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Frontiers in Medicine 2022Chronic autoimmune gastritis (CAG) refers to chronic atrophic gastritis due to autoimmunity. Loss of gastric glands in CAG results in hypergastrinemia and achlorhydria...
BACKGROUND
Chronic autoimmune gastritis (CAG) refers to chronic atrophic gastritis due to autoimmunity. Loss of gastric glands in CAG results in hypergastrinemia and achlorhydria leading to Vitamin B deficiency and hyperplasia of G cells and enterochromaffin-like (ECL) cells. Vitamin B deficiency could cause pernicious anemia and subacute combined degeneration, while G cells and ECL cells hyperplasia might develop gastric neuroendocrine tumor (G-NET).
CASE PRESENTATION
A 35-year-old Chinese female presented with multi-focal type-1 Grade 2 (G2) NETs with a 14-year history of pernicious anemia and subacute combined degeneration.
CONCLUSION
Here, we report a rare case of a Chinese patient presenting G-NET combined with pernicious anemia and subacute combined degeneration, which are secondary to chronic autoimmune gastritis. This case also illustrates the importance of routine gastroscopy in patients with Vitamin B deficiency.
PubMed: 35783638
DOI: 10.3389/fmed.2022.856125 -
Pharmaceutical Research Sep 2022pH-dependent drug-drug interactions (DDIs) with poorly soluble, weakly basic drugs may lead to clinical implications. Dasatinib is a tyrosine kinase inhibitor with...
PURPOSE
pH-dependent drug-drug interactions (DDIs) with poorly soluble, weakly basic drugs may lead to clinical implications. Dasatinib is a tyrosine kinase inhibitor with reduced absorption in patients on acid-reducing agents (ARAs). The objective of this study is to investigate the influence of gastric pH on dasatinib supersaturation and determine if vitamin C (L-ascorbic acid) can improve dasatinib concentrations under simulated hypochlorhydric gastric conditions.
METHODS
A dynamic, in vitro, multi-compartment, simulated stomach duodenum (SSD) model mimicking fluid volumes and transfer rates was used to investigate the concentration of BCS class IIb drugs versus time curves. Dasatinib and lamotrigine were explored under normal, fasted, simulated gastric fluids (pH 2) (FaSGF), hypochlorhydric simulated gastric fluids (pH 4.5) (FaSGF) and FaSGF with 1000 mg of vitamin C.
RESULTS
Significant supersaturation of dasatinib was observed in the duodenum compartment of the SSD model in FaSGF. A 90% reduction in dasatinib AUC was observed in FaSGF. Upon addition of vitamin C to FaSGF, drug concentrations were restored to those observed in FaSGF. Lamotrigine AUC in the duodenal compartment were similar in both FaSGF and FaSGF. The in vitro trends observed for dasatinib and lamotrigine are reflective of the trends observed in vivo in subjects receiving treatment with ARAs.
CONCLUSIONS
The SSD model serves as a good in vitro tool for assessing the effect of pH-dependent DDIs on bioavailability of weakly basic drugs with solubility/ dissolution limited absorption. Vitamin C provides a promising approach for improving bioavailability of poorly soluble, weakly basic drugs in hypochlorhydric patients.
Topics: Achlorhydria; Administration, Oral; Ascorbic Acid; Dasatinib; Duodenum; Humans; Hydrogen-Ion Concentration; Lamotrigine; Protein Kinase Inhibitors; Reducing Agents; Solubility
PubMed: 35778632
DOI: 10.1007/s11095-022-03321-y -
Acta Bio-medica : Atenei Parmensis Jul 2022Chronic Atrophic Gastritis (CAG) is a precancerous condition for gastric cancer (GC) as single risk factor, being a consequence of a previous Helicobacter pylori (Hp)...
BACKGROUND AND AIM
Chronic Atrophic Gastritis (CAG) is a precancerous condition for gastric cancer (GC) as single risk factor, being a consequence of a previous Helicobacter pylori (Hp) infection or based on autoimmune mechanisms. Achlorhydria plays an important role towards the formation of a class I carcinogen, acetaldehyde, after food intake. L-cysteine has been claimed to be able to bind in a covalent way acetaldehyde when administered at means.
METHODS
In this study we enrolled two CAG groups of patients, one treated whit 300 mg/daily of L-cysteine for one year, the other one untreated. We assessed gastric function lasting the one year follow-up by using non invasive surrogates, i.e. Pepsinogen I (PGI) and gastrin 17 (G17).
RESULTS
In the group of 77 CAG on therapy we found a statistically significative increase in PGI values and a decrease in G17 levels, in comparison with unchanged values in control group.
CONCLUSIONS
L-cysteine seems able to provide a recovery in gastric function when administered in CAG patients and could be proposed as a possible therapy in such patients.
