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写真a

ミサワ ノボル
三澤 昇
Noboru Misawa
所属
附属病院 内視鏡センター 助教
職名
助教
外部リンク

研究キーワード

  • 機能性腸疾患

  • 消化管腫瘍

研究分野

  • ライフサイエンス / 消化器内科学

学歴

  • 横浜市立大学   大学院医学研究科

    2017年4月 - 2021年3月

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  • 横浜市立大学   医学部   医学科

    2006年4月 - 2012年3月

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経歴

  • 横浜市立大学附属病院   内視鏡センター   助教

    2021年4月

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論文

  • Efficacy and safety of linaclotide in treatment-resistant chronic constipation: A multicenter, open-label study. 国際誌

    Tsutomu Yoshihara, Takaomi Kessoku, Tomohiro Takatsu, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Hidenori Ohkubo, Takuma Higurashi, Michihiro Iwaki, Takeo Kurihashi, Machiko Nakatogawa, Koji Yamamoto, Izuru Terada, Yusuke Tanaka, Masataka Morita, Atsushi Nakajima

    Neurogastroenterology and motility   36 ( 12 )   e14938   2024年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: This study aimed to evaluate the efficacy and safety of linaclotide in patients with chronic constipation (CC) or irritable bowel syndrome with constipation (IBS-C) who did not respond to treatment with magnesium oxide (MgO). METHODS: This study was designed as a multicenter, open-label, single-arm, exploratory study. Patients with CC or IBS-C who took MgO and those meeting the medication initiation criteria were administered linaclotide at a daily dosage of 500 μg for 12 weeks. The primary endpoint was a change in the Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) score from baseline, which was evaluated by using a paired t-test. KEY RESULTS: The patients' mean age (± standard deviation) was 67.6 ± 13.82 years. The full analysis set included 61 patients. The JPAC-QOL total score was 1.60 at baseline and 0.70 at 12 weeks, with a significant mean change of -0.89 ± 0.721 (p < 0.001). Several secondary endpoints also showed improvement. The frequency of spontaneous bowel movement (SBM) and complete SBM increased by 2.70 ± 7.254 (p < 0.01) and 2.81 ± 5.254 times, respectively (p < 0.001). The Bristol Stool Form Scale, abdominal bloating severity, and straining severity scores improved by 1.33 ± 1.274 (p < 0.001), -0.16 ± 0.563 (p < 0.05), and -0.46 ± 0.795 (p < 0.001) points, respectively. The safety analysis set included 65 patients, 7 of whom had diarrhea, which improved with dose reduction and drug withdrawal. CONCLUSION & INFERENCES: The study was conducted in an older adult population, similar to real clinical practice. Linaclotide may be an option for treating CC that shows an inadequate response to conventional therapy.

    DOI: 10.1111/nmo.14938

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  • Evidence-Based Clinical Guidelines for Chronic Diarrhea 2023. 国際誌

    Eikichi Ihara, Noriaki Manabe, Hidenori Ohkubo, Naotaka Ogasawara, Haruei Ogino, Kazuki Kakimoto, Motoyori Kanazawa, Hidejiro Kawahara, Chika Kusano, Shiko Kuribayashi, Akinari Sawada, Tomohisa Takagi, Shota Takano, Toshihiko Tomita, Toshihiro Noake, Mariko Hojo, Ryota Hokari, Tatsuhiro Masaoka, Tomohiko Machida, Noboru Misawa, Yoshiyuki Mishima, Hiroshi Yajima, Sayuri Yamamoto, Hiroshi Yamawaki, Tatsuya Abe, Yasumi Araki, Kunio Kasugai, Takeshi Kamiya, Akira Torii, Atsushi Nakajima, Koji Nakada, Shin Fukudo, Yasuhiro Fujiwara, Hiroto Miwa, Hiromi Kataoka, Akihito Nagahara, Kazuhide Higuchi

    Digestion   2024年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The Japan Gastroenterological Association (JGA) published the first version of clinical guidelines for chronic diarrhea 2023. These guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic diarrhea, and provide flowcharts for the diagnosis and treatment of chronic diarrhea based on the latest evidence. Treatment for chronic diarrhea begins by distinguishing secondary chronic constipation with a clear etiology, such as drug-induced diarrhea, food-induced diarrhea, systemic disease-associated diarrhea, infection-associated diarrhea, organic disease-associated diarrhea, and bile acid diarrhea. The first line of treatment for chronic diarrhea in the narrow sense, defined in these guidelines as functional diarrhea in routine medical care, is lifestyle modification and dietary therapy. The first medicines to be considered for oral treatment are probiotics for regulating the gut microbiome and antidiarrheals. Other medications, such as 5HT3 receptor antagonists, anticholinergics, Kampo medicine, psychotherapy, antibiotics, bulking agents, adrenergic agonists, and somatostatin analogues, lack sufficient evidence for their use, highlighting a challenge for future research. This Clinical Guidelines for Chronic Diarrhea 2023, which provides the best clinical strategies for treating chronic diarrhea in Japan, will also be useful for medical treatment worldwide.

    DOI: 10.1159/000541121

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  • Evidence-based clinical guidelines for chronic constipation 2023. 国際誌

    Eikichi Ihara, Noriaki Manabe, Hidenori Ohkubo, Naotaka Ogasawara, Haruei Ogino, Kazuki Kakimoto, Motoyori Kanazawa, Hidejiro Kawahara, Chika Kusano, Shiko Kuribayashi, Akinari Sawada, Tomohisa Takagi, Shota Takano, Toshihiko Tomita, Toshihiro Noake, Mariko Hojo, Ryota Hokari, Tatsuhiro Masaoka, Tomohiko Machida, Noboru Misawa, Yoshiyuki Mishima, Hiroshi Yajima, Sayuri Yamamoto, Hiroshi Yamawaki, Tatsuya Abe, Yasumi Araki, Kunio Kasugai, Takeshi Kamiya, Akira Torii, Atsushi Nakajima, Koji Nakada, Shin Fukudo, Yasuhiro Fujiwara, Hiroto Miwa, Hiromi Kataoka, Akihito Nagahara, Kazuhide Higuchi

    Digestion   2024年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    In July 2023 the Japan Gastroenterological Association published the first version of its clinical guidelines for chronic constipation 2023. Based on the latest evidence, these guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic constipation. They include flowcharts for both diagnosis and treatment of chronic constipation. In the treatment of chronic constipation, the first step involves differentiating between secondary forms, such as organic disease-associated constipation, systemic disease-associated constipation, and drug-induced constipation. The next step is to determine whether the chronic constipation stems from a motility disorder, a form of primary chronic constipation. For functional constipation and constipation-predominant irritable bowel syndrome, treatment should be initiated after evaluating symptoms like reduced frequency of bowel movement frequency type or defecation difficulty type. The first line of treatment includes improvement of lifestyle habits and diet therapy. The first drugs to consider for oral treatment are osmotic laxatives. If these are ineffective, secretagogues and ileal bile acid transporter inhibitors are candidates. However, stimulant laxatives are exclusively designated for as-needed use. Probiotics, bulk-forming laxatives, prokinetics, and Kampo medicine, for which there is insufficient evidence, are considered alternative or complementary therapy. Providing the best clinical strategies for chronic constipation therapy in Japan, these clinical guidelines for chronic constipation 2023 should prove useful for its treatment worldwide.

    DOI: 10.1159/000540912

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  • A Handheld Ultrasound Device Can Predict Constipation with Rectal Fecal Retention in a Palliative Care Setting. 国際誌

    Atsushi Yamamoto, Takaomi Kessoku, Tomoki Ogata, Tsumugi Jono, Kota Takahashi, Kosuke Tanaka, Ko Suzuki, Yuma Takeda, Anna Ozaki, Yuki Kasai, Naoki Okubo, Michihiro Iwaki, Takashi Kobayashi, Noboru Misawa, Tsutomu Yoshihara, Akihiro Suzuki, Akiko Fuyuki, Sho Hasegawa, Kento Imajo, Noritoshi Kobayashi, Masaru Matsumoto, Nao Tamai, Hiromi Sanada, Shunsuke Oyamada, Yasushi Ichikawa, Atsushi Nakajima

    Diagnostics (Basel, Switzerland)   14 ( 15 )   2024年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs' usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.

    DOI: 10.3390/diagnostics14151626

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  • Expert Consensus Document: An Algorithm for the Care and Treatment of Patients with Constipation Based on Ultrasonographic Findings in the Rectum. 国際誌

    Takaomi Kessoku, Masaru Matsumoto, Noboru Misawa, Momoko Tsuda, Yuka Miura, Ayaka Uchida, Yuki Toriumi, Tomoyuki Onodera, Hiromi Arima, Atsuo Kawamoto, Junko Sugama, Makoto Matsushima, Mototsugu Kato, Noriaki Manabe, Nao Tamai, Hiromi Sanada, Atsushi Nakajima

    Diagnostics (Basel, Switzerland)   14 ( 14 )   2024年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Chronic constipation is a common gastrointestinal disorder, and its management is critical. However, it is extremely difficult to assess its subjective symptoms when patients are unable to report them due to cognitive or physical disabilities, especially in cases of patients with incurable geriatric, pediatric, palliative, psychiatric, or neurological diseases. We had previously established a protocol for observing and assessing rectal fecal retention using ultrasonography and for classifying cases into three categories based on the rectal findings: no fecal retention, fecal retention without hard stools, and fecal retention with hard stools. However, although the detection of rectal fecal retention using ultrasonography would be expected to lead to better therapeutic management, there is no standard algorithm for selecting specific treatments and defecation care options based on ultrasonographic findings. Therefore, we organized an expert consensus meeting of multidisciplinary professionals to develop such an algorithm based on rectal ultrasonography findings for patients with constipation in both residential and hospital settings.

    DOI: 10.3390/diagnostics14141510

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  • Efficacy and safety of rifaximin in patients with chronic intestinal pseudo-obstruction: a randomized, double-blind, placebo-controlled, phase II-a exploratory trial.

