記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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掲載種別：研究論文（学術雑誌）  

We aimed to investigate the association between nurses’ electrocardiographic (ECG) monitoring education and their confidence and psychological stress regarding ECG monitoring. In 2019, a web-based cross-sectional study was conducted among Japanese nurses. A multivariable logistic regression analysis was performed to evaluate the effects of education on nurses’ confidence and psychological stress regarding ECG monitoring. In total, 1652 nurses were included in the study. Factors significantly associated with nurses’ confidence were post-graduate education experience (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.6–3.6), ≥11 post-graduate years (OR, 2.2; 95% CI, 1.5–3.1), male gender (OR, 4.4; 95% CI, 2.9–6.6), ≥5 helpful experiences with ECG monitoring (OR, 10.7; 95% CI, 6.0–19.1), work experience in an intensive care unit (OR, 2.3; 95% CI, 1.5–3.7), and work experience in a cardiology department (OR, 1.7; 95% CI, 1.2–2.4). Factors significantly associated with nurses’ psychological stress were male gender (OR, 1.9; 95% CI, 1.2–2.9), ≥5 helpful experiences with ECG monitoring (OR, 1.9; 95% CI, 1.2–2.9), and work experience in an emergency room (OR, 2.4; 95% CI, 1.3–4.8). These results suggest that nurses’ post-graduate ECG monitoring education enhanced their confidence, but did not reduce psychological stress regarding ECG monitoring.

DOI： 10.3390/ijerph19084742

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記述言語：日本語   出版者・発行元：横浜市立大学医学会  

がんなどの重い疾病を抱えた患者の住み慣れた自宅などの望む療養場所でつらい症状なく過ごすことが出来る支援を行うことが在宅緩和ケアの目標のひとつである.在宅緩和ケアに医療用麻薬などの症状緩和目的の薬剤は病院内と同様に必要であり,これらの薬剤を患者の元に届ける在宅訪問薬剤師は在宅緩和ケアの推進に不可欠な存在だと考えられる.しかし,実際には地域において医療用麻薬を扱う薬局は少なく,在宅医療に関わる訪問薬剤師の数は十分ではないと考えられている.そこで在宅医療の現場における,訪問薬剤師の印象と期待を聞き取り,今後の課題を考察した.医療,介護,教育,行政の各職種と地域住民などに対して,調査者と回答者が1対1で対面して聴取を行う個人面接を行って口頭データを収集し,インタヴュー形式による質的研究を行った.その結果,訪問薬剤師とその拠点となる保険薬局が在宅での終末期がん緩和ケアに対する医療資源になりうる事を認識している人が少ないなどの問題が明らかになった.在宅訪問薬剤師が在宅緩和医療に参画していくためには,患者にとっての生活の場である自宅と病院内との環境の違いを理解し,また在宅緩和ケアの一般的な在宅医療との相違点を理解し,それらに即した適切な業務を行っていくことが求められていると考えられた.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01499&link_issn=&doc_id=20211224360003&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00002196%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00002196%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：John Wiley and Sons Inc  

Background and Aim: Many patients are not satisfied with chronic constipation (CC) treatments. The aim of this study was to identify factors linked to CC treatment satisfaction or dissatisfaction. Methods: Our study population included patients who received CC treatment at a clinic or hospital. CC was diagnosed by a physician based on the patient's complaint. Treatment satisfaction was evaluated using the 28th question of the Patient Assessment of Constipation Quality of Life questionnaire. Results: We conducted this study at 28 facilities. We included 167 patients (mean age 66.7 ± 15.2 years, male:female ratio is 1:3.07). Sixty-eight (40.7%) of patients were satisfied with their constipation treatment. Treatment dissatisfaction of CC was significantly associated with frequency of bowel movement &lt
3/week (odds ratio [OR] = 0.376, 95% confidence interval [CI]: 0.156–0.904, P = 0.029) or Bristol Stool Form Scale (BSFS) type 3 (OR = 0.401, 95% CI: 0.170–0.946, P = 0.037). Conclusions: Our study showed that CC patients with BSFS type3 were not satisfied with constipation treatment. In general, BSFS types 3–5 are defined as normal stools. Therefore, BSFS type 3 may be set as a treatment goal even though the patient is not satisfied. The pathophysiology of CC differs by region and patient background. Therefore, parameters used to define successful treatment will be different by patient or region. We should reconsider the positioning of BSFS type 3 to improve treatment satisfaction for CC.

DOI： 10.1111/jgh.15428

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記述言語：日本語   出版者・発行元：(一社)日本プライマリ・ケア連合学会  

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

As end-of-life (EOL) care in nursing homes is gradually increasing, interprofessional collaboration in EOL care in nursing homes is becoming important. However, a method for measuring interprofessional collaboration has not been established. Therefore, this study aimed to clarify the effect of interprofessional collaboration on EOL care in nursing homes. Questionnaires were mailed to the facility directors of 378 nursing homes in Kanagawa Prefecture, Japan, and distributed to nurses, care managers, and professional caregivers. Three professionals from each nursing home completed the same questionnaire, which included 9 items on EOL care: shared facility policy, residents' wishes, each professional's roles, person in charge of the facility, residents' conditions, mental status of residents' families, emergency codes, residents' key people, and sufficient discussion among professionals. Based on the professionals' responses, interprofessional collaboration was assessed. We used multivariable analysis, with interprofessional collaboration as an independent factor. The outcome was the amount of EOL care in the nursing home. A total of 180 (47.6%) nursing homes participated. Multivariable analysis showed that interprofessional collaboration (beta [β] coefficient 2.5, 95% confidence interval [CI] 0.45-4.48; p = 0.017), availability of EOL care bonuses (β coefficient 4.4, 95% CI 1.41-7.38; p = 0.004), physician support for emergency care during off time (β coefficient 5.4, 95% CI 1.86-8.94; p = 0.003), and EOL care conferences (β coefficient 4.1, 95% CI 1.19-6.99; p = 0.006) were significant factors associated with the amount of EOL care in the nursing homes. We found evidence in the adjusted model that interprofessional collaboration among facility professionals is effective for EOL care in nursing homes.

DOI： 10.5582/ddt.2021.01030

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The effects of acotiamide on gastrointestinal motility have not been sufficiently investigated. The aim of this study was to determine whether single preprandial acotiamide or mosapride intake might affect the gastric emptying rate using the 13C breath test. Here, 11 healthy volunteers participated in a randomized three-way crossover study. The subjects received acotiamide (100 mg) or mosapride (5 mg) or placebo before liquid test meal ingestion. Gastric emptying was estimated by determining following parameters: the time required for 50% emptying of the labeled meal (T1/2), lag time for 10% emptying of the labeled meal (Tlag), gastric emptying coefficient (GEC) and regression-estimated constants (β and κ). These parameters were calculated from a 13CO2 breath excretion curve using conventional formulas. The acotiamide, mosapride and placebo conditions were compared, revealing that for gastric emptying rates (values expressed as median), T1/2 (87.83571 min vs 79.95057 min vs 88.74378 min, p = 0.1496), Tlag (46.36449 min vs 42.2897 min vs 47.08094 min, p = 0.4966), GEC (4.382027 vs 4.211441 vs 4.248495, p = 0.8858), β (1.917728 vs 1.757062 vs 1.869141, p = 0.4066) and κ (0.834051 vs 0.819820 vs 0.789523, p = 0.1225) did not significantly differ. In this study, acotiamide (100 mg) or mosapride (5 mg) had no effect on gastric emptying.

DOI： 10.3164/jcbn.20-162

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Managing irritable bowel syndrome (IBS) has attracted international attention because single-agent therapy rarely relieves bothersome symptoms for all patients. The Japanese Society of Gastroenterology (JSGE) published the first edition of evidence-based clinical practice guidelines for IBS in 2015. Much more evidence has accumulated since then, and new pharmacological agents and non-pharmacological methods have been developed. Here, we report the second edition of the JSGE-IBS guidelines comprising 41 questions including 12 background questions on epidemiology, pathophysiology, and diagnostic criteria, 26 clinical questions on diagnosis and treatment, and 3 questions on future research. For each question, statements with or without recommendations and/or evidence level are given and updated diagnostic and therapeutic algorithms are provided based on new evidence. Algorithms for diagnosis are requisite for patients with chronic abdominal pain or associated symptoms and/or abnormal bowel movement. Colonoscopy is indicated for patients with one or more alarm symptoms/signs, risk factors, and/or abnormal routine examination results. The diagnosis is based on the Rome IV criteria. Step 1 therapy consists of diet therapy, behavioral modification, and gut-targeted pharmacotherapy for 4 weeks. For non-responders, management proceeds to step 2 therapy, which includes a combination of different mechanistic gut-targeted agents and/or psychopharmacological agents and basic psychotherapy for 4 weeks. Step 3 therapy is for non-responders to step 2 and comprises a combination of gut-targeted pharmacotherapy, psychopharmacological treatments, and/or specific psychotherapy. These updated JSGE-IBS guidelines present best practice strategies for IBS patients in Japan and we believe these core strategies can be useful for IBS diagnosis and treatment globally.

DOI： 10.1007/s00535-020-01746-z

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

【目的】終末期がん患者のセクシュアリティへの支援に対する看護師の現状を明らかにする.【方法】2018年12月に神奈川県内緩和ケア病棟18施設の看護師313名を対象に終末期がん患者の「パートナーとの愛を育む時間」に対する認識,感情,支援への行動意図と実践について質問紙調査を行った.【結果】165名中(回収率52.7%)「パートナーとの愛を育む時間」への支援経験があるのは82名(49.7%)であった.行ったことのある具体的な支援内容は「スキンシップを勧める」,「傾聴」,「ハグを勧める」,「入室の際に,ノックや声掛け後に返事を待つなど十分な時間をとる」が多かった.一方,病棟カンファレンスで「パートナーとの愛を育む時間」について話したことがあるのは11名(6.7%)であった.【結論】現状,「パートナーとの愛を育む時間」への支援は個人に任され,組織的には行われていないことが示唆された.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Society for Free Radical Research Japan  

The effects of acotiamide on gastrointestinal motility have not been sufficiently investigated. The aim of this study was to determine whether single preprandial acotiamide or mosapride intake might affect the gastric emptying rate using the 13C breath test. Here, 11 healthy volunteers participated in a randomized three-way crossover study. The subjects received acotiamide (100 mg) or mosapride (5 mg) or placebo before liquid test meal ingestion. Gastric emptying was estimated by determining following parameters: the time required for 50% emptying of the labeled meal (T1/2), lag time for 10% emptying of the labeled meal (Tlag), gastric emptying coefficient (GEC) and regression-estimated constants (β and κ). These parameters were calculated from a 13CO2 breath excretion curve using conventional formulas. The acotiamide, mosapride and placebo conditions were compared, revealing that for gastric emptying rates (values expressed as median), T1/2 (87.83571 min vs 79.95057 min vs 88.74378 min, p = 0.1496), Tlag (46.36449 min vs 42.2897 min vs 47.08094 min, p = 0.4966), GEC (4.382027 vs 4.211441 vs 4.248495, p = 0.8858), β (1.917728 vs 1.757062 vs 1.869141, p = 0.4066) and κ (0.834051 vs 0.819820 vs 0.789523, p = 0.1225) did not significantly differ. In this study, acotiamide (100 mg) or mosapride (5 mg) had no effect on gastric emptying.

DOI： 10.3164/JCBN.20-162

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記述言語：日本語   出版者・発行元：(公社)地域医療振興協会  

目的:内科医に短時間の実技を交えた小外科講義を行うことで、プライマリ・ケア医に求められる小外科診療が可能となるか調査した。到達目標は「資料を確認すれば単独診療可能」とした。方法:病院勤務内科医14人を対象とした。平日夕方に1人の外科指導医が指切創、熱傷、四肢打撲の3つのテーマについて実技指導を交えた1時間程度の講義を行った。講義開始前、終了直後、終了3〜6ヵ月後の3回、診断、治療、後対応、総合評価の4項目について4段階の習熟度自己評価を行った。「資料を確認すれば単独診療可能」を3点に設定し、講義の短期・長期効果を評価した。結果:講義への参加者は指切創10人、熱傷11人、四肢打撲10人であった。全テーマ、全項目において、終了直後、終了3〜6ヵ月後の平均点は有意に上昇した。しかし、四肢打撲については全評価項目いずれも平均3点未満であった。結論:内科医に対する実技を交えた小外科講義には一定の効果が示唆されたが、四肢打撲の教育効果は限定的であった。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Education regarding death diagnosis is not often included in the medical education. OBJECTIVE: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. DESIGN: Uncontrolled, open-label, multi-center trial. SUBJECTS: A total of 131 doctors undergoing their initial training were enrolled this study. MEASUREMENTS: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors' behaviors at the death diagnosis based on our guidebook at each hospital. RESULTS: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that "I do not know what to say to the family after a death diagnosis". Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for "Give words of comfort and encouragement to family" increased significantly after the lecture to 0.9. CONCLUSIONS: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients' families. After the lecture using our guidebook, residents' mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

DOI： 10.1177/0825859720951698

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記述言語：日本語   出版者・発行元：(一社)日本医学教育学会  

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記述言語：日本語   出版者・発行元：(一社)日本在宅医療連合学会  

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掲載種別：研究論文（学術雑誌）  

© The Author(s) 2020. Background: Education regarding death diagnosis is not often included in the medical education. Objective: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. Design: Uncontrolled, open-label, multi-center trial. Subjects: A total of 131 doctors undergoing their initial training were enrolled this study. Measurements: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors’ behaviors at the death diagnosis based on our guidebook at each hospital. Results: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that “I do not know what to say to the family after a death diagnosis”. Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for “Give words of comfort and encouragement to family” increased significantly after the lecture to 0.9. Conclusions: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients’ families. After the lecture using our guidebook, residents’ mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

DOI： 10.1177/0825859720951698

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Several risk scoring systems exist for acute upper gastrointestinal bleeding (UGIB). The clinical Rockall score (clinical RS) and the Glasgow-Blatchford score (GBS) are major risk scores that consider only clinical data. Computed tomography (CT) findings are equivocal in non-variceal UGIB. We compared CT findings with clinical data to predict mortality, rebleeding and need for endoscopic therapy in non-variceal UGIB patients. This retrospective, single-center study included 386 patients admitted to our emergency department with diagnosis of non-variceal UGIB by urgent endoscopy between January 2009 and March 2015. Multivariable logistic regression analysis was used to investigate CT findings and risk factors derived from clinical data. CT findings could not significantly predict mortality and rebleeding in non-variceal UGIB patients. However, upper gastrointestinal hemorrhage in CT findings better predicted the need for endoscopic therapy than clinical data. The adjusted odds ratios were 10.10 (95% CI 5.01-20.40) for clinical RS and 10.70 (95% CI 5.08-22.70) for the GBS. UGI hemorrhage in CT findings could predict the need for endoscopic therapy in non-variceal UGIB patients in our emergency department. CT findings as well as risk score systems may be useful for predicting the need for endoscopic therapy.

DOI： 10.3164/jcbn.18-115

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AVES  

Background/Aims: The aim of this study was to determine the correlation between low-dose ramosetron pretreatment and gastric emptying using a novel, non-invasive technique for measuring gastric emptying, namely, the continuous real-time 13C breath test (BreathID system: Exalenz Bioscience Ltd., Israel). Materials and Methods: Twelve healthy male volunteers participated in this randomized two-way crossover study. The subjects fasted overnight and were randomly assigned to receive the test meal (200 kcal per 200 mL) after an hour pre-treatment with 5 µg ramosetron or the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal with the 13C-acetic acid breath test performed continuously using the BreathID system. Using Oridion Research Software (β version), T 1/2, T lag, GEC and the regression-estimated constants (β and κ) were calculated. The differences in the parameters measured at two time-points were analyzed using Wilcoxon’s signed-rank test. Results: There was a significant difference in the calculated parameter β. No significant differences in the calculated parameters T 1/2, T lag, GEC or κ were observed between the test meal with ramosetron group and the test meal alone group. Conclusion: This study showed that ramosetron pre-treatment enhances the early gastric emptying of liquid nutrients.

DOI： 10.5152/TJG.2015.4768

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記述言語：日本語   出版者・発行元：(一社)日本在宅医療連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本医学教育学会  

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

緩和ケアの目標はがん患者・家族の理想の生活を支えることであるが、医療者は目の前のがん患者のニーズをすべて聞き取れているとは限らない。入院患者の様々な苦痛は相手や場面を選んで表出される。そして隠された苦悩の代表的なものはセクシュアリティの問題ではないだろうか。がん患者のセクシュアリティの苦悩はふさわしい相手がいなければ表出されることはないと予想される。医療者は患者・家族のセクシュアリティの問題に対して準備をしているだろうか?今回われわれ緩和ケアチームは、入院中に性についての発言があった終末期がん患者とのかかわりから現況調査が必要と考えた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01159&link_issn=&doc_id=20190122060002&doc_link_id=10.2169%2Fnaika.108.16&url=https%3A%2F%2Fdoi.org%2F10.2169%2Fnaika.108.16&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

End-of-life (EOL) care conferences have an important role in promoting EOL care in nursing homes. However, the details of the conferences remain poorly understood. A Japanese prefecture-wide survey was conducted to investigate the factors involved in such conferences that contribute to an increase in the amount of EOL care. One hundred fifty-three nursing homes performed the conferences. The outcome was the amount of EOL care provided in nursing homes after adjusting for the facility beds in 2014. We investigated the factors of staff experience with EOL care, frequency of the conferences, years the conferences were conducted, review conferences after EOL care, and professional participants in the conferences. The multivariate analysis revealed significant associations between EOL care in nursing homes and nurses' experience with EOL care (adjusted β coefficient 2.9, 95% confidence interval (CI) 0.52 ~ 5.22, p = 0.017), more than 5 years of continuous conferences (adjusted β coefficient 3.8, 95% CI 0.46 ~ 7.05, p = 0.026), and family participation (adjusted βcoefficient ‒4.0, 95% CI ‒7.5 ~ ‒0.48, p = 0.026). In conclusion, the continuation of conferences and enrollment of the nurse with experience in EOL care may promote EOL care in nursing homes, while family enrollment in conferences may decrease EOL care in nursing homes. EOL care conferences in nursing homes should be continuously performed by staff, with an experienced nurse undertaking the task of information sharing before discussing EOL care with the patients' families.

DOI： 10.5582/ddt.2019.01002

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Gastroenterology  

DOI： 10.11405/nisshoshi.116.801

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本医学教育学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Celsius Publishing House  

Background/Aims: The aim of this study was to investigate the efficacy and safetyof the oral fluoropyrimidine derivativeS-1 in elderly patients with unresectable pancreatic cancer. Methods: Patients were eligible if they were at least 70 years old and had unresectable pancreatic carcinoma. S-1 was administered orally twice daily after meals at doses of 80, 100, and 120 mg/day forbody surface areasfor 28 consecutive days, followed by a 14-day rest period. Administration was repeated until the appearance of disease progression or unacceptable toxicity. Results: Twenty-one patients were enrolledin this study. Five patients (23.8%) achieved a partial response (95% CI, 8.2-47.2%),stable disease was observed in 9 patients (42.9%), and progressive disease was observed in 5 patients (23.8%).The disease control rate was 66.7%. The median time to progression and overall survivaltime were 3.7 months (95% CI, 2.3-6.5 months) and 7.3 months (95% confidence interval, 4.9-12.1 months), respectively. Toxicity was generally mild, and the most common grade 3/4 toxicities were neutro-penia (14.3%), anemia (14.3%), leucopenia (9.5%), thrombocytopenia (9.5%), anorexia (9.5%), and diarrhea (9.5%). There were no treatment-related deaths. Conclusions: Monotherapy with S-1 is an effective and well-tolerated regimen for elderly patients with unresectable pancreatic cancer.

DOI： 10.21614/sgo-23-3-191

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Celsius Publishing House  

Background/Aims: We conducted a trial to evaluate the FSSG questionnaire and GerdQ questionnaire for diagnostic accuracy given correlation with clinical findings. Methods: One hundred three consecutive patients who were seen in the Yokohama City University hospital with a gastrointestinal symptom in May 2011 were enrolled as potential subjects. Of these, 94 patients underwent upper gastrointestinal endoscopy, and clinical symptoms were evaluated using both the FSSG and GerdQ questionnaires. Results: There were 94 subjects with GERD and 9 subjects with functional dyspepsia as defined by the Rome III criteria. We investigated the sensitivity and specificity of FSSG and GerdQ for GERD. For FSSG, the sensitivity was 0.564, the specificity was 0.778, and the odds ratio was 4.462. For GerdQ, the sensitivity was 0.298, the specificity was 0.889, and the odds ratio was 3.363. When combining the FSSG and GerdQ, the sensitivity was 0.255, the specificity was 0.888, and the odds ratio was 2.722. When using either the FSSG or GerdQ, the sensitivity was 0.723, the specificity was 0.888, and the odds ratio was 5.307. Conclusions: We conclude that having patients complete both the FSSG and GerdQ may be more useful in routine medical examinations than completing only one questionnaire.

DOI： 10.21614/sgo-23-3-198

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞便秘は医師として基本的な診療対象の一つであるが,わが国の実地診療のなかでは混沌とした概念である.今回,慢性便秘症ガイドラインが刊行され,そのなかで診断につき概説された.問診,身体診察,検体検査,画像検査,専門的な医療機関で行う検査という流れのなかで,解説が行われている.問診では警告症状,危険因子の概念のほか,ブリストル便形状スケールの紹介が盛り込まれている.検体検査では二次性便秘を念頭においた検体検査についても言及されている.画像検査に関しては除外診断としての腹部単純X線検査と注腸X線検査,内視鏡検査が紹介され,一部,保険適用外であるが専門的施設で行われる検査についても触れられている.本稿ではその一部を紹介する.

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0043-122228

PubMed

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記述言語：英語   出版者・発行元：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.0341-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Society for Free Radical Research Japan  

Although chronic constipation is common, colonic functional evaluating tests are uncommon. This study examines whether chronic constipation and gastrointestinal symptoms are correlated with the lateral diameter of the colon measured from MRI images. We included chronic constipation patients in a prospective, cross- sectional study using MRI at three centers. We divided 3D MRI colorectal images into 6 segments using with specified sequences and selected the maximum luminal diameter from each segment. We used the GSRS questionnaire to evaluate gastrointestinal symptoms. We evaluated the correlation between luminal dia- meters and GSRS scores. We found the following positive correla- tions: descending colon and unsatisfactory defecation symptoms
sigmoid colon and diarrhea
and rectum and constipation. The sum and ratio of the ascending and sigmoid colon diameters correlated with nausea and diarrhea. The sum of the transvers to the sigmoid colon diameter also correlated with nausea and diarrhea. The sum of all segment diameters correlated with nausea and constipation. In conclusion, we showed cross-sectional study of colonic MRI correlate with gastrointestinal symptoms. MRI might be useful for colonic motility evaluations to determine appropriate constipation treatments (Clinical trial registry number UMIN 000021274).

DOI： 10.3164/jcbn.17-104

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background and AimFew studies have shown the associations between colonic diverticula and endoscopic findings such as location, inflammation, number of diverticula, sigmoid colon rigidity, and bowel habits.
MethodsJapanese subjects who underwent total colonoscopies at six centers in Japan from November 2015 to October 2016 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale. Location and number of diverticula, inflammation, and sigmoid colon rigidity were evaluated from endoscopy results.
ResultsA total of 762 subjects (486 men and 276 women [ratio, 1.76:1]) whose mean age was 65.511.4years were evaluated. In multivariate analysis, presence of constipation was associated with a significantly lower likelihood of left-sided colonic diverticula (odds ratio=0.40, 95% confidence interval 0.20-0.82, P=0.012), whereas right-sided and bilateral-sided colonic diverticula, multiple colonic diverticula, inflammation findings, and sigmoid colon rigidity were not related to bowel habits.
ConclusionsAmong endoscopic findings related to colonic diverticula and bowel habits, only left-sided colonic diverticula were inversely associated with constipation, whereas inflammation findings, multiple diverticula, and sigmoid colon rigidity were not related to bowel habits. However, the association of inflammation findings with colonic diverticula and bowel habits should be further studied. Investigation of changes in left-sided colonic diverticula may lead to new treatments for constipation.

DOI： 10.1111/jgh.13805

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

BackgroundsChronic intestinal pseudo-obstruction (CIPO) is an intractable rare digestive disease manifesting persistent small bowel distension without any mechanical cause. Intestinal decompression is a key treatment, but conventional method including a trans-nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method is urgently desired. We conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients.
MethodsSeven definitive CIPO patients (2 males and 5 females) were enrolled. All patients received PEG-J decompression therapy. The number of days with any abdominal symptoms in a month (NODASIM), body mass index (BMI), serum albumin level (Alb), and small intestinal volume before and after PEG-J were compared in all patients.
ResultsPercutaneous endoscopic gastro-jejunostomy was well tolerated and oral intake improved in all patients. NODASIM has significantly decreased (24.3 vs 9.3days/months) and BMI/Alb have significantly increased (14.9 vs 17.2kg/m(2) and 2.6 vs 3.8g/dL, respectively), whereas total volume of the small intestine has not significantly reduced (4.05 vs 2.59L, P=.18). Reflux esophagitis and chemical dermatitis were observed in one case but was successfully treated conservatively.
Conclusions & InferencesPercutaneous endoscopic gastro-jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG-J has the potential to be a non-invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long-term observation are needed (UMIN000017574).

