TNF activates astrocytes and catecholaminergic neurons in the solitary nucleus: implications for autonomic control

Tumor necrosis factor [TNF] produces a profound anorexia associated with gastrointestinal stasis. Our work suggests that the principal site of action of TNF to cause this change in gastric function is via vagal afferents within the nucleus of the solitary tract [NST]. Excitation of these afferents presumably causes gastric stasis by activating downstream NST neurons that, in turn, suppress gastric motility via action on neurons in the dorsal motor nucleus of the vagus that project to the stomach. Results from our parallel studies on gastric vago-vagal reflexes suggest that noradrenergic neurons in the NST are particularly important to the generation of reflex gastroinhibition. Convergence of these observations led us to hypothesize that TNF action in the NST may preferentially affect putative noradrenergic neurons. The current study confirms our observations of a dose-dependent TNF activation of cells [as indicated by cFOS production] in the NST. The phenotypic identity of these TNF-activated neurons in the NST was approximately 29% tyrosine hydroxylase [TH]-positive [i.e., presumably noradrenergic neurons]. In contrast, less than 10% of the nitrergic neurons were activated after TNF exposure. Surprisingly, another 54% of the cFOS-activated cells in the NST were phenotypically identified to be astrocytes. Taken together with previous observations, the present results suggest that intense or prolonged vagal afferent activity [induced by visceral pathway activity, action of gut hormones or cytokines such as TNF] can alter local astrocyte immediate early gene expression that, in turn, can provoke long-term, perhaps permanent changes in the sensitivity of vagal-reflex circuitry.

Correlation between gastrointestinal symptoms and disease severity in patients with COVID-19: a systematic review and meta-analysis

Objective

To study the correlation between gastrointestinal (GI) symptoms and disease severity in patients with COVID-19.

Design

We searched six databases including three Chinese and three English databases for all the published articles on COVID-19. Studies were screened according to inclusion and exclusion criteria. The relevant data were extracted and all the statistical analyses were performed using Revman5.3.

Result

In a meta-analysis of 9 studies, comprising 3022 patients, 479 patients (13.7%, 95% CI 0.125 to 0.149) had severe disease and 624 patients (14.7%, 95% CI 0.136 to 0.159) had GI symptoms. Of 624 patients with GI symptoms, 118 patients had severe disease (20.5%, 95% CI 0.133 to 0.276) and of 2397 cases without GI symptoms, 361 patients had severe disease (18.2%, 95% CI 0.129 to 0.235). Comparing disease severity of patients with and without GI symptoms, the results indicated: I²=62%, OR=1.21, 95% CI 0.94 to 1.56, p=0.13; there was no statistically significant difference between the two groups. The funnel plot was symmetrical with no publication bias.

Conclusion

Current results are not sufficient to demonstrate a significant correlation between GI symptoms and disease severity in patients with COVID-19.

The effect of tube versus bottle feeding colostrum on immunoglobulin G absorption, abomasal emptying, and plasma hormone concentrations in newborn calves

The objective of this study was to determine if feeding colostrum to newborn calves through an esophageal tube, compared with a nipple bottle, would delay abomasal emptying, which would in turn decrease passive transfer of IgG and plasma glucose, insulin, and glucagon-like peptide (GLP) 1 and GLP-2 concentrations. Twenty newborn Holstein bull calves were fed 3 L of colostrum replacer (200 g of IgG) through either an esophageal tube or nipple bottle at 2 h after birth followed by feeding pooled whole milk every 12 h after birth. Acetaminophen was mixed into the colostrum meal as a marker for abomasal emptying. A jugular catheter was inserted 1 h after birth and blood was sampled frequently to analyze serum for IgG and acetaminophen and plasma for glucose, insulin, GLP-1, and GLP-2. Feeding method did not affect abomasal emptying, and as a result no treatment effect was present on serum IgG concentrations. Maximum concentration of serum IgG was 24.4 ± 0.40 mg/mL (± standard error), which was reached at 14.6 ± 1.88 h after the colostrum meal for both groups. Apparent efficiency of absorption at maximum concentration of IgG was 52.9%, indicating high efficiency of passive transfer of IgG for both treatments. Tube feeding increased glucose and insulin area under the curve before the first milk meal, most likely due to the decreased time to consume the colostrum meal. In addition, tube-fed calves consumed 0.5 ± 0.13 L more milk in their first milk meal than bottle-fed calves. No treatment effect on plasma concentrations of GLP-1 or GLP-2 was present, but both hormones increased after colostrum feeding. These findings confirm that there is no effect on absorption of IgG from colostrum when feeding good-quality colostrum at a volume of 3 L through either an esophageal tube or nipple bottle.

