Serum Gastrin Research Articles

Laxative effect of Wenyang Yiqi Decoction on loperamide-induced astriction model mice.

Although a common disease, astriction is difficult to treat and severely affects quality of life. Wenyang Yiqi Decoction (WYD) is a kind of traditional Chinese medicine (TCM) that is used to treat astriction; however, the mechanism remains unclear. Therefore, this work assessed the laxative effect of WYD on loperamide-induced astriction (LIA) model mice. We replicated a constipation model in mice and detected changes in fecal parameters such as feces quantity and water content, intestinal transit function, and histopathological changes in the constipated mice. After five days of WYD intervention, mouse tissues were taken out for detection. We also measured the levels of gastrin (Gas), substance P (SP), acetylcholinesterase (AChE), and vasoactive intestinal peptide (VIP) in the mice's serum. Additionally, we used quantitative real-time polymerase chain reaction (qRT-PCR) and Western Blot to detect c-Kit and stem cell factor (SCF), and examined the effects of WYD on the tight junction (TJ) proteins occludin (Ocln), zonula occludens-1 (ZO-1), and claudin-1 (Cldn-1) in the mice's intestines. Through histopathological changes, we observed less destruction of epithelial cells and greater integrity of goblet and epithelial cells in WYD-treated mice than in mice in the loperamide group. qRT-PCR and western blot analysis of c-Kit and SCF showed that WYD could boost the levels of c-Kit and SCF. The qRT-PCR and immunohistochemical (IHC) analyses of enteral tight occludin (Ocln), occludenas-1 (ZO-1), and cldin-1 (Cldn-1) showed that WYD could boost the level of ZO-1 and decrease the level of Cldn-1. The study also investigated the effect of WYD treatment on the enteral barrier function of astriction model mice and found that the TJ proteins (ZO-1, Cldn-1) in the colon of the astriction model mice had significant changes compared to the normal group, and WYD intervention was found to increase the expression of ZO-1, and decrease the expression of Cldn-1. WYD alleviates LIA by regulating enteral hormones, boosting the number of interstitial cells of Cajal (ICCs), or adjusting enteral block action.

Effects of Jiawei Huangqi Guizhi Decoction on the expression of GAS, MTL, GC, and TGF-β3 signaling pathways in CAG rats

To study the effect of Jiawei Huangqi Guizhi Decoction on gastrointestinal hormones and TGF-β3 signal pathways in rats with chronic atrophic gastritis (CAG). The model was created by methylnitrosoguanidine (MNNG) comprehensive method. After successful modeling, it was divided into three groups: model group (MC group), frolic acid group (AC group), modified Huangqi Guizhi Decoction high dose group (HH group), modified Huangqi Guizhi Decoction middle dose group (HM group), and modified Huangqi Guizhi Decoction low dose group (HL group). Gastric pathology was observed by HE staining. The levels of gastrin (GAS) and motilin (MTL) in rat serum were detected by ELISA assay. After HE staining, the histopathological sections were analyzed. Inflammatory factors infiltration and disorder of mucosal epithelial cells were found in the model group, which were improved to some extent after administration. According to the pathological chart analysis and score of rats in each group, compared with the model group, the gastric tissue damage of rats in each administration group has been improved in different degrees, among which the pathological scores of HH and HM groups were lower, and the corresponding damage degree was smaller. According to the test results of ELISA, Jiawei Huangqi Guizhi Decoction could reduce the contents of GAS, TGF-β3, and increase MTL abundance in the serum of rats, thus accelerating the apoptosis of tumor cells and inhibiting cancer. Jiawei Huangqi Guizhi Decoction played a positive role in preventing the occurrence of gastric cancer through reducing the concentrations of GAS and TGF-β3 in serum, and increasing the concentration of MLT in serum. This results provided a new treatment idea for CAG.

CHANGES IN SERUM SOMATOSTATIN AND GASTRIN LEVELS IN PATIENTS AFTER CHOLECYSTECTOMY AND GASTROESOPHAGEAL REFLUX DISEASE.

