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Endoscopic diagnostics of early squamous cell carcinoma (SCC) in the laryngo-esophageal region have dramatically improved together with development of less invasive endoscopic treatment. It is essential for gastrointestinal endoscopists to detect lesions when they are still endoscopically treatable, especially in this region since surgical approach can still be extremely invasive. Pioneers have found some notable fundamental alterations in early SCC and created several classifications. Inoue [Dig Endosc 2001;13(suppl): 40-41] proposed the intrapapillary capillary (IPCL) classification, which focused on the microvascular change of the mucosal surface. One of the significances of this classification is that it clearly distinguished the lesions that require further pathological evaluation by categorizing the diameter change of the IPCLs. On the other hand, Arima et al. [Esophagus 2005;2:191-197] advocated the alteration of microvessels as well as change of the vascular arrangement in the area. Most recently, the Japan Esophageal Society constructed a new classification uniting these two exemplary classifications as the 'Japanese Classification of Magnifying Endoscopy for Early Squamous Cell Carcinoma'. This classification was intended to be simple and easily applicable in general clinical practice. Brownish color change between the IPCLs has reported to be one of the useful findings in distinguishing early SCC from benign changes such as inflammatory change and low-grade intraepithelial neoplasia. Nevertheless, the exact cause of this phenomenon remains unclear. We recently examined the association of color change with hemoglobin (Hb) in cancer tissue, since NBI exclusively detects the wavelength of Hb in superficial vessels in the gastrointestinal tract. This review article also describes our examination of a distinct finding in esophageal cancer, namely, 'background coloration'. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Rebamipide has a broad spectrum of pharmacological actions that include suppression of neutrophil functions and stimulation of mucosal epithelial cell regeneration by increasing the expression of epithelial growth factor (EGF) and the EGF receptor. Sixteen patients with active ulcerative colitis (UC; mild in 1 patient, moderate in 11, and severe in 4) were recruited. Enemas containing 150 mg rebamipide per dosing were administered during the daytime after passage of stool, twice a day for 4 weeks. UC disease activity index (UC-DAI), endoscopic activity index (EAI), and Floren's grading (FG) of mucosal biopsy specimens were measured at entry and at 4 weeks. Five of 16 patients did not complete the study, and therefore, final efficacy assessment was done on 11 patients who completed the 4 weeks of treatment. Improvements were observed in UC-DAI (P = 0.0049), EAI (P = 0.0043), and FG (P = 0.0084). There was no serious rebamipide-related side effect in any of the 16 patients. In conclusion, rebamipide topical therapy appears to be effective for the treatment of mildly to moderately active distal UC. Further controlled studies are warranted for this promising drug. [ABSTRACT FROM AUTHOR]

Background: Ghrelin may stimulate gastric motility via the vagal nerve pathway. However, the mechanism of ghrelin-induced changes in gastrointestinal motility has not yet been clearly defined. The present study was designed to investigate whether ghrelin accelerates gastric emptying via capsaicin-sensitive afferent neurones and directly affects the enteric neuromuscular function. Methods: Gastric emptying of nutrient solids was assessed after intravenous administration of saline or ghrelin in conscious rats. The effects of ghrelin on gastric emptying were also examined in rats pretreated with capsaicin. Gastric emptying and intestinal transit of non-caloric liquids were evaluated using 51 Cr solution. The effects of ghrelin on spontaneous contractile activities of isolated strips from stomach and jejunum were also investigated and the influence of ghrelin on motor responses to carbachol and electrical field stimulation was examined. Results: Ghrelin significantly accelerated gastric emptying of both nutrient solids and non-caloric liquids in conscious rats. The intestinal transit of non-caloric liquids was also enhanced by ghrelin. Pretreatment with capsaicin prevented the ghrelin-induced acceleration of gastric emptying of nutrient solids. Ghrelin did not modulate spontaneous and carbachol-induced contractions of strips of gastric body, gastric antrum and jejunum. However, electrical field stimulation-induced contractions were significantly enhanced by ghrelin in the gastric body. Conclusions: The results suggest that the stimulatory effects of ghrelin on gastric motility are mediated by direct stimulation of the enteric neural pathway and capsaicin-sensitive afferent neurones. [ABSTRACT FROM AUTHOR]

Background: The transcription factor nuclear factor-κB (NF-κB) plays a pivotal role in inflammatory responses by upregulating mRNA expression of, for example, proinflammatory cytokines and chemokines. Although in vitro studies have shown that Helicobacter pylori can induce NF-κB activation in gastric cancer cell lines, there is little information on cellular localization of NF-κB in H. pylori-infected gastric mucosa. Methods: H. pylori-infected and -negative patients with various endoscopic findings were examined. NF-κB expression was studied by means of Southwestern histochemistry, a new method of localizing transcription factors. Labeled double-stranded oligo-DNA with specific consensus sequence for the NF-κB binding site was reacted with frozen sections from gastric biopsy specimens. We compared mucosal interleukin-8 (IL-8) and IL-1β levels as measured with enzyme-linked immunosorbent assay with the degree of NF-κB expression. Results: NF-κB expression was often evident in nuclei of epithelial cells in H. pylori-infected gastric mucosa. The degree of NF-κB expression on the epithelium was significantly more severe in H. pylori-infected than in -negative mucosa. The degree of NF-κB expression also correlated with mucosal IL-8 levels but not with IL-1β. Conclusions: H. pylori infection increases the expression of NF-κB in gastric mucosa, suggesting that NF-κB is involved in inflammatory responses to H. pylori. [ABSTRACT FROM AUTHOR]