Comparative Effects of Intragastric and Intraduodenal Administration of Quinine on the Plasma Glucose Response to a Mixed-Nutrient Drink in Healthy Men: Relations with Glucoregulatory Hormones and Gastric Emptying

BACKGROUND

In preclinical studies, bitter compounds, including quinine, stimulate secretion of glucoregulatory hormones [e.g., glucagon-like peptide-1 (GLP-1)] and slow gastric emptying, both key determinants of postprandial glycemia. A greater density of bitter-taste receptors has been reported in the duodenum than the stomach. Thus, intraduodenal (ID) delivery may be more effective in stimulating GI functions to lower postprandial glucose.

OBJECTIVE

We compared effects of intragastric (IG) and ID quinine [as quinine hydrochloride (QHCl)] administration on the plasma glucose response to a mixed-nutrient drink and relations with gastric emptying, plasma C-peptide (reflecting insulin secretion), and GLP-1.

METHODS

Fourteen healthy men [mean ± SD age: 25 ± 3 y; BMI (in kg/m2): 22.5 ± 0.5] received, on 4 separate occasions, in double-blind, randomly assigned order, 600 mg QHCl or control, IG or ID, 60 min (IG conditions) or 30 min (IG conditions) before a mixed-nutrient drink. Plasma glucose (primary outcome) and hormones were measured before, and for 2 h following, the drink. Gastric emptying of the drink was measured using a 13C-acetate breath test. Data were analyzed using repeated-measures 2-way ANOVAs (factors: treatment and route of administration) to evaluate effects of QHCl alone and 3-way ANOVAs (factors: treatment, route-of-administration, and time) for responses to the drink.

RESULTS

After QHCl alone, there were effects of treatment, but not route of administration, on C-peptide, GLP-1, and glucose (P < 0.05); QHCl stimulated C-peptide and GLP-1 and lowered glucose concentrations (IG control: 4.5 ± 0.1; IG-QHCl: 3.9 ± 0.1; ID-control: 4.6 ± 0.1; ID-QHCl: 4.2 ± 0.1 mmol/L) compared with control. Postdrink, there were treatment × time interactions for glucose, C-peptide, and gastric emptying, and a treatment effect for GLP-1 (all P < 0.05), but no route-of-administration effects. QHCl stimulated C-peptide and GLP-1, slowed gastric emptying, and reduced glucose (IG control: 7.2 ± 0.3; IG-QHCl: 6.2 ± 0.3; ID-control: 7.2 ± 0.3; ID-QHCl: 6.4 ± 0.4 mmol/L)  compared with control.

CONCLUSIONS

In healthy men, IG and ID quinine administration similarly lowered plasma glucose, increased plasma insulin and GLP-1, and slowed gastric emptying. These findings have potential implications for lowering blood glucose in type 2 diabetes. This study was registered as a clinical trial with the Australian New Zealand Clinical Trials at www.anzctr.org.au as ACTRN12619001269123.

Probiotic L. gasseri strain (LG21) for the upper gastrointestinal tract acting through improvement of indigenous microbiota

Objective

To describe probiotics including a Lactobacillus gasseri strain LG21 used for the upper gastrointestinal tract, which are considered to act through improvement of indigenous microbiota inhabiting there.

