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J Gastroenterol. 2017 Feb;52(2):211-217. doi: 10.1007/s00535-016-1214-0. Epub 2016 Apr 27.

New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis.

Author information

1
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan. mkusano@gunma-u.ac.jp.
2
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan. mkusano@gunma-u.ac.jp.
3
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
4
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.
5
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
6
The Gunma Health Foundation, Maebashi, Gunma, Japan.

Abstract

BACKGROUND:

We recently demonstrated that cascade stomach detected by barium studies was correlated with upper gastrointestinal symptoms. We developed a new endoscopic classification of cascade stomach and examined its relationship with reflux esophagitis.

METHODS:

Study 1: the classification (grades 0-3) was based on detecting a ridge that runs from the cardia toward the anterior wall crossing the greater curvature. Inter-observer variation was evaluated by kappa statistics when ten experienced endoscopists used this classification three times each. Study 2: in 710 consecutive subjects (500 men and 210 women) undergoing endoscopic screening, the grade of cascade stomach and incidence of reflux esophagitis were compared.

RESULTS:

In study 1, the kappa values at the third assessment were 0.85, 0.58, 0.50, and 0.78 for each grade, respectively, while overall agreement was 0.68. In study 2, the incidence of reflux esophagitis in men was 20 % in grade 0, 17 % in grade 1, 25 % in grade 2, and 30 % in grade 3, showing significant differences. Among women, the incidence of reflux esophagitis in each grade was 9, 3, 6, and 35 %, respectively, also showing significant differences. Multivariate analysis showed that independent risk factors for reflux esophagitis were cascade stomach (odds ratio = 2.20), body mass index, and hiatus hernia in men, as well as cascade stomach (odds ratio = 9.01) and smoking tobacco in women.

CONCLUSIONS:

This endoscopic classification of cascade stomach showed acceptable inter-observer variation. Cascade stomach is a risk factor for reflux esophagitis.

KEYWORDS:

Cascade stomach; Inter-observer variation; Kappa statistics; Reflux esophagitis; Ridge

PMID:
27121685
DOI:
10.1007/s00535-016-1214-0
[Indexed for MEDLINE]

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