Chronic active and atrophic gastritis as significant contributing factor to the development of gastric cystica profunda

Gastric cystica profunda(GCP)is an uncommon but underestimated gastric lesion.Its precancerous potential determines its significance.In addition to previous mucosa injury due to operations,biopsy or polypectomy,chronic active and atrophic gastritis may also lead to the development of GCPs.By carefully examining the stomach and taking biopsy samples from the susceptible regions,the stage of atrophy can be determined.Chronic atrophic gastritis is a risk factor for cancer evolvement and it can also contribute to GCPs formation.GCPs frequently occur close to early gastric cancers(EGCs)or EGC can arise from the cystic glands.Endoscopic resection is an effective and minimally invasive treat-ment in GCP.

Yiwei Xiaoyu granules for treatment of chronic atrophic gastritis with deficiency syndrome of the spleen and stomach

BACKGROUND The Correa sequence,initiated by Helicobacter pylori(H.pylori),commonly progresses to gastric cancer through the stage of chronic atrophic gastritis(CAG).Although eradication of H.pylori only reduces the risk of gastric cancer,it does not eliminate the risk for neoplastic progression.Yiwei Xiaoyu granules(YWXY)are a commonly used composite preparation in Chinese clinics.However,the pursuit of excellence in clinical trials and the establishment of standardized animal experiments are still needed to contribute to full understanding and application of traditional Chinese medicine in the treatment of CAG.AIM To demonstrate the effectiveness of YWXY in patients with CAG and spleenstomach deficiency syndrome(DSSS),by alleviating histological scores,improving response rates for pathological lesions,and achieving clinical efficacy in relieving DSSS symptoms.METHODS We designed a double-blind,randomized,controlled trial.The study enrolled seventy-two H.pylori-negative patients(mean age,52.3 years;38 men)who were randomly allocated to either the treatment group or control group in a 1:1 ratio,and treated with 15 g YWXY or 0.36 g Weifuchun(WFC)tablet combined with the respective dummy for 24 wk.The pre-randomization phase resulted in the exclusion of 72 patients:50 participants did not meet the inclusion criteria,12 participants declined to participate,and 10 participants were excluded for various other reasons.Seven visits were conducted during the study,and histopathological examination with target endoscopic biopsy of narrow-band imaging was requested before the first and seventh visits.We also evaluated endoscopic performance scores,total symptom scores,serum pepsinogen and gastrin-17.RESULTS Six patients did not complete the trial procedures.Treatment with YWXY improved the Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM)stage,compared with WFC(P<0.05).YWXY provided better relief from symptoms of DSSS and better improvement in serum gastric function,compared with WFC(P<0.05).CONCLUSION YWXY compared with WFC significantly reduced the risk of mild or moderate atrophic disease,according to OLGIM stage,significantly relieved symptoms of DSSS,and improved serum gastric function.

Mucosal patterns change after Helicobacter pylori eradication:Evaluation using blue laser imaging in patients with atrophic gastritis

BACKGROUND Mucosal patterns(MPs)observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty,cracked,and mottled.Furthermore,we hypothesized that the spotty pattern may change to the cracked pattern after Helicobacter pylori(H.pylori)eradication.AIM To further substantiate and comprehensively investigate MP changes after H.pylori eradication in a larger number of patients.METHODS We included 768 patients who were diagnosed with atrophic gastritis with evaluable MP using upper gastrointestinal endoscopy at the Nishikawa Gastrointestinal Clinic,Japan.Among them,325 patients were H.pylori-positive,and of them,101 patients who underwent upper gastrointestinal endoscopy before and after H.pylori eradication were evaluated for post-eradication MP changes.The patients’MPs were interpreted by three experienced endoscopists who were blinded to their clinical features.RESULTS Among 76 patients with the spotty pattern before or after H.pylori eradication,the pattern disappeared or decreased in 67 patients[88.2%,95%confidence interval(CI):79.0%-93.6%),appeared or increased in 8 patients(10.5%,95%CI:5.4%-19.4%),and showed no change in 1 patient(1.3%,95%CI:0.2%-7.1%).In 90 patients with the cracked pattern before or after H.pylori eradication,the pattern disappeared or decreased in 7 patients(7.8%,95%CI:3.8%-15.2%),appeared or increased in 79 patients(87.8%,95%CI:79.4%-93.0%),and showed no change in 4 patients(4.4%,95%CI:1.7%-10.9%).In 70 patients with the mottled pattern before or after H.pylori eradication,the pattern disappeared or decreased in 28 patients(40.0%,95%CI:29.3%-51.7%),appeared or increased in 35 patients(50.0%,95%CI:38.6%-61.4%),and showed no change in 7 patients(10.0%,95%CI:4.9%-19.2%).CONCLUSION After H.pylori eradication,MPs changed from spotty to cracked in most patients,which may help endoscopists easily and precisely evaluate H.pylori-related gastritis status.

Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis:Insights into mechanisms,pathophysiology,and treatment options

BACKGROUND Autoimmune gastritis(AIG)is a progressive,chronic,immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor.Gastrointestinal symptoms such as dyspepsia and early satiety are very common,being second in terms of frequency only to anemia,which is the most typical feature of AIG.AIM To address both well-established and more innovative information and knowledge about this challenging disorder.METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 10 years.RESULTS A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.CONCLUSION AIG can cause a range of clinical manifestations,including dyspepsia.The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion,gastric motility,hormone signaling,and gut microbiota,among other factors.Managing dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in AIG.While proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease,they may not be appropriate for AIG.Prokinetic agents,antidepressant drugs,and non-pharmacological treatments may be of help,even if not adequately evidence-based supported.A multidisciplinary approach for the management of dyspepsia in AIG is recommended,and further research is needed to develop and validate more effective therapies for dyspepsia.

Efficacy and safety of Huangqi Jianzhong decoction in the treatment of chronic atrophic gastritis:A meta-analysis

BACKGROUND Chronic atrophic gastritis is a persistent disorder of the digestive system where the gastric mucosa epithelium and glands undergo atrophy,leading to a decrease in their number and thinning of the gastric mucosa.It is worth noting that the prevalence of chronic atrophic gastritis is higher in China compared to the global average,and it is also considered a precancerous condition for gastric cancer.AIM To evaluate the efficacy of Huangqi Jianzhong decoction in treating chronic atrophic gastritis.Chronic atrophic gastritis is a persistent illness characterized by the progressive disappearance of healthy gastric glands due to repeated injury.Huangqi Jianzhong decoctions are widely used in China to treat chronic atrophic gastritis.However,there is limited scientific evidence regarding their efficacy in treating this illness.METHODS The present meta-analysis adhered to the PRISMA guidelines and used the Cochrane Collaboration methodology.We performed a comprehensive search for clinical trials investigating the use of Huangqi Jianzhong decoction in treating chronic atrophic gastritis published until January 2023.The risk of bias and the quality of the included studies were evaluated using the Cochrane Handbook guidelines.Finally,a meta-analysis was conducted using the RevMan 5.4 softRESULTS This study included a total of 13 articles,comprising 1269 samples.The meta-analysis was conducted on these 13 articles,yielding the following results:I2=0%,P=0.60,[RR=1.24,95%CI:1.18 to 1.30,P<0.00001].The forest plot analysis of the Helicobacter pylori clearance rate revealed I2=0%,P=0.36,[RR=1.20,95%CI:1.05 to 1.38,P=0.009].The forest plot of PG-I level showed I2=99%,P<0.00001,[MD=4.99,95%CI:-1.59 to 11.58,P=0.14].The forest plot of stomach pain demonstrated I2=54%,P=0.04,[MD=-0.63,95%CI:-0.68 to-0.58,P<0.00001].The forest plot of reflux indicated I2=82%,P=0.0009,[MD=-0.48,95%CI:-0.63 to-0.33,P<0.00001].The forest plot of recurrence rate exhibited I2=0%,P=0.92,[RR=0.15,95%CI:0.04 to 0.66,P=0.01].The forest plot of adverse reactions showed no heterogeneity in outcome data,[RR=1.07,95%CI:0.53 to 2.17,P=0.86].CONCLUSION This study demonstrated that Huangqi Jianzhong decoction improved various factors in adults with chronic atrophic gastritis.These factors included the total effective rate,Helicobacter pylori clearance rate,symptoms such as stomachache and acid reflux alleviation,and recurrence rates.

