Publications by authors named "Koichi Kurahara"

31 Publications

Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high-volume centers.

Endoscopy 2021 Sep 8. Epub 2021 Sep 8.

Cancer Center, School of Medicine, Keio University, Tokyo, Japan.

Background And Study Aim: There is no enough data for endoscopic resection (ER) of superficial duodenal epithelial tumors (SDETs) due to its rarity. There are two main kinds of ER techniques for SDETs: EMR and ESD. In addition, modified EMR techniques, underwater EMR (UEMR) and cold polypectomy (CP), are getting popular. We conducted a large-scale retrospective multicenter study to clarify detailed outcomes of duodenal ER.

Patients And Methods: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs) (defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using Kaplan-Meier method.

Results: In total, 3107 patients (including 1017 receiving ESD) were included. En bloc resection rates were 79.1%, 78.6%, 86.8%, and 94.8%, and delayed AE rates were 0.5%, 2.2%, 2.8%, and 7.3% for CP, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher for ESD group than non-ESD group among lesions less than 19 mm (7.4% vs 1.9%, p<0.0001), but not among lesions larger than 20 mm (6.1% vs 7.1%, p=0.6432). The local recurrence rate was significantly lower in ESD group than non-ESD group (p<0.001). Furthermore, for lesions larger than 30 mm, the cumulative local recurrence rate at 2 years was 22.6% in non-ESD group compared to only 1.6% in ESD group (p<0.0001).

Conclusions: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.
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http://dx.doi.org/10.1055/a-1640-3236DOI Listing
September 2021

Gastric epithelial neoplasm of fundic-gland mucosa lineage: proposal for a new classification in association with gastric adenocarcinoma of fundic-gland type.

J Gastroenterol 2021 Sep 15;56(9):814-828. Epub 2021 Jul 15.

Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan.

Background: Gastric adenocarcinoma of fundic-gland type (GA-FG) is a rare variant of gastric neoplasia. However, the etiology, classification, and clinicopathological features of gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML; generic term of GA-FG related neoplasm) are not fully elucidated. We performed a large, multicenter, retrospective study to establish a new classification and clarify the clinicopathological features of GEN-FGML.

Methods: One hundred GEN-FGML lesions in 94 patients were collected from 35 institutions between 2008 and 2019. We designed a new histopathological classification of GEN-FGML using immunohistochemical analysis and analyzed via clinicopathological, immunohistochemical, and genetic evaluation.

Results: GEN-FGML was classified into 3 major types; oxyntic gland adenoma (OGA), GA-FG, and gastric adenocarcinoma of fundic-gland mucosa type (GA-FGM). In addition, GA-FGM was classified into 3 subtypes; Type 1 (organized with exposure type), Type 2 (disorganized with exposure type), and Type 3 (disorganized with non-exposure type). OGA and GA-FG demonstrated low-grade epithelial neoplasm, and GA-FGM should be categorized as an aggressive variant of GEN-FGML that demonstrated high-grade epithelial neoplasm (Type 2 > 1, 3). The frequent presence of GNAS mutation was a characteristic genetic feature of GEN-FGML (7/34, 20.6%; OGA 1/3, 33.3%; GA-FG 3/24, 12.5%; GA-FGM 3/7, 42.9%) in mutation analysis using next-generation sequencing.

Conclusions: We have established a new histopathological classification of GEN-FGML and propose a new lineage of gastric epithelial neoplasm that harbors recurrent GNAS mutation. This classification will be useful to estimate the malignant potential of GEN-FGML and establish an appropriate standard therapeutic approach.
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http://dx.doi.org/10.1007/s00535-021-01813-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370942PMC
September 2021

Early rectal cancer with perianal pagetoid spread.

Gastrointest Endosc 2021 May 7;93(5):1189-1190. Epub 2021 Jan 7.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

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http://dx.doi.org/10.1016/j.gie.2020.12.043DOI Listing
May 2021

Gastrointestinal involvement in patients with vasculitis: IgA vasculitis and eosinophilic granulomatosis with polyangiitis.

Endosc Int Open 2019 Nov 22;7(11):E1333-E1343. Epub 2019 Oct 22.

Division of Gastroenterology, Iwate Medical University, Morioka, Japan.