Background and design

Because the early definition of probiotics emphasized their effects on improving the intestinal microbial ecology, their effects on the intestinal tract and its immunity have been considered common general benefits associated with probiotics. This conclusion was also based on a body of successful clinical trials whose endpoints were the prevention or treatment of intestinal diseases. In contrast to intestinal microbiota, our understanding of the role of gastric microbiota in human health and physiology remains poor, as the bacterial load in the stomach is considered too small to exert a significant effect due to the highly acidic environment of the human stomach. Therefore, the intervention using probiotics in the stomach is still limited at present.Results:In this article using representative 38 quoted articles, we first describe the gastric microbiota, as the indigenous microbiota in the stomach is thought to be significantly involved in the pathophysiology of this organ, since probiotics exert their beneficial effects through improving the resident microbiota. We then review the present status and future prospects of probiotics for the treatment of upper gastrointestinal diseases by quoting representative published articles, including our basic and clinical data.

Conclusions

Probiotics have been demonstrated to suppress Helicobacter pylori in the stomach, and are also expected to improve functional dyspepsia through the correction of dysbiotic gastric microbiota.

The Inhibitory Effects of Nesfatin-1 in Ventromedial Hypothalamus on Gastric Function and Its Regulation by Nucleus Accumbens

Aim: The aim of this study was to investigate the effect of nesfatin-1 signaling in the ventromedial hypothalamus (VMH) on gastric functions, as well as the regulation of these effects by nucleus accumbens (NAc) projections to VMH.

Methods: The expression of c-fos in nesfatinergic VMH neurons induced by gastric distension (GD) was measured using the double fluoro-immunohistochemical staining. The firing rates of neurons were monitored with single-unit extracellular electric discharge recording. The projection of nesfatinergic neurons from NAc to VMH was observed by fluorogold retrograde tracer combined with fluoro-immunohistochemical staining. The effect of nesfatin-1 in VMH or electric stimulation in NAc on gastric function was studied by measuring food intake, gastric acid output, gastric motility, and gastric emptying, and the ability of the melanocortin-3/4 receptor antagonist SHU9119 or the anti-nesfatin-1 antibody to block nesfatin-1 in the VMH was assessed.

Results: Expression of c-fos was observed in VMH nesfatinergic neurons following GD in rats. Further, nesfatin-1 delivery to single GD-responsive neurons changed the firing rates of these neurons in the VMH. In awake, behaving rats, intra-VMH administration of nesfatin-1 inhibited food intake, gastric acid output, gastric motility, and gastric emptying. These effects were abolished by SHU9119. Fluorogold retrograde tracing showed nesfatinergic neural projection from the NAc to the VMH. Electrical stimulation of NAc modified the firing rates of the VMH neurons and inhibited food intake and gastric functions. The pretreatment with an anti-nesfatin-1 antibody in the VMH reversed the effects of NAc electrical stimulation on the VMH neuronal firing rates and gastric function.

Conclusions: Nesfatin-1 in the VMH inhibited food intake, gastric acid output, gastric motility, and gastric emptying. A nesfatinergic pathway between NAc and VMH transmitted metabolism-regulating signals.

Gastric function measurements in drug development

The function of the stomach includes initiation of digestion by exocrine secretions such as acid and pepsin, which are under the control of the endocrine secretion of hormones that also coordinate intestinal motility. The stomach also stores and mechanically disrupts ingested food. Various techniques have been developed to assess gastric physiology, the most important of which is assessment of acid secretion, as well as gastric motility and gastric emptying. The influence of drugs on gastric function and the effect of gastric secretion and mechanical actions on the bioavailability of novel compounds are of critical importance in drug development and hence to clinical pharmacologists. The control of acid secretion is essential in the treatment of peptic ulcer disease as well as gastrooesophageal reflux disease (GORD); pH-metry can be used to determine the necessary dose of an acid suppressant to heal mucosal damage. Disturbed gastric myoelectric activity leading to gastroparesis can cause delayed gastric emptying, often found in patients with diabetes mellitus. Electrogastrography (EGG) may be used to evaluate the influence of prokinetics and other drugs on this condition and aid in determining effective therapy.

