Toshiharu Takashima

Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese

Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NERD), and erosive GERD in Japan, and the factors influencing disease prevalence. Material and methods. A total of 2760 subjects (mean age 50.4 years, range 24–84 years) were prospectively enrolled in this multicenter study. GERD symptoms were assessed with the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and upper gastrointestinal endoscopy was performed on all study participants. Results. A total of 495 (17.9%) individuals were diagnosed with GERD by the presence of erosive esophagitis at endoscopy and/or by the presence of GERD symptoms. Erosive esophagitis was diagnosed endoscopically in 195 (7.1%), and symptomatic GERD was diagnosed in 351 (12.7%) based on a QUEST score of over 6. Of these 351 subjects, 300 (10.9%) were considered to have NERD. Male gender, hiatal hernia, and mild gastric mucosal atrophy were significant positive predictive factors of erosive esophagitis by multiple regression analysis. Hiatal hernia was the only significant predictor of GERD symptoms. Traditional Japanese foods, such as sweet cakes and rice cake, frequently exacerbated GERD symptoms. Conclusions. The prevalence of GERD in the Japanese was 17.9% and the prevalence rates of NERD and erosive esophagitis were 10.9% and 8.6%, respectively. The majority of symptomatic patients did not have endoscopically proven esophagitis. Hiatal hernia is the only important predictor of the presence of GERD symptoms.

Prevalence of functional dyspepsia and its relationship with Helicobacter pylori infection in a Japanese population.

Aim: To investigate the prevalence of functional dyspepsia and Helicobacter pylori infection and their relationship in a Japanese population.

Cardiovascular risk factors in subjects with Helicobacter pylori infection.

Background. It has been proposed that Helicobacter pylori infection is related to cardiovascular disease, although this has not been fully investigated. The aim of this study was to investigate whether H. pylori in‐fection is associated with cardiovascular risk factors.

Comparative evaluation of urine-based and other minimally invasive methods for the diagnosis of Helicobacter pylori infection.

Background: Diagnostic methods have recently been developed for detecting anti-Helicobacter pylori antibody in urine and H. pylori antigen in stool samples. Our aim was to evaluate the usefulness of noninvasive urine-based methods for the diagnosis of H. pylori infection. Methods: The study subjects were 100 asymptomatic Japanese volunteers. We investigated the diagnostic efficacy of various noninvasive diagnostic methods; five serological tests (Immunis anti-pylori, HM-CAP, EIAgen Helicobacter pylori IgG, Helico G, and GAP-IgG), one test for antigen in stool (HpSA enzyme immunoassay [EIA]), and two tests for antibody in urine (Urinelisa and Rapirun) by using the urea breath test (UBT) as the gold standard. Results: Fifty subjects were diagnosed as positive for H. pylori infection by the UBT. The serological tests showed good sensitivity, specificity, and accuracy. The diagnostic values of the feces-based test (HpSA EIA) were lower than that of the serological tests. The sensitivities of the two urine-based methods in frozen urine samples were markedly lower than those of the other tests. However, the use of unfrozen samples markedly improved the diagnostic accuracy of these urine-based tests, which was then superior to that of the feces-based method. Conclusions: This study clearly showed that urine-based tests were useful for the diagnosis of H. pylori infection. However, the use of frozen urine samples was not appropriate for the detection of anti-H. pylori antibody.

A study of arteriosclerosis in healthy subjects with HBV and HCV infection.

BackgroundIt is unclear whether infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) affects arteriosclerosis. We performed a cross-sectional study to clarify the effect of HBV and HCV infection on arteriosclerosis.MethodsThe study subjects were 1806 healthy individuals who visited Shimane Environment and Health Public Corporation for routine medical check-ups. Serum levels of total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, and blood glucose were investigated in all subjects. The degree of arteriosclerosis was assessed using systolic blood pressure, the bilateral ankle brachial index (ABI), the heart-carotid pulse wave velocity (HCPWV), and the heart-ankle PWV (HAPWV). These cardiovascular parameters were compared between control subjects and subjects with HBV and HCV infection, using analysis of covariance to adjust for confounding factors (sex, age, body mass index, and smoking and drinking).ResultsOf the 1806 subjects, 39 and 31 were diagnosed as positive for HBV and HCV infection, respectively. The remaining 1736 were considered to be the controls. Adjusted serum lipid levels in the subjects with HBV and those with HCV infection tended to be lower than those in the control subjects. Adjusted arteriosclerotic parameters in the subjects with HBV and HCV infection were similar to those in the control subjects, even after adjusting for serum lipid levels.ConclusionsInfection with HBV or HCV does not influence the severity of arteriosclerosis in healthy subjects.

Pulse-wave velocity and cardiovascular risk factors in subjects with Helicobacter pylori infection

Background: Helicobacter pylori infection has been reported to correlate with the onset of cardiovascular diseases. However, the relationship between H. pylori infection and the development of arteriosclerosis has not been fully investigated. We performed a cross‐sectional study to clarify the possible role of H. pylori infection in the development of arteriosclerosis.

Prevalence of irritable bowel syndrome and its relationship with Helicobacter pylori infection in a Japanese population

1. Chase MP, Yarze JC, “Giant” colon lipoma—to attempt endoscopic resection or not? Am J Gastroenterol 2000;95:2143–4. 2. Tammam EK, Fadi HM, Suhayl U. Sigmoid lipoma mimicking carcinoma: Case report with review of diagnosis and management. Gastrointest Endosc 2000;51:495–6. 3. Kudo S, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996;44:8–14.