DOI： 10.1111/nmo.13127

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0043-105487

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AVES  

Background/Aims: This study's purpose was to compare the efficacy of CO2-enhanced ultrasonography (US) with that of Sonazoid-enhanced US and conventional US in detecting local tumor residue after percutaneous radiofrequency (RF) ablation therapy for hepatocellular carcinoma.
Materials and Methods: Between February 2009 and March 2010, 141 lesions of 121 hepatocellular carcinoma patients were treated by percutaneous RF ablation, and 22 tumor residues were detected in 22 patients by contrast-enhanced computed tomography. These 22 patients were examined by conventional US, Sonazoid-enhanced US (0.5 mL/body of Sonazoid, intravenous administration), and CO2-enhanced US (10 mL of CO2, hepatic arterial administration).
Results: Tumor residue was confirmed by CO2-enhanced US in all the 22 patients (sensitivity: 100%) in 19 of the 22 patients by Sonazoid-enhanced US (sensitivity: 86%; 3 lesions that were not detected by this modality were located deeper than the sonographic depth (p=0.0109)), and in 17 of the 22 patients by conventional US (sensitivity: 77%; 5 lesions that were not detected by this modality were smaller in terms of the sonographic tumor size (p= 0.0278)).
Conclusion: Although CO2-enhanced US requires angiography, it was superior to both Sonazoid-enhanced US and conventional US for detecting tumor residues, particularly deep-seated ones, after percutaneous RF ablation.

DOI： 10.5152/tjg.2017.16641

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease.
The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated.
The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers.
Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

DOI： 10.1007/s00535-016-1251-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3164/jcbn.16-100

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Background Aspirin use is reportedly not to be associated with fecal immunochemical occult blood test (FIT) false-positive results for the detection of colorectal cancer. The need for additional small bowel exploration in FIT-positive, low-dose aspirin users with a negative colonoscopy is controversial. The aim of this study was to assess the ability of FIT to judge whether capsule endoscopy (CE) should be performed in low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy findings by comparing FIT results with CE findings.
Methods A total of 264 consecutive low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy who were scheduled to undergo CE at five hospitals in Japan were enrolled. Patients had been offered FIT prior to the CE. The association between the FIT results and the CE findings was then assessed.
Results One hundred and fifty-seven patients were included in the final analysis. Eighty-four patients (53.5 %) had positive FIT results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of positive FIT results for small bowel ulcers were 0.56, 0.47, 0.30, and 0.73, respectively. Furthermore, the NPV of positive FIT results for severe small bowel injury (Lewis score C790) was markedly high (0.90). When the analysis was performed only in low-dose aspirin users with anemia, the sensitivity of the positive FIT results was notably improved (0.72).
Conclusions Small bowel evaluation using CE is not recommended for FIT-negative, low-dose aspirin users. However, small bowel evaluation using CE should be considered in both FIT-positive and anemic low-dose aspirin users.

DOI： 10.1007/s00535-016-1212-2

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

【目的】従来のベンゾジアゼピン系薬剤を用いた鎮静と比較して、食道ESDにおけるプロポフォール(PF)とデクスメデトミジン(DEX)を併用した鎮静の有効性と安全性について検討する。【方法】当施設で食道ESDが施行された連続40症例の臨床情報を遡及的に解析した。20例はベンゾジアゼピン系薬剤による鎮静(従来群)、20例はPF・DEX併用による鎮静(併用群)が行われた。鎮静の有効性と安全性に関する各パラメータを両群で比較した。【結果】併用群は処置時間が有意に短く(61分vs 89分、P=0.03)、抑制を要する体動が見られた患者の割合も有意に少なかった(25% vs 65%、P=0.025)。一方、併用群は低血圧(60% vs 15%、P=0.008)と徐脈(60% vs 15%、P=0.008)の発生率が有意に高かった。治療中断を要する重篤な有害事象は両群ともになかった。【結論】PFとDEXを併用した鎮静は食道ESDにおいて患者体動を抑えた安定した鎮静となり得る可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00192&link_issn=&doc_id=20170321290011&doc_link_id=10.11280%2Fgee.59.226&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.59.226&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

死亡診断時の医師の立ち居振る舞いは,その後の遺族の悲嘆に大きく影響を及ぼすと考えられているが,現在の医学教育プログラムのなかには,死亡診断時についての教育内容はほとんど含まれていない.われわれは遺族アンケートを基に「地域の多職種でつくった死亡診断時の医師の立ち振る舞いについてのガイドブック」(以下ガイドブック)を作成した.本ガイドブックを用い,横浜市立大学医学部4年次生に対し授業を行い,授業前後で死亡診断時の困難感,自己実践の可能性を評価するアンケート調査を行い解析した.有効回答を得た39名において死亡確認についての困難感についての項目は,「死亡確認の具体的な方法」が最も高く,89.5%であった.しかし,授業前後では,死亡診断時における自己実践を評価する項目で有意な改善がみられた.死亡診断時の医師の立ち居振る舞いについての卒前教育にわれわれが作成したガイドブックは有効な可能性が示唆された.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05370&link_issn=&doc_id=20170908220014&doc_link_id=10.2512%2Fjspm.12.906&url=https%3A%2F%2Fdoi.org%2F10.2512%2Fjspm.12.906&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

死亡診断時の医師の立ち居振る舞いは,その後の遺族の悲嘆に大きく影響を及ぼすと考えられているが,現在の医学教育プログラムのなかには,死亡診断時についての教育内容はほとんど含まれていない.われわれは遺族アンケートを基に「地域の多職種でつくった死亡診断時の医師の立ち振る舞いについてのガイドブック」(以下ガイドブック)を作成した.本ガイドブックを用い,横浜市立大学医学部4年次生に対し授業を行い,授業前後で死亡診断時の困難感,自己実践の可能性を評価するアンケート調査を行い解析した.有効回答を得た39名において死亡確認についての困難感についての項目は,「死亡確認の具体的な方法」が最も高く,89.5%であった.しかし,授業前後では,死亡診断時における自己実践を評価する項目で有意な改善がみられた.死亡診断時の医師の立ち居振る舞いについての卒前教育にわれわれが作成したガイドブックは有効な可能性が示唆された.(著者抄録)

DOI： 10.2512/jspm.12.906

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Hellenic Society of Gastroenterology  

Background An ideal medication for acid-related diseases would offer prompt stopping of blood flow as well as efficient symptom resolution. The aim of this study was to investigate the gastric acid suppression potency of a single oral dose of rabeprazole alone, compared with administration of rabeprazole plus mosapride. Methods Twelve male volunteers, Helicobacter pylori (H. pylori)-negative, participated in this randomized, three-way crossover study. After a single oral administration of rabeprazole, rabeprazole with mosapride, or rabeprazole administered 1 h after mosapride, we monitored their intragastric pH constantly for 6 h. A 7-day washout period was allowed between each administration. Results The median 6-h intragastric pH after the administration of rabeprazole 1 h after mosapride was 4.41±1.22 (mean±s.d.), significantly higher than after rabeprazole alone 3.45±1.33, P=0.0376). There was no significant difference between the median 6-h pH after the administration of rabeprazole plus mosapride and that after rabeprazole alone (3.81±0.98 vs. 3.45±1.33, respectively
P=0.0927). Conclusion An oral dose of rabeprazole administered 1 h after mosapride increased the intragastric pH more rapidly than rabeprazole alone, in healthy, male, H. pylori-negative volunteers.

DOI： 10.20524/aog.2017.0161

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective The risk factors associated with severe erosive esophagitis are not well defined in Japan. We aimed to evaluate the risk factors associated with the endoscopic severity of esophageal mucosal injury.
Methods Eighty consecutive Japanese patients with severe erosive esophagitis [Los Angeles (LA) classification grade C or D] who had undergone upper endoscopies in the Gastroenterology Division of Omori Red Cross Hospital between June 2010 and March 2013 were retrospectively analyzed. For each case, a control with mild erosive esophagitis (LA classification grade A or B) who was matched by sex and age was randomly selected during the same period. Among the endoscopic findings, the condition of the gastroesophageal flap valve (GEFV) was graded according to Hill's classification. We identified the risk factors for severe erosive esophagitis using a multivariable logistic regression model.
Results A poor performance status (PS) (odds ratio [OR]=17.1201, 95% confidence interval [CI]=3.0268-140.3121, p=0.0008) and an abnormal GEFV (OR=3.0176, 95% CI=1.0589-9.4939, p=0.0385) were risk factors for severe erosive esophagitis, while the presence of open-type gastric mucosal atrophy (GMA) was inversely associated with severe erosive esophagitis (OR=0.2772, 95% CI=0.1087-0.6675, p=0.0040).
Conclusion Among patients with erosive esophagitis, a poor PS and an abnormal GEFV were associated while GMA was inversely associated with severe erosive esophagitis. Drug therapy alone or in combination with physical therapy may improve the therapeutic effect on severe erosive esophagitis in patients with a poor PS.

DOI： 10.2169/internalmedicine.56.8058

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Gastroenterological Endoscopy Society  

Background and Aim: The aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD). Methods: We retrospectively reviewed clinical data for 40 consecutive patients who had undergone esophageal ESD at the Yokohama City University Hospital between July 2012 and August 2014. Of these patients, 20 were sedated with benzodiazepines (conventional group) and another 20 patients were sedated with a combination of PF and DEX (combination group). Parameters for efficacy and safety of sedation were evaluated by comparisons between the two groups. Results: Median procedural times in the combination group were shorter than those in the conventional group (61min vs 89 min, P = 0.03), and the percentage of patients who showed restlessness in the combination group was significantly lower than that in the conventional group (25% vs 65%, P = 0.025). Incidences of hypotension and bradycardia in the combination group were higher than those in the conventional group (60% vs 15%, P=0.008, and 60% vs 15%, P = 0.008, respectively). Conclusion: This retrospective study suggests that a combination of PF and DEX may provide stable deep sedation with less body movement than benzodiazepines during esophageal ESD.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims: The aim of this study was to investigate the capability of magnifying endoscopy with narrow-band imaging (ME-NBI) to discriminate between early carcinomas (EC) and low grade adenomas (LGA) in gastric superficial elevated epithelial neoplasias. Patients and methods: We investigated 100 consecutive cases of gastric superficial elevated epithelial neoplasias that were removed using endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification; category 4 (mucosal high grade neoplasia) and category 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, whereas category 3 (mucosal low grade neoplasia) lesions were diagnosed as LGA. The associations between the postoperative pathological diagnoses and the ME-NBI findings were analyzed, and included the shape, specification, and area of irregularity in the microvascular architecture (MV) and the microsurface structure (MS). Results: Seventy-nine EC and 21 LGA cases diagnosed postoperatively were evaluated retrospectively. The lesion size (median; range (mm)) was significantly larger in the EC group (14; 2 - 95) compared to the LGA group (5; 2 - 16) (P < 0.001). Wavy forms in the MV shapes (P = 0.031), extension in the MV specifications (P = 0.035), and area with MV irregularity (P = 0.001) were found to be statistically significant predictive findings for EC. Villous forms in the MS shapes (P = 0.026), enlargement in the MS specifications (P = 0.044), and area with MS irregularity (P = 0.021) were also found to be statistically significant predictive findings for EC. The rates of preoperative sensitivity, specificity, and diagnostic accuracy of ME-NBI for discriminating EC were 86.1 %, 38.9 %, and 75 %, respectively. Conclusions: The present study suggests that ME-NBI is useful for the differential diagnosis of EC and LGA in gastric superficial elevated epithelial neoplasias. STUDY REGISTRATION: UMIN000012925.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTROENTEROLOGY & MOTILITY  

Background/Aims
Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range, of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects.
Methods
Forty-two healthy volunteers (25 men and 17 women) with a mean +/- standard deviation age of 33.3 +/- 12.4 years (range: 22-72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized.
Results
Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus.
Conclusions
Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24 hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.

DOI： 10.5056/jnm15195

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

Purpose: To clarify the family-perceived necessity of improvement in death pronouncement and explore the potential association between behaviors of physicians and the family-perceived necessity of improvement.
Subjects and Methods: A questionnaire survey was conducted involving 226 bereaved family members of patients who had died at home while receiving hospice service. A total of 91 responses were analyzed (response rate, 47%).
Results: All pronouncements were performed by physicians. A total of 89% (n=81, 95% confidence interval, 81%-94%) of family members reported that they felt no necessity of improvement at all or that almost no improvement was needed. Behaviors of physicians significantly positively correlated with the family-perceived necessity of improvement were that physicians acted calmly, and were not rushed. Those negatively associated were that physicians did not verify the time of death clearly, left the patient's clothes disheveled, and touched the family members' backs or shoulders as an expression of empathy. More than 90% of family members recommended that physicians act calmly, have a suitable appearance for the situation, introduce themselves to family members, explain the cause of death explicitly, and conduct a check using a light and stethoscope for death pronouncement.
Conclusion: Most of the family members who had experienced a patient's death at home were satisfied with the death pronouncement. Several factors were associated with family satisfaction, and further large studies are needed to confirm the results.

DOI： 10.1089/jpm.2015.0333

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AVES  

Background/Aims: This study aimed to determine the useful endoscopic findings in a differential diagnosis between early carcinomas (EC) and low-grade adenomas (LGA) in superficial elevated gastric epithelial neoplasia during conventional endoscopy with white- light imaging (C-WLI).
Materials and Methods: We investigated 270 consecutive cases of superficial elevated gastric epithelial neo-plasias, which were removed by endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification: category 4 (mucosal high-grade neoplasia) or 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, while category 3 (mucosal low-grade neoplasia) lesions were diagnosed as LGA. The association between the postoperative pathological diagnoses (EC or LGA) and the following endoscopic findings: localized site, lesion size, color (reddish or whitish), shape (smooth, petal, or irregular), and presences of depression, erosion, ulceration, or nodularity on the surface, were evaluated.
Results: Of 270 epithelial neoplasias, 222 (58 LGA and 164 EC) were retrospectively evaluated. Multiple logistic regression analysis revealed that the lesion size [odds ratio (OR), 1.216; p&lt;0.001) and reddish color (OR, 5.274; p&lt;0.001) were independent findings for EC.
Conclusion: The lesion size and reddish color were useful optical findings for discriminating between EC and LGA.

DOI： 10.5152/tjg.2015.150359

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Background and AimThe aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD).
MethodsWe retrospectively reviewed clinical data for 40 consecutive patients who had undergone esophageal ESD at the Yokohama City University Hospital between July 2012 and August 2014. Of these patients, 20 were sedated with benzodiazepines (conventional group) and another 20 patients were sedated with a combination of PF and DEX (combination group). Parameters for efficacy and safety of sedation were evaluated by comparisons between the two groups.
ResultsMedian procedural times in the combination group were shorter than those in the conventional group (61min vs 89min, P=0.03), and the percentage of patients who showed restlessness in the combination group was significantly lower than that in the conventional group (25% vs 65%, P=0.025). Incidences of hypotension and bradycardia in the combination group were higher than those in the conventional group (60% vs 15%, P=0.008, and 60% vs 15%, P=0.008, respectively).
ConclusionThis retrospective study suggests that a combination of PF and DEX may provide stable deep sedation with less body movement than benzodiazepines during esophageal ESD.

DOI： 10.1111/den.12559

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記述言語：英語   出版者・発行元：SPRINGER JAPAN KK  

DOI： 10.1007/s00535-015-1074-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

AIM: To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.
METHODS: We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August 2010 and March 2012 at Yokohama Rosai Hospital. Twenty patients were included in the review, consisting of 14 men and 6 women. The median age of the patients was 73.5 years. The duration of the follow-up period ranged from 1 to 19 mo (median: 9.8 mo). Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization, 6 patients who required it for re-bleeding that developed after the patient left the hospital, and 3 patients who required the procedure for the prevention of rebleeding. Barium (concentration: 150 w%/v%) was administered per the rectum, and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy. After confirmation that the ascending colon and cecum were filled with barium, the enema tube was withdrawn, and the patient's position was changed every 20 min for 3 h.
RESULTS: Twelve patients remained free of rebleeding during the follow-up period (range: 1-19 mo) after the therapeutic barium enema, including 9 men and 3 women with a median age of 72.0 years. Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years: 4 developed early re-bleeding, defined as re-bleeding that occurs within one week after the procedure, and the remaining 4 developed late re-bleeding. The DFI (disease-free interval) decreased 0.4 for 12 mo. Only one patient developed a complication from therapeutic barium enema (colonic perforation).
CONCLUSION: Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.

DOI： 10.3748/wjg.v21.i18.5555

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral dose of a proton pump inhibitor, esomeprazole 20 mg and omeprazole 20 mg. Methodology: A total of 14 Helicobacter pylori-negative male subjects participated in this study. Intragastric pH was monitored continuously for 6 hours after a single oral dose of omeprazole 20 mg and a single oral dose of esomeprazole 20 mg. Each administration was separated by a 7-day washout period. Results: During the 6-hour study period, the average pH after administration of esomeprazole was higher than that after the administration of omeprazole. Also during the 6-hour study period, each of pH &gt; 2, 3, 3.5, 4, and 5 was maintained for a longer duration after administration of esomeprazole 20 mg than after administration of omeprazole 20 mg (median: 75.4% vs. 53.8%, p = 0.0138; 52.1% vs. 33.4%, p = 0.0188; 45.8% vs. 28.2%, p = 0.0262; 42.5% vs. 20.7%, p = 0.0414; 35.8% vs. 11.6%, p = 0.0262; respectively). Conclusions: In Helicobacter pylori-negative healthy male subjects, single oral administration of esomeprazole 20 mg increased the intragastric pH more rapidly than single oral administration of omeprazole 20 mg.

DOI： 10.5754/hge13850

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AVES  

Background/Aims: The aim of this study was to determine the correlation between low-dose ramosetron pretreatment and gastric emptying using a novel, non-invasive technique for measuring gastric emptying, namely, the continuous real-time 13C breath test (BreathID system: Exalenz Bioscience Ltd., Israel).
Materials and Methods: Twelve healthy male volunteers participated in this randomized two-way crossover study. The subjects fasted overnight and were randomly assigned to receive the test meal (200 kcal per 200 mL) after an hour pre-treatment with 5 mu g ramosetron or the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal with the 13C-acetic acid breath test performed continuously using the BreathID system. Using Oridion Research Software (beta version), T 1/2, T lag, GEC and the regression-estimated constants (beta and kappa) were calculated. The differences in the parameters measured at two time-points were analyzed using Wilcoxon's signed-rank test.
Results: There was a significant difference in the calculated parameter beta. No significant differences in the calculated parameters T 1/2, T lag, GEC or. were observed between the test meal with ramosetron group and the test meal alone group.
Conclusion: This study showed that ramosetron pre-treatment enhances the early gastric emptying of liquid nutrients.

DOI： 10.5152/tjg.2014.4768

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

BackgroundThe association of diverticula with bowel habits is unclear. We therefore analyzed the association between diverticula and bowel habits in over 1000 Japanese individuals.
MethodsJapanese subjects who underwent total colonoscopies at seven centers in Japan from June to September 2013 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale, and stool form was assessed using a part of the Bristol Scale and Rome criteria. Diverticula were diagnosed by colonoscopy with a transparent soft-short hood.
Key ResultsThe study evaluated 1066 subjects, 648 males and 418 females (ratio, 1.55:1), of mean age 63.913.0years. After adjusting for age and sex, the presence of constipation was associated with a significantly reduced likelihood of diverticula (odds ratio [OR]=0.70, 95% confidence interval [CI] 0.52-0.93). When assessed according to the location of diverticula, the presence of constipation was associated with a significantly decreased likelihood of left-sided (OR=0.39, 95% CI 0.16-0.93), but not right-sided (OR=1.10, 95% CI 0.48-2.53), diverticula. Furthermore, stool form was unrelated with the presence or absence of diverticula.
Conclusions & InferencesThe wide-spread hypothesis that constipation was associated with colonic diverticula was not supported. Rather, we found that the absence of diverticula was associated with constipation, suggesting the need to reassess the etiology of colonic diverticula.

DOI： 10.1111/nmo.12478

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and gut-targeted pharmacotherapy is indicated for four weeks. Non-responders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients non-responsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world.

DOI： 10.1007/s00535-014-1017-0

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記述言語：英語  

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記述言語：日本語   出版者・発行元：一般社団法人 日本心身医学会  

消化管機能性疾患患者に対するわが国での画像検査の施行状況に関する報告はほとんどみられない.また診断時だけではなく,その後どのくらいの間隔で検査が行われているかについての報告はさらに少ない.今回われわれは診療データを調査するとともに,大学病院,市中病院,クリニックの消化器内科医を対象にアンケート調査を行ったところ,消化管機能性疾患患者においても多くの症例で定期的な消化管内視鏡検査が行われている現状を把握することができた.貴重な資料と考え,文献的考察を加え報告する.

DOI： 10.15064/jjpm.55.3_214

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その他リンク： http://search.jamas.or.jp/link/ui/2015170661

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective Right-sided type colonic diverticulosis has been predominant in Japan, in contrast to European counties where the left-sided type is predominant. Considering the recent change in the dietary habits of Japanese people to a more Western diet in urban areas of Japan, the features of colonic diverticulosis may also change to reflect a more Western type. Therefore, we attempted to clarify the current situation.
Methods A total of 435 consecutive outpatients who agreed to a barium enema and complete examination were enrolled in this study.
Results 113 patients (26.0%) revealed colon diverticulosis; 50.4% of the patients had more than ten diverticula. The percentage of man with ten or more diverticula (67.4%) was significantly higher than that of women patients (40.0%, p &lt; 0.01). Among the 88 patients who had four or more diverticula, 39 patients (44.3%) were right-side dominant, 27 (30.7%) left-side dominant and 22 (25.0%) were both-sides. Thirteen (68.4%) of the 19 patients who had more than 30 diverticula were left-side dominant.
Conclusion The clinical features of colon diverticulosis in the patients living in Yokohama may be changing to reflect a more Western type, in particular decreased right-side dominance, increases in the left-side and both-sides dominant patients, and the emergence of patients with crowded diverticula in the left-side colon was observed.

DOI： 10.2169/internalmedicine.54.4813

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

OBJECTIVES: No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).
METHODS: We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defi ned as sigmoid colon, descending colon, and rectum. Right-sided colon was defi ned as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.
RESULTS: Patient characteristics included mean age, 64.2 +/- 12.9 years and male: female ratio, 1.62: 1. Rightsided DD was identifi ed in 21.6% of subjects. Left-sided and bilateral DD was identifi ed in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confi dence interval (CI): 1.4-7.1; P = 0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P = 0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.
CONCLUSIONS: Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specifi c changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS

DOI： 10.1038/ajg.2014.323

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記述言語：日本語  

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記述言語：英語   出版者・発行元：AVES  

DOI： 10.5152/tjg.2014.4113

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記述言語：英語   出版者・発行元：AVES  

DOI： 10.5152/tjg.2014.5262

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

死亡診断の場面での医師の立ち居振る舞いは、その後の遺族の悲嘆に大きく影響を及ぼすと考えられる。死亡診断時の医師の立ち居振る舞いについてのマニュアルを作成し、研修医や医学部生の教育に利用している。現在、これをアップグレードする目的で地域の多職種(訪問看護師、薬剤師)で共同研究を行っている。当地域の現場で在宅医療を行っている医師・看護師へマニュアル作成について、また実際の看取りの場面についてのインタビューを行った。試みに対してはおおむね高評価であり、インタビューに協力的であった。地域の多職種連携は様々な形で行うことができる。地域の多職種で共同研究を行うことで地域連携はより円滑になると思われ、この過程を経てできあがったマニュアルは同地域で受け入れられやすいと思われる。(著者抄録)

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記述言語：英語   出版者・発行元：AVES  

DOI： 10.5152/tjg.2014.4114

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background: To develop appropriate management strategies for patients who take low-dose aspirin, it is important to identify the risk factors for GI injury. However, few studies have described the risk factors for small-bowel injury in these patients.
Objective: To investigate factors influencing the risk of small-bowel mucosal breaks in individuals taking continuous low-dose aspirin.
Design: Capsule endoscopy data were collected prospectively from 5 institutions.
Setting: Yokohama City University Hospital and 4 other hospitals.
Patients: A total of 205 patients receiving treatment with low-dose aspirin for over 3 months.
Interventions: Colonoscopic and upper GI endoscopy had been performed in all of the patients before the capsule endoscope evaluation.
Main Outcome Measurements: Risk factors for small-bowel mucosal breaks.
Results: Of the 198 patients (141 male; mean age 71.9 years) included in the final analysis, 114 (57.6%) had at least 1 mucosal break. Multivariate analysis identified protein pump inhibitor (PPI) use (OR 2.04; 95% confidence interval [CI], 1.05-3.97) and use of enteric-coated aspirin (OR 4.05; 95% CI, 1.49-11.0) as independent risk factors for the presence of mucosal breaks.
Limitations: Cross-sectional study.
Conclusion: PPI use appears to increase the risk of small-bowel injury in patients who take continuous low-dose aspirin. Clinicians should be aware of this effect of PPIs; new strategies are needed to treat aspirin-induced gastroenteropathy.

