Gender Differences in Patients with Gastric Adenocarcinoma.

Background: Gastric cancer (GC) epidemiology and outcomes vary by gender. Methods: We reviewed 18,436 GC patients from 2008 to 2018 and looked for gender differences in clinical characteristics and survival. Results: The gender proportion was 71% male and 29% female. Males had a significantly (p < 0.001) higher proportion of differentiated GC (66.3%) and a lower proportion of undifferentiated GC (26.3%). Diagnosis through medical check-ups was more common in males (30.0% vs. 26.4%, p < 0.001). Clinical staging revealed 54.6% of males and 52.9% of females had localized disease without lymph node metastasis (LNM), while distant metastasis occurred in 17.4% of males and 16.9% of females (p < 0.001). Kaplan-Meier survival curves indicated females had a significantly higher overall survival (p = 0.0018). The survival advantage for females was evident in the early stages, with a significant difference in localized disease without LNM (p < 0.001) and localized disease with LNM (p = 0.0026, log-rank test) but not in the advanced stages. Multivariate Cox regression analysis showed a significantly reduced mortality risk in females (p < 0.001). Conclusions: Significant gender differences exist with regard to pathological type, presentation, clinical stage, and overall survival. These findings suggest gender-specific strategies for screening, diagnosis, and treatment.

Gastric cancer mortality related to direct radiographic and endoscopic screening: A retrospective study.

BACKGROUND: Despite its decreased incidence in Japan, gastric cancer continues among the leading causes of cancer-related deaths in both men and women. Accordingly, efforts are still required to lower the mortality rate of gastric cancer in Japan. Maebashi City introduced endoscopic gastric cancer screening in 2004, and participants are able to choose between direct radiography and endoscopy. Hence, we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods. AIM: To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City, Japan. METHODS: Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography (n = 11155) or endoscopy (n = 10747) were included. Participants were followed until March 31, 2012, by cross-referencing their data against the Gunma Prefecture cancer registry data. We compared the detection rate of gastric cancers. Then, we compared the mortality rate between the two groups. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of gastric cancer death. Finally, the reduction in gastric cancer mortality rate associated with each screening method was evaluated. RESULTS: Gastric cancer was detected in 22 participants undergoing direct radiography (detection rate, 0.20%) and in 52 participants undergoing endoscopy (detection rate, 0.48%). However, most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death. We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not. When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis, the HR of gastric cancer death was 1.368 (95%CI: 0.7308-2.562) in the overall group of participants. The results showed no significant difference between the two screening methods in any of the analysis groups. CONCLUSION: Although endoscopic screening detected more gastric cancer than direct radiographic screening, no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.

New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis.

BACKGROUND: We recently demonstrated that cascade stomach detected by barium studies was correlated with upper gastrointestinal symptoms. We developed a new endoscopic classification of cascade stomach and examined its relationship with reflux esophagitis. METHODS: Study 1: the classification (grades 0-3) was based on detecting a ridge that runs from the cardia toward the anterior wall crossing the greater curvature. Inter-observer variation was evaluated by kappa statistics when ten experienced endoscopists used this classification three times each. Study 2: in 710 consecutive subjects (500 men and 210 women) undergoing endoscopic screening, the grade of cascade stomach and incidence of reflux esophagitis were compared. RESULTS: In study 1, the kappa values at the third assessment were 0.85, 0.58, 0.50, and 0.78 for each grade, respectively, while overall agreement was 0.68. In study 2, the incidence of reflux esophagitis in men was 20 % in grade 0, 17 % in grade 1, 25 % in grade 2, and 30 % in grade 3, showing significant differences. Among women, the incidence of reflux esophagitis in each grade was 9, 3, 6, and 35 %, respectively, also showing significant differences. Multivariate analysis showed that independent risk factors for reflux esophagitis were cascade stomach (odds ratio = 2.20), body mass index, and hiatus hernia in men, as well as cascade stomach (odds ratio = 9.01) and smoking tobacco in women. CONCLUSIONS: This endoscopic classification of cascade stomach showed acceptable inter-observer variation. Cascade stomach is a risk factor for reflux esophagitis.

Development and evaluation of a modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease to distinguish functional dyspepsia from non-erosive reflux disease.

BACKGROUND AND AIM: The Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) is the standard questionnaire used in Japan for the diagnosis of gastroesophageal reflux disease (GERD) and assessment of the response to treatment. We modified the FSSG in order to assess dyspepsia symptoms, and evaluated the modified questionnaire. METHODS: We modified the FSSG by adding two questions on interdigestive and postprandial epigastric pain. We then assessed the modified FSSG with 100 new untreated symptomatic patients presenting to hospital and in 200 subjects undergoing health checks. Endoscopic assessment of the esophagogastric junction was performed according to the modified Los Angeles classification with addition of Grade N (normal appearance) and Grade M (minimal change). Endoscopic images were assessed by five experienced endoscopists blinded to the questionnaire results. RESULTS: The 100 new patients included 16 with erosive GERD (>Grade A), 12 with peptic ulcer, and two with gastric cancer. Among the 70 patients with no evidence of organic disease, the modified FSSG diagnosed functional dyspepsia (FD) in 41 and non-erosive gastric disease (NERD) in 29. A significant difference was seen in the dyspepsia score between patients with FD and NERD. Subjects with endoscopic GERD undergoing health checks had significantly higher scores for all symptoms, reflux symptoms, and dyspeptic symptoms on the modified FSSG. CONCLUSION: The modified FSSG can clearly distinguish FD from NERD, and is useful for the assessment of dyspeptic symptoms.

