Upper Gastrointestinal Symptoms Research Articles

Key variables associated with gastroparesis in diabetes patients with gastroparesis-like symptoms

Background/aims Gastroparesis is a late complication of diabetes mellitus characterized by delayed gastric emptying and upper gastrointestinal symptoms. The disorder substantially impacts the quality of life, glycemic stability, nutrition and absorption of orally administered drugs. Since symptom severity is a poor predictor of gastric emptying status, the clinician has little to aid them in whom to refer for gastric emptying testing. In this study, we aim to identify clinical characteristics associated with delayed gastric emptying in diabetes patients with gastroparesis-like symptoms. Materials and methods Diabetes patients consecutively referred to Haukeland University Hospital for assessment of gastroparesis-like symptoms underwent gastric emptying scintigraphy, blood samples and questionnaires for assessing gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale), neuroticism (Eysenck Personality Questionnaire-Short Form), and symptoms of anxiety and depression (Hospital Anxiety & Depression Scale). Results: Seventy-one patients were included in the study, of which 28 displayed delayed gastric emptying. Delayed gastric emptying was characterized by having type 1 diabetes, younger age, lower BMI, presence of other late complications including distal symmetric polyneuropathy and retinopathy, higher Hb1Ac levels and lower albumin and hemoglobin levels. Symptoms were not related to gastric emptying status. Conclusion We identified several clinical variables associated with delayed gastric emptying in diabetes patients with gastroparesis-like symptoms. These variables are commonly assessed during a medical consultation and may be used to aid the clinician in choosing who to refer for gastric emptying testing.

Indobufen versus aspirin after percutaneous coronary intervention in elderly patients with acute coronary syndrome

BackgroundAntiplatelet therapy is pivotal in managing elderly patients with Acute Coronary Syndrome (ACS) following Percutaneous Coronary Intervention (PCI). While aspirin remains a cornerstone of this therapy, its use is sometimes limited by the risk of gastrointestinal (GI) complications or allergic reactions in certain patients.PurposeThis study aims to assess the safety and efficacy of Indobufen as an alternative to aspirin when used in combination with clopidogrel in elderly ACS patients post-PCI.MethodsThis is a single-center, retrospective study employing propensity score matching. Elderly ACS patients who underwent PCI between January 2019 and May 2022 were enrolled. Participant were categorized into two groups based on their medication regimen: the aspirin DAPT group and the indobufen DAPT group. The primary endpoint was the Net Adverse Clinical Event (NACE) at 1 year, which included all-cause mortality, stroke, myocardial infarction (MI), target lesion revascularisation, and bleeding events classified under the Bleeding Academic Research Consortium (BARC) criteria type 2, 3, or 5.ResultsA total of 2087 patients were enrolled in this study. Based on their medication regimen, 348 patients were assigned to indobufen DAPT group, while 1739 individuals were assigned to aspirin DAPT group. After applying 1:1 propensity score matching, 306 patients were included in each group. During the 1-year follow-up, the NACE occurred in 59 patients (19.9%) of the Indobufen DAPT group and 58 patients (18.6%) in the aspirin DAPT group, with no significant difference between the groups (HR 1.029, 95% CI 0.714–1.484, P = 0.876). Additionally, there were no significant difference in Patient-Oriented Composite Endpoint (POCE) and BARC 2, 3, or 5 bleeding events between the groups at 1, 3, or 6 months of follow-up. However, the indobufen DAPT group experienced a lower incidence of upper GI symptoms compared to the aspirin DAPT group.ConclusionIndobufen, as an alternative to aspirin, demonstrates comparable efficacy and safety in elderly ACS patients after PCI, with a potential reduction in gastrointestinal symptoms. These findings support the use of indobufen as a viable alternative for elderly ACS patients who are intolerant to aspirin.Clinical trial numberNot applicable.

