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BACKGROUND/AIMS: Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people. METHODS: A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. RESULTS: The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). CONCLUSION: Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

DOI： 10.5056/jnm23015

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Double-stranded RNA-activated protein kinase R (PKR) is highly expressed in colorectal cancer (CRC). However, the role of PKR in CRC remains unclear. The aim of this study was to clarify whether C16 (a PKR inhibitor) exhibits antitumor effects and to identify its target pathway in CRC. We evaluated the effects of C16 on CRC cell lines using the MTS assay. Enrichment analysis was performed to identify the target pathway of C16. The cell cycle was analyzed using flow cytometry. Finally, we used immunohistochemistry to examine human CRC specimens. C16 suppressed the proliferation of CRC cells. Gene Ontology (GO) analysis revealed that the cell cycle-related GO category was substantially enriched in CRC cells treated with C16. C16 treatment resulted in G1 arrest and increased p21 protein and mRNA expression. Moreover, p21 expression was associated with CRC development as observed using immunohistochemical analysis of human CRC tissues. C16 upregulates p21 expression in CRC cells to regulate cell cycle and suppress tumor growth. Thus, PKR inhibitors may serve as a new treatment option for patients with CRC.

DOI： 10.1038/s41598-024-59671-7

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The association between ulcerative colitis (UC) and erectile dysfunction (ED) has been previously reported. Numerous previous studies have also reported an association between gastrointestinal symptoms and ED. Constipation and diarrhea are common in patients with UC. However, the specific association between bowel movement frequency and ED remains unclear. The aim of this study is to investigate the association between bowel movement frequency and ED in 164 patients with UC. The definition of ED, moderate to severe ED, and severe ED was the Sexual Health Inventory for Men score <22, <12, and <8, respectively. Bowel movement frequency was divided into three categories: (1) high (More than once a day), (2) normal (once a day, reference), and low (less than one time/day). The definition of constipation was based on the Rome I criteria and/or medication for constipation. The prevalence of constipation and ED was 10.4% and 86.0%, respectively. The rate of high, normal, and low bowel movement frequency was 56.1%, 25.0%, and 18.9%, respectively. High bowel movement frequency was independently and positively associated with ED and moderate to severe ED (ED: adjusted odds ratio [OR] 4.42, 95% confidence interval [CI] 1.35-15.98; moderate to severe: adjusted OR 2.98, 95% CI 1.22-7.61). Low bowel movement frequency was independently and positively associated with moderate to severe ED and severe ED (moderate to severe: adjusted OR 3.96, 95% CI 1.27-13.08; severe: adjusted OR 3.20, 95% CI 1.08-9.86). No association between constipation and ED was found. In conclusion, in Japanese patients with UC, both high and low bowel movement frequency were independently and positively associated with ED.

DOI： 10.1038/s41443-024-00884-9

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BACKGROUND: Constipation is a common gastrointestinal symptom in patients with ulcerative colitis (UC). Several studies on the general population have demonstrated a link between allergic diseases and constipation. However, evidence regarding the association between allergic diseases and constipation in UC is limited. This study aims to evaluate this issue in Japanese patients with UC. METHODS: This cross-sectional study recruited consecutive 387 patients with UC. We used a self-administered questionnaire to estimate the prevalence of physician-diagnosed allergic diseases. The definition of constipation was based on Rome I criteria and/or medication for constipation. RESULTS: The prevalence of constipation was 12.5%. The prevalence rates of asthma, atopic dermatitis, pollen allergy, food allergy, and drug allergy were 11.8%, 9.0%, 36.3%, 6.2%, and 8.3%, respectively. Allergic diseases were not associated with constipation (adjusted odds ratio [OR] with asthma (adjusted OR 0.98 [95% confidence interval [CI] 0.27-2.80]), atopic dermatitis (adjusted OR 0.67 [95% CI 0.10-2.56]), pollen allergy (adjusted OR 0.92 [95% CI 0.41-1.97]), food allergy (adjusted OR 0.76 [95% CI 0.11-2.95]), and drug allergy (adjusted OR 1.06 [95% CI 0.28-3.24]). Additionally, the number of allergic diseases was not associated with the prevalence of constipation. CONCLUSIONS: In Japanese UC patients, no association between allergic diseases and constipation was found.

DOI： 10.7759/cureus.55912

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BACKGROUND: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. METHODS: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%-6.4%, 6.5%-7.4%, and ≥7.5%. RESULTS: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%-6.4%, 6.5%-7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%- 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. CONCLUSION: Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%-7.4%, contributing to NAFLD progression.

DOI： 10.4093/dmj.2023.0200

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Socioeconomic status is a risk factor for poor disease prognosis. No studies of patients with ulcerative colitis (UC) have investigated the association between socioeconomic status and erectile dysfunction (ED), although UC is independently positively associated with ED. Therefore, the purpose of this survey to evaluate this issue in Japanese patients with UC. The study enrolled 165 patients with UC. Education status (low, middle, high) and household income (low, middle, high) were classified in three groups using self-administered surveys. The information regarding the Sexual Health Inventory for Men (SHIM) was obtained using self-administered questionnaires. The definition of mild to moderate or severe ED and severe ED was SHIM score <17 and SHIM score <8, respectively. The prevalence of mild to moderate or severe ED and severe ED was 64.9% and 47.9%, respectively. In crude analysis, household income was inversely associated with mild to moderate or severe ED and severe ED. After adjustment for age, current drinking, current smoking, exercise habit, body mass index, mucosal healing, and duration of UC, high household income was independently and inversely associated with mild to moderate or severe ED (adjusted odds ratio [OR] 0.23, 95% confidence interval [CI] [0.05, 0.93], p for trend = .038) and severe ED (adjusted OR 0.26, 95% CI [0.07, 0.85], p for trend = .024). In contrast, no association between education status and ED was found. In conclusion, household income was independently and inversely associated with ED in Japanese UC patients.

DOI： 10.1177/15579883241256833

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BACKGROUND AND AIM: Although diet is one of the potential environmental factors affecting ulcerative colitis (UC), evidence is not sufficient to draw definitive conclusions. This Japanese case-control study examined the association between the consumption of coffee, other caffeine-containing beverages and food, and total caffeine and the risk of UC. METHODS: The study involved 384 UC cases and 665 control subjects. Intake of coffee, decaffeinated coffee, black tea, green tea, oolong tea, carbonated soft drinks, and chocolate snacks was measured with a semiquantitative food-frequency questionnaire. Adjustments were made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, body mass index, and intake of vitamin C, retinol, and total energy. RESULTS: Higher consumption of coffee and carbonated soft drinks was associated with a reduced risk of UC with a significant dose-response relationship (P for trend for coffee and carbonated soft drinks were <0.0001 and 0.01, respectively), whereas higher consumption of chocolate snacks was significantly associated with an increased risk of UC. No association was observed between consumption of decaffeinated coffee, black tea, green tea, or oolong tea and the risk of UC. Total caffeine intake was inversely associated with the risk of UC; the adjusted odds ratio between extreme quartiles was 0.44 (95% confidence interval: 0.29-0.67; P for trend <0.0001). CONCLUSIONS: We confirmed that intake of coffee and caffeine is also associated with a reduced risk of UC in Japan where people consume relatively low quantities of coffee compared with Western countries.

DOI： 10.1111/jgh.16439

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INTRODUCTION: There is evidence regarding the association between dysmenorrhea and irritable bowel syndrome (IBS), although it is lacking in the Asian population. Therefore, the purpose of this study was to investigate the association between menstrual status and IBS in a young Japanese. METHODS: Overall, 4693 female college students were included in the analysis of this study. Information regarding lifestyle habits, menstrual status (irregularity, pain severity, and medication), and IBS (Rome III criteria) was obtained using a self-reported questionnaire. Age, body mass index, exercise habits, smoking, drinking habits, and anemia were analyzed as potential confounders. RESULTS: The prevalence of IBS was 6.1%. Moderate (adjusted odds ratio [OR]: 1.89 [95% confidence interval (CI): 1.27-2.91]) and heavy (adjusted OR: 2.14 [95% CI: 1.42-3.45]) menstrual pain was independently positively associated with IBS (p for trend = 0.001). Using medication sometimes (adjusted OR: 1.41 [95% CI: 1.09-1.84]) and often (adjusted OR: 1.60 [95% CI: 1.13-2.24]) was independently positively associated with IBS. There was no association between menstrual cycle and IBS. In subjects without functional dyspepsia, irregular menstrual cycle was independently positively associated with IBS. CONCLUSION: In the young Japanese population, menstrual pain and medications for menstrual pain may have a significant positive association with IBS.

DOI： 10.1159/000533264

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AIM: Hepatitis C complicated by diabetes mellitus (DM) is considered a risk factor for the progression of fibrosis and development of hepatocellular carcinoma (HCC) and cardiovascular diseases. However, several studies may have lacked appropriate diagnosis of glucose intolerance. We aimed to examine the risk associated with abnormal glucose intolerance in the development of liver-related diseases, including HCC and complications of liver cirrhosis, such as ascites, esophageal and gastric varices, and hepatic encephalopathy, and cardiovascular diseases in patients with hepatitis C accurately diagnosed with impaired glucose tolerance. METHODS: This longitudinal retrospective study included 365 patients with chronic hepatitis C admitted to Ehime University Hospital for anti-hepatitis C therapy between September 1991 and January 2015. Patients were classified into normal glucose tolerance (NGT), prediabetes, and DM groups based on 75-g oral glucose tolerance test results. RESULTS: Both univariate and multivariate (adjusted for potential confounders) analyses revealed a significantly higher risk of developing HCC and cardiovascular events in the DM group than in the NGT group. However, in multivariate analysis, liver-related events, particularly liver cirrhosis complications, revealed no significant association. In addition, the prediabetes group had no significant risk of any outcome. CONCLUSIONS: Patients with hepatitis C complicated by DM, compared with patients with hepatitis C with NGT or complicated with prediabetes, have a higher risk of HCC and cardiovascular disease events, but not liver-related events, particularly in not developing liver cirrhosis complications. Therefore, appropriate follow-up is required for patients with hepatitis C based on their glucose tolerance status.

DOI： 10.1111/hepr.13925

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OBJECTIVE: To investigate the association between nocturia and constipation in patients with ulcerative colitis (UC). Constipation has recently been recognized as an important symptom in patients with UC. Although nocturia has been associated with constipation in the general population, the association between nocturia and constipation in UC patients is uncertain. METHODS: Consecutive series of 290 Japanese patients with UC, Information on constipation, nocturia, and lifestyle habits was obtained using self-administered questionnaires. The definition of constipation was based on Rome I criteria and/or current medication for constipation. Patients were divided into three groups based on nighttime urination: 1) no nocturia, 2) mild nocturia (nocturnal urination - one), and 3) serious nocturia (nocturnal urination - two or more). Multivariate logistic regression was used to evaluate the association between nocturia and constipation. RESULTS: Among all of the UC patients, the prevalence of mild nocturia, serious nocturia, and constipation was 35.2%, 26.9%, and 12.4%, respectively. The prevalence of constipation in the none, mild, and serious nocturia groups was 8.2%, 10.8%, and 20.5%, respectively. After adjustment for confounders such as age, sex, current drinking, current smoking, body mass index, and steroid use, nocturia severity was independently and positively associated with constipation (adjusted odds ratio for mild nocturia: 1.55 [95% confidence interval: 0.57-4.28], serious nocturia: 3.19 [95% confidence interval: 1.09-9.81], p for trend = 0.035). CONCLUSIONS: The severity of nocturia is positively associated with constipation, and physicians should consider the interrelationships between nocturia and constipation in managing UC patients.

DOI： 10.1016/j.urology.2023.07.035

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OBJECTIVE: Evidence regarding the association between exercise habits and irritable bowel syndrome (IBS) remains scarce in a young population. It is also unknown whether the existence of an exercise partner affects this issue. The purpose of this study was to explore the association between exercise habits that include an exercise partner and IBS in a young Japanese population. METHODS: This study enrolled 8923 Japanese university students and examined exercise frequency and intensity, and exercise partners using self-administered questionnaires. IBS and functional dyspepsia were defined according to the Rome III criteria. RESULTS: The prevalence of IBS in this survey was 6.5%. Moderate frequency exercise was inversely related with IBS [adjusted odds ratio (aOR): 0.65 (95% confidence interval, CI: 0.51-0.83), P for trend = 0.005]. Moderate and high exercise intensities were independently and inversely related with IBS, respectively [aORs were moderate: 0.76 (95% CI: 0.61-0.95) and high: 0.62 (95% CI: 0.48-0.78), P for trend = 0.001]. Exercising with a group or with friends instead of alone was independently inversely related with IBS [aOR with groups: 0.53 (95% CI: 0.40-0.70) and with friends: aOR 0.71 (95% CI: 0.54-0.93)]. After excluding subjects with overlapping IBS and functional dyspepsia, an inverse association between high intensity of exercise or exercise in a group and IBS remained significant. CONCLUSION: The frequency and intensity of exercise may be independently inversely related with IBS in a young Japanese population. Also, exercise with others may be important for preventing IBS.