DOI： 10.1016/j.gie.2014.03.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION  

Comparisons between the acid inhibitory effects of rabeprazole and esomeprazole after single oral administration with standard doses have not been previously presented. We examined intragastric pH after oral administrations of these two proton pump inhibitors using 24-h pH monitoring. Fifty-four normal volunteers not infected by Helicobacter pylori were investigated. Using a cross-over design, we administered 10 mg of rabeprazole or 20 mg of esomeprazole in 27 at 30 min after supper and in the remaining 27 subjects at 15 min before supper, and performed 24-h pH monitoring. Intra-gastric pH data were nearly identical when the proton pump inhibitors were taken after meals. Even if the data were compared in different CYP2C19 genotypes, rabeprazole and esomeprazole did not show the difference. In poor metabolizer, both of the drugs showed stronger acid inhibition. When taken before meals, intra-gastric pH after esomeprazole administration was slightly but not significantly higher than that observed after rabeprazole administration not only in daytime but also in nighttime period. In conclusion, rabeprazole and esomeprazole were similarly effective when administered after a meal.

DOI： 10.3164/jcbn.14-41

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to deter,. mine the possible existence of a correlation between the gastric transit time (GTT) measured by video capsule endoscopy (VCE) and the parameters of gastric empty! ing determined using 13C breath test (BreathID system). Methods: Eight healthy male volunteers participated in this randomized; two-way crossover study. The subjects were randomly assigned to undergo VCE using the pillCam SB capsule endoscopy system or the 13C breath test for 4 hours after a test meal (400 kcal per 400 mL) containing 100 mg of 13C acetic acid administered after overnight fasting. The VCE images were analyzed and the GTT was determined using the proprietary RAPID software. The parameters, namely T lag, T1/2 and GEC were calculated using the Oridion Research Software (beta version). The GTT measured by VCE and the parameters of gastric emptying were compared statistically. Results: No significant correlation was observed between the GTT and T lag (p = 0.5263), T 1/2 (p = 0.4100) or GEC (p = 0.2410), as determined by calculation of the Spearman's rank correlation coefficient. Conclusions: GTT measured by VCE cannot serve as a substitute for the gastric emptying time measured by the 13C breath test.

DOI： 10.5754/hge13358

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to comparatively examine the convenience of use of the QUEST and GerdQ questionnaires as self- administered diagnostic instruments. Methodology: This was a two-way crossover study conducted from December 2011 to April 2012. The subjects were 70 third-year nursing students of Yokohama Soei University in Yokohama, Japan. They were randomly assigned to fill in either of the study questionnaires first, and then the other on a later. Results: A significant difference was observed in the questionnaire completion time between the QUEST and GerdQ questionnaires (125.5 vs. 44 seconds, P &lt; 0.0001) and also in the number of subjects asking questions while completing the questionnaires (26 vs. 1 subject, respectively: P &lt; 0.0001). To detect GERD based on a QUEST score &gt;= 4 of ROC analysis revealed an area under the curve for the GerdQ score of 0.616. The sensitivity and specificity calculated using this cutoff value were 0.842 and 0.312, respectively. Conclusion: This study revealed that Japanese subjects may find it easier to complete the GerdQ than the QUEST questionnaire.

DOI： 10.5754/hge14396

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記述言語：日本語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background /Aims: The natural immunomodulator actoferrin is known to possess anti-inflammatory effects. However, there have been no studies examininig the mode of action of lactoferrin in protecting the esophageal mucosa against damage. We investigated the effect of lactoferrin on gastric acid secretion and in protecting against acute acid reflux-induced esophagitis in rats. Methodology: Male Wistar rats aged 8 weeks, weighing 210-240 g, were used for all the experiments. A gastric perfusion system was installed using the method of Ghosh et al. Lactoferrin was administered once via he caudate vein, starting 24 hours before an acute acid reflux (treatment mode), or saline (control). Statistical comparison of the parameters between the two test conditions was performed. Results: No significant differences in basal or stimulated gastric acid secretion, or in the serum gastrin level were observed between the two test conditions. Esophageal damage was attenuated by the improvement in the esophageal tissue weight and macroscopic scores. Significant reductions in the histological scores, myeloperoxidase activity and the levels of proinflammatory cytokines, tumor necrosis factor-a and interleukin-1 beta were also observed following lactoferrin administration. Conclusions: We concluded that lactoferrin exerts a protective effect against acute acid reflux-induced esophageal damage in rats.

DOI： 10.5754/hge13380

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist that reportedly has more potent antiemetic effects than other 5-HT3 receptor antagonists. The aim of this study was to determine the effect of ramosetron pretreatment on gastric emptying using the 13c-acetic acid breath test. Methodology: Ten healthy male and female volunteers participated in this randomized, twoway crossover study. After they had fasted overnight, the subjects were randomly assigned to receive 0.1 mg ramosetron 1 hour before ingestion of a test meal (200 kcal per 200 mL, containing 100 mg 13(c) acetate) or to receive the test meal alone. Under both conditions, breath samples were collected for 150 min following ingestion of the meal. Statistical com arison of the parameters tetween e two test conditions was formed. Results: No significant differences in the lated parameters, including T 1/2, T lag, GEC or beta and kappa, were observed between the two test conditions. Conclusions: The present study revealed that 0.1 mg mosetron had no significant effect on the rate of gastric emptying. Thus, our results suggest that ramosetron can be administered safely, without gastrointestinal adverse effects, even to terminal cancer patients with delayed or accelerated gastric emptying abnormality.

DOI： 10.5754/hge13057

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

This study compared the impacts of intragastric balloon (IGB) therapy and intensive lifestyle modification therapy on abdominal fat distribution. Sixteen extremely obese Japanese patients were assigned to an intensive lifestyle modification therapy group with educational hospitalisation (8 patients) or an IGB therapy group (8 patients) and were followed up for 6 months. The main outcome measures were the differences at 6 months, relative to the baseline values, in the visceral fat area (VFA), subcutaneous fat area (SFA), and liver volume as measured using computed tomography. At 0 month, the body weights (BWs) were 121.3 +/- 19.0 kg and 127.1 +/- 24.4 kg and the VFAs were 299 +/- 55 cm(2) and 257 +/- 56 cm(2) in the intensive lifestyle modification therapy group and the IGB therapy group, respectively. No statistically significant differences in the baseline characteristics were observed between these two groups. At 6 months, no difference in the changes in BW from the baseline value (-11.5 [-16.4, -6.6] kg vs. -11.2 [-18.9, -3.4] kg) was seen between the two groups. However, a statistically significant difference in the change in the VFA (-66 [-87, -44] cm(2) vs. -22 [-70, 26] cm(2) [P = 0.027]) was observed; no significant changes in the SFA or liver volume were seen. In conclusion, IGB therapy was as effective as intensive lifestyle modification therapy for weight reduction but was less effective with respect to the improvement in abdominal visceral fat accumulation and liver steatosis in super-obese Japanese patients. (C) 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.orcp.2013.07.002

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Gastroenterological Endoscopy Society  

Aim: The main aim of this study was to determine whether questionnaire evaluations of clinical symptoms in gastroesophageal reflux discase were useful to assess proton pump inhibitor therapy. Methods: A total of 185 Japanese patients (men, 88
women, 97
age : 55.7 ± 16.1 years) with gastroesophageal reflux disease were enrolled. The patients were divided based on the frequency scale for symptoms of gastroesophageal reflux disease : severe symptoms with scores ≥8 and mild symptoms with scores ≤7. Quality of life was evaluated with the Medical Outcomes Study 8-Item Short-Form Health Survey. All patients were treated with a proton pump inhibitor, rabe-prazole (10mg/day), for 8 weeks. Results: Patients were classified into four groups : reflux esophagitis with severe symptoms (n=92, 49.7%)
reflux esophagitis with mild symptoms (n=17, 9.2%)
non-erosive reflux disease with severe symptoms (n=66, 35.7%)
and non-erosive reflux disease with mild symptoms (n=10, 5.4%). The dysmotility score was high in non-erosive reflux disease with severe symptoms compared with reflux esophagitis with severe symptoms (9.1 ± 0.5 vs 6.8 ± 0.5, P&lt
0.05). The symptom score and quality of life in the severe symptoms groups for both reflux esophagitis and non-erosive reflux disease were significantly improved by rabeprazole treatment. Only the reflux score was improved by rabeprazole in the reflux esophagitis with mild symptoms group
no therapeutic effect was observed for the non-erosive reflux disease with mild symptoms group. Conclusions: Low scores on the frequency scale for the symptoms of gastroesophageal reflux disease indicate poor responsiveness to proton pump inhibitor treatment, and high scores indicate good responsiveness.

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0034-1377224

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 mu g tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE) and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen), a placebo tablet 60 minutes prior to CE and a 24 mu g tablet of lubiprostone 30 minutes prior to CE (P-L regimen), or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen). The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117-407) minutes in the P-P regimen, 122.5 (27-282) minutes in the L-P regimen, and 110.5 (11-331) minutes in the P-L regimen (P = 0.042). This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

DOI： 10.1155/2014/879595

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0034-1377634

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

死亡診断の場面での医師の立ち振る舞いは、その後の遺族の悲嘆に大きく影響を及ぼすと考えられる。医師教育のなかには死後の内容はほとんど含まれず、グリーフケアを意識して死亡確認を行う医師は少ないことが予想される。緩和ケア病棟の看護師へのアンケート調査を行った結果、主治医と主治医以外の医師では死亡診断の際の立ち振る舞いに違いがあることが示された。主治医以外の医師であってもグリーフケアを意識した死亡確認ができるように、立ち会う看護師の声に基づき、死亡診断時の医師の立ち振る舞いについてのマニュアルを作成した。(著者抄録)

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記述言語：日本語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background
The efficacy of proton pump inhibitors (PPIs) for treating functional dyspepsia (FD) is not well established.
Aim
This study, named the SAMURAI study, aimed to assess the efficacy and dose-response relationship of rabeprazole in Japanese patients with FD in a multicentre, double-blinded, randomised, placebo-controlled trial.
Methods
Investigated FD was diagnosed using the Rome III criteria. Subjects who did not respond to 1 week of single-blind placebo treatment in a run-in period were randomly assigned to 8 weeks of double-blind treatment with rabeprazole 10 mg, 20 mg, 40 mg or placebo, once daily. Dyspeptic symptoms were assessed by a dyspepsia symptom questionnaire (7-point Likert scale) and symptom diary.
Results
Of 392 subjects entered into the run-in period, 338 were randomly assigned. Although there was no significant difference between placebo and rabeprazole groups in complete symptom relief for four major dyspeptic symptoms, the satisfactory symptom relief of rabeprazole 20 mg was significantly higher than placebo according to the dyspepsia symptom questionnaire (45.3% vs. 28.2%, P = 0.027) and the symptom diary assessment (48.7% vs. 30.0%, P = 0.016). The efficacy was not influenced by syndrome type or Helicobacter pylori status. No statistically significant differences in the incidence of adverse events were seen among treatment groups.
Conclusions
Rabeprazole 20 mg once daily but not 10 or 40 mg significantly provides satisfactory symptom relief for functional dyspepsia.

DOI： 10.1111/apt.12444

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aim To identify the predictive factors for the presence of small bowel lesions in patients with obscure gastrointestinal bleeding (OGIB). Methods A total of 242 patients with OGIB (overt 149: occult 93) were retrospectively included in the present study. Capsule endoscopy (CE) was carried out to investigate the small bowel, and detected lesions were classified according to the P0-P2 system. Only P2 lesions were defined as significant lesions. Univariate and multivariate logistic regression analyses were carried out to define the predictive factors for the presence of small bowel lesions. Results In patients with overt OGIB, chronic kidney disease (CKD) ≥stage 4 (odds ratio [OR] 4.03
95% confidence interval [CI] 1.45-11.1, P = 0.007) was identified as an independent predictor of the presence of vascular lesions, and a history of non-steroidalanti-inflammatory drug (NSAID) use as that of erosive/ulcerated lesions (OR 4.73
95% CI 1.47-15.2, P = 0.009). However, in patients with occult OGIB, no significant predictors of the presence of vascular lesions were identified, whereas a history of low-dose aspirin (LDA) (OR 3.57
95% CI 1.21-10.5, P = 0.02) and proton pump inhibitor (PPI) use (OR 3.18
95% CI 1.02-9.92, P = 0.05) were identified as independent predictors of the presence of erosive/ulcerated lesions. Conclusions Our results indicated that bleeding pattern and clinical characteristics could contribute to predicting the origin of OGIB. © 2012 The Authors.

DOI： 10.1111/den.12002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

OBJECTIVES : Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO.
METHODS: Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups.
RESULTS: Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean +/- s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4 +/- 14.1, 11.1 +/- 1.5, and 10.9 +/- 1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1 +/- 11.0%, 73.0 +/- 9.3%, and 74.6 +/- 9.4%, respectively). No significant differences were observed in the contraction cycle.
CONCLUSIONS: This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.

DOI： 10.1038/ajg.2013.57

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：4  

Aim To identify the predictive factors for the presence of small bowel lesions in patients with obscure gastrointestinal bleeding (OGIB). Methods A total of 242 patients with OGIB (overt 149: occult 93) were retrospectively included in the present study. Capsule endoscopy (CE) was carried out to investigate the small bowel, and detected lesions were classified according to the P0-P2 system. Only P2 lesions were defined as significant lesions. Univariate and multivariate logistic regression analyses were carried out to define the predictive factors for the presence of small bowel lesions. Results In patients with overt OGIB, chronic kidney disease (CKD) ≥stage 4 (odds ratio [OR] 4.03
95% confidence interval [CI] 1.45-11.1, P = 0.007) was identified as an independent predictor of the presence of vascular lesions, and a history of non-steroidalanti-inflammatory drug (NSAID) use as that of erosive/ulcerated lesions (OR 4.73
95% CI 1.47-15.2, P = 0.009). However, in patients with occult OGIB, no significant predictors of the presence of vascular lesions were identified, whereas a history of low-dose aspirin (LDA) (OR 3.57
95% CI 1.21-10.5, P = 0.02) and proton pump inhibitor (PPI) use (OR 3.18
95% CI 1.02-9.92, P = 0.05) were identified as independent predictors of the presence of erosive/ulcerated lesions. Conclusions Our results indicated that bleeding pattern and clinical characteristics could contribute to predicting the origin of OGIB. © 2012 The Authors.

DOI： 10.1111/den.12002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN EPIDEMIOLOGICAL ASSOC  

Background: We estimated the prevalence and incidence of chronic intestinal pseudo-obstruction (CIPO) in Japan, investigated the patterns of hospital visits among those with CIPO, and examined present knowledge of CIPO among medical professionals.
Methods: A self-administered questionnaire survey was distributed to targeted hospitals throughout Japan, which were selected using stratified random sampling. The questionnaire asked about the number of patients receiving treatment for CIPO, the frequency of their hospital visits, and overall clinical knowledge of CIPO among medical professionals.
Results: CIPO prevalence was estimated to be 1.00 and 0.80 cases per 100 000 males and females, respectively. Incidence was 0.21 and 0.24 cases per 100 000 males and females, respectively. Prevalence and incidence did not significantly differ males and females. Mean age of patients was 63.1 years for males and 59.2 for females. Accurate diagnosis of CIPO sometimes required more than 3 months after initial presentation. Most medical professionals were unaware of or poorly understood CIPO.
Conclusions: We estimated the prevalence and incidence of CIPO in Japan, using data from a nationwide survey. The findings suggest that knowledge of CIPO should be further disseminated so that the disease is not overlooked and is diagnosed without delay.

DOI： 10.2188/jea.JE20120173

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記述言語：英語   出版者・発行元：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

DOI： 10.5056/jnm.2013.19.2.268

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：2  

Background/Aims: The gastrointestinal motility effects of endogenous incretin hormones enhanced by dipeptidyl peptidase-IV (DPP-IV) inhibitors have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial sitagliptin, the DPP-IV inhibitor, administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test. Methods Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted for overnight and were randomly assigned to receive 50 mg sitagliptin 2 hours before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C-acetate) or the test meal alone. Under both conditions, breath samples were collected for 150 minutes following the meal. Liquid gastric emptying was estimated by the values of the following parameters: the time required for 50% emptying of the labeled meal (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (Tlag), the gastric emptying coefficient and the regression-estimated constants (β and κ), calculated by using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 2 test conditions were compared statistically. Results No significant differences in the calculated parameters, including T1/2, Tlag, gastric emptying coefficient or ß and κ, were observed between the 2 test conditions. Conclusions The present study revealed that single-dose sitagliptin intake had no significant influence on the rate of liquid gastric emptying in asymptomatic volunteers. © 2013 The Korean Society of Neurogastroenterology and Motility.

DOI： 10.5056/jnm.2013.19.2.227

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The aim of this study was to verify the effectiveness of PET (positron emission tomography) or PET/CT (fusion images of PET with computed tomography) in detecting synchronous cancer in patients with head and neck carcinoma. We reviewed 682 patients with carcinoma of the head and neck between January 2001 and December 2010. In 98 patients, 111 synchronous cancers were diagnosed. Of these 98 patients, the index cancer was predominantly located in the hypopharynx (47 cases), followed by the larynx (23 cases), oropharynx (12 cases) and the oral cavity (6 cases). Esophageal cancer was diagnosed as the most synchronous cancer (57 lesions), followed by gastric cancer (20 lesions), lung cancer (9 lesions) and head and neck cancer (8 lesions). Among these 98 patients, PET or PET/CT was performed in 82 patients. Of these 82 patients, PET or PET/CT detected 34 out of 94 (36.2 %) synchronous cancers. No significant difference was observed between PET and PET/CT in terms of lesion detectability (p = 0.21). Regarding synchronous T1 and Tis upper gastrointestinal (UGI) cancer, PET or PET/CT detected 4 out of 43 (9.3 %) of the cancers. No statistical difference in detectability was observed in patients who underwent PET or PET/CT scanning before or after histological examination of synchronous UGI cancer. In conclusion, synchronous cancer was most frequently observed in the UGI, especially in the esophagus in patients with head and neck carcinoma. PET and PET/CT have limitations in the detection of these lesions.

DOI： 10.1007/s00405-012-2081-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Background Apelin-APJ signalling is known to play important roles in heart physiology and pathology; however, its functions in liver physiology and pathology remain unclear. On the other hand, Fas is an important molecule in hepatitis and other liver disease that belongs to the death receptor family. The aim of this study was to assess the relationship between apelin-APJ signaling and Fas-mediated liver injury in mice. Methods APJ-/- mice and wild type (WT) mice were administered an intraperitoneal injection of an agonistic anti-Fas antibody (clone; Jo2), and sacrificed after 3 or 6 h to assess the liver histology. The expression levels of apelin and APJ, plasma levels of transaminases, activities of hepatic caspases and activations of stress-activated protein kinases were also analysed. Results Before the Jo2 injection, APJ was weakly expressed in the hepatocytes in spots; on the other hand, after the Jo2 injection, it had spread into whole hepatocytes. Moreover, the mRNA expression level of apelin and APJ in the liver increased after Jo2 injection. In the APJ-/- mice, the liver injuries and apoptotic changes were significantly inhibited as compared with those in the WT mice. Dramatic increase in JNK activation was observed in the WT mice after Jo2 injection, whereas such activation was completely absent in the APJ-/- mice. JNK inhibitor partially, but significantly suppressed Jo2-mediated liver injury in WT mice. Conclusion Apelin-APJ signalling may promote Fas-induced liver injury at least partially via JNK activation, and may thus serve as a potential therapeutic target in cases of acute liver injury.

DOI： 10.1111/liv.12006

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

Background/Aims
The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument.
Methods
This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores.
Results
Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P &lt; 0.0001) and in whether subjects asked any questions (37 vs. 15 subjects, respectively; P &lt; 0.0001). Completion time in QUEST scores of &gt;= 4 was lower than &lt; 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025).
Conclusions
This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.

DOI： 10.5056/jnm.2013.19.1.54

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small-bowel lesions in these patients, or of the factors that could predict the presence of such lesions. Therefore we enrolled a total of 42 CKD patients (including 19 HD patients and 23 non-HD patients), and compared the incidence of the small-bowel lesions among two groups. Furthermore, to identify predictive factors for the presence of small-bowel lesions, we performed multivariate logistic-regression-analyses. The incidence of small-bowel vascular lesions was significantly higher in CKD patients than in age-and-sex matched non-CKD patients (P &lt
0.001). On the other hand, there was any significant difference of the incidence of small-bowel lesions between HD and non-HD patients. In CKD patients, past history of blood transfusion (OR 5.66
95% CI 1.10-29.1, P = 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00
95% CI 1.13-31.9, P = 0.04) was identified as that of erosive/ulcerated lesions. This indicated that proactive CE examination would be clinically meaningful for these patients. © 2013 Harunobu Kawamura et al.

DOI： 10.1155/2013/814214

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Malignant bowel obstruction affect a patient's quality of life, but, management of MBO is controversial. Case presentation. A 51-year-old woman who had been diagnosed as uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital. She was diagnosed as having a recurrence of peritoneal metastasis and bowel obstruction. For her nasal pain, we considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. After insertion of a percutaneous gastrostomy tube was performed endoscopically, we introduced a postpyloric decompression tube through her gastrostomy. She could be discharged home, and 91 days later, she died in her home under hospice care, as she had wished. Conclusions: Insertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction. © 2013 Kurita et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1756-0500-6-217

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

A 75-year-old man was admitted to the hospital with a loss of consciousness. His blood glucose level was 24 mg/dL. Abdominal computed tomography revealed multiple metastatic lesions in the liver, while upper endoscopy disclosed advanced gastric cancer. The hypoglycemia was refractory despite the administration of glucose and steroid therapy. The patient died within one month of admission. An autopsy revealed neuroendocrine-type gastric cancer, which, on examination with immunohistochemistry, was found to be negative for insulin and insulin-like growth factor I and positive for insulin-like growth factor II (IGF-II). The patient was diagnosed as having gastric cancer with non-islet cell tumor hypoglycemia (NICTH) caused by IGF-II.

DOI： 10.2169/internalmedicine.52.9372

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：1  

DOI： 10.2169/internalmedicine.52.8782

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Background Oral sumatriptan administration has been reported to delay gastric emptying after liquid meals. The aim of this study was to determine whether delayed gastric emptying is caused by enhanced gastric accommodation, impaired antral contractions, or both using ultrasonography. Methods Ten healthy volunteers were enrolled in this randomized two-way crossover study. After overnight fasting, the subjects received the liquid meal 60 min after ingesting a 50 mg sumatriptan tablet with 50 mL of water or 50 mL of water alone (control). The cross-sectional area of the proximal stomach was measured in a supine position after every 100 mL. The frequency and amplitude of the antral contractions were measured in a slightly backward sitting position. The intragastric distribution of the liquid meal was assessed by calculating the proximal stomach/distal stomach ratio (prox/distal ratio). Key Results The cross-sectional area after drinking 100, 200, and 300 mL of the liquid meal (oral sumatriptan vs control) was 34.49 vs 15.11 cm2 (P = 0.0051), 48.00 vs 30.61 cm2 (P = 0.0166), and 58.67 vs 47.19 cm2 (P = 0.0125), respectively. There was no significant difference in the amplitude of contractions, contraction cycle, motility index, and prox/distal ratio (97.15 vs 97.93%, P = 0.0745; 19.42 vs 19.5 s, P = 0.8590; and 887.58 vs 889.22, P = 0.5751; 9.75 vs 8.41, P = 0.8785; respectively). Conclusions & Inferences Oral sumatriptan administration enhanced gastric accommodation after the ingestion of liquid nutrients, but had no significant effect on antral contractions or intragastric distribution in healthy subjects.

