Atsuro Morozumi

Severe atrophic gastritis with Helicobacter pylori infection and gastric cancer

Background. We conducted a case-control study to evaluate whether patients with severe gastric atrophy (indicated by serum pepsinogen concentration) have a high risk of gastric cancer. Methods. At the time of diagnosis of gastric cancer, sera from 301 patients (cases) and 602 sex- and age-matched cancer-free individuals (controls) were tested for the presence of anti-Helicobacter pylori IgG antibody (HM-CAP enzyme-linked immunoassay [ELISA] kit; Kyowa Medix, Tokyo, Japan) and serum pepsinogen (PG) levels (PG I and II Riabead Kits; Dainabot, Tokyo, Japan). We defined positivity for pepsinogen a pepsinogen I concentration of less than 70 ng/mL and a PG I/II ratio of less than 3.0. We categorized the subjects according to serum pepsinogen levels and anti-Helicobacter pylori IgG antibody, creating four categories. Results. Of the 301 cancer cases, 177 had positive serum pepsinogen levels, and 172 were positive for anti-Helicobacter pylori IgG antibody. The category in which subjects had positive serum pepsinogen levels and were negative for anti-Helicobacter pylori IgG antibody had the highest proportion (76.9%) of individuals with gastric cancer and the highest odds ratio (4.20) of the four categories. The odds ratios were 2.55 (95% confidence interval; 1.92–3.88) for positive serum pepsinogen levels and 0.93 (95% confidence interval; 0.63–1.27) for positive anti-Helicobacter pylori IgG antibody. Conclusion. These results suggest that patients with positive serum pepsinogen levels who are negative for IgG antibody to Helicobacter pylori, constitute a high-risk group for gastric cancer. Helicobacter pylori infection is associated with the development of gastric cancer by providing a suitable environment i.e., severe gastric atrophy, for carcinogenesis of the gastric mucosa.

Multiple hepatic peribiliary cysts discovered incidentally at a medical examination

Abstract We report a living patient with multiple hepatic peribiliary cysts. It was discovered incidentally during an ultrasonographic screening at a medical examination. Peribiliary cysts are multiple retention cysts of peribiliary glands. Although many autopsy cases of peribiliary cysts have been reported, there are few clinical cases of it in living patients. A CT performed immediately after drip‐infusion cholangiography (DIC) was most useful for diagnosis in various imaging tests we performed.

Endoscopic urease sensor system for detecting Helicobacter pylori on gastric mucosa

BACKGROUND It is now accepted that the curing of Helicobacter pylori infection will result in healing of chronic active gastritis and will change the natural history of gastroduodenal ulcer disease. Both endoscopic observation and evaluation of H. pylori status of the stomach are necessary for diagnosis and treatment of such patients. We carried out a clinical evaluation of an endoscopic tube type urease sensor system for the detection of H. pylori on the gastric mucosa. The differential output of two pH-sensitive field effect transistors at the tip of the endoscopic tube reflects the pH change in a urea solution depending on the existence of urease. METHODS In vitro experiments and clinical evaluation of the system were performed. Fifty-one patients who were suspected to have a gastroduodenal disorder were examined for H. pylori infection with this system, using the combination of histologic and bacteriologic examinations and rapid urease test as the references. RESULTS Clinical sensitivity and specificity of this system were 26 of 28 (92.9%) and 22 of 23 (95.7%), respectively. A measurement at 1 site is completed in about 1 minute. Repetition of the procedure provides multi-site measurements. CONCLUSIONS The present system makes possible quick on-site detection of H. pylori under endoscopic observation, with satisfactory sensitivity and specificity.

Immunological Rapid Urease Test for Detecting Helicobacter pylori: Comparative Study of Biopsy Specimens and Gastric Mucus

Abstract: A variety of reliable methods are available for the detection of H. pylori during upper gastrointestinal endoscopy. We evaluated the clinical utility of an analyzer for H. pylori urease composed of a solid‐phase tip coated with a monoclonal antibody against H. pylori urease and ion‐sensitive field effect transistor‐based pH sensor system. Samples of both gastric mucus and gastric mucosal specimens were collected and the results from this system were compared. Sensitivity and specificity were 97% and 100% for mucus samples and 92% and 97% for mucosal specimens in the present system; compared to 95% and 96% for histological examination, 92% and 100% for bacteriological test, and 89% and 100% for rapid urease test, respectively. These results confirmed that the present system had high clinical sensitivity and specificity, especially for testing of mucus samples. This method has the advantage of requiring only one sample per patient because mucus can be collected from a broad area of the stomach lumen by stroking the mucosal surface with a brush. (Dig Endosc 1999; 11: 42–46)

Digital/analog hybrid system for filing of endoscopic images

A new system was developed for filing all the endoscopic images generated in our hospital. The system is composed of an on-line network for analog images supplied from the endoscopy stations and stored on 300 mm optical disks, on the one hand, and an off-line PACS for digital images recorded on a 130 mm magneto-optical disk (MOD) at each endoscopy station, on the other. For close examination of the images digital images are displayed from the MOD on a high-resolution computer graphic monitor, and for quick review of a large number of images, analog images are retrieved from the 300-mm optical disks. This system has been in clinical use at our university hospital for the past year and has proven useful for education of endoscopy, for the quality control of the endoscopy practice, and for the management of the patients.