The aim: To study of changes in the level of serum gastrin (GN) and somatostatin (SST) in patients with GERD after ChECT and determined their characteristics from clinical forms of GERD. Materials and methods: 64 patients with different clinical forms of GERD were examined. The patients with GERD were divide into 2 clinical groups. Group 1 included 34 patients with GERD after ChECT, among them there were 14 males (41.2 %) and 20 females (58.8 %), with the average age of 40.2 ± 3.2 years. Group 2 consisted of 30 patients with GERD without ChECT. Among them there were 18 males (60.0 %) and 12 females (40.0%), with the average age of 38.9 ± 4.7 years. All patients were tested for serum SST and GN level by enzyme-linked immunosorbent assay (ELISA). Results: In all patients with GERD of both group there was a significant increase in the level of serum SST. At the same time, a more higher indicators have been established in 2 Group of patients (increase up to 0.702 ± 0.029 pg / ml - p <0.01). Noteworthy is the change in the level of SST in the serum in both groups of the examined patients depending on the clinical form of GERD, with the maximum increase in patients with atypical manifestation of GERD. The analysis of the level of GN in blood serum indicates its decrease in the examined patients. In this case, the most pronounced changes were found in patients with extraesophageal clinical signs of GERD. Conclusions: 1. In patients after ChECT gastroesophageal reflux disease often has atypical symptoms (mostly cardiac and bronchopulmonary forms in 45.0% and 25.0 % of examend patients). 2. There was detected an increase in the level of blood SST of patients with GERD while there was observed a decrease in the GN indicator in the serum, especially in its atypical forms. 3. Duodenogastric reflux is often diagnosed during endoscopic examination of patients with GERD after cholecystectomy. At the same time, its severity correlates with the level of SST in blood serum (r=0.76; p<0.01 in the typical form and r= 0.72; p<0.05 in the atypical clinical form of GERD).

Clinico-epidemiological Profile of Incidentally Detected Gastrointestinal Neuroendocrine Tumours on Gastrointestinal Endoscopy: A Retrospective Study

Introduction: Neuroendocrine tumours (NETs) are rare tumours, with the Gastrointestinal (GI) tract and the lung as the most common sites with indolent course. Endoscopists play a pivotal role in the diagnosis of GI-NETS because the majority of patients with NETs are asymptomatic and NETs are discovered during screening examinations. Since GI-NETs are less common than other cancers, their natural history, diagnosis, and treatment may not be completely understood. Aim: To estimate the prevalence and to characterize the clinical, endoscopic, and histological features of incidentally detected GI NETs in nodular/polypoidal/ulcerated lesions on GI endoscopy. Materials and Methods: This record-based retrospective study was conducted at the Department of Medical Gastroenterology of a tertiary care facility. The data belonged to the period between January 2018 to December 2020. Data belonged to the patients that underwent Oesophago- gastro duodenoscopy (OGD)/ Colonoscopy and were found to have nodular/ polypoidal lesions. Records on serum chromogranin, serum gastrin and radiological tests such as Ultrasonography(USG) or Computed Tomography (CT) scan were recorded. The histopathological with immunohistochemistry staining report was used to diagnose NETs. Continuous variables were analysed for normality by the Kolmogorov Smirnov test. Results: A total of 59 eligible patients were studied. The prevalence of GI NET tumours in 2018 was 17 (0. 32%), 19 (0. 33%) in 2019, and 23 (0. 41%) in 2020 with an overall rate of 59 (0. 36%) for all the three years. Total male participants were 35 (59.32%), and the mean age of the patients was 56.13 ±12.44 years. Majority had abdominal pain (32, 54.24%) and 35(59.32%) had tumours in the duodenum, 15 (25.42 %) in the stomach. The most common site was duodenum 35 (59.32%). As per World Health Organisation (WHO) NET, most tumours were Grade I (50, 45.76%). Majority of tumours had Synaptophysin (57, 96.61%), Chromogranin (49, 83.05%), and a Ki67 (Kiel-clone no.67) index≤ 2 (49, 83.05%), while 27 (84. 75 %) tumours were of size of &lt;1 cm. Conclusion: GI-NETs are uncommon, and their biology, histopathology, and clinical behavior are distinct. Typically, they are slow-growing tumours, but their growth rate can fluctuate depending on the location, size, and grade of the tumour

Pantoprazole-Induced Bone Loss through Gastrin Secretion: A Stereological Study.