Study on Professor Diangui Li's Medication Experience in Treating Atrophic Gastritis Concomitant with Helicobacter Pylori Infection Based on Data Mining

Objective Our objective was to explore the national traditional Chinese medicine by studying master Diangui Li's medication experience in treating atrophic gastritis(AG)concomitant with Helicobacter pylori(Hp)infection based on data mining,and to provide the reference for the clinical treatment of relevant diseases.Methods The Chinese medicine prescriptions of the patients'first visits to the Famous Doctors'Consultation Room in Hebei Provincial Hospital of Chinese Medicine from May 2019 to December 2022 were collected and frequency analysis of the Chinese herbs,association rules analysis of the Chinese herbs,and cluster analysis were conducted using the Famous Doctor Inheritance Assistance Platform.ResultsA total of 188 prescriptions were collected,with 136 kinds of Chinese herbs.The highest use frequency of Chinese herbs was 185 and the lowest was 1.There were 28 kinds of Chinese herbs with high use frequency.The top 10 herbs with the high use frequency include Baihuasheshecao(Hedyotis Diffusae Herba),Huanglian(Coptidis Rhizoma),Yinchen(Artemisiae Scopariae Herba),jigucao(Abriherba),Baishao(Paeoniae Radix Alba),Danggui(Angelicae Sinensis Radix),Banzhilian(Scutellariae Barbatae Herba),Baihe(Lili Bulbus),Zhishi(Auranti Immaturus Fructus),Chuanxiong(Chuanxiong Rhizoma).Chinese herbs with high frequency use are mostly heat-clearing herbs and qi-regulating herbs;the flavors of the herbs are mainly pungent,bitter,and sweet;the properties are mainly warm,cold,and neutral;the meridian tropism is mainly the spleen,liver,and stomach meridians.The core herbal medicines are Huanglian(Coptidis Rhizoma),Yinchen(Artemisiae Scopariae Herba),Baishao(Paeoniae Radix Alba),Danggui(Angelicae Sinensis Radix),etc.;the results of association rules:Jigucao(Abriherba)-Kushen(Sophorae Flavescentis Radix),Jjiaogulan(Gynostemmatis Pentaphylli Rhizoma seu Herba)-Banlangen(lsatidis Radix),Huangqin(Scutellariae Radix)-Banlangen(lsatidis Radix),etc.;the results of cluster analysis showed that there were 10 clusters:(1)Yinchen(Artemisiae Scopariae Herba),Huanglian(Coptidis Rhizoma),Baihuasheshecao(Hedyotis Diffusae Herba),Banzhilian(Scutellariae Barbatae Herba),Jigucao(Abriherba);(2)Baishao(Paeoniae Radix Alba),Danggui(Angelicae Sinensis Radix),Chuanxiong(Chuanxiong Rhizoma),Wuyao(Linderae Radix);(3)Yuanhu(Corydalis Rhizoma),Danshen(Salviae Miltiorrhizae Radix et Rhizoma),Baizhi(Angelicae Dahuricae Radix).Conclusions For the treatment of AG concomitant with Hp infection,Professor Diangui Li mainly adopts the method of clearing heat and removing the toxin,regulating qi and resolving phlegm,combining disease differentiation with syndrome differentiation,performing reinforcing method,and reducing method simultaneously to regulate the mechanism of the human body.

Chronic atrophic gastritis detection with a convolutional neural network considering stomach regions

BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastric cancer mass screening.However,skilled doctors for interpretation of X-ray examination are decreasing due to the diverse of inspections.AIM To evaluate the effectiveness of stomach regions that are automatically estimated by a deep learning-based model for CAG detection.METHODS We used 815 gastric X-ray images(GXIs)obtained from 815 subjects.The ground truth of this study was the diagnostic results in X-ray and endoscopic examinations.For a part of GXIs for training,the stomach regions are manually annotated.A model for automatic estimation of the stomach regions is trained with the GXIs.For the rest of them,the stomach regions are automatically estimated.Finally,a model for automatic CAG detection is trained with all GXIs for training.RESULTS In the case that the stomach regions were manually annotated for only 10 GXIs and 30 GXIs,the harmonic mean of sensitivity and specificity of CAG detection were 0.955±0.002 and 0.963±0.004,respectively.CONCLUSION By estimating stomach regions automatically,our method contributes to the reduction of the workload of manual annotation and the accurate detection of the CAG.

