Masaaki Sumioka

Nodular Gastritis in Adults Is Caused by Helicobacter pylori Infection

A close relationship exists between nodular gastritis and Helicobacter pylori infection in children. The pathogenesis and optimal management of nodular gastritis in adults, however, are unclear. This study describes the clinicopathologic features of nodular gastritis in adults and correlates treatment with outcome. Of 97,262 adult patients who underwent endoscopy, 187 (0.19%) were diagnosed with nodular gastritis, 151 (81%) of whom had dyspepsia. Nodular gastritis predominantly affects young women (49 men and 138 women, mean age, 32.6 years). All 134 patients tested for Helicobacter pylori infection were infected, and 65/66 (98%) had inflammation of both the antrum and the corpus. Twenty-five (13%) had associated lesions (peptic ulcers or cancer). Dyspepsia improved after eradication of Helicobacter pylori infection, but did not improve spontaneously. Nodular gastritis in adults is caused by Helicobacter pylori infection and shows a predilection for females and young adults. Helicobacter pylori eradication decreases symptoms and reduces the risk of peptic ulcers and possibly gastric cancer.

Cigarette smoking promotes atrophic gastritis in Helicobacter pylori-positive subjects.

Aging and smoking are known to promote atrophic gastritis (AG) and intestinal metaplasia (IM). This study investigated the relationship between Helicobacter pylori (Hp) infection, aging, smoking, and AG/IM. Ninety-six Hp-negative and 231 Hp-positive subjects were divided according to age; (≤39 years, 40–59 years, and ≥60 years) and smoking history (never smoked, or currently smoking). Histologic grading was performed according to the updated Sydney system. Fasting pH, total bile acid (TBA) concentration, and ammonia (NH3) concentration in gastric juice were measured. Comparisons were made based on Hp status, age, and smoking. Independent relative risks for severe AG and IM were calculated. Grades of atrophy and IM were significantly higher in Hp-positive subjects, and these increased with age. Within Hp-positive subjects, grades of atrophy and IM were higher in smokers and in the middle and upper age groups. Within Hp-positive subjects, gastric pH and TBA were similarly higher in smokers and older subjects. An increased risk of severe AG/IM was statistically associated with smoking (OR 9.31, 3.85–22.50/OR 4.91, 1.90–12.68) and high TBA concentrations (OR 2.92, 1.19–7.17/OR 3.28, 1.25–8.62). Both Hp infection and aging are closely related to the development of AG and IM. Cigarette use and high TBA concentrations may play a role in the progression of AG and IM in Hp-positive subjects.

Antral gastrin and somatostatin concentrations in peptic ulcer patients.

As an attempt to approach the pathogenesis of peptic ulcer disease, antral gastrin and somatostatin concentrations were studied in normal subjects, patients with duodenal ulcer and gastric ulcer. In the patients with peptic ulcer, antral somatostatin concentrations were significantly lower than those in normal subjects. In non-ulcer subjects, including normal subjects and patients with atrophic gastritis, antral somatostatin concentrations were correlated inversely with the degree of antral gastritis, while in the patients with peptic ulcer, especially in duodenal ulcer, they were low, irrespective of histological picture of antral mucosa. In the patients with duodenal ulcer, low antral somatostatin concentrations with high antral gastrin/somatostatin ratio may cause increased serum gastrin levels and increased gastric acid secretion. From the above findings, it has been concluded that low antral somatostatin levels may be related to the pathogenesis of duodenal ulcer disease.

Isolated granulomatous gastritis successfully treated by Helicobacter pylori eradication : a possible association between granulomatous gastritis and Helicobacter pylori

We report two cases of granulomatous gastritis that resolved completely with Helicobacter pylori eradication. Two Japanese women, one 61 years old and one 58 years old, presented to our hospital with epigastralgia. Endoscopy revealed multiple shallow ulcerative lesions in the gastric corpus of both patients. Biopsy specimens demonstrated acute and chronic inflammation with multiple small, noncaseating granulomas at the level of the foveolar isthmi—the junction between the pits and the glands. Both specimens were positive for Helicobacter pylori. No other causes of organic granulomatous disease could be found. Both patients were diagnosed as having isolated granulomatous gastritis and were given triple therapy for Helicobacter pylori eradication, with their fully informed consent. The granulomatous gastritis resolved after successful Helicobacter pylori eradication therapy. This report describes a possible association between isolated granulomatous gastritis and Helicobacter pylori infection. To our knowledge, this is the first report describing isolated granulomatous gastritis successfully treated by triple therapy (Helicobacter pylori eradication therapy).

Magnifying colonoscopy used to predict disease relapse in patients with quiescent ulcerative colitis.

Background: Many patients with quiescent ulcerative colitis (UC) experience relapse. However, clinical and conventional colonoscopic signs are inadequate for predicting relapse. This studys aim was to investigate the effectiveness of magnifying colonoscopy in predicting relapse in patients with quiescent UC and to evaluate the association of the findings of magnifying colonoscopy with the histological findings. Methods: Magnifying colonoscopy was performed in 57 patients with clinical and endoscopic inactive UC. Patients were divided into 3 groups according to the findings of magnifying colonoscopy as MR (magnify‐regular), MI (magnify‐irregular), and MD (magnify‐defect). Their subsequent clinical course was compared to assess the clinical usefulness of magnifying observation in predicting relapse. We also compared histological findings according to Rileys criteria to each finding of magnifying colonoscopy. Results: Within 12 months, 1 of 18 patients (6.7%), 10 of 22 patients (45.5%), and 12 of 17 patients (70.6%) with findings of magnifying colonoscopy of MR, MI, and MD, respectively, experienced relapse. The MR group had a significantly low relapse rate compared with the MD and MI groups (P = 0.016, P = 0.002). When histological findings were compared with the findings of magnifying colonoscopy, the mean score of each variable, such as acute inflammatory cell infiltrate, chronic inflammatory cell infiltrate, and crypt architectural irregularities was significantly lower in the MR group than in the MD and MI groups. Conclusions: The findings of magnifying colonoscopy in patients with quiescent UC is useful for predicting relapse and is associated with histological grade of inflammation. Inflamm Bowel Dis 2009