 Among vasculitides, IgA vasculitis (IgAV) and eosinophilic granulomatosis with polyangiitis (EGPA) frequently damage the gastrointestinal tract. However, only a few studies have investigated the entire gastrointestinal tract in patients with IgAV or EGPA by endoscopy. The aim of this study was to clarify endoscopic characteristics of patients with IgAV and those with EGPA.  Clinicopathological and endoscopic findings were retrospectively compared between 33 patients with IgAV and 19 patients with EGPA.  Gastrointestinal involvement was observed in 33 patients with IgAV (100 %) and in 8 patients with EPGA (42 %;  = 0.0001). Duodenal involvement was more frequent in patients with IgAV (75.8 %) than in those with EGPA (21.1 %,  = 0.0002). Jejunoileal involvement was frequent in both groups (IgAV 94.4 %; EGPA 77.8 %). Gastric mucosal erythema was more frequent in patients with IgAV (18.2 %) than in those with EGPA (0 %,  = 0.0481). Duodenal mucosal erythema (IgAV 54.6 %; EGPA 21.1 %,  = 0.0227), ulcer (IgAV 33.3 %; EGPA 0 %,  = 0.0041), and hematoma-like protrusion (IgAV 21.1 %; EGPA 0 %,  = 0.039) were more frequently observed in patients with IgAV than in those with EGPA.  Frequent duodenal involvement, gastric mucosal erythema, and duodenal lesions including erythema, ulcer, and hematoma-like protrusion are characteristic of patients with IgAV. Because jejunoileal involvement was frequent in both groups of patients, small-bowel endoscopies should be performed for diagnosis of small-bowel lesions in patients with IgAV and EGPA.
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http://dx.doi.org/10.1055/a-0977-2777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805183PMC
November 2019

Risk factors for reflux esophagitis after eradication of .

Scand J Gastroenterol 2019 Oct 2;54(10):1183-1188. Epub 2019 Oct 2.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

While there is an association between successful eradication of (HP) and reflux esophagitis (RE), risk factors associated with RE remain obscure. The aim of this study is to determine risk factors associated with the development of RE after HP eradication. Among all patients treated with successful HP eradication from 2008 to 2016, we retrospectively analyzed those who were free from RE at initial esophagogastroduodenoscopy (EGD) and who were followed up with EGD after eradication. Patients were classified according to the presence or absence of RE at the follow-up EGD. RE was defined as mucosal breaks proximal to the squamous-columnar junction. Demographic data, underlying diseases, medications and endoscopic findings at the initial EGD were compared between patients with and without RE. Among 1575 patients, 142 (9.0%) had RE at the follow-up EGD. The time interval from HP eradication until EGD ranged from 4 to 24 months. The endoscopic grade of RE was higher in males than in females. Multivariate analysis revealed that male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04-2.24), body mass index ≥25 kg/m (OR, 2.91; 95% CI, 2.00-4.22), use of calcium channel blockers (OR, 1.70; 95% CI, 1.12-2.55), and hiatal hernia (OR, 3.46; 95% CI, 2.41-5.00) were associated with the development of RE. Calcium channel blocker use was found to be a risk factor for the development of RE after eradication of HP.
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http://dx.doi.org/10.1080/00365521.2019.1671487DOI Listing
October 2019

An Unusual Cause of Gastric Tumors.

Gastroenterology 2020 01 31;158(1):e5-e6. Epub 2019 Jul 31.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

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http://dx.doi.org/10.1053/j.gastro.2019.07.047DOI Listing
January 2020

Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics.

Dig Endosc 2020 Mar 2;32(3):364-372. Epub 2019 Oct 2.

Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan.

Background And Aim: In Japan, the prevalence of autoimmune gastritis (AIG) is assumed to be very low. With the recent rapid decrease in Helicobacter pylori (Hp) prevalence, reports on AIG are increasing. This multicenter registry study aimed to clarify the characteristics of AIG, especially its endoscopic appearance.

Methods: A total of 245 patients with AIG from 11 institutions in Japan from January 2010 to October 2016 were included, and their clinical and endoscopic findings were evaluated.

