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Serum anti-Helicobacter pylori antibody titer and its association with gastric nodularity,atrophy,and age:A cross-sectional study

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World Journal of Gastroenterology 2018年第35期24卷 4061-4068页

作者： Osamu Toyoshima Toshihiro Nishizawa Kosuke Sakitani Tadahiro Yamakawa Yoshiyuki Takahashi Nobutake Yamamichi Keisuke Hata Yasuyuki Seto Kazuhiko Koike Hidenobu Watanabe Hidekazu Suzuki Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Surgical Oncology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastrointestinal Surgery Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Pathology and Cytology Laboratory Japan Tokyo 166-0003Japan Medical Education Center Keio University School of MedicineTokyo 160-8582Japan

AIM To clarify the role of serum anti-Helicobacter pylori(H. pylori) antibody titers in gastric cancer.METHODS In this cross-sectional study, the effect of patients' baseline characteristics and endoscopic findings on their serum antibody titers were assessed. We evaluated consecutive patients who underwent esophagogastroduodenoscopy and their first evaluation for H. pylori infection using a serum antibody test. We excluded patients with a history of eradication therapy. The participants were divided into four groups according to their E-plate serum antibody titer. Patients with serum antibody titers < 3, 3-9.9, 10-49.9, and ≥ 50 U/m L were classified into groups A, B, C, and D, respectively. RESULTS In total, 874 participants were analyzed with 70%, 16%, 8.7%, and 5.1% of them in the groups A, B, C, and D, respectively. Patients in group C were older than patients in groups A and B. Gastric open-type atrophy, intestinal metaplasia, enlarged folds, diffuse redness, and duodenal ulcers were associated with a high titer. Regular arrangements of collecting venules, fundic gland polyps, superficial gastritis, and gastroesophageal reflux disease were related to a low titer. Multivariate analysis revealed that nodularity(P = 0.0094), atrophy(P = 0.0076), and age 40-59 years(vs age ≥ 60 years, P = 0.0090) were correlated with a high serum antibody titer in H. pylori-infected patients. Intestinal metaplasia and atrophy were related to age ≥ 60 years in group C and D.CONCLUSION Serum antibody titer changes with age, reflects gastric mucosal inflammation, and is useful in predicting the risk of gastric cancer.

关键词： Antibody Helicobacter pylori Gastritis Gastric cancer Endoscopy

Brown slits for colorectal adenoma crypts on conventional magnifying endoscopy with narrow band imaging using the X1 system

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World Journal of Gastroenterology 2022年第24期28卷 2748-2757页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Hidenobu Watanabe Nariaki Odawara Kosuke Sakitani Toru Arano Hirotoshi Takiyama Hideyuki Kobayashi Hirofumi Kogure Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology The Fraternity Memorial HospitalTokyo 130-8587Japan Department of Surgical Oncology The University of TokyoTokyo 113-8655Japan Department of Internal Medicine Umegaoka Ekimae ClinicTokyo 154-0022Japan

BACKGROUND Accurate diagnosis of colorectal premalignant polyps,including adenomas,is vital in clinical practice.AIM To investigate the diagnostic yields of novel findings of brown slits for adenomas.METHODS Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled.Polyps sized≥5 mm suspected of adenomas or clinically significant serrated polyps were included in the study.We defined the surface structures of colorectal polyps,which were brown curves inside and along the tubular glands identified using a combination of a new X1 system(Olympus Corporation)and a conventional magnifying colonoscope with non-staining narrow band imaging(NBI),as brown slits.The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma.We evaluated the diagnostic performance of brown slits for adenoma.RESULTS A total of 108 Lesions from 62 patients were eligible.The average age was 60.4 years and 41.9%were male.The mean polyp size was 7.45±2.83 mm.Fifty-seven lesions were positive for brown slits.Histopathological diagnosis comprised 59 low-grade tubular adenomas,16 sessile serrated lesions,and 33 hyperplastic polyps.Among 59 adenomas,56(94.9%)were positive for brown slits.Among 16 sessile serrated lesions,0(0%)was positive for brown slits.Among 33 hyperplastic polyps,1(3.0%)was positive for brown slits.The sensitivity,specificity,and accuracy of brown slits for adenoma were 94.9%,98.0%,and 96.3%,respectively.The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%,and 94.1%,respectively.CONCLUSION Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma.The new endoscopy system could be examined using new standards.

关键词： Adenoma Colonoscopy Narrow band imaging Magnifying endoscopy X1 Serrated polyp Colorectal neoplasm Endocytoscopy

Clinical features of cardiac nodularity-like appearance induced by Helicobacter pylori infection

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World Journal of Gastroenterology 2020年第35期26卷 5354-5361页

作者： Toshihiro Nishizawa Kosuke Sakitani Hidekazu Suzuki Shuntaro Yoshida Yosuke Kataoka Yousuke Nakai Hirotoshi Ebinuma Takanori Kanai Osamu Toyoshima Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of Gastroenterology Narita HospitalInternational University of Health and WelfareChiba 2868520Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 2740825Japan Department of Internal Medicine Tokai University School of MedicineKanagawa 2591193Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Keio University School of MedicineTokyo 1608582Japan

