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Background Methods Key Results Conclusion and Inferences Impaired gastric accommodation is one of the most frequent symptoms of functional dyspepsia. The safety and efficacy of conventional treatments remain to be proven and alternative herbal therapies have been proposed to alleviate gastrointestinal symptoms. This preclinical study examined the role of herbal Amara extract (containing Artemisia absinthium, Centaurium erythraea, Cichorium intybus, Gentiana lutea, Juniperus communis, Achillea millefolium, Peucedanum ostruthium, Salvia officinalis, and Taraxacum extracts) on gastric (fundus) accommodation and the possible implication of muscarinic receptors in its regulation.The effect of Amara extract on fundus motility was investigated in organ baths of smooth muscle strips isolated from the fundus of guinea pigs, and the role of the muscarinic receptor pathway was evaluated using functional and radioligand binding assays in cell lines expressing the M2 or M3 muscarinic receptor.Amara extract inhibited carbachol‐induced contraction of guinea pig smooth muscle strips in a dose‐dependent manner. This relaxant effect was not affected by the M3 antagonist J‐104129. Amara extract also inhibited M2, but not M3, receptor activity in CHO‐K1 cells (IC50 219 μg mL−1), and specifically bound the M2 receptor (IC50 294 μg mL−1). Of the nine herbal components of Amara extract, Juniperus communis, P. ostruthium, and Salvia officinalis inhibited M2 receptor activity (IC50 32.0, 20.8, and 20.1 μg mL−1, respectively), and P. ostruthium was sufficient to reverse carbachol‐induced ex vivo contraction of guinea pig fundic smooth muscles.Amara extract relaxes gastric smooth muscles by inhibiting the M2 muscarinic receptor. This study suggests the potential benefit of Amara extract for patients with impaired gastric accommodation. [ABSTRACT FROM AUTHOR]

Abstract Background To compare the difference of postoperative anastomotic leakage (AL) rate between neoadjuvant chemoradiotherapy (NCRT) with pembrolizumab and NCRT group, and investigate the risk factors of developing AL for locally advanced esophageal squamous cell cancer (ESCC). Materials and methods The GF was contoured on the pretreatment planning computed tomography and dosimetric parameters were retrospectively calculated. Univariate and multivariate logistic regression analysis was performed to determine the independent risk predictors for the entire cohort. A nomogram risk prediction model for postoperative AL was established. Results A total of 160 ESCC patients were included for analysis. Of them, 112 were treated with NCRT with pembrolizumab and 44 patients with NCRT. Seventeen (10.6%) patients experienced postoperative AL with a rate of 10.7% (12/112) in NCRT with pembrolizumab and 11.4% (5/44) in NCRT group. For the entire cohort, mean, D50, Dmax, V5, V10 and V20 GF dose were statistically higher in those with AL (all p

Background: To compare the difference of postoperative anastomotic leakage (AL) rate between neoadjuvant chemoradiotherapy (NCRT) with pembrolizumab and NCRT group, and investigate the risk factors of developing AL for locally advanced esophageal squamous cell cancer (ESCC). Materials and methods: The GF was contoured on the pretreatment planning computed tomography and dosimetric parameters were retrospectively calculated. Univariate and multivariate logistic regression analysis was performed to determine the independent risk predictors for the entire cohort. A nomogram risk prediction model for postoperative AL was established. Results: A total of 160 ESCC patients were included for analysis. Of them, 112 were treated with NCRT with pembrolizumab and 44 patients with NCRT. Seventeen (10.6%) patients experienced postoperative AL with a rate of 10.7% (12/112) in NCRT with pembrolizumab and 11.4% (5/44) in NCRT group. For the entire cohort, mean, D50, Dmax, V5, V10 and V20 GF dose were statistically higher in those with AL (all p < 0.05). Multivariate logistic regression analysis indicated that tumor length (p = 0.012), volume of GF (p = 0.003) and mean dose of GF (p = 0.007) were independently predictors for postoperative AL. Using receiver operating characteristics analysis, the mean dose limit on the GF was defined as 14 Gy. Conclusion: Based on our prospective database, no significant difference of developing AL were observed between NCRT with pembrolizumab and NCRT group. We established an individualized nomograms based on mean GF dose combined with clinical indicators to predict AL in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background and Aim: Since the first report of gastric adenocarcinoma of the fundic‐gland type in 2010, the clinicopathological characteristics of gastric neoplasm of the fundic‐gland type (GNFG) have become clearer; however, their risk factors remain unclear. This exploratory study aimed to identify the risk factors for GNFG. Methods: We conducted a single‐center, retrospective, matched case–control study using medical information recorded at our health management center from January 2014 to July 2023. During this period, 39 240 people underwent upper gastrointestinal endoscopy. GNFG were extracted as cases and matched to controls, according to age and sex, in a 1:8 ratio, excluding those with a history of gastrointestinal surgery and those with a history or comorbidity of cancer. Univariate analysis was used to compare patient background and endoscopic findings. Multivariable analysis was performed, adjusting for factors with P values < 0.1 and antacid use. Results: A total of 20 GNFG cases and 160 matched healthy controls were included. In the univariate analysis, only reflux esophagitis was significantly more common in GNFG (40.0% vs 18.1%; P = 0.036). Factors antacids and duodenitis had P values < 0.1. Logistic regression analysis was performed, adjusting for antacids, reflux esophagitis, and duodenitis. Antacids and reflux esophagitis were the independent risk factors for GNFG (odds ratio = 3.68 [95% confidence interval: 1.04–11.91] and 3.25 [95% confidence interval: 1.11–9.35]). Conclusions: Although the sample of patients with GNFG was small, antacids and reflux esophagitis were identified as a risk factor. The pathogenesis of antacids and reflux esophagitis may be involved in the development of GNFG. [ABSTRACT FROM AUTHOR]