Results: Mean age was 67.2 ± 11.4 years, and 63.7% of the participants were women. The most common approach to diagnose AIG was endoscopic examination. Repeated incorrect treatment for Hp infection, due to a false-positive result in C-urea breath test, ranked third among the basis for diagnosis of AIG. Associated gastric lesions were type 1 neuroendocrine tumor (11.4%), adenocarcinoma (9.8%), and hyperplastic polyps (21.1%). Corpus pan-atrophy was the most common appearance (90.1%); however, remnant oxyntic mucosa was found in 31.5% of the patients (flat, localized type, 48.6%). Sticky adherent dense mucus and scattered minute whitish protrusions were also observed in approximately 30% of the patients. Despite the prevailing presumption of the antral mucosa remaining normal, 42.3% of the patients presented with various extents of atrophy, and patchy redness and circular wrinkle-like patterns were both observed in approximately 20% of the patients.

Conclusions: The present study showed some prominent clinical characteristics and endoscopic findings of AIG. We believe that our study will facilitate the diagnosis of potential AIG.
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http://dx.doi.org/10.1111/den.13500DOI Listing
March 2020

Measurement of prostaglandin metabolites is useful in diagnosis of small bowel ulcerations.

World J Gastroenterol 2019 Apr;25(14):1753-1763

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka 020-8505, Japan.

Background: We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with gene (CEAS). Crohn's disease (CD) is a major differential diagnosis of CEAS, because these diseases share some clinical features. Therefore, there is a need to develop a convenient screening test to distinguish CEAS from CD.

Aim: To examine whether prostaglandin E major urinary metabolites (PGE-MUM) can serve as a biomarker to distinguish CEAS from CD.

Methods: This was a transactional study of 20 patients with CEAS and 98 patients with CD. CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of . We measured the concentration of PGE-MUM in spot urine by radioimmunoassay, and the concentration was compared between the two groups of patients. We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic (ROC) curve analysis.

Results: Twenty Japanese patients with CEAS and 98 patients with CD were enrolled. PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD (median 102.7 27.9 μg/g × Cre, < 0.0001). One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS [95% confidence interval (CI) 3.2-16.7]. A logistic regression analysis revealed that the association was significant even after adjusting confounding factors (adjusted odds ratio 29.6, 95%CI 4.7-185.7). ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9 μg/g × Cre with 95.0% sensitivity and 79.6% specificity.

Conclusion: PGE-MUM measurement is a convenient, non-invasive and useful test for the distinction of CEAS from CD.
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http://dx.doi.org/10.3748/wjg.v25.i14.1753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465938PMC
April 2019

Clinical usefulness of magnifying colonoscopy for the diagnosis of ulcerative colitis-associated neoplasia.

Dig Endosc 2019 Apr;31 Suppl 1:36-42

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

Background And Aim: The aim of this investigation was to evaluate the efficacy of Japanese magnifying colonoscopic classifications for ulcerative colitis-associated neoplasia (UCAN).

Methods: We reviewed the colonoscopy records from 2011 to 2018 at our institutions and identified cases of endoscopically or surgically resected UCAN observed by magnifying narrow-band imaging (NBI) endoscopy and magnifying chromoendoscopy. Association between magnifying endoscopic classification and histopathological findings was investigated retrospectively. Japan NBI expert team (JNET) classification and pit pattern classification were applied.

Results: There were 17 patients who had a diagnosis of UCAN. Tumors of types 2A, 2B and 3 by JNET classification correlated with the histopathological findings of low-grade dysplasia (LGD)/high-grade dysplasia (HGD), HGD, and massively submucosal invasive (mSM) carcinoma, respectively. Tumors of types III/IV, V low irregularity, and V high irregularity/V by pit pattern classification were correlated with the histopathological findings of LGD/HGD, HGD, and mSM carcinoma, respectively.

Conclusions: Japan NBI expert team classification and pit pattern classification may be predictive of the histological diagnosis and invasion depth of UCAN. This needs to be investigated prospectively in a large cohort or in a randomized clinical trial.
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http://dx.doi.org/10.1111/den.13382DOI Listing
April 2019

Secondary gastrointestinal amyloid A amyloidosis possibly caused by hidradenitis suppurativa.

Dig Endosc 2018 09 8;30(5):681. Epub 2018 Aug 8.

Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan.

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http://dx.doi.org/10.1111/den.13219DOI Listing
September 2018

Clinical features of chronic enteropathy associated with SLCO2A1 gene: a new entity clinically distinct from Crohn's disease.