Gastroptosis is associated with less dyspepsia, rather than a cause of dyspepsia, in Japanese persons.

OBJECTIVE: Gastroptosis is recognized by its characteristic appearance on barium studies. The present prospective study assessed the relationship between gastroptosis and dyspeptic symptoms. METHODS: Japanese subjects underwent health screening, and gastroptosis was diagnosed by barium studies. Consecutive subjects (500 women and 167 men) with gastroptosis were identified and the same number of age-matched subjects without gastroptosis were selected as controls. Dyspepsia was classified as reflux-like (heartburn and belching), dysmotility-like (bloating and fullness), or ulcer-like dyspepsia (epigastralgia) based on the Rome II criteria. RESULTS: Body mass index was significantly lower in women with gastroptosis than in controls [19.7 ± 1.83 (SD) vs. 23.4 ± 3.70, p<0.0001], and also in men (19.7 ± 2.00 vs. 23.9 ± 2.89, p<0.0001). The incidence of dyspepsia was significantly lower in women with gastroptosis than in controls (56/500 vs. 87/500, p<0.01) and also in men (10/167 vs. 25/167, p<0.05), especially in women with ulcer-like dyspepsia (15/500 vs. 32/500, p<0.05) and in men with reflux-like dyspepsia (2/167 vs. 12/167, p<0.05). By logistic regression analysis, gastroptosis was associated with a lower risk of dyspepsia (odds ratio: 0.62, 95% CI: 0.405-0.941, p=0.025) and ulcer-like dyspepsia (odds ratio: 0.36, 95% CI: 0.177-0.726, p=0.004) in women. CONCLUSION: Dyspeptic symptoms were significantly less common in subjects with gastroptosis. Accordingly, gastroptosis may protect against dyspeptic symptoms, rather than causing functional dyspepsia.

Proton pump inhibitors improve acid-related dyspepsia in gastroesophageal reflux disease patients.

It has been reported that proton pump inhibitors are more effective than H2 receptor antagonists in patients with functional dyspepsia. Dyspeptic symptoms that respond to proton pump inhibitors are classified as acid-related dyspepsia. A new questionnaire for assessing gastroesophageal reflux disease (GERD), the Frequency Scale for Symptoms of GERD, covers the 12 most common symptoms of GERD patients. A quantitative assessment of the changes of reflux symptoms and acid-related dyspepsia was made in GERD patients receiving proton pump inhibitor therapy. Sixty-eight GERD patients receiving proton pump inhibitor therapy completed the questionnaire before and after treatment for 8 weeks. There is a significant positive correlation between reflux symptoms and acid-related dyspepsia before and after therapy (r = 0.569 and r = 0.569; both P's < 0.001) and acid-related dyspepsia in patients with both nonerosive and erosive GERD. We conclude that GERD patients suffer not only from reflux symptoms, but also from acid-related dyspepsia, and proton pump inhibitors improve both types of symptoms.

Diagnosis of gastroesophageal reflux disease using a new questionnaire.

BACKGROUND AND AIM: An early and accurate evaluation by a general practitioner is needed to screen out non-gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire. METHODS: When admitted to hospital to undergo an upper gastrointestinal endoscopy for suspected GERD, 333 patients completed a 50-item questionnaire requiring 'yes/no' answers to different combinations of questions relating to symptoms of upper gastrointestinal tract conditions (e.g. GERD, ulcers and functional dyspepsia) and psychosomatic symptoms. The endoscopic diagnosis was then correlated with the rate of positive answers to each question. RESULTS: Based on the analysis of the 50 items, the 8-10 questions most often answered affirmatively by each of the GERD and non-GERD groups were chosen for the simplified questionnaire. Three draft questionnaires were compiled. After calculating the sensitivity, specificity and accuracy in relation to the diagnosis of GERD and other conditions, it was found that questionnaire B (selection of persons answering 'yes' to at least one of questions 1-5 and exclusion of persons answering 'yes' to at least three of questions 7-10) had a high sensitivity, high specificity and low false positive rate. CONCLUSION: A novel questionnaire was developed. It was designed to detect the symptoms of GERD while simultaneously excluding non-GERD patients. This simplified nine-item simplified questionnaire had a sensitivity of 79.8%, a specificity of 53.6% and an accuracy of 63.4%.