Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects

Gastric cancer (GC) occupies the first few places in the world among tumors in terms of incidence and mortality, causing serious harm to human health, and at the same time, its treatment greatly consumes the health care resources of all countries in the world. The diagnosis of GC is usually based on histopathologic examination, and it is very important to be able to detect and identify cancerous lesions at an early stage, but some endoscopists' lack of diagnostic experience and fatigue at work lead to a certain rate of under diagnosis. The rapid and striking development of Artificial intelligence (AI) has helped to enhance the ability to extract abnormal information from endoscopic images to some extent, and more and more researchers are applying AI technology to the diagnosis of GC. This initiative has not only improved the detection rate of early gastric cancer (EGC), but also significantly improved the survival rate of patients after treatment. This article reviews the results of various AI-assisted diagnoses of EGC in recent years, including the identification of EGC, the determination of differentiation type and invasion depth, and the identification of borders. Although AI has a better application prospect in the early diagnosis of ECG, there are still major challenges, and the prospects and limitations of AI application need to be further discussed.

WDJ-S4, a standardized herbal formula, promotes gastrointestinal motility via modulation of the acetylcholine pathway in a loperamide-induced functional dyspepsia mice

CONTEXT

WDJ-S4, a standardized herbal formula, has been prescribed for refractory functional dyspepsia (FD) in Korea, but the detailed mechanisms are lacking.

OBJECTIVE

The present study investigates the acceleration of gastrointestinal (GI) motility by WDJ-S4 and its potential mechanisms.

MATERIALS AND METHODS

For five days, WDJ-S4 (50, 100 and 200 mg/kg) or mosapride (3 mg/kg) was orally given to BALB/c mice. After 20 h of fasting, loperamide (10 mg/kg, i.p.) was given to the mice except for normal group. To assess gastric emptying or intestinal propulsion, 500 μL of 0.05% phenol red or 200 μL of 5% charcoal diet was given once orally.

RESULTS

Loperamide delayed gastric emptying and intestinal propulsion, while WDJ-S4 ameliorated peristaltic dysfunction, evidenced by reductions of remaining phenol red in the stomach and a marked increase of charcoal propulsion in the intestine. WDJ-S4 also normalized levels of acetylcholine and acetylcholine-related enzymes, including choline acetyltransferase (ChAT) and acetylcholinesterase (AChE), in the gastric antrum and jejunum. C-kit level and smooth muscle contraction-related genes were elevated by WDJ-S4 in both the gastric antrum and jejunum.

CONCLUSION

Overall, WDJ-S4 can effectively promote GI motility. The efficacy is associated with modulation of acetylcholine pathway and the interstitial cells of Cajal (ICCs) activation. All the results provide scientific evidence supporting the clinical usage of WDJ-S4 for FD.

Double filtration plasmapheresis in autoimmune gastritis with subacute combined degeneration of the spinal cord: A case report

Autoimmune gastritis (AIG) is characterized by the destruction of gastric parietal cells, leading to vitamin B12 deficiency and potentially causing subacute combined degeneration of the spinal cord (SCD). We present a case of a 61-year-old male with AIG who developed SCD and underwent three sessions of double filtration plasmapheresis (DFPP), resulting in significant reduction of autoantibody titers and improvement in neurological symptoms. DFPP demonstrated efficacy in treating AIG complicated by SCD, offering potentially faster clinical response than conventional therapies by rapidly reducing autoantibody levels. This case underscores the importance of early diagnosis and intervention in preventing irreversible neurological damage, suggesting DFPP as a promising adjunctive treatment for AIG with SCD and warranting further investigation into its mechanisms and applications in autoimmune diseases.

Appropriate use of the fixed-dose, extended-release combination of naltrexone and bupropion as treatment for obesity in primary care

Background

Obesity is considered a chronic disease and is influenced by biological, environmental, and behavioral factors that can contribute to its progression. Although lifestyle changes are integral to treating obesity and maintaining a healthful weight, weight reduction from behavioral intervention alone is often insufficient because neurophysiologic factors may work against such changes in lifestyle and behavior. Research suggests that the mechanisms underlying food cravings and obesity overlap with dopaminergic signaling in the brain and pathways involved in addiction. As a result, patients who are differentially impacted by food cravings may have better outcomes with treatments targeting neural systems implicated in both homeostatic and hedonic food consumption or addictive behaviors.

Methods

In this clinical review, we describe the safety and efficacy data for the fixed-dose, extended-release combination of naltrexone and bupropion (NB-ER) compared with its monotherapy constituents (naltrexone and bupropion), as well as discuss the appropriate use of NB-ER to treat patients with obesity.

Results

NB-ER is approved for the treatment of patients with obesity, with studies showing that patients can achieve significant weight reduction compared with placebo when treatment is combined with a reduced-calorie diet and increased physical activity. Across NB-ER phase 3 trials, responders to treatment had a mean body weight reduction of 11.7 % at 56 weeks. Of note, the unique combination of naltrexone, an opioid receptor antagonist, and bupropion, a norepinephrine-dopamine reuptake inhibitor associated with stimulating pro-opiomelanocortin cells (POMC), in NB-ER may work together to target POMC cells to prevent endogenous negative feedback, thereby decreasing appetite and improving weight-related outcomes.

Conclusions

Unlike monotherapy with its component drugs, NB-ER is optimized for the treatment of obesity. The appropriate use of NB-ER should consider the specific characteristics and adiposity-related complications of an individual.

Pseudo-Malabsorption in High Dose Levothyroxine-Resistant Hypothyroidism

A 38-year-old woman was diagnosed with hypothyroidism during pregnancy at age 35 years and started on levothyroxine (LT4). Despite increasing the dose to 400 μg/day and adding liothyronine, her thyroid function did not improve, leading to hospitalization. Upon admission, her thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) levels were 255 μIU/mL (255 mIU/L) (reference range [RR]: 0.35---4.94 μIU/mL; 0.35---4.94 mIU/L), 3.42 pg/mL (5.27 pmol/L) (RR: 1.71-3.71 pg/mL; 2.63-5.70 pmol/L), and 0.153 ng/dL (1.97 pmol/L) (RR: 0.70-1.48 ng/dL; 9.01-19.05 pmol/L), respectively. She reported good adherence to medication and not consuming interfering food or medication. Endoscopic examination revealed no malabsorption. A 1000-μg oral LT4 loading test showed an increase in free T4 level from 0.787 (10.1 pmol/L) to 2.40 ng/dL (30.9 pmol/L), indicating pseudo-malabsorption. After presenting the loading test results, she admitted to nonadherence. A multidisciplinary team intervened, conducting individual counseling and simplifying treatment. Post-discharge, with LT4 200 μg/day, her TSH, free T3, and free T4 levels improved to 0.496 μIU/mL (0.496 mIU/L), 5.23 pg/mL (8.05 pmol/L), and 2.19 ng/dL (28.2 pmol/L), respectively. When addressing treatment-resistant hypothyroidism, it is crucial to evaluate patient history and medication schedule and to check for malabsorption. Comprehensive interventions are recommended if nonadherence is suspected.

Mechanism of Helicobacter pylori vacuolar cytotoxin a-induced gastric mucosal atrophy: A histopathological and immunohistochemical analysis

OBJECTIVE

This study aims to examine the underlying mechanism of gastric mucosal atrophy induced by vacuolar cytotoxin A (VacA) produced by Helicobacter pylori.

METHODS

A total of 942 endoscopic biopsy and endoscopic submucosal dissection samples of gastric mucosa infected with H. pylori were subjected to detailed histomorphological and immunohistochemical analysis.

RESULTS

H. pylori exhibited specific adherence to surface mucus cells, proliferating extensively while producing and secreting VacA. The atrophic process was initiated by the upward migration and compensatory proliferation of cells in the deeper regions of the gastric pit, isthmus, and mucous neck cells. VacA disrupted the normal physiological organization and polarity of the proliferative zone, altering the proliferation patterns and directional growth of stem cells. This disruption resulted in a disordered state of cell proliferation. Insufficient downward migration of cells within the proliferative zone led to atrophy of the lamina propria glands in the gastric mucosa. This process was accompanied by epithelial cell proliferation and transformation, along with interstitial infiltration of lymphocytes, a small number of plasma cells, and neutrophils. These histopathological changes ultimately contributed to the characteristic atrophic gastritis associated with H. pylori infection.

CONCLUSION

A comprehensive understanding of the histopathological features of VacA-induced gastric mucosal atrophy is essential for the prevention and management of H. pylori-related gastric carcinogenesis.

