One hundred and fourty four patients with non-ulcer dyspepsia (NUD), as defined by the working party of AGA in 1987, (67 men and 77 women, 16-76 years, mean age 42.9±1.2 years) and 34 asymptomatic controls (25 men and 9 women, 17-75 years, mean age 50.6±2.4 years) parameters of gastrophysiological function (gastric acid secretion, postprandial gastric emptying-acetaminophen method, serum gastrin levels and cutaneous electrogastrography (EGG)) and the prevalence of Helicobacter pylori (Hp) (histological and urease test of biopsy specimens) were investigated. Based on symptom patterns, there were 68 patients with dysmotility-like dyspepsia, 27 with ulcer-like dyspepsia, 17 with reflux-like dyspepsia, 6 with aerophagia and the 26 with nonspecific or idiopathic dyspepsia. The age distribution of NUD was predominant in the fourth decade, and the sex distribution was not significantly different. In general, hypersecretion of gastric acid and hypergastrinemia were rare in NUD patients. There was no significant difference in gastric acid secretion, basal and food stimulated serum gastrin levels and prevalence of Hp between the two groups. But 51 of 144 NUD patients (41.10) had delayed gastric emptying (p<0.05) compared to controls. Indeed gastric emptying was markedly prolonged in patients with dysmotility-like (58.1%) and reflux-like (42.9%) dyspepsia. On EGG, about a half of NUD patients showed evidence of bradygastria or tachygastria, in particular in the postprandial state, which was related to delayed gastric emptying. By chronic administration of cisapride, score of symptoms was significantly decreased and postprandial gastric emptying was significantly accelerated in delayed gastric emptying cases. We conclude that in NUD patients, in particular those with dysmotility-like dyspepsia, tests of postprandial gastric emptying and/or EGG are useful for investigation of gastric motor disorder and therapeutic effects of several prokinetic drugs clinically.
Cardiac carcinoma is defined as the carcinoma whose center of the mucosal lesion is located at the area of the stomach within 2.0cm from the esophago-gastric junction. Histological and macroscopical examination was performed concerning to the frequency of macroscopic type, the direction of the mucosal invasion, the tendency of the submucosal invasion and the esophageal invasion by using these cardiac carcinomas. The objects of this study are a hundred and thirty-nine cases of cardiac carcinomas. The conclusions are as follows: 1) Depressed type (Type IIc) in early carcinoma, Type Borrmann 2 and Borrmann 3 in advanced carcinoma are the most frequent form of macroscopic types. 2) The majority (87.7%) of the early carcinomas was situated at the lesser curvature and the posterior wall of the cardiac mucosa (Figure 1). 3) The early cardiac carcinoma had a tendency to invade in the mucosal layer along the esophago-gastric junction (Table 2). 4) The cardiac carcinoma was thought to invade into the submucosa in its early phase, comparing to the carcinoma on the other area of the stomach (Table 3). Twenty-four out of thirty-five (68.6%) cases of cardiac carcinoma ranged from 11 to 20mm in diameter invaded into the submucosa (Table 3). 5) Twelve out of seventy-three (16.4%) of early cases and fifty-seven out of sixty-six (86.4%) of advanced cases showed the infiltration into the esophagus (Table 4, Figure 6). The reliable and surgical cut-line of the oral site can be established at the area over 11mm in the distance from the oral margin of the mucosal invasion in the cases of early cardiac carcinoma, over 25mm in the cases of advanced differentiated type, and over 30mm in the cases of advanced undifferentiated type (Figure 6).
The 24-hour intragastric pH monitoring was conducted in patients with gastric ulcers treated with an H2 blocker, and the pathophysiological conditions and the treatment of intractable gastric ulcers were studied from. the aspect of degree of intragastric acidity. During the administration of a standard dose of an H2 blocker, there was no difference of intragastric acidity at night between intractable gastric ulcers and tractable gastric ulcers. However, intragastric acidity was significantly higher during the day in the intractable gastric ulcers. The pH 3 holding time rate during the day in all intractable gastric ulcer patients was less than 4500; however, in the tractable gastric ulcer patients it was more than 45% during the day. In treating intractable gastric ulcers, if combined administration of synthetic prostaglandine E2 having a suppressing action of gastric acid secretion was performed or if the drug was changed to a proton pump inhibitor, a rise in intragastric pH was observed and earlier cure was obtained. That is to say, intractable gastric ulcers are characterized by inadequate suppression of gastric acid during the day, and it is surmised that if gastric acid can be adequately suppressed not only during the night but also during the day, no matter which drug or administration method is used, it will be effective against intractable gastric ulcers.
Forty male Wistar rats were given 1% dextran sulphate sodium (M.W.: 50000) as drinking water for six months. Well-defined elevated lesions were apparent in 12 (300), showing the histological features of well differentiated adenocarcinoma. Focal atypical glands were histologically observed in 16 (40%). In vivo labeling of bromodeoxyuridine (BrdU) showed significant differences in S-phase cells among cancer (27.0±2.4%), atypical glands (20.8±5.9), regenerative mucosa (14.4±4.4) and normal mucosa (7.7±2.6), respectively (p<0.01). BrdU labeling index of the upper part of the mucosal layer was smaller than that of the lower part in atypical glands, regenerative mucosa or normal mucosa, but they were similar in cancer. DNA aneuploidy was not detected either in cancer or in regenerative mucosa by flow cytometry. Ames test proved the low mutagenetic potency of 1% DSS (Ames ratio, 2.1). In this experiment, colonic carcinoma seems to orginate from mucosal inflammation itself.
We assessed a clinical usefulness of JSCC (Japan Society of Clinical Chemistry) recommended method for the measurement of serum alkaline phosphatase. The recommended method is completely correlated both in the liver-bone and intestine isoenzymes with Kind King method recommended by the expert panel of liver function tests in Japanese Society of Gastroenterology. On the other hand, mixed tests of liver-bone and intestine isoenzyme completely show the full recovery at any combinations of both enzymes using indoxylphosphate isoenzyme staining method. These results indicated that the quantitative analysis of blood alkaline phosphatase is possible employing the combination of JSCC recommended and indoxylphosphate staining methods. Employing these combinations, we could effectively assess the pathophysiological significance of intestine alkaline phosphatase appeared in liver cirrhosis and portal hypertension.
The point mutation of K-ras gene at colon 12 was investigated in 11 cases of gall bladder carcinoma, 10 cases of extrahepatic bile duct carcinoma, 2 cases of intrahepatic bile duct carcinoma, and 4 cases of ampullary carcinoma by modified two-step polymerase chain reaction which employed paraffin embedded materials. The results revealed that there were point mutations in 6/11, 10/10, 2/2, and 4/4, respectively. Judging from the ratio of density of wild and mutant band, not all cancer cells in the tissue section contained the mutation. So it was suggested that the normal cells were initiated for the malignant transformation by ras gene mutations and then, selection might occur against cells containing ras mutationsduring progression of the tumor. Modified two-step polymerase chain reaction was markedly useful for detecting mutation even at low frequency among tumor cells.