Functional and anatomical gastric regions and their relations to motility control

The common occurrence of gastric disorders, the accelerating emphasis on the role of the gut-brain axis, and development of realistic, predictive models of gastric function, all place emphasis on increasing understanding of the stomach and its control. However, the ways that regions of the stomach have been described anatomically, physiologically, and histologically do not align well. Mammalian single compartment stomachs can be considered as having four anatomical regions fundus, corpus, antrum, and pyloric sphincter. Functional regions are the proximal stomach, primarily concerned with adjusting gastric volume, the distal stomach, primarily involved in churning and propelling the content, and the pyloric sphincter that regulates passage of chyme into the duodenum. The proximal stomach extends from the dome of the fundus to a circumferential band where propulsive waves commence (slow waves of the pacemaker region), and the distal stomach consists of the pacemaker region and the more distal regions that are traversed by waves of excitation, that travel as far as the pyloric sphincter. Thus, the proximal stomach includes the fundus and different extents of the corpus, whereas the distal stomach consists of the remainder of the corpus and the antrum. The distributions of aglandular regions and of specialized glands, such as oxyntic glands, differ vastly between species and, across species, have little or no relation to anatomical or functional regions. It is hoped that this review helps to clarify nomenclature that defines gastric regions that will provide an improved basis for drawing conclusions for different investigations of the stomach.

Investigation of drug absorption from the gastrointestinal tract of man. V. Effect of the beta-adrenoceptor antagonist, metoprolol, on postprandial gastric function

The role of the adrenergic system in normal gastric function was assessed in five healthy volunteers by measuring gastric secretion and emptying after a mixed meal containing a non-absorbable marker, [14C]-PEG 4000, with and without 100 mg of metoprolol, a beta 1-adrenoceptor antagonist. Intraduodenal perfusion of PEG 4000, and gastric and jejunal sampling was achieved by means of a gastrointestinal intubation technique. Gastric function was assessed from the degree of dilution of the duodenal marker. Analysis of acid content by titration allowed the gastric acid secretory rate to be determined. Gastric emptying of a meal over 4 h was similar with and without metoprolol, the time to 50% emptying being 100 min. In the presence of metoprolol, gastric acid content was significantly increased during the late postprandial period producing a corresponding increase in acid load delivered to the duodenum. beta 1-adrenoceptor blockade appears to prolong the gastric secretory response to food without altering gastric emptying.

Role of serum EBV-VCA IgG detection in assessing gastric cancer risk and prognosis in Northern Chinese population

The study aimed to investigate the role of serum EBV‐VCA IgG in assessing gastric cancer (GC) risk and prognosis. A total of 1790 Northern Chinese participants with pathologically confirmed disease underwent EBV‐VCA IgG serologic testing using enzyme‐linked immunosorbent assay (ELISA), including 821 controls, 410 atrophic gastritis (AG) patients, and 559 GC patients. We found that positive EBV‐VCA IgG was significantly associated with GC and its precursor, conferring a 1.55‐ and 1.36‐fold increased risk of GC and AG, respectively (P = 0.001, 95% CI = 1.21‐1.99; P = 0.011, 95% CI = 1.07‐1.72, respectively). The risk effects were more remarkable in younger, female, and Helicobacter pylori‐negative individuals than in older, male, and H. pylori‐positive individuals. EBV‐VCA IgG‐positive subjects had a lower PGI/II ratio than EBV‐VCA IgG‐negative subjects (median 8.0 vs 8.8, P = 0.001), especially those in the H. pylori‐positive (median 6.1 vs 6.8, P = 0.027) and GC subgroups (median 6.4 vs 7.9, P = 0.020). In the intestinal GC subgroup, the survival of EBV‐VCA IgG‐positive patients was worse than that of EBV‐VCA IgG‐negative patients (P = 0.041, HR = 2.45, 95% CI = 1.04‐5.78). Our study suggests that EBV‐VCA IgG seropositivity has potential in predicting the risk of GC and its precursor as well as the prognosis of histologically classified GC.

