Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECK...Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECKMATE-649,ORIENT-16,and KEYNOTE-859 trials,have markedly transformed the treatment paradigm for advanced gastric cancer(AGC)3-5.展开更多
BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention tim...BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.展开更多
BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric ...BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric foveolar metaplasia,from which G-NADETs originate,protects the duodenal mucosa from gastric acidity.As gastric acid secretion is affected by endoscopic gastric mucosal atrophy(EGMA),we hypothesized that EGMA would be associated with GNADETs.AIM To evaluate the association between EGMA and the occurrence of G-NADETs.METHODS This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 patients.The duodenum was divided into parts 1(bulb),2(superior duodenal angle to the papilla),and 3(anal side of the papilla to the horizontal part).The effects of gastric acidity and presence of Brunner’s glands were considered.EGMA was divided into types C(no or mild atrophy)and O(severe atrophy).Mucin phenotype expressions in NADETs were divided into gastric,intestinal,gastrointestinal,and unclassifiable.RESULTS When NADETs were classified according to EGMA,105 were classified as type C and 29 as type O.G-NADETs were present in 11.9%(16 cases)of all cases,and all 16 cases were of type C.Among G-NADETs,93.8%(15 cases)were present in part 1 or 2.There was an association between G-NADETs and type C in part 1,and 50.0%(eight of 16 cases)of G-NADETs were associated with a current or previous Helicobacter pylori infection status.Additionally,all eight cases occurred in part 1.CONCLUSION G-NADETs were significantly associated with type C.Gastric acidity and Brunner's gland growth may be associated with G-NADETs.展开更多
BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,n...BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.展开更多
BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investig...BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investigate the diagnostic value of hematological and inflammatory markers in differentiating proximal and distal gastric cancers and to evaluate their association with clinical outcomes.METHODS A retrospective cohort study was conducted on 150 patients diagnosed with gastric adenocarcinoma through histopathological analysis.Patients were categorized into proximal gastric cancer and distal gastric cancer groups.Laboratory parameters were analyzed.RESULTS Of the 150 patients,84 had proximal gastric cancer and 66 had distal gastric cancer.Dysphagia was significantly more common in the proximal gastric cancer group,while anemia and higher platelet-to-lymphocyte ratio values were observed in the distal gastric cancer group(P=0.031).Tumor stage and neutrophil-to-lymphocyte ratio emerged as independent predictors of all-cause mortality.No significant differences were found in other laboratory or biochemical parameters between the groups.CONCLUSION Proximal and distal gastric cancers demonstrate distinct clinical and laboratory profiles.The platelet-to-lymphocyte ratio may serve as a valuable marker in differentiating cancer localization,while the neutrophil-to-lymphocyte ratio is a prognostic indicator for mortality.These findings highlight the potential of hematological markers in optimizing diagnosis and treatment strategies for gastric cancer.展开更多
BACKGROUND Tumors characterized by high cellular stemness often have unfavorable clinical outcomes,primarily due to their heightened potential for metastasis and resistance to chemotherapy.Among the model genes,the cl...BACKGROUND Tumors characterized by high cellular stemness often have unfavorable clinical outcomes,primarily due to their heightened potential for metastasis and resistance to chemotherapy.Among the model genes,the clinical relevance and prognostic significance of Niemann-Pick type C2(NPC2)in gastric cancer(GC)remained largely unexplored.AIM To identify stemness-associated genes in GC.METHODS In this study,epithelial cells were categorized as either tumor or normal epithelial cells using the infer copy number variation method.Stemness scores were calculated for both cell types.The hierarchical Weighted Gene Co-expression Network Analysis identified two gene modules with the strongest association with stemness.Prognostically significant stemness-related genes were pinpointed using univariate Cox regression based on The Cancer Genome Atlas dataset.A predictive model related to stemness was constructed using Least Absolute Shrinkage and Selection Operator regression followed by multivariate Cox analysis.RESULTS Functional roles of NPC2 were validated using single-cell and bulk RNA sequencing data.Further experimental validation revealed that elevated NPC2 expression promoted tumor cell stemness,invasiveness,migratory ability,and resistance to standard chemotherapeutic agents.Importantly,high NPC2 expression correlated with poorer overall survival in GC patients.CONCLUSION In summary,the proposed model offers prognostic insights that outperform traditional clinical staging and may inform more tailored therapeutic approaches for gastric cancer management.展开更多
Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies shoul...Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.展开更多
Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation ...Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa,in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis(Phase I)to gastric precancerous lesions(Phase II)and finally to GC(Phase III).Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa.Intervening in early gastric mucosal lesions,i.e.,Phases I and II,will be the key strategy to prevent and treat GC.Natural products(NPs)have been an important source for drug development due to abundant sources,tremendous safety,and multiple pharmacodynamic mechanisms.This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis.In Phase I,NPs modulate Helicobacter pylori urease activity,motility,adhesion,virulence factors,and drug resistance,thereby inhibiting H.pylori-induced gastric mucosal inflammation and oxidative stress,and facilitating ulcer healing.In Phase II,NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle,apoptosis,autophagy,and angiogenesis to reverse gastric precancerous lesions.In Phase III,NPs suppress cell proliferation,migration,invasion,angiogenesis,and cancer stem cells,induce apoptosis and autophagy,and enhance chemotherapeutic drug sensitivity for the treatment of GC.In contrast to existing work,we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development,providing new ideas for gastric cancer prevention,treatment,and drug development.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
Gastric ulcer(GU)is a common digestive system disease.Acupuncture,as one of the external treatments of traditional Chinese medicine(TCM),has the characteristics of multi-target,multi-pathway and multi-level action in ...Gastric ulcer(GU)is a common digestive system disease.Acupuncture,as one of the external treatments of traditional Chinese medicine(TCM),has the characteristics of multi-target,multi-pathway and multi-level action in the treatment of GU.The relationship between meridian points and Zang-fu is an important part of the theory of TCM,which is crucial for the diagnosis and treatment of diseases.There is an external and internal link between acupoints and Zang-fu.The pathological reaction of Zang-fu can manifest as acupoint sensitization,while stimulation of acupoints can play a therapeutic role in the internal Zang-fu.Therefore,the acupoint has the functions of reflecting and treating diseases.This review explores the tender points on the body surface of patients with GU and the rules of acupoint selection.In addition,Zusanli(ST36),as one of the most used acupoints of the stomach meridian,was selected to show the mechanisms behind acupoint stimulation in the treatment of GU in greater detail,specifically in the well-studied model of the stress GU(SGU).Hence,the mechanisms of acupuncture at ST36 and points commonly used in combination with ST36 to treat SGU are discussed further.Treatment effects can be achieved through anti-inflammatory and antioxidant activities,gastric mucosal injury repair,and interaction with the brain-gut axis.In summary,this review provides evidence for a comprehensive understanding of the phenomena and mechanism of acupoint functions for GU.展开更多
With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming a...With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming and may not guide immediate clinical decisions.This paper aims to introduce a novel classification system for GPs based on their potential risk of malignant transformation,categorizing them as"good","bad",and"ugly".A review of the literature and clinical case analysis were conducted to explore the clinical implications,management strategies,and the system's application in endoscopic practice.Good polyps,mainly including fundic gland polyps and inflammatory fibrous polyps,have a low risk of malignancy and typically require minimal or no intervention.Bad polyps,mainly including hyperplastic polyps and adenomas,pose an intermediate risk of malignancy,necessitating closer monitoring or removal.Ugly polyps,mainly including type 3 neuroendocrine tumors and early gastric cancer,indicate a high potential for malignancy and require urgent and comprehensive treatment.The new classification system provides a simplified and practical framework for diagnosing and managing GPs,improving diagnostic accuracy,guiding individualized treatment,and promoting advancements in endoscopic techniques.Despite some challenges,such as the risk of misclassification due to similar endoscopic appearances,this system is essential for the standardized management of GPs.It also lays the foundation for future research into biomarkers and the development of personalized medicine.展开更多
BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neut...BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)for GC.METHODS The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed.The information on peripheral blood platelet,neutrophil,and lymphocyte counts in each patient was collected,and the NLR,PLR,and SII levels of both groups were calculated.Additionally,multivariate logistic regression analysis was conducted,and the diagnostic implications of NLR,PLR,and SII in differentiating patients with precancerous gastric conditions,compared with those with GC,were analyzed through receiver operating characteristic(ROC)curves.RESULTS The data indicated that NLR,PLR,and SII had abnormally increased levels in the patients with GC.Gender and body mass index were risk factors for the occurrence of GC.ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions,who were differentiated from those with GC,were 0.824,0.787,and 0.842,respectively.CONCLUSION NLR,PLR,and SII are all abnormally expressed in GC and have diagnostic implications,especially when used as joint indicators,in distinguishing patients with precancerous gastric conditions from those with GC.展开更多
BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(...BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.展开更多
BACKGROUND Emerging evidence suggests that serum levels of pepsinogen(PG),gastrin-17(G17),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),and CA72-4 may aid in distinguishing gastric cancer(GC)from gas...BACKGROUND Emerging evidence suggests that serum levels of pepsinogen(PG),gastrin-17(G17),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),and CA72-4 may aid in distinguishing gastric cancer(GC)from gastric ulcer(GU).AIM To assess serum PG,G17,CEA,CA19-9,and CA72-4 in diagnosing GU and optimizing GC detection.METHODS A retrospective analysis was conducted from 263 patients treated at the Third People’s Hospital of Hefei,who were classified into three groups:Chronic non-atrophic gastritis(CG),GU,and GC.Fasting serum levels of PG,G17,CEA,CA19-9,and CA72-4 were measured and compared across the groups.RESULTS Serum levels of PGII and G17 were significantly elevated in both the GU and GC groups compared to the CG group(P<0.01),whereas the PGI/PGII ratio was markedly decreased(P<0.01).Levels of CEA,CA19-9,and CA72-4 were significantly higher in the GC group than in the CG and GU groups(P<0.01).Receiver operating characteristic curve analysis identified the optimal diagnostic cut-off values for GU and GC as follows:PGI(169.855 pmol/L),PGII(30.555μg/L),PGI/PGII ratio(16.529),G17(6.435 pmol/L),CEA(2.005 ng/mL),CA19-9(16.65 U/mL),and CA72-4(2.075 U/mL).The area under the curve for combined detection was 0.826(P<0.001),indicating good diagnostic performance.CONCLUSION Serological biomarkers effectively distinguish GC from GU,with combined detection of PGII,PGI/PGII ratio,G17,and tumor markers enhancing diagnostic accuracy.展开更多
Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al...Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al published the first report of CGEP in the English literature.We conducted a systemic review of the literature of CGEP published in English or Chinese,and found that CGEP occurred more frequently in the 6th and 7th decade of life,with a male predominance(89.7%).The majority of reported cases(89.2%)were from East Asia,and the underlying mechanism remains unknown.Most patients with CGEP presented non-specific symptoms,including abdominal pain,bloating,regurgitation,and belching.A few patients(30%)experienced upper gastrointestinal bleeding.Given the non-specific symptoms,misdiagnosis or underdiagnosis often occurs.Gastroscopy and upper gastrointestinal radiography are the main examinations used to confirm the diagnosis.Currently,conservative medication is the mainstay treatment.In this systematic review,we describe the history,etiology,diagnosis and treatment of CGEP in detail,aiming to provide a comprehensive understanding of this rare disease and avoid misdiagnosis.展开更多
BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increas...BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increased risk of impaired gastrointestinalmotility due to surgical alterations, immunosuppressive therapy, andpost-transplant complications. Given the high frequency of ERCP in this population,our anecdotal experience suggests an increased incidence of gastric foodretention at the time of the procedure.AIMTo evaluate the association between LT and gastric food retention observed atERCP over a two-year period.METHODSThis retrospective study included all patients who underwent standard ERCP atour institution between 2022 and 2024. Data were collected on demographics,medical history including LT and procedural details.RESULTSA total of 1100 patients underwent ERCP, including 238 LT recipients (22%).Gastric food retention was observed 17 patients (1.5%). The incidence was significantly higher in LT recipientscompared to non-transplant patients (3.8% vs 0.9%, P = 0.004). Multivariate analysis confirmed that LT recipientswere independently associated with an increased risk of food retention.CONCLUSIONLT recipients demonstrated over three-fold increased incidence of gastric food retention during ERCP. This shouldbe considered in pre-procedural assessment and preparation in this patient population.展开更多
Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality wor...Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality worldwide.Many studies have identified the gastrointestinal microbiota,or gut microbiota,as an important contributor to both the pathogenesis and treatment of GPL and GC,thus understanding its role in this transition is crucial.The purpose of this literature review is to introduce the current landscape of microbiota research associated with GPL and GC,with an emphasis on Helicobacter pylori(H.pylori)driven microbial dysbiosis and its modulation through Western medicine and traditional Chinese medicine(TCM)approaches.By elucidating the underlying mechanisms of H.pylori colonization,patterns,and interactions among microbiota,as well as the influence of microbial metabolites,this review highlights crucial driving factors of gastric carcinogenesis.The role of microbiota in conventional interventions,including H.pylori eradication,immunotherapy,as well as TCM herbal decoctions,is also discussed to provide a detailed understanding of the complex interactions between therapy and microbiota and how it could be potentially targeted for effective management of GPL and GC.Ultimately,microbiota-targeting therapeutics may represent a new path toward early detection,targeted treatment,improved prognosis,and potentially reduced incidence of GPL and GC.展开更多