Curcuma aeruginosa (CA) rhizomes are used in traditional medicine as gastrointestinal remedies, postpartum care and uterine issues. However, its effects on gastrointestinal motility have not yet been explored. Extracts of CA rhizomes prepared using chloroform, methanol and water were evaluated for their effects on gastrointestinal contractions using isolated rat gastric fundus and ileum. Varied solvents aim for extraction of different compounds of CA rhizome. In the ileum, the 3 extracts did not significantly affect spontaneous contractions, but significantly reduced contractions induced by acetylcholine (ACh, 0.3 μM) and KCl (40 mM) in a concentration-dependent manner. The order of potency, based on ACh-induced contraction, was chloroform > methanol > water extracts, with respective IC50 values of 0.025 ± 0.001, 0.46 ± 0.02 and 2.57 ± 0.47 mg/mL. Similar potency order against KCl-induced contraction was observed, with IC50 values of 0.011 ± 0.002, 0.47 ± 0.06 and 1.18 ± 0.18 mg/mL, respectively. In the isolated gastric fundus model, both methanol and water extracts resulted in an increase in the force of contraction in the absence of stimulation. However, when ACh (0.3 μM) was introduced, the methanol and water extracts exhibited a concentration-dependent reduction in contractions, with IC50 values of 0.62 ± 0.06 and 2.30 ± 0.32 mg/mL, respectively. As for KCl (40 mM)-induced contraction, only the highest concentration of the water extract (3.75 mg/mL) significantly decreased the contraction by 41.29 ± 2.94 %. CA extract demonstrated relaxant effects on both isolated rat gastric fundus and ileal contractions induced by ACh and KCl. These findings support the use of CA in traditional medicine as a gastrointestinal remedy. These extracts have the potential to be used as antispasmodics and to treat infectious and non-infectious diarrhea, the latter of which occurs in functional gastrointestinal diseases. It might also be useful as a gastroprokinetic. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a clinical condition of the gastrointestinal tract that has significant incidence in childhood. Major symptoms include abdominal pain, dyspepsia, delayed gastric emptying, anorexia, diarrhea and weight loss. IBD etiopathogenesis is multifactorial, with a proven involvement of cytokines. In this regard, cytokines like resistin and adiponectin produced by adipose tissue play a crucial role in inflammation. Particularly, resistin seems related to IBD severity and is considered a promising marker of disease occurrence and progression. Unraveling its mechanism of action and downstream effectors is mandatory when designing novel therapies. This preclinical study aims to further elucidate the action of resistin in causing functional gastrointestinal alterations, comparing it with the well-defined effect of adiponectin. To this end, we carried out electrophysiological analysis on murine gastric fundus. We found that resistin, similarly to adiponectin, increases smooth muscle cell (SMC) capacitance, indicative of cell surface remodeling, which is consistent with relaxation. However, contrary to adiponectin, resistin unalters membrane potential and inward Ca2+ entry and scarcely affects outward current, suggesting its inefficacy in markedly modifying electrical phenomena on the SMC membrane. This outcome, supporting the role of resistin in gastrointestinal distention, as observed in IBD, rules out a strikingly direct effect on SMCs. [ABSTRACT FROM AUTHOR]

Endoplasmic reticulum stress (ER stress) activates the unfolded protein response (UPR) as a defense mechanism for maintaining cellular vital activity. Data on interaction between pathways of UPR-sensors, their role and participation in the recovery of regulatory proteins at constant level are currently being accumulated. An experimental model of type 2 diabetes mellitus (T2DM) was reproduced in male rats fed on 3-month high-fat diet with additional streptozotocin administration. Rats in different groups were treated with metformin, propionate, and their combination for 2 weeks. We analyzed the expression of the GRP78, PERK, IRE-1, and ATF6 genes in gastric glandulocytes using PCR primers. The quantitation of protein content of the GRP78, PERK, IRE-1, and ATF6 genes was performed using western blotting. Statistical intergroup differences were calculated using a one-way ANOVA test followed by Tukey’s post-hoc. Comparison of mRNA and protein contents at rest state, in condition of ER stress and drug treatment, as well as the study of correlations between UPR-sensors, provides a basis for the development of the concept of defense mechanism activation in gastric glandulocytes under T2DM conditions. Under stress, chaperone GRP78 plays a crucial role to prevent protein misfolding: it dissociates from ER, enters cisternae and inactivates misfolded proteins. The ATF6 pathway is activated in all conditions. It probably activates transcription of the corresponding content turnover sites in both GRP78 and ATF6. The IRE-1 and PERK pathways are activated in glandulocytes under different circumstances, and they probably target to different regulatory actions. Combination drug treatment in T2DM conditions induces activation of all signaling sensors in the UPR system with simultaneous maximal downregulation of GRP78, causing a balance in the intracellular homeostasis system.

Background Helicobacter pylori is an important public health concern due to its status as a carcinogenic bacterium. Well adapted to the acidic environment of the human stomach, the variety of strains and virulence factors of the organism when interacting with the host immune system creates an individualistic response. Although estimates suggest that approximately half of the global population is infected with H pylori , the majority of infected persons remain asymptomatic while harboring an increased risk of intestinal metaplasia and gastric cancers. Therefore, appropriate diagnostic testing protocols are imperative. Methods This study compared labeling methodologies, including Wright stain, alcian yellow toluidine blue (AYTB), and immunohistochemistry (IHC) on formalin-fixed paraffin-embedded stomach resections from sleeve gastrectomy patients, to detect H pylori infection. Results Although all 3 labeling methods evidenced similar specificity in H pylori detection, the IHC method was significantly more sensitive. However, the IHC cost per test was approximately 5-fold higher than that of the Wright or AYTB stains, and the technical time required per test was at least 6-fold that of Wright or AYTB. Conclusion Despite the higher cost per test, IHC is the most sensitive and preferred method for determination of H pylori infection. [ABSTRACT FROM AUTHOR]

Purpose: Gastric cancer is one of the most common cancers in Korea, and the proportion of upper-third gastric cancers has been steadily increasing over the last two decades. This study aimed to evaluate the effect of tumor location on gastric cancer prognosis. Materials and Methods: We retrospectively reviewed 2,466 patients who underwent gastrectomy for pathologically proven gastric cancer between January 2011 and December 2016. The patients were divided into an upper-third group (U group; n=419, 17.0%) and a middle- and lower-third group (ML group; n=2,047, 83.0%). Clinicopathological characteristics, overall survival (OS), and recurrence-free survival (RFS) after surgery were compared. Results: The U group had more advanced disease than the ML group and a higher incidence of N3b disease for T3 (12.0% vs. 4.9%, p=0.023) and T4 tumors (33.3% vs. 17.5%, p=0.001). The 5-year RFS rate for stage III disease was marginally lower in the U group than that in the ML group (47.1% vs. 56.7%, p=0.082). The upper third location was an independent prognostic factor for both OS (hazard ratio [HR], 1.350; 95% confidence interval [CI], 1.065-1.711) and RFS (HR, 1.430; 95% CI, 1.080-1.823). Conclusions: Upper-third gastric cancer shows extensive node metastasis compared to those located more distally in ≥T3 tumors. The upper third location is an independent prognostic factor for both OS and RFS and may have an adverse impact on RFS, particularly in patients with stage III gastric cancer. [ABSTRACT FROM AUTHOR]

The article discusses the phenomenon of the cascade stomach, which is a fluoroscopic finding observed during the ingestion of oral contrast in an upright position. The cascade stomach occurs when the contrast fills the posterior fundus and then cascades into the gastric body and antrum. The etiology of this appearance has been attributed to various factors, including muscle spasm, displacement of organs, and abnormal motility. The clinical significance of the cascade stomach has evolved over time, with recent studies linking it to higher body mass index, upper gastrointestinal symptoms, and reflux esophagitis. For bariatric patients, the cascade stomach can complicate sleeve gastrectomy procedures. Treatment options for patients with symptoms related to the cascade stomach include sleeve resection or gastropexy with gastro-jejunostomy and jejuno-jejunostomy. [Extracted from the article]

