The role of bile acid in intestinal metaplasia

Pathogenesis and potential reversibility of intestinal metaplasia - a milestone in gastric carcinogenesis

BACKGROUND

Non-cardia gastric cancer remains a major cause of cancer-related mortality worldwide, despite declining incidence rates in many industrialized countries. The development of intestinal-type gastric cancer occurs through a multistep process in which normal mucosa is sequentially transformed into hyperproliferative epithelium, followed by metaplastic processes leading to carcinogenesis. Chronic infection with Helicobacter pylori is the primary etiological agent that causes chronic inflammation of the gastric mucosa, induces atrophic gastritis, and can lead to intestinal metaplasia and dysplasia. Both intestinal metaplasia and dysplasia are precancerous lesions, in which gastric cancer is more likely to occur. Atrophic gastritis often improves after eradication of Helicobacter pylori; however, the occurrence of intestinal metaplasia has been traditionally regarded as "the point of no return" in the carcinogenesis sequence. Helicobacter pylori eradication heals non-atrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions. In this article, we discuss the pathogenesis, epigenomics, and reversibility of intestinal metaplasia and briefly touch upon potential treatment strategy.

CONCLUSIONS

Gastric intestinal metaplasia no longer appears to be an irreversible precancerous lesion. However, there are still many controversies regarding the improvement of intestinal metaplasia after Helicobacter pylori eradication.

Ectopic bile duct concomitant with gastric ulcer hemorrhage: report of a case

BACKGROUND

An ectopic bile duct opening into the stomach is a rare congenital anomaly of the biliary system, and thus, there are few case reports with gastric ulcer hemorrhage. Herein, we presented a case of ectopic bile duct concomitant with gastric ulcer hemorrhage.

CASE PRESENTATION

A 75-year-old woman was referred to our hospital because she repeatedly vomited blood and had melena. Endoscopic hemostasis was attempted for hemorrhage from a gastric ulcer located on the anterior wall of the antrum. However, the bleeding was difficult to stop, and a laparoscopic distal gastrectomy was performed. Her postoperative course was uneventful. Pathological examination revealed that the bleeding point was an ectopic bile duct. In retrospect, an annual endoscopy performed at her family clinic had revealed a bulge in the same portion of the stomach. Exposure to bile acids from an ectopic bile duct opening can cause gastric mucosal damage and ulceration.

CONCLUSIONS

Ectopic bile ducts opening into the stomach can cause gastric ulcer and hemorrhage. Hemorrhage from a submucosal ridge with ulcer in the stomach may be rarely related to the presence of ectopic bile ducts.

Modified Chaishao Liujunzi Decoction inhibits bile acid-induced gastric intestinal metaplasia: from network prediction to experimental verification

Modified Chaishao Liujunzi Decoction (MCLD) is a traditional Chinese medicine formula that is used mainly to improve clinical symptoms, alleviate gastric mucosal inflammation, and improve gastric mucosal lesions in patients with gastric intestinal metaplasia (GIM). GIM is considered a precancerous gastric cancer (GC) lesion (PLGC) and exploring effective intervention measures for GIM is of great importance for the prevention of GC. The purpose of this study was to reveal the potential molecular mechanism of MCLD in improving GIM induced by bile acid (BA) using network pharmacology and experimental validation. Through network pharmacology, we speculated that MCLD could act on GIM by driving the epidermal growth factor receptor (EGFR)/PI3K/AKT/mammalian target of rapamycin (mTOR) pathway. After that, we used deoxycholic acid (DCA) to treat GES-1 cells to simulate BA-induced GIM and observed the effects of MCLD treatment. The results indicate that MCLD can significantly inhibit DCA-induced cell proliferation and down-regulate the expression of pro-inflammatory cytokines and intestinal-specific markers. At the same time, MCLD also negatively regulated the expression of genes and proteins of the EGFR/PI3K/AKT/mTOR pathway. Combination with EGFR agonists and inhibitors suggested that MCLD may improve GIM by inhibiting the EGFR/PI3K/AKT/mTOR pathway, which may be related to its inhibition of DCA-induced cell proliferation through this pathway. In conclusion, MCLD may improve BA-induced GIM through the EGFR/PI3K/AKT/mTOR pathway, as predicted by network pharmacology, and is a potential Chinese medicine prescription for the treatment or reversal of GIM.