Search Results (541)

Background: Irinotecan hydrochloride (CPT-11) is an important anticancer drug used in a wide range of regimens to treat colorectal and gastric cancers, and one of its severe side effects is delayed diarrhea. Therefore, based on known circadian variations in intestinal function and drug metabolism, we investigated whether CPT-11-induced delayed diarrhea may be attenuated by the time of dosing. Methods: When CPT-11 was administered to rats at 9:00 or 21:00, CPT-11-induced delayed diarrhea was assessed, and concentrations of CPT-11, its active metabolite SN-38, and SN-38 glucuronide (SN-38GL) in blood, intestinal tissues, and intestinal contents were measured. Results: The severity of diarrhea was significantly less in the 21:00 dosing group compared with the 9:00 dosing group. Blood SN-38 concentrations 8 h after the administration of CPT-11 were significantly higher in the 9:00 dosing group than in the 21:00 dosing group. SN-38, which exerts potent cytotoxic effects, circulates enterohepatically. When SN-38 is absorbed from the intestinal mucosa, intestinal tissues may be injured, resulting in delayed diarrhea. CPT-11 and SN-38 concentrations in intestinal tissues and contents 8 h after the administration of CPT-11 were significantly higher in the 9:00 dosing group than in the 21:00 dosing group at all measurement points. This was consistent with more severe CPT-11-induced delayed diarrhea in the 9:00 dosing group. Conclusions: Chronotherapy with CPT-11 may reduce CPT-11-induced delayed diarrhea. These differences in SN-38 concentrations in the intestinal tract at different dosing times may contribute to the time-dependent reduction in CPT-11-induced delayed diarrhea. Full article

Digestive tract structure is a key indicator of fish health and environmental adaptation, while seasonal dynamics of the gut microbiota reflect host responses to environmental changes. In this study, the digestive tract microstructure of Hypomesus nipponensis from Bosten Lake was characterized using H&E staining and scanning electron microscopy, followed by 16S rDNA gene V3-V4 region sequencing and analysis of the gut microbiota in spring, summer, and autumn. The results showed that the esophageal mucosa of H. nipponensis is a stratified columnar epithelium, with abundant gastric glands, and the circular muscle layer of the stomach caeca is significantly thickened (244.84 ± 49.01 μm). The pyloric caeca resemble the gut in structure; both are covered with dense microvilli on the luminal surface. Collectively, these features constitute the structural basis for its carnivorous diet. Microbiota analysis revealed that the diversity of gut microbiota fluctuated significantly with season: the Chao, Ace, and Sob indices in spring (144.63 ± 30.27) were significantly higher than in summer (82.13 ± 21.45) and autumn (83.25 ± 15.30) (p < 0.001), with no significant difference between summer and autumn (p > 0.05). The dominant marker genera of H. nipponensis in spring, summer, and autumn were Bacillus (31.60%), Clostridium (32.20%), and Sarcina (29.32%), respectively. This study describes the adaptive characteristics of the digestive tract structure and feeding habits of H. nipponensis and reveals the seasonal changes in its gut microbiota. Importantly, since the digestive tract structure data were collected only in summer, the direct relationship between the structure and seasonal microbial dynamics cannot be determined, and multi-season histological sampling is needed for further investigation. Nevertheless, these findings provide preliminary morphological and microbiological references for the ecological adaptation of this species in Bosten Lake and offer a scientific basis for water resource management in this area. Full article

Background/Objectives: AA amyloidosis is a serious complication of chronic inflammation, which may arise in the setting of inborn errors of immunity (IEIs) due to recurrent or persistent infections. Common variable immunodeficiency (CVID) is the most frequent symptomatic IEI in adults, yet its association with secondary AA amyloidosis remains rarely reported. Case presentation: We describe a 37-year-old male with a history of recurrent pneumonia, chronic sinusitis, and osteomyelitis with sepsis since childhood. At age 33, he developed bilateral pneumonia after COVID-19, followed by repeated lower respiratory tract infections. At age 36, nephrotic syndrome (proteinuria 10.69 g/day, hypoalbuminemia) led to kidney and gastric mucosa biopsies, which confirmed AA amyloidosis. Immunological workup revealed panhypogammaglobulinemia (IgG 0.1 g/L, IgA 0.01 g/L, IgM 0.28 g/L), markedly reduced switched memory B cells, and an inverted CD4⁺/CD8⁺ ratio. Chest CT showed bronchiectasis, bronchiolitis, and mediastinal lymphadenopathy. Whole-exome sequencing excluded known monogenic IEIs, autoinflammatory, or hereditary amyloidosis genes; a heterozygous likely pathogenic variant in ODAD2 (associated with primary ciliary dyskinesia) was considered incidental. A diagnosis of CVID with secondary AA amyloidosis was established. Conclusions: This case illustrates that CVID may remain undiagnosed for decades and present with secondary AA amyloidosis as the first major complication. In any patient with nephrotic syndrome and a history of recurrent or unusual infections, an IEI should be actively excluded. Early recognition of CVID and appropriate immunoglobulin replacement therapy can prevent infectious exacerbations and potentially halt amyloid progression. Full article

Background and Clinical Significance: Familial gastric polyposis is a rare condition associated with an increased risk of malignant transformation, particularly in patients with a strong family history of gastrointestinal malignancies. Case Presentation: We report the case of a 46-year-old female presenting with severe epigastric pain, persistent vomiting, and significant weight loss. Endoscopic and histopathological evaluation confirmed diffuse fundic gland polyposis with intestinal metaplasia involving the entire gastric mucosa. Given the extensive disease, pronounced symptoms, and significant familial cancer burden, the patient underwent total gastrectomy with Roux-en-Y esophagojejunostomy. The postoperative course was uneventful, with satisfactory recovery and favorable functional outcomes during follow-up. This case highlights the clinical challenges associated with diffuse symptomatic familial gastric polyposis and underscores the importance of timely surgical intervention in high-risk patients. Conclusions: Due to clinical complexity of such presentations, detailed case descriptions remain important for guiding clinical practice. Full article

Background: The clinical significance of lymphatic invasion in mucosal early gastric cancer (EGC) treated with endoscopic submucosal dissection (ESD) remains unclear. We evaluated clinicopathologic features and long-term outcomes in patients with lymphatic invasion as the sole non-curative factor. Methods: We retrospectively reviewed 9117 patients who underwent ESD for EGC at Samsung Medical Center between 2001 and 2022. Among patients with mucosal disease and lymphatic invasion as the sole non-curative factor, long-term clinical outcomes were summarized using an outcome flowchart, and characteristics of lymph node-positive cases were analyzed in relation to curative resection criteria. Results: Among 7444 patients with mucosal EGC treated with ESD, lymphatic invasion was identified in 154 patients (2.1%). Among the 117 patients with lymphatic invasion as the sole non-curative factor, the overall rate of pathologically confirmed or clinically suspected lymph node metastasis (LNM) was 4.3% (5/117). Specifically, LNM was identified in 3.2% (3/95) of patients who underwent additional surgery, and in 9.0% (2/22, including one clinically suspected case) managed with observation alone during a median follow-up of 58.0 months. LNM was observed exclusively in lesions involving the muscularis mucosae or in lesions larger than 2 cm, whereas no LNM occurred in tumors confined to the lamina propria measuring ≤ 2 cm. Conclusions: Despite mucosal confinement, lymphatic invasion was associated with a clinically meaningful risk of LNM, whereas no LNM was observed in lesions ≤ 2 cm confined to the lamina propria. For patients with mucosal EGC in whom lymphatic invasion is the sole non-curative factor, careful, individualized decision-making is warranted. Full article