DOI： 10.1111/j.1365-2982.2012.01984.x

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

多くの終末期がん患者がホスピス・緩和ケア病棟での療養を希望するが、実際に利用できる患者は非常に少ない。当院は、「なるべく多くの方に緩和ケアを提供する」ことを目標とし、「一般病棟も含め緩和ケアの場とする」、「ホスピスへの入院はホスピスを希望する方のなかで最も予後予測の悪い方を優先する」を実践してきた。2007年4月～2011年3月の集計で87%の患者が希望するタイミングで当院に入院できた。地域の医療資源を考慮してホスピス病棟の運用を工夫することで、終末期がん患者はより多くの時間を自宅で過ごせる可能性があると考える。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J00296&link_issn=&doc_id=20121228360014&doc_link_id=issn%3D0385-0684%26volume%3D39%26issue%3D12%26spage%3D39&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0385-0684%26volume%3D39%26issue%3D12%26spage%3D39&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aim: The main aim of this study was to determine whether questionnaire evaluations of clinical symptoms in gastroesophageal reflux disease were useful to assess proton pump inhibitor therapy. Methods: A total of 185 Japanese patients (men, 88; women, 97; age: 55.7 +/- 16.1 years) with gastroesophageal reflux disease were enrolled. The patients were divided based on the frequency scale for symptoms of gastroesophageal reflux disease: severe symptoms with scores =8 and mild symptoms with scores =7. Quality of life was evaluated with the Medical Outcomes Study 8-Item Short-Form Health Survey. All patients were treated with a proton pump inhibitor, rabeprazole (10 mg/day), for 8 weeks. Results: Patients were classified into four groups: reflux esophagitis with severe symptoms (n = 92, 49.7%); reflux esophagitis with mild symptoms (n = 17, 9.2%); non-erosive reflux disease with severe symptoms (n = 66, 35.7%); and non-erosive reflux disease with mild symptoms (n = 10, 5.4%). The dysmotility score was high in non-erosive reflux disease with severe symptoms compared with reflux esophagitis with severe symptoms (9.1 +/- 0.5 vs 6.8 +/- 0.5, P &lt; 0.05). The symptom score and quality of life in the severe symptoms groups for both reflux esophagitis and non-erosive reflux disease were significantly improved by rabeprazole treatment. Only the reflux score was improved by rabeprazole in the reflux esophagitis with mild symptoms group; no therapeutic effect was observed for the non-erosive reflux disease with mild symptoms group. Conclusions: Low scores on the frequency scale for the symptoms of gastroesophageal reflux disease indicate poor responsiveness to proton pump inhibitor treatment, and high scores indicate good responsiveness.

DOI： 10.1111/j.1443-1661.2012.01301.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：119  

DOI： 10.5754/hge11849

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出版者・発行元：10  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aim A case-controlled study was performed to investigate the association of colonic angiectasia with other conditions and to identify risk factors for bleeding. Method Information was collected from all patients who underwent colonoscopy at our hospital between January 2008 and December 2010. Data on 90 individuals with angiectasia [58 men; median age 69 (2692) years] were compared with those of 180 individuals without angiectasia, matched for gender and age. Results Multivariate analysis showed that occult gastrointestinal bleeding [odds ratio (OR) 2.523; 95% confidence interval (CI) 1.2385.142], liver cirrhosis (OR 13.195; 95% CI 3.50249.711), chronic renal failure (OR 6.796; 95% CI 1.59828.904) and valvular heart disease (OR 6.425; 95% CI 1.02840.165) were identified as significant predictors of the presence of colonic angiectasia. Eight patients were diagnosed with bleeding from angiectasia. Cardiovascular disease (OR 22.047; 95% CI 1.063457.345) and multiple angiectasias (P-value 0.0019) were identified as significant risk factors for active bleeding. Medication and a large size were not associated with an increased risk of bleeding. Conclusion The presence of colonic angiectasia was associated with valvular heart disease, liver cirrhosis and chronic renal failure. Valvular heart disease and multiple lesions increased the risk of bleeding.

DOI： 10.1111/j.1463-1318.2012.03132.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBL GRP CO LTD  

AIM: To determine the expression statuses of tumor necrosis factor (TNF)-alpha, its receptors (TNF-R) and downstream effector molecules in human colorectal adenomas.
METHODS: We measured the serum concentrations of TNF-alpha and its receptors in 62 colorectal adenoma patients and 34 healthy controls. The protein expression of TNF-alpha, TNF-R1, TNF-R2 and downstream signals of the TNF receptors, such as c-Jun N-terminal kinase (JNK), nuclear factor-kappa B and caspase-3, were also investigated in human colorectal adenomas and in normal colorectal mucosal tissues by immunohistochemistry. Immunofluorescence confocal microscopy was used to investigate the consistency of expression of TNF-R1 and phospho-JNK (p-JNK).
RESULTS: The serum levels of soluble TNF-R1 (sTNF-R1) in adenoma patients were significantly higher than in the control group (3.67 +/- 0.86 ng/mL vs 1.57 +/- 0.72 ng/mL, P &lt; 0.001). Receiver operating characteristic analysis revealed the high diagnostic sensitivity of TNF-R1 measurements (AUC was 0.928) for the diagnosis of adenoma, and the best cut-off level of TNF-R1 was 2.08 ng/mL, with a sensitivity of 93.4% and a specificity of 82.4%. There were no significant differences in the serum levels of TNF-alpha or sTNF-R2 between the two groups. Immunohistochemistry showed high levels of TNF-R1 and p-JNK expression in the epithelial cells of adenomas. Furthermore, a high incidence of co-localization of TNF-R1 and p-JNK was identified in adenoma tissue.
CONCLUSION: TNF-R1 may be a promising biomarker of colorectal adenoma, and it may also play an important role in the very early stages of colorectal carcinogenesis. (C) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i38.5360

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: The differences in the small intestinal toxicity of low-dose aspirin based on the type of aspirin used remains unclear. The purpose of this study was to evaluate the differences in the small bowel mucosal injury between buffered and enteric-coated aspirin users by capsule endoscopy.
Methods: We retrospectively reviewed the findings in chronic low-dose aspirin users (&gt;3 months) who underwent capsule endoscopy for the investigation of obscure gastrointestinal bleeding. The patients were classified into two groups based on the type of low-dose aspirin that they had been prescribed (enteric-coated aspirin group or buffered aspirin group), and evaluated the numbers of small bowel lesions and the Lewis score.
Results: Capsule-endoscopic findings of a total of 70 patients taking low-dose aspirin were reviewed. Significant differences in the number of erosions and ulcers were observed between the buffered and enteric-coated aspirin groups (P = 0.017 and P = 0.037, respectively). The median Lewis score for the small bowel mucosal inflammatory change was significantly higher in the enteric-coated aspirin group than in the buffered aspirin group (P = 0.035).
Conclusions: The results of this study suggested that enteric-coated aspirin might be more injurious to the small bowel mucosa than buffered aspirin. (C) 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.dld.2012.05.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBL GRP CO LTD  

AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients.
METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were diagnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined.
RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO.
CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP. (C) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i33.4557

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aim: Endoscopic screening and removal of colorectal adenomas can reduce the incidence of colorectal cancer. However, given the possibility of adenoma recurrence, surveillance colonoscopy is currently recommended after the initial screening and removal of colorectal adenomas. Aberrant crypt foci (ACF) have been shown to serve as a reliable surrogate marker of colorectal carcinogenesis. In this study, the relationship between the number of ACF at the initial endoscopic polypectomy and the likelihood of colorectal adenoma recurrence after polypectomy were investigated. Methods: High-magnification chromoscopic colonoscopy was performed in 82 subjects who underwent endoscopic polypectomy to identify ACF in the lower rectum. Surveillance colonoscopy was then performed 3 years after the baseline polypectomy at Yokohama City University Hospital. Results: The number of ACF was greater in patients who showed adenoma recurrence (7.88 +/- 6.35) than in those who did not (2.19 +/- 2.95) (P &lt; 0.001). Receiveroperating curve analysis showed that the number of ACF was a highly specific predictor of the risk of adenoma recurrence. Conclusions: This is the first study conducted to investigate the relationship between the number of ACF after endoscopic polypectomy and the likelihood of recurrence of colorectal adenomas. These results suggest that the number of ACF is a useful predictor of the likelihood of colorectal adenoma recurrence.

DOI： 10.1111/j.1443-1661.2012.01289.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Recently, high serum DPP-4 activity was found in patients with NAFLD. Therefore, the possibility of NAFLD adversely influencing the therapeutic effect afforded by DPP-4 inhibitors in type 2 diabetic patients was suggested. Methodology: A total of 20 type 2 DM patients with NAFLD and 85 type 2 DM patients without NAFLD were enrolled in the present study. The patients were administered sitagliptin at the dose of 50 mg/day for 12 weeks. Results: The change in HbA1c from the baseline following treatment with sitagliptin was -0.47% (4 weeks), -0.73% (8 weeks) and -0.88% (12 weeks) in the type 2 DM patients with NAFLD and -0.26% (4 weeks), -0.41% (8 weeks) and -0.49% (12 weeks) in type 2 DM without NAFLD. The changes in the HbA1c from the baseline after sitagliptin treatment for 8 and 12 weeks were significantly greater in type 2 DM patients with NAFLD than in type 2 DM patients without NAFLD. Conclusions: The results of this study suggest that NAFLD might adversely affect the therapeutic effect afforded by sitagliptin treatment in patients with type 2 DM. NAFLD may be an independent predictor of the effect of sitagliptin in patients with type 2 DM.

DOI： 10.5754/hge11689

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記述言語：英語   出版者・発行元：BAISHIDENG PUBL GRP CO LTD  

The Prague C and M Criteria have been developed for the objective endoscopic diagnosis of Barrett's esophagus (BE). BE arises between the squamocolumnar junction and the gastroesophageal junction at the proximal margin of the gastric folds. In this study, we reported that 43.0% of the subjects examined were diagnosed with BE based on the Prague C and M Criteria. Previous criticism by John Dent proposed that our data should be considered invalid because the prevalence of BE reported in our study was extraordinarily high and discordant with previous studies. Dent predicted that the position of the gastroesophageal junction in our study was judged to be lower than the actual position due to the effacement of the proximal ends of the gastric folds because of the routine use of a high degree of air distension during typical Japanese endoscopic examinations. The endoscopic evaluation of the superior gastric folds is certainly influenced by the degree of air distension of the esophagus. However, in our study, the proximal limit of the gastric nnucosal folds was prospectively imaged while the oesophagus was minimally insufflated. Then, under a high level of air distension, the distal ends of the palisade-shaped longitudinal vessels were imaged because they are more easily observed when distended. In the majority of patients, the distal ends of the palisade-shaped longitudinal vessels correspond to the proximal limit of the gastric mucosal folds. Our endoscopic evaluation was appropriately performed according to the Prague C and M Criteria. We suspect that the high prevalence of BE in our study may be due to the inclusion of ultrashort-segment BE, which defines BE with an affected mucosal length under 5 mm, in our positive results. (C) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i26.3477

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

AIM: TO determine the effect of oral sumatriptan on gastric emptying using a continuous C-13 breath test (BreathID system).
METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to receive a test meal (200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg (sumatriptan condition), or the test meal alone (control condition). Gastric emptying was monitored for 4 h after administration of the test meal by the C-13-acetic acid breath test performed continually using the BreathID system. Then, using Oridion Research Software (beta version), the time taken for emptying of 50% of the labeled meal (T-1/2) similar to the scintigraphy lag time for 10% emptying of the labeled meal (T-lag), the gastric emptying coefficient (GEC), and the regression-estimated constants (beta and kappa) were calculated. The statistical significance of any differences in the parameters were analyzed using Wilcoxon's signed-rank test.
RESULTS: In the sumatriptan condition, significant differences compared with the control condition were found in T-1/2 [median 131.84 min (range, 103.13-168.70) vs 120.27 min (89.61-138.25); P = 0.0016], T-lag [median 80.085 min (59.23-125.89) vs 61.11 min (39.86-87.05); P = 0.0125], and beta [median 2.3374 (1.6407-3.8209) vs 2.0847 (1.4755-2.9269); P = 0.0284]. There were no significant differences in the GEC or kappa between the 2 conditions.
CONCLUSION: This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal. (C) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i26.3415

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and study aim: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are being used increasingly to treat superficial oropharyngeal and hypopharyngeal carcinomas. The aim of this study was to clarify whether ESD provided better results than EMR for en bloc and complete resection of superficial pharyngeal carcinomas.
Patients and methods: A total of 76 superficial pharyngeal carcinomas in 59 consecutively treated patients were included. Patients underwent either conventional EMR (using a transparent cap or strip biopsy) (n=45 lesions) or ESD (n=31 lesions) between October 2006 and January 2011. The rates of en bloc resection, complete resection (defined as en bloc resection with tumor-free margins), major complications, and local recurrence were evaluated retrospectively as the therapeutic outcomes.
Results: ESD yielded significantly higher rates of both en bloc and complete resection compared with EMR (en bloc 77.4% [24/31] vs. 37.8% [17/45], P=0.0002; complete 54.8% [17/31] vs. 28.9% [13/45], P=0.0379). ESD was more frequently complicated by severe laryngeal edema (4/21 [19.0 %] vs. 1/31 [3.2%], P=0.1446) and was also more time-consuming (124.9+/-65.1 minutes vs. 57.2+/-69.6 minutes; P=0.0014). Local recurrence was observed more often after EMR than after ESD (3/45 [6.7 %] vs. 0/31 [0 %]), although this difference did not reach statistical significance (P=0.2658).
Conclusions: ESD appears to be a superior method of endoscopic resection of superficial pharyngeal carcinomas for achieving both en bloc and complete resection, although these benefits were also associated with a higher incidence of complications and a significantly longer procedure time. Large prospective studies are needed to compare ESD with conventional EMR for superficial pharyngeal carcinomas.

DOI： 10.1055/s-0032-1309720

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The ideal medication for acid-related diseases should have a rapid onset of action to promote hemostasis and cause efficient resolution of symptoms. The aim of our study was to comparatively investigate the inhibitory effect on gastric acid secretion of a single oral administration of omeprazole plus mosapride with that of omeprazole alone.
Methods: Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 hours after a single oral administration of omeprazole 20 mg or that of omeprazole 20 mg plus mosapride 5 mg (the omeprazole being administered one hour after the mosapride). Each administration was separated by a 7-days washout period.
Results: The average pH during the 6-hour period after administration of omeprazole 20 mg plus mosapride 5 mg was higher than that after administration of omeprazole 20 mg alone (median: 3.22 versus 4.21, respectively; p = 0.0247).
Conclusions: In H. pylori -negative healthy male subjects, an oral dose of omeprazole 20 mg plus mosapride 5 mg increased the intragastric pH more rapidly than omeprazole 20 mg alone.

DOI： 10.1186/1471-230X-12-25

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2011.11.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Before the introduction of capsule endoscopy and double-balloon endoscopy, there were no effective modalities for reliable evaluation of the small bowel. Recently, the SmartPill, a wireless pH/pressure recording capsule, has been utilized to measure:the whole gut transit time. However, there are few studies on the small bowel pH. The aim of this study was to investigate the relationship between small bowel disease and the small bowel pH, we designed a new modality, the "pH capsule", to non-invasively record sequential images and the pH. Methodology: Ten healthy male volunteers swallowed the "pH capsule" with 50mL of water. The "pH capsule" transmitted the acquired images and the pH to the recorder unit located outside the body for about ten hours while the subject was fasting. Results: All subjects completed this study. The intra-gastric pH was low and the pH in the whole small intestine was 7.61, 7.55: 7.2-8.1 (mean, median: range). The pH value increased from the duodenum to the terminal ileum (p&lt;0.0001). Conclusions: We could non-invasively monitor sequential images and the pH of the small intestine with this new modality. The "pH capsule", is expected to become a valuable tool for clinical assessment of the small bowel.

DOI： 10.5754/hge11394

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：GEORG THIEME VERLAG KG  

Background and study aim: Endoscopic submucosal dissection (ESD) of undifferentiated-type early gastric cancer (UD-EGC) is technically feasible; however, the long-term clinical outcomes of the procedure have not yet been fully investigated. The aim of our study was to elucidate long-term outcomes of ESD for UD-EGC.
Patients and methods: Between September 2003 and October 2009, a total of 153 patients were diagnosed endoscopically as having UD-EGC fulfilling the expanded criteria for ESD. After informed consent was obtained, 101 patients were selected to undergo ESD and 52 to undergo surgical operation. We assessed the clinical outcomes of ESD in 101 consecutive patients with 103 UD-EGC lesions who were undergoing ESD for the first time. The overall mortality and disease-free survival rates after ESD were evaluated as the long-term outcomes.
Results: The rates of en bloc and curative resection were 99.0% (102/103) and 82.5% (85/103), respectively. We encountered one patient with nodal metastasis detected by computed tomography before diagnostic ESD, although curative resection of the primary lesion was achieved based on routine histological examination. Among the 78 patients without a past history of malignancy within the previous 5 years in whom curative resection of the primary lesion was achieved, no cases of local recurrence or distant metastasis were observed during follow-up; however, 1 synchronous and 2 metachronous lesions were detected in 2 patients (2.6%) after primary ESD. Thus, estimated over a median follow-up period of 40.0 months (range 19-92 months) and 36.0 months (range 9-92 months), the 3- and 5-year overall mortality rates were 1.9% and 3.9%, respectively, and the 3- and 5-year overall disease-free survival rates were both 96.7%.
Conclusions: Although our single-center retrospective study may be considered to be only preliminary, our data indicate that ESD for UD-EGC may yield good long-term outcomes.

DOI： 10.1055/s-0031-1291486

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ZHEJIANG UNIV  

Objective: The ideal medication for the treatment of acid-related diseases, e.g., peptic ulcers, stress-related gastric bleeding, functional dyspepsia, and gastroesophageal reflux disease, should have a rapid onset of action to promote hemostasis and relieve the symptoms. The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral administration of a proton pump inhibitor, omeprazole 20 mg, and an H-2-receptor antagonist, roxatidine 75 mg. Methods: Ten Helicobacterpylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 h after single oral administration of omeprazole 20 mg and roxatidine 75 mg. Each administration was separated by a 7-d washout period. Results: During the 6-h study period, the average pH after administration of roxatidine was higher than that after administration of omeprazole (median: 4.45 vs. 2.65; P=0.0367). Also during the 6-h study period, a longer duration of maintenance at pH above 2, 5, and 6 was observed after administration of roxatidine 75 mg than after administration of omeprazole 20 mg (median: 90.6% vs. 55.2%, P=0.0284; 43.7% vs. 10.6%, P=0.0125; 40.3% vs. 3.3%, P=0.0125; respectively). Conclusions: In Helicobacter pylori-negative healthy male subjects, oral administration of roxatidine 75 mg increased the intragastric pH more rapidly than that of omeprazole 20 mg.

DOI： 10.1631/jzus.B1100078

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objectives The aim of this study was to characterize the pancreatic cystic lesions in von Hippel-Lindau (VHL) disease and to document the changes that occur in the pancreas.
Methods We retrospectively analyzed the medical records and the computed tomography (CT) and magnetic resonance imaging (MRI) findings of 20 VHL patients who were diagnosed between 1996 and 2010 at our hospital. The clinical findings, family history and type of tumors and/or cysts were reviewed for each patient. We also analyzed the imaging findings for the pancreas in detail.
Results Pancreatic involvement was noted in 16 of the 20 patients (80%). Eleven patients had multiple cysts diffusely distributed in the pancreas, and one patient had a single cyst in the pancreas head. Two patients had serous cystic neoplasms (SCNs) with multiple cysts, and another two patients had neuroendocrine tumors (NETs) which were conventional radiological findings. The largest cysts of four patients (26.7%) increased in size and that of three patients (20%) decreased in size during the follow-up period. We performed surgical resections for the pancreatic tumors (one NET and one SCN) and also performed endoscopic treatment for a pancreatic cyst in one VHL patient with obstructive jaundice. None of the patients died as a result of pancreatic disease.
Conclusion The most common type of pancreatic lesions was multiple cysts. SCNs were present in only 10% of the VHL patients. Pancreatic cysts showed positive and/or negative growth according to the CT and MRI findings. The pancreatic cystic lesions did not influence the outcome of the VHL patients.

DOI： 10.2169/internalmedicine.51.7194

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Introduction: Recently, attention is being paid to gastrointestinal symptoms for Rome III criteria. The aim of this study was to determine whether Japanese volunteers could discriminate between manpuku (satiety) and bouman (epigastric bloating) in Japanese volunteers. Methods: Seventeen healthy subjects were recruited for a modified Boeckxstaens' water drink test. Data from the drink test and a questionnaire were analyzed. Results: The median value of maximum ingested volume was 1350mL. Maximum ingested volume and body mass index were correlated (P=0.0445). All subjects felt manpuku (satiety), bouman (epigastric bloating) and nausea. The time courses of manpuku (satiety) and bouman (epigastric bloating) in the questionnaires were classified into 5 groups: manpuku (satiety) dominant type (29.4%), bouman (epigastric bloating) dominant type (23.5%), manpuku (satiety) preceding type (11.7%), bouman (epigastric bloating) preceding type (29.4 %) and equal type (5.8%). Conclusion: Some Japanese discriminate between manpuku and bouman, but others feel them as identical symptoms.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background and Aim: Diverticular hemorrhage is the common cause of lower gastrointestinal bleeding, and its incidence has been increasing in Japan. However, the exact cause of diverticular hemorrhage is not well understood. We investigated the risk factors for diverticular hemorrhage. Methods: We selected 103 patients with diverticular hemorrhage as cases and patients with colonic diverticulosis without a history of bleeding were selected as control subjects, exactly matched for age and gender. We collected the data from the medical records of each of the patients, such as those related to the comorbidities, medications and findings of colonoscopy, and conducted a matched case-control study to analyze the risk factors for diverticular hemorrhage. Results: Both groups were composed of 75 men and 28 women. The median age of the patients in both groups was 72.0 years (47.0-87.0). The body weight (p = 0.0065), body mass index (p = 0.006), prevalence of hypertension (p = 0.0242), prevalence of ischemic heart disease (p = 0.0015), and frequency of use of low-dose aspirin (p = 0.042) were significantly different between the two groups. The percentage of patients with bilateral diverticula, that is, diverticula on both the right and left hemicolon, was significantly higher in the diverticular hemorrhage group (p = 0.0011). Multiple regression analysis identified only the diverticular location as being significantly associated with the risk of diverticular hemorrhage (p = 0.0021). Conclusions: Only the diverticular location (bilateral) was found to be an independent risk factor for diverticular hemorrhage. Copyright (C) 2012 S. Karger AG, Basel

DOI： 10.1159/000336351

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background and Aims: Chronic intestinal pseudo-obstruction (CIPO) is an intractable disease in which clinical symptoms of intestinal obstruction appear without mechanical cause. No clear diagnostic criteria have been established; therefore, we proposed diagnostic criteria to facilitate the diagnosis of this rare disease and aim to evaluate their usefulness and validity. Materials and Methods: A questionnaire was sent to 378 institutions belonging to the Japanese Society of Gastroenterology between December 2009 and February 2010. We summarized the returned data and performed a statistical analysis. Results: A total of 160 cases were included, and 141 cases (88.1%) fulfilled the criterion of disease duration of &gt;6 months, 157 cases (98.1%) the criterion of the clinical symptoms of abdominal pain and/or bloating and 154 cases (96.2%) fulfilled the criterion of imaging findings. Eventually, 138 cases (86.3%) fulfilled all criteria. Conclusions: The proposed diagnostic criteria were useful, with a high sensitivity of 86.3% for Japanese patients. Improved recognition of CIPO and practical use of the criteria are desired. The criteria should be appropriately modified by additional researchers to make them more practical and internationally applicable. Copyright (C) 2012 S. Karger AG, Basel

DOI： 10.1159/000337528

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Background The immunochemical faecal occult blood test (IFOBT) is widely performed for colorectal cancer screening, but the usefulness of IFOBT in the detection of disorders of the small intestine is unknown. The objective of this study was to investigate what proportion of IFOBT-positive subjects with negative colonoscopy and oesophagogastroduodenoscopy has pathologies of the small intestine detected by capsule endoscopy (CE).
Methods Between October 2008 and June 2010, asymptomatic IFOBT-positive patients with negative total colonoscopy and oesophagogastroduodenoscopy underwent CE. CE findings were classified into three categories: P0 (no abnormalities, or findings without potential for bleeding), P1 (findings with uncertain potential for bleeding), P2 and (findings with high potential for bleeding).
Results Fifty-three patients (37 males, 16 females; 52.1 +/- A 13.0 years) were included. There were no cases with P2, 19 cases with P1, and 34 cases with P0 (there were no abnormalities in 25 of 34 cases). As a result, lesions in the small intestine were detected in 28 cases. Additional examination was considered necessary for five patients after CE, but no abnormality was detected, and therapeutic intervention was not undertaken in any case. Caecal completion rate was 92.5%.
Conclusions No significant pathologies of the small intestine were detected in asymptomatic IFOBT-positive cases with negative colonoscopy and oesophagogastroduodenoscopy. CE is of limited use in asymptomatic patients with positive IFOBT.