Duodenal Neuroendocrine Tumour: An Incidental Discovery of an Indolent Disease

Neuroendocrine neoplasms arise from the neuroendocrine cells distributed throughout the body. Duodenal neuroendocrine neoplasms are rare. Most of these are nonfunctional and therefore present with nonspecific symptoms or with clinico-pathological features unique to their location. The management of neuroendocrine tumours is dependent on its grade and stage. Classification of neuroendocrine tumours and hence its grading has been updated multiple times. Here we present a patient who complained of very non specific upper gastrointestinal symptoms and was found to have a duodenal polyp on endoscopy which was diagnosed by histology and immunohistochemistry as a grade three neuroendocrine tumour according to the latest WHO classification (2022).

A Case of Olmesartan-associated Gastritis Observed Over Time

A 61-year-old woman who had been taking olmesartan for 7 years complained of epigastric pain, diarrhea, loss of appetite, and weight loss. Esophagogastroduodenoscopy revealed roughened mucosa and erosions in the stomach and duodenum. An endoscopic biopsy failed to identify the cause of the mucosal disorder. Small-bowel capsule endoscopy revealed villous atrophy in the small bowel, which led to suspicion of olmesartan-associated sprue-like enteropathy and gastritis. After the discontinuation of olmesartan, the symptoms and gastric mucosal findings improved. A final diagnosis of olmesartan-associated gastritis was confirmed. Olmesartan-associated gastritis should be considered in patients taking olmesartan for upper gastrointestinal symptoms.

High Economic Burden Yet Low Clinical Value: Why Is so Much Sucralfate Prescribed?

Sucralfate is a commonly prescribed medication in use for decades. Despite the availability of more effective medications for acid-dyspeptic conditions, including proton pump inhibitors and histamine H2-receptor antagonists, sucralfate continues to be utilized for upper gastrointestinal symptoms. We reviewed the limited evidence base supporting the approval and ongoing usage of sucralfate and performed a cost analysis using the ClinCalc database. The financial impact of sucralfate was comparable to famotidine, lansoprazole and ranitidine. We encourage further studies to accurately gauge the true clinical efficacy of sucralfate and to question its ongoing prescription until then.

Proton pump inhibitors and upper gastrointestinal cancer: a matched case-control study addressing confounding by indication.

To assess the association between proton pump inhibitor (PPI) use and upper gastrointestinal (GI) cancer while addressing potential confounding by indication. Matched case-control study using multivariable conditional logistic regression. Electronic health records from a national health provider. Patients diagnosed with upper GI cancer (n=875), each matched with 10 cancer-free controls (n=8750) by age, sex, and ethnic group. Adjusted odds ratios (aORs) for upper GI cancer associated with prior exposure to PPIs, H2 receptor antagonists, or antacids, with medication exposure modelled as multiple binary variables corresponding to distinct time windows before the index date. Additional models adjusted for GI-related diagnoses recorded prior to the index date (e.g., gastritis, gastroesophageal reflux disease, peptic ulcer disease). PPI use in the five years before the index date was initially associated with increased odds of upper GI malignancy (e.g., esomeprazole aOR 3.90 [95% CI 3.14 to 4.84]; omeprazole aOR 2.60 [2.22 to 3.06]). However, when exposure was modelled as separate binary variables for each time window, the association was strongest for use within six months of diagnosis and was not observed-or reversed-for more remote exposures. After excluding the final year before diagnosis and adjusting for symptom-related diagnoses, no positive association remained. Remote PPI use was associated with reduced risk (e.g., omeprazole more than 3 years before the index date: aOR 0.62 [0.51 to 0.75]). The association between PPI use and upper GI malignancy appears to reflect confounding by indication, with PPIs prescribed in response to early symptoms associated with increased cancer risk. After accounting for timing of use and underlying GI diagnoses, no harmful association remained. These findings suggest that new-onset upper GI symptoms warrant investigation for malignancy, rather than attribution of risk to acid-suppressive therapy.

