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Summary: Background: Vonoprazan (V), a potassium‐competitive acid blocker, has a more durable acid‐inhibitory effect as compared with standard‐dose proton pump inhibitors (PPIs) but has not been compared with 2‐4 times higher daily PPI doses administered in two divided doses. Aims: To evaluate the acid‐inhibitory effect of V 10/20 mg once‐daily (OD; V10/V20) vs rabeprazole (R) 10/20 mg twice‐daily (BID; R20/R40) in healthy Japanese volunteers. Methods: This multicentre, randomised, open‐label, two‐period, crossover study compared V10 or V20 vs R20, or V20 vs R40 using three cohorts of 10 healthy Japanese adults. Within each cohort, subjects were randomised to receive V or R for 7 days and, following a washout period ≥7 days, the other treatment for 7 days. On day 6 of each period, 24‐hours multichannel gastric impedance‐pH monitoring was performed. Percent times pH ≥ 3, ≥4 and ≥5 (pH 3, 4 and 5 holding time ratios [HTRs]) in 24 hours were evaluated as primary pharmacodynamic endpoints. Results: Acid‐inhibitory effect (24‐hours pH 3 HTR) of V20 was greater than those of R20 (91.0% vs 65.3%; P =.0049) and R40 (98.5% vs 85.9%; P =.0073). Similar results were obtained for 24‐hours pH 4 and 5 HTRs. V20 also achieved greater nocturnal pH 4 (91.5% vs 73.2%; P =.0319) and 5 HTRs (78.8% vs 62.2%; P =.0325) as compared with R40. One subject (20%) developed diarrhoea while receiving R40 which was considered treatment‐related. Conclusions: Compared with 2‐4 times the standard daily dose of R, V20 exerts a more potent and durable acid‐inhibitory effect. Trial identifier: UMIN000022198 (www.umin.ac.jp/ctr/index.htm). [ABSTRACT FROM AUTHOR]

Although the prevalence of gastroesophageal reflux disease (GERD) used to be lower in East Asia as compared to Western countries, it has recently been increasing, most likely due to the socioeconomic development in the East. The prevalence of both GERD and functional gastrointestinal disorders (FGIDs) ranges between 10% and 25% worldwide and there are distinct subgroups of patients with overlapping of GERD and FGIDs. However, the true prevalence of an overlap between GERD and FGIDs can be determined only when a formal pathophysiological evaluation has been performed. Nocturnal reflux symptoms have a significant impact on patients' sleep quality and quality of life. Although proton pump inhibitors (PPIs) can improve both reflux and sleep‐related symptoms, the relationship between nocturnal reflux events and sleep disturbance is not fully understood. GERD plays an important role in the pathogenesis of lung fibrosis, and PPIs or fundoplication may decrease the likelihood of pulmonary exacerbation or even improve pulmonary function. Refractory reflux symptoms without esophagitis have become one of the most common presentations of GERD in gastroenterology clinics. There are several new medical therapies, and endoscopic as well as laparoscopic techniques that have been increasingly used in these patients. The selection of options should be tailored and individualized based on the pathophysiology of refractory GERD. Gastroesophageal reflux disease (GERD) is a condition, which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The prevalence of GERD varies remarkably throughout the world, the causes of GERD symptoms are likely multifactorial and its pathophysiology is not fully understood. In this concise review, we have reviewed current and future perspectives in the management of GERD. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aim: Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) often coexist or overlap. In this study, the efficacy of acotiamide in combination with a standard dose of rabeprazole for GERD and FD was compared with that of a double dose of rabeprazole. Methods: Patients with overlap between GERD and FD experiencing heartburn and epigastric fullness symptoms after standard‐dose proton pump inhibitor (PPI) for ≥ 8 weeks were randomized into two groups and received either acotiamide 300 mg/day + rabeprazole 10 mg/day or rabeprazole 20 mg/day for 4 weeks. Efficacy was assessed by reductions in symptom scores using the Izumo scale questionnaire and modified F‐scale questionnaire. Results: As the primary endpoint, three upper gastrointestinal symptoms (heartburn, epigastralgia, and epigastric fullness) were reduced by ≥ 50% in 40.8% and 46.9% of patients in the combination and PPI double‐dose groups, respectively, with no significant difference between the two groups. Essentially similar results were obtained for the modified F‐scale questionnaire. No serious adverse events were noted. Conclusions: Acotiamide 300 mg/day in combination with rabeprazole 10 mg/day or rabeprazole 20 mg/day relieved symptoms in patients with overlap between GERD and FD experiencing heartburn and epigastric fullness symptoms after standard‐dose PPI for ≥ 8 weeks, and the efficacies did not differ between the two treatments. The combination therapy may be an alternative option for persistent symptoms in these patients. [ABSTRACT FROM AUTHOR]

Aim: Combination therapy with sofosbuvir and ribavirin (SOF/RBV) has been recently available for chronic hepatitis C patients with genotype 2 (CHG2) in Japan. The domestic phase III clinical trial showed a high antiviral effect with a relatively safe adverse event (AE) profile. Our aim was to report an important AE detected during treatment. Methods: A prospective multi‐institutional study of 12‐week combination therapy with SOF/RBV for CHG2 was carried out to evaluate efficacy and safety. Results: The eligible subjects included 142 patients. Out of 50 assessable patients, 16% of the patients were diagnosed with hyperuricemia. The proportions of subjects with grade 1, grade 3, and grade 4 hyperuricemia were 12, 2, and 2%, respectively. Serum uric acid (UA) levels at week 1 of the therapy (W1) were numerically the highest during therapy in patients with hyperuricemia, and the ratio of W1/baseline serum UA levels was significantly higher than that of post‐treatment week 4 or 8/baseline serum UA levels in assessable patients. Serum UA levels at W1 were significantly correlated with body mass index. The difference between serum UA levels at W1 and baseline serum UA levels was significantly correlated with the difference between serum creatinine levels at W1 and baseline serum creatinine levels. Conclusions: Elevated serum UA level was a notable AE associated with SOF/RBV therapy for CHG2. However, because of the small number of subjects, the exact frequency of AEs should be re‐evaluated with larger cohorts. We need to remember that elevated serum UA level might develop during the therapy, especially at W1. [ABSTRACT FROM AUTHOR]

The administration of direct-acting antiviral agents (DAAs) to treat hepatitis C virus (HCV) infection has been reported to cause hepatitis B virus (HBV) reactivation. However, the actual conditions of HBV reactivation and the ideal timing of medical intervention have not been fully evaluated. We report the cases of two female patients dually infected with HBV and HCV. Both patients were inactive HBV carriers. Although the serum HCV RNA levels promptly decreased after the initiation of DAA-based therapy, the serum HBV DNA levels gradually increased during DAA-based therapy, with the peak serum HBV DNA levels observed at 16 weeks after the initiation of DAA-based therapy in both cases. Subsequently, we checked the serum HBV DNA levels closely every week several times. Fortunately, the serum HBV DNA levels gradually decreased without medical intervention. Neither case developed an alanine aminotransferase flare-up. The HCV genotypes were 2a and 1b, and the DAA-based therapies of Cases 1 and 2 were 12 weeks of sofosbuvir/ribavirin and ombitasvir/paritaprevir/ritonavir, respectively. The significance of our case reports is the demonstration of the existence of spontaneous remission of HBV reactivation that developed during DAA-based therapy, the avoidance of intervention of nucleot(s)ide analogs by frequent monitoring of serum HBV DNA levels, and development of HBV reactivation regardless of the viral genotype or class of DAA. In conclusion, the close monitoring of serum HBV DNA levels during and after DAA-based therapy is essential and medical intervention for HBV reactivation should be carefully considered on an individual basis. [ABSTRACT FROM AUTHOR]

Aim To evaluate the clinical and virological features of acute hepatitis E (AH-E) in Gunma prefecture and focus on the hepatitis E virus (HEV) infection in immunocompromised patients. Methods A total of 30 patients with AH-E diagnosed at our Gunma University Hospital, and located in 3-39-15 Showa-machi, Maebashi, Gunma 371-8511 Japan, and its affiliated hospitals from 2004 to 2015, were studied. We evaluated the detailed medical histories, laboratory examinations and virological features of these participants. Results Of the 30 patients, 21 patients were men, with a median age of 61 years. Three of these patients had a history of recent oversea travel. A total of 14 patients had eaten raw or undercooked meat/viscera from animals, and two patients had contracted transfusion-transmitted AH-E. Eight patients were immunocompromised, including those with hematological disease, cancer receiving systemic chemotherapy and kidney transplant or connective tissue disease undergoing immunosuppressive medications. The alanine aminotransferase and total bilirubin levels were more significantly reduced in these immunocompromised patients than in the non-immunocompromised patients. Severe thrombocytopenia, an extra-hepatic manifestation of AH-E, occurred in one case. Among the 22 HEV strains whose subgenotype was determined, two were imported strains (1a and 1f), and 11 strains formed four distinct phylogenetic clusters within subgenotype 3b. The remaining nine strains differed from each other by 9.8-22.4%, and were classified into four subgenotypes (3a, 3b, 3e and 3f). Conclusion Markedly divergent HEV strains (3a, 3b, 3e and 3f) were found to circulate in Gunma. Although immunosuppression appears to play a crucial role in establishing chronic sequels, AH-E in eight immunocompromised patients, including transfusion-transmitted HEV infection in two patients, did not become chronic. [ABSTRACT FROM AUTHOR]

Polyethylene glycol- (PEG-) based bowel preparations for colonoscopies are often poorly tolerated due to the large volumes of fluid intake required. We compared low-volume “modified” PEG + ascorbic acid (AJG522) with standard PEG with electrolytes (PEG + E) in addition to a stimulant laxative and an agent to improve bowel function for the bowel cleansing before colonoscopy to evaluate its efficacy, safety, and acceptability. Outpatients scheduled to undergo colonoscopy were randomized to receive either AJG522 or PEG + E. Bowel cleansing conditions were assessed via macroscopic fecal findings by blinded and independent investigators. A survey of the patients’ feedback regarding the preparation was conducted by questionnaire. Successful cleansing was achieved in all cases, except for 4 cases in the PEG + E group, at 3 hours after taking the preparation. The fecal properties were significantly clearer in the AJG522 group than in the PEG + E group at 2 hours after taking each preparation P=0.013. Although the total liquid volume of the bowel preparation was not reduced, the AJG522 preparation could significantly reduce the required volume of the preparation P<0.0001. Moreover, the patients in the AJG522 group had better acceptability P=0.010. There were no significant differences in the safety profiles between groups (UMIN000013892). [ABSTRACT FROM AUTHOR]

Background Acotiamide is a first-in-class drug that is used to treat functional dyspepsia ( FD). It is considered that acotiamide acts as an antagonist on muscarinic autoreceptors in the enteric nervous system and inhibits acetylcholinesterase activity. We examined the effect of acotiamide on gastric emptying in healthy adult humans. Materials and methods Twelve healthy adult males were enrolled in this double-blind crossover study. Acotiamide or placebo was administered orally in the 12 subjects 30 min before ingestion of a nutritional liquid meal (400 Kcal/400 mL). Six of the 12 participants took 100 mg of acotiamide or placebo, and six of the 12 participants took 300 mg of acotiamide or placebo in a double-blind crossover fashion. All subjects underwent measurement of gastric emptying by the 13C breath test. Results After the meal with placebo was ingested, the %dose/h curve ascended. The %dose/h curve after a meal with 100 or 300 mg of acotiamide ascended in an identical manner compared with the results with placebo. No significant differences were observed at any studied time point, and there were no significant changes in gastric emptying parameters (gastric emptying coefficient, t-1/2ex and t-lag ex). Conclusions A single administration of 100 or 300 mg of acotiamide did not affect gastric emptying after a liquid meal in healthy adult humans. Acotiamide has profound effects on restoring delayed gastric emptying and impaired accommodation in patients with FD but may have no effect on gastric emptying in healthy subjects. Such pharmacological actions have not been observed in previous gastroprokinetic studies. [ABSTRACT FROM AUTHOR]

The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH-impedance monitoring in globus evaluation; and treatment for reflux-associated globus. [ABSTRACT FROM AUTHOR]

Aim: The main aim of this study was to determine whether questionnaire evaluations of clinical symptoms in gastroesophageal reflux disease were useful to assess proton pump inhibitor therapy. Methods: A total of 185 Japanese patients (men, 88; women, 97; age: 55.7 ± 16.1 years) with gastroesophageal reflux disease were enrolled. The patients were divided based on the frequency scale for symptoms of gastroesophageal reflux disease: severe symptoms with scores ≥8 and mild symptoms with scores ≤7. Quality of life was evaluated with the Medical Outcomes Study 8-Item Short-Form Health Survey. All patients were treated with a proton pump inhibitor, rabeprazole (10 mg/day), for 8 weeks. Results: Patients were classified into four groups: reflux esophagitis with severe symptoms ( n = 92, 49.7%); reflux esophagitis with mild symptoms ( n = 17, 9.2%); non-erosive reflux disease with severe symptoms ( n = 66, 35.7%); and non-erosive reflux disease with mild symptoms ( n = 10, 5.4%). The dysmotility score was high in non-erosive reflux disease with severe symptoms compared with reflux esophagitis with severe symptoms (9.1 ± 0.5 vs 6.8 ± 0.5, P < 0.05). The symptom score and quality of life in the severe symptoms groups for both reflux esophagitis and non-erosive reflux disease were significantly improved by rabeprazole treatment. Only the reflux score was improved by rabeprazole in the reflux esophagitis with mild symptoms group; no therapeutic effect was observed for the non-erosive reflux disease with mild symptoms group. Conclusions: Low scores on the frequency scale for the symptoms of gastroesophageal reflux disease indicate poor responsiveness to proton pump inhibitor treatment, and high scores indicate good responsiveness. [ABSTRACT FROM AUTHOR]

Background and Aim: The Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) is the standard questionnaire used in Japan for the diagnosis of gastroesophageal reflux disease (GERD) and assessment of the response to treatment. We modified the FSSG in order to assess dyspepsia symptoms, and evaluated the modified questionnaire. Methods: We modified the FSSG by adding two questions on interdigestive and postprandial epigastric pain. We then assessed the modified FSSG with 100 new untreated symptomatic patients presenting to hospital and in 200 subjects undergoing health checks. Endoscopic assessment of the esophagogastric junction was performed according to the modified Los Angeles classification with addition of Grade N (normal appearance) and Grade M (minimal change). Endoscopic images were assessed by five experienced endoscopists blinded to the questionnaire results. Results: The 100 new patients included 16 with erosive GERD (>Grade A), 12 with peptic ulcer, and two with gastric cancer. Among the 70 patients with no evidence of organic disease, the modified FSSG diagnosed functional dyspepsia (FD) in 41 and non-erosive gastric disease (NERD) in 29. A significant difference was seen in the dyspepsia score between patients with FD and NERD. Subjects with endoscopic GERD undergoing health checks had significantly higher scores for all symptoms, reflux symptoms, and dyspeptic symptoms on the modified FSSG. Conclusion: The modified FSSG can clearly distinguish FD from NERD, and is useful for the assessment of dyspeptic symptoms. [ABSTRACT FROM AUTHOR]

Background and Aim: A correlation to obesity has been reported in patients with gastroesophageal reflux disease (GERD). However, insufficient data have been obtained regarding underweight GERD patients. Post hoc analysis of a multicenter prospective cohort study was conducted to evaluate subjective symptoms and health-related quality of life (HRQOL) in underweight GERD patients (body mass index [BMI] < 18.5) and to evaluate therapeutic response to proton pump inhibitors. Methods: A total of 2646 patients who underwent endoscopy were classified by BMI and analyzed. Rabeprazole was administered for 8 weeks. Subjective symptoms and HRQOL were assessed using questionnaires (F-Scale and SF-8™). Results: Baseline endoscopy revealed 29.2% of patients had non-erosive reflux disease (NERD). Underweight status was identified in 5.8% of GERD patients, and mean baseline symptoms score and SF-8 physical component summary (PCS) score were 18.6 and 42.4, respectively, reflecting greater impairment compared with the values of 15.4 and 45.6 in normal-weight patients (BMI ≥ 22 but < 25). Treatment with rabeprazole resulted in a decrease from 18.6 at baseline to 6.7 at week 8 in underweight reflux esophagitis subjects, and from 15.0 to 6.3 in underweight NERD patients. PCS score improved in underweight patients. These changes were about the same as in normal-weight or obese patients. Conclusions: Japanese GERD patients are often obese, as reported previously, but some GERD patients are underweight. Baseline symptoms and QOL in underweight GERD patients tended to be more severe than in normal-weight patients, but therapeutic response with proton pump inhibitors was about the same as in normal-weight or obese patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Functional dyspepsia (FD) is a common condition seen in primary gastroenterology practice. The present study was conducted to compare the clinical effectiveness of mosapride and teprenone in patients with FD. Methods: Prospective clinical comparative study with random allocation of open labeled medications was performed as a multicenter trial in Japan. 1042 patients presenting symptoms of FD, either with gastric stasis (GSS) and/or epigastric pain (EPS), were enrolled. After initial endoscopic evaluation, medication either with mosapride 5 mg tid or teprenone 50 mg tid was started. Severity and frequency of GSS and EPS, health-related quality of life (HR-QOL) by the SF-36 Japanese version, and patients' compliance to medication was evaluated. Results: Organic lesions were found in 90 patients (9%) in the 1027 patients examined by endoscopy. Among those without any specific lesions detected by endoscopy, gastrointestinal symptoms were resolved within one week after the endoscopy in 264 (28%) patients before initiating medication. 618 patients who remained symptomatic were randomized to medication either with mosapride ( n = 311) or teprenone ( n = 307). Two-week treatment with mosapride significantly improved GSS and EPS, while teprenone tended to improve only GSS. Mosapride also improved HR-QOL. 91% of patients treated with mosapride favored their medication, while only 52% of patients treated with teprenone favored their medication. Conclusions: Endoscopic evaluation at patients' presentation was effective to find active lesions and to improve FD symptoms. Mosapride was more favorably accepted than teprenone by the patients with sufficient safety and efficacy. [ABSTRACT FROM AUTHOR]

It has been suggested that there could be three possible mechanisms of gastric dysfunction in patients with FD: (i) delayed gastric emptying, (ii) impaired gastric accommodation of food intake, and (iii) hypersensitivity to gastric distention. Postprandial fullness seems to be the most severe symptom in patients who report aggravation of their symptoms after meals. Therefore, it has been assumed that delayed gastric emptying and consequent prolonged antral distension could reduce hunger, increase satiety, and even cause gastric discomfort, all of which would pose a significant barrier to adequate nutrition. We previously reported that postprandial water intake inhibits gastric antral motility along with an increase of cholecystokinin (CCK) in normal subjects. We assumed that the rapid increase of CCK after water intake was initiated by a feedback mechanism related to the inflow of fatty chyme into the duodenum that inhibits gastric antral activity. This duodeno-gastric interaction is known as the 'duodenal break.' We also reported that total gastric emptying was more rapid after the intake of a high-viscosity liquid meal than after a low-viscosity meal, because the low-viscosity liquid meal inhibits gastric empting after rapid initial inflow into the duodenum. Considering these results, we hypothesized that rapid gastric emptying, rather than delayed gastric emptying, could be a cause of FD. In some patients with postprandial distress syndrome (PDS), we have found a significant correspondence between PDS-related dyspepsia and accelerated gastric emptying in the early postprandial period. It is worth emphasizing that the duodenum and the duodeno-gastric interaction (duodenal break) could have an important role in the pathophysiology of FD. We consider that rapid gastric emptying might be a more important factor than delayed gastric emptying in patients with FD. [ABSTRACT FROM AUTHOR]

Background and Aim: We compared endoscopic findings of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), a written questionnaire developed in Japan, to that for the questionnaire for the diagnosis of reflux esophagitis (QUEST) for the diagnosis of reflux esophagitis. Methods: We registered 475 patients with untreated symptoms of upper abdominal pain (male/female: 252/223, average age 52.4 ± 17.8 years). Subjects were assessed first with the FSSG and QUEST questionnaires, then by endoscopy, before allocation to a gastric ulcer (GU), duodenal ulcer (DU), gastroesophageal reflux disease (GERD) or functional dyspepsia (FD) group. Results: On the basis of the endoscopic findings the diagnoses for the 475 subjects were as follows: FD 52.2%, DU 7.6%, GU 7.8%, and GERD 32.4% (Grade M 10.1%, Grade A + B 20.2%, Grade C + D 2.3%). There was no difference between the FSSG and QUEST in sensitivity, specificity or accuracy for any condition. The FSSG score rose with increasing endoscopic severity of GERD, but there was no correlation between the QUEST score and endoscopic severity. The FSSG total score was inferior to QUEST in terms of distinguishing GERD from other conditions, but when only the questions relating to reflux symptoms were used, the FSSG was able to distinguish GERD from other conditions as well as QUEST. Conclusions: The FSSG score reflects the severity of the endoscopic findings of GERD. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of this study was to determine whether the gastric longitudinal shortening occurs during the gastric phase III in man. Methods: Intragastric pH and gastroduodenal motility were simultaneously measured by means of a 24-h ambulatory recording system in 14 healthy volunteers. In nine subjects (group A), the catheter assembly was endoscopically clipped to the gastric mucosa with the middle transducer and the distal pH sensor in the antrum. In the remaining five subjects (group B), measurements were performed without securing the assembly. Results: In 23 of the 25 gastrointestinal interdigestive migrating complexes in group A, the distal and middle transducers showed characteristic duodenal contractions (11–12 c.p.m.). Neutralization was noted at the distal pH sensor. Similar phenomena were observed during all 15 gastrointestinal interdigestive migrating complexes in group B. The catheter assemblies escaped into the duodenum despite the fact that they were secured to the stomach. This may be explained by gastric longitudinal shortening during gastric phase III activities. Conclusions: Studies of intragastric physiology with test catheters must take the effect of gastric longitudinal shortening during phase III into consideration. [ABSTRACT FROM AUTHOR]

An early and accurate evaluation by a general practitioner is needed to screen out non-gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire.When admitted to hospital to undergo an upper gastrointestinal endoscopy for suspected GERD, 333 patients completed a 50-item questionnaire requiring‘yes/no’ answers to different combinations of questions relating to symptoms of upper gastrointestinal tract conditions (e.g. GERD, ulcers and functional dyspepsia) and psychosomatic symptoms. The endoscopic diagnosis was then correlated with the rate of positive answers to each question.Based on the analysis of the 50 items, the 8–10 questions most often answered affirmatively by each of the GERD and non-GERD groups were chosen for the simplified questionnaire. Three draft questionnaires were compiled. After calculating the sensitivity, specificity and accuracy in relation to the diagnosis of GERD and other conditions, it was found that questionnaire B (selection of persons answering‘yes’ to at least one of questions 1–5 and exclusion of persons answering‘yes’ to at least three of questions 7–10) had a high sensitivity, high specificity and low false positive rate.A novel questionnaire was developed. It was designed to detect the symptoms of GERD while simultaneously excluding non-GERD patients. This simplified nine-item simplified questionnaire had a sensitivity of 79.8%, a specificity of 53.6% and an accuracy of 63.4%. [ABSTRACT FROM AUTHOR]

Gastritis cystica polyposa (GCP) is a well-known precancerous lesion of the remnant stomach. We report a case of carbohydrate antigen (CA) 19–9-producing well-differentiated adenocarcinoma of the remnant stomach that resembled GCP. The patient was a 66-year-old Japanese man who had undergone subtotal gastrectomy 20 years previously. The tumor developed in the remnant stomach at the anastomotic line. Histologically, the lesion completely encircled the gastroenterostomy stoma. There was florid growth of glands with cystic dilatation and minimal atypia extending through the thickened muscularis propria into the subserosa. Small foci of less well-differentiated adenocarcinoma were also detected, including irregular glands or small clusters of mucus-producing cells with moderate atypia. Immunostaining revealed that numerous tumor cells were positive for carcinoembryonic antigen and CA19-9, whereas only a few cells were positive for p53. The macroscopic, histopathological and immunohistochemical findings indicated a diagnosis of CA19-9-producing well-differentiated adenocarcinoma of the remnant stomach. To avoid underdiagnosis, careful attention should be paid to the above-mentioned morphological features and immunohistochemical findings, in addition to the endoscopic findings. [ABSTRACT FROM AUTHOR]

We previously reported that a new endoscopic classification of gastroesophageal reflux disease, the Los Angeles classification, showed considerable observer variation depending on the experience of the endoscopist. In the present study, we evaluated some modifications of the classification to determine whether we could decrease observer variation. Fifty endoscopic photographs, each showing four images of the squamo-columnar junction, were prospectively obtained from 50 consecutive patients with gastroesophageal reflux disease. Two groups of eight endoscopists divided by their endoscopic experience, group 1 (100–500 procedures) and group 2 (more than 500 procedures), assessed the photographs using classifications with the following modifications: (i) addition of grade O to describe healed mucosal breaks and setting grade B as more than 5 mm or 10 mm; or (ii) addition of grade O and setting grade D as 75–99% or 100% circumferential. Changing the definition of grade B or grade D did not increase the kappa values for either group of observers. These modifications of the Los Angeles classification were unable to decrease observer variation. [ABSTRACT FROM AUTHOR]

Abstract A 22-year-old man was unable to belch. He could sense intraesophageal gas, but had no chest pain. An upper gastrointestinal X-ray series and endoscopic examination showed no abnormalities. Esophageal manometry showed normal relaxation of both the upper and lower esophageal sphincters with primary peristalsis during deglutition. However, bolus injection of air into the middle esophagus failed to initiate the belch reflex. [ABSTRACT FROM AUTHOR]

The article presents the case of a 34-year-old woman identified with maturity onset diabetes of the young (MODY5). It mentions that the woman had has a mutation of HNF1 gene or the gastrointestinal duplication of cysts that commonly occurs in small intestine. The article discusses a case of MODY5 accompanied with duodenal cysts.