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  1. Fulltext The Microenvironment in Epstein-Barr Virus-Associated Malignancies
    Tan GW, Visser L, Tan LP, van den Berg A, Diepstra A
    Pathogens, 2018 04 13;7(2).
    PMID: 29652813 DOI: 10.3390/pathogens7020040
    The Epstein–Barr virus (EBV) can cause a wide variety of cancers upon infection of different cell types and induces a highly variable composition of the tumor microenvironment (TME). This TME consists of both innate and adaptive immune cells and is not merely an aspecific reaction to the tumor cells. In fact, latent EBV-infected tumor cells utilize several specific mechanisms to form and shape the TME to their own benefit. These mechanisms have been studied largely in the context of EBV+ Hodgkin lymphoma, undifferentiated nasopharyngeal carcinoma, and EBV+ gastric cancer. This review describes the composition, immune escape mechanisms, and tumor cell promoting properties of the TME in these three malignancies. Mechanisms of susceptibility which regularly involve genes related to immune system function are also discussed, as only a small proportion of EBV-infected individuals develops an EBV-associated malignancy.
    Matched MeSH terms: Stomach Neoplasms
  2. Unexplained ascites, a sign for neuroendocrine carcinoma
    Mohd Kamil MK, Ngiu CS, Md Isa N, Yaacob Y Y, Deborah Chew CH, Wong ZQ, et al.
    Med J Malaysia, 2018 02;73(1):60-62.
    PMID: 29531208 MyJurnal
    Neuroendocrine neoplasm is an epithelial neoplasm with predominant neuroendocrine differentiation that can arise from many organs in the body. We reported a rare case of gastric neuroendocrine carcinoma which accounts for less than 1% of all gastric tumours that is associated with poor prognosis. The recognition of this rare tumour in early stage is challenging and high suspicious into it might bring to early detection and so forth might improve the prognostication.
    Matched MeSH terms: Stomach Neoplasms
  3. Fulltext What indigestion means to the malays?
    Lee YY, Chua AS
    J Neurogastroenterol Motil, 2013 Jul;19(3):295-300.
    PMID: 23875095 DOI: 10.5056/jnm.2013.19.3.295
    Despite being a large ethnic group within the South-East Asia, there is a paucity of reported literatures on dyspepsia in the Malay population. Recent population-based studies indicate that uninvestigated dyspepsia, based on the Rome II criteria, is reported in 12.8% and 11.6% of Malays in the urban and rural communities respectively. Organic causes of dyspepsia including upper gastrointestinal tract cancers, its precancerous lesions, and erosive diseases are uncommon which is largely due to an exceptionally low prevalence of Helicobacter pylori infection in this population. On the other hand, functional dyspepsia and irritable bowel syndrome are relatively common in the Malays than expected. Within a primary care setting, functional dyspepsia, based on the Rome III criteria, is reported in 11.9% of Malays, of which epigastric pain syndrome is found to be more common. Married Malay females are more likely to have functional dyspepsia and psychosocial alarm symptoms. Also based on the Rome III criteria, irritable bowel syndrome, commonly overlapped with functional dyspepsia, is reported in 10.9% of Malays within a community-based setting. Rather than psychosocial symptoms, red flags are most likely to be reported among the Malays with irritable bowel syndrome despite having a low yield for organic diseases. Based upon the above observations, "proton pump inhibitor test" is probably preferable than the "test and treat H. pylori" strategy in the initial management of dyspepsia among the Malays.
    Matched MeSH terms: Stomach Neoplasms
  4. Microsatellite Instability and Altered Expressions of MLH1 and MSH2 in Gastric Cancer
    Haron NH, Mohamad Hanif EA, Abdul Manaf MR, Yaakub JA, Harun R, Mohamed R, et al.
    Asian Pac J Cancer Prev, 2019 Feb 26;20(2):509-517.