Topics: Acetaldehyde; Control Groups; Cysteine; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Pepsinogen A
PubMed: 35775759
DOI: 10.23750/abm.v93i3.12812 -
Food Research International (Ottawa,... Jul 2022We applied in vitro models of gastrointestinal (GI) digestion simulating the conditions of the GI tract of healthy adults and elderly individuals with achlorhydria (EA)...
We applied in vitro models of gastrointestinal (GI) digestion simulating the conditions of the GI tract of healthy adults and elderly individuals with achlorhydria (EA) to investigate differences in the digestibility of meat (chicken, beef and pork) and soy proteins. Digestibility was significantly affected by EA alterations. Peptidomics analyses revealed significant differences in peptide profiles between control and EA conditions, including number, length distribution, clustering, and differentially abundant peptides (DAPs). Our results revealed that the differences in meat peptide profiles diminished going from the gastric to intestinal phase. For soy protein, the marked differences between control and EA conditions were maintained in the gastric and intestinal phases. Higher numbers of potentially bioactive peptides were generated under the control condition compared to the EA condition. The present study provides insight into the distinct peptide profiles generated by in vitro digestion of meat and soy proteins under adult and EA GI conditions.
Topics: Adult; Aged; Animal Proteins, Dietary; Animals; Digestion; Humans; Meat; Peptides; Soybean Proteins
PubMed: 35761537
DOI: 10.1016/j.foodres.2022.111215 -
Journal of Clinical Medicine Jun 2022Autoimmune gastritis (AIG) is chronic atrophic gastritis caused by an autoimmune mechanism of unknown etiology and presents with various pathological conditions by... (Review)
Review
Autoimmune gastritis (AIG) is chronic atrophic gastritis caused by an autoimmune mechanism of unknown etiology and presents with various pathological conditions by causing an achlorhydria state through parietal cell damage. The most characteristic endoscopic finding in AIG is advanced corpus-dominant mucosal atrophy. A recent study that examined several cases in Japan revealed the presence of endoscopic features other than corpus-dominant advanced atrophy. Remnants of oxyntic mucosa and sticky adherent dense mucus were found in ≥30% of cases, and hyperplastic polyps were found in ≥20% of cases. In image-enhanced endoscopy (IEE), white globe appearance (WGA) was observed in 32% of AIG cases. Additionally, some reports have stated that the findings in AIG cases using IEE showed cast-off skin appearance (CSA) and foveola type mucosa; however, a consensus is yet to be achieved. These endoscopic results were found in cases of advanced-stage AIG. There have been few reports concerning early-stage AIG cases. In these few reports, all of the cases were pathologically diagnosed as early AIG. In all of the cases, the pathological findings almost always showed neither parietal cell destruction nor atrophy. Endoscopic findings such as "mosaic pattern with slight swelling of the areae gastricae", "diffuse reddened and edematous gastric fundic gland mucosa", and "pseudopolyp-like nodules" may be common characteristics of early images. In such early cases, high antibody titers, no atrophic changes, and few clinical abnormal findings were shown. Endoscopists are expected to update their knowledge regarding AIG diagnosis with the evolution of imaging equipment.
PubMed: 35743593
DOI: 10.3390/jcm11123523 -
Endocrine Journal Oct 2022VIPomas are generally rare functioning pancreatic neuroendocrine tumors (PanNETs) that cause watery diarrhea, hypokalemia, and achlorhydria. Due to their extreme rarity,...
VIPomas are generally rare functioning pancreatic neuroendocrine tumors (PanNETs) that cause watery diarrhea, hypokalemia, and achlorhydria. Due to their extreme rarity, the clinicopathological features and outcomes of VIPomas have not been well reported. This study aimed to determine the diagnostic and therapeutic characteristics and prognosis of VIPomas and to compare them with other PanNETs at a Japanese reference hospital. Medical records of 293 patients with PanNETs were collected. Patient and tumor characteristics and outcomes were retrospectively reviewed. This cohort had only 1.4% (four patients) of patients with VIPomas, and three of these patients changed from non-functioning (NF-) PanNETs during their disease course. Recurrences of hormonal symptoms were observed in all patients despite the initial controls, and all of them died from their disease, more specifically mainly from hormonal symptoms. Compared to the other PanNETs, VIPomas were all located at the pancreatic tail, were larger, and had a higher Ki-67 index and more metastasis. The median survival time was significantly shorter for patients with VIPoma than for those with NF-PanNET (5.9 vs. 26.7 years, p < 0.0001), insulinoma (21.8 years, p < 0.0001), and gastrinoma (12.3 years, p = 0.0325). This study presents the possibility of shifting from non-symptomatic to symptomatic VIPomas as they grow or of transforming from NF-PanNETs to VIPomas. VIPomas should be considered in patients with relatively large NF-PanNETs, especially those located in the pancreatic tail, when diarrhea is continuously observed. As hormonal symptoms are an important cause of death in VIPomas, long-term symptomatic control, which is relatively difficult, is of great significance.
