Daisuke Kamino

Relation between histologic gastritis and gastric motility in Japanese patients with functional dyspepsia: evaluation by transabdominal ultrasonography

BackgroundWhether mucosal inflammation affects gastric motility in patients with functional dyspepsia (FD) is controversial. Few reports discuss gastric motility in relation to histologic gastritis. We examined the relation between gastric motility and histologic gastritis in Japanese patients with FD.MethodsSubjects were 198 patients examined by ultrasonography (US) and endoscopic biopsy. Histologic gastritis scores were compared to three US gastric motility indices: the motility index (MI), gastroduodenal reflux index (RI), and gastric emptying rate (GER). In cases of gastritis with a high inflammation score (score 2–3), the macrophages in biopsy specimens were counted and compared to the motility indices.ResultsOf the 198 patients, 159 were Helicobacter pylori positive. Comparison of 39 age-and sex-matched H. pylori-positive and 39 H. pylori-negative patients showed that the MI was lower in H. pylori-positive patients (6.78 ± 2.17 vs. 7.63 ± 2.35, P < 0.05), and the RI was higher (5.64 ± 4.70 vs. 2.13 ± 2.58, P < 0.01). Among H. pylori-positive patients, US revealed a decreased MI in patients with a high inflammation score (score 2–3) in the antrum compared with the MI of those with a low inflammation score (score 0–1) (6.52 ± 2.38 vs. 7.82 ± 1.89, P < 0.01). The number of macrophages was not associated with motility indices in patients with a high inflammation score.ConclusionHistologic gastritis with severe inflammation may inhibit gastric motility.

Long-term Ultrasonographic Follow-up Study of Gastric Motility in Patients with Functional Dyspepsia.

Although patients with functional dyspepsia complain of epigastric symptoms, the relation between these symptoms and gastric motility remains controversial. There are few reports on the clinical course of functional dyspepsia, including changes in gastric motility, observed over a considerably long period. We conducted a study to examine association between changes in symptoms and changes in ultrasonographically evaluated gastric motility over a long-term follow-up period in patients with functional dyspepsia. Forty patients (18 men, 22 women; mean age, 53.7 years) with functional dyspepsia were followed up by medical interview, physical examination, endoscopy, and ultrasonography for gastric motility. Follow-up ranged from 1.0 to 7.8 years (mean, 3.0 years). Ultrasonographic evaluation of gastric motility included gastric emptying rate and antral contractions. During the follow-up period, patients were treated with proton pump inhibitors, H2-blockers, or prokinetics. Symptoms improved in 21 patients (group A), but symptoms persisted or worsened in 19 patients (group B). There were no significant differences in clinical characteristics between the two groups. Gastric motility improved in group A but not in group B. In conclusion, improved gastric motility appears to correspond to and may explain improved symptoms in some patients with functional dyspepsia.

Famotidine prevents canine gastric blood flow reduction by NSAIDs

Aim : To investigate the effect of famotidine on gastric blood flow reduction induced by diclofenac sodium, a common non‐steroidal anti‐inflammatory drug in Japan, using laser Doppler flowmetry in the canine stomach.

Real-time visualization and quantitation of canine gastric mucosal blood flow by contrast-enhanced ultrasonography.

Objective. Contrast-enhanced ultrasonography has become a method of choice for evaluating gastric blood flow, but intermittent scanning techniques can sometimes distort the results. Low-mechanical index imaging using Definity as the injected contrast material has been advocated for real-time evaluation of microperfusion in other organs. We investigated the reliability of low-mechanical index imaging using Definity in the evaluation of gastric mucosal blood flow. Material and methods. Under general anesthesia, 10 beagle dogs weighing 9–10 kg underwent real-time harmonic imaging under low acoustic power (mechanical index = 0.2) after intravenous contrast injection using Definity (60 mg/kg). Laser Doppler flow measurement was also performed to evaluate gastric mucosal blood flow. After administration of a diclofenac sodium suppository, low-mechanical index imaging and laser Doppler flowmetry were repeated. Results. Real-time visualization of gastric mucosal blood flow was successful in all dogs undergoing low-mechanical index imaging with Definity. Quantitative assessment of gastric mucosal blood flow was successful in eight dogs. After diclofenac sodium administration, gastric mucosal blood flow measured by both laser Doppler flowmetry and contrast ultrasonography decreased in seven of eight dogs; in the other dog, gastric mucosal blood flow increased slightly. A strong positive correlation was evident between blood flow measured by laser Doppler flowmetry and low-mechanical index imaging (r=0.777, p<0.005). Conclusions. Low-mechanical index imaging with Definity is a non-invasive way to evaluate gastric mucosal blood flow in real-time, high-resolutional images, which may have additional important gastrointestinal tract applications.

Gastrointestinal Stromal Tumor in Jejunum: Diagnosis Using Contrast-Enhanced Ultrasonography and Double-Balloon Enteroscopy

Gastrointestinal stromal tumors (GISTs) in the small intestine are rare and are sometimes incidentally detected by sudden gastrointestinal bleeding. The patients often undergo surgery without an accurate diagnosis, because most of these lesions are inaccessible by conventional endoscopy. Ultrasonography (US) has become an effective diagnostic modality for gastrointestinal diseases. In addition, recent studies have revealed that the microcirculation of the gastrointestinal wall can be assessed by contrastenhanced imaging using the agent SHU 508A (Levovist; Schering, Berlin, Germany) (1, 2). However, there have been few reports of the sonographic features of GISTs. We report a patient with GIST in the jejunum that was diagnosed by US as a screening tool and that was confirmed preoperatively by double-balloon enteroscopy.

Initial experience with catheter probe US when using a multibending endoscope.

BACKGROUND High-frequency catheter probe US provides detailed images when the scanning plane is perpendicular to the area of interest and the latter is within the focal zone. A multibending endoscope has been developed that has two bending sections that can be deflected independently. The aim of this study was to determine whether this new endoscope enhances high-frequency catheter probe US. METHODS High-frequency catheter probe US was performed with the multibending endoscope in 33 patients with upper-GI lesions. The endoscope was carefully maneuvered until the scanning plane was perpendicular to the area of interest and the target area was within the focal zone of the probe. The effects of deflecting the second bending section on the image and on the rotating elements in the probe were evaluated. RESULTS For 28 lesions, no improvement was observed with use of both bending sections. However, for 5 lesions, the US image was improved by use of the second bending section. These lesions were located in the stomach on the lesser or greater curve. In no instance did deflection of both bending sections result in uneven rotation of the mechanical elements in the probe. CONCLUSIONS For certain lesions, US images obtained with a catheter probe can be improved by using an endoscope with a second bending section.

Sonographic detection of longitudinal ulcers in Crohn's disease

Background: The purpose of this study was to investigate the characteristic sonographic features, such as focal disappearance of the wall stratification sign (FD sign), of longitudinal ulcers in pa...