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Yamamichi N, Shimamoto T, Hirano C, Takahashi Y, Minatsuki C, Takeuchi C, Takahashi M, Sakaguchi Y, Tsuji Y, Niimi K, Wada R, Mitsushima T, Koike K. Clinicopathological features and prognosis of developed gastric cancer based on the diagnosis of mucosal atrophy and enlarged folds of stomach by double-contrast upper gastrointestinal barium X-ray radiography. Clin J Gastroenterol 2021; 14:947-954. [PMID: 34018155 DOI: 10.1007/s12328-021-01445-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mucosal atrophy and enlarged folds of stomach by double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) are two major features of Helicobacter pylori-induced chronic gastritis. These were previously shown to be risk indicators of gastric cancer, but their predictability for clinicopathological characters of developed gastric cancer is unelucidated. In addition, evidence for decreasing the mortality of gastric cancer by appropriate follow-up of UGI screening is needed. METHODS The 5134 generally healthy UGI-XR examinees, who underwent follow-up UGI-XR or upper gastrointestinal endoscopy (UGI-ES) more than once, were prospectively observed for 10 years. RESULTS At the beginning of follow-up, 1515 (29.5%) had mucosal atrophy and 990 (19.5%) had enlarged folds. For the serum anti-H. pylori IgG, 1301 (25.3%) were positive, 177 (3.4%) were possibly positive, and 3656 (71.2%) were negative. During the 10-year observation period, gastric cancer developed in 15 subjects, among which 13 had mucosal atrophy and 10 had enlarged folds. These two features were expectedly useful indicators for gastric cancer incidence, but they showed no significant association with tumor stage or histological type of developed cancer. Only one of the 5134 subjects died of gastric cancer during 10 years, which was significantly lower than the predicted number of gastric cancer death (6.78 for 10 years) according to the mortality rate in Japan. CONCLUSIONS Neither mucosal atrophy nor enlarged folds of stomach showed a significant association with clinicopathological features of developed gastric tumors. Appropriate follow-up of cancer screening by UGI-XR or UGI-ES can reduce the risk of gastric cancer-related death.
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Affiliation(s)
- Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Takeshi Shimamoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Chigaya Hirano
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Takeuchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mami Takahashi
- Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Niimi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryoichi Wada
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Toru Mitsushima
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Perillo M, Becker-Weidman D, Bezuidenhout AF, Siewert B, Eisenberg RL. Infections of the Gastrointestinal Tract. Semin Roentgenol 2017; 52:63-72. [PMID: 28606310 DOI: 10.1053/j.ro.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Perillo
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - B Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Ronald L Eisenberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
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Takeuchi C, Yamamichi N, Shimamoto T, Takahashi Y, Mitsushima T, Koike K. Gastric polyps diagnosed by double-contrast upper gastrointestinal barium X-ray radiography mostly arise from the Helicobacter pylori-negative stomach with low risk of gastric cancer in Japan. Gastric Cancer 2017; 20:314-321. [PMID: 26972573 DOI: 10.1007/s10120-016-0607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is a method broadly used for gastric cancer screening in Japan. Gastric polyp is one of the most frequent findings detected by UGI-XR, but how to handle it remains controversial. METHODS Gastric polyps of the 17,264 generally healthy subjects in Japan who underwent UGI-XR or upper gastrointestinal endoscopy (UGI-ES) in 2010 were analyzed. RESULTS Of the 6,433 UGI-XR examinees (3,405 men and 3,028 women, 47.4 ± 9.0 years old), gastric polyps were detected in 464 men (13.6 %) and 733 women (24.2 %) and were predominantly developed on the non-atrophic gastric mucosa (p < 0.0001). Multiple logistic regression analysis showed that the presence of gastric polyps has significant association with lower value of serum anti-Helicobacter pylori IgG titer, female gender, lighter smoking habit, older age, and normal range of body mass index (≥18.5 and <25), but not with drinking or serum pepsinogen I/II ratio. During the 3-year follow-up, gastric cancer occurred in 7 subjects (0.11 %), but none of them had gastric polyps at the beginning of the follow-up period. Of the 2,722 subjects with gastric polyps among the 10,831 UGI-ES examinees in the same period, 2,446 (89.9 %) had fundic, 267 (9.8 %) had hyperplastic, and 9 (0.3 %) had adenomatous/cancerous polyps. CONCLUSIONS Gastric polyps diagnosed by UGI-XR predominantly arise on the Helicobacter pylori-negative gastric mucosa with a low risk of gastric cancer in Japan. In the prospective observation, none of the UGI-XR examinees with gastric polyps developed gastric cancer for at least 3 years subsequently.
