Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis

Differences in image-enhanced endoscopic findings between Helicobacter pylori -associated and autoimmune gastritis

Background and study aims  The aim of this study was to elucidate the differences in image-enhanced endoscopy (IEE) findings between Helicobacter - pylori -associated and autoimmune gastritis. Patients and methods  Seven H. pylori -naïve, 21 patients with H. pylori -associated gastritis and seven with autoimmune gastritis were enrolled. Mucosal atrophy in the corpus was evaluated using autofluorescence imaging and classified into small, medium and large. In a 2 × 2-cm area of the lesser curvature of the lower corpus, micromucosal pattern was evaluated by magnifying narrow band imaging and proportion of foveola (FV)- and groove (GR)-type mucosa was classified into FV > 80 %, FV 50 % to 80 %, GR 50 % to 80 %, and GR > 80 %, then a biopsy specimen was taken. Results  Fifteen of 21 (71 %) H. pylori -associated gastritis patients exhibited medium-to-large atrophic mucosa at the corpus lesser curvature. All autoimmune gastritis patients had large atrophic mucosa throughout the corpus ( P  < 0.001). All H. pylori -naïve patients had the FV > 80 % micromucosal pattern. Nineteen of 21 (90 %) H. pylori -associated gastritis patients had varying proportions of GR- and FV-type mucosae and five of seven (71 %) autoimmune gastritis patients showed FV > 80 % mucosa ( P  < 0.001). Compared with patients who were H. pylori -naïve, patients with H. pylori -associated and autoimmune gastritis exhibited a higher grade of atrophy ( P  < 0.001), but only patients with H. pylori -associated gastritis showed a higher grade of intestinal metaplasia ( P  = 0.022). Large mucosal atrophy with FV > 80 % micromucosal pattern had sensitivity of 71 % (95 % CI: 29 %-96 %) and specificity of 100 % (95 % CI: 88 % to 100 %) for diagnosis of autoimmune gastritis. Conclusions  IEE findings of the gastric corpus differed between H. pylori -associated and autoimmune gastritis, suggesting different pathogenesis of the two diseases.

Pre-malignant signs of gastric MALT lymphoma

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.

Shenqi Yiwei decoction for treatment of atrophic gastritis of spleen-stomach deficiency cold type: Clinical efficacy and influence on TXB2 and 6-keto-PGF1α

AIM

To evaluate the clinical efficacy of Shenqi Yiwei decoction in the treatment of atrophic gastritis of spleen-stomach deficiency cold type and investigate its influence on TXB₂ and 6-keto-PGF1α.

METHODS

Eighty-six patients with atrophic gastritis of spleen-stomach deficiency cold type were selected from January 2016 to October 2017 at the Third Affiliated Hospital of Zhejiang Chinese Medicine University, and the patients were randomly divided into either an experimental group (n = 43) or a control group (n = 43). The control group was treated with omeprazole, while the experimental group was treated with Shenqi Yiwei decoction. The patients in both groups were treated for 8 wk. The effective rates of the two groups were compared. Main symptom scores (including abdominal distension, dry mouth, anorexia, fatigue, and indigestion), endoscopic scores (including mucosal appearance, mucosal erosion, bile reflux, mucous folds, and blood vessels), TXB₂ and 6-keto-PGF1α, and complications were also compared between the two groups.

RESULTS

The total effective rate was significantly higher in the experimental group than in the control group (95.35% vs 81.40%, χ² = 4.0741, P = 0.0436). Before treatment, abdominal distension, dry mouth, anorexia, fatigue, and indigestion scores were not statistically significant between the two groups (P > 0.05); after treatment, these scored significantly decreased in both groups (P < 0.05), and the decrease was more significant in the experimental group. Before treatment, scores of mucosal appearance, mucosal erosion, bile reflux, mucous folds, and blood vessels were not statistically significant between the two groups (P > 0.05); after treatment, these scores were significantly improved in both groups (P < 0.05), and the improvement was more significant in the experimental group (P < 0.05). Before treatment, TXB₂ and 6-keto-PGF1α differed significantly between the two groups (P > 0.05); after treatment, TXB₂ decreased significantly and 6-keto-PGF1α increased significantly in both groups (P < 0.05), and the changes were more significant in the experimental group (P < 0.05). Adverse reactions such as constipation and vomiting did not occur in either group.

CONCLUSION

Shenqi Yiwei decoction has a good therapeutic effect in atrophic gastritis of spleen-stomach deficiency cold type, and it can significantly reduce clinical symptoms and improve endoscopic changes possibly by regulating TXB₂ and 6-keto-PGF1α.