Munetoshi Toki

Development and evaluation of FSSG: frequency scale for the symptoms of GERD.

BackgroundThe aim of this study was to produce a simplified questionnaire for evaluation of the symptoms of gastroesophageal reflux disease (GERD).MethodsA total of 124 patients with an endoscopic diagnosis of GERD completed a 50-part questionnaire, requiring only “yes” or “no” answers, that covered various symptoms related to the upper gastrointestinal tract, as well as psychosomatic symptoms. The 12 questions to which patients most often answered “yes” were selected, and were assigned scores (never = 0; occasionally = 1; sometimes = 2; often = 3; and always = 4) to produce a frequency scale for symptoms of GERD (FSSG). Sensitivity, specificity, and accuracy of the FSSG questionnaire were evaluated in another group of patients with GERD and non-GERD. The usefulness of this questionnaire was evaluated in 26 other GERD patients who were treated with proton pump inhibitors for 8 weeks.ResultsWhen the cutoff score was set at 8 points, the FSSG showed a sensitivity of 62%, a specificity of 59%, and an accuracy of 60%, whereas a cutoff score of 10 points altered these values to 55%, 69%, and 63%. The score obtained using the questionnaire correlated well with the extent of endoscopic improvement in patients with mild or severe GERD.ConclusionsThis new questionnaire is useful for the objective evaluation of symptoms in GERD patients.

Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification

BACKGROUND A new endoscopic classification of gastroesophageal reflux disease (GERD) has been proposed, and the term mucosal break has been introduced to describe mucosal damage. This new classification was evaluated by endoscopists with different levels of experience. METHODS Fifty endoscopic photographs for each of 20 randomly selected patients with GERD were assessed retrospectively by three groups of seven endoscopists classified by experience: group 1 (100 to 500 procedures), group 2 (500 to 3000), and group 3 (more than 3000). The new classification was modified by adding grade 0 to describe healed mucosal breaks, so that there were five grades. All photographs were assessed twice at an interval of more than 1 week, and kappa statistics were used to determine observer variation. RESULTS Interobserver variation within group 3 (kappa = 0.39, n = 21) and between groups 3 and 2 (kappa = 0.36, n = 49) was significantly different (p < 0.01) from that between groups 3 and 1 (kappa = 0.26, n = 49). Intraobserver variation in group 1 (kappa = 0.39, n = 7) was significantly different (p < 0.01) from that in group 2 (kappa = 0.51, n = 7) and group 3 (kappa = 0.54, n = 7). CONCLUSIONS Observer variation depends on level of endoscopic experience. Only experienced endoscopists should use the new classification for grading of GERD.

Diagnosis of gastroesophageal reflux disease using a new questionnaire

Background and Aim: An early and accurate evaluation by a general practitioner is needed to screen out non‐gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire.

Comparative efficacy of acid reflux inhibition by drug therapy in reflux esophagitis.

SummaryThe advent of histamine H2 receptor antagonists (H2-RA) has allowed the treatment of reflux esophagitis (RE) to be controlled over a relatively long term. The authors have experienced some cases resistant to H2-RA, but it was revealed that these cases can be successfully treated with proton pump inhibitors. It has been suggested that esophagogastric dysmotility can lead to RE. RE has been treated for many years by using GI-prokinetic agents, which theoretically inhibit acid reflux and improve esophageal acid clearance. In order to compare the effects on acid reflux of an H2-RA (famotidine), a proton pump inhibitor (omeprazole) and a GI-prokinetic agent (cisapride), we measured the 24-hour pH in the esophagus and stomach simultaneously, before and after treatment in 17 patients with RE. It was found that the proton pump inhibitor was the most effective drug for inhibiting esophageal acidification, followed by famotidine and then cisapride. Furthermore, we found that cisapride often actually exacerbated acid reflux. The differences in inhibitory effects on acidification allowed us to draw conclusions regarding the treatment of RE. It was concluded that the stronger the inhibitory effect of a drug on acid secretion, the more useful it was in the treatment of RE. The GI-prokinetic drug did not inhibit acid reflux as much as we had expected.

Numerical modification of the Los Angeles classification of gastroesophageal reflux disease fails to decrease observer variation

Background:  We previously reported that a new endoscopic classification of gastroesophageal reflux disease, the Los Angeles classification, showed considerable observer variation depending on the experience of the endoscopist. In the present study, we evaluated some modifications of the classification to determine whether we could decrease observer variation.

Electronic Endoscopy and Biopsy Findings During the Course of Reflux Esophagitis

Abstract: We observed the esophageal mucosa in 90 patients with reflux, esophagitis using a zoom‐type electronic endoscope and clarified the endoscopic characteristics of each stage of the disease as well as the response to treatment. It was possible to differentiate between white slough, erosions and regenerating epithelium from observations of the magnified mucosa.

Gastric longitudinal shortening may occur during gastric phase III activities in man.

Background and Aim:  The aim of this study was to determine whether the gastric longitudinal shortening occurs during the gastric phase III in man.

Endoscopic Ultrasonography of the Lower Esophageal Sphincter in Reflux Esophagitis and Achalasia

Abstract: The endoscopic ultrasonography findings at the lower esophageal sphincter (LES) were compared in patients with reflux esophagitis and esophageal achalasia to clarify the differences in wall structure between these diseases. In reflux esophagitis, the esophageal wall was hypertrophied at the LES and featured both irregularity and interruption of the submucosa, muscularis propria, and adventitia. In achalasia, there was generalized hypertrophy of the esophageal wall at the LES including the mucosa, submucosa, muscularis propria and adventitia but for each layer the normal 5‐layer structure was visualized well.