1
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Arçay A, Aydın F, Akın M. Mass-like Appearance on 18F-FDG PET/CT: Cascade Stomach. Mol Imaging Radionucl Ther 2022; 31:250-251. [PMID: 36268940 PMCID: PMC9586002 DOI: 10.4274/mirt.galenos.2022.83798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 56-year-old female patient who had involuntary weight loss underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for detection of malignancy. The scan revealed non-metabolic soft tissue density in the posterior wall of the stomach requiring endoscopy. Endoscopical examination was performed 9 days after PET/CT and cascade stomach was detected. Cascade stomach is a rare entity that can be diagnosed by radiographic barium evaluations and endoscopy, the appearance on CT is largely incidental and CT has rarely been relied on for the diagnosis. We present this incidental case of cascade stomach on PET/CT to be familiar with the appearance.
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Affiliation(s)
- Ayça Arçay
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
| | - Funda Aydın
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
| | - Mete Akın
- Akdeniz University Hospital, Department of Internal Medicine, Division of Gastroenterology, Antalya, Turkey
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2
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Nikaki K, Sifrim D. Pathophysiology of Pediatric Gastroesophageal Reflux Disease: Similarities and Differences With Adults. J Clin Gastroenterol 2022; 56:99-113. [PMID: 34560757 DOI: 10.1097/mcg.0000000000001604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux (GOR) is defined as "the passage of gastric contents into the esophagus with or without regurgitation and vomiting" and gastroesophageal reflux disease (GORD) is defined "when GOR leads to troublesome symptoms affecting the daily functioning and/or complications." This definition was first developed in 2006 by the Montreal consensus group (1) and later on adopted by pediatric gastroenterology societies such as ESPGHAN and NASPGHAN in 2009 (2). The definition of gastroesophageal reflux reveals little about its pathophysiology and is focused on symptomatology. In this way, it acts as an umbrella term for the multifactorial causes of the disease and the various phenotypes encountered; from functional heartburn to hypersensitive esophagus and nonerosive reflux disease, to erosive esophagitis and Barrett's esophagus. This article is devoted to the pathophysiology of pediatric GORD in comparison to adult GORD and is divided in 2 parts. In the first part, we will systematically describe the different mechanisms for the generation and clearance of reflux events, while on the second part we will discuss the mechanisms involved in symptoms generation. Finally, we will discuss the similarities and differences between pediatric and adult GORD.
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Affiliation(s)
- Kornilia Nikaki
- Gastroenterology Department, Great Ormond Street Hospital for Children
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, The Blizard Institute, QMUL, London, UK
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3
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Miwa H, Nagahara A, Asakawa A, Arai M, Oshima T, Kasugai K, Kamada K, Suzuki H, Tanaka F, Tominaga K, Futagami S, Hojo M, Mihara H, Higuchi K, Kusano M, Arisawa T, Kato M, Joh T, Mochida S, Enomoto N, Shimosegawa T, Koike K. Evidence-based clinical practice guidelines for functional dyspepsia 2021. J Gastroenterol 2022; 57:47-61. [PMID: 35061057 PMCID: PMC8831363 DOI: 10.1007/s00535-021-01843-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. In Japan, FD became a disease name for national insurance in 2013, and has been gradually recognized, though still not satisfactory. Following the revision policy of Japanese Society of Gastroenterology (JSGE), the first version of FD guideline was revised this time. METHOD Like previously, the guideline was created by the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, the questions were classified to background questions (BQs, 24 already clarified issues), future research questions (FRQs, 9 issues cannot be addressed with insufficient evidence), and 7 clinical questions that are mainly associated with treatment. RESULTS AND CONCLUSION These revised guidelines have two major features. The first is the new position of endoscopy in the flow of FD diagnosis. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. The second feature is that the drug treatment options have been changed to reflect the latest evidence. The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), and Japanese herbal medicine (rikkunshito). The second-line treatment includes anxiolytics /antidepressant, prokinetics other than acotiamide (dopamine receptor antagonists, 5-HT4 receptor agonists), and Japanese herbal medicines other than rikkunshito. The patients not responding to these treatment regimens are regarded as refractory FD.