Somatostatin in gastric juice in normal subjects and patients with duodenal ulcer

Somatostatin in gastric juice was determined in normal subjects and patients with duodenal ulcer. Gel exclusion chromatography of gastric juice revealed that the main immunoreactivity existed at the position of somatostatin-14. A large amount of somatostatin was present in gastric juice, and the quantity increased following tetragastrin stimulation. Furthermore, there was a good inverse correlation between somatostatin concentration and acidity of gastric juice; however, there was no difference between normal subjects and patients with duodenal ulcer in the amount of somatostatin released into gastric juice.

Effect of famotidine on recurrent bleeding after successful endoscopic treatment of bleeding peptic ulcer.

Aim:  We investigated the effect of acid suppression therapy on recurrent bleeding after successful endoscopic treatment of bleeding peptic ulcer.

Influence of diet on the development of gastrin- and somatostatin-like immunoreactivity in the stomach of rats

The effects of changes in diet on antral gastrin-like immunoreactivities and antral and corporal somatostatin-like immunoreactivities were studied in three groups of young male rats. Group 1 rats were weaned physiologically, group 2 rats received only breast milk, and group 3 rats were fed milk until 20 days of age and then were switched abruptly to laboratory chow. In group 1, antral gastrin-like immunoreactivity and somatostatin-like immunoreactivity increased gradually from 13 days of age to adults. In group 2, antral gastrin-like immunoreactivity did not increase, and antral and corporal somatostatin-like immunoreactivity increased until 20 and 25 days of age, respectively. In group 3, there were three- to fivefold increases of antral gastrin-like immunoreactivity and somatostatin-like immunoreactivity after changing to laboratory chow. Dietary changes had no effect on the concentration of corporal somatostatin-like immunoreactivity. These results suggest that the developmental patterns of gastric gastrin-like immunoreactivity and somatostatin-like immunoreactivity are closely related to diet; laboratory chow may play an important role in the development of these gut hormones.

Sa1585 The Corresponding Rate of Magnification Observation Findings of Narrow Band Imaging (NBI) and Flexible Spectral Imaging Color Enhancement (FICE) in Gastric Tumors and in Colorectal Lesions

The Corresponding Rate of Magnification Observation Findings of Narrow Band Imaging (NBI) and Flexible Spectral Imaging Color Enhancement (FICE) in Gastric Tumors and in Colorectal Lesions Yuko Hiraga*, Masaaki Sumioka, Tomoki Hiramoto, Morihisa Akagi, Daisuke Komichi, Yukio Kuwada, Mikiya Kitamoto, Chiyuki Watanabe, Takashi Nishisaka Department of endoscopy, Hiroshima prefectural Hospital, Hirosima, Japan; Department of gastroenterology, Hiroshima prefectural Hospital, Hirosima, Japan; Department of pathology, Hiroshima prefectural Hospital, Hirosima, Japan Introduction/Objectives: There is a difference in how to see the microvessels by NBI and FICE for the reason that the method of the image enhancement is different, so that it has not been clear whether NBI magnification classification can apply to FICE also. We have been able to use both the instruments in our hospital, so that we were able to do the comparative study of NBI findings and FICE ones at the same lesions for the purpose of examining whether the classification of NBI magnification fits FICE magnification findings also. Methods: We examined a total of 161 lesions (22 gastric tumors, 139 colorectal lesions) that observed by both NBI magnification and FICE magnification between April 2009 and August 2011, treated by endoscopic or surgical resection and diagnosed clinicopathologically. The interval of NBI and FICE examinations was 62.3days (shortest one day, longest 475 days). We examined on the comparison with the NBI findings and the FICE ones and on the relationship between them and histological diagnosis. We classified NBI/FICE magnifying findings according to whether surface pattern was visible or not and whether that was regular or not, and whether microvessels were regular or not and whether avascular area appeared or not. We followed VS classification system (Vascular pattern; regular, irregular or absent, Surface pattern; regular, irregular or absent) in gastric tumors, and followed Hiroshima classification (A, B, C1, C2 or C3) in colorectal lesions. Results: 1) Gastric tumors: In surface pattern diagnosis, FICE findings corresponded with NBI ones at all 22 lesions. But in microvessels pattern diagnosis, evaluations differed in two lesions (regular-irregular, regular-absent). The corresponding rate of NBI and FICE magnification findings was overall 90.9% in gastric tumors, in each of histological diagnosis, it was 91.7% in adenomas, and 90.0% in cancers. 2) Colorectal lesions: The diagnoses of FICE findings differed from NBI ones in 16 lesions, concretely A-B 1 lesion, B-C1 13 lesions and C1-C2 2 lesions. The diagnoses of C3-type, with invisible surface pattern and fragmental microvessels or avascular area, corresponded in all 6 lesions. The corresponding rate of NBI and FICE magnification findings was overall 88.5% in colorectal lesions, in each of histological diagnosis, it was 100% in non-neoplasm, 89.6% in adenomas, 90.5% in intramucosal cancers, and 66.7% in invasive cancers. Conclusions: In gastric tumors and colorectal lesions, the diagnoses between NBI magnification and FICE ones almost corresponded. We were able to apply the classification of NBI magnification to also FICE magnification by using the classification that paid attention to a visibility of surface pattern and to an irregularity of microvessels diameter and distribution.