    Hidenori Ohkubo, Takaomi Kessoku, Kosuke Tanaka, Kota Takahashi, Tomohiro Takatsu, Tsutomu Yoshihara, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Shingo Kato, Takuma Higurashi, Kunihiro Hosono, Masato Yoneda, Toshihiro Misumi, Satoru Shinoda, Vincenzo Stanghellini, Atsushi Nakajima

    Bioscience of microbiota, food and health   43 ( 2 )   135 - 144   2024年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Chronic intestinal pseudo-obstruction (CIPO) is a rare intractable disease with limited treatment options. Small intestinal bacterial overgrowth (SIBO) often co-occurs with several diseases, including CIPO. While rifaximin (RFX) is effective in treating SIBO, its efficacy for CIPO remains unclear. Here, we aimed to investigate the efficacy and safety of RFX in adult patients with CIPO. Twelve patients were randomly assigned to receive RFX (400 mg three times daily, n=8) or a placebo (PBO, n=4) for 4 weeks. The global symptom score for abdominal bloating (GSS-bloating) and an original whole gastrointestinal symptoms score (O-WGSS) were collected, and a glucose hydrogen breath test (GHBT) and abdominal computed tomography (CT) were performed. No significant differences were observed in the primary endpoint. GSS-bloating improved by 75% and 25% in the PBO and RFX groups, respectively, and O-WGSS improved by 25% in both groups. No significant differences were observed in secondary and other endpoints, including the SIBO eradication rate in the GHBT and small intestinal volume on CT. In a post hoc analysis of SIBO-positive patients with CIPO (4/4 and 4/8 in the PBO and RFX groups), SIBO was eradicated in 25% and 75% of the patients (PBO and RFX groups, respectively) at the end of treatment, indicating a high eradication rate in the RFX group. Furthermore, the small intestinal gas volume decreased in the RFX group, and no severe adverse events occurred. Although no significant improvements were observed in subjective indicators, RFX may be beneficial in alleviating SIBO and reducing the small intestinal gas volume in SIBO-positive patients with CIPO.

    DOI: 10.12938/bmfh.2023-080

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  • Diagnostic Ability of Ultrasonography Compared with Computed Tomography for Assessing Rectal Feces.

    Noboru Misawa, Masaru Matsumoto, Momoko Tsuda, Shigeki Tamura, Tsutomu Yoshihara, Keiichi Ashikari, Takaomi Kessoku, Hidenori Ohkubo, Takuma Higurashi, Hiromi Sanada, Mototsugu Kato, Atsushi Nakajima

    Journal of the anus, rectum and colon   8 ( 2 )   126 - 131   2024年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: Chronic constipation is a common gastrointestinal disorder, and management is crucial. Computed tomography (CT) is useful for evaluating rectal fecal mass but limited owing to radiation exposure, cost, and inaccessibility at certain facilities. Ultrasonography (US) avoids these pitfalls, but it is unknown whether it accurately assesses rectal feces. In this study, we evaluated the diagnostic performance of US compared with CT as the gold standard for assessing rectal feces. METHODS: We prospectively evaluated rectal fecal mass retention using US performed within 1 h of CT to assess the degree of agreement between methodologies. Rectal stool findings were evaluated on three levels: no stool (R1), presence of stool (R2), and hard stool filling (R3). RESULTS: The sample included 100 patients (55 men, 45 women), of whom 47 were constipated. The kappa coefficients for rectal content detection were excellent between US and CT (p <0.001). Eighty-two cases (R1: 46 cases; R2: 28 cases; R3: 8 cases) were matched with CT and US findings, and 18 were not. Cases that did not match had low urine or high gas volumes. CT and US findings showed high agreement in constipation (kappa coefficient 0.674, p <0.001) and non-constipation groups (kappa coefficient 0.677, p <0.001). All cases with R3 on CT were found in the constipation group, while more than half of the cases with R1 on CT were in the non-constipation group. CONCLUSIONS: CT and US showed high agreement in evaluating rectal fecal mass retention, indicating that US can substitute CT.

    DOI: 10.23922/jarc.2023-058

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  • Current Treatment Practices for Adult Patients with Constipation in Japan. 国際誌

    Takaomi Kessoku, Noboru Misawa, Hidenori Ohkubo, Atsushi Nakajima

    Digestion   105 ( 1 )   40 - 48   2024年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The prevalence of constipation in Japan is estimated to be 2-5%. Constipation is a disease found in older adults. In particular, Japan is an aging society, with 65% of men and 80.5% of women aged 65 years or older accounting for the majority of its population. Chronic constipation may be associated with survival, cardiovascular events, decreased quality of life, and death. This study summarizes the recent findings regarding constipation treatment practice in Japan. SUMMARY: Until recently, the diagnosis of constipation was mainly based on medical interviews; however, with the recent development of handheld ultrasound devices, both physicians and nurses can easily and objectively diagnose fecal retention. Magnesium oxide and stimulant laxatives have been the mainstay treatments; however, since 2012, more than five new drugs for treating constipation have become available in Japan. KEY MESSAGES: Magnesium oxide is less effective in patients who use acid-secretion inhibitors and patients who have undergone total gastrectomy and should be cared for hypermagnesemia. In addition, regular use of stimulant laxatives may lead to colonic inertia and decreased bowel movements; therefore, they should be used only occasionally. The following is an overview of the different uses of conventional and newer laxatives for treating constipation.

    DOI: 10.1159/000533548

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  • Trends in Gastrointestinal Infections during the COVID-19 Pandemic and Concerns of Post-Pandemic Resurgence in Japan. 国際誌

    Takuma Higurashi, Shigeki Tamura, Noboru Misawa, Nobuyuki Horita

    Diseases (Basel, Switzerland)   12 ( 1 )   2023年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The impact of the COVID-19 pandemic was very broad and substantial, affecting a variety of fields worldwide. In Japan, the infection began spreading in March 2020. At that time, the government alerted people to cancel overseas travel, and encouraged wearing of masks, handwashing, sanitizing and keeping social distance. We sought to determine how COVID-19 infections affected other infectious diseases by investigating the trends in seven gastrointestinal infections that are listed among the 77 important infectious diseases designated by the National Institute of Infectious Diseases. We compared seven gastrointestinal infectious diseases, namely cholera, bacterial dysentery, enterohemorrhagic Escherichia coli, typhoid fever, paratyphoid fever, amoebic dysentery, and giardiasis, in terms of numbers of new cases before the COVID-19 pandemic (2012-2019) and during the pandemic (2020-2022). During the COVID-19 pandemic period (2020-2022), the incidence of the seven infections decreased significantly (p < 0.05) compared with before the pandemic (2012-2019). The sharp and significant decline in incidence of these seven infections in Japan during the COVID-19 pandemic period (2020-2022) appears to be due to restrictions on overseas travel and strict anti-infection measures, such as self-quarantine and encouragement of handwashing and sanitizing. The number of new cases of gastrointestinal infections in Japan is expected to increase in 2024 as these measures lapse. It is important for physicians to continue to monitor trends in gastrointestinal infections and educate people about proper infection prevention.

    DOI: 10.3390/diseases12010004

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  • The Prevalence and Characteristics of Symptomatic Uncomplicated Diverticular Disease Among Asian Patients With Unexplained Abdominal Symptoms

    Tsumugi Jono, Yuki Kasai, Takaomi Kessoku, Tomoki Ogata, Kosuke Tanaka, Tsutomu Yoshihara, Noboru Misawa, Shingo Kato, Takuma Higurashi, Kunihiro Hosono, Masato Yoneda, Kosuke Seita, Takayuki Kato, Eiji Sakai, Takeo Kurihashi, Machiko Nakatogawa, Shunsuke Oyamada, Seiji Futagami, Kok-Ann Gwee, Atsushi Nakajima

    Journal of Neurogastroenterology and Motility   2023年11月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:The Korean Society of Neurogastroenterology and Motility  

    DOI: 10.5056/jnm22162

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  • Changes in the Number of Gastrointestinal Cancers and Stage at Diagnosis with COVID-19 Pandemic in Japan: A Multicenter Cohort Study. 国際誌

    Kento Kuzuu, Noboru Misawa, Keiichi Ashikari, Shigeki Tamura, Shingo Kato, Kunihiro Hosono, Masato Yoneda, Takashi Nonaka, Shozo Matsushima, Tatsuji Komatsu, Atsushi Nakajima, Takuma Higurashi

    Cancers   15 ( 17 )   2023年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    This retrospective cohort study compared the number of newly diagnosed patients, stage at diagnosis, and detection process of gastrointestinal cancers based on hospital-based cancer registry data at two tertiary Japanese hospitals. The pre-COVID-19 period was from January 2017 to February 2020, with phase 1 (midst of COVID-19 pandemic) from March to December 2020 and phase 2 (the transition period to the "new normal") from January to December 2021. Each month, the number of patients diagnosed with esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers were aggregated, classified by stage and detection process, and compared, including a total of 6453 patients. The number of colorectal Stage 0-II patients decreased significantly in phase 1 and increased in phase 2. The total number of colorectal cancer patients returned to pre-COVID-19 levels (mean monthly patients [SD]: 41.61 [6.81] vs. 36.00 [6.72] vs. 46.00 [11.32]). The number of patients with gastric cancer Stage I significantly decreased in phase 2 following phase 1. The number of gastric cancer patients decreased significantly from pre-COVID-19 levels (30.63 [6.62] vs. 22.40 [5.85] vs. 24.50 [4.15]). During phase 2, the number of patients diagnosed after screening with colorectal cancer increased significantly, whereas that with gastric cancer remained considerably lower. The number of Stage III colorectal and gastric cancer patients increased significantly from the pre-COVID-19 levels. Thus, gastric cancer may not be optimally screened during phases 1 and 2. There was a significant increase in patients with Stage III colorectal and gastric cancers from the pre-COVID-19 period; hence, the stage at diagnosis may have progressed.

