Gastroduodenitis associated with ulcerative colitis:A case report

BACKGROUND Ulcerative colitis(UC)is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel.In addition,UC affects only the large bowel except for backwash ileitis and pouchitis,whereas Crohn’s disease(CD)affects the entire digestive tract.Inflammatory bowel disease(IBD)patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion.However,in recent years,some UC patients are reported to have various degrees of lesions in gastroduodenum.Here,we report a case of gastroduodenitis associated with UC(GDUC).CASE SUMMARY A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk.Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy.Subsequent gastroscopy revealed mucosa with diffuse edema,ulcers,errhysis,and granular and friable changes in the stomach and duodenal bulb,which were similar to the appearance of the rectum.After ruling out other possibilities according to a series of examinations,a diagnosis of GDUC was considered.The patient hesitated about intravenous corticosteroids,so he received a standardized treatment with pentasa of 3.2 g/d.After 0.5 mo of treatment,the patient’s symptoms achieved complete remission.Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.CONCLUSION The occurrence of gastrointestinal involvement in UC is rare,which may open a new window for studying the etiology and pathogenesis of UC.Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.

Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis

We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J -pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin?). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis.

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction:A case report and review of literature

BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.

Foregut tuberculosis:Too close but miles apart

The worldwide burden of tuberculosis(TB)has increased and it can involve virtually any organ of the body.Intestinal TB accounts for about 2%of the cases of TB worldwide.The ileocecal region is the most commonly affected site,and the foregut is rarely involved.The reported incidence is approximately 0.5%.Esophageal TB presents with dysphagia,weight loss,and hematemesis in rare cases.Gastroduodenal TB usually manifests with symptoms such as nausea,vomiting,weight loss,and sometimes with gastric outlet obstruction.Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected,therefore histopathology plays pivotal role.On computed tomography,duodenal TB typically manifests as duodenal strictures predominantly,accompanied by extrinsic compression,and occasionally as intraluminal mass.But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing,TB polymerase chain reaction investigation and histopathological analysis.Despite being in close proximity to the lungs,the esophagus and stomach are rare sites of TB.The reasons could be low gastric pH and acidity which does not let mycobacterium grow.But there are various case reports of TB involving the foregut.We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy,histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.

Interferon-gamma release assays as a tool for differential diagnosis of gastrointestinal tuberculosis

In this editorial,we comment on an article published in a recent issue of the World Journal of Clinical Cases.There is a pressing need for reliable tools for diagnosing tuberculosis(TB)of the gastrointestinal tract.Despite advancements in the diagnosis and treatment,TB remains a global health challenge.Ali et al demon-strated that TB may mimic gastrointestinal conditions,such as gastric outlet obstruction,causing a delay in the diagnosis.Furthermore,the latter complication is frequently observed during infections,including Helicobacter pylori,and rarely is related to TB,as in the presented case.In line with this,we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract.Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.

Revisiting tuberculosis as a cause of gastric outlet obstruction:Insights from a case report

Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Gastroduodenal artery disconnection during liver transplantation decreases non-anastomotic stricture incidence

Background:The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation(LT).Gastroduodenal artery(GDA)disconnection increased proper hepatic artery flow.Whether this procedure attenuates biliary non-anastomotic stricture(NAS)is not clear.Methods:A total of 241 patients with LT were retrospectively analyzed.The patients were divided into the GDA disconnection(GDA-)and GDA preservation(GDA+)groups.Propensity score matching(PSM)was administrated to reduce bias.Logistic regression was conducted to analyze risk factors for biliary NAS before and after PSM.Postoperative complications were compared.Kaplan-Meier survival analysis and log-rank tests were performed to compare overall survival.Results:In all,99 patients(41.1%)underwent GDA disconnection,and 49(20.3%)developed NAS.Multivariate logistic regression revealed that GDA preservation(OR=2.24,95%CI:1.11-4.53;P=0.025)and model for end-stage liver disease(MELD)score>15(OR=2.14,95%CI:1.12-4.11;P=0.022)were risk factors for biliary NAS.PSM provided 66 pairs using 1:2 matching method,including 66 GDA disconnection and 99 GDA preservation patients.Multivariate logistic regression after PSM also showed that GDA preservation(OR=3.15,95%CI:1.26-7.89;P=0.014)and MELD score>15(OR=2.41,95%CI:1.08-5.36;P=0.031)were risk factors for NAS.When comparing complications between the two groups,GDA preservation was associated with a higher incidence of biliary NAS before and after PSM(P=0.031 and 0.017,respectively).In contrast,other complications including early allograft dysfunction(P=0.620),small-for-size graft syndrome(P=0.441),abdominal hemorrhage(P=1.000),major complications(Clavien-Dindo grade≥3,P=0.318),and overall survival(P=0.088)were not significantly different between the two groups.Conclusions:GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.