J Gastroenterol 2018 Aug 8;53(8):907-915. Epub 2018 Jan 8.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: Chronic enteropathy associated with SLCO2A1 gene (CEAS) is a hereditary disease caused by mutations in the SLCO2A1 gene and characterized by multiple small intestinal ulcers of nonspecific histology. SLCO2A1 is also a causal gene of primary hypertrophic osteoarthropathy (PHO). However, little is known about the clinical features of CEAS or PHO.

Methods: Sixty-five Japanese patients recruited by a nationwide survey of CEAS during 2012-2016 were enrolled in this present study. We reviewed the clinical information of the genetically confirmed CEAS patients.

Results: We identified recessive SLCO2A1 mutations at 11 sites in 46 patients. Among the 46 patients genetically confirmed as CEAS, 13 were men and 33 were women. The median age at disease onset was 16.5 years, and parental consanguinity was present in 13 patients (28%). Anemia was present in 45 patients (98%), while a single patient experienced gross hematochezia. All patients showed relatively low inflammatory markers in blood tests (median CRP 0.20 mg/dl). The most frequently involved gastrointestinal site was the ileum (98%), although no patient had mucosal injuries in the terminal ileum. Mild digital clubbing or periostosis was found in 13 patients (28%), with five male patients fulfilling the major diagnostic criteria of PHO.

Conclusions: The clinical features of CEAS are distinct from those of Crohn's disease. Genetic analysis of the SLCO2A1 gene is therefore recommended in patients clinically suspected of having CEAS.
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http://dx.doi.org/10.1007/s00535-017-1426-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061663PMC
August 2018

Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case-control study.

Scand J Gastroenterol 2017 Sep 22;52(9):948-953. Epub 2017 May 22.

a Division of Gastroenterology, Department of Internal Medicine , Iwate Medical University , Morioka , Japan.

Objective: The aim of this study was to compare clinical characteristics and outcomes of bleeding gastroduodenal ulcer between patients taking antithrombotic medications and those not taking antithrombotic medications.

Methods: We performed a case-control study of 346 patients with endoscopically verified bleeding gastroduodenal ulcer, which included 173 cases taking antithrombotic medications throughout peri-bleeding period and 173 age- and sex-matched controls not taking antithrombotic medications.

Results: The cases showed less frequent Helicobacter pylori (H. pylori) infections (45.1% versus 60.7%, p = .005), more frequent duodenal location (31.8% versus 19.1%, p = .009), and more frequent rebleeding (13.9% versus 5.8%, p = .02) than the controls. Multivariate analysis revealed that duodenal location (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.37-6.65) and use of antithrombotic medications (OR 2.47, 95% CI 1.13-5.77) were independent factors for rebleeding. However, there were no differences in clinical outcomes, including final successful endoscopic hemostasis, need for surgical intervention, and mortality between cases and controls. Thromboembolic events did not occur in any cases and controls during the periendoscopic period.

Conclusions: Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithrombotic medications can be accepted for bleeding gastroduodenal ulcer.
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http://dx.doi.org/10.1080/00365521.2017.1328989DOI Listing
September 2017

Whipple's disease diagnosed using electron microscopy and polymerase chain reaction.

Nihon Shokakibyo Gakkai Zasshi 2016 ;113(11):1894-1900

Division of Gastroenterology, Matsuyama Red-cross Hospital.

A 50-year-old man presented with bloody diarrhea and 25-kg weight loss over 3 months. Upper and lower endoscopy showed diffuse shaggy white villi in the duodenum and terminal ileum. In addition, capsule endoscopy and double-balloon enteroscopy revealed shaggy white villi in the entire small intestine. Histological examination of biopsy specimens found the lamina propria of the duodenal and intestinal mucosa to be densely infiltrated by rich foamy macrophages that were periodic acid-Schiff-positive. Electron microscopy showed numerous bacilli in the lamina propria. Tropheryma whipplei DNA was detected in the specimens by polymerase chain reaction. Based on these findings, the patient was diagnosed with Whipple's disease. He was treated with a 2-week course of ceftriaxone followed by trimethoprim-sulfamethoxazole. At the 2-month follow up, diffuse white shaggy villi improved dramatically.
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http://dx.doi.org/10.11405/nisshoshi.113.1894DOI Listing
March 2017

Clinicopathologic Features of Inverted Serrated Lesions of the Large Bowel.

