It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Biopsy ; Female ; Follow-Up Studies ; Gastric Mucosa/*pathology ; Gastritis/diagnosis/etiology/microbiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/pathology ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies

OBJECTIVETo assess the efficacy and safety of Moluodan () in treating dysplasia in chronic atrophic gastritis (CAG) patients.

METHODSThis was a multi-centered, double-blind, randomized controlled trial. The total of 196 subjects were assigned to receive either Moluodan or folic acid in a 2:1 ratio by blocked randomization. Mucosa marking targeting biopsy (MTB) was used to insure the accuracy and consistency between baseline and after 6-month treatment. Primary outcomes were histological score, response rate of pathological lesions and dysplasia disappearance rate. Secondary endpoints included gastroscopic findings, clinical symptom and patient reported outcome (PRO) instrument.

RESULTSDysplasia score decreased in Moluodan group (P =0.002), significance was found between groups (P =0.045). Dysplasia disappearance rates were 24.6% and 15.2% in Moluodan and folic acid groups respectively, no significant differences were found (P =0.127). The response rate of atrophy and intestinal metaplasia were 34.6% and 23.0% in Moluodan group, 24.3% and 13.6% in folic acid group. Moluodan could improve erythema (P =0.044), and bile reflux (P =0.059), no significance between groups. Moluodan was better than folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite (P <0.05), with symptom disappearance rates of 37% to 83%.

CONCLUSIONSMoluodan improved dysplasia score in histopathology, and erythema and bile reflux score in endoscopy, and superior to folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite. [ChiCTR-TRC-00000169].

Chronic Disease ; Double-Blind Method ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; therapeutic use ; Female ; Gastritis, Atrophic ; drug therapy ; microbiology ; pathology ; Gastroscopy ; Helicobacter pylori ; drug effects ; Humans ; Male ; Middle Aged ; Treatment Outcome

Eosinophilic gastroenteritis (EGE) is a disorder characterized by eosinophilic infiltration of the bowel wall and various gastrointestinal (GI) manifestations. This study aimed to evaluate the characteristics of EGE in infants and children. A total of 22 patients were diagnosed with histologic EGE (hEGE) or possible EGE (pEGE). Serum specific IgE levels, peripheral eosinophil counts, and endoscopic biopsies were carried out. In the hEGE group (n = 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. All patients in the infant group showed clinical improvement after switching from cow's milk feeding to special formula or breast feeding. The infant group showed a higher eosinophil count in the gastric mucosal biopsy than the child group. In the pEGE group (n = 9) initial symptoms included hematemesis, abdominal pain, and vomiting. Seven patients in this group showed a good response to treatment with restriction of the suspected foods and/or the administration of ketotifen. Both hEGE and pEGE groups showed clinical improvement after restriction of suspected foods in the majority of cases and also showed a similar clinical course. EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly.
Child ; Child, Preschool ; Diagnosis, Differential ; Disease Progression ; Endoscopy, Gastrointestinal/*methods ; Enteritis/*pathology/*therapy ; Eosinophilia/*pathology/*therapy ; Female ; Gastritis/*pathology/*therapy ; Humans ; Infant ; Infant, Newborn ; Intestinal Mucosa/*pathology ; Male ; Republic of Korea ; Treatment Outcome

Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.
Alkylating Agents/therapeutic use ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Clarithromycin/therapeutic use ; *Communicable Disease Control ; Cytochrome P-450 CYP3A Inhibitors/therapeutic use ; *Disease Eradication ; *Drug Resistance, Bacterial ; Drug Therapy, Combination ; Gastritis/microbiology/pathology ; Helicobacter Infections/*drug therapy ; Helicobacter pylori ; Humans ; Metronidazole/therapeutic use ; Proton Pump Inhibitors/*therapeutic use ; Republic of Korea ; Tinidazole/therapeutic use

BACKGROUNDHelicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years.

METHODSFrom an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group (T; n = 276) or a placebo group (P; n = 276). In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination.

RESULTSGastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P = 0.176). When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group (n = 6) was much higher than that in the T group (n = 0, P = 0.013).

CONCLUSIONSHp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis. Hp eradication is helpful for reducing the risk for gastric cancer, especially in the early stage of Hp infection.