    DOI: 10.3390/cancers15174410

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  • Prior appendectomy and cerebral infarction as potential risk factors for recurrent ischemic colitis: A retrospective observational study. 国際誌

    Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Keiichi Ashikari, Takaomi Kessoku, Hidenori Ohkubo, Kunihiro Hosono, Masato Yoneda, Satoru Saito, Atsushi Nakajima, Takuma Higurashi

    JGH open : an open access journal of gastroenterology and hepatology   7 ( 8 )   559 - 566   2023年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: Ischemic colitis (IC) is a benign disease associated with acute lower gastrointestinal bleeding and frequent recurrence. While several studies have investigated risk factors for IC onset, few have assessed the risk factors for recurrent IC. This study aimed to identify risk factors for recurrent IC. METHODS: Potential risk factors for recurrence were assessed by examining medical records and laboratory findings in this single-center retrospective study. We extracted the following data from the patients' medical records: patient characteristics, clinical signs and symptoms, laboratory findings, method of treatment, length of hospital stay, disease course, and the frequency of IC morbidities. Patients with IC were selected from a total of 439 312 patients over an 11-year period. Patients were divided into recurrent and nonrecurrent IC groups. RESULTS: In total, 225 patients met the diagnostic criteria for IC during the specified study period; of these, 204 patients (90.7%) and 21 patients (9.3%) were included in the nonrecurrent and recurrent IC groups, respectively. Univariate and multivariate analyses showed a significant association between IC recurrence and both cerebral infarction (P = 0.008, odds ratio [OR] = 6.3) and history of appendectomy (P = 0.0005, OR = 6.2). The median (interquartile range [IQR]) follow-up time for all patients was 1556 (353-2768) days; this was much longer than the median (IQR) time to recurrence of 291 (64-907) days in the recurrent IC group. CONCLUSION: The results of this study suggest that prior cerebral infarction and appendicectomy may be risk factors for IC recurrence.

    DOI: 10.1002/jgh3.12948

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  • Clinicopathological features of endoscopically treated early gastric cancer with lymphovascular infiltration. 国際誌

    Koji Takano, Keiichi Ashikari, Shigeki Tamura, Noboru Misawa, Tomohiro Takatsu, Tsutomu Yoshihara, Takashi Nonaka, Jun Arimoto, Atsuhiko Sakamoto, Hideyuki Chiba, Satoshi Fujii, Atsushi Nakajima, Takuma Higurashi

    Journal of cancer research and clinical oncology   149 ( 9 )   5781 - 5790   2023年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Lymphovascular infiltration (LVI) may play a critical role in radicality and prognostic assessment of early gastric cancer (EGC). However, risk factors for LVI in endoscopically resected EGC remain unknown. This study evaluated the clinicopathological characteristics and prognoses of patients who underwent endoscopic resection of EGC to identify potential risk factors of LVI. METHODS: A cross-sectional study of patients who received gastric endoscopic submucosal dissection between February 1, 2012, and December 31, 2019, at two institutions was conducted. Among 1,462 lesions, 943 met the criteria for radical treatment considering features other than LVI and were included. The lesions were classified based on the presence of LVI. The clinicopathological characteristics of the two groups were compared. RESULTS: LVI was detected in 17 lesions (1.8%). The positivity rates of LVI were 0.7% (7/903) for intramucosal cancer and 25% (10/40) for submucosally invasive cancer. The LVI positivity rate was significantly higher for mixed-type cancer (lesions containing differentiated and undifferentiated-type carcinoma) than for non-mixed-type cancer (35.3 vs. 2.8%; P < 0.001) and for submucosally invasive cancer than for intramucosal cancer (58.8 vs. 3.2%; P < 0.001). In the multivariate logistic regression analysis, independent risk factors for LVI were mixed-type cancer (odds ratio; 95% confidence interval: 23.9; 5.0-115; P < 0.001) and submucosal invasion (58.7; 16.0-215; P < 0.001). CONCLUSIONS: Mixed-type cancer and submucosal invasion were risk factors for LVI in endoscopically resected EGC. These factors may play a critical role in the radicality and prognostic assessment of EGC.

    DOI: 10.1007/s00432-022-04536-7

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  • Natural History of Chronic Intestinal Pseudo-obstruction and Need for Palliative Care. 国際誌

    Kosuke Tanaka, Hidenori Ohkubo, Atsushi Yamamoto, Kota Takahashi, Yuki Kasai, Anna Ozaki, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Noboru Misawa, Akiko Fuyuki, Shingo Kato, Takuma Higurashi, Kunihiro Hosono, Masato Yoneda, Takeo Kurihashi, Masataka Taguri, Atsushi Nakajima, Kok-Ann Gwee, Takaomi Kessoku

    Journal of neurogastroenterology and motility   29 ( 3 )   378 - 387   2023年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND/AIMS: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. METHODS: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. RESULTS: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2, 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. CONCLUSION: CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

    DOI: 10.5056/jnm22152

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  • Exploratory, multicenter, open-label study to evaluate the effects of linaclotide in patients with chronic constipation with an insufficient response to magnesium oxide: A study protocol. 国際誌

    Tsutomu Yoshihara, Takaomi Kessoku, Tomohiro Takatsu, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Hidenori Ohkubo, Takuma Higurashi, Michihiro Iwaki, Takeo Kurihashi, Machiko Nakatogawa, Koji Yamamoto, Izuru Terada, Yusuke Tanaka, Atsushi Nakajima

    Contemporary clinical trials communications   30   101019 - 101019   2022年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Chronic constipation leads to poor quality of life, and treatment remains unsatisfactory for patients. In Japan, magnesium oxide has been commonly used as the first choice of treatment for constipation; however, there are some cases of low satisfaction with magnesium oxide treatment. Linaclotide has recently been used to treat chronic constipation. In this study, we will examine whether linaclotide improves symptoms and quality of life in patients showing insufficient response to magnesium oxide. METHODS: This is an exploratory multicenter open-label study. The target number of patients is 64: 32 patients with and 32 without abdominal symptoms. Patients with chronic idiopathic constipation or irritate bowel syndrome with constipation diagnosed according to the Rome-IV criteria are eligible. Patients prescribed 0.99-2 g/day of magnesium oxide for at least 4 weeks will be included. Those who consent to the study will continue taking magnesium oxide for 2-4 weeks, and defecation will be documented. Patients who meet the criteria will be prescribed linaclotide (0.5 mg) daily for 12 weeks. The primary endpoint is a change in the Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) score after 12 weeks of treatment. CONCLUSION: This is the first study to investigate the usefulness of linaclotide as a second-line treatment for chronic constipation. We will test the efficacy of treatment of constipation in patients with inadequate response to magnesium oxide. TRIAL REGISTRATION: This study is registered with the Japan Registry of Clinical Trials (jRCT, jRCTs031200048).

    DOI: 10.1016/j.conctc.2022.101019

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  • Leukotriene Receptor Antagonist Therapy for the Chemoprevention of Human Rectal Aberrant Crypt Foci: Nonrandomized, Open-Label, Controlled Trial. 国際誌

    Takuma Higurashi, Keiichi Ashikari, Shigeki Tamura, Yusuke Saigusa, Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Takaomi Kessoku, Kunihiro Hosono, Masato Yoneda, Atsushi Nakajima

    Cancer prevention research (Philadelphia, Pa.)   15 ( 10 )   661 - 668   2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    UNLABELLED: Leukotriene receptor antagonists (LTRA) are widely used drugs for treating allergic asthma, and they have recently been suggested to have a suppressive effect on carcinogenesis and cancer cell proliferation. Aberrant crypt foci (ACF) are considered a reliable surrogate biomarker of colorectal cancer. This prospective study explored the chemopreventive effect of an LTRA on colonic ACF formation and the safety of the medicine in patients as a pilot trial leading to a colorectal cancer chemoprevention trial. This was a nonrandomized, open-label, controlled trial in patients with colorectal ACFs. The participants were allocated to LTRA or observation groups. Patients in the LTRA group received 10 mg of montelukast orally daily for 8 weeks. After the intervention, colonoscopy was performed to evaluate the changes in the number of ACFs. From November 2017 to March 2020, 40 patients were enrolled. The first 30 were assigned to the LTRA group, and the remaining 10 were assigned to the observation group. In the LTRA group, the mean change in the number of ACFs per patient at 8 weeks from baseline was -2.4 ± 2.2, while the mean change in the observation group was 0.4 ± 2.3 (P = 0.002). There were no severe adverse events. This is the first study to explore the effect of LTRAs against colorectal ACF formation in humans. LTRAs are potential candidates for chemoprevention in colorectal cancer. PREVENTION RELEVANCE: We conducted the first LTRA chemoprevention trial for human rectal ACFs, which is considered a surrogate marker of colorectal carcinogenesis. 8-week treatment with LTRA suppressed ACF formation and cell proliferation in colonic epithelium. LTRAs are possible candidates for chemoprevention in colorectal cancer. See related Spotlight, p. 637.

    DOI: 10.1158/1940-6207.CAPR-22-0049

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  • Comparison of the diagnostic performance of NBI, Laser-BLI and LED-BLI: a randomized controlled noninferiority trial. 国際誌

    Takuma Higurashi, Keiichi Ashikari, Shigeki Tamura, Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Yuki Ninomiya, Yuki Okamoto, Masataka Taguri, Taku Sakamoto, Shiro Oka, Atsushi Nakajima, Shinji Tanaka, Takahisa Matsuda

    Surgical endoscopy   36 ( 10 )   7577 - 7587   2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIMS: New image-enhanced endoscopy (IEE), blue Light Imaging (LED-BLI) is launched in USA and Europe, whereas Blue Laser Imaging (Laser-BLI) is available only Asian and some countries. No studies have directly compared the diagnostic accuracy of narrow band imaging (NBI), Laser-BLI and LED-BLI for colorectal tumors. The present study aimed to compare the diagnostic accuracy of the three methods for colorectal tumor using the NBI international colorectal endoscopic (NICE) classification and the Japanese NBI Expert Team (JNET) classifications. METHODS: This was a multi-center evaluator-blinded, randomized control trial of patients who underwent endoscopic colorectal tumor resection. The patients were randomly assigned to NBI, Laser-BLI or LED-BLI. Cropped images were sent to blinded external evaluators and diagnosed according to NICE and JNET classifications. The diagnostic accuracy of each endoscopy system was compared with non-inferiority test. RESULTS: A total of 619 colonic tumors were resected from 230 patients and evaluated by external four evaluators. The diagnostic accuracy of NBI for NICE 1, NICE 2, NICE 3 was 90.6%, 90.3% and 99.5%, respectively and for JNET 1, JNET 2A, JNET 2B and JNET 3, it was 94.6%, 72.0%, 79.2% and 99.1%, respectively. In non-inferiority test, Laser-BLI and LED-BLI revealed non-inferiority to NBI in all NICE and JNET categories (p&lt;0.001). CONCLUSIONS: Laser-BLI and LED-BLI had high diagnostic accuracy and non-inferiority of NBI, especially for hyperplastic polyp/sessile serrated lesion and low-grade dysplasia. This is first trial to compare the diagnostic accuracy with NBI, Laser-BLI and LED-BLI and useful to understand the position of each IEE. This trial was registered as UMIN000032107.

