BACKGROUND: Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death.
METHODS: This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel\'s diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel\'s diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery.
CONCLUSIONS: Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.

报道1例胃底锯齿状异型增生伴癌变病例。患者胃底隆起型病变，镜下观察见肿瘤上皮显著的锯齿状改变，表面部分呈乳头状生长，腺体结构复杂，见低级别、高级别异型增生2种形态。免疫组织化学：MUC5AC阳性，MUC6部分阳性，p53异常过表达，Ki-67表达不定，热点区阳性指数60%。分子病理：KRAS基因第2号外显子突变。胃锯齿状异型增生临床较罕见，胃镜及病理医师易漏诊、低诊断，诊断主要依赖于病理学，且常与腺癌相伴，日常工作中应高度重视。.

OBJECTIVE: Data regarding Helicobacter pylori (H. pylori)-associated mucosa-associated lymphoid tissue (MALT) lymphoma in children are lacking. We aimed to characterize the diagnosis, management, and outcome of H. pylori-associated MALT lymphoma in pediatric patients.
METHODS: A retrospective multicenter case series of the pediatric patients with H. pylori-associated MALT lymphoma who were diagnosed during 2010-2022.
RESULTS: Five children, of them three females, were identified. The mean age at diagnosis was 14.6 ± 2.4 years. The clinical presentation included abdominal pain (5/5), nausea (3/5), weight loss, night sweats, recurrent fever (1/5), and iron deficiency anemia (2/5). Endoscopic findings in both the stomach antrum and body included a fragile and hyperemic mucosa, large ulcers, extensive nodularity, and exudate. All the biopsies from the gastric mucosa were consistent with MALT lymphoma, and positive for H. pylori (by Giemsa stain). All the patients received triple therapy (amoxicillin, nitroimidazole, or a macrolide, and a proton pump inhibitor, for 14 days), and achieved H. pylori eradication. All had complete resolution of histological findings at the last follow-up. In one patient, the histology of MALT lymphoma persisted 12 months after H. pylori eradication, and only the 18-month-biopsy was free of residual disease.
CONCLUSIONS: In this series of pediatric MALT lymphoma, complete resolution of disease occurred in all the patients, yet histological remission was delayed in one. This supports the importance of endoscopic follow-up.

Az oxynticus mirigy neoplasia terminológia a gyomor olyan atípusos fő- és fedősejtek által alkotott mirigyei esetében használatos, amikor nem látszik invázió, tehát a fundus mirigy adenocarcinoma diagnózisa nem állítható fel, ugyanakkor a laesio nem került kompletten eltávolításra, tehát teljes vastagsága nem vizsgálható. Az oxynticus mirigy neoplasiák etiológiája jelenleg tisztázatlan, egyes források protonpumpagátlókkal, valamint antihisztamin-használattal hozták őket összefüggésbe. Endoszkópos vizsgálat során a morfológiájuk nem specifikus, lapos és polypoid laesiók egyaránt lehetnek, és döntően a gyomor felső egyharmadára lokalizáltak. Amennyiben komplett endoszkópos nyálkahártya-reszekció kivitelezhető, további kezelés nem szükséges, tehát összességében jó prognózisú elváltozásoknak tarthatók. Közleményünkben egy 84 éves nő esetét mutatjuk be, akinél haspuffadás miatt indult kivizsgálás, és gasztroszkópia történt. A corpus területén 1 cm-es, lapos polypus volt látható, melyből többszörös biopszia történt, a képlet közel teljes eltávolításával. A szövettani vizsgálat során a nyálkahártya mélyén jól körülírt és jól differenciált, expanzív szélű elváltozás volt megfigyelhető, melyet atípusos fősejtek, elvétve pedig fedősejtek alkottak. Ezek a sejtek oxynticusmirigy-szerű struktúrákat képeztek. A pepszinogénreakció a fősejtekben szemcsés jellegű, citoplazmatikus pozitivitást mutatott. H+/K+ ATPáz reakcióval a fedősejtekben szintén szemcsés jellegű, citoplazmatikus pozitivitás látszott. MUC6-tal a laesionalis sejtekben diffúz, citoplazmatikus pozitivitás volt megfigyelhető. Invázió jeleit nem láttuk. A morfológiai, valamint az immunfenotípus alapján is az elváltozást oxynticus mirigy neoplasiának véleményeztük, ’low-grade’ dysplasiával. Az oxynticus mirigy neoplasiák mind klinikai, mint patológiai szempontból fokozott figyelmet igényelnek, ugyanis ritka entitásokról van szó, melyeknek egyelőre sem az etiológiájuk, sem a prognózisuk nem tisztázott teljes mértékben. Differenciáldiagnosztikai szempontból fundus mirigy polypus, pylorus mirigy adenoma, valamint neuroendokrin tumor jön szóba. A definitív diagnózis felállítását pepszinogén, H+/K+ ATPáz, valamint MUC6 immunhisztokémiai reakciók segíthetik. Orv Hetil. 2024; 165(27): 1053–1057.

