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Motoyasu Kusano,
Fumitaka Moki,
Hiroko Hosaka,
Yasuyuki Shimoyama,
Osamu Kawamura,
Atsuto Nagoshi, Masaki Maeda,
Shikou Kuribayashi,
Hiroaki Zai,
Masafumi Mizuide,
Tsutomu Horikoshi,
Masatomo Mori,
Masako Akuzawa
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ABSTRACT: Gastroptosis is recognized by its characteristic appearance on barium studies. The present prospective study assessed the relationship between gastroptosis and dyspeptic symptoms.
Japanese subjects underwent health screening, and gastroptosis was diagnosed by barium studies. Consecutive subjects (500 women and 167 men) with gastroptosis were identified and the same number of age-matched subjects without gastroptosis were selected as controls. Dyspepsia was classified as reflux-like (heartburn and belching), dysmotility-like (bloating and fullness), or ulcer-like dyspepsia (epigastralgia) based on the Rome II criteria.
Body mass index was significantly lower in women with gastroptosis than in controls [19.7 ± 1.83 (SD) vs. 23.4 ± 3.70, p<0.0001], and also in men (19.7 ± 2.00 vs. 23.9 ± 2.89, p<0.0001). The incidence of dyspepsia was significantly lower in women with gastroptosis than in controls (56/500 vs. 87/500, p<0.01) and also in men (10/167 vs. 25/167, p<0.05), especially in women with ulcer-like dyspepsia (15/500 vs. 32/500, p<0.05) and in men with reflux-like dyspepsia (2/167 vs. 12/167, p<0.05). By logistic regression analysis, gastroptosis was associated with a lower risk of dyspepsia (odds ratio: 0.62, 95% CI: 0.405-0.941, p=0.025) and ulcer-like dyspepsia (odds ratio: 0.36, 95% CI: 0.177-0.726, p=0.004) in women.
Dyspeptic symptoms were significantly less common in subjects with gastroptosis. Accordingly, gastroptosis may protect against dyspeptic symptoms, rather than causing functional dyspepsia.
Internal Medicine 01/2011; 50(7):667-71. · 0.94 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 10/2010; 107(10):1592-603.
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ABSTRACT: Functional dyspepsia is a clinical syndrome that features abdominal symptoms centered in the upper abdomen without an organic basis. Three possible mechanisms of gastric dysfunction could be related to functional dyspepsia: 1) delayed gastric emptying, 2) impaired gastric accommodation to food intake, and 3) hypersensitivity to gastric distention. Delayed gastric emptying has been suggested to lead to prolonged antral distension that causes dyspeptic symptoms. Delayed gastric emptying is therefore a focal point of debate about anorexia caused by dyspepsia, and prokinetic agents are often administered in Japan for its treatment. Recently, we found that addition of monosodium L-glutamate (MSG) to a high-energy liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method to improve delayed gastric emptying could be enhancement of chemosensors that activate the autonomic nervous system innervating the gastrointestinal tract. In conclusion, enrichment with glutamate promoted gastric emptying after intake of a high-protein meal, suggesting that free glutamate is important for protein digestion and that MSG may be helpful for management of delayed gastric emptying in patients with functional dyspepsia.
Journal of Pharmacological Sciences 01/2010; 112(1):33-6. · 2.08 Impact Factor
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ABSTRACT: Free glutamate activates taste receptors on nerves in the oral cavity to elicit a unique taste known as umami. Recently, umami taste receptors were also found in the gastric mucosa. Although reports suggest that mucosal receptors may respond to free glutamate to modulate gastric function, no evidence of any effect on gastric emptying has been documented.
We hypothesized that glutamate may act as a modulator of gastric function. We studied the effects of L-glutamate enrichment of a protein-rich liquid meal, and similar enrichment of an equicaloric carbohydrate meal or noncaloric water, on gastric emptying.
Ten healthy men were enrolled. Nine of the 10 subjects included in the study ingested all test meals with and without monosodium L-glutamate (MSG), and the remaining subject ingested only the protein-rich meals with and without MSG. All experimental and control liquid meals included [1-(13)C]sodium acetate as a tracer. After a test meal or water was ingested, (13)C breath tests were performed to estimate gastric emptying.
