Background: In the treatment of early gastric cancer, patients suitable for endoscopic submucosal dissection (ESD) are selected on the basis of endoscopic findings and biopsy results, while the final diagnosis is confirmed by examination of the resected specimen. Aim: To examine the discrepancies between clinical and pathological findings before and after ESD. Materials and Methods: We retrospectively identified 335 lesions treated by ESD for early gastric cancer at the National Cancer Center between 2020 and 2025, compared the endoscopic, biopsy and pathological findings, and identified the factors associated with discrepancy. Result: At least one of the three pre-treatment parameters was discordant in 175 lesions (52.2%). Of the 249 lesions judged to be ulcer-free on endoscopy, 51 (20.5%) were ulcerated histologically, while 28 lesions were overestimated (P<0.05). Underestimation of ulceration was more likely in lesions located in the upper or middle third of the stomach (OR 2.17, 95% CI 1.22–3.99) and in lesions measuring ≥20 mm (OR 1.68, 95% CI 1.00–2.84). Of the 110 lesions diagnosed as high-grade dysplasia on biopsy, 36 (32.7%) contained adenocarcinoma in the resected specimen, one of which was of undifferentiated type. Of the remaining 18 undifferentiated lesions, 6 (33.3%) had been diagnosed as differentiated type before treatment. Submucosal and lymphovascular invasion were associated with a tumor size of ≥20 mm (OR 3.58 and 3.15) and undifferentiated histology (OR 4.47 and 7.56); all P<0.01. Conclusion A significant discrepancy was observed between the pre- and post-ESD clinicopathological findings.

Background: Inflammatory bowel disease (IBD) is a chronic immune-related condition caused by interactions between genetics, immune dysfunction, gut microbiota changes, and environmental factors, often presenting as persistent or recurring diarrhea. Clinically, it commonly presents with chronic diarrhea and other gastrointestinal symptoms. The global prevalence of IBD is increasing, currently affecting approximately 0.5% of the population, with projections suggesting a rise to nearly 1% by 2030. Fecal calprotectin is a neutrophil-derived S100 calcium-binding protein that is elevated in intestinal mucosal inflammation and serves as a reliable noninvasive biomarker of inflammatory activity. Due to its high stability and close association with intestinal inflammatory activity, fecal calprotectin has been established as a dependable, non-invasive marker for identifying intestinal inflammation. In clinical practice, it is extensively used to distinguish IBD from functional gastrointestinal disorders, especially irritable bowel syndrome, among patients presenting with chronic diarrhea. However, its diagnostic utility in Mongolia remains underexplored, and this study aims to determine its sensitivity and specificity in inflammatory bowel disease and compare its diagnostic performance with other inflammatory markers. Aim: To determine the sensitivity and specificity of fecal calprotectin in inflammatory bowel disease and to compare it with other inflammatory markers. Materials and Methods: A total of 109 participants aged 18-87 years with chronic diarrhea, who attended the gastroenterology outpatient clinics of the Mongolia–Japan Hospital and Intermed Hospital between December 2024 and December 2025 and provided informed consent, were enrolled in this study. Data were collected using structured questionnaires, and laboratory investigations included complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and measurement of fecal calprotectin levels from stool samples. Based on fecal calprotectin results, selected participants underwent colonoscopic examination as clinically indicated. Results: Among the 109 participants included in the study, 17.4% were diagnosed with inflammatory bowel disease (IBD), with a mean age of 47.41±15.52 years. Fecal calprotectin levels were significantly higher in the IBD group compared to the control group (p<0.001). Fecal calprotectin demonstrated a weak positive correlation with C-reactive protein (CRP) and leukocyte count (p=0.042, p=0.06), while no significant correlation was observed with erythrocyte sedimentation rate (ESR). At a cutoff value of 250 µg/g, fecal calprotectin showed a sensitivity of 94.4%, specificity of 69.2%, positive predictive value (PPV) of 37.8%, and negative predictive value (NPV) of 98.4%. Receiver operating characteristic (ROC) curve analysis identified an optimal cutoff value of approximately 400 µg/g (AUC=0.919, Youden index=0.724), at which the sensitivity remained 94.4% and specificity increased to 78.0%. In contrast, CRP and ESR demonstrated comparatively lower diagnostic performance, with AUC values of 0.640 and 0.644, respectively. Conclusion This study demonstrates that fecal calprotectin has superior diagnostic performance compared to conventional inflammatory markers in differentiating inflammatory bowel disease (IBD). An optimal cutoff value of approximately 400 µg/g yielded the highest sensitivity and specificity. Therefore, fecal calprotectin may serve as a valuable tool in clinical practice for both screening and diagnostic confirmation.