PVI-induced periesophageal vagal nerve injury detected by Electrogastrography

PVI-induced periesophageal vagal nerve injury detected by Electrogastrography

Achalasia-Associated Superior Mesenteric Artery Syndrome with Massive Gastric Dilatation

BackgroundAchalasia and superior mesenteric artery (SMA) syndrome are both uncommon gastrointestinal disorders. When they occur together—a rare clinical scenario—they can cause serious complications, including severe gastric distension.Case PresentationWe report the case of a 62-year-old man with a known history of achalasia, previously managed with botulinum toxin injections. He presented with progressively worsening abdominal bloating, unintentional weight loss, and abdominal discomfort. Endoscopy revealed a strikingly dilated oesophagus and stomach, filled with nearly 9 litres of fluid. Further imaging with computed tomography angiography showed a narrowed aortomesenteric angle measuring just 16.7°, consistent with a diagnosis of SMA syndrome. Remarkably, despite the massive distension, no perforation was identified.DiscussionThis case highlights a rare but important overlap between achalasia and SMA syndrome, leading to extreme gastric dilatation in the absence of rupture. Despite the extreme degree of gastric dilatation observed on both endoscopy and imaging, the stomach wall remained intact, and there were no signs of ischemia or perforation. Although SMA syndrome may occur secondary to other health conditions, this case underscores how variable and potentially dangerous this dual pathology can be.ConclusionClinicians should remain vigilant for the possibility of SMA syndrome in patients with achalasia who develop new or worsening upper gastrointestinal symptoms, particularly if there is significant gastric dilatation. Early imaging and recognition can be crucial in preventing severe outcomes like perforation.LEARNING POINTSThe patient has a very rare combination of achalasia and superior mesenteric artery syndrome, presenting with massive dilatation of the stomach with no perforation.Early detection through computed tomography angiography and early decompression are essential to prevent potentially fatal complications, including gastric rupture.This case adds to the limited literature describing achalasia-superior mesenteric artery overlap and reinforces the need for a high degree of clinical suspicion when symptoms diverge from baseline.

Comparison effectiveness of topical analgesics with and without Entonox for esophagogastroduodenoscopy: A randomized controlled trial.

Esophagogastroduodenoscopy (EGD) is vital for diagnosing and treating upper gastrointestinal symptoms, but patient discomfort and anxiety can affect procedural outcomes. This study aimed to compare the effectiveness of topical analgesics with and without Entonox during EGD in terms of procedural success, patient tolerance, and satisfaction. A prospective, randomized, double-blinded, controlled trial. Patients were assigned to receive either 10% xylocaine spray in the control group (Group C) or 10% xylocaine spray combined with Entonox (Group E). Procedural success and patient comfort were evaluated using the Bath Gastroscopy Toleration Score and patient comfort scores, with scores of 0 or 1 indicating success. Satisfaction was measured using the numeric rating scale, where scores of 7 or higher indicated high satisfaction. A total of 211 patients underwent EGD successfully (Group C=106, Group E=105). Patients in Group E demonstrated a significantly higher proportion of success rate (76.2%vs. 35.9%, p<0.001), better toleration score (82.9%vs. 75.5%, p=0.004), and better patient comfort score (86.7%vs. 39.6%, p<0.001) compared to Group C. Endoscopists and patients in Group E expressed higher satisfaction levels (9vs. 8, p<0.01 and 9vs. 8, p<0.01). The side effects of Entonox were minimal. Notably, Group E had a lower proportion of high blood pressure and tachycardia during the procedure (p<0.001). Combining Entonox with topical analgesics significantly improves tolerance, satisfaction, and procedural success during EGD, offering a safe and effective option for managing patient discomfort and anxiety.

Frequency of Helicobacter pylori infection in gastric biopsies in renal transplant recipients with upper gastrointestinal symptoms