    PMID: 30803214
    Introduction: Microsatellite instability (MSI) is a hallmark of defective DNA mismatch repair (MMR) of genes especially MLH1 and MSH2. It is frequently involved in the carcinogenesis of various tumours including gastric cancer (GC). However, MSI in GCs have not been reported in Malaysia before. Objective: This study was conducted to determine the microsatellite instability (MSI) status in gastric cancer by microsatellite analysis, sequencing, its association with MLH1 and MSH2 protein expression and H.pylori infection by immunohistochemistry. Method: A total of 60 gastric cancer cases were retrieved. DNA was extracted from paired normal and tumour tissues while MLH1 and MSH2 protein expression as well as H. pylori status were determined by IHC staining. For microsatellite analysis, polymerase chain reaction (PCR) was performed for paired tissue samples using a panel of five microsatellite markers. MSI-positive results were subjected for DNA sequencing to assess mutations in the MLH1 and MSH2 genes. Results: Microsatellite analysis identified ten MSI positive cases (16.7%), out of which only six cases (10.3%) showed absence of MLH1 (n=3) or MSH2 (n=3) protein expression by IHC. The most frequent microsatellite marker in MSI positive cases was BAT26 (90%). Nine of ten MSI positive cases were intestinal type with one diffuse and all were located distally. H. pylori infection was detected in 13 of 60 cases (21.7%) including in three MSI positive cases. All these results however were not statistically significant. Our sequencing data displayed novel mutations. However these data were not statistically correlated with expression levels of MLH1 and MSH2 proteins by IHC. This may be due to small sample size to detect small or moderately sized effects. Conclusion: The frequency of MSI in this study was comparable with published results. Determination of affected MMR genes by more than two antibodies may increase the sensitivity of IHC to that of MSI analysis.
    Matched MeSH terms: Stomach Neoplasms/genetics*; Stomach Neoplasms/metabolism*; Stomach Neoplasms/pathology
  5. Why do we still have Helicobacter Pylori in our Stomachs
    Abadi AT, Ierardi E, Lee YY
    Malays J Med Sci, 2015 Sep;22(5):70-75.
    PMID: 28239271
    The existence of any infectious agent in a highly acidic human stomach is contentious, but the chance finding of Helicobacter pylori is by no means an accident. Once H. pylori colonises the gastric mucosa, it can persist for a lifetime, and it is intriguing why our immune system is able to tolerate its existence. Some conditions favour the persistence of H. pylori in the stomach, but other conditions oppose the colonisation of this bacterium. Populations with high and extremely low prevalence of H. pylori provide useful insights on the clinical outcomes that are associated with this type of infection. Adverse clinical outcomes including peptic ulcer disease and gastric cancer depend on a delicate balance between a harmless inflammation and a more severe kind of inflammation. Is the only good H. pylori really a dead H. pylori? The jury is still out.
    Matched MeSH terms: Stomach Neoplasms
  6. Fulltext Preliminary study suggests low incidence of gastric carcinoma in kelantan relates to low rate of helicobacter pylori infection
    Kaur G, Raj SM
    Malays J Med Sci, 2001 Jan;8(1):31-3.
    PMID: 22973153 MyJurnal
    Helicobacter pylori-associated gastric carcinoma is generally more common in the antrum/body and is of the intestinal type. The aim of this study was to determine the pattern of gastric carcinoma in an area known to have a low prevalence of H. pylori. Pathology records of gastric carcinoma diagnosed at Hospital University Sains Malaysia between 1995 and 1999 were retrieved and studied. There were a total of 23 cases. The median age was 60 years. Eighteen patients were Malay and 5 were Chinese. The most common location of the tumour was the cardia/gastrooesophageal junction (61%, 14/23 patients). The majority was of the intestinal type (69.6%, 16/23). The frequency of gastric carcinoma appears to be exceptionally low in the area of study. The Chinese population was over-represented. The higher frequency of tumour in the cardia/gastro-oesophageal junction as compared to the antrum and body is in sharp contrast to most other studies. This reaffirms the notion that Helicobacter pylori infection is a causative agent for non-cardia gastric carcinomas.
    Matched MeSH terms: Stomach Neoplasms
  7. Purification and characterization of a novel polysaccharide-peptide complex from Clinacanthus nutans Lindau leaves
    Huang D, Li Y, Cui F, Chen J, Sun J
    Carbohydr Polym, 2016 Feb 10;137:701-708.