DOI： 10.1097/MEG.0000000000002561

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BACKGROUND: The association between disease activity and erectile dysfunction (ED) in patients with inflammatory bowel disease (IBD) is inconsistent, although IBD, including ulcerative colitis (UC), is reported as a risk factor for ED. AIM: The purpose of this study was to explore this association in Japanese patients with UC. METHODS: In this study, we enrolled 165 Japanese male patients with UC. Information regarding the Sexual Health Inventory for Men (SHIM) score, medication, and severity of UC was obtained from medical records, self-administered questionnaires, and reports from physicians. The definition of ED and severe ED is a SHIM score <17 and <8, respectively. OUTCOMES: No association between severity of UC and ED was found in Japanese patients. Aging is independently positively associated with ED in patients with UC. RESULTS: The prevalence of severe ED and ED was 47.9% and 64.9%, respectively. In this study, mucosal healing, clinical remission, duration of UC, disease extent, and medication were not associated with the prevalence of ED. Older age (≥63 years of age) was independently positively associated with ED (adjusted odds ratio, 12.93; 95% CI: 4.51-43.00) and severe ED (adjusted odds ratio, 9.02; 95% CI: 3.66-23.91). CLINICAL IMPLICATIONS: Disease severity of UC might not be associated with the prevalence of ED in patients with UC. STRENGTHS AND LIMITATIONS: This is the first study to investigate the association between several factors regarding UC activity and ED. The limitation of this study is the definition of ED based on SHIM scores. CONCLUSION: No association between severity of UC and ED was found in Japanese patients. As expected, aging may be independently positively associated with ED in patients with UC.

DOI： 10.1093/sexmed/qfad024

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DOI： 10.14309/ajg.0000000000001982

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INTRODUCTION: Recent meta-analysis showed that ulcerative colitis (UC) is a risk factor for cardiovascular disease (CVD). Dyslipidemia is a well-established risk factor for CVD. However, evidence regarding inflammatory bowel disease (IBD), including UC and lipid profiles, is limited. Additionally, no study has assessed the association between endoscopic activity and lipid profiles in patients with IBD. Therefore, we aimed to clarify the association between mucosal healing (MH) and lipid profiles in patients with UC. METHODS: A total of 221 Japanese patients with UC were enrolled in this analysis. Total cholesterol (T-chol), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) were divided into tertiles (high, moderate, and low) based on the distributions, respectively. Self-administered questionnaire was used to obtain information regarding medication for dyslipidemia. Complete MH and MH are based on Mayo endoscopic subscore 0 and 0-1, respectively. RESULTS: The percentage of complete MH was 30.8%. In patients without medication for dyslipidemia, high HDL-C (>66 mg/dL) was significantly positively associated with complete MH (adjusted odds ratio [OR] 2.58, 95% CI: 1.04-6.64, p for trend = 0.037). In patients with nonproctitis, a positive association between HDL-C and complete MH was found (adjusted OR 3.54, 95% CI: 1.22-11.01, p for trend = 0.020). T-chol and TG were not associated with MH, regardless of medication for dyslipidemia. CONCLUSIONS: Complete MH was significantly positively associated with HDL-C in UC patients without medication for lipid. The disease extent might affect the association between complete MH and HDL-C.

DOI： 10.1159/000527353

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Restless legs syndrome (RLS) is a common sleep disorder in the Western population. The prevalence of restless legs syndrome in the Japanese population is 4.6%. Inflammatory and/or immune alteration might be associated with the development of restless legs syndrome. Ulcerative colitis is a chronic inflammatory bowel disease. Evidence regarding the association between ulcerative colitis and the prevalence of restless legs syndrome is limited. Herein, we investigated the association between clinical outcomes and the prevalence of restless legs syndrome in Japanese patients with ulcerative colitis. This was a cross-sectional study using baseline data from a prospective cohort study. Subjects in this study were 273 patients with ulcerative colitis. The definition of restless legs syndrome was achieved using a self-administered questionnaire based on the diagnostic criteria for restless legs syndrome in an epidemiological study approved by the Executive Committee of the International Restless Leg Syndrome Study Group in 2002. Clinical outcomes were clinical remission and mucosal healing. The association between clinical remission and mucosal healing and the prevalence of restless legs syndrome was assessed by multivariate logistic regression analyses. The percentage of clinical remission and mucosal healing was 58.4% and 63.1%, respectively. The prevalence of restless legs syndrome in this cohort was 4.7%. Clinical remission (adjusted odds ratio 0.23, 95% confidence interval 0.05-0.93) and mucosal healing (adjusted odds ratio 0.23, 95% confidence interval 0.05-0.90) were independently inversely associated with restless legs syndrome. No association between serum haemoglobin and restless legs syndrome was found. In conclusion, clinical remission and mucosal healing were independently and inversely associated with the prevalence of restless legs syndrome in Japanese patients with ulcerative colitis.

DOI： 10.1111/jsr.13691

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Language：Japanese   Publisher：日本安定同位体・生体ガス医学応用学会  

脂質中の飽和脂肪酸は,肝脂肪毒性を有し肝病態に強く関与する.食事由来脂肪酸は,これまで13C標識試薬の経口投与を主とした小腸脂肪酸吸収試験が行われてきたが,胃の排出能や消化時間のバイアスを受け評価を困難にしていた.我々は,上部消化管内視鏡に胃を介さず13C標識試薬を投与することで,ヒト小腸におけるより正確な脂肪酸吸収評価法を確立した.同法を用いた13C呼気試験は,門脈圧亢進症を伴う肝硬変患者における小腸飽和脂肪酸吸収異常を証明し,非アルコール性脂肪肝炎(non-alcoholic steatohepatitis:NASH)患者における小腸パルミチン酸吸収亢進と病態進展への関与を見出した.肝臓は,食事由来脂質だけでなく,消化管ホルモン,腸内細菌叢など腸管から様々な影響を強く受ける臓器であり,その関係性は腸肝軸(Gut-Liver axis)と評される.今後,簡便かつ安全性の高い13C呼気試験を用いた腸管脂質吸収動態研究は,種々の肝疾患の病態解明においてさらに重要となることが予想される.(著者抄録)

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PURPOSE: The association between body mass index (BMI) and irritable bowel syndrome (IBS) has been inconsistent in the Asian population. Also, no evidence regarding this issue in the young population exists. The aim of the present study is to investigate the association between BMI and IBS based on the Rome III criteria in young Japanese people. METHODS: This study was a cross-sectional study consisted of 8923 Japanese university students. The definition of IBS was based on the Rome III criteria. BMI was divided into four categories (quartiles) on the basis of the study subjects' distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, and overweight was BMI < 18.5 kg/m2, 18.5 ≤ BMI < 25 kg/m2 (reference), and 25 ≤ BMI kg/m2, respectively. Age, sex, drinking, smoking, exercise habit, anemia, and sports injury were selected a priori as potential confounding factors. RESULTS: The prevalence of IBS was 6.5%, with females having a significantly higher prevalence than males (6.0% vs. 7.2%, p = 0.029). In females, being overweight was independently positively associated with IBS after adjustment (adjusted odds ratio [OR]: 1.81 [95% confidence interval (CI): 1.13-2.79]). In contrast, in males, no association between being lean or overweight and IBS was found. CONCLUSIONS: Among the young Japanese population, being overweight might be independently positively associated with prevalence of IBS in females but not in males.

DOI： 10.1007/s00384-022-04267-8

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The incidence of inflammatory bowel disease (IBD) is increasing; hence, effective treatments are warranted. The therapeutic effect of human carbonic anhydrase I (hCA I) in IBD remains unknown. Therefore, we investigated whether oral tolerization to hCA I would induce antigen-specific protection from intestinal inflammation in vivo. Severe combined immunodeficient mice received hCA I, keyhole limpet hemocyanin (KLH), or phosphate-buffered saline (PBS) orally for 7 days. Colons and mesenteric lymph nodes (MLNs) were collected 4 weeks after cell transfer. Additionally, the mechanisms underlying the therapeutic effects were investigated. The comparison between the effects of well-established drugs and hCA I oral administration was investigated. Oral administration of hCA I ameliorated colitis remarkably. hCA I reached the cecum and ameliorated colitis more effectively than mesalazine and similarly to prednisolone. Compared with PBS treatment, hCA I treatment reduced interleukin (IL)-17a, IL-6, and retinoic acid-related orphan receptor gamma t (RORγt) expression in the colon or MLNs; moreover, hCA I markedly reduced IL-6, IL-17, and interferon-gamma (IFN-γ) levels in the MLN. Oral administration of hCA I induced immune tolerance and suppressed colitis in vivo. Thus, hCA I administration could be proposed as a new treatment option for IBD.

DOI： 10.1038/s41598-022-22455-y

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The relationship between advanced nonalcoholic steatohepatitis (NASH) and plasma fatty acid composition remains unknown. We aimed to examine the plasma fatty acid composition in biopsy-confirmed nonalcoholic fatty liver disease (NAFLD) and evaluate the relationship between histological findings and fatty acid composition. Overall, 235 patients (134 women) with NAFLD were enrolled. Comprehensive blood chemistry tests and histological examinations of liver samples were conducted. Multivariate analyses adjusted for age, sex, body mass index, alanine aminotransferase, hemoglobin A1c, creatinine, total cholesterol, triglyceride, and NAFLD Activity Score values showed that lower levels of arachidic, behenic, α-linolenic, eicosatetraenoic, docosapentaenoic, and docosahexaenoic acids and higher levels of mead acid were associated with fibrosis stage 3-4. Furthermore, higher lauric acid, myristic acid, and palmitic acid levels and monounsaturated fatty acids such as palmitoleic acid and oleic acid were significantly associated with high NAS in analyses adjusted for the same factors and fibrosis stage. The plasma fatty acid composition was associated with the histological evidence of NASH. Increased synthesis of fatty acids is associated with NASH; insufficient intake of n-3 essential fatty acids and reduced elongation of fatty acids are associated with fibrosis in NASH. These features may help clinicians to understand and treat advanced NASH cases.

DOI： 10.3390/biomedicines10102540

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OBJECTIVE: Socioeconomic status is a risk factor for worse outcomes in many diseases. However, evidence on the association between socioeconomic status and clinical outcome in patients with ulcerative colitis (UC) is limited. In the clinical setting, the therapeutic goal for UC is to achieve mucosal healing (MH). Thus, the aim of this study is to examine the association between socioeconomic status and MH in patients with UC. METHODS: The study population consisted of 298 patients with UC. Education status and household income were divided into three groups based on a self-administered questionnaire. MH and complete MH were defined as a Mayo endoscopic subscore of 0-1 and 0, respectively. The association of socioeconomic status with MH and complete MH was assessed by multivariate logistic regression analysis. Patients with UC were divided into a younger group (<51 years old) and an older group (≥51 years old) based on median age. RESULTS: The percentage of MH and complete MH was 62.4% and 25.2%, respectively. In all patients, socioeconomic status was not associated with MH and complete MH, respectively. In the older group, education but not household income was independently positively associated with MH and complete MH. In contrast, in the younger group, no association between socioeconomic status and MH and complete MH was found. CONCLUSION: In older Japanese patients with UC, education status but not household income was independently positively associated with MH and complete MH.

DOI： 10.1136/bmjgast-2022-001000

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Background/Aims: Functional dyspepsia (FD) may be a common digestive disease worldwide and reduces the quality of life of patients. However, only a few studies have investigated the association between eating behavior and FD. The purpose of this cross-sectional study is to examine the association between eating behavior and prevalence of FD in a young Japanese cohort. Methods: In this study, we enrolled 8923 Japanese university students. FD is diagnosed based on the Rome III criteria. Eating habits and frequency of meals were investigated using a self-administered questionnaire. Results: The FD subjects had a younger mean age, a lower body mass index, and a lower proportion of men compared to the non-FD subjects. An independent positive association between skipping breakfast and/or lunch and FD was found (adjusted ORs were 1.60 [95% CI, 1.10-2.32] for breakfast and 2.52 [95% CI, 1.04-5.18] for lunch). Skipping dinner, extra meals (snacks) or midnight snacks was not associated with FD. The prevalence of FD in subjects eating 1, 2, and 3 meals per day was 4.8%, 2.2%, and 1.7%, respectively. The frequency of meals was independently inversely associated with prevalence of FD (adjusted ORs were 1 per day: 2.72 [95% CI, 1.19-5.42], and 2 per day: 1.69 [95% CI, 1.16-2.43], P for trend = 0.001). Conclusions: In the young Japanese people, the frequency of meals may be independently inversely associated with prevalence of FD. In particular, skipping breakfast and/or lunch was associated with the prevalence of FD.