We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of H.pylori infection.In the previous study,we included only the patients who were evaluated for H.pylori infection for therst time,and excluded patients with a history of eradication.Therefore,the prevalence and clinical features of cardiac nodularity remains unknown.AIM To perform this cross-sectional study to explore the characteristics of cardiac nodularity.METHODS Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy Clinic were enrolled in this study.We included H.pylori-negative,H.pylori-positive,and H.pylorieradicated patients,and excluded patients with unclear H.pylori status and eradication failure.H.pylori infection was diagnosed according to serum anti-H.pylori antibody and the urea breath test or histology.Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction.Nodularity was visualized as whitish in the narrow-band imaging mode.We collected data on the patients’baseline characteristics.RESULTS A total of 1078 patients were finally included.Among H.pylori-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%each.Among H.pylori-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,respectively.Among H.pylori-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,respectively.The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H.pylori-positive and-eradicated patients.The frequencies of cardiac nodularity and antral nodularity in H.pylori-eradicated patients were significantly lower than those in H.pylori-positive patie

关键词： Cardia Nodularity Helicobacter pylori Diagnosis Gastritis

Enlarged folds on endoscopic gastritis as a predictor for submucosal invasion of gastric cancers

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World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 426-436页

作者： Osamu Toyoshima Shuntaro Yoshida Toshihiro Nishizawa Akira Toyoshima Kosuke Sakitani Tatsuya Matsuno Tomoharu Yamada Takashi Matsuo Hayato Nakagawa Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicSetagayaku 157-0066TokyoJapan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520ChibaJapan Department of Colorectal Surgery Japanese Red Cross Medical CenterShibuya-ku 150-8935TokyoJapan Department of Gastroenterology Sakitani Endoscopy ClinicNarashino 275-0026ChibaJapan Department of Gastroenterology Graduate School of MedicineThe University of TokyoBunkyo-ku 113-8655TokyoJapan Department of Internal Medicine Sakura Internal Medicine ClinicSetagayaku 157-0071TokyoJapan

BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P<0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P<0.001)were indep

关键词： Gastric cancer Gastritis Enlarged fold Endoscopy Kyoto classification

Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

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World Journal of Gastrointestinal Endoscopy 2021年第5期13卷 125-136页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Tomonori Aoki Fumiko Nagura Kosuke Sakitani Yosuke Tsuji Hayato Nakagawa Hidekazu Suzuki Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Internal Medicine Chitosefunabashi Ekimae ClinicTokyo 157-0054Japan Department of Gastroenterology Sakiatani Endoscopy ClinicNarashino 275-0026Japan Department of Gastroenterology and Hepatology Tokai University School of MedicineIsehara 259-1193Japan

BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatment application,and prognosis.Therefore,accurately assessing the Lauren classification before treatment is crucial.However,studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H.pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.The effects of age,sex,and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed.We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification.Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H.pylori-infected patients(49.6%males;average age:54.9 years)were enrolled;132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers)and 367 cancer-free controls were eligible.Gastric cancer was independently associated with age≥65 years,high atrophy score,high intestinal metaplasia score,and low nodularity score when compared to the control.Factors independently associated with intestinal-type cancer were age≥65 years(coefficient:1.98),male sex(coefficient:1.02),high intestinal metaplasia score(coefficient:0.68),and low enlarged folds score(coefficient:-1.31)when compared to diffuse-type cancer.The Lauren predictive background score was defined as the sum of+2(age≥65 years),+1(male sex),+1(endoscopic intestinal metaplasia),a

关键词： Gastric cancer Lauren classification Endoscopy Pathology Gastritis Kyoto classification

Kyoto classification in patients who developed multiple gastric carcinomas after Helicobacter pylori eradication

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World Journal of Gastrointestinal Endoscopy 2020年第9期12卷 276-284页

作者： Kosuke Sakitani Toshihiro Nishizawa Akira Toyoshima Shuntaro Yoshida Tatsuya Matsuno Tomoharu Yamada Masatoshi Irokawa Yoshiyuki Takahashi Yousuke Nakai Osamu Toyoshima Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalChiba286-8520Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Graduate School of Medicinethe University of TokyoTokyo 113-8655Japan

BACKGROUND Endoscopic Kyoto classification predicts gastric cancer risk;however,the score in the patients with primary gastric cancer after Helicobacter pylori(H.pylori)eradication therapy is unknown.AIM To elucidate the Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after H.pylori eradication.METHODS The endoscopist recorded the Kyoto classification at the endoscope and the Kyoto classification score at the time of the first diagnosis of gastric cancer after H.pylori eradication.The score was compared between single gastric cancer group and multiple gastric cancers group.RESULTS The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H.pylori eradication was 4.0 points in average.The score was 3.8 points in the single gastric cancer group,and 5.1 points in the multiple gastric cancers group.The multiple group had a significantly higher score than the single group(P=0.016).In the multiple gastric cancers group,all the patients(7/7)had 5 or higher Kyoto score,while in single gastric cancer group,the proportion of patients with a score of 5 or higher was less than half,or 44.7%(17/38).CONCLUSION Patients diagnosed with gastric cancer after H.pylori eradication tended to have advanced gastritis.In particular,in cases of multiple gastric cancers developed after H.pylori eradication,the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.

关键词： Kyoto classification Gastric cancer Helicobacter pylori Eradication therapy Metachronous Intestinal metaplasia