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Affiliation(s)
- Hiroto Miwa
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan ,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Akihito Nagahara
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Akihiro Asakawa
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Makoto Arai
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Tadayuki Oshima
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Kunio Kasugai
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Kazuhiro Kamada
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Hidekazu Suzuki
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Fumio Tanaka
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Kazunari Tominaga
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Seiji Futagami
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Mariko Hojo
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Hiroshi Mihara
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Kazuhide Higuchi
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Motoyasu Kusano
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Tomiyasu Arisawa
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Mototsugu Kato
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Takashi Joh
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Satoshi Mochida
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Nobuyuki Enomoto
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Tooru Shimosegawa
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the “Evidence-Based Clinical Practice Guidelines for Functional Dyspepsia”, The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004 Japan
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4
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Cheng SM, Hung KL, Wang YJ, Ng SP, Chiang HF. Influence of gastric morphology on gastroesophageal reflux in adults: An observational study. Medicine (Baltimore) 2021; 100:e27241. [PMID: 34559123 PMCID: PMC8462620 DOI: 10.1097/md.0000000000027241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/23/2021] [Indexed: 01/05/2023] Open
Abstract
The study's aim was to determine if there was an association between gastric morphology and gastroesophageal reflux (GER). Few published studies have investigated the relationship between gastric morphology and the risk of GER.A total of 777 patients were randomly selected from 3000 to 3300 patients who presented at a medical center in Taipei for annual health checkups from early 2008 through to late 2010 and underwent a series of radiographs of the upper gastrointestinal tract (UGI). GER was recorded during the real-time fluoroscopic study. Thirty-nine participants had a follow-up endoscopy, and another 164 participants were followed up by a second UGI series 12 +/ -1.5 months later, from late 2008 through to early 2022. All participants completed a lifestyle and symptom questionnaire. The variables included current smoking and alcohol consumption. Participants who had heartburn and dysphagia were included in the study. Additionally, all participants underwent a limited physical examination which recorded age, sex, body mass index, and total cholesterol and triglyceride levels.All participants were classified into types 1 to 6 based on the gastric morphology determined from the first UGI. Cascade stomach is recognized by characteristic findings on UGI. Gastric types 2 and 3 tend to appear as cascade stomachs and were significantly associated with GER (P < .05) compared with the other groups. Morphologic type 5 appeared as an elongated sac extending downward into the pelvic cavity and was less likely to develop GER (P < .001). The results of follow-up studies by UGI and endoscopy were similar to those of the first UGI. Gastric morphologic type 2 was significantly associated, and type 5 was usually not associated, with GER and erosive esophagitis (P < .05) compared with the other groups, by both UGI and endoscopy.Gastric morphologic types 2 and 3, with cascade stomach, might provide a relatively easy method for the development of the GER phenomenon. Gastric morphologic type 5 appeared as an elongated sac that might reduce the incidence of the GER phenomenon. The study suggested that gastric morphologic type could influence the occurrence of GER.
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Affiliation(s)
- She-Meng Cheng
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Long Hung
- Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- Neurological Division of Pediatric Department, Cathay General Hospital, Taipei, Taiwan
| | - Yu-Jen Wang
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
| | - Suk-Ping Ng
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
| | - Hsin-Fan Chiang
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan
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5
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Bernante P, Balsamo F, Rottoli M, Sciannamea A, Di Simone MP, Iannelli A, Poggioli G. Cascade Stomach as a Risk Factor for Incomplete Resection of the Gastric Fundus in Laparoscopic Sleeve Gastrectomy: a Point of Technique. Obes Surg 2020; 30:5139-5141. [PMID: 32440775 DOI: 10.1007/s11695-020-04718-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Bernante
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy. .,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy. .,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.
| | - Francesca Balsamo
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Rottoli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Sciannamea
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Massimo P Di Simone
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Côte d'Azur, Nice, France
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
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6
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Suzuki H. New Medical Approach to Functional Dyspepsia, from Core Symposium 3, Japan Gastroenterological Association 2015-2017. Digestion 2018; 97:6-12. [PMID: 29393229 DOI: 10.1159/000484029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the annual meeting of the Japan Gastroenterological Association (JGA), the scientific organizing committee selected the serial topics for the core symposium. One of the core symposia held during 2015-2017 was entitled "New medical approach to functional dyspepsia (FD)." In 2015, the subtitle of this symposium was "Helicobacter pylori gastritis and FD." In 2016, the subtitle of this symposium was "overlap with other functional GI disorders." In 2017, the subtitle was "therapeutic approach to FD." During these 3 years, a total of 24 presentations were included in Core Symposium 3 and deep and intensive discussions were carried out.