Phenotypical Characterization of Gastroenterological and Metabolic Manifestations in Patients With Williams-Beuren Syndrome

Gastrointestinal (GI) symptoms are common in patients with Williams-Beuren syndrome (WBS), but their prevalence and possible causes are not yet fully known. This study assessed GI symptoms' prevalence and their possible origin by performing a predefined set of tests in adult WBS patients. Laboratory tests and a questionnaire were administered to assess GI symptoms and dietary habits. All the patients underwent the urea breath test, H2-lactose and H2-glucose breath tests, and intestinal ultrasound (IUS) and vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP, dB/m). Thirty-one patients were enrolled (72% of the whole cohort, 17 males, median age 32 years). Gastroesophageal reflux disease (GERD) symptoms were reported in 29% of the patients, abdominal pain in 26%, and altered bowel habits in 48%. Pathologic signs at (IUS) were present in 60% of the cases. Prevalence was 0.26 (95% CI 0.12-0.44) for Helicobacter pylori infection and 0.61 (95% CI 0.42-0.78) for lactose intolerance. LSM was > 6 kPa (in the range of a fibrosis score > F1) in three patients, and CAP values were > 268 dB/m (corresponding to a steatosis score > S2, e.g., moderate steatosis) in nine. The presence of altered bowel habits was significantly related to chronic abdominal pain (OR 13.1, p = 0.03). Increased BMI (> 28 kg/m2) (OR 10.8, p = 0.04) was associated with the presence of moderate-severe hepatic steatosis. After specific treatment and dietary counseling, most patients reported resolution/improvement of symptoms, whereas a few retained/developed symptoms during follow-up. Chronic abdominal pain, GERD symptoms, and unbalanced metabolic parameters were common in our WBS patients, together with an increased prevalence of lactose intolerance/colonic diverticula. Specific counseling and treatment improved symptoms for most patients.

Outcomes in eosinophilic esophagitis: current understanding and future directions

PURPOSE OF REVIEW

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder that demands lifelong management due to its potential to progress to fibrosis and esophageal strictures. This review synthesizes current strategies for evaluating EoE outcomes and highlights emerging approaches aimed at reconciling the often discordant relationship between clinical symptoms and histologic findings. An updated synthesis is crucial to guide evolving clinical practices.

RECENT FINDINGS

Recent literature emphasizes the multifaceted nature of EoE, revealing limitations in traditional outcome measures. Advances in patient-reported outcomes (PROs), histologic scoring systems, and endoscopic assessments have enriched our understanding of disease activity. Furthermore, the integration of functional assessments through modalities such as high-resolution manometry and EndoFLIP, along with digital data integration, has refined disease monitoring and provided nuanced insights into treatment responses and long-term progression. Additionally, emerging evidence suggests that integrating novel biomarkers may further refine disease stratification and outcomes.

SUMMARY

A multidimensional approach that combines clinical, histologic, endoscopic, and functional data is crucial for personalized management of EoE. These insights pave the way for improved therapeutic decision-making and highlight the need for standardized, comprehensive tools in both clinical practice and future research. These additional findings advocate for a shift towards precision medicine, emphasizing multidisciplinary and patient-centric approaches.

Monitoring the follow-up of autoimmune chronic atrophic gastritis using parietal cell antibodies and markers of gastric function

Increased interest in the pathogenesis and the evolution of autoimmune chronic atrophic gastritis (A-CAG) has led to the search for serological markers that can be used to detect changes in the gastric mucosa at an early stage and to monitor the course of the disease. Parietal cell autoantibodies have been proposed as suitable immunological markers of atrophic damage, as they can be detected in the serum when symptoms of gastritis are not yet present. However, the utility of measuring only the level of parietal cell autoantibodies in the follow-up of A-CAG does not appear to suffice. Recent evidence has suggested that, in monitoring A-CAG, parietal cell antibodies should be associated with an evaluation of gastric function through biochemical and hormonal tests, such as pepsinogens and gastrin 17. This integrated approach will allow for the more effective real-time monitoring of the state of the gastric mucosa. As A-CAG is a progressive disorder associated with an increased risk of gastric cancer and neuroendocrine tumors, the precise follow-up of patients with gastric atrophy needs to be better defined. Further longitudinal studies in large cohorts must be performed with long-term follow-up.

Symptom Management for Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline

PURPOSE

To develop a clinical practice guideline and recommendations for symptom management of patients with well-differentiated grade 1 to grade 3 metastatic gastroenteropancreatic neuroendocrine tumors.

METHODS

ASCO convened an Expert Panel to develop a clinical practice guideline by reviewing the literature for relevant guidelines, systematic reviews, randomized controlled trials (RCTs), and observational studies to develop recommendations for clinical practice.

RESULTS

The literature review identified eight guidelines, 19 systematic reviews, and three RCTs that informed the development of guideline recommendations.

RECOMMENDATIONS

Recommendations are included for carcinoid syndrome, carcinoid heart disease and carcinoid crisis, and functional pancreatic neuroendocrine tumor syndromes. Recommendations are provided for surgical management, liver-directed therapy, and systemic therapy options, as well as palliative care. Limited guidance is provided for sequencing of interventions.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.

A scoping review of worldwide guidelines for diagnosis and treatment of Helicobacter pylori infection

BACKGROUND

This study comprehensively analyzes the diagnostic criteria, eradication indications, treatment, and other information in the latest guidelines published by various countries around the world, so that researchers can have a systematic understanding of Helicobacter pylori and further provide a basis for clinical H. pylori diagnosis and treatment.

METHODS

Nine online databases were searched to find the latest version of guidelines for H. pylori worldwide. Two researchers read the included guidelines independently and extracted the eradication indications, diagnostic criteria, and treatment in the guidelines, conducting a summary of them.

RESULTS

A total of 25 guidelines or consensus were included. Among all diagnostic methods for H. pylori infection, the urea breath test is widely recommended as the first choice. A total of 20 guidelines mentioned indications for H. pylori eradication. Among them, the indications with a higher proportion of recommendations were long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) in 90% of patients with peptic ulcer history or active peptic ulcer disease 80%; gastric mucosa-associated lymphoid tissue (MALT) lymphoma 75%. It is worth mentioning that 40% of the guidelines pointed out that, as long as H. pylori infection is confirmed, it should be eradicated. A total of 24 guidelines mentioned treatment for H. pylori. Among them, bismuth quadruple therapy (a combination of a bismuth, two antibiotics, and a proton pump inhibitor (PPI)) was the most recommended first-line therapy. Levofloxacin triple therapy (a combining of a bismuth, an antibiotic, and a PPI) was the most recommended second-line therapy.

CONCLUSION

Current global Helicobacter pylori management guidelines share foundational consensus, yet exhibit regional variations in diagnostic criteria, eradication indications, and therapeutic regimens due to context-specific epidemiological, socioeconomic, and antimicrobial resistance profiles. Clinical practice should prioritize regionally tailored approaches, integrating local guidelines while maintaining awareness of international recommendations to optimize decision-making. Moreover, health authorities responsible for guideline development must ensure timely updates based on dynamic surveillance of local resistance patterns and socioeconomic realities.

Development of a nomogram for predicting the risk of carcinoma in chronic atrophic gastritis

OBJECTIVE

To construct a machine learning (ML) model to predict the progression of chronic atrophic gastritis (CAG) to gastric cancer (GC), given its precancerous significance.

METHODS

Using medical records from the Affiliated Hospital of Qingdao University, common laboratory indicators were extracted. LASSO regression identified 10 core risk factors, which were further analyzed using binary logistic regression to develop a nomogram model in R. The model's performance was evaluated using receiver operating characteristic (ROC) curves, the concordance index (C-index), calibration curves, and decision curve analysis (DCA).

RESULTS

The model showed excellent performance, with a C-index of 0.887. The key factors included sex, coagulation, blood cell indexes, and blood lipid levels. The ROC areas were 0.892 (quantitative) and 0.853 (qualitative), confirming model reliability.

CONCLUSION

A new nomogram model for assessing GC risk in CAG patients was successfully developed. However, due to data collection and time limitations, future studies should expand the sample size, perfect the validation process, and optimize the model to achieve more accurate risk prediction.

The Role of Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) in Assessing the Extent and Degree of Gastric Intestinal Metaplasia

OBJECTIVES

We aimed to evaluate the consistency between endoscopic grading of gastric intestinal metaplasia (EGGIM) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging, as well as the value of endoscopic grading of gastric intestinal metaplasia (GIM) in early gastric cancer (EGC) risk.

METHODS

The sample size was estimated to be at least 210 patients. To evaluate GIM, EGGIM staging was used during magnifying endoscopy with narrow-band imaging, while the OLGIM staging was carried out according to the updated Sydney system. The consistency between the two scoring systems and the accuracy of EGGIM in diagnosing OLGIM III/IV cases were evaluated. EGC risk was evaluated using the Kimura-Takemoto classification, the operative link on gastritis assessment (OLGA)/OLGIM, and EGGIM.

RESULTS

Among the 210 patients, 68 (32.4%) had (previous) EGC and 142 (67.6%) had chronic atrophic gastritis (CAG). EGGIM and OLGIM staging showed good consistency (κ = 0.805, U = 12.620, p < 0.001) in diagnosing OLGIM III/IV GIM, with an area under the receiver operating characteristic curve for EGGIM of 0.95. Using a cut-off value of > 4, the sensitivity and specificity were 95.7% and 91.4%, respectively. The EGGIM score was higher in the EGC group than in the CAG group (4.93 vs. 3.92, p < 0.001).

