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INTRODUCTION:Functional dyspepsia (FD) is subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS), each with a different pathophysiological mechanisms driving the symptoms of these syndromes. Cine MRI aids observation in any continuous cross-section and measures gastrointestinal peristalsis without radiation exposure. In this study, we aimed to evaluate gastric peristalsis in FD using cine MRI.METHODS:This study was a prospective interventional study. Patients diagnosed with FD according to ROME IV diagnostic criteria were included. Cine MRI was performed before and after the test meal. Gastric maximum short axis diameter, amplitude, contraction frequency, peristaltic wave height, peristaltic wave velocity, and gastric motility index were evaluated and compared between healthy control (HC) and patients with FD (PDS/EPS).RESULTS:This study consisted of 18 HC and 31 patients with FD (including 22 with PDS and 9 with EPS). Preprandial comparison of the HC, PDS, and EPS groups showed no significant difference. Postprandial comparison of the 3 groups showed significant differences in maximum short axis diameter of fornix (HC: 51.5 ± 9.1/PDS: 47.1 ± 10.3/EPS: 59.0 ± 13.6 mm, P = 0.045), amplitude of fornix (HC: 7.3 ± 5.1/PDS: 12.1 ± 4.3/EPS: 11.3 ± 8.7 mm, P = 0.009), contraction frequency (HC: 2.9 ± 0.3/PDS: 2.7 ± 0.5/EPS: 2.6 ± 0.2 times/min, P = 0.007), peristaltic wave height (HC: 14.9 ± 4.0/PDS: 9.2 ± 2.5/EPS: 9.5 ± 3.2 mm, P < 0.001), and gastric motility index (HC: 24.5 ± 7.1/PDS: 16.8 ± 6.1/EPS: 15.9 ± 6.3 mm2/s, P = 0.002).DISCUSSION:Cine MRI can be used to visually evaluate gastric peristalsis dysfunction and impaired gastric accommodation in FD.

Abstract Introduction: In recent years, the frequency of idiopathic peptic ulcers (IPUs) has increased. However, the clinicopathological characteristics of IPU have not been fully elucidated and treatment methods for recurrent and refractory cases have not yet been established. Case Presentation: A man in his forties complained of epigastric discomfort. Esophagogastroduodenoscopy revealed a gastric ulcer in the lesser curvature of the gastric angle. After Helicobacter pylori was eradicated, the gastric ulcer recurred despite the administration of a potassium competitive acid blocker (PCAB), and a diagnosis of IPU was made. Twenty-four-hour intragastric pH monitoring revealed insufficient gastric acid suppression. Misoprostol was added to the patient’s treatment. Subsequently, the ulcer healed and recurrence was not observed. Conclusion: For refractory IPU, the evaluation of pathophysiological function through 24-h gastric pH monitoring may lead to the selection of an appropriate treatment. If a proton pump inhibitor and PCAB do not improve the IPU, combination treatment with misoprostol may be considered as an option.

Objectives Recently, the incidence of Helicobacter pylori‐uninfected gastric cancers, such as gastric epithelial neoplasm of fundic‐gland mucosa lineage (GEN‐FGML), has increased with the widespread use of eradication therapy. Because the detection and endoscopic diagnosis of GEN‐FGML are difficult, an effective observation method in screening endoscopy is required. We investigated whether texture and color enhancement imaging (TXI) improved the visibility of GEN‐FGML compared with white light imaging (WLI). Methods In this single‐center prospective clinical study, 50 GEN‐FGML lesions (35 patients) treated at our hospital between October 2020 and June 2023 were analyzed. The endoscopic images of GEN‐FGML obtained using WLI, TXI mode 1 (TXI‐1), TXI mode 2 (TXI‐2), and narrow‐band imaging were compared by 10 endoscopists. We analyzed the visibility score and inter‐rater reliability (intraclass correlation coefficient and conducted an objective evaluation based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system. Results Histologically, GEN‐FGML was classified as gastric adenocarcinoma of fundic‐gland type (n = 45) and gastric adenocarcinoma of fundic‐gland mucosa type (n = 5). The total visibility score for all endoscopists was significantly higher for TXI than for WLI (p < 0.01); and for TXI‐1 than for TXI‐2 (p < 0.01). The intraclass correlation coefficients for TXI‐1 and TXI‐2 were “almost perfect” and “substantial,” respectively, for all endoscopists. ΔE* was significantly higher for TXI than for WLI (p < 0.01). Conclusions TXI improved the visibility of GEN‐FGML for all endoscopists compared with WLI when evaluated subjectively and objectively.

