A Case of Chronic Gastric Anisakiasis Coexisting With Early Gastric Cancer

Background: Anisakiasis is a parasitic disease caused by the consumption of raw or undercooked fish that is infected by anisakis third-stage larvae. In countries, such as Japan, Italy, and Spain, where people have a custom of eating raw or marinated fish, anisakiasis is a common infection. Although anisakiasis has been reported to occur in the gastrointestinal tract in several countries, reports of anisakiasis accompanied by cancer are rare. Case presentation: We present the rare case of a 40-year-old male patient who had anisakiasis coexisting with mucosal gastric cancer. Submucosal gastric cancer was suspected on gastric endoscopy and endoscopic ultrasonography. After laparoscopic distal gastrectomy, granulomatous inflammation with anisakis larvae in the submucosa was pathologically revealed beneath mucosal tubular adenocarcinoma. Histological and immunohistochemical investigation showed cancer cells as intestinal absorptive-type cells that did not harbor mucin. Conclusion: Anisakis larvae could have injected into the cancer cells selectively because of the lack of mucin in the cancerous epithelium. Anisakiasis coexisting with cancer is considered reasonable rather than coincidental.

Prevalence of gastric ulcer syndrome in horses with different exercise intensity

Gastric ulcers or equine gastric ulcer syndrome (EGUS) is a common pathology in horses of different breeds. The objective of our research work was to investigate and determine the prevalence and severity of equine gastric ulcer syndrome (EGUS) in population of n = 28 riding horses with periods of physical activity and training intensity. Two breeds were presented in this study: English Thoroughbred (n = 15) and Ukrainian riding horse (n = 13). Horses were two age groups 3–7 and 8–16 years, including 17 mares and 11 geldings. Gastric endoscopy was performed as a diagnostic tool using a 3m video endoscope. Mucosal defects was evaluated using grading system proposed by (Equine Gastric Ulcer Council 0–4 grading system) ranging from 0 (normal mucosa with no lesions) to 4 (diffuse ulceration of mucosa with deep lesions). The study was conducted in two periods. Each period is related to different workload with mixed intensity in exercise during training program. The results of gastroscopic examination of the stomach indicate the prevalence of EGUS in 35.7 % during the first stage in horses with mild training. The severity of mucosal defect during this period which were related to grade 1 was shown in 10.7 % of horses, 2 – 21.4 %, 3 – 10.7 % and 4 – 0 %. Difference in results was found in the presence and severity of gastric ulcers between two periods in this study. During period of intermediate training the prevalence of EGUS was 46.4 % with severity of mucosal defect grade 1 presented in 14.2 % of affected horses, 2 – 28.5 %, 3 – 14.2 % and 4 – 3.5 %. Ulcerations on squamous gastric mucosa was diagnosed more often during each period (35.7 – 50 %) compare to glandular (7.1 – 10.7 %). The study confirms association between training intensity and gastric ulceration in two breed of horses. The prevalence and severity is dependent of the training intensity.

The Effects of Helicobacter pylori Infection on Microbiota Associated With Gastric Mucosa and Immune Factors in Children

BackgroundHelicobacter pylori infection is the main cause of chronic gastritis in children. Little is known about the effect of Helicobacter pylori on microbiota and immunity. This study was aimed at characterizing stomach microbiota and immune-regulatory properties of children with Helicobacter pylori colonization.MethodsWe studied 122 children who had undergone gastric endoscopy due to gastrointestinal symptoms, 57 were diagnosed with Helicobacter pylori infection. Endoscopic mucosal biopsy samples were obtained for DNA and RNA extraction. Microbiomes were analyzed by 16S rRNA profiling, with the differentially expressed genes analyzed using RNA sequencing. The RNA-sequencing results of selected genes were validated by qRT-PCR.ResultsBacterial diversity of Helicobacter pylori-positive gastric specimens were lower than those of negative, and both groups were clearly separated according to beta diversity. Helicobacter pylori-positive group significantly reduced proportions of six phyla and eight genera; only Helicobacter taxa were more abundant in Helicobacter pylori-negative group. Gastric tissues RNA sequencing showed increased expression of multiple immune response genes in Helicobacter pylori -infection. Helicobacter pylori -infected children with restructured gastric microbiota had higher levels of FOXP3, IL-10, TGF-β1 and IL-17A expressions, which were consistent with increased CD4+T cell and macrophagocyte, compared with non-infected children.ConclusionsPresence of Helicobacter pylori significantly influences gastric microbiota and results in lower abundance of multiple taxonomic levels in children. Meanwhile, it affects gastric immune environment and promotes the occurrence of gastritis.Clinical Trial Registration[http://www.chictr.org.cn], identifier [ChiCTR1800015190]

