of the entity of the primary disease or its localization, since GSC may well be amenable to surgical cure as demonstrated in the presented case. Outpatient follow up results of the last four years indicated no recurrence in this case.

Medium- and Long-Term Results of Jejunal Pouch Reconstruction After a Total and Proximal Gastrectomy

We developed several kinds of jejunal (J)-pouch reconstruction after a gastrectomy for gastric cancer. The aim of this study was to investigate the advantages of these methods. As for the treatment of malignant gastric diseases at stage II or earlier, we employed the J-pouch reconstruction (Roux-en-Y method: JPRY, or J-pouch interposing: JPI) following a total gastrectomy. We also used JPI after a proximal gastrectomy for early gastric cancer located in the upper third of the stomach. Out of a total of 80 patients, JPRY was performed in 40 patients and JPI in 40. No anastomotic leaks were associated with the use of an automatic stapler. The stapler (Endo GIA; U.S. Surgical, Norwalk, CT, USA) with a 60-mm-long white cartridge minimized bleeding from the anastomotic site and reduced the operative time. While two patients died of recurrence, all other patients are alive and well for a maximum of 15 years after surgery. The motility of the J pouch was satisfactory after both surgical procedures, as measured by the bile regurgitation test or the transit test employing radiopaque markers. The mean percentage of the radiopaque markers eliminated from the J pouch 1 h after breakfast was 7.5% in the JPRY group and 0%-33% in the JPI group. After another hour, the corresponding percentage was 19.5% in the JPRY group and 14%-60% in the JPI group. Our procedures for J-pouch reconstruction are considered to result in a favorable postoperative quality of life and prognosis. J-pouch reconstruction is therefore advantageous in terms of operative morbidity, postoperative clinical signs, symptoms, and dietary status.

Factors affecting the serum gastrin 17 level: an evidence‐based analysis of 3906 serum samples among Chinese

To investigate the influence of gender, age, site of lesion, disease type and Helicobacter pylori (H. pylori) infection on the human serum gastrin-17 level and to study the diagnostic value of serum gastrin-17 in gastric precancerous lesions and gastric cancer. Serum gastrin-17 and serum H. pylori IgG antibody were detected by the ELISA method. The different gastric disease groups were confirmed by endoscopy and histopathology. Among the 3906 serum samples according to the gender, age, site of lesion and the data of different gastric disease groups, the serum gastrin-17 level was markedly higher in people>or=60 years old than that in younger age groups. The serum gastrin-17 level increased progressively in the following order: healthy control group, nonatrophic gastritis group, gastric ulcer group, and the serum gastrin-17 level was higher in the atrophic gastritis with dysplasia group than that without it, the lowest level being in the gastric cancer group. Among the 2946 serum samples matched with the site of the lesion, the serum gastrin-17 level was higher in those with antral diseases than in those with gastric corpus diseases. Among the 3805 serum samples matched with the H. pylori infection data, the serum gastrin-17 level was higher in the H. pylori-positive group than in the H. pylori-negative group. In people over 60 years of age, the serum gastrin-17 level tends to increase. In subjects with precancerous gastric lesions, it may increase significantly with the progression of gastric disease, and ultimately decrease in gastric cancer. Serum gastrin-17 is a good biomarker to differentiate benign from malignant gastric diseases. The site of the gastric lesions is an important factor affecting the serum gastrin-17 level, whereas H. pylori infection is usually associated with its increment.

Are there useful biomarkers for gastric cancer?

In spite of a remarkable decrease of gastric cancer incidence [1], the neoplasia of the stomach represents the second most frequent cause of cancer mortality in the world [2], mainly, because of a late diagnosis. In the management of malignant gastric diseases, the challenge consists in selecting the high-risk population for which strategies could be developed for gastric cancer prevention. For this purpose, it is important to know both the histopathological sequence and aetio-pathogenetic mechanisms underlying gastric cancer.