Linked color imaging (LCI) for image-enhanced endoscopy (IEE) highlights mucosal color differences. We investigated risk factors associated with mucosal redness of the duodenal bulb using LCI. Consecutive patients were retrospectively selected after their duodenal bulbs were observed via LCI. A symptom questionnaire (Izumo scale) was completed. The LCI of the duodenal bulb was subjectively evaluated on whether redness was present and objectively evaluated based on L* a* b* color values. The clinical characteristics of the 302 study participants were: male/female, 120/182; mean age, 70.9 years. Twenty-one cases (7.0%) were in the redness (+) group. After multiple regression analysis, independent predictors for the red component (a*) of the duodenal bulb using LCI were: age (β = −0.154, p < 0.01), female (β = −0.129, p < 0.05), body mass index (BMI; β = −0.136, p < 0.05), Helicobacter pylori eradication (β = 0.137, p < 0.05), endoscopic gastric mucosal atrophy score (EGAS; β = −0.149, p < 0.05), and constipation-related quality of life (QOL) (β = −0.122, p < 0.05) scores. Lower age, lower BMI, lower EGAS, a constipation-related QOL score, post-H. pylori eradication, and being male were associated with mucosal redness in the duodenal bulb with IEE using LCI.

Background: Barrett’s esophagus and esophageal adenocarcinoma cases are increasing as gastroesophageal reflux disease increases. Using artificial intelligence (AI) and linked color imaging (LCI), our aim was to establish a method of diagnosis for short-segment Barrett’s esophagus (SSBE). Methods: We retrospectively selected 624 consecutive patients in total at our hospital, treated between May 2017 and March 2020, who experienced an esophagogastroduodenoscopy with white light imaging (WLI) and LCI. Images were randomly chosen as data for learning from WLI: 542 (SSBE+/− 348/194) of 696 (SSBE+/− 444/252); and LCI: 643 (SSBE+/− 446/197) of 805 (SSBE+/− 543/262). Using a Vision Transformer (Vit-B/16-384) to diagnose SSBE, we established two AI systems for WLI and LCI. Finally, 126 WLI (SSBE+/− 77/49) and 137 LCI (SSBE+/− 81/56) images were used for verification purposes. The accuracy of six endoscopists in making diagnoses was compared to that of AI. Results: Study participants were 68.2 ± 12.3 years, M/F 330/294, SSBE+/− 409/215. The accuracy/sensitivity/specificity (%) of AI were 84.1/89.6/75.5 for WLI and 90.5/90.1/91.1/for LCI, and those of experts and trainees were 88.6/88.7/88.4, 85.7/87.0/83.7 for WLI and 93.4/92.6/94.6, 84.7/88.1/79.8 for LCI, respectively. Conclusions: Using AI to diagnose SSBE was similar in accuracy to using a specialist. Our finding may aid the diagnosis of SSBE in the clinic.

