Clinicopathological features of gastric cancer detected by endoscopy as part of annual health checkup.

BACKGROUND AND AIM: Upper gastrointestinal endoscopy is generally accepted as the gold standard for the clinical evaluation of gastric cancer (GC). However, the efficacy of endoscopic screening for asymptomatic GC remains controversial. The present study is designed to clarify the efficacy of endoscopic screening for the detection of early GC by investigating the clinicopathological features. METHODS: A total of 17 522 patients who had underwent endoscopic screening as a part of their annual health checkup at the Seirei Center for Health Promotion and Preventive Medicine between April 2002 and March 2006 were enrolled in this study. We investigated the clinicopathological findings of GC detected by endoscopy. Furthermore, in accordance with the screening interval at our center, patients with GC were categorized into two groups: group A, patients with repeated endoscopic screening within the last 2 years, and group B, patients without endoscopic screening within the last 2 years. RESULTS: Thirty-nine GC (mean age of patients: 62.2 +/- 8.0 years, 36 males and three females) were detected in total (0.22%). The proportion of early GC was 87.2%. Notable differences between groups A and B were not found in the rate of early GC (P = 0.6342). However, eight of 27 cases (29.6%) in group A were treated by endoscopic resection, but none in group B (P = 0.0344). In six of 26 cases (23.1%) in group A, the recorded images from the previous endoscopic examination indicated some macroscopic abnormalities at the same location, suggesting GC or premalignant lesions. CONCLUSION: Endoscopic screening is useful for detecting GC at the early stages, and repeated examinations at short-time intervals contribute to the detection of resectable lesions by endoscopy. Further studies are needed to decrease the false negative rate of endoscopic screening.

Involvement of Helicobacter pylori infection and impaired glucose metabolism in the increase of brachial-ankle pulse wave velocity.

BACKGROUND: The role of Helicobacter pylori in the pathogenesis of atherosclerosis remains controversial. The present study was designed to elucidate the pathogenic role of H. pylori in the early stages of atherosclerosis by measurement of brachial-ankle pulse wave velocity (baPWV) in relation to glucose metabolism. MATERIALS AND METHODS: baPWV level, anti-H. pylori antibody, fasting blood glucose (FBG), and glycosylated hemoglobin A1c (HbA1c) and other conventional risk factors for cardiovascular diseases were measured in 947 subjects who attended their annual medical check-up. RESULTS: Multiple regression analyses indicated that age, gender (male), body mass index, FBG, systolic blood pressure, and smoking habits were each independently related to baPWV values. In younger subjects (30-49 years), H. pylori seropositivity was significantly correlated with an increase of baPWV levels (r = 0.100, p = .0445). baPWV values in the H. pylori-positive subjects with impaired glucose metabolism (IG: FBG >or= 110 mg/dL and/or HbA1c >or= 5.9%) were significantly greater than those in the H. pylori-negative subjects with IG (p = .0078). Furthermore, H. pylori-positive subjects with IG were at higher risk for increase of baPWV, in younger (r = 0.203, p < .0001) as well as in older subjects (50-69 years, r = 0.099, p = .0009). CONCLUSIONS: These results suggest that H. pylori seropositivity is a potential risk factor for increased baPWV levels, and that H. pylori infection accelerates the effect of IG on an increase of baPWV, especially in younger subjects. Thus, the possible interaction between H. pylori infection and IG may contribute to the early development of atherosclerosis.

Duodenal ulcer and pancreatitis associated with pancreatic arteriovenous malformation.

Arteriovenous malformation (AVM) of the pancreas is a rare condition that may cause severe gastrointestinal bleeding. We describe a 54-year-old man with a 7-year history of recurrent duodenal ulcer due to AVM in the pancreatic head. We recommended pancreatoduodenectomy because of recurrent haemorrhage from the duodenal ulcer, but the patient refused surgery on several occasions. He was admitted to our hospital complaining of severe upper abdominal pain radiating to the back and was diagnosed with acute pancreatitis. He agreed at that stage to the surgical treatment. The resected specimen contained a highly vascular malformation in the pancreatic head and ulceration in the adjacent descending duodenum. Histopathological examination revealed numerous vascular structures with dilated and tortuous vessels in the pancreatic head, confirming the presence of AVM. Moreover, oedema, inflammatory cell infiltration, haemorrhage and necrosis were evident, confirming the presence of acute pancreatitis.