Comparison of endoscopic findings with symptom assessment systems (FSSG and QUEST) for gastroesophageal reflux disease in Japanese centres.

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.

[Assessment on effects of tongjiang granule on experimental reflux esophagitis in rats].

OBJECTIVE: To study the effects of tongjiang granule (TJG) on reflux esophagitis (RE) in rats. METHODS: Two rat models of RE were established respectively by cardioplasty + pyloric ligation + Roux-en-Y gastro-jejunum anastomosis and by placed a fixed steel ring into the gastric cardia, and the model rats were treated with various dosages of TJG or cisapride by gastric perfusion. RESULTS: Rat models were established successfully by both methods. The score of pathological changes of esophagus mucosa in the model rats, made by either method, after high-dosage TJG treatment was lower than that in the model rats (P < 0.05), but equal to that in the cisapride treated model rats. High and moderate dosages of TJG were shown by transmission electron microscope to have effects of alleviating heckle cells and inflammatory reaction. They could reduce the level of gastric acid, more significant in high and moderate dosage groups (P < 0.05), while cisapride couldn't. CONCLUSION: TJG is effective in treating experimental RE in rats to a certain extent.

[Intravenous treatment with quamatel in reflux-esophagus and erosive gastritis]. / Intravenozno lechenie s quamatel pri reflux-ezofagit i eroziven gastrit.

Organism's good tolerance toward Ranitidin and Famotidin makes possible an application of doses higher than the ones put into everyday practice. This is a very favorable circumstance considering the fact that according to some authors the decreasing of acidity in oesophagus apparently depends on the applied dose of the medicine. Thus the treatment with famotidin 2 x 40 mg allows an additional decreasing of acidity in lower oesophagus. We investigate the effect of intravenous application of famotidin (quamatel) in dose 2 x 20 mg and 2 x 40 mg as monotherapy in cases of reflux-oesophagitis and erosive gastritis as well as organism's tolerance toward it. There are 23 patients studied--17 men and 6 women, between 18 and 70 years old. The diagnoses are: reflux-oesophagitis--23, chronic erosive gastritis and reflux-oesophagitis--8. The patients are selected according to clinical criteria--scalding and/or pain in the oesophagus accompanied with acidity in the mouth cavity. The diagnoses are put gastoscopically. The results of the intravenous applying of quamatel are accounted in reference to the clinical complaints (scalding and/or pain in the oesophagus, acidity in mouth cavity) as well as to the endoscopic and histologic changes in the oesophagus and stomach mucosa. In patients with chronic erosive oesophagitis the efficiency of treatment was confirmed with complete epithelization of the erosions in 22 of 23. The short-period use of large doses 2 x 40 mg quickly improves the clinic symptoms and decreases the period of epithelization twice. The clinic experience shows that the intravenous form of quamatel remains the most effective in cases of short-term and intensive therapy of erosive gastritis with accomplicated hard and emergency clinical cases when the aim is to be avoided the peroral application of anti-ulcer means. An important advantage of the intravenous treatment with quamatel is its low price.

Assessment of oesophagitis by histology and morphometry.

Morphometric measurements of nuclear area, nuclear concentration and nucleolar dimensions in defined tissue zones of orientated oesophageal biopsy sections were compared between three patient groups--asymptomatic/normal endoscopy (n = 8); symptomatic reflux/normal endoscopy (n = 17); and symptomatic/endoscopic oesophagitis (n = 15). No significant differences could be shown for any mean parameter between clinical groups. In a further group of 16 patients, identical morphometric measurements were made in non-orientated grasp biopsies and correlated with prolonged ambulatory pH data. No significant correlations could be shown between nuclear parameters and acid reflux measurements. These results suggest that morphometric measurement cannot be recommended as a diagnostic tool in the diagnosis of oesophagitis, although it may be useful in the assessment of individual therapeutic response in clinical trials.

A comparative assessment of tube esophagography with double-contrast esophagography in the detection of reflux esophagitis.

We undertook a prospective study comparing the sensitivities of double-contrast and tube esophagography in 34 patients with gastroesophageal reflux and compared our findings with those at endoscopy. Neither test detected changes accurately in mild inflammation; however, they both became more sensitive as the severity of esophagitis increased. The sensitivity of both tests increased from 0% in grade 2 to 86% in grade 4 esophagitis. The tube esophagogram demonstrated inflammatory changes better than the double-contrast esophagogram in only 18% of the 34 patients, all with grade 3 or 4 esophagitis, despite the elimination of the barium pool in the distal esophagus and improved distension of the esophagogastric junction. Endoscopy is still the most reliable means of diagnosing and grading esophagitis.

Morphometric assessment of reflux oesophagitis in fibreoptic biopsy specimens.

The oesophageal epithelium of patients with reflux oesophagitis has been studied by means of computer aided morphometry. Measurements of histological features were made on biopsies from six cases before and after treatment. The size and elongation of the nuclei and their variation, the number of nuclei per unit length or per unit sectioned area, and the size and number of nucleoli per nucleus were measured for two zones of the epithelium, the base layer and the intermediate layer, which were independent of section orientation. The measurements were analysed using discriminant analysis. Significant discrimination was found between the two groups. The most important parameters were the number of intermediate layer nuclei per sectioned square millimetre, the mean intermediate layer nuclear area, and the number of nuclei per millimetre of base epithelium. These parameters are consistent with increased cell turnover of the non-ulcerated epithelium before treatment.

Preoperative assessment of esophageal pathology.

Panmural esophagitis results in esophageal thickening and shortening and prevents adequate reduction of a hernia. Twenty patients with panmural esophagitis, treated by Belsey repair, have been followed up for more than 5 years; 9 of them remain asymptomatic and 11 have symptomatic reflux, 7 of whom have required further surgery. Belsey also has reported a 45 per cent recurrence rate in patients with this type of disease. Preoperative recognition of panmural esophagitis allows a planned surgical approach and the use of a surgical technique designed for the management of an irreducible hernia. The ability to predict these changes was studied in 124 patients, who were evaluated by history, radiology, endoscopy, and manometry prior to transthoracic hernia repair. The esophagus was inspected at operation to determine the presence of panmural changes. History was of no value in assessment. Radiologically, a large and irreducible hernia was associated with panmural changes, but these changes also occurred in the absence of ulceration. Manometric studies allowed accurate prediction of mural changes. Over 90 per cent of patients with panmural esophagitis have more than 40 per cent disordered motor activity (DMA) in the distal part of the esophagus, and 75 per cent of such patients have more than 60 per cent DMA. Combining these investigative data allowed the accurate prediction of panmural changes in 90 per cent of the 124 patients.