DOI： 10.5056/jnm21146

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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BACKGROUND: The interleukin (IL)-23/Th17 pathway plays a critical role in ulcerative colitis (UC). The IL-12p40 subunit, which is shared by IL-23 and IL-12, is encoded by the IL12B gene. The current case-control study investigated the association between IL12B SNP rs6887695 and the UC risk. METHODS: There were 384 cases within 4 years of UC diagnosis and 661 controls who were enrolled. Adjustments were made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, and body mass index. RESULTS: Subjects with the GG IL12B SNP rs6887695 genotype had a significantly increased risk of UC compared with those with the CC genotype (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.08-2.36). This positive association was also significant using the additive and recessive models (AOR, 1.25; 95% CI, 1.03-1.52; AOR, 1.50; 95% CI, 1.08-2.09, respectively). An independent inverse relationship was observed between ever alcohol consumption and the UC risk in those with the CC genotype while no significant association was found in those with at least one G allele (P for interaction = 0.0008). CONCLUSIONS: IL12B SNP rs6887695 was significantly associated with UC. The influence of alcohol consumption might rely on rs6887695.

DOI： 10.1016/j.cyto.2022.155901

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DOI： 10.1055/a-1858-4826

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population. METHODS: This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire. RESULTS: The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)). CONCLUSION: In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

DOI： 10.3390/ijerph19095686

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Background/Aims: Evidence regarding the association between body mass index (BMI) and functional dyspepsia (FD) in the Asian population is limited. Further, no study has evaluated this issue in young people in Asian and Western populations. Thus, we aim to investigate this issue among young Japanese people. Methods: The study subjects comprised of 8923 Japanese university students. BMI was divided into 4 categories (quartiles) on the basis of the study subjects' distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, overweight, and obese was BMI < 18.5 kg/m2, 18.5 ≤ BMI < 25 kg/m2 (reference), 25 kg/m2 ≤ BMI < 30 kg/m2, and 30 kg/m2 ≤ BMI, respectively. The definition of FD was based on the Rome III criteria. Results: The prevalence of FD was 1.9% in this cohort. The lowest BMI was independently associated with FD after adjustment (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.46-3.67); P for trend = 0.001). The lowest BMI was independently associated with FD in women but not in men (OR, 2.94; 95% CI, 1.59-5.77; P for trend = 0.001). Leanness was independently associated with FD in total and in women but not in men (total: adjusted OR, 2.01; 95% CI, 1.40-2.86) and women (OR, 2.19; 95% CI, 1.35-3.45). However, interaction analysis showed no significant difference for sex. Conclusions: Among young Japanese people, BMI may be independently inversely associated with FD. Leanness may be an independent associated factor for FD in the young Japanese women.

DOI： 10.5056/jnm21076

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AIMS: To investigate whether fibrosis-4 index can help stratify the risk of diabetes mellitus in subjects with fatty liver disease. METHODS: Based on fatty liver disease and fibrosis-4 index (cutoff value, 1.3), we retrospectively divided 9,449 subjects, who underwent at least two annual health checkups, into four groups stratified by gender: normal, high fibrosis-4 indexwithout fatty liver disease, low fibrosis-4 index with fatty liver disease, and high fibrosis-4 index with fatty liver disease groups. RESULTS: Onset rates for diabetes mellitus in the normal, high fibrosis-4 index without fatty liver disease, low fibrosis-4 index with fatty liver disease, and high fibrosis-4 index with fatty liver disease groups were 1.6%, 4.3%, 6.8%, and 10.2%, respectively, in men, and 0.6%, 0.9%, 5.3%, and 7.0%, respectively, in women. Compared with the normal group, the high fibrosis-4 index without fatty liver disease, low fibrosis-4 index with fatty liver disease, and high fibrosis-4 index with fatty liver disease groups were at a significant risk for diabetes mellitus onset in both male and female subjects. Moreover, in both genders, high fibrosis-4 index with fatty liver disease remained a significant risk factor on multivariate analysis (high fibrosis-4 index with fatty liver disease group: adjusted harzard ratio, 95% confidence interval: 4.03, 2.19-7.42 [men] and 6.40, 1.77-23.14 [women]). CONCLUSIONS: Subjects with fatty liver disease and high fibrosis-4 index had a higher risk of diabetes mellitus onset. Therefore, fibrosis-4 index can help stratify the risk of diabetes mellitus in patients with fatty liver disease and identify patients requiring intervention.

DOI： 10.1111/jdi.13812

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND AIM: Although an inverse relationship between current smoking and the development of ulcerative colitis (UC) has been shown in North America and Europe, evidence is limited in Asian countries, where the incidence of UC is rapidly increasing. This Japanese case-control study examined the association between active and passive smoking and risk of UC. METHODS: A self-administered questionnaire was used to obtain information on smoking and potential confounding factors in 384 cases with a diagnosis of UC within the past 4 years and 665 controls. RESULTS: Compared with having never smoked, having ever smoked was associated with an increased risk of UC (adjusted odds ratio [OR] = 1.70, 95% confidence interval [CI]: 1.23-2.37). No association was observed between current smoking and risk of UC, but former smokers had a significant elevation in risk (adjusted OR = 2.40, 95% CI: 1.67-3.45). There was a positive dose-response relationship with pack-years smoked (P for trend = 0.006). Among never smokers, passive smoking exposure at home was significantly associated with an increased risk of UC (adjusted OR = 1.90, 95% CI: 1.30-2.79). A significant dose-response gradient was also observed between pack-years of passive smoking at home and risk of UC (P for trend = 0.0003). CONCLUSIONS: We confirmed that former smoking elevated the risk of UC, whereas an inverse association between current smoking and the risk of UC did not reach a statistically significant level. Passive smoking may be associated with an increased risk of UC.

DOI： 10.1111/jgh.15745

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Purpose: The albumin-to-globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. Methods: The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). Results: The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52-14.18 and adjusted OR, 4.97; 95% CI, 2.14-12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56-11.51 and adjusted OR, 5.22; 95% CI, 1.97-14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06-21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Conclusion: Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH.

DOI： 10.3393/ac.2021.01032.0147

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INTRODUCTION: Untreated nonalcoholic fatty liver may progress to nonalcoholic steatohepatitis (NASH) and cirrhosis and induce hepatocellular carcinoma and liver failure. Type 2 diabetes mellitus (T2DM), often complicated with nonalcoholic fatty liver disease (NAFLD), is a driver of NAFLD progression. Thus, efficacious treatment strategies for patients with coexisting NAFLD and T2DM are important for preventing NAFLD progression. Although previous studies have demonstrated that either sodium-glucose transporter 2 inhibitors (SGLT2is) or glucagon-like peptide 1 receptor agonists (GLP-1 RAs) benefit NASH patients with T2DM, the rate of NASH resolution has not sufficiently improved. Therefore, we developed a protocol for a randomized controlled trial to examine whether the addition of an SGLT2i to the treatment regimen of patients receving a GLP-1 RA (combination therapy), within the therapeutic dose range for T2DM, increases the rate of NASH resolution in patients with coexisting NASH and T2DM. METHODS: This open-label, randomized, parallel-group study commenced in June 2021, will conclude recruitment in May 2023, and will end by March 2025. Sixty patients with NASH complicated by T2DM are enrolled at the Ehime University Hospital in Toon, Japan. Participants will be randomized into: (1) an intervention group receiving combination therapy with the SGLT2i luseogliflozin 2.5 mg, once daily (Taisho Pharmaceutical, Tokyo, Japan) and the GLP-1 RA semaglutide 0.5 mg, once per week (Novonordisk, Copenhagen, Denmark); and (2) a control group receiving monotherapy with the GLP-1 analog semaglutide. The primary endpoints, which will be ascertained by liver biopsy, are: (1) NASH resolution rate from baseline without worsening of liver fibrosis after 52 weeks of intervention; (2) rate of improvement from baseline of at least 1 point in the NAFLD activity score without worsening of liver fibrosis after 52 weeks of intervention; and (3) rate of improvement from baseline of at least one fibrosis stage without worsening of NASH after 52 weeks of intervention. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) number: UMIN000045003. Japan Registry of Clinical Trials registration number: jRCTs061210009.

DOI： 10.1007/s13300-022-01239-7

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

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INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is diagnosed after excluding other liver diseases. The pathogenesis of NAFLD when complicated by other liver diseases has not been established completely. Metabolic dysfunction-associated fatty liver disease (MAFLD) involves more metabolic factors than NAFLD, regardless of complications with other diseases. This study aimed to clarify the effects of fatty liver occurring with metabolic disorders, such as MAFLD without diabetes mellitus (DM), on the development of DM. MATERIALS AND METHODS: We retrospectively assessed 9,459 participants who underwent two or more annual health check-ups. The participants were divided into the MAFLD group (fatty liver disease with overweight/obesity or non-overweight/obesity complicated by metabolic disorders), simple fatty liver group (fatty liver disease other than MAFLD group), metabolic disorder group (metabolic disorder without fatty liver disease), and normal group (all other participants). RESULTS: The DM onset rates in the normal, simple fatty liver, metabolic disorder, and MAFLD groups were 0.51, 1.85, 2.52, and 7.36%, respectively. In the multivariate analysis, the MAFLD group showed a significantly higher risk of DM onset compared with other three groups (P < 0.01). Additionally, the risk of DM onset was significantly increased in fatty liver disease with overweight/obesity or pre-diabetes (P < 0.01). CONCLUSIONS: Fatty liver with metabolic disorders, such as MAFLD, can be used to identify patients with fatty liver disease who are at high risk of developing DM. Additionally, patients with fatty liver disease complicated with overweight/obesity or prediabetes are at an increased risk of DM onset and should receive more attention.

DOI： 10.1111/jdi.13772

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

[目的]高齢の切除不能膵癌患者の予後因子を明らかにする。[方法]診断時65歳以上の切除不能膵癌患者の全生存期間(OS)との関連性を化学療法施行の有無、年齢、Eastern Cooperative Oncology Group Performance Status(ECOG-PS)、腹水量、栄養評価の指標である好中球/リンパ球比(Neutrophil to lymphocyte ratio:NLR)、予後推定栄養指数(Prognostic nutritional index:PNI)、体組成の指標である腸腰筋指数(Psoas muscle mass index:PMI)との関連性を解析した。[結果]化学療法導入群、ECOG-PS1以下、腹水量少量以下が独立した予後延長に関する因子であった。栄養評価項目、体組成の指標は今回の検討ではOSに関連する独立した因子ではなかった。[結論]高齢者においても化学療法による予後の改善が期待できるが、治療選択にあたっては身体機能、腹水量を考慮する必要がある。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

【目的】高齢早期胃癌・内視鏡的非治癒切除例において、追加手術と低骨格筋量の予後への影響を明らかにする。【方法】内視鏡的根治度C-2と判定された75歳以上の早期胃癌患者55例を、追加手術の有無で検討した。また、サルコペニア関連因子としてCTで測定したPsoas muscle mass index(PMI)を用い、予後との関連を評価した。【結果】再発率は、両群間で差がなかった。腸腰筋体積は、追加手術群で経年的減少が見られた。予後は、追加手術の有無で差はなく、ESD3年後の低PMI群において予後不良傾向を認めた(P=0.068)。【結論】高齢早期胃癌において、予後は術後低栄養との関連が示唆された。(著者抄録)

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BACKGROUND: A simple serum biomarker for clinical outcome in patients with ulcerative colitis (UC) remains an unmet need. Some studies have shown an association between C-reactive protein (CRP)-albumin ratio (CAR) and prognosis in patients with inflammatory bowel disease (IBD), but evidence regarding the association between CAR and UC remains limited. We evaluated the association between CAR and clinical outcome in Japanese patients with UC. METHODS: Subjects were 273 Japanese patients with UC. Clinical remission was defined as absence of both abnormally high stool frequency (< 3 per day) and rectal bleeding. Mucosal healing (MH) was defined as Mayo endoscopic subscore (MES) 0. Moderate to severe endoscopic activity was defined as MES 2-3. Subjects were divided according to CAR into tertiles (low, moderate, and high). RESULTS: The proportions of patients with clinical remission, MH, and moderate to severe endoscopic activity were 57.9%, 26.0%, and 37.0%, respectively. High CAR was significantly positively associated with moderate to severe endoscopic activity but not MH or clinical remission after adjustment (adjusted odds ratio [OR] 2.18 [95% confidence interval (CI) (1.11-4.35)], p for trend 0.023), but only in patients with long disease duration (> 7 years) (adjusted OR 2.95 [95% CI (1.06-8.79)], p for trend 0.023). CAR was not associated with clinical remission or MH. CONCLUSIONS: CAR may be significantly positively associated with moderate to severe endoscopic activity but not clinical remission or MH in Japanese patients with UC. In patients with long UC duration, CAR might be a useful serum marker for disease activity.

