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Background: Gastroesophageal reflux occurs mainly during the daytime in patients with Los Angeles grade A esophagitis, but predominantly during the night in patients with grade C and D esophagitis. The purpose of the present paper was to investigate whether this difference in the pattern of gastroesophageal reflux influences the circumferential localization of erosions in the esophageal wall. Methods: The subjects were 394 consecutive patients diagnosed endoscopically as having reflux esophagitis (grade A, n = 223; B, n = 93; C, n = 53; D, n = 25 cases). Their endoscopic films were reviewed retrospectively to determine the circumferential location of esophageal mucosal breaks, and also the prevalence and size of hiatal hernia (HH). Results: The numbers of mucosal breaks analyzed in patients with grade A, B and C esophagitis were 321, 173 and 54, respectively. Patients with grade A and B esophagitis had longitudinal mucosal breaks mainly in the right-anterior wall of the lower esophagus, whereas patients with grade C esophagitis had transverse mucosal breaks mainly in the posterior wall. The prevalence and size of HH was significantly higher and larger, respectively, in patients with grade C or D esophagitis than in those with grade A and B esophagitis. Conclusion: The circumferential location of esophageal mucosal breaks differs significantly among different grades of esophagitis. [ABSTRACT FROM AUTHOR]

Background and Aims: Nocturnal gastric acid breakthrough (NAB) is defined as an intragastric pH < 4.0 lasting more than 1 h during the night in patients taking a proton pump inhibitor (PPI). Gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal acid reflux accompanied by NAB are thought to be refractory to PPI treatment. The aim of this study was to endoscopically identify the patients with predominant nocturnal gastroesophageal acid reflux. Methods: The subjects were 37 patients with erosive reflux esophagitis (Los Angeles classification (LA) grade A, 12; B, 10; C, eight; and D, seven cases) and a control group of 20 patients without esophagitis. The results of ambulatory 24 h gastric and esophageal pH monitoring were compared among different grades of esophagitis. Results: Gastroesophageal reflux during 24 h in patients with high-grade esophagitis was more frequent than for patients with low-grade esophagitis or no esophagitis. Although the length of esophageal acid exposure (percentage time with pH < 4.0) in patients with grade A or without esophagitis was longer in the daytime, that in patients with grades C and D was longer during the night. The reason for the delayed nocturnal acid exposure was the longer nocturnal acid clearance in high-grade reflux esophagitis. Conclusions: Nocturnal exposure of the esophagus to acid occurs frequently in patients with LA grades C and D esophagitis. Thus, the existence of NAB with resulting nocturnal acid reflux should be considered when the patient with high-grade esophagitis shows resistance to PPI treatment. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims: The pathogenetic mechanism responsible for the increased prevalence of reflux esophagitis in the elderly remains controversial. The aim of this study was to determine if an increased occurrence of hiatus hernia (HH) and/or a lower rate of gastric mucosal atrophy (GMA) are the main causes of the increased prevalence of reflux esophagitis in elderly patients. Methods: The prevalence of HH, GMA, and reflux esophagitis was investigated by reviewing the endoscopic films of 2788 consecutive patients examined during a 3-year period. Results: The prevalence of esophagitis in males was higher than in females (11.6% vs 7.6%, P < 0.0005). The prevalence of reflux esophagitis and HH was found to increase with age in females, but not in male patients. The prevalence of reflux esophagitis in hernia-positive patients also increased with age in women, but not in men. Age, male gender, presence of HH, and closed-type of GMA were significant risk factors for the prevalence of esophagitis (P = 0.0001, 0.0229, < 0.0001, < 0.0001, respectively). In addition, the risk ratios of HH and low-grade GMA for reflux esophagitis increased with age, and this tendency was higher in female patients than in males. Conclusions: Aging, male gender, HH and closed-type GMA are most likely the risk factors of endoscopically proven reflux esophagitis in Japanese patients. [ABSTRACT FROM AUTHOR]

Background: Eradication therapy for Helicobacter pylori is effective in preventing peptic ulcer recurrence, but its efficacy in ulcer healing is still controversial. The effect of H. pylori on artificial ulcers after endoscopic resection is not known. The purpose of the present study was therefore to evaluate the influence of H. pylori infection on ulcer healing after endoscopic submucosal dissection (ESD). Methods: One hundred and 10 patients who underwent ESD for gastric tumors, and for whom the infection status of H. pylori was confirmed before treatment, were included. The healing stage was studied by endoscopy performed at 8 weeks after ESD. In addition, 73 patients whose serum pepsinogen (PG) was evaluated before ESD, were divided into three groups: PG positive (PGI ≤ 70 ng/mL and I/II ≤ 3 ng/mL), strongly positive (PGI ≤ 30 ng/mL and I/II ≤ 2 ng/mL) and negative, to study the influence of atrophic gastritis on ulcer healing. Results: Ulcer healing was observed in 85 patients (93%) who were H. pylori positive, and in 19 patients (100%) in whom H. pylori had been eradicated previously. Serum PG level had no influence on the healing process. Among 15 patients with ulceration or ulcer scar with the lesion, ulcer healing was observed in nine patients (60%), which was significantly low. Conclusions: Infection status of H. pylori and the extent of gastric atrophy do not affect ulcer healing after ESD. Preoperative existence of fibrotic change in the submucosal layer may delay the healing process. [ABSTRACT FROM AUTHOR]