Diffuse muscular thickening of esophagus associated with multiple leiomyomas diagnosed by endoscopic ultrasonography

Idiopathic muscular hypertrophy of the esophagus is a rare pathological condition reported mainly in Western countries (1-4). Although leiomyoma is the most common submucosal tumor of the esophagus, association of idiopathic muscular hypertrophy and leiomyoma has not been reported in a patient. We report here a case of multiple esophageal leiomyomas associated with diffuse thickening of the muscularis propria diagnosed by endoscopic ultrasonography (EUS). Clinically, this patient was diagnosed as having idiopathic muscular hypertrophy of the esophagus.

Endosonographic criteria for assessment of the depth of duodenal invasion in carcinoma of the papilla of Vater

Background: Imaging criteria by endosonography for assessment of the depth of duodenal invasion of carcinoma of the papilla of Vater (papilla carcinoma) have not been established.

Morphological changes of small pancreatic cysts in response to secretin stimulation observation by endoscopic ultrasonography

It is difficult to discriminate clinically the etiology of small pancreatic cysts using conventional methods. Endoscopic ultrasonography can delineate small lesions. In order to help differentiate the etiology of cystic lesions of the pancreas by endoscopic ultrasonography, we investigated morphological changes following stimulation of the pancreatic secretion with secretin. After an intravenous injection of secretin (50 CU), the size, shape, and echogenicity of a cyst smaller than 2 cm were recorded for 15 min. Of 17 cases examined, 10 patients showed an alteration of these factors. These cases were thought to be nonneoplastic cysts, which included all six cases where communication to the main pancreatic duct was demonstrated by ERCP. Five cases of neoplastic cyst did not show the change in shape and size. These results indicate that secretin stimulation provides useful information in the diagnosis of the etiology of pancreatic cyst by endoscopic ultrasonography.

Alpha-fetoprotein producing carcinoma of the gallbladder associated with anomalous arrangement of the pancreaticobiliary ductal system—Early detection through an attack of acute pancreatitis

SummaryA 56-year-old female was admitted to our hospital with a diagnosis of acute pancreatitis. Ultrasonography revealed a hypoechoic tumor in the gallbladder. The serum α-fetoprotein (AFP) level was 971 ng/ml. After healing of the acute pancreatitis, the anomalous arrangement of the pancreaticobiliary ductal system (APDS) was demonstrated by ERCP with mild dilatation of the common bile duct. Within one month after admininon, AFP level reached 4390 ng/ml. On operation, a pedunculated tumor, 6.5 × 3 cm in size, was found in the gallbladder. Histological examination revealed a moderately differentiated adenocarcinoma and positive immunohistochemical staining of cancer cells for AFP. After absolutely curative (stage II) resection, normal serum AFP levels were recognized. This is the first report of an AFP-producing cancer of the gallbladder associated with APDS and it was detected as a result of an attack of acute pancreatitis.

4708 Immunological rapid urease test-a new diagnostic system for detecting helicobacter pylori-.

Introduction: New diagnostic methods have been developed aiming at sensitive, specific and rapid detection of H. pylori. We established a new diagnostic system using a monoclonal antibody against H. pylori urease and pH sensor. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of the present system and to determine the calibration curve and detection limits the system. Methods: H. pylori urease adsorbed on a solid-phase tip coated with a monoclonal antibody against H. pylori urease after 15 min of incubation with a gastric mucus sample solution was measured by the pH change of the urea solution inside the tip.The detection limit of H. pylori urease using this system was determined and compared with that of the CLO test. Clinical evaluation of the system was performed in 155 patients. Histological examination, CLO test and culture were used as the standard tests. Results:The present system could detect 0.25 mIU/ml of H. pylori urease in less than 20 min. The sensitivity of the present system is superior to that of the CLO test by about two orders of magnitude. If a patient with at least one positive result in a standard test for H. pylori was considered to be positive, the sensitivity, specificity, positive predictive value and negative predictive value of the system were calculated as 95.2%, 98.9%, 98.4% and 96.8%, respectively.The present system had a significantly higher rate of determining the correct diagnosis than the CLO test and histological examination (McNemars test, p=0.023 and p=0.027, respectively). However, ten of 19 H. pylori -positive cases with the pH change less than 0.1 were negative for at least one of the standard tests, whereas the present system could detect H. pylori correctly in all but for three of these 19 cases. The present system accurately determined H. pylori status in 75 of 76 patients (98.7% ) who had completed treatment. Conclusions: Immunological rapid urease test makes it possible to detect H. pylori within 20 min, and gives very high sensitivity and specificity, especially in the patients with low urease activity.