CONCLUSIONS

EGGIM shows good diagnostic performance and consistency with OLGIM, which can simplify endoscopic surveillance by reducing the need for biopsy. The EGGIM score is associated with EGC risk, and endoscopic surveillance is recommended for patients with EGGIM score > 4.

Artificial intelligence system improves the quality of digestive endoscopy: A prospective pretest and post-test single-center clinical trial

BACKGROUND

With the assistance of ENDOANGEL, a study was conducted at Hainan General Hospital to evaluate the effect of artificial intelligence (AI) system on the detection of gastrointestinal precancerous lesions.

METHODS

The prospective, randomized, pretest and post-test, single-center clinical trial compared the detection rates of gastric precancerous lesions and intestinal adenomas between baseline and post-intervention phase among traditional digestive endoscopy (control groups i and ii, and experimental group i) and AI-assisted endoscopy (experimental group ii). Additionally, the effect of AI on the detection rate of different seniority physicians was analyzed.

RESULTS

AI assistance significantly increased the detection rates of intestinal metaplasia (experimental group ii vs control group ii: 14.23 % vs 9.15 %, P = 0.013), atrophy (experimental group ii vs control group ii: 22.76 % vs 17.28 %, P = 0.031) and intestinal adenomas (experimental group ii vs control group ii: 48.52 % vs 24.58 %, P < 0.001). The improvement was particularly notable among junior doctors, with significant enhancements in the detection rates of intestinal metaplasia (experimental group ii vs control group ii: 14.39 % vs 9.09 %, P = 0.008), atrophy (experimental group ii vs control group ii: 22.04 % vs 15.31 %, P = 0.004), and intestinal adenomas (experimental group ii vs control group ii: 45.18 % vs 29.27 %, P = 0.002).

CONCLUSIONS

AI systems have the potential to significantly improve the detection rates of precancerous conditions, particularly among less experienced endoscopists. This advancement can lead to more accurate and appropriate follow-up and review strategies for patients, ultimately reducing the risk of missed early cancer diagnoses.

Helicobacter pylori and Arsenic Co-exposure Intensify Gastric Barrier Damage and Serum Metabolic Disorder

Environmental arsenic exposure and Helicobacter pylori (H. pylori) infection are widespread public health concerns, yet their combined effects on gastric pathophysiology remain poorly understood. This study investigated the impact of H. pylori infection and arsenic co-exposure on gastric barrier integrity, oxidative stress, and serum metabolic profiles using a murine model. Mice were divided into control, single-exposure (arsenic), and multiple exposure group (H. pylori infection and arsenic exposure). Gastric barrier function was assessed via immunofluorescence staining of ZO-1 and occludin proteins. Untargeted metabolomics, including PCA, PLS-DA, and KEGG pathway enrichment analyses, were employed to characterize serum metabolic alterations. Gene expression levels of IL-18, Nrf2, Keap1, Cat, Sod1, and Hmox1 in gastric tissues were quantified by qRT-PCR, with Spearman correlation analysis to evaluate metabolite-gene expression relationships. Fluorescence intensity of ZO-1 and occludin was significantly reduced in H. pylori-infected mice, with further deterioration under arsenic co-exposure. Metabolomic profiling revealed distinct serum metabolic perturbations across groups, with the multiple exposure group exhibiting more pronounced fluctuations in metabolite levels (e.g., lipids, amino acids, and peptides) and greater pathway diversity compared to single exposure groups. qRT-PCR analysis demonstrated synergistic upregulation of oxidative stress (Nrf2, Hmox1) and inflammatory (IL-18) markers in the multiple exposure group. Spearman correlation analysis identified significant associations between specific metabolites (e.g., acylcarnitines, bile acids) and antioxidant gene expression, suggesting bidirectional interactions between systemic metabolism and gastric oxidative responses. This study establishes a murine model of H. pylori infection and arsenic co-exposure, revealing synergistic disruption of gastric barrier function, oxidative homeostasis, and metabolic regulation. These findings provide critical insights into the pathophysiological interplay between microbial infection and environmental toxicants, highlighting potential therapeutic targets for mitigating combined exposure risks.

Prospective uncontrolled clinical study shows rapid and long lasting relief of heartburn and acid related gastric discomfort with Refluthin

Heartburn and acid regurgitation are main symptoms of gastro-esophageal reflux, a widespread complaint with a significant impact on quality of life (QoL). Refluthin® for Heartburn chewable tablets (Refluthin) are a symptomatic treatment option containing a combination of an antacid (CaCO3, MgCO3) and a polysaccharide-rich extract with mucoprotective substances from Opuntia ficus-indica cladodes. To investigate performance and safety of Refluthin in the rapid and long lasting relief of heartburn and acid related gastric discomfort under practical use conditions, a prospective, clinical, uncontrolled, open-label study was conducted. Adults with symptomatic heartburn, acid regurgitation, and/or recurrent acid related gastric discomfort took one tablet Refluthin up to four times/day as needed for up to 4 weeks. Endpoints were both time to onset and duration of symptom relief; reflux symptom intensity/frequency; global assessments (QoL, performance, satisfaction, usability, tolerability); and safety. 81/100 participants (81%) responded with a first symptom relief within ≤ 20 min in ≥ 50% of the individual applications. Long lasting effects of > 120 min were reported by 83/100 (83%) participants. Significant reductions in heartburn event frequency and intensity were seen within the 4 weeks of intermittent use (p < 0.0001, respectively). Global assessment results and safety-relevant findings were also favorable. Results thus demonstrated a distinct rapid and long lasting symptom relief after intake of Refluthin, with a safe and easy use. The significant reductions in frequency and intensity of heartburn events over time indicate sustained effects under treatment. These long-term effects might be explainable by soothing and protection of the irritated mucous membrane by Refluthin.

Risk factors and correlation of intestinal metaplasia: A case- control study in Wuwei

BACKGROUND

Intestinal metaplasia (IM) is a significant gastric mucosal change that warrants attention due to its potential role in the pathogenesis of gastric cancer. IM is often triggered by Helicobacter pylori (H. pylori) infection and some risk factors.

PATIENTS AND METHODS

This study examined H. pylori infection and related risk factors in 7,096 participants, identifying 2,200 cases of IM linked to H. pylori and 4,896 controls without the infection in Wuwei, Gansu Province, China. The Operative Link on Gastritis/Intestinal Metaplasia (OLGIM) and (Operative Link on Gastritis Assessment (OLGA) classifications tools were used for identifying participants at high risk for gastric cancer by evaluating the severity and extent of H. pylori infection and IM.

RESULTS

The study found that IM and H. pylori prevalence were gender-related, with males representing 41.09 % of cases compared to 33.92 % of controls, a significant difference (P < 0.0001). Conversely, females were more prevalent in the control group (66.07 %) compared to the case group (58.91 %). Age analysis showed higher proportions of IM cases in the 40-49 years group (46.95 %) compared to controls (43.40 %), with significant differences across age groups (P < 0.0001). IM showed significant positive correlations with smoking , alcohol consumption , and drinking water sources . H. pylori infection was detected in 238 (10.81 %) of the case group and 542 (11.07 %) of the control group. Using the OLGIM classification, which incorporates IM into gastric cancer risk assessment, stage 0 (no IM) was observed in 1,189 (24.28 %) of the control group and 530 (24.09 %) of the case group. Stage 1 (mild IM) was found in 3,165 (64.62 %) of the controls and 1,432 (65.09 %) of the cases. Stage 2 (moderate IM) was present in 520 (10.62 %) of the controls and 220 (10 %) of the cases, while stage 3 (severe IM) was observed in 24 (0.49 %) of the controls and 18 (0.82 %) of the cases. For OLGA staging, the case group had a higher percentage of individuals in higher stages (III and IV) compared to the control group. Specifically, 50.84 % of the cases were classified as stage 0, 19.75 % , stage I, 14.71 %, stage II, 8.40 %, stage III, and IV, 6.30 %. In the control group, 54.43 % were classified as stage 0, 24.17 %, stage I, 18.45 %, stage II, 1.66 %, stage III, and IV, 1.29 % respectively.

CONCLUSIONS

These findings suggest that older individuals, males, smokers, drinkers, and those using certain drinking water sources are more likely to develop IM. The study highlights the combined impact of H. pylori and risk factors on IM development, emphasizing the need for comprehensive public health strategies to address these risks. The higher proportion of advanced OLGA stages in the case group suggests more severe gastric atrophy, potentially indicating a higher risk for gastric cancer development.

Accuracy of CT colonography with mannitol preparation for detecting synchronous lesions in obstructive colorectal cancer

OBJECTIVE

Preoperative detection of advanced neoplasms is essential for surgical planning in colorectal cancer (CRC). CT colonography (CTC) has emerged as a reliable alternative when obstructive CRC prevents complete optical colonoscopy (OC). Mannitol, commonly used for OC preparation in some countries, offers potential advantages over polyethylene glycol (PEG), including low cost, reduced ingestion volume, fast action, and a more palatable sweet taste. We evaluated the diagnostic accuracy of mannitol-based CTC for detecting synchronous lesions in CRC, hypothesizing that this low-volume preparation could maintain high accuracy while improving patient tolerability.