Digestion 2016 18;93(4):280-7. Epub 2016 May 18.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

Background/aims: Serrated lesions (SLs) of the large bowel occasionally manifest as inverted growths with endophytic expansion within the muscularis mucosa. The aims of this investigation were to investigate the incidence of inverted SLs (ISLs) among SLs and to describe the clinicopathologic features.

Methods: We reviewed the colonoscopy records from 2006 to 2014 at our institution and identified cases of endoscopically or surgically resected SLs, including hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps) and traditional serrated adenomas (TSAs). The incidence of ISLs among the SLs and their colonoscopic findings were investigated retrospectively.

Results: There were 35 HPs in 30 patients, 80 SSA/Ps in 65 patients and 70 TSAs in 65 patients. The incidence of ISLs was significantly higher among SSA/Ps (8.8%) and HPs (5.7%) than among TSAs (0%; p = 0.04). A predominant right-sided location, a flat-elevated configuration with a central depression and round-open pit pattern or expanded crypt openings were characteristic of ISLs of the SSA/P type.

Conclusions: Right-sided flat lesions with a central depression and round or expanded crypts are indicative of ISLs of the SSA/P type.
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http://dx.doi.org/10.1159/000446394DOI Listing
March 2017

Depressed Gastric Adenocarcinoma of the Fundic Gland Type.

Intern Med 2016 1;55(5):543-4. Epub 2016 Mar 1.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Japan.

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http://dx.doi.org/10.2169/internalmedicine.55.5706DOI Listing
July 2016

Significance of a white opaque substance under magnifying narrow-band imaging colonoscopy for the diagnosis of colorectal epithelial neoplasms.

Gastrointest Endosc 2015 Dec 30;82(6):1097-104. Epub 2015 Jul 30.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

Background And Aims: The aim of this study was to examine the significance of a white opaque substance (WOS) found on magnifying narrow-band imaging (M-NBI) for the diagnosis of colorectal neoplastic lesions.

Methods: We retrospectively reviewed colonoscopy records from 2006 to 2012 at our institution and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms observed by M-NBI colonoscopy. The colonoscopic and histologic characteristics of the lesions were compared between WOS-positive and WOS-negative lesions. We further classified the WOS as regular or irregular and compared the histologic characteristics between the two types of lesions.

Results: There were 105 WOS-positive lesions and 451 WOS-negative lesions. The former were subdivided into lesions with regular and irregular WOS. The incidence of high-grade dysplasia or carcinoma was significantly higher in WOS-positive lesions (61.9%) than in WOS-negative lesions (28.6%) (P < .05). Among the WOS-positive lesions, massive submucosal invasion was more frequent in lesions with irregular WOS (82.4%) than in those with regular WOS (1.4%) (P < .05). Among cancers with massive submucosal invasion, lymph node metastasis was more frequent in cancers with irregular WOS (17.4%) than in those with regular WOS or without the WOS (0%) (P < .05).

Conclusions: A WOS in colorectal neoplasms may be an optical marker for high-grade dysplasia and cancer. An irregular WOS may be indicative of massive submucosal invasion and lymph node metastasis.
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http://dx.doi.org/10.1016/j.gie.2015.06.023DOI Listing
December 2015

Primary small-bowel follicular lymphoma with a stenosis: radiographic and endoscopic findings.

Gastrointest Endosc 2016 Jan 11;83(1):267-8. Epub 2015 Jul 11.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

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http://dx.doi.org/10.1016/j.gie.2015.06.006DOI Listing
January 2016

Time trends of the impact of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs on peptic ulcer bleeding in Japanese patients.

Digestion 2015 20;91(1):37-41. Epub 2015 Jan 20.

Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan.

Background/aims: Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The purpose of the present study was to elucidate the time trends of the impact of H. pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer bleeding (PUB) in Japanese patients.

Methods: We retrospectively reviewed 719 patients who had received endoscopic hemostasis for PUB between 2002 and 2013. Subjects were divided into either the first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n = 356). The clinical characteristics of the patients, including the prevalence of H. pylori infection and use of NSAIDs and antithrombotic agents, were compared between the two groups.

