found that if collecting venules were visible as numerous minute points, regularly distributed over the entire gastric body, the patients had a normal stomach and no H. pylori infection. 8,9,11 We termed this finding "regular arrangement of collecting venules (RAC)." Further characterization using magnified views showed RAC to consist of collecting venules, a network of true capillaries, and gastric pits with a pinhole-like appearance. [8][9][10][11] Patients in whom RAC was not observed endoscopically (RAC-negative) had H. pylori infection. Compared to culturing and histological diagnosis, the accuracy of RAC in identifying H. pylori infection was 95%. From 1998 onwards, we began using RAC as a diagnostic method, and subsequently we studied the incidence of adenocarcinomas arising in patients with and without H. pylori infection. The RAC method is very practical, given that almost all chronic gastritis is induced by H. pylori and that this bacterium is involved in various disease states.
Regular arrangement of collecting venules (RAC): a characteristic endoscopic feature of the H. pylorinegative normal stomachOn conventional endoscopy, H. pylori-negative normal stomach shows numerous minute points throughout the gastric body (Fig. 1), and it is not unusual to observe these minute points near the pyloric ring, especially in young patients. This endoscopic finding was termed "regular arrangement of collecting venules (RAC)," because the minute points were revealed to be collecting venules. 8-11 On closer observation, the points were shown to be star-fish like arrangements of vessels. Patients in whom RAC is observed endoscopically are termed 9,11 In patients with duodenal ulcer, or young patients with H. pylori infection, minute points are often observed in the middle body or upper gastric body, because the infection does not always ex-
The purpose of this study was to ascertain whether areas of yellow elevated change in the distal squamous epithelium represent esophageal cardiac gland and to further assess the features of the exposed esophageal cardiac gland in the magnified view. In addition, the relationship between the columnar-lined esophagus, gastro-esophageal reflux disease (GERD), reflux esophagitis, and H. pylori infection was also assessed. Fifty patients (28 men, 22 women; median age 61 years) underwent elective upper GI endoscopy. The distal margin of the squamo-columnar junction was observed to ascertain whether a yellow elevated lesion was present. When such a lesion was observed, this area was studied using magnifying endoscopy with acetic acid and a biopsy specimen was taken. Furthermore, biopsy specimens of the cardia, antrum, and body were taken for biopsy specimen to check for the presence of carditis, gastritis, and H. pylori. Of 38 patients showing the yellow elevated change, all showed exposed columnar epithelium and 30 patients proved to have esophageal cardiac gland tissue in biopsy specimens. Of 31 patients with H. pylori infection, all had carditis and the yellow elevated lesion. Of 19 patients with a H. pylori-negative normal stomach, none had carditis and seven patients had the yellow elevated change which was ascertained to be esophageal cardia by biopsy. The yellow elevated change at the distal squamo-columnar junction was revealed to be esophageal cardiac gland and exposed esophageal cardiac gland was visible in all cases by magnifying endoscopy with acetic acid.
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