This is an innovative report about the role of serum EBV‐VCA IgG detection in assessing the risk of gastric cancer (GC) and its precursor as well as GC prognosis. And this is the first report about the relationship between EBV‐VCA IgG serology assay and gastric function status. Our study provides theoretical and experimental basis for evaluating the potential of serum EBV‐VCA IgG as a biomarker in prediction of GC risk and prognosis.

Low Serum B12 Concentrations Are Associated with Low B12 Dietary Intake But Not with Helicobacter pylori Infection or Abnormal Gastric Function in Rural Mexican Women

Background: Gastric function, Helicobacter pylori infection, and vitamin B12 (B12) dietary intake were assessed as predictors of serum B12. Methods: H. pylori antibodies, gastric function, B12 dietary intake, and biochemical/hematological parameters were measured in 191 adult women from two rural communities in Querétaro, Mexico. Results: The overall mean serum B12 concentration was 211 ± 117 pmol/L. The prevalences of low (≤ 148 pmol/L), marginal (148 to 221 pmol/L), and adequate (> 221 pmol/L) serum B12 were 28.4%, 31.1%, and 40.5%, respectively. Seventy-one percent of women tested positive for H. pylori antibodies. The prevalence of gastric function categories did not differ by serum B12 categories. The odds ratio for having low serum B12 was 2.7 (p = 0.01) for women with an intake below the estimated average requirement, 3.6 (p = 0.01) for those in the lowest tertile of total B12 intake, and 3.0 (p = 0.02) for those in the lowest tertile of B12 intake from animal source foods. Age and B12 intake were predictors of serum B12 concentrations [serum B12 (pmol/L) = 90.060 + 5.208 (B12 intake, µg/day) + 2.989 (age, years). Conclusions: Low serum B12 concentrations were associated with low B12 dietary intake but not with H. pylori infection or abnormal gastric function in rural Mexican women.

A non-invasive combined strategy to improve the appropriateness of upper gastrointestinal endoscopy

Background and aim Increasing the appropriateness of upper gastrointestinal endoscopy (UGIE) improves the quality of care while containing costs. The aim of this study was to improve the appropriateness of UGIE through a process involving evaluation of prescriptions and the use of a non-invasive alternative. Materials and methods A senior endoscopist evaluated the appropriateness of all outpatient referrals for UGIE and established the proper timing. Referrals were either accepted and programmed, canceled, or substituted by a non-invasive evaluation of gastric function, determining serum levels of gastrin-17 (G17), Pepsinogen I (PGI) and II (PGII), and antibodies against Helicobacter pylori. Results A total of 5102 requests for UGIE examinations were evaluated; 540 (10.4%) were inappropriate and had been prescribed for: gastroesophageal reflux disease (n=307), surveillance with erroneous timing (n=113), dyspepsia (n=66), other indications (n=20), and absence of written indication (n=34). Gastric function was evaluated in 282/540 patients; findings included normal values in 94 patients without proton-pump inhibitor therapy (PPI) and in 48 on PPI, active H pylori infection in 56, previous H pylori infection in 30, GERD in n=50, and atrophic gastritis in n=4. UGIE was performed in the latter 4 cases.  Within 2 years (range 1-22 months) of the initial refusal, 105/504 patients underwent UGIE, with normal endoscopic findings in 71/105 (67.5%), and with no cases of cancer. Conclusions This strategy, based on a strict control of prescriptions, is effective to increase the appropriateness while containing public health costs. The use of gastric function testing improves patient selection for UGIE endoscopy.

