Search Results (58)

Background and Clinical Significance: Sengstaken–Blakemore tube insertion is a temporary but important intervention for uncontrolled upper gastrointestinal bleeding, especially when endoscopic hemostasis fails. Case presentation: We present the case of a 63-year-old man with a history of esophageal cancer surgery and gastric variceal treatment who presented to the emergency department with hematemesis and altered consciousness. Endoscopy revealed a bleeding ulcer at the intrathoracic esophagus. Endoscopic band ligation failed, and the patient’s condition deteriorated, prompting the insertion of an Sengstaken–Blakemore tube. Owing to prior Ivor Lewis surgery, the gastric balloon was not used; only the esophageal balloon was inflated, and hemostasis was successfully achieved. Despite the relative contraindication of prior esophageal surgery, no complications occurred. The patient was discharged on hospital day 20 without recurrence. Conclusions: This case illustrates that in patients with unstable upper gastrointestinal bleeding with surgical history, selective use of Sengstaken–Blakemore tube may offer life-saving hemostasis when endoscopy fails, even when standard indications are not met. Full article

Background and aim: The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined. Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings. Methods: This retrospective study included 38,392 adults (≥18 years) who tested positive for FIT between 2016 and 2022 across eight medical centers in Israel. Of them, 1560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included the detection of neoplastic and precancerous lesions, with the rates of adenoma and polyp detection calculated. Gastroscopy findings, including gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy, were analyzed and compared between patients with normal and abnormal colonoscopy results. Results: Among 38,392 FIT-positive adults, 1560 underwent bidirectional endoscopy; of these, 632 (40.5%) had normal and 928 (59.5%) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.5% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 15% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Gastric ulcers were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group. Conclusions: Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare. Full article

Background/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies. Full article

Background: The relationship between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) remains a topic of ongoing debate. In particular, the intragastric distribution of H. pylori—whether localized in the antrum or corpus—may influence gastric acid secretion and esophageal physiology in different ways. However, its potential effects on esophageal motility and reflux parameters have not been comprehensively evaluated using combined diagnostic tools. This study aimed to assess whether H. pylori positivity, based on its histologically confirmed intragastric localization, is associated with alterations in endoscopic, manometric, and reflux monitoring findings in patients with typical GERD symptoms. Methods: This retrospective study included 213 patients with typical reflux symptoms who underwent upper gastrointestinal endoscopy with gastric biopsies, high-resolution esophageal manometry (HREM), and 24 h multichannel intraluminal impedance–pH (MII-pH) monitoring. Based on histopathology, patients were classified into three groups: H. pylori-negative, antrum-predominant infection, and corpus-predominant infection. Clinical symptoms, endoscopic findings, reflux characteristics, and esophageal motility parameters were compared. Results: Of 213 patients, 90 were H. pylori-positive (60 antrum-predominant, 30 corpus-predominant). There were no significant differences between groups in terms of typical GERD symptoms, endoscopic esophagitis, DeMeester scores, acid exposure time, or mean nocturnal baseline impedance (MNBI). Nausea and chronic laryngitis were significantly more frequent in antral H. pylori-positive patients. Notably, contraction front velocity (CFV) was significantly lower in patients with antral H. pylori compared with H. pylori-negative individuals (p = 0.002), indicating subtle slowing of esophageal peristalsis. Although this reduction in CFV did not correlate with symptom severity or bolus clearance, it may represent early functional impairment of esophageal motility. Conclusions: Although H. pylori infection—particularly when antrum-predominant—is not associated with increased reflux burden or esophagitis, it may contribute to extra-esophageal symptoms and minor motility alterations such as reduced CFV. These findings suggest that routine H. pylori eradication in GERD patients may not be necessary solely based on reflux parameters. However, treatment decisions should be individualized based on symptom profiles and endoscopic findings, including the presence of peptic ulcers, premalignant gastric lesions, or a family history of gastric malignancy, in accordance with general H. pylori eradication criteria. Full article