DOI： 10.1186/s12876-022-02113-3

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BACKGROUND: Functional dyspepsia (FD) is a very common disease worldwide. Dysmenorrhea impairs quality of life among females of reproductive age. Although dysmenorrhea is associated with irritable bowel syndrome (IBS), no study has yet evaluated the association between dysmenorrhea and FD. METHODS: This study's subjects consisted of 4693 female Japanese university students. We defined FD according to the Rome III criteria. Subjects completed a self-reported questionnaire regarding menstrual irregularity, menstrual pain, and medication for menstrual pain. Age, body mass index, drinking, smoking, exercise habit, anemia, and first-year student status were selected as potential confounding factors. RESULTS: The prevalence of FD, epigastric pain syndrome (EPS), and postprandial distress syndrome (PDS) was 2.5%, 0.6%, and 2.1%, respectively. Heavy menstrual pain was independently positively associated with FD and PDS but not EPS (adjusted ORs: FD, 3.18 [95% CI: 1.60-6.89] and PDS, 2.93 [95% CI: 1.56-7.93] for heavy menstrual pain, p for trend = 0.001 and 0.004, respectively). Using medication for menstrual pain often was independently positively associated with FD, EPS, and PDS, respectively, (adjusted ORs: FD, 2.41 [95% CI: 1.50-3.83], EPS, 2.93 [95% CI: 1.04-7.93], PDS, 2.44 [95% CI: 1.46-4.01]). Irregular menstrual cycle was not associated with FD or with subtype of FD. CONCLUSION: Among the young female Japanese population, menstrual pain might be independently positively associated with FD and PDS but not EPS. The use of medication for menstrual pain might be independently positively associated with FD including subtype of FD.

DOI： 10.1111/nmo.14324

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Language：Japanese   Publisher：(一社)日本病態栄養学会  

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Language：Japanese   Publisher：金原出版(株)  

症例は71歳男性。胃潰瘍の既往歴があり、黒色便と貧血の精査で紹介受診した。来院時に嘔吐を認め、その後胸痛と呼吸苦が出現した。胸腹部造影CTで縦郭気腫を広範囲に認め、下縦郭で食物残渣の食道外への漏れを伴っていた。胃内には出血と思われる高濃度域を伴う液体貯留を認めた。特発性食道破裂、縦郭限局型に加えて上部消化管出血と診断し、経口内視鏡を併用した腹腔鏡下食道破裂修復術を施行した。経口内視鏡による観察で胃潰瘍と出血点を認め、クリップと高張ナトリウム・エピネフリン法で止血した。食道には左壁に縦走する裂創と筋層外膜に至る穿破を認めた。無送気で裂創部をクリッピングし、粘膜と粘膜下層を閉鎖した。その後腹腔鏡操作を行い、破裂した外膜筋層を縫合閉鎖した。縦郭内にドレーンを留置し閉創した。これらの治療により救命できた。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00620&link_issn=&doc_id=20220114040017&doc_link_id=10.18888%2Fop.0000002585&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002585&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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INTRODUCTION: Monocytes play an important role in innate immunity. Some epidemiological evidence indicates an association between peripheral blood monocytes and ulcerative colitis (UC). The association between peripheral blood monocytes and mucosal healing (MH), however, remains unclear. We evaluated this issue in patients with UC. METHODS: Study subjects consisted of 272 Japanese patients with UC. Monocyte counts were taken in the morning after overnight fasting. Monocyte count was divided into tertiles based on the distribution of values among all study subjects. Information on clinical remission was obtained from medical records. MH was assessed using the Mayo endoscopic subscore. RESULTS: The mean monocyte count was 360.1 ± 155.3/mm3. Rates of clinical remission, MH, and complete MH were 61.0%, 66.2%, and 27.9%, respectively. High monocyte count was significantly inversely associated with clinical remission, MH, and complete MH (adjusted odds ratio [OR] 0.45 [95% confidence interval [CI]: 0.23-0.89], OR 0.45 [95% CI: 0.23-0.89], and OR 0.48 [95% CI: 0.23-0.97], respectively). Patients were also classified according to C-reactive protein (CRP) levels; in the low CRP group (<0.1 mg/dL), high monocyte count was independently inversely associated with complete MH but not with clinical remission or MH (OR 0.33 [95% CI: 0.10-0.92], P for trend = 0.027). In the high CRP group, there was no association between monocyte count and clinical outcomes. DISCUSSION: Our findings suggest that peripheral blood monocyte count can be used as a serum supplemental marker for MH in UC patients with low CRP levels.

DOI： 10.14309/ctg.0000000000000429

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BACKGROUND: Evidence regarding the association between sleep disturbance and functional dyspepsia (FD) remains limited in the young population. AIMS: This study aimed to investigate the association between sleep disturbance and FD including subgroups among Japanese young people. METHODS: Study subjects were 8923 university students. FD was defined according to the Rome III criteria. Subjects with FD were further categorized as having postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS). Subjects completed a self-reported questionnaire assessing self-reported sleep duration, sleep disturbance, difficulty falling asleep, deep sleep disorder, nocturnal awakening, early awakening, and daytime sleepiness. RESULTS: The prevalence of FD was 1.9%. After adjustment, all types of sleep disturbances were independently positively associated with FD (total sleep disturbance: OR 4.11 [95% CI: 2.89-5.78], difficulty falling asleep: OR 3.97 [95% CI: 2.53-6.01], deep sleep disorder: OR 4.85 [95% CI: 3.06-7.40], nocturnal awakening: OR 4.35 [95% CI: 1.90-8.67], early awakening: OR 4.50 [95% CI: 1.97-8.97], and daytime sleepiness: OR 2.83 [95% CI: 1.25-5.56]). While nocturnal awakening and daytime sleepiness were not associated with EPS, the other types of sleep disturbance were independently positively associated with EPS and PDS. No association between self-reported sleep duration and FD was found. CONCLUSIONS: Sleep disturbance may be independently positively associated with the prevalence of FD among Japanese young people. Nocturnal awakening and daytime sleepiness were not associated with EPS; the other types of sleep disturbance were independently positively associated with EPS and PDS.

DOI： 10.1007/s10620-021-07260-3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Research Square Platform LLC  

<title>Abstract</title>
Background

The gut microbiota has potential implications in the pathogenesis of primary biliary cholangitis (PBC). However, little is known about the significance of small intestinal mucosa-associated microbiota (MAM) in PBC. We aimed to investigate the ileal MAM profile and identify its association with liver pathology in patients with PBC.
Methods

Forty-three patients with PBC and 24 healthy controls who underwent colonoscopy at our hospital between March 2018 and January 2020 were enrolled in a cross-sectional study. We performed 16S ribosomal RNA gene sequencing of MAM samples obtained from the mucosa of the terminal ileum of all subjects. We also examined the relationship between the abundance of ileal MAM and chronic nonsuppurative destructive cholangitis using liver specimens from patients with PBC.
Results

Dysbiosis of ileal MAM was observed in patients with PBC, with a characteristic overgrowth of <italic>Sphingomonadaceae</italic> and <italic>Pseudomonas</italic>. Multivariate analysis showed that the overgrowth of <italic>Sphingomonadaceae</italic> and <italic>Pseudomonas</italic> is an independent association factor for PBC. Moreover, the abundance of <italic>Sphingomonadaceae</italic> was associated with chronic nonsuppurative destructive cholangitis in PBC.
Conclusions

Overgrowth of <italic>Sphingomonadaceae</italic> and <italic>Pseudomonas</italic> in ileal MAM is an independent association factor for diagnosing PBC. <italic>Sphingomonadaceae</italic> may be particularly associated with the pathological development of PBC.

DOI： 10.1038/s41598-021-99314-9

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Other Link： https://www.researchsquare.com/article/rs-645870/v1.html

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INTRODUCTION: Fatty liver disease (FLD) is a surrogate condition for glucose intolerance development. FLD may involve normal or abnormal liver enzyme levels. Whether FLD is a risk factor for glucose intolerance, regardless of liver enzyme levels, remains unknown. We assessed relationships between the development of impaired fasting glucose (IFG) and FLD, liver enzyme abnormalities, and alcohol consumption. MATERIALS AND METHODS: We retrospectively evaluated 8,664 participants with more than two annual health check-ups. Participants were classified according to sex, alcohol consumption, alanine aminotransferase (ALT) levels, and fatty liver status. RESULTS: In univariate analyses, IFG onset among men was related to normal or high ALT levels with FLD in the nonalcoholic and alcoholic groups (P-trend < 0.01). In multivariate analyses, IFG onset among nonalcoholic men was associated with normal or high ALT levels with FLD, independent of potential confounding factors (P-trend < 0.01). However, IFG onset was non-independently associated with any condition among alcoholic men. In univariate analyses, IFG onset among women was related to normal or high ALT levels with FLD in the nonalcoholic group (P-trend < 0.01) and high ALT levels with FLD in the alcoholic group (P-trend < 0.05). In multivariate analyses, IFG onset was independently associated with only normal ALT levels in nonalcoholic FLD women. CONCLUSIONS: Among nonalcoholic men and women, FLD was a risk factor for IFG onset, including normal ALT concentrations. Care is needed for individuals with nonalcoholic FLD, regardless of liver injury, possibly helping reduce glucose intolerance risk.

DOI： 10.1111/jdi.13548

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(株)医事出版社  

便通異常を有する糖尿病患者の便通異常に対する意識などを明らかにすることを目的に、民間の疾患パネルデータベースを用いて抽出した過去1年以内に入通院歴のある2型糖尿病患者を対象にWebアンケート調査を行い、GSRSスコアを用いたスクリーニング調査で得られた過去1週間に便通異常のあった856名(男性739名、女性117名、平均年齢62.9±10.1歳)の回答を検討した。その結果、56.5%が便通異常により日常生活に何らかの影響があると回答し、食事療法を行っている患者の17.7%、運動療法を行っている患者の16.9%が、便通異常による治療の妨げを感じていることが分かった。

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Dietary palmitic acid (PA) promotes liver fibrosis in patients with nonalcoholic steatohepatitis (NASH). Herein, we clarified the intestinal absorption kinetics of dietary PA and effect of trans-portal PA on the activation of hepatic stellate cells (HSCs) involved in liver fibrosis in NASH. Blood PA levels after meals were significantly increased in patients with NASH compared to those in the control. Expression of genes associated with fat absorption and chylomicron formation, such as CD36 and MTP, was significantly increased in the intestine of NASH model rats compared with that in the controls. Plasma levels of glucagon-like peptide-2, involved in the upregulation of CD36 expression, were elevated in NASH rats compared with those in the controls. Furthermore, portal PA levels after meals in NASH rats were significantly higher than those in control and nonalcoholic fatty liver rats. Moreover, PA injection into the portal vein to the liver in control rats increased the mRNA levels associated with the activation of HSCs. Increased intestinal absorption of diet-derived PA was observed in NASH. Thus, the rapid increase in PA levels via the portal vein to the liver may activate HSCs and affect the development of liver fibrosis in NASH.

DOI： 10.1038/s41598-021-92790-z

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Oxidative stress is considered one of the etiologic factors involved in ulcerative colitis (UC), yet there is limited epidemiologic information regarding the relationship between antioxidant intake and the risk of UC. The aim of the present case-control study in Japan was to examine the association between intake of green and yellow vegetables, other vegetables, fruit, vitamin C, vitamin E, retinol, alpha-carotene, beta-carotene, and cryptoxanthin and UC risk. METHODS: A total of 384 cases within 4 y of diagnosis with UC and 665 controls were included in the study. Data on dietary intake and confounders were obtained using a self-reported questionnaire. Information on dietary factors was collected using a 169-item semiquantitative food-frequency questionnaire. Adjustment was made for sex, age, pack-y of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, and body mass index. RESULTS: Higher intake levels of other vegetables, vitamin C, and retinol were independently associated with a reduced risk of UC. The adjusted odds ratio between extreme quartiles was 0.51 (95% confidence interval [CI], 0.34-0.76; P for trend ≤ 0.001) for other vegetables, 0.45 (95% CI, 0.30-0.69, P for trend ≤ 0.001) for vitamin C, and 0.64 (95% CI, 0.43-0.95, P for trend = 0.04) for retinol. There were no associations between intake of green and yellow vegetables, fruit, vitamin E, alpha-carotene, beta-carotene, or cryptoxanthin and UC risk (P for trend = 0.29, 0.56, 0.89, 0.20, 0.69, and 0.22, respectively). CONCLUSIONS: Intake of other vegetables, vitamin C, and retinol was inversely associated with UC risk.