Appropriateness of Proton Pump Inhibitor Prescription Evaluated by Using Serological Markers

Inappropriate prescription of proton pump inhibitors (PPI) has been widely reported, often lacking initial exclusion of Helicobacter pylori (HP) infection and evaluation of gastric functional status. The aim of this study was to evaluate the utility of gastric functional tests to define the acid output, as well as HP status, in order to better direct PPI therapy prescription. Dyspeptic patients without alarm symptoms from a primary care population were evaluated. For each patient, serum Pepsinogen I (PGI) and II (PGII), gastrin 17 (G17) and anti-HP IgG antibodies (Biohit, Oyj, Finland) were determined. For each subject, data were collected regarding symptoms, past medical history of HP infection, and PPI use. Therapeutic response to PPIs was determined according to PGI and G17 values, where G17 > 7 in the presence of elevated PGI and absence of chronic atrophic gastritis (CAG) was considered an adequate response. Among 2583 dyspeptic patients, 1015/2583 (39.3%) were on PPI therapy for at least 3 months before serum sampling, and were therefore included in the study. Active HP infection and CAG were diagnosed in 206 (20.2%) and 37 (3.6%) patients, respectively. Overall, an adequate therapeutic response to PPIs was observed in 34.9%, reaching 66.7% at the highest dose. However, 41.1% and 20.4% of patients showed low (G17 1-7) or absent (G17 < 1) response to PPI, regardless of the dosage used. According to gastric functional response, most patients currently on PPI maintenance therapy lack a proper indication for continuing this medication, either because acid output is absent (as in CAG) or because gastrin levels fail to rise, indicating absence of gastric acid negative feedback. Lastly, HP eradication is warranted in all patients, and gastric function testing ensures this pathogen is sought for and adequately treated prior to initiating long-term PPI therapy.

Gastric emptying and myoelectrical activity testing in children with esophageal atresia: A pilot study

Objectives

Abnormalities of gastric function in children with esophageal atresia (EA) could potentially contribute to gastrointestinal symptoms and reduced quality of life (QOL). Therefore, we aimed to determine the feasibility and clinical usefulness of gastric function testing in children with EA.

Methods

The validated PedsQL Gastrointestinal Symptoms Questionnaire (PedsQL-GI) was completed to assess gastrointestinal symptoms and symptom-related QOL. Gastric emptying and gastric myoelectrical activity were studied using 13C-gastric emptying octanoic acid breath test (13C-GEBT) and surface electrogastrography (EGG). Correlations between 13C-GEBT and EGG parameters and PedsQL-GI scores were investigated.

Results

Fifteen patients (four males) were included (median age: 6 [3.0-8.5] years). Mean PedsQL-GI scores as reported by the children were comparable to the healthy population. However, parents reported a diminished QOL. Gastric function tests (gastric emptying and/or surface EGG) showed abnormalities in 12 patients (80%). Patients with abnormal slow waves showed abnormal gastric emptying coefficient more often. There was no significant association between 13C-GEBT nor EGG results and PedsQL-GI scores.

Conclusions

13C-GEBT and EGG can be used to evaluate gastric function in patients with EA. Abnormal gastric function tests were present in 80% of our cohort. However, abnormal gastric function did not significantly correlate with reported gastrointestinal symptom-related QOL.

Laparoscopic D2 radical gastrectomy improves postoperative inflammation and gastric function in elderly patients with advanced gastric cancer

OBJECTIVE

To investigate the effect of laparoscopic radical gastrectomy on the inflammation and recovery of gastrointestinal function in elderly patients with advanced gastric cancer (GC).

METHODS

Data of 80 elderly patients with advanced GC admitted to the Taizhou First people's Hospital from May 2014 to January 2019 were collected for this retrospective analysis. Among them, 34 patients underwent open D2 radical gastrectomy were regarded as control group. The other 46 patients underwent laparoscopic D2 radical gastrectomy were considered as observation group. Both groups underwent 2/3 or more mid-segment gastrectomy with D2 regional lymphatic dissection. The operative time, intraoperative bleeding, postoperative ventilation time, length of stay (LOS) and perioperative complication rates were compared between the two groups. Peripheral blood was drawn before and after surgery to detect the inflammatory factors C-reactive protein (CRP), calcitoninogen (PCT), tumor necrosis factor-α (TNF-α), gastric function gastrin 17 (G-17), and pepsinogen (PG) I and II. Subsequently, patients were followed up for 3-year prognosis to document the survival of patients.

