Different Pattern of Inflammatory and Atrophic Changes in the Gastric Mucosa of the Greater and Lesser Curvature

Background & Aims: Appropriate biopsy sampling is important for the classification of gastritis, yet the extent of inflammation and atrophy of different regions of the stomach with chronic gastritis have been addressed only in a few studies. The aim of our study was to analyze the inflammatory, atrophic and metaplastic changes in the greater and lesser curvature of the antrum and corpus mucosa. Methods: 420 patients undergoing upper endoscopy were enrolled in the study. Four expert gastrointestinal pathologists graded biopsy specimens according to the updated Sydney classification. Results: The obtained results showed that the mononuclear and granulocyte inflammatory cells were more prominent in the corpus lesser curvature compared to the corpus greater curvature (p=0.01 and p=0.0001, respectively). In addition, the extent and degree of atrophy and intestinal metaplasia were more prominent in the corpus lesser compared to the greater curvature (p=0.002 and p=0.0065, respectively). The frequency of distribution of H. pylori did not differ throughout both the corpus and antrum greater and lesser curvature. However, the degree of H. pylori colonization in the corpus was higher in the lesser than in the greater curvature. The interobserver agreement was significantly higher for corpus atrophy compared to antrum atrophy.Conclusions: These findings demonstrated that the more severe atrophic, metaplastic and inflammatory changes were observed in the lesser compared to the greater curvature of the stomach. In routine clinical settings, corpus and antral biopsies should be obtained from both lesser and greater curvature. Analysis of the incisura biopsy is also important.

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The Distribution of Incomplete Gastric Intestinal Metaplasia (GIM) Subtype among Biopsy Sites according to the Updated Sydney System and Its Association with GIM Extension

Gastroenterology Research and Practice ◽

10.1155/2018/4938730 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Duc Trong Quach ◽

Huy Minh Le ◽

Trung Sao Nguyen ◽

Toru Hiyama

Keyword(s):

High Risk ◽

Intestinal Metaplasia ◽

Periodic Acid ◽

Risk Marker ◽

Gastric Intestinal Metaplasia ◽

Biopsy Specimens ◽

Sydney System ◽

Updated Sydney System ◽

Greater Curvature ◽

Lesser Curvature

Background. Current guidelines recommend that extensive gastric intestinal metaplasia (GIM) be considered as a high-risk marker for the development of gastric cancer (GC). But there is emerging evidence that the incomplete GIM subtype is also a high-risk marker. Aims. To evaluate the performance of biopsy sites according to the updated Sydney system on detecting the incomplete GIM subtype and to assess its association with GIM extension. Patients and methods. A cross-sectional study was conducted on 280 Vietnamese patients with nonulcer dyspepsia. Biopsy specimens were taken from gastric sites according to the updated Sydney system, and sections were routinely stained with Giemsa and hematoxylin and eosin. Biopsy specimens with intestinalization were further evaluated for GIM subtypes with alcian blue 2.5 and periodic acid Schiff stainings. Two experienced pathologists jointly examined all the specimens and reached consensus. Results. The rates of patients with GIM and the incomplete GIM subtype were 81 (28.9%) and 24 (8.4%), respectively. There was no GIM in specimens taken from the greater curvature of corpus. The proportions of the incomplete GIM subtype detected at the incisura angularis, lesser curvature of corpus, lesser curvature of antrum, and greater curvature of antrum were 34.3% (12/35), 34.5% (10/29), 40.5% (17/42), and 31.6 (6/19), respectively, which were not significantly different (p=0.89). The presence of an incomplete GIM subtype was associated with multifocal GIM (i.e., ≥3 out of 5 biopsy sites with GIM) (OR=4.02, CI 95%, 1.33–12.16, p=0.022) and extensive GIM (i.e., GIM in specimens from both of corpus and antrum) (OR=2.89, CI 95% 1.04–8.02, p=0.045). Conclusions. The proportions of an incomplete GIM subtype were not significantly different among gastric biopsy sites with intestinalization. The association between an incomplete GIM subtype and GIM extension, therefore, may be due to an sum accumulation effect.

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Detection of H. Pylori by PCR analysis in liver biopsy specimens

Journal of Hepatology ◽

10.1016/s0168-8278(01)80682-6 ◽

2001 ◽

Vol 34 (0) ◽

pp. 185-186

Author(s):

I Kupcinskas

Keyword(s):

Liver Biopsy ◽

Pcr Analysis ◽

Biopsy Specimens ◽

H Pylori

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Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study

Endoscopy International Open ◽

10.1055/a-1352-3437 ◽

2021 ◽

Vol 09 (03) ◽

pp. E388-E394

Author(s):

Francesco Cocomazzi ◽

Marco Gentile ◽

Francesco Perri ◽

Antonio Merla ◽

Fabrizio Bossa ◽

...