    DOI: 10.1007/s00464-022-09197-8

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  • Rationale and design of a multicenter, single-group, open-label trial aiming at investigating the effectiveness of elobixibat for loss of defecation desire in patients with chronic constipation. 国際誌

    Atsushi Yamamoto, Takaomi Kessoku, Kosuke Tanaka, Kota Takahashi, Yuki Kasai, Anna Ozaki, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Noboru Misawa, Kanji Ohkuma, Akiko Fuyuki, Takuma Higurashi, Kunihiro Hosono, Masato Yoneda, Tomoyuki Iwasaki, Takeo Kurihashi, Machiko Nakatogawa, Ayao Suzuki, Masataka Taguri, Shunsuke Oyamada, Keisuke Ariyoshi, Noritoshi Kobayashi, Yasushi Ichikawa, Atsushi Nakajima

    Contemporary clinical trials communications   28   100958 - 100958   2022年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Approximately 60% of patients with chronic constipation (CC) have a significantly higher rate of loss of defecation desire (LODD). Bile acids are expected to have a restorative effect on defecation desire (DD) because they lower the rectal sensory threshold, which is an objective index of DD. Elobixibat (EXB) specifically inhibits the ileal bile acid transporter/apical sodium-dependent bile acid transporter, which is a transporter involved in the reabsorption of bile acids in the terminal ileum. This study aims to investigate the LODD improvement rate in patients with CC after 4 weeks of EXB treatment. Methods: A total of 40 adult patients with CC who meet the eligibility criteria will be enrolled. Patients will receive oral EXB (10 mg/day) for 4 weeks. A patient diary will be provided daily at 4 weeks after treatment. The primary endpoint will be the percentage LODD improvement at week 4 of the treatment period from week 2 of the observation period using questionnaires. Ethics and dissemination: Ethical approval was obtained from the Yokohama City University Certified Institutional Review Board prior to participant enrolment (approval number: CRB21-008). The results of this study will be submitted for publication in international peer-reviewed journals, and key findings will be presented at international scientific conferences. Participants desiring the results of this study will be directly contacted for data dissemination. Trial registration: This trial was registered at ClinicalTrials.gov (NCT05165199). Protocol version: 1.0, September 21, 2021.

    DOI: 10.1016/j.conctc.2022.100958

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  • Point of care ultrasonographyで診断した便排出障害に対して経肛門的処置と経口治療の有効性を比較した前向き観察研究

    結束 貴臣, 緒方 智樹, 城野 紡, 田中 幸介, 山本 敦, 高橋 宏太, 尾崎 杏奈, 葛西 祐樹, 竹田 雄馬, 大久保 直紀, 岩城 慶大, 小林 貴, 三澤 昇, 吉原 努, 鈴木 章浩, 冬木 晶子, 小林 規俊, 中島 淳, 市川 靖史

    Palliative Care Research   17 ( Suppl. )   S.179 - S.179   2022年7月

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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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  • Point of care ultrasonographyで診断した便排出障害に対して経肛門的処置と経口治療の有効性を比較した前向き観察研究

    結束 貴臣, 緒方 智樹, 城野 紡, 田中 幸介, 山本 敦, 高橋 宏太, 尾崎 杏奈, 葛西 祐樹, 竹田 雄馬, 大久保 直紀, 岩城 慶大, 小林 貴, 三澤 昇, 吉原 努, 鈴木 章浩, 冬木 晶子, 小林 規俊, 中島 淳, 市川 靖史

    Palliative Care Research   17 ( Suppl. )   S.179 - S.179   2022年7月

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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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  • 消化器希少難病である慢性偽性腸閉塞患者の自然経過と緩和ケアに対するニーズを調査した観察研究

    田中 幸介, 結束 貴臣, 大久保 秀則, 緒方 智樹, 城野 紡, 山本 敦, 高橋 宏太, 竹田 雄馬, 大久保 直紀, 尾崎 杏奈, 葛西 祐樹, 岩城 慶大, 小林 貴, 三澤 昇, 吉原 努, 冬木 晶子, 小林 規俊, 市川 靖史, 中島 淳

    Palliative Care Research   17 ( Suppl. )   S.363 - S.363   2022年7月

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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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  • 消化器希少難病である慢性偽性腸閉塞患者の自然経過と緩和ケアに対するニーズを調査した観察研究

    田中 幸介, 結束 貴臣, 大久保 秀則, 緒方 智樹, 城野 紡, 山本 敦, 高橋 宏太, 竹田 雄馬, 大久保 直紀, 尾崎 杏奈, 葛西 祐樹, 岩城 慶大, 小林 貴, 三澤 昇, 吉原 努, 冬木 晶子, 小林 規俊, 市川 靖史, 中島 淳

    Palliative Care Research   17 ( Suppl. )   S.363 - S.363   2022年7月

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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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  • Rationale and design of a multicentre, 12-week, randomised, double-blind, placebo-controlled, parallel-group, investigator-initiated trial to investigate the efficacy and safety of elobixibat for chronic constipation. 国際誌

    Kosuke Tanaka, Takaomi Kessoku, Atsushi Yamamoto, Kota Takahashi, Yuki Kasai, Anna Ozaki, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Noboru Misawa, Takayuki Kato, Jun Arimoto, Akiko Fuyuki, Eiji Sakai, Takuma Higurashi, Hideyuki Chiba, Kunihiro Hosono, Masato Yoneda, Tomoyuki Iwasaki, Takeo Kurihashi, Machiko Nakatogawa, Ayao Suzuki, Masataka Taguri, Shunsuke Oyamada, Keisuke Ariyoshi, Noritoshi Kobayashi, Yasushi Ichikawa, Atsushi Nakajima

    BMJ open   12 ( 5 )   e060704   2022年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Chronic constipation (CC) is a functional disorder that negatively impacts the quality of life of patients. This is a protocol for a multicentre, 12-week, randomised, double-blind, placebo-controlled study to test the efficacy and safety of elobixibat (EXB) versus placebo in patients with CC. METHODS AND ANALYSIS: This will be a multicentre, double-blind, placebo-control, randomised controlled trial. A total of 100 adult patients with CC, diagnosed based on Rome IV criteria, who fulfil the inclusion/exclusion criteria will be enrolled. The patients will be randomly assigned to receive EXB (10 mg) or placebo treatment (n=50 per group). Blood tests and stool sampling will be performed 12 weeks following initiation of treatment and questionnaires will be issued to participants. The primary outcome will be the change in complete spontaneous bowel movements after 12 weeks of administration. The secondary outcomes will include the change in Japanese Patient Assessment of Constipation Quality of Life and absolute serum and faecal bile acid. ETHICS AND DISSEMINATION: Ethics approval has been obtained from Yokohama City University Certified Institutional Review Board before participant enrolment. The results of this study will be submitted for publication in international peer-reviewed journals and the key findings will be presented at international scientific conferences. PROTOCOL VERSION: V.3.0, 15 June 2021. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (number NCT04784780).

    DOI: 10.1136/bmjopen-2021-060704

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  • 携帯型超音波で診断した便排出障害に対して経肛門的処置と経口治療の有効性の比較検討

    結束 貴臣, 田中 幸介, 山本 敦史, 野上 麻子, 岩城 慶大, 三澤 昇, 冬木 晶子, 小林 規俊, 市川 靖史, 中島 淳

    超音波医学   49 ( Suppl. )   S585 - S585   2022年4月

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    記述言語:日本語   出版者・発行元:(公社)日本超音波医学会  

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  • 携帯型超音波で診断した便排出障害に対して経肛門的処置と経口治療の有効性の比較検討

    結束 貴臣, 田中 幸介, 山本 敦史, 野上 麻子, 岩城 慶大, 三澤 昇, 冬木 晶子, 小林 規俊, 市川 靖史, 中島 淳

    超音波医学   49 ( Suppl. )   S585 - S585   2022年4月

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    記述言語:日本語   出版者・発行元:(公社)日本超音波医学会  

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  • Expert Consensus Document: Diagnosis for Chronic Constipation with Faecal Retention in the Rectum Using Ultrasonography. 国際誌

    Masaru Matsumoto, Noboru Misawa, Momoko Tsuda, Noriaki Manabe, Takaomi Kessoku, Nao Tamai, Atsuo Kawamoto, Junko Sugama, Hideko Tanaka, Mototsugu Kato, Ken Haruma, Hiromi Sanada, Atsushi Nakajima

    Diagnostics (Basel, Switzerland)   12 ( 2 )   2022年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient's colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation.

    DOI: 10.3390/diagnostics12020300

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  • A prospective interventional trial on the effect of periodontal treatment on Fusobacterium nucleatum abundance in patients with colorectal tumours. 国際誌

    Tsutomu Yoshihara, Mitomu Kioi, Junichi Baba, Haruki Usuda, Takaomi Kessoku, Michihiro Iwaki, Tomohiro Takatsu, Noboru Misawa, Keiichi Ashikari, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Mitsuharu Matsumoto, Koichiro Wada, Atsushi Nakajima, Takuma Higurashi

    Scientific reports   11 ( 1 )   23719 - 23719   2021年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Fusobacterium nucleatum is associated with the progression of colorectal cancer. Thus, the possibility of preventing colorectal cancer or its progression by targeting F. nucleatum has been explored. As F. nucleatum is associated with periodontitis, we analysed whether treating periodontitis could influence F. nucleatum abundance in the colon. Patients with colorectal tumours who underwent colonoscopy were recruited. Patients diagnosed with periodontitis by a dentist were treated for approximately 3 months. Endoscopic resection of colorectal tumours was performed after periodontitis treatment, and resected tumours were pathologically classified as high-(HGD) or low-grade dysplasia (LGD). Saliva and stool samples were collected before and after the treatment. Of the 58 patients with colorectal tumours, 31 were included in the study, 16 showed improvement in periodontitis, and 11 showed no improvement. Stool F. nucleatum levels before treatment were significantly lower in the LGD group than in the HGD group. A significant decrease in faecal F. nucleatum levels was observed in patients who underwent successful treatment but not in those whose treatment failed. Salivary F. nucleatum levels were not altered in patients despite periodontal treatment. Thus, successful periodontitis treatment reduces stool F. nucleatum levels and may aid research on periodontitis and suppression of colorectal cancer development.