MSG enrichment not only resulted in a significant decrease in the mathematically simulated half-excretion (emptying) time of a protein-rich meal, but also increased the area under the curve (%dose/h) significantly. In contrast, MSG had no significant effect on the gastric emptying of a carbohydrate meal or a noncaloric water meal.
Enrichment with MSG facilitated gastric emptying of a protein-rich meal exclusively, which suggests that free glutamate is important for protein digestion and may be helpful in the management of delayed gastric emptying.
American Journal of Clinical Nutrition 01/2009; 89(1):431-5. · 6.67 Impact Factor
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Motoyasu Kusano,
Yasuyuki Shimoyama,
Osamu Kawamura, Masaki Maeda,
Shikou Kuribayashi,
Atsuto Nagoshi,
Hiroaki Zai,
Fumitaka Moki,
Tsutomu Horikoshi,
Munetoshi Toki,
Sayaka Sugimoto,
Masatomo Mori
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ABSTRACT: It has been reported that proton pump inhibitors are more effective than H2 receptor antagonists in patients with functional dyspepsia. Dyspeptic symptoms that respond to proton pump inhibitors are classified as acid-related dyspepsia. A new questionnaire for assessing gastroesophageal reflux disease (GERD), the Frequency Scale for Symptoms of GERD, covers the 12 most common symptoms of GERD patients. A quantitative assessment of the changes of reflux symptoms and acid-related dyspepsia was made in GERD patients receiving proton pump inhibitor therapy. Sixty-eight GERD patients receiving proton pump inhibitor therapy completed the questionnaire before and after treatment for 8 weeks. There is a significant positive correlation between reflux symptoms and acid-related dyspepsia before and after therapy (r = 0.569 and r = 0.569; both P's < 0.001) and acid-related dyspepsia in patients with both nonerosive and erosive GERD. We conclude that GERD patients suffer not only from reflux symptoms, but also from acid-related dyspepsia, and proton pump inhibitors improve both types of symptoms.
Digestive Diseases and Sciences 08/2007; 52(7):1673-7. · 2.12 Impact Factor
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ABSTRACT: The effects of postprandial water intake on the gastrointestinal tract have not been systematically investigated in humans.
In 8 healthy volunteers, the gastric antral pressure was measured with a strain gauge transducer, while the esophageal and lower esophageal sphincter pressures were measured with an infused catheter with a Dent sleeve. The esophageal pH at 5 cm above the lower sphincter was measured with a microglass electrode. A standard test meal (560 kcal) was eaten and 500 ml water was ingested 1 h later. The plasma cholecystokinin level was assessed at 4-min intervals. As a control, the same study was done on another day with sham water intake.
At 4 min after water intake, there was a significant decrease in gastric antral motility and a significant increase in the plasma cholecystokinin level. Water intake also significantly increased the occurrence of gastroesophageal reflux.
The rapid increase in cholecystokinin after water intake may be initiated by a feedback mechanism related to inflow of fatty chyme into the duodenum that inhibits gastric antral activity.
Scandinavian Journal of Gastroenterology 11/2005; 40(10):1176-81. · 2.02 Impact Factor
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ABSTRACT: We compared the epidemiology of Barrett's esophagus in Japan and the West. Japan GERD Society Study Committee conducted the epidemiological survey in 2,595 patients who underwent endoscopy the first time, confirming that Barrett's mucosa was observed in 536 patients (20.8%) out of 2,577. But Barrett's esophagus (>3 cm of columnar lined epithelium) was detected only 5 (0.2%). The prevalence of typical Barrett's esophagus was markedly low in Japanese compared with Westerners. In Western, the incidence of Barrett's esophagus has increased markedly since the 1970s. It is estimated that Barrett's esophagus is found in approximately 6-12% of patients undergoing endoscopy for symptoms of GERD and in 1% or less of unselected patient populations undergoing endoscopy.
Nippon rinsho. Japanese journal of clinical medicine 08/2005; 63(8):1333-9.
