1
|
Suda H, Sakurai K, Eto S, Fujie S, Okuda A, Takeichi T, Urata M, Murao T, Hasuda K, Hirano M, Kato Y, Haruma K. Effects of Medication Period and Gastrin Levels on Endoscopic Gastric Mucosal Changes in Long-Term Proton Pump Inhibitor Users. Diagnostics (Basel) 2024; 14:2540. [PMID: 39594206 PMCID: PMC11592694 DOI: 10.3390/diagnostics14222540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 10/29/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5-10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250-500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5-10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46-29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79-45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period.
Collapse
Affiliation(s)
- Hiroko Suda
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Koichi Sakurai
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Sachi Eto
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Satomi Fujie
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Ayako Okuda
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Takayuki Takeichi
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Masayuki Urata
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Tetsuya Murao
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Kiwamu Hasuda
- Hattori Clinic, 2-12-35 Shin-Machi, Chuo-ku, Kumamoto City 860-0004, Kumamoto, Japan; (S.E.); (S.F.); (A.O.); (T.T.); (M.U.); (T.M.); (K.H.)
| | - Masahiro Hirano
- Hirano Gastroenterology Clinic, 2-3029-2 Onuki-cho, Nobeoka 882-0803, Miyazaki, Japan;
| | - Yo Kato
- Hibiya Digital Diagnostic Pathology Clinic, 2-2-3 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011, Japan;
| | - Ken Haruma
- Department of Internal Medicine 2, Kawasaki Medical School General Medical Center, 577 Matsushima, Kurashiki-City 701-0192, Okayama, Japan
| |
Collapse
|
2
|
Li B, Jiang H, Cai C, Chen H. TPOAb Indicates neuroendocrine tumor in autoimmune gastritis: A retrospective study of 91 patients. Am J Med Sci 2024:S0002-9629(24)01402-2. [PMID: 39154962 DOI: 10.1016/j.amjms.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The association between serological indexes and occurrence of complications in patients with autoimmune gastritis (AIG) remains unclear. METHODS 91 patients with AIG were recruited and their clinical information were collected. The differences between serological indexes and complications of AIG were analyzed. And potential biomarker for early prediction and diagnosis of AIG with complications was explored. RESULTS AIG patients in our study was 58.12 ± 11.68 years old, containing 31 males and 60 females. G17 was elevated in 49 of 52; PGI/II decreased in 43/49; GPA positive in 48/61; Anemia presented 28 in 80; Vitamin B12 deficiency occurred 23 in 58. Neuroendocrine tumor (NET) was the most common complication in AIG patients, accounting for 27/91. The second was polyps, making up for 14/91. There is also 9/91 of gastric mucosa neoplasia happened in AIG. No significant difference of G7, PGI, PGII, PGI/II and VB12 in AIG was found in different gastric mucosal lesions (P > 0.05). However, AIG patients with TPOAb positive had a higher risk in the occurrence of NET simultaneously (P = 0.0212). Those AIG with NET patients exhibited a significantly higher TPOAb level (P = 0.0078). ROC curve suggested that TPOAb can predict the existence of NET in AIG (AUC = 0.7410, P < 0.05). CONCLUSION We found that TPOAb can serve as a predictive biomarker of NET in AIG. This accessible test is helpful for endoscopy specialists to pay attention to gastric mucosal lesions in TPOAb-positive AIG patients, improving early diagnosis and intervention of comorbidities ability.
Collapse
Affiliation(s)
- Bo Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Honggang Jiang
- Department of Gastroenterology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, Zhejiang, China
| | - Congbo Cai
- Department of Emergency, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China.