DOI： 10.1007/s10620-011-1798-4

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

緩和医療における胃瘻の適応は十分に論議されていないのが現状である。内視鏡やデバイスの進化により従来は不可能だった症例も安全に胃瘻造設が行えるようになった。胃瘻はがん患者の在宅療養に非常に有用なツールの一つである。緩和医療における胃瘻の適応は引き続き論議されるべきテーマと考えられる。当院においての適応は、(1)必要な栄養・水分を自発的に摂取できない(通過障害に加え口腔内疼痛も含む)、(2)消化管吸収機能正常、(3)生命予後予測4週以上(+悪液質ではない)、(4)本人の意思としている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20111222400029&doc_link_id=issn%3D0385-0684%26volume%3D38%26issue%3D12%26spage%3D85&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0385-0684%26volume%3D38%26issue%3D12%26spage%3D85&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver injury, and is considered as the hepatic manifestation of metabolic syndrome. However, no effective drug therapy for NAFLD has been established yet. In the present study, we evaluated the efficacy of 4 months of treatment with sitagliptin in NAFLD patients with type 2 diabetes mellitus (DM). Methodology: We evaluated 30 NAFLD patients with type 2 DM. NAFLD was diagnosed by ultrasonography. The patients were administered sitagliptin (50mg/body/day) for 4 months. Results: Significant decreases of the plasma glucose and serum HbA1c, AST, ALT and gamma-GTP levels were observed after 4 months of treatment with sitagliptin. Conclusions: In this study, not only the parameters of diabetes, but also those of liver tests were improved by the treatment with sitagliptin. Our study demonstrated the efficacy of sitagliptin in NAFLD patients with type 2 DM, suggesting that a large-scale clinical trial is warranted in the future.

DOI： 10.5754/hge11263

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, for which the development of new biomarkers and therapeutic targets has become critical. The main cause of poor prognosis in PDAC patients is the high invasive and metastatic potential of the cancer. In the present study, we report a new signaling pathway that was found to mediate the enhanced tumor cell motility in pancreatic cancer. Semaphorin 4D (Sema4D) is a ligand known to be expressed on different cell types, and has been reported to be involved in the regulation of immune functions, epithelial morphogenesis, and tumor growth and metastasis. In this study, we revealed for the first time that the cancer tissue cells expressing Sema4D in PDAC are tumor-infiltrating lymphocytes. The overexpression of Sema4D and of its receptor, plexinB1, was found to be significantly correlated with clinical factors, such as lymph node metastasis, distant metastasis, and poor prognosis in patients with PDAC. Through in vitro analysis, we demonstrated that Sema4D can potentiate the invasiveness of pancreatic cancer cells and we identified the downstream molecules. The binding of Sema4D to plexinB1 induced small GTPase Ras homolog gene family, member A activation and resulted in the phosphorylation of MAPK and Akt. In addition, in terms of potential therapeutic application, we clearly demonstrated that the enhanced-cell invasiveness induced by Sema4D could be inhibited by knockdown of plexinB1, suggesting that blockade of plexinB1 might diminish the invasive potential of pancreatic cancer cells. Our findings provide new insight into possible prognostic biomarkers and therapeutic targets in PDAC patients. (Cancer Sci 2011; 102: 2029-2037)

DOI： 10.1111/j.1349-7006.2011.02053.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Duodenal variceal rupture is rare, and there is little agreement on the best therapeutic option. A 72-year-old man treated for liver cirrhosis with HCV visited the emergency room complaining of dizziness and tarry stool. Fiberscope images showed varices (F2CbRC+) with white plaques at the horizontal region of the duodenum. The patient was treated using endoscopic variceal ligation (EVL), and no more bleeding has been detected.

DOI： 10.5754/hge09470

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2011.06.022

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

Background/Aims
The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals.
Methods
Six healthy male volunteers underwent 3 tests at intervals of &gt; 1 week. After fasting for &gt; 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A C-13-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (beta version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test.
Results
Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone.
Conclusions
This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.

DOI： 10.5056/jnm.2011.17.4.395

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Background and Aims: The diagnostic use of magnification endoscopy with narrow-band imaging (ME-NBI) to assess histopathologically undifferentiated-type early gastric cancers (UD-type EGCs) is not well elucidated. The purpose of this study was to examine the comparative relationship between ME-NBI images and histopathological findings in UD-type EGCs.
Methods: We analyzed 78 consecutive cases of UD-type EGCs &lt;= 20 mm in diameter that underwent ME-NBI &lt;= 2 weeks prior to resection. The ME-NBI images were compared with histopathological findings following either endoscopic submucosal dissection (ESD) or surgery. Applying the comparative results, we prospectively evaluated the success of identifying the lateral extent of UD-type EGCs resected by ESD in additional consecutive cases.
Results: Lesions with preserved but irregular surface microstructures (S-type based on ME-NBI) showed mucosal atrophy and corresponded histologically to the non-whole-layer type of intramucosal cancer (24/24, 100%). Lesions with an irregular microvasculature type (V-type, for example, corkscrew pattern) or mixed type upon ME-NBI corresponded histopathologically to the non-whole-layer type of intramucosal cancer (15/54, 27.8%), the whole-layer type of intramucosal cancer (27/54, 50.0%) or submucosal (sm) invasion cancer (12/54, 22.2%). Applying these comparative results, we used ME-NBI to successfully predict the lateral extent of cancer, which corresponded to the histopathological lateral extent in all 18 additional consecutive UD-type EGCs resected by ESD.
Conclusions: ME-NBI images of UD-type EGCs were very closely related to the histopathological findings. Thus, ME-NBI can be useful in the pretreatment assessment of the histopathological patterns of cancer development and the lateral extent of such lesions.

DOI： 10.1111/j.1440-1746.2011.06730.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

Background/Aims
The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous C-13 breath test (BreathID system, Exalenz Bioscience Ltd, Israel).
Methods
Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of C-13-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the C-13-acetic acid breath test performed using the BreathID system.
Results
No significant differences in the calculated parameters, namely, the T-1/2, T-lag, GEC, beta and kappa, were observed among the 3 test conditions.
Conclusions
The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.

DOI： 10.5056/jnm.2011.17.3.287

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Few studies have investigated measures to prevent small bowel injuries induced by aspirin. Our aim was to evaluate the effect of probiotic treatment on the small bowel injuries induced by chronic low-dose aspirin use.
Thirty-five patients who took low-dose enteric-coated aspirin 100 mg daily (for more than 3 months) plus omeprazole 20 mg daily and were diagnosed as having unexplained iron deficiency anemia participated in this prospective randomized controlled trial. We assigned the patients to receive probiotic treatment with Lactobacillus casei for 3 months (L. casei group) or not receive the probiotic (control group). Patients underwent capsule endoscopy (CE) before and after treatment.
Twenty-five patients, including 13 in the L. casei group and 12 in the control group, underwent the full analysis. Significant decreases in the number of mucosal breaks and the CE score were observed at the 3-month evaluation in the L. casei group as compared with the results in the control group (P = 0.039). The change from the baseline in the median number of mucosal breaks in the L. casei group was -2, as compared with 0.5 in the control group. The change from the baseline in the median CE score in the L. casei group was -228 compared with -4 in the control group (P = 0.026).
Co-administration of L. casei is effective for the treatment of aspirin-associated small bowel injury.

DOI： 10.1007/s00535-011-0410-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Few studies have investigated measures to prevent small bowel injuries induced by aspirin. Our aim was to evaluate the effect of probiotic treatment on the small bowel injuries induced by chronic low-dose aspirin use.
Thirty-five patients who took low-dose enteric-coated aspirin 100 mg daily (for more than 3 months) plus omeprazole 20 mg daily and were diagnosed as having unexplained iron deficiency anemia participated in this prospective randomized controlled trial. We assigned the patients to receive probiotic treatment with Lactobacillus casei for 3 months (L. casei group) or not receive the probiotic (control group). Patients underwent capsule endoscopy (CE) before and after treatment.
Twenty-five patients, including 13 in the L. casei group and 12 in the control group, underwent the full analysis. Significant decreases in the number of mucosal breaks and the CE score were observed at the 3-month evaluation in the L. casei group as compared with the results in the control group (P = 0.039). The change from the baseline in the median number of mucosal breaks in the L. casei group was -2, as compared with 0.5 in the control group. The change from the baseline in the median CE score in the L. casei group was -228 compared with -4 in the control group (P = 0.026).
Co-administration of L. casei is effective for the treatment of aspirin-associated small bowel injury.

DOI： 10.1007/s00535-011-0410-1

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記述言語：英語  

Intestinal pseudo-obstruction is a clinical syndrome in which the clinical symptoms of intestinal obstruction appear without mechanical obstruction of the intestine. We searched for articles from Japana Centra Revuo Medicina for the period 1983-2009 using the keywords 'chronic' and 'intestinal pseudo-obstruction'. 124 articles were identified, and of these 121 cases were investigated using our diagnostic criteria. The patients were between 0 (just after birth) and 84 years of age, indicating that chronic intestinal pseudo-obstruction (CIP) can occur at any age. The mean age was 43.6 years and the median age was 47 years. Forty-nine patients were male and 72 were female, showing a slight tendency towards female predominance. Five cases (4.2%) had a definitive family history. Of the identified causes of secondary CIP, systemic sclerosis was the most common. Abdominal bloating was the most common initial symptom, seen in 90 (81%) patients. Patients having poor intestinal peristalsis with stagnation of the contents of the small intestines causing fatty stools and bacterial overgrowth complained of diarrhea. The interval between the initial symptoms and diagnosis ranged from 0 to 60 years, with a mean and median interval of 7.3 and 2 years, respectively. In case reports of CIP in Japan, the sensitivity of our diagnostic criteria was found to be 85.9%, indicating that the criteria are useful. For improvement in the rate of recognition of CIP and practical application of the diagnostic criteria in Japan, it is important to conduct further studies. © 2011 Springer.

DOI： 10.1007/s12328-011-0219-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

Expression of the forkhead/winged helix family of transcription factor P3+ regulatory T cells (FOXP3(+) Treg), a master gene of regulatory T cells (Treg) is observed in patients with autoimmune pancreatitis (AIP). We investigated the usefulness of detection of FOXP3(+) Treg in the main duodenal papilla for differential diagnosis between AIP and pancreatic cancer (Pca).
Firstly, we determined the cut-off value of FOXP3 expression in duodenal papilla taken from the patients with AIP (n = 22) and chronic pancreatitis (n = 21). Data from 32 patients with AIP and 30 patients with Pca who had undergone endoscopic biopsy were then studied. The numbers of FOXP3(+) Treg-positive lymphocytes and IgG4-positive plasma cells per high-power field (HPF) were counted in all the histopathological specimens.
The areas under the receiver-operating characteristic (AUROC) curves for FOXP3(+) and IgG4 expression were 0.934 and 0.953, respectively. Cut-off values calculated based on AUROC data were 14/HPF in FOXP3 and 10/HPF in IgG4. Seropositivity for IgG4 was observed in 22 out of the 31 patients with AIP (sensitivity 71.0%, specificity 84.6%, accuracy 75.0%). Significant infiltration of the major duodenal papilla by FOXP3(+) lymphocytes (a parts per thousand yen14/HPF) was recognized in 18 of the 32 patients with AIP (sensitivity 56.3%, specificity 100%, accuracy 77.4%). Significant infiltration of the major duodenal papilla by IgG4-positive plasma cells (a parts per thousand yen10/HPF) was recognized in 27 of the 32 patients with AIP (sensitivity 84.4%, specificity 80.0%, accuracy 82.3%).
Observation of FOXP3(+) cells in the main duodenal papilla may be useful in the differential diagnosis between AIP and Pca.

DOI： 10.1007/s00534-010-0359-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

Background/Aims
There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time C-13 breath test (BreathID system).
Methods
Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the C-13-acetic acid breath test performed continually using the BreathID system.
Results
No significant differences in the calculated parameters, namely, T-1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), T-lag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group.
Conclusions
This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.

DOI： 10.5056/jnm.2011.17.2.174

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER MASSON  

Background and objective: The incidence of Clostridium difficile infection (CDI) has increased throughout the world and patients with ulcerative colitis (UC) are at a high risk for CDI. Potentially, CDI can exacerbate UC. Therefore, knowledge on the prevalence of CDI should contribute to better management of UC patients.
Methods: The presence of toxin A antigen was defined as CDI, and the outcome of the test in patients with active UC during 2006-2009 was reviewed for identifying patients with CDI. Demographic data (disease profile, clinical response to medications and the need for colectomy) in UC patients with CDI were compared with the data from CDI free UC patients.
Results: Fifty-five of 137 patients (40.1%) were CDI positive. Univariate and multivariate analyses revealed that CDI was not associated with any demographic factor. Intensive antibiotic therapy spared five of 17 (29.4%) steroid refractory patients with CDI from steroids. CDI was not a predictor of colectomy although this could be an outcome of efficient eradication strategy.
Conclusion: CDI was not associated with any demographic factor or colectomy rate. However, CDI eradication therapy allowed some refractory patients to withdraw from steroids. Patients with active UC benefit from regular CDI test and eradication treatment for CDI. (C) 2011 Elsevier Masson SAS. All rights reserved.

DOI： 10.1016/j.clinre.2011.02.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT SCIENTIFIC LITERATURE, INC  

Background: A visceral fat area of more than 100 cm(2) as measured by computed tomography (CT) at the umbilical level has been included as a criterion for obesity in all the proposed criteria for metabolic syndrome. However, CT cannot be used frequently because of radiation exposure. We evaluated the usefulness of measurement of the serum levels of nitric oxide (NO), instead of CT and the waist circumference, as a marker of abdominal visceral fat accumulation.
Material/Methods: The study was carried out in 80 subjects. The serum levels of NO metabolites (nitrate/nitrite) were measured using the Griess reagent.
Results: Simple and multiple regression analysis revealed that the serum levels of NO metabolites showed the greatest degree of correlation with the visceral fat area (r = 0.743, p &lt; 0.0001), and corresponded to a visceral fat area of 100 cm(2), as determined using the ROC curve, was 21.0 mu mol/ml (sensitivity 88%, specificity 82%); this method was more sensitive than the waist circumference for evaluation of the visceral fat accumulation.
Conclusions: Measurement of the serum levels of NO metabolites may be a simple, safe, convenient and reliable method for the evaluation of visceral fat accumulation in clinical diagnostic screening.

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記述言語：英語   出版者・発行元：JAPANESE PHARMACOLOGICAL SOC  

The factors involved in the progression of non-alcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) are not fully understood and thus it is urgently needed to elucidate these factors. Steatosis is not causal in the development of NASH, but rather it sensitizes the liver to the damaging effects of second hits such that stressors innocuous to a healthy liver lead to the development of NASH in the steatotic liver. In the previous study, most of the hepatic lipid metabolite profiles were similar in the NAFL and NASH groups. However, very-low-density lipoprotein (VLDL) synthesis, especially hepatic microsomal triglyceride transfer protein (MTP) mRNA expression, was impaired in the NASH group. Moreover, NASH showed significantly higher incidence of minor alley appearance compared with NAFL, indicating the possibility of association between NASH pathogenesis and decreased congenital MTP activity. MTP is one of the enzymes that transfer triglycerides to nascent apolipoprotein B, producing VLDL and removing lipid from the hepatocyte. A growing body of literature suggests that the measurement of hepatic MTP expression may be helpful for diagnosis; and moreover, hepatic MTP activator may be a possible therapeutic agent for the treatment of NASH.

DOI： 10.1254/jphs.10R14FM

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: To determine the correlation between domperidone and gastric emptying using the continuous real time C-13 breath-test (BreathID system), a novel non-invasive technique for measuring gastric emptying.
Methodology: Six healthy male volunteers participated in this randomized, two-way crossover study. Subjects fasted overnight and were randomly assigned to receive a test meal (400kcal per 400mL) 30 minutes after intake of domperidone (10mg) with 50mL of water or intake of 50mL of water alone. Gastric emptying was monitored for 4h after administration of the test meal by C-13-acetic acid breath test continually performed using the BreathID system. The time taken for emptying of 50% of the labeled meals (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T lag), the gastric emptying coefficient (GEC), and the regression-estimated constants (6 and K) were calculated. Differences in the parameters measured at two time-points were analyzed using the Wilcoxon&apos;s signed-rank test.
Results: No significant differences in calculated parameters (T lag, T1/2, GEC, beta or kappa) were observed between the treated and non-treated groups.
Conclusions: This study showed that domperidone had no effect on gastric emptying. The drug ameliorates nausea and vomiting via its antagonic activity against dopamine receptor. Therefore, domperidone probably ameliorates nausea through other mechanisms.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：106  

Background/Aims: Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, in some patients MWS results in a fatal outcome. Therefore, this study was carried out to analyze the risk factors for mortality in patients with MWS. Methodology: The medical records of patients with MWS seen between March 1994 and July 2007 were reviewed retrospectively. The demographic characteristics, clinical and laboratory parameters, and endoscopic findings of the patients were analyzed and the risk factors for mortality were evaluated. Results: A total of ninety-three patients (13 female and 80 male patients
median age, 53 years) were treated. The mortality rate was 9.7% (9/93). The patients with a fatal outcome were of advanced age and had a higher frequency of shock on arrival, lower hemoglobin level, more prolonged prothrombin time, higher AST and ALT levels, higher frequency of detection of exposed vessels on endoscopy, higher frequency of rebleeding, longer hospital stay, and required a larger volume of blood transfusion than those who did not have a fatal outcome. According to the results of a multivariate analysis, the significant risk factors for mortality in the MWS patients were advanced age (OR 1.222, 95% CI 1.015-1.028), very low hemoglobin level (OR 2.137, 95% CI 1.063-4.295), elevated AST level (OR 1.007, 95% CI 1.001-1.013), and presence of the clinical symptom of tarry stool (OR 45.45, 95% CI 1.080-1000). Conclusions: Intensive care with close monitoring is required for patients of advanced age with a low hemoglobin level, an elevated AST level, and the clinical symptom of tarry stool, since these are of prognostic importance in terms of the mortality in MWS patients. © H.G.E. Update Medical Publishing S.A.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

The possible role of leptin in colorectal tumors has been investigated in previous studies; however, to date, the conclusions remain under debate. Therefore, we investigated the serum leptin levels in colorectal adenoma patients. In addition, expression of the leptin receptor, and the leptin receptor-mediated signaling pathways were investigated in biopsy specimens collected from human patients with colorectal adenoma. No significant difference in the mean serum leptin level was observed between the colorectal adenoma patients and the control subjects; however, increased expression and activation of the leptin receptor, as indicated by findings such as the phosphorylation of Tyr 1141, was observed in the colorectal adenoma tissues. In addition, activation of the JAK/STAT signaling pathway mediated by the leptin receptor and increased transcriptional regulation of downstream target molecules were observed in colorectal adenomas compared with the non-adenoma tissues. These results indicate STAT3-mediated leptin receptor signaling pathways may be activated in human colorectal adenomas. (Cancer Sci 2011; 102: 367-372)

DOI： 10.1111/j.1349-7006.2010.01803.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

OBJECTIVES: Although sporadic nonampullary duodenal adenoma (SNDA) is regarded as a precancerous lesion, its natural course is uncertain. The aim of this study was to evaluate the risk of development of adenocarcinoma in SNDA lesions initially diagnosed as showing low-grade dysplasia (LGD; category 3) or high-grade dysplasia (HGD; category 4.1).
METHODS: We analyzed 68 SNDAs, diagnosed based on initial and subsequent biopsies, in 66 consecutive patients. Of these, 46 (43 LGD lesions, 3 HGD lesions) were followed up for &gt;= 6 months without treatment (mean 27.7 +/- 16.9 months; range 6-72 months), including 8 lesions that were eventually resected during follow-up. Sixteen lesions (eight LGD lesions, eight HGD lesions) were resected immediately, either endoscopically or surgically, and six lesions were excluded because of a short follow-up (&lt; 6 months). The histopathological diagnoses and macroscopic changes were evaluated.
RESULTS: Among the 43 LGD lesions followed up for &gt;= 6 months, 34 (79.1%) showed no histopathological changes during follow-up, whereas the remaining 9 (20.9%) showed progression to HGD, including 2 (4.7%) that progressed eventually to noninvasive carcinoma (category 4.2). Macroscopically, 76.7% (33 of 43) of the LGD lesions showed no notable changes in size, 16.3% (7 of 43) became undetectable, 4.7% (2 of 43) reduced in size, and 2.3% (1 of 43) became larger in size. In contrast, all the three HGD lesions that were followed up for &gt;= 6 months remained unchanged histologically, based on biopsy, and showed no notable macroscopic changes, although one of these HGD lesions resected endoscopically revealed evidence of noninvasive carcinoma. Although we diagnosed all lesions as HGD from biopsy samples, a high percentage of cancers (54.5%, 6 of 11) were diagnosed from resected specimens. A multivariate analysis identified HGD diagnosed at first biopsy and a lesion diameter of &gt;= 20 mm as being significantly predictive of progression to adenocarcinoma.
CONCLUSIONS: LGD lesions show a low risk of progression to adenocarcinoma, but some risk of progression to HGD, which warrants careful follow-up biopsy. However, HGD lesions and large SNDAs &gt;= 20 mm in diameter show a high risk of progression to adenocarcinoma. Therefore, they should be treated immediately.

DOI： 10.1038/ajg.2010.422

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Liver abscess is recognized as a life-threatening disease. However, even in recent years, approximately 50% of liver abscess cases are considered to be cryptogenic. Here, we report a case of liver abscess associated with periodontal bacterial infection by Fusobacterium necrophorum, which is commonly found in the oropharyngeal flora. A 36-year-old man presented with fever and contrast-enhanced abdominal computed tomography revealed multiple liver abscesses. F.necrophorum was isolated from oral smears, liver aspirates and blood samples. Liver abscesses caused by periodontal bacterial infection are rare, however, the incidence is expected to increase in the future, as periodontitis is extremely common and is on the rise as one of the most common chronic infections in the world. A systemic survey including periodontitis may be required for the exact diagnosis of the source of infection.

DOI： 10.1111/j.1872-034X.2010.00748.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Low-dose aspirin is widely used for the prevention of cardiovascular and cerebrovascular diseases. However, administration of low-dose aspirin is associated with an increased risk of upper gastrointestinal complications, such as upper gastrointestinal erosions, ulcers and bleeding. The aim of this study was to clarify the prevalence and various clinical factors of upper gastrointestinal complications associated with low-dose aspirin treatment.
Methodology: A total of 1213 patients taking low-dose aspirin were evaluated with upper endoscopi.c examinations. We studied retrospectively the incidence of and risk factors for upper gastrointestinal complications associated with low-dose aspirin use.
Results: Of the 1213 patients taking low-dose aspirin, 598 patients and 72 patients were found to have gastroduodenal erosions (57.3%) and peptic ulcers (5.9%), respectively. Of these 72 peptic ulcers, 27 were diagnosed as hemorrhagic ulcers. Previous ulcer history was identified as a risk factor for peptic ulcer and upper gastrointestinal bleeding during low-dose aspirin therapy. Upper gastrointestinal symptoms and no use of gastroprotective agents were also identified as risk factors for peptic ulcers. In this study, the use of a histamine-2 receptor antagonist was indicated as a protective factor for peptic ulcers.
Conclusions: Low-dose aspirin therapy is associated with an increased risk of developing upper gastrointestinal complications. Administration of a histamine-2 receptor antagonist was effective for the prevention of low-dose aspirin induced peptic ulcers.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Background and Aim:
Differentiation of sclerosing cholangitis-associated autoimmune pancreatitis (SC-AIP), primary sclerosing cholangitis (PSC) and cancer of the hilar part of the bile duct (CHB) has been challenging. The aim of the present study was to evaluate characteristic intraductal ultrasonography (IDUS) features that could be used to discriminate SC-AIP from PSC and CHB.
Methods:
Six patients with SC-AIP, 10 patients with PSC and 12 patients with CHB were identified. We reviewed the following bile duct features observed using IDUS to determine their usefulness for differentiating SC-AIP from PSC and CHB: presence of symmetrical wall thickness, wall thickness, presence of homogeneous internal foci and presence of lateral mucosal lesions continuous to the hilar.
Results:
IDUS results (SC-AIP, PSC, CHB) were as follows: wall thickness (mm), 3.7 +/- 0.9, 2.6 +/- 0.9, 2.8 +/- 0.0.6; presence of symmetrical wall thickness, 100% (6/6), 20% (2/10), 8.3% (1/12); presence of homogeneous internal foci, 100% (6/6), 10% (1/10), 8.3% (1/12); and presence of lateral mucosal lesions continuous to the hilar, 83.3% (5/6), 40%(4/10), 25% (3/12). Symmetrical wall thickness of the bile duct, homogeneous internal foci and lateral mucosal lesions continuous to the hilar were detected significantly more often among the patients with SC-PSC than among the patients with PSC or CHB (P &lt; 0.05).
Conclusions:
IDUS findings, such as symmetrical wall thickness, presence of homogeneous internal foci and presence of lateral mucosal lesions continuous to the hilar can facilitate the differential diagnosis of SC-AIP from PSC and CHB.