    PMID: 26686182 DOI: 10.1016/j.carbpol.2015.10.102
    A novel polysaccharide-peptide complex CNP-1-2 with molecular weight of 9.17 × 10(4) Da was obtained from Clinacanthus nutans Lindau leaves by hot water extraction, ethanol precipitation, and purification with Superdex 200 and DEAE-Sepharose Fast Flow column chromatography. CNP-1-2 exhibited the highest growth inhibitory effect on human gastric cancer cells SGC-7901 with inhibition ratio of 92.34% and stimulated activation of macrophages with NO secretion level of 47.53 μmol/L among the polysaccharide fractions. CNP-1-2 comprised approximately 87.25% carbohydrate and 9.37% protein. Monosaccharide analysis suggested that CNP-1-2 was composed of L-rhamnose, l-arabinose, D-mannose, D-glucose and D-galactose with a molar ratio of 1.30:1.00:2.56:4.95:5.09. Methylation analysis, FT-IR, and (1)H NMR spectroscopy analysis revealed that CNP-1-2 might have a backbone consisting of 1,4-linked Glcp, 1,3-linked Glcp, 1,3-linked Manp, 1,4-linked Galp, 1,2,6-linked Galp and 1,2,6-linked Galp. Its side chain might be composed of 1-linked Araf, 1,6-linked Galp and 1-linked Rhap residues. AFM (atomic force micrograph) analysis revealed that CNP-1-2 had the molecular aggregation along with branched and entangled structure.
    Matched MeSH terms: Stomach Neoplasms/drug therapy
  8. Fulltext Helicobacter pylori infection--a boon or a bane: lessons from studies in a low-prevalence population
    Lee YY, Mahendra Raj S, Graham DY
    Helicobacter, 2013 Oct;18(5):338-46.
    PMID: 23607896 DOI: 10.1111/hel.12058
    Helicobacter pylori (H. pylori) infection is etiologically associated with gastric cancer and peptic ulcer diseases which are both important public health burdens which could be largely eliminated by H. pylori eradication. However, some investigators urge caution based on the hypothesis that eradication of H. pylori may result in an increase in the incidence of gastroesophageal reflux disease, esophageal adenocarcinoma, and childhood asthma. The ethnic Malays of northeastern Peninsular Malaysia have long had a low prevalence of H. pylori infection and, as expected, the incidence of gastric cancer and its precursor lesions is exceptionally low. The availability of a population with a low H. pylori prevalence and generally poor sanitation allows separation of H. pylori from the hygiene hypothesis and direct testing of whether absence of H. pylori is associated with untoward consequence. Contrary to predictions, in Malays, erosive esophagitis, Barrett's esophagus, distal esophageal cancers, and childhood asthma are all of low incidence. This suggests that H. pylori is not protective rather the presence of H. pylori infection is likely a surrogate for poor hygiene and not an important source of antigens involved in the hygiene hypothesis. Helicobacter pylori in Malays is related to transmission from H. pylori-infected non-Malay immigrants. The factors responsible for low H. pylori acquisition, transmission, and burden of H. pylori infection in Malays remain unclear and likely involves a combination of environmental, host (gene polymorphisms), and strain virulence factors. Based on evidence from this population, absence of H. pylori infection is more likely to be boon than a bane.
    Matched MeSH terms: Stomach Neoplasms/etiology*
  9. Fulltext Time trends in peptic ulcer, erosive reflux oesophagitis, gastric and oesophageal cancers in a multiracial Asian population
    Goh KL, Wong HT, Lim CH, Rosaida MS
    Aliment Pharmacol Ther, 2009 Apr 1;29(7):774-80.
    PMID: 19183160 DOI: 10.1111/j.1365-2036.2009.03930.x
    Dramatic changes in the prevalence and pattern of gastrointestinal disease has taken place in Asia in recent years.
    Matched MeSH terms: Stomach Neoplasms/epidemiology*
  10. Changing epidemiology of Helicobacter pylori in Asia
    Tan HJ, Goh KL
    J Dig Dis, 2008 Nov;9(4):186-9.