DOI： 10.1016/j.nut.2021.111378

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Serum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association. DESIGN: This cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0-1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression. RESULTS: Rates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found. CONCLUSION: In Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.

DOI： 10.1136/bmjgast-2021-000662

PubMed

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Functional dyspepsia (FD) has a high prevalence worldwide and reduces patients' quality of life. The etiology of FD is likely multifactorial. Although two studies showed an inverse association between exercise habits and FD, evidence regarding the association between exercise habits and FD remains scarce. AIMS: This study aimed to investigate the association between exercise habits and FD among the young Japanese population, taking the presence or absence of an exercise partner as an additional variable. METHODS: The study subjects consisted of 8923 Japanese university students. The definition of FD was based on the Rome III criteria. Information on exercise frequency, exercise intensity, and exercise partners was obtained from a self-administered questionnaire. RESULTS: The prevalence of FD was 1.9% in this cohort. Low, moderate, and high frequency of exercise was independently inversely associated with FD (adjusted odds ratio [OR] was low: OR 0.69 [95% confidence interval (CI) 0.47-0.997], moderate: OR 0.53 [95% CI 0.34-0.81] and high: OR 0.53 [95% CI 0.30-0.88], p for trend p = 0.002). Moderate and high intensity of exercise was independently inversely associated with FD (moderate: OR 0.56 [95% CI 0.36-0.84] and high: OR 0.49 [95% CI 0.30-0.76], p for trend p = 0.001). Exercise with groups and with friends was independently inversely associated with FD whereas the association between exercising alone and FD was not significant (groups: OR 0.28 [95% CI 0.14-0.50] and friends: OR 0.44 [95% CI 0.24-0.74]). CONCLUSION: Among the young Japanese population, frequency and intensity of exercise may be independently inversely associated with FD. Additionally, exercise with groups and with friends but not by oneself was inversely associated with exercise and FD, respectively.

DOI： 10.1007/s10620-021-07017-y

PubMed

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BACKGROUND: Causes of non-alcoholic fatty liver disease and its progression include visceral fat accumulation and loss of muscle mass; however, which of the two phenomena is more critical is unclear. Therefore, we intended to examine the relationship between body composition and non-alcoholic fatty liver disease progression as indicated by fibrosis and the non-alcoholic fatty liver disease activity score. METHODS: This cross-sectional study comprised 149 patients (55 men; age, 20-76 years) treated for non-alcoholic fatty liver disease between December 2010 and January 2020. Body composition measurements, histological examinations of liver samples, and comprehensive blood chemistry tests were performed. The relationship between body composition and non-alcoholic fatty liver disease histology findings was analyzed using the logistic regression model. RESULTS: Fibrosis was significantly and inversely correlated with muscle mass and appendicular skeletal muscle mass and significantly and positively correlated with fat mass, fat mass/height squared, visceral fat area, and waist-hip ratio (P < 0.05). After adjustment for sex, blood chemistry measurements, and body composition indices, fibrosis remained associated with appendicular skeletal muscle mass, fat mass, fat mass/height squared, and visceral fat area (P < 0.05). Non-alcoholic fatty liver disease activity score ≥ 5 significantly correlated with fat mass and fat mass/height squared in a univariate but not multivariate analysis. CONCLUSIONS: Fibrosis in non-alcoholic fatty liver disease, an indicator of unfavorable long-term outcomes, is associated with more indices of fat mass than of those of muscle mass. Hence, fat mass should be controlled to prevent non-alcoholic fatty liver disease progression.

DOI： 10.1186/s12876-021-01748-y

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although the association between eating habits which can be modified and digestive diseases has been reported, to date, no research has evaluated the association between eating habits and ulcerative colitis (UC). Thus, we investigate the association between eating behavior and clinical outcome in Japanese patients with UC. METHODS: Eating quickly, eating until full, and skipping breakfast data was obtained from a self-administered questionnaire. Information on clinical outcome was collected from medical records. Mucosal healing (MH) and partial MH was defined as a Mayo endoscopic subscore of 0 or 0-1, respectively. Age, sex, BMI, current smoking, current drinking, prednisolone use, and anti-TNFα monoclonal antibody use were selected a priori as potential confounding factors. RESULTS: Study subjects consisted of 294 Japanese patients with UC. Eating at speed moderate and eating quickly were independently inversely associated with MH: the adjusted odds ratios (ORs) were 0.38 (95% confidence interval [CI] 0.16-0.85) and 0.38 (95% CI 0.17-0.81) (p for trend = 0.033). Eating until full was independently inversely associated with MH: the adjusted OR was 0.38 (95% CI 0.27-0.86). MH in patients who skipped breakfast was marginally lower than that in patients who did not skip breakfast. No association between eating habits and clinical remission or partial MH was found. CONCLUSION: Among patients with UC, eating rate and eating until full may be independently inversely associated with MH but not clinical remission.

DOI： 10.1186/s12876-021-01724-6

PubMed

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We found that oxidized Cu nanoparticles can catalyze the growth of boron nitride nanotubes from borazine via plasma-assisted chemical vapor deposition. The Raman spectra suggest that the formation of thin-walled nanotubes show a radial breathing mode vibration. The presence of oxygen in the plasma environment was necessary for the growth of the nanotubes, and a part of the nanotubes had a core shell structure with a cupper species inside it. In atomic resolution transmission electron microscope (TEM) images, Cu2O was found at the interface between the Cu-core and turbostratic BN-shell. The growth mechanism seemed different from that of carbon nanotube core-shell structures. Therefore, we pointed out the important role of the dynamic morphological change in the Cu2O-Cu system.

DOI： 10.3390/nano11030651

PubMed

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Epidemiological evidence on the association between physical activity (PA) and ulcerative colitis (UC) is limited, and the effect of PA on the prognosis of UC is currently unknown. We evaluated the association between PA and clinical outcomes, including clinical remission and mucosal healing (MH), in Japanese patients with UC. METHODS: The study subjects were 327 Japanese patients with UC. Subjects were asked about the average time spent per day on 4 types of PA (sedentary, standing, walking, and strenuous activity) and metabolic equivalents (METs) using a validated questionnaire. Clinical outcomes were complete MH, MH, and clinical remission. The association between PA, including hours spent on each type of PA and average daily METs, and clinical outcomes was assessed by multivariate logistic regression. RESULTS: Plentiful strenuous activity was significantly inversely associated with MH and complete MH after adjustment (MH: adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.23-0.89; complete MH: adjusted OR 0.24, 95%CI 0.07-0.62; P for trend=0.008). A very high daily MET total was significantly inversely associated with complete MH after adjustment (adjusted OR 0.37, 95%CI 0.16-0.80; P for trend=0.010). In contrast, no association between PA and clinical remission was found (plentiful strenuous activity: adjusted OR 1.10, 95%CI 0.55-2.23; very high daily total METs: adjusted OR 0.74, 95%CI 0.37-1.46). CONCLUSION: In Japanese patients with UC, time spent per day on strenuous activity and total PA per day may be significantly inversely associated with complete MH, but not with clinical remission.

DOI： 10.20524/aog.2021.0663

PubMed

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

門亢症に伴う出血リスクとして門脈圧亢進症性胃症(PHG)、胃前庭部毛細血管拡張症(GAVE)は食道胃静脈瘤(EV)と同様に重要である。近年、門脈圧と肝・脾硬度の相関について報告されているが、本研究ではPHG、GAVEも含めた消化管出血リスクを評価し、肝・脾硬度との関連を調べた。対象は上部消化管内視鏡検査と肝・脾硬度を測定した92名。EV、PHG、GAVE、および治療歴から定義した門亢症関連消化管病変(PHRGL)と肝・脾硬度等の関連を解析した。EVは41.3%、PHG43.5%、GAVE9.8%に合併していた。PHRGL有無別での肝硬度は2.114 vs 1.802、脾硬度は2.621 vs 2.263と各々合併群が高かった(p<0.05)。PHRGL合併に寄与する因子は血小板数、脾硬度、アルブミンであった。PHRGLは肝・脾硬度と関連し、特に脾硬度がその囲い込みに有用であった。(著者抄録)

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

門亢症に伴う出血リスクとして門脈圧亢進症性胃症(PHG)、胃前庭部毛細血管拡張症(GAVE)は食道胃静脈瘤(EV)と同様に重要である。近年、門脈圧と肝・脾硬度の相関について報告されているが、本研究ではPHG、GAVEも含めた消化管出血リスクを評価し、肝・脾硬度との関連を調べた。対象は上部消化管内視鏡検査と肝・脾硬度を測定した92名。EV、PHG、GAVE、および治療歴から定義した門亢症関連消化管病変(PHRGL)と肝・脾硬度等の関連を解析した。EVは41.3%、PHG43.5%、GAVE9.8%に合併していた。PHRGL有無別での肝硬度は2.114 vs 1.802、脾硬度は2.621 vs 2.263と各々合併群が高かった(p<0.05)。PHRGL合併に寄与する因子は血小板数、脾硬度、アルブミンであった。PHRGLは肝・脾硬度と関連し、特に脾硬度がその囲い込みに有用であった。(著者抄録)

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：English  

DOI： 10.2169/internalmedicine.3886-19

PubMed

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

【背景・目的】原発性胆汁性胆管炎(PBC)における食道胃静脈瘤の評価は重要である。一方、門脈圧亢進症性胃症(PHG)も門脈圧亢進により発症し、無症候性PBCにも合併するが意義は不明で、それを明らかにするため検討を行った。【対象】PBCで食道胃静脈瘤、PHGを継続し評価しえた112例を調査した。【結果】PHG合併は、PBC診断時21例、観察期間中の出現例6例の計27例(21.9%)であった。PHG合併別では生命予後には有意な差異はなかったが、症候性への移行はPHG合併群が有意に早かった。症候性移行時点での食道胃静脈瘤合併はPHG合併群、非合併群でそれぞれ74%、40%であり、PHG合併群は門脈圧亢進症型への移行が多かった。また、PHG合併は症候性移行の独立した危険因子であった。【結語】PHGの合併は、症候性への進展、門脈圧亢進症型へ移行する可能性が高く、慎重な経過観察が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Publishing type：Research paper (scientific journal)  

DOI： 10.1007/978-981-32-9737-1_7

Web of Science

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Language：Japanese   Publisher：日本門脈圧亢進症学会  

【背景・目的】原発性胆汁性胆管炎(PBC)における食道胃静脈瘤の評価は重要である。一方、門脈圧亢進症性胃症(PHG)も門脈圧亢進により発症し、無症候性PBCにも合併するが意義は不明で、それを明らかにするため検討を行った。【対象】PBCで食道胃静脈瘤、PHGを継続し評価しえた112例を調査した。【結果】PHG合併は、PBC診断時21例、観察期間中の出現例6例の計27例(21.9%)であった。PHG合併別では生命予後には有意な差異はなかったが、症候性への移行はPHG合併群が有意に早かった。症候性移行時点での食道胃静脈瘤合併はPHG合併群、非合併群でそれぞれ74%、40%であり、PHG合併群は門脈圧亢進症型への移行が多かった。また、PHG合併は症候性移行の独立した危険因子であった。【結語】PHGの合併は、症候性への進展、門脈圧亢進症型へ移行する可能性が高く、慎重な経過観察が必要である。(著者抄録)

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Language：Japanese   Publisher：日本小腸学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.2169/internalmedicine.3886-19

PubMed

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：English   Publishing type：Research paper (scientific journal)  

Schistosomiasis infection is a major cause of morbidity and mortality in endemic areas. Developed countries have declared that schistosomiasis has been eradicated; however, residents of these countries may travel and stay in endemic areas and the number of foreign travelers is increasing in the recent years. Thus, schistosomiasis is regarded as an imported infection. Ultrasonography and serum antibody titer tests are well established as diagnostic methods for schistosomiasis. However, a definitive diagnosis cannot be obtained using these tests in some cases. We herein report a case in which schistosomiasis was confirmed based on laparoscopic liver biopsy without a definitive diagnosis by blood test, fecal examination, or imaging.