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Yasuyuki Shimoyama,
Motoyasu Kusano,
Sayaka Sugimoto,
Osamu Kawamura, Masaki Maeda,
Keiko Minashi,
Shikou Kuribayashi,
Tatsuya Higuchi,
Hiroaki Zai,
Kyoko Ino,
Tsutomu Horikoshi,
Fumitaka Moki,
Tadashi Sugiyama,
Munetoshi Toki,
Tsuneo Ohwada,
Masatomo Mori
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ABSTRACT: 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%.
Journal of Gastroenterology and Hepatology 05/2005; 20(4):643-7. · 2.87 Impact Factor
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ABSTRACT: A 24-year-old woman was admitted to our department for further examination of hypercalcemia, a high level of intact parathyroid hormone (PTH) and a right parathyroid tumor. She complained of bone pain throughout her body and was unable to walk due to systemic cystic osteofibrosis, including a brown tumor of the left lower extremities. Neck ultrasonography (US) and magnetic resonance imaging (MRI) revealed a tumor 2 cm in diameter in the upper side of the right thyroid lobe. 99mTc sestamibi (99mTc-MIBI) imaging and F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) were performed to diagnose primary hyperparathyroidism and examination of other parathyroid glands. However, neither imaging modality detected the parathyroid tumor. To confirm the diagnosis, we performed selective venous sampling around the parathyroid and the patient was diagnosed with primary hyperparathyroidism due to a right parathyroid tumor. Resection of the right parathyroid tumor was performed and the pathological diagnosis was parathyroid adenoma. To date, both 99mTc-MIBI and FDG-PET are useful to localize parathyroid tumors. In this case, however, neither modality detected the tumor. Although recent studies state that expression of P-glycoprotein (P-gp) in parathyroid tumors plays an important role in the false-negative results of both 99mTc-MIBI scans and FDG-PET, immunohistological study detected no P-gp expression in the parathyroid tumor in the current case.
Internal Medicine 10/2004; 43(9):816-23. · 0.94 Impact Factor
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Motoyasu Kusano,
Yasuyuki Shimoyama,
Sayaka Sugimoto,
Osamu Kawamura, Masaki Maeda,
Keiko Minashi,
Shiko Kuribayashi,
Tatsuya Higuchi,
Hiroaki Zai,
Kyoko Ino,
Tsutomu Horikoshi,
Tadashi Sugiyama,
Munetoshi Toki,
Tsuneo Ohwada,
Masatomo Mori
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ABSTRACT: The aim of this study was to produce a simplified questionnaire for evaluation of the symptoms of gastroesophageal reflux disease (GERD).
A total of 124 patients with an endoscopic diagnosis of GERD completed a 50-part questionnaire, requiring only "yes" or "no" answers, that covered various symptoms related to the upper gastrointestinal tract, as well as psychosomatic symptoms. The 12 questions to which patients most often answered "yes" were selected, and were assigned scores (never = 0; occasionally = 1; sometimes = 2; often = 3; and always = 4) to produce a frequency scale for symptoms of GERD (FSSG). Sensitivity, specificity, and accuracy of the FSSG questionnaire were evaluated in another group of patients with GERD and non-GERD. The usefulness of this questionnaire was evaluated in 26 other GERD patients who were treated with proton pump inhibitors for 8 weeks.
When the cutoff score was set at 8 points, the FSSG showed a sensitivity of 62%, a specificity of 59%, and an accuracy of 60%, whereas a cutoff score of 10 points altered these values to 55%, 69%, and 63%. The score obtained using the questionnaire correlated well with the extent of endoscopic improvement in patients with mild or severe GERD.
This new questionnaire is useful for the objective evaluation of symptoms in GERD patients.