Current experimental models struggle to simulate the complex process of the transformation from atrophic gastritis to gastric cancer,while gastric organoid technology,especially region-specific modeling,provides a mor...Current experimental models struggle to simulate the complex process of the transformation from atrophic gastritis to gastric cancer,while gastric organoid technology,especially region-specific modeling,provides a more precise in vitro platform for studying this carcinogenic mechanism.Helicobacter pylori activates carcinogenic signaling pathways through virulence factors,inducing DNA damage,epigenetic dysregulation,and immune microenvironment imbalance,driving inflammation-cancer conversion.Intestinal metaplasia and spasmolytic polypeptide-expressing metaplasia serve as critical precursor lesions,gradually developing into dysplasia and adenocarcinoma under the influence of chronic inflammation and genetic instability through intestinal cell transformation and high trefoil factor 2-expressing cell expansion.The immune suppression,metabolic reprogramming,and matrix remodeling within the tumor microenvironment collaboratively create a pro-cancer ecosystem that accelerates inflammationcarcinogenesis transformation.The gastric organoid model successfully simulates the spatiotemporal dynamics of the carcinogenesis process in atrophic gastritis,and its future integration with single-cell omics,real-time imaging technologies,and artificial intelligence technologies could provide a more precise platform for elucidating molecular mechanisms and screening intervention strategies.These advances position gastric organoids as pivotal tools for clinical translation,enabling personalized risk stratification,early intervention targeting precancerous transitions,and ex vivo prediction of patient-specific therapeutic responses to guide precision management of gastric cancer.展开更多
This study reviews the findings of a recent study by Li et al,which demonstrated that perioperative chemotherapy benefits patients with diffuse-type gastric cancer compared to surgery alone.Despite potential biases,th...This study reviews the findings of a recent study by Li et al,which demonstrated that perioperative chemotherapy benefits patients with diffuse-type gastric cancer compared to surgery alone.Despite potential biases,the study supports the inclusion of perioperative chemotherapy in treatment guidelines.Neoadjuvant and adjuvant chemotherapy may also provide similar survival outcomes,allowing for flexible treatment planning.展开更多
Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support....Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support.Given its clinical significance,establishing effective,evidence-based,and standardized manage-ment strategies is essential for bettering patient outcomes and mitigating compli-cations.This review systematically synthesized the diagnostic criteria,assessment methods,influencing factors,management procedures,and intervention strategies for gastric retention in EN patients.Although no universal consensus exists re-garding gastric residual volume(GRV)thresholds,evidence indicates that EN can continue at high GRV levels in the absence of gastrointestinal symptoms.Bedside ultrasound emerged as a non-invasive,and precise method GRV assessment,offering potential to standardize clinical practice.Key risk factors for gastric retention include neurological disorders and EN infusion rates exceeding 100 mL/h.Effective management strategies encompass non-pharmacological inter-ventions,pharmacological agents,and traditional Chinese medicine(TCM)the-rapies.This review underscored the need for integrated,multi-modal manage-ment strategies and recommended the adoption of bedside ultrasound and stan-dardized protocols to optimize EN delivery and improve patient outcomes.Large-scale,multicenter clinical trials should be a priority for future investigation to verify the effectiveness of TCM therapies and develop personalized intervention plans for high-risk patients.展开更多
基金supported by The National Key Research and Development Program of China(Grant no.2021YFA0910100)Healthy Zhejiang One Million People Cohort(Grant no.K-20230085)+5 种基金Post-doctoral Innovative Talent Support Program(Grant no.BX2023375)Lingyan Project of Zhejiang Provincial Department of Science and Technology(Grant no.2025C02059)the National Natural Science Foundation of China(Grant nos.82304946,82473489,and 82403546)Natural Science Foundation of Zhejiang Province(Grant nos.LR21H280001,LGF22H160056,ZCLQN25H1602,and LMS25H160006)Medicine and Health Science Fund of Zhejiang Province Health Commission(Grant nos.2025KY047 and 2022KY658)Traditional Chinese Medicine Science and Technology Project of Zhejiang Provincial Health Commission(Grant no.2022ZA023).
