Clinical significance of white gastric crypt openings observed via magnifying endoscopy

AIM:To evaluate the relationship between Helicobacter pylori(H.pylori)-induced gastritis and white gastric mucosal crypt openings(COs)in the gastric corpus.METHODS:A total of 175 consecutive patients(including 69 patients with gastric cancer)were enrolled in this study.We used magnifying endoscopy(ME)to observe the mucosa microsurface of the lesser and greater curvature of the gastric corpus(350 areas in all).We focused on areas with a round pit microstructure(primarily observed in non-atrophied areas)and evaluated the white openings of these gastric pits.We classified the whiteness of the COs as the"white-edged dark spot"type(consisting of a dark spot bordered by white);the"white"type(pure white with no dark spot);and the"dense white pit(DWP)"type(dense white,resembling a snowball).Gastritis was also histologically evaluated according to the updated Sydney System.RESULTS:We detected round COs using ME in 246 of the 350 areas examined.The histological examination showed significantly more mononuclear cells and neutrophil infiltration in the"white"and"DWP"types than the"white-edged dark spot"type(P<0.001).Furthermore,significantly high-grade inflammation and evidence of active H.pylori-induced gastritis was observed in the"DWP"type(P<0.001).Significant differences were observed in the whiteness of COs between H.pylori-positive(n=139)and negative(n=36)patients(P<0.001).The sensitivity and specificity of the"white"and"DWP"types for predicting H.pylori infection were78.5%and 81.7%,respectively.Of the patients with gastric cancer,22.5%(18/80)had"white-edged dark spots",51.3%(41/80)had"white"COs,and 26.3%(21/80)had"DWP"-type COs."DWPs"were frequently observed among patients with undifferentiated gastric cancer[45.7%(16/35)].CONCLUSION:CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation and H.pyloriinduced activity.

Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan

AIM:To examine the prevalence of gastroesophageal reflux disease (GERD) symptoms in a large unselected general population in Japan. METHODS: In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged > 40 years. A total of 160 983 Japanese (60 774 male, 100 209 female; mean age 61.9 years) who underwent a stomach check up were enrolled in this study. In addition, from these 160 983 subjects, we randomly selected a total of 82 894 (34 275 male, 48 619 female; mean age 62.4 years) to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period. RESULTS: The respective prevalences of the symptoms in males and females were: heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year agegroup. Dysphagia was also significantly more frequent in female patients. CONCLUSION: The prevalence of typical GERD symptoms (heartburn) was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.