METHODS

Of 150 CRC patients with incomplete OC who underwent preoperative CTC following cathartic preparation with mannitol, 62 were retrospectively analyzed. Their CTC findings were compared with postoperative surgical and pathological results and follow-up OC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for lesions ≥6 mm. In addition, the quality of bowel preparation with mannitol (amount of liquid and solid residue) was compared with historical data from published studies.

RESULTS

In 62 patients (372 segments), 26 synchronous lesions were identified (9 ≥ 10 mm, 17 sized 6-9 mm). For lesions ≥6 mm, CTC achieved a sensitivity of 92.3 % (95 % CI: 74.9-99.1 %), specificity of 99.1 % (95 % CI: 97.5-99.8 %), PPV of 88.9 % (95 % CI: 70.8-97.6 %), and NPV of 99.4 % (95 % CI: 97.9-99.9 %). Bowel cleansing was adequate, with 82.8 % of segments showing no or minimal residual fluid and 96.3 % with no or minimal solid residue.

CONCLUSION

CTC with a mannitol-based preparation demonstrated high accuracy in detecting synchronous neoplasms among patients with obstructive CRC and incomplete OC. These findings suggest that mannitol is a feasible alternative to PEG, maintaining excellent diagnostic performance while possibly improving tolerability. Additionally, it could streamline surgical planning and improve overall outcomes in modern CRC management.

Associations Between Antiparietal Cell Antibody Values and Atrophy in a South and Southeast Asian General Population

GOALS

To investigate the association between atrophy severity and antiparietal cell antibody (APCA) levels in South and Southeast Asia.

BACKGROUND

APCA is an autoantibody that damages gastric parietal cells; autoimmune gastritis (AIG) is a chronic gastric inflammatory disease related to APCA and severe predominant corpus atrophy. Although a positive APCA result is a key clinical diagnostic tool for AIG, its rates vary widely among ethnic groups, and its exact relationship with AIG and predominant corpus atrophy remains unclear.

STUDY

Associations between histopathology-assessed and endoscopy-assessed atrophy, APCA positivity rates, Helicobacter pylori status, and pepsinogen levels were investigated in 1982 symptomatic patients from Vietnam, Thailand, Myanmar, Bangladesh, and Nepal.

RESULTS

Overall, 38.5% of participants were negative for Helicobacter pylori infection, while 57.6% had a current infection. A positive APCA result, defined as a titer >10, was present in 44.0% of participants (95% confidence interval: 41.8%-46.3%, 873/1982). Pathologic atrophy, corpus atrophy, and predominant corpus atrophy were found in 8.7% (169/1982), 5.1% (101/1982), and 4.1% (81/1982) of participants, respectively. Positive APCA rates significantly differed among countries (10.6% to 63.8%, P<0.001). No significant correlation was found between APCA results and the presence or severity of atrophy.

CONCLUSIONS

Although APCA positivity was high among symptomatic patients from South and Southeast Asian countries, few had severe predominant corpus atrophy or positive pepsinogen tests, which suggests a low rate of AIG in this population. Long-term surveillance of APCA-positive individuals is necessary to determine the clinical significance of a positive APCA result without AIG.

Serum Gastrin Levels Are Associated With Prevalent Neuroendocrine Tumors in Autoimmune Metaplastic Atrophic Gastritis

INTRODUCTION

Autoimmune metaplastic atrophic gastritis (AMAG) is a precancerous condition that predisposes to gastric neuroendocrine tumors (gNETs). There exist no methods to stratify patients with AMAG for gNET risk.

METHODS

We identified a cohort of patients with AMAG within a university health system using histopathologic and serologic criteria. We analyzed features predictive of prevalent gNET.

RESULTS

We identified 181 patients with AMAG and 41 (22.7%) with prevalent gNET. Gastrin levels were elevated in gNET (1,859.8 vs 679.5 pg/mL, P < 0.001), and gastrin titers demonstrated good discrimination (c = 0.799, 95% CI 0.707-0.892) for gNET.

DISCUSSION

Gastrin levels differ significantly between patients with AMAG with and without gNET.

Risk Factors Analysis and Predictive Model Construction for Autoimmune Gastritis: A Nationwide Multicenter Case-Control Study in China

OBJECTIVE

Here, we ascertained the clinical characteristics of Chinese patients with autoimmune gastritis (AIG) and determined the correlation of dietary and lifestyle factors with AIG occurrence and development to establish a noninvasive predictive model for AIG.

METHODS

In this case-control study, we enrolled 479 patients from seven independent centers nationwide in China; of them, 279 had AIG, 112 had chronic atrophic gastritis mostly in the antrum, and 88 had chronic nonatrophic gastritis. Their clinical and lifestyle data were systematically collected and analyzed. Finally, a multivariate logistic regression disease prediction model was then established and validated.

RESULTS

Most of the 279 patients with AIG were middle-aged, older, and female. In the predictive model of AIG, the larger amount of cooking oil used per meal and comorbid autoimmune thyroid disease was considered risk factors, and a diet rich in vitamin B12 was considered a protective factor. We plotted a receiver operating characteristic (ROC) curve of the model in the discovery and validation cohorts, and the areas under the ROC curves were 0.72 and 0.74, respectively. In addition, dietary structure, eating habits, sleep quality, and smoking status were noted to be correlated with the occurrence of gastrointestinal symptoms and complications, as well as histopathological grades of AIG.

CONCLUSION

Dietary and lifestyle factors may predict AIG risk in Chinese populations and were related to AIG prognosis.

The challenge of assessing impaired awareness of hypoglycaemia in diabetes in the era of continuous glucose monitoring: A narrative review of evidence and translation into clinical practice

Iatrogenic hypoglycaemia remains a major barrier in diabetes care. Over time, and with repeated hypoglycaemic episodes, the physiological responses to hypoglycaemia can become blunted, resulting in impaired awareness of hypoglycaemia (IAH). In IAH, the onset of cognitive dysfunction precedes the onset of autonomic symptoms, often preventing appropriate self-treatment, thus increasing the frequency of severe hypoglycaemia (SH). Historically, IAH has been assessed with questionnaires, such as the Gold and Clarke scores, which were developed in the 1990s. A stepwise change in diabetes management in the last few decades has been the deployment of continuous glucose monitoring (CGM). CGM allows people with diabetes to set alarms that can warn them of hypoglycaemia or even impending hypoglycaemia, thus providing a degree of 'technological' awareness. This creates a challenge in assessing awareness status, as people may be alerted to low-sensor glucose events before they experience any symptoms. CGM also allows the introduction of new measures of hypoglycaemia exposure such as time below range, which might complement traditional methods of risk assessment. These changes in the field prompt a need for reassessment of the measures of IAH. This narrative review evaluates the current epidemiology of SH and IAH, explores different measures of IAH, and evaluates the relationship between CGM metrics, IAH and SH. We conclude that a clinical approach involving traditional questionnaires, or newer updated alternatives such as the Hypo A-Q awareness scale, combined with CGM metrics and clinical assessment of human factors is recommended in the absence of a clearly superior measure.

Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025

At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] > 20 per 100 000 person-years) every 2 to 3 years or, if cost-effectiveness has been proven, in intermediate risk regions (ASR 10-20 per 100 000 person-years) every 5 years, but not in low-risk regions (ASR < 10).ESGE/EHMSG/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. ESGE/EHMSG/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients' comorbidities should be considered when treatment of superficial lesions is planned.ESGE/EHMSG/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.ESGE/EHMSG/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.ESGE/EHMSG/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or ≤ 30 mm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size ≤ 10 mm with low likelihood of malignancy.ESGE/EHMSG/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and ≤ 30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and ≤ 20 mm; and in both cases with no ulcerative findings.ESGE/EHMSG/ESP recommends patient management based on the following histological risk after endoscopic resection: Curative/very low-risk resection (lymph node metastasis [LNM] risk < 0.5 %-1 %): en bloc R0 resection; dysplastic/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and ≤ 30 mm if ulcerated. No further staging procedure or treatment is recommended.Curative/low-risk resection (LNM risk < 3 %): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion ≤ 500 µm, differentiated, size ≤ 30 mm; or b) pT1a, undifferentiated, size ≤ 20 mm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required. Local-risk resection (very low risk of LNM but increased risk of local persistence/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion ≤ 500 µm; well-differentiated; size ≤ 30 mm, and VM0]). Endoscopic surveillance/re-treatment is recommended rather than other additional treatment. High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (> 500 µm from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size > 20 mm; (c) pT1b differentiated lesions with submucosal invasion ≤ 500 µm with size > 30 mm; or (d) intramucosal ulcerative lesion with size > 30 mm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.ESGE/EHMSG/ESP suggest the use of validated endoscopic classifications of atrophy (e. g. Kimura-Takemoto) or intestinal metaplasia (e. g. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.ESGE/EHMSG/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.ESGE/EHMSG/ESP recommend that patients with extensive endoscopic changes (Kimura C3 + or EGGIM 5 +) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment/operative link on gastric intestinal metaplasia [OLGA/OLGIM] III/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual's country of origin.ESGE/EHMSG/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.ESGE/EHMSG/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.ESGE/EHMSG/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.