Keyword(s):

Interobserver Agreement ◽

Classification Systems ◽

Sensitivity Analyses ◽

Size Estimation ◽

Rater Agreement ◽

Staff Members ◽

Video Clips ◽

Paris Classification ◽

Level Of Agreement

Abstract Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08–0.12) or the AC1 statistics (0.59–0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen’s κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.

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Clinicopathological and Endoscopic Features of Raspberry-Shaped Gastric Cancer in Helicobacter pylori-Uninfected Patients

Digestion ◽

10.1159/000511907 ◽

2020 ◽

pp. 1-8

Author(s):

Noboru Yatagai ◽

Hiroya Ueyama ◽

Muneo Ikemura ◽

Ryota Uchida ◽

Hisanori Utsunomiya ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Submucosal Tumor ◽

Clinicopathological Characteristics ◽

Fundic Gland ◽

Histopathological Classification ◽

Histological Characteristics ◽

Greater Curvature ◽

H Pylori ◽

Tumor Shape

Background: Gastric adenocarcinoma of foveolar type (GA-FV) is a raspberry-shaped gastric cancer (RSGC) and garners much attention as H. pylori (Hp)-uninfected gastric cancer. However, the classification and clinicopathological and endoscopic features of RSGCs in Hp-uninfected patients are poorly defined. We designed a new histopathological classification of RSGC and compared them via endoscopic and clinicopathological characteristics. Summary: From 996 patients with early gastric cancers resected by endoscopy in our hospital, we studied 24 RSGC lesions from 21 (2.4%) Hp-uninfected patients. RSGCs were classified into 3 histological types as follows: GA-FV (n = 19), gastric adenocarcinoma of fundic gland type (GA-FG, n = 2), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM, n = 3). Most of the lesions were found at the greater curvature of the upper or middle third of the stomach. GA-FV lesions were homogeneously reddish and frequently accompanied with a whitish area around the tumor and an irregular microvascular (MV) pattern; these features were confirmed histopathologically by the presence of homogeneous neoplastic foveolar epithelium with foveolar hyperplasia around the tumors. GA-FG lesions might be heterogeneously reddish with a submucosal tumor shape and regular MV pattern; these were confirmed by the presence of covered or mixed nonneoplastic epithelium on deeper regions of tumors. GA-FGM lesions might be homogeneously reddish and occasionally had a submucosal tumor shape and irregular MV pattern; these were confirmed by the presence of homogeneous neoplastic foveolar epithelium on deeper regions of the tumors. Key Messages: RSGCs in Hp-uninfected patients are classified into 3 histopathological types. For accurate diagnosis of RSGCs, it may be necessary to fully understand endoscopic features of these lesions based on these histological characteristics and to take a precise biopsy.

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Dysregulated Immune Responses by ASK1 Deficiency Alter Epithelial Progenitor Cell Fate and Accelerate Metaplasia Development during H. pylori Infection

Microorganisms ◽

10.3390/microorganisms8121995 ◽

2020 ◽

Vol 8 (12) ◽

pp. 1995

Author(s):

Yoku Hayakawa ◽

Yoshihiro Hirata ◽

Masahiro Hata ◽

Mayo Tsuboi ◽

Yukiko Oya ◽

...

Keyword(s):

Epithelial Cells ◽

Immune Responses ◽

Cell Fate ◽

Knockout Mice ◽

Suppressor Cells ◽

Inflammatory Cells ◽

Immune Disorder ◽

Host Immune Responses ◽

Epithelial Homeostasis ◽

H Pylori

The mechanism of H. pylori-induced atrophy and metaplasia has not been fully understood. Here, we demonstrate the novel role of Apoptosis signal-regulating kinase 1 (ASK1) and downstream MAPKs as a regulator of host immune responses and epithelial maintenance against H. pylori infection. ASK1 gene deficiency resulted in enhanced inflammation with numerous inflammatory cells including Gr-1+CD11b+ myeloid-derived suppressor cells (MDSCs) recruited into the infected stomach. Increase of IL-1β release from apoptotic macrophages and enhancement of TH1-polarized immune responses caused STAT1 and NF-κB activation in epithelial cells in ASK1 knockout mice. Dysregulated immune and epithelial activation in ASK1 knockout mice led to dramatic expansion of gastric progenitor cells and massive metaplasia development. Bone marrow transplantation experiments revealed that ASK1 in inflammatory cells is critical for inducing immune disorder and metaplastic changes in epithelium, while ASK1 in epithelial cells regulates cell proliferation in stem/progenitor zone without changes in inflammation and differentiation. These results suggest that H. pylori-induced immune cells may regulate epithelial homeostasis and cell fate as an inflammatory niche via ASK1 signaling.