At present, the gold standard for gastric cancer (GC) confirmation relies mostly on histopathology, an invasive procedure. Noninvasive detection methods using serum for large-scale screening may be useful for the early diagnosis of GC. Helicobacter pylori (HP) infection and chronic atrophic gastritis are major GC risk factors. We recently developed a noninvasive test called the DSC test-based on the patient’s age, sex, their serum PGI and PGII, anti-HP immunoglobulin (IgG), and gastrin G17 levels-predicting GC risk as low (score 0, S0) or high (score 2, S2). The comparative investigation at the serum protein level of the two different patient groups detected by our DCS test (S0 and S2) may undoubtedly help to identify gastric disease-dependent proteins, resulting from bacterial infection or gastric mucosa inflammation, as well as get better insight into the molecular scenario associated with pre-cancerous conditions. We used an untargeted liquid chromatography–tandem mass spectrometry (LC-MS/MS)-based proteomic profiling approach, followed by univariate statistical analysis to compare the different DSC groups across two patient cohorts (exploratory and validation). Significantly differentially abundant proteins differing more than 1.5-fold between S0 and S2 groups were selected and validated, and their putative role(s) in gastritis and GC were discussed. In both the exploratory and the validation cohorts, four proteins (beta-2-microglobulin, EGF-containing fibulin-like extracellular matrix protein 1, complement factor D, and cystatin-C) were more abundant, while two (sex hormone-binding globulin and pregnancy zone protein) were less abundant in the sera of S2 individuals (|fold change| ≥ 0.6, p < 0.05, t-test). The higher presence of beta-2-microglobulin (B2M) and the lower content of pregnancy zone protein (PZP) in S2 sera were validated by immunoblotting. Replacing age and sex in our DSC model with two specific candidate biomarkers can lead to a refined, albeit modest, improvement in classification accuracy. This study identified a proteomic signature that was differentially associated with the sera of patients with a different risk to develop advanced atrophy/GC according to the DSC test. Moving from a demographic model to a proteomic-driven model can better reflect the personalized biology of pathological processes associated with DSC. Full article

Background/Objectives: This study presents the development of an activated carbon/sodium alginate-based gastric-retentive delivery system aimed at enhancing the gastroprotective efficacy of eugenol (Eug) in simulated body fluids. Methods: Hybrid hydrogel beads were fabricated using tea waste-derived activated carbon (AC) as a core material and sodium alginate as a wall material. Results: The system achieved a loading capacity of 3.37 ± 0.11 mg Eug/g hydrogel beads, and in vitro assays revealed a controlled release profile, with cumulative release reaching 0.694 ± 0.006 mg/g hydrogel beads in simulated gastric fluid (SGF) and 0.198 ± 0.002 mg Eug/g hydrogel beads in simulated intestinal fluid (SIF). Conclusions: Kinetic modeling confirmed a predominantly diffusion-controlled process with non-Fickian transport mechanism, indicating combined diffusion and matrix relaxation. By maintaining local therapeutic concentrations in the gastric mucosa, this pH-responsive Alg/Eug@AC system offers a sustainable strategy to overcome Eug’s low bioavailability and provide effective gastroprotection against oxidative damage. Full article

Juniperus phoenicea L. is a popular plant in alternative medicine, particularly in the steppe and highland regions of western Algeria. The present study focuses on characterizing the essential oil of Juniperus phoenicea growing spontaneously in the Ain El Orak region of El Bayadh province, where it is a valuable resource. The essential oil yield obtained by hydrodistillation was 0.98%, and its characterization by GC-MS revealed 46 compounds, predominantly α-Terpinolene at 21.29%, Limonene at 14.68%, Terpinene 4-ol at 12.04%, β-Myrcene at 9.93%, and β-Pinene at 7.31%. The study of the anti-radical activity against DPPH showed an IC50 value of approximately 0.23 mg/mL. The evaluation of the anti-ulcer property on experimentally induced ulcers in mice through oral administration of ethanol demonstrated excellent protection of the gastric mucosa, with 48.07%, 54.87%, and 81.92% protection for doses of 50, 100, and 200 mg/kg, respectively, comparable to omeprazole at 72.40%. The hepatoprotective activity against toxicity induced by intraperitoneal injection of a 250 mg/kg dose of paracetamol in mice showed a protective effect expressed by the decrease in serum levels of AST (260.33 ± 9.69 IU/L) and ALT (56.22 ± 9.63 IU/L) to values comparable to the those of the physiological group, especially for the 300 mg/kg dose of the essential oil of J. phoenicea. Full article

The endoscopic findings of gastric mucosa-associated lymphoid tissue (MALT) lymphoma are highly nonspecific and the sampling error or false-negative probabilities during conventional biopsy make its diagnosis more challenging. Confocal laser endomicroscopy is a novel technology which allows in vivo microscopic analysis of gastrointestinal mucosa. Here we present a case of gastric MALT lymphoma by targeted biopsy guided by magnifying endoscopy and probe-based confocal laser endomicroscopy. Full article