Effects of insulin-induced hypoglycaemia on cardiac function in people with type 1 and type 2 diabetes and people without diabetes

AIMS

Cardiovascular disease is the most common complication and cause of death in people with diabetes. Hypoglycaemia is independently associated with the development of cardiovascular complications, including death. The aim of this study was to assess changes in cardiac function and workload during acute hypoglycaemia in people with and without diabetes and to explore the role of diabetes type, magnitude of the adrenaline response, and other phenotypic traits.

MATERIALS AND METHOD

We enrolled people with type 1 diabetes (n = 24), people with insulin-treated type 2 diabetes (n = 15) and controls without diabetes (n = 24). All participants underwent a hyperinsulinaemic-normoglycaemic-(5.3 ± 0.3 mmol/L)-hypoglycaemic (2.8 ± 0.1 mmol/L)-glucose clamp. Cardiac function was assessed by echocardiography, with left ventricular ejection fraction (LVEF) as the primary endpoint.

RESULTS

During hypoglycaemia, LVEF increased significantly in all groups compared to baseline (6.2 ± 5.2%, p < 0.05), but the increase was significantly lower in type 1 diabetes compared to controls without diabetes (5.8 ± 3.4% vs. 9.4 ± 5.0%, p = 0.03, 95% CI difference: -5.0, -0.3). In people with type 1 diabetes, ΔLVEF was inversely associated with diabetes duration (β: -0.16, 95% CI: -0.24, -0.53, p = 0.001) and recent exposure to hypoglycaemia (β: -0.30, 95% CI: -0.53, -0.07, p = 0.015). Hypoglycaemia also increased global longitudinal strain (GLS) in controls without diabetes (p < 0.05), but this did not occur in the two diabetes subgroups (p > 0.10).

CONCLUSIONS

Hypoglycaemia increased LVEF in all groups, but the increase diminished with longer disease duration and prior exposure to hypoglycaemia in type 1 diabetes, suggesting adaptation to recurrent hypoglycaemia. The increment in GLS observed in controls was blunted in people with diabetes. More research is needed to determine the clinical relevance of these findings.

Women's Health Disorders in a Coeliac Disease Population After Diagnosis-A Nationwide Cohort Analysis

BACKGROUND

There is a female predominance of diagnosed coeliac disease with sex-related differences in clinical presentation. Delayed menarche, infertility and pregnancy complications have been linked to poor nutritional status and autoimmune mechanisms, but women's health data in coeliac disease are scant and contradictory.

AIM

To describe rates of women's health disorders in US patients with coeliac disease.

METHODS

We used TriNetX, a database of 80 healthcare organisations, for a retrospective observational analysis. Coeliac disease was identified using ICD-10 code (K90.0) and positive coeliac serology. Women aged 10-60 years with coeliac disease were compared to ambulatory women without a diagnosis of coeliac disease or positive coeliac serology. We divided women into age groups matched by propensity score.

RESULTS

We identified > 25,000,000 outpatient women without coeliac disease, and 9368 with coeliac disease. Patients with coeliac disease were younger (mean 25 vs. 28.5 years) and had lower mean BMI (24.6 vs. 26.1). Women with coeliac disease had higher odds of later women's health conditions including absent/rare menstruation (4.6% vs. 2.0%; OR 2.34), infertility (1.4% vs. 0.9%; OR 1.69), polycystic ovarian syndrome (3.3% vs. 1.0%; OR 3.2), menopausal disorders (4.3% vs. 1.56%; OR 285) and primary ovarian failure (0.96% vs. 0.16%; OR 6.25).

CONCLUSIONS

Women with coeliac disease have higher frequencies of subsequent women's health disorders related to ovarian function, menstruation, fertility and menopause. Clinicians should be aware of these associations to detect women's health disorders during longitudinal coeliac care and promptly refer for a multidisciplinary approach with obstetrics and gynaecology.

A convolutional neural network-based system for identifying neuroendocrine neoplasms and multiple types of lesions in the pancreas using EUS (with videos)

BACKGROUND AND AIMS

EUS is sensitive in detecting pancreatic neuroendocrine neoplasm (pNEN). However, the endoscopic diagnosis of pNEN is operator-dependent and time-consuming because pNEN mimics normal pancreas and other pancreatic lesions. We intended to develop a convolutional neural network (CNN)-based system, named iEUS, for identifying pNEN and multiple types of pancreatic lesions using EUS.

METHODS

Retrospective data of 12,200 EUS images obtained from pNEN and non-pNEN pancreatic lesions, including pancreatic ductal adenocarcinoma (PDAC), autoimmune pancreatitis (AIP), and pancreatic cystic neoplasm (PCN), were used to develop iEUS, which was composed of a 2-category (pNEN or non-pNEN pancreatic lesions) classification model (CNN1) and a 4-category (pNEN, PDAC, AIP, or PCN) classification model (CNN2). Videos from consecutive patients were prospectively collected for a human-iEUS contest to evaluate the performance of iEUS.

RESULTS

Five hundred seventy-three patients were enrolled in this study. In the human-iEUS contest containing 203 videos, CNN1 and CNN2 showed an accuracy of 84.2% and 88.2% for diagnosing pNEN, respectively, which were significantly higher than that of novices (75.4%) and comparable with intermediate endosonographers (85.5%) and experts (85.5%). In addition, CNN2 showed an accuracy of 86.2%, 97.0%, and 97.0% for diagnosing PDAC, AIP, and PCN, respectively. With the assistance of iEUS, the sensitivity of endosonographers at all 3 levels in diagnosing pNEN has significantly improved (64.6% vs 44.8%, 87.5% vs 71.9%, and 74.0% vs 57.6%, respectively).

CONCLUSIONS

The iEUS precisely diagnosed pNEN and other confusing pancreatic lesions and thus can assist endosonographers in achieving more accessible and accurate endoscopic diagnoses with EUS. (Clinical trial registration number: ChiCTR2100049697.).

The Role of AI in the Evaluation of Neuroendocrine Tumors: Current State of the Art

Advancements in Artificial Intelligence (AI) are driving a paradigm shift in the field of medical diagnostics, integrating new developments into various aspects of the clinical workflow. Neuroendocrine neoplasms are a diverse and heterogeneous group of tumors that pose significant diagnostic and management challenges due to their variable clinical presentations and biological behavior. Innovative approaches are essential to overcome these challenges and improve the current standard of care. AI-driven applications, particularly in imaging workflows, hold promise for enhancing tumor detection, classification, and grading by leveraging advanced radiomics and deep learning techniques. This article reviews the current and emerging applications of AI computer vision in the care of neuroendocrine neoplasms, focusing on its integration into imaging workflows, diagnostics, prognostic modeling, and therapeutic planning.

Unmet social needs and diverticulitis: a phenotyping algorithm and cross-sectional analysis

OBJECTIVE

To validate a phenotyping algorithm for gradations of diverticular disease severity and investigate relationships between unmet social needs and disease severity.

MATERIALS AND METHODS

An algorithm was designed in the All of Us Research Program to identify diverticulosis, mild diverticulitis, and operative or recurrent diverticulitis requiring multiple inpatient admissions. This was validated in an independent institution and applied to a cohort in the All of Us Research Program. Distributions of individual-level social barriers were compared across quintiles of an area-level index through fold enrichment of the barrier in the fifth (most deprived) quintile relative to the first (least deprived) quintile. Social needs of food insecurity, housing instability, and care access were included in logistic regression to assess association with disease severity.

RESULTS

Across disease severity groups, the phenotyping algorithm had positive predictive values ranging from 0.87 to 0.97 and negative predictive values ranging from 0.97 to 0.99. Unmet social needs were variably distributed when comparing the most to the least deprived quintile of the area-level deprivation index (fold enrichment ranging from 0.53 to 15). Relative to a reference of diverticulosis, an unmet social need was associated with greater odds of operative or recurrent inpatient diverticulitis (OR [95% CI] 1.61 [1.19-2.17]).

DISCUSSION

Understanding the landscape of social barriers in disease-specific cohorts may facilitate a targeted approach when addressing these needs in clinical settings.

CONCLUSION

Using a validated phenotyping algorithm for diverticular disease severity, unmet social needs were found to be associated with greater severity of diverticulitis presentation.

Burden of Comorbidities and Concomitant Medications and Their Associated Costs in Patients with Gastroenteropancreatic or Lung Neuroendocrine Tumors: Analysis of US Administrative Data

INTRODUCTION

This study investigated the burden of comorbidities and concomitant non-cancer medications and their cost in patients with neuroendocrine tumors (NETs).

METHODS

Adults with gastroenteropancreatic (GEP)-NETs and lung-NETs, with or without carcinoid syndrome (CS), who initiated first-line NET treatment (index date) with a somatostatin analog or telotristat and had ≥ 1 inpatient or ≥ 2 distinct outpatient claims (study period January 1, 2016-December 31, 2022) were identified from the US MarketScan database and matched (age, sex, insurance type) with up to four adults without cancer (reference group). At 0-90 and 91-180 days post-index, medication counts (generalized linear model, GLM), medication frequency distributions (chi-squared test), and medication costs in USD (two-part model: logit model and GLM for the first and second parts, respectively) were assessed. Frequencies of comorbidities of interest (≥ 1 diagnosis claim) in the 6 months post-index were calculated.