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7
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Tack J, Pandolfino JE. Pathophysiology of Gastroesophageal Reflux Disease. Gastroenterology 2018; 154:277-288. [PMID: 29037470 DOI: 10.1053/j.gastro.2017.09.047] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
The pathogenesis of gastroesophageal reflux disease (GERD) is complex and involves changes in reflux exposure, epithelial resistance, and visceral sensitivity. The gastric refluxate is a noxious material that injures the esophagus and elicits symptoms. Esophageal exposure to gastric refluxate is the primary determinant of disease severity. This exposure arises via compromise of the anti-reflux barrier and reduced ability of the esophagus to clear and buffer the refluxate, leading to reflux disease. However, complications and symptoms also occur in the context of normal reflux burden, when there is either poor epithelial resistance or increased visceral sensitivity. Reflux therefore develops via alterations in the balance of aggressive and defensive forces.
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Affiliation(s)
- Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Belgium.
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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8
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Miyaue N, Tada S, Ando R, Yabe H, Nishikawa N, Nagai M, Nomoto M. Cascade stomach associated with delayed-on or no-on phenomenon in a patient with Parkinson's disease. Mov Disord 2017; 32:1492-1493. [PMID: 28782858 DOI: 10.1002/mds.27109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Noriyuki Miyaue
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Satoshi Tada
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Rina Ando
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Hayato Yabe
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Noriko Nishikawa
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Masahiro Nagai
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
| | - Masahiro Nomoto
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Tohon Ehime, Japan
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9
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Kawada A, Kusano M, Hosaka H, Kuribayashi S, Shimoyama Y, Kawamura O, Akiyama J, Yamada M, Akuzawa M. Increase of transient lower esophageal sphincter relaxation associated with cascade stomach. J Clin Biochem Nutr 2017; 60:211-215. [PMID: 28584403 PMCID: PMC5453019 DOI: 10.3164/jcbn.16-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/27/2016] [Indexed: 12/22/2022] Open
Abstract
We previously reported that cascade stomach was associated with reflux symptoms and esophagitis. Delayed gastric emptying has been believed to initiate transient lower esophageal sphincter relaxation (TLESR). We hypothesized that cascade stomach may be associated with frequent TLESR with delayed gastric emptying. Eleven subjects with cascade stomach and 11 subjects without cascade stomach were enrolled. Postprandial gastroesophageal manometry and gastric emptying using a continuous 13C breath system were measured simultaneously after a liquid test meal. TLESR events were counted in early period (0-60 min), late period (60-120 min), and total monitoring period. Three parameters of gastric emptying were calculated: the half emptying time, lag time, and gastric emptying coefficient. The median frequency of TLESR events in the cascade stomach and non-cascade stomach groups was 6.0 (median), 4.6 (interquartile range) vs 5.0, 3.0 in the early period, 5.0, 3.2 vs 3.0, 1.8 in the late period, and 10.0, 6.2 vs 8.0, 5.0 in the total monitoring period. TLESR events were significantly more frequent in the cascade stomach group during the late and total monitoring periods. In contrast, gastric emptying parameters showed no significant differences between the two groups. We concluded that TLESR events were significantly more frequent in persons with cascade stomach without delayed gastric emptying.
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Affiliation(s)
- Akiyo Kawada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Hiroko Hosaka
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Shiko Kuribayashi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Yasuyuki Shimoyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Osamu Kawamura
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Junichi Akiyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showamachi, Maebashi-shi, Gunma 371-8511, Japan
| | - Masako Akuzawa
- Hidaka Hospital, 886 Nakaomachi, Takasaki-shi, Gunma 370-0001, Japan
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10
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Kusano M, Hosaka H, Yasuoka H, Kawamura O, Kawada A, Kuribayashi S, Shimoyama Y, Mizuide M, Tomizawa T, Ishihara S, Sagawa T, Akiyama J, Sato K, Kakizaki S, Moki F. New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis. J Gastroenterol 2017; 52:211-217. [PMID: 27121685 DOI: 10.1007/s00535-016-1214-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND We recently demonstrated that cascade stomach detected by barium studies was correlated with upper gastrointestinal symptoms. We developed a new endoscopic classification of cascade stomach and examined its relationship with reflux esophagitis. METHODS Study 1: the classification (grades 0-3) was based on detecting a ridge that runs from the cardia toward the anterior wall crossing the greater curvature. Inter-observer variation was evaluated by kappa statistics when ten experienced endoscopists used this classification three times each. Study 2: in 710 consecutive subjects (500 men and 210 women) undergoing endoscopic screening, the grade of cascade stomach and incidence of reflux esophagitis were compared. RESULTS In study 1, the kappa values at the third assessment were 0.85, 0.58, 0.50, and 0.78 for each grade, respectively, while overall agreement was 0.68. In study 2, the incidence of reflux esophagitis in men was 20 % in grade 0, 17 % in grade 1, 25 % in grade 2, and 30 % in grade 3, showing significant differences. Among women, the incidence of reflux esophagitis in each grade was 9, 3, 6, and 35 %, respectively, also showing significant differences. Multivariate analysis showed that independent risk factors for reflux esophagitis were cascade stomach (odds ratio = 2.20), body mass index, and hiatus hernia in men, as well as cascade stomach (odds ratio = 9.01) and smoking tobacco in women. CONCLUSIONS This endoscopic classification of cascade stomach showed acceptable inter-observer variation. Cascade stomach is a risk factor for reflux esophagitis.