| | - Hongtan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
3
|
Massironi S, Gallo C, Lahner E, Sciola V, Cavalcoli F, Lenti MV, Zilli A, Dottori L, De Rossi G, Miceli E, Annibale B, Vecchi M, Cantù P, Di Sabatino A, Invernizzi P, Danese S. Occurrence and characteristics of endoscopic gastric polyps in patients with autoimmune gastritis (AGAPE study): A multicentric cross-sectional study. Dig Liver Dis 2024:S1590-8658(24)00887-9. [PMID: 39112216 DOI: 10.1016/j.dld.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/06/2024] [Accepted: 07/22/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Autoimmune gastritis (AIG) leads to increased gastrin (G) levels due to hypo-achlorhydria, providing proliferative stimuli on the gastric mucosa. AIMS To evaluate the incidence and characteristics of gastric polyps in AIG patients across six tertiary centers in Italy. METHODS A multicentric, cross-sectional study enrolled patients with AIG diagnosed from January 2000 to June 2023, who underwent at least one endoscopy. Data on demographics, clinical history, biochemical profiles, and endoscopic and histopathological findings were systematically collected. RESULTS Among 612 AIG patients followed for a median of 4 years, 222 (36.3 %) developed at least one gastric polyp. Of these, 214 were non-endocrine lesions detected in 162 patients, including 151 inflammatory (70.5 %), 29 adenomatous (13.6 %), 18 fundic gland polyps (8.4 %), 13 adenocarcinomas (6.1 %), and one MALT lymphoma. Additionally, 108 patients had gastric neuroendocrine neoplasms (gNENs), with 48 also having non-endocrine polyps. Older age and higher gastrin and chromogranin A levels were associated with polyp occurrence. No differences in OLGA/OLGIM stages or Helicobacter pylori status were noted among patients with and without lesions. CONCLUSION This large multicentric study underscores the substantial occurrence of gastric polyps in AIG patients, including notable rates of gNENs and adenocarcinomas, emphasizing the importance of proactive endoscopic surveillance and histopathological examination for effective management.
Collapse
Affiliation(s)
- Sara Massironi
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Camilla Gallo
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Edith Lahner
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Valentina Sciola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Federica Cavalcoli
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy
| | - Ludovica Dottori
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Gaia De Rossi
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Emanuela Miceli
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bruno Annibale
- Sapienza University of Rome, Dept Medical-surgical sciences and translational medicine, Rome, Italy
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology IRCCS San Gerardo dei Tintori Monza, MB, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
4
|
Chen YY, Guo WJ, Shi YF, Su F, Yu FH, Chen RA, Wang C, Liu JX, Luo J, Tan HY. Management of type 1 gastric neuroendocrine tumors: an 11-year retrospective single-center study. BMC Gastroenterol 2023; 23:440. [PMID: 38097952 PMCID: PMC10722838 DOI: 10.1186/s12876-023-03079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Type 1 gastric neuroendocrine tumors (NETs) are relatively rare to the extent that some physicians have little experience in diagnosing and treating them. The purpose of this study was to increase the understanding of the disease by analyzing and summarizing the management and prognoses of patients with type 1 gastric NETs at our center. METHODS The data of 229 patients (59.4% female) with type 1 gastric NETs who were treated at our center during 2011-2022 were retrospectively analyzed. RESULTS The average patient age was 50.5 ± 10.8 years. Multiple tumors affected 72.5% of the patients; 66.4% of the tumors were < 1 cm, 69.4% were NET G1, and 2.2% were stage III-IV. A total of 76.9% of the patients had received endoscopic management, 60.7% had received traditional Chinese medicine treatment, 10.5% received somatostatin analogues treatment, and 6.6% underwent surgical resection. Seventy patients (41.2%) experienced the first recurrence after a median follow-up of 31 months (range: 2-122 months), and the median recurrence-free time was 43 months. The 1-, 2-, and 3-year cumulative recurrence-free survival rates were 71.8%, 56.8%, and 50.3%, respectively. During a median follow-up of 39 months (range: 2-132 months), one patient had bilateral pulmonary metastasis, and no disease-related deaths were observed. CONCLUSION Type 1 gastric NETs have a high recurrence rate and a long disease course, underscoring the importance of long-term and comprehensive management.
Collapse
Affiliation(s)
- Ying-Ying Chen
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Wen-Juan Guo
- Department of Gastroenterology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Yan-Fen Shi
- Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Fei Su
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Fu-Huan Yu
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Ru-Ao Chen
- Beijing University of Chinese Medicine, 11 North Third Ring East Road, Beijing, 100029, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Chao Wang
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China
| | - Ji-Xi Liu
- Digestive Disease Center, Beijing United Family Hospital, No. 2 Jiangtai Road, Beijing, 100015, China
| | - Jie Luo
- Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China.
| | - Huang-Ying Tan
- Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing, 100029, China.
