Abstract
1. The distensibility of the gastric wall was evaluated from both sides, serosa and mucosa, using a intragastric pressure stabilizer. Greater curvature of the f ornix, anterior wall of the upper body and greater curvature of the prepyloric region showed the higher distensibility than other parts, and there-fore named as "endoscopic over-distended areas." Distention of these areas results in the exaggeration of atrophic changes endoscopically which is confirmed by the comparison of endoscopic view and histological findings. A parts of them is well known as "liver area." 2. The correlation between intragastric pressure and the mucosal features of the upper part of the stomach was investigated by the use of controlled gastric insufflation. In 20 cases of almost normal and / or slight atrophic gastritis as histologically diagnosed, at minimal pressures, the gastiric rugae were tortuous, and the anterior and posterior wall at the gastric cardia started undergoing distention. On raising the pressure, the fornix became gradually more distended, and the esophagogastric junction (EGJ) began to dilate at pressure of 11mmHg. The branching of blood vessels was more obvious at 13 mmHg, and the liver area as described by Palmer took on a green appearance at 15mmHg. At maximal pressres, 21mmHg, the distention of the upper part of the stomach became complete and EGJ underwent maximal opening. Then, the opening of EGJ will be 22mmHg in diameter, and the junction can be clearly identified. From these dynamic observation, mucosal changes of the upper part of the stomach and the function of the cardia can be easily diagnosed by the difference from these normal findings. 3. The diagnostic evaluation of the gastric mucosa, especially in cases of atrophic gastritis, giant rugae and intestinal metaplasia of the stomach, should be done in relation to the distention of the gastric wall by air insufflation. A pressure stabilizer was designed to control intragastric pressure and was connected to a gastroscope. This is a portable, and compact unit with a pressure gauge with controls reom 5 to 30 cmH 20. The results showed the accuracy of coorresponding intragastric pressures indicated by the stabilizer. The resistance of the insufflation channel on the FGS-BL was negligible. Clinical application was simple and this was useful in the diagnosis of atrophic gastritis and giant rugae. 4. The mucosa of the upper part of the stomach was investigated from the part of acid producing f untion. For that purpose, the patterns of gastric acid production was observed endoscopically by the discoloring reaction of congored and biopsy. For the sake of convenience, we have taken the liberty of calling the cardiac staining pattern which is similar to that of the pylorus "the cardiac border." The cardiac border can be classified into 4 types (I-IV), that is, type 1: Those restricted to EGJ with an irregular shaped red zone surrounded by the black colored zone. Type II: Those extending further into the upper body and fornix than type I. Type III: This case shows an increased spreading of the red zone surroundings of the EGJ. Type IV: Those showing an extensive spreading of the red red zone to include the greater curvature of the fornix. Therefore, the black colored zone is either restricted to the greater curvature of the body or not observed. And they were closely related with pyloric atrophic patterns. Histologically, the black colored zone was composed of fundic glands and normal gastric mucosa, and the red zone was composed of both cardiac and f undic glands. Fundic glands in the red zone showed a decrease in glandular activity or severe atrophic and inflammatory changes. We must take care of the fact that this cardiac border does not means the boundary of the fundic glands and cardiac glands. This theref oro have to be regard as the border between atrophic and non-atrophic zone within the f undic gland in the upper part of the stomach. 5. 59 cases diagnosed as esophage
