Clinical Recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on Diagnosis and Treatment of Gastritis and Duodenitis

Aim. The clinical guidelines are intended to supplement specialty decision-making for improved aid quality in patients with gastritis and duodenitis though acknowledging the latest clinical evidence and principles of evidencebased medicine.Key points. Gastritis is an inflammatory disease of stomach mucosa, with a separate definition of acute and chronic gastritis. Chronic gastritis is a cohort of chronic diseases uniting a typical morphology of persistent inflammatory infiltration, impaired cellular renewal with emergent intestinal metaplasia, atrophy and epithelial dysplasia of gastric mucosa. Oesophagogastroduodenoscopy (OGDS) or high-resolution OGDS with magnified or non-magnified virtual chromoendoscopy, including targeted biopsy for atrophy and intestinal metaplasia grading and neoplasia detection, are recommended to verify gastritis and duodenitis, precancer states and/or gastric mucosal changes. All chronic gastritis patients positive for H. рylori should undergo eradication therapy as aetiological and subsidiary for gastric cancer prevention. Chronic gastritis patients with symptoms of dyspepsia (epigastric pain, burning and congestion, early satiety), also combined with functional dyspepsia, are recommended proton pump inhibitors, prokinetics, rebamipide and bismuth tripotassium dicitrate in symptomatic treatment. With focal restricted intestinal metaplasia, follow-up is not required in most cases, mainly when advanced atrophic gastritis is ruled out in high-quality endoscopy with biopsy. However, a familial history of gastric cancer, incomplete intestinal metaplasia and persistent H. pylori infection render endoscopy monitoring with chromoendoscopy and targeted biopsy desirable once in three years. Patients with advanced atrophic gastritis should have high-quality endoscopy every 3 years, and once in 1–2 years if complicated with a familial history of gastric cancer.Conclusion. The recommendations condense current knowledge on the aetiology and pathogenesis of gastritis and duodenitis, as well as laboratory and instrumental diagnostic techniques, main approaches to aetiological H. pylori eradication and treatment of dyspeptic states.

CHANGES IN VASCULAR ENDOTHELIAL GROWTH FACTOR LEVEL IN HELICOBACTER PYLORI-ASSOCIATED GASTRODUODENAL DISEASES

A populational infection with Helicobacter (H.) pylori poses a global problem. Mucosal colonization of H. pylori in the gastroduodenal area can initiate development multiple diseases with hyper-or hypoplasia of mucosal epithelial cells secreting vascular endothelial growth factor (VEGF). The aim of the study was to assess VEGF serum level, its diagnostic and prognostic value in diseases affecting the gastroduodenal area. Material and methods. 180 patients with exacerbated chronic gastritis, gastric ulcer, duodenal ulcer as well as 30 healthy volunteers were examined after providing an informed consent. Patients were divided into groups depending on the degree of mucous contamination with H. pylori. In the subjects examined during esophagogastroduodenoscopy, a biological material was collected during targeted biopsy for microscopic and histological studies. Blood samples for immunological examination were obtained in the morning on an empty stomach from the ulnar vein in the volume of 5 ml, and the serum was isolated by centrifugation. The level of VEGF, pepsinogens, and titer of total antibodies against the H. pylori cytotoxin-associated protein were determined in the blood serum from the subjects by using the enzyme immunoassay method. The long-term prognosis was analyzed for up to 2 years. The data obtained were processed statistically. Results. Patients were found to have excessive serum VEGF levels in healthy volunteers. For gastric ulcer associated with H. pylori, 80% of cases had increased discriminatory VEGF level. In patients, direct relationships between the serum VEGF level and degree, stage of gastritis, the degree of contamination with H. pylori, the serum pepsinogens level were uncovered. Regression analysis found that patients with diseases targeting gastroduodenal area had serum VEGF level equal to or greater than 231 pg/ml in 60% of cases that correctly predicted an increase in mucosal atrophy. If the amount of VEGF ≥373 pg/ml in 91.5% of cases, then ulceration of gastric epithelium developed, whereas for ≥396 pg/ml level it was observed in 89% cases with ulceration of the intestinal epithelium. The probability of gastroduodenal bleeding at a serum VEGF level of 408 pg/ml or higher was predicted correctly in 96% of cases. Conclusion. More than 54% of patients with H. pylori-associated chronic gastritis, peptic ulcer disease had level of VEGF significantly exceeding magnitude found in healthy volunteers and the discriminatory level reflects the morphofunctional state of the stomach and duodenum. Assessing serum VEGF level in gastroduodenal diseases can be recommended for predicting development of atrophy, ulceration of the gastric and intestinal epithelium, and gastroduodenal bleeding.