Adult ; Aged ; Amoxicillin ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Clarithromycin ; therapeutic use ; Double-Blind Method ; Female ; Follow-Up Studies ; Gastric Mucosa ; drug effects ; pathology ; Gastritis, Atrophic ; diagnosis ; drug therapy ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; pathogenicity ; Humans ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Stomach Neoplasms ; diagnosis ; prevention & control

Animals ; Anti-Bacterial Agents ; administration & dosage ; Escherichia coli ; Female ; Galactosylceramides ; immunology ; Gastric Mucosa ; pathology ; Gastritis, Atrophic ; pathology ; Helicobacter Infections ; complications ; drug therapy ; Helicobacter pylori ; pathogenicity ; Humans ; Inflammation ; pathology ; Intestines ; microbiology ; Levofloxacin ; Lymphocyte Activation ; Male ; Natural Killer T-Cells ; microbiology ; Ofloxacin ; administration & dosage ; Sphingomonas ; Stomach ; pathology

Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment.
Anti-Bacterial Agents/therapeutic use ; Clarithromycin/*therapeutic use ; Enteritis/*drug therapy/immunology/pathology ; Eosinophilia/*drug therapy/immunology/pathology ; Gastritis/*drug therapy/immunology/pathology ; Humans ; Immunologic Factors/therapeutic use ; Male ; Middle Aged ; Prednisolone/administration & dosage

Menetrier's disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier's disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier's disease showing mucus bridge by excessive mucus observed during the endoscopy.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Clarithromycin/therapeutic use ; Drug Therapy, Combination ; Gastric Mucosa/*pathology/secretion ; Gastritis, Hypertrophic/*diagnosis/pathology ; Gastroscopy ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Mucus/secretion ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Adult ; Ascites ; diagnosis ; etiology ; Biopsy ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; Endoscopy, Gastrointestinal ; Enteritis ; complications ; drug therapy ; Eosinophilia ; complications ; drug therapy ; Gastritis ; complications ; drug therapy ; Humans ; Intestinal Mucosa ; pathology ; Male ; Tomography, X-Ray Computed

OBJECTIVETo study the therapeutic effect of Weiyan serial recipes (WYSR) in treatment of chronic atrophic gastritis (CAG) accompanied with intestinal metaplasia (IM) and/or dysplasia (Dys) and to explore its molecular mechanisms for reversing the gastric precancerous lesions.

METHODSOne hundred and fifty patients with confirmed diagnosis of CAG accompanied with IM and/or mild Dys were randomly assigned to the treatment group (120 cases) and the control group (30 cases). Patients in the treatment group were respectively treated with WYSR I-IV according to Chinese medicine syndrome typing as incoordination of Gan and Wei syndrome (32 cases), deficiency of Pi and Wei syndrome (35 cases), insufficient Wei-yin syndrome (28 cases), and stasis stagnation in Wei-channel syndrome (25 cases). Patients in the control group orally took Weifuchun Pill. The therapeutic course for all was 3 months, and totally 2 courses. The clinical effects, changes under the gastroscope, the pathological changes, and expressions of gastric mucosal hypoxia-inducible factor-1alpha(HIF-1alpha), vascular endothelial growth factor (VEGF) protein were compared between the two groups before and after treatment.

RESULTSThe total effective rate of the treatment group was 86.7% and the total effective rate of the gastroscopic changes was 78.3%, which was higher than those of the control group (56.7% and 40.0%), showing significant difference (P < 0.01, P < 0.05). The total effective rate of clinical symptoms and that of the pathological changes were higher in the treatment group than in the control group with statistical significance shown (P < 0.05). There was no statistical difference in the expressions of HIF-1alpha and VEGF protein of the control group between before and after treatment (P > 0.05). Compared with before treatment, the post-treatment expressions of HIF-1alpha and VEGF protein both obviously decreased in the treatment group (P < 0.01), and were lower than those in the control group (P < 0.05).

CONCLUSIONSWYSR showed better effects on treating gastric precancerous lesions. It could significantly improve the atrophy, IM, and Dys, and promote the reversal of gastric precancerous lesions. Its mechanisms might possibly be correlated with inhibiting the over-expressions of HIF-1alpha and VEGF protein.

Adult ; Aged ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastritis, Atrophic ; drug therapy ; metabolism ; pathology ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Middle Aged ; Phytotherapy ; Precancerous Conditions ; drug therapy ; metabolism ; pathology ; Stomach Neoplasms ; prevention & control ; Vascular Endothelial Growth Factor A ; metabolism ; Young Adult