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Affiliation(s)
- Chihiro Takeuchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takeshi Shimamoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, 261-0023, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Mitsushima
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, 261-0023, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Yamamichi N, Hirano C, Ichinose M, Takahashi Y, Minatsuki C, Matsuda R, Nakayama C, Shimamoto T, Kodashima S, Ono S, Tsuji Y, Niimi K, Sakaguchi Y, Kataoka Y, Saito I, Asada-Hirayama I, Takeuchi C, Yakabi S, Kaikimoto H, Matsumoto Y, Yamaguchi D, Kageyama-Yahara N, Fujishiro M, Wada R, Mitsushima T, Koike K. Atrophic gastritis and enlarged gastric folds diagnosed by double-contrast upper gastrointestinal barium X-ray radiography are useful to predict future gastric cancer development based on the 3-year prospective observation. Gastric Cancer 2016; 19:1016-22. [PMID: 26486508 DOI: 10.1007/s10120-015-0558-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is the standard gastric cancer screening method in Japan. Atrophic gastritis and enlarged gastric folds are considered the two major features of Helicobacter pylori-induced chronic gastritis, but the clinical meaning of evaluating them by UGI-XR has not been elucidated. METHODS We analyzed healthy UGI-XR examinees without a history of gastrectomy, previous Helicobacter pylori eradication and usage of gastric acid suppressants. RESULTS AND CONCLUSIONS Of the 6433 subjects, 1936 (30.1 %) had atrophic gastritis and 1253 (19.5 %) had enlarged gastric folds. During the 3-year prospective observational follow-up, gastric cancer developed in seven subjects, six of whom (85.7 %) had atrophic gastritis with H. pylori infection and five of whom (71.4 %) had enlarged gastric folds with H. pylori infection. The Kaplan-Meier method with log-rank testing revealed that both UGI-XR-based atrophic gastritis (p = 0.0011) and enlarged gastric folds (p = 0.0003) are significant predictors for future gastric cancer incidence.
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Affiliation(s)
- Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Chigaya Hirano
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, 261-0023, Japan
| | - Masao Ichinose
- Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Matsuda
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chiemi Nakayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeshi Shimamoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Niimi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yosuke Kataoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Itaru Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Itsuko Asada-Hirayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Takeuchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Seiichi Yakabi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hikaru Kaikimoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuta Matsumoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Natsuko Kageyama-Yahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryoichi Wada
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, 261-0023, Japan
| | - Toru Mitsushima
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, 261-0023, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Yamamichi N, Hirano C, Takahashi Y, Minatsuki C, Nakayama C, Matsuda R, Shimamoto T, Takeuchi C, Kodashima S, Ono S, Tsuji Y, Fujishiro M, Wada R, Mitsushima T, Koike K. Comparative analysis of upper gastrointestinal endoscopy, double-contrast upper gastrointestinal barium X-ray radiography, and the titer of serum anti-Helicobacter pylori IgG focusing on the diagnosis of atrophic gastritis. Gastric Cancer 2016. [PMID: 26223472 DOI: 10.1007/s10120-015-0515-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Upper gastrointestinal endoscopy (UGI-ES) and double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) are two major image-based methods to diagnose atrophic gastritis, which is mostly induced by Helicobacter pylori infection. However, there have been few studies directly comparing them. METHODS Atrophic gastritis was evaluated using the data of 962 healthy subjects who underwent UGI-ES and UGI-XR within 1 year. RESULTS AND CONCLUSION Based on UGI-ES and UGI-XR, 602 subjects did not have atrophic gastritis and 254 subjects did have it. Considering UGI-ES-based atrophic gastritis as the standard, sensitivity and specificity of UGI-XR-based atrophic gastritis were 92.0 % (254/276) and 92.8 % (602/649), respectively. The seven-grade Kimura-Takemoto classification of UGI-ES-based atrophic gastritis showed a strong and significant association with the four-grade UGI-XR-based atrophic gastritis. Sensitivity and specificity of serum anti-Helicobacter pylori IgG to detect UGI-ES/UGI-XR-based atrophic gastritis were 89.4 % (227/254) and 99.8 % (601/602), indicating that atrophic gastritis can be overlooked according to serum anti-Helicobacter pylori IgG alone.
