Endoscopic biopsy is essential to the proper diagnosis and treatment of gastric cancer. Unfortunately, the results of endoscopic biopsy are not always the same as what is expected based on gross endoscopic findings. The results of endoscopic biopsy can be negative for malignancy in Borrmann type Ⅳ advanced gastric cancer (AGCa) or gastric lymphoma. However, in the case of type Ⅱ AGCa, repeated biopsies negative for malignancy have not been reported. A 49-year-old male patient underwent esophagogastroduodenoscopy three times due to large gastric ulcer suspected to be Borrmann type Ⅱ cancer. However, three repeat endoscopic biopsies with multiple specimens showed necrosis and superficial regenerative epithelium without malignant findings. The patient underwent laparoscopic distal gastrectomy with D2 lymph node dissection. The surgical specimen revealed that the mucosal layer was completely replaced with regenerative epithelium without cancer cells.
BackgroundGastric acidity could determine Helicobacter pylori (H. pylori)-associated gastritis patterns. In reverse, H. pylori infection could lead disturbance in gastric acid secretion. We attempted to elucidate gastric acid status by conventional endoscopy with pepsinogen test.MethodsA total of 196 subjects who visited our health promotion center were consecutively enrolled and evaluated by conventional endoscopy, and blood examinations with pepsinogen I, II, and fasting serum gastrin were conducted. As a Japanese study suggested that in H. pylori-positive subjects the cutoff value was PG I/II ratio ≤ 2.7 for hypochlorhydia, PG I/II ratio ≥ 3.3 for hyperchlorhydria. Based on these serological data, we compared conventional endoscopic images with each acid level.ResultsIt showed that for hypoacidity, older age, and most of the H. pylori-associated endoscopic appearances featuring mucosal inflammation and more atrophy of corpus or antrum were in favor of hypoacidity in closed type. Mucosal appearances showing severe corpus atrophy and remnant gastritis with advanced background atrophy determine hypoacidity in open type. For hyperacidity, mucosal appearances featuring intact mucosa and less severe atrophy were associated with hyperacid status. Male gender, antrum camouflage were also involved in hyperacidity.ConclusionsConventional endoscopy with pepsinogen test could be useful in gastric acid assessment.
Background/Aims
Rugal hyperplastic gastritis (RHG) is associated with Lauren’s diffuse-type gastric cancer (GC) and the accompanying active inflammation is linked to gastric hypoacidity. We tried to establish the steps for identifying high-risk GC patients.
Methods
We included 196 patients with confirmed
Helicobacter pylori
infection by rapid urease test during screening endoscopy for health check-up from January 2016 to September 2016; all patients underwent blood tests for pepsinogen I and II and fasting serum gastrin. We compared RHG findings with various other endoscopic mucosal images. We also evaluated the relationships between RHG and other mucosal aspects for a given acid status based on serological markers.
Results
Hypoacid and ultra-low-acid (67%) statuses were dominant, with only 18% hyperacid patients. RHG with high acid was related to a less atrophic body type (
p
=0.001), and RHG with ultra-low acid was associated with body xanthoma (
p
=0.029) and increased serum gastrin level (
p
=0.038). However, RHG’s influence on gastric acidity was only seen in closed-type endoscopic atrophic border (EAB), not in open type (
p
=0.001).
Conclusions
The majority of RHG patients had hypoacid status. RHG frequency showed no difference between closed and opentype EAB, but gastric acidity was influenced by RHG only in closed-type EAB.
Phlegmonous gastritis is a rare disease of acute suppurative inflammation in the stomach wall. It is rapidly progressive and potentially fatal. Its mortality rate remains very high because the clinical diagnosis is often delayed. Many patients with phlegmonous gastritis undergo surgery. We present the case of 63-year-old woman with epigastric pain, fever, nausea and vomiting. The presumed diagnosis of acute phlegmonous gastritis was made by esophagogastroduodenoscopy, abdominal computed tomography, endoscopic ultrasonography and deep submucosal biopsy assisted with hook knife. Acinetobacter baumannii was cultured in the aspiration from the stomach. We treated the patient with antibiotics alone. Early recognition of phlegmonous gastritis by endoscopic biopsies and bacteriological study may improve the prognosis of these patient. 입원일 시행한 상부위장관내시경에서 위에 전반적인 부종이 있으면서 내강이 좁아져 보였으나 점막은 정상이었고, 위 출구 폐쇄 소견은 보이지 않았다 (Fig. 1). 복부 CT에서 위 체부에서 전정부에 걸쳐 미만성으로 저밀도의 위벽 부종이 관찰되었다
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