RESULTS

The operative time and LOS were shorter and intraoperative bleeding was lower in the observation group than those in the control group (P<0.05). There was no statistical difference in treatment costs and incidence of perioperative complications between the two groups (P>0.05). After surgery, CRP, PCT and TNF-α were elevated in both groups but were lower in the observation group than that in the control group (P<0.05). PG I was dramatically higher (P<0.05), while PG II and G-17 were lower (P<0.05) in both groups after treatment. Also, the posttreatment PG I and G-17 were higher (P<0.05) and PG II was lower (P<0.05) in the observation group than those in the control group. Prognostic follow-up revealed no statistical difference between groups in terms of the 1-year and 3-year overall survival (P>0.05).

CONCLUSION

Laparoscopic D2 radical surgery is more effective in the treatment of advanced GC in the elderly, because it can effectively suppress the postoperative inflammation and improve recovery of gastric function. Hence, it has a high clinical application value.

[Is dorsal vagal complex the key nucleus of acupuncture regulation of gastric function？]

Acupuncture has remarkable effects on treating functional gastrointestinal diseases, but its central mechanism is not clear. At present, the research has mainly focused on several central nuclei, such as the dorsal vagus complex (DVC), nucleus raphe magnus (NRM), locus coeruleus (LC), subnucleus reticularis dorsalis (SRD), hypothalamic paraventricular nucleus (PVN), cerebellar fastigial nucleus (FN), central amygdala (CeA), etc. It is not clear whether the nuclei are involved in acupuncture regulation of gastric function through certain interrelation. A further summary of related literature indicates that many brain regions or nuclei in the central nervous system are closely related to gastric function, such as DVC, NRM, parabrachial nuclei (PBN), LC, periaqueductal gray (PAG), cerebellum, PVN, arcuate nucleus (Arc), hippocampus, CeA, etc. Most of these nuclei have certain fiber connections with each other, in which DVC is the basic center, and other nuclei are directly or indirectly involved in the regulation of gastric function through DVC. Is DVC the key target in acupuncture regulation of gastric function? Does other nuclei have direct or indirect neural circuit with DVC to participate in the regulation of gastric function by acupuncture, such as the possibility of CeA-DVC neural loop in acupuncture regulating gastric function. Therefore, more advanced techniques such as photogenetics, chemical genetics should be introduced and the central mechanism of acupuncture on regulating gastric function with DVC as center, from the view of nerve loop, will become the focus of further research, which could explain the central integration mechanism of acupoint compatibility by modern neuroscience technology.

Epstein-Barr Virus is Associated with Gastric Cancer Precursor: Atrophic Gastritis

Background: About 10% of gastric cancer (GC) has been described to be Epstein-Barr virus (EBV) positive. Previous researches have described the association between EBV and GC. However, the association of EBV with atrophic gastritis (AG) is underrecognized. Our study aimed to investigate the relationship between EBV and AG and assess the influence of EBV on gastric function. Methods: A total of 468 pathologically-confirmed chronic gastritis patients underwent circulating EBV DNA test, include 271 non-atrophic gastritis (NAG) and 197 AG patients. Results: In this study, H. pylori infection rate was 33.3%, EBV infection rate was 40%, and co-infection rate was 15%. The EBV DNA-positive was significantly associated with AG (P=0.031, OR= 1.509, 95% CI 1.037-2.194), especially in H. pylori-negative subjects (P=0.044, OR=1.619, 95% CI 1.012-2.589). EBV DNA-positive patients had a lower pepsinogen I (PG I) / pepsinogen II (PG II) ratio (PGR) than EBV DNA-negative patients (P=0.0026), especially in the AG subgroup (P=0.0062). There was no significant association between EBV and H. pylori co-infection with increased risk of AG (P>0.05). Conclusion: EBV infection significantly increased the risk of AG, especially in H. pylori-negative patients. The circulating EBV DNA had a potential in predicting the risk of atrophic gastritis.