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Affiliation(s)
- Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Chigaya Hirano
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Chiemi Nakayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Rie Matsuda
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Shimamoto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Chihiro Takeuchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Wada
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Toru Mitsushima
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Kitchin DR, Lubner MG, Menias CO, Santillan CS, Pickhardt PJ. MDCT diagnosis of gastroduodenal ulcers: key imaging features with endoscopic correlation. ACTA ACUST UNITED AC 2015; 40:360-84. [PMID: 25117561 DOI: 10.1007/s00261-014-0207-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although the overall prevalence of peptic ulcer disease (PUD) and related hospitalizations are decreasing, the initial presentation of complicated PUD on CT remains common. It, therefore, remains critical for radiologists to recognize the findings of PUD at CT for initial diagnosis. While the CT findings of complicated PUD have been previously described in the literature, the CT findings of uncomplicated PUD have not been well documented. Furthermore, although CT is certainly not the diagnostic evaluation of choice for patients with suspected uncomplicated PUD, many patients with PUD will nonetheless present to the emergency department with unexplained abdominal pain and undergo MDCT evaluation as the initial diagnostic test. Therefore, recognizing the MDCT findings of uncomplicated PUD can help appropriately direct patient management, and help prevent the development of complications. To facilitate improved recognition of PUD on abdominal CT, we present an overview of the CT findings of both uncomplicated and complicated PUD, as well as several diagnostic pitfalls which can result in misdiagnosis from peptic ulcer mimics.
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Affiliation(s)
- D R Kitchin
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA,
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Correlation between the ABC classification and radiological findings for assessing gastric cancer risk. Jpn J Radiol 2015; 33:636-44. [DOI: 10.1007/s11604-015-0469-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/29/2015] [Indexed: 02/06/2023]
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Yamamichi N, Shimamoto T, Minatsuki C, Yoshida Y, Fujishiro M, Kodashima S, Kato J, Goto O, Ono S, Niimi K, Takahashi Y, Konno-Shimizu M, Ichinose M, Koike K. Postprandial fullness correlates with rapid inflow of gastric content into duodenum but not with chronic gastritis. BMC Gastroenterol 2011; 11:140. [PMID: 22189089 PMCID: PMC3293739 DOI: 10.1186/1471-230x-11-140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 12/21/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study is evaluating the correlation of postprandial fullness with chronic gastritis or rapid inflow of gastric content into duodenum, based on double-contrast barium X-ray imaging. METHODS 253 healthy subjects who underwent upper gastrointestinal barium X-ray examination were analyzed. Chronic gastritis was judged from mucosal atrophy and hypertrophic thickened folds on barium X-ray images. For the gastric excretion, the tips of barium flow on the single-contrast frontal barium X-ray images of the stomach were classified into four categories; V type (all the barium remained in the stomach), V-H type (some barium had flowed into the duodenum but the tip of barium remained in the proximal half of the duodenal bulb), H-V type (some barium had flowed into the duodenum and the tip of barium was in the distal half of duodenal the bulb, but no barium was observed in the descending part of the duodenum), and H type (some barium had flowed into the descending part of the duodenum). The chi-square test and Cochran-Mantel-Haenzel test were used for evaluation. RESULTS Chronic gastritis was observed in 72 subjects, among which 21 subjects (29.2%) presented with postprandial fullness. For the remaining 181 subjects without chronic gastritis, 53 subjects (29.3%) complained of postprandial fullness. There is no significant correlation between chronic gastritis and postprandial fullness (p = 0.973). For the rapid flow of gastric content into duodenum, all the 253 subjects comprised 136 subjects with V type (in the stomach), 40 subjects with V-H type (in the proximal half of the duodenal bulb), 21 subjects with H-V type (in the distal half of the duodenal bulb), and 56 subjects with H type (in the descending part of the duodenum). Postprandial fullness was present in 30 subjects with V type (22.1%), 9 subjects with V-H type (22.5%), 8 subjects with H-V type (38.1%), and 27 subjects with H type (48.2%). There is a distinct correlation between postprandial fullness and gastric barium excretion on barium X-ray imaging (p = 0.002). CONCLUSIONS Bothersome postprandial fullness correlates with rapid inflow of gastric content into duodenum, but not with chronic gastritis.