H2 histamine receptor antagonists (H2RAs) are widely used in patients with acid-related diseases, and the onset of antisecretory activity of H2RAs is reported to be faster than that of proton pump inhibitors (PPIs). The aim of this study was to compare the rapidity of onset of antisecretory activity of cimetidine and famotidine when orally administered.Fifteen healthy male Japanese volunteers (fiveH. pylori-positive and 10H. pylori-negative) participated in a randomized cross-over study. All subjects were examined three times by ambulatory 6-h pH monitoring (from 17:30 to 23:30) with no medication or oral administration of 400 mg of cimetidine or 20 mg of famotidine. Drugs were administered at 19:30 after eating a standard meal, and plasma concentrations were also examined for 4 h periods.The plasma concentration of cimetidine increased rapidly after oral administration, while that of famotidine increased gradually. Intragastric pH was increased and percentage time with pH < 4.0 decreased significantly 2 h after administration of either cimetidine or famotidine. There was no statistically significant difference in acid-suppressing effect between cimetidine and famotidine during the short-term post-administration period.Rapidity of antisecretory activity did not differ between oral cimetidine and famotidine administered orally. [ABSTRACT FROM AUTHOR]

Rabeprazole has a faster onset of antisecretory activity than omeprazole and lansoprazole. The aim of the present study was to clarify whether there is any difference in the speed of symptom relief in patients with reflux esophagitis following the administration of these three proton pump inhibitors (PPI). Eighty-five patients with erosive reflux esophagitis were randomized to receive 8 weeks of 20 mg of omeprazole ( n = 30), 30 mg of lansoprazole ( n = 25), or 20 mg of rabeprazole ( n = 30) once a morning. Daily changes in heartburn and acid reflux symptoms in the first 7 days of administration were assessed using a six-point scale (0: none, 1: mild, 2: mild–moderate, 3: moderate, 4: moderate–severe, 5: severe). The mean heartburn score in patients administered rabeprazole decreased more rapidly than those given the other PPI. Complete heartburn remission also occurred more rapidly in patients administered rabeprazole (compared with omeprazole: P = 0.035, compared with lansoprazole: P = 0.038 by log-rank test). No differences were seen in the rate of endoscopic healing of reflux esophagitis at 8 weeks between the three treatment regimens. Rabeprazole may be more effective than omeprazole and lansoprazole for the rapid relief of heartburn symptoms in patients with reflux esophagitis. [ABSTRACT FROM AUTHOR]

Background and Aim: Reflux esophagitis is caused by esophageal motor dysfunction in patients with sufficient gastric acid secretion. Helicobacter pylori causes atrophic gastritis and influences gastric acid secretion. Hiatus hernia (HH) of the esophagus causes motor dysfunction in the lower esophagus. Therefore, this study aimed to test whether H. pylori infection, gastric mucosal atrophy and HH are predictive factors for reflux esophagitis. Methods: Helicobacter pylori infection was examined in 781 patients by the measurement of serum immunoglobulin (Ig)G antibody, bacteriological culture and histological examination of biopsy specimens. The prevalence of HH, endoscopically identified gastric mucosal atrophy (closed- or open-type) and reflux esophagitis were investigated by reviewing endoscopic films. Investigated patients were divided into three age groups, under 49, 50-69, and over 70 years. The prevalence of esophagitis, H. pylori infection, gastric mucosal atrophy, and HH were compared to identify the possible predictive factors for reflux esophagitis by using logistic regression analysis. Results: Sixty-nine patients with reflux esophagitis were found among the 781 investigated cases. The odds ratios of negative H. pylori infection, endoscopically identified closed-type gastric mucosal atrophy, and HH for the prevalence of reflux esophagitis were 1.342, 1.751 and 5.527, respectively. These results indicated that the presence of H. pylori infection was only a weak negative risk factor, and that HH was the most reliable endoscopic predictive factor for reflux esophagitis. Conclusion: Helicobacter pylori infection is a weak negative risk factor for the prevalence of reflux esophagitis, while HH is the most reliable predictive factor. [ABSTRACT FROM AUTHOR]

Investigates the prevalence of functional dyspepsia and Helicobacter pylori infection and the relationship in Japanese population in Japan. Description of functional dyspepsia; Types of functional dyspepsia; Assessment of Helicobacter pylori infection.

AbstractBackground: Non-ulcer dyspepsia (NUD) is one of the most frequently encountered disorders in general practice in Western countries. The prevalence of this disorder in the Japanese, however, has not been fully investigated. This study is designed to clarify the characteristics and prevalence of dyspepsia in the Japanese. Methods: The subjects were 1139 people who visited our institutes for their annual medical check up for gastric cancers. After routine medical examination, all subjects were asked standardized questions in order to check for the presence of any symptoms suggesting dyspepsia. Results: The results of the study showed that dysmotility-like dyspepsia, characterized by the presence of nausea, fullness and early satiety, is the most frequently observed dyspepsia in Japanese and that this type of dyspepsia decreases with age. Ulcer-like dyspepsia, which is the major type of dyspepsia in Western countries, is the least frequently experienced dyspepsia in the Japanese. Conclusions: This study clarified that NUD is also one of the most prevalent disorders in the Japanese, although its characteristics may be somewhat different from those in Western countries. © 1999 Blackwell Science Asia Pty Ltd. [ABSTRACT FROM AUTHOR]