Helicobacter Pylori Infection and Gastroduodenal Lesions in Patients with Chronic Kidney Disease: A Comparative Study

Introduction: Gastroduodenal lesions are common in chronic kidney disease (CKD). They are linked to various factors including Helicobacter pylori infection (H. pylori). Few data are available in Africa on H. pylori infection and chronic kidney disease. The aim of this study was to assess the impact of H. pylori infection and to describe the gastroduodenal lesions found in patients with chronic kidney disease. Patients and Methods: A cross-sectional study was conducted, February 1st to May 31st, 2021, at the Douala General Hospital in Cameroon. We included patients with CKD classified as stages 3 to 5 according KDIGO classification, on hemodialysis or not, who agreed to participate in the study. They were matched with a “control” population including patients with normal renal function according to sex and age (ratio 1:2). Patients on antibiotics and/or proton pump inhibitors were excluded. We collected data from CKD patients and from medical records for non-CKD group. Each patient underwent an upper digestive endoscopy and identification of H. pylori using a urease rapid test. Logistic regression was used to identify independent associations for a significance level set at p Results: We included 99 patients including 33 with CKD and 66 control patients. Among patients with CKD, the predominance was male (n = 18/33 or 54.5%). The mean age was 51.2 ± 12.8 years. Arterial hypertension was the first etiology of CKD (n = 13 or 39.4%). The prevalence of H. pylori in patients with CKD was 63.6% versus 37.9% in control patients (p-value = 0.015). The main endoscopic lesions were erosive gastropathy (n = 14 or 42.4%) and erythematous gastropathy (n = 7 or 21.2%). Patients with CKD were 5 times more likely to have H. pylori infection (OR = 5.69;CI 95% 0.14 - 0.82;p = 0.017). Factors associated with H. pylori infection were chronic kidney disease (aOR = 1.02;CI 95% 0.14 - 0.82;p = 0.017) and hemodialysis (aOR = 10;CI 95% 1.08 - 91.9;p = 0.042). Conclusion: The prevalence of H. pylori infection is higher in patients with CKD. Endoscopic lesions are inflammatory. Factors associated with H. pylori infection are chronic kidney disease and hemodialysis.

Increased numbers of Foxp3-positive regulatory T cells in gastritis, peptic ulcer and gastric adenocarcinoma

AIM: To determine the number of regulatory T cells (Tregs) in gastric mucosa of patients with gastritis, peptic ulcers and gastric cancer. METHODS: This study was a retrospective analysis of gastric antrum biopsy specimens from healthy controls (n = 22) and patients with gastritis (n = 30), peptic ulcer (n = 83), or gastric cancer (n = 32). Expression of CD4, CD25 and Foxp3 was determined by immunohistochemistry in three consecutive sections per sample.RESULTS: Compared with healthy controls, there was an increased number of CD25+ and Foxp3+ cells in patients with gastritis (P = 0.004 and P = 0.008), peptic ulcer (P < 0.001 and P < 0.001), and gastric cancer (P < 0.001 and P < 0.001). The ratio of CD25+/CD4+ or Foxp3+/CD4+ cells was also significantly higher in all disease groups (P < 0.001, respectively). The number of CD4+, CD25+, and Foxp3+ cells, and the ratio of CD25+/CD4+ and Foxp3+/CD4+ cells, were associated with the histological grade of the specimens, including acute inflammation, chronic inflammation, lymphoid follicle number, and Helicobacter pylori infection. The number of CD4+, CD25+ and Foxp3+ cells, and the ratio of CD25+/CD4+ and Foxp3+/CD4+ cells, were negatively associated with intestinal metaplasia among gastritis (P < 0.001, P < 0.001, P < 0.001, P = 0.002 and P = 0.002) and peptic ulcer groups (P = 0.013, P = 0.004, P < 0.001, P = 0.040 and P = 0.003).

Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy

Low-dose aspirin(LDA) is clinically used for the prevention of cardiovascular and cerebrovascular events with the advent of an aging society.On the other hand,a very low dose of aspirin(10 mg daily) decreases the gastric mucosal prostaglandin levels and causes significant gastric mucosal damage.The incidence of LDAinduced gastrointestinal mucosal injury and bleeding has increased.It has been noticed that the incidence of LDA-induced gastrointestinal hemorrhage has increased more than that of non-aspirin non-steroidal anti-inflammatory drug(NSAID)-induced lesions.The pathogenesis related to inhibition of cyclooxygenase(COX)-1 includes reduced mucosal flow,reduced mucus and bicarbonate secretion,and impaired platelet aggregation.The pathogenesis related to inhibition of COX-2 involves reduced angiogenesis and increased leukocyte adherence.The pathogenic mechanisms related to direct epithelial damage are acid back diffusion and impaired platelet aggregation.The factors associated with an increased risk of upper gastrointestinal(GI) complications in subjects taking LDA are aspirin dose,history of ulcer or upper GI bleeding,age > 70 years,concomitant use of non-aspirin NSAIDs including COX-2-selective NSAIDs,and Helicobacter pylori(H.pylori) infection.Moreover,no significant differences have been found between ulcer and non-ulcer groups in the frequency and severity of symptoms such as nausea,acid regurgitation,heartburn,and bloating.It has been shown that the ratios of ulcers located in the body,fundus and cardia are significantly higher in bleeding patients than the ratio of gastroduodenal ulcers in patients taking LDA.Proton pump inhibitors reduce the risk of developing gastric and duodenal ulcers.In contrast to NSAIDinduced gastrointestinal ulcers,a well-tolerated histamine H2-receptor antagonist is reportedly effective in prevention of LDA-induced gastrointestinal ulcers.The eradication of H.pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding.Continuous aspirin therapy for patients with gastrointestinal bleeding may increase the risk of recurrent bleeding but potentially reduces the mortality rates,as stopping aspirin therapy is associated with higher mortality rates.It is very important to prevent LDA-induced gastroduodenal ulcer complications including bleeding,and every effort should be exercised to prevent the bleeding complications.

Helicobacter pylori infection: New pathogenetic and clinical aspects

Helicobacter pylori (H. pylori) infects more than half of the world&#x02019;s human population, but only 1% to 3% of infected people consequently develop gastric adenocarcinomas. The clinical outcome of the infection is determined by host genetic predisposition, bacterial virulence factors, and environmental factors. The association between H. pylori infection and chronic active gastritis, peptic ulcer disease, gastric cell carcinoma, and B cell mucosa-associated lymphoid tissue lymphoma has been well established. With the exception of unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, H. pylori infection has no proven role in extraintestinal diseases. On the other hand, there is data showing that H. pylori infection could be beneficial for some human diseases. The unpredictability of the long-term consequences of H. pylori infection and the economic challenge in eradicating it is why identification of high-risk individuals is crucial.

Effects of the myeloperoxidase 463 gene polymorphisms on development of atrophy in H pylori infected or noninfected gastroduodenal disease

AIM： To investigate the relationship between myeloperoxidase polymorphisms as a host-related factor and atrophy caused by H pylori. METHODS： Our study enrolled 77 patients. Biopsy materials obtained during gastrointestinal endoscopies were evaluated for the presence of H pylori. Polymerase chain reaction-restriction fragment length polymorphism assay was used to characterize myeloperoxidase genothpes. RESULTS： Forty four patients （57.1%） were lip （＋） and 33 （42.9%） were Hp （-）. Sixty six （85.7%） had GG genotype, 10 （12.9%） had GA genotype and 1 （1.29%） had AA genotype. The change in atrophy in relation to neutrophil infiltration was significant in Hp （＋） patients （P = 0.0001）. The change in atrophy in relation to neutrophil infiltration in patients with GG genotype was significant （P = 0.002）. However, the change in atrophy in relation to neutrophil infiltration was not significiant in patients with Hp （＋） GG genotype （r = 0.066, P = 0.63）. CONCLUSION： Myeloperoxidase genotype is critical for development of atrophy in relation to the severity of inflammation. However, it is interesting to note that, H pylori does not show any additive effect on development of atrophy.