Background: Alpinia officinarum, better known as Chinese ginger, is used for the treatment of gastrointestinal disorders in traditional Chinese and Ayurveda medicine. However, scientific evidence of an effect on gastrointestinal motility is missing. Purpose: This study aimed to estimate the effect of a phytopharmaceutical compound (PPC) based on Alpinia officinarum on gastric motility in vitro in order to assess its potential use in the treatment of functional dyspepsia. Study Design: We investigated to which extent the compound affects the activity of gastric smooth muscle and we identified involved mediating cellular mechanisms. Methods: Basal and stimulated muscle activity were recorded from muscle-myenteric plexus preparations from three different regions of the guinea pig stomach before and after incubation with different concentrations of the PPC in an organ bath setup. Effect-mediating mechanisms were investigated by pharmacology. Results: PPC exhibited a smooth muscle relaxation in a concentration-dependent manner. This was region- and muscle type specific as it was greater in fundus and corpus than in antrum and more pronounced in the circular than in the longitudinal muscle layer. The effect was primarily myogenic and at least partly mediated by TRPA1. Conclusion: The investigated PPC reduces basal tone particularly of fundus smooth muscle in a non-neuronal manner by inhibiting calcium influx via TRPA1, without affecting antral motility. Based on these data, Alpinia officinarum could be considered for phytopharmaceutical treatment of functional dyspepsia.

Background: Glycemic control, after metabolic surgery, is achieved in two stages, initially with neuroendocrine alterations and in the long-term with sustainable weight loss. The resection of the gastric fundus, as the major site of ghrelin production, is probably related with optimized glucose regulation. The aim of the present study is to investigate whether the modification of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with fundus resection offers superior glycemic control, compared to typical LRYGBP. Materials and Methods: Participants were 24 patients with body mass index (BMI) ≥40kg/m2 and type II diabetes mellitus (T2DM), who were randomly assigned to undergo LRYGBP and LRYGBP with fundus resection (LRYGBP+FR). Gastrointestinal (GI) hormones [ghrelin, glucagon-like-peptide-1 (GLP-1), peptide-YY (PYY)] and glycemic parameters (glucose, insulin, HbA1c, C-peptide, insulinogenic index, HOMA-IR) were measured preoperatively, at 6 and 12 months during an oral glucose tolerance test (OGTT). Results: Ninety-five percent of patients showed complete remission of T2DM after 12 months. LRYGBP+FR was not related with improved glycemic control, compared to LRYGBP. Ghrelin levels were not significantly reduced at 6 and 12 months after LRYGBP+FR. GLP-1 and PYY levels were remarkably increased postprandially in both groups at 6 and 12 months postoperatively (p<0.01). Patients who underwent LRYGBP+FR achieved a significantly lower BMI at 12 months in comparison to LRYGBP (p<0.05). Conclusion: Fundus resection is not associated with improved glycemic regulation, compared to typical LRYGBP and the significant decrease in BMI after LRYGBP+FR has to be further confirmed with longer follow-up. [ABSTRACT FROM AUTHOR]

Adipokines are peptide hormones produced by the adipose tissue involved in several biological functions. Among adipokines, adiponectin (ADPN) has antidiabetic and anti-inflammatory properties. It can also modulate food intake at central and peripheral levels, acting on hypothalamus and facilitating gastric relaxation. ADPN exerts its action interacting with two distinct membrane receptors and triggering some well-defined signaling cascades. The ceramidase activity of ADPN receptor has been reported in many tissues: it converts ceramide into sphingosine. In turn, sphingosine kinase (SK) phosphorylates it into sphingosine-1 phosphate (S1P), a crucial mediator of many cellular processes including contractility. Using a multidisciplinary approach that combined biochemical, electrophysiological and morphological investigations, we explored for the first time the possible role of S1P metabolism in mediating ADPN effects on the murine gastric fundus muscle layer. By using a specific pharmacological inhibitor of SK2, we showed that ADPN affects smooth muscle cell membrane properties and contractile machinery via SK2 activation in gastric fundus, adding a piece of knowledge to the action mechanisms of this hormone. These findings help to identify ADPN and its receptors as new therapeutic targets or as possible prognostic markers for diseases with altered energy balance and for pathologies with fat mass content alterations. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to investigate the potential association between gastric fundus diverticulum and metaplasia by retrospectively analysing patient data and biopsy results. Material and Methods: 37 patients with gastric fundus diverticulum were examined, with their data compared to a control group of 50 patients without it. All diagnoses were made endoscopically. Demographic information, laboratory parameters, and endoscopic biopsy results were compared between the groups. Results: No significant differences were identified between the two groups concerning several laboratory parameters. However, there were significant differences in lymphocytes, urea, albumin, Na, and K values (p<0.05). Helicobacter pylori and atrophy distributions did not differ between the groups (p>0.05), while a notable difference was seen in the distribution of metaplasia (p<0.05). Metaplasia positivity was found to be 16% in patients without gastric diverticulum and 43.2% in patients with gastric diverticulum. Conclusions: This study found a higher prevalence of metaplasia positivity in patients with gastric diverticulum than those without. These findings suggest a potentially significant link between the gastric diverticulum and the occurrence of metaplasia, which warrants further research to better understand the underlying mechanisms and implications for patient management. [ABSTRACT FROM AUTHOR]

Background: It has been reported diabetic gastroparesis is related to diabetic autonomic neuropathy of the gastrointestinal tract, and berberine (BBR) could ameliorate diabetic central and peripheral neuropathy. However, the influence of BBR on the function and motility of the gastric fundus nerve is unclear. Methods: A diabetic rat model was constructed, and HE staining was used to observe the morphological changes in the gastric fundus. The changes in cholinergic and nitrogen-related neurochemical indexes and the effects of BBR on them were measured using Elisa. The effects of BBR on the neural function and motility of gastric fundus were investigated by electric field stimulation (EFS) induced neurogenic response in vitro. Results: In the early stage of STZ-induced diabetic rats, the contractile response of gastric fundus induced by EFS was disorder, disturbance of contraction amplitude, and the cell bodies of neurons in the myenteric plexus of gastric fundus presented vacuolar lesions. Administration with BBR could improve the above symptoms. BBR further enhanced the contraction response in the presence of a NOS inhibitor or the case of inhibitory neurotransmitters removal. Interestingly, the activity of ACh could affect NO release directly and the enhancement of BBR on contractile response was canceled by calcium channel blockers completely. Conclusions: In the early stage of STZ-induced diabetic rats, the neurogenic contractile response disorder of the gastric fundus is mainly related to cholinergic and nitrergic nerve dysfunction. BBR promotes the release of ACh mainly by affecting the calcium channel to improve the neurological dysfunction of the gastric fundus.