    PMID: 18959588 DOI: 10.1111/j.1751-2980.2008.00344.x
    As in developed societies, the prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence-based and endoscopy-based studies. While the decline in the incidence of gastric cancer has now been observed, a decrease in peptic ulcer disease has not been so clearly evident. This apparent paradox can be explained by an increase in non-H. pylori associated ulcers - such as those related to non-steroidal anti-inflammatory drugs or idiopathic ulcers. The increase of gastroesophageal reflux disease in Asia has been widely observed and commented on and its relationship to the decline in H. pylori speculated upon. However there have been few conclusive studies from Asia on this subject. While the improved diagnosis and elimination of H. pylori has contributed to its decline, a more basic change involving large segments of the Asian population must be responsible. An improvement in hygiene and living conditions that results from more affluent Asian societies is thought to be a possible cause.
    Matched MeSH terms: Stomach Neoplasms/epidemiology*
  11. Fulltext Differences in the pattern of gastric carcinoma between north-eastern and north-western peninsular Malaysia: a reflection of Helicobacter pylori prevalence
    Gurjeet K, Subathra S, Bhupinder S
    Med J Malaysia, 2004 Oct;59(4):560-1.
    PMID: 15779598 MyJurnal
    A retrospective study on demographics of gastric carcinoma was conducted in Hospital Pulau Pinang (HPP) with the aim of comparing it to a previous study done in Hospital Universiti Sains Malaysia (HUSM), Kelantan. The incidence of gastric carcinoma was much higher in Penang compared to Kelantan. It was commonest in males and Chinese. The incidence and site of gastric carcinoma closely parallels Helicobacter pylori infection rates. This was evidenced by the higher incidence and non-cardia location of gastric carcinomas in an area with higher H. pylori infection rates (HPP) compared to a much lower incidence and preponderance of cardia tumours in HUSM where the H. pylori infection rate is exceptionally low.
    Matched MeSH terms: Stomach Neoplasms/epidemiology*
  12. Fulltext Laparoscopic transgastric resection for intraluminal gastric gastrointestinal stromal tumors located at the posterior wall and near the gastroesophageal junction
    Siow SL, Mahendran HA, Wong CM
    Asian J Surg, 2017 Sep;40(5):407-414.
    PMID: 26922628 DOI: 10.1016/j.asjsur.2015.12.001
    OBJECTIVE: Intraluminal gastric gastrointestinal stromal tumors (GISTs) located at the posterior wall and near the gastroesophageal junction represent a surgical challenge. We present our experience of laparoscopic transgastric resection for gastric GISTs of such location.

    METHODS: Data of seven patients undergoing laparoscopic transgastric resection were identified and retrospectively reviewed with regard to procedural steps and patient outcomes.

    RESULTS: Seven patients (4 men; mean age 64.1 ± 14.6 years) with gastric GISTs underwent laparoscopic transgastric resection from January 2010 to May 2015. Three of the seven GISTs were located near the gastroesophageal junction and the rest were found in the posterior wall of the stomach. All seven patients underwent successful laparoscopic resection without any conversions. There were no mortalities and no significant postoperative complications. Intraoperative endoscopy was performed for all patients. The mean operative time was 164.0 ± 59.1 minutes. Regular diet was resumed within 3 days on average and mean postoperative stay was 3.6 ± 1.3 days. All patients achieved complete R0 resection with a mean tumor size of 5.5 ± 1.1 cm. At a mean follow-up of 48.0 ± 13.4 months, all patients were recurrence free.

    CONCLUSIONS: GISTs of the posterior wall and in close proximity to the gastroesophageal junction can be safely resected laparoscopically using such an approach. Standard technique is required to achieve good oncological outcomes.

    Matched MeSH terms: Stomach Neoplasms/surgery*
  13. Experience with gastroscopy in the diagnosis of stomach cancer in Malaysia
    Paramarajah S
    Southeast Asian J. Trop. Med. Public Health, 1985 Dec;16(4):609-12.
    PMID: 3835705
    Two hundred and eight patients underwent oesophago-gastro-duodenoscopy within the first year of its introduction at a peripheral general hospital in Malaysia. There were 7 cases of gastric cancer, proved histologically, as compared to 38 cases of benign gastric ulcer. The frequencies of the common symptoms and signs in the two conditions are compared. Of the 3 main ethnic groups, Malays, Chinese and Indians, the incidence of gastric ulcer was highest among the Chinese, next the Indians; however, the number of gastric cancers were too few for analysis of its racial incidence.