RESULTS

A total of 662 patients with GEP-NETs (279 with CS) and 84 with lung-NETs (30 with CS) were included. Irrespective of CS status, mean medication counts in the 0-90 and 91-180 days post-index was 1.5-1.8 times higher for GEP-NETs (p < 0.001) and 1.6-1.9 times higher for lung-NETs (p < 0.005) than reference groups. Medications most frequently prescribed for both NET groups were oral cardiovascular, central nervous system, and gastrointestinal agents. The most common comorbidities of interest in patients with NETs (vs reference groups) were hypertension (GEP-NETs: 68.7% vs 55.0%; lung-NETs: 73.8% vs 58.3%) and type 2 diabetes (GEP-NETs: 35.5% vs 24.1%; lung-NETs: 50.0% vs 28.3%). Excluding anticancer medications, mean per-patient-per-month medication costs (vs reference groups) were $276-811 (vs $176-349) and $390-647 (vs $210-$302) for 0-90 days and 91-180 days post-index, respectively.

CONCLUSION

Compared with people without cancer, patients with NETs had a higher prevalence of comorbidities and concomitant medication use, which was associated with a greater economic burden.

A case of multiple pancreatic metastases from renal cell carcinoma mimicking a neuroendocrine tumor

Herein, we present the case of a 73-year-old man with recurrent pancreatic tumors 20 years postnephrectomy for clear cell renal cell carcinoma (RCC). Imaging studies revealed multiple hypervascular tumors in the pancreas, posing a diagnostic challenge in differentiating RCC metastases from well-differentiated neuroendocrine tumors (NETs). Magnetic resonance imaging (MRI) chemical shift imaging played a pivotal role in suggesting the presence of fat, supporting RCC metastasis. Surgical resection confirmed the diagnosis.

Poor agreement between biopsies and endoscopic submucosal dissection specimens of Esophageal and Gastric Epithelial Lesions in a western setting

BACKGROUND

Endoscopic forceps biopsy is the primary method for obtaining mucosal tissues, but can lead to false negatives.

AIMS

To assess the agreement between endoscopic biopsies and submucosal dissection specimens in esophageal and gastric epithelial lesions and to identify factors associated.

METHODS

Cross-sectional study using data from the Spanish national multicenter endoscopic submucosal dissection register. Patients, lesions and technical characteristics were prospectively collected. Prognostic factors for discrepancies were analyzed.

RESULTS

604 endoscopic submucosal dissection with previous biopsies were performed between January 2016 and December 2023 across 32 centers. 48.7% presented disagreement between biopsies and endoscopic submucosal dissection; specifically, 40.4% were underestimated by endoscopic biopsy. Carcinoma was detected in 270 endoscopic submucosal dissection specimens, with 54.8% not suspected on the initial biopsy. The carcinomas already diagnosed with the biopsy presented more submucosal and lymphovascular invasion. Notably, a larger lesion (≥ 22 mm) was a significant predictor for histological upstaging.

CONCLUSIONS

The high rate of disagreement between endoscopic forceps biopsy and endoscopic submucosal dissection highlights biopsies limitations in accurately diagnosing esophageal and gastric epithelial lesions. In this setting, endoscopic submucosal dissection should be used not only as a treatment option, but also as a valuable diagnostic tool.

2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

The Solute Carrier Family 47 Member 1, Transcriptionally Regulated by GATA Binding Protein 6, Inhibits Ferroptosis in Gastric Cancer

Gastric cancer (GC) remains the leading cause of cancer deaths worldwide. GC development is a multistep and multifactorial process, and the molecular characterization of the multistage progression of gastric lesions to GC is poorly understood. Induction of ferroptosis driven by iron-dependent phospholipid peroxidation ameliorates the malignant progression of GC. Here, we found that solute carrier family 47 member 1 (SLC47A1) promoted GC progression by regulating ferroptosis. Clinically, SLC47A1 was elevated during the progression of gastritis to GC, and its high expression was associated with poor prognosis in patients with GC. Knockdown of SLC47A1 significantly inhibited cell proliferation, colony formation, and tumor growth. Further studies revealed that SLC47A1 was a regulator of ferroptosis rather than apoptosis or necrosis. Knockdown of SLC47A1 promoted ferroptosis in GC cells, as evidenced by increased erastin-induced cytoplasmic membrane rupture, cell death, lipid peroxidation, and malondialdehyde levels. Mechanistically, GATA6 promoted SLC47A1 transcription, leading to elevated SLC47A1 expression and promoting ferroptosis in GC cells. In summary, our study revealed the significant role of SLC47A1 in the development and progression of GC through regulating ferroptosis. Targeting the GATA6/SLC47A1 axis may be a promising therapeutic strategy for GC.

Diabetes mellitus secondary to endocrine diseases: a position statement of the working group of the club of the Italian society of endocrinology (SIE)-Nutrition hormones and metabolism

PURPOSE

This position statement addressed the limited scientific literature on the management of diabetes mellitus secondary to endocrinopathies, despite its frequent occurrence in hormonal diseases such as acromegaly, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, and neuroendocrine tumors. The aim was to review the pathophysiological mechanisms, clinical features, and management strategies, focusing on nutritional and pharmacological approaches.

METHODS

A comprehensive review of existing literature was conducted regarding studies on diabetes secondary to endocrinopathies and the effects of treatments for these conditions, such as somatostatin analogues and pancreatic surgery. Particular emphasis was placed on understanding glucose metabolism derangements and the interplay between endocrine excess and therapeutic interventions.

RESULTS

Secondary diabetes arises not only from hormone excess but also as a consequence of treatments for endocrine disorders. For instance, somatostatin analogues, while effective in resolving hormone hypersecretion, impair glucose metabolism by inhibiting pancreatic insulin secretion. Similarly, pancreatic surgery for neuroendocrine tumors often exacerbates glycemic disturbances. The management of secondary diabetes requires a multidisciplinary approach that includes treating the underlying endocrine disorder, tailoring antidiabetic therapy, and optimizing nutritional strategies to mitigate metabolic disruptions.

CONCLUSION

Diabetes secondary to endocrinopathies presents unique challenges due to its complex etiology and the metabolic effects of treatments. This position statement underscores the importance of an integrated management approach, offering guidance for clinicians in addressing this multifaceted condition. Further research is needed to develop evidence-based guidelines for optimal care.

Prevalence and evolution of newly diagnosed autoimmune gastritis in a large Spanish retrospective cohort

INTRODUCTION

There is a growing interest in autoimmune gastritis (AIG), particularly regarding its prevalence and natural history.

METHODS

Retrospective observational study including all patients with positive parietal cell antibodies and performance of gastroscopy between 2013 and 2023. The first subsequent gastroscopy was defined as follow-up endoscopy and considered for histological comparison. Categorization of histological stages was made into stage 0 (potential), stage I (non-atrophic gastritis), stage II (atrophic gastritis) and stage III (dysplasia, neuroendocrine tumor or adenocarcinoma).

RESULTS

a total of 426 patients were included, 316 females with a median of 54.4 years (IQR 45.3-63.2). During this period, a total of 26798 patients underwent at least one upper endoscopy, so the prevalence of AIG was 1.6% (95% CI 1.4-1.7%). Histologically, 105 patients were classified as potential AIG (24.7%), 99 patients as stage I (23,2%), 215 patients as stage II (50.5%) and 7 patients as stage III (1.6%). 15364 patients presented a follow endoscopy. A significant increase of advanced stages was observed at follow-up (difference 18.72.1% 95% CI 7.61.4%-292.6%; p=0.0013) and a decrease of potential GAI (difference -20.214% 95% CI 11.8-5.5% -28.722.5%; p<0.001). At baseline 39 patients exhibited hyperplastic polyps (9.2%), 8 patients fundic gland polyps (1.9%), 3 adenomas with low-grade dysplasia (0.7%) and 3 patients presented G1 neuroendocrine tumours (0.7%). Only one patient (0.2%) was diagnosed with signet-ring cell gastric carcinoma.

CONCLUSIONS

AIG presented a low prevalence among patients undergoing gastroscopy. Biopsies in patients with positive parietal cell antibodies revealed that around half of the population exhibited significant atrophy and a notable progressive disease.

FZHWT alleviates chronic atrophic gastritis by inhibiting inflammatory pathways and promoting mucosal repair

BACKGROUND

Chronic atrophic gastritis (CAG) is a prevalent chronic digestive disorder that, through sustained inflammation, can lead to severe mucosal damage and even gastric cancer. Current treatments offer limited efficacy, whereas Fu-Zheng-Huo-Wei Decoction (FZHWT), a traditional Chinese medicine (TCM) formulation, shows promising potential in treating CAG.

PURPOSE

This study aims to identify the key active components of FZHWT and evaluate its therapeutic effects on CAG.

METHODS

UPLC-MS/MS was used to identify the bioactive compounds in FZHWT. A CAG rat model was established to assess its therapeutic effects, and transcriptome sequencing was conducted to identify key targets and mechanisms. A CAG cell model was used for validation of the transcriptomic findings, and histological techniques and molecular biology methods were employed for further validation.

RESULTS

A total of 1362 chemical components were identified in FZHWT, of which 25 are bioavailable compounds. Differential metabolite analysis revealed four key active ingredients: Nicotiflorin, Stachydrine, 5-O-p-Coumaroylquinic acid, and N-(4-oxopentyl)-acetamide. In the CAG rat model, FZHWT significantly reduced inflammation and gastric mucosal damage. Transcriptome sequencing highlighted Sema5a as a key target and revealed the involvement of several inflammatory signaling pathways. In the CAG cell model, FZHWT alleviated CAG by inhibiting inflammation and promoting gastric mucosal repair.

CONCLUSIONS

FZHWT demonstrates significant therapeutic potential in treating CAG by modulating inflammatory pathways and promoting mucosal repair. This study provides new insights into the treatment of CAG and supports the modernization of multi-component TCM formulas.

Predicting [177Lu]Lu-DOTA-TATE dosimetry by using pre-therapy [68Ga]Ga-DOTA-TATE PET/CT and biomarkers in patient with neuroendocrine tumors

BACKGROUND

Lutetium-177 DOTA-TATE peptide receptor radionuclide therapy (PRRT) is an established and effective treatment modality for patients with metastatic neuroendocrine tumors (NETs).

PURPOSE

This study aims to predict patient-absorbed doses from [177Lu]Lu-DOTA-TATE PRRT in the liver, kidney and lesion by utilizing patient-specific absorbed doses from pre-therapeutic [68Ga]Ga-DOTA-TATE PET/CT.

METHODS

Before the treatment of cycle 1, 11 patients with NETs underwent PET/CT scans at 0.5, 1.0, 2.0 and 4.0 h after the injection of [68Ga]Ga-DOTA-TATE. Patients then received [177Lu]Lu-DOTA-TATE PRRT and underwent SPECT/CT scans at 4, 24, 96, and 168 h post-administration. The segmentations and dosimetry were performed by using a professional software. The linear regression model used the absorbed doses from [68Ga]Ga-DOTA-TATE alone as the predictor variable. The multiple linear regression model used the absorbed doses from [68Ga]Ga-DOTA-TATE and the relevant clinical biomarkers as the predictor variables.

RESULTS

The mean absorbed doses from [177Lu]Lu-DOTA-TATE PRRT in kidney and liver were 4.1 and 2.1 Gy, respectively. In comparison, the mean absorbed doses from [68Ga]Ga-DOTA-TATE were significantly lower: 18.0 mGy and 11.0 mGy, respectively. For lesions, the maximum absorbed dose from [68Ga]Ga-DOTA-TATE ranged from 24.1 to 170.4 mGy, while the maximum absorbed dose from [177Lu]Lu-DOTA-TATE PRRT was significantly higher, ranging from 9.6 to 77.9 Gy. The linear regression model yielded moderate R-squared values of 0.50, 0.59, and 0.36 for kidney, liver and lesion, respectively. The performance of multiple linear regression model was better, with R-squared values increasing to 0.81, 0.77, and 0.84.

CONCLUSION

Absorbed doses from [177Lu]Lu-DOTA-TATE PRRT can be accurately predicted. Moreover, our models are formalized into simple equations.

Risk prediction of second primary malignancies in patients with primary gastric neuroendocrine neoplasms: a population-based study

PURPOSE

Patients with gastric neuroendocrine neoplasms (GNENs) face elevated risks of second primary malignancies (SPMs), yet tools for personalized risk prediction are lacking. This study aimed to explore the risk factors associated with the development of SPMs in patients with GNENs and to establish a new competing-risk nomogram to predict the occurrence of SPMs.

METHODS

We obtained clinical data for GNENs patients from the Surveillance, Epidemiology, and End Results (SEER) database covering the period from 2000 to 2015. Using Fine and Gray's proportional sub-distribution hazards model, potential risk factors for SPM development in GNENs' patients were identified. A competing-risk nomogram was then constructed to quantify the probability of SPMs' occurrence and was evaluated using the area under the receiver-operating characteristic (ROC) curves (AUC) and calibration curves.

RESULTS

Among the 5160 GNENs patients, 18.7% developed SPMs during a maximum follow-up period of approximately 131 months (median 82 months). Independent risk factors for SPMs included age, marital status, tumor size, histopathological grade, disease extent, and T staging. The nomogram based on these factors demonstrated relatively strong predictive accuracy.

CONCLUSION

This study identifies key risk factors for SPMs in GNENs patients and introduces a nomogram that effectively predicts SPM risk. This tool may help clinicians better assess patient risk and guide treatment decisions.

The correlation between different lifestyles and body composition focuses on eating habits, nutritional status, and physical exercise components

When it comes to nutritional status and physical performance, body composition is significant. Previous research has shown the correlation between body composition and the mismatch between nutrient intake and requirements. However, this paper aims to evaluate the crucial role of lifestyle factors, such as eating behavior and meal timing, in influencing body composition. Lifestyle variables are important because they affect hormone and growth factor imbalances, which can cause changes in protein synthesis or breakdown, insulin resistance, and overeating. These factors collectively affect muscle mass and fat mass, their influence being consistent across juvenile and adult groups, between men and women. Regarding food preferences, sexual dimorphism of adiposity between men and women seems to be a critical determinant. Additionally, chronic stress leads to emotional eating, while enough sleep plays a big role in affecting growth factors and hormone balances, although the research on this subject is as yet scant. Therefore, understanding and modifying lifestyle habits are essential for the improvement of body composition, irrespective of an individual's gender or age.

Proton pump inhibitors and the risk of gastric cancer: a systematic review, evidence synthesis and life course epidemiology perspective

OBJECTIVES

Since proton pump inhibitors (PPI) have been introduced, many concerns were raised regarding potential gastric carcinogenicity. We aim to summarise and weigh the epidemiological evidence and address possible causality.

DESIGN

Systematic literature review, evidence synthesis and life-course assessment.

DATA SOURCES

PubMed, Web of Science and Cochrane database (from inception up to October 2024), and back- and forward citation tracking (Web of Science).

ELIGIBILITY CRITERIA

Original studies and quantitative evidence syntheses assessing the association between PPIs and gastric cancer in humans, without language restrictions.

DATA EXTRACTION AND SYNTHESIS

Study design, definitions (and participant numbers) of PPI use and gastric cancer, study characteristics (setting, period, follow-up, lag-time), age and sex distribution presented in tables and evidence mapping.

RESULTS

We identified 33 original studies, 21 meta-analyses, three umbrella meta-analyses, one individual patient data meta-analysis and a Markov model (2006-2023). PPIs were consistently associated with an increased gastric cancer risk with 20/21 meta-analyses reporting pooled relative risks between 1.3 and 2.9. Available trials were underpowered. Reverse causation/protopathic bias, residual confounding (by indication) and lag time seem the largest methodological challenges, as well as disentangling the effects of Helicobacter pylori and its' eradication. Insufficient data are available on age and sex-specific risks, with no studies specifically addressing PPIs in young populations. We hypothesise a sensitive-period exposure model, in which PPI use during pregnancy and early life may be particularly damaging regarding long-term cancer risk. An exploration of Swedish cancer incidence data suggests potential cohort effects as overall gastric cancer risk decreased over time (1970-2022). The risk has increased in young (<40 years) men since the early 2000s, ~10 years after the introduction of Helicobacter pylori eradication and PPIs.

CONCLUSION

Although for older individuals with valid indications, the gastric cancer risk related to PPI use may be limited, we do argue for a more rational and evidence-supported use of PPIs in young populations.

Evaluation of enterochromaffin-like cell hyperplasia can help categorize patients with Helicobacter-negative atrophic gastritis

OBJECTIVES

Atrophic gastritis (AG) is characterized by atrophy of gastric glands-in particular, oxyntic glands-in the setting of chronic inflammation; it is often autoimmune. The diagnosis is confirmed by immunohistochemistry (IHC) for gastrin (to confirm biopsy site), and pathologists often use IHC for neuroendocrine markers to evaluate for enterochromaffin-like cell hyperplasia (ECL-H). The utility of neuroendocrine staining is unclear, and we undertook this study to determine whether ECL pattern provided any additional information in cases of Helicobacter-negative AG.

METHODS

We reviewed clinicopathologic findings in 184 cases from 184 patients with histologic AG and no evidence of Helicobacter infection. Using neuroendocrine IHC markers, cases were divided into 3 groups: Group 1 showed complete ECL-H (both qualitative and quantitative criteria met), group 2 showed focal ECL-H (qualitative but not quantitative criteria met), and group 3 showed no ECL-H (neither criteria met).

