Status of the gastric mucosa with endoscopically diagnosed gastrointestinal stromal tumor

An unusual presentation of a gastric gastrointestinal stromal tumor as a chronic contained perforation with concomitant Helicobacter pylori infection: A case report and literature review

INTRODUCTION

Gastrointestinal stromal tumors (GISTs) rarely present as perforations. When they do, they more often involve the small bowel and present as an acute abdomen. GISTs are also not commonly associated with Helicobacter pylori (H. pylori) infection.

PRESENTATION OF CASE

This is a case report of a patient on chronic non-steroidal anti-inflammatory drugs (NSAIDs) presenting with abdominal pain and found to have a large abdominal mass connected to his stomach. The patient was taken to the operating room and was found to have a chronic contained gastric perforation. Final pathology was positive for GIST and H. pylori.

DISCUSSION

Literature review confirms the rarity of gastric GIST perforations. In addition, there are no reports of GISTs presenting as a chronic perforation. It also reveals very few studies exploring the possible association of H. pylori infection to gastric GISTs.

CONCLUSION

This case report highlights a possible connection between GISTs and H. pylori that should be further explored and demonstrates a rare presentation of GISTs as a chronic gastric perforation that clinicians should be aware of.

Transient Receptor Potential Ankyrin 1 and Substance P Mediate the Development of Gastric Mucosal Lesions in a Water Immersion Restraint Stress Rat Model

BACKGROUND

Activation of substance P (SP) contributes to the development and maintenance of gastric lesions, but the mechanisms underlying the release of SP and SP-mediated damage to the gastric mucosa remain unknown. Transient receptor potential ankyrin 1 (TRPA1) is expressed in SP-positive neurons in the dorsal root ganglion (DRG) and stomach of rats. We hypothesized that water immersion restraint stress (WIRS) may activate and sensitize TRPA1 in DRG neurons, subsequently inducing the release of SP from DRG and stomach cells, causing the development of acute gastric mucosal lesions (AGML).

METHODS

Changes in TRPA1 and SP expression in T8-11 DRG sensory neurons and the stomach in an AGML rat model were determined by reverse transcription polymerase chain reaction, western blotting and immunohistochemistry. The SP levels of serum and gastric mucosa were measured by using an enzyme-linked immunosorbent assay (ELISA). Gastric lesions were evaluated by histopathological changes. The TRPA1 antagonist HC-030031 and TRPA1 agonists allyl isothiocyanate were used to verify effect of TRPA1 and SP on AGML.

RESULTS

SP and TRPA1 in the DRG and stomach were upregulated, and the serum and gastric mucosa levels of SP were increased after WIRS, which are closely associated with AGML. The release of SP was suppressed and AGML were alleviated following a selective TRPA1 antagonist HC-030031. TRPA1 agonists AITC increased release of SP and led to moderate gastric lesions. We confirmed that WIRS induced the release of SP in the DRG, stomach, serum and gastric mucosa, and in a TRPA1-dependent manner.

CONCLUSIONS

Upregulated SP and TRPA1 in the DRG and stomach and increased serum and gastric mucosa SP levels may contribute to stress-induced AGML. TRPA1 is a potential drug target to reduce stress-induced AGML development in patients with acute critical illnesses. This study may contribute to the discovery of drugs for AGML treatment.