文摘Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECKMATE-649,ORIENT-16,and KEYNOTE-859 trials,have markedly transformed the treatment paradigm for advanced gastric cancer(AGC)3-5.
基金Supported by Shanghai Municipal Hospital Emerging Frontier Technology Joint Project,No.SHDC12019105Shanghai Science and Technology Development Funds,No.24YF2758200National Natural Science Foundation of China,No.82100699.
文摘BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.
文摘BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric foveolar metaplasia,from which G-NADETs originate,protects the duodenal mucosa from gastric acidity.As gastric acid secretion is affected by endoscopic gastric mucosal atrophy(EGMA),we hypothesized that EGMA would be associated with GNADETs.AIM To evaluate the association between EGMA and the occurrence of G-NADETs.METHODS This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 patients.The duodenum was divided into parts 1(bulb),2(superior duodenal angle to the papilla),and 3(anal side of the papilla to the horizontal part).The effects of gastric acidity and presence of Brunner’s glands were considered.EGMA was divided into types C(no or mild atrophy)and O(severe atrophy).Mucin phenotype expressions in NADETs were divided into gastric,intestinal,gastrointestinal,and unclassifiable.RESULTS When NADETs were classified according to EGMA,105 were classified as type C and 29 as type O.G-NADETs were present in 11.9%(16 cases)of all cases,and all 16 cases were of type C.Among G-NADETs,93.8%(15 cases)were present in part 1 or 2.There was an association between G-NADETs and type C in part 1,and 50.0%(eight of 16 cases)of G-NADETs were associated with a current or previous Helicobacter pylori infection status.Additionally,all eight cases occurred in part 1.CONCLUSION G-NADETs were significantly associated with type C.Gastric acidity and Brunner's gland growth may be associated with G-NADETs.
基金Supported by Jiangsu Science and Technology Project,No.BK20211039the Top Talent Support Program for Young and Middle-Aged People of the Wuxi Health Committee,No.BJ2023008+3 种基金the Major Program of Wuxi Medical Center,Nanjing Medical University,No.WMCM202305the Cohort and Clinical Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202302the Scientific Research Program of Wuxi Health Commission,No.Z202208Wuxi Municipal Health and Health Commission Precision Medicine Project,No.J202104.
文摘BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.
基金This study was approved by the Agrı Training and Research Hospital Scientific Research Ethics Committee(No.E-95531838-050.99-86900)conducted in accordance with the Declaration of Helsinki.
文摘BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investigate the diagnostic value of hematological and inflammatory markers in differentiating proximal and distal gastric cancers and to evaluate their association with clinical outcomes.METHODS A retrospective cohort study was conducted on 150 patients diagnosed with gastric adenocarcinoma through histopathological analysis.Patients were categorized into proximal gastric cancer and distal gastric cancer groups.Laboratory parameters were analyzed.RESULTS Of the 150 patients,84 had proximal gastric cancer and 66 had distal gastric cancer.Dysphagia was significantly more common in the proximal gastric cancer group,while anemia and higher platelet-to-lymphocyte ratio values were observed in the distal gastric cancer group(P=0.031).Tumor stage and neutrophil-to-lymphocyte ratio emerged as independent predictors of all-cause mortality.No significant differences were found in other laboratory or biochemical parameters between the groups.CONCLUSION Proximal and distal gastric cancers demonstrate distinct clinical and laboratory profiles.The platelet-to-lymphocyte ratio may serve as a valuable marker in differentiating cancer localization,while the neutrophil-to-lymphocyte ratio is a prognostic indicator for mortality.These findings highlight the potential of hematological markers in optimizing diagnosis and treatment strategies for gastric cancer.
文摘BACKGROUND Tumors characterized by high cellular stemness often have unfavorable clinical outcomes,primarily due to their heightened potential for metastasis and resistance to chemotherapy.Among the model genes,the clinical relevance and prognostic significance of Niemann-Pick type C2(NPC2)in gastric cancer(GC)remained largely unexplored.AIM To identify stemness-associated genes in GC.METHODS In this study,epithelial cells were categorized as either tumor or normal epithelial cells using the infer copy number variation method.Stemness scores were calculated for both cell types.The hierarchical Weighted Gene Co-expression Network Analysis identified two gene modules with the strongest association with stemness.Prognostically significant stemness-related genes were pinpointed using univariate Cox regression based on The Cancer Genome Atlas dataset.A predictive model related to stemness was constructed using Least Absolute Shrinkage and Selection Operator regression followed by multivariate Cox analysis.RESULTS Functional roles of NPC2 were validated using single-cell and bulk RNA sequencing data.Further experimental validation revealed that elevated NPC2 expression promoted tumor cell stemness,invasiveness,migratory ability,and resistance to standard chemotherapeutic agents.Importantly,high NPC2 expression correlated with poorer overall survival in GC patients.CONCLUSION In summary,the proposed model offers prognostic insights that outperform traditional clinical staging and may inform more tailored therapeutic approaches for gastric cancer management.
