Effects of Rikkunshito (TJ-43) on Esophageal Motor Function and Gastroesophageal Reflux.

BACKGROUND/AIMS: Rikkunshito (TJ-43), an herbal medicine, has been demonstrated to relieve gastroesophageal reflux symptoms. However, the effects of TJ-43 on esophageal motor functions have not been fully determined. This double-blind crossover study was performed to investigate the effects of TJ-43 on esophageal motor functions and gastroesophageal reflux. METHODS: The subjects were 10 normal male volunteers. Lower esophageal sphincter pressure and esophageal body peristaltic contractions with and without 1-week administration of TJ-43 were examined in a crossover fashion. Post-prandial gastroesophageal reflux was also determined using a multi-channel impedance pH dual monitor. RESULTS: TJ-43 at a standard dose of 7.5 g/day did not significantly augment esophageal peristaltic contraction pressure measured in the proximal, middle and distal segments of the esophagus, whereas increment of resting lower esophageal sphincter pressure was observed in a supine position. In addition, TJ-43 administration did not decrease post-prandial gastroesophageal acid, non-acid reflux events or accelerate esophageal clearance time. CONCLUSIONS: TJ-43 at a standard dose did not have a significant effect on esophageal motor activity or gastroesophageal reflux in healthy adults.

Different sex-related influences of eating habits on the prevalence of reflux esophagitis in Japanese.

BACKGROUND AND AIM: Many types of food have been shown to affect lower esophageal sphincter pressure and esophageal motor function, and thus, the prevalence of reflux esophagitis. The present study was performed to clarify the different eating habits that predominantly affect the prevalence of reflux esophagitis in Japanese. METHODS: The study included 2303 individuals (males: 1599, females: 704, mean age: 49.9 years) who underwent upper gastrointestinal endoscopy for gastric cancer screening. The daily dietary contents of the patients were analyzed using a self-administered questionnaire. RESULTS: A total of 201 patients had endoscopically-proven reflux esophagitis, and the percentage of males with reflux esophagitis was significantly higher than their female counterparts (11.3% vs 2.8%). The body mass indexes of individuals with reflux esophagitis were significantly higher than those without, both for males and females. Total energy intake was the most important risk factor for the occurrence of reflux esophagitis in males, but the food content was not a significant risk factor. Dietary habit did not affect the prevalence of reflux esophagitis in the female patients. The age and height of females with reflux esophagitis significantly exceeded those of females without reflux esophagitis, and were independent risk factors for the occurrence of reflux esophagitis only in the female patients. CONCLUSION: There is a sex-related difference in the influence of eating habits on the prevalence of reflux esophagitis in Japanese.

Usefulness of catheterless radiotelemetry pH monitoring system to examine the relationship between duodenal acidity and upper gastrointestinal symptoms.

BACKGROUND AND AIM: To clarify the usefulness of a newly designed method for measuring intraduodenal pH to examine the relationship between duodenal acidity and upper gastrointestinal symptoms during intragastric acid infusion. METHODS: The study subjects were six healthy volunteers. A Bravo pH capsule with thread fixed to the gastric wall was endoscopically introduced into the second portion of the duodenum, and intraduodenal acidity was measured during intragastric infusion of 300 mL of 0.1 mol/L hydrochloric acid or pure water through an elemental diet tube. The severity of several upper gastrointestinal symptoms were assessed by using a 10-cm visual analogue scale every 2 min for up to 30 min, and the area under the severity scale-time curve (cm×min.) were calculated. RESULTS: The percentage time during 30 min when the intraduodenal pH was <4.0 and was significantly greater than during water infusion (61.4±6.1% vs 24.8±6.5%). Several upper gastrointestinal symptoms were observed during acid infusion (acid vs water epigastric heaviness, 29.1±12.0 vs 2.7±1.4; dull epigastric pain, 8.8±4.9 vs 0.7±0.7 cm×min/30 min). Intraduodenal pH below 4.0 was correlated with the severity of dull pain in the stomach (R(2)=0.342, P=0.044). CONCLUSION: The newly designed intraduodenal pH monitoring by using catheterless radiotelemetry system is useful to examine the relationship between duodenal acidity and upper gastrointestinal symptoms.

[Drug therapy for the elderly patients with gastric ulcer].

The number of patients with low dose aspirin or non-steroidal anti-inflammatory drug-related gastric ulcers is steadily increasing. The elderly patients have higher risk to develop gastric ulcers during these treatments. For the treatment and prophylactic therapy of the ulcers in the elderly, the following points should be recognized. (1) The drugs that are prescribed for ulcer diseases may interact with drugs that have been administered for the treatment of the pre-existing diseases. (2) The decreased motor function of gastrointestinal tract frequently observed in the elderly may interfere with the normal absorption of the drugs administered for the treatment of ulcers. (3) The impaired renal function of the elderly may elevate plasma concentration of administered drugs that are expected to be excreted from kidneys. (4) Appropriate guidance for patients is necessary to keep the compliance of drug therapy for prophylactic treatment of low dose aspirin or non-steroidal anti-inflammatory drugs.

Effects of mosapride on esophageal functions and gastroesophageal reflux.