Diagnosing gastrointestinal disorders (GIDs) remains a significant challenge, particularly when relying on wireless capsule endoscopy (WCE), which lacks advanced imaging enhancements like Narrow Band Imaging (NBI). To address this, we propose a novel framework, the Spectrum-Aided Vision Enhancer (SAVE), especially designed to transform standard white light (WLI) endoscopic images into spectrally enriched representations that emulate both hyperspectral imaging (HSI) and NBI formats. By leveraging color calibration through the Macbeth Color Checker, gamma correction, CIE 1931 XYZ transformation, and principal component analysis (PCA), SAVE reconstructs detailed spectral information from conventional RGB inputs. Performance was evaluated using the Kvasir-v2 dataset, which includes 6490 annotated images spanning eight GI-related categories. Deep learning models like Inception-Net V3, MobileNetV2, MobileNetV3, and AlexNet were trained on both original WLI- and SAVE-enhanced images. Among these, MobileNetV2 achieved an F1-score of 96% for polyp classification using SAVE, and AlexNet saw a notable increase in average accuracy to 84% when applied to enhanced images. Image quality assessment showed high structural similarity (SSIM scores of 93.99% for Olympus endoscopy and 90.68% for WCE), confirming the fidelity of the spectral transformations. Overall, the SAVE framework offers a practical, software-based enhancement strategy that significantly improves diagnostic accuracy in GI imaging, with strong implications for low-cost, non-invasive diagnostics using capsule endoscopy systems. Full article

Helicobacter pylori (Hp), a widespread gastric pathogen, has long been studied for its role in upper gastrointestinal disorders. While its involvement in gastritis, peptic ulcer disease, and gastric cancer is well established, its impact on esophageal diseases remains an area of ongoing investigation. Nevertheless, some data indicate that Hp may be involved in the pathogenesis of gastroesophageal reflux disease–Barrett’s esophagus–esophageal adenocarcinoma sequence. Similarly, the Hp-related mast cell activation—an essential immunological event—may also play a crucial role in the progression from gastroesophageal reflux disease to Barrett’s esophagus and esophageal adenocarcinoma. The underlying mechanisms include immune modulation, cytokine cascades, and microbial interactions that collectively shape the esophageal microenvironment. This review provides an in-depth analysis of these pathways, highlighting the potential role of Hp-induced, mast cell-driven inflammation in esophageal disease progression and discussing emerging therapeutic strategies. Full article

Ulcerative colitis, polyps, esophagitis, and other gastrointestinal (GI) diseases significantly impact health, making early detection crucial for reducing mortality rates and improving patient outcomes. Traditional white light imaging (WLI) is commonly used during endoscopy to identify abnormalities in the gastrointestinal tract. However, insufficient contrast often limits its effectiveness, making it challenging to distinguish between healthy and unhealthy tissues, particularly when identifying subtle mucosal and vascular abnormalities. These limitations have prompted the need for more advanced imaging techniques that enhance pathological visualization and facilitate early diagnosis. Therefore, this study investigates the integration of the Spectrum-Aided Vision Enhancer (SAVE) mechanism to improve WLI images and increase disease detection accuracy. This approach transforms standard WLI images into hyperspectral imaging (HSI) representations, creating narrow-band imaging (NBI-like) visuals with enhanced contrast and tissue differentiation, thereby improving the visualization of vascular and mucosal structures critical for diagnosing GI disorders. This transformation allows for a clearer representation of blood vessels and membrane formations, which is essential for determining the presence of GI diseases. The dataset for this study comprises WLI images alongside SAVE-enhanced images, including four categories: ulcerative colitis, polyps, esophagitis, and healthy GI tissue. These images are organized into training, validation, and test sets to develop a deep learning-based classification model. Utilizing principal component analysis (PCA) and multiple regression analysis for spectral standardization ensures that the improved images retain spectral characteristics that are vital for clinical applications. By merging deep learning techniques with advanced imaging enhancements, this study aims to create an artificial intelligence (AI)–driven diagnostic system capable of early and accurate detection of GI diseases. InceptionV3 attained an overall accuracy of 94% in both scenarios; SAVE produced a modest enhancement in the ulcerative colitis F1-score from 92% to 93%, while the F1-scores for other classes exceeded 96%. SAVE resulted in a 10% increase in YOLOv8x accuracy, reaching 89%, with ulcerative colitis F1 improving to 82% and polyp F1 rising to 76%. VGG16 enhanced accuracy from 85% to 91%, and the F1-score for polyps improved from 68% to 81%. These findings confirm that SAVE enhancement consistently improves disease classification across diverse architectures, offers a practical, hardware-independent approach to hyperspectral-quality images, and enhances the accuracy of gastrointestinal screening. Furthermore, this research seeks to provide a practical and effective solution for clinical applications, improving diagnostic accuracy and facilitating superior patient care. Full article

Rare presentations are surprising and may disturb the day-to-day routine of a medical unit; however, they are expected (not as individual entities, but as a group of “uncommon causes”). While reviewing the literature in relation to three clinical cases of upper gastrointestinal bleeding (UGIB) encountered in our institution—gastric metastases of breast cancer (GMB), pyloric gland adenoma, and gastrointestinal stromal tumor (GIST)—we identified seven and 29 case reports for the first two entities, and over 100 publications addressing GIST. This prompted a shift in focus from novel reporting to diagnostic contextualization. We found it difficult to obtain an overview of the spectrum of UGIB etiologies, as most publications refer to a few individual entities or to a subgroup of rare causes. The narrative review we conducted arose from this particular research methodology. Based on a broad literature search, UGIB etiologies were organized in five categories (lesions of the mucosa, neoplasms, vascular causes, bleeding predisposition, and external sources of bleeding). In the management of patients with UGIB, the underlying etiology deviates from the classic peptic ulcer disease/esophageal varices dyad in approximately half of the cases. This underscores the need for heightened clinical vigilance, particularly in complex scenarios, where endoscopic findings, imaging results, and histopathological interpretations may be unexpected or prone to misinterpretation. As an illustration, we conducted two systematic reviews of case reports of bleeding GMB and PGA. Our findings support a proactive diagnostic and research mindset and advocate for improved awareness of uncommon UGIB etiologies. Full article

Ellagitannins are bioactive phenolic acids found in various fruits, plants, and beverages such as wine and spirits. This review aims to discuss the metabolism, absorption, and some health benefits related to the intestinal activity of these molecules, as well as some supplements developed from them. Ellagitannins are first biodegraded to ellagic acid and then to urolithins, which are more easily absorbed. This process is mediated by specific enzymes and intestinal microbiota. Not all individuals can metabolize ellagitannins into urolithins due to differences in the composition of the intestinal microbiota, resulting in three phenotypes: metabotypes A, B, and 0. In recent decades, ellagitannins and their derivatives (ellagic acid and urolithins) have gained significant attention for their potential benefits against various digestive diseases, including irritable bowel syndrome, peptic ulcers, gastritis, colon cancer, esophageal cancer, and pancreatic cancer. As a result, nutraceutical supplements have been developed to treat these conditions, representing significant and promising applications of these compounds in digestive health. Full article

Inflammatory bowel disease (IBD) in the pediatric population presents distinct characteristics compared to adult cases. Pathology plays a critical role in its diagnosis, and this review underscores key considerations in the pathologic evaluation of pediatric IBD. Recognizing inflammatory patterns in the upper gastrointestinal tract can improve disease classification and aid in diagnosing IBD in certain scenarios, such as isolated upper gastrointestinal or small bowel involvement. Additionally, familiarity with distinctive subtypes, including IBD associated with primary sclerosing cholangitis and monogenic forms of IBD, supports early comorbidity detection, enhances patient management, and improves prognostication. Full article

