Does off-hours endoscopic hemostasis affect outcomes of nonvariceal upper gastrointestinal bleeding?

Aim: Different researches showed controversial results about the ‘off-hours effect’ in nonvariceal upper gastrointestinal bleeding (NVUGIB). Materials & methods: A total of 301 patients with NVUGIB were divided into regular-hours group and off-hours group based on when they received endoscopic hemostasis, and the relationship of the clinical outcomes with off-hours endoscopic hemostasis was evaluated. Results: Patients who received off-hours endoscopy were sicker and more likely to experience worse clinical outcomes. Off-hours endoscopic hemostasis was a significant predictor of the composite outcome in higher-risk patients (adjusted OR: 4.63; 95% CI: 1.35–15.90). However, it did not associate with the outcomes in lower-risk patients. Conclusion: Off-hours effect may affect outcomes of higher-risk NVUGIB patients receiving endoscopic hemostasis (GBS ≥12).

Antimicrobial Bacillus: Metabolites and Their Mode of Action

The agricultural industry utilizes antibiotic growth promoters to promote livestock growth and health. However, the World Health Organization has raised concerns over the ongoing spread of antibiotic resistance transmission in the populace, leading to its subsequent ban in several countries, especially in the European Union. These restrictions have translated into an increase in pathogenic outbreaks in the agricultural industry, highlighting the need for an economically viable, non-toxic, and renewable alternative to antibiotics in livestock. Probiotics inhibit pathogen growth, promote a beneficial microbiota, regulate the immune response of its host, enhance feed conversion to nutrients, and form biofilms that block further infection. Commonly used lactic acid bacteria probiotics are vulnerable to the harsh conditions of the upper gastrointestinal system, leading to novel research using spore-forming bacteria from the genus Bacillus. However, the exact mechanisms behind Bacillus probiotics remain unexplored. This review tackles this issue, by reporting antimicrobial compounds produced from Bacillus strains, their proposed mechanisms of action, and any gaps in the mechanism studies of these compounds. Lastly, this paper explores omics approaches to clarify the mechanisms behind Bacillus probiotics.

Toward Automatic Detection of Gastric Lesion for Upper Gastrointestinal Endoscopy with Neural Network

In this paper, we compared the performance of several neural networks in the classification of early gastric cancer (EGC) images and proposed a method of converting the output value of the network into a calorific value to locate the lesion. The algorithm was improved using transfer learning and fine-tuning principles. The test set accuracy rate reached 0.72, sensitivity reached 0.67, specificity reached 0.77, and precision rate reached 0.78. The experimental results show the potential to meet clinical demands for automatic detection of gastric lesion.

Predictive Role of Admission Venous Lactate Level in Patients with Upper Gastrointestinal Bleeding: A Prospective Observational Study

Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies. Risk stratification is essential in patients with this potentially life-threatening condition. The aim of this prospective study was to evaluate the usefulness of the admission venous lactate level in predicting clinical outcomes in patients with UGIB. All consecutive adult patients hospitalized due to UGIB were included in the study. The clinical data included the demographic characteristics of the observed population, etiology of UGIB, need for surgical intervention and intensive care, bleeding recurrence, and mortality rates. Venous lactate was measured in all patients on admission. Logistic regression analyses were used to calculate the odds ratios (OR) of lactate levels for all outcomes. The receiver operating characteristic (ROC) curve was used to determine the accuracy of lactate levels in measuring clinical outcomes, while Youden index was used to calculate the best cut-off points. A total of 221 patients were included in the study (151M; 70F). There were 24 cases of UGIB recurrence (10.8%), 19 patients (8.6%) required surgery, and 37 individuals (16.7%) required intensive care. Mortality rate was 11.3% (25 cases). The logistic regression analysis showed statistically significant association between admission venous lactate and all clinical outcomes: mortality (OR = 1.39, 95%CI: 1.22–1.58, p < 0.001), recurrence of bleeding (OR = 1.16, 95%CI: 1.06; 1.28, p = 0.002), surgical intervention (OR = 1.17, 95%CI: 1.06–1.3, p = 0.002) and intensive care (OR = 1.33, 95%CI: 1.19–1.5, p < 0.001). The ROC curve analysis showed a high predictive value of lactate levels for all outcomes, especially mortality: cut-off point 4.3 (AUC = 0.82, 95%CI: 0.72–0.92, p < 0.001) and intensive care: cut-off point 4.2 (AUC = 0.76, 95%CI: 0.66–0.85, p < 0.001). Admission venous lactate level may be a useful predictive factor of clinical outcomes in patients with UGIB.

Cavernous Gastric Hemangioma as an Unusual Cause of Upper Gastrointestinal Bleeding in a Young Woman

Gastric hemangiomas (GHs) are extremely rare vascular lesions of mesodermal origin that may occur in isolation or in conjunction with underlying congenital pathology. Due to the scarcity of these tumors, there is no standardized diagnostic method; however, many have found the combination of endoscopic investigation and radiographic imaging to be most effective, with the presence of phleboliths on computerized tomography as being pathognomonic for GHs. Surgical treatment for symptomatic lesions is curative with no reports of recurrence. We describe a 21-year-old woman who presented with epigastric pain and one episode of 250 mL hematemesis earlier that morning. Under the impression of an upper gastrointestinal bleed due to peptic ulcer disease, esophagogastroduodenoscopy was performed which revealed a 5-cm blood clot-like mass similar in appearance to that of a II-b peptic ulcer, but the presence of a bridging fold led to the suspicion of a possible submucosal tumor. Dynamic computerized tomography scan showed similar findings, and the patient was referred for surgical intervention. Laparoscopic distal gastrectomy was performed with the final diagnosis of cavernous GH made via histological evaluation. The patient was discharged 9 days later with no complications. This case puts emphasis on the importance of considering cavernous GH as a potential cause of severe upper GI bleeding especially in those with atypical demographic profile and history.

Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”

Upper gastrointestinal endoscopy is now widely used as a first-line procedure to investigate upper gastrointestinal symptoms in most countries around the world [...]

Helicobacter pylori eradication in renal transplant candidates

Introduction: Treatment for Helicobacter pylori (H. pylori) infection is recommended in transplant candidates due to the association between this infection and gastrointestinal disorders, which could significantly increase morbidity after renal transplantation with the use of immunosuppression. The objective of this study was to analyze the rate of eradication of H. pylori after antimicrobial treatment in chronic kidney disease patients who are candidates for kidney transplantation. Methods: A multicenter prospective cohort study was conducted. All adult chronic kidney disease patients seen at our institution were included. In the pre-transplantation evaluation, 83 patients underwent an upper gastrointestinal endoscopy with 2 diagnostic methods to detect H. pylori: histology and the rapid urease test. In total, 33 patients with H. pylori infection received treatment with 20 mg omeprazole, 500 mg amoxicillin, and 500 mg clarithromycin once daily for 14 days. Another upper gastrointestinal endoscopy was performed 8 to 12 weeks after the end of treatment to check for healing. Results: The study showed a prevalence of H. pylori in 51 (61.4%) patients. Histology was positive in 50 (98%) patients and the rapid urease test was positive in 31 (60.8%). The infection eradication rate was 48.5% (16 patients). Conclusions: There was a high prevalence rate of H. pylori and a low eradication rate after the long-term antimicrobial triple scheme used. The association of the rapid urease test with gastric mucosa histology did not increase the detection rate of H. pylori.