Inflammatory cytokine gene polymorphisms increase the risk of atrophic gastritis and intestinal metaplasia

AIM: To investigate the effects of interleukin-8 (IL-8 ), macrophage migration inhibitory factor (MIF ) gene polymorphisms, Helicobacter pylori (H. pylori ) infection, on the risk of developing severe chronic atrophic gastritis (SCAG) and intestinal metaplasia (IM). METHODS: A total of 372 cases were selected from a cohort study in Linqu County, a high risk area for gastric cancer (GC) in northern China. To obtain a sufficient group size, patients with normal or superficial gastritis were included. Based on an average follow-up period of 56 mo, the 372 cases were divided into no progres-sion group (no histological progression from normal or superficial gastritis, n = 137), group Ⅰ (progressed from normal or superficial gastritis to SCAG, n = 134) and group Ⅱ (progressed from normal or superficial gastritis to IM, n = 101). IL-8 , MIF gene polymorphisms were detected by polymerase chain reaction-based denaturing high-performance liquid chromatography analysis and DNA sequencing. RESULTS: An increased risk of SCAG was found in subjects with IL-8-251 AA genotype [odds ratio (OR) = 2.62, 95% CI: 1.23-5.72] or IL-8-251 A allele carriers (AA + AT) (OR = 1.81, 95% CI: 1.06-3.09). An elevated risk of IM was found in subjects with IL-8-251 AT genotype (OR = 2.27, 95% CI: 1.25-4.14) or IL-8-251 A allele carriers (OR = 2.07, 95% CI: 1.16-3.69). An increased risk of SCAG was found in subjects with MIF-173 GC genotype (OR = 2.36, 95% CI: 1.38-4.02) or MIF-173 C allele carriers (GC + CC) (OR = 2.07, 95% CI: 1.21-3.55). An elevated risk of IM was found in subjects with MIF-173 CC genotype (OR = 2.27, 95% CI: 1.16-4.46) or MIF-173 C allele carriers (OR = 3.84, 95% CI: 1.58-9.34). The risk of SCAG and IM was more evident in subjects carrying IL-8-251 A allele (OR = 6.70, 95% CI: 1.29-9.78) or MIF-173 C allele (OR = 6.54, 95% CI: 2.97-14.20) and positive for H. pylori infection. CONCLUSION: IL-8-251 and MIF-173 gene polymorphisms are significantly associated with the risk of SCAG and IM in a population with a high risk of GC in Linqu County, Shandong Province, China.

Histopathological classification and follow-up analysis of chronic atrophic gastritis

BACKGROUND The pathological diagnosis and follow-up analysis of gastric mucosal biopsy have been paid much attention,and some scholars have proposed the pathological diagnosis of 12 kinds of lesions and accompanying pathological diagnosis,which is of great significance for the treatment of precision gastric diseases,the improvement of the early diagnosis rate of gastric cancer,and the reduction of missed diagnosis rate and misdiagnosis rate.AIM To perform a histopathological classification and follow-up analysis of chronic atrophic gastritis(CAG).METHODS A total of 2248 CAG tissue samples were collected,and data of their clinical characteristics were also gathered.Based on these samples,the expression levels of Mucin 1(MUC1),MUC2,MUC5AC,and MUC6 in CAG tissue were tested by immunohistochemical assay.Moreover,we followed these patients for up to four years.The difference between different stages of gastroscopic biopsy was observed.RESULTS Through observation,it is believed that CAG should be divided into four types,simple type,hyperplasia type,intestinal metaplasia(IM)type,and intraepithelial neoplasia(IEN)type.Simple CAG accounted for 9.1%(205/2248),which was more common in elderly people over 60 years old.The main change was that the lamina propria glands were reduced in size and number.Hyperplastic CAG accounted for 29.1%(654/2248),mostly occurring between 40 and 60 years old.The main change was that the lamina propria glands were atrophy accompanied by glandular hyperplasia and slight expansion of the glands.IM CAG accounted for 50.4%(1132/2248),most of which increased with age,and were more common in those over 50 years.The atrophy of the lamina propria glands was accompanied by significant IM,and the mucus containing sialic acid or sulfate was distinguished according to the nature of the mucus.The IEN type CAG accounted for 11.4%(257/2248),which developed from the previous types,with severe gland atrophy and reduced mucus secretion,and is an important precancerous lesion.CONCLUSION The histological typing of CAG is convenient to understand the property of lesion,determine the follow-up time,and guide the clinical treatment.