    DOI: 10.1038/s41598-021-03083-4

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  • Gastrointestinal Cancer Stage at Diagnosis Before and During the COVID-19 Pandemic in Japan 国際誌

    Kento Kuzuu, Noboru Misawa, Keiichi Ashikari, Takaomi Kessoku, Shingo Kato, Kunihiro Hosono, Masato Yoneda, Takashi Nonaka, Shozo Matsushima, Tatsuji Komatsu, Atsushi Nakajima, Takuma Higurashi

    JAMA Network Open   4 ( 9 )   e2126334 - e2126334   2021年9月

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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:American Medical Association (AMA)  

    Importance: The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages. Objective: To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals. Exposures: The pre-COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020. Main Outcome and Measure: Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared. Results: The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre-COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre-COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; -26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; -13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; -35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; -32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; -34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; -35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001). Conclusions and Relevance: In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.

    DOI: 10.1001/jamanetworkopen.2021.26334

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  • 緩和ケア領域の便秘における携帯型超音波の有用性の検討

    結束 貴臣, 田中 幸介, 尾崎 杏奈, 葛西 祐樹, 竹田 雄馬, 大久保 直紀, 岩城 慶大, 小林 貴, 三澤 昇, 吉原 努, 鈴木 章浩, 本多 靖, 冬木 晶子, 小林 規俊, 中島 淳, 市川 靖史

    Palliative Care Research   16 ( Suppl. )   S251 - S251   2021年6月

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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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  • 歯周病治療が与える便や大腸腫瘍のF.nucleatumへの影響

    吉原 努, 日暮 琢磨, 中島 淳, 高津 智弘, 三澤 昇, 芦苅 圭一, 大久保 秀則, 馬場 隼一, 來生 知, 臼田 春樹, 和田 孝一郎

    日本消化器病学会雑誌   118 ( 臨増総会 )   A417 - A417   2021年3月

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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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  • 歯周病治療が与える便や大腸腫瘍のF.nucleatumへの影響

    吉原 努, 日暮 琢磨, 中島 淳, 高津 智弘, 三澤 昇, 芦苅 圭一, 大久保 秀則, 馬場 隼一, 來生 知, 臼田 春樹, 和田 孝一郎

    日本消化器病学会雑誌   118 ( 臨増総会 )   A417 - A417   2021年3月

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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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  • Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection. 国際誌

    Keiichi Ashikari, Takashi Nonaka, Takuma Higurashi, Tomohiro Takatsu, Tsutomu Yoshihara, Noboru Misawa, Jun Arimoto, Kenji Kanoshima, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Hideyuki Chiba, Atsushi Nakajima

    Journal of gastroenterology and hepatology   36 ( 7 )   1920 - 1926   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone. METHODS: This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections. RESULTS: Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred. CONCLUSION: The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.

    DOI: 10.1111/jgh.15417

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  • Effects of colorectal endoscopic submucosal dissection on postoperative abdominal symptoms: a prospective observational study. 国際誌

    Hiroaki Tanabe, Takuma Higurashi, Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Shungo Goto, Jun Arimoto, Keiichi Ashikari, Leo Taniguchi, Hideyuki Chiba, Atsushi Nakajima

    Surgical endoscopy   36 ( 1 )   314 - 320   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective procedure to resect large superficial gastrointestinal neoplasms. In gastric ESD, several studies showed the relationship between postoperative abdominal symptoms and endoscopic treatment. However, the influence of colorectal ESD on abdominal symptoms after treatment is still unknown. To the best of our knowledge, this is the first prospective multicenter study performed to investigate the impact of colorectal ESD on postoperative abdominal symptoms. This study aimed to clarify the association between change of abdominal symptoms and ESD. METHODS: This study was a prospective multicenter observational trial that enrolled 141 out of 171 patients who underwent colorectal ESD and answered the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire from March 2015 to August 2019. We evaluated abdominal symptoms in the patients using the GSRS questionnaire before ESD and a few weeks after ESD. RESULTS: Comparing the GSRS before and after ESD, overall scores changed from 1.58 ± 0.58 to 1.48 ± 0.48, and the five subscales (reflux syndrome, abdominal pain, indigestion syndrome, diarrhea syndrome, and constipation syndrome) were slightly improved. Overall scores, indigestion syndrome, and constipation syndrome were statistically significantly different before and after ESD (P < 0.05). CONCLUSIONS: In GSRS, a score of ≥ 3 is often treated as a clinically significant symptom. Therefore, our findings indicated that there was no clinically significant difference. For this reason, colorectal ESD does not affect postoperative abdominal symptoms and is considered a minimally invasive treatment. The analysis of the impact of colon ESD on gastrointestinal symptoms UMIN000016914.

    DOI: 10.1007/s00464-020-08278-w

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  • Relationship between Stool Form and Quality of Life in Patients with Chronic Constipation: An Internet Questionnaire Survey. 国際誌

    Hidenori Ohkubo, Tsutomu Yoshihara, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Tetsuya Matsuura, Takuma Higurashi, Kento Imajo, Kunihiro Hosono, Masato Yoneda, Noritoshi Kobayashi, Satoru Saito, Atsushi Nakajima

    Digestion   102 ( 2 )   147 - 154   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Chronic constipation (CC) is a highly prevalent functional bowel disorder with low treatment satisfaction and impaired quality of life (QOL). However, physicians tend to emphasize only "stool frequency," and relationship between "stool form" and QOL remains unclear. In this study, we aimed to investigate the actual situation of CC treatment in Japan and elucidate the relationship between stool form and QOL in patients with CC. METHODS: We conducted an online questionnaire survey in September 2018 targeting Japanese adult patients already diagnosed with CC and taking prescribed drugs. Assessments included the type of drug treatment, treatment duration, frequency of drug use, frequency of bowel movements (BMs), Bristol Stool Form Scale (BSFS), and Japanese version of the Patient Assessment of Constipation QOL (PAC-QOL) scores. Relationship between BSFS and Japanese PAC-QOL scores was analyzed, and most important factor that influences QOL was investigated. RESULTS: A total of 614 subjects were enrolled. Of these, 398 (64.8%) regularly used magnesium oxide and 162 (26.4%) used stimulant laxative, especially 81 (50.0%) used stimulant laxative "everyday." Mean score of the PAC-QOL was 1.29 ± 0.74, and the lowest score (highest QOL) of 0.94 ± 0.61 was observed in BSFS type 4. Significant difference was seen between BSFS type 4 and all the other types except type 7. Multivariate analysis revealed that normal stool form (BSFS type 4) and BMs ≥3/week are strongly related to decreases of PAC-COL score. In BSFS types 6 and 7, 36% of individuals experienced self-discontinuation of prescribed drugs and 53% self-reduced drug intake because of excessive effects. CONCLUSIONS: Stool form and frequency of BMs are relevant to QOL, especially normal stool form (BSFS type 4) is important for improving the QOL in patients with constipation. Physicians should focus on "stool form" and reconsider the prescription especially in BSFS types 6-7 patients.

    DOI: 10.1159/000502815

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  • Efficacy of Bifidobacterium bifidum G9-1 in improving quality of life in patients with chronic constipation: a prospective intervention study.

    Akiko Fuyuki, Takuma Higurashi, Takaomi Kessoku, Keiichi Ashikari, Tsutomu Yoshihara, Noboru Misawa, Michihiro Iwaki, Takashi Kobayashi, Hidenori Ohkubo, Masato Yoneda, Haruki Usuda, Koichiro Wada, Atsushi Nakajima

    Bioscience of microbiota, food and health   40 ( 2 )   105 - 114   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Chronic constipation is a functional disorder that decreases a patient's quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in patients with constipation. This was a prospective, single-center, non-blinded, single-arm feasibility trial. A total of 31 patients with constipation and decreased QOL received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was change in the overall Japanese version of the patient assessment of constipation of QOL (JPAC-QOL) score after probiotic administration relative to that at baseline. Secondary endpoints included changes in gut microbiota, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. The overall JPAC-QOL scores and frequency of bowel movement significantly improved after BBG9-1 administration from those at baseline (p<0.01 and p<0.01, respectively). There were no statistically significant changes in other clinical symptoms. Subset analysis revealed that patients with initial Bristol Stool Form Scale stool types of <4 had improvements in stool consistency, a significant increase in the frequency of bowel movements, and a significant alleviation in the degree of straining, following BBG9-1 administration. At the genus and species levels, Sarcina and Sarcina maxima were significantly increased. Functional analysis showed that butanoate metabolism increased significantly, whereas methane metabolism decreased significantly. We concluded that BBG9-1 is safe and improves QOL in patients with constipation. The underlying improvements may be due to changes in stool consistency.

    DOI: 10.12938/bmfh.2020-073

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  • The efficacy of aspirin and metformin combination therapy in patients with rectal aberrant crypt foci: a double-blinded randomized controlled trial. 国際誌

    Takuma Higurashi, Jun Arimoto, Keiichi Ashikari, Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Atsushi Nakajima

    BMC cancer   20 ( 1 )   1043 - 1043   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The incidence and mortality rates of colorectal cancer (CRC) continue to increase worldwide. Therefore, new preventive strategies are needed to lower the burden of this disease. Previous studies reported that aspirin could suppress the development of sporadic colorectal adenoma. In addition, metformin is a biguanide derivative that is long widely used for the treatment of diabetes mellitus and has recently been suggested to have a suppressive effect on carcinogenesis and cancer cell growth. Both drugs exhibit a chemopreventive effect, but their efficacy is limited. Aberrant crypt foci (ACF), defined as lesions containing crypts that are larger in diameter and stain more darkly with methylene blue than normal crypts, are more prevalent in patients with cancer and adenomas, and considered a reliable surrogate biomarker of CRC. Thus, we designed a prospective trial as a preliminary study prior to a CRC chemoprevention trial to evaluate the chemopreventive effect of aspirin combined with metformin on colorectal ACF formation in patients scheduled for polypectomy. METHODS: This study is a double-blind randomized controlled trial that will be conducted in patients with both colorectal ACF and colorectal polyps scheduled for polypectomy. Eligible patients will be recruited for the study and the number of ACF in the rectum will be counted at the baseline colonoscopy. Then, the participants will be allocated to one of the following two groups; the aspirin plus placebo group or the aspirin plus metformin group. Patients in the aspirin plus placebo group will receive oral aspirin (100 mg) and placebo for 8 weeks, and those in the aspirin plus metformin group will receive oral aspirin (100 mg) and metformin (250 mg) for 8 weeks. After 8 weeks of administration, polypectomy will be performed to evaluate changes in the number of ACF, and the cell-proliferative activity in the normal colorectal mucosa and colorectal polyps. DISCUSSION: This is the first study proposed that will explore the effect of aspirin combined with metformin on the formation of colorectal ACF in humans. TRIAL REGISTRATION: This trial has been registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000028259 . Registered 17 July 2017.