The Research of Chronic Gastritis Diagnosis with Electronic Noses

In order to solve the problem of existing diagnostic methods for chronic gastritis which are complex and traumatic, a novel noninvasive method for diagnosis of chronic gastric based on e-nose and deep convolutional neural network is proposed. Firstly, in order to collect samples, a respiratory gas sampling device was established and the response curve of respiratory gas is generated. Then, a deep convolutional neural network for the diagnosis of chronic gastritis is proposed to recognize and classify the respiratory gas response curve. The DCNN model attained good results with accuracy, sensitivity, and specificity of 85.00%, 90.00%, and 80.00%, respectively, for chronic gastric prediction. The proposed method provides a new way for the clinical auxiliary diagnoses of chronic gastric.

The Abnormal Metabolites in Tongue Coating of Chronic Gastritis Patients Reflect the Changes in Indexes of Gastroscopic Observation and Gastric Mucosal Pathology

ObjectiveIn this study, we analyzed the correlation between different metabolites in the tongue coating of patients with chronic gastritis, gastroscopy and pathological indexes, and discussed the metabolic mechanism at different pathological stages in the development of chronic gastritis.MethodsWe used GC-TOF-MS and UHPLC-QE-MS metabonomics to detect the distribution of metabolites in the tongue coating of patients with chronic gastritis, and analyzed the correlation between different metabolites in the tongue coating of patients with chronic gastritis and gastroscopy and pathological indexes.ResultsCompared with 50 healthy people, 54 metabolites were upregulated and 47 metabolites were downregulated in 350 patients with chronic gastritis. The main differential metabolites were Lipids and lipid-like molecules, which contain 47 metabolites. The best diagnostic model was composed of 5 metabolites, with an accuracy of 95.4%, a specificity of 87.4% and a sensitivity of 88.0%. These 5 metabolites were 1-methyladenosine, Sphinganine 1-phosphate, 3-Hydroxycapric acid, 4-Ipomeanol, and Nervonic acid. Compared with healthy people, Sphinganine 1-phosphate, 4-Ipomeanol, and Nervonic acid were significantly upregulated in chronic gastritis patients, and 1-methyladenosine and 3-Hydroxycapric acid were significantly downregulated in chronic gastritis patients. After correlation analysis between differential metabolites in tongue coatings and gastroscopic indexes, we found that Trimethylaminoacetone, Sphinganine1-phosphate, alpha-Carboxy-delta-decalactone, and 5,6-Dihydroxyindole were positively correlated with intestinal metaplasia. Conduritol-beta-expoxide, Tetracosanoic acid, Lactosylceramide(d18:1/26:0), Chondrillasterol 3-[glucosyl-(1->4)-glucoside], Azelaic acid, and 1-Methyladenosine were negatively correlated with intestinal metaplasia. Sphinganine1-phosphate, alpha-Carboxy-delta-decalactone, and 5,6-Dihydroxyindole were positively correlated with atrophic. Octadecanol, conduritol-beta-expoxide, Tetracosanoic acid, Smilanippin A, Lactosylceramide(d18:1/26:0), Chondrillasterol 3-[glucosyl-(1->4)-glucoside], and Azelaic acid were negatively correlated with atrophic. 6-deoxyglucitol was negatively correlated with bile reflux, methylmaleic acid, 4-methylcatechol, and 2,4-dichloro-1-(2-chloroethenyl)-benzene were negatively correlated with Hp, 3-benzoyloxy-11-oxo-12-ursen-28-oic acid was negatively correlated with gastric mucosal erosion. From the change trend of different metabolites in different pathological stages, we found that the content of conduritol-beta-expoxide decreased significantly in mild atrophic compared with moderate atrophic and the content of conduritol-beta-expoxide decreased significantly in mild intestinal metaplasia compared with moderate intestinal metaplasia.ConclusionsWe found that Lipids and lipid-like molecules were the main abnormal metabolites in patients with chronic gastritis. Among them, Sphinganine 1-phosphate, which was significantly positively correlated with the aggravation of atrophic and intestinal metaplasia, could be used as one of the diagnostic model markers for chronic gastritis. Additionally, the amount of conduritol-beta-expoxide significantly decreased with the aggravation of atrophic and intestinal metaplasia. We believe that these differential markers in tongue coating may help us to establish a noninvasive and convenient auxiliary detection method for gastritis and gastric precancerous lesion in the future.