Background: Although the pathogenesis of gastric xanthoma (GX) remains unclear, an association of GX with atrophic gastritis has been reported. Helicobacter pylori is closely related to atrophic gastritis. The aim of this study was to investigate the relationship among GX, H. pylori, and atrophic gastritis. Methods: Sixty-seven patients with GX were assessed for H. pylori infection by serum anti-H. pylori IgG antibody, in addition to the rapid urease test, culture, and histologic examination using biopsy specimens of the antrum and corpus. The findings were compared with 67 age- and sex-matched control subjects without GX. The distribution of atrophic gastritis was assessed endoscopically. The severity of atrophic gastritis was determined endoscopically and histologically. Serum pepsinogen (PG) levels were also measured. Immunohistochemical staining of GX samples for H. pylori antigen was performed. H. pylori clinical isolates from patients with GX and controls were assessed for cagA by means of polymerase chain reaction. Results: The prevalence of H. pylori was significantly higher in patients with GX than in controls (94% and 72%, respectively). A significantly more extensive atrophic gastritis was present in patients with GX, as determined endoscopically and histologically, than in controls. Serum PG-I levels and the PG-I/PG-II ratio were significantly lower in the GX group than in the control group. H. pylori antigens were frequently identified in the cytoplasm of xanthoma cells in H. pylori-positive specimens of GX (54 of 63 specimens, 86%), whereas no immunoreactivity for H. pylori antigens was detected in H. pylori-negative specimens of GX. There was no significant difference in the positive rate of cagA between the two groups. Conclusions: Our results identified a close relationship among H. pylori infection, GX, and atrophic gastritis. A proportion of GXs may be provoked by H. pylori infection. [ABSTRACT FROM AUTHOR]

Apart from insulinomas, pancreatic tumors are rarely complicated by hypoglycemia and some may produce insulin-like growth factor II (IGF-II). To our knowledge, IGF-II-producing pancreatic tumors associated with hypoglycemia have not been reported previously. We describe what we believe to be the first case of "big" IGF-II-producing pancreatic acinar cell carcinoma. A 68-year-old man presented with a history of recurrent hypoglycemia. Abdominal computed tomography scan and magnetic resonance imaging showed a mass, approximately 5 cm in diameter, in the tail of the pancreas and two low-density areas in the liver. Low serum glucose was associated with low insulin levels and high levels of hormones (i.e., glucagon and IGF-II) that are functionally opposite to insulin. Although serum IGF-II level was within the normal range, most IGF-II was of the high molecular weight form, as determined by Western immunoblot analysis. Based on these findings, a diagnosis of hypoglycemia induced by IGF-II-producing pancreatic tumor was made. Surgery was not possible because of the patient's poor general condition. The patient ultimately died as a result of malignant cachexia. At autopsy, a yellowish-white tumor was found in the tail of the pancreas, and a histopathologic diagnosis of acinar cell carcinoma was made. Immunohistologically, the tumor cells contained IGF-II in an irregular staining pattern, suggesting that the hypoglycemia was caused by a pancreatic tumor producing "big" IGF-II. [ABSTRACT FROM AUTHOR]

Two case studies are presented an 84-year-old woman and a 70-year-old man with history of dysphagia accompanied by vomiting and excessive weight loss. The woman patient was diagnosed with severe simultaneous contractions in the lower esophagus while the man patient shows corkscrew-shaped contractions and blockage of barium passage at the proximal portion of contractions. Both patients were administered with peroral endoscopic myotomy (POEM).

The article presents a case study of a 66-year-old man with anemia and tarry stool. A reddish irregular elevated mass lesion with giant folds in the distal ileum were shown by double-balloon endoscopy and Fuji Intelligent Chromo Endoscopy (FICE) highlighted superficial vessels. The patient was diagnosed with intestinal mantle cell lymphoma based on histopathological and immunophenotypic findings.

The article presents a case study of a 45-year-old man who was diagnosed with acute monocytic leukemia. The patient developed hemorrhagic cystitis following intensive chemotherapy and after undergoing allergenic stem cell transplant. He had also underwent gastrointestinal endoscopy which revealed irregular-shaped ulcers in the lesser curvature and anterior wall. It adds that the patient was treated with omeprazole for eight weeks.

The article presents a case study of a 63-year-old woman who was diagnosed with primary duodenal follicular lymphoma. It mentions that the patient underwent magnified endoscopy with Fuji Intelligent Chromo Endoscopy (FICE) wherein mild irregularity and dilatation of the villous structures within lesions was discovered. It discusses the use of FICE which is a type of endoscopic imaging that detects microvascular and microsurface pattern abnormality of the gastrointestinal lymphoma.

The article presents a case study of a 36-year-old man with Cowden's disease, which with the use of narrow band imaging (NBI) was manifested by esophageal polyposis with a characteristic appearance on magnifying endoscopic.

The article offers information on the case of a 79-year-old man diagnosed with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. It mentions that narrow band imaging (NBI) with magnifying endoscopy can be used in the identification of MALT lymphoma. It adds that the patient underwent gastrointestinal (GI) endoscopy as part of the health checkup.