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

  • Original Article—Alimentary Tract
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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.

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Abbreviations

CS:

Cascade stomach

GI:

Gastrointestinal

RE:

Reflux esophagitis

BMI:

Body mass index

TLESR:

Transient lower esophageal sphincter relaxation

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Authors and Affiliations

  1. Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan

    Motoyasu Kusano, Osamu Kawamura & Taku Tomizawa

  2. Division of Gastroenterology and Hepatology, Department of Integrated Internal Medicine, Gunma University Hospital, Maebashi, Gunma, Japan

    Motoyasu Kusano, Hiroko Hosaka, Hidetoshi Yasuoka, Osamu Kawamura, Shiko Kuribayashi, Yasuyuki Shimoyama, Masafumi Mizuide, Taku Tomizawa, Ken Sato & Satoru Kakizaki

  3. Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Akiyo Kawada, Shingo Ishihara, Toshihiko Sagawa & Junichi Akiyama

  4. The Gunma Health Foundation, Maebashi, Gunma, Japan

    Fumitaka Moki

Authors
  1. Motoyasu Kusano
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  2. Hiroko Hosaka
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  3. Hidetoshi Yasuoka
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  4. Osamu Kawamura
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  5. Akiyo Kawada
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  6. Shiko Kuribayashi
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  7. Yasuyuki Shimoyama
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  8. Masafumi Mizuide
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  9. Taku Tomizawa
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  10. Shingo Ishihara
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  11. Toshihiko Sagawa
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  12. Junichi Akiyama
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  13. Ken Sato
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  14. Satoru Kakizaki
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  15. Fumitaka Moki
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Corresponding author

Correspondence to Motoyasu Kusano.

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Kusano, M., Hosaka, H., Yasuoka, H. et al. New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis. J Gastroenterol 52, 211–217 (2017). https://doi.org/10.1007/s00535-016-1214-0

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  • DOI: https://doi.org/10.1007/s00535-016-1214-0

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