This document summarizes the OLGA staging system for classifying and assessing the risk of gastric cancer from gastritis. The OLGA system stages gastritis from Stage 0 to Stage IV based on the degree and location of gastric atrophy identified on biopsy. Stages 0-II are considered low risk for gastric cancer while Stages III-IV are high risk. The staging is done by combining an antrum atrophy score and corpus atrophy score assessed from biopsies of the gastric antrum and corpus according to a standardized sampling protocol.
A brief description on Cholangiocarcinoma, its classification and management. Contains management of Intrahepatic cholangiocarcinoma, Perihilar cholangiocarcinoma, Distal cholangiocarcinoma.
Cholangiocarcinomas (bile duct cancers) arise from the epithelial cells of the intrahepatic and extrahepatic bile ducts.
Please do not edit or rename.
Note it is only for academic purposes.
A brief description on Cholangiocarcinoma, its classification and management. Contains management of Intrahepatic cholangiocarcinoma, Perihilar cholangiocarcinoma, Distal cholangiocarcinoma.
Cholangiocarcinomas (bile duct cancers) arise from the epithelial cells of the intrahepatic and extrahepatic bile ducts.
Please do not edit or rename.
Note it is only for academic purposes.
This slide show that how GSTM1(Glutathione S-transeferase M1) initiate sporadic breast cancer.Also show what is breast cancer,their types and causes.This is a short case control study on breast cancer cases and healthy population.
Gastritis is a condition in which the stomach
lining—known as the mucosa—is inflamed. The stomach lining contains special
cells that produce acid and enzymes, which help break down food for digestion,
and mucus, which protects the stomach lining from acid. When the stomach lining
is inflamed, it produces less acid, enzymes, and mucus.
Gastritis may be acute or chronic. Sudden,
severe inflammation of the stomach lining is called acute gastritis. Inflammation
that lasts for a long time is called chronic gastritis. If chronic gastritis is
not treated, it may last for years or even a lifetime.
Erosive gastritis is a type of gastritis that
often does not cause significant inflammation but can wear away the stomach
lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive
gastritis may be acute or chronic.
The relationship between gastritis and
symptoms is not clear. The term gastritis refers specifically to abnormal
inflammation in the stomach lining. People who have gastritis may experience
pain or discomfort in the upper abdomen, but many people with gastritis do not
have any symptoms.
The term gastritis is sometimes mistakenly
used to describe any symptoms of pain or discomfort in the upper abdomen. Many
diseases and disorders can cause these symptoms. Most people who have upper
abdominal symptoms do not have gastritis.
Presented by Darren M. Brenner, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation Greater Chicago Chapter on Saturday, October 12 in Chicago, IL.
The first statistical analysis of stomach cancer incidence and mortality was in Italy, in the 18s century. Stomach cancer remains one of the leadings causes of cancer incidence and mortality globally.
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...Jarrod Lee
Helibacter pylori affects 50% of the world's population. It is a major cause of peptic ulcer disease and gastric cancer. We present a contemporary evidence based approach for the primary care doctor, incorporating the latest guidelines. We provide a diagnostic and management approach incorporating the latest studies, and present a contemporary approach to preventing gastric cancer
Similar to Olga staging system for diagnosis of gastritis (20)
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Description of different ultrasound features of carpal tunnel syndrome before and after carpal tunnel release including Doppler imaging and elastography
Doppler ultrasound of visceral arteriesSamir Haffar
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Histological classification of gastritis
• Sydney system1 1990
• Houston version of Sydney system2 1994
• Operative Link for Gastritis Assessment3 2005
OLGA
1 Price AB. J Gastroenterol Hepatol 1991 ; 6 : 209 – 22.
2 Dixon MF et al. Am J Surg Pathol 1996 ; 20 : 1161 – 81.
3 Rugge M & Genta RM. Human Pathol 2005 ; 36 : 228 – 233.
reporting gastritis according to gastric cancer risk
from lowest (stage 0) to highest (stage IV)
3. Risk factor for gastric cancer
• H. pylori Most consistent risk factor
Eradication reduces risk of cancer
• Genetic factors Cytokines: IL-1β, IL-8, IL-10, TNF-α
No recommended marker at present
• Environmental factors N-nitroso compounds
Salted foods, tobacco, alcohol
Subordinate to effect of HP infection
Protective effect of NSAID & aspirin
Malfertheiner P et al. Gut 2012 ; 61: 646 – 664.
4. Gastric cancer pathways
Eradication of H pylori reduces risk of gastric cancer
But not eliminate cancer due to predetermined genetic pathways:
Hereditary diffuse gastric cancers & autoimmune gastritis
Talley NJ. Lancet 2008 ; 372 : 350 – 352.
5. Carcinogenicity of H. pylori
Atrophic corpus gastritis
H. pylori infection
Hypochlorhydria
Overgrowth of non-HP
organisms
Reduce nitrates to nitrites
& N-nitrosamines
Reduced/absent concentrations
of ascorbic acid
Ascorbic acid scavenges
carcinogenic N-nitrosamines
Malfertheiner P et al. Gut 2012 ; 61: 646 – 664.
6. Prevention of gastric cancer
Identification of subjects with high risk of gastric cancer
• Non-invasive tests Validated serology for H. pylori
Low incidence + Markers of atrophy (pepsinogens)
PGI: chief cell
PGII: chief cell – pyloric glands
Low PGI or low PG1/PGII → atrophy
• Invasive test Gastroscopy & biopsies
High incidence OLGA staging system*
* OLGA: Operative Link for Gastritis Assessment
Dinis-Ribeiro M et al. Endoscopy 2012 ; 44 : 74 – 94.
Malfertheiner P et al. Gut 2012 ; 61: 646 – 664.