Evaluation of chronic constipation is important, although it is often difficult to satisfactorily treat due to the complex interplay of factors. This study aimed to determine whether the volume of intraluminal contents and lateral diameter of the colon measured from computed tomography (CT) images were correlated with the symptoms of chronic constipation and stool consistency. Consecutive patients who underwent the Constipation Scoring System (CSS), Bristol Stool Form Scale (BSFS) questionnaires and simple abdominal CT were selected retrospectively. The intestinal tract diameter at each site was measured, and the amounts of stool and gas in the intestinal tract were evaluated at five levels. Of the 149 study participants, 54 were males and 95 were females and their mean age was 72.1 years. In the right hemi-colon, CSS5 (Time) correlated significantly with gas volume (p < 0.01). In the left hemi-colon, stool volume correlated significantly with CSS2 (Difficulty), CSS3 (Completeness), CSS5 (Time) and CSS total (p < 0.05). The BSFS negatively correlated with gas volume and diameter in the right hemi-colon and with gas volume in the rectum (p < 0.05). CT findings including stool volume, gas volume and diameter correlated with some constipation symptoms and stool consistency. These findings may be useful in evaluating and treating constipation.

The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type (GA-FGM). A total of 62 GEN-FGML lesions, including 52 GA-FG and 10 GA-FGM, were retrospectively analyzed using endoscopic and clinicopathological findings to provide information of diagnostic value using white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (M-NBI). GA-FG frequently presented with a whitish, submucosal tumor (SMT) shape with dilated vessels with branching architecture and background mucosa without atrophic change in WLI, an indistinct demarcation line (DL), dilatation of the crypt opening and intervening part (IP), and microvessels without distinct irregularity in M-NBI. GA-FGM frequently presented as a reddish, elevated lesion in WLI, with a distinct DL, dilatation of the IP, and an irregular microvascular pattern in M-NBI. As for an M-NBI diagnosis, five GA-FGM lesions met the diagnostic criteria for cancer, whereas none of the GA-FG lesions met the same criteria. We highlight the endoscopic features of GEN-FGML, and the differentiation between GA-FG and GA-FGM might be possible by combination of lesion color and morphology in WLI and M-NBI diagnoses.

Bile acids are strongly associated with the pathogenesis of functional gastrointestinal diseases. In recent years, blue laser imaging (BLI) endoscopy has emerged as a novel image-enhanced endoscopic method, which illustrates bile as a reddish hue. The present study investigated the factors that affect the area of bile in duodenal bulbs using BLI. For this purpose, patients (356 cases) who underwent upper endoscopy with BLI between April, 2017 and December, 2019, and completed patient background and symptom questionnaires [Constipation Scoring System (CSS), Bristol Stool Form Scale (BSFS) and Frequency Scale for Symptoms of gastroesophageal reflux disease (FSSG)], were retrospectively investigated. Each BLI bile score was calculated as a percentage of bile area in a field of view in the duodenal bulb using a KS400 image analysis system, and the association with abdominal symptoms was examined using multiple regression analysis. The patient characteristics included the following: Age (in years), 69.9±11.3; male/female ratio, 146/210; body mass index, 23.0±3.8; reflux esophagitis (M/A/B/C), 143/19/3/3; atrophic gastritis (C-0/C1-3/O1-3), 132/100/124; proton pump inhibitor potassium competitive acid blocker/aspirin/ursodeoxycholic acid/gall bladder stones/cholecystectomy, 105/27/18/43/18; BLI bile score, 7.10 (±14.34); CSS score, 3.55 (±3.80); BSFS score, 3.91 (±1.02); and FSSG score, 4.80 (±5.76). Correlation coefficients (P<0.05) for the BLI bile score were found for cholecystectomy (Rho=0.137) and aspirin use (Rho=0.118). In multiple regression analysis, independent predictors of the BLI bile score were cholecystectomy [standardized partial regression coefficient (β)=0.169, P=0.001] and the BSFS score (β=0.107, P=0.042). On the whole, the present study demonstrates that the duodenal bile area in BLI upper endoscopy is associated with cholecystectomy and fecal characteristics.

A 'gray color sign' (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS. In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on color values and the color difference (Δ *) in the CIE LAB color space system. Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI ( < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was \"excellent\" for all endoscopists. The use of Δ * revealed statistically significant differences between WLI and TXI-1 ( < 0.01). TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.