Technique for endoscopic examination of the extent of gastritis in upper portion of the stomach was established with congo red solution. Gastritis in upper portion of the stomach was then examined by this technique and in resected stomachs. The results was as follows: 1. By means of congo red test, it is possible to demonstrate the extent of gastritis in the upper stomach as "non-discolored area" characterized by absence of acid secretion.2. Histological characteristics of gastritis in the upper stomach consisted mainly of atrophy of fundic glands and intestinal metaplasia, while epithelial defect, edema, inflanimatory cell infiltration and hyperemia were also detected. 3. Two different modes of gastritic extension were recognized: one in which gastritis spreads from the lower corpus to cardiac side, and the other in which it begins on the cardiac side and spreads to the lower. 4. Gastritis starting on the cardiac side, grows with aging, and the histological changes were advance of fundic gland's atrophy and intestinal metaplasia.

The clinicopathological features of simultaneous multiple gastric cancers, and the accuracy of their diagnosis by routine endoscopic examination were analyzed. In addition, the accuracies of diagnosis of coexisting early gastric cancers by routine endoscopic examination and by the endoscopic Congo red--methylene blue test developed in our hospital were compared. The results showed that multiple cancers occurred frequently in elderly male patients, in patients with early gastric cancer of the flat and elevated types and the depressed type without converging folds, and in patients with advanced cancer of Borrmann type I. These patients frequently have early cancers of the flat or depressed types without converging folds, and advanced cancers of Borrmann type I. The coexisting lesions are very difficult to diagnose by routine endoscopic examination: a correct diagnosis of coexisting early cancers was made in only 28.3% of the cases by routine endoscopic examination. But with the Congo red--methylene blue test, the diagnostic rate was raised significantly to 88.9%. In this test, Congo red and methylene blue are sprayed on the surface of the stomach and are bleached within 2 to 5 minutes on the surface of a tumor, but not on the surface of unaffected mucosa.

The relationship of the level of carcinoembryonic antigen (CEA) in the gastric juice to the extent of intestinal metaplasia and gastric cancer, and clinical values of gastric CEA for identifying high-risk patients for gastric cancer were examined. A significant correlation was found between the levels of gastric CEA and the distribution of intestinal metaplasia. Studies were made by the endoscopic Congo red-methylene blue test developed at our hospital. Gastric CEA levels were significantly higher in patients with localized and diffuse intestinal metaplasia than in those with no intestinal metaplasia. The mean levels of gastric CEA in patients with well-differentiated adenocarcinomas were significantly higher than in those with diffuse intestinal metaplasia. They were also significantly higher in patients with poorly differentiated adenocarcinomas than in patients with no intestinal metaplasia, but not significantly higher than in those with diffuse intestinal metaplasia. Endoscopic follow-up examinations show that gastric cancer was detected in only 1 patient with a gastric CEA level of 10 ng/ml or more, but in none of those with gastric CEA of less than 10 ng/ml, during the average observation period of 4.3 years. These results indicate that gastric CEA is produced both by intestinal metaplasia and well- and poorly differentiated adenocarcinomas, and that gastric CEA is useful in identifying high-risk patients for gastric cancer.

The extension and histological changes of fundal gastritis were investigated by endoscopic congo red test, combined with gastric biopsy under direct vision, and obtained the following results.

No abstract