    DOI: 10.1186/s12885-020-07564-z

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  • The protective effect of Bifidobacterium bifidum G9-1 against mucus degradation by Akkermansia muciniphila following small intestine injury caused by a proton pump inhibitor and aspirin. 国際誌

    Tsutomu Yoshihara, Yosuke Oikawa, Takayuki Kato, Takaomi Kessoku, Takashi Kobayashi, Shingo Kato, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Hidenori Ohkubo, Takuma Higurashi, Yoko Tateishi, Yoshiki Tanaka, Shunji Nakajima, Hiroshi Ohno, Koichiro Wada, Atsushi Nakajima

    Gut microbes   11 ( 5 )   1385 - 1404   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Proton pump inhibitors (PPIs) can alleviate upper gastrointestinal injury but paradoxically exacerbate aspirin (ASA)-induced small intestine injury. In this study, our goal was to simulate this exacerbation by developing an appropriate animal model, which may help in establishing treatments. Methods: Male mice were fed a 60% fructose diet for 9 weeks, then administered 200 mg/kg ASA 3 h before sacrifice. The PPI omeprazole was administered intraperitoneally once daily for 9 weeks. Bifidobacterium bifidum G9-1 was administered orally for the last week. In addition, Akkermansia muciniphila was administered orally for 9 weeks instead of omeprazole. Results: ASA-induced small-intestine injury was observed in high-fructose fed mice. Omeprazole exacerbated ASA-induced intestinal damage, significantly decreased Bifidobacteria levels, and significantly increased A. muciniphila counts in the jejunum. The direct administration of A. muciniphila caused thinning of the jejunum mucus layer, which was also observed in mice that received ASA and omeprazole. On the other hand, the administration of Bifidobacterium bifidum G9-1 inhibited A. muciniphila growth and reduced thinning of the mucus layer. The number of goblet cells in the jejunum was reduced by the administration of ASA and omeprazole, while Bifidobacterium bifidum G9-1 prevented the reduction. Conclusions: These results suggest that omeprazole-induced gut dysbiosis promotes Akkermansia growth and inhibits Bifidobacterium growth, leading to a thinning of the mucus layer through a reduction in goblet cells in the small intestine. Probiotics are, therefore, a promising approach for the treatment of small intestine injury.

    DOI: 10.1080/19490976.2020.1758290

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  • The benefit of elobixibat in chronic constipation is associated with faecal deoxycholic acid but not effects of altered microbiota. 国際誌

    Noboru Misawa, Takuma Higurashi, Tomohiro Takatsu, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Keiichi Ashikari, Takaomi Kessoku, Akiko Fuyuki, Tetsuya Matsuura, Hidenori Ohkubo, Haruki Usuda, Koichiro Wada, Nakayuki Naritaka, Hajime Takei, Hiroshi Nittono, Mitsuharu Matsumoto, Akira Honda, Atsushi Nakajima, Michael Camilleri

    Alimentary pharmacology & therapeutics   52 ( 5 )   821 - 828   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Elobixibat, a novel inhibitor of apical sodium-dependent bile acid transporter for treating chronic constipation, increases colonic bile acid concentrations, stimulating bowel function. However, it is not clear which bile acids are altered, or whether altered gut microbiota are associated with functional effects that may alter bowel function. AIMS: To investigate the effects of elobixibat on changes in the faecal concentrations of total and individual bile acids and in faecal microbiota. METHODS: This was a prospective, single-centre study. After baseline period, patients received 10 mg daily of elobixibat for 2 weeks. We evaluated the effects on bowel function, changes in faecal bile acid concentrations and composition of gut bacteria, before and after elobixibat administration. RESULTS: In the 30 patients analysed, the frequency of pre- and post-treatment bowel movements per fortnight was 7 and 10 (P < 0.001), respectively. The pre-treatment faecal bile acid concentration increased significantly from 10.9 to 15.0 µg/g stool post-treatment (P = 0.030), with a significant increase in faecal deoxycholic acid (pre-treatment 3.94 µg/g stool to post-treatment 5.02 µg/g stool, P = 0.036) and in glycine-conjugated deoxycholic and chenodeoxycholic acids. Shannon index was significantly decreased, but there were no significant changes at the genus and phylum levels. CONCLUSIONS: Short term treatment with elobixibat increased the concentrations of total bile acids and deoxycholic acid and decreased the diversity of faecal microbiota. The biological effects of elobixibat are associated with its effects on secretory bile acids, rather than the structural changes of an altered faecal microbiota.

    DOI: 10.1111/apt.15950

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  • Difference in Defecation Desire Between Patients With and Without Chronic Constipation: A Large-Scale Internet Survey. 国際誌

    Hidenori Ohkubo, Tomohiro Takatsu, Tsutomu Yoshihara, Noboru Misawa, Keiichi Ashikari, Akiko Fuyuki, Tetsuya Matsuura, Takuma Higurashi, Kouji Yamamoto, Heido Matsumoto, Takeo Odaka, Anthony J Lembo, Atsushi Nakajima

    Clinical and translational gastroenterology   11 ( 9 )   e00230   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Defecation desire (DD) is an important physiological component of normal defecation. However, knowledge of DD in the general population and in individuals with chronic constipation (CC) is lacking. We aimed to assess the prevalence of DD in the general population and individuals with CC and to understand the impact of treatment on DD among individuals with CC. METHODS: We conducted an online questionnaire survey targeting the Japanese general population in 2019. DD was reported as never, rarely, usually, or always. Individuals who self-reported constipation and met the Rome IV criteria for functional constipation but did not for irritable bowel syndrome were included in the CC group, while the same number of age-/sex-matched controls who met neither functional constipation nor irritable bowel syndrome criteria was included in the non-CC group. Individuals who reported DD as rarely or never were defined as having loss of DD (LODD). RESULTS: Of the 20,986 participants, 2,587 were included in the CC group (12.3%). LODD was significantly higher in the CC individuals than in the non-CC controls (57.4% vs 8.3%, respectively, P < 0.001, odds ratio 14.84 [95% confidence interval 12.65-17.42]). Satisfaction with treatment for constipation was lower in individuals with persistent LODD (25.9%) compared with those with improved LODD (56.5%) on treatment (P < 0.001, odds ratio 2.48 [1.39-4.43]). DISCUSSION: LODD is common in CC and is associated with decreased satisfaction to treatment. Greater attention should be paid to DD when treating patients with CC.

    DOI: 10.14309/ctg.0000000000000230

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  • The efficacy of a leukotriene receptor antagonist in the treatment of human rectal aberrant crypt foci: a nonrandomized, open-label, controlled trial. 国際誌

    Takuma Higurashi, Jun Arimoto, Keiichi Ashikari, Tomohiro Takatsu, Noboru Misawa, Tsutomu Yoshihara, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Atsushi Nakajima

    BMC cancer   20 ( 1 )   770 - 770   2020年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Leukotriene receptor antagonists (LTRAs) are broadly used for the management of allergic asthma and have recently been indicated to inhibit carcinogenesis and cancer cell growth. In colorectal cancer (CRC) chemoprevention studies, the occurrence of adenoma or CRC itself is generally set as the trial endpoint. Although the occurrence rate of CRC is the most confident endpoint, it is inappropriate for chemoprevention studies because CRC incidence rate is low in the general population and needed for long-term monitoring. Aberrant crypt foci (ACF), defined as lesions containing crypts that are larger in diameter and darker in methylene blue staining than normal crypts, are regarded to be a fine surrogate biomarker of CRC. Therefore, this prospective study was designed to explore the chemopreventive effect of LTRA on colonic ACF formation and the safety of the medicine in patients scheduled for a poly resection as a pilot trial leading the CRC chemoprevention trial. METHODS: This study is a nonrandomized, open-label, controlled trial in patients with colorectal ACF and polyps scheduled for a polypectomy. Participants meet the inclusion criteria will be recruited, and the number of ACF in the rectum will be counted at the baseline colonoscopic examination. Next, the participants will be assigned to the LTRA or no treatment group. Participants in the LTRA group will continue 10 mg of oral montelukast for 8 weeks, and those in the no treatment group will be observed without the administration of any additional drugs. At the end of the 8-week LTRA intervention period, a polypectomy will be conducted to evaluate the changes in the number of ACF, and cell proliferation in the normal colorectal epithelium will be analyzed. DISCUSSION: This will be the first study to investigate the effect of LTRAs on colorectal ACF formation in humans. TRIAL REGISTRATION: This trial has been registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000029926 . Registered 10 November 2017.

    DOI: 10.1186/s12885-020-07266-6

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  • 消化器疾患における共生微生物叢研究の新たな知見 エロビキシバット水和物投与による胆汁酸増加が慢性便秘症患者の腸内細菌叢に与える影響についての検討

    三澤 昇, 結束 貴臣, 中島 淳

    日本消化器病学会雑誌   117 ( 臨増総会 )   A76 - A76   2020年7月

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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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  • Clinical impact of evaluation of frailty in endoscopic submucosal dissection for early gastric cancer in elderly patients.

