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BACKGROUND/AIMS: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL. METHODS: The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake. RESULTS: In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06-16.2). CONCLUSION: Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

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Objective Multiple white and flat elevated lesions (MWFLs) observed in the stomach have only been presented in abstracts at academic conferences over the last decade; therefore, relatively little is known about these lesions. Our aim was to prospectively clarify the clinical characteristics of MWFLs, to identify their risk factors and to retrospectively evaluate the clinical progression of these lesions. Methods A prospective analysis of clinical characteristics and risk factors was conducted in participants who underwent esophagogastroduodenoscopic screening at our hospital. A retrospective analysis of the medical chart of patients identified as having MWFLs was conducted to describe the clinical progression of these lesions. Results The prevalence rate of MWFLs was 10.4% (80/767), with the following risk factors identified on a logistic regression analysis: use of proton pump inhibitors [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.92-6.43], female sex (OR, 1.92; 95% CI, 1.19-3.12) and a 1-year increase in age (OR, 1.05; 95% CI, 1.02-1.08). Among the 70 cases with MWFLs observed over a mean duration of 2.3 years, no progression of MWFLs was detected in 67 cases (96%). Among the 3 remaining cases, progression was mild, with none of the lesions progressing to malignancy. Conclusion The use of proton pump inhibitors (PPIs), female sex, and age are risk factors for MWFLs. We believe that endoscopists should recognize these lesions.

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Objective The pathogenesis of multiple white and flat elevated lesions in the stomach has not been elucidated. We investigated the prevalence of such lesions and their characteristics in affected individuals. Methods The subjects were 1,995 individuals (1,320 men, 675 women; mean age 54.2±9.5 years) who visited our medical center for a comprehensive annual medical checkup and in whom the status of Helicobacter pylori infection could be determined. The presence of multiple white and flat elevated lesions in the stomach and the degree of gastric mucosal atrophy were evaluated using endoscopic findings. Results Multiple white and elevated lesions in the stomach were observed in 60 subjects (3.0%), who were predominantly women and older in comparison to those without such lesions. The prevalence rates of these lesions in H. pylori-positive and H. pylori-negative and in post-eradicated subjects were 0.5%, 1.3%, and 4.6%, respectively. A multiple logistic regression analysis demonstrated that post-eradication status, female gender, older age, and a higher grade of gastric mucosal atrophy were significant risk factors for the occurrence of multiple white and elevated lesions. Conclusion Multiple white and elevated lesions were frequently observed in subjects with successful H. pylori eradication.

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BACKGROUND AND AIM: It is clinically important to diagnose drug-induced gastric lesions correctly. Recently, the use of proton pump inhibitors (PPI) has increased worldwide. The histological features induced by PPI have been reported; however, few reports have described endoscopic findings induced by PPI. Therefore, we aimed to clarify the characteristic endoscopic features in PPI users and associated pathogenic factors. METHODS: We prospectively registered 1007 consecutive participants (70 PPI users and 937 nonusers) who underwent endoscopic examination for cancer screening in three hospitals/clinics. Clinical data and endoscopic findings were recorded in the registration forms. We compared the endoscopic features between the two groups and evaluated contributing factors via univariate and multivariate analyses. RESULTS: Multiple white elevated lesions (MWEL) and cobblestone-like mucosa (CLM) were more commonly observed in PPI users compared with nonusers (p < .01). Foveolar hyperplastic polyps were also frequently observed in PPI users but were not statistically significantly different (p = .06). MWEL and CLM were more frequently observed in older patients than in younger patients. MWEL was more frequently observed in female patients than in male patients; however, CLM was predominantly observed in male patients. CONCLUSION: MWEL and CLM are characteristic endoscopic features in PPI users. A gender-associated difference was noted in terms of the frequency of these lesions.

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Objective To assess the curative effect and safety of endoscopic therapy at duodenum elevated lesions. Methods We retrospectively studied the clinical data including general data, the procedure of performance, the lesions pathological characters, complications and recurrence after the treatment of patients who underwent endoscopic treatment. Results 111 patients of 112 patients were treated by endoscopic treatment successfully, 1 case was treated by surgery. 49 lesions were treated by electrocoagulation, 36 lesions were treated by polypectomy or endoscopic mucosal resection (EMR), 27 by endoscopic submucosal dissection (ESD). Complication rate was 16.96%(19/112), 1 case of active bleeding was treated by surgery in hemostasis difficulty. 6 cases of perforation, 2 cases of delayed bleeding, 2 cases of transient increase in amylase level and 1 case of delayed perforation. All the patients were successfully performed. Post-operation follow-up period was 1~12 months. Conclusion Endoscopic treatment holds advantages of minimally invasive, quick recovery, low cost, and less risk which may be play an important role in duodenal elevated lesions.

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OBJECTIVE: This study sought to determine the impact of voice disability on children with elevated vocal fold lesions (nodules, cysts, polyps). The Pediatric Voice Handicap Index (pVHI) was used to assess the impact on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness and overall severity of dysphonia were also determined. STUDY DESIGN: Case series with chart review of children evaluated at a voice clinic from 2007 to 2011. SETTING: Tertiary specialized children's hospital. SUBJECTS AND METHODS: Medical records of 33 children (11 girls, 22 boys) diagnosed with an elevated vocal fold lesion by a pediatric laryngologist were reviewed for voice disability using the pVHI. The pVHI is a parental proxy of perceived voice handicap in functional, physical, and emotional aspects and includes a talkativeness rating scale and visual analog overall severity rating of voice (VAS). Data were examined for young children (age 2-5 years), children (age 6-10 years), and adolescents (age 11-17 years). RESULTS: The VAS was significantly correlated with pVHI-total. There was no significant difference between age groups for overall pVHI (mean, 29.3) or talkativeness, but all groups had significantly higher functional disability (mean, 16) compared with physical (mean, 8.2) or emotional (mean, 5.1) disability. CONCLUSIONS: Children across all age groups with elevated vocal fold lesions have significant voice disability, greatest for functional aspects of voice. Voice care team professionals must recognize the functional impact of dysphonia on the pediatric patient.

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BACKGROUND/AIMS: This is the study to clarify the relation between the mucosal patterns by magnifying endoscopy and the histologic findings in the gastric mucosal elevated lesions. METHODS: The objectives were 51 lesions from 48 patients with gastric mucosal elevated lesions. Gastric mucosal elevated lesions have been magnified up to 80 times by using the magnifying endoscope and were obtained tissue. Magnifying mucosal patterns were classified into 6 types (dot, sulciolar, reticular, irregular, destructive and abnormal vessel pattern) and two group (Group A: dot, sulciolar, reticular pattern-preservation of mucosal arrangement, Group B: irregular, destructive, abnormal vessel pattern-destruction of mucosal arrangement). And then we compared the relation between the mucosal patterns and the histologic findings in the gastric mucosal elevated lesions. RESULTS: In magnifying mucosal patterns, dot, sulciolar, reticular, irregular, destructive, and abnormal vessel pattern were 8, 5, 15, 4, 12, 7, respectively. There was significant difference in the rate of severe dysplasia or carcinoma between two groups (Group A: 0% (0/28), Group B: 70% (16/23) (p<0.05)). The score of intestinal metaplasia and atrophy in group A were less than that of group B (p<0.05). CONCLUSIONS: Irregularity, destruction and abnormal vessel formation of gastric mucosal pattern by magnifying endoscope may be suspected the histologic malignancy in the gastric mucosal elevated lesions.

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