Background and Clinical Significance: Mexiletine is a class 1B antiarrhythmic drug commonly prescribed for ventricular arrhythmias and neuropathic pain. It works as a blocker of the sodium channel that modulates cardiac conduction and reduces aberrant nerve signaling. While it is generally well tolerated, gastrointestinal side effects, such as nausea, vomiting, and abdominal pain, are relatively common. Esophagitis and esophageal ulcerations have been described as rare side effects; however, they are poorly documented in the literature. Esophageal ulceration induced by oral medications, termed pill esophagitis, occurs due to prolonged contact between the medication and the esophageal mucosa. Factors contributing to this phenomenon include improper administration, such as swallowing without sufficient water, taking medication before lying down, or inherent irritant properties of the drug itself. Mexiletine-induced esophageal ulceration has not been extensively reported, making such cases clinically significant and worth investigating. In particular, the prompt diagnosis of mexiletine-induced esophageal injury is essential for timely treatment initiation or the discontinuation of the drug, preventing complications such as bleeding, strictures, or perforation. Altogether, these actions are important to prevent the onset of potentially serious complications, such as bleeding, strictures, and the perforation of the esophagus. Case Presentation: Two different patients were included in this case report on mexiletine-induced esophageal ulceration: a 78-year-old woman affected by primary dilated cardiomyopathy and atrial fibrillation with high ventricular response and a 19-year-old man affected by dilated cardiomyopathy and systemic sclerosis. Conclusions: This case report underscores the importance of recognizing mexiletine-induced esophageal ulceration, and it advocates for timely diagnosis and management to optimize patient outcomes. Full article

Background: Lichen planus (LP) is a chronic inflammatory disease that can present with significant morbidity, particularly in children. Erosive lichen planus (ELP), its rare destructive subtype, can be particularly difficult to diagnose and manage. We present a rare pediatric case of ELP with multisite involvement and discuss the differential diagnosis. Case Presentation: A 12-year-old boy presented with painful erosions and ulcers on the lateral tongue and dystrophic nails. His six-year history of tongue and nail lesions prompted several comprehensive examinations. Laboratory tests did not reveal any abnormalities. Histopathological examination of the tongue lesions was representative of ELP. Line-field confocal optical coherence tomography (LC-OCT) examination of the tongue lesions showed features that strongly correlated with histopathology. The patient was later hospitalized due to dysphagia and esophageal food impaction, during which esophageal ELP was confirmed. The patient was initially managed with topical corticosteroids. He was later started on systemic therapy in the form of methotrexate and low-dose naltrexone to address his symptoms and disease presentation. Conclusions: This case highlights the complexities of diagnosis and management of ELP in pediatric patients. A multidisciplinary approach and regular follow-up are necessary to manage symptoms, prevent complications, and improve quality of life. Full article

The purpose of this research is to contribute to the development of approaches for the classification and segmentation of various gastrointestinal (GI) cancer diseases, such as dyed lifted polyps, dyed resection margins, esophagitis, normal cecum, normal pylorus, normal Z line, polyps, and ulcerative colitis. This research is relevant and essential because of the current challenges related to the absence of efficient diagnostic tools for early diagnostics of GI cancers, which are fundamental for improving the diagnosis of these common diseases. To address the above challenges, we propose a new hybrid segmentation model, U-MaskNet, which is a combination of U-Net and Mask R-CNN models. Here, U-Net is utilized for pixel-wise classification and Mask R-CNN for instance segmentation, together forming a solution for classifying and segmenting GI cancer. The Kvasir dataset, which includes 8000 endoscopic images of various GI cancers, is utilized to validate the proposed methodology. The experimental results clearly demonstrated that the novel proposed model provided superior segmentation compared to other well-known models, such as DeepLabv3+, FCN, and DeepMask, as well as improved classification performance compared to state-of-the-art (SOTA) models, including LeNet-5, AlexNet, VGG-16, ResNet-50, and the Inception Network. The quantitative analysis revealed that our proposed model outperformed the other models, achieving a precision of 98.85%, recall of 98.49%, and F1 score of 98.68%. Additionally, the novel model achieved a Dice coefficient of 94.35% and IoU of 89.31%. Consequently, the developed model increased the accuracy and reliability in detecting and segmenting GI cancer, and it was proven that the proposed model can potentially be used for improving the diagnostic process and, consequently, patient care in the clinical environment. This work highlights the benefits of integrating the U-Net and Mask R-CNN models, opening the way for further research in medical image segmentation. Full article