文摘Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.
基金supported by the Chengdu University of Traditional Chinese Medicine"Xinglin Scholars"Program,China(Grant No.:MPRC2023014).
文摘Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa,in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis(Phase I)to gastric precancerous lesions(Phase II)and finally to GC(Phase III).Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa.Intervening in early gastric mucosal lesions,i.e.,Phases I and II,will be the key strategy to prevent and treat GC.Natural products(NPs)have been an important source for drug development due to abundant sources,tremendous safety,and multiple pharmacodynamic mechanisms.This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis.In Phase I,NPs modulate Helicobacter pylori urease activity,motility,adhesion,virulence factors,and drug resistance,thereby inhibiting H.pylori-induced gastric mucosal inflammation and oxidative stress,and facilitating ulcer healing.In Phase II,NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle,apoptosis,autophagy,and angiogenesis to reverse gastric precancerous lesions.In Phase III,NPs suppress cell proliferation,migration,invasion,angiogenesis,and cancer stem cells,induce apoptosis and autophagy,and enhance chemotherapeutic drug sensitivity for the treatment of GC.In contrast to existing work,we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development,providing new ideas for gastric cancer prevention,treatment,and drug development.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
基金funded by National Key Research and Development Program of China(No.2022YFC3501705)National Natural Science Foundation of China general projects(No.82274066)Shanghai Science and Technology Innovation Project(No.22S21901200).
文摘Gastric ulcer(GU)is a common digestive system disease.Acupuncture,as one of the external treatments of traditional Chinese medicine(TCM),has the characteristics of multi-target,multi-pathway and multi-level action in the treatment of GU.The relationship between meridian points and Zang-fu is an important part of the theory of TCM,which is crucial for the diagnosis and treatment of diseases.There is an external and internal link between acupoints and Zang-fu.The pathological reaction of Zang-fu can manifest as acupoint sensitization,while stimulation of acupoints can play a therapeutic role in the internal Zang-fu.Therefore,the acupoint has the functions of reflecting and treating diseases.This review explores the tender points on the body surface of patients with GU and the rules of acupoint selection.In addition,Zusanli(ST36),as one of the most used acupoints of the stomach meridian,was selected to show the mechanisms behind acupoint stimulation in the treatment of GU in greater detail,specifically in the well-studied model of the stress GU(SGU).Hence,the mechanisms of acupuncture at ST36 and points commonly used in combination with ST36 to treat SGU are discussed further.Treatment effects can be achieved through anti-inflammatory and antioxidant activities,gastric mucosal injury repair,and interaction with the brain-gut axis.In summary,this review provides evidence for a comprehensive understanding of the phenomena and mechanism of acupoint functions for GU.
文摘With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming and may not guide immediate clinical decisions.This paper aims to introduce a novel classification system for GPs based on their potential risk of malignant transformation,categorizing them as"good","bad",and"ugly".A review of the literature and clinical case analysis were conducted to explore the clinical implications,management strategies,and the system's application in endoscopic practice.Good polyps,mainly including fundic gland polyps and inflammatory fibrous polyps,have a low risk of malignancy and typically require minimal or no intervention.Bad polyps,mainly including hyperplastic polyps and adenomas,pose an intermediate risk of malignancy,necessitating closer monitoring or removal.Ugly polyps,mainly including type 3 neuroendocrine tumors and early gastric cancer,indicate a high potential for malignancy and require urgent and comprehensive treatment.The new classification system provides a simplified and practical framework for diagnosing and managing GPs,improving diagnostic accuracy,guiding individualized treatment,and promoting advancements in endoscopic techniques.Despite some challenges,such as the risk of misclassification due to similar endoscopic appearances,this system is essential for the standardized management of GPs.It also lays the foundation for future research into biomarkers and the development of personalized medicine.