A Signet Ring Cell Carcinoma Presented as Refractory Acquired Thrombotic Thrombocytopenic Purpura

Microangiopathic hemolytic anemia (MAHA) can be observed as a paraneoplastic syndrome (PS) in certain tumors. MAHA-related signet ring cell carcinoma (SRCC) of an unknown origin is very infrequent. Herein we present a SRCC case presented with refractory acquired thrombotic thrombocytopenic purpura (TTP). A 35-year-old man applied to the emergency service with fatigue and headache. His laboratory tests resulted as white blood cell 9,020/µL, hemoglobin 3.5 g/dL, platelet 18,000/µL. Schistocytes, micro-spherocytes, and thrombocytopenia were observed in his blood smear. MAHA was present and he was considered as having TTP. Plasma exchange treatment was initiated; however, he was refractory to this treatment. Thorax and abdomen computerized tomography revealed thickening of minor curvature in stomach corpus with hepatogastric and paraceliac lymphadenopathy. Bone marrow (BM) investigation by our clinic resulted as the metastasis of adenocarcinoma. Ulceration and necrosis were observed by gastric endoscopy procedure. Biopsy was taken during endoscopic intervention, which resulted as SRCC. MAHA may be seen as a PS in some tumors, especially gastric cancers. Tumor-related MAHA is generally accompanied by BM metastases. As a result, BM investigation may be used as the main diagnostic method to find the underlying cancer. The clinical course of cases with tumor-related MAHA is usually poor, and these cases are usually refractory to plasma exchange treatment. In conclusion, physicians should suspect a malignancy and BM involvement when faced with a case of refractory TTP.

Stomach Cancer in a Patient with Chronic Lymphocytic Leukaemia

Introduction. Chronic lymphocytic leukaemia (CLL) is a malignant clonal lymphoproliferative disorder characterised by the accumulation of atypical mature CD5/CD19/CD23-positive B lymphocytes, predominantly in blood, bone marrow, lymph glands, liver and spleen. Chemotherapy protocols with the inclusion of nucleotide analogues, alkylating drugs and monoclonal antibodies are currently the standard of treatment. FCR (fludarabine, cyclophosphamide, rituximab) is one of the most effective protocols. CLL may lead to various immunologic disorders resulting in an increased risk of a malignant neoplasm. This paper aims to present a demonstration of a case of the combination of chronic lymphocytic leukaemia and stomach cancer, and an attempt to establish — based on literature data — a link between the diagnosed stomach adenocarcinoma and the main disease.Materials and methods. Authors have analysed the case history, laboratory and instrumental data and the treatment of a patient with chronic lymphocytic leukaemia and stomach adenocarcinoma.Results and discussion. The patient E., 63 yo, was diagnosed with chronic lymphocytic leukaemia in 2016. The patient was started on FCR chemotherapy protocol (Fludarabine, 70 mg days 2-4 of CT, Endoxan 500 mg days 2-4 of the cycle, Rituximab 700 mg day 1 od CT) in June 2018. When the patient came to the BSMU hospital for a chemotherapy cycle in August 2018, gastric endoscopy was performed; tissue pathology examination resulted in the diagnosis of stomach adenocarcinoma. A concilium of surgeons, oncologists and haematologists made a decision to perform a gastrectomy with the oesophageal resection and Roux anastomosis.Conclusion. Having used a clinical case as an example and reviewed available literature, the authors have demonstrated that either CLL or the immunosuppressed status served as the causal factors for the development of the adenocarcinoma. The development of stomach adenocarcinoma in patients with chronic lymphocytic leukaemia makes the course and outcome of the main disease much more severe. A decision regarding the management strategy for such patients has to make individually every time, taking into account the severity of the oncological disease; this impacts on the choice of the treatment protocol. All the cases of spontaneous remissions in patients with lymphocytic leukaemia must be screened extensively in order to facilitate early diagnosis of malignant neoplasms.