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Inflammatory cell numbers in the stomach of Japanese subjects with endoscopically normal mucosa without H. pylori infection

Digestive Diseases ◽

10.1159/000515345 ◽

2021 ◽

Author(s):

Naoki Sumi ◽

Ken Haruma ◽

Tomoari Kamada ◽

Mitsuhiko Suehiro ◽

Noriaki Manabe ◽

...

Keyword(s):

Inflammatory Cells ◽

Normal Mucosa ◽

Mucosal Inflammation ◽

Upper Gastrointestinal Endoscopy ◽

Fundic Gland ◽

Eosinophilic Gastritis ◽

Pyloric Mucosa ◽

Sydney System ◽

Updated Sydney System ◽

H Pylori

Introduction: Since inflammatory cells, such as lymphocytes and plasma cells, normally inhabit the stomach, the border between normal and mild inflammation is difficult to visually determine using the updated Sydney system scale of gastritis. Additionally, eosinophils in the gastric mucosa must be counted to diagnose eosinophilic gastritis. We aimed to determine the normal number of inflammatory cells in patients with endoscopically normal mucosa and without H. pylori infections. Methods: We assessed patients aged 20–79 years, who had undergone upper gastrointestinal endoscopy at Kawasaki Medical School Hospital between January 2010 and December 2014. Inflammatory cells were counted in 1,000 μm2 fields of pyloric and fundic gland mucosal biopsy specimens. We finally included 325 (male, n = 141; female, n = 184; average age = 49.3 years) patients without inflammation who had H. pylori-negative endoscopic results and negative histological findings interpreted based on the updated Sydney System and the Kyoto classification of gastritis. Results: The average numbers of nucleated cells were 83.3 ± 14.2/mm2 and 65.4 ± 12.6/mm2 in the pyloric and fundic gland mucosae, respectively. Inflammatory cells were significantly more abundant in the pyloric mucosa than the fundic gland mucosa (p < 0.05). Age and sex distribution did not significantly differ. Eosinophils were absent or scanty in the gastric mucosae of both glands in all patients. Conclusion: We determined the absolute values of inflammatory cells, including eosinophils, in normal mucosae of pyloric and fundic glands. These findings could be important in defining gastric mucosal inflammation, including eosinophilic gastritis diagnosis.

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Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1724134 ◽

2021 ◽

Vol 12 (02) ◽

pp. 103-106

Author(s):

Avnish Kumar Seth ◽

Rinkesh Kumar Bansal

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Gastrointestinal Endoscopy ◽

Gastroesophageal Junction ◽

Upper Gastrointestinal Endoscopy ◽

Proximal Stomach ◽

Endoscopic Gastrostomy ◽

Lesser Curvature ◽

Upper Gastrointestinal ◽

New Onset

Abstract Background We report three patients with endoscopic insufflation–induced gastric barotrauma (EIGB) during upper gastrointestinal endoscopy (UGIE) for percutaneous endoscopic gastrostomy (PEG). A definition and classification of EIGB is proposed. Materials and Methods Records of patients undergoing UGIE over 7 years (April 2013–March 2020) were reviewed. Patients who developed new onset of bleeding or petechial spots in proximal stomach, in an area previously documented to be normal during the same endoscopic procedure, were studied. Results New onset of bleeding or petechial spots in proximal stomach occurred in 3/286 (0.1%) patients undergoing PEG and in none of the 19,323 other UGIE procedures during the study period. All patients were men with median age 76 years (range 68–80 years), with no coagulopathy. Aspirin and apixaban were discontinued 1 week and 3 days prior to the procedure. Fresh blood was noted in the stomach at a median of 275 seconds (range 130–340) seconds after commencement of endoscopy. At retroflexion, multiple linear mucosal breaks of up to 3 cm, with oozing of blood, were noted in the proximal stomach along the lesser curvature, close to the gastroesophageal junction in two patients. In the third patient, multiple petechial spots were noticed in the fundus. The plan for PEG was abandoned and the stomach deflated by endoscopic suction. There was no subsequent hematemesis, melena, or drop in hemoglobin. One week later, repeat UGIE in the first two patients revealed multiple healing linear ulcers of 1 to 3 cm in the lesser curvature and PEG was performed. Conclusion Overinsufflation over a short duration during UGIE may lead to EIGB. Early detection is key and in the absence gastric perforation, patients can be managed conservatively.