文摘BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)for GC.METHODS The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed.The information on peripheral blood platelet,neutrophil,and lymphocyte counts in each patient was collected,and the NLR,PLR,and SII levels of both groups were calculated.Additionally,multivariate logistic regression analysis was conducted,and the diagnostic implications of NLR,PLR,and SII in differentiating patients with precancerous gastric conditions,compared with those with GC,were analyzed through receiver operating characteristic(ROC)curves.RESULTS The data indicated that NLR,PLR,and SII had abnormally increased levels in the patients with GC.Gender and body mass index were risk factors for the occurrence of GC.ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions,who were differentiated from those with GC,were 0.824,0.787,and 0.842,respectively.CONCLUSION NLR,PLR,and SII are all abnormally expressed in GC and have diagnostic implications,especially when used as joint indicators,in distinguishing patients with precancerous gastric conditions from those with GC.
基金Supported by the Startup Fund for Scientific Research,Fujian Medical University,No.2020QH1168Fujian Provincial Science and Technology Innovation Joint Funds,No.2024Y9023the Fujian Provincial Natural Science Foundation of China,No.2024J011644.
文摘BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.
基金Supported by Chinese Medicine Research Project of Anhui Chinese Medicine Society,No.2024ZYYXH135.
文摘BACKGROUND Emerging evidence suggests that serum levels of pepsinogen(PG),gastrin-17(G17),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),and CA72-4 may aid in distinguishing gastric cancer(GC)from gastric ulcer(GU).AIM To assess serum PG,G17,CEA,CA19-9,and CA72-4 in diagnosing GU and optimizing GC detection.METHODS A retrospective analysis was conducted from 263 patients treated at the Third People’s Hospital of Hefei,who were classified into three groups:Chronic non-atrophic gastritis(CG),GU,and GC.Fasting serum levels of PG,G17,CEA,CA19-9,and CA72-4 were measured and compared across the groups.RESULTS Serum levels of PGII and G17 were significantly elevated in both the GU and GC groups compared to the CG group(P<0.01),whereas the PGI/PGII ratio was markedly decreased(P<0.01).Levels of CEA,CA19-9,and CA72-4 were significantly higher in the GC group than in the CG and GU groups(P<0.01).Receiver operating characteristic curve analysis identified the optimal diagnostic cut-off values for GU and GC as follows:PGI(169.855 pmol/L),PGII(30.555μg/L),PGI/PGII ratio(16.529),G17(6.435 pmol/L),CEA(2.005 ng/mL),CA19-9(16.65 U/mL),and CA72-4(2.075 U/mL).The area under the curve for combined detection was 0.826(P<0.001),indicating good diagnostic performance.CONCLUSION Serological biomarkers effectively distinguish GC from GU,with combined detection of PGII,PGI/PGII ratio,G17,and tumor markers enhancing diagnostic accuracy.
基金Supported by National Key Research and Development Project,No.2022YFC2503603and 985th Hospital Research Project,No.YN202405.
文摘Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al published the first report of CGEP in the English literature.We conducted a systemic review of the literature of CGEP published in English or Chinese,and found that CGEP occurred more frequently in the 6th and 7th decade of life,with a male predominance(89.7%).The majority of reported cases(89.2%)were from East Asia,and the underlying mechanism remains unknown.Most patients with CGEP presented non-specific symptoms,including abdominal pain,bloating,regurgitation,and belching.A few patients(30%)experienced upper gastrointestinal bleeding.Given the non-specific symptoms,misdiagnosis or underdiagnosis often occurs.Gastroscopy and upper gastrointestinal radiography are the main examinations used to confirm the diagnosis.Currently,conservative medication is the mainstay treatment.In this systematic review,we describe the history,etiology,diagnosis and treatment of CGEP in detail,aiming to provide a comprehensive understanding of this rare disease and avoid misdiagnosis.
文摘BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increased risk of impaired gastrointestinalmotility due to surgical alterations, immunosuppressive therapy, andpost-transplant complications. Given the high frequency of ERCP in this population,our anecdotal experience suggests an increased incidence of gastric foodretention at the time of the procedure.AIMTo evaluate the association between LT and gastric food retention observed atERCP over a two-year period.METHODSThis retrospective study included all patients who underwent standard ERCP atour institution between 2022 and 2024. Data were collected on demographics,medical history including LT and procedural details.RESULTSA total of 1100 patients underwent ERCP, including 238 LT recipients (22%).Gastric food retention was observed 17 patients (1.5%). The incidence was significantly higher in LT recipientscompared to non-transplant patients (3.8% vs 0.9%, P = 0.004). Multivariate analysis confirmed that LT recipientswere independently associated with an increased risk of food retention.CONCLUSIONLT recipients demonstrated over three-fold increased incidence of gastric food retention during ERCP. This shouldbe considered in pre-procedural assessment and preparation in this patient population.