Journal of Gastroenterology 10/2004; 39(9):888-91. · 4.16 Impact Factor
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ABSTRACT: It should be considered that the causes of refractory gastroesophageal reflux disease (GERD) are multifactorial. Esophageal manometry study is useful when we make distinguish patients with esophageal motility disorders from those with refractory GERD. Endoscopic ultrasonography is also performed to observe the thickness of esophageal wall which represents the disturbance of esophageal motor function. Esophageal pH monitoring is useful to detect the acid clearance disturbance and phenomenon of nocturnal acid breakthrough. Both are occurred at night, and are recently considered to be responsible for refractory GERD. Catheter-free pH monitoring system, Bravo, makes it possible to measure esophageal pH under quite physiological conditions. Genotype of CYP2C19 is sometimes checked in patients with PPI resistance GERD. Intra-gastric pH with omeprazole and lansoprazole depends on patient's genotype of CYP2C19. Monitoring of 24-hour bilirubin, Bilitec, is also useful to detect duodeno-gastro-esophageal reflux.
Nippon rinsho. Japanese journal of clinical medicine 09/2004; 62(8):1475-82.
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Motoyasu Kusano,
Sayaka Sugimoto,
Osamu Kawamura,
Keiko Minashi, Masaki Maeda,
Yasuyuki Shimoyama,
Kyoko Ino,
Naoko Mimura,
Tatsuya Higuchi,
Yoichi Kon,
Kazuma Kikuchi,
Tohko Shirota,
Masahumi Mizuide,
Naoko Oshimoto,
Munetoshi Toki,
Tsuneo Ohwada,
Masatomo Mori
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ABSTRACT: Background: 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.Methods: 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.Results: Changing the definition of grade B or grade D did not increase the kappa values for either group of observers.Conclusions: These modifications of the Los Angeles classification were unable to decrease observer variation.
Digestive Endoscopy 12/2003; 16(1):9 - 11. · 1.19 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 10/2003; 100(9):1095-105.
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ABSTRACT: The cag pathogenicity island genes of Helicobacter pylori (ie, cag1, cag5, cagT, cagE, and cagA) were detected by PCR in DNA extracted from endoscopically collected gastric juice, and the relationship between these genes and gastric disease was studied in 25 patients with early gastric cancer, 9 patients with gastric ulcer, and 15 patients with chronic active gastritis. In three patients with early gastric cancer and one patient with gastric ulcer, cag pathogenicity island genes were amplified although H. pylori was not detected by conventional methods. Compared with conventional methods, the sensitivity of detection of cag genes was 92.3% (36/39) and the specificity was 60% (6/10). Among the patients with cagA amplification, only cagE was not amplified in one case each with early cancer and chronic active gastritis. In addition, none of cag1, cag5, cagT, and cagE were amplified in spite of cagA amplification in one patient with gastric ulcer. This method is a simple procedure, has a high sensitivity, and appears to be useful for accurate assessment of infection with cagA-positive strains. Because deletion of cag PAI genes was found in the patients with all three gastric diseases that we studied, it was suggested that the pathogenicity of H. pylori might not be determined by cag PAI genes in those cases.
Digestive Diseases and Sciences 02/2003; 48(1):47-53. · 2.12 Impact Factor
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Gastroenterology 01/2003; 124(4). · 11.68 Impact Factor
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ABSTRACT: We investigated whether esophageal tone was altered by fluid infusion before the onset of esophageal contraction. In nine healthy volunteers, intraluminal esophageal pressure and esophageal pH were measured with a three-channel solid-state transducer and microglass electrodes, respectively. Saline or 0.1 N hydrochloric acid was infused at 0.25 ml/sec 5 cm above the lower esophageal sphincter. The effect of atropine (80 microg/kg, intravenously) was also studied. Infusion of either saline or hydrochloric acid suddenly increased the midesophageal intraluminal pressure (8.2-8.4 mm Hg) and decreased the pressure more distally (8.0-8.5 mm Hg) with a latency of 23 sec. There were no significant differences between the effects of saline and hydrochloric acid. Atropine significantly (P < 0.05) lessened the midesophageal increase in pressure, but only slightly inhibited the distal decrease. Atropine did not alter the latency. Esophageal tone was altered by slow fluid infusion. This previously unknown physiological response may be a mechanism for storing liquid in the esophageal body until the start of contractions for clearance.
Digestive Diseases and Sciences 02/2002; 47(2):251-5. · 2.12 Impact Factor