Results: Compared to the first-half group, patients in the second-half group were characterized by older age (proportion of the patients above 60 years old, 63.9 vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p < 0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant difference was observed regarding the use of antithrombotic agents between the two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and proportion of patients above 60 years old were significantly different between the two groups in a multivariate analysis.

Conclusion: The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.
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http://dx.doi.org/10.1159/000368810DOI Listing
September 2015

Pyogenic granuloma of the ileum depicted by small-bowel radiography, capsule endoscopy and double balloon endoscopy.

Dig Liver Dis 2015 May 5;47(5):436. Epub 2014 Dec 5.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.

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http://dx.doi.org/10.1016/j.dld.2014.11.014DOI Listing
May 2015

Endoscopic findings of indolent systemic mastocytosis involving the colon.

Endoscopy 2014 19;46 Suppl 1 UCTN:E678-9. Epub 2014 Dec 19.

Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan.

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http://dx.doi.org/10.1055/s-0034-1390916DOI Listing
September 2015

Gastric tuberculosis resembling depressed type, early gastric cancer.

Endoscopy 2014 19;46 Suppl 1 UCTN:E669-70. Epub 2014 Dec 19.

Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan.

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http://dx.doi.org/10.1055/s-0034-1390865DOI Listing
September 2015

Primary small-bowel adult T-cell leukemia/lymphoma with gastric AL amyloidosis.

Endoscopy 2014 11;46 Suppl 1 UCTN:E613-4. Epub 2014 Dec 11.

Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan.

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http://dx.doi.org/10.1055/s-0034-1390757DOI Listing
September 2015

Low-Dose Aspirin and Non-steroidal Anti-inflammatory Drugs Increase the Risk of Bleeding in Patients with Gastroduodenal Ulcer.

Dig Dis Sci 2015 Apr 1;60(4):1010-5. Epub 2014 Nov 1.

Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505, Japan,

Background: Non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), non-aspirin antiplatelet medications (APs), and anticoagulant medications (ACs) increase the risk of gastrointestinal bleeding.

Aim: To examine whether NSAIDs, LDA, APs, and ACs use is associated with bleeding from gastroduodenal ulcers.

Methods: This was a case-control study of patients with endoscopically verified gastroduodenal ulcer diagnosed at our institution from 2004 to 2011. Among 1,611 patients, we identified those who required endoscopic hemostasis for bleeding ulcers as cases. Age-matched, sex-matched, and Helicobacter pylori status-matched patients who did not require therapeutic interventions served as controls. Use of NSAIDs, LDA, APs, and ACs within 2 weeks prior to the endoscopy was compared between cases and controls, and effects on ulcer bleeding were calculated.

Results: We recruited 341 cases and 668 controls. The site and number of ulcers were not different between groups. Multivariate analyses revealed that LDA and NSAIDs, individually, were associated with the increase in the risk of bleeding (OR 1.80 and 95 % CI 1.18-2.75 for LDA; 1.35 and 1.01-1.80 for NSAIDs). In addition, a combination of LDA and NSAIDs or LDA and APs contributed more profoundly to the bleeding (OR 3.59 and 95 % CI 1.19-10.81 for LDA/NSAIDs; OR 6.70 and 95 % CI 1.83-24.50 for LDA/APs). However, ACs, alone or in combination, were not associated with bleeding ulcers.

Conclusions: Both LDA and NSAIDs are risk factors for upper GI bleeding in patients with gastroduodenal ulcer, while ACs are unrelated to the increased risk. The risk of bleeding with LDA may increase with simultaneous use of APs.
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http://dx.doi.org/10.1007/s10620-014-3415-9DOI Listing
April 2015

Management and clinical outcomes of type I gastric carcinoid patients: retrospective, multicenter study in Japan.

Dig Endosc 2014 May 5;26(3):377-84. Epub 2013 Nov 5.

Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background And Aim: Type I gastric carcinoids (TIGC) are associated with chronic atrophic gastritis (CAG) with hypergastrinemia and hyperplasia of enterochromaffin-like cells. Several treatment options are currently available for these tumors including total gastrectomy, partial resection, antrectomy, endoscopic resection and endoscopic surveillance. The present study evaluated different treatment approaches and clinical outcomes of patients with TIGC in Japan.