Introduction: Acrylamide is a toxic chemical used in many industrial uses. It is generated in carbohydrate-rich foods cooked using high temperature. Quercetin is amongst the most effective antioxidant of the flavonoids. Objective: To assess the effects of acrylamide on the gastric mucosa in adult male albino rats after maternal exposure to it during pregnancy and lactation and the possible ameliorative role of quercetin. Materials and Methods: Twenty-four pregnant albino rats were randomly divided into four equal groups. Group 1: (Control group): kept without treatment. Group 2: (Acrylamide treated group): they received acrylamide in a dose of 30 mg/kg body weight/day Group 3: (Quercetin and acrylamide treated group): they received quercetin in a dose 50 mg/kg body weight/day 2 hours before the acrylamide at the same dose of the previous group. Group 4: (Quercetin treated group): they received quercetin at the same dose as in the previous group. The drugs were received by gastric intubation from day 6 of gestation till the 21st day after birth. Adult offspring in each group were sacrificed. Specimens from the gastric fundus were processed for light microscopic, transmission and scanning electron microscopic examination in addition to morphometric study. Results: Acrylamide induced mucosal injury, sloughing of surface mucosal cells, glandular disarrangement, and decreased mucosal thickness, as well as a decrease in the PAS-positive reaction. Scanning electron microscope showed exfoliation of the surface cells. Electron microscopic studies showed deteriorating changes in parietal cells, chief cells, mucous cells, and enteroendocrine cells. In contrast, most of the changes induced by acrylamide were improved in the acrylamide and quercetin treated group. Conclusion: Quercetin exerted an ameliorative effect against acrylamide-induced gastric toxicity. [ABSTRACT FROM AUTHOR]

Background: The fundus of the stomach is a challenging region for endoscopic resection of gastrointestinal stromal tumors (GISTs), especially in the anterior wall of the fornix at the side of the greater curvature. This study aimed to introduce the Forward-Return Way (FRW) technique in gastric fundus operations and provide evidence of its advantages. The FRW technique allows the gastroscope to access the stomach fornix without entering the gastric antrum after passing through the gastric cardia. Using FRW, the gastroscope body makes a forward return along the wall of the posterior wall of the upper gastric body and the wall of the greater curvature. Methods: The clinical data of patients with stromal tumors in muscularis propria at the gastric fundus (STMF) at the Fourth Hospital of China Medical University between May 2020-March 2021 were reviewed. The novel FRW technique was used in the procedures, and the beneficial effects, suitability, applicable lesion site, and success rates of FRW were analyzed. Results: A total of 10 cases were reviewed, and the FRW technique was successfully performed in 7 cases (70%). The gastroscope's tip reached the area just below the gastric cardia, allowing endoscopists to successfully access all angles and sites of the stomach's fundus in all seven patients. The lesion was easily accessed, and the gastroscope was stable with good left-right and forward-backwards movements. Conclusion: The FRW technique significantly facilitates the resection of the GISTs by aligning the endoscopy body movement direction with the observation direction. Gastrointestinal Stromal Tumor; forward-return of gastroscopy along the gastric body wall; muscularis propria; gastric fundus. [ABSTRACT FROM AUTHOR]

Background: To date, no prospective study has compared the safety and efficacy of band-assisted endoscopic mucosal resection (BA-EMR) with those of endoscopic dissection (ESD) for the treatment of submucosal tumors (SMTs) in the gastric fundus. We aimed to compare the safety and efficacy of BA-EMR with those of ESD for SMTs ≤ 1.5 cm in the gastric fundus. Methods: In total, 62 patients with SMTs ≤ 1.5 cm in the gastric fundus underwent band ligation; the lesions that could be completely ligated were excised using a snare, while others were removed by ESD. Results: Of 62 patients, 42 had their lesions completely ligated by the band and underwent BA-EMR, while 20 had lesions that could not be completely ligated and underwent ESD. The average tumor size was 0.94 ± 0.16 and 1.30 ± 0.16 cm in the BA-EMR and ESD groups, respectively. Compared with ESD, BA-EMR had significantly fewer complications and a significantly shorter mean operating time and hospital stay. Conclusion: BA-EMR is a safe and effective method for small SMTs in the gastric fundus, but is only suitable for SMTs < 1.2 cm. For small SMTs (< 1.2 cm) in the gastric fundus, BA-EMR may simplify the treatment procedure, shorten the operation time, and reduce complications. [ABSTRACT FROM AUTHOR]

[Display omitted] • In diabetic rats, the neurogenic contractile response of gastric fundus is disordered. • BBR enhances the EFS-induced neurogenic contractile response of diabetic rats' gastric fundus. • BBR promotes the release of Ach through calcium channels to correct contraction disorder. It has been reported diabetic gastroparesis is related to diabetic autonomic neuropathy of the gastrointestinal tract, and berberine (BBR) could ameliorate diabetic central and peripheral neuropathy. However, the influence of BBR on the function and motility of the gastric fundus nerve is unclear. A diabetic rat model was constructed, and HE staining was used to observe the morphological changes in the gastric fundus. The changes in cholinergic and nitrogen-related neurochemical indexes and the effects of BBR on them were measured using Elisa. The effects of BBR on the neural function and motility of gastric fundus were investigated by electric field stimulation (EFS) induced neurogenic response in vitro. In the early stage of STZ-induced diabetic rats, the contractile response of gastric fundus induced by EFS was disorder, disturbance of contraction amplitude, and the cell bodies of neurons in the myenteric plexus of gastric fundus presented vacuolar lesions. Administration with BBR could improve the above symptoms. BBR further enhanced the contraction response in the presence of a NOS inhibitor or the case of inhibitory neurotransmitters removal. Interestingly, the activity of ACh could affect NO release directly and the enhancement of BBR on contractile response was canceled by calcium channel blockers completely. In the early stage of STZ-induced diabetic rats, the neurogenic contractile response disorder of the gastric fundus is mainly related to cholinergic and nitrergic nerve dysfunction. BBR promotes the release of ACh mainly by affecting the calcium channel to improve the neurological dysfunction of the gastric fundus. [ABSTRACT FROM AUTHOR]

Introduction: Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation. Methods: A total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated. Results: Of the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage (p = 0.42, p = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak (p = 0.58, p = 0.39, and p = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities. Conclusions: In our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak. [ABSTRACT FROM AUTHOR]

