Characterization of the Gastric Mucosal Microbiota in Patients with Liver Cirrhosis and Its Associations with Gastrointestinal Symptoms

Several studies have indicated that the oral and gut microbiota may exhibit differences in patients with cirrhosis.Less is known about the microbiota in the stomach,which is located between the oral cavity and the intestinal tract.In this study,the gastric mucosal microbiota of patients with liver cirrhosis and controls were analyzed with 16S ribosomal RNA(rRNA)pyrosequencing.Cirrhotic patients had significantly lower Helicobacter pylori(H.pylori)infection rates,as confirmed by both the histological method and the pyrosequencing method.In H.pylori-negative subjects,gastric bacterial communities of healthy and cirrhosis cohorts were clustered into four clusters based on bacterial compositions:Cluster_1 and Cluster_2(mostly cirrhosis),Cluster_3(mostly healthy),and Cluster_4(around half of each).Compositional and functional differences were observed among these different clusters.At the genus level,Cluster_1 and Cluster_2 showed enrichment of Neisseria and Streptococcus,respectively.Functionally,Cluster_2 was characterized as depleted of genetic information processing,as well as of modules related to glycan biosynthesis and metabolism.Patients in Cluster_2 had more severe gastrointestinal symptoms and a higher rate of previous endoscopic variceal ligation(EVL)therapy than patients in other clusters.Our findings suggest that the colonization of both H.pylori and non-H.pylori is influenced in liver cirrhosis.Although the H.pylori-negative gastric mucosal microbiota showed considerable heterogeneity,associations between specific gastric microbiota and clinical characteristics could be observed.Previous EVL therapy might lead to a distinct structure of the gastric mucosal microbiota,thus aggravating the gastrointestinal symptoms in H.pylori-negative cirrhotic patients.

Correlations of portal hypertensive gastropathy of hepatitis B cirrhosis with other factors

Objective: To study the clinical relations of portal hy- pertensive gastropathy (PHG) of hepatitis B cirrho- sis to other factors. Methods: Three groups of subjects were studied pro- spectively at our hospital from March 2000 to March 2001: 159 hepatitis B cirrhotic patients with portal hypertension, 114 hepatitis B cirrhotic patients with- out portal hypertension, and 97 control subjects. Free portal vein pressure (FPP) was measured dur- ing surgery. Liver function was assessed by Pugh's modification of Child's criteria. The area of liver collagen fibrin was studied using color image analysis system. Esophageal varices were identified by Dagra- di grading. Gastric varices were identified according to Northern Italian Endoscopic Council (NIEC) grading. Hypersplenism was assessed with the reduc- tion of WBC, HGB and PLT. Hepatitis B virus in the gastric mucosa was detected by immunizing histo- chemistry. Helicobacter pylori (H. pylori) organisms were identified by rapid urease testing and/or exami- nation of the stained biopsy specimens (haematoxylin and eosin). To analyze the correlation between these endoscopic signs at the gastric level and other fac- tors. Results: The differences of FPP among the three groups (patients with grade Ⅰ, Ⅱ, and Ⅲ gastropa- thy) were not significant. There was no correlation between Child-Pugh classification grading and the se- verity of gastropathy (P=0. 153). The differences of the area of liver collagen fibrin among the three grade gastropathy were not statistically significant (P =0. 801). There was a significant difference in the prevalence of severe PHG among grade Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ esophageal varices (P<0. 001). PHG was present in a similar percentage of patients with gas- tric varices compared with those without gastric vari- ces (P=0. 209). There was a significant difference in the severity between PHG and hypersplenism (P= 0. 003). Seven patients with PHG had no microscopic evidence of hepatitis B virus infection in the gastric wall. There was no correlation between Child-Pugh classification grading and infection of H. pylori (P= 0. 7491). Conclusions: The most important element causing PHG is the increased portal pressure as a prerequi- site. In addition, other factors may contribute to the development of PHG. PHG often occurs in patients with the presence of esophageal varices. There is a marked correlation between the severity of PHG and hypersplenism. Hepatitis B virus and H. pylori infec- tion are unlikely to be involved in the pathogenesis of PHG. The development of PHG is less influenced ei- ther by the severity of liver disease (Child-Pugh grade) and cirrhosis or by the presence or non pre- sence of gastric varices.

Alternative uses of lumen apposing metal stents

The advent of lumen apposing metal stents(LAMS)has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions.These procedures have garnered popularity due to their minimally invasive nature,higher technical and clinical success rate and lower rate of adverse events.By virtue of their unique design,LAMS provide more efficient drainage,serve as conduit for endoscopic access,are associated with lower rates of leakage and are easy to be removed.Initially used for drainage of pancreatic fluid collections,the use of LAMS has been extended to gallbladder and biliary drainage,treatment of luminal strictures,creation of gastrointestinal fistulae,pancreaticobiliary drainage,improved access for surgically altered anatomy,and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections.As new indications of endosonographic techniques and LAMS continue to evolve,this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.

Value of magnifying endoscopy with narrow-band imaging in diagnosis of 124 early gastric neoplastic lesions

Objective To investigate the value of intervening part(IP)ratio under magnifying endoscopy with narrowband imaging(ME-NBI)in the diagnosis of early gastric neoplastic lesions.Methods From September 2012 to May 2015,a total of 124 patients with suspected superficial gastric neoplastic lesions under white light endoscope(WLI)were enrolled,87 male with mean age of(63.