New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis.
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.
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan. mkusano@gunma-u.ac.jp.|Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan. mkusano@gunma-u.ac.jp.
Motoyasu
M
Kusano
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Hiroko
H
Hosaka
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Hidetoshi
H
Yasuoka
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.|Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Osamu
O
Kawamura
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Akiyo
A
Kawada
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Shiko
S
Kuribayashi
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Yasuyuki
Y
Shimoyama
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Masafumi
M
Mizuide
Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.|Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Taku
T
Tomizawa
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Shingo
S
Ishihara
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Toshihiko
T
Sagawa
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Junichi
J
Akiyama
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Ken
K
Sato
Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan.
Satoru
S
Kakizaki
The Gunma Health Foundation, Maebashi, Gunma, Japan.
Fumitaka
F
Moki
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D012307:Risk Factors; D012737:Sex Factors; D013272:Stomach Diseases / Q000145:classification / Q000150:complications / Q000175:diagnosis*
Cascade stomach; Inter-observer variation; Kappa statistics; Reflux esophagitis; Ridge