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Purpose: The purpose of this study is to determine the incidence of gastric tube abnormalities after SG and its relationship with esophagitis progression. Methods: Retrospective study which included 459 patients in the postoperative period of SG who underwent an esophagogastroduodenoscopy in both pre- and postoperative periods. The main studied variables were presence of gastric tube abnormalities (dilation, neofundus, twist, and hiatal hernia) and esophagitis progression. Results: Among the 459 patients who underwent SG, 393 (85.6%) were women, and 66 (14.4%) men, with mean age of 40.4 years. Mean preoperative BMI was 39.70 kg/m2. In total, 20.3% of the sample presented progression of esophagitis after surgery. Among the whole sample, 130 (28.3%) presented with an abnormality of the remnant gastric tube. The most common alteration was gastric dilation, which occurred in 16.1% of the patients, followed by gastric twist (10.7%), neofundus (7.4%), and hiatal hernia (0.2%). Patients who presented with any abnormality of the gastric tube were significantly prone to presenting esophagitis progression (p = 0.013). When analyzing each morphological abnormality isolated, there was no statistically significant correlation. Conclusion: Abnormalities of the gastric tube are not uncommon after SG and seems to contribute partially to the relevant rates of GERD and esophagitis after this surgery. [ABSTRACT FROM AUTHOR]

It has been reported that adiponectin (ADPN) and resistin are co-secreted by white mouse adipocytes and exert similar inhibitory effects in the mouse gastric fundus, in which resistin was observed to increase neuronal nitric oxide synthase (nNOS) expression. On these grounds, the present work aimed to investigate whether the effects of the two adipokines on the neurally-induced relaxant responses potentiate each other and whether there is a possible correlation with changes in nNOS expression in preparations from the mouse gastric fundus. In carbachol (CCh)-precontracted strips, electrical field stimulation elicited nitrergic relaxant responses, whose amplitude was increased by ADPN or resistin, but no additional enhancements were observed in their concomitant presence. Western blot and immunofluorescence analyses revealed that ADPN, like resistin, was able to up-regulate nNOS expression and to increase the percentage of nNOS-positive neurons in the myenteric plexus: co-treatment with the two adipokines did not induce additional changes. The results indicate that the two adipokines modulate nitrergic neurotransmission, and both do so by up-regulating nNOS expression. Therefore, nNOS appears to be a shared target for the two adipokines' effects, which, rather than mutually reinforcing each other, may represent a dual physiological control mechanism to guarantee gastric fundus relaxation. [ABSTRACT FROM AUTHOR]

A 22-year-old man presented with recurrent dizziness and melena. He had no remarkable medical history except for the reflux symptoms for which 18 months of proton pump inhibitor (PPI) intake was required. Gastroscopy revealed a 1-cm, blood-tinged polyp within the gastric rugae. A thickened gastric corpus was observed with a regular arrangement of collecting venules on its surface. Hyperplastic foveolar epithelium was observed in the biopsied specimens from the fundus and gastric rugae. The diagnosis after polypectomy was gastric hyperplastic polyp. Abdominal CT revealed hypertrophy only in the gastric corpus without antral involvement. Increased levels of serum pepsinogen I (>160 ng/mL), pepsinogen II (>50 ng/mL), chromogranin A (>1,800 ng/mL), and gastrin (534 pg/mL) were noted. Three months after PPI discontinuation, CT revealed improvement of the hypertrophic gastric corpus. Serum chromogranin A and gastrin levels decreased to 950.4 ng/mL and 517.0 pg/mL, respectively. Herein, we report a young, Helicobacter pylori-naive patient with prominent hyperplasia in the gastric corpus and a bleeding hyperplastic polyp after long-term PPI use.

Abstract Background Heterotopic tumor is a rare disease. Thus far, no cases of heterotopic cholangiocarcinoma have been reported in the world. Cholangiocarcinoma mainly metastasizes by direct invasion, and it can lead to liver metastasis in its advanced stage. There were few clinical cases of gastric metastasis in advanced tumors, mainly seen in breast cancer, lung cancer, liver cancer, malignant melanoma, choriocarcinoma, and hematological tumors. Metastases of cholangiocarcinoma to the stomach also are exceptionally rare. Case presentation A 58-year-old man was admitted to the hospital because of difficulty swallowing for one year. Upon gastroscopy, we found the tumor at the region of the cardia and gastric fundus. Macroscopical appearance of the tumor suggested its malignant nature. Computed tomography (CT) findings showed that the wall of the cardia, fundus, and stomach body were thickened, suggesting a tumor. Because the patient had obvious difficulty swallowing, we invited cardiothoracic surgeons for consultation. They considered that the patient had definite mechanical obstruction in the lower esophagus; hence, they performed an operation. Immunohistochemical staining revealed low-to-medium differentiated adenocarcinoma (containing mucinous adenocarcinoma components) of biliary origin. Conclusions We highlight the importance of the endoscopic biopsy of gastric tumor. However, when its results are inconsistent with the clinician’s judgment, further examination is required. Endoscopic ultrasonography and enhanced CT may be a good choice. If necessary, on the premise of patient acceptance, the diagnosis could be confirmed after surgical excision. Here we report a case of a patient with heterotopic cholangiocarcinoma in the gastric fundus. The most common tissue ectopias in the digestive tract include esophagogastric gastric mucosal ectopia, duodenal gastric mucosal ectopia, and gastric mucosal small intestinal ectopia. Thus far, there have been no reports of ectopic cholangiocarcinoma and associated cancer in the stomach. In addition, metastases of cholangiocarcinoma to the stomach are also exceptionally rare, and most of them are due to a direct invasion. The discovery of the primary lesion is an important clue for the reliable diagnosis in such cases.

IntroductionStandard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation.MethodsA total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated.ResultsOf the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage (p = 0.42, p = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak (p = 0.58, p = 0.39, and p = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities.ConclusionsIn our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak.

Purpose: Oxyntic gland neoplasm (OGN) is a rare condition that can be classified as oxyntic gland adenoma (OGA) or gastric adenocarcinoma of fundic-gland type (GA-FG). GA-FG primarily presents as early gastric cancer, with only a few reported cases of advanced gastric cancer (AGC). We aimed to investigate the clinicopathological features of OGN and describe an aggressive variant., Materials and Methods: We investigated a total of 29 cases, including a patient with double primary cases, diagnosed with OGN or differentiated-type adenocarcinoma with GA-FG morphology, between November 2016 and April 2022. We analyzed 54 pathological specimens and reviewed their clinicopathological, endoscopic, and histological features. The lesions were reclassified as OGA or GA-FG, and immunohistochemical (IHC) staining for MUC-5AC and MUC-6 was performed on available resected GA-FG cases., Results: The median patient age was 65 years and males accounted for 58.6% of patients. Most cases occurred in the body horizontally (69.0%) and on the greater curvature side cross-sectionally (48.3%). Endoscopically, type 0-IIa (41.4%) and a subepithelial tumor-like appearance (24.1%) were the most common findings. Histologically, there were 8 cases of OGA (27.6%) and 21 cases of GA-FG (72.4%). In GA-FG, MUC-6 was positive in 13 cases (81.3%), whereas MUC-5AC was positive in 8 cases (50.0%). Three cases presented as AGCs., Conclusions: Although OGNs are generally considered low-grade, they can present as AGCs and may exhibit features of lymphovascular or perineural invasion. Recognizing the clinicopathological features and accurately diagnosing OGN are important for providing adequate treatment., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2024. Korean Gastric Cancer Association.)

