The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

Abstract

The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and highresolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.

Comparative Study of Helicobacter pylori-Infected Gastritis in Okinawa and Tokyo Based on the Kyoto Classification of Gastritis

“…In the Kyoto Classification of Gastritis, atrophy, intestinal metaplasia, diffuse redness, and nodularity are risk factors for gastric cancer [ 22 , 24 , 25 , 26 , 27 , 28 ]. Enlarged fold has also been weakly associated with undifferentiated gastric carcinoma [ 26 ].…”

“…The Kyoto Classification of Gastritis allows efficient evaluation of gastric cancer risk based on the state of the background mucosa with 19 endoscopic findings. In particular, diffuse redness, mucosal swelling, enlarged fold, sticky mucus, and spotty redness are considered findings suggestive of H. pylori infection [ 14 , 15 , 16 , 18 , 19 , 20 , 21 , 22 ].…”

Pharynx and esophagus: Esophageal benign diseases

“…Moreover, endoscopic ultrasonography (EUS) and high‐resolution manometry (HRM) may be used for diagnosis or evaluations of treatment outcomes. In a recent study using EUS and HRM, the significantly thicker muscle layer and higher distal contractile integral (DCI) values were recognized in the symptomatic group than the asymptomatic group, and esophageal wall thickness and DCI values as well as EoE symptoms were significantly improved after treatment 1 . Further studies are required to confirm the usefulness of those modalities for EoE predictors.…”

“…In contrast, it has been reported that lugol chromoendoscopy and image enhanced endoscopy such as auto fluorescence imaging, narrow band imaging, and linked color imaging compared with WLI may improve visibility and reliability for non‐erosive reflux disease (NERD) diagnosis. On the other hand, 24‐h intra‐esophageal pH‐impedance monitoring can be used to confirm NERD and differentiate it from functional heartburn 1 …”