**6. References**

180 Gastrointestinal Endoscopy

cavity, continues to have a low accuracy index. The degree of distension of the stomach wall and visualization of the submucosal vascular network depends primarily on the professional skill and experience of the examiner, as well as on the availability of good quality equipment. Even at centers specialized in gastrointestinal endoscopy, the endoscopic-histologic correlation is weak, with sensitivity and specificity of about 40 to 60% (Eshmuratov, et al.

Therefore, since the histological method is also not reliable, at least for cases of mild or moderate atrophy, its use in combination with endoscopy continues to rest on quicksand. Opening good perspectives for the near future, the endoscopic method has progressed with the description of new visualization techniques to amplify the resolution and definition of gastrointestinal mucosa details. Thus, endoscopic techniques involving magnification with high resolution have been reported to be considerably more reliable than standard endoscopy to identify normal gastric mucosa, chronic gastritis and gastric atrophy (Anagnostopoulos et al. 2007). The progress of endoscopic techniques and the availability of high-resolution confocal laser endomicroscopy are now starting to gain firmer ground in the detection of minute lesions of the gastrointestinal mucosa, among them the different degrees of gastric mucosa atrophy (Li, CQ and Li, YQ, 2010; Goetz, M. and Kiesslich, R. 2010; Canto,

The term ABG was used in the present article to designate cases of chronic gastritis with selective glandular atrophy of the mucosa of the stomach body while the antral mucosa continued to show a normal aspect or only minimal inflammatory changes. Extensive areas of intestinal metaplasia, pseudoantral metaplasia and endocrine cell hyperplasia often occur in the atrophic mucosa of the body. Taken together, these changes of the gastric mucosa strongly suggest the presence of an inflammatory process of autoimmune etiology accompanied or not by pernicious anemia of subclinical or even clinical evolution. Thus, the major importance of the histologic diagnosis of ABG resides in the fact that, for many dyspeptic patients submitted to upper digestive endoscopy this may be the first opportunity

The histologic diagnosis of glandular atrophy of the stomach of mild or moderate grade is highly subjective and depends on many factors linked to tissue collection and processing. From an endoscopic viewpoint, the diagnostic imprecision is even greater. However, the more extreme grades of atrophy of the gastric mucosa are easy to interpret histologically when tissue samples are collected, processed and interpreted in an appropriate manner. When this is not the case, the histologic diagnosis of ABG is frequently inconclusive or equivocal. In the present study, out of 230 cases with an inconclusive histological diagnosis reviewed by an expert pathologist in the gastrointestinal area, 55 (24%) were confirmed as ABG, many of them after new histologic sections were obtained from paraffin blocks. Although in the cases studied the degree of gastric atrophy was intense and circumscribed to the body, the standard endoscopic exam showed a very low correlation with the histological findings. This fact associated with problems regarding tissue collection and processing impairs a conclusive diagnosis of ABG in many cases, with a consequent delay in the diagnosis of the principal disease of a patient who seeks a service of digestive endoscopy due to nonspecific dyspeptic complaints. However, new endoscopic techniques show a clear progress that promises to reverse the current secondary role of endoscopy in combination

they have to receive a correct diagnosis of their main disease.

2010).

2010).

**4. Conclusions** 


**13** 

*Japan* 

**Evaluation of** 

Manabu Ishii et al.\*

*Kawasaki Medical School, Kurashiki,* 

**Duodenal Hypersensitivity to** 

**Acid Using Transnasal Endoscopy** 

*Division of Gastroenterology department of Internal Medicine,* 

According to the Rome ІІІ classification, functional gastroduodenal disorders (FGIDs) in adults are subdivided into six domains. Functional dyspepsia (FD) is a subcategory of the FGIDs. It is characterized by the presence of symptoms that are believed to be associated with gastroduodenal lesions, particularly epigastric pain or burning, postprandial fullness, or early satiation, without the evidence of organic disease to explain the onset of these symptoms at least 6 months before diagnosis (Tach J et al., 2006). Furthermore, FD is divided into 2 subtypes postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The diagnostic criteria for PDS include the presence of 1 or both of the following symptoms several times in a week: bothersome postprandial fullness occurring after ordinary-sized meals, and early satiation that prevents finishing a regular meal. The diagnostic criteria for EPS include the presence of all of the following symptoms: moderately severe pain or burning localized to the epigastrium at least once per week, and intermittent pain, not generalized or localized to other abdominal or chest regions, not relieved by defecation or passage of flatus, and not fulfilling the criteria for gallbladder and

FD is a functional disorder that affects 10-30% of the population worldwide. The results of an Itarian population-based study, indicated that the prevalence rates of FD were 11%. Of these, PDS, EPS, and PDS accompanied with EPS were 67.5%, 48.2%, and 15.8% respectively (Zagari RM et al.,2010).The results of a Swedish population-based study, indicated that the prevalence rates of FD, PDS, EPS, and PDS accompanied with EPS were 15.7%, 12.2%, 5.5%, and 1.7%, respectively (Aro P et al., 2009). The results of a Norwegian population-based study, showed that the lifetime prevalence rate of FD was 23% in men and 18% in women

\* Hiroaki Kusunoki2, Noriaki Manabe3, Tomoari Kamada1, Ken-ichi Tarumi1, Hiroshi Matsumoto1, Motonori Sato1, Yoshiyuki Yamanaka1, Takahisa Murao1, Hideaki Tsutsui1, Akiko Shiotani1, Jiro Hata3,

<sup>1</sup>*Division of Gastroenterology department of Internal Medicine,* <sup>2</sup>*Division of General Medicine* <sup>3</sup>*Division of Endoscopy and Ultrasound Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical* 

(Johnsen et al., 1988), and that in the United States, was 29% (Shaib Y et al., 2004).

**1. Introduction** 

sphincter of Oddi disorders.

and Ken Haruma1

*School, Kurashiki, Japan*