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Affiliation(s)
- Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
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10
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Rubesin SE, Levine MS, Laufer I. Double-contrast upper gastrointestinal radiography: a pattern approach for diseases of the stomach. Radiology 2008; 246:33-48. [PMID: 18096527 DOI: 10.1148/radiol.2461061245] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The double-contrast upper gastrointestinal series is a valuable diagnostic test for evaluating structural and functional abnormalities of the stomach. This article will review the normal radiographic anatomy of the stomach. The principles of analyzing double-contrast images will be discussed. A pattern approach for the diagnosis of gastric abnormalities will also be presented, focusing on abnormal mucosal patterns, depressed lesions, protruded lesions, thickened folds, and gastric narrowing.
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Affiliation(s)
- Stephen E Rubesin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
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11
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Abstract
Since the application of cross-sectional imaging to the examination of the gastrointestinal tract, dramatic changes have occurred in the modern gastrointestinal fluoroscopic suite. Besides the great decrease in use of fluoroscopy, the types of fluoroscopic examinations requested and performed nowadays are different from those of just 2 or 3 decades ago. This paper will review the recent history and the current uses of fluoroscopy in adults at the beginning of the twenty-first century, illustrated by case images and utilization data from a large academic medical center. Fluoroscopy survives because of its unique illustration of motility in real-time, its superior detection and accurate localization of leaks in post-operative patients, and its ability to provide immediate answers and targeted examinations tailored to the individual patient.
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Affiliation(s)
- David A Boyajian
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
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12
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Mazzie JP, Wilson SR, Sadler MA, Khalili M, Javors BR, Weston SR, Katz DS. Imaging of Gastrointestinal Tract Infection. Semin Roentgenol 2007; 42:102-16. [PMID: 17394923 DOI: 10.1053/j.ro.2006.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph P Mazzie
- Department of Radiology, St. Vincent's Catholic Medical Center-Manhattan, New York, NY, USA
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13
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Abstract
Gastritis is a histologic diagnosis. To understand gastritis, the radiologist must have some working knowledge of gastric histology and pathology. Therefore, this article first describes normal histologic and radiologic anatomy. The pathology of gastritis is then presented to give the radiologist a basis for understanding the radiologic findings. Finally, gastritis is discussed from a clinical and radiologic perspective.
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Affiliation(s)
- S E Rubesin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Farrell S, Magowan H, Sweeney L, McCallion WA. Gastric lymphoid hyperplasia: radiological evidence of childhood Helicobacter pylori infection. Clin Radiol 2004; 59:758-60. [PMID: 15262552 DOI: 10.1016/j.crad.2004.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S Farrell
- Department of Child Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
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15
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Affiliation(s)
- Marc S Levine
- Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
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16
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Dheer S, Levine MS, Redfern RO, Metz DC, Rubesin SE, Laufer I. Radiographically diagnosed antral gastritis: findings in patients with and without Helicobacter pylori infection. Br J Radiol 2002; 75:805-11. [PMID: 12381689 DOI: 10.1259/bjr.75.898.750805] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to characterize the radiographic findings of antral gastritis and to determine whether there are differences in the appearance of antral gastritis in patients with and without Helicobacter pylori infection. A search of radiology, endoscopy and pathology files revealed 90 patients with antral gastritis on double contrast upper gastrointestinal tract studies who had endoscopy with testing for H. pylori. The barium studies were evaluated to further characterize the findings of antral gastritis without knowledge of the H. pylori status of the patients or of the endoscopy or pathology findings. The radiographic findings of antral gastritis included thickened folds in 67 patients (74%), polypoid antral gastritis (a subset of patients with thickened folds) in 6 (9%), antral erosions in 21 (23%), enlarged areae gastricae in 14 (16%), crenulation of the lesser curvature in 4 (4%), mucosal nodularity in 2 (2%), a hypertrophied antral-pyloric fold in 2 (2%) and antral striae in 1 (1%). 43 patients (48%) with antral gastritis were H. pylori positive and 47 patients (52%) were H. pylori negative. Thickened folds were detected in 39 H. pylori-positive patients (91%) with antral gastritis vs 28 H. pylori-negative patients (60%) (p<0.001); polypoid gastritis in 6 H. pylori-positive patients (14%) vs 0 H. pylori-negative patients (p<0.05); enlarged areae gastricae in 14 H. pylori-positive patients (33%) vs 0 H. pylori-negative patients (p<0.0001); and antral erosions in 2 H. pylori-positive patients (5%) vs 19 H. pylori-negative patients (40%) (p<0.0001). Our experience suggests that antral gastritis caused by H. pylori infection is associated with characteristic features on double contrast studies (including thickened folds, polypoid gastritis and enlarged areae gastricae) and that this condition is rarely associated with antral erosions. Thus, radiologists can often suggest whether the patient's gastritis is caused by H. pylori on the basis of radiographic findings.