Adipokines are peptide hormones produced by the adipose tissue involved in several biological functions. Among adipokines, adiponectin (ADPN) has antidiabetic and anti-inflammatory properties. It can also modulate food intake at central and peripheral levels, acting on hypothalamus and facilitating gastric relaxation. ADPN exerts its action interacting with two distinct membrane receptors and triggering some well-defined signaling cascades. The ceramidase activity of ADPN receptor has been reported in many tissues: it converts ceramide into sphingosine. In turn, sphingosine kinase (SK) phosphorylates it into sphingosine-1 phosphate (S1P), a crucial mediator of many cellular processes including contractility. Using a multidisciplinary approach that combined biochemical, electrophysiological and morphological investigations, we explored for the first time the possible role of S1P metabolism in mediating ADPN effects on the murine gastric fundus muscle layer. By using a specific pharmacological inhibitor of SK2, we showed that ADPN affects smooth muscle cell membrane properties and contractile machinery via SK2 activation in gastric fundus, adding a piece of knowledge to the action mechanisms of this hormone. These findings help to identify ADPN and its receptors as new therapeutic targets or as possible prognostic markers for diseases with altered energy balance and for pathologies with fat mass content alterations.

The article reports that endoscopic ablation of the gastric fundus led to a significant reduction in ghrelin levels, the primary hunger hormone, and resulted in notable weight loss among a small group of female patients with obesity. Topics discussed include the effectiveness of endoscopic ablation in decreasing ghrelin and hunger, the observed weight loss and reduction in stomach capacity, and the safety and non-surgical nature of the procedure.

Background: Heterotopic tumor is a rare disease. Thus far, no cases of heterotopic cholangiocarcinoma have been reported in the world. Cholangiocarcinoma mainly metastasizes by direct invasion, and it can lead to liver metastasis in its advanced stage. There were few clinical cases of gastric metastasis in advanced tumors, mainly seen in breast cancer, lung cancer, liver cancer, malignant melanoma, choriocarcinoma, and hematological tumors. Metastases of cholangiocarcinoma to the stomach also are exceptionally rare.Case Presentation: A 58-year-old man was admitted to the hospital because of difficulty swallowing for one year. Upon gastroscopy, we found the tumor at the region of the cardia and gastric fundus. Macroscopical appearance of the tumor suggested its malignant nature. Computed tomography (CT) findings showed that the wall of the cardia, fundus, and stomach body were thickened, suggesting a tumor. Because the patient had obvious difficulty swallowing, we invited cardiothoracic surgeons for consultation. They considered that the patient had definite mechanical obstruction in the lower esophagus; hence, they performed an operation. Immunohistochemical staining revealed low-to-medium differentiated adenocarcinoma (containing mucinous adenocarcinoma components) of biliary origin.Conclusions: We highlight the importance of the endoscopic biopsy of gastric tumor. However, when its results are inconsistent with the clinician's judgment, further examination is required. Endoscopic ultrasonography and enhanced CT may be a good choice. If necessary, on the premise of patient acceptance, the diagnosis could be confirmed after surgical excision. Here we report a case of a patient with heterotopic cholangiocarcinoma in the gastric fundus. The most common tissue ectopias in the digestive tract include esophagogastric gastric mucosal ectopia, duodenal gastric mucosal ectopia, and gastric mucosal small intestinal ectopia. Thus far, there have been no reports of ectopic cholangiocarcinoma and associated cancer in the stomach. In addition, metastases of cholangiocarcinoma to the stomach are also exceptionally rare, and most of them are due to a direct invasion. The discovery of the primary lesion is an important clue for the reliable diagnosis in such cases. [ABSTRACT FROM AUTHOR]

The cytotoxin-associated gene (Cag) pathogenicity island is a strain-specific constituent of Helicobacter pylori (H. pylori) that augments cancer risk. CagA translocates into the cytoplasm where it stimulates cell signaling through the interaction with tyrosine kinase c-Met receptor, leading cellular proliferation. Identified as a potential gastric stem cell marker, cluster-of-differentiation (CD) CD44 also acts as a co-receptor for c-Met, but whether it plays a functional role in H. pylori-induced epithelial proliferation is unknown. We tested the hypothesis that CD44 plays a functional role in H. pylori-induced epithelial cell proliferation. To assay changes in gastric epithelial cell proliferation in relation to the direct interaction with H. pylori, human- and mouse-derived gastric organoids were infected with the G27 H. pylori strain or a mutant G27 strain bearing cagA deletion (∆CagA::cat). Epithelial proliferation was quantified by EdU immunostaining. Phosphorylation of c-Met was analyzed by immunoprecipitation followed by Western blot analysis for expression of CD44 and CagA. H. pylori infection of both mouse- and human-derived gastric organoids induced epithelial proliferation that correlated with c-Met phosphorylation. CagA and CD44 co-immunoprecipitated with phosphorylated c-Met. The formation of this complex did not occur in organoids infected with ∆CagA::cat. Epithelial proliferation in response to H. pylori infection was lost in infected organoids derived from CD44-deficient mouse stomachs. Human-derived fundic gastric organoids exhibited an induction in proliferation when infected with H. pylori that was not seen in organoids pre-treated with a peptide inhibitor specific to CD44. In the well-established Mongolian gerbil model of gastric cancer, animals treated with CD44 peptide inhibitor Pep1, resulted in the inhibition of H. pylori-induced proliferation and associated atrophic gastritis. The current study reports a unique approach to study H. pylori interaction with the human gastric epithelium. Here, we show that CD44 plays a functional role in H. pylori-induced epithelial cell proliferation.

Background: Radiation dose received by the gastric fundus (GF) in neoadjuvant chemoradiotherapy (NACRT) may influence the development of postoperative anastomotic leak (AL) in the management of resectable esophageal carcinoma (EC) by trimodality therapy. The present study aims to evaluate dose-volume parameters of the GF and their association with occurrence of AL in EC. Materials and Methods: A retrospective analysis was performed of 27 patients with EC who underwent NACRT followed by esophagectomy with cervical esophagogastric anastomosis between January 2015 and July 2018. The GF was retrospectively contoured; dose-volume parameters of the GF were recorded. Postoperative AL was identified from surgical records. Logistic regression analysis was used to identify risk factors associated with AL. Results: The mean age of the patients was 51 ± 10.5 years; 56% (15/27) had involvement of lower 1/3 esophagus, 10/27 (37%) midthoracic esophagus, and 2/27 (7%) upper thoracic esophagus; 40% (11/27) patients developed postoperative AL and 7/11 had distal and 4/11 had mid thoracic esophageal lesions. Four of five (80%) patients treated by 3-dimensional conformal radiotherapy versus 7/22 (32%) patients treated by volumetric modulated arc therapy developed AL (p = 0.12). Univariate logistic regression revealed no significant correlation between Dmean, Dmax, V20, V25, V30, V35, D50, and AL. 8/27 patients underwent ischemic preconditioning of gastric conduit, and 2/8 had AL; 19/27 did not undergo preconditioning, and 9/19 patients experienced AL (p = 0.4). Conclusion: There was no significant negative impact of the dose received by the GF in NACRT upon AL rates. Further studies with a larger sample size are required to clarify this issue. [ABSTRACT FROM AUTHOR]

Background: Stomach is a common location for benign and malignant lesions in the digestive system from inflammation to cancer. Therefore, recognition and diagnosis in the endoscopic stage and its confirmation in a pathological examination will be critical. Objective: The aim of this study was to investigate the correlation between endoscopic and histopathological findings in the patients with stomach lesion. Methods: In this cross-sectional study, 350 patients who referred to endoscopy center in Firoozgar Hospital were selected from 2016 to 2017. The stomach endoscopy was performed on various parts including; fundus, body (lesser and greater curvatures) and antrum, and pathological examination was performed on biopsy samples. The checklist was used to record patients’ age and gender. Data were analyzed by t-test and Pearson correlation coefficient. Findings: The mean age of patients was 51±6 years and 207 patients (59.1%) were male. The correlation between pathologic and endoscopic results for antrum, body and fundus were 0.62, 0.56 and 0.46 respectively. Also, the significant correlation between endoscopy and histopathology was found (P

Background/Aim: An increasing number of patients and an ophthalmologist shortage in some areas necessitate reaching more patients in a shorter time to decrease the burden of devastating visual complications of diabetic retinopathy (DR). Screening and diagnosing DR using fundus photographs may save time and effort. In this study, we aimed to report the results of DR screening in a Turkish treatmentnaive diabetes mellitus (DM) patient group by examining fundus photographs taken with ETDRS protocol and compare them with clinical examination and optical coherence tomography (OCT) findings. Methods: Two hundred and ninety-two eyes of 150 DR treatment-naive DM patients were included in this cross-sectional study. Complete ophthalmic examination was performed by a single examiner. Fundus photograph acquisition according to ETDRS protocol and OCT were performed by an experienced technician. Fundus photographs were evaluated by the same examiner who was blinded to patient names, at the end of the study period. Results: Two hundred and ninety-two eyes of 150 DR treatment-naive DM patients' findings were evaluated. According to stereoscopic fundus examination, 76 (26%) eyes showed no signs of DR, 76 (26%) eyes showed mild non-proliferative diabetic retinopathy (NPDR) signs, 44 eyes (15.1%) showed moderate NPDR signs, 78 eyes (26.7%) showed severe NPDR signs, and 18 eyes (6.2%) showed PDR signs. According to images acquired with the ETDRS protocol, 79 (27.1%) eyes showed no signs of DR, 81 (27.7%) eyes showed mild NPDR signs, 50 eyes (17.1%) showed moderate NPDR signs, 68 eyes (23.3%) showed severe NPDR signs, and 14 eyes (4.8%) showed PDR signs. Clinical examination and fundus photography showed substantial agreement in detecting DR severity (Kappa value: 0.78, P<0.001). Diabetic macular edema (DME) was present in 106 and 68 eyes according to OCT and ETDRS fundus photographs, respectively. These two methods showed moderate agreement in detecting DME (Kappa value: 0.57, P<0.001). ETDRS fundus photography is an effective method for screening DR severity in a Turkish DR population. When patients with no evident DR findings were excluded, we found a statistically significant negative correlation (P<0.001, Spearman Rho coefficient: -0.306) between central retinal thickness and best-corrected visual acuity, as expected. Conclusion: For screening DR severity, ETDRS fundus photography is an effective method in a Turkish DR population. [ABSTRACT FROM AUTHOR]

Purpose: Gastric cancer is one of the most common cancers in Korea, and the proportion of upper-third gastric cancers has been steadily increasing over the last two decades. This study aimed to evaluate the effect of tumor location on gastric cancer prognosis., Materials and Methods: We retrospectively reviewed 2,466 patients who underwent gastrectomy for pathologically proven gastric cancer between January 2011 and December 2016. The patients were divided into an upper-third group (U group; n=419, 17.0%) and a middle- and lower-third group (ML group; n=2,047, 83.0%). Clinicopathological characteristics, overall survival (OS), and recurrence-free survival (RFS) after surgery were compared., Results: The U group had more advanced disease than the ML group and a higher incidence of N3b disease for T3 (12.0% vs. 4.9%, p=0.023) and T4 tumors (33.3% vs. 17.5%, p=0.001). The 5-year RFS rate for stage III disease was marginally lower in the U group than that in the ML group (47.1% vs. 56.7%, p=0.082). The upper third location was an independent prognostic factor for both OS (hazard ratio [HR], 1.350; 95% confidence interval [CI], 1.065-1.711) and RFS (HR, 1.430; 95% CI, 1.080-1.823)., Conclusions: Upper-third gastric cancer shows extensive node metastasis compared to those located more distally in ≥T3 tumors. The upper third location is an independent prognostic factor for both OS and RFS and may have an adverse impact on RFS, particularly in patients with stage III gastric cancer., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2024. Korean Gastric Cancer Association.)

Background/Aims: Roux-en-Y Gastric Bypass, RYGB, is the most effective strategy to control body weight in morbid obesity. RYGB leads to rapid improvement of glycemic status and weight loss, which are largely attributed to the alteration of gastrointestinal hormones including ghrelin. The current study examined potential mechanisms of altered ghrelin synthesis after RYGB. Methods: Gastric mammalian target of rapamycin (mTOR) signaling, ghrelin synthesis and secretion were determined in lean or obese male mice with or without RYGB operation, as well as in obese patients pre- and post-RYGB surgery. Ghrelin expression and mTOR signaling were investigated by western blotting and immunohistochemistry. Ghrelin mRNA levels were detected by real-time PCR. Plasma ghrelin was measured by enzyme immunoassay. Results: mTOR activity in the gastric fundus was significantly lower than in the forestomachs. Both of them were decreased after 24h fasting. A significant negative correlation was found between gastric levels of phospho-S6 (phospho-S6 ribosomal protein) and proghrelin during changes of energy status. mTOR activity was activated, whereas ghrelin expression was inhibited by Roux-en-Y Gastric Bypass in both rodents and human beings. Increment of ghrelin synthesis and decline of mTOR signaling induced by rapamycin were significantly reversed by RYGB in both lean and obese mice. Administration of Ad-S6K1 (adenovirus-mediated p70 ribosomal protein subunit 6 kinase 1) from tail vein suppressed the expression of ghrelin in RYGB-operated mice relative to control animals. Conclusion: mTOR is therefore a gastric fuel sensor whose activity is linked to the regulation of ghrelin after Roux-en-Y Gastric Bypass.

Xanthomas are rare and incidental lesions usually seen during upper gastrointestinal system endoscopy. They can be seen in all parts of gastrointestinal tractus but they are commonly found in stomach, especially at the antrum and piloric region. There are few reports in the literature which are about cardia and fundus localization. Gastric xanthomas are in pale yellow in colour and form multiple mucosal nodules or plaques in 1 to 2 mm in diameter. They may mimic malignancy during endoscopy and may be confused with malignancy by inexperienced clinicians. They may histopathologically resemble clear cell carcinoid tumors and signet ring cell adenocarcinomas. We are presenting two gastric xanthoma cases at rare localisations such as cardia and fundus. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility and efficacy of single-channel gastroscopy, double-channel gastroscopy, and double gastroscopy in treating submucosal tumors in the cardia and gastric fundus.Methods: The data of 77 patients with submucosal tumors (SMTs) in the cardia and gastric fundus parts of the stomach who underwent single-channel gastroscopy, double-channel gastroscopy, and double gastroscopy were retrospectively analyzed. The observed therapeutic effect, complications, and local recurrence from these three groups were then compared.Results: All lesions were completely taken out under endoscopy, and the operation time for single-channel gastroscopy group was 20-90 min with an average of 44.5 min, and the postoperative hospitalization time was 5-9 days with an average of 7.5 days. The operation time for the double-channel gastroscopy group was 40-110 min with an average of 60.5 min, and the postoperative hospitalization time was 7-10 days with an average of 8.3 days, whereas the operation time of double gastroscopy group was 35-120 min with an average of 66.3 min, and the postoperative hospitalization time was 7-10 days with an average of 8.5 days. No patient was required to be transferred to the General Surgery Department for continuous treatment. Bleeding was noted from all the patients during operation, and hemostasis was performed successfully. Postoperative bleeding was not observed in any of the cases. Full-thickness resection was performed in all the three groups. No residual or recurrent lesions were detected via reexamination of gastroscopy in all the patients.Conclusion: Single-channel gastroscopy, double-channel gastroscopy, and double gastroscopy present potential capability with distinctive advantages in the endoscopic treatment of submucosal tumors of the cardia and gastric fundus, and it also shows that appropriate operation methods should be selected based on the situation of an individual patient. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the technical feasibility, safety and clinical outcomes of coil-assisted retrograde transvenous obliteration II (CARTO-II) for gastric varices (GV).Materials and Methods: Thirty-six consecutive patients who had undergone CARTO-II between June 2016 and April 2018 were included in the study. In the CARTO procedure, coil embolization of the drainage vein is performed "before" injection of the sclerosant to replace the use of balloon catheter. In the CARTO-II procedure, coil embolization of the drainage vein was performed "after" injection of the sclerosant to prevent migration of the sclerosant. CARTO-II was performed with ethanolamine oleate iopamidol, and the balloon catheter was immediately removed after coil placement. Technical and clinical success rates, number of coils used, presence or absence of severe complications, timing of the procedure, and rate of GV recurrence after the procedure were analyzed retrospectively.Results: In all patients, GV sclerosis, coil placement and removal of the balloon catheter were successfully completed. The technical success rate was 100%. No patients experienced severe complications such as coil migration or pulmonary embolization. The mean number of metallic coils used per procedure was 3.36. Mean length of the procedure was 132.8 min. Contrast-enhanced computed tomography after CARTO-II confirmed complete variceal thrombosis in all cases. The recurrence rate of GV during follow-up was 2.8% (mean follow-up, 207 days).Conclusion: CARTO-II was feasible and safe and could be performed relatively quickly. The number of coils used and the rate of GV recurrence were both low. CARTO-II may have an important role to play in the management of GV. [ABSTRACT FROM AUTHOR]

Cerebral embolism caused by tissue adhesive injection for varices of gastric fundus: one case report [ABSTRACT FROM AUTHOR]

Aims. Both hepatoid adenocarcinoma of stomach (HAS) and alpha-fetoprotein-positive gastric cancer (AFPGC) are rare but aggressive subtypes of gastric cancer, but few studies focus on the clinicopathologic differences and prognostic factors between them because of their rarity and histologic overlap. And the significance of AFP level in HAS prognosis was not well studied. Methods. 41 patients with AFPGC and 52 patients with HAS were included in this study. The clinicopathologic features were compared by Chi-square analysis. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed with the Kaplan-Meier method. Results. The patients with HAS were of a younger age compared with AFPGC, and nearly 60% of tumor located in the gastric antrum and the gastric fundus of cardia. The OS of AFPGC was shorter than that of HAS, due to a higher rate of metastasis. Furthermore, the survival analysis showed that HAS with high AFP expression (AFPHigh HAS) had a significantly poorer OS compared to HAS with low AFP expression (AFPLow HAS) (P = 0.046). Conclusions. Compared with AFPGC, the patients of HAS were of a younger age and had less rate of liver and other organ metastasis. The serum AFP level was a sensitive prognostic indicator for OS. Therefore, much attention should be paid to AFPHigh HAS in clinical practice. [ABSTRACT FROM AUTHOR]

Agouti-related protein (AGRP) is an orexigenic peptide secreted from the arcuate nucleus (ARC) of the hypothalamus. AGRP increases food intake and plays a role in energy balance, adiposity, weight gain, and growth-hormone release. The objective of the current study was to examine the effects of running exercise on resting hepatic, fundus, and pancreas AGRP mRNA expression, as well as liver glycogen and ATP contents, using a rat model. Twenty adult male Wistar rats (12-14 wk old, 200-220 g) were randomly assigned to control (n = 10) and training (n = 10) groups. The training group was exercised for 8 wk on a motor-driven treadmill (26 m/min, 0% grade, 60 min, 5 d/wk). Twenty-four hours before sacrifice the rats were further divided into fed control (FEC), fed trained (FET), fasted control (FAC), and fasted trained (FAT) groups. The liver, fundus, and pancreas were excised and frozen in liquid nitrogen for later analysis. Results demonstrated that 8 wk of treadmill exercise reduced hepatic but not fundus and pancreatic AGRP expression and enhanced glycogen and ATP concentrations (p < .001) in trained-rat liver, whereas fasting lowered liver glycogen and ATP levels and increased hepatic AGRP mRNA expression in nonexercising controls. Data indicate that both treadmill-exercise-induced decrease and fast-induced increase in rat liver AGRP expression might depend on liver glycogen content as an important source for energy provision. [ABSTRACT FROM AUTHOR]