DOI： 10.1111/j.1443-1661.2010.01039.x

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

DOI： 10.1111/j.1443-1661.2010.01056.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Aim:
The major limitation of capsule endoscopy (CE) has been the lack of a standardized and validated severity scale for mucosal injury. The aim of the present study was to verify the usefulness of quantifying small bowel mucosal changes associated with giving low-dose aspirin (LDA) using a CE scoring index.
Methods:
The CE score for small bowel mucosal injury was investigated to evaluate the severity of mucosal injury. Healthy volunteers and patients suspected of having small bowel disease were recruited for this study. The short-term LDA group (V + S-LDA group) consisted of volunteers who took low-dose aspirin for 14 days; this group was then compared with healthy volunteers who did not receive LDA treatment (V-Control group). The long-term LDA group (L-LDA group) consisted of patients with at least a 3-month history of daily LDA use; this group was compared with non-users of LDA (P-Control group).
Results:
The CE score was significantly higher in the V + S-LDA group than in the V-Control group. In the V-Control group, almost all the subjects were categorized as exhibiting a &apos;normal&apos; change. &apos;Mild&apos; changes were observed significantly more frequently in the V + S-LDA group than in the V-Control group. The CE score was significantly higher in the L-LDA group than in the P-Control group. &apos;Mild&apos; or &apos;moderate or severe&apos; changes were observed significantly more frequently in the L-LDA group than in the P-Control group.
Conclusion:
The CE scoring system was useful for evaluating LDA-associated small bowel mucosal disease activity and for objectively scoring the small bowel inflammatory disease state.

DOI： 10.1111/j.1443-1661.2010.01044.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: This study examines the effect of systemic chemotherapy with gemcitabine (GEM) on survival in elderly patients (aged &gt;= 70 years) with unresectable biliary tract cancer and compares it with best supportive care (BSC).
Methodology: We conducted a retrospective study of consecutive patients aged &gt;= 70 years, with unresectable biliary tract cancer who were administered GEM (800-1,000 mg/m2) on days 1, 8, and 15 every 4 weeks as a first-line treatment.
Results: Twenty-eight patients were enrolled: 13 (46.4%) received chemotherapy with GEM and 15 (53.6%) received BSC. No cases of complete or partial response were observed. Stable disease was observed in 9 patients (69.2%) and progressive disease in 2 patients (15.4%). Disease control rate was 69.2%. The median overall survival time of patients treated with GEM and BSC was 9.1 and 2.9 months, and the 1-year survival rates were 15.4% and 6.7% respectively. Grade 3/4 neutropenia occurred in three patients (23.1%), leukopenia in two patients (15.4%) and anemia in one patient (7.7%). Grade 3 non-hematologic toxicities were constipation (7.7%) and fatigue (7.7%).
Conclusions: Chemotherapy with single-agent GEM is a safe and well tolerated regimen for elderly patients with unresectable biliary tract cancer.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: ideally, medications for the treatment of acid-related diseases should have a rapid onset of action to promote hemostasis and the resolution of symptoms. The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral administration of lafutidine alone or combined with peppermint oil.
Methodology: Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 4 hours after a single oral administration of lafutidine (10mg) or the administration of lafutidine (10mg) with peppermint oil (0.64mL). Each administration was separated by a 7-day washout period.
Results: No significant difference in the average pH was observed during the 4-hour period after the combined administration of lafutidine and peppermint oil and after the administration of lafutidine alone (median gastric pH: 5.09 versus 5.29; p=0.3122).
Conclusions: In H. pylori-negative healthy male subjects, an oral dose of lafutidine combined with peppermint oil did not increase the intragastric pH faster than lafutidine alone.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to determine whether oral Itopride hydrochloride (itopride) intake might have any effect on the rate of gastric emptying, using a novel non-invasive technique for measuring the rate of gastric emptying, namely, the continuous real time C-13 breath test (BreathID system: Exalenz Bioscience Ltd., Israel).
Methodology: Eight healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted overnight and were randomly assigned to receive 50mg itopride following a test meal (200 kcal per 200mL, containing 100mg C-13 acetate), or the test meal alone. Under both conditions, gastric emptying was monitored for 4 hours after administration of the test meal by the C-13-acetic acid breath test performed continually using the BreathID system. Using Oridion Research Software (6 version), the time required for emptying of 50% of the labeled meal (T 1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T lag), the gastric emptying coefficient (GEC), and the regression-estimated constants (6 and x) were calculated. The parameters measured under the two conditions were compared using the Wilcoxon&apos;s signed-rank test.
Results: No significant differences in the calculated parameters, namely, the T 1/2, T lag, GEC, B or K, were observed between the two test conditions, namely, administration of a test meal+itopride and administration of the test meal alone.
Conclusions: The present study revealed that postprandial itopride intake had no significant influence on the rate of gastric emptying. Recently, several studies have shown that itopride may be effective in the treatment of patients with functional dyspepsia. Our results suggest that the efficacy of itopride in patients with functional dyspepsia may be based on its effect of improving functions other than the rate of gastric emptying, such as the activities at neuronal sites, brain-gut correlation, visceral hypersensitivity, gastric accommodation and distension-induced adaptation.

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000313694

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Scientific Literature Inc.  

Background: Pretreatment with a proton pump inhibitor (PPI) reportedly decreases the efficacy of Helicobacter pylori (H. pylori) eradication, however, the effect of pretreatment with an H2 receptor antagonist (H2RA) on H. pylori eradication has not yet been studied. We compared the efficacy of eradication regimen (lansoprazole/amoxicillin/clarithromycin) in patients with H. pylori infection with or without H2RA pretreatment. Material/Methods: In this retrospective study conducted at three centers, 310 patients with H. pylori infection were treated. The diagnosis of H. pylori infection was made using the rapid urease test, bacterial cultures and histological examination of endoscopic biopsy specimens. The patients were assigned to receive an eradication regimen first or following pretreatment with H2RA. Eradication was assessed using the 13C-urea breath test more than 4 weeks after the completion of therapy. Results: Overall, H. pylori was eradicated in 79.7% of the cases: the eradication rate was 81.6% in the pretreatment group, and 77.6% in the eradication first group (p=0.3799, chi-square test). No significant difference in the eradication rate was observed between the two groups. Conclusions: Pretreatment with H2RA had no significant influence on the efficacy of H. pylori eradication therapy. © Med Sci Monit, 2011.

DOI： 10.12659/MSM.881762

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Scientific Literature Inc.  

Background: Pretreatment with a proton pump inhibitor (PPI) reportedly decreases the efficacy of Helicobacter pylori (H. pylori) eradication, however, the effect of pretreatment with an H2 receptor antagonist (H2RA) on H. pylori eradication has not yet been studied. We compared the efficacy of eradication regimen (lansoprazole/amoxicillin/clarithromycin) in patients with H. pylori infection with or without H2RA pretreatment. Material/Methods: In this retrospective study conducted at three centers, 310 patients with H. pylori infection were treated. The diagnosis of H. pylori infection was made using the rapid urease test, bacterial cultures and histological examination of endoscopic biopsy specimens. The patients were assigned to receive an eradication regimen first or following pretreatment with H2RA. Eradication was assessed using the 13C-urea breath test more than 4 weeks after the completion of therapy. Results: Overall, H. pylori was eradicated in 79.7% of the cases: the eradication rate was 81.6% in the pretreatment group, and 77.6% in the eradication first group (p=0.3799, chi-square test). No significant difference in the eradication rate was observed between the two groups. Conclusions: Pretreatment with H2RA had no significant influence on the efficacy of H. pylori eradication therapy. © Med Sci Monit, 2011.

DOI： 10.12659/MSM.881762

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000308654

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Laparoscopic wedge resections are increasingly performed for gastric submucosal tumors such as gastrointestinal stromal tumor (GIST). Despite this, no defined strategy exists to guide the surgeon in choosing the appropriate laparoscopic technique for an individual case on the basis of tumor characteristics such as location or size. Laparoscopy-endoscopy cooperative surgery (LECS) can be used for submucosal tumor resection independent of tumor location and size. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intraluminal endoscopy. Subsequently, the seromusclar layer was laparoscopically dissected on the exact three-fourths cut line around the tumor. The submucosal tumor then was exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device. We employed LECS for the resection of gastric submucosal tumors. In two cases with GIST, the LECS procedure was successful in dissecting out the gastric submucosal tumor. In the first case, the tumor was more than 5cm in diameter and was located in the lower gastric portion near the pyloric ring. In the second case, the tumor was located in the upper gastric portion near the esophagogastric junction. The postoperative course was uneventful in both cases. The LECS procedure for dissection of gastric submucosal tumors such as GIST may be performed safely with reasonable operation times, less bleeding, and adequate cut lines. In addition, the success of the procedure does not depend on tumor location such as in the vicinity of the esophagogastric junction or pyloric ring.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

According to the guidelines of the Japanese Society of Gastroenterology, when the diagnosis of gastroesophageal reflux disease (GERD) is objectively confirmed, surgical therapy should be considered in individuals for whom medical management has failed. A large body of literature on the laparoscopic surgical treatment of GERD exists. The majority of published studies have demonstrated lower dysphagia rates after Toupet fundoplication and no difference in heartburn control between the Toupet and Nissen procedures at follow up. On the basis of these reports, we selected Toupet fundoplication. This case was a 65-year-old male who complained of heartburn and was diagnosed as having GERD 4years previously, but medical management failed. The postoperative course was uneventful. After Toupet fundoplication, he had no complications of GERD without proton pump inhibitor.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective The aim of this study was to assess the changes in the clinical parameters during intragastric balloon therapy for Japanese obese patients.
Methods Between March 2009 and September 2010, 8 patients underwent intragastric balloon therapy at our hospital. The visceral fat area, liver volume and the liver-spleen ratio were measured by computed tomography. Blood examination and computerized tomography were performed before the balloon placement, and at 1, 3 and 6 months after the balloon placement in all of the patients.
Results Eight patients (5 males and 3 females, median age, 39 years; median BMI, 44.0 kg/m(2)) underwent intragastric balloon therapy without severe complications. The median weight loss was 8.6 kg, mean BMI loss was 2.8 kg/m(2), and the percent excess weight loss was 14.8% at 6 months after the balloon placement. The body weight and liver volume decreased significantly during the first month, and the results were maintained at the same levels until after the second month. The liver-spleen ratio also improved significantly during the first month, but worsened again during the last 3 months. The visceral fat area showed no significant differences during the treatment as well as no differences in liver enzymes, glucose and lipid metabolism.
Conclusion Intragastric balloon therapy achieved a moderate effect in weight and liver volume reduction during the early months of the treatment. Intragastric balloon therapy may have a role as a minimally invasive method for pretreatment before laparoscopic surgery.

DOI： 10.2169/internalmedicine.50.5672

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction. A hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers Syndrome is diagnosed as a solitary Peutz-Jeghers type hamartomatous polyp. As compared with Peutz-Jeghers Syndrome, Peutz-Jeghers type hamartomatous polyps are diagnosed with a lower risk of cancer and are regarded as a different disorder. Case presentation. In case one, we describe an 84-year-old Japanese man with a 14 mm duodenal polyp. Endoscopic mucosal resection was performed and histological examination showed findings suggestive of a hamartomatous polyp with a focus of well-differentiated adenocarcinoma. In case two, we describe a 76-year-old Japanese man who had been treated for prostate, rectal and lung cancer. Upper gastrointestinal endoscopy revealed a duodenal polyp measuring 15 mm in diameter. Endoscopic mucosal resection was performed, and histological examination showed findings suggestive of a hamartomatous polyp. Liver and thyroid cancers were found after the endoscopic treatment. Conclusion: Although duodenal solitary hamartomatous polyps are associated with a lower risk of cancer, four patients, including our cases, have been diagnosed with cancerous polyps. Patients with duodenal solitary hamartomatous polyps should be treated by endoscopic or surgical resection and need whole-body screening. © 2011 Sekino et al
licensee BioMed Central Ltd.

DOI： 10.1186/1752-1947-5-240

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background/Aims: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by diffuse mucosal inflammation, traditionally regarded as being limited to the colorectum. Although several gastroduodenal lesions have also been reported recently in cases of UC, in general, small-bowel lesions in UC are believed to be extremely rare. The aim of this study was to examine the small bowel by capsule endoscopy in patients with UC. Methods: The study was conducted in 23 well-documented UC patients and 23 control volunteers. The frequency of small-bowel lesions, the number of small-bowel lesions per patient and the capsule endoscopy score were comparatively evaluated between the two groups. Results: Of the 23 UC patients, 13 (57%) showed small-bowel lesions, and 8 (35%) had erosions. There were significant differences in the frequency of the small-bowel lesions (p &lt; 0.001) and erosions (p = 0.009) between the two groups. The capsule endoscopy score was correlated with the UC disease activity index (r = 0.718, p &lt; 0.001). Conclusions: This is the first capsule-endoscopic study conducted to examine the small-bowel involvement in UC patients as compared with the healthy volunteers. It was concluded that UC, a chronic inflammatory bowel disease, can also involve the small bowel. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000333086

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Mucosal prolapse syndrome (MPS) has been recognized as a chronic benign inflammatory disorder, characterized mainly by rectal mucosal prolapse. Disorders representing this condition include solitary rectal ulcer syndrome (SRUS), rectal prolapse, proctitis cystica profunda, and inflammatory cap polyps. The gross appearance of rectal MPS can be occasionally misinterpreted as rectal cancer. In contrast, there have been a few reports of colorectal cancer originating from prolapsed mucosa. Herein, we report a case of MPS associated with two independent rectal cancers extending into the submucosal layer. We speculate that long-standing MPS may increase the risk of malignant transformation.

DOI： 10.2169/internalmedicine.50.5924

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

A 19-year-old Japanese male with a BMI of 55.4 kg/m(2) who also had liver dysfunction, dyslipidemia and hyperuricemia underwent repeated intragastric balloon therapy. The percent excess weight loss was 22.5% at the first balloon removal and 28.6% at the second balloon removal. The hepatic dysfunction resolved after the second balloon therapy, however, the dyslipidemia and hyperuricemia did not improve. The Japanese population is regarded as a high-risk race for obesity-related diseases at lower BMI values, and morbidly obese Japanese patients may need more serious weight reduction protocols to improve the comorbidities than similarly obese Americans or Europeans.

DOI： 10.2169/internalmedicine.50.4528

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記述言語：英語  

DOI： 10.2169/internalmedicine.50.5009

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DOI： 10.2169/internalmedicine.50.5009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the &apos;conventional group&apos; (without any preparation) and the &apos;real-time group&apos; (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule had reached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution. Results: The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group. Conclusions: The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000323225

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000313695

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記述言語：英語   出版者・発行元：KARGER  

It still remains controversial whether simple obesity, as measured by the body mass index (BMI), is an independent risk factor for Barrett's esophagus (BE). Recent studies have shown abdominal obesity, as defined by the waist circumference (WC) and the waist-to-hip ratio (WHR), to be a risk factor for BE, independent of the BMI, with the association between BMI and BE being no longer observed after adjustment for the WC and WHR. Moreover, visceral obesity, as directly measured by the surface area of the visceral adipose tissue (VAT) on abdominal CT images, has also been reported to have an association with the risk of BE. In addition to the mechanical effects of abdominal obesity, that is, increase of the intra-abdominal pressure by the large amount of adipose tissue, circulating factors secreted from the VAT, such as tumor necrosis factor-alpha, interleukin-6, leptin, and adiponectin, have also been proposed to be pathogenetically linked to BE and esophageal adenocarcinoma. Obesity is associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal obesity, especially visceral obesity. This raises several questions regarding the pathogenesis of obesity-related BE. Larger studies with prospective enrollment of patients are required for further examination of this issue. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000321810

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Scientific Literature Inc.  

Background: A visceral fat area of more than 100 cm2 as measured by computed tomography (CT) at the umbilical level has been included as a criterion for obesity in all the proposed criteria for metabolic syndrome. However, CT cannot be used frequently because of radiation exposure. We evaluated the usefulness of measurement of the serum levels of nitric oxide (NO), instead of CT and the waist circumference, as a marker of abdominal visceral fat accumulation. Material/Methods: The study was carried out in 80 subjects. The serum levels of NO metabolites (nitrate/nitrite) were measured using the Griess reagent. Results: Simple and multiple regression analysis revealed that the serum levels of NO metabolites showed the greatest degree of correlation with the visceral fat area (r=0.743, p&lt
0.0001), and corresponded to a visceral fat area of 100 cm2, as determined using the ROC curve, was 21.0 μmol/ml (sensitivity 88%, specificity 82%)
this method was more sensitive than the waist circumference for evaluation of the visceral fat accumulation. Conclusions: Measurement of the serum levels of NO metabolites may be a simple, safe, convenient and reliable method for the evaluation of visceral fat accumulation in clinical diagnostic screening. © Med Sci Monit.

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0030-1255772

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0030-1255704

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Pegylated interferon and ribavirin combination therapy is the standard treatment for patients with chronic hepatitis C (CHC), but treatment failure can be difficult to predict. We and others have reported a relation between lipid values and sustained viral responses in patients with CHC. However, the relationship between lipid values and treatment failure has not been previously reported. The present study investigated the association between the profiles of phospholipids and free cholesterol (FC), the main constitutive ingredients of the surface of lipoprotein, classified according to particle size and hepatitis C treatment, and determined the usefulness of these parameters for predicting the outcome of treatment. Fifty-five patients with CHC (33 men and 22 women) were included in the study. The serum total cholesterol, triglyceride, phospholipids, and FC levels in the lipoprotein subclasses were determined using high-performance liquid chromatography with gel permeation columns, enabling the lipoproteins to be classified into 13 subclasses according to particle size. According to a univariate analysis, the treatment failure group had a significantly higher serum phospholipid level overall in the high-density lipoprotein (HDL) and medium HDL fractions as well as a higher serum FC level in the HDL fraction and all HDL subclass fractions compared with the corresponding values in the non-nonvirological response group. Higher serum phospholipid and FC concentrations in the HDL subclasses were predictive of a failure to respond in patients with genotype 1b.

DOI： 10.1111/j.1365-2893.2009.01253.x

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0030-1255719

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Pretreatment with a proton pump inhibitor (PPI) has been reported to decrease the efficacy of Helicobacter pylori (H. pylori) eradication. We compared the efficacy of an eradication regimen (lansoprazole/amoxicillin/clarithromycin) first or following pretreatment with a PPI.
Methodology: In this retrospective study conducted at three centers, 353 patients infected with H. pylori were treated. The H. pylori status was determined using the rapid urease test, bacterial cultures, and the histological examination of endoscopic biopsy specimens. The patients were assigned to receive an eradication regimen first or following pretreatment with a PPI. Eradication was assessed using the C-13-urea breath test more than 4 weeks after the completion of therapy.
Results: Overall, H. pylori was eradicated in 78.8% of the cases: 79.6% in the pretreatment group, and 77.6% in the eradication first group (p=0.6541 by chi square test). No significant difference in the eradication rates was observed between the two groups.
Conclusions: This retrospective study indicated that pretreatment with a PPI does not significantly reduce the efficacy of eradication therapy in patients infected with H. pylori.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: This study aims to investigate whether histamine H2-receptor antagonists are sufficient to treat nonerosive reflux disease in Japanese patients. The efficacy of lafutidine in Japanese nonerosive reflux disease patients was studied.
Methodology: The subjects were 24 heartburn patients with two or more cases of heartburn in a week before the period of observation, QUEST score of 6 or above and diagnosed as no erosion in esophagus by upper gastrointestinal endoscopy. Following obtained informed consent, gastroesophageal 24-hour pH was monitored after the placebo period (2 weeks) and the completion of the lafitidine period (at the dose of 10 mg twice daily for 4 weeks).
Results: Twenty three patients completed the study. The percentage of time that the intraesophageal pH was less than 4 decreased significantly, from 3.07% to 1.17%, after the lafutidine administration. The overall percentage of time that the intragastric pH was above 3 increased significantly from 26.6% to 56.5% after the lafutidine administration, and increased from 22.7% to 51.0% (daytime period) and 34.6% to 67.2% (nighttime period), respectively. Lafutidine markedly improved heartburn and other symptoms, as recorded in patient diaries.
Conclusions: Lafutidine markedly improved the intraesophageal pH and the symptoms of heartburn in Japanese patients with nonerosive reflux disease. Lafutidine also inhibited gastric acid secretion not only during the nighttime but also during the daytime.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Percutaneous endoscopic gastrostomy is the standard method for enteral feeding in patients predicted to require long-term enteral nutrition because of dysphagia. A direct techinique with gastropexy is available, in which oropharyngeal passage of the internal bumper can be avoided. The aim of this study was to assess the early complications of percutaneous endoscopic gastrostomy performed using the new direct technique.
Methodology: Between August 2005 and July 2009, 231 patients underwent percutaneous endoscopic gastrostomy at our hospital. We analyzed the clinical characteristics of the patients related to the development of early complications such as bleeding or local infection. Early complications were defined as complications occurring within 7 days of the percutaneous endoscopic gastrostomy.
Results: The study population comprised 231 patients: 157 men and 74 women (median age, 73 years; range, 28-92 years). The percutaneous endoscopic gastrostomy was performed using the pull-through technique in 134 of these patients (58%), whereas the direct technique with gastropexy was employed in the remaining 97 patients (42%). In the multiple logistic regression analyses, only the use/non-use of the direct technique was identified as a variable significantly associated with the incidence of bleeding (odds ratio 5.236, 95% confidence interval 1.040 - 26.316; p=0.0447) and the incidence of local infection (odds ratio 0.283, 95% confidence interval 0.100 - 0.802; p=0.0175).
Conclusions: Use of the direct technique for performing percutaneous endoscopic gastrostomy was associated with the increased incidence of the early complication of bleeding, but the decreased incidence of local infection.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to evaluate the correlation between gastrointestinal symptoms and diet therapy.
Methodology: The subjects comprised of 8 patients who attended the diabetes division at Fujisawa City Hospital between April and June 2007. The subjects were diagnosed as having diabetes mellitus based on the results of a blood analysis. The body weight of the subjects was measured, and the subjects were asked to score their gastrointestinal symptoms according to the Frequency Scale for the Symptoms of GERD (FSSG) before and after diet therapy for 9 to 14 days.
Results: Diet therapy for diabetic subjects was effective for weight reduction. The total FSSG score was decreased, and the reduction in dysmotility-like symptoms was greater than the reduction in acid-reflux-related symptoms.
Conclusions: Diet therapy for mild diabetic patients also improves gastrointestinal symptoms.

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

The biguanide metformin is widely used for treating diabetes mellitus. We previously showed the chemopreventive effect of metformin in two rodent models of colorectal carcinogenesis. However, besides epidemiologic studies, little is known about the effects of metformin on human colorectal carcinogenesis. The objective of this pilot study was to evaluate the chemopreventive effect of metformin on rectal aberrant crypt foci (ACF), which are an endoscopic surrogate marker of colorectal cancer. We prospectively randomized 26 nondiabetic patients with ACF to treatment with metformin (250 mg/d, n = 12) or no treatment (control, n = 14); 23 patients were evaluable for end point analyses (9 metformin and 14 control); the two groups were similar in ACF number and other baseline clinical characteristics. Magnifying colonoscopy determined the number of rectal ACF in each patient at baseline and after 1 month in a blinded fashion (as were all laboratory end point analyses). We also examined proliferative activity in colonic epithelium (via proliferating cell nuclear antigen labeling index) and apoptotic activity (via terminal deoxynucleotidyl transferase dUTP nick-end labeling). At 1 month, the metformin group had a significant decrease in the mean number of ACF per patient (8.78 +/- 6.45 before treatment versus 5.11 +/- 4.99 at 1 month, P = 0.007), whereas the mean ACF number did not change significantly in the control group (7.23 +/- 6.65 versus 7.56 +/- 6.75, P = 0.609). The proliferating cell nuclear antigen index was significantly decreased and the apoptotic cell index remained unaltered in normal rectal epithelium in metformin patients. This first reported trial of metformin for inhibiting colorectal carcinogenesis in humans provides preliminary evidence that metformin suppresses colonic epithelial proliferation and rectal ACF formation in humans, suggesting its promise for the chemoprevention of colorectal cancer. Cancer Prev Res; 3(9); 1077-83. (C) 2010 AACR.

DOI： 10.1158/1940-6207.CAPR-10-0186

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1244147

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1214857

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

Metformin is widely used for the treatment of diabetes mellitus. Adenosine monophosphate-activated protein kinase (AMPK) is known to be activated by metformin and to inhibit the mammalian target of rapamycin (mTOR) pathway. The mTOR pathway plays an important role in the protein translational machinery and cell proliferation. We examined the effect of metformin on the suppression of colorectal carcinogenesis in chemical carcinogen-induced models. Seven-wk-old BALB/c mice were intraperitoneally (i.p.) injected with azoxymethane (AOM, 10 mg/kg) and then treated with or without metformin (250 mg/kg/d) for 6 wk (for the investigation of aberrant crypt foci [ACF] formation) or 32 wk (for polyp formation). We next investigated colonic epithelial proliferation using bromodeoxyuridine (BrdU) and the proliferating cell nuclear antigen (PCNA) labeling indices. Furthermore, to examine the indirect effect of metformin, the insulin resistance status and the serum lipid levels were assessed. Treatment with metformin significantly reduced ACF formation. The effect of metformin on colon polyp inhibition was relatively modest. No significant difference in body weight or glucose concentration was observed. The BrdU and PCNA indices decreased in mice treated with metformin. A Western blot analysis revealed that the phosphorylated mTOR, S6 kinase, and S6 protein levels in the colonic mucosa decreased significantly in mice treated with metformin. In conclusion, metformin suppresses colonic epithelial proliferation via the inhibition of the mTOR pathway through the activation of AMPK. As metformin is already used daily as an antidiabetic drug, it might be a safe and promising candidate for the chemoprevention of colorectal cancer. (c) 2010 Wiley-Liss, Inc.