    Matched MeSH terms: Stomach Neoplasms/diagnosis*
  14. Fulltext Upper gastrointestinal endoscopy as an initial investigation in dyspepsia--a Malaysian experience
    Kudva MV, Thein-Htut
    Med J Malaysia, 1988 Dec;43(4):311-7.
    PMID: 3241596
    Matched MeSH terms: Stomach Neoplasms/diagnosis
  15. Carcinoma of he stomach, colon, and rectum. A survey of 772 surgical biopsies from Malaya
    King M, Kutty MK
    Br J Surg, 1971 Feb;58(2):123-6.
    PMID: 5548502
    Matched MeSH terms: Stomach Neoplasms/epidemiology*
  16. Laparoscopic transgastric resection of gastroduodenal intussusception due to gastric leiomyoma
    Siow SL, Wong CM, Febra S, Goh RET
    Med J Malaysia, 2020 09;75(5):609-611.
    PMID: 32918440
    Gastric leiomyoma of the antrum intussuscepted into first part of the duodenum is a rare complication. We report here an 80-year-old woman who presented at the Sarawak General Hospital, Kuching, Sarawak, Malaysia with early satiety and epigastric fullness for 3 months. She had no prior medical or surgical history other than an uneventful open cholecystectomy. Upper endoscopy showed a large submucosal mass in the first part of duodenum with pyloric converging gastric folds. Computed tomography scan of the abdomen showed a gastroduodenal intussusception with a 4x6cm mass at the junction between the first and second part of duodenum. Laparoscopic transgastric resection was performed. Histopathological examination of the resected specimen confirmed leiomyoma. She remained well at 43 months follow-up.
    Matched MeSH terms: Stomach Neoplasms/complications
  17. Safety and efficacy of endoscopic submucosal dissection of large (≥3 cm) subepithelial tumors located in the cardia
    Li J, Tang J, Lua GW, Chen J, Shi X, Liu F, et al.
    Surg Endosc, 2017 12;31(12):5183-5191.
    PMID: 28597288 DOI: 10.1007/s00464-017-5585-y
    BACKGROUND: Upper gastrointestinal subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the treatment strategy remains controversial. Compared to surgical resection, endoscopic resection has many advantages such as less invasive, shorter hospital stay, lower costs, and better quality of life. However, Endoscopic resection of large SETs in the cardia is challenging. The purpose of this study was to evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of such SETs.

    METHODS: A total of 41 patients with large SETs (≥3 cm in diameter) located in the cardia were involved in the study. All patients underwent ESD. Data on therapeutic outcomes and follow-up were collected, for analysis of risk factors of complication rates.

    RESULTS: The average tumor size was 4.7 ± 1.7 cm. The average procedure time was 69.3 ± 32.7 min and the average postoperative hospital stay was 3.5 ± 1.1 days. A total of 41 tumors were removed successfully, in which 35 were leiomyomas, three were gastrointestinal stromal tumors, two were lipomas, and one was gastritis cystica profunda. The en bloc resection rate was 90.2%, and was significantly higher for tumors with a round or oval shape (100%) than for those with an irregular shape (75.0%) (P 

    Matched MeSH terms: Stomach Neoplasms/surgery*
  18. Association of IGF-1 and IGFBP-3 levels with gastric cancer: A systematic review and meta-analysis
    Liu H, Gu H, Kutbi EH, Tan SC, Low TY, Zhang C
    Int J Clin Pract, 2021 Nov;75(11):e14764.
    PMID: 34469629 DOI: 10.1111/ijcp.14764
    PURPOSE: Many studies have investigated the association between serum IGF-1 and IGFBP levels with gastric cancer (GC), but the results remained inconclusive. In this work, we performed a systematic review and meta-analysis to examine the precise association of serum levels of IGF-1 and IGFBP with GC.