Recent researches have failed to uncover a clear explanation for proton pump inhibitors' bone-loss effects. In light of pantoprazole's effects on gastrin secretion, the goal of this study was to see if it caused bone loss through gastrin secretion. Forty male rats were divided into control, octreotide (Oct), pantoprazole (Pan), and pantoprazole plus octreotide (Pan+Oct) groups. Serum calcium, phosphorous, alkaline phosphatase, parathyroid hormone, and gastrin were measured before and three months after the treatment, and bone densitometry was examined. The rats' femoral bones were examined stereologically at the end of the investigation. The Pan group had considerably greater levels of serum alkaline phosphatase, parathyroid hormone (PTH), and gastrin, but this was prevented in the presence of Oct, a gastrin secretion inhibitor. All parameters of femoral bone densitometry in the Pan group were significantly lower than the control after treatment which was considerably inhibited in the presence of Oct. Furthermore, when compared to the control and Oct groups, the rats in the Pan group had a lower trabecular volume, femur bone weight, and volume, as well lower number of osteocytes. The amount of osteoclasts, on the other hand, was much higher in the Pan group than in the other groups. Overall findings revealed that pantoprazole caused bone loss, which could be prevented by adding octreotide. Because these detrimental effects were not detected in rats given both Oct and Pan, it was suggested that the effect of Pan on bone was produced by a hypergastrinemic condition.

The sun beside the pancreatic neck: The lymph node gastrinoma (with video).

The sun beside the pancreatic neck: The lymph node gastrinoma (with video).

Novel Magnetic-Bead-Assisted Sequential Extraction Method for Liquid Chromatography-Mass Spectrometry (MS)/MS of Components with Diverse Properties: Gastrin Determination as a Case Study

Sample preparation is the rate-limiting step in liquid chromatography-mass spectrometry (LC-MS)/MS-based clinical analysis when target analytes possess significantly different properties. Repeated solid-phase extraction (SPE) processes are typically required, resulting in low throughput and excessive consumption of labor, materials, and samples. In this study, we developed and validated a feasible and productive method to enrich target analytes with different properties during a single operation, while sufficiently removing matrix interferences to meet LC-MS/MS requirements. Gastrin determination was selected as the subject of this study. An automated magnetic-bead-assisted sequential extraction (MBASE) workflow was developed to simultaneously isolate nonsulfated gastrin-17 (G17ns), sulfated gastrin-17 (G17s), nonsulfated gastrin-34 (G34ns), and sulfated gastrin-34 (G34s) from human serum. It performs two different ion-exchange-based magnetic-bead extraction steps on one sample aliquot to produce one combined extract for LC-MS/MS analysis. When compared with the traditional SPE process, the MBASE workflow saves over 75% time and labor expenses as well as over 90% material cost, while providing even higher extraction efficiency. The MBASE LC-MS/MS method was validated as accurate and robust. Clinical sample test results demonstrated that the conventional chemiluminescence immunoassay method significantly under-estimated total gastrins in human serum, and the MBASE LC-MS/MS method could serve as an ideal tool to provide a comprehensive and accurate gastrin profile.

Global transcriptomic analysis reveals candidate genes associated with different phosphorus acquisition strategies among soybean varieties.

Soybean adapts to phosphorus-deficient soils through three important phosphorus acquisition strategies, namely altered root conformation, exudation of carboxylic acids, and symbiosis with clumping mycorrhizal fungi. However, the trade-offs and regulatory mechanisms of these three phosphorus acquisition strategies in soybean have not been researched. In this study, we investigated the responses of ten different soybean varieties to low soil phosphorus availability by determining biomass, phosphorus accumulation, root morphology, exudation, and mycorrhizal colonization rate. Furthermore, the molecular regulatory mechanisms underlying root phosphorus acquisition strategies were examined among varieties with different low-phosphorus tolerance using transcriptome sequencing and weighted gene co-expression network analysis. The results showed that two types of phosphorus acquisition strategies-"outsourcing" and "do-it-yourself"-were employed by soybean varieties under low phosphorus availability. The "do-it-yourself" varieties, represented by QD11, Zh30, and Sd, obtained sufficient phosphorus by increasing their root surface area and secreting carboxylic acids. In contrast, the "outsourcing" varieties, represented by Zh301, Zh13, and Hc6, used increased symbiosis with mycorrhizae to obtain phosphorus owing to their large root diameters. Transcriptome analysis showed that the direction of acetyl-CoA metabolism could be the dividing line between the two strategies of soybean selection. ERF1 and WRKY1 may be involved in the regulation of phosphorus acquisition strategies for soybeans grown under low P environments. These findings will enhance our understanding of phosphorus acquisition strategies in soybeans. In addition, they will facilitate the development of breeding strategies that are more flexible to accommodate a variety of production scenarios in agriculture under low phosphorus environments.

Development of amplified luminescent proximity homogeneous assay for quantitation of gastrin-17

A highly sensitive and convenient amplified luminescent proximity homogeneous assay (AlphaLISA) method with high throughput and automation potential was developed for quantitation of serum Gastrin-17 (G-17) levels, which can facilitate the early diagnosis of atrophic gastritis in people at high risk of gastric cancer using a non-invasive approach. In this study, donor and acceptor beads with modified carboxyl groups on the surface were directly coupled to anti-G-17 antibodies through activation was proposed for application in the development of the new AlphaLISA, which can effectively simplify the steps and shorten the reaction time to achieve faster detection. Therefore, the G-17-AlphaLISA only needs to react for 15 min to obtain good analysis results. The proposed method has a wider detection range than commercial enzyme-linked immunosorbent assay (ELISA) kits (0.12–112.8 pmol/L > 0.5–40 pmol/L). In addition, results of G-17-AlphaLISA and ELISA had good correlation and agreement (ρ = 0.936). Importantly, the developed method may be more suitable for the large-scale screening of people at high risk for gastric cancer than traditional ELISA and provides a novel solution for other biomarkers that require accurate, highly sensitive, and high throughput detection.

Randomized controlled trial to evaluate the efficacy and safety of fexuprazan compared with esomeprazole in erosive esophagitis

Fexuprazan, a novel potassium-competitive acid blocker, reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells. Fexuprazan's suppression of gastric acid was maintained in healthy individuals for 24 h in a dose-dependent manner. To compare fexuprazan to esomeprazole and establish its efficacy and safety in patients with erosive esophagitis (EE). Korean adult patients with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg or esomeprazole 40 mg once daily for eight weeks. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy at week 8. The secondary endpoints included the healing rate of EE at week 4, symptom response, and quality of life assessment. Safety profiles and serum gastrin levels were compared between the groups. Of the 263 randomized, 218 completed the study per protocol (fexuprazan 40 mg, n = 107; esomeprazole 40 mg, n = 111). Fexuprazan was non-inferior to esomeprazole regarding the healing rate at week 8 [99.1% (106/107) vs 99.1% (110/111)]. There were no between-group differences in the EE healing rate at week 4 [90.3% (93/103) vs 88.5% (92/104)], symptom responses, and quality of life assessments. Additionally, serum gastrin levels at weeks 4 and 8 and drug-related side effects did not significantly differ between the groups. Fexuprazan 40 mg is non-inferior to esomeprazole 40 mg in EE healing at week 8. We suggest that fexuprazan is an alternative promising treatment option to PPIs for patients with EE.

Two Cases of Duodenal Neuroendocrine (Carcinoid) Tumor Concurrent with Invasive Gastric Adenocarcinoma and Pancreatic Intraductal Papillary Mucinous Neoplasm

Abstract Introduction/Objective Neuroendocrine (carcinoid) tumors of the duodenum are extremely rare and account for only 2-4% of gastrointestinal tract neuroendocrine tumors. We report two cases of incidentally discovered duodenal neuroendocrine tumor which respectively occurred in a patient with invasive gastric adenocarcinoma and in a patient with pancreatic intraductal papillary mucinous neoplasm (IPMN). Methods/Case Report The first case involved a 60-year old male who presented with melena and symptomatic anemia and was found on EGD to have a large circumferential mass at the gastric antrum/pylorus, which was revealed to be an invasive gastric adenocarcinoma on biopsy. At the time of distal gastrectomy for this malignancy, a concurrent, 0.6 cm-sized, low grade neuroendocrine tumor was incidentally discovered at the duodenal margin. The duodenal tumor consisted of nests and trabeculae of monotonous cells with ovoid/round nuclei, finely speckled “salt and pepper” chromatin, and low mitotic rate (&amp;lt; 2 mitoses/2 mm2), and invaded only into submucosa. The tumor cells were strongly and diffusely positive for neuroendocrine markers chromogranin, synaptophysin, and CD56, positive for CK7 and CDX2, negative for CK20, and with low Ki67 proliferation index (&amp;lt; 3%). The second case involved a 69-year old female who presented with epigastric pain and was found on abdominal CT to have a 4 cm-sized cystic mass in the pancreatic head. While biopsy of the pancreatic mass revealed an IPMN, a separate biopsy of an incidentally discovered, 1 cm-deep ulcer in the duodenum bulb revealed a low-grade neuroendocrine tumor with similar morphologic features, mitotic rate, and immunohistochemical staining pattern as the prior case while also negative for IMP3 stain. The patient had normal serum gastrin and urine HIAA levels, but elevated serum chromogranin-A levels. Results (if a Case Study enter NA) NA. Conclusion Duodenal carcinoids are rare (1-3% of primary duodenal tumors) and are mostly non-functional and unifocal. The duodenum is also the least common site (2-4%) for GI tract neuroendocrine tumors. The pathophysiology of these tumors is still poorly understood, with the majority occurring sporadically and a minority in the setting of hereditary cancer syndromes. This report documents two very rare instances of duodenal neuroendocrine tumor incidentally discovered with invasive gastric adenocarcinoma and pancreatic IPMN.

Value of serum pepsinogen, gastrin, and cadherin-17 detection combined with narrowband imaging magnifying endoscopy in distinguishing early gastric cancer and precancerous lesions

Value of serum pepsinogen, gastrin, and cadherin-17 detection combined with narrowband imaging magnifying endoscopy in distinguishing early gastric cancer and precancerous lesions