Background: In contemporary clinical practice, gastroesophageal reflux disease (GERD) is classified into four phenotypes based on upper gastrointestinal endoscopy and 24-hour multichannel intraluminal impedance-pH monitoring: erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH). Although the prevalence of GERD in Mongolia is high, and certain chronophysiological aspects have been investigated, there remains a significant lack of data regarding GERD phenotypic classification and physiological diagnostic evaluation using impedance-pH monitoring. This knowledge gap provided the rationale for conducting the present study. Aim: To determine the prevalence of GERD phenotypes among adults presenting with heartburn symptoms and to compare selected manometric and pH-impedance parameters among phenotype groups. Materials and Methods: This study analyzed data from 347 adults who presented to Intermed Hospital between 2022 and 2025 with heartburn symptoms and underwent 24-hour multichannel intraluminal impedance-pH monitoring. Statistical analysis was performed using SPSS version 26. Results: Among the study population, 193 patients (55.6%) were diagnosed with ERD, 34 (9.8%) with NERD, 73 (21.0%) with RH, and 47 (13.5%) with FH. Significant differences were observed among the groups in body mass index (BMI), esophageal acid exposure, total reflux episodes, reflux characteristics, and mean nocturnal baseline impedance (MNBI). Type III esophagogastric junction morphology was identified in 78.76% of the ERD group, 64.7% of the NERD group, 56.2% of the RH group, and 42.6% of the FH group, demonstrating statistically significant intergroup differences. Conclusion ERD was the predominant GERD phenotype among adults with heartburn symptoms, followed by RH, FH, and NERD. Significant differences among GERD phenotypes were observed in BMI, total reflux burden, reflux characteristics, esophageal nocturnal baseline impedance, and esophagogastric junction morphology.

Background: Liver fibrosis is the underlying pathology of chronic liver disease complications, including cirrhosis and hepatocellular carcinoma, and its early detection is essential for preventing mortality and disease progression. Liver biopsy remains the gold standard for diagnosing fibrosis; however, it is invasive, costly, limited in repeatability, and not suitable for population-level screening. Moreover, liver fibrosis is often asymptomatic for a prolonged period, necessitating reliable and accessible methods for early identification of at-risk populations. Therefore, non-invasive approaches based on routine laboratory parameters, particularly the FIB-4 index, have been widely adopted in clinical practice. Aim: To assess liver fibrosis using the FIB-4 index and to identify risk factors associated with indeterminate and high-risk groups among individuals participating in a national early detection program in Mongolia. Materials and Methods: A total of 37,961 adults who met the inclusion and exclusion criteria were selected from 447,409 individuals who participated in the national early detection screening program between 2022 and 2023. The FIB-4 index was calculated using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, and categorized as low (<1.3), indeterminate (1.3–2.67), and high (≥2.67) risk. Body mass index, blood pressure, fasting glucose, triglycerides, and viral hepatitis status were classified according to standard criteria. Statistical analyses were performed using SPSS version 21.0. Continuous variables were expressed as mean±standard deviation, categorical variables were compared using the χ² test, and logistic regression analysis was used to identify risk factors. Results: The mean age of participants was 44.96±11.31 years, with 61.3% (n=23,285) female and 38.7% (n=14,676) male. The mean FIB-4 index was 0.89±1.09. Based on FIB-4, 86.9% were classified as low risk, 11.8% as indeterminate risk, and 1.4% as high risk; overall, 13.1% (n=4,975) were in the indeterminate and high-risk groups. FIB-4 risk increased progressively with age, reaching the highest level in individuals aged ≥60 years. In multivariable logistic regression analysis, male sex (OR=1.45; 95% CI: 1.36–1.56), viral hepatitis (OR=1.85; 95% CI: 1.68–2.03), and increasing age remained independently associated with indeterminate and high risk. Underweight status and very high triglyceride levels were associated with increased risk, whereas overweight, obesity, and central obesity showed an inverse association. Conclusions 1. The FIB-4 index is a simple, cost-effective tool for identifying individuals at risk of liver fibrosis in primary healthcare settings. Male sex, older age, and viral hepatitis were independent risk factors for indeterminate and high-risk groups. 2. Therefore, the FIB-4 index can be implemented as an initial risk stratification tool in national screening programs to identify high-risk populations for further evaluation and management.