Gastrosplenic fistula: A rare complication of splenic abscess

Gastrosplenic fistulas are rare complications of malignant gastric or splenic diseases and, less frequently, are the result of benign diseases such as gastric ulcers and Crohn's disease. Spontaneous gastrosplenic fistula as a result of splenic abcess has not been reported in the literature so far. A 70‐year‐old man presented with a splenic abscess which had spontaneously developed a gastrosplenic fistula. The fistula was diagnosed by computed tomography scan and upper gastrointestinal endoscopy and was successfully managed by splenectomy with en bloc resection of part of the greater curvature of the stomach. Although gastrosplenic fistulas are a relatively rare complication of gastric or splenic diseases, an awareness might lead the clinician to early recognition and surgery can be offered earlier as the treatment of choice.

Magnetic Resonance Imaging Gastrography

We sought to demonstrate the feasibility of depicting gastric tumors using magnetic resonance imaging (MRI) while applying the dark lumen technique. The findings were correlated with conventional gastroscopy. In addition, we evaluated the screening for lymph nodes and liver metastases during the same session to identify potential tumor spread. The study included 15 patients with known malignant gastric disease. Conventional gastrointestinal endoscopy was performed in all patients as gold standard. All patients were examined with computed tomography for tumor staging. MRI was performed using 1 L of tap water as oral contrast agent for all protocols. The MRI program included an axial T1-weighted (T1w; 2D-FLASH) sequence, an axial STIR and T2w (TSE) sequence, and 2 postcontrast T1w (3D coronal /2D axial FLASH) sequences using 0.2 mmol/kg gadolinium diethylenetriaminepenta-acetic acid as intravenously injected contrast agent. Qualitative analysis and comparison with conventional gastroscopy were performed. The images obtained with the postcontrast 3D coronal T1w-FLASH sequence were the most suitable in identifying gastric tumors. Complete correlation with conventional gastroscopy was achieved in 80% of the cases and partial correlation in 13% of the cases. The same imaging sequence was also appropriate for the evaluation of lymph nodes. For the identification of liver metastases, the images obtained with the axial postcontrast T1w 2D-FLASH sequence provided a higher diagnostic confidence as compared with other imaging protocols. Applying the dark lumen technique through MRI is suitable for imaging gastric tumors and has the potential to become a "one-stop shopping" method because of the possibility for lymph node evaluation and screening for metastases during the same session based on the same images.

Helicobacter pylori stimulates host vascular endothelial growth factor-A (vegf-A) gene expression via MEK/ERK-dependent activation of Sp1 and Sp3.

VEGF-A is a key regulator of inflammatory and tumor-associated angiogenesis. H. pylori plays a critical role in the pathogenesis of benign and malignant gastric diseases. It has been suggested that H. pylori infection is associated with activation of host angiogenesis, however, underlying mechanisms as well as angiogenic growth factors activated by the bacterium have not yet been identified. Therefore, we investigated the influence of the bacterium on VEGF-A as a candidate host target gene in vivo and in vitro. We show that H. pylori potently up-regulates production and release of VEGF-A protein as well as vegf-A mRNA levels, and we provide strong evidence that enhanced recruitment of Sp1 and Sp3 transcription factors to two proximal GC-rich vegf-A promoter elements mediates H. pylori-triggered vegf-A gene expression. In addition, H. pylori infection increased the transactivating capacity of both Sp1 and Sp3, which suggests additional mechanism(s) of vegf-A gene regulation by the bacterium. Signaling studies identified the MEK>ERK1/-2 kinase cascade as principal host signaling pathway mediating H. pylori-stimulated vegf-A transcription. By identifying H. pylori as potent activator of vegf-A gene expression and characterization of underlying molecular mechanisms, our results provide novel insights into pathways linking the bacterium to host angiogenesis and may help to develop strategies to influence vegf-A gene expression in the setting of H. pylori infection.