RESULTS

Group 1 patients were more likely to have positive autoantibody serologies (73%, P = .0007 vs group 2) and higher mean gastrin levels (700 pg/mL, P = .017 vs group 3), and only these patients developed gastric neuroendocrine tumors. Group 2 patients were more likely to take proton pump inhibitors (64%, P = .0002 vs group 1). Group 3 patients were more likely to be male (70%, P = .008 vs group 1) and to have microcytic anemia (44%, P = .022 vs group 2) and less likely to have intestinal metaplasia (50%, P = .044 vs group 1).

CONCLUSIONS

Stratification based on degree of ECL-H is not necessary for diagnosis of AG but does lead to statistically significant clinical and pathologic differences among groups.

Endoscopists and endoscopic assistants' qualifications, but not their biopsy rates, improve gastric precancerous lesions detection rate

BACKGROUND

Detecting gastric precancerous lesions (GPLs) is critical for the early diagnosis and treatment of gastric cancer. Endoscopy combined with tissue examination is an important method for detecting GPLs. However, negative biopsy results often increase patients' risks, economic burdens, and lead to additional healthcare costs. Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.

AIM

To explore the relationships between the endoscopist biopsy rate (EBR), qualifications of endoscopists and endoscopic assistants, and detection rate of GPLs.

METHODS

EBR, endoscopists, and endoscopic assistants were divided into four groups: Low, moderate, high, and very high levels. Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions. Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR, endoscopist or endoscopic assistant qualifications, and the detection rate of positive lesions.

RESULTS

Compared with those in the low EBR group, the odds ratio (OR) values for detecting positive lesions in the moderate, high, and very high EBR groups were 1.12 [95% confidence interval (CI): 1.06-1.19, P < 0.001], 1.22 (95%CI: 1.14-1.31, P < 0.001), and 1.38 (95%CI: 1.29-1.47, P < 0.001), respectively. EBR was positively correlated with the detection rate of gastric precancerous conditions (atrophic gastritis/intestinal metaplasia) (ρ = 0.465, P = 0.004). In contrast, the qualifications of the endoscopists were positively correlated with GPLs detection (ρ = 0.448, P = 0.005). Compared to endoscopists with low qualification levels, those with moderate, high, and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13% (OR = 1.13, 95%CI: 0.98-1.31), 20% (OR = 1.20, 95%CI: 1.03-1.39), and 32% (OR = 1.32, 95%CI: 1.15-1.52), respectively. Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia (ρ = 0.350, P = 0.034), angularis (ρ = 0.396, P = 0.015) and gastric body (ρ = 0.453, P = 0.005) but not in the antrum (ρ = 0.292, P = 0.079). Moreover, the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications (ρ = 0.427, P = 0.015).

CONCLUSION

Endoscopists and endoscopic assistants with high/very high qualifications, but not EBR, can improve the detection rate of GPLs. These results provide reliable evidence for the development of gastroscopic quality control indicators.

The effect of therapeutic massage combined with conventional therapy in children with functional dyspepsia: a systematic review and meta-analysis

Background

Therapeutic massage has been widely used for functional dyspepsia (FD) in children. Emerging evidence suggests that it serves as an effective complementary therapy for pediatric FD. However, no related systematic reviews have been published to date.

Objective

To conduct a systematic review and meta-analysis to evaluate the effectiveness of therapeutic massage in conjunction with conventional therapy for children with FD.

Methods

A search was conducted across PubMed, the Cochrane Library, and nine additional databases, up to November 2024. We included randomized controlled trials (RCTs) that recruited children with functional dyspepsia. These trials compared therapeutic massage combined with conventional therapy to conventional therapy alone. Dichotomous symptom data were aggregated to calculate the relative risk (RR) of overall response following therapy. Continuous data were aggregated utilizing a standardized mean difference with a 95% confidence interval.

Results

The search identified 1,190 citations. Twelve RCTs were eligible for inclusion, which contained 1,161 patients. The response rate of combination therapy, which includes therapeutic massage alongside conventional therapy, was found to be superior to that of conventional therapy alone. Subgroup analysis indicated that both point massage and chiropractic, when combined with conventional therapy, also demonstrated superior response rates compared to conventional therapy alone. Subgroup analysis of the frequency of intervention over a 2-week duration of therapeutic massage indicated that the overall response rates for combination therapy at frequencies of five times per week and seven times per week were superior to those of conventional therapy. In comparison to conventional therapy, combination therapy markedly reduced symptom scores related to abdominal pain, flatulence, anorexia, eructation, nausea and vomiting, and early satiety. Additionally, it enhanced levels of growth hormone-releasing peptide, neuropeptide Y, motilin, and gastrin, while decreasing levels of 5-hydroxytryptophan.

Conclusion

Results demonstrated that compared to conventional therapy, therapeutic massage combined with conventional therapy can significantly reduce symptoms and enhance gastrointestinal hormone levels in children with functional dyspepsia. However, due to the heterogeneity of the findings and the low quality of evidence, further extensive and methodologically sound trials are necessary to validate whether therapeutic massage can serve as an effective complementary therapy for pediatric functional dyspepsia.

Systematic Review Registration

identifier CRD42024540844.

Gastric cancer in patients with Helicobacter pylori-negative autoimmune gastritis

Although Helicobacter pylori (H. pylori) is implicated in the development of most cases of gastric cancer with autoimmune gastritis, cases of gastric cancer have been reported in patients testing negative for H. pylori. Here, we aimed to outline the current research status of the factors involved in the development of gastric cancer in H. pylori-negative autoimmune gastritis. Predictive pathological conditions for the development of gastric cancer in H. pylori-negative autoimmune gastritis are postulated to be: (1) Severe atrophy; (2) Hypergastrinemia; (3) Bile reflux; and (4) Low acidity, which are directly related to the pathophysiology of autoimmune gastritis, as well as smoking and family history, which are not related to autoimmune gastritis. In autoimmune gastritis, where there is a possibility of spontaneous disappearance of H. pylori in advanced atrophy, it is difficult to assess H. pylori. Since H. pylori infection begins in the antrum and subsequently progresses to the proximal stomach, it is interpreted as H. pylori-negative autoimmune gastritis if histologically consistent with autoimmune gastritis in the body with spared antrum, and negative for other H. pylori tests. However, it is essential to examine whether the currently prevailing histological interpretation used to evaluate H. pylori infection status is appropriate.

Molecular Alterations in Gastric Intestinal Metaplasia Shed Light on Alteration of Methionine Metabolism: Insight into New Diagnostic and Treatment Approaches

Gastric intestinal metaplasia (GIM) is a precancerous lesion and the key risk factor in the development of gastric cancer (GC), but early detection and treatment remain challenging. The traditional endoscopic diagnosis of metaplastic lesions is complicated by an increased rate of inappropriateness and false negativity. Although early interventions with H. pylori eradication, as well as endoscopic therapy results, were promising, there is still a significant unmet need to control GIM progression and recurrences. Molecular alterations, such as an increased DNA methylation index, have been identified as a crucial factor in the downregulation of tumor suppressor genes, such as the caudal-type homeobox (CDX2) gene, which regulates epithelial cell proliferation and GIM progression and is associated with treatment failure. CDX2 is downregulated by promoter hypermethylation in the colonic-type epithelium, in which the methylation was correlated with reduced intake of dietary folate sources. Tumor cells alter to dietary methionine sources in the biosynthesis of S-Adenosylmethionine, a universal methyl donor for transmethylation, under the conditions of limited folate and B12 availability. The gut microbiota also exhibited a shift in microbial composition, which could influence the host's dietary methionine metabolism. Meanwhile, activated oncogenic signaling via the PI3K/Akt/mTORC1/c-MYC pathway could promotes rewiring dietary methionine and cellular proliferation. Tumor methionine dependence is a metabolic phenotype that could be helpful in predictive screening of tumorigenesis and as a target for preventive therapy to enhance precision oncology. This review aimed to discuss the molecular alterations in GIM to shed light on the alteration of methionine metabolism, with insight into new diagnostic and treatment approaches and future research directions.

Sensitively detecting antigen of SARS-CoV-2 by a homogeneous immunoassay based on ortho-touch reaction and graphene oxide (GO) quenched acridine esterification chemiluminescence

In this study, a homogeneous immunoassay based on ortho-touch reaction and graphene oxide (GO) quenched acridine esterification chemiluminescence is developed for sensitive detection of SARS-CoV-2 antigen. The sensitivity and specificity of this method was further evaluated with viral protein, virus strains and clinical samples. Benefiting from strong chemiluminescence signal and good quenching performance of GO, this method allows enhanced signal-to-background ratio, and the limit of detection is down to 0.02 ng/ml of viral protein or equivalently 200 copies/ml of virus strains. In clinical evaluations, our approach demonstrated a high level of agreement with digital RT-PCR, achieving a positive coincidence rate of 90.87 %, a negative coincidence rate of 99.77 %, and an overall concordance of 96.53 %, while showing no cross-reactivity with other prevalent viruses. This method offers a promising, sensitive, rapid, and cost-effective platform for early SARS-CoV-2 diagnosis. Moreover, it can potentially be adapted for detecting other pathogens.