    Noboru Misawa, Takuma Higurashi, Jun Tachikawa, Hiroaki Tanabe, Tsutomu Yoshihara, Keiichi Ashikari, Kenji Kanoshima, Akiko Fuyuki, Hidenori Ohkubo, Yusuke Saigusa, Hideyuki Chiba, Takashi Nonaka, Hitoshi Kuriyama, Noritoshi Kobayashi, Atsushi Nakajima

    Geriatrics & gerontology international   20 ( 5 )   461 - 466   2020年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIMS: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is performed safely and effectively in elderly patients; however, whether ESD for EGC in elderly patients with frailty is safe and improves prognosis remains unclear. METHODS: In total, 142 patients aged ≥80 years who underwent ESD for EGC between September 2008 and September 2014 were included. We compared outcomes between patients with frailty and those without frailty. Frailty was assessed using the Clinical Frailty Scale (CFS) based on a patient's status before admission. Study endpoints were short- and long-term clinical outcomes after ESD. RESULTS: Patients were allocated into two groups: no frailty (CFS 1-3, n = 101) versus frailty (CFS 4-7, n = 41). Short-term clinical outcomes, specifically, adverse events and curability, did not differ between the two groups. For the long-term clinical outcomes, patients with frailty had significantly worse outcomes after ESD than those without frailty (the 3-year overall survival rates were 73.2% vs. 93.1%; P < 0.001 with log-rank test). The Cox proportional hazards model showed that frailty was only an independent risk factor for poor prognosis. CONCLUSIONS: ESD for EGC is safe for elderly patients with or without frailty. However, elderly patients with frailty have a significantly poorer prognosis than those without frailty after ESD. Our results indicate that the frailty evaluation may be helpful to determine whether ESD for EGC should be performed. Geriatr Gerontol Int 2020; 20: 461-466.

    DOI: 10.1111/ggi.13905

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  • Risk factors for incomplete polyp resection after cold snare polypectomy. 国際誌

    Jun Arimoto, Hideyuki Chiba, Takuma Higurashi, Ryo Fukui, Jun Tachikawa, Noboru Misawa, Keiichi Ashikari, Toshihiro Niikura, Hiroki Kuwabara, Michiko Nakaoka, Tohru Goto, Atsushi Nakajima

    International journal of colorectal disease   34 ( 9 )   1563 - 1569   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP. PURPOSE: Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP. METHODS: Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness. RESULTS: Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP. CONCLUSIONS: Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.

    DOI: 10.1007/s00384-019-03347-6

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  • Investigation of the Local Recurrence Rate after Colorectal Endoscopic Mucosal Resection: Is Incomplete Polyp Resection Really a Clinically Important Problem? Analysis of the Rationale for the "Resect and Discard" Strategy. 国際誌

    Jun Arimoto, Takuma Higurashi, Hideyuki Chiba, Noboru Misawa, Tsutomu Yoshihara, Takayuki Kato, Kenji Kanoshima, Akiko Fuyuki, Hidenori Ohkubo, Takashi Nonaka, Takamitsu Sato, Eiji Sakai, Hiroshi Iida, Tohru Goto, Atsushi Nakajima

    Canadian journal of gastroenterology & hepatology   2019   7243515 - 7243515   2019年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background/Aims: The "Resect and Discard" strategy is a potentially useful strategy. At present, only the lesion size and accuracy of diagnosis are cited as considerations for clinical adoption of this strategy. On the other hand, histopathology of the resected specimens after Endoscopic Mucosal Resection (EMR) reveals often an unclear or positive-margin status, implying Incomplete Polyp Resection (IPR). If IPR indeed increased the risk of local recurrence, histopathological evaluation of the margin would be indispensable and clinical adoption of this strategy is difficult. The aim of this study is to verify the association between IPR and the risk of local recurrence. Methods: The 1872 polyps and 603 EMR cases in 597 patients who had EMR between May 2013 and May 2014 were enrolled. The local recurrence rate until 3 years after the EMR in cases with the target lesions of the "Resect and Discard" strategy was determined in the negative-margin and IPR groups. Results: The final analysis was performed using the data of 1092 polyps, and 222 were categorized into the IPR group. There were no cases of recurrence in either of the groups. Conclusion: This is the world's first report conducted to examine the correlation of IPR and the local recurrence rate for clinical practice of "Resect and Discard" strategy. There is the possibility that pathological evaluation of the margins after EMR in patients with small polyps can be skipped.

    DOI: 10.1155/2019/7243515

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  • Continued Use of a Single Antiplatelet Agent Does Not Increase the Risk of Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection. 国際誌

    Jun Arimoto, Takuma Higurashi, Hideyuki Chiba, Noboru Misawa, Tsutomu Yoshihara, Takayuki Kato, Kenji Kanoshima, Akiko Fuyuki, Hidenori Ohkubo, Shungo Goto, Yuutaro Ishikawa, Jun Tachikawa, Keiichi Ashikari, Takashi Nonaka, Masataka Taguri, Hitoshi Kuriyama, Kazuhiro Atsukawa, Atsushi Nakajima

    Digestive diseases and sciences   63 ( 1 )   218 - 227   2018年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: With the aging of the population and rising incidence of thromboembolic events, the usage of antiplatelet agents is also increasing. There are few reports yet on the management of antiplatelet agents for patients undergoing colorectal endoscopic submucosal dissection (ESD). AIMS: The aim of this study is to evaluate whether continued administration of antiplatelet agents is associated with an increased rate of delayed bleeding after colorectal ESD. METHODS: A total of 1022 colorectal neoplasms in 927 patients were dissected at Yokohama City University Hospital and its three affiliate hospitals between July 2012 and June 2017. We included the data of 919 lesions in the final analysis. The lesions were divided into three groups: the no-antiplatelet group (783 neoplasms), the withdrawal group (110 neoplasms), and the continuation group (26 neoplasms). RESULTS: Among the 919 lesions, bleeding events occurred in a total of 31 (3.37%). The rate of bleeding after ESD was 3.3% (26/783), 4.5% (5/110), and 0% (0/26), respectively. There were no significant differences in the rate of bleeding after ESD among the three groups (the withdrawal group vs. the no-antiplatelet group, the continuation group vs. the no-antiplatelet group, and the withdrawal group vs. the continuation group). CONCLUSIONS: Continued administration of antiplatelet agents is not associated with any increase in the risk of delayed bleeding after colorectal ESD. Prospective, randomized studies are necessary to determine whether treatment with antiplatelet agents must be interrupted prior to colorectal ESD in patients who are at a high risk of thromboembolic events.

    DOI: 10.1007/s10620-017-4843-0

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    三澤 昇

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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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    その他リンク: https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00060&link_issn=&doc_id=20240528020003&doc_link_id=issn%3D0039-2359%26volume%3D289%26issue%3D8%26spage%3D546&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D289%26issue%3D8%26spage%3D546&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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  • 十二指腸非乳頭部腫瘍の治療成績と偶発症予防の工夫

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  • 当院における十二指腸非乳頭部腫瘍の治療成績

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    記述言語:日本語   出版者・発行元:(株)診断と治療社  

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    その他リンク: https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00697&link_issn=&doc_id=20220815080012&doc_link_id=%2Fae4digta%2F2022%2F011008%2F014%2F1015-1019%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4digta%2F2022%2F011008%2F014%2F1015-1019%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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    記述言語:日本語   出版者・発行元:(株)診断と治療社  

    <Headline>1 SIBOとは小腸内で細菌増殖が病的に起き、腹部膨満などの症状を訴える病態異常である。2 blind loop syndromeや小腸の蠕動低下で発生する。3 診断のゴールドスタンダードはゾンデ法による培養であるが、非侵襲的な水素呼気テストが行われる。(著者抄録)

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    その他リンク: https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00697&link_issn=&doc_id=20220714130008&doc_link_id=%2Fae4digta%2F2022%2F011007%2F009%2F0881-0885%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4digta%2F2022%2F011007%2F009%2F0881-0885%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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    三澤 昇, 立川 準, 吉原 努, 芦苅 圭一, 有本 純, 鹿野島 健二, 冬木 晶子, 大久保 秀則, 日暮 琢磨, 千葉 秀幸, 栗山 仁, 中島 淳

    日本消化器病学会雑誌   116 ( 臨増総会 )   A323 - A323   2019年3月

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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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  • 当院におけるクローン病に対するウステキヌマブの使用経験

    鹿野島 健二, 鈴木 洸, 三澤 昇, 吉原 努, 芦苅 圭一, 冬木 晶子, 大久保 秀則, 日暮 琢磨, 中島 淳

    日本消化器病学会雑誌   116 ( 臨増総会 )   A437 - A437   2019年3月

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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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  • MSI陽性胃癌の性差

    鈴木章浩, 三澤昇, 加藤真吾, 米田正人, 中島淳

    日本高齢消化器病学会誌   22 ( 1 )   2019年

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  • 内視鏡的切除をしえたfundic gland polyps with dysplasiaの一例

    春日範樹, 三澤昇, 吉原努, 芦苅圭一, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    日本消化管学会雑誌   3 ( Supplement )   2019年

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  • フレイルの観点から見た高齢者における胃ESDの適応に関する検討-多施設共同研究より-

    三澤昇, 立川準, 吉原努, 芦苅圭一, 有本純, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 千葉秀幸, 栗山仁, 中島淳

    日本消化器病学会雑誌(Web)   116   2019年

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  • 虚血性腸炎に類似した所見をとり,診断に苦慮した大腸アミロイドーシスの一例

    海老澤佑, 高津智弘, 吉原努, 三澤昇, 芦苅圭一, 松浦哲也, 冬木晶子, 日暮琢磨, 中島淳

    日本消化器病学会関東支部例会プログラム・抄録集   357th   2019年

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  • 当院におけるクローン病に対するウステキヌマブの使用経験

    鹿野島健二, 鈴木洸, 三澤昇, 吉原努, 芦苅圭一, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    日本消化器病学会雑誌(Web)   116   2019年

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  • 食道ESDにおけるプロポフォール・デクスメデトミジン併用鎮静の有効性と安全性

    芦苅圭一, 野中敬, 吉原努, 三澤昇, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    Gastroenterological Endoscopy (Web)   61 ( Supplement2 )   2019年

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  • 慢性便秘症患者の我が国における治療実態および便形状とQOLの関係;インターネットによる全国調査