INTRODUCTION: It is known that Helicobacter pylori (HP) plays an important role in gastritis and peptic ulcer disease. In addition, the International Agency for Research on Cancer (IARC) categorized HP infection as a type I carcinogen and it is considered as the primary cause of gastric cancer. HP eradication reduces relapse in peptic ulcer and decreases gastric cancer risk. The incidence of gastrointestinal (GI) complications in renal transplant recipients (RTRs) is relatively high and complications may be severe and may lead to graft loss and even patient death. The most frequently found gastrointestinal disease in transplant recipients is the peptic ulcer, a frequent cause of mortality, accounting for 4% of deaths after transplantation. In transplant patients, immunosuppression such as cyclosporine A (CyA), steroids (STs) and Mycophenolate mofetil (MMF) contributes much more to cancer risk because it interrupts normal cancer surveillance mechanism. Incidence of malignant tumors in transplant recipients is 3 to 5 times higher than in the general population. Therefore, the accurate assessment of HP infection status in renal transplant recipients is important. There is currently no information on the prevalence of HP in renal transplant recipients in Pakistan. So, this study will help fill this gap in knowledge on the prevalence of HP in our population. OBJECTIVE To determine the frequency of Helicobacter pylori (HP) infection in gastric biopsies in renal transplant recipients with upper gastrointestinal symptoms. STUDY DESIGN: Descriptive, cross-sectional study. DURATION OF STUDY: Six months (December 2019-May 2020). SUBJECTS AND METHODS: All renal transplant patients of age range 10-65 years (children and adults) of any gender who had any one or more of the upper gastrointestinal symptoms such as epigastric pain, burning, nausea and vomiting, post prandial fullness and early satiety and in whom gastro-intestinal endoscopy and biopsies were performed, were included in the study. Data was collected from request forms and clinical charts. Age, sex and presence/absence of HP were recorded on a structured proforma. RESULTS: A total of 315 renal transplant recipients and non-renal transplant recipients underwent upper gastro-intestinal endoscopy in the gastroenterology department of SIUT, Karachi, during the study period. Of these, 106 consecutive biopsies of renal transplant recipients who had gastrointestinal symptoms were eligible for inclusion in the study. Out of which, 86 (81.1%) were male and 20 (18.9%) were female with a male to female ratio of 4.3:1. The mean age of all patients was 34.5±10.15 years (range: 12-65 years); the median age was 33.67 years. Majority of patients, 70 out of 106 (66.1%), were in age group ranging from 20-40 years. HP infection was positive in 11 (10.4%) biopsies of renal transplant recipients. Chronic active (diffuse) inflammation was observed in 9 (81.81%), chronic active (focal) gastritis in 1 (9.09%) and follicular gastritis with activity in 1 (9.09 %) biopsies with HP infection. Intestinal metaplasia (IM) was found in two (18.2%) biopsies. All patients in positive group were males (100%). The most frequent gastrointestinal complaints noticed in HP positive patients were weight loss in nine (81.81%) patients followed by epigastric pain in three (27.27%) patients. No correlation was found between gender (p=0.168) and age (p=0.36) and occurrence of HP infection. The other 95 (89.6%) gastric biopsies of renal transplant recipients were negative for HP infection. The histological findings included chronic nonspecific gastritis in 83 (89.2%), chronic active (diffuse) gastritis in 5 (5.4%), chronic active (focal) gastritis in 3 (3.2) and follicular gastritis with activity in 2 (2.2%). Goblet cell metaplasia was found in 5 (5.3%) HP negative biopsies. CONCLUSION: In conclusion, the frequency of HP infection is 10.4% in our renal transplant recipients which is quiet low compared to non-transplant patients. Further, large scale studies are needed to determine the true prevalence of this common pathogen in our transplant population.

Tislelizumab plus chemotherapy versus placebo plus chemotherapy as first-line treatment of advanced gastric or gastroesophageal junction adenocarcinoma: patient-reported outcomes in the RATIONALE-305 study