Updated Kimura-Takemoto classification of atrophic gastritis

BACKGROUND The Updated Sydney system for visual evaluation of gastric mucosal atrophy viaendoscopic observation is subject to sampling error and interobserver variability.The Kimura-Takemoto classification system was developed to overcome theselimitations.AIMTo compare the morphological classification of atrophic gastritis between theKimura-Takemoto system and the Updated Sydney system.METHODSA total of 169 patients with atrophic gastritis were selected according to diagnosisby the visual endoscopic Kimura-Takemoto method. Following the UpdatedKimura-Takemoto classification system, one antrum biopsy and five gastriccorpus biopsies were taken according to the visual stages of the Kimura-Takemoto system. The Updated Kimura-Takemoto classification system was thenapplied to each and showed 165 to have histological mucosal atrophy;theremaining 4 patients had no histological evidence of atrophy in any biopsy. The Updated Kimura-Takemoto classification was verified as a referencemorphological method and applied for the diagnosis of atrophic gastritis. Addingone more biopsy from the antrum to the six biopsies according to the Updated Kimura-Takemoto classification, constitutes the updated combined Kimura-Takemoto classification and Sydney system.RESULTSThe sensitivity for degree of mucosal atrophy assessed by the Updated Sydneysystem was 25% for mild, 36% for moderate, and 42% for severe, when comparedwith the Updated Kimura-Takemoto classification of atrophic gastritis formorphological diagnosis. Four types of multifocal atrophic gastritis wereidentified: sequential uniform (type 1;in 28%), sequential non-uniform (type 2;in7%), diffuse uniform (type 3;in 23%), diffuse non-uniform (type 4;in 24%), and"alternating atrophic – non-atrophic" (type 5;in 18%). The pattern of the spread ofatrophy, sequentially from the antrum to the cardiac segment of the stomach,which was described by the Updated Kimura-Takemoto system, washistologically confirmed in 82% of cases evaluated.CONCLUSIONThe Updated Sydney system is significantly inferior to the Updated Kimura-Takemoto classification for morphological verification of atrophic gastritis.

Comparison of operative link for gastritis assessment, operative link on gastric intestinal metaplasia assessment, and TAIM stagings among men with atrophic gastritis

BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.

HOGG1 polymorphism in atrophic gastritis and gastric cancer after Helicobacter pylori eradication

AIM:To investigate the association between Ser326Cys human oxoguanine glycosylase 1(hOGG1) polymorphism and atrophic gastritis and gastric cancer after Helicobacter pylori(H.pylori) eradication.METHODS:A total of 488 subjects(73 patients with gastric cancer,160 with atrophic gastritis after H.pylori eradication and 255 controls) were prospectively collected.Polymerase chain reaction-restriction fragment length polymorphism analysis was performed to distinguish hOGG1 Ser326Cys polymorphism.Statistical analysis was conducted by two-sample t test for continuous variables and χ2 test for categorical variables.Logistic regression models were used to f ind the risk factors for gastric cancer and atrophic gastritis.RESULTS:Neither the hOGG1 Ser/Cys nor the Cys/Cys genotype was associated with gastric cancer.Compared with the Ser/Ser genotype,odds ratio(OR) for Ser/Cys was 0.96,(95% CI:0.51-1.84) and OR for Cys/Cys was 1.1(95% CI:0.48-2.1).No association was detected between hOGG1 polymorphism and Lauren type of gastric cancer(P=0.61) either.However,Ser/Cys and Cys/Cys were signif icantly associated with atrophic gastritis with OR:1.76 for Ser/Cys(95% CI:1.03-3.0) and 2.38 for Cys/Cys(95% CI:1.34-4.23).After controlling for age,gender,smoking and alcohol,there were still signif icant associations with OR:2.05 for Ser/Cys(95% CI:1.14-3.68) and 2.76 for Cys/Cys(95% CI:1.47-5.18).CONCLUSION:HOGG1 polymorphisms(Cys/Cys and Ser/Cys) are associated with atrophic gastritis.No significant association is detected between hOGG1 polymorphisms(Cys/Cys or Ser/Cys) and gastric cancer.

Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.

Effects of Granule Dendrobii on chronic atrophic gastritis induced by N-methyl-N'-nitro-N-nitrosoguanidine in rats

BACKGROUND Dendrobium officinale is an herb of Traditional Chinese Medicine(TCM)commonly used for treating stomach diseases.One formula of Granule Dendrobii(GD)consists of Dendrobium officinale and American Ginseng(Radix Panacis quinquefolii),and is a potent TCM product in China.Whether treatment with GD can promote gastric acid secretion and alleviate gastric gland atrophy in chronic atrophic gastritis(CAG)requires verification.AIM To determine the effect of GD treatment on CAG and its potential cellular mechanism.METHODS A CAG model was induced by feeding rats N-methyl-N'-nitro-N-nitrosoguanidine(MNNG)for 12 wk.After oral administration of low,moderate,and high doses of GD in CAG rats for 8 wk,its effects on body weight,gastric mucosa histology,mucosal atrophy,intestinal metaplasia,immunohistochemical staining of proliferating cell nuclear antigen(PCNA)and B-cell lymphoma-2,and hemoglobin and red blood cells were examined.RESULTS The body weights of MNNG-induced CAG model rats before treatment(143.5±14.26 g)were significantly lower than that of healthy rats(220.2±31.20 g,P<0.01).At the 8th week of treatment,the body weights of rats in the low-,moderate-,and high-dose groups of GD(220.1±36.62 g)were significantly higher than those in the untreated group(173.3±28.09 g,all P<0.01).The level of inflammation in gastric tissue of the high-dose group(1.68±0.54)was significantly reduced(P<0.01)compared with that of the untreated group(3.00±0.00,P<0.05).The number and thickness of gastric glands in the high-dose group(31.50±6.07/mm,306.4±49.32μm)were significantly higher than those in the untreated group(26.86±6.41/mm,244.3±51.82μm,respectively,P<0.01 and P<0.05),indicating improved atrophy of gastric mucosa.The areas of intestinal metaplasia were significantly lower in the high-dose group(1.74%±1.13%),medium-dose group(1.81%±0.66%)and low-dose group(2.36%±1.08%)than in the untreated group(3.91%±0.96%,all P<0.01).The expression of PCNA in high-dose group was significantly reduced compared with that in untreated group(P<0.01).Hemoglobin level in the high-dose group(145.3±5.90 g/L),medium-dose group(139.3±5.71 g/L)and low-dose group(137.5±7.56 g/L)was markedly increased compared with the untreated group(132.1±7.76 g/L;P<0.01 or P<0.05).CONCLUSION Treatment with GD for 8 wk demonstrate that GD is effective in the treatment of CAG in the MNNG model by improving the histopathology of gastric mucosa,reversing gastric atrophy and intestinal metaplasia,and alleviating gastric inflammation.

Risk assessment models of integrative medicine indicators for malignant transformation of chronic atrophic gastritis:A registry study protocol

Objective:Traditional Chinese medicine(TCM)and modern medicine have both been used in arresting malignant transformation of chronic atrophic gastritis(CAG)in China with good therapeutic effect.However,no studies have been undertaken to assess the risk of malignant transformation in CAG patients using both modern medicine and TCM features.Our study aimed to develop risk assessment models for malignant transformation of CAG combining indicators of both TCM and modern medicine.These models will facilitate early warning and control of malignant transformation of CAG from the perspective of evidence-based integrative medicine.Methods:In the proposed registry study,a total of 1000 eligible CAG patients will be recruited from four hospitals in China.A 10-year follow-up study will be conducted both on-site and off-site to track the events of malignant transformation.Frequency analysis and chi-squared tests will be used to perform the comparative analysis on the prevalence of malignant transformation events and indicators in TCM or modern medicine in different groups.A multivariate Cox proportional hazard model will be used to perform correlation analyses of malignant transformation events and factors of TCM or modern medicine.Conclusion:The proposed study has been designed with a large sample size and long follow-up period,in which wide-ranging modern medicine and TCM indicators can be gathered over the whole process of malignant transformation of CAG.Based on this study,risk assessment models for malignant transformation ofCAGmaybe constructed fromthe perspective of integrative medicine.This may provide clinicians and patients with an optimized early warning system as well as prevention strategies for malignant transformation of CAG.