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Affiliation(s)
- Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan. .,Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
| | - Hiroko Hosaka
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hidetoshi Yasuoka
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Osamu Kawamura
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.,Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Akiyo Kawada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shiko Kuribayashi
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Yasuyuki Shimoyama
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Masafumi Mizuide
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Taku Tomizawa
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.,Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Shingo Ishihara
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Toshihiko Sagawa
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Junichi Akiyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ken Sato
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Satoru Kakizaki
- Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan
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Wang YJ, Hung KL, Yang JN, Wang TC, Chin CH. Gastric Anatomic Type Is Associated with Obesity and Gender. Obes Facts 2016; 9:221-9. [PMID: 27327512 PMCID: PMC5644865 DOI: 10.1159/000445062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/03/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To enhance our understanding of the associations among gastric anatomy, obesity, and gender. METHODS 777 randomly selected participants received health checkups, including a series of radiographs of the upper gastrointestinal tract (UGI); the findings were linked with each corresponding subject's gender and BMI. We measured the length, angle, and different portions of the stomach with the subjects in the standing position using radiographs to classify all individuals into anatomic types 1 through 6 based on gastric morphology. The gastric morphology was identified based on the initial UGI examination: 166 follow-up UGI radiographs at 12 ± 1.5 months to evaluate whether the stability of gastric anatomy persisted over time. RESULTS There was a significant difference in anatomic types between females and males (p < 0.001). The proportions of men with certain types (e.g., barium initially pools in a retroflexed fundus) were significantly higher than those of women; these participants were more likely to be overweight/obese (p < 0.001) compared with participants with other anatomic types. Additionally, the proportion of women with gastroptosis was significantly higher than that of men; participants with this type were less likely to be overweight/obese (p < 0.001). CONCLUSION Gastric anatomic types were associated with obesity and gender.
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Affiliation(s)
- Yu Jen Wang
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan
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Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol 2015; 50:125-39. [PMID: 25586651 DOI: 10.1007/s00535-014-1022-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 02/06/2023]
Abstract
General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list "functional dyspepsia" as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.
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Lee SH, Park YK, Cho SM, Kang JK, Lee DJ. Technical skills and training of upper gastrointestinal endoscopy for new beginners. World J Gastroenterol 2015; 21:759-785. [PMID: 25624710 PMCID: PMC4299329 DOI: 10.3748/wjg.v21.i3.759] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/17/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
The incidence of gastric cancer remains high in South Korea. Upper gastrointestinal (GI) endoscopy, i.e., esophagogastroduodenoscopy (EGD), has a higher diagnostic specificity and sensitivity than the upper GI series. Additionally, EGD has the ability to biopsy, through taking a tissue of the pathologic lesion. Successful training of EGD procedural skills require a few important things to be learned and remembered, including the posture of an examinee (e.g., left lateral decubitus and supine) and examiner (e.g., one-man standing method vs one-man sitting method), basic skills (e.g., tip deflection, push forward and pull back, and air suction and infusion), advanced skills (e.g., paradoxical movement, J-turn, and U-turn), and intubation techniques along the upper GI tract (e.g., oral cavity, pharynx, larynx including vocal cord, upper and middle and lower esophagus, gastroesophageal junction, gastric fundus, body, and antrum, duodenal bulb, and descending part of duodenum). In the current review, despite several limitations, we explained the intubation method of EGD for beginners. We hope this will be helpful to beginners who wish to learn the procedure.
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Yoshida M, Kinoshita Y, Watanabe M, Sugano K, Kato M, Joh T, Suzuki H, Tominaga K, Nakada K, Nagahara A, Futagami S, Manabe N, Inui A, Haruma K, Higuchi K, Yakabi K, Hongo M, Uemura N, Kinoshita Y, Sugano K, Shimosegawa T. JSGE Clinical Practice Guidelines 2014: standards, methods, and process of developing the guidelines. J Gastroenterol 2015; 50:4-10. [PMID: 25448314 DOI: 10.1007/s00535-014-1016-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/29/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Masahiro Yoshida
- Guidelines Committee for the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13 Ginza, Chuo, Tokyo, 104-0061, Japan,
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