LBSUN345 Diagnostic Dilemma In A Case of Vipoma

Abstract Introduction Vasoactive intestinal polypeptide secreting tumors (VIPoma) are rare neuroendocrine tumors that have nonspecific features of watery diarrhea, hypokalemia and achlorhydria. With an incidence of 1 in a million per year, it is diagnosed based on serum VIP levels (&amp;gt;75pg/ml) followed by imaging studies to localize the tumor and look for metastases. We present a challenging case of VIPoma that was successfully managed with surgical exploration despite classic yet nonspecific clinical features and poor evidence on imaging. Case Discussion A 78-year-old Caucasian woman presented with persistent secretory diarrhea for 2 months. Past medical history was significant for intractable peptic ulcer disease and Billroth II reconstruction. Laboratory investigations showed severe hypokalemia (2.1 mmol/l), serum bicarbonate 13 and chloride 117. Blood glucose and calcium levels were within normal range. Stool studies confirmed secretory diarrhea with stool osmotic gap of 10 mOsm/kg but no growth. Serum gastrin, parathyroid hormone, chromogranin and urine 24-hour 5-hydroxy indoleacetic acid (5-HIAA) levels were within normal limits. Plasma VIP levels were elevated at 79 pg/mL. Computed tomography of the abdomen and pelvis did not show any evidence of pancreatic tumor or biliary ductal dilatation. Endoscopic ultrasound could not fully evaluate the head of pancreas but showed unremarkable liver, pancreatic body and tail. Capsule endoscopy was unremarkable as well. An octreotide scan, however, demonstrated increased activity near the head of the pancreas and abdominal aorta. As clinical picture and octreotide scan findings were consistent with VIPoma, operative exploration for possible pancreaticoduodenectomy was pursued. No evidence of palpable or occult metastatic disease was found; but intraoperative color doppler ultrasound localized two lesions less than 1 cm in size at the level of the uncinate process and ampulla. An open pancreaticoduodenectomy was performed and the existing Billroth II anatomy was modified to accommodate pancreatojejunostomy, gastrojejunostomy and choledochojejunstomy. A jejunostomy tube was placed for enteral access. At 2-month post-operative follow-up, the patient had significant improvement of his diarrhea. Radiographic resolution was noted on repeat octreotide scan 4 months following resection. Conclusion VIPomas are usually diagnosed by elevated VIP levels and imaging studies are used to localize the tumor for further treatment. However, this case highlights that in secretory diarrhea with elevated VIP level and no alternate diagnosis, despite negative imaging studies further exploration with octreotide scan is warranted. Surgical exploration may show the site of lesion and appropriate surgical intervention may lead to resolution of VIPoma. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PSUN369 Glucagonoma-Associated Dilated Cardiomyopathy in a Young Female: A Case Report

Abstract Background Dilated cardiomyopathy has been reported in patients with glucagonoma. Since glucagon increases myocardial cAMP levels independent of beta adrenoreceptor blockade, thereby increasing heart rate and cardiac output, chronic excessive glucagon stimulation of the heart may lead to cardiomyopathy (Chang-Chretien, 2004). Clinical Case A 26 year old female presented with a 2-year history of palpable epigastric mass, vomiting and weight loss. Abdominal CT showed a heterogeneously enhancing, lobulated pancreatic head-body mass measuring 6.7×6.1×9.9 cm and a hypo-enhancing nodule in hepatic segment IVb, worrisome for metastasis. Endoscopy-guided FNAB of the pancreatic mass revealed a well-differentiated pNET, Grade 3. Chromogranin and synaptophysin stains were positive, Ki-67 index was 33.6%. She was lost to follow-up. After 4 months, she was admitted due to 1 week history of increased vomiting episodes up to 10x daily and abdominal discomfort with 2 day history of incomprehensible speech and right-sided weakness. On examination, she was weak-looking, tachycardic (114 bpm), underweight (BMI 17.45 kg/m2) and with palpable, hard, non-tender epigastric mass measuring 10×7 cm. She also had hyperpigmented patches on both legs initially manifesting as intermittent oozing excoriations over the past 2 years. Cranial MRI revealed subacute CVD infarct. Anticoagulation was given. On the second day, she started having diarrheal episodes. Supportive management was given. Serum glucagon was markedly elevated (&amp;gt;25,000 pg/mL, normal &amp;lt;80). Serum PP (6562 pg/mL, normal &amp;lt;228) and gastrin (621 pg/mL, normal 13-115) were elevated. Serum VIP (&amp;lt;50 pg/mL, normal &amp;lt;75) was normal. Further investigations showed prediabetes (FBS 112 mg/dL, HbA1c 5.7%) and normocytic, normochromic anemia. Screening for MEN1 was unremarkable. On the third day, she had progression of slurred speech and right-sided weakness. Cranial MRI revealed acute lacunar infarcts. As part of hypercoagulability workup, 2D-Echocardiogram showed depressed ejection fraction (20.9%), dilated LV with normal relative wall thickness, and global hypokinesia of the LV wall, confirming dilated cardiomyopathy. Carotid and Venous Duplex scans were normal. Anti-heart failure regimen was initiated. Due to her current neurologic, cardiac and metabolic conditions, she cannot proceed with surgery and chemotherapy. She was given octreotide injection 30 mg every 4 weeks for 3 doses. Post-treatment, repeat abdominal CT and 2D-Echocardiogram showed no significant change. In the meantime, she had improved appetite and no recurrence of vomiting nor diarrhea. She denies palpitations and can better tolerate walking and climbing stairs. Conclusion We reported a rare case of glucagonoma in a young female with documented constellation of symptoms and complications associated with the syndrome, prominently including dilated cardiomyopathy. It is therefore recommended that cardiovascular evaluation should be initiated at the time of glucagonoma diagnosis for timely and appropriate management. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PMON40 A Rare Etiology of Chronic Diarrhea: Zollinger-Ellison Syndrome

