Yuri Yoshii

A Comparative Case‐Control Study of Colorectal Cancer and Adenoma

We conducted a comparative case‐control study of colorectal cancer and adenoma involving 221 cases with colorectal cancer, 525 cases with colorectal adenoma and 578 neighborhood controls. Daily vegetables intake was associated with lower risks of distal colon adenoma (relative risk (RR)=0.59, 95% confidence interval (CI): 0.39–0.89) and rectal cancer (RR=0.46, 95% CI: 0.25–0.84). Daily beans intake was associated with lower risk of colon adenoma (RR=0.58, 95% CI: 0.37–0.91 for the proximal colon and RR=0.63, 95% CI: 0.45–0.88 for the distal colon) and daily intake of seaweeds was associated with lower risk of rectal cancer (RR=0.42, 95% CI: 0.22–0.82). Daily intake of fish and shellfish also showed an inverse association with the risk of colon adenoma (RR=0.67, 95% CI: 0.45–0.99 for the proximal colon and RR=0.70, 95% CI: 0.52–0.94 for the distal colon). Generally, intakes of animal or vegetable fat‐rich foods, especially meats, were associated with decreases in risks of both adenoma and cancer, though the association of cancer was not statistically significant. Other than dietary factors, daily alcohol drinking was associated with an increased risk of adenoma in the proximal colon (RR=1.95, 95% CI: 1.15–3.29) and ex‐drinkers showed higher risks for colon adenoma and colorectal cancer. Sports or occupational activities and coffee drinking were inversely associated and family history of colorectal cancer was positively associated with the risks of both colorectal adenoma and cancer.

A prospective study of atrophic gastritis and stomach cancer risk

The relation of atrophic gastritis, other gastric lesions and lifestyle factors to stomach cancer risk was prospectively studied among 3,914 subjects who underwent gastroscopic examination and responded to a questionnaire survey at the Aichi Cancer Center Hospital. During 4.4 years of follow‐up on average, 45 incident cases of stomach cancer were identified at least three months after the initial examination. If the baseline endoscopic findings indicated the presence of atrophic gastritis, the risk of developing stomach cancer was increased 5.73‐fold, compared with no indication at the baseline. The risk further increased with advancing degree of atrophy and increasing extension of atrophy on the lesser curvature. These trends in the relative risks were statistically significant (P= 0.027 and P= 0.041, respectively). The risk of developing stomach cancer was statistically significantly increased among subjects with gastric polyps, but not among those with gastric ulcer. Stomach cancer cases tended to consume more cigarettes, alcohol, rice, pickles and salted fish gut/cod roe and less fruits and vegetables and to have more family histories of stomach cancer than noncases, although these differences were not statistically significant. The results of the present study provide additional evidence on the relation between atrophic gastritis and stomach cancer and suggest a need for intensive follow‐up of patients with atrophic gastritis and gastric polyps.

Atrophic gastritis and stomach cancer risk: cross-sectional analyses.

The relationship between atrophic gastritis and stomach cancer risk was investigated in case‐control analyses involving 387 cases with stomach cancer and 5,422 control subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April, 1985 to March, 1989. The presence of atrophic gastritis, the degree and extension of the atrophy and the presence of granularity and erosion were diagnosed endoscopically by six gastroenterologists. The prevalence of atrophic gastritis increased with age and was higher in males than in females. The relative risk (RR) of stomach cancer was S.13 (95% confidence interval (CI): 2.79–9.42) if a subject had any type of atrophic gastritis. The risk further increased with advancing degree of atrophy and increasing extension on the greater and lesser curvatures. The RR associated with severe atrophy was 7.73 (95% CI: 3.95–15.12). These associations remained significant when analyzed by sex and age. The presence of granularity and erosion did not much affect the estimated risks. A clear difference in risk appeared in the analyses by histological type of cancer. The RR associated with atrophic gastritis was 24.71 (95% CI: 3.46–176.68) for the intestinal type and 3.49 (95% CI: 1.77–6.87) for the diffuse type. These findings may suggest a need for intensive follow‐up of patients with severe atrophic gastritis.

Changes in serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase) activity of patients with gastric carcinoma after surgical excision and the enzyme activity in the carcinoma tissue.

Abstract Serum dipeptidyl-aminopeptidase IV (glycylprolyl dipeptidyl-aminopeptidase, GP-DAP) activity was found to be significantly decreased in patients with gastric carcinoma. The patients with advanced carcinoma showed more significant reduction of serum enzyme activity. After successful surgical removal of gastric carcinoma, serum enzyme activity tended to return to the normal level. In cases of recurring carcinoma serum activity decreased progressively. When hepatitis or liver metastasis was complicated, serum activity was significantly increased. Gastric carcinoma tissue itself had lower GP-DAP activity than normal gastric tissue of the same patients.

Use of direct vision biopsy in the diagnosis of gastroesophageal malignancy

The technique of direct-vision endoscopic biopsy has been used in 185 cases to differentiate benign from malignant lesions of esophagus and stomach. No complications were encountered. Of 48 malignant lesions, 83.3% were correctly identified. No false positive interpretations were given to biopsy specimens from 137 benign lesions. Routine use of endoscopic biopsy improves substantially the accuracy of endoscopic diagnosis.

Selective use of brushing cytology in gastrointestinal strictures.

Endoscopic brushing has yielded cytologic material of specific diagnostic quality in 80% of carcinomas of the esophagus, stomach, and colon. Brushing at the time of endoscopy is of particular value in lesions where proximal stenosis precludes direct biopsy of the neoplastic tissue.

Endoscopic diagnosis of gastric non-epithelial tumors

Benign non-epithelial tumors of the stomach characteristically are observed endoscopically as circumscribed masses. Ulcerated or infiltrative lesions connote malignancy and may be confused with carcinoma. Gastroscopy supplemented by biopsy and cytology can lead to an accurate diagnosis in a majority of these cases.

Endoscopic diagnosis of multiple benign gastric ulcers

In a group of 88 patients with benign peptic ulcer disease of the stomach on careful fiberoptic endoscopic examination, 31.8% found to have 2 or more ulcers simultaneously present. No factors were recognized which might predispose the patient to multiple ulceration or which might indicate a pathogenesis different from that of single ulcer. The fiberoptic endoscope has been found capable of detecting the true frequency of almost all ulcerated lesions of the stomach.