Background: Although heartburn and reflux are frequently reported in ulcerative colitis [UC], the correlation between UC and gastroesophageal reflux disease [GERD], and its complications, esophageal stricture and Barrett’s esophagus [BE], is not well understood. This study aims to examine the prevalence and associated risk of GERD and its complications within the UC population. Methods: We analyzed the National Inpatient Sample (NIS) dataset, consisting of 7,159,694 patients, comparing GERD patients with and without UC to those without GERD. We assessed the degree of colonic involvement in UC and the occurrence of esophageal complications. Bivariate analyses were conducted using the chi-squared test or Fisher exact test (two-tailed). Results: A higher prevalence of GERD (23.0% vs. 16.5%) and GERD phenotypes, such as non-erosive reflux disease (NERD) (22.3% vs. 16%) and erosive esophagitis (EE) (1.2% vs. 0.6%), was found in UC patients (p < 0.01), including pancolitis, proctitis, proctosigmoiditis, left-sided colitis, and indetermined UC (with undefined colonic involvement). UC patients were more likely to develop GERD (1.421), NERD (1.407), and EE (1.681) (p < 0.01). A higher prevalence of esophageal stricture (16.9 vs. 11.4 per 10,000 patients) and BE without dysplasia (94.5 vs. 39.3 per 10,000 patients) was found in UC (p < 0.05). The odds of developing BE without dysplasia were higher (1.892) in patients with UC (p < 0.01), including ulcerative pancolitis, proctitis, and indeterminate UC (OR of 1.657, 3.328, and 1.996, respectively) (p < 0.05). Conclusions: Our study demonstrates an increased risk of developing GERD and its complications in UC. This highlights the importance of vigilant monitoring and early intervention to minimize associated GERD-related risks in patients with UC. Full article

Gastric acid secretion is closely associated with the development and treatment of chronic gastritis, gastric ulcers, and reflux esophagitis. However, gastric acid secretion is affected by complex physiological and pathological factors, and real-time detection and control are complicated and expensive. A gastric delivery system for antacids and therapeutics in response to low pH in the stomach holds promise for smart and personalized treatment of stomach diseases. In this study, pH-responsive modular units were used to assemble various modular devices for self-regulation of pH and drug delivery to the stomach. The modular unit with a release window of 50 mm² could respond to pH and self-regulate within 10 min, which is related to its downward floatation and internal gas production. The assembled devices could stably float downward in the medium and detach sequentially at specific times. The assembled devices loaded with antacids exhibited smart pH self-regulation under complex physiological and pathological conditions. In addition, the assembled devices loaded with antacids and acid suppressors could multi-pulse or prolong drug release after rapid neutralization of gastric acid. Compared with traditional coating technology, 3D printing can print the shell layer by layer, flexibly adjust the internal and external structure and composition, and assemble it into a multi-level drug release system. Compared with traditional coating, 3D-printed shells have the advantage of the flexible adjustment of internal and external structure and composition, and are easy to assemble into a complex drug delivery system. This provides a universal and flexible strategy for the personalized treatment of diseases with abnormal gastric acid secretion, especially for delivering acid-unstable drugs. Full article