Helicobacter pylori infection and family history of gastroduodenal diseases in a Japanese population

Helicobacter pylori infection and family history of gastroduodenal diseases in a Japanese population

Helicobacter pylori-independent effect of hyperglycemia on gastric mucosal atrophy

TO THE EDITOR: The relationship between Helicobacter pylori (H. pylori) infection and diabetes mellitus is still controversial (1, 2), although diabetes-related immunosuppression may influence the infection rate and clinical course. We have previously demonstrated that the H. pylori infection rate is not influenced by fasting blood glucose (FBG) level (3). However, diabetes-related immunosuppression may augment gastric colonization by H. pylori and aggravate the resulting gastritis and mucosal atrophy even if it is not related to the infection rate. Therefore, we performed the present study to investigate the correlation between the FBG level and gastric mucosal atrophy, with or without H. pylori infection. A total of 2500 people who visited Shimane Institute of Health Science, Shimane, Japan, for their annual medical checkup from September, 1998 to August, 1999 were prospectively enrolled in the present study. FBG level and H. pylori infection status were tested in all of the subjects. H. pylori infection was determined by measurement of serum H. pylori IgG antibody with an ELISA kit (IMMUNIS anti-PYLORI EIA, Institute of Immunology, Tokyo, Japan). Subjects who showed a FBG level exceeding 126 mg/dL (hyperglycemic group) or less than 85 mg/dL (normoglycemic group) were selected for measurement of serum pepsinogens I and II, and the I/II ratio, with an ELISA kit (AUTO ACE PG pepsinogen I and II, AZWELL, Osaka, Japan). Statistical analysis was performed using analysis of covariance to adjust for confounding values using the SPSS statistical package (version 6.1 for Macintosh, SPSS, Chicago, IL). Differences at p 0.05 were considered to be significant. There were 102 hyperglycemic subjects and 126 normoglycemic subjects, among whom H. pylori infection was detected in 59 (57.8%) and 63 (50.0%), respectively. The difference in the H. pylori infection rate between the groups was not significant. As shown in Table 1, hyperglycemic H. pylori-positive subjects tended to be older than normoglycemic H. pylori-negative subjects. Therefore, we corrected for age and sex as confounding factors in the subsequent statistical analysis of the data. Concentrations of serum pepsinogen I were significantly lower in hyperglycemic than in normoglycemic subjects, and pepsinogen II concentrations were markedly elevated in the H. pylori-positive subjects. Accordingly, the pepsinogen I/II ratio, a marker of the integrity of the gastric fundic mucosa, was significantly lower not only in H. pylori-positive but also hyperglycemic subjects (Table 1 and Fig. 1). Because the pepsinogen I/II ratio was lower in hyperglycemic subjects without H. pylori infection, these results demonstrated that hyperglycemia, like H. pylori infection, was an independent risk factor for the development of gastric mucosal atrophy. Marrollo et al. recently reported that diabetes mellitus aggravated H. pylori-induced gastritis (4). In the present study, however, we clarified that hyperglycemia may not only accelerate H. Table 1. Serum Pepsinogen I and II in Four Groups of Subjects

Prevalence of noncardiac chest pain in Japanese patients with recurrent chest pain.

We answer question (1) as follows. In the three patients who were diagnosed as having non-A-non-G hepatitis, all known viral markers, including hepatitis A virus (IgM anti-HAV), hepatitis B virus (IgM HB core [c] and HBV DNA, detected by polymerase chain reaction [PCR]), HCV (HCV RNA, detected by reverse transcription [RT]-PCR), hepatitis D virus (IgM anti-HDV), hepatitis E virus (HEV RNA, detected by PCR), hepatitis G virus (HGV RNA, detected by PCR), cytomegalovirus (IgM antiCMV), Epstein Barr virus (IgM anti-EBV), herpes virus (IgM anti-herpes V), and Hantaan virus (Hantaan virus RNA, detected by PCR) were confirmed to be negative. Serum ceruloplasmin, and serum and urine copper were also examined. Because we recognized that IFN was contraindicated for AIH, various autoimmune markers were closely examined and were found to be negative. All patients diagnosed as having non-A–non-G hepatitis underwent liver biopsy under laparoscopic observation. Histological findings were consistent with those of the resolving phase of acute viral hepatitis. Therefore, we presumed viral etiology in the three non-A–non-G patients. Aplastic anemia, which sometimes develops after viral FHF,2 developed in one patient with non-A–non-G hepatitis 4 weeks after discharge. He was readmitted to our hospital, and showed full recovery with cyclosporin A treatment. Regarding question (2), one patient was found to have HCV RNA in serum by PCR, and was diagnosed with acute hepatitis C. The genotype was 1b and the initial viral load was 190 KIU/ml. The route of infection was not ascertained. The acute severe hepatitis resolved rapidly with a decrease of the HCV RNA level. The prevalence of HCV infection in adult patients with FHF at our hospital during the late 1980s was as high as 60% in non-A–non-B FH,3 and the rate dropped to 4% after the introduction of blood-donor screening for anti-HCV by the Japanese Red Cross. Regarding question (3), the four patients were followed up for 60 months (range, 54–71 months) and liver function test results were continuously within the normal range. All patients enjoyed normal lives without any medication. In Japan, at present, in 70% of children who undergo livingrelated liver transplantation (Ltx) the etiology of of the underlying disease is not known, and Kyoto University Hospital, one of the centers for LTx, has reported that they often experience graft dysfunction probably attributable to unidentified viral infection.3 The use of IFN combined with immunosuppressive drugs is warranted for non-A–non-G hepatitis in school-aged patients with FHF in areas where viral infection is endemic. Kazuaki Inoue, Makoto Yoshiba Department of Gastroenterology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan