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G A A b st ra ct s located either in the proximal third of the corpus or in the fundus. Cardia tumors were classified according to the AEG-classification by Siewert and colleagues (AEG = adenocarcinoma of the esophagogastric junction; Siewert Br J Surg 1998). Included were tumors with their main tumor mass located directly at the cardia or subcardial with involvement of the cardia (AEG 2 and 3). Barrett carcinomas and supracardial cancers (AEG1) have been excluded. Patients were compared concerning the influence of H. pylori infection and the presence of histopathological changes. The chi-square test and consecutively Fisher's exact test were used for statistical analysis. RESULTS: There was no difference in the prevalence of H. pylori in proximal versus distal GC. The histological differentiation between intestinal versus diffuse type cancers revealed significantly more intestinal type tumors at proximal location compared to distal GC (65 vs 46%; P = 0.022). Individual parameters of the proximal versus distal GC are reported in the table. Subanalysis of adenocarcinomas at the esophagogastric junction revealed no significant difference of H. pylori prevalence between cardial (AEG2) and subcardial (AEG3) tumors. CONCLUSION: There is no difference in the prevalence of H. pylori infection in proximal as compared to distal gastric cancer provided the allocation of the tumor is correctly assessed. To obtain correct prevalence data it is essential to exclude Barrett's carcinomas (AEG1) from other adenocarcinomas at the esophagogastric junction. There was no distinct association of H. pylori with any of the histological types according to Lauren. Prevalence for H. pylori, CagA, IM and glandular atrophy by histolgical type and tumor location.

Background and Aim: Antimitochondrial autoantibodies (AMA) are known to be a hallmark of primary biliary cirrhosis, and it has been suggested that AMA play a crucial role in generating biliary changes. Biliary tract lesions are not uncommon in patients with autoimmune hepatitis (AIH) and previous works have demonstrated that AMA are occasionally detectable in sera of patients with AIH. Therefore, the role of AMA as a cause of bile duct lesions in AIH livers should be addressed. The aim of the present study was to determine whether the presence of AMA is associated with clinical features, especially the occurrence of bile duct lesions, in patients with AIH. Methods: Forty-one patients diagnosed as having AIH according to the revised scoring system of the International Autoimmune Hepatitis Group were enrolled in this study. Clinical data were retrospectively reviewed, and histological findings of the liver were investigated. AMA reactivity was determined by immunoblotting using beef heart mitochondria as antigens. Results: Although not found in any enrolled patient by conventional indirect immunofluorescence, AMA were detectable in 14 out of 41 patients (34%). Clinical parameters including biochemistry, autoantibody profile, and responses to treatment were similar irrespective of AMA status. Bile duct lesions were noted in 14/14 (100%) and 23/27 (85%) of AMA-positive and -negative patients with AIH, respectively (P = 0.134). There was no statistically significant difference in the grade of inflammation or stage of fibrosis between the two groups. Conclusion: Antimitochondrial autoantibodies were found to be present in sera of patients with AIH more frequently than expected, even at very low titer. However, clinical features and histological findings of AIH were not influenced by the AMA status.

Study On Japanese Patients with Obscure Gastrointestinal Bleeding Based On the Combined Use of Capsule Endoscopy and Double-Ballon Endoscopy Mari Hirata, Kyoto Imase, Yuji Yamada, Yoko Ikei, Genichi Koyama, Shin-Ichi Takahashi Background: Recently, the development of capsule endoscopy (CE) and doubleballon endoscopy (DBE) has made diagnosis and treatment on the disease of small-intestinal disorders more effective. Aim: The aim of this study was to evaluate the utility of CE and DBE for obscure gastrointestinal bleeding (OGIB). Patients & Method: The subjects were 46 patients (mean age: 54 G 17 yrs., 22 males and 24 females) with OGIB who underwent treatment in our hospital between March 2004 and October 2005. In principle, we performed CE at first and then DBE on the basis of the diagnosis of CE. CE was performed in all patients. DBE examinations were performed in 15 patients. As the approach method of DBE, we choosed ‘oral approach’ or ‘anal approach’ which depend upon the presumable source of the abnormal small bowel located by CE. Results: The rate of concomitant disease of the case of OGIB at our hospital was 26.2%. The details of concomitant disease are as follows: liver cirrhosi (6 cases), Chronic renal failure (3 cases), heart disease (3 cases), no concomitant disease (34 cases). Median hemoglobin was 9.9 G 2.0 g/dl, 41% of patients had required transfusion, 15% took NSAID or anticoagulant drugs. CE detected significant diagnosis in the OGIB to 26 patients (60%) out of 46 patients: 5 cases of Angiodysplasia, 5 cases of Ulcer, 10 cases of erosion, 6 cases of active bleeding, one case of esophageal varix. The rate of significant diagnosis by DBE was 73.3%. The significant diagnosis were Angiodysplasia (6 cases), Ulcer (4 cases), Crohn’s disease (1 case). With regard to treatment, endoscopic treatment was performed in 6 patients (argon plasma coagulation and clipping: 1case, argon plasma coagulation: 1case, clipping: 4cases) for Angiodysplasia. Conclusion: Performing CE before DBE was useful not only for getting the information of small bowel disease, but also for choosing approach method of DBE as well as for diagnosis and treatment of OGIB.

Background: Gastric mucosa has two types of mucous cells: surface mucous cells (SMCs) and gland mucous cells (GMCs). Hdicobacter pylori (li. pyIori) do not attach to GMCs and mucins from GMCs inhibit the movement of li, pylori in the gastric mucous gel layer. H. pylon increase the cell kinetics ot gastric epithelial cells. AIM: To examine the effect of li. IEvlori intection on gastric epithelial cell kinetics from the viewpoint of the phenotype of gastric mucous ceils. Methods: Gastric mucosal biopsy specimens obtained from 10 nonintectad volunteers and 20 H, pylori infected patients before and after eradication were used. Formalin-fixed and paraffin-embedded tissue sections were examined by a sequential staining consisting ot immunoalkaline phosphatase method for Ki67, immunopemxidase method with monoclonal antibody HIK1083, and histochemical staining for SMCs (periodic acid oxidation-thionine Schiff reaction: PA-TS), Ki-67 labeling indices (Lls) and phenotype of proliferating gastric mucous cells were analyzed. Results: SMCs, GMCs and proliferating cells were simultaneously visualized in histological specimens; SMCs were stained blue with PA-TS, GMCs were stained red with liIK1083, and nuclei of proliferating cells stained brown with Ki-67. Proliferating SMCs were distributed in lower part of gastric foveola and proliferating GMCs were localized in the lower part ot gastric lm, eola around the generating zone. Ki-67 LIs were higher in H. pylori infected patmnts (0.15 in the corpus and 0,21 in the antrum) than in vohinteers (0.06 and 0.11) (p

Background: Hemorrhagic gastric ulcer is a more serious disorder in elderly patients than in young patients. Emergency surgery in elderly patients carries high risk. Thus, less invasive treatment by endoscopy may be advantageous. This study aimed to evaluate the efficacy of endoscopic treatment for hemorrhagic gastric ulcer in patients aged 80 or more. Methodology: A total of 269 patients underwent endoscopic hemostatic treatment for hemorrhagic gastric ulcer over a four year period. As hemostatic measures, hemoclipping and pure ethanol injection, either alone or in combination, were employed. These patients were divided into two groups: elderly (≥80 years old, n=26) and younger (

Aim: Endoscopic treatment with sclerotherapy or thermal methods has been widely used for upper gastrointestinal (UGI ) bleeding due to Mallory-Weiss syndrome (MWS). However, the potential drawback of thermal methods and the injection of sclerosing agents is that these may cause excessive tissue injury leading to necrosis and perforation. Recently, endoscopic hemoclipping was shown to be highly effective for as a hemostatic treatment for UGI bleeding. Hemoclipping causes less damage to the surrounding area than sclerotherapy or thermal methods. However, the efficacy and safety of hemoclipping for MWS bleeding has not been reported. The aim of the present study was to assess prospectively the usefulness of endoscopic hemoclipping for MWS bleeding. Methods: This prospective study was performed over a 5 year period beginning in January 1994. When patients were diagnosed with MWS by endoscopy , hemoclipping was performed for patients with active bleeding , visible vessel and/or red clots (Group H). The remaining patients with old clots and linear tears in the Esophagogastric junctional (EGJ) mucosa as the only possible origin of bleeding were conservatively treated (Group C). The clinical data and outcome of endoscopic treatment were compared between these two groups. Results: A total of 58 patients underwent emergency endoscopy for UGI bleeding due to MWS from January 1994 to August 1999. During endoscopic examination, active bleeding was found in 17 patients (29%), a visible vessel in one patient (2%) and red clots in 8 patients (14%); Hemoclipping was performed on all 26 patients. Of the remaining 32 patients, 12 patients (21%) had old clots, and 20 (34%) had linear tears without stigmata of recent hemorrhage in the EGJ; these patients did not receive hemoclipping. Significantly more patients in Group H had shock and trasfusional requirements over 800ml than in Group C [the former 4 (17%) vs 0, the latter 4 (17%) vs 0]. The mean hemoglobin level on admission was significantly lower in Group H (10.6±2.9g/dl)than in Group C (12.2±3.0g/dl). Significantly more patients in Group H had critical concomitant diseases than in Group C [14 (54%) vs 8 (25%)]. However, all patients in Group H successfully underwent endoscopic hemostasis with no rebleeding. No patients in Conservative group had rebleeding. No complications related to the endoscopic procedures and no hospital deaths were found in either group. Conclusion : Endoscopic hemoclipping provided an effective and safe modality for securing hemostasis for MWS bleeding.

症例は30歳主婦.妊娠31週から食思不振,全身倦怠感が出現し,妊娠中毒症の疑いで当院産婦人科に昭科56年2月12日に入院した.入院時GOT 497mIU, GOT 506mIU, LDH 589mIU, T. Bil 3.9mg/dl, ALP 34.4K.U, LAP3,168GR.U, PT時間37%と肝機能異常を認め,血清クレアチニン2.7mg/dl, WBC 13,000/mm3であった.2月15日に意識混濁が出現し,出血傾向,肝濁音界の縮小もみられたが,17日胎児を死産.20日頃から意識も清明となり血液学的肝機能異常も軽快した.3月4日腹腔鏡下肝生検を行った.当科初診時は妊娠性急性脂肪肝も疑ったが,生検組織像からは急性ウイルス性肝炎の所見であった.妊娠後期のウイルス性肝炎は,ときに重症化することがあるので注意を要すると思われる.

The incidence and severity of gastroesophageal reflux disease (GERD) in Japan tends to increase in elderly women. Rikkunshito (RKT), a traditional Japanese medicine, acts as a prokinetic agent and improves gastric emptying and gastric accommodation. Our previous prospective randomized placebo-controlled study showed that RKT combined with a standard-dose of rabeprazole (RPZ) significantly improved the acid-related dysmotility symptoms (ARD) in elderly patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study aimed to evaluate clinical characteristics of elderly PPI-refractory NERD patients with ARD symptoms who responded to RKT. Two hundred forty-two patients with PPI-refractory NERD were randomly assigned to 8 weeks of either RPZ (10 mg/q.d.) + RKT (7.5 g/t.i.d.) (RKT group) or RPZ + placebo (PL group). Among them, 95 were elderly (≥65 years) with ARD (RKT group: n = 52; PL group: n = 43). We analyzed the changes using the 12 subscale score of frequency scale for the symptoms of GERD (FSSG) and 15 items of the Gastrointestinal Symptom Rating Scale at 4 and 8 weeks and compared the therapeutic efficacy between the 2 groups. There were no marked differences in baseline demographic or clinical characteristics in the 2 groups except for rate of current smoking. The FSSG score (mean ± SD at 0, 4, and 8 weeks) in both the RKT (16.0 ± 7.0; 9.9 ± 8.4; 7.0 ± 6.4) and PL (15.1 ± 6.4; 10.9 ± 6.7, 11.1 ± 8.5) groups significantly decreased after treatment. However, the degree of improvement of total and ARD scores of FSSG after the 8-week treatment was significantly greater in the RKT group than in the PL group. Combination therapy with RKT for 8 weeks showed significant improvement in 3 subscale scores (abdominal bloating, heavy feeling in stomach and sick feeling after meals) of the ARD domain and 1 subscale score (heartburn after meals) of the reflux symptom domain. RKT may be useful for improving GERD symptoms in elderly PPI-refractory NERD patients with ARD. Thus, RKT was particularly effective for resolving postprandial GERD symptoms (heavy feeling in stomach, sick feeling, and heartburn after meals). ( UMIN000005880 )