Background: Academician Ragchaa B made a profound contribution to the foundation and development of internal medicine in Mongolia. He was among the first graduates of the Faculty of Medicine at the National University of Mongolia, becoming the country’s first internal medicine physician, educator, and researcher in the field of internal pathology. Ragchaa B achieved numerous pioneering roles, including being, the first Mongolian head of the Department of Internal Medicine, and the first professor in this specialty. His extensive contributions helped establish and advance internal medicine and medical education in Mongolia. Aim: The aim of this study is to analyze the scholarly works of Academician Ragchaa Byambajav to explore and disseminate his valuable contributions to the foundation and development of the science of “Internal Medicine Diagnostics” and hepatology Materials and Methods: This study utilized a documentary research method to analyze the contributions of the distinguished scholar, Academician Ragchaa B. The research involved a comprehensive review of his published books, textbooks, scientific articles, presentations, and archival materials. Additionally, the study examined references to Ragchaa B in books, newspapers, and collected written and oral recollections from his former students across different generations. Through systematic analysis of these sources, the study aimed to provide an in-depth understanding of his academic and professional legacy. Results: Academician Ragchaa B, during his teaching career, graduated approximately 4,000 medical professionals and produced a total of 156 scholarly works. Drawing from his vast knowledge, skills, and experience, he became renowned for writing the textbooks “Clinical Aspects of Botkin’s Disease” (1969) and “Diagnosis of Internal Diseases” (1970), earning recognition as the first scholar to author a Mongolian medical textbook. In 1977, Professor Ragchaa B consolidated his research on liver diseases and authored the monograph “Clinical Aspects of Botkin’s Disease,” which led to him earning the Doctor of Medical Sciences (Sc.D.) degree. Conclusion 1. Academician Ragchaa Byambajav was a distinguished scholar who made significant contributions to the science of internal medicine diagnostics. He served as the first Mongolian head of the “Department of Internal Medicine Diagnostics” in 1953, teaching for over 50 years and acting as a consultant in internal medicine for more than 40 years. 2. He directed research on viral hepatitis and authored the monograph “Clinical Aspects of Botkin’s Disease”, which led to his achievement of a Doctor of Medical Sciences degree in 1977. This accomplishment established him as the first specialized researcher and educator in hepatology in Mongolia.

Background: Small intestinal bacterial overgrowth (SIBO) is characterized by symptoms such as malabsorption, nutrient deficiencies, bloating, and abdominal pain. It can occur independently or in association with other gastrointestinal disorders. This study aims to determine the prevalence of SIBO in patients with digestive complaints, evaluate diagnostic outcomes, and analyze the composition and types of pathogenic bacteria present in the small intestine. Materials and Methods: A single-center, cross-sectional study was conducted at the Mongolian-Japanese Hospital, enrolling a total of 46 participants. SIBO was diagnosed using the hydrogen breath test (H₂BT) with lactulose/glucose as substrates. Among the 27 diagnosed cases, 5 patients were randomly selected for microbiological analysis of small intestinal contents. Results: SIBO was detected in 58.7% of the study participants. Among the 5 patients who underwent microbiological analysis, 80% (4/5) tested positive for pathogenic bacteria. The identified pathogens included: Gram-positive bacteria: Staphylococcus aureus (S. aureus); Gram-negative bacteria: Klebsiella pneumoniae (K. pneumoniae); Antibiotic-resistant bacteria: Methicillin-resistant Staphylococcus aureus (MRSA); Fungi: Candida albicans (C. albicans). The remaining 20% (1/5) had a baseline H₂BT value exceeding twice the standard threshold despite no detected pathogens. Conclusion SIBO is highly prevalent among patients with digestive complaints and may be associated not only with bacterial infections but also fungal overgrowth. Therefore, a multidisciplinary treatment approach, including antibiotics, dietary modifications, probiotics, and antifungal therapy, is necessary. While the hydrogen breath test is an effective diagnostic tool for SIBO, standardization of diagnostic protocols is required for improved accuracy.