Atrophic gastritis and gastric cancer tissue miRNome analysis reveals hsa-miR-129-1 and hsa-miR-196a as potential early diagnostic biomarkers

BACKGROUND Gastric cancer(GC)is one of the most frequently diagnosed tumor globally.In most cases,GC develops in a stepwise manner from chronic gastritis or atrophic gastritis(AG)to cancer.One of the major issues in clinical settings of GC is diagnosis at advanced disease stages resulting in poor prognosis.Micro RNAs(mi RNAs)are small noncoding molecules that play an essential role in a variety of fundamental biological processes.However,clinical potential of mi RNA profiling in the gastric cancerogenesis,especially in premalignant GC cases,remains unclear.AIM To evaluate the AG and GC tissue mi RNomes and identify specific mi RNAs’potential for clinical applications(e.g.,non-invasive diagnostics).METHODS Study included a total of 125 subjects:Controls(CON),AG,and GC patients.All study subjects were recruited at the Departments of Surgery or Gastroenterology,Hospital of Lithuanian University of Health Sciences and divided into the profiling(n=60)and validation(n=65)cohorts.Total RNA isolated from tissue samples was used for preparation of small RNA sequencing libraries and profiled using next-generation sequencing(NGS).Based on NGS data,deregulated mi RNAs hsa-mi R-129-1-3 p and hsa-mi R-196 a-5 p were analyzed in plasma samples of independent cohort consisting of CON,AG,and GC patients.Expression level of hsa-mi R-129-1-3 p and hsa-mi R-196 a-5 p was determined using the quantitative real-time polymerase chain reaction and 2-ΔΔCt method.RESULTS Results of tissue analysis revealed 20 differentially expressed mi RNAs in AG group compared to CON group,129 deregulated mi RNAs in GC compared to CON,and 99 altered mi RNAs comparing GC and AG groups.Only 2 mi RNAs(hsa-mi R-129-1-3 p and hsa-mi R-196 a-5 p)were identified to be step-wise deregulated in healthy-premalignant-malignant sequence.Area under the curve(AUC)-receiver operating characteristic analysis revealed that expression level of hsa-mi R-196 a-5 p is significant for discrimination of CON vs AG,CON vs GC and AG vs GC and resulted in AUCs:88.0%,93.1%and 66.3%,respectively.Comparing results in tissue and plasma samples,hsa-mi R-129-1-3 p was significantly down-regulated in GC compared to AG(P=0.0021 and P=0.024,tissue and plasma,respectively).Moreover,analysis revealed that hsa-mi R-215-3 p/5 p and hsa-mi R-934 were significantly deregulated in GC based on Helicobacter pylori(H.pylori)infection status[log2 fold change(FC)=-4.52,P-adjusted=0.02;log2 FC=-4.00,P-adjusted=0.02;log2 FC=6.09,P-adjusted=0.02,respectively].CONCLUSION Comprehensive mi RNome study provides evidence for gradual deregulation of hsa-mi R-196 a-5 p and hsa-mi R-129-1-3 p in gastric carcinogenesis and found hsami R-215-3 p/5 p and hsa-mi R-934 to be significantly deregulated in H.pylori carrying GC patients.

Efficacy of Shugan Hewei Therapy for Chronic Atrophic Gastritis:A Systematic Review and Meta-Analysis

