A total of 191 gastric adenomas in 178 patients was studied macroscopically by endoscopy and histopathologically by endoscopic biopsy. Among the lesions, 85 in 74 patients were followed‐up for six months to 12 years. Gastric adenomas were found to be more frequent in the aged, with a rate of 0.1% in the third decade but 3.7% in the ninth decade, on gastroscopic examination. Gastric cancers coexistent with the gastric adenomas were seen in 14 cases (8%), and were more frequent in male than in female patients (sex ratio, 12:2). Only eight of the 85 lesions (9%) revealed macroscopic changes. Four of these showed a reduction in size, while the other four lesions showed enlargement. In 21 of the 85 lesions (25%), histologic changes were observed. Four (5%) changed from moderate dysplasia (Group III) to nondysplastic or intestinal metaplasia (Group I), eight lesions (9%) revealed histologic changes (Group III to IV, or vice versa) without malignant transformation, and nine lesions (11%) showed malignant changes. Neither submucosal invasion nor lymph node metastasis was found. These lesions consisted of carcinoma in situ with small foci in the lesions exhibiting moderate dysplasia, and a gradual transition from severe dysplasia to cancer was seen in resected lesions obtained by endoscopic polypectomy or surgical resection. In addition, a gradual increase in dysplasia of tissue from moderate to severe was revealed by repeated gastroscopic biopsy. These findings suggest that the gastric adenomas underwent malignant changes with gradual transformation from moderate through severe dysplasia.

Jejunal endoscopy and histopathological study of biopsied specimens were performed to clarify states of jejunal mucosa and the mechanism of enteric protein loss in six patients with protein-losing enteropathy, including four patients with intestinal lymphangiectasia, one patient with constrictive pericarditis associated with dilated lymphatics of the intestine, and one patient with Budd-Chiari syndrome. Three cardinal endoscopic findings, scattered white spots, white villi, and chyle-like substances covering the mucosa, were demonstrated in protein-losing enteropathy. Scattered white spots indicated markedly dilated lymphatics in the stroma of the villi. White villi seemed to be due to fats including chylomicrons or fat droplets in the absorptive cells, interepithelial spaces, and/or stroma, even though the biopsies were obtained in the fasting state. Therefore, white villi suggest impaired transport of fats from intestinal epithelial cells to intestinal lymphatics. These three cardinal findings are thought to be characteristic for protein-losing enteropathy secondary to lymphatic disorders.

Reflectance spectrophotometry in assessing gastroduodenal mucosal perfusion was evaluated. Ischemia without congestion, e.g., during hemorrhagic hypotension or celiac artery occlusion, was associated with a reduction in the indexes of mucosal hemoglobin concentration and of oxygen saturation. Ischemia with congestion, e.g., during portal vein occlusion, or in absolute ethanol or suction-induced mucosal lesions, was associated with an increase in the index of mucosal hemoglobin concentration but a reduction in the index of oxygen saturation. An increase in the index of mucosal hemoglobin concentration associated with a normal index of oxygen saturation was found in the postischemic hyperemia after release of celiac artery occlusion and during the sustained increase in corpus mucosal blood flow induced by vagus nerve stimulation. Thus reflectance spectrophotometric measurements reflected ischemia, without or with congestion, and hyperemia. Additionally, although regional differences in reflectance spectrophotometric measurements were demonstrated in the duodenal, antral, and corpus mucosa, such differences bore no consistent relationship to regional differences in blood flow demonstrated in previous studies.

Summary Background Ghrelin, growth‐hormone‐releasing peptide, has been reported to accelerate food intake and gastrointestinal motility. Aim The present study was designed to investigate the plasma ghrelin levels in patients with functional dyspepsia (FD). Patients and Methods Ninety‐seven patients, who showed no evidence of peptic ulcer disease or gastrointestinal cancer on upper gastrointestinal endoscopy, were recruited. Seventeen patients who had no gastrointestinal symptoms were recruited as controls. Forty‐seven patients were diagnosed to be suffering from FD, based on the Rome II criteria. The FD patients were further subdivided into those with ulcer‐like FD, dysmotility‐like FD and non‐specific‐type FD, based on their Gastrointestinal Symptom Rating Scale (GSRS) scores. Fourteen patients were categorized as having gastro‐oesophageal reflux disease, and 19 patients were excluded as having the irritable bowel syndrome, based on the GSRS. The plasma ghrelin levels were measured by radioimmunoassay. Results The plasma ghrelin levels were significantly higher in FD patients, especially in those with dysmotility‐like FD, as compared with those in controls. The plasma ghrelin levels were also correlated well with the indigestion scores. Conclusion Plasma ghrelin levels are significantly higher in patients with dysmotility‐like FD, suggesting that this parameter could become useful as a novel supportive marker for the diagnosis of FD.

Background: The clinical significance of Helicobacter pylori antibody titer has been