Objective RATIONALE-305 (NCT03777657) demonstrated that tislelizumab plus chemotherapy statistically improved overall survival versus placebo plus chemotherapy as first-line treatment in patients with advanced gastric/gastroesophageal junction adenocarcinoma (GC/GEJC). This analysis examined patient-reported outcomes (PROs) at final analysis. Methods Adults with previously untreated, unresectable, or metastatic GC/GEJC were randomized (1:1) to tislelizumab or placebo intravenously once every 3 weeks plus chemotherapy. PROs assessed health-related quality of life (HRQoL) using EORTC QLQ-C30 and EORTC QLQ-STO22. A mixed model for repeated measures was used for PRO endpoints at treatment cycles 4 and 6, and time to deterioration was analyzed. Results Tislelizumab arm had improved outcomes over placebo arm in least-squares (LS) mean change from baseline to cycle 6 for QLQ-C30 global health status/quality of life (GHS/QoL) (LS mean difference, 2.52 [95% CI: 0.29-4.74]), physical functioning (2.46 [0.49-4.43]), fatigue (–3.01 [–5.78 to –0.24]), and STO22 index score (–1.62 [–3.12 to –0.12]) as well as maintenance of upper gastrointestinal symptoms (–1.74 [–3.55 to 0.06]) and pain/discomfort (–1.88 [–4.03 to 0.27]). Patients receiving tislelizumab plus chemotherapy had a lower risk for deterioration of GHS/QoL (hazard ratio 0.77 [95% CI: 0.60-0.98]), physical functioning (0.72 [0.57-0.92]), STO22 index score (0.64 [0.45-0.92]), pain/discomfort (0.74 [0.58-0.96]), and upper gastrointestinal symptoms (0.73 [0.56-0.95]). Conclusions Advanced GC/GEJC patients treated with tislelizumab plus chemotherapy versus placebo plus chemotherapy in first-line had sustained and improved HRQoL. These results, along with previous efficacy and safety data, support tislelizumab plus chemotherapy as a first-line treatment option for GC/GEJC. Trial registration: The RATIONALE-305 trial is registered on ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT03777657).

Olmesartan-associated gastroduodenitis that was detected on endoscopic follow-up

Abstract We present a rare case of olmesartan-associated gastroduodenitis in a 65-year-old female with predominant upper gastrointestinal symptoms and significant changes in endoscopic findings over a short period. The patient presented with epigastralgia and nausea but no diarrhea. Esophagogastroduodenoscopy (EGD) performed 26 months earlier showed a duodenal ulcer and partial mucosal atrophy in the lower gastric body. EGD conducted at our hospital revealed diffuse atrophic mucosa throughout the stomach and fragile mucosa from the middle gastric body to the antrum, with white purulent adhesions. Diffuse inflammatory changes were also observed in the duodenal bulb and descending part. Mucosal biopsy showed atrophic changes, inflammatory cell infiltrations, and epithelial detachments in both the stomach and duodenum. Colonoscopy findings were normal. After discontinuing olmesartan, the patient’s symptoms improved immediately. A follow-up EGD conducted 4 months after discontinuation revealed marked improvement in the stomach and duodenum. At 16 months post-discontinuation, the patient remained asymptomatic, with minimal inflammation and residual gastric atrophy observed on EGD. This case underscores the importance of considering olmesartan as a potential cause of gastroduodenitis, particularly when symptoms and endoscopic findings improve after discontinuation of the medication.

Eosinophilic esophagitis and allergic susceptibility: A systematic review and meta-analysis.

Eosinophilic esophagitis and allergic susceptibility: A systematic review and meta-analysis.

Repetitive Feeding-Challenge With Different Nutritional Densities on Markers of Gastrointestinal Function, Substrate Oxidation, and Endurance Exercise Performance.