Ethanol disrupts gastric mucosal integrity and induces inflammation. Transient receptor potential ankyrin 1 (TRPA1) and transient receptor potential vanilloid 1 (TRPV1) are receptors expressed in the gastrointestinal tract, but their role in gastric protection against ethanol-induced injury remains unclear. This study investigated the contribution of TRPA1 and TRPV1 to gastric responses following ethanol exposure. Wild-type mice and mice lacking TRPA1, TRPV1, or both receptors were subjected to intragastric ethanol administration. Gastric injury was evaluated by macroscopic and histologic analysis. Messenger RNA expression of selected proinflammatory cytokines and receptor transcripts was quantified using quantitative polymerase chain reaction. Receptor localization was examined by double immunofluorescence and confocal microscopy. Ethanol administration induced pronounced gastric mucosal injury in receptor-deficient mice, whereas only minimal changes were observed in wild-type animals. The protective effect was gradational, with weaker protection associated with TRPV1, greater protection with TRPA1, and the strongest protection when both receptors were present, suggesting a combined contribution of both receptors. In wild-type animals, ethanol exposure induced time-dependent changes in receptor expression, suggesting adaptive regulation. Immunofluorescence revealed localization of both receptors in neuronal and non-neuronal structures of the gastric wall. These findings demonstrate the distinct roles of TRPA1 and TRPV1 in protecting the gastric mucosa against ethanol-induced injury. Full article

Introduction: Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete involution of the vitelline duct during the fifth to seventh week of gestation. This study aimed to assess the prevalence, anatomical features, clinical manifestations, and heterotopic tissue of MD through a comprehensive meta-analysis of studies reporting on this anomaly. Methods: A systematic search of PubMed, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Contents Connect, and the Korean Journal Database was conducted up to March 2024 following PRISMA guidelines. Original studies with extractable data on Meckel’s diverticulum were included, while case reports, reviews, and studies with incomplete data were excluded. Outcomes included prevalence, anatomical features, clinical manifestations, complications, and postoperative outcomes. The study quality was assessed using CATAM and AQUA tools. Results: The results of the present meta-analysis comprised 172 studies. The pooled prevalence of MD was 1.56% (95% CI: 0.98–2.28%). Nausea and vomiting were the most frequent symptoms in the pediatric group, with an incidence of 52.34% (95% CI: 38.59–65.92%). In adults, wound infections or dehiscence or anastomotic leakage were the most common postoperative outcomes, with a pooled prevalence of 6.20% (95% CI: 4.02–8.79%). Conclusions: This systematic review and meta-analysis provide a comprehensive quantitative synthesis of MD characteristics. Symptomatic cases most frequently presented with intestinal obstruction, diverticulitis, and bleeding, each showing distinct age-related trends. Ectopic gastric mucosa was identified in over 40% of pediatric MD. Postoperative outcomes were generally favorable, particularly in elective settings, with low rates of morbidity and mortality. It is hoped that the findings of this study will aid clinicians in diagnosing, risk-stratifying, and managing patients with MD, particularly in guiding surgical decisions for incidentally discovered cases. Full article

Background/Objectives: Rebamipide is a gastroprotective agent with poor aqueous solubility and rapid gastrointestinal clearance, leading to reduced therapeutic efficiency. This study aimed to enhance the solubility, mucoadhesion, and sustained oral delivery of Rebamipide through the development of a deep eutectic mixture (DEM)-based bioadhesive controlled-release granule formulation. Methods: In silico hydrogen-bonding interactions between Rebamipide, malonic acid, and urea were analyzed using CCDC tools. A thermodynamically stable DEM (1:3:1) was prepared and incorporated into bioadhesive granules using chitosan and HPMC. Physicochemical characterization was conducted using FTIR, DSC, TGA, and PXRD. Solubility, in vitro dissolution, ex vivo mucoadhesion (sheep gastric mucosa), and in vivo gastric retention (BaSO₄-loaded granules in rats) were evaluated. Results: The optimized DEM significantly enhanced Rebamipide solubility (10.08 mg/mL vs. 0.045 mg/mL). Solid-state analyses confirmed hydrogen-bond formation and reduced crystallinity. DEM granules exhibited sustained drug release over 24 h (99.7 ± 0.8%) with improved dissolution efficiency compared to the marketed tablet (Mucosta®, 100 mg; T₅₀%: 5.03 h vs. 0.82 h). Kinetic modeling indicated non-Fickian anomalous transport (n = 0.47). The bioadhesive force of DEM granules (0.29 ± 0.02 N) was significantly higher than that of the pure drug and physical mixture. In vivo radiographic studies confirmed prolonged gastric retention. Conclusions: The DEM-based bioadhesive granule system effectively improves solubility, dissolution rate, mucoadhesion, and gastric retention of Rebamipide. This approach represents a promising platform for once-daily gastroretentive oral delivery, pending further pharmacokinetic evaluation. Full article