DOI： 10.1002/mc.20637

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aim: Although non-alcoholic fatty liver disease (NAFLD) is now a common cause of chronic liver disease, discriminating between simple steatosis and non-alcoholic steatohepatitis (NASH), especially early-stage NASH, remains difficult. We investigated the clinical usefulness of measuring the spleen volume as a marker of early-stage NASH.
Methods: We evaluated computed tomography (CT) images obtained in 84 patients with histologically diagnosed NAFLD (22 with simple steatosis, 62 with NASH with mild fibrosis [stages 1-2]). We defined the data obtained by the following formula as a spleen-body index (SBI): SBI = maximal CT axial section area of the spleen (cm(2))/body surface area (BSA) (cm(2)) x 10(4). We compared the SBI between patients with simple steatosis and those with NASH with mild fibrosis.
Results: The mean SBI of the simple steatosis group was 15.8 +/- 3.9, while that of the NASH with mild fibrosis group was 18.7 +/- 5.7. This difference between the two groups was significant (P = 0.0314). A multiple logistic regression analysis showed that the SBI was significantly correlated with the discrimination of simple steatosis and NASH with mild fibrosis. The area under the receiver-operator curve was 0.661 for distinguishing between simple steatosis and NASH with mild fibrosis (P = 0.026, 95% confidence interval = 0.532-0.789).
Conclusion: Spleen enlargement may be a distinct feature of NASH, especially early-stage NASH. SBI might be a non-invasive and simple method of differentiating NASH and simple steatosis.

DOI： 10.1111/j.1872-034X.2010.00643.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Aim:
Non-alcoholic steatohepatitis (NASH) is considered a hepatic manifestation of metabolic syndrome. However, effective drug therapy for NASH has not been established yet. In the present study, we evaluated the efficacy of 6 months of ezetimibe treatment for NASH patients with dyslipidemia for the comparison of improvement of the clinical parameters and histological alterations.
Methods:
We prospectively evaluated 10 consecutive NASH patients with dyslipidemia who agreed to participate in this study. The patients were given ezetimibe (10 mg/day) for 6 months, and clinical parameters and histological alterations were comparatively evaluated before and after treatment. All the patients were given standard calorie diet (30 kcal/kg per day, carbohydrate 50-60%, fat 20-30%, protein 15-20%) and exercise counseling from 3 months before the ezetimibe treatment.
Results:
The serum aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein and type IV collagen 7 s levels were significantly improved by the treatment with ezetimibe for 6 months. In histological observations, follow-up liver biopsies revealed that the NAS score and steatosis grade were also significantly improved. The fibrosis stage did not change significantly, but six of the 10 patients exhibited an improvement in their fibrosis stage.
Conclusion:
Major clinical parameters and histological observations were significantly improved by the treatment with ezetimibe. Our pilot study demonstrated the efficacy of ezetimibe for drug therapy of NASH and may lead to a large-scale clinical trial in the future.

DOI： 10.1111/j.1872-034X.2010.00644.x

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2010.01.033

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Standard endoscopic mucosal resection or endoscopic submucosal dissection is a procedure for patients with minute cancers, complicated with esophageal varices that puts them at high risk of bleeding. CASE PRESENTATION: We present the case of a 77-year-old Japanese man with alcoholic cirrhosis who underwent a routine endoscopy examination as a screening procedure for esophageal varices and was incidentally diagnosed as having minute cancer of the esophagogastric junction with esophageal varices. Endoscopic ultrasonography findings suggested that the minute cancer was a non-invasive carcinoma (carcinoma in situ) and a 2 mm in diameter blood vessel, feeding the esophageal varices, pierced the lesion. Following the examination, we carried out endoscopic treatment of the minute cancer and esophageal varices. Endoscopic variceal ligation was performed using a pneumo-activated device (Sumitomo Bakelite, Tokyo, Japan). Two years after the treatment, during the follow-up endoscopic examination on the patient, recurrence of carcinoma was not detected endoscopically or histologically. CONCLUSION: Endoscopic therapy using an endoscopic variceal ligation device for minute cancer of the esophagogastric junction, complicated with esophageal varices, may be an acceptable and easily applicable method.

DOI： 10.1186/1752-1947-4-149

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS AS  

Objective. The role of gastric acid reflux is difficult to separate from that of pancreatic-biliary reflux in the pathogenesis of erosive esophagitis (EE) and Barrett&apos;s esophagus (BE). Gastric surgery patients provide a good mode. for both significant pancreatic-biliary reflux and marked gastric acid inhibition. We assessed the risk of EE and BE after distal gastrectomy in a case-controlled study. Material and methods. One hundred and sixty patients (121 men, 39 women; median age 68 years; range 32-86 years) with distal gastrectomies (Billroth-I) and 160 sex- and age-matched controls with intact stomachs were enrolled. The presence of EE and BE were diagnosed based on the Los Angeles Classification and the Prague C & M Criteria, respectively. A conditional logistic regression model with adjustments for potential confounding factors was used to assess the associations. Results. According to the multivariate analyses, patients with distal gastrectomies tended to have inverse associations with the risks of EE and BE, and the inverse association with the risk of BE reached a significant level. Conclusions. Distal gastrectomy is not a risk factor for the development of BE and BE. This lack of a. positive association between distal gastrectomy and BE and BE may suggest that pancreatic-biliary reflux with a limited amount of acid is not sufficient to damage the esophageal mucosa.

DOI： 10.3109/00365520903536507

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Paraganglioma, a sporadically occurring rare tumor should be included in the differential diagnosis of retroperitoneal tumors, such as malignant lymphomas, gastrointestinal stromal tumors, sarcoma and carcinoma of unknown primary site. A 58-year-old Japanese woman presented with a large retroperitoneal tumor detected by ultrasonography (US). She had no medical history of hypertension. Computed tomography showed a mass, 7 cm in diameter, located between the pancreas and the inferior vena cava. It was unclear whether the mass originated from the duodenum or the mesentery. Endoscopic ultrasonography (EUS) demonstrated a large solid paraduodenal mass. Doppler US revealed sparse vascularity in the tumor. With the differential diagnosis of retroperitoneal tumor, we carried out EUS-FNA. At the time of the third needle puncture, transient severe hypertension was noted, with a blood pressure measurement of 269/130 mmHg. Data obtained from urine and blood examinations after EUS-fine-needle aspiration indicated a diagnosis of paraganglioma.

DOI： 10.1111/j.1443-1661.2010.00939.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Pegylated interferon and ribavirin combination therapy is the standard treatment for patients with chronic hepatitis C (CHC). Some groups have reported a relation between lipid values and response while others have reported that microsomal triglyceride transfer protein, a key enzyme in the assembly and secretion of lipoproteins, was related to hepatitis C virus (HCV). The aim of this study was to investigate the association between the lipoprotein profiles, classified according to size, and hepatitis C treatment and the usefulness for predicting the outcome of treatment. Forty-four patients with CHC (27 men and 17 women) were included in the study. The serum cholesterol and triglyceride (TG) levels in the lipoprotein subclasses were determined using high-performance liquid chromatography with gel permeation columns, which classified lipoproteins into 20 subfractions based on particle size. According to a univariate analysis, those who achieved an sustained viral response (SVR) had a significantly higher serum total cholesterol level, higher cholesterol levels in the low-density lipoprotein subfraction (25.5 nm in diameter) and the very low-density lipoprotein (VLDL) subfraction (44.5 and 36.8 nm), and a higher serum TG level in the VLDL subfraction (44.5 nm), compared with the corresponding values in the non-SVR group. Higher serum cholesterol and TG concentrations in the lipoprotein subfractions were predictive of an SVR to therapy for HCV infection with genotype 1b prior to the start of interferon treatment.

DOI： 10.1111/j.1365-2893.2009.01179.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W J G PRESS  

AIM: To clarify the gender differences about the clinical features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients.
METHODS: There were 453 patients under treatment with LDA (298 males, 155 females) who underwent esophagogastroduodenoscopy at the Department of Gastroenterology and Hepatology of Hiratsuka City Hospital between January 2003 and December 2007. They had kept taking the LDA or started treatment during the study period and kept taking LDA during the whole period of observation. Of these, 119 patients (87 males, 32 females) were diagnosed as having LDA-associated peptic ulcer. We examined the clinical factors associated with LDA-associated peptic ulcer in both sexes.
RESULTS: A history of peptic ulcer was found to be the risk factor for LDA-associated peptic ulcer common to both sexes. In female patients, age greater than 70 years (prevalence ORs 8.441, 95% CI: 1.797-33.649, P = 0.0069) was found to be another significant risk factor, and the time to diagnosis as having LDA-associated peptic ulcer by endoscopy was significantly shorter than that in the male patients (P = 0.0050).
CONCLUSION: We demonstrated gender differences about the clinical features and risk factors of LDA-associated peptic ulcer. Special attention should be paid to aged female patients taking LDA. (C) 2010 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v16.i15.1896

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1215119

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver injury. The spectrum of NAFLD is broad, extending from simple steatosis through nonalcoholic steatohepatitis (NASH). Iron is regarded as a putative element that interacts with oxygen radicals, and high rates of hyperferritinemia and increased hepatic iron stores have been demonstrated in NASH. We investigated serum ferritin concentrations, HFE gene mutations, and insulin resistance in Japanese NASH patients and the diagnostic utility of serum ferritin concentrations as a means of distinguishing NASH. Serum ferritin concentrations were measured in 86 patients with histopathologically verified NAFLD (24 with steatosis and 62 with NASH) and 20 control subjects, they were tested for HFE gene mutations and their insulin resistance was measured. The serum ferritin concentration was significantly higher in the NASH patients than in the patients with simple steatosis (P = 0.006). There was no significant difference between the groups in HFE gene mutation (C282Y, H63D, and S65C), and the serum ferritin level was related with insulin resistance. The area under the ROC curve was 0.732 for distinguishing NASH from simple steatosis (P = 0.005; 95% CI, 0.596-0.856). In conclusion high serum ferritin concentrations are a distinguishing feature of Japanese NASH patients independent of HFE gene mutations.

DOI： 10.1007/s10620-009-0771-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

A 68-year-old female with liver cirrhosis presented at the Emergency Room of our hospital with copious tarry stools. Upper gastrointestinal endoscopy showed an isolated gastric variceal rupture, and we performed endoscopic injection sclerotherapy using cyanoacrylate, on four occasions, resulting in successful hemostasis. Injection of CA is a useful emergency treatment option for gastric variceal bleeding without gastro-renal shunt.

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1243873

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background. The pathogenesis of nonalcoholic steatohepatitis (NASH) is still unclear. Recently, the 2-hit hypothesis was proposed, in which nitric oxide production, representing oxidative stress, was proposed as a very important candidate for the second hit.
Methods. The total study period was 10 weeks. A total of 20 rats were randomly divided into 2 groups. Group 1 was administered the Choline-Deficient, l-Amino Acid-Defined diet to produce a NASH model, and Group 2 as control received the Choline-Sufficient, l-Amino Acid-defined diet. The blood and tissue concentrations of nitrate + nitrite were measured using the Griess reagent and the expression levels of inducible nitric oxide synthase (iNOS) proteins and mRNA was determined by Western blotting.
Results. In regard to nitric oxide (NO) and NO metabolites, there were significant differences in the blood (especially portal venous blood) as well as tissue (liver and visceral fat) concentrations between the 2 animal groups; the amounts of NO metabolites in the tissues were much higher in the NASH models. The level of nitrotyrosine was much markedly higher in the NASH models than in the controls. In regard to the tissue expression of iNOS a significant difference between the 2 groups was found in the visceral fat, especially in the mesenterium.
Conclusions. Based on these results, we hypothesize that the iNOS expression and NO levels in the visceral fat increase, with increased diffusion of NO and its metabolites into the liver, resulting in increased nitrotyrosine formation in the liver; this, in turn, induces inflammation, apoptosis, and fibrosis in the liver, which are one of the characteristic features of NASH.

DOI： 10.1111/j.1530-0277.2008.00756.x

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1215414

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Objective: Patients with autoimmune pancreatitis (AIP) sometimes present with Mikulicz disease (MD); however, the clinical features regarding these AIP patients with MD have not yet been fully elucidated. Our aim is to study the clinical differences between AIP with and without MD.
Methods: Twenty-eight AIP patients were divided into 2 groups, one with MD and one without it. The following factors having a possible association with the presence or absence of MD were investigated: sex; serum IgG and IgG4 levels; the presence or absence of antinuclear auto-antibodies, jaundice, diabetes mellitus, swollen duodenal papilla, diffuse pancreatic swelling, spontaneous remission, and relapse.
Results: The MD and non-MD groups consisted of 5 AIP and 23 AIP patients, respectively. The results of univariate analysis revealed that AIP patients presenting with MD were significantly associated with a younger onset, female predominance, high serum IgG4 titer, and diffuse pancreatic swelling (P &lt; 0.05). In 4 of the MD patients, onset preceded pancreatitis.
Conclusions: Autoimmune pancreatitis patients presenting with MD tended to have different clinical features from the non-MD AIP patients, such as having an earlier onset, female tendency, and diffuse pancreatic swelling with a high titer of serum IgG4. Autoimmune pancreatitis with MD tended to precede gastroenterological events.

DOI： 10.1097/MPA.0b013e3181bc119d

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

A 45-year-old man under treatment for liver cirrhosis (LC) due to chronic hepatitis C and hemophilia A was seen in our emergency room because of a 10-kg weight gain in the previous week due to ascites. Portal vein thrombosis (PVT) was detected with computer tomography (CT) and ultrasonographic (US). Danaparoid sodium (DS) and antithrombin III (AT III) were administrated and doppler US images showed improvement of portal venous blood flow. DS or AT III may be safe and alternative therapies for PVT.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

AIM: To test the hypothesis that the shape and length of Barrett's epithelium are associated with prevalence of erosive esophagitis.
METHODS: A total study population comprised 869 patients who underwent endoscopy during a health checkup at our hospital. The presence and extent of Barrett's epithelium were diagnosed based on the Prague C & M Criteria. We originally classified cases of Barrett's epithelium into two types based on its shape, namely, flamelike and lotus-like Barrett's epithelium, and into two groups based on its length, its C extent &lt; 2 cm, and &gt;= 2 cm. Correlation of shape and length of Barrett's epithelium with erosive esophagitis was examined.
RESULTS: Barrett's epithelium was diagnosed in 374 cases (43%). Most of these were diagnosed as short-segment Barrett's epithelium. The prevalence of erosive esophagitis was significantly higher in subjects with flame-like than lotus-like Barrett's epithelium, and in those with a C extent of &gt;= 2 cm than &lt; 2 cm.
CONCLUSION: Flame-like rather than lotus-like Barrett's epithelium, and Barrett's epithelium with a longer segment were more strongly associated with erosive esophagitis. (C) 2010 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v16.i4.484

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

A 71-year-old man was diagnosed with ulcerative colitis (UC) complicated by bacterial infections, and his active disease proved difficult to treat with steroid therapy or antibiotics. Although the patient&apos;s UC failed to respond to several types of induction therapy, his condition finally improved when treated using Bifidobacterium. Probiotics could be one of the treatment agents for induction of remission in UC. Copyright (C) 2010 S. Karger AG, Basel

DOI： 10.1159/000236042

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記述言語：英語   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

DOI： 10.2169/internalmedicine.49.3233

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000297160

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000288508

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000283576

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000276896

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：B M J PUBLISHING GROUP  

Background and aims: The molecular mechanisms underlying the promotion of colorectal carcinogenesis by a high-fat diet (HFD) remain unclear. We investigated the role of the insulin-signal pathway and the c-Jun N-terminal kinase (JNK) pathway, which reportedly play crucial roles in insulin resistance, during colorectal carcinogenesis in the presence of hyperinsulinaemia induced by a HFD.
Methods: Azoxymethane-induced aberrant crypt foci formation and cell proliferation in the colonic epithelium were compared between mice fed a normal diet (ND) and mice fed a HFD. A western blot analysis was performed to elucidate the mechanism affecting colorectal carcinogenesis by a HFD.
Results: The number of aberrant crypt foci and the colonic epithelial cell proliferative activity were significantly higher in the HFD group than in the ND group. While the plasma insulin level was significantly higher in the HFD group than in the ND group, a western blot analysis revealed the inactivation of Akt, which is located downstream of the insulin receptor, in the colonic epithelia of the HFD group. On the other hand, JNK activity was significantly higher in the HFD group than in the ND group. A JNK specific inhibitor significantly suppressed the increase in epithelial cell proliferation only under a HFD, but not under a ND.
Conclusions: Colonic cell proliferation was promoted via the JNK pathway in the presence of a HFD but not in the presence of a ND. This novel mechanism may explain the involvement of the JNK pathway in the effect of dietary fat intake on colon carcinogenesis.

DOI： 10.1136/gut.2009.183624

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to clarify the prevalence and various clinical factors of upper gastrointestinal bleeding (UGIB) associated with low-dose aspirin (LDA) treatment.
Methodology: There were 6,807 patients who were under treatment with LDA at our hospital between January 2003 and November 2007. They had kept taking the LDA or started treatment in the study period and kept taking the whole period of observation. Esophagogastroduodenoscopy (EGD) was performed 453 patients of these patients, and 71 were diagnosed as LDA-associated UGIB. We examined the prevalence and various clinical factors of UGIB associated with LDA treatment.
Results: The occurrence rate of UGIB was 0.209 UGIB per 100 patient-years at least. The multivariate odds ratio of LDA-associated UGIB was 3.318 (95% confidence interval (CI) 1.650-6.671, p=0.0008) for a history of peptic ulcer, 0.086 (95% CI: 0.011-0.652, p=0.0176) for the use of a proton pump inhibitor (PPI) with LDA, and 0.253 (95% CI: 0.113-0.569, p=0.0009) for the use of a histamine type 2 receptor antagonist (H2RA) with LDA.
Conclusions: Our results suggest that a history of peptic ulcer significantly increases the risk of LDA-associated UGIB. Regular use of a PPI or a H2RA effectively decreases the risk.

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記述言語：英語   出版者・発行元：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0029-1214690

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Aim:
Genetic factors as well as environmental factors play an important role in the development of non-alcoholic fatty liver disease (NAFLD). Recently, inducible nitric oxide synthase (iNOS) was significantly higher in the severest form of non-alcoholic steatohepatitis (NASH), and nitric oxide (NO) has been determined to play an important role in the process of fibrosis in NASH. In this study, we investigated iNOS gene polymorphisms for associations with NAFLD.
Methods:
A total of 115 NAFLD patients, consisting of 65 patients with NASH and 50 patients with simple steatosis, in whom a positive diagnosis had been made by liver biopsy, and 435 healthy control subjects, were recruited into this study.
Results:
We investigated 10 single nucleotide polymorphisms (SNP) of the iNOS gene, one of which, rs1060822, had the lowest P-value in the allele frequency model (P = 0.00078) with an odds ratio (95% confidence interval) of 0.49 (0.32-0.75). Four SNP, rs2297510, rs2297511, rs2797512 and rs1060822, were significantly associated with NAFLD, even when the most conservative Bonferroni&apos;s correction was applied. Linkage disequilibrium analysis revealed that SNP rs1060822 and three other SNP, rs2297510, rs2297511 and rs2797512, were in the same block. We also investigated associations between rs1060822 genotypes and the fibrosis index, and the results of the analysis revealed an additive increase in the fibrosis index and intrahepatic iNOS mRNA expression in the patients with the T allele of rs1060822.
Conclusion:
This is the first study to identify genetic variations in iNOS that may influence the risk of NAFLD and liver fibrosis in NAFLD.

DOI： 10.1111/j.1872-034X.2009.00539.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Hepatic mitochondrial beta-oxidation is considered to play a pivotal role in the pathogenesis of nonalcoholic steatohepatitis (NASH). The aim of this study was to determine whether there were differences between patients with NASH and healthy controls in a breath test with C-13-octanoate, a medium-chain fatty acid.
Methodology: The subjects were 8 patients (5 men, 3 women, median age 46.5 years) with histologically proven NASH and 6 healthy controls (5 men, 1 women, and median age 27.8 years). The C-13 breath test was performed for 4 hours using the BreathID system with a 100mL of water, containing 100mg C-13-octanoate.
Results: There were no significant differences between NASH patients and controls about all breath test; parameters.
Conclusions: NASH-mediated changes in breath test parameters after ingestion of C-13-octanoate were not observed in our study. The present study findings suggest the possible preservation of C-13-octanoate metabolism (mitochondrial beta-oxidation) in patients with NASH.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JOHN WILEY & SONS INC  

The specific mechanisms of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) pathogenesis remain unknown. In the present study we investigated the differences between NAFL and NASH in terms of liver lipid metabolites and serum lipoprotein. In all, 104 Japanese subjects (50 men and 54 postmenopausal women) with histologically verified NAFL disease (NAFLD) (51 with NAFL, 53 with NASH) were evaluated; all diagnoses were based on liver biopsy findings and the proposed diagnostic criteria. To investigate the differences between NAFL and NASH in humans, we carefully examined (1) lipid inflow in the liver, (2) lipid outflow from the liver, (3) very-low-density lipoprotein (VLDL) synthesis in the liver, (4) triglyceride (TG) metabolites in the liver, and (5) lipid changes and oxidative DNA damage. Most of the hepatic lipid metabolite profiles were similar in the NAFL and NASH groups. However, VLDL synthesis and lipid outflow from the liver were impaired, and surplus TGs might have been produced as a result of lipid oxidation and oxidative DNA damage in the NASH group. Conclusion: A growing body of literature suggests that a deterioration in fatty acid oxidation and VLDL secretion from the liver, caused by the impediment of VLDL synthesis, might induce serious lipid oxidation and DNA oxidative damage, impacting the degree of liver injury and thereby contributing to the progression of NASH. Therefore, dysfunctional VLDL synthesis and release may be a key factor in progression to NASH. (HEPATOLOGY 2009;50:772-780.)

DOI： 10.1002/hep.23094

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome that is closely associated with multiple factors such as obesity, hyperlipidemia, type 2 diabetes mellitus and hypertension, making it difficult to treat NAFLD effectively using any monotherapy available to date. In this study, we propose a novel combination therapy for NAFLD comprising ezetimibe (EZ), a cholesterol absorption inhibitor, and acarbose (AC), an alpha-glucosidase inhibitor.
Methods: C57BL/6J mice were divided into five treatment groups as follows: basal diet (1113), high-fat diet (HFD) only, HFD with EZ (5 mg/kg/day), HFD with AC (100 mg/kg/day), and HFD with both EZ and AC for 24 weeks.
Results: Long-term combination therapy with EZ and AC significantly reduced steatosis, inflammation and fibrosis in the liver, compared with long-term monotherapy with either drug, in an HFD-induced NAFLD mouse model; the combination therapy also significantly increased the expression of microsomal triglyceride transfer protein (MTP) and peroxisome proliferators-activated receptor-alpha 1 (PPAR-alpha 1) in the liver, compared with either monotherapy, which may have led to the improvement in lipid metabolic disorder seen in this model.
Conclusions: Combination therapy with EZ and AC for 24 weeks improved the histopathological findings in a mouse model of NAFLD. (C) 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jhep.2009.05.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The management of acute intestinal bleeding is not standardized. The aim of this study was to determine the most suitable method of bowel preparation for urgent colonoscopy.
Methodology: One hundred and forty patients admitted with acute lower intestinal bleeding (ALIB) to our Hospital (April 1998 to March 2004) were studied. The preparation for colonoscopy consisted, usually, of oral administration of polyethylene glycol (PEG)-salt solution. For elderly patients or for those suspected of bleeding from a sigmoid colon lesion, colonoscopy was performed following glycerin enemas or water enemas. For patients with a suspected rectal lesion or soon after undergoing a polypectomy, colonoscopy was performed without any of the above procedures.
Results: Ischemic colitis was the most common cause of bleeding. The overall cecal completion ratio was 41%, compared with 74% in the PEG group. The percentage of those in whom colonoscopy was impossible (poor preparation) was 16% overall, compared with 5% in the PEG group. Endoscopic hematemesis were performed successfully for 26 patients who were mainly postpolypectomy cases or had rectal ulcers.
Conclusions: In urgent colonoscopy, the preparation with PEG-salt solution may improve the patient&apos;s outcome. In postpolypectomy patients and those with rectal ulcers preparation was not always needed.

