Intragastric acidity during the first day following administration of low-dose proton pump inhibitors: a randomized crossover study.

OBJECTIVE: Low-dose proton pump inhibitors (PPIs) are often administrated as maintenance therapy for gastroesophageal reflux disease (GERD) and on-demand PPI therapy is a viable option for long-term management of GERD. The aim of this study is to investigate intragastric acidity during the first day following the administration of low-dose PPIs. SUBJECTS AND METHODS: The study employed a crossover design. The subjects were 10 healthy volunteers who were administrated lansoprazole 15 mg (orally disintegrating) or rabeprazole 10mg. All subjects underwent pH monitoring with a wireless system during the first day after PPI administration. RESULTS: There was no significant difference in the average intragastric pH during the first day of administration of lansoprazole and rabeprazole (3.3±1.1 vs. 3.2±0.7, paired t test), although the pH was significantly higher with both drugs as compared with the baseline (1.8±0.4, P<0.01). The pH 4 holding time ratio during the first day showed no significant difference between lansoprazole and rabeprazole (35.2±22.4% vs. 34.3±15.0%), and was also significantly higher than at baseline (0.35±1.73%, P<0.01). The two PPIs differed with respect to the peak of the pH 4 holding time ratio. CONCLUSIONS: Lansoprazole 15 mg and rabeprazole 10 mg showed sufficient inhibition of intragastric acidity during the first day after PPI administration and the effects did not differ between drugs, although there was a difference in their time at which the peak effects were reached.

Clinical significance of endoscopic ultrasound for gastric submucosal tumors.

BACKGROUNDS AND AIMS: Gastric submucosal tumors (SMTs) are often detected during routine gastroendoscopy but little is known about their natural history. The aim of this study was to evaluate the natural course of gastrointestinal mesenchymal tumors (GIMTs) in the stomach. PATIENTS AND METHODS: From October 2001 to November 2011, a total of 228 gastric SMTs were evaluated by endoscopic ultrasonography (EUS). Based on the findings of EUS and enhanced CT, we diagnosed these tumors as lipomas, cysts, aberrant pancreases, extramural compressions, and GIMTs. The gastric GIMTs which were examined by EUS twice or more were included in this study and the factors associated with an increase in the size of gastric GIMTs were analyzed. RESULTS: Fifty GIMTs were followed by EUS twice or more. The mean age was 66.4 ± 8.3 years old and the mean period of follow-up was 23.8 ± 21.7 months. Fourteen (28%) of 50 GIMTs increased in size and the time taken for gastric GIMTs to double in size was 19.1 ± 18.2 months. In multivariate logistic regression analysis, age (odds ratio [OR]=1.12, 95% confidence interval [CI]=1.03-1.21), non-upper area of the stomach (OR=5.08, 95%; CI=1.37-18.8) and the detection of an anechoic lesion on EUS (OR=5.90, 95%; CI=1.10-31.8) were the factors predicting an increase in size of gastric GIMTs. CONCLUSIONS: We evaluated gastric SMTs by EUS and clarified the factors predicting the growth of gastric GIMT. EUS is indispensable for the diagnosis and management of gastric SMTs.

Efficacy of computed image modification of capsule endoscopy in patients with obscure gastrointestinal bleeding.

AIM: To investigate whether flexible spectral color enhancement (FICE) improves diagnostic yields of capsule endoscopy (CE) for obscure gastro-intestinal bleeding (OGIB). METHODS: The study subjects consisted of 81 patients. Using FICE, there were three different sets with different wavelengths. Using randomly selected sets of FICE, images of CE were evaluated again by two individuals who were not shown the conventional CE reports and findings. The difference between FICE and conventional imaging was examined. RESULTS: The overall diagnostic yields in FICE sets 1, 2, 3 and conventional imaging (48.1%) were 51.9%, 40.7%, 51.9% and 48.1%, respectively, which showed no statistical difference compared to conventional imaging. The total numbers of detected lesions per examination in FICE imaging and conventional imaging were 2.5 ± 2.1 and 1.8 ± 1.7, respectively, which showed a significant difference (P = 0.01). CONCLUSION: The diagnostic yield for OGIB is not improved by FICE. However, FICE can detect significantly more small bowel lesions compared to conventional imaging.

Factors Associated with Inadequate Tissue Yield in EUS-FNA for Gastric SMT.

Aims. Our aim was to identify the factors that made the specimens inadequate and nondiagnostic in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy of suspected submucosal tumors (SMTs). Methods. From August 2001 to October 2009, 47 consecutive patients with subepithelial hypoechoic tumors originating in the fourth sonographic layer of the gastric wall suspected as GIST by standard EUS in Chiba University hospital underwent EUS-FNA for histologic diagnosis. We evaluated patient age, sex, location of lesion, size, pattern of growth in a stomach, and pattern of echography retrospectively. We defined a case of gaining no material or an insufficient material for immunohistological diagnosis as nondiagnostic. Results. The diagnostic yield of EUS-FNA for the diagnosis of gastric SMTs was 74.5%. Multivariate logistic regression analysis identified that age of under 60 years (compared with patients older than 60 years: odds ratio [OR] = 11.91, 95% confidence interval [CI] = 1.761-80.48) and location of SMT at lower third area (compared with upper or middle third area: OR = 10.62, 95% CI = 1.290-87.42) were the predictive factors for inadequate tissue yield in EUS-FNA. Conclusions. The factors associated with inadequate tissue yield in EUS-FNA were younger age and the location of lesion at lower third area in stomach.