    大久保秀則, 冬木晶子, 三澤昇, 日暮琢磨, 中島淳

    日本潰瘍学会プログラム・抄録集   47th   2019年

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  • 当院でEMRを施行した胃ポリープ3症例の検討

    河野豪, 芦苅圭一, 海老澤佑, 高津智弘, 三澤昇, 吉原努, 松浦哲也, 冬木晶子, 日暮琢磨, 中島淳

    Progress of Digestive Endoscopy   96 ( Supplement )   2019年

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  • 内視鏡的切除をしえたfundic gland polyps with dysplasiaの2例

    佐野誠, 三澤昇, 春日範樹, 吉原努, 芦苅圭一, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    日本消化器病学会関東支部例会プログラム・抄録集   354th   2019年

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  • 高齢者の消化器診療 高齢者慢性便秘

    三澤昇, 日暮琢磨, 中島淳

    月刊消化器・肝臓内科   6 ( 5 )   2019年

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  • 機能性消化管疾患:下部 I.総論 慢性便秘症の疫学と病因・病態

    大久保秀則, 三澤昇, 冬木晶子, 日暮琢磨, 中島淳

    日本臨床   77 ( 11 )   2019年

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  • アスピリン起因性小腸粘膜障害マウスモデルを用いた,PPIによる粘膜障害の増悪とプロバイオティクスによる治療の検討

    吉原努, 三澤昇, 芦苅圭一, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 結束貴臣, 中島淳

    消化器疾患病態治療研究会プログラム・抄録集   28th   2019年

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  • 脈管侵襲陽性胃粘膜内癌の臨床的特徴の検討

    芦苅圭一, 日暮琢磨, 中島淳, 三澤昇, 吉原努, 鹿野島健二, 冬木晶子, 大久保秀則, 三宅暁夫

    Gastroenterological Endoscopy (Web)   61 ( Supplement1 )   2019年

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  • アスピリン起因性小腸粘膜障害マウスモデルにおける,PPIおよびBifidobacterium bifidum G9-1投与による腸内細菌と腸管免疫の影響

    吉原努, 及川洋祐, 田中良紀, 加藤孝征, 結束貴臣, 三澤昇, 芦苅圭一, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    日本小腸学会学術集会プログラム・抄録集   57th   2019年

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  • 超高齢者における胃ESDの安全性と有効性に関する検討

    三澤昇, 日暮琢磨, 中島淳

    日本高齢消化器病学会誌   22 ( 1 )   2019年

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  • リハビリテーション医療に必要な薬物治療 第8回 排便障害(便秘症)

    三澤昇, 高津智弘, 吉原努, 芦苅圭一, 冬木晶子, 松浦哲也, 大久保秀則, 日暮琢磨, 中島淳

    総合リハビリテーション   47 ( 8 )   2019年

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  • シネMRIとカラーマップMRIの比較:慢性偽性腸閉塞症の新たな小腸蠕動評価方法

    大久保秀則, 冬木晶子, 三澤昇, 吉原努, 芦苅圭一, 鹿野島健二, 日暮琢磨, 中島淳

    日本消化管学会雑誌   3 ( Supplement )   2019年

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  • 過敏性腸症候群患者におけるQOLと症状重症度の評価

    冬木晶子, 日暮琢磨, 大久保秀則, 芦苅圭一, 三澤昇, 吉原努, 中島淳

    日本消化管学会雑誌   3 ( Supplement )   2019年

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  • アレルギー消化器疾患 食物摂取からみた機能性消化管疾患

    三澤昇, 日暮琢磨, 中島淳

    月刊消化器・肝臓内科   3 ( 5 )   2018年

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  • 内視鏡的に切除したSSA/P由来大腸癌の検討

    田村繁樹, 吉原努, 春日範樹, 三澤昇, 芦刈圭一, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 中島淳

    Progress of Digestive Endoscopy   94 ( Supplement )   2018年

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  • 過敏性腸症候群患者におけるQOLと疾患重症度の評価

    冬木晶子, 日暮琢磨, 大久保秀則, 鹿野島健二, 芦苅圭一, 三澤昇, 吉原努, 春日範樹, 中島淳

    日本神経消化器病学会プログラム・抄録集   20th   2018年

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  • 慢性偽性腸閉塞症(CIPO)の臨床像の解析-成人拠点病院における本邦最大規模の解析

    大久保秀則, 冬木晶子, 春日範樹, 吉原努, 三澤昇, 芦苅圭一, 鹿野島健二, 日暮琢磨, 中島淳

    日本神経消化器病学会プログラム・抄録集   20th   2018年

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  • 小腸のmotilityに関わる因子についてカプセル内視鏡を用いての検討

    三澤昇, 加藤孝征, 吉原努, 有本純, 鹿野島健二, 冬木晶子, 大久保秀則, 日暮琢磨, 亘育江, 中島淳

    Gastroenterological Endoscopy (Web)   60 ( Supplement1 )   2018年

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  • 当院の脳卒中後の自動車運転再開に向けた支援~取り組みの成果と今後の展望~

    三澤陵, 石田昇也, 涌井大樹, 平原由梨子, 海野寿美, 晴山剛行, 関谷宏美, 佐藤吉沖, 中島育昌

    回復期リハビリテーション病棟協会研究大会プログラム・抄録集   31st (CD-ROM)   2018年

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  • 大腸ESD施行時における抗血小板薬の取り扱いについての検討

    有本純, 日暮琢磨, 千葉秀幸, 三澤昇, 吉原努, 加藤孝征, 鹿野島健二, 冬木晶子, 大久保秀則, 後藤駿吾, 石川裕太郎, 立川準, 芦苅圭一, 野中敬, 栗山仁, 厚川和裕, 中島淳

    日本消化管学会雑誌   2 ( Supplement )   2018年

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  • 臨床的特徴に基づいた腹部膨満患者の治療戦略:自験例での検討

    大久保秀則, 冬木晶子, 吉原努, 三澤昇, 鹿野島健二, 加藤孝征, 日暮琢磨, 中島淳

    日本大腸肛門病学会雑誌(Web)   70   2017年

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  • 消化管機能障害と内視鏡〔小腸・大腸〕慢性便秘症の鑑別診断

    鹿野島健二, 吉原努, 三澤昇, 有本純, 加藤孝征, 冬木晶子, 日暮琢磨, 大久保秀則, 中島淳

    消化器内視鏡   29 ( 10 )   2017年

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  • 当院における大腸イレウスに対する金属ステント留置術治療後経過

    内山崇, 内山崇, 栗山仁, 岩瀬麻衣, 三澤昇, 岩崎綾, 鈴木章浩, 内田苗利, 谷口礼央, 村田依子, 秦康夫, 遠藤宏樹, 中島淳

    Progress of Digestive Endoscopy   87 ( Supplement )   2015年

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  • 超音波内視鏡での観察が有用であった腎癌胆嚢転移の一例

    谷口礼央, 栗山仁, 田邉浩紹, 石川裕太郎, 岩瀬麻衣, 三澤昇, 岩崎綾, 内田苗利, 村田依子, 秦康夫, 中島淳

    Progress of Digestive Endoscopy   88 ( Supplement )   2015年

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  • 体外式衝撃波結石破砕術(ESWL)によって採石し得た巨大総胆管結石の2例

    岩瀬麻衣, 栗山仁, 三澤昇, 岩崎綾, 鈴木章浩, 内田苗利, 谷口礼央, 内山崇, 村田依子, 遠藤宏樹, 秦康夫, 中島淳

    Progress of Digestive Endoscopy   87 ( Supplement )   2015年

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  • 超音波内視鏡にて深達度判診断し内視鏡的粘膜下層剥離術で治癒切除を得た10cm大の1型胃癌の一例

    谷口礼央, 栗山仁, 岩瀬麻衣, 三澤昇, 鈴木章浩, 内田苗利, 内山崇, 村田依子, 遠藤宏樹, 秦康夫, 中島淳

    Progress of Digestive Endoscopy   87 ( Supplement )   2015年

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  • 当院における超高齢者のERCP経験

    内山崇, 内山崇, 栗山仁, 岩瀬麻衣, 三澤昇, 岩崎綾, 鈴木章浩, 内田苗利, 谷口礼央, 村田依子, 秦康夫, 中島淳

    日本高齢消化器病学会誌   18 ( 1 )   2015年

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  • 胸部外科用インテリジェント手術機器システムの開発

    佐久間一郎, JOUNG Sanghyun, KIM Hongho, DE LANGE Paul, 安藤岳洋, 高田祐平, 小林英津子, 小野稔, KYO Shunei, 本村昇, 中島淳, 谷口和弘, 兵頭亮治, 岸宏亮, 高橋誠也, 小野田正弘, 宇野拓也, 三澤裕

    日本ロボット学会学術講演会予稿集(CD-ROM)   28th   2010年

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▼全件表示

共同研究・競争的資金等の研究課題

  • 胆汁酸性下痢症における新規診断法および革新的治療法の開発

    研究課題/領域番号:21K15955  2021年4月 - 2026年3月

    日本学術振興会  科学研究費助成事業  若手研究

    三澤 昇

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    配分額:4680000円 ( 直接経費:3600000円 、 間接経費:1080000円 )

    下痢症の治療は対症療法が中心となることが多く、使用できる薬剤の種類も限られており、治療に難渋することが日常臨床では多々見受けられる。胆汁酸性下痢症は、下痢型過敏性腸症候群(IBS-D:diarrhea-predominant irritable bowel syndrome)や機能性下痢症の患者に多数含まれていると考えられているが、診断法や治療法が確立されていないことから消化器病専門家の間でも疾患概念の認知度は低い疾患である。本研究では、C4(7α-hydroxy-4-cholesten-3-one)、FGF19(Fibroblast growth factor 19)を測定することにより、これまで診断が困難であった本疾患を採血で簡便に診断する方法を確立させ、さらに本疾患患者に陰イオン交換樹脂、プラセボを用いたRCTを実施し、本疾患の治療法を確立させることを目的としている。
    検討として、既存の治療ではコントロール不良な下痢症状を有するIBS-Dや機能性下痢症の患者を対象として、ベースライン期間(2週間)と陰イオン交換樹脂投与期間(2週間)の1日の平均排便回数の変化についての検討を策定した。その研究において、C4・FGF19を含めた血液検査を施行、効果があった患者と効果が無かった患者の比較検討を行い、陰イオン交換樹脂奏功群に対するC4、FGF19の診断感度やcut off設定を目指すこととした。
    上記検討について患者のリクルートを行った。

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