Gastric Cancer Presenting as Isolated Ascites: A Diagnostic Challenge

Malignant ascites is a rare first manifestation of gastric carcinoma and is usually associated with symptoms which include early satiety, abdominal pain and deteriorating clinical state. The authors describe the case of a male patient presenting with malignant ascites of rapid onset which was the sole presentation of gastric cancer, highlighting the importance of upper gastric endoscopy even in the absence of gastrointestinal symptoms.

Low Anisakis-specific IgE prevalence in dyspeptic patients in Italy – a retrospective study

The aims of this case-control study were to determine the prevalence ofAnisakis-specific IgE in patients reporting chronic or acute gastrointestinal (GI) symptoms and to investigate the correlation with raw fish ingestion habits.A group of patients undergoing gastric endoscopy and a control group of healty subjects answered a self-administered questionnaire on their food habits, presence of symptoms (both allergic and not allergic), and general life style. The presence of anti-AnisakisIgE has been evaluated using a serum immunoCAP assay.Our data show a low prevalence of IgE directed againstAnisakisallergens in Italy in dyspeptic patients, despite the high consumption of poorly cooked fish. These findings does not correlate with the results of studies from other Mediterranean countries, such as Spain, for example.The general prevalence ofAnisakisallergens sensitization in Italy could be further investigated through screenings in the allergic population, especially on those patients who claim to have developed a fish allergy and with history of raw fish consumption. Moreover, the attention should be moved on recent allergic reactions associated with fishing ingestion. This could in fact indicate a recent encounter with the parasite. Finally, we must underline that the evaluation ofAnisakis-specific IgG would have probably shown a difference in terms of exposure between the two groups; thus, it might be useful to detect also this antibody class in future population-based studies.

18F-fluorodeoxyglucose positron emission tomography-computed tomography scan after gastric endoscopy in those who present with non-specific symptoms, is it necessary or not?

Background and Aims: Retrospectively analyze the sensitivity of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in the diagnosis of gastric malignancy compared with gastric endoscopy in persons with nonspecific symptoms and evaluate the necessity of 18F-FDG PET-CT scan before surgery. Materials and Methods: A total of 53 patients with gastric malignancy proven by surgery and pathology were enrolled in the study. All the patients underwent gastric endoscopy and PET-CT scan before surgery. And the PET-CT images were interpreted by the observers who were blinded to the results of the gastric endoscopy. The sensitivity of gastric endoscopy, 18F-FDG PET-CT, and serum tumor markers in the diagnosis of gastric malignancy were calculated ultimately. Results: Of 53 gastric malignancy patients, five cases were proven to be false-negative detected by gastric endoscopy, and the sensitivity of which was 90.57%. The sensitivity of PET scan alone was 86.79%, which was observed no significant difference to that of gastric endoscopy diagnosis, P = 0.54. While all of the patients had been detected positive on PET-CT images, the sensitivity of which was significantly higher than that of the gastric endoscopy diagnosis or that of the serum tumor markers, P < 0.001. And the FDG uptake was positively correlated with the depth of the cancer invasion into the gastric wall (P < 0.0001) and the degree of lymph nodes infiltration (P = 0.02). It also various from different differentiation degree significantly, P = 0.04. Conclusions: 18F-fluorodeoxyglucose PET-CT could detect gastric carcinoma in persons with nonspecific symptoms which showed negative in gastric endoscopy. And it is necessary to be aware of the possibility of gastric malignancy when the result of PET-CT scan is positive.

Effect of exercise on gastric health in field retrievers

Exercise-induced gastrointestinal disease (EIGD) has been reported in all domestic athletes. In dogs and humans, EIGD is most commonly associated with ultra-endurance racing sled dogs and marathon/triathlon competitors, respectively, suggesting that the syndrome is specifically a function of prolonged exercise. However, EIGD is also common in horses that exercise for brief periods, and more recently, EIGD has been identified in Labrador retrievers that perform off-leash explosive detection patrols. In this study, we tested the hypothesis that EIGD could be induced in retrievers performing competition-style retrieves. Gastric endoscopy and histopathological examination of gastric biopsies were performed on 10 healthy retrievers before and 24 h after a series of multi-set retrieves totalling over 5 km. Although the exercise challenge resulted in a small but statistically significant increase in gastric endoscopy severity score, it did not result in a higher prevalence of clinically-significant gastric disease or changes in gastric histopathology. We conclude that competitive retrieving is unlikely to induce clinically-significant gastric disease in healthy dogs.