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Affiliation(s)
- S Dheer
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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17
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Affiliation(s)
- Marc S Levine
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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18
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Levine MS. Invited Commentary. Radiographics 2001. [DOI: 10.1148/radiographics.21.6.g01nv141502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Charagundla SR, Levine MS, Langlotz CP, Rubesin SE, Laufer I. Visualization of areae gastricae on double-contrast upper gastrointestinal radiography: relationship to age of patients. AJR Am J Roentgenol 2001; 177:61-3. [PMID: 11418398 DOI: 10.2214/ajr.177.1.1770061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether the frequency of visualization of areae gastricae on double-contrast upper gastrointestinal tract examinations is related to a patient's age. MATERIALS AND METHODS A total of 141 double-contrast upper gastrointestinal tract examinations with normal findings were reviewed for the presence or absence of areae gastricae on double-contrast images of the stomach. All images were evaluated by two radiologists who were blinded to the age of the patients. The data were then analyzed to determine if the frequency of visualization of areae gastricae on double-contrast studies was significantly related to the age of patients. RESULTS The frequency of visualization of areae gastricae increased significantly with increasing age (p = 0.008). The youngest age group (20--29 years old) exhibited areae gastricae in only four (19%) of 21 cases, whereas the oldest age group (> or = 70 years old) exhibited areae gastricae in 19 (76%) of 25 cases. On average, the rate of visualization of areae gastricae on double-contrast studies increased by 9% per decade. CONCLUSION Our data show that the frequency of visualization of areae gastricae on double-contrast upper gastrointestinal tract examinations increases significantly with increasing patient age. It is important for radiologists to be aware of the effect of aging on the delineation of areae gastricae on double-contrast studies.
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Affiliation(s)
- S R Charagundla
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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20
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Torigian DA, Levine MS, Gill NS, Rubesin SE, Fogt F, Schultz CF, Furth EE, Laufer I. Lymphoid hyperplasia of the stomach: radiographic findings in five adult patients. AJR Am J Roentgenol 2001; 177:71-5. [PMID: 11418401 DOI: 10.2214/ajr.177.1.1770071] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to report the radiographic findings of biopsy-proven lymphoid hyperplasia of the stomach in five adult patients. CONCLUSION Lymphoid hyperplasia of the stomach is characterized by distinctive findings on double-contrast upper gastrointestinal tract barium examinations; all five patients had innumerable tiny (1--3 mm in diameter) round frequently umbilicated nodules that carpeted the mucosa of the gastric antrum or antrum and body. Three of these five patients had associated Helicobacter pylori gastritis. The diagnosis of gastric lymphoid hyperplasia, therefore, can be suggested on the basis of the radiographic findings.
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Affiliation(s)
- D A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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Chang D, Levine MS, Ginsberg GG, Rubesin SE, Laufer I. Portal hypertensive gastropathy: radiographic findings in eight patients. AJR Am J Roentgenol 2000; 175:1609-12. [PMID: 11090387 DOI: 10.2214/ajr.175.6.1751609] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the findings of portal hypertensive gastropathy on barium studies in eight patients and whether there are useful radiographic criteria for diagnosing this condition. CONCLUSION Our experience suggests that portal hypertensive gastropathy may manifest on barium studies as thickened nodular folds in the gastric fundus. Although varices or various forms of gastritis can also produce thickened gastric folds, portal hypertensive gastropathy should be suspected when this finding is detected in patients with known portal hypertension.