文摘Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality worldwide.Many studies have identified the gastrointestinal microbiota,or gut microbiota,as an important contributor to both the pathogenesis and treatment of GPL and GC,thus understanding its role in this transition is crucial.The purpose of this literature review is to introduce the current landscape of microbiota research associated with GPL and GC,with an emphasis on Helicobacter pylori(H.pylori)driven microbial dysbiosis and its modulation through Western medicine and traditional Chinese medicine(TCM)approaches.By elucidating the underlying mechanisms of H.pylori colonization,patterns,and interactions among microbiota,as well as the influence of microbial metabolites,this review highlights crucial driving factors of gastric carcinogenesis.The role of microbiota in conventional interventions,including H.pylori eradication,immunotherapy,as well as TCM herbal decoctions,is also discussed to provide a detailed understanding of the complex interactions between therapy and microbiota and how it could be potentially targeted for effective management of GPL and GC.Ultimately,microbiota-targeting therapeutics may represent a new path toward early detection,targeted treatment,improved prognosis,and potentially reduced incidence of GPL and GC.
基金Supported by National Traditional Chinese Medicine Advantageous Specialty Project of National Administration of Traditional Chinese MedicineShuguang Hospital Siming Foundation Research Special Project,No.SGKJ-202304.
文摘Current experimental models struggle to simulate the complex process of the transformation from atrophic gastritis to gastric cancer,while gastric organoid technology,especially region-specific modeling,provides a more precise in vitro platform for studying this carcinogenic mechanism.Helicobacter pylori activates carcinogenic signaling pathways through virulence factors,inducing DNA damage,epigenetic dysregulation,and immune microenvironment imbalance,driving inflammation-cancer conversion.Intestinal metaplasia and spasmolytic polypeptide-expressing metaplasia serve as critical precursor lesions,gradually developing into dysplasia and adenocarcinoma under the influence of chronic inflammation and genetic instability through intestinal cell transformation and high trefoil factor 2-expressing cell expansion.The immune suppression,metabolic reprogramming,and matrix remodeling within the tumor microenvironment collaboratively create a pro-cancer ecosystem that accelerates inflammationcarcinogenesis transformation.The gastric organoid model successfully simulates the spatiotemporal dynamics of the carcinogenesis process in atrophic gastritis,and its future integration with single-cell omics,real-time imaging technologies,and artificial intelligence technologies could provide a more precise platform for elucidating molecular mechanisms and screening intervention strategies.These advances position gastric organoids as pivotal tools for clinical translation,enabling personalized risk stratification,early intervention targeting precancerous transitions,and ex vivo prediction of patient-specific therapeutic responses to guide precision management of gastric cancer.
文摘This study reviews the findings of a recent study by Li et al,which demonstrated that perioperative chemotherapy benefits patients with diffuse-type gastric cancer compared to surgery alone.Despite potential biases,the study supports the inclusion of perioperative chemotherapy in treatment guidelines.Neoadjuvant and adjuvant chemotherapy may also provide similar survival outcomes,allowing for flexible treatment planning.
基金Supported by Zhejiang Province Medical and Health Technology Planning Project,No.2019332856.
文摘Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support.Given its clinical significance,establishing effective,evidence-based,and standardized manage-ment strategies is essential for bettering patient outcomes and mitigating compli-cations.This review systematically synthesized the diagnostic criteria,assessment methods,influencing factors,management procedures,and intervention strategies for gastric retention in EN patients.Although no universal consensus exists re-garding gastric residual volume(GRV)thresholds,evidence indicates that EN can continue at high GRV levels in the absence of gastrointestinal symptoms.Bedside ultrasound emerged as a non-invasive,and precise method GRV assessment,offering potential to standardize clinical practice.Key risk factors for gastric retention include neurological disorders and EN infusion rates exceeding 100 mL/h.Effective management strategies encompass non-pharmacological inter-ventions,pharmacological agents,and traditional Chinese medicine(TCM)the-rapies.This review underscored the need for integrated,multi-modal manage-ment strategies and recommended the adoption of bedside ultrasound and stan-dardized protocols to optimize EN delivery and improve patient outcomes.Large-scale,multicenter clinical trials should be a priority for future investigation to verify the effectiveness of TCM therapies and develop personalized intervention plans for high-risk patients.