Methods: Between 1991 and 2011, 82 patients with TIGC were identified at multicenter institutions in Japan. Patient demographics, tumor size, depth of invasion, vessel involvement, treatment approach, Helicobacter pylori infection, serum gastrin level, recurrence-free survival (RFS) and disease-specific survival (DSS) were analyzed.

Results: Median age of all patients at the time of diagnosis was 56 years (range, 24-79 years). There were 44 males and 38 females. Patients underwent endoscopic surveillance (n=25), endoscopic resection (n=41) or surgical resection (n=16). Intramucosal invasion was found in 19 patients, submucosal invasion in 44 patients and muscularis propria invasion in one patient. Tumor diameter was ≤ 10 mm in 71 patients, 11-20mm in five patients and ≥ 21 mm in five patients. None of the patients showed rapidly growing tumors, local recurrence or metastasis. The median (range) follow-up period was 7(0-20) years. RFS was 97.6% and DSS was 100% in all the patients.

Conclusion: The prognosis of TIGC patients treated by different modalities in Japan is favorable regardless of the generational change of management for TIGC.
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http://dx.doi.org/10.1111/den.12197DOI Listing
May 2014

[Present status of gastrointestinal damage due to non-steroidal anti-inflammatory drugs (NSAIDs)].

Nihon Rinsho 2013 Jun;71(6):1109-15

Department of Gastroenterology, Kagawa Prefectural Central Hospital.

Non-steroidal anti-inflammatory drugs (NSAIDs) are roughly divided into a low-dose aspirin group used for primary and secondary prevention of cardiovascular events and non-aspirin NSAIDs used for treatment of bone and joint diseases. Both cause gastrointestinal damage directly or indirectly. In the present study, we reviewed gastrointestinal damage due to non-aspirin NSAIDs with respect to the esophagus, stomach/duodenum, small intestine and colon. Damage due to NSAIDs occurs in all digestive tracts and since the analgesic effect of NSIADs hides subjective symptoms, the symptoms are often not treated until they are advanced to a serious state. Further, patients receiving NSAIDs are mostly elderly and have complications so that the onset of the conditions is serious and prevention is important. It is necessary to investigate a method that is effective for preventing damage for all digestive tracts and the mechanisms of damage must be understood for this reason.
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June 2013

[Clinicopathological features of serrated lesions of the colorectum].

Nihon Shokakibyo Gakkai Zasshi 2012 Sep;109(9):1546-55

Division of Gastroenterology, Matsuyama Red Cross Hospital.

We reviewed 428 subjects with colorectal serrated lesions resected endoscopically or surgically at our institution. Colorectal serrated lesions were pathologically divided into 3 groups: hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA). SSA/P was detected frequently in the right colon and SSA/P was mainly flat-elevated. Cancers occurring in SSA/P were found more frequently than HP or TSA. The incidence of cancer in SSA/P was equivalent to that of cancer in traditional adenoma. Further studies are warranted to clarify clinicopathological features of serrated lesions of the colorectum.
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September 2012

[Characteristics of nonsteroidal anti-inflammatory drugs-induced colopathy].

Nihon Rinsho 2011 Jun;69(6):1098-103

Division of Gastroenterology, Matsuyama Red-Cross Hospital.

Nonsteroidal anti-inflammatory drugs (NSAIDs) induce a broad spectrum of toxicologic manifestations throughout the gastrointestinal tract, including the large intestine. Even though several studies indicated that NSAIDs can cause perforation and bleeding of diverticula or they exacerbate inflammatory bowel disease, NSAIDs possibly damage the normal large intestine; such involvement has been characterized by ulceration, stricture and colitis. And NSAIDs might be an etiological factor in collagenous colitis. While severe stricture, which has been referred to as "diaphragm-like stricture", has been known to be the most characteristic phenotype of the colonic involvement, NSAIDs-induced colonic ulceration should be regarded as a preceding stage for the stricture formation. Further epidemiological studies and therapeutic trials are warranted to clarify NSAIDs-induced colopathy.
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June 2011

Translocation t(14;18)/IGH-BCL2 in gastrointestinal follicular lymphoma: correlation with clinicopathologic features in 48 patients.