7. OLGA staging system for gastritis
International group of gastroenterologists & pathologists
• Applies histology reporting format for chronic hepatitis
• Given number of portal tracts for staging of hepatitis
Well-defined biopsy protocol Antrum (3) – Corpus (2)
• Main lesion of cirrhosis risk Fibrosis
Main marker of gastric cancer Mucosal atrophy
• Staging by combining degree of atrophy & topography
• Assess risk of gastric cancer Stage 0 to stage 4
OLGA: Operative Link for Gastritis Assessment
Rugge M & Genta RM. Gastroenterology 2005 ; 129 : 1807 – 8 .
8. Gastric biopsy sampling protocol
A1 – A2
Greater & lesser curvatures of distal antrum
A3
Lesser curvature at incisura angularis
C1 – C2
Anterior & posterior walls of proximal corpus
At least five biopsies
Rugge M et al. Dig Liver Dis 2008 ; 40 : 650 – 658.
Minimum requirement for reliable staging of gastritis
9. Normal & atrophic glandular units in stomach
Nl mucosecreting gland Non-metaplastic atrophy
Normal oxyntic gland Non-metaplastic atrophy Metaplastic atrophy
Pseudopyloric metaplasia
Metaplastic atrophy
Intestinal metaplasia
Ruggea M et al. Dig Liver Dis 2008 ; 40 : 650 – 658.
AntrumCorpus
10. OLGA staging system for gastritis
Combining degree of atrophy & location
• Atrophy No atrophy (0%) Score 0
Mild (1 – 30%) Score 1
Moderate (31 – 60%) Score 2
Severe (> 60%) Score 3
• Location Antral atrophy score (Aas) Mean A1 + A2 + A3
Corpus atrophy score (Cas) Mean C1 + C2
• OLGA Overall Aas & Cas Stage 0, I, II: low risk
Stage III, IV: high risk
Rugge M et al. Dig Liver Dis 2008 ; 40 : 650 – 658.
11. OLGA staging system for gastritis
Ruggea M et al. Dig Liver Dis 2008 ; 40 : 650 – 658.
A
n
t
r
u
m
No atrophy
Score 0
Mild atrophy
Score 1
Moderate atrophy
Score 2
Severe atrophy
Score 3
Stage 0 Stage I Stage II Stage II
Stage I Stage I Stage II Stage III
Stage II Stage II Stage III Stage IV
Stage III Stage III Stage IV Stage IV
Atrophy score
Corpus
No atrophy
Score 0
Mild atrophy
Score 1
Moderate atroph
Score 2
Severe atrophy
Score 3
12. Stage 0 gastritis
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
Visual analog scales at each of biopsy level to stage a given patient
H. pylori-status has to be reported
13. Stage I gastritis
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
Atrophy most frequently detected in angularis incisura
In patients on PPI, HP may be difficult or impossible to identify
Coexisting polymorphs & lymphoid infiltrate suggest presence of HP
14. Stage II gastritis
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
Stages 0, I, and II are associated with DU more than GU
15. Stage III gastritis
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
GU encountered more frequently than in OLGA stages 0 – I – II
16. Stage III gastritis
Corpus predominant atrophy should suggest an autoimmune etiology
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
17. Stage IV gastritis
Pan-atrophic gastritis
Endoscopic surveillance in stage III–IV patients
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
18. Assessment of elementary lesions
• H. pylori status Positive – Negative
Absent in PPI user & atrophic gastritis
• Inflammation Lympho-monocytic – Polymorphic
May suggest presence of HP
• Metaplasia Intestinal – Pseudo-pyloric
• Precancerous lesions IEN (formerly dysplasia)*
* IEN: Intra-Epithelial Neoplasia
Rugge M et al. Dig Liver Dis 2011 ; 43S : S373 – S384.
Information on likely etiology: H. pylori, autoimmune,..
19. Staining for H. pylori
• Basic stain Hematoxylin & eosin
• Special stain Modified Giemsa
• Triple stain Genta
El-Zimaity
• Immunohistochemical
HP status assessed by special stain has to be reported
20. Eradicating epidemic gastric cancer has long been a dream
Now this dream can come true
Rugge M et al. Nat Rev Gastroenterol Hepatol 2012 ; 9 : 128 – 129.
Gram-negative bacterium with helical rod shape.Prominent flagellae facilitating penetration of thick mucous layer in the stomach.
(OLGA) system may afford a reliable indication of the cancer risk of individual patients.
Inflammation of the gastric mucosa leads to an increase in both PGI and PGII serum levels, usually with a more marked increase of PGIIand thus a decrease in the PGI/II ratio. With the development of atrophy and loss of specialized cells, both PGI and PGII may decrease, but PGI usually shows a more marked decrease than PGII, thus there is a further decline in the PGI/II ratio (see review by Kuipers EJ: “In through the out door: serology for atrophic gastritis,” Eur J GastroenterolHepatol 2003: 877–879). Thus, a low PGI level, a lowPGI/II ratio, or both, are good indicators of atrophic changes in the gastric mucosa.Subjects with severe gastric atrophy, in whom H pylori has disappeared and who are therefore serologically negative for H pylori, are at a particularly high risk.
both the oxyntic and the antral mucosa have to be “explored”and also considering the incisuraangularis “highly informative” for purpose of establishing earliest onset of atrophic–metaplastic transformation.
Antral atrophy scoreCorpus atrophy score
Patients on PPI, H. pylori may be difficult (or even impossible) to identify histologically at antral or corpus level, in which case coexisting inflammatory lesions (polymorphs and lymphoid infiltrate) may suggest the bacterium’s presence and a comment on the suspectedbacterial etiology (“suspicious for H. pylori infection”) should be added (whatever the stage of atrophy recorded).