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

DOI： 10.1111/j.1440-1746.2009.05991.x

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Purpose To determine the prevalence and progression of Barrett's epithelium and associated risk factors in Japan. Methods The study population comprised 869 cases. Endoscopic Barrett's epithelium was diagnosed based on the Prague C & M Criteria. The correlations of clinical factors with the prevalence and progression of endoscopic Barrett's epithelium were examined. Results Endoscopic Barrett's epithelium was diagnosed in 374 cases (43%), in the majority of which the diagnosis was short-segment Barrett's esophagus. The progression of Barrett's epithelium was identified in 47 cases. In univariate and multiple logistic regression analyses, aging, smoking habit, and erosive esophagitis were significantly associated with the prevalence of Barrett's epithelium, whereas aging and erosive esophagitis, especially severe erosive esophagitis, were significant contributing factors to the progression of Barrett's epithelium. Conclusions Forty-three percent of the total study population was diagnosed as having endoscopic Barrett's epithelium. During the follow-up period, 12.6% of the cases with Barrett's epithelium exhibited progression which was associated with aging and severe erosive esophagitis.

DOI： 10.1007/s10620-008-0537-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Background
Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury in many countries. Genetic factors are important for the development of NAFLD, as well as environmental factors. Recently an angiotensin II type 1 receptor (AGTR1) has been recognized as important in the aetiology of fibrosis in the liver.
Objective
In this study we investigated the association between angiotensin II type 1 receptor gene polymorphism (ATGR1) and NAFLD.
Methods
One hundred and sixty-seven NAFLD patients [106 with nonalcoholic steatohepatitis (NASH) and 61 with simple steatosis] with a positive diagnosis by liver biopsy and 435 healthy control subjects were recruited in this study.
Results:
We investigated 12 single nucleotide polymorphisms (SNPs) of the ATGR1 gene, among which rs3772622 showed the lowest P-value of allele frequency model (P=0.0000012) with an odds ratio (95% confidence interval) of 1.95 (1.49-2.55). Five SNPs (rs3772622, rs3772633, rs2276736, rs3772630 and rs3772627) were significantly associated with NAFLD, even when the most conservative Bonferroni&apos;s correction was applied. Linkage disequilibrium analysis revealed that SNP rs3772622 and another four SNPs (rs3772633, rs2276736, rs3772630 and rs3772627) were in the same block. We investigated the association between rs3772622 genotypes and the fibrosis index. The results of the analysis revealed an additive increase of the fibrosis index in the patients with the A allele of rs3772622.
Conclusions
This is the first report to demonstrate the genetic variations in ATGR1 that may influence the risk of NAFLD and liver fibrosis in NAFLD.

DOI： 10.1111/j.1478-3231.2009.01988.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

The goal of this study was to investigate Cystatin SN, a cysteine protease inhibitor, as a novel tumor marker for colorectal cancer (CRC). Gene expression profiles of mRNA from normal tissues and cancer cell lines were performed. Twenty-eight monoclonal antibodies for Cystatin SN were generated and serum Cystatin SN was quantified using ELISA in sera from 159 patients with CRC and 40 healthy controls. Cystatin SN was highly expressed in colon cancer cells. Employing a receiver-operating characteristic curve, we obtained an area under the curve of 0.708 for Cystatin SN, 0.819 for carcinoembryonic antigen (CEA) and 0.703 for carbohydrate antigen 19-9 (CA19-9). The combination assay of Cystatin SN, CEA and CA19-9 showed 62.9% sensitivity and 90.0% specificity. Especially, the sensitivity of the combination assay in stages I and IT detection, in which stages curative operation would be possible, was improved over that of the assay testing only for CEA and CA 19-9 (from 37.5 to 42.5% in stage I, from 49.0 to 60.8% in stage II). Furthermore, Western blot analysis revealed that Cystatin SN was increased in the urine from patients with CRC. Our results suggest the possibility of utilizing this novel tumor marker that can be tested in urine samples. These observations suggest that Cystatin SN in combination with CEA and CA19-9 is a useful tumor marker for detecting early stage CRC and that it is a unique urinary excretory protein, suggesting that Cystatin SN might be a novel candidate for use in mass screening for CRC.

DOI： 10.3892/ijo_00000310

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Aim:
We evaluated the characteristic endoscopic ultrasonography (EUS) findings of early autoimmune pancreatitis (AIP).
Methods:
Nineteen patients with AIP were identified from our database. We reviewed the following features of EUS as being potentially characteristic of early AIP: hyperechoic foci, hyperechoic strands, lobularity, hyperechoic pancreatic duct margins and reduced echogenicity. According to the Cambridge classification for chronic pancreatitis, we classified AIP into early AIP (Grades 0-2) and advanced AIP (Grades 3-5) and examined the histopathological findings in each stage of AIP.
Results:
There were nine cases of early AIP and 10 cases of advanced AIP. Five of the nine early cases of AIP showed spontaneous remission without corticosteroid therapy (P &lt; 0.05). The EUS findings were as follows (early vs advanced): hyperechoic foci, 100% (9/9) vs 100% (10/10); hyperechoic strands, 66.7% (6/9) vs 70% (7/10); lobularity, 77.8% (7/9) vs 20% (2/10); hyperechoic pancreatic duct margin, 88.9% (8/9) vs 30% (3/10); reduced echogenicity, 88.9% (8/9) vs 90% (9/10). Lobularity and hyperechoic pancreatic duct margin were detected at a significantly higher frequency in early AIP than in the advanced AIP patients (P &lt; 0.05). Regarding the histopathological findings, acinar cells were better preserved in the cases of early AIP, whereas acinar cells were reduced in number and replaced by massive fibrosis in the patients with advanced AIP.
Conclusions:
Lobularity and hyperechoic pancreatic duct margin are characteristic EUS features of early AIP, which has a more favorable prognosis, and shows a higher frequency of spontaneous remission and preservation of acinar cells, than advanced AIP.

DOI： 10.1111/j.1443-1661.2009.00879.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The association between obesity and the risk of Barrett&apos;s esophagus (BE) is unclear. Furthermore, the association between visceral obesity and the risk of BE is entirely unknown.
Methods: We conducted a retrospective study in 163 patients with non-alcoholic fatty liver disease (NAFLD) who underwent both endoscopy and abdominal CT at an interval of less than a year at our institution. BE was endoscopically diagnosed based on the Prague C & M Criteria. The surface areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated from CT images at the level of the umbilicus. The correlations between the BMI, VAT, and SAT and the risk of BE were examined by univariate and multivariate analyses.
Results: Sixty-nine of the 163 study participants (42.3%) were diagnosed to have endoscopic BE, which was classified as short-segment BE (SSBE) in almost all of the cases. There were no significant differences in the age or gender distribution between the groups with and without BE. According to the results of the univariate analysis, VAT was significantly associated with the risk of BE; the BMI tended to be higher in the group with BE than in the group without BE, but this relation did not reach statistical significance. VAT was independently associated with the risk of BE even after adjustment for the BMI.
Conclusion: In Japanese patients with NAFLD, obesity tended to be associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal visceral adiposity.

DOI： 10.1186/1471-230X-9-56

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The ideal medication for treatment of acid related diseases should have a rapid onset of action to promote hemostasis and resolution of symptoms. The aim of our study was to investigate the inhibitory effects on gastric acid secretion after a single oral administrations of lafutidine, is a newly synthesized H2-receptor antagonist, with mosapride 5 mg or lafutidine alone.
Methods: Ten Helicobacter pylori negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 4 hours after a single oral administration of lafutidine 10 mg or lafutidine 10 mg with mosapride 5 mg (the lafutidine being administrated one hour after the mosapride). Each administration was separated by a 7-day washout period.
Results: The average pH during the 4-hour period after administration of lafutidine 10 mg with mosapride 5 mg was higher than after lafutidine 10 mg alone (median: 5.25 versus 4.58, respectively; p = 0.0318). During the 3-4 hour study period, lafutidine 10 mg with mosapride 5 mg provided a higher pH, compared to lafutidine 10 mg alone (median: 7.28 versus 6.42; p = 0.0208).
Conclusion: In H. pylori negative healthy male subjects, an oral dose of lafutidine 10 mg with mosapride 5 mg more rapidly increased intragastric pH than lafutidine 10 mg alone.

DOI： 10.1186/1471-230X-9-52

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

Hepatocellular carcinoma (HCC) is one of the most commonly occurring malignances worldwide. Curative therapies such as resection, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have been applied to patients with early-stage HCC. Patients with more advanced cancers require local or systemic therapies. We present the results of our retrospective review conducted to evaluate whether transarterial chemoembolization (TACE) alone and combined TACE with percutaneous ablation for HCC exhibited superior efficacy to palliative treatment.
The effects of TACE and of the combined therapies (TACE + PEI or TACE + RFA) on the long-term survival rates were evaluated in 268 untreated HCC patients by various statistical analyses.
The cumulative survival rates in the TACE alone group were significantly superior to those in the palliative treatment group. Further, the cumulative survival rates in the combined TACE + PEI/RFA group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE + PEI/RFA group than in the PEI/RFA alone group.
The aforementioned treatment modalities yielded greater improvements of the survival rate and survival duration as compared to palliative treatment in HCC patients. Furthermore, in terms of the effect on the survival period, combined TACE + PEI/RFA therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors fulfilling the Milan criteria.

DOI： 10.1111/j.1872-034X.2009.00490.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

The antithrombotic effects of low-dose aspirin (LDA) are well established, and it is used for primary and secondary prevention of cardiovascular events. However, the small intestinal toxicity of LDA remains unclear. The aim of this study was to review the characteristics of small bowel injury in long-term LDA users with capsule endoscopy (CE).
We retrospectively reviewed all chronic LDA users (&gt; 3 months) who underwent CE for suspected small bowel diseases from May 2004 to May 2008 at two medical centers.
At our institutions, a total of 22 patients (13 males and 9 females, mean age 66.3 years) taking LDA underwent a CE examination. The indications for CE were obscure gastrointestinal bleeding in 21 patients and 1 patient who had abdominal pain. Twenty-one patients (95.5%) had some small bowel mucosal injury. Small bowel erosions were identified in 14 patients (63.6%). This enteropathy was characterized by multiple petechiae, loss of villi, erosions, and ulcers with round, irregular, and punched-out shapes. Two patients had circumferential ulcers with stricture. In most patients, small bowel lesions were multifocal and were evenly distributed in the small bowel. No patients failed to pass the capsule.
This is the first CE report that has studied the characteristics of small bowel injury in chronic LDA users. CE is useful to diagnose small bowel enteropathy associated with LDA.

DOI： 10.1007/s00535-009-0040-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Coffee is one of the most popular beverages worldwide, however, few studies have examined the effects of coffee on the gastrointestinal system. The aim of this study was to determine whether there was a correlation between coffee intake and gastric emptying using a novel non-invasive technique for measuring gastric emptying with a continuous real time C-13 breath test (BreathID system: Oridion, Israel).
Methodology: Six healthy male volunteers participated in this randomized, two-way crossover study. The subjects were randomly assigned to receive a test meal (200kcal per 200mL) plus postprandial 190mL black coffee or the test meal alone after fasting overnight. A C-13-acetic acid breath test was continuously performed using the BreathID system, which monitors gastric emptying, for 4 hours after the administration of the test meal. Using Oridion Research Software (13 version), the time for emptying of 50% of the labeled meals (T 1/2) and the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T lag) were calculated. The parameters between two occasions were compared using the Wilcoxon signed-rank test.
Results: After coffee intake the T 1/2 and T lag constant were significantly decreased.
Conclusions: The decrease in the T 1/2 and T lag suggests the acceleration of gastric emptying. This study showed that postprandial coffee intake enhances gastric emptying, suggesting the potential use of coffee in clinical settings for patients with functional gastrointestinal disorders.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: We aimed to estimate whether the macroscopic extent of gastric mucosal atrophy is associated with a risk for esophageal squamous cell carcinoma using a case-control study in Japanese subjects, a population known to have a high prevalence of CagA-positive H. pylori infection.
Methods: Two hundred and fifty-three patients who were diagnosed as having esophageal squamous cell carcinoma, and 253 sex-and age-matched controls were enrolled in the present study. The macroscopic extent of gastric mucosal atrophy was evaluated based on the Kimura and Takemoto Classification. A conditional logistic regression model with adjustment for potential confounding factors was used to assess the associations.
Results: Body gastritis, defined endoscopically, was independently associated with an increased risk for esophageal squamous cell carcinoma.
Conclusion: Our findings suggest that macroscopic body gastritis may be a risk factor for esophageal squamous cell carcinoma in Japan. Further studies are needed to confirm these findings.

DOI： 10.1186/1471-230X-9-34

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The aim of the study was to evaluate bowel dysmotility in patients with a history of abdominal surgery by measuring both gastric transit time and small bowel transit time during capsule endoscopy and assessing the completeness of the examination. The study included 26 patients who had undergone abdominal surgery (postoperative group) and 52 patients who had not (control group). The capsule reached the cecum in 50.0% of the postoperative group and 80.8% of the control group (P = 0.005). While there was no significant difference in gastric transit time between the two groups (P = 0.882), small bowel transit time was significantly longer in the postoperative group (338.3 +/- A 119.2 min) than in the control group (266.4 +/- A 110.8 min, P = 0.010). This is the first study to report that the small bowel transit time during capsule endoscopy is prolonged in patients who had a history of abdominal surgery, resulting in a lower frequency of complete examination.

DOI： 10.1007/s10620-008-0467-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

In human subjects, aberrant crypt foci (ACF) can be classified as dysplastic or non-dysplastic using magnifying colonoscopy. Dysplastic ACF are thought to be a biomarker for the risk of colorectal cancer (CRC). Hyperinsulinemia and insulin-like growth factor-1 (IGF-1) have also been reported to be associated with an increased risk of CRC. To clarify this association, we investigated the relationship between diabetes risk, IGF-1 and the number of dysplastic ACF. Assessment of the number of dysplastic ACF in the entire colorectum is technically difficult, and we imaged the lower rectum only. Blood collections were taken in the morning on the day of colonoscopy. A total of 512 ACF were counted in 84 male participants, and a correlation was demonstrated to exist between age, body mass index (BMI), fasting blood sugar (FBS), insulin, homeostasis model assessment-insulin resistance (HOMA-IR), plasma leptin levels, plasmal IGF-1 levels and the number of dysplastic ACF. A significant association between plasma IGF-1 levels and the number of dysplastic ACF was still demonstrable after adjustment for age, BMI, FBS, insulin, HOMA-IR and plasma leptin levels. Our findings suggest that increased plasma leptin and IGF-1 levels, hyperinsulinemia and insulin resistance may promote the growth of dysplastic ACF. The results of multiple regression analysis revealed that increased plasma IGF-1 levels are associated with the number of dysplastic ACF present, and may be an independent risk factor for CRC. In conclusion, elevated plasma IGF-1 may promote the growth of dysplastic ACF and play a key role in colon carcinogenesis in male individuals.

DOI： 10.3892/mmr_00000105

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to evaluate the risk factors of perforation during endoscopic submucosal dissection (ESD).
Methodology: ESD was performed using a Flex knife in 64 patients with a total of 67 gastric tumors. Perforation occurred at the sites of a total of 4 lesions (5.9% [4/67]) for which conservative treatment had been effective. We evaluated several possible risk factors for perforation following ESD, such as tumor size, the location of the lesion, the operation time, and other clinical factors.
Results: All the perforations occurred in the posterior wall of the gastric upper or middle body. In an analysis adjusted for age and sex, the tumor size (odds ratio (OR), 1.017; 95% confidence interval (CI), 1.004-1.030), the location of the lesion in an upper region (OR, 10.64; 95%CI, 1.160-10.00) and the operation time (OR, 1.017; 95%CI, 1.013-1.295) were significantly associated with the incidence of perforation. All perforations were transient, resolving within 7 days, and did not require surgical treatment.
Conclusions: A large tumor size, the location of the lesion in an upper region, and a long operation time are risk factors for perforation following ESD.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: Spontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases. The aim of this study was to determine the factors influencing prognosis in cases of spontaneously ruptured HCC and to investigate the outcomes of the treatments employed, especially transcatheter arterial embolization (TAE).
Methods: A retrospective multicenter study was conducted in 48 cirrhotic patients with spontaneous rupture of HCC. Conservative treatment was employed in 32 patients (ConT group) and TAE was performed in 16 patients (TAE group).
Results: The median survival time (MST) in the ConT group was only 13.1 days and the survival rate was extremely poor: 59.4% at 7 days, 37.5% at 14 days, and 6.3% at 30 days. On the other hand, the MST in the TAE group was 244.8 days and the survival rate was 87.5% at 1 month, 56.3% at 3 months, 23.4% at 12 months, and 15.6% at 24 months. According to the results of univariate analyses, factors associated with poor hepatic function and poor suitability for TAE was important determinants of short-term death (less than 3 weeks) among the patients (p &lt; 0.05). On the other hand, among the patients in whom initial TAE was successfully performed (n = 15), a multivariate analysis showed that a maximum tumor size not exceeding 7 cm was the only independent factor determining long-term survival (p = 0.0130).
Conclusion: Despite the inherent limitations of this retrospective study, TAE appears to be a useful treatment strategy for cirrhotic patients with spontaneous HCC rupture, as it yielded a longer survival period compared with conservative treatment in patients with ruptured HCC. Among the patients with ruptured HCC in whom initial TAE was successfully performed, the maximum tumor size was an important factor influencing survival.

DOI： 10.1186/1471-230X-9-29

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

We compared endoscopic findings of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), a written questionnaire developed in Japan, to that for the questionnaire for the diagnosis of reflux esophagitis (QUEST) for the diagnosis of reflux esophagitis.
We registered 475 patients with untreated symptoms of upper abdominal pain (male/female: 252/223, average age 52.4 +/- 17.8 years). Subjects were assessed first with the FSSG and QUEST questionnaires, then by endoscopy, before allocation to a gastric ulcer (GU), duodenal ulcer (DU), gastroesophageal reflux disease (GERD) or functional dyspepsia (FD) group.
On the basis of the endoscopic findings the diagnoses for the 475 subjects were as follows: FD 52.2%, DU 7.6%, GU 7.8%, and GERD 32.4% (Grade M 10.1%, Grade A + B 20.2%, Grade C + D 2.3%). There was no difference between the FSSG and QUEST in sensitivity, specificity or accuracy for any condition. The FSSG score rose with increasing endoscopic severity of GERD, but there was no correlation between the QUEST score and endoscopic severity. The FSSG total score was inferior to QUEST in terms of distinguishing GERD from other conditions, but when only the questions relating to reflux symptoms were used, the FSSG was able to distinguish GERD from other conditions as well as QUEST.
The FSSG score reflects the severity of the endoscopic findings of GERD.

DOI： 10.1111/j.1440-1746.2008.05747.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The aim of this study was to determine whether there is a correlation between aperitif and gastric emptying. Ten healthy male volunteers participated in this randomized, two-way crossover study. Under two conditions (after drinking an aperitif versus not), the (13)C breath test was performed for 4 h with a liquid meal (200 kcal/200 ml) containing 100 mg (13)C acetate. We used 50 ml of umeshu as the aperitif. This is a traditional Japanese plum liqueur, and contains 7 ml alcohol (14%). In the aperitif group, T (1/2), T (lag), and T (peak) were significantly delayed [T (1/2) (132: 113-174) versus (112: 92-134) (P = 0.0069); T (lag) (80: 63-94) versus (55: 47-85) (P = 0.0069); and T (peak) (81: 62-96) versus (54: 34-84) (P = 0.0069), (median: range, aperitif versus control, min)]. Gastric emptying was significantly delayed in the aperitif group as compared with the control group. This study revealed that even a small amount of alcohol such as an aperitif may contribute to delayed gastric emptying.

DOI： 10.1007/s10620-008-0427-3

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The ideal medication for treatment of acid related diseases should have a rapid onset of action to promote hemostasis. The aim of our study was to investigate the inhibitory effects on gastric acid secretion after single intravenous administrations of lansoprazole 30 mg and famotidine 20 mg.
Methodology: Twelve Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 4 hours after single intravenous administration of lansoprazole 30 mg or famotidine 20 mg.
Results: The average pH during the 4-hour period after administration of famotidine was higher than after lansoprazole (median: 5.15 versus 3.55, respectively; p = 0.0376). During the 4-hour study period, famotidine 20 mg provided a longer duration of pH &gt; 3, 3.5, 4, 5, 6 and 7, compared to lansoprazole 30 mg (median: 73.6% versus 57.0%; p = 0.0414, 66.8% versus 47.8%; p = 0.0281, 60.8% versus 38.8%; p = 0.0150, 55.7% versus 29.7%; p = 0.0281, 45.0% versus 23.1%; p = 0.0414 and 23.9% versus 3.65%; p = 0.0076).
Conclusions: In Helicobacter pylori-negative healthy male subjects, an intravenous dose of famotidine 20 mg more rapidly increases intragastric pH than lansoprazole 30 mg.

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

DOI： 10.1111/j.1440-1746.2008.05765.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

The association between obesity and the risk of colorectal cancer (CRC) cannot be easily evaluated because CRC itself is associated with a gradual loss of bodyweight. Aberrant crypt foci (ACF) can be classified as dysplastic ACF or non-dysplastic ACF by magnifying colonoscopy, and dysplastic ACF are thought to be a biomarker of CRC. Ninety-four participants who underwent colonoscopy at Yokohama City University Hospital, Japan, were enrolled in the current study. We detected 557 ACF, including 67 dysplastic ACF (12.0%). Univariate regression analysis was conducted to determine correlations between the number of dysplastic ACF and various potential risk factors, including patient age, waist circumference, body mass index, visceral fat area (VFA), and plasma adiponectin level. The results of multiple regression analysis revealed that the number of dysplastic ACF correlated with age (correlation coefficient r = 0.212, P = 0.0383) and plasma adiponectin level (r = -0.201, P = 0.0371), even after adjustments for sex, waist circumference, body mass index, and VFA. Our univariate correlation analysis data showed a significant correlation with the number of dysplastic ACF with VFA (r = 0.238, P = 0.0209), no correlation with subcutaneous fat area, and an inverse correlation with the plasma level of adiponectin (r = -0.258, P = 0.0118). Thus, our results suggest that aging and visceral fat accumulation could correlate moderately with colorectal carcinogenesis. The novelty of our study lies in the finding that visceral fat accumulation and a low plasma adiponectin level may promote colorectal carcinogenesis; therefore, these obesity-related parameters may serve as novel targets for CRC prevention. (Cancer Sci 2009; 100: 29-32).

DOI： 10.1111/j.1349-7006.2008.00994.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: In contrast to Western countries where erosive esophagitis (EE) is more prevalent in males, there is a high incidence of EE in elderly females in Japan. We aimed to examine the gender differences in the age-stratified prevalence of EE and Barrett&apos;s epithelium.
Methodology: The study population comprised 869 cases (463 men and 406 women) who had undergone an upper endoscopy at the Gastroenterology Division of Yokohama City University Hospital between August 2005 and July 2006. EE was graded according to the Los Angeles Classification. Barrett&apos;s epithelium was diagnosed based on the Prague C & M Criteria.
Results: In contrast to the decrease of the proportion of EE with aging in males, that in females remained constant. The results suggest that the suppressive effect of the increased gastric mucosal atrophy associated with aging was wiped out by the age-related effect of the increased incidence of hiatal hernia. The proportions of Barrett&apos;s epithelium in both males and females increased with aging.
Conclusions: In Japan, the prevalence of elderly females complicated with hiatal hernia, which was partly due to osteoporosis and kyphosis, may affect the proportion of EE and probably Barrett&apos;s epithelium.

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000227044

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記述言語：英語   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

DOI： 10.2169/internalmedicine.48.1800

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000213242

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000209218

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction. Penetration of the colon to the posterior uterine wall secondary to diverticulitis is unusual, with diagnostic methods not yet established. Non-invasive imaging, such as computed tomography and magnetic resonance imaging may help to establish a proper diagnosis, but confirmation may be reached only after surgical exploration. Case presentation. We report the case of a 78-year-old Japanese woman who presented with a low grade fever and mild diarrhea which occurred two or three times a week. Computed tomography and magnetic resonance imaging demonstrated a capsular lesion including an air structure with a diameter of 5 cm, between the posterior aspect of the uterine body and the sigmoid colon. A gastrograffin enema and colonoscopy demonstrated a giant diverticulum of the sigmoid colon with no evidence of malignancy. These data confirmed the diagnosis of diverticulitis complicated by a giant diverticulum. Because of a relapsing fever after therapy with antibiotics, the patient had en bloc surgical treatment of the uterus, fallopian tubes, ovaries and sigmoid colon, the organs involved in the diverticulitis, followed by an uneventful recovery. Conclusion. This is a rare case report of penetration of the sigmoid colon to the posterior uterine wall secondary to diverticulitis. © 2009 Akiyama et al.
licensee Cases Network Ltd.

DOI： 10.4076/1752-1947-3-8957

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記述言語：英語   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

DOI： 10.2169/internalmedicine.48.2229

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記述言語：英語   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

DOI： 10.2169/internalmedicine.48.2822

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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000236031

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