Introduction: Determining stages of liver fibrosis in chronic liver disease is essential for clinical practice such as decision making on medical treatment, setting the interval of follow-up examination for its complication, screening intervals for hepatocellular carcinoma. Goal: We compared non-invasive fibrosis markers among the patients with chronic hepatitis Delta. Materials and Methods: Totally 70 patients with chronic hepatitis D enrolled into this study. The blood samples were examined for complete blood count, liver function test and serum M2BPGi level. Non-invasive markers such as AAR, APRI, Fib-4 scores were calculated. Those with AAR >1, APRI >0.7, FIB-4 >1.45 were considered with advanced fibrosis. All patients underwent liver stiffness measurement using FibroScan M2 probe. The cutoff values of FibroScan for advanced fibrosis were 9 kPa for patient with normal transaminase level and 11 kPa for patients with elevated transaminase. Results: Advanced fibrosis was observed in 25.7%, 38.6% and 38.6% by AAR, APRI and Fib-4 score, respectively. When cut-off levels of serum M2BPGi for advanced fibrosis was 2.2 COI, 35.7% had advanced fibrosis. FibroScan tests showed 34.4% had advanced fibrosis. The AUROC of M2BPGi were 0.894 and 0.827 for predicting advanced fibrosis and liver cirrhosis. Conclusion Serum M2BPGi and FibroScan would be reliable diagnostic tool for identifying liver fibrosis in Mongolian patients with chronic hepatitis D.

Background: The intestinal microbiota of Mongolians and its composition is of great interest of researchers, a few studies have did in this fields. Maybe Mongolian encompass a uniquely wide range of environmental conditions, ethno geographical cohorts and traditional nomadic lifestyles. Goal: We aimed to determine the amount of gut microbiota, including Lactobacillus and Bifidobacterium in the fecal samples of relative healthy Mongolian adults residing in various regions of Mongolia by conventional culture method and PCR. Material and Methods: The study was performed population based cross sectional study in healthy volunteers. In this study, 256 relative healthy Mongolian adults with no history of gastrointestinal associated diseases were enrolled between July 2018 and April 2019. Each participants was asked to complete a questionnaire containing 164 questions about demographics, physical activity, dietary habits. Fecal samples were collected for Lactobacillus and Bifidobacterium analysis using culture method and determination of genus of Bifidobacterium sрp and Lactobacillus spp by PCR. ResultsParticipants had a mean age of 38.9±12.8 years. The mean values of Lactobacillus by culture method were 5.9±1.28 and 6.24±0.94 log10 CFU/ml (4.67х106 , 4.66х106 CFU/ml), respectively. The abundance of Lactobacillus had a positive correlation with grams for fiber and amount of bifidobacterium ((r= 0.495, р<0.001, r=0.288, p<0.05), respectively). Significant difference were observed between groups of milk frequency per day for amounts of lactobacillus. In adult intestinal tracts, B.Bifidum was the most common taxon 31 (29%) followed by B. angulatum 14 (13.1%), B. adolescentis 10 (9.3%), B. catenulatum group 10 (9.3%), B. longum 9 (8.4%). B. lactis, B. breve, B. dentium and B. gallicum were subdominant species. Conclusion: The mean amount of Bifidobacterium and Lactobacillus of all participants were 6.24±0.94 and 5.9±1.28 log10 CFU/ml (4.66*106 , 4.67*106 CFU/ml) respectively. The Lactobacillus abundance of healthy adults was higher in region of Khangai, East and West of Mongolian than other regions. The composition of lactobacillus altered with ageing. Significant correlations were found between fiber, fats, potato and amount of Lactobacillus. Keywords: Bifidobacterium, Colony forming unit, Gut microbiota, Lactobacillus

BACKGROUND. The 84.4 percent of newly diagnosed patients with diabetes have obesity in Mongolia. Nowadays, prevalence of obesity has increased steadily in Mongolia. Diabetic patients with viral hepatitis has high risk of having liver cirrhosis. Therefore, screening of fatty liver and liver fibrosis in diabetic patients is more important. The main diagnosing method of fatty liver and liver fibrosis is liver biopsy and histology but so far, we are able to detect viral infection using viral marker and determine fibrosis stage of NAFLD in patients who has diabetes mellitus type 2. Using noninvasive method determining liver fibrosis involve many researches to reveal new biomarkers and technics to find out liver fibrosis. Japanese researchers has found The Wisteria floribunda agglutinin- positive human Mac-2-binding protein (WFA+-M2BP) was recently shown to be a liver fibrosis glycobiomarker with a unique fibrosis-related glycoalteration.This biomarker helps to determine liver fibrosis stage in fatty liver disease and viral hepatitis. There is no research to reveal viral infection, fatty liver and liver fibrosis in diabetic patients in Mongolia, so far. So it is necessary to study revealing viral infection, fatty liver disease and to determine stages of fibrosis using WFA+-M2BP to screen liver fibrosis in diabetic patients. OBJECTIVE. To identify viral infection, HCV/HBV in patients with diabetes and to compare liver function and diabetes control for diabetic patients with liver disease. METHODS. We collect data from 25thNovember, 2015 to October of 2016. We got permission of research from the patients by handwriting signature who diagnosed Diabetes mellitus in National University Hospital. Haemotology, biochemistry test, coagulogramm, immunology test are evaluated in 415 patients in clinical laboratory of National university hospital. By the objective, the diabetes patients with viral hepatitis will attend to second step of research. We used HISCL 5000 apparatus of Sysmex Japan to do immunology tests. Also we use SPSS 19.0 and EXCEL program. RESULT. There were 294 patients and by WHO classification of ages 20-29 aged patient (n=4), 30-39 aged(n=19), 40-49 aged(n=65), 50-59 aged(n=126), 60-70 aged(n=48), over 70 aged(n=14)or 53.24±9.43. 146 patients are male,148 patients are female.By BMI 29.9±1.14.By blood test, thrombocytes counted 256.6±11.7;in coagulogramm the prothrombin time was 111.7±31.4; in biochemistry test total bilirubin 16.46±10.6; AP 364.7±192.3;AST 35.7±45.7; ALT 42.8±45.5; GGT 86.53±123.4;albumin 42.06±23.95;total cholesterol 6.04±2.47;triglyceride 5.72±34.5;HbA1c 8.83±5.92; in immunology testsanti-HCV 29.37±18.87 (n=58); HBsAg 590.134±1013.7 (n=23); M2BP (COI) counted 2.24±2.19. CONCLUSION. There were 58 diabetic patients with C viral infection and 23 diabetic patients with B viral infection. By WFA+-M2BP glycobiomarker, we found that diabetic patients with viral hepatitis has more liver fibrosis.

