Yuichiro Kojima

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.n 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.n 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.n 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.

Nonspecific esophageal motor disorder associated with thickened muscularis propria of the esophagus

A case of a nonspecific esophageal motor disorder associated with muscular hypertrophy, revealed by endoscopic ultrasonography, is reported. A 41-year-old man was admitted to the hospital with chest pain and dysphagia. Manometric studies of the esophagus disclosed prolonged duration of propulsive waves with normal amplitude. Endoscopic ultrasonography showed downward thickening of the esophageal muscular layer; the maximum thickness was found at the lower esophageal sphincter. Thickening of the esophageal wall of unknown etiology has been reported as a diffuse esophageal muscular hypertrophy. Previous cases of diffuse esophageal muscular hypertrophy were diagnosed by autopsy. Some cases involved dysphagia and/or chest pain. Therefore, some of the reported cases of nonspecific esophageal motor disorders may have been associated with diffuse esophageal muscular hypertrophy. Association of the two categories was shown by endoscopic ultrasonography for the first time in the present case. Endoscopic ultrasonography is a useful tool for the diagnosis of the thickening of the muscular layer of the esophagus.

Endoscopic urease sensor system for detecting Helicobacter pylori on gastric mucosa

BACKGROUNDnIt 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.nnnMETHODSnIn 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.nnnRESULTSnClinical 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.nnnCONCLUSIONSnThe 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)

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.

Esophageal Stenosis and Thickening of the Muscularis Propria Diagnosed by Endoscopic Ultrasonography (EUS Diagnosis of Esophageal Muscle Thickening)

Abstract: Thickening of the muscularis propria of the esophagus was diagnosed by endoscopic ultrasonography as being the fourth hypoechoic layer larger than 2 mm in thickness. A thickened muscularis propria was observed in 40 patients with dysphagia caused by esophageal stenosis. In the patients with esophageal cancer, the thickening appeared at the proximal end of a layer‐destructive tumor. In the patients with reflux esophagitis, the thickening of the muscularis propria was distinguished from the thickened submucosal layer at the stenosis. In the patients with achalasia, the thickening ivas maximal at the level of the stenosis and the thickness was significantly greater than in the other cases. The thickening of the muscularis propria tapered gradually and disappeared within 10 cm except in the patients with achalasia in whom the thickening reached the upper esophagus. The prestenotic thickening of the muscularis propria depended on the duration of the history of dysphagia and the narrowness of the stenosis.

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.

Glycogenic Acanthosis of the Esophagus—An Analysis of Clinically Relevant Factors (Glycogenic Acanthosis of the Esophagus)

Abstract: Glycogenic acanthosis (GA) of the esophagus is often found in routine endoscopic examination of the upper GI tract but has not received much attention. However, there is controversy concerning the nature, clinical significance and prevalence of this condition. An endoscopic study of 654 patients studied consecutively revealed a higher incidence of the lesion (72.3%) than previously reported. Its incidence was found to be significantly higher in males (p<0.01). An increasing incidence tendency was observed with respect to age in patients in their twenties to sixcties, but in patients in their seventies the incidence was lower than in those in their sixties, Smoking increased the frequency of GA. Extensive lesions were significantly more prevalent in smokers in their 40s (p<0.01). The number of cigarettes per day had a positive correlation with the incidence. GA did not have a clear relationship with alcohol intake, dietay, habits, condiments or acid reflux. Therefore, age, sex and smoking appear to be risk factors of GA, as in esophageal carcinoma.