The most common histological type of gastric cancer (GC) is gastric adenocarcinoma arising from the gastric epithelium. Less common variants include mesenchymal, lymphoproliferative and neuroendocrine neoplasms. The Lauren scheme classifies GC into intestinal type, diffuse type and mixed type. The WHO classification includes papillary, tubular, mucinous, poorly cohesive and mixed GC. Chronic atrophic gastritis (CAG) and intestinal metaplasia are recommended as common precancerous conditions. No definite precancerous condition of diffuse/poorly/undifferentiated type is recommended. Chronic superficial inflammation and hyperplasia of foveolar cells may be the focus. Presently, the management of early GC and precancerous conditions mainly relies on endoscopy including diagnosis, treatment and surveillance. Management of precancerous conditions promotes the early detection and treatment of early GC, and even prevent the occurrence of GC. In the review, precancerous conditions including CAG, metaplasia, foveolar hyperplasia and gastric hyperplastic polyps derived from the gastric epithelium have been concluded, based on the overview of gastric epithelial histological organization and its renewal.

Gastric epithelial histology and precancerous conditions

The aim of this prospective study was to explore the clinical efficacy of Weisu granules combined with Weifuchun tablets in the treatment of chronic atrophic gastritis and its effect on serum gastrin-17 (G-17), pepsinogen I (PG I), and II (PG II) levels.Totally, 120 patients with chronic atrophic gastritis admitted to our hospital from February 2019 to February 2020 were enrolled and randomized into a control group (n=60) treated with Weifuchun tablets, and a experimental group given Weisu granules. Serum G-17, PG I, and PG II levels, inflammatory factor levels, TCM syndrome scores, gastric mucosa pathological scores, and clinical efficacy were compared between the two groups. Gastric tissue changes were observed using gastroscopy and HE staining.After treatment, the levels of serum G-17, PG I, and PG II of the experimental group were significantly better than those of the control group (P<0.001). The levels of inflammatory factors, traditional Chinese medicine (TCM) syndrome scores, and gastric mucosal pathology scores of the experimental group were significantly lower than those of the control group (P<0.001). The overall response rate of the experimental group was significantly higher than that of the control group (P<0.05). The experimental group showed a lower HP positive result and a higher HP negative conversion ratio than the control group (all P<0.05). HE staining results revealed that after treatment, the number of glands was basically restored to the level of normal gastric mucosa, and the improvement of inflammatory cell infiltration in the experimental group was significantly better than that in the control group.Weisu granule combined with Weifuchun tablets can ameliorate serum G-17, PG I, and PG II levels in patients with chronic atrophic gastritis, relieve inflammatory responses and clinical symptoms, and improve the treatment effect, which is worth promoting in clinical practice.Chinese Registry of Clinical Trials.ChiCTR200002548416. Trial URL: http://www.chictr.org.cn/showproj.aspx?proj=26516901. 

Clinical efficacy of Weisu granule combined with Weifuchun tablet in the treatment of chronic atrophic gastritis and its effect on serum G-17, PG I and PG II levels.

OBJECTIVE
The aim of this prospective study was to explore the clinical efficacy of Weisu granules combined with Weifuchun tablets in the treatment of chronic atrophic gastritis and its effect on serum gastrin-17 (G-17), pepsinogen I (PG I), and II (PG II) levels.


METHODS
Totally, 120 patients with chronic atrophic gastritis admitted to our hospital from February 2019 to February 2020 were enrolled and randomized into a control group (n=60) treated with Weifuchun tablets, and a experimental group given Weisu granules. Serum G-17, PG I, and PG II levels, inflammatory factor levels, TCM syndrome scores, gastric mucosa pathological scores, and clinical efficacy were compared between the two groups. Gastric tissue changes were observed using gastroscopy and HE staining.


RESULTS
After treatment, the levels of serum G-17, PG I, and PG II of the experimental group were significantly better than those of the control group (P<0.001). The levels of inflammatory factors, traditional Chinese medicine (TCM) syndrome scores, and gastric mucosal pathology scores of the experimental group were significantly lower than those of the control group (P<0.001). The overall response rate of the experimental group was significantly higher than that of the control group (P<0.05). The experimental group showed a lower HP positive result and a higher HP negative conversion ratio than the control group (all P<0.05). HE staining results revealed that after treatment, the number of glands was basically restored to the level of normal gastric mucosa, and the improvement of inflammatory cell infiltration in the experimental group was significantly better than that in the control group.


CONCLUSION
Weisu granule combined with Weifuchun tablets can ameliorate serum G-17, PG I, and PG II levels in patients with chronic atrophic gastritis, relieve inflammatory responses and clinical symptoms, and improve the treatment effect, which is worth promoting in clinical practice.


CLINICAL TRIAL REGISTRATION
Chinese Registry of Clinical Trials.