Gastroduodenal ulcer bleeding in elderly patients on low dose aspirin therapy

AIM To determine the clinical characteristics of elderly patients of hemorrhagic gastroduodenal ulcer on low-dose aspirin(LDA)therapy.METHODS A total of 1105 patients with hemorrhagic gastroduodenal ulcer treated in our hospital between January 2000 and March 2016 were grouped by age and drugs used,and these groups were compared in several factors.These groups were compared in terms of length of hospital stay,presence/absence of hemoglobin(Hb)decrease,presence/absence of blood transfusion,Forrest Ⅰ,percentage of Helicobacter pylori infection,presence/absence of underlying disease,and percentage of severe cases.RESULTS The percentage of blood transfusion(62.6%vs 47.7%,P<0.001),Hb decrease(53.8% vs 40.8%,P<0.001),and the length of hospital stay(23.5 d vs 16.7 d,P<0.001)were significantly greater in those on drug therapy.The percentage of blood transfusion(65.3%vs 47.8%,P<0.001),Hb decrease(54.2%vs 42.1%,P<0.001),and length of hospital stay(23.3 d vs 17.5 d,P<0.001)were significantly greater in the elderly.In comparison with the LDA monotherapy group,the percentage of severe cases was significantly higher in the LDA combination therapy group when elderly patients were concerned(16.1%vs34.0%,P=0.030).Meanwhile,among those on LDA monotherapy,there was no significant difference between elderly and non-elderly(16.1%vs 16.0%,P=0.985).CONCLUSION A combination of LDA with antithrombotic drugs or nonsteroidal anti-inflammatory drugs(NSAIDs)contributes to aggravation.And advanced age is not an aggravating factor when LDA monotherapy is used.

Gastroduodenal intussusception due to gastric schwannoma treated by billroth Ⅱ distal gastrectomy:One case report

Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem.The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein.Wepresent a case report of a rare complication of gastric schwannoma causing gastroduodenal intussusception that was successfully managed by a BillrothⅡdistal gastrectomy.In this rare case,the patient had intermittent,colicky abdominal pain,nausea,and vomiting for over 4wk accompanied by a weight loss.A diagnosis of gastric intussusception was made by computed tomography.A BillrothⅡdistal gastrectomy was then performed,and complete en bloc removal(R0 resection)was achieved.Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.

“Wrapping the gastroduodenal artery stump” during pancreatoduodenectomy reduced the stump hemorrhage incidence after operation

Objective： After pancreaticoduodenectomy （PD）, the postoperative gastroduodenal artery stump （GDAS） hemorrhage is one of the most serious complications. The purpose of this study is to determine whether wrapping the GDAS during PD could decrease the postoperative GDAS hemorrhage incidence. Methods： A retrospective review involving 280 patients who underwent PD from 2005 to 2012 was performed. Wrapping the GDAS during PD was defined as ＂Wrapping the GDAS using the teres hepatis ligamentum during PD＂. A total of 140 patients accepted the ＂wrapping＂ procedure （wrapping group）. The other 140 patients didn＇t apply the procedure （non-wrapping group）. Age, sex, preoperative data, estimated intraoperative blood loss, postoperative complications, pathologic parameters and hospitalization time were compared between two groups. ResultsI There were no significant differences in patient characteristics between two groups. After wrapping, the incidence of postoperative GDAS bleeding decreased significantly （1/140 vs. 9/140, P=0.01）. The rates of the other complications （such as intra-abdominal infection pancreatic fistula, billiary fistula, gastrointestinal bleeding, et aL） showed no significant differences. Conclusions： Wrapping the GDAS during PD significantly reduced the postoperative GDAS hemorrhage incidence. And the ＂wrapping＂ had no obvious influence on other complications.

Celecoxib-related gastroduodenal ulcer and cardiovascular events in a randomized trial for gastric cancer prevention

AIM: To evaluate the long-term risk of gastroduodenal ulcer and cardiovascular events induced by celecoxib in a population-based, randomized, double-blind, placebo-controlled study.METHODS: From 2004 to 2006, a total of 1024 Chinese patients (aged 35 to 64 years) with severe chronic atrophic gastritis, intestinal metaplasia or dysplasia were randomly assigned to receive 200 mg of celecoxib twice daily or placebo in Linqu County (Shandong Province, China), a high-risk area of gastric cancer. All gastroduodenal ulcer and cardiovascular events occurred were recorded and the patients were followed up for 1.5 years after treatment. At the end of the trial, a systematic interview survey about other adverse events was conducted. RESULTS: Gastroduodenal ulcer was detected in 19 of 463 (3.72%) patients who received celecoxib and 17 of 473 (3.31%) patients who received placebo, respectively (odds ratio = 1.13, 95% CI = 0.58-2.19). Cardiovascular (CV) events occurred in 4 patients who received celecoxib and in 5 patients who received placebo, respectively. Compared with those who received placebo, patients who received celecoxib had no signif icant increase in occurrence of CV events (hazard ratio = 0.84, 95% CI = 0.23-3.15). Among the adverse events acquired by interview survey, only the frequency of bloating was signif icantly higher in patients treated with celecoxib than in those treated with placebo. CONCLUSION: Treatment of gastric cancer with celecoxib is not associated with increased risk of gastroduodenal ulcer and cardiovascular events.