Gut-training has been shown to improve gastrointestinal tolerance, circulatory glucose availability, and exercise performance. The study aimed to investigate the effects of a repetitive feeding-challenge using fat versus carbohydrate (CHO) on markers of gastrointestinal function, glucose availability, and subsequent performance when challenged with a high-CHO load (87g/hr) during exercise. Forty-four endurance athletes (mean ± SD [9 females and 35 males]: body mass: 71.2 ± 9.2kg, height: 173.6 ± 7.0cm, V˙O2max: 55.0 ± 6.1ml·kg-1·min-1) completed a preintervention gut-challenge trial (T1), involving a 2hr run (60% V˙O2max) while taking a CHO gel every 20min (87g/hr, 10% w/v), followed by a 1hr self-paced distance test with ad libitum water. Participants were then randomized to a fat (fat feeding-challenge [FFC]; 20g nut butter, 124kcal, 11g fat, 3g protein, and 3g CHO) or CHO supplement (CHO feeding-challenge [CFC]; 47g CHO gel: 123kcal, 29g CHO) group to complete a 7-day repetitive feeding-challenge (1hr exercise and supplement intake every 20min with 290ml water), followed by a gut-challenge retrial (T2). FFC did not differ from CFC in terms of resting orocecal transit time, feeding tolerance, or substrate oxidation during T1 and T2. Peak breath hydrogen was lower in FFC than CFC (p = .028) at T2. Total (FFC: 27%, p = .005 vs. CFC: 38%, p = .001) and upper gastrointestinal symptoms severity (FFC: 26%, p = .013 vs. CFC: 40%, p < .001) during exercise was reduced similarly between groups from T1 to T2. FFC covered more distance in T2 (11.51 ± 2.02 vs. 11.08 ± 2.02km, p = .013), but not significantly different to CFC (p = .341). A repetitive feeding-challenge with fat does not enhance nor worsen gastrointestinal and fueling outcomes compared with a CHO repetitive feeding-challenge.

Immune Checkpoint Inhibitor Related Gastritis; a Case Report from a Tertiary Centre

Background Immune Check point Inhibitor (ICI) use has been growing in various fields of oncology. ICI related side effects are therefore being more commonly seen. ICI related gastritis is a rare side effect that can be a challenging complication to manage. Case summary We present a severe case of steroid-refractory gastritis secondary to a combination immunotherapy (ipilimumab and nivolumab) being used to treat metastatic melanoma in a middle-aged gentleman. Despite being treated with intravenous (IV) proton pump inhibitors (PPI) and steroids, the patient did not show the expected response to treatment. Therefore, we have treated him with infliximab. He showed good clinical, endoscopic and histological response after a total of 5 doses of infliximab along with steroid treatment. Conclusion It is important to keep ICI related gastritis on the differentials list when patients receiving ICI therapy present with upper gastrointestinal symptoms. Anti-Tumour Necrosis Factor (anti-TNF) is a good option to be considered when patients fail to respond to initial treatment with IV PPI and steroids.

A hospital-based cross-sectional study on gastrointestinal symptoms in diabetics compared to nondiabetics

Abstract Background: The gastrointestinal (GI) group of diseases (upper and lower GI tract) are common among diabetics. However, awareness that diabetics suffer more from these problems is low among physicians. Early diagnosis by symptom screening and treatment may help diabetics reduce morbidities and improve quality of life. Objective: The objective of this study was to compare prevalence of GI symptoms between diabetics and nondiabetics. Materials and Methods: Hospital-based cross-sectional study was carried out among 226 diabetics and 225 patients without diabetes. Both group subjects were screened for upper and lower GI symptoms. Sociodemographic details, addictions, and duration of diabetes were recorded. Fasting blood sugar and glycated hemoglobin were investigated. Results: Both groups were comparable (P &gt; 0.05) for age, sex, residence, education, working status, and addictions. All upper GI symptoms were significantly more (P &lt; 0.05) in diabetics compared to nondiabetics (Globus: 64.1% vs. 35.9%; heart burn: 56.9% vs. 43.1%; acid regurgitation: 58.8% vs. 41.2%; noncardiac chest pain: 60.2% vs. 39.8%; and indigestion: 67.2% vs. 32.8%). Lower GI symptoms were more frequent in diabetics than nondiabetics, but difference was not significant (P &gt; 0.05). Overall, the prevalence of upper GI symptoms was 64.5% and lower GI symptoms was 44.6%. The prevalence of upper GI symptoms was significantly more in diabetics (73.5%) than controls (55.6%); (P &lt; 0.05). However, the prevalence of lower GI symptoms was almost similar in both groups (P &gt; 0.05). Being from rural area, advanced age and prolonged diabetes duration were significantly associated with upper GI symptoms in diabetics (P &lt; 0.05). Conclusion: The prevalence of upper and lower GI symptoms was very high in the present study in both groups. However, it was more in diabetics than nondiabetics. Upper GI all symptoms were significantly more in diabetes group than controls. Being from rural area, advanced age and prolonged diabetes duration were risk factors of upper GI symptoms in diabetics.