TRIAL REGISTRATION NUMBER
ChiCTR200002548416. Trial URL: http://www.chictr.org.cn/showproj.aspx?proj=26516901.

The two major risk factors of gastric cancer (GC) are Helicobacter pylori (HP) infection and atrophic gastritis (AG). It is currently possible to diagnose HP-infection and AG reliably by using serological testing with a panel of biomarkers (GastroPanel®, Biohit Oyj, Finland): pepsinogen I (PGI), pepsinogen II (PGII), gastrin-17 (G-17) and HP-antibodies. Severe AG leads in acid-free stomach colonized by HP and other bacteria, producing acetaldehyde (Group I human carcinogen; IARC). Together with other conditions leading to a) acid-free stomach (e.g. chronic users of PPI medication, autoimmune AG) or b) those exposing the subjects to increased concentrations of acetaldehyde (e.g. cigarette smokers, alcohol intake, ALDH2 enzyme mutations), these subjects are at high-risk for gastric and esophageal cancer. This document has a dual purpose: First, to give an introduction to the GastroPanel® as the first non-invasive diagnostic tool for i) dyspeptic symptoms, and for ii) screening of asymptomatic subjects for the risks of GC. Second, to describe a novel formulation (Acetium® Capsule, Biohit Oyj) based on slow-release L-cysteine, designed to protect the stomach mucosa in these high-risk subjects by its capacity to eliminate carcinogenic acetaldehyde. GastroPanel® is based on stomach physiology both in health and disease. Accordingly, pepsinogen levels and their ratio is decreased in corpus atrophy (AGC), accompanied by elevated G-17b (basal). G-17b level also sensitively responds to gastric acid output, being low with high acid output and high when the stomach is acid-free (due to PPI-treatment or AGC). In antrum atrophy (AGA), G-17b is low and, importantly, does not respond to a protein stimulation (G-17s), because the G-cells are disappeared. The results of GastroPanel® test are interpreted by a specially designed software (GastroSoft®) identifying 8 diagnostic marker profiles (Figure 1). Of those, four (profiles 1,2,3 and 8) represent purely functional disorders (of acid output), while three others specify structural abnormalities (profiles 5,6, and 7 for AGC, AGA, and AGpan, respectively). The remaining (profile 4) is typical to HP-infection, with three possible outcomes: a) active HP-infection, b) successful eradication, and c) failed eradication. During the past 10 years, GastroPanel® has been validated in an increasing number of studies both in clinical and screening settings, and its excellent clinical performance was validated in two recent meta-analysis. In addition to its high specificity for both AGA and AGC, GastroPanel® test has excellent longitudinal predictive values (NPV and PPV) for incident GC as shown in two recent cohort studies. Acetium® Capsule is a novel formulation of slow-release L-cysteine, being a unique medical device designed to elimination of carcinogenic acetaldehyde in the stomach. A regular use of Acetium® Capsule is indicated for all those who have acid-free stomach, irrespective of its cause. This formulation effectively protects the stomach against the exposure to acetaldehyde. The most common high-risk groups include the following: 1) AG associated with HP infection; 2) AG caused by autoimmune mechanisms; 3) cigarette smokers; 4) alcohol consumers; 5) chronic users of PPI medication, and 6) those (500 million) people in Asia who have a mutation 173 Serum Biomarker Panel (GastroPanel®) and Slow-Release L-cysteine (Acetium® Capsule): Rationale for the Primary Prevention of Gastric Cancer Citation: Kari Syrjänen. “Serum Biomarker Panel (GastroPanel®) and Slow-Release L-cysteine (Acetium® Capsule): Rationale for the Primary Prevention of Gastric Cancer”. EC Gastroenterology and Digestive System 3.6 (2017): 172-192. of the aldehyde dehydrogenase (ALDH2) enzyme, failing to metabolize acetaldehyde to acetic acid, and exposed to higher local concentrations of acetaldehyde. The efficacy of Acetium® Capsule in acetaldehyde elimination has been documented in controlled clinical experiments. In all studies, L-cysteine concentration in the gastric juice remained elevated for up to 3 hours, suggesting that an insignificant amount of L-cysteine is absorbed from the stomach or transported into the small intestine. It was demonstrated that slow-release L-cysteine effectively (by 60 80%) eliminates carcinogenic acetaldehyde in patients with acid-free stomach caused by either AG or PPI treatment. This was the case in individuals with either active or deficient ALDH2 enzyme. This capacity of slow-release L-cysteine to eliminate acetaldehyde persisted for up to three hours after ingestion of two Acetium® Capsules. L-cysteine was combined with acetaldehyde locally in the stomach, forming a stable and non-carcinogenic 2-methylthiazolidine carboxylic acid (MTCA). MTCA concentrations in the gastric juice remained significantly elevated for up to three hours after the administration of alcohol and Acetium® Capsules. With a rational use of these two medical devices, one can diagnose the gastric high-risk conditions and subsequently protect the stomach against acetaldehyde exposure.