The predominant characteristic of autoimmune gastritis (AIG) is corpus-dominant advanced atrophy, which is mostly observed in the middle to late stages. More reports are needed on the endoscopic features of the early stage. In this report, we present two cases of early-stage AIG in which endoscopic examinations showed no atrophy of the gastric mucosa but displayed a transition of collecting venules from a regular to an irregular arrangement. In addition, yellowish-white cobblestone-like elevations were observed in the fundic gland region. Histologically, the observed manifestations included pseudohypertrophy and protrusion of parietal cells into the lumen, possibly along with hyperplasia of G cells, lymphocytic infiltration and potentially pseudopyloric gland metaplasia. Serologically, the anti-parietal cell antibody returned positive results, whereas the anti-intrinsic factor antibody yielded negative results. In this study, we summarized some endoscopic features of two patients, aiming to provide clues for endoscopists to detect early-stage AIG.

Trained immunity is a concept in immunology in which innate immune cells, such as monocytes and macrophages, exhibit enhanced responsiveness and memory-like characteristics following initial contact with a pathogenic stimulus that may promote a more effective immune defense following subsequent contact with the same pathogen. Helicobacter pylori, a bacterium that colonizes the stomach lining, is etiologically associated with various gastrointestinal diseases, including gastritis, peptic ulcer, gastric adenocarcinoma, MALT lymphoma, and extra gastric disorders. It has been demonstrated that repeated exposure to H. pylori can induce trained immunity in the innate immune cells of the gastric mucosa, which become more responsive and better able to respond to subsequent H. pylori infections. However, interactions between H. pylori and trained immunity are intricate and produce both beneficial and detrimental effects. H. pylori infection is characterized histologically as the presence of both an acute and chronic inflammatory response called acute-on-chronic inflammation, or gastritis. The clinical outcomes of ongoing inflammation include intestinal metaplasia, gastric atrophy, and dysplasia. These same mechanisms may also reduce immunotolerance and trigger autoimmune pathologies in the host. This review focuses on the relationship between trained immunity and H. pylori and underscores the dynamic interplay between the immune system and the pathogen in the context of gastric colonization and inflammation.

暂无摘要。

BACKGROUND: Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP.
METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection.
RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective.
CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.

暂无摘要。

Autoimmune gastritis (AIG) is characterized by the destruction of gastric parietal cells, resulting in hypochlorhydria and eventual achlorhydria, as oxyntic glands in the corpus are destroyed and become atrophic. The permanent loss of gastric acid has many impacts-both theoretical and documented. The most concerning of these are hypergastrinemia and increased N-nitroso compounds, both of which increase the risk of gastric cancers. While known deficiencies of B12 and iron are often replaced in AIG, acid is not. Moreover, patients with AIG are often prescribed acid suppression for a stomach that is decidedly no longer acidic, worsening the sequelae of gastric atrophy. Betaine hydrochloride (BHCL) is a short-acting acidifying agent, available over the counter in capsule form. Mealtime acid supplementation has an historic basis and could ameliorate many AIG-related gastrointestinal symptoms. Theoretically, acidification could also reduce the potential for hypergastrinemia and the production of N-nitroso compounds, consequently reducing the risk of gastric cancers. Supplemental vitamin C may also help in preventing gastric N-nitroso formation, regardless of the gastric pH. This narrative review describes the functions of gastric acid in gastrointestinal and immune health, documents the effects of hypochlorhydria in AIG, and proposes potential options for safely re-establishing the acid milieu of the stomach for patients with AIG.