Endoscopic findings in patients with persistent dyspepsia in a tertiary care hospital of South Punjab

Background: One of the most common clinical problem encountered by physicians in clinical practice is dyspepsia. This symptom has great impact on quality of life of patients. There are numerous causes of dyspepsia, organic as well as functional. Endoscopy is the diagnostic test of choice in these patients. Aim: The aim of our study was to see the endoscopic findings in patients with persistent dyspepsia. Methods: Retrospective analysis of data of patients who underwent Esophagogastroduodenoscopy (EGD) for persistent dyspepsia was collected and evaluated. Results: There were 495 patients in our study, 244 females and 251 males, with a mean age of 41 years. Almost half of the patients belonged to 21-40 years age group. The most common endoscopic finding in patients with persistent dyspepsia was gastritis (n=219, 44.2%), followed by normal endoscopy (n= 94, 19%), incompetent lower esophageal sphincter (n=67, 13.5%), gastric malignancy (n=48, 9.7%). Ulcer disease was found in just 15 patients (3%). Conclusion: Most common endoscopic finding in patients with persistent dyspepsia was gastritis followed by normal endoscopy. Key Words: dyspepsia, endoscopy

Management and outcomes of carcinoma stomach in Central India: a prospective cross-sectional study

Background: Adenocarcinoma of the stomach is one of the leading causes of cancer-related deaths worldwide. Cancer rates in India are rising with increase in life expectancy and changes in lifestyles. Although the incidence of gastric cancer has decreased, number of newly diagnosed cases of proximal gastric and esophago-gastric junction adenocarcinomas has increased markedly. It is necessary to identify the population and risk factors along with malignancy characteristics in Central India.Methods: A prospective observational study of 84 histopathological proven cases of gastric malignancy were analysed and evaluated. Treatment for the same was categorised after staging. Surgical resection, therapeutic and palliative chemotherapy was employed in the treatment protocols. A follow-up of 6 months was taken to observe the early complications.Results: Eighty-four patients were analysed and evaluated. The mean age was 54.1 year with male predominance (1.54:1). Hypertension was commonest comorbidity, while smoking was commonest associated risk factor observed. Majority (56%) of patients underwent palliative chemotherapy while 34% underwent curative surgery. Subtotal gastrectomy with Billiroth II gastrojejunostomy was commonest performed operation (34%). Postoperative wound infection was commonest complication. Mean follow-up period of 11.3 months was observed where one patient expired of ARDS and one was readmitted for anastomotic site stricture.Conclusions: There was high incidence of gastric malignancy patients presenting in stage IV in 5th decade of life with weight loss as main feature. Palliative chemotherapy is commonly followed because of advanced disease. The rates of inoperability are high and unfavourable histopathological variety occur frequently in older patients.

Predictors of 30-day readmission rate after total gastrectomy in patients with gastric malignancy.

e16109 Background: Total gastrectomy with lymph node dissection is curative for early gastric malignancy which accounts for 1.5% of cancer cases in the U.S. Readmissions are common postoperatively, and are associated with increased morbidity, mortality, hospital costs and decreased quality of life. We hence aim to identify incidence, impact and independent predictors for readmission in patients who underwent total gastrectomy in gastric malignancy. Methods: We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for total gastrectomy with a concomitant diagnosis of gastric malignancy. T-test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. ICD 10 codes were used to identify diagnoses and procedures. Results: A total of 1,779 patients with gastric malignancy underwent total gastrectomy. The 30-day readmission rate was 18.5%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Readmitted patients were more likely to be on chemotherapy. (40.1% vs 27.2%; P<0.01) and more likely to be discharged to a skilled facility (13.5% vs 17.9%; P<0.01). The total health care in-hospital economic burden of readmission was $6.5 million in total charges and $25 million in total costs. Independent predictors of readmission were major bleeding, respiratory failure requiring mechanical ventilation, peripheral parenteral nutrition, history of non-alcoholic hepato-steatosis, and prolonged length of stay. Conclusions: Readmissions after gastrectomy in patients with gastric malignancies are associated with lower in-hospital mortality yet pose a substantial economic burden on healthcare. The lower mortality might be explained by the relatively stable course and lower comorbidities of patients who become eligible for discharge after surgery. Further studies are suggested. Modifiable risk factors like malnutrition and sepsis warrant special attention to decrease readmissions and improve overall outcomes.[Table: see text]

Diagnostic utility of alarm features in predicting malignancy in patients with dyspeptic symptoms

Background Clinical features are of modest benefit in determining the etiology of dyspepsia. Dyspeptic patients with alarm features are suspected to have malignancy; but the proportions of patients and true cutoff values of various quantitative parameters in predicting malignancy are explored to a lesser extent. Methods This is a prospective observational study of consecutive patients undergoing esophagogastroduodenoscopy (EGD) for dyspeptic symptoms. Patients’ alarm features and clinical details were recorded in a predesigned questionnaire. The diagnostic accuracy of alarm features in predicting malignancy was studied. Results Nine hundred patients, 678 (75.3%) males, with a mean (standard deviation [SD]) age of 44.6 (13.54) years were enrolled. Commonest indication for EGD was epigastric pain in 614 (68.2%) patients. Dyspepsia was functional in 311 (34.6%) patients. EGD revealed benign lesions in 340 (37.8%) and malignancy in 50 (5.5%) patients. Among the malignant lesions, gastric malignancy was present in 28 (56%) and esophageal malignancy in 20 (40%) patients. Alarm features were present in 206 (22.9%), out of which malignant lesions were seen in 46 (22.3%) patients. Altogether, the alarm features had a sensitivity of 92% and specificity of 81.2% for predicting malignancy. The sensitivity and specificity for weight loss were 76% and 90.8%, while that of abdominal mass were 10% and 99.9% respectively. Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 46.5 years in this population. Conclusions Patients of age group 40 to 49 years with dyspeptic alarm symptoms (predominant weight loss) need prompt endoscopy to screen for malignancy. The alarm features are inexpensive screening tools, found to be useful in India, and should be utilized in countries with similar healthcare conditions and disease epidemiology.