The Overlap of Allergic Disorders and Upper Gastrointestinal Symptoms: Beyond Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic disease which clinically presents with symptoms related to esophageal dysfunction, while pathologically it is characterized by eosinophilic infiltration of esophageal epithelium. Most patients with EoE present with food and/or inhalant allergy symptoms. The results of animal model studies and genetic studies, as well as the efficacy of elimination diets in managing the symptoms, suggest an atopic background of the disease. The aim of this study was to evaluate the prevalence of EoE in a group of patients with upper gastrointestinal symptoms and food and/or inhalant allergies and to assess the influence of drugs used in type I allergies on the results of endoscopic, histopathological, and immunohistochemical tests. Methods: This was a prospective observational study. Patients with inhalant/food allergies and upper esophageal symptoms constituted the study group while patients without allergies who were diagnosed with dyspepsia or irritable bowel syndrome constituted the control group. All study group subjects underwent allergy testing, including prick testing and blood tests. All participants underwent a gastroscopy with specimen collection. Esophageal specimens were stained for eotaxin-1 and desmoglein-1. Results: Based on histopathology results, eosinophilic esophagitis was found in 9 of the 73 patients from the study group. All patients with EoE presented with multimorbidity and were diagnosed with at least one allergic disease in addition to EoE. Positive staining for CCL-11 was found in 56 (78%) patients in the study group, including all patients with EoE while only 3 (17%) individuals from the control group showed positive staining. The presence of DSG-1 in esophageal specimens was detected in 6 (7%) subjects from the study group in contrast to 14 (78%) subjects from the control group. DSG-1 was not found in any of the specimens of patients diagnosed with EoE. Conclusions: EoE is a rare disease, usually accompanied by allergic multimorbidity. Positive staining for eotaxin-1 and negative staining for desmoglein-1 in patients with esophageal symptoms and allergies but who did not meet EoE diagnostic criteria could be indicative of subclinical course of the disease or a masking effect of corticosteroids. It is now vitally important for both researchers and practicing clinicians to recognize that eosinophilic esophagitis (EoE) is not a homogeneous disease but rather consists of multiple subtypes (phenotypes). The so-called "classic" form of EoE-defined by current diagnostic criteria as the presence of more than 15 eosinophils per high power field on histopathological examination-appears to represent only the tip of the iceberg. There is an urgent need for further research in order to refine endoscopic techniques, expand the scope of histopathological assessments, and identify novel biomarkers to better define the distinct phenotypes of eosinophilic esophagitis.

Diagnostic value of endoscopic findings under white light gastroscopy for Helicobacter pylori infection in children

To explore the clinical value of endoscopic findings under white light gastroscopy in diagnosing Helicobacter pylori (Hp) infection in children. A retrospective analysis was conducted on the clinical data of 340 children who underwent gastroscopy and gastric mucosa tissue Hp culture from July 2022 to June 2023 in the Department of Gastroenterology at Wuxi Children's Hospital due to upper gastrointestinal symptoms. Based on the results of Hp culture, the children were categorized into an Hp-infected group (146 cases) and a non-infected group (194 cases). The detection rates of various endoscopic findings in the gastric mucosa between the two groups were compared, and the association between each endoscopic finding and different Hp infection statuses was analyzed, as well as the diagnostic value of each endoscopic finding under different Hp infection statuses. The proportions of white mucus, diffuse redness, mucosal edema, enlarged folds, chicken skin-like changes, and ulcers in the Hp-infected group were higher than those in the non-infected group (P<0.05), while the proportions of regular arrangement of collecting venules (RAC) and ridge-like redness were lower in the Hp-infected group compared to the non-infected group (P<0.05). Multivariate logistic regression analysis showed that diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes were closely associated with Hp infection (P<0.05), while RAC and ridge-like redness were closely associated with the absence of Hp infection (P<0.05). Receiver operating characteristic curve analysis indicated that the area under the curve for diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes in predicting Hp infection was 0.798, 0.731, 0.782, and 0.760, respectively (P<0.05). The area under the curve for RAC and ridge-like redness in predicting the absence of Hp infection was 0.861 and 0.589, respectively (P<0.05). Endoscopic findings under white light gastroscopy are associated with Hp infection in children, with diffuse redness, mucosal edema, chicken skin-like changes, and enlarged folds showing significant diagnostic value for Hp infection.