Duodenal stenting for malignant gastric outlet obstruction:Prospective study

AIM： To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score （GOOS）.

rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

AIM To evaluate the rate of adverse events(AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after theprocedure. RESULTS308 patients were included and a single polypectomy was performed in 205. Only 36(11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm(5-60) and in 294 cases(95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219(71.1%) patients. Nine patients presented AEs(2.9%), and 6 of them were bleeding(n = 6, 1.9%)(in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.CONCLUSION Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana

Gastroduodenal disease(GDD)was initially thought to be uncommon in Africa.Amongst others,lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world.Following the increasing availability of flexible upper gastro-intestinal endoscopy,it has now become apparent that GDD,especially peptic ulcer disease(PUD),is prevalent across the continent of Africa.Recognised risk factors for gastric cancer(GCA)include Helicobater pylori(H.pylori),diet,Epstein-Barr virus infection and industrial chemical exposure,while those for PUD are H.pylori,non-steroidal antiinflammatory drug(NSAID)-use,smoking and alcohol consumption.Of these,H.pylori is generally accepted to be causally related to the development of atrophic gastritis(AG),intestinal metaplasia(IM),PUD and distal GCA.Here,we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy,and complement the analysis with new data obtained on premalignant gastric his-topathological lesions in Accra,Ghana which was compared with previous data from Maputo,Mozambique.As there is a general lack of structured cohort studies in Africa,we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals.In Africa,there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns.Furthermore,there are differences in PUD within-country despite universally endemic H.pylori infection.PUD is not uncommon in Africa.Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries.An additional intriguing observation is a recent,ongoing decline in PUD in some African countries where H.pylori infection is still high.One possible reason for the high,sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations.The prevalence of AG and IM,were similar or modestly higher over rates in western countries but lower than those seen in Asia..In our new data,sampling of 136 patients in Accra detected evidence of pre-malignant lesions(AG and/or IM)in 20 individuals(14.7%).Likewise,the prevalence of pre-malignant lesions,in a sample of 109 patients from Maputo,were 8.3%AG and 8.3%IM.While H.pylori is endemic in Africa,the observed prevalence for GCA is rather low.However,cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems,diagnostic health facilities and expertise.Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent.We conclude that evidence is still lacking to support(or not)the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.

Anatomic and technical skill factor of gastroduodenal complication in post-transarterial embolization for hepatocellular carcinoma: A retrospective study of 280 cases

AIM: To reduce the possibility of gastroduodenal complications. The purpose of this retrospective study was to survey the literature and compare and discuss the incidence of post-transarterial embolization (TAE)gastroduodenal complications.METHODS: We found reports describing 280 cases of hepatocellular carcinoma with TAE procedures done during the past 4 years and selected all of them for our study.Amongst these cases, 86 were suspected of suffering gastroduodenal complications within one month of postTAE treatment. Fifteen of these cases were proved by pan-endoscopy to have gastroduodenal erosions or ulcerations. We reviewed the angiographic pictures in patient records to evaluate the possibility that anatomic and technical skill factors could explain the complications.RESULTS: Amongst the 15 cases, 9 were primary lesions of the antrum and prepylorus; 4 had duodenal ulcer or erosions; 2 had mid-body lesions; none showed a lesion at the fundus or cardia region. Three cases had not received TAEs using our ideal method, and may be associated with possible regurgitation of gel-foam pieces into the right or left gastric arteries. Two cases involved sub-selective embolization at a distal point on the hepatic artery; one case was found by angiography to have complete occlusion of the celiac trunk.CONCLUSION: Comparing our results with past cases of post-TAE gastroduodenal complications, we surmise that our relatively low incidence (5.3%) of gastric complications might be explained by our concerted efforts to improve our technical skills in multi-sequential, selective and superselective approaches to the embolization of tumor vessels.