Prognostic Autophagy-Related Genes of Gastric Cancer Patients on Chemotherapy

Background Chemotherapy resistance based on fluorouracil and cisplatin is one of the most encountered postoperative clinical problems in patients diagnosed with gastric cancer (GC), resulting in poor prognosis. Methods This study aimed to combine autophagy-related genes (ATGs) to investigate the susceptibility of victims with gastric malignancy to postoperative chemotherapy. Based on the TCGA database, gene expression data for GC patients undergoing and during chemotherapy were integrated and analyzed. Prognostic genes were screened based on univariate and various analysis regression models. Subjects were divided into high-risk and low-risk groups and analyzed by the median risk score approach. The product limit estimator method was used to evaluate the OS and DFS. The accuracy of the prediction was resolved by the subject curve analysis. In addition, proper analysis carrying out was done in our work for some detailed assessments. The differential expression of ATGs is mainly related to chemotherapy resistance. Results A total of 9 ATGs of chemotherapy administration outcomes in these suffers were screened. Based on GEO and TCGA databases, the model accurately predicted DFS and OS after chemotherapy administration. Conclusions This study established prognostic markers based on 9 genes, predicting that ATGs are related to chemotherapy susceptibility of GC patients, which can provide better individualized treatment regimens for clinical practice.

Prognostic Autophagy-Related Genes of Gastric Cancer Patients on Chemotherapy

Background, Chemotherapy resistance based on the use of fluorouracil and cisplatin is one of the most encountered clinical problems resulting from post operation and gives rise to poor prognosis in patients diagnosed with gastric cancer (GC). Methods , this study aims to combine autophagy-related genes (ATGs) to provide an investigation of the susceptibility of victims with gastric malignancy to postoperative chemotherapy. Based on the TCGA database, gene expression data for GC patients undergoing and are using chemotherapy were integrated and analyzed. Prognostic genes were screened based on univariate and various analysis regression models. Subjects were divided into those with high and low-risk groups. This was analyzed by the utilization of the median risk score approach. The product limit estimator method had to be used to evaluate the OS and DFS. The accuracy of the prediction was resolved by the subject curve analysis. In addition, the carrying out of proper analysis was done in our work for some detailed assessments. The differential expression of ATGs is mainly related to chemotherapy resistance. Results, a total of 9 ATGs of chemotherapy administration outcomes in these suffers were screened. Based on GEO and TCGA databases, the model accurately predicted DFS and OS after chemotherapy administration. Conclusions, this study established prognostic markers based on 9 genes, which can predict ATGs related to chemotherapy susceptibility of GC patients, and provide better individualized treatment regimens for clinical practice.

Diagnostics of stomach cancer in Russia: fi rst results of the multicenter study “RADIUS” (Early diagnosis of stomach cancer in dyspepsia)

The aim of the study was to evaluate the timeliness and eff ectiveness of the diagnosis of precancerous diseases and early forms of gastric cancer in primary health care. Materials and methods. A multicenter retrospective descriptive study was conducted with an analysis of the medical records of 426 patients who were diagnosed with malignant neoplasm of the stomach at the time of going to outpatient facilities. We used data from 125 outpatient facilities in 7 centers for the period from 2009 to 2019. Results. The average age of patients with a fi rst established diagnosis of malignant neoplasia was 61,7 (95% CI 58.6 ÷ 64.8) years. The prevailing form of malignant neoplastic disease was the option “Adenocarcinoma, intestinal cancer” — 77,7%, diff use type cancer — 12,7%, other histological types — 9,6%. The diagnosis of malignant neoplastic disease at the III and IV stages of the disease was fi rst established in 67,4% of patients. The number of years lived by patients with a diagnosis of gastric gastric cancer was 2,0 years. Over a 10-year follow-up, 75% of patients died. Risk factors for gastric cancer were identifi ed in 41% of respondents. Signs of dyspepsia syndrome were observed in 31,5% of patients, and they appeared on average 4,6 (95% CI 4,4 ÷ 4,8) years before the diagnosis of gastric malignancy. Among people with gastric cancer, dyspepsia symptoms occur every day in every third patient. The features of the manifestations of dyspepsia in the observed patients were: daily manifestations of symptoms (33,3%), symptoms at night — 9,4%, an increase in the intensity of dyspepsia (21,3%), the lack of a clinical response to the therapy (proton pump inhibitors, prokinetics, eradication of Helicobacter pylori infection) in 58% of cases. Anxiety symptoms were recorded 2,4 years before a diagnosis of stomach cancer.