Abstract Introduction Zollinger-Ellison Syndrome (ZES) is a rare etiology of chronic diarrhea caused by a gastrin-secreting neuroendocrine tumor. Early suspicion can prevent multiple readmissions for recurrent diarrhea thus improving clinical outcomes through prompt diagnosis and treatment, as the following case highlights. Case presentation A 74-year-old African-American female with hypertension and chronic atrial fibrillation presented to the ED complaining of watery, non-bloody diarrhea for the past 3 weeks. She reports her symptoms worsened after completing a course of amoxicillin for pharyngitis one week prior. On further questioning, she reported intermittent diarrhea for over 20 years lasting approximately two days per episode. She denied recent travel, sick contacts, pet reptiles, and recent ingestion of undercooked meat. On arrival, she was afebrile and hemodynamically stable. She was admitted for an acute kidney injury with an elevated creatinine of 3.23 mg/dL (N: 0.6-1.1 mg/dL) due to dehydration. Her renal function improved with fluids, but she developed bloody diarrhea for which gastroenterology was consulted. Stool studies were negative for Shiga-toxin, C. difficile, lactoferrin, and parasites. Computed Tomography of the abdomen showed enteritis with fluid noted throughout the colon consistent with colitis. Unprepped colonoscopy revealed blood throughout the length of the colon, suggestive of an upper gastrointestinal bleed. Esophagogastroduodenoscopy (EGD) revealed multiple bleeding duodenal ulcers controlled with hemostasis. Her symptoms improved and she was discharged home on oral pantoprazole, and told to follow up outpatient. Two weeks later, she denied any new episodes of diarrhea, and a random serum gastrin level was elevated at 413 pg/mL (N: &amp;lt;180 pg/mL). Repeat gastrin level off pantoprazole for 7 days was also elevated at 678 pg/mL, and a serum Chromogranin A level was elevated at 629 pg/mL (N: &amp;lt;390 pg/mL). Repeat EGD found her Gastric pH to be 1 with multiple non-bleeding duodenal ulcers. Somatostatin receptor scintigraphy revealed a high intensity signal consistent with a duodenal gastrinoma causing ZES. She elected for surgical resection, and was discharged home on high dose pantoprazole. Three months later, she stated that her diarrhea had completely resolved. Conclusion This case confirms ZES as a rare cause of chronic diarrhea in the setting of multiple duodenal ulcers refractory to proton pump inhibitors. Diagnosis can be made with a fasting serum gastrin level &amp;gt;1000 pg/mL or &amp;gt;400 pg/mL with a gastric pH &amp;lt;1. A Secretin Stimulation Testing can also be used. Treatment starts with high dose proton pump inhibitors, octreotide for hormonal regulation, and surgical resection if necessary. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Metastatic multiple gastric neuroendocrine tumors with a long history of proton pump inhibitor use: A case report