Topics: Humans; Vipoma; Neuroendocrine Tumors; Retrospective Studies; Pancreatic Neoplasms; Vasoactive Intestinal Peptide; Diarrhea
PubMed: 35644576
DOI: 10.1507/endocrj.EJ22-0111 -
Frontiers in Cellular and Infection... 2022In recent years, the role of gastric and duodenal microbiota has acquired increasing importance in the homeostasis of the host, although, to date, most evidence concern...
In recent years, the role of gastric and duodenal microbiota has acquired increasing importance in the homeostasis of the host, although, to date, most evidence concern the faecal microbiota. Indeed, the gastric, and duodenal microbiota are challenging to study, due to gastric acid, bile, digestive enzymes, and rapid transit time. Specifically, the gastric acid environment may influence their bacterial composition since the acid barrier protects against orally ingested microorganisms and leads to their inactivation before reaching the intestine. The aim of this study was to assess a correlation between intragastric pH and gastric as well as intestinal microbiota of patients with histologic gastric alterations. pH was measured in the gastric juice and the bacterial composition in gastric and duodenal biopsies and faecal samples, was investigated 16s rRNA gene sequencing. The main result is the direct correlation of duodenal microbiota biodiversity, alpha diversity measures, with intragastric pH values. In particular, patients with hypochlorhydria showed increased duodenal microbiota biodiversity, higher intragastric pH values being prevalent in patients with chronic atrophic gastritis. Lastly, the latter was also strongly associated to the presence of oral bacteria, like and , in the duodenal microbiota. In conclusions, our results suggest a low-acid gastric environment as a contributive factor for duodenal dysbiosis, potentially leading to the development of pathological conditions of the gastrointestinal tract.
Topics: Achlorhydria; Dysbiosis; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; RNA, Ribosomal, 16S
PubMed: 35521214
DOI: 10.3389/fcimb.2022.854904 -
Food Chemistry Jul 2022Among the physiological functions declining with aging, decreased secretion of gastric fluid, achlorhydria, is commonly observed. We evaluated the digestion of meat...
Among the physiological functions declining with aging, decreased secretion of gastric fluid, achlorhydria, is commonly observed. We evaluated the digestion of meat (chicken, beef, and pork) and soy proteins using in vitro conditions mimicking gastrointestinal (GI) digestion in adults (control, C) and elderly individuals with achlorhydria (EA). Changes in degrees of hydrolysis (DH), SDS-PAGE profiles, peptide concentrations, and proteomic profiles during digestion were investigated. Digestion under the EA conditions markedly decreased DH, especially for soy proteins. SDS-PAGE profiling and proteomics showed that myofibrillar/sarcoplasmic proteins from meat and glycinin/beta-conglycinin from soy were most affected by digestion conditions. Our results indicated that differences in the digestibility of meat protein between EA and control conditions gradually narrowed from the gastric to the intestinal phase for meat protein, while a pronounced difference persisted in the intestinal phase for soy protein. Our work provides new insight of value for future dietary recommendations for elderly individuals.
Topics: Achlorhydria; Animals; Cattle; Digestion; Meat; Meat Proteins; Proteomics; Soybean Proteins
PubMed: 35183956
DOI: 10.1016/j.foodchem.2022.132465 -
Internal Medicine (Tokyo, Japan) Aug 2022A 69-year-old woman with multiple neuroendocrine neoplasms (NENs) was referred to our hospital. Although she had extreme hypergastrinemia (11,675 pg/mL), no findings...
A 69-year-old woman with multiple neuroendocrine neoplasms (NENs) was referred to our hospital. Although she had extreme hypergastrinemia (11,675 pg/mL), no findings that indicated types I to III gastric NENs were found. Although gastric corpus atrophy was suspected on conventional white-light imaging, findings on magnifying endoscopy with narrow-band imaging indicated no severe atrophy. A biopsy from the background fundic gland mucosa revealed no atrophic changes, parietal cells with vacuolated cytoplasm and negative findings for HK-ATPase. Thus, this case was diagnosed as multiple NENs with parietal cell dysfunction. Neither progression nor metastasis has been confirmed during two-year follow-up.
Topics: Achlorhydria; Aged; Atrophy; Female; Gastric Mucosa; Gastritis, Atrophic; Humans; Neuroendocrine Tumors; Parietal Cells, Gastric; Stomach Neoplasms
PubMed: 35110476
DOI: 10.2169/internalmedicine.8253-21