Cancer 2011 Jun 29;117(11):2467-77. Epub 2010 Dec 29.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: Chromosomal translocation t(14;18)(q32;q21) involving the immunoglobulin heavy chain gene (IGH) and the BCL2 gene (t[14;18][q32;q21]/IGH-BCL2) is present in 60% to 90% of nodal follicular lymphomas. To the authors' knowledge, the prevalence and clinical significance of this translocation have not been examined previously in gastrointestinal follicular lymphomas.

Methods: Clinicopathologic and molecular features were investigated in 48 patients who had gastrointestinal follicular lymphoma. The site of involvement was the duodenum in 54% of patients, the jejunum in 52%, the ileum in 52%, the stomach in 29%, and the colorectum in 15%. The presence of the t(14;18)/IGH-BCL2 translocation was detected by interphase fluorescence in situ hybridization.

Results: Treatment modalities included surgical resection (n = 16), rituximab plus chemotherapy (n = 13), rituximab alone (n = 6), antibiotics (n = 5), and watchful waiting (n = 8). Complete remission (CR) of lymphoma was achieved in 31 patients (65%). The overall survival and event-free survival rates after 5 years were 93% and 68%, respectively. The t(14;18)/IGH-BCL2 was detected in 39 patients (81%). The involvement of multiple sites (69% vs 0%), manifestation of the lymphomatous polyposis type (72% vs 22%), and histologic grade 1 or 2 tumors (92% vs 56%) were more frequent in the t(14;18)-positive group than in the negative group. In addition, the CR rate was lower in the t(14;18)-positive group than in the negative group (56% vs 100%; P = .0179), and a trend was observed toward poorer event-free survival in the positive group (P = .089).

Conclusions: The t(14;18)/IGH-BCL2 chromosomal translocation occurred frequently in gastrointestinal follicular lymphomas. The current results indicated that this translocation may be a predictor of an adverse clinical course.
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http://dx.doi.org/10.1002/cncr.25811DOI Listing
June 2011

Double-contrast barium enteroclysis as a patency tool for nonsteroidal anti-inflammatory drug-induced enteropathy.

Dig Dis Sci 2011 Nov 13;56(11):3247-53. Epub 2011 May 13.

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.

Background: Evaluating small bowel patency is recommended for capsule endoscopy in patients suspected of nonsteroidal anti-inflammatory drug-induced (NSAID) enteropathy.

Aims: The aim of this investigation was to examine whether radiography is a candidate of patency tool in NSAID enteropathy.

Methods: We reviewed double-contrast barium enteroclysis in 21 patients with NSAID enteropathy diagnosed either by capsule endoscopy or balloon-assisted endoscopy. The endoscopic findings were classified into circular ulcers, linear ulcers and small mucosal defects. The radiographic signs of the corresponding endoscopic findings were retrieved and the depiction rate was calculated.

Results: Of the 21 patients, endoscopy detected circular ulcers, linear ulcers, and small ulcers in 12, 3 and 12 patients, respectively. Small bowel radiography depicted circular narrowing as pseudo-folds in 10 patients (83%) and linear ulcers as eccentric rigidity in 2 patients (67%). However, radiography was able to depict small mucosal defects in only 3 patients (17%). Two of 5 patients with pseudo-folds experienced retention of the capsule.

Conclusion: "Pseudo-folds" is a sign corresponding to circular ulcer in NSAID enteropathy, which may be predictive of capsule retention.
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http://dx.doi.org/10.1007/s10620-011-1742-7DOI Listing
November 2011

[Clinical features of nonsteroidal anti-inflammatory drug-induced colopathy].

Nihon Rinsho 2007 Oct;65(10):1875-8

Division of Gastroenterology, Matsuyama Red-Cross Hospital.

NSAID induce a broad spectrum of toxicologic manifestations throughout the gastrointestinal tract, including the large intestine. Even though several studies indicated that NSAIDs can cause perforation and bleeding of diverticula or they exacerbate inflammatory bowel disease, NSAIDs possibly damage the normal large intestine; such involvement has been characterized by ulceration, stricture, colitis and the suppository induced rectal ulcer or proctitis. While severe stricture, which has been referred to as "diaphragm-like stricture", has been known to be the most characteristic phenotype of the colonic involvement, NSAID-induced colonic ulceration should be regarded as a preceding stage for the stricture formation. Further epidemiological studies and therapeutic trials are warranted to clarify NSAID-induced colopathy.
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October 2007
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