Objective To evaluate the gastric microbiome in patients with chronic superficial gastritis(CSG)and intestinal metaplasia(IM)and investigate the influence of Helicobacter pylori(H.pylori)on the gastric microbiome.Meth...Objective To evaluate the gastric microbiome in patients with chronic superficial gastritis(CSG)and intestinal metaplasia(IM)and investigate the influence of Helicobacter pylori(H.pylori)on the gastric microbiome.Methods Gastric mucosa tissue samples were collected from 54 patients with CSG and IM,and the patients were classified into the following four groups based on the state of H.pylori infection and histology:H.pylori-negative CSG(n=24),H.pylori-positive CSG(n=14),H.pylori-negative IM(n=11),and H.pylori-positive IM(n=5).The gastric microbiome was analyzed by 16S rRNA gene sequencing.Results H.pylori strongly influenced the bacterial abundance and diversity regardless of CSG and IM.In H.pylori-positive subjects,the bacterial abundance and diversity were significantly lower than in H.pylori-negative subjects.The H.pylori-negative groups had similar bacterial composition and bacterial abundance.The H.pylori-positive groups also had similar bacterial composition but different bacterial relative abundance.The relative abundance of Neisseria,Streptococcus,Rothia,and Veillonella were richer in the I-HP group than in G-HP group,especially Neisseria(t=175.1,P<0.001).Conclusions The gastric microbial abundance and diversity are lower in H.pylori-infected patients regardless of CSG and IM.Compared to H.pylori-positive CSG group and H.pylori-positive IM,the relative abundance of Neisseria,Streptococcus,Rothia,and Veillonella is higher in H.pylori-positive patients with IM than in H.pylori-positive patients with CSG,especially Neisseria.展开更多
Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular patient.Modern clas...Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular patient.Modern classification approach with the definition of the stage of gastritis determines the need,activities and frequency of dynamic monitoring of a patient.However,this attitude to the patient suffering from CG was far from always.The present publication is a literature review describing the key milestones in the history of CG research,from the description of the first observations of inflammation of the gastric mucosa,assessment of gastritis as a predominantly functional disease,to the advent of endoscopy of the upper digestive tract and diagnostic gastric biopsy,assessment of the role of Helicobacter pylori infection in progression of inflammatory changes to atrophy,intestinal metaplasia,dysplasia and GC.展开更多
目的探讨窄带成像放大内镜(narrow band imaging magnification endoscopy,NBI-ME)分级系统在慢性萎缩性胃炎(chronic atrophic gastritis,CAG)实时诊断及危险分层中的价值。方法收集40岁以上接受NBI-ME检查患者的内镜和病理资料,评估NB...目的探讨窄带成像放大内镜(narrow band imaging magnification endoscopy,NBI-ME)分级系统在慢性萎缩性胃炎(chronic atrophic gastritis,CAG)实时诊断及危险分层中的价值。方法收集40岁以上接受NBI-ME检查患者的内镜和病理资料,评估NBI-ME分级系统和组织病理学金标准—OLGA/OLGIM(operative link for gastritis assessment/operative link for gastric intestinal metaplasia assessment)分期系统的相关性及一致性。结果共纳入63例患者,男41例,女22例,胃窦和胃体部的NBI-ME评分和组织学评分的一致性均为73.0%,总体一致性显著(Kappa=0.695,P<0.05;加权Kappa=0.907,P<0.05),其中胃窦的一致性良好(Kappa=0.604,P<0.05),胃体的一致性中等(Kappa=0.487,P<0.05);Cochran-Mantel-Haenszel分析表明,高危NBI-ME分级(Ⅱ~Ⅳ级)的患者诊断为高危OLGA/OLGIM分期的可能性更高(P<0.0001),NBI-ME分级诊断高危CAG/GIM的敏感性为81.8%(95%CI:59.7%~94.8%),特异性为95.1%(95%CI:83.5%~99.4%)。结论NBI-ME评分与组织病理学评分具有较高一致性,它是一种简便、经济并实时诊断CAG及识别胃癌高危人群的检查及随访方式。展开更多
Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for ga...Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and histology.The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resourcesensitive approach.展开更多
Gastric cancer is believed to result in part from the accumulation of multiple genetic alterations leading to oncogeneoverexpression and tumor suppressor loss. Epigenetic alterations as a distinct and crucial mechanis...Gastric cancer is believed to result in part from the accumulation of multiple genetic alterations leading to oncogeneoverexpression and tumor suppressor loss. Epigenetic alterations as a distinct and crucial mechanism to silence a varietyof methylated tissue-specific and imprinted genes, have been extensively studied in gastric carcinoma and play impor-tant roles in gastric carcinogenesis. This review will briefly discuss the basic aspects of DNA methylation and CpGisland methylation, in particular the epigenetic alterations of certain critical genes implicated in gastric carcinogenesisand its relevance of clinical implications.展开更多
目的:探讨益胃消瘀颗粒治疗萎缩性胃炎胃黏膜肠化的治疗作用与机制。方法:8周龄雄性SD大鼠60只,按随机数字表法分为空白组、模型组、胃复春组、益胃消瘀颗粒高剂量组、益胃消瘀颗粒中剂量组、益胃消瘀颗粒低剂量组共6组,N-甲基-N’-硝基...目的:探讨益胃消瘀颗粒治疗萎缩性胃炎胃黏膜肠化的治疗作用与机制。方法:8周龄雄性SD大鼠60只,按随机数字表法分为空白组、模型组、胃复春组、益胃消瘀颗粒高剂量组、益胃消瘀颗粒中剂量组、益胃消瘀颗粒低剂量组共6组,N-甲基-N’-硝基-N-亚硝基胍(MNNG)和法莫替丁联合造模。6个月及7个月后分次抽检3只,造模成功后开始进入实验给药阶段,给药3个月后观察大鼠胃黏膜组织学改变,RT-qPCR检测胃黏膜标本中尾型同源盒转录因子2(caudal-related homeobox transcription factor2,CDX2)、干细胞转录调控因子性别决定相关基因簇2(Sex de-termining region Y-box 2,SOX2)的表达,Western blot检测胃黏膜中NK6同源框蛋白3(NK6 Homeobox Protein 3,NKX6.3)、骨形成蛋白4(bone morphogenic protein 4,BMP4)的表达。结果:光镜下观察胃黏膜病理组织,模型组可见黏膜萎缩及肠化,益胃消瘀颗粒高、中剂量组及胃复春组萎缩及肠化均较模型组明显改善,低剂量组萎缩及肠化有所减轻;与空白组比较,模型组NKX6.3、Sox2表达明显下降,BMP4、CDx2表达明显升高;与模型组比较,益胃消瘀颗粒高、中剂量组和胃复春组NKX6.3表达明显上升,益胃消瘀颗粒高、中、低剂量组及胃复春组Sox2表达明显升高,BMP4、CDx2表达明显下降。结论:益胃消瘀颗粒能够改善萎缩性胃炎肠化大鼠胃黏膜组织病理形态,其机制可能与激活NKX6.3、下调Cdx2、上调Sox2和抑制BMP4表达有关。展开更多
基金supported by the Medicine and Health,Science and Technology Plan Project of Zhejiang(2020KY1009).
文摘Objective To evaluate the gastric microbiome in patients with chronic superficial gastritis(CSG)and intestinal metaplasia(IM)and investigate the influence of Helicobacter pylori(H.pylori)on the gastric microbiome.Methods Gastric mucosa tissue samples were collected from 54 patients with CSG and IM,and the patients were classified into the following four groups based on the state of H.pylori infection and histology:H.pylori-negative CSG(n=24),H.pylori-positive CSG(n=14),H.pylori-negative IM(n=11),and H.pylori-positive IM(n=5).The gastric microbiome was analyzed by 16S rRNA gene sequencing.Results H.pylori strongly influenced the bacterial abundance and diversity regardless of CSG and IM.In H.pylori-positive subjects,the bacterial abundance and diversity were significantly lower than in H.pylori-negative subjects.The H.pylori-negative groups had similar bacterial composition and bacterial abundance.The H.pylori-positive groups also had similar bacterial composition but different bacterial relative abundance.The relative abundance of Neisseria,Streptococcus,Rothia,and Veillonella were richer in the I-HP group than in G-HP group,especially Neisseria(t=175.1,P<0.001).Conclusions The gastric microbial abundance and diversity are lower in H.pylori-infected patients regardless of CSG and IM.Compared to H.pylori-positive CSG group and H.pylori-positive IM,the relative abundance of Neisseria,Streptococcus,Rothia,and Veillonella is higher in H.pylori-positive patients with IM than in H.pylori-positive patients with CSG,especially Neisseria.