Depression or Anxiety in GI Outpatients: Upper GI Symptoms and Symptom Clusters Showed Stronger Associations Than Lower GI.

Gastrointestinal (GI) problems have been always linked to psychiatric disorders. The aim of our study was to explore specific GI symptoms or symptom clusters that may indicate the presence of depression or anxiety in outpatients. One thousand one hundred twenty-five outpatients from 20 hospitals completed questionnaires assessing GI symptoms, depression (the Patient Health Questionnaire-9, PHQ-9), and anxiety (General Anxiety Disorder-7, GAD-7). Principal component analysis was employed to identify symptom clusters based on 22 GI symptoms. The patients were categorized into three groups: Control (PHQ-9 < 5 and GAD-7 < 5), DA1 (5 ≤ PHQ-9 < 10 or/and 5 ≤ GAD-7 < 10), and DA2 (PHQ-9 ≥ 10 or GAD-7 ≥ 10). There were 781, 249, and 95 patients in the group of Control, DA1, and DA2, respectively. Fecal incontinence (4.835, [2.213-10.563]), heartburn (3.338, [2.416-4.611]), belching (2.862, [2.145-3.821]), and globus sensation (2.845, [2.110-3.837]) demonstrated the highest potential risk of psychiatric comorbidity. The 22 GI symptoms were categorized into eight clusters. Dyspepsia-related Cluster F2, reflux-related Cluster F3, and esophageal-related Cluster F4 were noteworthy in the identification of psychiatric comorbidity. Cluster F4, including globus sensation, discomfort with swallowing, and chest pain, exhibited the most significant increase in the prevalence of depression or anxiety (2.645, [1.851-3.778]). Specific GI symptoms including heartburn, belching, globus sensation, and GI symptom clusters including F2, F3, and F4 were noteworthy in the identification of psychiatric comorbidity. They were mostly focused on the upper GI tract. It is critical for gastroenterologists to recognize psychiatric comorbidities and implement appropriate measures accordingly.

Patterns of Diagnostic Testing for Oesophagogastric Cancer-Related Symptoms in Australian General Practice.

Oesophagogastric (OG) cancer-associated symptoms are common in primary care, but most research has focused on patients with a confirmed OG cancer diagnosis, rather than those presenting with symptoms for the first time. To examine diagnostic testing patterns for upper gastrointestinal symptoms linked to OG cancer. Retrospective cohort study used a linked primary care database. It included de-identified patients aged 55 and older who presented with symptoms suggestive of OG cancer between 2008 and 2022. We analysed the proportion of patients who underwent pathology, imaging, referral, endoscopy, or a test of treatment. Differences across socioeconomic groups were also examined, along with the proportion of patients diagnosed with OG cancer. The study cohort consisted of 44,402 patients, of whom 126 (0.28%) were diagnosed with OG cancer within 12 months of presentation. Reflux was the most common symptom (57%), followed by nausea (11%). Patients over 75 were less likely to be investigated or referred (OR = 0.59, 95% CI: 0.56-0.62, p < 0.001). Those from less disadvantaged areas were 1.4 times more likely to be investigated (OR = 1.44, 95% CI: 1.36-1.53, p < 0.001). Patients on 'test of treatment' medications were less likely to receive further investigation (OR = 0.66, 95% CI: 0.63-0.69, p < 0.001). Multiple symptoms and visits increased the likelihood of investigation (OR = 2.77, 95% CI: 2.55-3.00, p < 0.001). Significant variations in diagnostic testing could contribute to disparities in OG cancer outcomes.