A 27-year-old male presented with chronic diarrhea, bloating, and abdominal pain since age 13. Initially attributed to lactose intolerance, treated with dairy-free diet, symptoms persisted despite negative workup—normal celiac serology, stool studies, and abdominal ultrasound. Recent symptoms included severe diarrhea, fatigue, weakness, 8 kg weight loss, hair loss, elevated IgE and fecal calprotectin. Gastroscopy showed flattened, granular gastric mucosa with focal hyperemia in the antrum and greater curvature. Histology revealed severe chronic inactive H. pylori-negative gastritis with a prominent subepithelial collagen band (verified by Crossmon’s trichrome), confirming collagenous gastritis—a rare entity first described in 1989. The condition has a slight female predominance and bimodal age peaks (adolescence and >60 years). Symptoms are nonspecific, including abdominal pain, diarrhea, weight loss and anemia. Pediatric cases often feature nodular mucosa and anemia; adults more commonly present with watery diarrhea, sometimes linked to collagenous colitis. Diagnosis requires histological features including patchy subepithelial collagen band ≥ 10 μm thick, lymphocytic or eosinophilic infiltration of the lamina propria, epithelial changes and entrapped capillaries. Patterns include atrophic, lymphocytic-like, and eosinophil-rich. Crossmon’s or Masson’s trichrome, Congo red, and tenascin immunohistochemistry aid in proving collagen and excluding amyloidosis. Treatment is mainly symptomatic or with proton pump inhibitors; corticosteroids may be effective in refractory cases. Full article

Gastric-type lesions in the duodenum, including pyloric gland adenoma and gastric foveolar metaplasia, have been increasingly recognized for their unique histogenesis and potential link through the metaplasia–neoplasia sequence. However, the coexistence of neoplastic and non-neoplastic gastric-type lesions within the same histological section has not been previously reported. Here, we present a case of a 73-year-old Japanese woman who underwent endoscopic submucosal dissection for a 34 × 20 mm elevated lesion in the duodenal bulb. Based on the preoperative biopsy results, pyloric gland adenoma was diagnosed; however, histopathological examination of the resected specimen revealed a far more complex picture. The main lesion consisted of two contiguous components: a hyperplastic polyp with gastric foveolar-type phenotype (Lesion I) and a pyloric gland adenoma mixed with gastric foveolar-type hyperplastic polyp (Lesion II). Importantly, the transitional zone between these components demonstrated histological continuity, with areas showing admixture of hyperplastic and adenomatous features within the same microscopic field. A separate hyperplastic polyp with gastric foveolar-type phenotype (Lesion III) was also identified, separated from Lesions I and II by intervening normal duodenal mucosa. All lesions shared a gastric-type mucin phenotype (MUC5AC-positive, CD10-negative), and extensive Brunner’s gland hyperplasia was observed throughout the specimen. This case provides compelling morphological evidence for a histogenetic link between non-neoplastic gastric-type hyperplasia and pyloric gland adenoma, supporting the concept of a metaplasia–neoplasia sequence in the duodenum. Furthermore, the presence of an additional separate lesion with the same phenotype suggests a field change in the development of gastric-type lesions. Full article

Helicobacter pylori is a Gram-negative bacterium that inhabits the gastric mucosa, with a global prevalence in humans of approximately 40%. It is likely the cause of 90% of gastric cancer (GC) cases and thus considered the most prominent driver of GC development. However, during gastric mucosal atrophy, other bacteria such as nitrate-reducing bacteria (NRB) also proliferate. In this study, we isolated NRB from patients with gastritis and GC to examine their effects on the epithelial cell cycle and production of various cytokines in monocytic cell lines. Bacterial counts (excluding H. pylori and NRB) increased with the progression of gastric mucosal atrophy and were significantly higher in patients with GC. Gastric epithelial cell lines were stimulated with isolated NRB, and the proportion of cells in each cell cycle was measured. Strains from patients with open-type gastritis progressed more rapidly through cell cycles than those from patients with GC. NRB isolated from gastric cancer had high nitrate-reducing activity. Thus, NRB may contribute to GC progression during H. pylori-induced carcinogenesis. Therefore, evaluating gastric atrophy and microbiota may be important for managing the risk of GC. Full article