BACKGROUND AND AIM: A substantial number of patients with gastroesophageal reflux disease show symptomatic resistance to high-dose proton pump inhibitors. In those cases, prokinetics are possible candidates for treatment. The aim of the present study was to determine whether mosapride, a prokinetic agent, stimulates esophageal functions, and prevents acidic and non-acidic gastroesophageal reflux. METHODS: Normal volunteers (nine and 13 for two experiments, respectively) were enrolled. Salivary secretion, esophageal peristaltic contractions, and resting lower esophageal sphincter pressure with and without mosapride administration were recorded using a cross-over protocol. Post-prandial acidic and non-acidic reflux levels were also recorded. RESULTS: Mosapride at a standard dose of 15 mg/day did not stimulate salivary secretion or any esophageal motor functions. It also failed to prevent acidic and non-acidic post-prandial gastroesophageal reflux. CONCLUSIONS: Mosapride at 15 mg/day, a standard dose in Japan, did not change the esophageal motility and salivary secretion in healthy volunteers. Future study on a larger number of individuals with higher dose of mosapride is worthwhile.

Effects of anti-hypertensive drugs on esophageal body contraction.

AIM: To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possible relationship with gastro-esophageal reflux disease. METHODS: Thirteen healthy male volunteers were enrolled. Esophageal body peristaltic contractions and lower esophageal sphincter (LES) pressure were measured using high resolution manometry. All subjects were randomly examined on four separate occasions following administrations of nifedipine, losartan, and atenolol, as well as without any drug administration. RESULTS: Peristaltic contractions by the esophageal body were separated into three segments by two troughs. The peak peristaltic pressures in the mid and lower segments of the esophageal body under atenolol administration were significantly higher than those without medication in a supine position. On the other hand, peristaltic pressures under nifedipine administration were lower than those observed without drug administration. Losartan did not change esophageal body peristalsis. Atenolol elevated LES pressure and slowed peristaltic wave transition, while the effects of nifedipine were the opposite. CONCLUSION: Among the anti-hypertensive drugs tested, atenolol enhanced esophageal motor activity, which was in contrast to nifedipine.

Half-solidification of nutrient does not decrease gastro-esophageal reflux events in patients fed via percutaneous endoscopic gastrostomy.

BACKGROUND & AIMS: Percutaneous endoscopic gastrostomy (PEG) tube feeding is widely used for patients with swallowing dysfunction, and aspiration pneumonitis induced by reflux of gastric contents is one of the most frequent and life-threatening events in such patients. We performed this study to clarify the effect of half-solidification of nutrient on gastro-esophageal reflux (GER) of acidic and non-acidic gastric contents in patients with PEG. METHODS: The subjects were 14 elderly patients undergoing PEG feeding (female: 11, mean age 83.1 y). Twenty-four hour esophageal multichannel intraluminal impedance (MII) and pH (MII-pH) monitoring were performed during and after feeding with half-solid and liquid nutrient, respectively. The numbers of GER events during 4h after the start of feeding were compared. RESULTS: There was no significant difference in the total number of GER events between half-solid nutrient feeding and liquid nutrient feeding (5.6+/-1.5 vs. 6.6+/-1.5). The number of acid reflux events after half-solid nutrient feeding tended to be higher than that after liquid nutrient feeding (1.9+/-1.1 vs. 1.4+/-0.8). CONCLUSION: Half-solidification of nutrition does not appear to be effective for preventing GER caused by liquid PEG feeding.

Esophageal epithelial surface in patients with gastroesophageal reflux disease: an electron microscopic study.

AIM: To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD). METHODS: Eighteen patients with erosive esophagitis, 10 patients with non-erosive reflux disease (NERD), and 18 normal asymptomatic volunteers were enrolled. Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion. Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment. RESULTS: The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals. CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.

Helicobacter pylori infection does not accelerate the age-related progression of arteriosclerosis: a 4-year follow-up study.

BACKGROUND AND AIM: Helicobacter pylori (H. pylori) infection has been reported to correlate with the onset of cardiovascular diseases. However, the relationship between H. pylori infection and the progression of arteriosclerosis has not been fully investigated. The aim of this study was to clarify the possible role of H. pylori infection in the development of arteriosclerosis. METHODS: Study subjects were 258 cases who attended their annual medical check-ups and were twice investigated by the parameters of arteriosclerosis at a 4-year interval. Arteriosclerotic parameters (systolic blood pressure [SBP]), ankle brachial index [ABI], and pulse wave velocity [PWV]) were measured non-invasively using an automatic device. H. pylori-infection status was determined by assaying serum anti-H. pylori IgG antibodies. The changes in the arteriosclerotic parameters during the 4 years were compared between H. pylori-seropositive and seronegative individuals. RESULTS: A total of 166 subjects (64.3%) were H. pylori-seropositive. After adjustment for gender, age, body mass index, and smoking and drinking habits, there were no differences in any of the arteriosclerotic parameters between the groups, not only at enrollment but after the 4 years, although the high-density lipoprotein cholesterol levels of the seropositive groups were significantly lower than those of seronegative groups. SBP and PWVs were significantly increased during 4 years in both the seropositive and seronegative groups. The percentage of changes in SBP and PWVs, which were calculated by ([values after 4 years--values at enrollment/values at enrollment] x 100), did not differ between the groups. CONCLUSION: H. pylori infection does not accelerate the age-related progression of arteriosclerosis in Japanese individuals.

A case of gastric cancer detected incidentally following to chylothorax, followed by change in the appearance of pleural effusion with cancer progression.

We report a case of gastric cancer that was detected due to chylothorax. A 64-year-old man visited our hospital with chief complaints of anterior chest pain and right lower leg swelling. Chest X-ray showed bilateral pleural effusion. Biochemical tests of the pleural fluid detected chyle and cytological examination of the left pleural revealed poorly differentiated adenocarcinoma cells. An upper gastrointestinal examination revealed a type 4 gastric cancer that was diagnosed as the primary lesion. The appearance of the pleural effusion changed from chylaus to light yellow as the cancer progressed. Gastric cancer combined with chylothorax is quite rare and we discussed in this report how this change of the appearance of the pleural effusion occurred in comparison with the mechanism of chylothorax.