BACKGROUND Helicobacter pylori (H.pylori), the main cause of gastric and duodenal ulcer, is considered as a type 1 carcinogen. The primary prevention of gastric cancer is eradicating chronic H.pylori infection. However, the antimicrobial eradication rates are decreasing as low as 80% in some countries, less than 70% in Europe and are inversely correlated with antibiotic resistance rates reported worldwide. The current international guidelines recommended several regimens with higher success rate including sequential, combined, bismuth-containing and resistance-guided treatment and states that the local susceptibility testing in H.pylori should be studied. The research data that is covering correlation between H.pylori associated gastric changes and precancerous diseases, evaluation of H.pylori eradication rate are sparse in Mongolia. METHODS Totally, 495 eligible candidates were enrolled into this study. 225 patients who visited to endoscopy unit, received gastroscopy with multiple biopsies for rapid urease test, histology and H.pylori culturing. Out of these, 131 (52.2%) patients were positive for H.pylori infection. These were further tested for antibiotic resistance. 76 patients were treated with targeted therapy based on antibiotic resistance testing. Another 270 eligible patients with confirmed H.pylori associated gastritis were randomized into the following 1st line therapy regimen groups clarithromycin-based triple therapy (CBTT, n=90); bismuth-based quadruple therapy (BBQT, n=90) and sequential therapy (ST, n=90). In 43 patients that were not responded to 1st line therapy, levofloxacin-based triple therapy (LBTT) was prescribed as a second line treatment. Eradication rates were assessed using H.pylori stool antigen test 28 days of therapy just subsequent to termination of treatment. RESULTS During the gastroscopy, presence of active gastritis, nodular change and atrophy were 32.9%, 12% and 52.9% respectively. Epigastric pain was reported in 73.3%, 62.2%, 60-80% and 41.3% of patients with normal mucosa, nodular change, stomach and duodenal ulcer and antral atrophy (p<0.05). Abdominal fullness was more common among patients with extensive gastric atrophy (69.2%, p<0.05). In <40 age group gastritis was predominantly in the prepylori, while in the >50 age group it was predominantly the corpus region. H.pylori resistance rates to amoxicillin, clarithromycin, metronidazole and more than 2 antibiotics were 8.4%, 37.4%, 74% and 30.5%. On ITT analysis, eradication rates of 1st line H.pylori targeted treatment, CBTT, BBQT and ST were 92.1%, 71.1%, 87.8% and 67.8% (p<0.0001); on PP analysis, that were 94.6%, 72.7%, 89.8% and 68.5% (p<0.0001) respectively. Eradication rates of 2nd line treatment LBTT were 55.8% and 60% by ITT and PP analysis. Higher side-effects were reported during the second line treatment. CONCLUSION H.pylori infection rate was high among the dyspeptic patients resulting chronic gastritis and atrophic change. H.pylori resistance rate to metronidazole and clarithromycin was high. Among 1st line therapies; the eradication rates of CBTT and ST were poor, while BBQT and Targeted therapy had a higher success rate. 2nd line therapy showed higher failure rate.