Autoimmune atrophic gastritis is an immune-mediated disease resulting in autoimmune destruction of the specialized acid-producing gastric parietal cells. As a consequence, in autoimmune atrophic gastritis, gastric acid secretion is irreversibly impaired, and the resulting hypochlorhydria leads to the main clinical manifestations and is linked, directly or indirectly, to the long-term neoplastic complications of this disease. In the last few years, autoimmune atrophic gastritis has gained growing interest leading to the acquisition of new knowledge on different aspects of this disorder. Although reliable serological biomarkers are available and gastrointestinal endoscopy techniques have substantially evolved, the diagnosis of autoimmune atrophic gastritis is still affected by a considerable delay and relies on histopathological assessment of gastric biopsies. One of the reasons for the diagnostic delay is that the clinical presentations of autoimmune atrophic gastritis giving rise to clinical suspicion are very different, ranging from hematological to neurological–psychiatric up to gastrointestinal and less commonly to gynecological–obstetric symptoms or signs. Therefore, patients with autoimmune atrophic gastritis often seek advice from physicians of other medical specialties than gastroenterologists, thus underlining the need for increased awareness of this disease in a broad medical and scientific community.

Gastric cancer (GC) is a significant healthcare concern, and the identification of high-risk patients is crucial. Indeed, gastric precancerous conditions present significant diagnostic challenges, particularly early intestinal metaplasia (IM) detection. This study developed a deep learning system to assist in IM detection using image patches from gastric corpus examined using virtual chromoendoscopy in a Western country. Utilizing a retrospective dataset of endoscopic images from Sant’Andrea University Hospital of Rome, collected between January 2020 and December 2023, the system extracted 200 × 200 pixel patches, classifying them with a voting scheme. The specificity and sensitivity on the patch test set were 76% and 72%, respectively. The optimization of a learnable voting scheme on a validation set achieved a specificity of 70% and sensitivity of 100% for entire images. Despite data limitations and the absence of pre-trained models, the system shows promising results for preliminary screening in gastric precancerous condition diagnostics, providing an explainable and robust Artificial Intelligence approach.

First-degree family history of gastric cancer is a risk factor for gastric cancer and precancerous conditions, but only a few studies exist regarding the endoscopic follow-up of these patients. This study investigates endoscopic and histological findings over a 15-year period in patients with first-degree relatives of gastric cancer intestinal type who underwent follow-up upper gastrointestinal endoscopies. we conducted a retrospective real-world observational study involving patients who underwent at least two upper gastrointestinal endoscopies between 2008 and 2023 at Sant'Andrea Hospital, Rome. The study analyzed histological findings, dividing participants into four subgroups based on their baseline conditions [H. pylori infection, gastric atrophy, intestinal metaplasia, dysplasia]. 106 patients were included, only 13% were indicated for follow-up endoscopy according to the MAPS guidelines. An additional 13% of patients developed precancerous conditions, most of whom were H. pylori positive at the index examination, with an odds ratio risk of 6.778 (p = 0.004). performing routinely virtual chromoendoscopy during the index endoscopy in these patients could improve the detection of precancerous conditions. Special attention should be given to H. pylori-positive patients due to their increased risk of developing precancerous conditions, for whom follow-up endoscopies may be beneficial.

Background/Objectives: H. pylori is the main preventable risk factor for gastric cancer through the development of extensive precancerous lesions, namely mucosal atrophy and intestinal metaplasia. Methods: This multicenter, nationwide study enrolled consecutive patients who underwent their first upper gastrointestinal endoscopy with standard biopsies. Clinical, endoscopic and histological data were gathered for statistical analysis using both univariate and multivariate analyses. Results: Data from 775 patients were collected, and H. pylori infection was detected in 172 (22.2%) cases. The infection prevalence significantly increased with age, and it was significantly higher in patients aged ≥50 years compared to younger patients (26.2% vs. 13.7%; p < 0.001; OR: 2.23; 95% CI = 1.48–3.36). The prevalence of extensive gastric precancerous lesions was 2.6%. The multivariate analysis showed that H. pylori infection (OR: 4.77; 95% CI = 1.51–15; p = 0.007), family history of gastric cancer (OR: 4.86; 95% CI = 1.36–15; p = 0.007), and age (OR: 1.07; 95% CI = 1.02–1.13; p = 0.007) independently increased the risk of these lesions. Conclusions: Data provided by this large study on the endoscopic prevalence of both H. pylori infection and extensive precancerous lesions in the stomach may be useful for designing preventive strategies aimed at reducing gastric cancer mortality.

Background and Aims: An adequate bowel preparation is essential for performing high-quality ccolonoscopy; however, it remains ineffective for a certain percentage of patients. We conducted a literature search to identify evidence on salvage strategies following inadequate bowel preparation. Methods: The search of medical literature was conducted using Medline and Google Scholar, restricted to studies published in English as a full paper. From retrieved studies, the success rate was calculated according to the rescue approaches used, including different oral- or device-assisted procedures, and pooling data of similar approaches. Results: By considering data of 17 studies with 2,167 patients, an adequate colon cleaning was overall achieved in 79.3% (95%CI: 77.5-80.1). By grouping data of similar approaches, the success rate was 78.1% with oral high-volume polyethylene glycol (PEG), 75.3% with low-volume PEG, 82.5% with oral sennosides, and 84.6% following colonoscope or device-assisted preparation. Conclusions: Effective bowel cleansing is not achieved in nearly 20% of patients due to inadequate bowel preparation and although multiple approaches have been investigated, none has consistently provided adequate bowel preparation for all patients.

Autoimmune gastritis(AIG), at increased gastric cancer(GC) risk, may be purely autoimmune or H.pylori-triggered. GC-risk in AIG may be H. pylori-related, but cannot be excluded in pure AIG. Distinguishing pure AIG(H.pylori-naïve) from that H.pylori-triggered is challenging. H.pylori-specific genes in AIG patients' gastric tissue have not yet been assessed. This study aimed to assess H.pylori-specific genes on DNA extracted from gastric biopsies in AIG patients with and without GC. This single-center study included 63 histologically-diagnosed AIG patients (median age 63 years; F88.7%) with parietal cell(100%) and/or intrinsic factor autoantibodies(42.6%) positivity, of whom ten were complicated with GC. DNA was extracted from formalin-fixed, paraffin-embedded(FFPE) tissue sections of gastric biopsies and RT-PCR was performed to test for H.pylori-specific gene probes:ureA, ureC, cagA. 16sRNA and β2-microglobulin probes were used as amplification-control of bacterial and human DNA. Previous history of H.pylori infection and histopathology were negative in all 63 AIG patients. Among AIG patients without GC, the H.pylori-specific ureC gene was detected in four(7.5%), three of whom were also ureA-positive, and one was also cagA-positive. All four ureC-positive patients had positive H.pylori serology. H.pylori-related genes were not detected in any of the ten AIG patients with GC. All available sera of AIG patients with GC were H.pylori seronegative(6/6100%). Bacterial 16 S rRNA and human-β2-microglobulin genes were similar in ureC-positive and ureC-negative AIG patients. Assessment of H.pylori-related genes helps confirm patients with the pure H.pylori-naïve AIG type. This latter group also comprises AIG patients with GC, supporting the development of GC in AIG through H. pylori-independent mechanisms.