Drug-associated gastropathy: diagnostic criteria

Drugs are widely used to treat different diseases in modern medicine, but they are often associated with adverse events. Those located in the gastrointestinal tract are common and often mild, but they can be serious or life-threatening and determine the continuation of treatment. The stomach is often affected not only by drugs taken orally but also by those administered parenterally. Here, we review the mechanisms of damage, risk factors and specific endoscopic, histopathological and clinical features of those drugs more often involved in gastric damage, namely NSAIDs, aspirin, anticoagulants, glucocorticosteroids, anticancer drugs, oral iron preparations and proton pump inhibitors. NSAID- and aspirin-associated forms of gastric damage are widely studied and have specific features, although they are often hidden by the coexistence of Helicobacter pylori infection. However, the damaging effect of anticoagulants and corticosteroids or oral iron therapy on the gastric mucosa is controversial. At the same time, the increased use of new antineoplastic drugs, such as checkpoint inhibitors, has opened up a new area of gastrointestinal damage that will be seen more frequently in the near future. We conclude that there is a need to expand and understand drug-induced gastrointestinal damage to prevent and recognize drug-associated gastropathy in a timely manner

Evaluation of the CDX2 protein distribution in the gastric mucosa in chronic gastritis by a semi-quantitative index and its reproducibility

The purpose of the study was to assess the reproducibility of the semi-quantitative CDX2 index calculation in chronic atrophic gastritis stages I-IV.Цель исследования – оценка воспроизводимости методики расчета полуколичественного индекса CDX2 при I-IV стадиях хронического атрофического гастрита

PDCD4 and CDX-2 as immunohistochemical markers of gastric mucosa atrophy in chronic gastritis

The aim of the work is to evaluate the possibility of using immunohistochemical markers PDCD4 and CDX-2 to diagnose atrophy of the gastric mucosa in chronic gastritis and increase the informative value of biopsy examination.Цель работы – оценка возможности использования иммуногистохимических маркеров PDCD4 и CDX-2 для диагностики атрофии слизистой оболочки желудка при хроническом гастрите, повышения информативности биопсийного исследования

Consensus as a method for evaluating the reproducibility of gastric intraepithelial neoplasia/dysplasia: possibility of using in the process of continuing professional education of pathologists

The reproducibility of the Modified Vienna classification of gastrointestinal neoplasia on the gastric mucosal biopsies was evaluated by using the kappa statistic. The work of a group of pathologists-experts was organized in the remote access mode with a demonstration of 26 cases (98 microphotographs) and an evaluation of the diagnostic category of gastric intraepithelial neoplasia/dysplasia. Different levels of agreement between the opinions of the participating experts have been established in depending on the diagnostic difficulty level. The kappa level ranged from 0.2 (poor agreement) to 0.66 (good agreement) and was depending from the chosen method of correction of the result. , This circumstance contributed to the formation of opinion that the diagnoses indefinite neoplasia/dysplasia-low and high grade neoplasia/dysplasia were the most difficult decisions. Possible reasons which reduce the level of consistency of pathologists are discussed.Методами каппа-статистики проведена оценка воспроизводимости Модифицированной Венской классификации неоплазий пищеварительного тракта на материале биопсий слизистой оболочки желудка. В дистанционном режиме организована работа группы патологоанатомов-экспертов с демонстрацией 26 наблюдений (98 фотографий) с оценкой диагностической категории интраэпителиальной неоплазии/дисплазии слизистой оболочки желудка. Установлены различные уровни совпадения мнения участвовавших экспертов в зависимости от сложности диагностической задачи. Уровень каппа колебался от 0,2 (плохое согласие) до 0,66 (хорошее согласие) в зависимости от выбранного метода коррекции результата, что способствовало формированию мнения о наиболее сложных с точки зрения согласованного мнения диагностических категориях, находящихся в ряду неопределенная неоплазия/ дисплазия – неоплазия/дисплазия низкой и высокой степени. обсуждаются возможные причины, снижающие уровень согласованности патологоанатомов-экспертов

Neuroendocrine Tumour as a Diagnostic and Prognostic Criterion for Autoimmune Gastritis

Aim. To describe modern approaches to the diagnosis and treatment of neuroendocrine gastric tumours associated with chronic autoimmune gastritis on the example of a clinical case.General provisions. Patient H., born in 1948, suffered from a dyspepsia syndrome, the presence of chronic exhelicobacter gastritis and neuroendocrine tumour of unclear histogenesis in the upper third of the stomach body. The patient also suffered from systemic lupus erythematosus with skin lesions (discoid rash, palmar and plantar capillaries) and joint lesions (migrating polyarthritis). A general clinical examination revealed mild chronic iron deficiency anemia and increased neuron-specific enolase (NSE). An EGDS examination using expert-class equipment with the NBI function of close focus identified subepithelial formations of the stomach body. The histological results showed a morphological pattern consistent with a highly differentiated neuroendocrine tumour (G1), type 1, associated with chronic autoimmune gastritis.Conclusion. The autoimmune genesis of the chronic inflammation of the gastric mucosa may serve as a background for the development of neuroendocrine tumours of the stomach, which determines the management tactics in such conditions

Esophageal Mucosal Resistance in Reflux Esophagitis: What We Have Learned So Far and What Remains to Be Learned

Gastroesophageal reflux disease (GERD) has the highest prevalence among diseases of the digestive system and is characterized by a significant decrease in patients’ quality of life, comparable to arterial hypertension and coronary heart disease. One in every ten cases of reflux esophagitis leads to the formation of Barrett’s esophagus, which is associated with a high risk of esophagus adenocarcinoma. The key factors determining the progression of the disease are the frequency and duration of the reflux of the stomach’s contents. As a result, refluxate, which includes hydrochloric acid, pepsin, and, in the case of concomitant duodeno-gastric reflux, bile acids and lysolecithin, is thrown into the overlying sections of the digestive tract. At the same time, in addition to aggression factors, it is necessary to take into account the state of resistance in the esophageal mucosa to the effects of aggressive refluxate molecules. This review was prepared using systematized data on the protective properties of the esophageal mucosa and modern methods to assess the mucosal barrier in reflux esophagitis. Lesions of the epithelial barrier structure in the esophagus are recognized as the main pathogenetic factor in the development of reflux esophagitis and are a potentially significant therapeutic target in the treatment of GERD and Barrett’s esophagus. This article presents the characteristics of the esophageal mucosal barrier and the protective mechanisms of the esophagus’s mucous membrane in conditions of gastroesophageal reflux. Diagnostic approaches for assessing the course of reflux esophagitis are described for both histological criteria and the possibility of a comprehensive assessment of the state of mucins, tight-junction proteins, and the proliferative activity of the mucosa, including under the conditions of ongoing therapy

Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux

This article systematizes available data from the literature on biliary gastritis (BG) in order to increase the awareness of specialists about the latest possibilities for diagnosing the disease. BG occurs as a result of pathological duodenogastric reflux. In patients with a preserved duodenogastric junction, the dominant factor is represented by motor disorders of the upper digestive tract (primary biliary gastritis), while in patients recovering from surgical interventions it is represented by structural changes (secondary biliary gastritis). Progressive BG can lead to atrophy of the gastric mucosa, intestinal metaplasia, epithelial dysplasia, and eventually to gastric cancer. Diagnostic methods for BG are carried out to identify risk factors, exclude alarm symptoms and identify persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as to diagnose gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). The diagnosis of BG should be based on a multidisciplinary approach that combines a thorough analysis of a patient’s complaints, an anamnesis of the disease, and the results of endoscopic and histological research methods