| |
Collapse
|
5
|
Beduleva L, Fomina K, Sidorov A, Terentiev A, Ivanov P, Menshikov I. Rat Experimental Autoimmune Gastritis Model. Immunol Invest 2023; 52:1023-1038. [PMID: 37962068 DOI: 10.1080/08820139.2023.2283103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Autoimmune gastritis (AIG) is an autoimmune disease of the stomach characterized by the destruction of the oxyntic mucosa, which stops producing acid and becomes both functionally and morphologically atrophic. The pathogenic mechanisms behind the disease are still poorly understood. There is no early diagnosis and specific AIG therapy. To elucidate the pathogenesis of AIG, to search for early diagnostic markers, as well as to test new therapeutic approaches, an adequate and easily reproducible experimental model for autoimmune gastritis (EAG) is needed. Existing EAG models have some limitations, including slow development of signs, absence of advanced gastritis, irrational use of animals to obtain antigen. The aim was to find out whether it is possible to cause autoimmune gastritis similar to human disease in Wistar rats through immunization with a homologous gastric mucosa extract. METHODS Wistar rats were immunized with gastric mucosa extract. Histology studies and evaluation of serological parameters were performed 56 and 91 days later. RESULTS Destruction of oxyntic glands by infiltrating T lymphocytes were detected in rats on 56 and 91 days after initial immunization with gastric mucosa extract. Hyperplasia of enterochromaffin-like (ECL) cells was detected on the 91st day. Antral mucosa remained unchanged. CONCLUSION Wistar rats, immunized with gastric mucosa extract, developed EAG similar to human AIG. The advantages of received EAG model are the ease of obtaining, the rapid development of oxyntic mucosa damage, which may progress to ECL cell hyperplasia.
Collapse
Affiliation(s)
- Liubov Beduleva
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Kseniya Fomina
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Alexandr Sidorov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Alexey Terentiev
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| | - Pavel Ivanov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
| | - Igor Menshikov
- Laboratory of Molecular and Cell Immunology, Department of Immunology and Cell Biology, Udmurt State University, Izhevsk, Russian Federation
- Laboratory of Biocompatible Materials, Udmurt Federal Research Center UB RAS, Izhevsk, Russian Federation
| |
Collapse
|
6
|
Wang X, Lu CJ, Li H, Zhang JY, Zheng JW, Wu N, Yang WL, Yu J, Huang WF. Clinicopathological characteristics of autoimmune gastritis: A single-center retrospective study. Clin Res Hepatol Gastroenterol 2023; 47:102154. [PMID: 37311519 DOI: 10.1016/j.clinre.2023.102154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Autoimmune gastritis (AIG) is a prominent risk factor for pernicious anemia (PA) and gastric neoplasia. This study aimed to investigate the clinicopathological characteristics of AIG patients in China, with a focus on those who had positive anti-intrinsic factor antibodies (AIFA). METHODS A total of 103 AIG patients who were diagnosed between January 2018 and August 2022 were reviewed in a large academic tertiary teaching hospital. Patients were divided into two groups based on the presence or absence of AIFA, and their serologic and histopathological characteristics were analyzed. RESULTS The mean age of the 103 AIG patients was 54.16±11.92 years (range 23-79), with 69 (66.99%) being women. AIFA were present in 28.16% of patients. Patients with AIFA-positive had a higher risk of PA than those with AIFA-negative, as demonstrated by a larger mean corpuscular volume (MCV), lower hemoglobin level, and lower vitamin B-12 level (P<0.05). There were no statistically significant differences in gastric histopathology, gastrin level, and pepsinogen level when patients were divided into AIFA-positive and AIFA-negative group. Of the 103 cases, 34 (33.01%) were concomitant with other autoimmune diseases, with autoimmune thyroid diseases being the most common (25.24%, 26/103). Thyroid peroxidase antibody, which accounted for 45.45% (25/55), was the most prevalent thyroid antibody, followed by anti-thyroglobulin antibody (34.55%, 19/55), thyroid stimulating antibody (12.73%, 7/55), and thyrotropin receptor antibody (3.64%, 2/55). CONCLUSION This study highlights the increased risk of severe anemia in AIFA-positive AIG patients, particularly for PA. Clinicians should consider the presence of AIFA as a warning sign for PA and prioritize early diagnosis and appropriate treatment to prevent serious complications.
Collapse
Affiliation(s)
- Xu Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chun-Jing Lu
- Department of Blood Transfusion, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Hua Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Zheng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Na Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Lin Yang
- Endoscopy Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Juan Yu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
| |
Collapse
|