/pdf/serum-biomarker-panel-gastropanel-and-slow-release-l-4o2598uict.pdf

Serum biomarker panel (GastroPanel) and slow-release L-cysteine (Acetium Capsule): Rational for the primary prevention of gastric cancer

Regulatory effect of traditional Chinese medicines on signaling pathways of process from chronic atrophic gastritis to gastric cancer

Background and aim Atrophic gastritis is a precancerous gastric lesion, therefore its early detection is a priority in preventing gastric cancer. The aim of the present paper is to develop a narrative synthesis of the present knowledge on diagnostic methods of chronic atrophic gastritis. Methods A literature search was carried out on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier) for the period 2000-2020. The searched keywords were: chronic atrophic gastritis, intestinal metaplasia and dysplasia + diagnosis. Inclusion criteria were focused on the articles about the invasive and non-invasive diagnosis of chronic atrophic gastritis and of precancerous gastric lesions, intestinal metaplasia and dysplasia; exclusion criteria were articles published before 2000 and those that did not include the proposed theme. Results The search returned 575 papers addressing the topic of precancerous lesions. From these, 60 articles were qualified representative for the materials published on the topic of this synthesis article, being those that met the inclusion criteria. The data emphasize the need to use upper digestive endoscopy with biopsies for the diagnosis of chronic atrophic gastritis. However serological diagnosis is available as alternative mainly recommended in follow up. Conclusions There are two main methodological approaches for the evaluation of chronic atrophic gastritis as a precancerous gastric lesions: invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, being the "gold standard" for diagnosis, and non-invasive serological examination using markers of gastric function.

/pdf/chronic-atrophic-gastritis-an-update-on-diagnosis-35h89ktcan.pdf

Chronic atrophic gastritis: an update on diagnosis.

Aim. To study clinical efficacy and antihelicobacter activity of combined treatment of duodenal ulcer (DU) with famotidin (qamatel), metronidasol (trichopol) and jozamycin (walpraphen). Material and methods. A total of 96 patients with uncomplicated DU have been treated (mean age 42.5 ± 1.5 years). The examination included standard tests, endoscopy, pH-metry (on the treatment days 1, 15 and 28), biopsies and prints from the antral stomach and its body. The sections were stained by Gimsefor morphological assessment of duodenal mucosa and detection of Helicobacter pylori (HP). Gastric acid-producing function was examined with intragastric pH-metry. The patients were divided into 3 groups: group 1 received monotherapy with famotidin (20 mg twice a day); group 2 received combined treatment with famotidin (40 mg/day), metronidasol (500 mg twice a day), josamycin (300 mg in 3 doses) for a week with following intake of famotidin alone (40 mg/day) for 3 weeks; group 3 received the same treatment plus clarythromycin. Group 1 patients benefited from the treatment but elimination of pain and dyspeptic syndromes was longer than in groups 2 and 3 (p < 0.05). Ulcer healing to treatment day 28 was observed in 71.8, 90.0 and 88.2%, respectively. Side effects occurred in 0, 10 and 16.7% cases, respectively.
Conclusion. 1-week schemes of combined treatment with famotidin, metronidasol, josamycin or clarythromycin are highly effective in DU and their side effect rates are not very high.

[Efficacy of different schemes of anti-helicobacter therapy in duodenal ulcer].

Peculiarities of cardiac rhythm in stable chronic obstructive pulmonary disease

Complex ultrasound examination in the diagnosis of early forms of hepatic steatosis

Introduction: Detection and close monitoring of patients with precancerous lesions - chronic atrophic gastritis (GCA), gastric intestinal metaplasia (MIG) and gastric mucosal epithelial dysplasia (DEMG) is a priority to increase early detection and, implicitly, decrease mortality and mortality. by gastric cancer (GC). The aim of the present study is to develop a narrative synthesis of contemporary studies on GCA diagnostic methods. Material and methods: Eligible studies were searched in the PubMed, Hinari, SpringerLink and Scopus (Elsevier) databases during the years 2000-2020. Results: Out of 575 articles addressing the topic of precancerous lesions, 59 articles were qualified representative for the materials published on the topic of this synthesis article. Conclusions: There are two main methodological approaches for GCA evaluation: non-invasive serological examination using gastric function markers and invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, the latter being the „gold standard” for diagnosis.

Nicolae Bodrug

Papers

Chronic atrophic gastritis: an update on diagnosis.

[Efficacy of different schemes of anti-helicobacter therapy in duodenal ulcer].

Peculiarities of cardiac rhythm in stable chronic obstructive pulmonary disease

Complex ultrasound examination in the diagnosis of early forms of hepatic steatosis

News in the diagnosis of gastric precancerous lesions