    METHODS: A comprehensive systematic search was carried out in PubMed/MEDLINE, SCOPUS, Web of Science, and EMBASE databases for (nested) case-control studies that reported the levels of IGF-1 and IGFBP in GC cases and healthy controls, from inception until October 2020. Weighted mean difference (WMD) was calculated for estimating combined effect size. Subgroup analysis was performed to identify the source of heterogeneity among studies.

    RESULTS: We found eight and five eligible studies (with 1541 participants) which provided data for IGF-1 and IGFBP, respectively. All studies on IGFBP reported the IGFBP-3 isoform. The pooled results indicate that GC patients had significantly lower serum IGF-1 [WMD = -26.21 ng/mL (95% CI, -45.58 to -6.85; P = .008)] and IGFBP-3 [WMD = -0.41 ng/mL (95% CI, -0.80 to -0.01; P = .04; I2  = 89.9%; P 

    Matched MeSH terms: Stomach Neoplasms*
  19. Fulltext Dysbiosis of the microbiome in gastric carcinogenesis
    Castaño-Rodríguez N, Goh KL, Fock KM, Mitchell HM, Kaakoush NO
    Sci Rep, 2017 11 21;7(1):15957.
    PMID: 29162924 DOI: 10.1038/s41598-017-16289-2
    The gastric microbiome has been proposed as an etiological factor in gastric carcinogenesis. We compared the gastric microbiota in subjects presenting with gastric cancer (GC, n = 12) and controls (functional dyspepsia (FD), n = 20) from a high GC risk population in Singapore and Malaysia. cDNA from 16S rRNA transcripts were amplified (515F-806R) and sequenced using Illumina MiSeq 2 × 250 bp chemistry. Increased richness and phylogenetic diversity but not Shannon's diversity was found in GC as compared to controls. nMDS clustered GC and FD subjects separately, with PERMANOVA confirming a significant difference between the groups. H. pylori serological status had a significant impact on gastric microbiome α-diversity and composition. Several bacterial taxa were enriched in GC, including Lactococcus, Veilonella, and Fusobacteriaceae (Fusobacterium and Leptotrichia). Prediction of bacterial metabolic contribution indicated that serological status had a significant impact on metabolic function, while carbohydrate digestion and pathways were enriched in GC. Our findings highlight three mechanisms of interest in GC, including enrichment of pro-inflammatory oral bacterial species, increased abundance of lactic acid producing bacteria, and enrichment of short chain fatty acid production pathways.
    Matched MeSH terms: Stomach Neoplasms/microbiology*
  20. Lessons learnt from the epidemiology of Helicobacter pylori infection in Malaysia: JGHF Marshall and Warren Lecture 2017
    Goh KL
    J Gastroenterol Hepatol, 2018 Jun;33(6):1177-1184.
    PMID: 29498759 DOI: 10.1111/jgh.14131
    The study of Helicobacter pylori in Malaysia has given several important insights into the epidemiology of the infection and pathogenesis of disease. Malaysia has a multiracial Asian population with three major Asian races living together-Malay, Chinese, and Indian. Races remain fairly distinct because of a paucity of interracial marriages. The "Racial Cohort Hypothesis" proposes that the infection occurs within racial groups rather than between. As such, the high prevalence among Indians (> 50%) and Chinese (40-50%) reflects the high prevalence in their countries of origin even though migration had taken place more than two generations before. The Malays have a comparatively low prevalence of about 10-20%. Despite the high prevalence of H. pylori, the Indians have a low gastric cancer incidence of less than 10 per 100 000 per year. This is in contrast to the Chinese who has an incidence in excess of 20 per 100 000 per year. We have called this the "Indian Enigma." The reason for this enigma is unclear and is the result of interaction between bacterial virulence factors, host susceptibility, and environmental factors. Phylogenetically, Chinese bacterial strains are distinct from Indians and Malays and are predominantly hpEastAsia/hsp EAsia. CagA EPIYA motifs among Chinese belong predominantly to the more virulent ABD motif. There is no clear distinguishing profile among host genetic factors. Environmental factors particularly diet may play an important role. Indians consume chilies and curries, which may be gastro protective, whereas Chinese consume more preserved and salted foods, which are thought to be carcinogenic.
    Matched MeSH terms: Stomach Neoplasms/epidemiology
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