Objective:Shugan Hewei therapy(SHT)acts to soothe the liver and harmonize the stomach.It is a classical traditional Chinese medicine method widely used in China to treat chronic atrophic gastritis(CAG)due to liver qi invading the stomach.However,the clinical effects of SHT remain unclear.We aimed to evaluate the overall clinical effective rate and safety of SHT in treating CAG.Methods:We used the Jadad scale and Cochrane Collaboration risk of bias tool to evaluate the methodological quality of studies investigating SHT.Eight medical databases were searched to identify relevant studies.After data extraction and quality evaluation,27 randomized controlled trials,including 2,441 patients,were considered eligible for analysis.No serious heterogeneity or publication bias was observed across the included studies.We used Revman 5.3 statistical software to evaluate the general clinical effective rate and safety of SHT.Results:The results showed that SHT was more effective(RR=1.25;95%CI[1.20,1.29];P<0.01)and safer(MD=0.24,95%CI[0.08,0.75];P<0.01)than control interventions comprising western medicine,Chinese patent medicine,and/or western medicine+Chinese patent medicine.Compared with the control interventions,SHT resulted in greater improvements in the symptom scores for stomach distension and stomachache,serum gastrin level,histopathologic changes,Helicobacter pylori(HP)inhibition rate,and gastric mucosal inflammation.Conclusion:SHT was more effective and safer than control interventions for CAG.

Application of"balancing digestive functions by regulating pivot"in chronic atrophic gastritis and professor Wei Wei's clinical experience

Chronic atrophic gastritis(CAG)has attracted wide attention in clinic due to its high incidence rate and high canceration rate.At present,modern medicine lacks an effective treatment scheme for CAG.Traditional Chinese medicine can improve clinical symptoms,laboratory indexes,pathological examination results and patients'quality of life for patients of CAG.Professor Wei used the method of"Balancing Digestive Functions by Regulating Pivot"to treat CAG in clinical practice.With flexible addition and subtraction on the basic prescription Banxia Xiexin decoction and coordination with various external treatment methods and psychological construction,professor Wei has achieved satisfactory clinical effects with the pungent-opening and bitter-descending method and dispersing liver and promoting blood circulation method.

Validation of diagnostic strategies of autoimmune atrophic gastritis:A case report

BACKGROUND Autoimmune atrophic gastritis(AAG)is a type of chronic gastritis that mainly affects the gastric corpus.Due to the lack of standard diagnostic criteria and overlaps with the courses of Helicobacter pylori-related atrophic gastritis,reports on the diagnostic strategy of AAG at an early stage are limited.CASE SUMMARY A 71-year-old woman with severe anemia was diagnosed with AAG.Endoscopic views and pathological findings showed the coexistence of normal mucosa in the gastric antrum and atrophic mucosa in the gastric fundus.Serological tests showed that anti-parietal cell antibodies and anti-intrinsic factor antibodies were both positive.Immunohistochemical results,which showed negative H^(+)-K^(+)ATPase antibody staining and positive chromogranin A(CgA)staining,confirmed the mechanism of this disease.After vitamin B12 and folic acid supplementation,the patient recovered well.CONCLUSION Successful diagnosis of AAG includes serological tests,endoscopic characteristics,and immunohistochemistry for H^(+)-K^(+)ATPase and CgA antibodies.

Clinical Observation on 34 Cases of Chronic Atrophic Gastritis Treated with Shenlian Twelve Flavors

[Objectives]The research aimed to observe the curative effect of Shenlian Twelve Flavors in treating CAG patients with spleen deficiency and blood stasis toxin.[Methods]66 cases of CAG patients with spleen deficiency and blood stasis toxin were selected,32 cases in the control group and 34 cases in the observation group were generated according to the random number table method.The control group was treated with Moluodan;the observation group was treated with Shenlian Twelve Flavors.After treatment,the effective rate,TCM symptom score,gastroscopic score,pathological score,serum gastrin 17(G-17)level,and adverse reactions were compared between the two groups.[Results]The total effective rates of control group and observation group were 84.37%and 91.18%,respectively,and there was no statistical significance between the two groups(P>0.05).For the improvement of TCM symptom score,both groups were improved significantly compared with that before treatment,and observation group was better than control group(P<0.05).For the improvement of gastroscopic score,both groups were improved compared with that before treatment,and observation group was better than control group(P<0.05).For the improvement of pathological scores,both groups were improved compared with that before treatment,but there was no statistical significance between the two groups(P>0.05).[Conclusions]Shenlian Twelve Flavors has definite clinical efficacy in the treatment of CAG with spleen deficiency and blood stasis toxin.It could improve clinical symptoms,delay pathological progress,and regulate the level of G-17.There is no obvious adverse reaction,and it is worthy of clinical reference.