DOI： 10.2169/internalmedicine.2776-19

PubMed

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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DOI： 10.2169/internalmedicine.2776-19

PubMed

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Language：Japanese   Publisher：日本小腸学会  

<p>【目的】 転移性小腸腫瘍は、稀な疾患であり剖検例での報告が中心であった。今回、当科で施行したダブルバルーン内視鏡（Double Balloon Endoscopy; DBE）にて診断しえた転移性小腸腫瘍の臨床的特徴を明らかにする。</p><p>【対象と方法】 2004年3月から2019年6月までに当科でDBEを施行した285症例（のべ436症例）を対象とし、臨床的事項を解析した。</p><p>【結果】 小腸腫瘍は、39例（転移性小腸腫瘍6例、原発性小腸癌8例、悪性リンパ腫17例、GIST 7例、カルチノイド1例）認めた。転移性小腸腫瘍は、平均年齢73歳（66-77歳）、男性4例、女性2例、原発巣は、肺癌2例（共に大細胞癌）、乳癌、腎癌、腹膜癌、S状結腸癌が各1例ずつであった。DBEの検査契機となった主訴は、下血が3例と最も多く、他イレウス2例、腹痛1例であった。腫瘍の局在は、6例中5例（83.3%）が空腸であった。腫瘍の肉眼所見は、発赤または潰瘍を伴う粘膜下腫瘍様隆起が3例、他、壁外性圧排狭窄、潰瘍性病変、腫瘤状隆起が各1例ずつであった。小腸転移に対する治療は、外科切除3例、化学療法2例、保存的加療が1例に行われた。予後は、長期生存1例を除き平均生存期間6.6か月（1-13か月）と不良であった。</p><p>【結論】 転移性小腸腫瘍は、主に空腸にみられ、肉眼型は粘膜下腫瘍様隆起をとることが多く、DBEがその発見および質的診断にも有用であった。今後、化学療法の進歩などによる担癌患者の長期生存例が増加することにより、転移性小腸腫瘍の増加が予想され、それを念頭に置いた小腸診療が必要である。</p>

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Language：Japanese  

DOI： 10.19020/CG.0000000570

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(公社)大阪府理学療法士会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: In the general population, late-night dinner is positively associated with gastroesophageal reflux disease (GERD). No evidence exists regarding the relationship between eating behaviours and GERD in patients with type 2 diabetes mellitus, though the prevalence of GERD in patients with type 2 diabetes is higher than in those without diabetes. We conducted this study to investigate the association between eating behaviours and GERD in Japanese patients with type 2 diabetes. METHODS: The study's subjects were 817 Japanese patients with type 2 diabetes. GERD was defined as being present when a subject had a Quality of Life and Utility Evaluation Survey Technology (QUEST) score of 4 or higher. The assessment of eating behaviour was performed by self-administered questionnaire. Subjects were considered positive for late-night dinner if they answered yes to the question "Do you eat dinner within 2 hours before bedtime at least 3 times per week? RESULTS: The prevalence values of GERD, skipping breakfast, bedtime snacking, late-night dinner and fast eating were 32.0%, 13.7%, 27.1%, 28.8%, and 44.4%, respectively. Late-night dinner was independently positively associated with GERD in patients with type 2 diabetes; the adjusted odds ratio was 1.46 (95% CI 1.03 to 2.05). No relationships were found between skipping breakfast, bedtime snacking or fast eating and GERD. CONCLUSIONS: Late-night dinner may be positively associated with GERD in Japanese patients with type 2 diabetes.

DOI： 10.1016/j.jcjd.2017.07.007

PubMed

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1403201417

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Language：English   Publishing type：Research paper (scientific journal)  

In the general population, late-night dinner is positively associated with gastroesophageal reflux disease (GERD). No evidence exists regarding the relationship between eating behaviours and GERD in patients with type 2 diabetes mellitus, though the prevalence of GERD in patients with type 2 diabetes is higher than in those without diabetes. We conducted this study to investigate the association between eating behaviours and GERD in Japanese patients with type 2 diabetes.The study's subjects were 817 Japanese patients with type 2 diabetes. GERD was defined as being present when a subject had a Quality of Life and Utility Evaluation Survey Technology (QUEST) score of 4 or higher. The assessment of eating behaviour was performed by self-administered questionnaire. Subjects were considered positive for late-night dinner if they answered yes to the question "Do you eat dinner within 2 hours before bedtime at least 3 times per week?The prevalence values of GERD, skipping breakfast, bedtime snacking, late-night dinner and fast eating were 32.0%, 13.7%, 27.1%, 28.8%, and 44.4%, respectively. Late-night dinner was independently positively associated with GERD in patients with type 2 diabetes; the adjusted odds ratio was 1.46 (95% CI 1.03 to 2.05). No relationships were found between skipping breakfast, bedtime snacking or fast eating and GERD.Late-night dinner may be positively associated with GERD in Japanese patients with type 2 diabetes.

DOI： 10.1016/J.JCJD.2017.07.007

Web of Science

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Language：Japanese  

DOI： 10.11477/mf.1403201353

J-GLOBAL

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞多くの胃癌は慢性胃炎を背景として発生するため,胃炎の中に紛れて発見が困難な早期胃癌も少なくない.見逃しの少ないスクリーニング上部消化管内視鏡検査には,適切な前処置および,胃内をくまなく系統立てて観察する技術が求められる.内視鏡の盲点になりやすい,噴門部小彎,胃角から胃体部後壁,胃体部大彎,蠕動を伴う胃前庭部には注意が必要である.早期胃癌を見つけるために注目すべき内視鏡所見としては,(1)色調の変化,(2)粘膜表面構造の変化,(3)血管透見の消失,(4)自然出血である.分化型胃癌は,萎縮や腸上皮化生を背景とした,淡い発赤に注意して観察し,インジゴカルミンの撒布を適宜行うことにより病変が発見されやすくなる.未分化型胃癌は,萎縮のない胃底腺領域の小さな褪色に注意して観察すべきである.

DOI： 10.11477/mf.1403201353

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(株)医学書院  

患者は60歳代,男性.H. pylori未感染.前医で施行した上部消化管内視鏡検査(EGD)で胃癌が疑われ,精査加療目的に当科へ紹介となった.治療前のEGDで胃穹窿部に平坦隆起性病変を認めた.白色光観察では病変は淡い発赤調,強い発赤調,白色調の3領域から構成されていた.拡大観察では強い発赤調領域に一致して微小血管の口径不同を認め高分化腺癌を疑い,内視鏡治療の方針とした.切除標本の病理組織学的検索では,淡い発赤調領域はMUC6陽性細胞が主体の胃型(幽門腺型)腺腫から成り,強い発赤調領域にはMUC6とMUC5AC陽性細胞が混在する胃型形質を示す低異型度高分化腺癌成分を認めた.白色調領域はMUC5AC陽性細胞が主体であったが,構造異型・細胞異型は軽微で胃型(腺窩上皮型)腺腫と診断した.(著者抄録)

DOI： 10.11477/mf.1403201266

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.11641/pde.91.1_144

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(有)科学評論社  

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Language：English   Publisher：WILEY  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器がん検診学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Palmitic acid is an important risk factor for the pathogenesis of non-alcoholic steatohepatitis (NASH), but changes in palmitic acid intestinal absorption in NASH are unclear. The aim of this study was to clarify changes in palmitic acid intestinal absorption and their association with the pathogenesis of NASH.
A total of 106 participants were recruited to the study, of whom 33 were control subjects (control group), 32 were patients with NASH Brunt stage 1-2 [early NASH (e-NASH)], and 41 were patients with NASH Brunt stage 3-4 [advanced NASH (a-NASH)]. C-13-labeled palmitate was administered directly into the duodenum of all participants by gastrointestinal endoscopy. Breath (CO2)-C-13 levels were measured to quantify palmitic acid absorption, and serum Apolipoprotein B-48 (ApoB-48) concentrations were measured after a test meal to quantify absorbed chylomicrons. Expressions of fatty acid (FA) transporters were also examined. The associations of breath (CO2)-C-13 levels with hepatic steatosis, fibrosis and insulin resistance was evaluated using laboratory data, elastography results and liver histology findings.
Overall, (CO2)-C-13 excretion was significantly higher in e-NASH patients than in the control subjects and a-NASH patients (P &lt; 0.01). e-NASH patients had higher serum ApoB-48 levels, indicating increased palmitic acid transport via chylomicrons in these patients. Jejunal mRNA and protein expressions of microsomal triglyceride transfer protein and cluster of differentiation 36 were also increased in both NASH patient groups. The (CO2)-C-13 excretion of e-NASH patients was significantly correlated with the degree of hepatic steatosis, fibrosis and insulin resistance (P = 0.005, P &lt; 0.001, P = 0.019, respectively).
Significantly upregulated palmitic acid absorption by activation of its transporters was evident in patients with NASH, and clinical progression of NASH was related to palmitic acid absorption. These dietary changes are associated with the onset and progression of NASH.

DOI： 10.1007/s00535-016-1298-6

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：IVYSPRING INT PUBL  

Purpose The therapeutic benefit of a three-drug combination of antiemetics has not been established in moderately emetogenic chemotherapy (MEC). The aim of this study was to compare the antiemetic effectiveness and cost-saving of palonosetron plus dexamethasone (control group) with aprepitant, granisetron, and dexamethasone (study group) in cancer patients who received MEC.
Methods We switched the standard antiemetic treatment from the control group to the study group in gastrointestinal cancer patients who received MEC after October 2015. The antiemetics in both groups were modified using salvage antiemetic therapy at the clinicians' discretion, according to the severity of chemotherapy-induced nausea and vomiting. We retrospectively reviewed the electronic medical records from patients, before and after switching groups, from between April 2014 and March 2016.
Results We evaluated 443 treatment courses in 83 patients. The proportion of courses that included salvage antiemetic therapy in the control group and the study group was 34.8 % (116/333) and 8.2 % (9/110), respectively, and was statistically significant (p &lt; 0.001). The mean integrated costs of antiemetics per course in the control group and the study group were 193 +/- 55 USD and 143 +/- 38 USD, respectively. Multivariate logistic regression analysis revealed that the study group was significantly associated with a reduced risk of requiring salvage antiemetic therapy (p = 0.038).
Conclusions These results suggest that the antiemetic effectiveness and cost-saving of a three-drug combination of aprepitant, generic granisetron, and dexamethasone was superior to a two-drug combination of palonosetron plus dexamethasone in gastrointestinal cancer patients who received MEC.

DOI： 10.7150/jca.17102

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Only limited epidemiological evidence exists regarding the relationship between age and gastroesophageal reflux disease (GERD) among Japanese patients with type 2 diabetes mellitus.
The purpose of the present study is to investigate this issue among Japanese patients with type 2 diabetes mellitus.
A multicenter cross-sectional study was conducted in 847 Japanese patients with type 2 diabetes mellitus. Subjects were divided into quartiles according to age: (1) 19 aecurrency sign age &lt; 56, (2) 56 aecurrency sign age &lt; 64, (3) 64 aecurrency sign age &lt; 71, and (4) 71 aecurrency sign age &lt; 89. GERD was defined as present when a subject had a Carlsson-Dent self-administered questionnaire (QUEST) score aeyen4.
The prevalence of GERD was 31.5 %. Younger age was independently associated with a higher prevalence of GERD: the adjusted odds ratios (95 % confidence intervals) for GERD in relation to age &lt; 56, 56 aecurrency sign age &lt; 64, 64 aecurrency sign age &lt; 71, and aeyen71 were 3.73 (2.16-6.53), 1.98 (1.21-3.27), 1.66 (1.05-2.68), and 1.00 (reference), respectively (P for trend = 0.001). Among 201 patients with PPI or histamine H-2-receptor antagonist (H2RA), less than 56 years of age was independently positively associated with GERD: the adjusted OR was 5.68 (95 % CI 1.55-22.18) (P for trend = 0.02).
Younger age may be independently positively associated with GERD among Japanese type 2 diabetes mellitus patients, regardless of the use of PPI or H2RA.