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Pathomorphological study on gastroduodenal ulceration in horses: Localisation of lesions

Acta Veterinaria Hungarica ◽

10.1556/avet.55.2007.2.10 ◽

2007 ◽

Vol 55 (2) ◽

pp. 241-249 ◽

Cited By ~ 11

Author(s):

Barbora Bezdekova ◽

P. Jahn ◽

M. Vyskocil

Keyword(s):

Single Case ◽

Proximal Part ◽

Gastric Ulcers ◽

Squamous Mucosa ◽

Oesophageal Ulceration ◽

Prevalent Disease ◽

Greater Curvature ◽

Gastroduodenal Ulceration ◽

Lesser Curvature ◽

Low Prevalence

Gastroduodenal ulceration is a prevalent disease in foals and adult horses. Decreased performance as well as fatal complications relate to this syndrome. The objective of our study was to determine the prevalence of gastric ulceration in a mixed population of horses by postmortem examination and to evaluate a possible association between equine gastric ulcer syndrome (EGUS) and sex or age of the examined horses, to evaluate the localisation of lesions in the proximal part of the gastrointestinal tract and to determine the occurrence of gastric parasites. Post-mortem examinations were performed on 71 horses over a period of 24 months. Gastric ulcers were found in 52 horses (73.2%). There was no significant association between age or sex and occurrence of gastric ulcers. In all horses the squamous mucosa lesions were localised near the margo plicatus (100% of the cases), whereas in 23 horses the lesions were near the margo plicatus and lesser curvature and in 7 horses at the greater curvature. In 18 horses the mucosa was affected in the whole extent of the margo plicatus and in 1 horse diffuse lesions of the squamous mucosa were noted. Lesions of the glandular mucosa were localised in 11 horses at the fundic area, in 1 horse they occurred in the pylorus, and in 10 horses diffuse lesions of the glandular mucosa were recorded. A low prevalence of Gasterophilus intestinalis infection was detected (1 horse, 1.4%). We have confirmed that gastric ulcers are a common problem in horses and duodenal or oesophageal ulceration is rare (not a single case of the latter was found in this study). Lesions in the glandular mucosa of the stomach are more frequent in suckling foals than in older animals. Lesions of the glandular mucosa are also common in adult horses, and a complete gastroscopic examination including examination of the pylorus is advisable to evaluate this syndrome.

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Evidence for the Origin of Plasma Cells from Adventitial Cells

Blood ◽

10.1182/blood.v29.1.41.41 ◽

1967 ◽

Vol 29 (1) ◽

pp. 41-56 ◽

Cited By ~ 1

Author(s):

MOTOE HIRATA-HIBI

Keyword(s):

Plasma Cells ◽

Inflammatory Cells ◽

Neutral Red ◽

Dorsal Skin ◽

Connective Tissues ◽

Chromatin Pattern ◽

Adventitial Cells ◽

Subcutaneous Connective Tissue ◽

Diffuse Distribution

Abstract Arthus reactions were induced in the dorsal skin, and the subcutaneous connective tissues from the sensitized areas were examined at various stages. The subcutaneous connective tissue was used due to its simplicity of construction and because it could be studied conveniently by both supravital and fixed methods. This combination of tissue and technic allowed both an accurate classification of various types of inflammatory cells and a close examination of their relationships to the blood vessels. Cells transitional between adventitial cells and plasma cells were observed after antigenic stimulation. Their location on the walls of the venules and capillaries indicated that they were adventitial cells but their morphology was that of plasma cells. By supravital technic they exhibited a glassy and homogeneous cytoplasm, a circular formation of neutral red granules, and a diffuse distribution of Janus green granules; and by fixed method they exhibited a chromatin pattern similar to that of plasma cells, an increased cytoplasmic basophilia, and a nucleolus was often present. Small plasma cells appeared simultaneously around the venules and capillaries. The local origin of plasma cells would appear to explain the absence of plasmacytosis during strong tissue plasma cell reactions. Immunofluorescence was only found in plasma cells and in transitional adventitial cells, indicating a functional similarity between the 2 cells.

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