4). Open in a separate window Figure 4. The circumferential distribution of the esophageal mucosal breaks at different distances from your esophagogastric junction (a: 0-1 cm, b: 1-2 cm, c: 2-3 cm, d: 3 cm). Discussion In the present study, we investigated the relationship between the vertical and circumferential localizations of esophageal mucosal breaks in patients with reflux esophagitis, with results showing that this distribution of those breaks was markedly different depending on the distance from your esophagogastric junction. mucosal breaks occurring relatively near the esophagogastric junction mainly exist on the right anterior wall, whereas those farther from that junction tend to exist around the posterior wall of the esophagus. The circumferential location of esophageal mucosa highly exposed to refluxed gastric contents changes based on the distance from your esophagogastric junction. strong class=”kwd-title” Keywords: circumferential localization, vertical localization, esophageal mucosal breaks, reflux esophagitis Introduction The main location of esophageal mucosal breaks in patients with low-grade reflux esophagitis [A and B in the Los Angeles (LA) classification] has been shown to be the right anterior wall, while that in high-grade patients (grades C and D) is generally the posterior wall of the distal esophagus (1,2). This difference in the localization of such mucosal breaks between low- and high-grade esophagitis is considered to be related to the area exposed to Ursolic acid (Malol) refluxed acidic gastric contents. Indeed, an intra-esophageal pH monitoring study showed that nocturnal gastroesophageal reflux is usually predominant in patients with high-grade esophagitis, and the posterior wall of the esophagus may be exposed to refluxed acid while in a supine position (3). In addition, a study that utilized a catheter equipped with eight pH sensors radially arrayed at the same level revealed that the location of esophageal mucosal breaks fits with the area mainly exposed to acid in patients with low-grade esophagitis (4). Therefore, esophageal mucosal breaks in all types of esophagitis are considered to occur in locations with high exposure to gastric acid. We noticed that esophageal mucosal breaks sometimes exist in areas relatively far from the esophagogastric Ursolic acid (Malol) junction. The site of esophageal mucosal break is usually theoretically Ursolic acid (Malol) identical to the locations with high exposure to refluxed gastric contents, even though the mucosal break exists apart from the esophagogastric junction. However, the relationship between the vertical and circumferential localization of esophageal mucosal breaks has not been examined. The purpose of the present study was to investigate the circumferential localization of esophageal mucosal breaks that exist relatively far from the esophagogastric junction. Materials and Methods The study subjects were individuals who visited the Health Center of Shimane Environment and Health Public Corporation for an annual detailed medical checkup between April 2015 and March 2016. All underwent upper endoscopic examinations. Those with a history of gastric surgery were not included in this study, whereas subjects who had taken medications, such as proton pump inhibitors or H2 receptor antagonists, were not excluded. All upper endoscopic examinations were performed by licensed experienced endoscopists using an EG-530NW or EG-L580NW device (Fujifilm, Tokyo, Japan). At our institution, upper endoscopic examinations are performed with the subjects in an unsedated condition without anti-cholinergic drug administration, and the endoscope is typically inserted in a transnasal manner. The size of the diaphragmatic hiatus was assessed during endoscopic observation by comparing the width of the cardiac opening with the diameter of the shaft using endoscopy at the cardiac portion, with the findings used to divide the subjects into 3 groups based on the Rabbit Polyclonal to OR10H2 hiatus size (1.0, 1.0-2.0, 2.0 cm). Gastric mucosal atrophy was evaluated based on endoscopic findings using the classification of Kimura and Takemoto, in which gastric mucosal atrophy is usually classified into six groups (C1, C2, C3, O1, O2, O3) (5). This classification has been shown to correlate well with the histological features of atrophy. For the present study, C1-C2 was defined as moderate, C3-O1 as moderate, and O2-O3 as severe gastric mucosal atrophy. The endoscopic findings of reflux esophagitis were evaluated using the LA classification (6), and individuals with a grade of A, B, C, or D were diagnosed as positive for reflux esophagitis. All endoscopic images were examined by one of the authors (K.A.) who investigated the vertical and circumferential localization of esophageal mucosal breaks. For this study, only esophageal mucosal breaks that showed longitudinal extension were analyzed so as Ursolic acid (Malol) to more clearly investigate the relationship between the circumferential distribution of mucosal breaks and distance from your esophagogastric junction. Therefore, esophageal mucosal breaks that were transversely extended in grade C and D cases were excluded from your analysis. We defined the esophagogastric junction as the distal margin of the palisade vessels, based on the criteria of The Japan Esophageal Society (7). Vertical localization was decided based on the distance between the distal end of the esophageal mucosal break and the esophagogastric junction. The distance between.