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Affiliation(s)
- D Chang
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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22
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Brown JA, Carson BW, Gascoyne RD, Cooperberg PL, Connors JM, Mason AC. Low grade gastric MALT Lymphoma: radiographic findings. Clin Radiol 2000; 55:384-9. [PMID: 10816406 DOI: 10.1053/crad.2000.0449] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Gastric MALT (mucosa-associated lymphoid tissue) lymphoma is now recognized as a distinct entity within extranodal non-Hodgkin's lymphoma. The purpose of this study was to describe the radiographic findings in low grade gastric MALT lymphoma. MATERIALS AND METHODS We retrospectively reviewed the radiographic findings in 22 cases of low-grade gastric MALT lymphoma. The study group consisted of 15 men and seven women (median age 68 years, range 41-91 years). Lesions were designated as infiltrative or polypoid by consensus of two radiologists. Polypoid lesions were categorized by number and size. Anatomical site within the stomach and presence of transpyloric or oesophagogastric extension was determined for each case. The presence of abdominal lymphadenopathy was categorized as regional or distant. The presence of Helicobacter pylori was determined from endoscopic and surgical biopsies. RESULTS Computed tomography (CT) revealed abnormalities of the stomach in 19 cases of the 21 in which it was performed. There were 14 infiltrative lesions and five polypoid lesions. Of the 14 infiltrative lesions, the mean gastric wall thickness was 2.2 cm (range 0.8-6.0 cm). There were three single and two multiple polypoid lesions (mean size 2.2 cm, range 1. 5-2.7 cm). Transpyloric extension was observed in two cases and oesophagogastric extension in one. Abdominal lymphadenopathy was observed in 10 of 21 patients. Helicobacter pylori was found in 19 of 22 cases (86%). CONCLUSION Low grade B cell gastric MALT lymphomas present with an infiltrative form on CT in about three-quarters of cases and a polypoid pattern in the remainder. Abdominal lymphadenopathy is seen in approximately one-half of cases. There is a high association with Helicobacter pylori.
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Affiliation(s)
- J A Brown
- Department of Radiology, St. Paul's Hospital, Vancouver, B.C
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Arora R, Levine MS, Harvey RT, Laufer I, Rubesin SE. Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients. Radiology 1999; 213:347-51. [PMID: 10551211 DOI: 10.1148/radiology.213.2.r99nv30347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. MATERIALS AND METHODS A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. RESULTS All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. CONCLUSION A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.
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Affiliation(s)
- R Arora
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Kim YH, Lim HK, Han JK, Choi BI, Kim YI, Lee WJ, Kim SH. Low-grade gastric mucosa-associated lymphoid tissue lymphoma: correlation of radiographic and pathologic findings. Radiology 1999; 212:241-8. [PMID: 10405748 DOI: 10.1148/radiology.212.1.r99jn11241] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To describe upper gastrointestinal (Gl) examination findings of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to correlate them with pathologic examination findings. MATERIALS AND METHODS A retrospective review of upper Gl examinations was performed in 25 patients with proved low-grade gastric MALT lymphomas. Upper Gl examinations were reviewed for common findings and most probable diagnosis, and these findings were correlated with pathologic findings in resected specimens in 15 patients. RESULTS The common findings at upper Gl examination included mucosal nodularity (n = 13), ulcer (n = 12), rugal thickening (n = 6), mass (n = 4), and enlarged areae gastricae (n = 2). The most probable diagnoses were early gastric carcinoma (n = 7), advanced gastric carcinoma (n = 6), gastritis (n = 9), and lymphoma (n = 3). Of 17 lesions found on resected specimens, six ulcers and two masses were not depicted at barium study. Disorganized convergent rugae projecting to multiple points and vague ulcer margins were present in four and seven lesions, respectively. Multiple ulcers were seen in two patients. CONCLUSION Although the common radiographic and pathologic findings observed in low-grade gastric MALT lymphomas were similar to those of gastric carcinomas or gastritis, disorganized convergent rugae, vague ulcer margins, and multiplicity of lesions may be helpful in differentiating them from gastric carcinomas or gastritis.
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Affiliation(s)
- Y H Kim
- Department of Radiology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea
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25
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Paciorek M, D'Altorio R, Gleeson G. Resolution of giant gastric folds after eradication of Helicobacter pylori. J Clin Gastroenterol 1997; 25:696-7. [PMID: 9451693 DOI: 10.1097/00004836-199712000-00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Paciorek
- Department of Radiology, St. Francis Medical Center, Pittsburgh, Pennsylvania, USA
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