DOI： 10.1007/s10620-016-4311-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Fatty liver disease is associated with glucose intolerance and hepatic insulin resistance. However, there are distinct etiologies for alcoholic versus non-alcoholic fatty liver disease (NAFLD), and it is unknown whether alcohol consumption influences the onset of glucose intolerance in fatty liver disease patients. Therefore, we investigated the relationship between fatty liver disease and the onset of impaired fasting glucose (IFG) with respect to alcohol consumption.
The records of 6804 Japanese subjects were reviewed to identify those meeting the criteria for IFG. Male and female subjects were classified into five and four groups, respectively, based on average alcohol consumption (g/week). IFG onset was defined as fasting plasma glucose levels aeyen110 mg/dl.
In the non-drinker, &gt; 0-70 g/week, &gt; 70-140 g/week, &gt; 140-210 g/week (men only), and &gt; 210 g/week (men only) or &gt; 140 g/week (women only) groups, 7.3, 6.7, 6.4, 9, and 6.4 % of men and 2, 1.7, 3.1, and 3.2 % of women, respectively, developed IFG. Fatty liver was positively associated with the onset of IFG in men of the &gt; 0-70 g/week group (adjusted hazard ratio [aHR], 2.808; 95 % confidence interval [CI] 1.605-5.049, p &lt; 0.001) and women of the &gt; 70-140 g/week group (aHR, 4.193; 95 % CI, 1.036-14.584, p = 0.045) after adjusting for previously reported IFG risk factors. No associations were observed in the other groups.
A small amount of alcohol consumption is a significant risk factor for the onset of IFG in NAFLD patients; onset risk differs according to the amount of alcohol consumption.

DOI： 10.1007/s00535-016-1194-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background:Carbonic anhydrase I (CA I), a major cecal bacterial antigen, improves inflammatory bowel disease (IBD) symptoms in a murine model. The aim of this study was to identify the responsible epitope region within the CA I protein and evaluate its effect on inflammation using a murine IBD model.Methods:Candidate peptides within the CA I protein sequence that interact with major histocompatibility complex class II were chosen and their immune responses were evaluated using mesentery lymph nodes (MLNs) from a CD4(+)CD25(-) T-cell transfer murine colitis model. Mice were treated with regulatory dendritic cells (Reg-DCs)-pulsed CA I peptide. We assessed their clinical signs, histopathology, induction of cytokines and transcription factors, and generation of CD103(+)CD11c(+) dendritic cells and regulatory T cells (Tregs).Results:We identified 4 candidate epitope peptides of CA I. Among these, Reg-DCs pulsed with CA I 58-73 peptide (Reg-DCsCA I 58-73) alone ameliorated colitis. Reg-DCsCA I 58-73-treated mice showed higher mRNA expression levels of forkhead box protein 3, aldehyde dehydrogenase family 1a2, transforming growth factor-, and interleukin (Il)10, when compared with lower mRNA expression of retinoic acid-related orphan receptor gamma and Il17a in MLNs. Compared with control mice, these mice also showed higher numbers of Foxp3(+)CD4(+)CD25(+) Tregs and CD103(+)CD11c(+) dendritic cells in MLNs and colon. Administration of Reg-DCsCA I 58-73 induced antigen-specific Tregs in MLNs of colitic mice.Conclusions:CA I 58-73 peptide induces antigen-specific therapeutic effect in a murine IBD model using Reg-DCs, indicating that CA I 58-73 is a candidate epitope for IBD immunotherapy.

DOI： 10.1097/MIB.0000000000000781

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

3,5,3'-triiodo-L-thyronine regulates the glucose metabolism, lipid metabolism, and hepatic steatosis. Several groups have shown the relationships between hypothyroidism and nonalcoholic fatty liver and hypothyroidism and nonalcoholic steatohepatitis (NASH). However, the effect of hyperthyroidism on NASH has not yet been investigated. We herein report effects of thyroid hormone on the pathological condition of NASH in a patient with NASH complicated by Graves' disease. In our case, the liver enzyme level improved with the increasing thyroid hormone level; however, the liver enzyme level was aggravated with the improving thyroid hormone level. Therefore, hyperthyroidism may improve the pathological condition of NASH.

DOI： 10.2169/internalmedicine.55.6640

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society of Hepatology  

A 65-year-old female with hepatitis C (genotype 1b) was started on a planned 24-week course of daclatasvir (DCV) and asunaprevir (ASV) treatment. She was a treatment-naïve case of anti-hepatitis C virus (HCV). She was estimated to be interferon-intolerant. At 11 days after starting treatment, she had a high fever, slight elevation in total bilirubin, and prolonged prothrombin time. However, there was no elevation of AST or ALT. Additionally, she developed ascites after starting treatment, and her blood test results indicated eosinophilia and high levels of serum immunoglobulin E and C-reactive protein. The DCV_ASV therapy was discontinued at 17 days after starting treatment
after discontinuation of therapy, her fever resolved and her hepatic functional reserve improved.

DOI： 10.2957/kanzo.56.109

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Language：Japanese   Publisher：愛媛医学会  

症例は77歳女性で、呼吸困難、意識障害を主訴に救急搬送となった。来院時、敗血症性ショックを呈し、ICU入室にて集中治療を開始した。胸部CTでは誤嚥性肺炎を認め、腹部CTでは胆嚢気腫と十二指腸球部に存在する結石が確認され、Bouveret症候群の診断に至った。集学的治療により全身状態は改善し、経過中の腹部CTで胆石の空腸内への移動が確認された。入院後第25病日に胆石イレウスに対し開腹手術を施行し、空腸切除、結石採石、再縫合、胆嚢摘出を行った。切除標本は6×3×3cmの巨大な胆嚢結石で、術後経過良好にて、第72病日にリハビリ目的で転院となった。

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Language：Japanese  

DOI： 10.11280/gee.55.3609

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

食事由来の脂質の中で、特に飽和脂肪酸は、動脈硬化性疾患、非アルコール性脂肪肝炎、種々の癌腫の発癌において重要な危険因子である。飽和脂肪酸は、食事中の中性脂肪が膵リパーゼなど消化酵素により脂肪酸の状態まで加水分解された後、主に上部空腸粘膜より吸収される。安定性・非放射性同位元素13C標識脂肪酸試薬を用いた13C呼気ガス診断は、小腸の脂肪酸吸収能を評価することができるが、従来からこの試験は経口投与で行われており、胃の排出時間の差がその結果の評価を困難にしていた。そこで、上部消化管内視鏡下に胃を介さず十二指腸に直接試薬を散布する方法を開発した。飽和脂肪酸は、常温で固形、水に不溶であるため、内視鏡投与のためには飽和脂肪酸を液状化する技術が必要だが、それは経腸栄養剤ラコールの乳化作用を利用することで可能である。この内視鏡アプローチ法によってより正確な小腸脂肪酸吸収能を評価することができる。(著者抄録)

DOI： 10.11280/gee.55.3609

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese  

DOI： 10.19020/J01937.2013226590

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Language：Japanese   Publisher：(株)日本メディカルセンター  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC NUTRITION-ASN  

Background: Dietary long-chain fatty acid (LCFA) intake is an important risk factor for hepatic inflammation and hepatocarcinogenesis. An alternate route of dietary LCFA absorption has been suggested in patients with liver cirrhosis (LC).
Objective: We aimed to determine this alternate route and to identify its mechanism.
Design: Twenty healthy control subjects and 47 patients with LC-n = 23 with portal hypertension [PH(+)LC] and 24 without portal hypertension [PH(-)LC)]-were enrolled. [C-13]Palmitate (an LCFA) and octanoate (a medium-chain fatty acid [MCFA]) were administered by using gastrointestinal endoscopy. Breath (CO2)-C-13 was measured to quantify metabolized fatty acids. We also examined intestinal specimens of patients in these groups.
Results: A more rapid increase in metabolized palmitate, which showed a pattern similar to that of octanoate metabolism, was observed in patients with LC than in healthy control subjects. The increase in the PH(-)LC group was higher than that in the PH(+)LC group. However, the concentration of metabolized palmitate increased with treatment of the PH(+)LC group with a portal-systemic shunt. Morphologic changes such as expanded lymph and blood vessels were present, and glycosylated CD36 increased in the jejunum of the PH(+)LC group. This group had high serum concentrations of glucagon-like peptide-2. These data suggest that dietary LCFAs, similar to MCFAs, are absorbed via blood vessels in patients with LC.
Conclusions: Rapid absorption of LCFAs by an alternative method occurred in patients with LC. This altered LCFA processing is likely related to upregulation of intestinal glycosylated CD36 and could contribute to pathogenesis in patients with LC. This trial was registered at http://www.umin.ac.jp/ctr/index.htm as UMIN000006637 and UMIN000006638. Am J Clin Nutr 2012;96:90-101.

DOI： 10.3945/ajcn.111.033084

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Language：Japanese   Publisher：愛媛医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

A 69-year-old man presented with multiple nodules on the spleen and liver that had been detected by computed tomography (CT). A liver tumor biopsy was performed, and the patient was diagnosed to have histiocytic sarcoma (HS). Splenectomy was performed, and the chemosensitivity of the spleen tumor was measured using the collagen gel droplet-embedded culture drug sensitivity test (CD-DST). Hepatic arterial infusion chemotherapy was administered, based on the results of the CD-DST. The patient achieved complete remission (CR) after this therapy and remained alive without recurrence at the final follow-up. This is the first known case of CR in response to chemotherapy for advanced splenic HS.

DOI： 10.2169/internalmedicine.51.8325

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A 77-year-old man with hypertension, diabetes mellitus, ischemic heart disease and a smoking habit presented at our hospital with sudden abdominal pain. Computed tomography indicated edematous swelling and pneumatosis of the intestinal wall in a localized area of the ascending colon with inflamed adipose tissue. Acute mesenteric ischemia was diagnosed. Abdominal angiography showed stenosis of the mesenteric arteries. Virtual histology-intravascular ultrasound imaging indicated a fibrous change in the superior mesenteric artery with a necrotic core. Endovascular treatment with stent placement after percutaneous transluminal angioplasty was effective. Surgery would usually be considered as the first choice for treating patients with acute mesenteric ischemia; however, when this condition is complicated with metabolic diseases, stenotic changes in the mesenteric arteries that would normally be found in patients with chronic mesenteric ischemia need to be considered to ensure optimal treatment.

DOI： 10.1007/s12328-011-0236-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Transcatheter arterial chemoembolization (TALE) has been reported as effective therapy for unresectable hepatocellular carcinoma (HCC), however, few have described methods for predicting prognosis, especially in patients treated by repeated TALE. To determine risk factors for death and try to predict the prognosis, we evaluated clinical data.
Methodology: We retrospectively analyzed the clinical parameters of 224 patients with unresectable HCC treated with repeated TALE from January 1997 to December 2007. TALE was repeated when recurrence was diagnosed by tumor marker elevation and/or dynamic computed tomography findings. Factors affecting survival were evaluated using multivariate analysis after univariate analysis. Next, we combined the score for each significant factor into a single prognostic score and added up the positive factors in each case, then analyzed the significance of prognosis, after which the results were compared with other prognostic scoring systems.
Results: Multivariate analysis revealed that bilobular HCC, alpha-fetoprotein (&gt;= 400 ng/ml), tumor invasion of the portal vein, tumor size (&gt;= 10 cm), and albumin (&lt;2.8 g/dl) were related to poor prognosis, and developed a prognostic scoring system from those. According to that score, patients were classified into 5 groups.
Conclusion: Our scoring system was easily performed and the results showed that repeated TALE should not be administered to patients with scores of 3 or more.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Radiofrequency ablation therapy (RFA) has become widely used against hepatocellular carcinoma (HCC), mainly because of its ease of use, lower level of invasiveness, and high level of effectiveness. To compare the efficacy and safety of RFA with surgery, we retrospectively investigated relevant patient clinical data.
Methodology: The patients with a single HCC (3 cm &gt;= Child-Pugh A or B) who were treated with RFA (RFA-group: n=105) or surgery (Surgery-group: n=59) from January 2000 to June 2007 were enrolled.
Results: The ratio of patients classified as Child-Pugh B was greater in RFA-group (24.8% vs. 8.5%, P = 0.011), though the sizes of the tumors were not significantly different. There were no significant differences for survival rates or disease free survival rates after 3- and 5-years (RFA-group vs. Surgery-group; survival: 87.8 and 59.3% vs. 91.4 and 59.4%, disease free survival: 58.7 and 24.6% vs. 64.3 and 22.4%, respectively). As for complications, in RFA-group there was no severe complication while there was 1 case of postoperative hepatic failure death and 2 with a postoperative abscess in Surgery-group.
Conclusions: In the present study, patients with a single HCC smaller than 3cm who underwent RFA had a lower frequency of severe complications, thus the efficacy of RFA was thought to be equal to a surgical procedure.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

A primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT) is very rare. We found a solitary mass 27 mm in size in the left lobe of the liver of a 58-year-old Japanese man with a history of hepatitis-C infection. Based on the results of imaging studies, the tumor was diagnosed as a hepatocellular carcinoma (HCC). The left lobe of the liver was lobectomized and microscopic findings showed that the tumor was a hepatic MALT lymphoma, while immunohistochemistry showed it to be positive for CD20 and CD79a. In a fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning (FDG-PET CT) before surgery, the tumor was revealed to have a high standardized uptake value (SUV) for FDG. The patient received chemotherapy after surgery. To the best of our knowledge, 45 cases had been reported with a mean age for all patients of 61.4 years. The pathogenesis remains unclear, although half of the patients had a past history of chronic inflammatory liver disease. Surgical resection was performed in most cases and some patients received postoperative chemotherapy or radiotherapy. The clinicopathologic characteristics and management of this extremely rare disease are also discussed.

DOI： 10.1007/s12185-008-0153-9

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Language：Japanese   Publisher：愛媛医学会  

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Language：Japanese   Publisher：愛媛医学会  

症例は50歳時にアルコール依存症にて精神科入院・59歳時右足関節骨折歴、高血圧・糖尿病の既往がある60歳男性で、屋外歩行中に転倒し一過性意識消失をきたし救急外来を受診、来院時、意識JCSI-2,頭部CT上異常所見なく精査加療目的で総合診療科入院となった。血液検査では血小板減少と凝固能低下がみられ、アルコールに起因すると考えられる黄疸・肝機能異常を認めたが一過性意識障害の原因となる異常所見は認めなかった。入院後第1病日深夜より幻視・幻聴がみられ激しい不穏・暴力行為がみられ、翌日には腰痛・股関節痛が出現し、腰背部から肛門周囲にかけて腫脹と皮下出血斑を認めた。採血にて顕著な貧血進行と血圧低下がみられ、腹部CTでは両腸腰筋は腫大し、骨盤腔に高吸収域がみられ腸腰筋血腫・後腹膜出血が疑われた。骨盤部MRIではT2強調像で左右腸腰筋と骨盤腔に高信号域がみられ腸腰筋腫と診断、アルコール性肝硬変に起因する出血と判断され消化器内科に転科となった。出血性ショック状態であり照射赤血球濃厚液・新鮮凍結血漿の投与により、翌日には循環動態が安定し皮下出血の広がりは認めず、同日施行の腹部エコーにて前日のCT所見と比べ血腫サイズの増大を認めなかったため保存的加療を継続した。その後、貧血は徐々に改善し、第19病日の腹部造影CTでは血腫の縮小がみられ、リハビリテーションを開始、経過中に右頭頂葉の出血性梗塞を認めたが運動麻痺遺残はなく経過し、第34病日の腹部造影CTにてさらなる血腫の縮小がみられ転院となった。以上より、肝硬変患者では急激な貧血の進行を伴う場合や長期臥床など筋肉ストレスを伴う環境にさらされる場合には、これを念頭に置いて診療に当ることが重要と考えられた。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Objective: This study was aimed at investigating the efficacy and safety of minimally invasive laparoscopic splenectomy in patients with hypersplenism secondary to cirrhosis.Background: While advances have been made in the treatment of liver cancer and chronic hepatitis, certain treatments such as radio frequency ablation (RFA) must often be discontinued due to thrombocytopenia caused by hypersplenism. Laparoscopic splenectomy is performed to treat diseases as idiopathic thrombocytopenic purpura, but is contraindicated for hypersplenism in many institutions. Few studies have thus examined the safety and efficacy of this approach.Methods: Efficacy and safety were retrospectively analyzed for laparoscopic splenectomies starting from January 2003. Relationships between postoperative increases in platelet count and thrombopoietin, platelet-associated immunoglobulin, excised spleen weight, and serum parameters were examined. Perioperative data of open splenectomies starting from January 1990 were compared with those of laparoscopic splenectomies.Results: No laparoscopic cases were converted to open surgery in this series. Mean operative times of open and laparoscopic splenectomy were 205 and 173 min respectively. Mean blood losses were 750 and 359 ml (P < 0.05) and the mean weights of excised spleen were 460 and 525 g respectively. Postoperatively, no changes in liver function were noted, and platelet and leukocyte counts were significantly increased. Compared with preoperative platelet count, degree of increase at 2 weeks postoperatively did not correlate with preoperative thrombopoietin levels, but significantly correlated with levels of platelet-associated immunoglobulin and spleen volume (P < 0.05). Postoperative portal or splenic vein thrombosis (PSVT) was seen in 3 patients and these patients did not exhibit any clinical symptoms.Conclusions: Laparoscopic splenectomy is a safe technique for the treatment of hypersplenism and contributes to postoperative increases in platelet counts. Postoperative increases in platelet count seem to depend on platelet-associated immunoglobulin level and spleen weight, which may be valuable prognosticators.

DOI： 10.1007/s00268-006-0504-8

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PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

We treated 3 patients complicated with colon cancer without liver metastasis, who were admitted to our hospital because of a high fever and diagnosed with liver abscesses. In a general screening after performing percutaneous transhepatic abscess drainage, colon cancer was detected in each, though hepatobiliary diseases were not found. Hepatobiliary diseases were the most common etiology of hepatic abscesses in our hospital in the past 41 cases from 1990 to 2005, 3 of which were due to colon cancer. If a cause is not determined, general screening, especially of the colon tract, should be performed in hepatic abscesses patients.

DOI： 10.2169/internalmedicine.46.0080

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PubMed

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化管学会  

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Language：Japanese   Publisher：日本消化器病学会-四国支部  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society  

<p>A 40-year-old female was found to have pancreatico-biliary maljunction on abdominal computed tomography. She has neurofibromatosis type 1 (NF1) with a family history for NF1. She has had an elevated alkaline phosphatase level in the serum and was eventually diagnosed as having osteomalacia at 40 years of age. When endoscopic retrograde cholangiopancreatography was performed to confirm the diagnosis of pancreatico-biliary maljunction, a white raised lesion with a diameter of 3mm was observed in the papilla of Vater. Pathologic examination of the biopsy specimen of the lesion raised the suspicion of neuroendocrine tumor (NET). Pancreatoduodenectomy was performed and the final diagnosis was NET G1. Patients with a gastrointestinal tumor associated with NF1 are usually symptomatic and there have only been a few reports on asymptomatic patients with this condition. Nevertheless, our case suggests that asymptomatic patients with NF1 should undergo gastrointestinal screening.</p>

DOI： 10.11280/gee.59.2732

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

65歳女。hepatitis C virus感染の既往があり、Child-Pugh分類Aの肝硬変に対してダクラタスビル(DCV)・アスナプレビル(ASV)併用療法を開始したが、治療開始11日より発熱が出現した。画像所見では腹水が出現し、血液検査所見ではAST、ALTの上昇は認めなかったが、急激なアルブミン値の低下、プロトロンビン時間(PT)の著明延長、T-Bil の上昇とCRPの軽度上昇を認め、特徴的な所見は血中好酸球分画の上昇と血中IgEの上昇であった。DCV・ASVを中止したところ、速やかに解熱してPTの改善、T-Bilの正常化と腹水の消失を認めた。

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

80歳以上の超高齢者肝細胞癌(HCC)46例(男性27例、女性19例;平均年齢83.5±3.6歳)への治療内容と経皮的治療の安全性及び有用性について検討を行った。治療法の内訳は、外科的切除2例、ラジオ波焼灼法(RFA)14例、経皮的エタノール注入療法(PEIT)4例、肝動脈塞栓術(TAE)18例、無治療8例である。TAE、無治療例26例中10例がperformance status(PS)3以上であった。PS良好(0または1)かつミラノクライテリア内の症例では、経皮的治療例とTAE単独治療例では生存率に有意差を認めなかったが、局所療法例が成績良好な傾向であった。また、ミラノクライテリア内で経皮的治療を行った超高齢者16例と非高齢者149例を比較すると、TNM stage、JIS score、生存率に有意差は認めなかった。以上より、超高齢者HCCにおいても腫瘍因子、肝予備能、PS、意思決定能力が良好であれば、RFAを中心とした経皮的治療は良好な予後を得られる可能性があると考えられた。

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

30〜93歳までの肝細胞癌(HCC)症例536例を、75歳以上の高齢者118例(男性74例、女性44例:平均年齢79.4±4.1歳)と75歳未満の非高齢者418例(男性321例、女性97例:平均年齢63.7±8.4歳)に分類し、高齢者HCCの臨床像について検討した。その結果、高齢者の方が女性の割合や非B非Cの割合が有意に多く、経皮的治療が有意に多かった。一方、非高齢者はアルコール性の成因が有意に多く、外科的手術が多かった。生存率は高齢者の方が低い傾向であったが有意差を認めなかった。

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

早期癌と胃腺腫に対して胃内視鏡的粘膜下層剥離術(ESD)を行った、80歳以上の超高齢者25例(男性19例、女性6例)の治療成績と安全性について、79歳以下の非高齢者(男性61例、女性27例)と比較検討した。その結果、施行時間、根治度、偶発症の頻度は有意差を認めなかった。また、偶発症において、穿孔例は胃上・中部領域の方が胃下部より有意に多かった。以上より、ESDは超高齢者に対しても有効性、安全性があると考えられた。

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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65歳女。hepatitis C virus感染の既往があり、Child-Pugh分類Aの肝硬変に対してダクラタスビル(DCV)・アスナプレビル(ASV)併用療法を開始したが、治療開始11日より発熱が出現した。画像所見では腹水が出現し、血液検査所見ではAST、ALTの上昇は認めなかったが、急激なアルブミン値の低下、プロトロンビン時間(PT)の著明延長、T-Bil の上昇とCRPの軽度上昇を認め、特徴的な所見は血中好酸球分画の上昇と血中IgEの上昇であった。DCV・ASVを中止したところ、速やかに解熱してPTの改善、T-Bilの正常化と腹水の消失を認めた。

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早期癌と胃腺腫に対して胃内視鏡的粘膜下層剥離術(ESD)を行った、80歳以上の超高齢者25例(男性19例、女性6例)の治療成績と安全性について、79歳以下の非高齢者(男性61例、女性27例)と比較検討した。その結果、施行時間、根治度、偶発症の頻度は有意差を認めなかった。また、偶発症において、穿孔例は胃上・中部領域の方が胃下部より有意に多かった。以上より、ESDは超高齢者に対しても有効性、安全性があると考えられた。

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Language：Japanese  

30〜93歳までの肝細胞癌(HCC)症例536例を、75歳以上の高齢者118例(男性74例、女性44例:平均年齢79.4±4.1歳)と75歳未満の非高齢者418例(男性321例、女性97例:平均年齢63.7±8.4歳)に分類し、高齢者HCCの臨床像について検討した。その結果、高齢者の方が女性の割合や非B非Cの割合が有意に多く、経皮的治療が有意に多かった。一方、非高齢者はアルコール性の成因が有意に多く、外科的手術が多かった。生存率は高齢者の方が低い傾向であったが有意差を認めなかった。

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Language：Japanese  

80歳以上の超高齢者肝細胞癌(HCC)46例(男性27例、女性19例;平均年齢83.5±3.6歳)への治療内容と経皮的治療の安全性及び有用性について検討を行った。治療法の内訳は、外科的切除2例、ラジオ波焼灼法(RFA)14例、経皮的エタノール注入療法(PEIT)4例、肝動脈塞栓術(TAE)18例、無治療8例である。TAE、無治療例26例中10例がperformance status(PS)3以上であった。PS良好(0または1)かつミラノクライテリア内の症例では、経皮的治療例とTAE単独治療例では生存率に有意差を認めなかったが、局所療法例が成績良好な傾向であった。また、ミラノクライテリア内で経皮的治療を行った超高齢者16例と非高齢者149例を比較すると、TNM stage、JIS score、生存率に有意差は認めなかった。以上より、超高齢者HCCにおいても腫瘍因子、肝予備能、PS、意思決定能力が良好であれば、RFAを中心とした経皮的治療は良好な予後を得られる可能性があると考えられた。

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症例は41歳女性。健診でALP高値を指摘され、当院整形外科で骨軟化症と診断された。自覚症状はなかったがCTで膵・胆管合流異常を指摘され、当科を紹介受診した。神経線維腫症I型(von Recklinghausen病、以下VRD)の家族歴があり、体幹・四肢にカフェオレ斑が多発、皮膚生検でVRDと診断された。ERCP時主乳頭に3mm大の黄白色隆起がみられ、生検で神経内分泌腫瘍(以下NET)が疑われた。手術を施行されNET(G1)と診断された。VRDに合併する消化管腫瘍は、腹痛や黄疸などの自覚症状を契機に発見されることが多く、本症例のように無症候で発見されることは稀である。VRD患者は無症状であっても積極的な内視鏡精査が望まれる。(著者抄録)

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