文摘Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular patient.Modern classification approach with the definition of the stage of gastritis determines the need,activities and frequency of dynamic monitoring of a patient.However,this attitude to the patient suffering from CG was far from always.The present publication is a literature review describing the key milestones in the history of CG research,from the description of the first observations of inflammation of the gastric mucosa,assessment of gastritis as a predominantly functional disease,to the advent of endoscopy of the upper digestive tract and diagnostic gastric biopsy,assessment of the role of Helicobacter pylori infection in progression of inflammatory changes to atrophy,intestinal metaplasia,dysplasia and GC.
文摘目的探讨窄带成像放大内镜(narrow band imaging magnification endoscopy,NBI-ME)分级系统在慢性萎缩性胃炎(chronic atrophic gastritis,CAG)实时诊断及危险分层中的价值。方法收集40岁以上接受NBI-ME检查患者的内镜和病理资料,评估NBI-ME分级系统和组织病理学金标准—OLGA/OLGIM(operative link for gastritis assessment/operative link for gastric intestinal metaplasia assessment)分期系统的相关性及一致性。结果共纳入63例患者,男41例,女22例,胃窦和胃体部的NBI-ME评分和组织学评分的一致性均为73.0%,总体一致性显著(Kappa=0.695,P<0.05;加权Kappa=0.907,P<0.05),其中胃窦的一致性良好(Kappa=0.604,P<0.05),胃体的一致性中等(Kappa=0.487,P<0.05);Cochran-Mantel-Haenszel分析表明,高危NBI-ME分级(Ⅱ~Ⅳ级)的患者诊断为高危OLGA/OLGIM分期的可能性更高(P<0.0001),NBI-ME分级诊断高危CAG/GIM的敏感性为81.8%(95%CI:59.7%~94.8%),特异性为95.1%(95%CI:83.5%~99.4%)。结论NBI-ME评分与组织病理学评分具有较高一致性,它是一种简便、经济并实时诊断CAG及识别胃癌高危人群的检查及随访方式。
文摘Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and histology.The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resourcesensitive approach.
文摘Gastric cancer is believed to result in part from the accumulation of multiple genetic alterations leading to oncogeneoverexpression and tumor suppressor loss. Epigenetic alterations as a distinct and crucial mechanism to silence a varietyof methylated tissue-specific and imprinted genes, have been extensively studied in gastric carcinoma and play impor-tant roles in gastric carcinogenesis. This review will briefly discuss the basic aspects of DNA methylation and CpGisland methylation, in particular the epigenetic alterations of certain critical genes implicated in gastric carcinogenesisand its relevance of clinical implications.
文摘目的:探讨益胃消瘀颗粒治疗萎缩性胃炎胃黏膜肠化的治疗作用与机制。方法:8周龄雄性SD大鼠60只,按随机数字表法分为空白组、模型组、胃复春组、益胃消瘀颗粒高剂量组、益胃消瘀颗粒中剂量组、益胃消瘀颗粒低剂量组共6组,N-甲基-N’-硝基-N-亚硝基胍(MNNG)和法莫替丁联合造模。6个月及7个月后分次抽检3只,造模成功后开始进入实验给药阶段,给药3个月后观察大鼠胃黏膜组织学改变,RT-qPCR检测胃黏膜标本中尾型同源盒转录因子2(caudal-related homeobox transcription factor2,CDX2)、干细胞转录调控因子性别决定相关基因簇2(Sex de-termining region Y-box 2,SOX2)的表达,Western blot检测胃黏膜中NK6同源框蛋白3(NK6 Homeobox Protein 3,NKX6.3)、骨形成蛋白4(bone morphogenic protein 4,BMP4)的表达。结果:光镜下观察胃黏膜病理组织,模型组可见黏膜萎缩及肠化,益胃消瘀颗粒高、中剂量组及胃复春组萎缩及肠化均较模型组明显改善,低剂量组萎缩及肠化有所减轻;与空白组比较,模型组NKX6.3、Sox2表达明显下降,BMP4、CDx2表达明显升高;与模型组比较,益胃消瘀颗粒高、中剂量组和胃复春组NKX6.3表达明显上升,益胃消瘀颗粒高、中、低剂量组及胃复春组Sox2表达明显升高,BMP4、CDx2表达明显下降。结论:益胃消瘀颗粒能够改善萎缩性胃炎肠化大鼠胃黏膜组织病理形态,其机制可能与激活NKX6.3、下调Cdx2、上调Sox2和抑制BMP4表达有关。