It is widely accepted that gastric neuroendocrine tumors (NETs) develop due to enterochromaffin-like (ECL) cell proliferation following exposure to hypergastrinemia, which causes hyperplastic-dysplastic-neoplastic changes. Here we describe the case of a 46-year-old female patient diagnosed with metastatic NETs by liver biopsy and evaluated at an external center. At our hospital, nodular structures extending from the cardia to the antrum were observed by gastroscopy, considered the primary tumor focus. Histopathological examination revealed a trabecular-insular pattern, with microNETs consisting of monotone cells with round-oval nuclei and surrounding neuroendocrine cell hyperplasia foci and fundic gland polyps. The patient had a history of regular proton pump inhibitor (PPI) use for 10 years and a serum gastrin of 9240 pg/mL. A 3-cm metastatic lesion in the left lobe of the liver was observed in whole-body imaging with octreotide. By gastrectomy, we observed a large number of nodular lesions in the corpus-antrum and a 3-cm diameter lesion in the hepatectomy material. Histopathological examination revealed NETs in multiple foci with submucosal invasion in the stomach. The Ki-67 proliferative index was 3%. Metastatic tumors of similar morphology were found in the liver and three of the greater curvature lymph nodes. We made a diagnosis of multiple gastric NETs (Grade 2). In Type I gastric NETs, the neuroendocrine cell proliferation spectrum up to NET is observed as a result of hypergastrinemia due to atrophic gastritis. Also, in experimental studies, prolonged hypergastrinemia has been reported to cause ECL cell neoplasms in animals treated with PPIs. Although our case could be accepted as Type 1 NET, the possibility of developing NET secondary to long-term PPI use should also be considered.

The relationship of serum gastrin-17 and oral mucositis in head and neck carcinoma patients receiving radiotherapy

ObjectiveThe aim of this study was to analyze the relationship of serum gastrin-17 (G-17) and oral mucositis in head and neck carcinoma (HNC) patients receiving radiotherapy.MethodsSerum G-17 were detected in patients before and after radiotherapy. Patients were divided into high G-17 group (baseline serum G-17 ≥ 5pmol/L) and low G-17 group (baseline serum G-17 < 5pmol/L). The severity of oral mucositis was analyzed between the two groups. Other complications such as dysphagia, salivary gland, mandible, thyroid function, larynx, pain, and weight loss were also investigated.ResultsForty-two patients were analyzed in this study. The level of serum G-17 had a significant decrease after radiotherapy (7.29 ± 5.70pmol/L versus 4.93 ± 4.46pmol/L, P = 0.038). In low serum G-17 group, the incidences of grade 0, 1–2 and 3–4 of oral mucositis were 0%, 30.4%, and 69.6%, respectively. In high serum G-17 group, the incidences of grade 0, 1–2 and 3–4 of oral mucositis were 0%, 63.2%, and 36.8%, respectively. Pearson correlation analysis showed that serum G-17 was negatively correlated with oral mucositis (r=-0.595, P < 0.01). Weight loss of low G-17 group was more serious than that of high G-17 group.ConclusionSerum G-17 has a close relationship with oral mucositis. Baseline serum G-17 may be a potential predictor for the severity of oral mucositis in HNC patients receiving radiotherapy.

Effects of Quadruple Therapy Combined with Probiotics on Helicobacter Pylori-Related Peptic Ulcer.

The present study was designed to observe the effect of quadruple therapy combined with probiotics on Helicobacter pylori-related peptic ulcer. The patients in the control group (n = 90) were given regular quadruple therapy including proton pump inhibitor ilaprazole enteric-coated tablet + two antibiotics amoxicillin dispersible tablet and metronidazole tablet + colloidal bismuth pectin capsule for 2 weeks. Patients in the study group (n = 90) were given abovementioned quadruple therapy combined with probiotics live combined Bifidobacterium, Lactobacillus, and Enterococcus Capsules, oral for 2 weeks. Then Hp clearance rate, recurrence rate, levels of gastrointestinal hormone makers, and advance reactions between two groups were compared. At the 2nd week after the treatment, the Helicobacter pylori clearance rate in the study group (87.79%) was significantly higher than the control group (78.89%), and the total recurrence rate in the study group (6.67%) was significantly lower than the control group (13.33%) (P < 0.05). Serum gastrin and motilin expression were lower, and somatostatin expressions was significantly higher than those in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05). In summary, quadruple therapy combined with probiotics in the treatment of Helicobacter pylori-related peptic ulcer can improve the Helicobacter pylori clearance rate, reduce the Helicobacter pylori recurrence rate, and is beneficial to improving the level of gastrointestinal hormones, with certain safety.

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

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

S3615 Gastric Neuroendocrine Tumor of Indeterminate Type

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