We studied the complications of gastric mass screening by indirect fluororadiography. During a period of 5 years, from 1998 to 2002, when we started to use a high-density, low-viscosity barium sulfate suspension in indirect fluororadiography, 1,012,976 participants were examined. Of 118 cases with complications, 100 had aspiration of barium sulfate (0.0099%, 3 admission), 4 had ileus, 8 had nausea / vomiting, 4 had constipation, one had dizziness and one had excoriation of the upper arm. The critically severe complications were barium sulfate aspiration and ileus. Elderly men and persons with recurrent disease, impaired intellect, post-laryngectomy, post-cerebral infarction and Parkinsonism were at high risk for barium sulfate aspiration. These high-risk groups should be referred to endoscopic examination rather than fluororadiography. Ileus was a critical complication, because three of four cases had perforation and peritonitis. Elderly women were at high risk for ileus or perforation. Gastric cancer screening by fluororadiography was regarded as contraindicated for participants who had past histories of ileus or limited water intake. It is therefore necessary to carefully record the clinical history and to teach participants to drink plenty of water after the examination. Anaphylactic and allergic reactions did not increase with the use of high-density barium sulfate suspension. With the increase in the number of elderly participants in mass screenings, careful interviews, informed consent regarding the merits and demerits of screening, an introduction to opportunistic screening, including endoscopic examination, and the limitation of the eligibility of participants may be necessary

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We investigated the association between quality of the mass screening and the cancer detection rates for the 18 medical facilities providing gastric cancer screening in Fukuoka prefecture, Japan. Data from The Gastric Mass Survey Committee of Fukuoka Area were analyzed by the weighted linear regression. For each medical facility conducting mass screening, the individuals screened from 1987 to 2003 were divided into the regional group who received the mass screening for the general population over 40 years without employees and the occupational group who received the mass screening for the employees at the analyses. The analyses were also conducted as the combined group by adding the regional and occupational groups. If the number of recipients screened belonging to the group was too few, the group in the medical facility was excluded from the analyses. Total number of persons analyzed was 732, 589 for the regional group, 1,110, 865 for the occupational group, and 1,988, 444 for the combined group. The average number of persons per medical facility was 110, 469 for the combined group, 73, 259 for the regional group and 69, 429 for the occupational group. The multiple regression analysis indicated that the cancer detection rates statistically significantly associated with the follow-up rate of screening abnormalities after adjusting for the probable uptake rate of the screening abnormalities and the positive predictive value. It is estimated that the improvement of the follow-up rates of screening abnormalities greatly contributes to the cancer detection rates. This study suggests that the establishment of the socio-political systems to improve the follow-up rate of screening abnormalities is important and should be urgently promoted in Japan.

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We studied the results of a screening for stomach cancer conducted in Maebashi City from 1998 to 2003. Elderly people, 65 years of age or older, accounted for 50% of the total examinees, and the increase in the number of people 75 years of age or older was remarkable. The male examinees increased more rapidly in number than the female. The rate of individuals required to undergo further examinations increased with age, but the probability of cancer detection rose even higher, and so the positive predictive value became high with age. The probability of early cancer detection was higher in women than in men.
In the future, society will age, and the improvement of early cancer detection methods is crucial.
We expect that early cancer detection will be improved by the new radiography method which uses high-concentration, low-viscosity barium.
We look forward to the introduction of endoscopic submucosal dissection in many hospitals.

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We studied the characteristics of gastroesophageal reflux disease (GERD) as discovered by a mass survey which lasted from November 2004 to September 2005. The subjects were 691 persons, each of whom underwent a medical examination by upper-gastrointestinal endoscopy at our medical examination center. There were 526 male and 165 female subjects, and their average age was 52.6 years. The incidence of reflux esophagitis and NERD was 12.2% and 10.4%, respectively.
Using multivariable analysis, we investigated the factors which affect the onset of GERD. Young age (odds ratio: 0.40, 95% C. I.: 0.17-0.81, p<.05), female gender (odds ratio: 0.61, 95% C. I.: 0. 17-0.84, p<.05) and smoking (odds ratio: 1.95, 95% C. I.: 1.15-4.99, p<.05) were the risk factors of NERD. On the other hand, the risk factors of reflux esophagitis were esophageal hiatal hernia (odds ratio: 12.38, 95% C. I.: 6.41-21.0, p<.01), slight atrophy of the gastric mucosa (odds ratio: 0.14, 95% C. I.: 0.04-0.29, p<.01), male gender (odds ratio: 4.85, 95% C. I.: 1.17-7.97, p<.02) and obesity (odds ratio: 2.45, 95% C. I.: 1.01-3.44, p<.05). Because obesity and smoking were associated with the onset of reflux esophagitis and NERD, respectively, we concluded that GERD is one of the lifestyle-related diseases. It was suggested that the modification or eradication of certain habits might lead to the prevention of GERD.

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In recent years, fatty liver has not been considered to be a benign disease, but a progressive disease. We aimed to determine the clinical significance of end-stage fatty liver through an investigation of contributing factors. NAFLD patients were divided into normals (400 cases) and abnormals (288 cases) based on liver function results. For the abnormal group, a univariate analysis revealed that they were young, predominantly male, had significantly high BMI, systolic blood pressure, fasting blood glucose level and HbA1c. A multivariate analysis revealed that being male and young, and having a high fasting blood glucose level were significant risk factors. In a comparison between males and females, a multivariate analysis revealed that for males, being young, having a high BMI and fasting blood glucose level were significant risk factors, whereas for females, only high systolic blood pressure was considered to be a significant risk. The results suggest that liver impairment in NAFLD patients is not related to the ageing process, and that for females other factors may be involved.

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The accuracy of stomach examinations, including biopsies, is an important issue for the standardization of gastric endoscopy. In this study, we evaluated the endoscopic examinations of the stomach performed mainly within the framework of comprehensive medical examinations, and compared the accuracy of examinations conducted by physicians with different years of experience in interpreting endoscopic images, using data obtained during the past 3 years at our center. The cancer detection rate was 0.18%, and the percentage of early cancer was 89.9%. These percentages were higher than those for radiography. Half of the early cancer cases (49.2%) were detected during annual health check-ups, indicating the importance of annual examinations for the detection of early cancer. Radical endoscopic treatment was possible in 46.4% of the gastric cancers detected, suggesting that a high quality of life (QOL) was attained. For the physicians with many years of experience in interpreting endoscopic images, the biopsy rate was low, and the cancer detection rate and the accuracy of positive diagnosis were high. To prevent the occurrence of accidental health problems due to the examination procedure, unnecessary biopsy, complications due to biopsy, or false negatives, endoscopic examinations should be performed by physicians with many years of experience in interpreting endoscopic images.

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